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No 

Boston 

Medical  Library 

Association, 

19     BOYLSTON     PLACE. 


-< 


THE 


Hflir  Ctrnik.   f sfalt.  isss. 

Sdns  t^e  incmvorAtion  of  ti^e  JTotiimalit  |ft|mo  ftnoton   a0<*2n^e|ll«lifeal  fpnitit' 

atiO  **^t  fUtnUtH  CirnOaC 


a  ^teklg  Iffttrnal 


OP 


MEDICINE    AND    MEDICAL   AFFAIRS. 


PROM    JANUARY    TO    JUNE, 


1896. 


LONDON  :   20  &  21  KING  WILLIAM  STREET,  STRAND.  DUBLIN :  39  MOLESWORTH  STREET. 


The  HmSSyptwmaM  drrnli** 


INDEX 


i«MM^  ipM. 


INDEX. 

♦ 

VOL.  LXI.    NEW  SERIES.        (VOL.  CXIL    OLD  SERIES.) 
JANUARY   TO    JUNE,   1896, 


Abortioii,  new  method  of  indadDg. 

629 
itaMeas,  perlftiniit,  479 
Ateoen,  retro-uterine,  142 
itaeeM,  eabphrenic,  13 
AtaDTdum,  MTOtbenpT,  ad,  384 
Academy  headache.  042 
Aoceaaory  nerre,  paralyaia  of  the 

aplnal,  604 
Aeeident,  two  deatha  ftom,  121 
Acddenta,  lamp,  806 
Acromegaly,  604 
Aci,  a  Hendlab,  642 
Act,  curioiia  proaecntlon  noder  the 

medical,  148 
AcL  the  new  factory,  87 
AdaiaonIL  nnnaaal  caae  of  morboa, 

84 
Adsexa  operatioiia,  Taalna],  821 
AdaHcraUon  caae,  aaU<7Ue,  66 
Advertiaiog,  etiquette  of  profea- 

aloDal.S68 
Advertialng,   legal  aapect  of  ob- 

acene,  984 
AdTertiaing,  medical,  428, 464 
AdvertUogT  what  la  profeaalODid, 

9S0 
Aaiicaltore,  bacteria  in,  847 
Bd  aodeUaa  abroad,  medical,  482 
Allehin,  Dr.,  the  bnatdng  atiain, 

619 
Anin^iam.  Hr.  H.  W.,  tnteatlnal 

reeectiou,  101, 180 
AUoznrlne  bodlea,  242 
Atthana,  Dr.,  Impotency  and  ita 

treatasent  by  electiicity,  6S0 
America,importatloD  oi  wlneainto, 
196 


478 ;  aplenie,  669 
perntdoua,  r  ^ 


Dr. 


,S96 
AneaCheiia,  the  riaka  of,  90 
Aaaatomoala,      Inteathial, 

%ig4lna,647 
Aaehyloatomoaia,  822 
Anderaon,  Mr.,  the  caae  of,  121 
ABoandale,  Prot,  868 
Annria,878 
Anthrax,  177 
Anteflexion,  permanent  cue  of. 

Dr.  Kdth,  229. 
Antipjretiea,  medldnal,  478 
Antitoiin.214 
Antttozla,  report  on,  860 
AntitheroUc,  a  powerful.  84 
ADtl-racdnation  ay  at  Olonceater, 

the  expiring,  680 
Antt-Taccinativniat,  another  medi- 

eal,042 
Aatl-Taednatlan     qneatlon,      an 

Stti^iih  judge  on,  218 
Aoita,  atenoala  of.  669 
Aorta,  mptore  of  the  abdominal, 

Mr.  l-latt,  808 
Apa&ta  water,  887 
Apotheearlea'  hall  and  the  Privy 

council,  584 
A|9eal,aa,698 
AypoMlidtia,  840,  477 
Avpaadidtia,  perforatiTe,  624 
Aypeadix,  Termiform  667 
Appointmenta-  end  of  each  No. 
AreoaTanoriaer,  the,  464 
Aigeata,  Dr.  death  of,  642 
Amy,  dental  auraeona  for  the,  220 
Army  medical  department,  goT«in- 

meot  and  the,  829 
Army  medlcd  department,  offloera 
^    ofthe.587 
Army  medied  service,  90 


Army  medical  aenrloe,  dearth  of 

oandldatea  for,  664 
Arthritla,  InllneDzal,  Dr.  Sanaom, 

609 
Arthritla,  rbeunatdd,  Or.  Sibley, 

607 
Aabeatoa  for  boota  and  ahoea,  221 
Aahanti  expeditton,  the,  818 
"  Aa  othera  aee  u»,"  879 
Ataociatlon,  annual  meeting  of  the 

Britiah  medioal,  688 
Aaaodation,  Iriah  medlcd,  689 
Atylumi,  board  of  control  of  Iriah 

lunatic.  640 
Aaylnms,  the  qneatlon  of  private 

lunatic,  822 
Aayluroa.  trade-nnloniam  in.  088    . 
Ataxy,  Jriedrdoh'a,  462  ■ 
Athetoala.  poat-hemiplcgic,.426  • 
Auria,  carcmoma,  426 
Auatria,  medlcd  women  in,  407 
Anatralia,  a  warning  ftom  South, 

486 
Anatralia,  friendly  aodiatiea' quea- 

tionin,404 
Anatrdia,  immord  advertiaing  in, 

611 
Auatralia,  medlcd  joamalin^  In,' 

197  «       . 

Aoatrdaaia,  medlcd  congreaa  of, 

889 
Ayre,  Fleet-anrgeon  W.,  death  of, 

646 


r'l,  gg 

reaeardiea 

wlih  dectridtyon  diphtheritic, 

849 

Badni,  the  diphtheria,  119 
Baker,  the  hours  of  the,  618 
Balneologlcd      aaaodation,     the 

Britiah,  181 
Barker  anatomicd  prlaea,  the,  880 
Barmdda.  leglalatlon  for,  664 
Baaedowii  cured,  caae  of  mocbu, 

191 
Baaedowii.  notea  on  morbus,  426 
Bearda  ?  anould  medied  men  wear, 

90 
Bedford,  formation  of  a  medlcd 

aodety  at.  47 
Beer,  pure,  610 
Bee  atlDga.  treatment  of,  878 
Belnave  hoapitd,  887 
Bella,  the  ringing  of  churah,  876 
Belta.  electric,  618 
Belta,  electric  doth,  98 
Benevolent  fund,  Britldi  medlcd, 

99 
Beegdi  profeaaor,  a,  98 
Bequest,  a  generona,  888 
Bicepa.  rupture  of  the,  148 
BIcydiata,  eye  tronblea  of,  91 
Bills,  payment  of  medlcd,  469 
Birmingham,  infectiooa  diaeaae  in, 

98 
Birmingham,    Qneen'a    hoapital, 

867 
Birtha— end  of  each  Ko. 
Bite,  syphilitic  sderoala   fn>m  a, 

148 
Blame,  who  la  to,  89 
Blister,  the  fly,  874 
blood,  dldnfeoting  the,  600 
Blood,  microacopic  examlnatlona 

offreah,  818 
Bloodlemnesa,  artifleid,  667 


Blood-poiaoning,    oorioua    death 

from,  174 
Board,  proposed  centrd  hospltd, 

412 
Boat-race,  Inter-hoapitd,  671 
Bone,  anenriam  of  the.  212 
Bone-graftlog  extraordinary,  177 
Booka,  antiaeptic,  89 
Bottlea.  among  the,  884 
Boulger,  Mr.  D..  176 
Bowel,  fragment  of  glaai  passed 

through,  668 
Breast,  cancer  of,  Mr.  Thomaon, 

698 
"  Britannia,"  parotltia  on  the,  671 
*•  Britiah  medioal  joumd,"  action 

for  libel  agdnat  the,  860 
Bronchi,  concretion  in  the,  898 
BroniBhl^a,  infantile,  849 
Brotherhood,  blood.  688 
Bullet,  the  Lee-Metford,  178 
Burna,'248 
Button,  a  new  anaatomoti«,  Dr. 

Chapnt  (illuatrated),  865 
Bnttona.  Meacd,  178 
Bjxn%  Dr.,death  of,  807 


Gdro,  diolera  riot  in,  818, 649 
Gdcutta,  medlcd  adiool  of,  66 
Oalomel,  98 
Cancer  hoapital,  268 
Cancer  ?  la  auigeiy  a  onie  for,  816 
Cancer  curera,  vegetariana  aa,  198 
Cancer,  diflenut  f orma  of ,  88 
Cancer,    objeota    and    limita   of 

operation  for,    Mr.   Chayne, 

888,887,841 
Candidatea,  phyalcd  examination 

of  competitive,  880 
Cantharidine,  stimulating  aotton 

of,  88 
Carbo-hydrates,  the  physiology  of 

the,  149 
Carbuncle,     treatment    oi;    Mr. 

O'Conor,  446 
Carcinoma,  lactic  add  and  the 

diagnoaia  of  gaatrle,  808 
Cardiff  case,  apped  in  the,  666 
Carlide  meeting,  the,  166, 887 
Carats  preparations,  liquor,  619 
Castration,  treatment  of  prostatic 

hypertrophy  by,Prof.  finglisch, 

441 
Catgut,  the  sterilisation  of,  88 
Cerebrum,  multiple   tumours  of 

the.  849 
Ceromony,  an  opening,  197 
Centenarian,  death  of  a  medied, 

686 
Certlflcate,  midwife's  tdie,  666 
Certlflcate,   obatetricd  aodety'a, 

174 
Certiiication,  medied,  600 
Charitlea,  novd  method  of  raidng 

fuodafor.  149 
Charitlea,  roydty  and  hoapital,  689 
<  harta,  new  diniod,  617 
Cheaterfldd,  the  medlcd    ward 

queatlnn  at,  S78 
Cheyne,  Mr.,  objecta  and  limita 

of  operationa  for  cancer,  882, 

287,841 
ChUdhood,  the  hygiene  of  Infancy 

and.  Dr.  Madden,  621 
Childnn,  dcoholism  In,  197 
Children,  broncho-pneumonia  in, 

895 
Childnn's  hoapitd  report,  681 
Children,  mentd  training  of,  624 


Childreo,  mord  odtwo  dt  ^B 
Chinoaol,  881  ^^ 

Chloroform,  a  death  firom,  m^  ^ 
Chloroform  adminiatration,  Um* 

687 
Chloroform,  jnblleo  of  the  dU- 

covery  of ,  869  _    .  ,^ 

Chloroform,  adenUflo  admlditiaF 

tton  of,  17  .     ^ 

Cholera,  blood-preaaoro  in,  807 
Cholagognea,  296 
Cholesteatoma,  400 
Cigarette,  the,  160  ^       ^ 

Circulation,  (tymnaatlc  tveatvent 

for  the,  214 
Citiea,  roortdity  of,  186, 9n»  (48, 

646 
Clarke,  Dr.,  manifeatotion  of  eye> 

atrain,646  .    , 

Clark  memorid,  exit  the  Andrew, 

80 
Clavide,  dlaplaoement  of,  48B 
CUp,  baaln-enema,  187 
Climbed  down,  408 
Coodne,  857 

Collea'  law  abadutof  if,  144 
ColUna,  Dr.  W.  J.,  876 
Oolon«  rnptoro  of  the,  874 
Colon,  twiaUng  of  the,  191 
Cammiadona,experta'  fees  at  royd, 

274 
Cenudaalons,  medlcd  agenti  and, 

607 
Committee,  d?n  rii^ti  ddenoe, 

618 
Compensation,  a  noTd  ddm  for, 

687 
Competition,  anny  medlcd,  644 
Competltlvea,  army  medlcd,  810, 

Conoeaaiona,  ann/  medical,  611 
Confldenoea,  profaadond,  610 
na,  double,  188 


Conaumptlvea,  health  raaoKta  and, 

686 
CoDamnplien,  hoapitd,  nadondlf 

Inland,  868, 489 
Conaumptlon,    hydrapathy    and 

pulmonary,  860 
Contract,  a  dlaputed,  667 
CkmtroveEBlaa,  phaimaoanllod,  196 


COBBBSPOITDXNCI. 


Advertiaing,  601 

Advertiaing,  the  ethica  of 
dond,  880,  807,  888,  1 
410. 486,  468,  487,  616,  641 

Antitoxin,  nport  on,  409 

Army  mealed  competition,  644 

Asylnma.  the  rdlgtoua  qneatlon  in, 
46,97,126,168 

Cardiff  caae,  medied  ddence  un- 
ion and  the,  691 

Chemiata,    eviu    of  praaeriMng 
pharmaoenticd,  886.  487, 616 

Chloroform,  death  under,  800 

Cocdne,486 

Confidence,  jonraalistic,  644' 

Council,  generd  medied,  si,  96 

"Counter-preaoribing,*'  411 

Coxalirla,  paendo.  261 

Diploma,  public  hedth,  278 

Doctor,  the  tlUe  of,  127 

Dublin  medical  lecturer,  death  of 
an  old,  692 

Dudley,  death  from  chloroform  at, 
8S7 

Ether,  Dr.  Carter'a  thermo-inhaler 
for,  71,  97, 179 


TheH« 


SappUmKitto 
'adinSf  r 


VnmoadObKahx. 


I  N  D  K  i. 


FmUarM,  army  medioal  ezamlnt- 

tioD,262 
Ffbniary,  weather  lor,  179 
OalenoB,  theDew,6lft 
Qorey,  the  iraten  of,  488 
Goy'i  hospital,  the  "hat"   for, 

667 
flonpltala,  Baiter  holldayi  at,  862 
Hydrophobia  scare,  886 
Insanuy,  hypnotism  for  the  core 

of,  616 
Ireland,  election  of  direct  repre- 

sentaUyefor,  127,  179 
Ktngiboty  v.  Hart,  887 
Laboor?  what  is  a  natural,  71 
Lady  medicals,  the  etiquette  of. 

616,  668 
London,  low  death-rate  in,  164 
Mason  «.  Hadden,  22, 97, 16ft 
M.D..  the  Sdinborgh,  202,  224 
Metilo  ^jstem,  the.  641 
Midwirea*  bill,  616 
*■  Mothers  of  Kngland,  the,'*  225 
Penis,  Inzatio,  44 
Pharmacology,  the  deposition  of, 

262,  278,  882         . 
PriTilege,  Sir  J.  WQliams  and  the 

question  of,  615 
Pabllc  health)  examinations  for 

the,  862 
Qualiflcations,  public  health,  616 
Represenutiyes,   forthcoming  el- 
ection of  direct,  648 
Sootltnd,  commissioner  in  lunacy 

for,  486 
ScoUaod,  directrepresentationfor, 

Senrioe'  theBngUsh  sanitary,  487 
St.  Andrews,  representation  of  the 

uniyersitiesofBdInburgh,  and, 

411,  648 
St.  John's  hospital,  226,  279,  809, 

888 
Titles  bill,  proposed  medical,  21, 

Tltles,'medJcal,  n,  224 
Tongue,  soft  sore  on  the,  279 
WUtiams,  Sir  John,  and  the  ques- 
tion of  priyilege,  691 


Correspondents,  notices  to^end  of 

each  No. 
Oists,  an  anti  yaodnation  bill,  877 
Ootton,  how  to  sterilise,  260 
Council,  general  medical,  summer 

seision,  602.  683 

GOUMOIL,  GINERAL  MBDICA.L— The 

address,  602  ;  the  examination 
system,  602 ;  apothecaries  hall 
of  Ireland,  t08  ;  James  Charles 
Ady— phonography  at  the  pre- 
liminary examination— Oeonte 
IngerMll,  Currah  —  Gordon 
uilfflths  Jones,  604;  John 
Hamilton  Foley  —  aement 
Harry  Sanders- medlctl  de- 
fence union,  605,  «69 ;  apothe- 
caries' haU  of  Dahlia— K. 
Theobald  agaln^-withdrawal 
of  a  quaUflcation  —  pei>al 
powers  of  the  qualifyins  medi- 
cal authorities-dental  business 
—reiwrt  of  the  education  com- 
initlee— report  on  preliminarr 
examinations,  684 ;  recom- 
mendations respecting  profes- 
sional examinations— report  of 
public  health  committed- 
midwifery  diplomas— resigna- 
tion of  dlplomA,685 

Council,  meeting  of  the  general 
medical,  688 

Council,  the  press  and  the  general 
medical,  612 

Councillors  at  the  royal  college  of 
suigoons,  Bngiand,  642 

Couuoiliurs,  election  ot,  565 

Coxulgtn,  pseudo,  Dr.  DupiVi  68 

CTiminal  ?  lunatic  or,  89 

Criminals,  scientiflc  treatment  of. 
198 

Cromwell's  head.  174 

Cub«,  Spain  and,  405 

Caba,  the  medical  senrlce  and  the 
war  in,  331 

Curantur,  slmlla  similibus,  612 

cutis,  sarcomatosis.  297 

CycUng'aad  its  inflaenceon  health, 
60 

Qylt,  dermoid,  503 

Cystotomy,  212 

Cysts,  hydatid,  212 


D 


Dayles,  Deputy  surgeon-general 
death  of,  617 

Deaths— end  of  each  No. 

Death-rate,  the  metropolitan,  466 

Death-trap,  sanitary,  88 

Defence  committee,  ciyll  rights, 
829 

Defence,  medical,  278 

Degeneration,  calcareous,  427 

Degeneration,  the  apostle  of.  219 

Demonstrations,  post  •  graduate 
clinical,  Mr.  J.  Hutchinson, 
76,129 

Dentist,  chloroforming  by  an  un- 
registered dentist,  461 

Dentists,  American,  666 

Dentists,  rights  of  unregistered, 
274 

Dermatology,  international  con- 
gress of;  804,  664,  619 

Deyonshire,  roral  sanitation  in, 
274 

DUbetes,  12 

Diabetes,  experimental,  84,  66 

Diabetes,  treatment  of,  Dr.  Thadl- 
chum,  421 

Diagnosis,  *' snap-shot,*' 460 

Diarrhoea,  antiseptics  in  infantile, 
824 

Diarrhoea  mortality,  686 

Diathesis,  uric  acid,  876 

Director-general,  appointment  of , 
69,14tt 

Director-general,  new  medical,  276 

Digitalines,  relatiye  yalne  of  the 
yarious.  879 

Digitalis,  strophanthus  v.,  511 

Dinner,  army  medical,  466 

Diphtheria,  bacteriological  diagno- 
sis of,  178 

Diphtheria,  bacillus,  yalue  of  the, 
557 

Diphtheria,  Infeetioas  sore  throat 
and.  Dr.  Beld,  626 

Diphtheria,  serum  treatment  of, 
114 

Diploma-granting,  amateur,  856 

Diploma  registration,  610 

Diseases  act  and  its  adoption,  no- 
tification of,  2*8 

Disease,  heart,  89» 

Disease,  pauper  schools  and,  4^9 

Disease,  the  adrenal  treatment  of 
Addison's.  91 

Disposal,  refuse,  Mr.  Flinn,  869 

Dlyerticull,  multiple  intestinal, 
142 

Doctors,  foreign,  118 

Doctor,  penny-ln-the-slot,  457 

Douloureux,  tic,  84 

DrilUng,  medical  staff  corps  and, 
196 

Drugs  act,  the  food  and,  880 

Drug  contract  system,  the  Irish, 
588 

Dublin,  bad  me^t  trafDc  in.  40 

Dublin,  health  facts  from,  88S 

Dublin,  small-pox  in,  09 

Dublin,  the  barrack  accommoda- 
tion of,  278 

Daplay,  Dr.,  pseudo-coxalgia,  b^ 

Dyspnoea,  excision  of  lymphadeno- 
matoas  glands  causing,  625 


Ear,  ulceration  of  the  middle,  40J 

Bar>,  promiofnt,  658 

Ectles,  Dr.,  some  cjses  of  hernia, 

256 
Kcchymoses,  178 

E<li8on  and  the  KOntgen  ravs,  830 
Education,  a  pioneer  In  sdentttti;, 

483 
Education,  place  of  science  in,  536 
Electricity,    iropotenoy    and    lis 

treatment  by,  l)r.  Althaus,  520 
Elder,  Dr.,  yaglnal  hysterectomy, 

205 
Elections  at  the  royal  college  of 

physicians,  509 
Eleciloos,  coming,  485 
Elephantiasis,  a  case  of  so-called 

(lilnatrated).  Dr.  Kidd,  255 
EUut.  Dr.,  gynncological cases,  258  ■ 
Emaciation,  danger  of  artificial,  40 


Embolism,  pulmonary,  Dr.  Glenn, 
549 

Emphysema,  subcutaneous,  656 

Enaemic  diseases,  regular  pheno- 
mena  of  some,  241 

England,  royal  collese  of  surgeons 
of,  86,  69,  176,  826,  886.  4u8 

England,  small-pox  in  the  weit  of, 
618 

Bnglisoh,  Prof.,  treatment  of  pros- 
tatic, hypertrophy  by  castra- 
tion. 441 

Enterprise  in  Edinburgh,  uniyer- 
sity,  612 

Enteric  feyer,  perforation  io.  Dr. 
Wiggin.6 

EiUdemlc,  the  Oloacester,  450 

Epileptics,  marriage  of,  618 

Epithelioma,  400 

Eruption,  summer,  115 

Eryslpelss,  148 

EryslpeUs,  antidote  for,  42 

"EtUc8.''687 

Ethics,  professional,  19, 71 

Bucalne,  462 

Eustachian  orifices,  abnormal  p  id- 
tlonof.  479 

Examinations,  Irish  conjoint,  89 

Exhibition,  a  degradlna,  666 

Esperiment  an  interesttng,  671 

Extracts,  meat,  274 

Extract,  supra-renal,  296 

Extraordinary  case,  an,  176 

Eye,  a  surgeon's,  880 

Eye-ttrain,  Dr,  Clarice,  646 


Face,  lupus  of  the,  426 
Factory  bill,  the  new.  21,  87 
Fa'stories,  new  chief  iospector  of, 

880 
Fads  and  "ads.," 455 
Farming,  child  murder  and  baby, 

408 
Fees,    ffuardlans'    assessment   of 

medical,  856 
Female,  sterility  In  the,  612 
Kerdtnand,  John,  couTlctlon  o^  69 
Feyer  accommodation,  17 
Feyer,  alcohol  and,  160 
Feyer.  how  spread,  is 
Feyer,  puerperal.  425 
Keyer  is  spread,  now  scarlet,  588 
Feyer?  what  is  swine,  488 
Finance,  hospital.  208 
Finland,  phthisis  In,  401 
Fistula,  entero-yeslcal.  Dr.  Inne«, 

46)» 
Fitagendd,  Dr.,  death  of.  226 
Flinn,  Mr.,  refuse  disposal,  869 
Flnids,  use  of  aniesthetlsing,  118 
Fly-papers,  poisoonns,  119 
Food,  artificial  milk.  6  2 
Fools,  drug  traps  for,  4i)t 
Foot,  the  climbing.  640 
Foramen,  hernia  of  the  obturator. 

212 
Formula,  selected  ii>7, 186 
Fowler,  Suig-capt ,  the  case  of,  668 
Foy,  Mr.  O.,  agaricme  in  phthisis, 

285;  medioo-chimrgioal  ttems, 

398 ;    Spanish     prescriptio-s, 

446.  478,  527,  551 
France,  forirign  medical  men  in, 

122,665 
France,  the  population  of.  149 
Frauds,    Surg,  sen.,     diminished 

respiratory  fanctioo,  6i 
Franks,  Dr.,  banquet  to,  619 
Free  hospital,  royal,  253 
French  hospital,  418 
ITrench  ophthalmological  congress, 

466 
Friend,  the  mother^s,  90 
Friendly  societies'  question,  ^82 
Fagax,  episcleritis  periodica,  Mr. 

S.  Stephenson,  288 
Function,  ciiminithed  respiratory, 

Surg.-gen.  Krancis,  61 


Qargle,  abolition  of  the,  92 ;  seda- 
tive, 657 

Oamanlt,  Dr.,  destriictt'^n  of  the 
membranous  yestlbule,  5 

Osstrosoope.  a  new,  860 

Qelatine,  formaline,  266 


June  24th,  18M. 


German  surgeons,  congress  of,  6S7 
Oermany,  made  in,  689 
Germany,  suicide  in,  160 
Oland,  iodide  in  the  thyroid,  142 
Oland,  thyroid,  216 
Glands,  analysis  of  suinra-renal  ttnd 

thyroid,  876 
Glenn,  Dr.,  pulmonaiy  emboUnm, 

549 
Gloucester,  the  small-pox  leooo  at^ 

828 
Gloucester,  the  turn  of  the  •nU- 

yaccinatiou  tide  at,  86 
Gloucester,  the  press  and  the  oat- 
break  of  small-pox  at,  406 
Gloucester,  yaooinated  and  unyao- 

cioated  at,  889 
Glycerine,  intra-uterine  Injection 

of.  247 
Goat,  phthisical  lungs  from  a,  101 
Godson,  Dr.,  presidential  addreaa 

to      British      gynaoologieal 

society.  77  ^  

Goitre,  modem  treatment  of,  682 
Goitre,  treatment  of.  168 
Gonococcl,  locomotion  of,  12 
Gossip,  literary  notes  and  go«tp, 

46,  162 
Gradaates' association,  the  Irish, 

274 
Gruber,  Prof.,  morbus  meniervi, 

2S 
Guaiaco^  295 
Guardians'  economy,  a  life  lacri- 

flced  to,  a'SS 
GuUd,  the  medical.  166 
Gumma,  syphilitic.  84 
Gannlng,  Dr.,  death  of,  868 
Guy's  hospital  basaar,  698 
Gyn»ooloary*   Udy   examiner  in, 

568,  667 
Gynaocoic^cal  cases,    Dr.    Eliot, 

268 
Gynecological  society,  British,  99 


H»m'»rrhage,    accidental,  Dr.  O 

Gorman,  286 
B»morrhage,    post-partum,    426 

699 
Hair,  function  of,  876 
Hall,  Dr..  cerebellar  tumour,  497 
Hamilton,  Mr.,  preeenta8lottto,671 
daryeian  society,  the,  99 
Baryey,  Dr.,  chronic  ulcer,  660 
Hrad4che,  academy,  642 
Hnalth  examinations,  public,  08 
Health,    examinatioa   papers    In 

J>abllc,  94,  184,  901,  228,  971 
th  officer,  Imperial,  679 
Health,  remuneration  of  medical 

officers  of,  66 1 
Health,  the  badget  and  national, 

481 
Heaps,  houses  built  on  ash,  68 
Hearing,  the  mystery  of,  67 
Heart  disease,  deyelopmenttl,  844 
Heart,  dilated,  260 
Heart,  Nauhetm  and  Schott  treat- 
ment of  disease*  of  the,  889, 

840 
Heart,  rupture  of  the^ 
Hernia,  ingalnal,  Dr.Henston,  894 
Hernia,  muscular,  668 
Hernia,  some  cases  of.  Dr.  Eccles, 

266 
Heirlooms,  Infected,  67 
Hendley,  fluigeon-general,  death 

of,  868 
Henry,  Prince,  death  of,  116 
Heuston,    Dr.,    inguinal    hernia, 

891 
Hepatitis,  syphilitic,  12 
Hip-joint,  saccessful  resection  of 

the,  218 
Hip-Joint,  tubercalous,  Mr.  B.  L. 

Swan  (Illustrated),   167,    181, 

281,  815,  496 
Hirscb,  Baron.  461 
History  is  made,  how,  611 
Hollanders,  English  horse-flesh  for, 

408 
Honours,  new  years',  42 
Honorable,  an  amende,  407 
Horse  sickness,  South  African,  513 
Horse-fleih  as  food,  682 
Hospitals,  continental,  20 
Hospitals,  compounding  medicines 

in  workhouse,  71  ** 

Hospitals,  central  control  of,  660 
Hot-air  bath,  therapeutic  yi^ue  of 

localised,  175 


'^^'^Tm^S^^S'iSimmA  { 


INDEX 


Jone  g4tb,  1806. 


Bmehlmoii,  Mr.  J.,  po8t-fl;rmdiute 
elialoal    demoMCnitioDB,    76, 

Hulej  memorial,  the,  881 
Brdnvhobla,  17,  SSI,  408, 434 
HTdroftboblm,  Loodon  death  from, 

BydSophobla  acaie,  fhe,  m 
gyperfaypliy,jjrortatic  480 
HyimotlRD,  408 

HTiiop,  Dr.,  dtasnoria  of  Insaaitr, 
1.  ft,  49,  78,  lOS,  182,  UO,  184, 

gyrtersetomT.  pteaent  podtion  of 
lotal,899  ^^ 

HjBtaracloQy,  three  nteriiemoTed 
bjTagbul,8ie 

Hjraterectomy,  vaghial.  Dr.  Elder, 
206 


loa,  |yph(4d  from,  08 
lee-ereama,  the  daogers  of  atreet, 

808 
IdkMy,  operatlTe  treatment  of,  68 
niMltimMy,  618 
Inda,  female  medical  education 

in,  122 
India,  inHaenxa  In,  106 
Irideotomj,  hTdrophthalmna  and, 

SS7 
Indnstry.  a  new,  408 
Ineteiate,  the  chronic  polloe-ceO, 

Infancy,  management  of,  681 
iBfhnt  lite,  protection  of,  518 
Infanta,  management  of  the  ombl- 

liens  in,  212 
Inflnenza,  the  weather  and,  120 
Innea,  Dr.,  entero-Tesical  llatala. 

468 
InqoiiT,  a  matter  for.  882 
Inaanity.  antoioxia  hi  the  caata- 

tionoL661 
Inaanitr,  diacnoala  of ,  Dr.  Hyslnp, 

1, 26,  49,  78, 108, 182,  150,  184, 

2C^ 
Inaanitr,  hypnoilam  for  the  cnre 

of,  586 
laeanlqr,  snpentitlon  and,  66 
Inaaoitj,  treatment  of  traumatic, 

42 
laapec'  or,  charge  againit  a  London 

•anltary,  6e 
Inapection,  aanfUry,  61 
Intaatioal  anrgery,  Ungen  v.  bnt- 

tonaln,  582 
Intesdne.  rrgetable  diet  and  the 

length  of  the  bnnmn,  801 
Inralids,  importation  of,  460 
Irelaad,  oompulaory   notification 

fee  in,  09 
Ireland,  direct  repreaentatlon  for, 

120 
Ireknd,  eleciiona  at  the  royal  ool- 

lege  of  anrgeona,  580 
Ireland,  general  medical  council 

repreaentattTefor,  election  of, 

146. 196,  S21,  846 
IreiaDd,  health  of.  00,  517 
Ireland,  registranhip  of  general 

medical  oooncil  in,  41 
Iiitia,  treatment  of,  Mr.  Juler.  467. 

4«S 

hen,  reaorptlon  of  the  aalta  of,  266 


Jackaon,  Mr.,  death  of.  47 

Jameeoo,  Dr.,  40 

Janoe  watera,  hnnyadi,  154 

Jeaner.  centvnaty,  580 

Jenrer   celebration,  a,  821,    451, 

Ml,  600 
Jenner  memorial  fund,  the^  47 
Jeoner  rociety,  a,  482 
JeMett,  Mr.,  lUBmorrh^glc  c)8t  of 

otary,  200 
Johaaneabnrg,  the  health  of,  00 
Joluuon.  Sir  Oeoige,  death  of.  614 
Jonee,  Dr.  Macnaagbton,  error*  of 

refraction     in     neoraatheuic 

women,  811 
JoonaUim,  hideceat,  827,  882 


Juler,  Mr.,  pathology  and  treat- 
ment of  Mtla,  467;  408 
Juftloe,  Spartan,  866,  403 


Ceiller'a  cocoa,  488 

Keith,  Dr.,  permanent  cure  of  an- 

tefleziona,  229 
Kenny,  Dr.,  409 
Kidd.  Dr.,  a  caae  of  ao-called  ele- 

phantlaeie  (illustrated),  258 
Kldd,  Dr.,  the  late,  868 
Knee-joint,  hydrarthrosla  of  the, 

206 


Laboratory  for  London,  bacterlo- 

loffioil,  610 
Labyrinth  ezperlmente,  61 
Lady  doctors,  adyertlaing  by,  858 
Lady  doctors  and  the  medical  bo- 

detlea,  561 
Lady  examiner,    demonatrationa 

againat,  588 
Lake,  Mr.,  suppuration  of  the  mid- 
dle ear,  2U8 
Lankester,  Prof.  Say,  40 
Laparotomy,  inyagination  and,  401 
Larynx,  extirpation  of  the,  142 
Laryngologlcal  society  of  London, 
47 


LEADING  ABTICLES. 


Act.  the  new  factory,  87 
AdTertislng,  etiquette  of  profes- 

aional.  268.  428,  454,  4dl 
Adyertlaing.  medical.  428,  451,  481 
Antemla,  aplenic.  659 
Armstrong,  Dr.,  245 
"As others aee us,"  870 
Asylums,  trade-unionism  in,  688 
Australia,  friendly  aocletiea'  ques- 
tion in,  404 
Bicycling  harmful  for  girla,  Is,  482 
Buttons,  flrgen  v.,  in  inteetlnal 

aurgery,  6s2 
Cancer?  is  surgery  a  cure  for,  216 
CoUes'  law  abeolu  e,  Is,  144 
Com-nleslons,  medical  Kgenta,  and, 

607 
Competitlyes.  army  medical,  269, 

800 
Competition,  army  medical,  607 
Goeto,  anci-yaccloatlon  bill  of,  877 
Council,  general  medical,  588,  606, 

696 
Diarrhoea,  antlieptics  in  infantile, 

824 
Diphtheria,    bacteriological    dia- 

goosla  of,  178 
IMaeaae,  pauper  aohools  and,  420 
Bngland,  royal  college  of  aurgeon*, 

86,  826, 
Bttquette,  lady  doctors  and  pro- 

feasional,  481 
Fade  and  "  ads,"  456 
Beart  disease,  deyel'^pmeotal  244 
B«nry.  the  death  of  Prince,  116 
Horsefleah  as  food  588 
Boepltals,  central  control  of,  661 
Byatereotomy,  preaent  position  of, 

SOO 
Idiocy,   operatiye  treatment  for, 

68 
Inebriate,  the  chronic  police-cell 

217 
Inaanity,  autotoxls  in  the  treat- 
ment of,  66i 
Ireland,  direct  repieaenta'ion  of, 

16, 116,  246 
Juettce,  Spartto,  402 
Lady  doctore,  medical    socletlei 

and.  663 
Liyerpool,   midwife  qnestioo   in, 

430 
Magistratea  and  the  medical  act», 

106 
Meaaies  and  its  death-rate,  687 
Meaales.  notltication  of.  3  5 
Jiedlcine  the  future  of,  64 
Metropolitan  death-rate.  456 
Mldelve's  legiatratlon  bill,  4b8 


Mortality,  faifant.  118 
Oyatera,  baoteriology  of,  865 
Paralysis,  nature  ofgeneral,  608 
Paying,  street,  88 
Penalou,  medical  poor-law.  171 
Pharmaoista,  preacribing  by,  681 
Pharmaoology,  108,  506 
Photography,  the  new,  146 
Practice,  adence  and,  660 
Pririlege,  the  plea  of,  862 
Progreia,  sanitary,  117 
Puerperium,  the  msanitieB  of  the, 

86 
Question,  the  friendly  socletlea, 

588 
Scarlatida  infection  ceaae,  when 

doe8.854 
Science,  the  giant  stride  of,  15 
f*ecrecy  and  pririlege.  402 
Sheffield,  medical  officer  of  health 

for,  195 
Strain,  the  breaking,  588 
Superannuation,  poor-law  medical, 

270 
Sorgery,  public  school,  87 
Sypbilia,  extra-senltal.  1^ 
Therapeatice,  Kiandalar.  62 
Therapeuaie  ?  what  is,  S78 
Water  companiea,  the  metropoli- 
tan. 301 
Williams,  Sir  John,  and  the  quea- 

tion  of  pririlege,  534 
Women,      Cambridge    nniyeraity 

degreea  for,  172 
Workhouae  reform,  Iriab,  507 

Lead  polaoning,  536 

Leeds,  hospital  accommodation  in, 

48 
Legacy  for  a  medical  man,  pros- 

pectiye,  222 
Leicester  and  its  dust  remoyal,  10  i 
Lemon  as  a  peaaary,  478 
Leproay.84. 114,  207 
Leyee,  the  profession  at  the.  680 
Librarieaand  the  dissemination  of 

diseaae,  66 
"Light "cure,  the,  382 
Lister.  Sir  J..  537 
Litmus  pencil,  610 
Liver,  abecess  of  the,  180 
Llyer,   amyloid    degeneration  of, 

480 
Llyer,  cardiac,  88 
Llyerpool  deadlock.  664 
Uyerpool  lylng-ln  hospital,  dead- 
lock at  the,  537 
Llyerpool  lying-in  hospital,  686, 

600 
Llyerpool,   midwife  question  in, 

480 
Llyerpool    post-graduate  course, 

401 
Ldffler's  baciUus,  658 
liogan.  Sir  Thomas,  death  of,  668 
London,  central  hoapital  board  for, 

122 
London   uoiyersity,  regiatrarahlp 

of,  18 
Lor^gna  muscle,  dlalocation  of  the 

peronens,  680 
Lunacy  requirements,  266 
Lupus.  658 
Luxation,  bloodleaa  treatment  of 

congenital,  101 


M 


Mallgnum,  deciduoma,  850 
Maclnt>re,  Br.,  Rontgeo's  rays  In 

laryngeal  aurgery,  470 
Mackenrie,  Dr.  Shaw,  prognoela  in 

sypbllis,415,  4i8 
Madagaacar  campaign,  808 
Mad'ien.  Or.  More,  the  hygiene  of 

infancy  and  childhood,  621 
Malaria,  parasites  of.  109 
M4Jlgna,  decldU'tma,  t^ss 
Man  and  animals,  malaria  in,  480 
Man,  bravery  of  a  medical,  15  • 
Managers,  ladies  «8  hospital,  10 
Marriages,  conaangaineons,  147 
Marriages— end  of  each  No. 
M«ttel,  the  late  Count,  4U6 
Manser  n  flex,  th«,  457 
M.D..  alterationa  In  the  Edlobargb, 

121 
Me«l.  adulterated  linseed,  435 
Meas'es  and  Ics  deaih-rate,  6o7 
Measles,  the  notlflcaiion  act  and, 

150 


Meaalea,  the  notification  of.  826 
Medical  acU,  magistratea  and  the, 

104 
Medical  congress,  inter-colonlal,  08 
Medical  council,  direct  repreaenta- 
tlon of  Ireland  in,  16 
Medical  council,  meeting  of,  566, 

686 
Medical   director^neral  of   the 

army,  the  new.  806 
Medical  man,  accident  to  a,  156 
Medical  men,  personal  estate  left 

by,  60 
Medical  protection  aoclety,  465, 

491 
Medical  aociety,  conyeraaxlone  of 

the,  567 
Medicine,  the  future  of.  64 
Medlcine-mongering,  abortion,  461 
Medico-psychological  association, 

281,  548 
Memel,  leprosy  in  the  Kreise,  670 
Metric  system,  the,  462.  510 
Men,  aoclety  for  relief  of  widows 

and  orphans  of  medical,  00, 

418 
Men.  the  righta  of  medical,  502 
Menl^rei,  morbus,  Prol  Oraber,  28 
Meni6rel,  morbus,  400 
Menlerel.  morbos,  638 
Meningitis,  tapping  in  tuberculous 

503 
Meningitis,  tuberculous,  523 
Microbes,  composition  of,  68 
Midwifery,  diplomas  in,  640 
M  Ida  Ives,  registration  of,  176 
Midwiyea'  registration  bill,  coat  of 

opposing,  828 
Midwiyea'  regUtration  bill,  481, 

bS6 
Milk,  adalteration  of,  431 
MUk,  bacteria  in,  406 
MUltls,  Sir  John,  539 
Minister    of    France,   a  chemist 

foreign.  884 
"  Moder  dweUings,  450 
Moffett,  Sir  Thoma«,  68 
Molluscum,  contsgiosum,  558 
Morality,  army.  565 
Morison,  Dr.,  abdominal  aurgery, 

391.  417. 547, 578 
Morphinomania,  180 
Morphlnomaniaca,  the  nntruthf  nl- 

neas  of,  91 
Mortalitv  infant  US 
Mouth,  disinfection  of  the,  60 
Mouth,  tumoors  of  the,  295 
Moxey,  Dr.,  death  of,  542 
Murrell.      Dr.,     pharmacological 

action  of  porgatiyee,  25 
Multiforme,  erythema  ex«udattya, 

580 
Myopia,  452 
Myopia,  prograssiye,  60 
Myrineitis,  001 
Myxmlema,  212 


N 


Nap,  the  afternoon,  611 
Nauheim,  Bad,  82i 
Nauhelm  tre«troent,the,  250 
Nayal  hoapitals,   dispensers  for, 

539 
Neuralgia,  locaiiaed,  50 
Nenrasthenla,  678 
Neuritis,  trophic,  169 
*'  No  ICngUsh  wanted,"  196 
Norway,  leprosy  in.  HO 
Notification  act,  flaw  in  the,  66 1 
Notification  aystem,  the  compol- 

sury.  48 
Nottingham,  medical  men  in,  143 
Nursery,  the,  622 
Narsea'  exhibition,  4*  1, 615 


Obeaity.  tbyroldln  and,  S22 

Obecenlty,  newspapers  as  the  me- 
dium for,  38 

Obstetrics,  international  coogreaa 
of.  125 

0* Conor,  Dr.,  excision  of  the 
tongue.  806;  excision  of  the 
cervix  uteri,  676 :  treatment  of 
carbuncle,  446 


Boppliinmt  to 
VhB  Medleal  Pwm  and  OJitmUr. 


INDEX. 


Jane  84th,  iaP<. 


Odoan.  ilreet,  611 
Oa-thop.  madleloe  from  an,  281 
Old  faonei  go  to.  where,  689 
OHrer,  Dr.,  large  flbro-myoiiui  of 

atenu,69e 
Onychogrmphy,  605 


OPE&ATING    TflSATRBS. 


CBBL8BA  Hospital  vor  Womih- 

Gholecratotomy,  848 

Oeitatlon,  raptured  tab«l,  876 
CITT  or  DCBLIH  HOSPITAL— 

Nephrectomy  ,361 
GRBAT  NORTHSRll  HOSPITAL^ 

Cerebral  tnmonr,  trephining  for, 
68 

Bpltbelioma,  268 

Intauoeception,  caie  of,  68 
OUT'S  Hospital— 

Pynmia,  aoate  portal,  427 
Kino's  Gollsqe  Hospital— 

cartilage,  displaoed  aemi-lnnar 
14S 

Blbow,  arthroctomy  of  the,  216 

Femur,  aarcoma  of,  680 

Ooitre,  cystic,  605 

Malleolua,   tabercoloiu  diaeiie 
of  external,  298 

Neurectomy  of  the  fifth  nerre, 
480 

Ulnar  nerre,  secondary  nerre 
suture  after  diTlaion  of  the,  85 
LoR)x>N  Hospital— 

Humerus,  amputation  of  the,  170 

Palate,  sarcoma  of  the,  401.  464 

Salpingitis,  suppuratire,  606 
MIDULESBX  HOSITAL— 

Abscess,  llio-psoas,  116 

CsBsanan  section,  876 

Carcinoma,  acute,  559 

Cephal-bydrocele,  428 

Cyst,  dermoid,  888 ;  rapture  of 
an  orarian,  669 

Hermaphrodite,    nephro  •  litho- 
tomy in  a  supposed,  480 

Knee-joint,  Stephen  Smith's  am- 
putation at  the,  85 

Nephro-lithotomy,  144 

Tumour,  obscure  abdominal,  888 

Tongue,  lymphatic  nnvus  of  the, 
848 
EiOHMOND  Hospital,  Dublin-- 

larynx,  total  extirpation  of  the, 
686 
BOTAL  Frbb  Hospital— 

Cure,  radical,  681 

Innominatum,  tumour  of  oa,  681 

Joint  cases,  tvro,  45  i 

Perinseum,  ruptured,  581 

Photosraphy,  localisation  of  a 
needle  by  the  new,  216, 868 

Pyoealpinx,  170 

Section,  abdominal,  86 

Thigh,  removal  of  a  large  mol- 
luscum  flbrosnm  from  the,  85 

St.  OBORGB'S  HOSPITAL— 

Orariotomy,  268 
St.  MARf'S  HOSPITAL— 
Osteo-myelltls,  acute  septic,  685 

St.  IHOMAS'S  HOSPITAL— 

Ankle-joint,  arthrectomy  of  the, 

402 
CoDsariao  section,  267 
Cystotomy,  »upra-pubic,  248 
Cholecystotomy,  »61 
Eyelids,  plastic  operation  upon, 

61 
Osstrostomy,  116 
lntu«snsception,  192 
Ovariotomy,  658 
Peiitonitis,  suppurative,  IS 
Photogiaphy,  removal  of  liCedle 

after  localisation  by  the  new, 

852 

Spine,  laminectomy  for  tubercu- 
lous disease  of  the,  606 
Univbrsitt  Collbgk  Hospital— 
Elbow,  arthrectomy  of  ihe,  215 


Oaaides,  excision  of,  Mr.  Lake,  208 

Osteomalacia,  580 

Out-patients,  payments  by  hospi- 
tal, 610 

Orsry,  dermoid  cyst  of  the,  290 

Ovary,  heemorrhagic^  cyst,  Mr. 
Jessett,  209 

Ovary,  remarkable  dermoid  cyst  of 
the,  151 

Oversight,  a  milkman's,  248 

Owen,  Mr.  E.,  children's  spines,  7/ 


Oxyfren,  chronic  ulcer  treated  1^, 

Mr.  Harvey,  650 
Oysters,  the  bacteriology  of,  856  ; 

typhoid  ferer  and,  656 


Pain,  capacity  of  women  for  bear- 
ing, 467 
Paralysis,  facial,  8i4 
Parasite,  the  malarial,  247 
Paris,  anti-foreign  medical  move- 
ment in,  248 


PASS   USTS. 


Aberdeen  university,  418 
Apothecaries  hall,  Ireland,  71 
Apothecaries  of  London,  society 

of,  887 
Army  medical  service,  166.  227 
Durham  university.  439,  466,  491 
Edinburgh  university,  489 
England,  royal  college  of  sur- 
geons of,  28,  619,  671 
Ouuutow  university,  868 
Indian  medical  service,  155,  327 
Ireland,  royal  ooUege  of    aur- 

geons  Id,  227 
London  university.  47,  287 
Naral  medical  service,  648 
Scotland,  conjoint  examinationa 
in,  208,  465,  617,  548 


Paiteur,  93 
Pasteur  memorial,  837 
Pasteurlsm,  tbe  vaIuc  of.  587 
Pathology,  interesting  discovery  In 

comparative,  221 
Patients,  prostatic.  578 
Pauper  schools,  charity  organisa- 
tion society  and,  640 
Paupers,  milk  for,  407 
Paving,  street-,  88 
Penis,  ring  on,  112 
Pensions,  old-age,  281 
Pensions,  poor-law,  171 
Peritonitis,  tuberculous.  11,  241 
Petroleum,  perils  of,  460 
Pharmacy,  one-priced,  409 
Pharmacy,  the  study  of.  90 
Pharmacologv,  176, 193 
Philadelphia,  unlversltj  of,  91 
Phleb  tis,  inflammation  of  middle 

ear  from,  427 
Phoephoms,  216 
Phosphorus  in  matches,  substitute 

for,  580 
Photography  in  surgery,  electrical, 

42 
Photography,    the     new    (Illus- 
trated). 141,  177.  200,  222 
Phthisis,  agarlcine  in,  Mr.  O.  f  oy, 

V86 
Phthisis,  tuberculin  In,  850 
Physicians,   presidency    of  royal 

college  of,  829 
Physicians,  royal  college  of  Lon- 
don, 161.  305,  884,  606 
Playfair,  lUtaon  v.,  86u 
Piatt,  Mr.,  rapture  of  the  abdom- 
inal aorte,  »68 
Pleurisy,  traumatic,  608 
Plumbers*  registration  bill,  434 
Poisons,  the  uncontrolled  trade  in, 

406 
Poisoning,  carbolic  acid.  48,  640 
Poisoning  case,  the    seram.  478, 

608,648 
*'  Policeman  "  at  the  dinner  table, 

the,  465 
Pollution,    river    fl»h,  and  river, 

93 
Population,  density  of.  il5 
Postal  medical  offlcers,  667 
Postal  servants,  relative  health  of, 

611 
Potts,  Mrs.  Longshore.  438 
Practice,  cases  in  private.  Dr.   C. 
Simpson,  624;  control  of  quack, 
662 ;  dangers  of  gynsecolugical, 
668 
Practitioner,  remarkable  death  of 

a  medical,  119 
Practitioners,  a  new  order  of  medi- 
cal, 3;3 
Prieternaturalls,  anus,  426 
Pregnancy,  extra-utrrine,  140 
Pregnancy,  lactation  and,  38 
Pregnancy,  the  insanities  of,  86 


Preliminary  examination,  Dublin 

conjoint,  689 
Prescribing,  counter,  857 
Prescriptions,   Spanish   Dr.    Foy, 

446.  479,  627.  661 
Priestley.  Sir  W.,  640 
Prisons,  bdnstries  in,  198 
Prison  medical  oflloers,  women  ■§, 

199 
Privilege,  secrecy  and  468 
Privilege,  tbe  plea  of,  868 
Professor,  the  Utle  of,  83 
Profession,  an  orercrowded.  889 
Profeuion,  medical  aid  societies 

and  the,  687 
ProfessionSjOver-prodnctlonin  the, 

3U4 
Prophetess,  a,  874 
Prostote,  hypertrophy  of  the,  148, 

814 
Protection  society,   London   and 

counties,  518 
Public,  druj  stores  and  the,  641 
Public,   diagnosis  of  measles  by 

the.  666 
Public  housee,8unday  doaiog  of  ,512 
"Puff  "direct,  the,  868 
Pulmonary      diseases,      curative 

resorts  for,  822 
Pulse,  treatment  of  slow,  168 
Puncture,  lumbar,  601 
Pupils,  a  surgeon  and  hla,  611 
Puxgatives,phannacological  action 

of.  Dr.  MurreU,  25 
Pylori,  cardnomi,  698 


Quackery  In  high  places,  890 

Quack  nostrums,  808 

Quack  practice,  reaponsibllitieB  of, 

272 
Quack  prosecution,   the   Cardiff, 

260 
Queen,  Mr.  K,  B.  Anderson  and 

the,  221 
Question,  the  M.D.,  U.S.A.,  822 
Quinine,  monopoly  of,  216 


Raid,  medical  men  and  Dr.  Jame- 
son's, 148 
Hallway  companies,  city  men  and, 

271 
Band,  health  of  the,  518 
Bays.  R6ntgen,  895,  613 
Rebellion,  Uie  Matabele,  461 
R^us,  Dr.,  hot  water  in  surgery, 

162 
Rectum,  Innervation  of  the,  861 
Rectum,  new  method  of  removing 

a  csrdnomatous,  408 
Red  cross,  the  founder  of  the,  806 
Registrar,  appolotmeot  of,  90 
Registration  craze  again,  the,  689 
Refd,  Dr.,  Infectious  sore  throat 

and  diphtheria.  626 
Report,  armv  medical,  197 
Representatives,  election  of  direct, 

648 
Reprisals,  curious,  804 
Resection,  Intestinal,  Mr.  H.  W. 

Allingham,  lOl,  180 


REVIEWS. 


Anatomy,  Qualn's  elementa  of,  888 
Annual  for  1896,  medical,  437 
KoumeiDOUth   in   lung    troubles, 

Mllner'a.  669 
Carbohydrates,  Pavy  on  the,  488 
Chart,  new  dlulcal,  4S8 
Children.  Sach's  nervous  dUeases 

of,  88 ;  Ashbya,  670 
Compounding,  Scoville's  art  of,  61 7 
Consumption,  pulmonary,  Harris 

and  Beale's,  642 
ConnteMrriUtlon,  Gillies'.  43^ 
Dental  materia  medica,  Stocken*s, 

98 
Dental  profession,  Turaer's  guide 

to  the  medical  and,  98 
Fracturformar,  Kocber's,  464 
Hygleue,  Notter's,  670 
Index-catalogue  of  U.S,  surgeon- 
general's  office,  489 
Nervous  s)stem,  Jakob's  atlas  of 

the,  886 


Ophthalmoscopy,  Haab's  atlas  of, 

«26 
Oxford  English  dictionary,  281 
Pathology,  manual  of,  Gocta'a.  648 
Perioardlom,    Broadbenrs  adha- 

rent,  880 
Pharmacy,  year-book  of,  497 
Pharmacology,  Bine's  lednrea  on, 

Fharmaoology,  MomU's,  464 
Praotloe,twentieth  oantnxy,  38^  668 
Pnlae-gangiag,  Oliver's,  669 
Skin,  Anderson's  disease  of  the,  98 
Skin  diseases,  Kaposi  on.  616 
Spinal  cord,  Marian's  leotorea  on, 

281 
St.  Bartholomew's  report,  670 
Soigery.    international     eooyolo- 

paMilaof,617 
Surgery,  smaller  atlas  of  cUnleal, 

Hutchinson's,  642 
a^hais.  Cooper  on,  618 
I%«atment,  year-book  of,  216 
WIssenschalten,    Ubliothak     dar 

gesammten  mediniachen,  648 

Reynolds,  Sir  R.,  fflness  of,  618, 

640;  death  o(  585,  690 
Reynolds,  the  late  Sir  RnaseU,  his 

successor,  648 
Rhinoplasty,  874 
Robson,  Mr.  M.,ventro-fizatlonor 

ventro-snspension   of  uterus, 

818 
Roll,  our  professional  muster,  808 
Rontgen,  Balvionl  on,  199 
Rontgen  rays  In  laryngeal  surgery, 

Mr.  Madntyre,  470 
Rontgen's  sensational   discoviefy, 

118 
Royalty    at     the    West   London 

hosplUl.  698 
Ryan,  Dr.,  death  of,  616 


Safety,  culpable  neglect  of  the 
pobUc,  149 

Safety  lamp.  Brace's,  868 

Sanltas  co.,  tbe,  881 

f«anitary  Institute,  the,  648 

Sanitary  progress,  117 

Sanltotion,  Dublin,  468 

Sanitation,  guardians'  notions  of 
workhouse,  6S6 

Sanitation,  over-zealous,  93 

Sarcoma,  the  blaatomycetea  of, 
816 

Sane,  influence  of  aqrlum  life  on 
the,  666 

Sauiom,  Dr ,  InflneDzal  arthritis, 
669 

Saturday  hospital  fund,  the  medi- 
cal profession  and  the,  665 

Scabies.  425 

Scandal,  a  seram,  618 

Scare,  the  oyater.  20 

Scarlatina,  69, 167 

Scarlatina  infection,  when  does  it 
cease.  334 

Schofleld,  Dr.,  mental  thera- 
peutics, 623 

Schoolboy,  meals  and  food  for  the, 
610 

Science,  giant  stride  of,  16 


SCOTLAND. 


Aberdeen  unlvenity,  extension  of, 

860 
Act,  fatal  accident  inqniiy,  128 
Appllaoces,  fire,  409 
Appointments,  new.  94 
Aodorson,  Dr.,  the  late,  251 
Asylum  for  Edinburgh,  new,  643 
Asylum,  royal  Edinburgh,  276 
Asylum,  tragedy  at  a  lunatic,  667 
Bacteria,  filter  beds  and,  882 
Bequests,  munificent,  614 
Bin,  new  pubUc  health,  276,  881, 

610,567 
Brechin,  hospital  accommodation 

in,  667 
Calrd.  Prindpai.  health  of.  807 
Chairs,  new  medical,  640 
Centenary,  Glasgow  technical  ool- 


lege,  435 
emiatr 


Cbemiatry  in  schools,  44 
Chloroform,  death  under,  44 


^»M»HoSi  Pm«i and  ClrcnUr 


INDEX. 


>g|th,18Qft. 


OcauBlMloii.  fho  piiMM.  127, 161 
Ctakada  uid  cmU  piciened,  a, 

014 
Condttfan^  herith,  S78 
CoDTslMorat    honncSi 

dllftoallarwUh,488 
CoBrt.  SdiDDiusb  vnlTenitj,  666 
Dfgttm,  Sdinbugb  modical,  462 
DeireM,  hononxy,  400 
fi^hUMria,  sttmm  tnatmant  of, 

614 
DimdMp   mMUndtf  hoipltel  for, 

901 
Dondeo,  pabUc  hemlth  bilk  and, 

487 
Dondoe,  rojal  inflrmary,  514, 64S 
1806,  Sdlnbilishin,  21 
XdiBboigb,  M^.  for,  860, 614 
Xdiabars^      medico  •  cfaimigioal 

•ocie^,  222 
KdlBbiixi^  zoyal  society,  614 
~     »,bonorarvde0ee,2OO 


VlBueeL  BdlDbBor^,  486 
GliiVyw  nonorary  aegieef.  886 
Oluiov  ,       medloo  -  durnzgloal 
•odety  of,  614 


ooa^vw,    ■>B««vwaB»j^  Of*  514 

flinncology,  historical  iketch  of, 

261 
Baalth.  Tecognltlon  of  the  servicea 

of  'a  lonl  medioal  officer  of, 

S86 
Hoapital  caie,  Lelth,  70, 124, 806 
Hdmltal,     Xdinbnrgh    infectlouB 

^aaeaaea,614 
Howes,  iiMualtary,  178 
lnfeetioiH  diaeaaea,  Glasgow  latest 

hoapttal  for,  468 
IblfaiDary,  Are  at  the  Sdinbiirgh 

H^Ul 


iBflrmaxy,  Sdiabun^,  70,  261 
KeiTin,  lord,  JubUeeof,  178 
Kirkoddy,  typhoid  fever  at,  614 
Lslth  hoapttal,  228 
Locda.  pobUc  health  bill  in  the, 


Lothian  aanitaiy 


261 


ler. 


,881 
of  a, 


lanacy  commissioner,  the  deputy, 

409 
Maigaret  college,  quesn,  177, 807 
M.D..  Bcottiah  nniverslty,  200 
Meat,  poisoning  from  presenred, 

6a 
Medical  sodely.  royal,  70 
Medial    man,     seriooa    chaige 

agalDsta,  881 
Medlco-jsychological  aaudatlon, 

807 
Militaiy  aathofitles,  claim  agahist 

the,  468 
Mtt£2,  Mi*,,  death  of,  468 
Mitchell,  Sir  Arthur,  praaentatlon 

to,  128 
Mori8onlectaxe,the.261 
VotUloatlon  act,  naefnl  extension 

of  the,S88 
HoCiflcatloB  difficoltlea,  70 
Qftoen,  poor-law  medioal,  161 
Of  erarowding,  276 
Oyitecs,  stin  about  the,  04 
faisley  tsflnnary,  806 
Piisley,  Maitary  oondition  of,  876 
Pexth  mflnaary,  178 
Poisoned,  muie  accidentally,  48 
Pioblem,  filasgow  hospital,  614 
(loaeki,  dab  praotice  aod,  640 
Seetonhip  of  Glasgow  nniversity, 

lend.  88  j 
Bsoedy,  a  draatle,  277 
lepott,  ldinbnx|m  annnal,  70 
Bh^oviien,  medical  foes  and,  04 
Snan-poK  hospital,  destmction  of 

tte  IdtaibQigh.  21 
Smart,  Mr.  T.  a,  the  late,  680 
floeisty,  tlM  royal,  806 
8t  Aadrsw's  unlTenity,  nnlnn  of 
Dondee  with,  860, 666 
idy,ltthyearof,261 
Btadsttta,  nwdylam  of  medical, 

4S6 
au|aoDslil&  police,  277 
MMNDloda,900 
ly9boid^o^breakof,222,886 
Wood,  Dr.,  the  late,  462 
Woaen's  medical  school,  70 
WfloiflB,  medical  edncatlon  of,  228 
Women  stodenta,  860 


8eisan,tfas 


of    a 


8«e,BE.Q.,death>f,641 


"Belaodon,"the,670 

'8eptic»mia,  11 

Serom,  alleged  death  from  anti- 

dlphtheriUo,  406 
Bemrn,  aoti-dipbtberttic,  840 
Semm,  artiflcia],  80, 188. 520 
Semm,  coral  Ire,  840,  851,467 
Berom,  preparation  of  antitoxic, 

884 
Serum,  sale  of  diphtheria,  12 
Seram;   the  alleged  death  from 

antitoxin,  648 
Seram  troatment,  the  antl-dipb- 

theritic,  381 
Serrloe.  army  medioal,  unpopn- 

larity  of,  248 
Sex,  mistaken,  176 
Sheffield,  health  officer  of.  196 
Shelter  case,  the  salvation  army, 

67 
Sibley,  Dr.,  rheomatoid  arthritis 

treated  by  the  hot-air  method, 
607 
Sldmouth,  sanitary,  88S 
Simplex,  appendicitis,  360 
Simpson,    Dr.,   cases   In  private 

practice,  624 
Bkampa,  Dr.,  death  of,  61 
ekln-graftlng,  a  new  material  for, 

SI 


oM^wln,  Dr.,  death  of.  862 
Small-pox  hospital,  Doming  of  a, 

140 
Small-pox,  eczema  mistaken  for, 

688 
Small-pox,  vaccination  and,  641 


SOCIKTIES. 


AOADEMT  OF  MKDIOIHI— 
Aiiaatomotis,  intestinal,  8 
Brain-lesion,  localising,  847 
CatTOt-tntnres,   reoent  method 

of  preparing,  666 
Chorea,  tetal  case  of,  166 
Dysentery,  outbreak  of  acute, 

478 
Sclampsia,  268 
Bmbousm,  pnlmonary,  666 
Gall-bladder,  cancer  of,  110 
Gout,  defective  metabolism  in 

relation  to,  472 
Hernia,  inguinal,  440 
Hip- joints  tuberculous  disease  of, 

187 
Insane,  criminal  req^nsiblllty 

of  the,  BTI 
Kidneys,  malignant  tumour  ol 

600 
Kidneys,  topographical  anatomy 

of  the  pancreas,  duodenum, 

spleen,  and,  811 
iMTynXf  excision  of  haU  of  the, 

8 
Larynx,  excision  of,  187 
Leprosy,  847 
Lencocytiuemia,  664 
Liver,  oanoer  of  the,  109 
Kose,    Indian    operation     for 

restoration  of  the,  440 
Omithorhynchus,  211 
Ovarv,  suppuration  In  an,  800 
Ovariotomy,  67 
Ovariotomy,  notes  on,  680 
Paraplegia,  878 
Pericarditis,  suppurative,' 664 
Pneumogastric  nerve,  211' 
Pregnancy,  n^tursd  tubal,  800 
Bash,  enteric,  106 
Sarcoma,  mtra-ooular,  600 
Spasms,  chronic,  878 
Sideen,  rotated,  67 
Splenica,  leuchinnia,  100 
Statistics,  criminal,  208 
Syringomyelia,  81 
Trachea,  stenosis  ot  422 
Throat  disease,  unconmion  sym- 
ptoms in,  80 
Tumour,  ovarian.  66, 262 
Water  supplies  in  Irdand,  vil- 
lage, 678 
Water,  testing,  422 
AvJUxmexibTs,  sooiitt  of— 
Sther.    precise    and    sdentiflo 

method  of  administering,  38 
Balhbolooioal  ahd  Olimatolo- 

GIGAL  SOcIBTT,  BKITIBH— 
Gout,  articular,  476 
Bradvokd  Midioo-Chibueoical 

SOOMTT— 

CUmcal  evening,  848 
XrythematoeuSk  204 


Hlp-jofait  disease,  204 

CLIHIOAL  SOOnTT  on  LOHDOH— 
Acromegaly,  447 
Addison^s  disease.  66 
Aneurism,  orbital,  100 
Articulations,  ankylosis  of  both 

temporo-maxlllary,  107 
Atrophy,  muscular,  104,  286 
Deformans,  osteitis,  286 
Bone,  fracture  of  the  neck  of  the 

femui*  from  dry  oaries  of  the, 

600 
Breast,  cancer  of,  187 
Boy,  malingering  in  a,  406 
Chlorosis,   thrombosis    of    the 

cerebral  veins  and  sinuses  in, 

66 
Colon,  chronic  dilatation  of  the, 

662 
Cranium,  acute  swellings  over 

the,  446 
Cjst,  cranial,  807 
C^t,  neoplasm,  291 
Deformans,  arthritis,  108 
Dislocation,  congenital,  286 
Duodenum,  perforating   ulcers 

of,  844 
Bilusion,   serous  expectoration 

after  paracentesis  for  serous, 

888 
Bntereotomy,  cases  of,  843 
Facial  paralysis,  double,  286 
Femur,  sarcoma  of,  662 
Fibula ,  excision  of,  446 
Forearm,  contraction  of,  286 
Forearm,  enlargement  of,  287 
Bystero-epilepsy,  108 
Hyperpyrexia,     typhoid     fever 
^tii;651 
Laryngectomy,  three  oases  of, 

408 
Lipomata,  287 

Liver,  abscess  of  the,  807  ! 

Neck,  removal  of  a  secondary' 

epithellomatous  tumour  from 

the,  400 
Necrosis,  sypfailltio  cranial,  807 
Neuritis,  infective,  446 
Nerve,  tumour  of  median,  287 
Palsy,  hypertrophic,  100 
Pseudo-rickets,  447 
Kidney,  movable,  64 
Pleurisy,  188 

Bibs,  deficiency  of  lower,  446 
Scrotum,  lymph,  201 
Skin-ftraftlog,  106 
Speech,  curious  defect  of,  446 
Splenectomy,  187 
Strophanthns,  601 
Tendons,  suture  of  ^  887 
Tibia,  dellcieot  development  of, 

446 
Tibia,  epiphysis  of,  100 
Tumour,  sacro-coccygeal,  447 
Vaccination,  accidental,  286 
Varolii,   hsemorrhage  into  the 

pons,  202 
Vesicae,  eotopion,  28i5 
Dbbmatolooioal     Socutt     or 

Grxat    Beitaui   and   Iki- 

LAHD— 

Fungoides,  mycosis,  180 

lEllINBUBGH  MHDIOO-CHDlUBaxaAL 

SociaTT— 

Arteries,  calcareous  degenera- 
tion of  the  heart  and,  166 

Cancer,  Inoperable  cases  of,  666 

Demonstrations,  656 

Dietetics,  the  role  of  oarbohy- 
dratea  m,  681 

Fats,  action  of  the  liver  on,  81 

Hepatic  abscess,  sarcoma  of  the 
liver  with  simulated,  681         , 

Influenza,  166  ' 

Lead-polsonlng,  266 

MelUtus,dUbetes,264 

Neonatorum,  ophthalmia,  264 

Fancress.  cyst  of  the,  0 

Peritonitis  chronic,  268 

Spedmen,  80 

Xeroderma,  pigmentosa,  0 
Gthjboologioal    Booutt, 

BUXIBH— 

Advertising,  70 

Allan,  the  bridge  of,  600 

Carcinoma,  uterine,  210 

Gestation,  unruptured  tubal,  676 

Hysterectomy,  vaginal,  817 

Omentum,  multilooular  cyst  of 
great,  676 

Ovary,  cyst  of  the,  210 

Practitioners,  exclusion  of  ho- 
moeopathic, 70 

Specimens,  8u,  210 

uterus,  carcinoma  of  the,  576 


trteniB,  veotro-auspeDtfon    of 

the,  817,  447 
Habvsah  Soamr  of  Lovdoh— 
Address,  presidential,  82 
Acromegaly,  810 
Cseruleus,  morbus,  810 
Children,  syphilis  In,  603 
Cretinism.  698 
Ear,  middle,   chronic  non-snp- 

puratlve  catarrh,  474 
Heart  disease,  Sohott  treatment 

of,  845 
Heml-aottsthesla,  600 
Leprosy,  anasthetie,  810 
Parotid  gland,  sweliiog  of  the, 

473 
Pneumonia.  887 
Psf  chrosBSthesIa,  608 
Therapeutics,  mental.  628 
Vitiligo,  case  of  so-called,  608 
Huntbbian  Sooirt^ 
Arthritis,  rheumatoid,  82 
Ataxy,  locomotor,  602 
Cases,  112,  320 
cilDical  cases,  847 
Diphtheria,  laryngeal  affections 

and  their  relation  to,  81 
PerityphUtU.  424 
Lartbgoloqioal  and  RHnroLoai* 

OAL  ABSOOIATIOH  > 
Apoplexy,  cochlea,  112 
Attic,  disease  of  the,  477 
Cases,  111 

Nasal  obstruction,  chronio,  112 
Throat,  disease  of  the.  111 
Labtbooloqical     Sooianr     of 

LON]X>N— 

Cases,  11, 188,  848 

Ciy,  unoontrollable  laryngeal, 

656 
Larynx,  destrucion  of,  656 ;  thy- 

rotomy   of  the,   665;  healed 

tuberculous  disease  of  the,  656 
Paralysis,  abductor,  656 
Passages,  foreign  bodies  in  the 

food,  289,  474 
Typhoid  fever,  laryngeal  oompli- 

oation  in,  %69 
LlYBBPOOL  MBDIOAL  SOOIBTT— 

Bifida,  two  cases  of  spina,  60S 
Cancer,  180 

Bffusions,  thoracic,  180 
GaU-stones,  180 
Hiematocele,  167 
Hernia,  strangulated.  167 
Leucocythamia,  111 
Mid  wives  question,  440 
Nose,  diseases  of  the,  881 
Nose,  rodent  uloer  of  the.  820 
Opacities,  treatment  of,  oy  elec- 
trolysis, 821 
Photography,  the  new,  180 
Bickets,  recrudescent,  167 
Sanitary  point  of   view,   a  re- 
sponsibiilty  to    the    lylog-in 
patient  from  a,  10 
Spinal  localisation,  10 
Throat  cases,  0 

Uterus,  penetration  of  gravid. 
440  ^ 

Obsibtbigal  Sooiitt— 
Address,  presidential,  165 
Colpotoroy.  anterior,  620 
Cyst,  double  bubo-ovarian,  164 
Fihroid,  uterine,  200 
Foetus,  curious  appearance  In  a. 
261  ^ 

Gestation,  ruptured  tubal,  168 
Hydronephrosis,  261 
Hysterectomy,  abdominal,  164, 

Lactation,  effects  of,  80 

Mallgnum,  dedduoma,  872,  627 

Osteomalacia,  20 

Ovary  removed  during  pros- 
nancy.  260  '  ^ 

Ovary,  fibroma  of  the.  628 

Pregnancy,  impacted  dermoid 
cyst  removed  during  ninth 
month  of,  620 

Uteri,  carcinoma,  260 
Ophthalmolooioal   Sooikft  of 

GBXaT  BBnADI— 

Amblyopia,  reflex  reonrring.  818 
Atrophy,  optic,  186 
Choroid,  leucosarooma  of,  168 
Drainage,  detachment  oi  retina 

healed  by,  664 
Eyelids,  lymphangiaectasls  of, 

664 
Iris,  uveal  cyst  of,  186 
Gout,  cataract  extraction  and, 

Mother  and  three  children,  optio 
nerve  disease  In  a,  668 


Snppi«m0Dtto 
TiM  Had.cal  Pnm  and  Oboata& 


INDEX. 


JqneMth,  18061 


Nenritii,  spmloiii  optie,    668; 

double  optic,  663 
Norvet,  paralytlB  of  ocnUr,  818 
KyaUgmns,  aequired,  668 
Ophthalmia,  reoorery  ftomaym- 

pathetlo,  568 
Orbit,  hemorrhage  into  the,  664 ; 

qnt  of  the,  668 
Paralyaia,  onendded  aixth  nenre, 

664 
Befraottye  error,  limul  eflecta 

of.  186 
Betina,  ruptnrea  In  detached, 

668 
ORTH0PJD)I0   BOOISTT,  BBIZXSH— 

Annual  meeting,  88 
BHIFmLD    liJEDIOO^HIBVBOiaAL 
SOCUTT^ 

Gaaea,  188. 240 

Cholangltu,  suppuratiTe,  424 

Cortex,  changea  in  the  cerebral, 
424 

K^e  caaea,  294 

Nystagmna,  424 

Onjchatroptria,  congenital,  899 

Bajnaud's  diaeace,  240 

Tomonr,  solid  ovarian,  460 

Urine,  retention  of,  189 

Y#ntfio"**,  190 
SOUTH.  WaBI    LOHDOH    HXOIOAL 
800DETT— 

Unionism,  profetalonal,  69 
Wist  Kut  Mjedioo-Cbirusoioal 

SOOUBTT— 

Addreaa,  annual,  666 
Joints,  pathology  of  diaeaaea  of. 
460 

WISTLONIMH   MlDIOO-CHIEVBai' 

OAL  SOOUTT— 
Artery,  anenriam  of  the  doraalis 

pedis,  681 
Arthritia.  osteo,  681 
Bicycle  riding,  deformity  of  chest 

produced  by,  «8l 
Cheek,  rodent  uloer  of,  681 
Comedones^  eztenstre  acne  with, 

681 
Clinical  evening,  298 
Cysts,  ovarian,  428 
Enteroc(ditia,68 
Gonorrhceal  inflammatloD,  68 
Hare-lip,  double,  681 
Lip,  chronic  ulceration  of  the, 

6S1 
Obetruction,  nasal,  601 
Scnrvy,  infantile,  428 
Ulcer,  rodent,  681 
Whooping-cough,  601 


Societies,  medical  aid,  468 
Bore  throat,  infectious,  626 
Spain,  medical  practice  in,  867 
^asm,  histrionic,  872 
Bpftth,  Dr..  death  of,  617 
Specialist,  notorious  hernia,  227 
Spectacles,  board-achool  children 

and,  219 
Spinal  accessory,  paralysis  of  ibe, 

680 
Spines,  children's,  Mr.  E.  Owen, 

77 
Stage,  modem  medicine  on  the, 

42 
SUtiatics,  vaccination,  418 
btatiatica,  vital,  28,  166,  179,  20.), 

418,  491,  648,  646 
Stenosis,  laryngeal,  851 
Stephenaon,   Mr,  S.,    epiackritia 

periodica  lugax,  288 
Strain,  the  breaking,  633 
Strain,  the  breaking,  Dr.  Allchin, 

619 


(Stocks,  Dr.,  the  charge  against, 
404 

Stomach,  catheterising  of  the,  297 

Stower's  lime  juice,  671 

St.  Thomas's  hospital,  286,  688 

Stuart,  Mr.,  death  of,  667 

Students.  London  medical,  608 

Sued,  401 

Sulphonal  t  what  is  the  dose  of,  889 

Sunday,  Dublin  hospital,  220 

Sunday  fund,  metropolitan.  645  ; 
charity  organisation  society 
and  the,  666 

Superannuation,poor-law  medic  al, 
270 

Surge/y,  abdominal.  Dr.  B.  Mori- 
son,  891.  417,  647 

Surgery,  abdominal,  678 

Surgery,  hot  water  in.  Dr.  Beclns, 
162 

Surgery,  Pompelan,  67 

Surgery,  public  school,  87 

Surgery, "  the  first  female  master  " 
in,  92 

Surgeons,  annnal  election  at  the 
royal  college  of,  612 

Surgeon^  holidays  for  hospital 
physicians  and,  369 

Surgical  congress,  26th  German, 
«8i 

Swan,  Mr.  B.  L.,  tuberculous  hip- 
Joint  (iUustrated),  15, 18L,  281, 

Sweetman,  deputy-inspector-genl., 

death  of,  690 
Symblepharon,  case  of,  697 
Synophthalmia,  congenital,  190 
bymea.  Dr.,  scarlet  fever  in  the 

puerperal  state,  662 
Syphilis,  extra-genital,  14 
Syphilis  from  an  Insurance  point 

of  view,  249 
SyphUis,  origin  of,  669, 680 
Syphilis,  piognoais  in.  Dr.  Shaw 

MacKende,  415,  448 
Syphilis,  tabes  doraalis  and.  686 
System,  early  syphilitic  disease  of 

the  nervous,  11 


Tabloids,  a  freah  batch  of,  488 
Tactics,  antivacdnatlonlrt,  460 
Tamer,  death  of  a,  41 
Telephone,tranmatic  hysteria  from 

use  of  the,  271 
Temperance  associatUm,  British, 

Terrier,  M.,  hospital  tuberculosis, 

187 
Terrol,127 
Tett,   bacteriological    diphtheria, 

110 
Theatre-goers,  death  trapa  for,  806 
Theobromine,  112 
Therapeusis?  what  is,  878 
Therapeutics,  mental,    Dr.  Bcho- 

fleld,  628 
Therapeutica,  glanduUr,  62 
Thigh,  sponumeous    fracture  of 

the,  682 
Thomson,  Mr., cancer  of  the  breast, 

696 
Thudichum,  Dr.,  treatment  of  dia- 
betes, 421 
Thyroid,  Iodine  in  the,  297 
Thyroid  medication.  667 
Thyroid  preparation,  529 
"  Times,^  '*  I  he  Medical  Press  and 

Circular,"  and  the,  222 


Tongue,    excision    of    the,    Dr. 

O'Conor,  896 
Tongue,  hicoough  cured  by  rthy* 

mical  traction  of  the,  286 
Tonsurans,  trichophyton,  604 
Torture-mongers.  488 
Tonsil,  tumour  of  the,  142 
Towelettet,  sanitary,  164 
Trachoma,  216 
Ttansvaal  government  and  foreign 

medloal  practitioners,  461 
Tuberculin.  266 
Tnbereulosis,  167 
Tuberculosis,  hospital,  M.  Terrier, 

187 
Tuberculoela,     hydrotherapeutics 

and,  860 
Tubercolosia  in  Oermany,  218 
Tuberculous  Individuals,  sperma 

and  sexual  glands  in,  218 
TuberculoeiR,  local,  682 
Tumour,  cerebellar,  Dr.  Hall,  497 
Tumour,  cerebral.  6' 7 
Tumonrs,     extirpation     of,     Dr. 

Wiggin,  470 
Tumour,  ovarian,  290 
Tumour,  psra-uterine  and  para- 
vaginal, Ur.  Edge,  79 
T^ne  port  sanitary  authority  and 

Dr.  Armstrong,  245 
I^hold  bacillus,  114 
^phoid,  diagnosis  of,  681 
iTphold,  immunity  against  cholera 

and,  503 


Unvaodnated,  the.  806 
University     reconstruction,     the 

London,  689 
Urethral  troubles,  blcyde-rlding 

and,  260 
Urine,  hydrogen  sulphides  in  the, 

221 
Urine,  test  for  albumen  In,  169 
Uteri,  exdsion  of  the  cervix.  Dr. 

O^Conor,  676 
Uterus,  cancer  of  the,  462 
Uterus,  extirpation  of  the,  12 
Uterus,  large  flbro-myoma  of.  Dr. 

OUver,  696 
Uterus,  ventro-Hxation  or  ventro- 

suspension  of,  Mr.  M.  Bobaon, 

818 


Vacandes— end  cf  each  No. 

Vacdnation,  Glouoester  board  of 
guardians  and,  272 ;  Islington 
board  of  guardians  and,  66S 

Vacdnation,  the^ouae  of  commons 
and.  640, 641 

Vagino-flxation,  Dr.  Wiggin,  106 

Vaginalis,  infantUe.  88 

Vara,  ooxa,  580 

Vaao-motors,  the  heart  and  667 

Vegetans  psorospermosis,  cutan- 
eous, 148 

Vena  cava,  ocdusion  of,  606 

Venom,  immunisation  against 
serpent's,  829 

Veterinary  college,  489 

Ventnor,  national  hospital  for 
consumption,  202 


Vestibule,  destruction  of  the  mem- 
branoua.  Dr.  Gamault,  6 

VUvi  treatment,  90 

Victoria  hospital— course  of  leO' 
tares,  617 

Vienna,  a  sensational  ease  in,  261 

Vivisection,  41 

Volunteer  medical  orRaalsation, 
126 

Vomiting,  powders  for  oerebnl,  18 

Vulva,  craurosis,  860 


W 


Wade,  Sir  W.,  127 
War  hoapltals,  emergency,  1S2 
War,  mutilation  of  soldiers  in,  484 
Warning,  a  public,  881 
Water,  baotwia  in  aerated,  306 
Water  oompanlea,  the  .metropoli- 
tan, 301 
Water-gaa,  828 
Water,  pocket  soda,  612 
Water,  sterilised  town,  888 
West  London  hoepltal,  686 
West  London  medico-diiruqilesl 

society,  617 
Wiggin,  Dr.,  extirpation  of  to- 
moura,  470 ;  penoratlon  Id  ea- 
teric  fever,  6 ;  vagino-flxstioB, 
106;  Inteatinia  anastomcsii 
(illustrated).  647 
Wmiams,  Sir  J.,  and  the  question 

of  privilege,  684 
Women,  acute  gonorrhosa  in,  84 
Women,  Cambridge  degrees  tod, 

172 

Women,  Chelsea  hospital  for,  686 

Women,  errors  of    refraction  in 

neurasthenic,  Dr.  MacNaugh- 

ton-Jones.  811 

Women,  medical  attendance  on 

Indian  high  caste,  828 
Women  medical  ofllcen,  889 
Woods,  Dr.,  restoration  of  nose 
destroyed    by    lupus   QOm- 
trated),660 
Workhouse  children,  teeth  of,  606 
Woridiouse  reform,  607 
Workhouses,  lunacy  in,  664 
Wounds,  gunshot,  484 
Wounds,  stitching  of,  427 
Wound,  the  modem  gunahot,  407 


Xanthoma,  190 

Xeroderma,  pigmentoaa.  9 

"  X  "  rays,  further  marvds  of  the. 


Teasts,  pathogenic,  830 
Younc  cigarette  smoking 
the,  431 


Zephyron,  the,  618 


Ut  ^ti 


^ 


•v^ 


mi  (^vmht 


"SALUS 


SUPREMA    LEX." 


voiwCxn. 


WEDNESDAY,    JANUARY    1,     1896. 


No.  1. 


ON 

THE   DIAGNOSIS   OF  INSANITY. 

By  THEO.  B.  HYSLOP,  M.D., 

Lecturer  on  If ental  DiBcaies  to  St.  Mary's  Hospital  Medfoal  School, 
Aasiitaiit  Physician  to  Bethlsm  Sojal  Bospital. 

In  tiieae  lectarea  I  propose  to  deal  with  some  of  the 
practical  and  controTemial  aspects  of  insanity,  and  to 
submit  for  consideration  some  hints  as  to  the  method 
of  approaching,  with  a  certain  degree  of  confidence, 
those  who  are  alleged  to  be  insane.  Attention  to 
these  hints  will  save  much  trouble,  not  only  in  your 
examination  and  diagnosis  of  the  nature  of  the  mental 
malady,  but  also  in  your  subsequent  experiences  should 
they  ever  extend  to  the  law  courts.  My  purpose, 
therefore,  is  to  point  out  some  of  the  dani^ers  and 
difficulties  which  stand  in  your  way  in  dealing  with 
insane  patients. 

The  first  point  of  importance  is  that  you  should, 
before  seeing  the  patient,  obtain  all  the  details  of  the 
case  from  the  friends.  Sometimes  this  is  no  easy  task. 
The  relatives  of  insane  patients  are  only  too  fond  of 
dia^pusing,  or  of  entirely  withholding,  the  history  of 
an  insane  inheritance.  I  have  often  been  told  in  most 
emphatic  terms  that  such  a  thing  as  insanity  has  never 
been  known  in  the  family  ;  whereas,  on  investigation, 
the  whole  family  for  generations  nad  suffered  from 
some  form  of  neurosis.  The  friends  are  also  fond  of 
attributing  the  illness  of  the  patient  to  some  fall, 
shock,  overwork,  religious  meeting,  or  other  cause 
which  no  one  neea  be  ashamed  of,  rather  than  admit 
the  existence  of  a  family  taint  or  predisposition.  The 
parents  of  idiots  are  especially  prone  to  assign  as  the 
causes  of  their  children's  defects,  some  accidental  cir- 
cumstances which  in  reality  have  little  or  no  value  as 
factors. 

Another  difficulty  with  which  one  has  to  contend  is, 
the  informants  themselves  may  be  eccentric  or  even 
insane.  One  lady  who  applied  for  the  admission  of 
her  sister  to  Bethlem,  gave  a  connected  and  detailed 
account  of  her  sisters  delusions,  moral  perversions, 
and  tendencies  to  impulsive  violence.  Subsequently, 
however,  I  was  told  that  the  informant  herself  was  the 
victim  of  delusions  as  to  her  sister,  and,  moreover,  she 
was  actually  under  certificates  at  the  time  she  made 
the  application,  the  sister  being  perfectly  sound.  On 
another  occasion  a  lady  describea  very  graphically  the 
sufferings  of  a  friend,  who  eventually  turned  out  to  be 
the  lady  herself. 

These  few  notes  of  warning  as  to  the  relatives  of 
insane  persons  ought  to  be  borne  in  mind,  and  it  is 
well  to  suspend  all  judgment  until  you  bave  inter- 
viewed the  patient,  i.e.,  wait  until  you  bave  fully 
inquired  into  both  sides  of  the  question.  Over  and 
over  again,  patients  tell  us  that  their  friends  are 
insane,  and,  curiously  enough,  the  friends  also  not 
infrequently  sseert  that  the  obvious  lunatic  is  as  sane 
as  anyone.  Quite  recently  one  of  our  patients  escaped 
on  account  of  the  stupidity  of  the  police.  Being 
allowed  out  on  leave  with  an  attendant  m  plain  clothes 
he  feave  the  attendant  in  charge  as  a  wandering 
lunatia 


One  word  more  as  to  the  informants.  They  may  be 
aiding  a  malingerer.  On  one  occasion  a  patient  was 
brought  into  our  reception  room  without  the  usual 
admission  papers.  The  friends  were  very  mysterious, 
and  appeared  to  be  unduly  anxious  to  impress  me 
with  the  fact  that  the  patient  was  suffering  from  the 
delusion  that  he  had  been  poisoned.  On  interviewing 
the  patieiit,  the  most  noticeable  feature  was  a  constant 
attempt  at  restlessness.  Thef orced  expression  of  the  face, 
and  the  evident  desire  to  impress  me  with  his  insanity, 
were  noteworthy.  The  friends  had  followed  me  into 
the  room,  and  hastened  to  explain  the  nature  of  the 
symptoms.  After  obtaining  silence  I  said  to  the 
patient.  **  What  is  the  matter  with  you  V  He  made 
no  reply,  but  redoubled  his  exertions,  so  I  said, 
"  Unless  you  can  tell  me  what  is  the  matter  I  must 
ask  you  to  go  elsewhere.''  He  looked  rather  foolish  at 
this,  and  ventured  to  glance  at  his  friends  for  some 
advice  on  the  matter.  After  a  few  moments  of  painful 
and  perplexed  silence,  during  which  all  the  vcluntarj/ 
facial  contortions  had  ceased,  he  stated  that  he  had 
Deen  poisoned.  "By  whom?"  I  asked.  **By  my 
enemies/'  he  replied.  "Who  are  your  enemies?"  I 
continued.  "  That's  my  business,"  he  replied.  **  How 
do  you  know  they  poisoned  you?"  I  asked.  "Oh," 
he  replied,  "  I  saw  them  put  it  into  my  beer."  "  And 
yet  you  drank  the  beer  all  the  same,"  I  ventured  to 
remark.  At  this  the  would-be  patient,  contrary  to  the 
usual  custom  of  the  insane,  perceived  the  folly  of  his 
ways  and  lost  his  temper.  After  submitting  to  severe 
abuse  from  both  friends  and  patient,  and  threats  to 
make  the  matter  public  by  means  of  the  press,  I 
suggested  that  since  he  had  seen  the  poison  put  into 
the  beer,  and  had  voluntarily  drank  it,  the  best  thing 
he  could  do  would  be  to  go  to  St.  Thomas's  Hospital 
and  get  an  emetic.  Subsequently,  I  found  that  the 
would-be  patient  had  endeavoured  to  avoid  being 
summoned  as  a  witness  in  an  important  matter  then 
enga^ng  the  attention  of  the  country. 

This  instance  is  of  importance,  and  I  may  point  out 
that  insane  patients  do  not  argue  in  this  way.  Delu- 
sions as  to  poison  are  usually  the  result  of  many 
factors.  Dyspepsia,  or  discomfort  after  food,  is  apt  to 
be  misinterpreted  by  the  insane  mind,  and  as  a  conse- 
quence some  cause  for  the  unpleasant  sensations  is 
sought,  and  poison  is  naturally  suggested.  The 
patient  usually  arrives  at  his  fallacious  conclnsion  from 
his  own  feelings,  and  it  is  not  common  to  have  such 
direct  evidence  brought  forward.  Moreover,  tbe 
absurdity  of  the  idea  of  a  man  voluntarUy  drinking  a 
fluid  containing  poison  was  evident  even  to  the 
patient  himself. 

To  enter  at  length  upon  the  question  of  feigned 
insanity  would  occupy  too  much  of  the  time  at  my 
disposal  Ever  since  David  "  changed  his  behaviour 
and  feigned  himself  mad,  and  scraboled  on  the  doors 
of  tbe  gate,  and  let  tbe  spittle  fall  down  upon  bis 
beard/'  there  have  arisen  keen  controversies  as  to 
whether  aT>parent  insanity  in  real  or  assumed.  The 
presence  of  a  motive,  tbe  bistoiy  of  tbe  onset  of  tbe 
symptoms,  and  tbe  inconsistency  in  tbe  patient's  con- 
duct and  statements,  are  tbe  main  points  for  ]^onr 
guidance.  Sometimes  absolute  silence  is  maintaiocd 
by  tbe  patient.  Blandford  says,  *' Comparing  a  true 
with  a  feigned  cf  se.  I  may  say  generally,  that  a  real 


2     The  Medical  Prkss. 


ORIGINAL  COMMUNICATIOXS. 


Jak.  1,  1896. 


luDatic,  Tvhen  approached  byaatranger,  appears  at  first 
rather  better  than  worse,  and  more  on  his  guard ;  he 
tries  to  brio^;  his  wits  together  and  understand  what  is 
going  on.  But  a  sham  lunatic  when  we  go  to  him  re- 
doumes  his  efforts  to  seem  insane  ;  he  is  more  energeti- 
cally noisy,  idiotic,  and  maniacal.  Sham  lunatics 
over  act  or  under  act  their  parts,  and  frequently  declare 
themselves  to  be  insane." 

Epilepsy  has  been  simulated,  especially,  by  profes- 
sional mendicants.  The  traditional  use  ot  a  i>iece  of 
soap  to  produce  foaming  at  the  mouth  is  of  interest 
One  person,  reported  to  have  fits,  when  first  aid  was 
rendered,  and  tne  collar  loosened,  was  found  to  have 
on  his  chest  a  placard  stating,  '*  Brandy  always  cures 
me." 

Delusions  are  not  uncommonly  simulated,  but  it 
must  also  be  remembered  that  the  prolonged  assump- 
tion of  a  delusion  will  sometimes  end  in  actual  insanity. 
This  may  come  about  in  two  ways.  The  malingerer 
may  become  exhausted  through  constant  anxiety  and 
forced  attention  to  the  role  he  assumes,  or  the  constant 
repetition  of  his  tale  may  result  in  a  belief  in  its  actual 
reality.  Many  of  uo,  at  times,  imitate  the  mental 
aspect  of  the  famous  Bill  Adams,  who  fought  the  Battle 
of  Waterloo.  We  invent  a  ^arn  and  improve  upon  it 
so  often  that  ultimately  we  incorporate  it  as  a  part  of 
our  own  actual  experience.  I  do  not,  however,  propose 
to  push  this  argument  too  far. 

Should  I  desire  to  assume  the  role  of  a  certifiably 
insane  patient,  my  first  act  would  be  to  dissociate  my- 
self from  others.  I  would  allow  my  friends  to  discover 
for  themselves  some  eccentricity  of  conduct  or  some 
Ftrangeness  of  view,  together  witn  an  attitude  of  melan- 
choly and  despondency.  Having  raised  the  element  of 
expectant  attention  in  those  who  are  solicitous  as  to 
my  welfare,  the  remainder  would  be  easy.  If  I  simu- 
lated an  hallucination,  I  would  let  others  discover  it ; 
if  a  delusion,  I  would  be  consistent  about  it,  and  teach 
people  how  to  argue  in  a  circle,  and  in  spite  of  the 
evident  fallacy  in  my  reasoning,  always  return  to  the 
point  from  whence  I  started. 

Attention  to  these  matters  will  furnish  any  medical 
man  with  ample  material  for  certification  ;  but  the 
certificate  can  be  rendered  more  valid  by  some  hint  or 
attempt  to  commit  suicide.  In  asylum  practice,  the 
worst  cases  with  which  we  have  to  deal  are  those  in 
which  there  is  some  confession  as  to  suicide  or  homi- 
cide, and  the  element  of  risk  adds  to  our  desire  to 
retain  the  patient  under  proper  control. 

Criminals  not  uncommonly  plead  forgetfulness  of 
their  crime,  but  it  is  often  a  difficult  matter  to  decide. 
Many,  however,  have  been  hanged  in  spite  of  this  plea, 
and  from  a  practical  point  of  view,  it  is  far  from  being 
efficacious. 

Being  now  fully  aware  of  the  possibility  of  deception 
on  the  part  of  friends  and  patients  we  will  proceed  to 
the  examination  of  the  patient.  In  the  majority  of 
instances  it  is  advisable  that  you  should  be  introduced 
to  the  patient  as  a  medical  man.  Barely  is  it  neces- 
sary that  deception  need  be  resorted  to.  The  relatives 
are  only  too  apt  to  practice  deception  and  to  seek  to 
introduce  you  as  some  old  friend  of  one  of  the  family, 
or  as  a  man  come  to  see  about  a  dog,  or  some  such 
frivolous  pretext.  Any  system  of  deception  seldom 
effects  its  purpose,  and  the  patient  will  naturally 
resent  being  cross-questioned  by  a  remote  friend  of 
the  family  or  by  a  dog  fancier.  Moreover,  if  his  sus- 
picions be  aroused,  he  is  apt  to  refuse  to  submit  to 
any  examination  whatsoever.  It  is,  in  my  opinion, 
the  wiser  course  to  be  strictly  honest  with  all  insane 
patients.  You  can  effect  more  by  means  of  a  judicious 
consultation  than  by  any  other  method. 

I  have  been  much  impressed  by  the  methods  in 
which  various  members  of  the  legal  and  of  our  own 
profession  have  first  tackled  patients.  When  the 
present  Lunacy  Act  first  came  into  force  it  was  ordered 


that  either  a  magistrate,  judge  of  county  courts,  or 
justice  of  the  peace  specially  appointed  under  the 
Act,  should,  after  seeing  the  medical  certificates,  sign 
an  order  for  the  admission  of  a  patient  to  an  asylum. 

If  not  satisfied  with  the  certificate  these  legal  gentle- 
men had  the  right  to  personally  examine  the  alleged 
lunatic.  My  first  experience  of  one  of  these  inter- 
views was  highly  entertaining.  The  magistrate  began 
by  confessing  to  me  that  he  knew  nothing  about 
lunacy,  and  had  never  seen  a  lunatic  in  his  life.  He 
was  very  anxious  to  know  what  he  ought  to  do  in 
order  to  test  the  patient,  but  I  politely  remarked  that 
it  would  be  presumption  on  my  part  to  instruct  him  in 
his  own  business,  so  with  mi^ny  misgjivings  he  entered 
upon  his  task.  *'  Good  morning,"  said  the  magistrate. 
Tlie  lady  (who  was  remarkable  for  her  serenity  and 
capability  of  justly  estimating  men  and  matters) 
replied,  '*Good  morning.  Sir,  but  I  have  not  the 
pleasure  of  knowing  you. '  He  at  once  proceeded  to 
explain  who  he  was,  but  she  turned  to  me  and  said 
"perhaps  you  will  tell  me  this  gentleman's  name.*' 
I  did  so.  and  the  magistrate  proceeded.  *'  How  art 
you,  maaam  ? "  **  Very  well,  thank  you,"  she  replied, 
"How  are  you?"  " Oh,  Tm  all  right."  he  said.  "I 
shouldn't  have  thought  so,"  she  remarked,  "  you  look 
peculiar  about  the  eyes.  Are  you  a  male  patient  ? " 
'*  No  ! "  he  replied,  ** Tve  come  to  inquire  into  your 
state  of  mind."  "Look  to  yourself,'' she  said,  ^'and 
remember  that  I  may  excuse  mere  eccentricity,  but  I 
will  not  submit  to  impertinence."  With  that  the  magis- 
trate flushed  somewhat,  but  returned  to  the  charge. 
'*  Madam,  what  I  wish  to  know  is,  have  you  any 
delusions  ? "  At  this  she  rose  and  said,  "  Now  I  know 
jrou  are  neither  eccentric  nor  rude.  You  are  a  poor 
Ignorant  man  with  little  or  no  pretence  even  to  common 
sense.  Anyone  could  tell  you  that  if  I  had  any 
delusions,  and  knew  they  were  delusions,  thev  would 
no  longer  be  delusions.  Good  morning  to  you.^'  With 
that  the  interviews  terminated. 

I  trust  the  magistrate  has  benefited  by  his  experi- 
ence.  I  have  given  this  illustration  because  it  repre- 
sents a  position  in  which  you  all  may  find  yourselves 
unless  you  know  how  to  set  about  eliciting  facts.  A 
patient  should  never  perceive  that  you  are  searching 
for  mental  defects.  We  all  naturally  resent  being 
cross-questioned  as  to  our  innermost  thoughts  by  a 

gerfect  stranger.  Therefore  I  submit  that  you  ought 
rst  to  pla^  your  part  as  medical  men,  inquiring  into 
the  conditions  of  bodily  health,  digestion,  sleep,  &c., 
then  when  you  have  convinced  the  patient  that  vou 
really  sympathise  with  his  or  her  trouble,  the  road  is 
easy  to  find  out  the  mental  interpretations  of  the 
disordered  feelings. 

There  are  three  rules  for  the  examination  of  patients, 
and  unless  you  hold  them  ever  before  you,  you  will 
sooner  or  later  find  yourselves  in  the  law  courts  with 
possibly  the  stigma  of  negligence  attached  to  your 
action.    These  rules  are  as  follows  : — 

1.  Teat  the  Facts,  i.e.,  find  out  whether  the  state- 
ments of  the  patient  are  facts  or  not,  and  as  part  of 
this  rule,  you  must  decide  whether  the  api)arent 
mental  perversion  is  the  result  of  natural  causes.  In 
illustration  of  this  point  I  ma^  tell  you  some  of  my 
own  experiences.  One  patient  was  admitted  to 
Bethlem  under  a  medical  certificate  to  the  effect  that 
he  was  emotional,  restless,  crying  bitterlv,  and  that  he 
stated  that  during  the  last  week  he  had  lost  his  father, 
mother,  and  sister.  The  medical  man  had  actually 
neglected  to  test  the  statements.  As  a  matter  of  fact, 
the  statements  were  quite  correct,  and,  moreover,  the 
depression  was  but  the  natural  reaction  to  such  a  series 
of  losses.  A  man  may  suffer  greatly  at  the  lo^s  of  his 
relatives  or  become  excited  at  the  sudden  acquisition 
of  wealth.  Did  we  not  respond  in  some  measure  to 
ordinary  influences  our  mental  reactions  would  be 
defective. 


Jak«  1,  1896. 


OEIGINAL  COMMUNICATIONS. 


Thi  Midical  PitT»<«.     3 


A  wall-known  specialist  was  lately  consulted  about 
an  old  gentleman  who  was  apparently  morbidly 
emotionar  and  full  of  ideas  of  min.  The  patient 
declaimed  bitterly  that  he  was  mined,  and  that  ne  had 
not  a  penny  in  the  world.  His  wife  on  the  other 
hand  asanred  the  specialist  that  this  was  far  from  being 
the  caae.  **  Indeed,"  she  said  "  how  could  we  keep 
up  this  laige  house  and  live  as  we  do  if  we  had  not 
ami^  means  1 "  In  consideration  of  the  ample  means 
ana  tbe  age  of- the  patient  it  was  decided  to  iceep  him 
at  home  under  suitable  nursing  and  superyision.  The 
old  man  died  in  a  few  weeks  and  it  was  found  that  all 
lis  statements  were  correct.  He  had  been  living  on 
trust  money  and  his  mental  state  was  but  a  natural 
reaction  after  all. 

And  now,  gentlemen,  I  wish  to  speak  to  you  of  a 
caae  which  proved  a  v^  wholesome  lesson  to  me.  I 
admitted  to  Bethlem  a  male  patient  who  had  the 
foIk>wing  symptoms  of  insanity  :^The  patient  left  his 
home,  came  to  London,  went  to  a  tabemade,  offered 
up  a  prayer,  upon  the  sweetness  of  which  he  was  com- 
nfimented  oy  various  members  of  the  congregation, 
umiediately  went  to  the  Elephant  and  Castle,  spoke 
to  a  woman  of  ill-fame  and  married  her.  Stated  that 
his  laOier  was  in  the  habit  of  committing  unnatural 
offences,  that  he  would  set  the  Thames  on  fire,  and 
that  henad  had  communication  with  the  dead.  What 
with  the  patient's  excited  demeanour  and  attempts  to 
do  violence  to  all  (rf  us  I  did  not  hesitate  in  admitting 
him,  imd  more  emcially  upon  such  evidence  as  was 
given  in  the  certificates. 

When  the  excitement  had  somewhat  subnded,  how- 
ever, he  reasoned  as  foUows:— 

**  All  my  life  I  have  known  that  my  father  has  com- 
mitted unnatural  offences^  and  of  this  you  will  have 
evidence  from  the  authorities  at  Scotland  Yard.  At 
times  I  have  been  aware  of  sexual  instincto  in  myself. 
Knowing  that  no  decent  girl  would  marry  the  son  of 
such  a  father,  and  fearing  lest  I  should  give  way  to 
a  morlnd  impulse  which  was  ever  before  me  in  all  its 
horrors,  I  determined  that  of  two  evils  I  would  choose 
the  lesser,  and  it  was  with  this  deliberate  intention 
that  I  came  to  London,  went  to  the  Tabernacle  te 
make  my  peace  with  God.  Then  I  looked  for  the  most 
suitable  person,  and  (he  said  b^  way  of  an  aside)  I 
think  you  will  sgree  that  my  wife  is  everything  that 
could  oe  desired 

On  being  Questioned  as  to  his  state  of  excitement 
he  replied,  '^  Uow  would  you  like  to  be  shoved  into  a 
place  like  this  the  day  after  your  marriage.  Give  a 
man  credit  for  some  show  of  energy.''  Again  he  con- 
tinued, "^  What!  I  said  I  would  set  the  Thames  on 
fire,  did  1 1  WeU,  what  of  that  ?  Have  you  never  in 
your  conceit  thought  you  would  vet  the  Thames  on 
fire  f  Perhaps  you  think  I  intended  to  light  it  with  a 
mateh.  Ton  mu$i  be  a  fool  if  you  take  that  in  its 
literal  sense."  ^  But  what  about  the  communications 
with  the  dead!"  said  I.  ''My  good  sir,"  he  replied, 
'^if  you're  going  to  shut  up  everybodv  who  believes 
that,  what  about  all  the  members  of  my  faith  P  I 
have  been  tau^t  to  believe  that  all  my  life,  and  it  is 
no  more  than  your  own  lot  of  psychical  research 
people  believe.  How  about  them,  with  their  media, 
and  tdepathv,  and  all  that?  Why  don't  you  shut 
them  all  up?  ^' 

After  a  few  days  this  patient  was  allowed  to  resume 
his  honeymoon,  and  it  was  with  great  pleasure  that  I 
subsequently  heard  his  marriagenad  proved  far  from 
being  a  failure.    Although  the  episode  occurred  several 

{ears  ago,  uf)  to  the  present  time  the  loving  couple 
ave  maintained  a  good  stendard  of  moral  and  mental 
reHitude. 

The  second  point  to  which  I  would  draw  your  atten- 
tion is  the 

2.  Pre$mce  of  Hallucinations  or  Leltisions. — In 
order  to  elicit  the  presence  of  either  of  these  symptoms 


it  is  absolutely  necessary  that  you  should  proceed  io  a 
systematic  way. 

Just  as  you  would  first  discuss  the  customary  dif  t 
of  a  patient  suffering  from  some  abdominal  complaii  t, 
so  you  ouffht  to  discuss  the  mental  diet  provided  by 
the  special  senses  in  every  form  of  mental  disorder. 
The  special  senses  provide  the  mind  with  food  for 
reflection,  and  it  is  to  their  special  consideration  that  I 
now  propose  to  devote  attention. 

Unfortunately  it  is  a  common  experience  with  us  to 
have  the  whole  nature  of  a  case  misrepresented,  owirg 
to  neglect  of  the  examination  of  the  special  secees. 
Many  of  the  feeble  certificates  which  we  have  ,to  do 
are  owins  to  such  neglect.  Thus,  patiento  have  been 
described  as  preoccupied,  inattentive,  and  morose,  facts 
which  are  of  little  value  in  a  law  court,  when  a  ver^ 
little  care  might  have  elicited  the  presence  of  halluci- 
nations of  one  other  senses,  the  mere  presence  of  tbe 
hallucination  itself  giving  a  correct  clue  to  the  nature 
of  the  malady.  As  a  matter  of  routine,  I  usually  begin 
with  the  digestive  organs  and  inquire  about  the  furc- 
tions  of  the  whole  length  of  the  digestive  tract.  In 
many  cases  attention  to  this  point  will  provide  you 
with  a  true  estimate  of  the  case.  Thus  a  patient  may 
suffer  from  a  foul  taste  in  his  mouth,  difllculty  in 
swallowing,  pain  after  food,  feelings  of  fulness,  consti- 
pation, or  other  disorder.  Having  ascertained  these 
facts,  find  out  what  the  patient  thinks  of  them.  A  foul 
taste  may  be  the  clue  to  ideas  of  poison  and  delusions 
of  persecution.  Difficulty  in  swallowing  may  be  inter- 
preted as  due  to  the  presence  of  orgjanic  disease,  or 
there  may  be  some  otner  hypochondriacal  interpreta- 
tion. Pain  after  food  may  be  attributed  to  the 
presence  of  cancer,  snakes,  or  even  the  DevU.  Fulness 
of  the  abdomen  has  been  attributed  to  the  presence  of 
all  sorto  of  abnormal  influences,  whilst  constipation  has 
furniBhed  even  some  males  with  the  idea  that  they 


were  pregnant 
Attention  to    common  sensation  will  reveal 


the 


existence  of  tinglings,  twitehinffs,  numbness,  &c,,  and 
these  very  sensations  are  the  aue  to  delusions  as  to 
electricitv,  and  other  influences  thought  to  be  at  work. 
The  j[)ar8Jytic  who  says  he  is  in  the  habit  of  walkirg 
on  air  may  receive  the  impression  owing  to  ansestheda 
of  his  feet.  The  woman  who  accuses  those  around  her 
of  persecuting  her  b^  batteries  may  have  some  feeling 
of  pins  and  needles  in  her  limbs.  So  it  is  with  the 
sense  of  smell,  sight,  and  hearing.  Remember,  how- 
ever, it  is  with  the  interpretation  of  the  actual  sensa- 
tions that  you  have  to  do. 

In  connection  with  this  second  rule  I  feel  that  I 
must  tread  upon  ground  which  is  of  necessity  mainly 
controversial.  When  we  remember  that  our  senses  are 
very  defective  in  many  respects,  and  when  we  teke  into 
consideration  the  various  illusions  and  hallucinatioDs 
to  which  even  the  wisest  of  us  are  subject  we  must  be 
generous  and  open-minded  in  our  estimate  of  what  is 
abnormal  in  others.  Abnormal  conditions  of  percep- 
tion occur  in  the  sane,  in  intermediate  states  between 
sanit]^  and  insanity,  and  in  the  insane.  A  false  perceD- 
tion  is  technically  called  an  illusion,  and  it  must  be 
borne  in  mind  that  the  process  ib  often  largely  the  psme 
in  a  false  perception  as  in  a  true  one.  Some  authors 
would  seek  the  explanation  of  the  fallacy  in  an  illusion 
by  toking  into  account  the  action  of  the  senses  only, 
and  they  would  assume  the  mental  interpretation  r  f 
the  false  sensory  impression  to  be  the  abstract  result  of 
a  fallacy  of  the  senses. 

In  the  sane  person  there  is  a  constant  liability  to 
errors  of  ]>erception,  illusions  are  common  to  us  an. 
Our  discrimiLating  power  is  necessarily  limited  and 
d^ective.  Thus  the  study  of  sensory  perversiocs 
belong  both  to  the  psychologist  and  to  the  mental 
pathoTogiBt.  There  is  no  sudden  break  between  the 
illusions  of  the  pane  and  those  of  tbe  insane,  and  tbeie 
is  often  great  difficulty  in  distinguishing  between  them. 
Our  judgmente  are  liable  to  be  distorted  at  any  time, 


4     TnA  Medical  Press. 


OEIGINAL  COMMUNICATIONS. 


Jan.  1,  1896. 


and  our  f  enaorr  duciiminatioDB  may  be  at  variance. 
Any  emotional  oiBtarbance,  any  state  of  ezhaiution, 
inattention,  expectancy,  or  mental  preparednesB,  may 
favour  the  development  of  some  false  sensory  percep- 
tion. The  transition  from  sane  to  insane  perceptions 
is  often  difficult  to  demonstrate. 

In  the  intermediate  conditions,  half-way  conditions 
between  sanity  and  insanitv,  we  have  many  examples 
of  sensory  disturbances.  Tnos,  in  some  dream  states, 
night-mare,  religious  fanaticism,  and  many  excessive 
emotional  states,  we  have  perversions  which  are  sug- 

f;estive  of  a  neurosis  rather  than  true  nerve  health, 
n  hysterical  temperaments,  especially,  do  we  find 
illusory  morbid  conditions.  In  the  sane  the  illusory 
percepts  may  be  due  to  defective  knowledge ;  or  the 
illusory  nature  of  the  percepts  may  be  recognised  by 
the  individuals  in  whom  they  occur  as  the  results  of 
defective  energisation.  In  the  intermediate  states 
there  is  often  failure  to  recognise  the  true  nature  of 
the  illusory  phenomena  at  the  time  of  their  occurence, 
but  this  knowledge  may  be  gained  at  some  subsequent 
period. 

In  the  insane  there  is  not  only  a  failure  to  recognise 
the  true  nature  of  the  phenomena,  but  also  a  belief  in 
their  objective  reality,  and.  as  a  conseouence,  there  is 
a  tendency  on  the  part  of  tne  individual  in  whom  they 
occur  to  act  upon  the  false  evidence  presented  to  the 
mind  by  way  of  the  senses. 

In  order  to  fully  appreciate  the  influence  of  the 
various  senses  and  their  perversions  of  functions  in  the 
production  of  morbid  perceptual  processes,  we  ought 
to  devote  our  attention  more  pardcularlv  to  the  con- 
sideration of  the  special  senses  themselves  in  their 
morbid  objects.  Time,  however,  will  not  permit  this 
so  I  now  pass  to  the  consideration  of  actual  delusions. 

The  imperfection  of  judgments  formed  by  any  indi- 
vidual may  be  due  to 

1.  Imperfect  observation. 

2.  Defective  conditions  of  memory. 

3.  Imperfect  use  and  conception  of  words. 

4.  The  presence  of  emotional  disturbances. 

5.  Traditions,  t.e.,  attending  to  the  notiors  of  others. 

6.  Rapidity  of  formation. 

Judgments  may  be  correct  or  otherwise  in  respect 
of  their  mode  of  formation,  but,  if,  when  formed,  they 
are  persistent,  they  may  become  advantageous  or  the 
reverse.  Thus,  in  every  branch  of  science  and  litera- 
ture we  note  the  obstinacy  with  which  erroneous  judg- 
ments are  adhered  to,  and  the  obstacles  which  they 
thus  nresent  to  the  advance  of  knowledge*  A  distinc- 
tion has  been  made  between  instinctive  and  reasoned 
judgments.  Professor  James  says  a  savage  is  often  as 
tactful  and  astute  socially  as  a  trained  diplomatist. 
Women's  intuitions,  so  fine  in  the  sphere  of  social  or 

Sirsonal  relations,  are  seldom  good  at  mechanics, 
ost  boys  teach  themselves  how  a  clock  goes ;  few 
girls.  Whateley  says  woman  is  an  unreasoning 
animal,  and  pokes  the  fire  from  on  top. 

In  diseaeea  states,  the  delusions  of  women,  arrived 
at  by  intuitional  processes,  are  seldom  capable  of  cor- 
rection by  logical  reasoning.  The  evolution  of  the 
mind  in  man  differs  essentially  from  that  in  woman. 
The  woman  at  twenty  has  often  formed  her  mental 
character  in  nearly  all  its  essentials,  and  this 
remains  through  life,  or,  perchance,  be^sins  to  develop 
from  the  reasoning  side  at  the  close  of  the  reproductive 
period  ;  whereas  m  the  youth  of  twenty  the  reasouing 
faculty  is  undergoing  active  evolution,  the  mind  is 
developing  and  endeavouring  to  ansume  a  shape,  is 
easily  moulded,  and  deals  little  with  intuitions  as  com' 
pared  with  reasoning. 

The  evolution  of  the  mind  of  woman  at  the  charac- 
teristic period  I  commcDd  to  your  notice.  It  in  from 
the  ranks  of  such  unfortunate  sufferers  that  we  obtain 
pome  deluded,  but  so-called  strong-minded,  individuals. 
They  become  platform  orators,  seek  to  redress  their 


grievances,  subdue  that  reptile  man,  and,  perohanoe, 
reform  the  empire  generally. 

As  we  have  slreeAj  seen,  delusional  states  are  often 
associated  with  illusions  and  hallucinations,  but  the 

Sresence  of  delusions  does  not  necessarily  imply  a  con- 
ition  of  mental  weakness.  Such  patients^  are  often 
shrewd  and  intelligent,  memory  good,  volition  strong, 
and  they  are  able  to  keep  their  emotions  well  under 
control.  In  the  sane  we  see  everv  variety  of  delusion, 
arising  in  some  instances  from  false  sense-impressions 
or  illusory  phenomena,  in  others  from  the  propagation 
of  false  intellectual  beliefs,  as  in  the  various  psycho- 
pathic epidemics,  and  as  the  result  of  ignorance.  In 
the  half-way  conditions  delusions  vary  from  the  effects 
of  dreams  or  nightmare,  to  superstitious  and  false 
beliefs.  Hysterical  people  are  subject  to  temporary 
delusions,  which  are  the  outcome  of  emotions  or  loss  of 
control..  An  insane  delusion  is  usually  defined  as  a 
belief  in  something  that  would  be  incredible  to  sane 
people  of  the  same  class,  education,  or  race  as  the 
person  who  expresses  it ;  this  resulting  from  diseased 
working  of  the  brain  convolutions.  An  insane  dehision 
affects  the  conduct  of  life,  and  is  not  due  to  ignorance^ 
In  examining  every  case  it  is  well  to  remember  that 
delusions  may  arise— 

(1)  In  regard  to  an  individual's  self-consciousness. 
He  may  become  exalted  or  depressed. 

(2)  They  may  relate  to  the  individual's  physical 
organism,  as  the  outcome  of  sensory  disturbances. 

(3)  They  may  relate  to  any  part  of  the  physical  or 
social  environment. 

SO  Not  onl^  may  a  man  feel  that  he  has  lost  himself, 
that  he  is  someone  else,  but  there  may  be  an 
alternating  condition,  in  which  he  believes  he  is  at  one 
time  one  individual,  and  at  other  times  another.  Or 
he  may  believe  that  he  is  two  persons  at  onoe. 

Now  you  will  ask  yourselves,  what  are  the  practical 
points  for  your  guidance  in  recording  the  presence  of 
delusions  in  your  certificates  f  I  womd  advise  you  to 
avoid  such  statements  as  the  following : — 

"  Patient  says  I  am  a  fool." 

"  Patient  says  he  does  not  believe  in  the  marriage 
ceremony.'* 

"  Patient  says  he  feels  depressed,"  &c. 

As  a  matter  of  fact,  practitioners  who  believe  in  life 
everlasting  hesitate  not  in  certifying  a  man  who  be- 
lieves he  will  live  for  ever,  and  conversely,  the  believer 
in  dust  to  dust  consigns  to  an  asylum  the  unfortunate 
being  who  says  he  is  going  to  die.  When  a  man 
accepts  the  declamations  of  his  pastor  and  is  at  last 
convinced  that  his  soul  is  lost  ne  has  only  to  men- 
tion his  conviction  to  furnish  the  most  common  of  all 
the  certified  facts  indicating  insanity. 

We  must  be  generous  in  our  estimation  of  the  feel- 
ings and  beliefs  of  others,  and  I  would  caution  you 
upon  accepting  their  creeds  as  evidences  of  insanity. 
It  is  done  daily,  but,  sooner  or  later,  trouble  will  arise, 
and  you  may  find  yourselves  in  a  ridiculous  position  in 
a  law  court,  and  figuring  as  a  would-be  judge  upon 
matters  which  transcend  the  knowledge  of  even  the 
most  enlightened  theologians. 

One  more  caution  I  would  give  you. 

The  fact  that  hallucinations  are  exceedingly  common 
in  insane  people  is  no  argument  that  they  are  neces- 
sarily always  insane  symptoms.  On  the  contrary, 
some  hallucinations  mav  be  perfectly  compatible  with 
sanity.  Who  shall  denne  tne  limits  of  interpretation 
of  what  appears  to  the  mind  7  The  materialist  assumes 
the  existence  of  a  molecular  causation  to  account  for 
the  origin  of  all  objects  of  perception,  whereas  the 
spiritualist  believes  in  spiritual  factors.  Who  shall 
decide  the  issue  and  prove  the  sanity  or  insanity  of 
these  combatants  7  Until  we  are  able  to  solve  these 
ultimate  problems,  we  must,  as  presumably  sane  indi- 
viduals, be  generous  in  the  limits  we  assign  to  the 
interpretation  which  others  give  to  their  own  experi- 
ences. 


Jak.  1,  1896. 


ORIGINAL  COMMUNICATIONS. 


The  Mft>t''*t.  Prfps.     5 


Unfortanatel^,  many  men  define  mental  health  from 
a  purely  objective  standpoint  They  make  of  it  an 
objectiTe  deecription  and  not  a  anbjectiye  appreciation. 
The  objective  manifestiona  of  the  sensibilities,  aims, 
beliefe,  and  characteristics  of  others,  they  regard  from 
their  own  nibjective  standpoint  Their  own  functions, 
which  they  regard  as  sound,  are  compared  with  the 
objective  manifestations  of  others,  ana  any  departure 
from  their  own  standpoint  is  regarded  as  psychopathic, 
and  not  to  be  tolerated. 

Of  late  years  we  have  had  a  superabundance  of 
liteiatare  upon  the  decay  and  degeneration  of  the 
human  race.  Were  we  to  resort  to  the  curgumentum 
ad  hominem  we  might  see  that  these  advocates  of 
degeneracy  are  in  r^lity  degenerate  advocates.  They 
themselves  adopt  that  weapon  of  rhetoricians  and 
demagogues,  the  argwrnentum  adpopvlum,  in  that  they 
address  themselves  to  the  masses  at  large,  and  seek  to 
excite  their  feelings  by  arrogant  and  insulting  bio- 
graphical details,  which  tend  to  prevent  the  formation 
of  a  dispassionate  judgment  upon  the  matter  in 
hand. 

Max  Nordau  might,  from  his  writings,  be  described 
as  a  de^jenerate.  He  is  not,  however,  an  example  of 
the  genraa  who  is  degenerate,  but  of  the  gifted  man 
idio  suffers  from  auto-hypnotism,  and  who  appears  to 
exhibit  a  condition  of  monoideism,  which  has  been 
developed  at  the  expense  of  his  sense  of  justice  and 
practical  reason.  I  sgree  with  Professor  James  that 
the  real  lesson  of  the  books  upon  degeneration  and 
genraa  la  that  we  should  welcome  susceptibilities, 
impnlsea,  obsersions,  if  we  have  them,  so  long  as  by 
their  means  the  field  of  our  experience  grows  deeper, 
and  we  contribute  the  better  to  the  race's  stores ;  that  we 
should  broaden  our  notion  of  health  instead  of  narrow- 
ing it ;  that  we  should  regard  no  single  element  of 
weakness  as  fatal— in  short,  that  we  should  not  be 
afraid  of  life. 

In  another  place  (a)  I  have  sought  to  condemn  much 
of  the  farcical  writing  upon  the  subject  of  degenera- 
tion, and  I  there  pointed  out  my  belief  that  such 
writinga  were  due  to^ 

1.  Want  of  true  breadth  of  culture—i.e.,  a  sympathy 
with  art  pursuits,  literature,  science,  and  religion, 
derived  from  sometiiing  more  than  a  mere  superncial 
examination  of  the  eviaence  thereof. 

2.  The  difficulty  of  forming  an  opinion  of  the 
general  question  from  any  one  standpoint,  and  under 
the  light  of  any  one  set  of  traditions. 

3.  The  fact  that  the  causes  and  sources  which  are 
most  vital  can  often  only  with  reluctance  be  dis- 
closed to  a  nerveless  and  unsympathetic  public 
opinion. 

4.  Materialistic  bias,  and  the  consequent  lack  of 
healthy  sociological  determination  of  the  will,  seeing 
that  toe  belief  in  the  supernatural  has  always  been 
idmost  universal. 

And  now,  gentlemen,  it  only  remains  for  me  to 
mention  the  third  rule  for  your  guidance  in  the  esti- 
mation of  a  case  of  insanity.  The  law  requires  that 
not  only  must  a  person  tmnk  abnormally  but  there 
must  also  be  some  perversion  of  the  conduct  which 
renders  the  individual  unsafe  towards  himself  or  to  his 
fellow-beings,  and  thereby  makes  him  a  proper  person 
for  care  and  control.  The  third  point,  therefore,  is  to 
note  the  practical  outcome  of  the  mental  perversion 
and  how  the  patient's  conduct  is  affected.  At  present 
the  law  is  loth  to  recognise  that  a  person  mav  be  insane 
in  his  conduct  without  at  the  same  time  having  any 
actual  discoverable  mental  defect  This,  however,  is  a 
controversial  matter  which  we  cannot  devote  attention 
to  at  present  We  have  more  to  do  with  morbid  con- 
ditions of  action  as  we  find  them  associated  witii 
mental  perversions. 

(a)  "  Mental  PhysiolOfy." 


Cainically,  we  have  to  note  the  following  types  of 
morbid  impulse  :— 

1.  QenenJ  impulsiveness,  or  the  tendency  to  react 
immediately  to  all  sorts  of  external  or  internal  stimuli. 
Patients  of  this  type  break  windows,  strike  others,  and 
are  continually  getting  into  mischief. 

2.  Epileptiform  impulses  which  are  unconscious  in 
character,  or  in  whicn,  at  anv  rate,  the  patient  is 
unable  to  recall  the  reasons  for,  or  the  nature  of,  the 
impulsive  act 

3.  Sexual  impulses,  which  include  the  excessive  ten- 
dencies towards  sexual  intercourse,  onanism,  bestiality, 

4.  Morbid  appetites,  in  which  patients  are  unable  to 
resist  eatin£[  and  drinking  all  sorts  of  filth. 

5.  Homicidal  or  suicidal  impulses. 

6.  Dipsomania,  kleptomania,  hyromania. 

7.  Impulsive  conditions,  which  alternate  with  forms 
of  intellectual  or  moral  insanity. 

These  clinical  varieties  do  not,  however,  include 
some  of  the  most  difficult  cases  with  which  you 
may  have  to  deal.  I  refer  to  those  csiaea  in  which 
the  tendency  to  act  out  of  conformi^  with  our 
notioDS  of  social  and  morsd  rectitude  is  the  result 
of  the  evolution  of  socialistic  and  other  modes  of 
reasoning.  In  dealing  with  such  cases  as  these,  my 
test  is,  and  I  venture  to  believe  that  you  agree 
with  me,  to  put  the  patient  in  the  liffht  of  a  sister, 
and  then  to  decide  whether  you  will  sanction  the 
meditated  departure  from  the  moral  laws  which 
civilisation  has  imposed  upon  us.  It  is  needless  to 
say  I  refer  to  an  instance  now  engaging  the  attention 
of  the  public,  in  which  the  marriage  laws  are  defied  as 
being  at  variance  with  social  freedom. 

In  subsequent  lectures  I  purpose  dealing  in  detail 
with  the  more  important  points  in  diagnosis,  aod  in 
order  to  do  so  with  some  de^ee  of  completeness,  con- 
siderable attention  will  be  given  to  the  various  sensory 
illusions  and  hallucinations  met  with  in  the  insane, 
and  also  to  the  mental  perversions  associated  with 
defective  memory,  false  conception,  and  disordered 
feelings. 

♦ 

THE  EFFECTS  PRODUCED  IN  THE  RABBIT 
AND  PIGEON  BY  THE  EXTRACTION  OF 
THE  STAPES  OR  OF  THE  COLUMELLA, 
AND  THE  EXPERIMENTAL  DESTRUCTION 
OF  THE  MEMBRANOUS  VESTIBULE. 
By  Pbof.  GARNAULT,  M.D. 
[from  cub  fbxnch  oobkbsfondxnt.] 
A  COMMUNICATION  was  read  on  the  above  subject  at 
the  last  meeting  of  the  Academic  des  Sciences,  by  Dr. 
Gamault. 

In  1893  the  author  attempted  extraction  of  the 
stapes  in  dogs  and  of  the  columella  in  pigeons.  He 
took  very  incomplete  antiseptic  precautions,  but  sup- 
puration occurred  in  only  one  case,  and  in  that  the 
animal  made  as  good  a  recovery  as  the  others.  No 
reaction  of  any  kind  was  manifested,  and  no  complica- 
tions, temporary  or  permanent,  occurred. 

The  hearinff  of  animals  operated  upon  on  both  sides 
was  notably  diminished  during  about  a  fortnight,  but 
at  the  end  of  two  or  three  months  it  was  difficult  to 
distinguish  animals  experimented  upon  from  those 
intact. 

He  destroyed  also  the  tympanic  membrane  and 
cauterised  it  with  nitrate  of  silver,  so  that  it  was  not 
again  repaired. 

Having  confirmed  the  previous  experiments  of 
Eessel  and  Botey  M.  Garnault  felt  justified  in  practis- 
ing on  men  extraction  of  the  stapes,  and  he  com- 
municated to  the  Congress  of  Ilome,  1894,  three 
operations  of  the  kind. 

In  a  new  series  of  experiments  which  he  has  madeM. 
I  Garuault  put  ononesiae— only  noting  it  incidentally— 

C 


6     Ths  Mbdical  rHEss. 


ORIGINAL  COMMUNICATIONS. 


Jak.  I9  1896. 


the  return  of  heario^.  on  which  subject  his  experiments, 
as  well  aa  those  of  Kessel,  Botey,  and  Straaten,  left  no 
doubt.  He  wished  to  take  special  note  by  personal 
observation  of  the  effects  upon  the  pigeon  and  rabbit 
of  the  operation  which  he  wished  to  perform  upon  man, 
in  which  there  is  the  danger  of  opening  the  membranous 
labyrinth.  When  the  integrity  of  the  auditory  nerve 
has  been  proved  by  lUnne's  test ;  and  when  it  has  been 
determined  by  examination  by  means  of  the  probe, 
and  particularly  by  centripetal  pressure,  that  the  stapes 
is  fixed  by  bon^  ankylosis  to  the  walls  of  its  cell, 
indications  for  its  removal  exist ;  for  it  is  known  by 
experiments  on  animals  that  in  extraction  practised 
on  man  in  comparable  cases— that  is,  the  auditory 
nerve  being  unaffected,  but  where  there  does  not  exist 
bony  ankylosis  of  the  stapes— membranous  occlusion 
after  operation  of  the  f enestrum  ovale,  and  the  return 
of  a  high  degree  of  hearing  power  is  certain.  Unfor- 
tunately, in  these  cases,  the  branches  of  the  stapes 
become  broken,  when  it  is  extracted  by  means  of  a 
hook ;  and  it  cannot  otherwise  be  withdrawn  without 
danger  of  opening  the  membranous  labyrintL 

M.  Gamault  resolved  to  produce  more  severe  lesions 
of  this  kind  in  animals.  In  pigeons  he  opened  the 
membranous  labyrinth  by  introduction  of  an  elevator 
through  the  fenestrum  ovale.  In  one  pigeon  he 
repeated  the  operation  twice  at  intervals  of  three 
weeks.  He  did  the  same  operation  on  rabbits,  in 
which  he  extracted  the  stapes,  dislocating  and  break- 
ing it  by  means  of  a  sharp  elevator.  When  the  laby- 
rinth was  opened  in  pigeons  and  rabbits  the  operation 
was  never  followed  by  serious  or  lasting  effects  on 
powers  of  standing,  locomotion,  or  flight,  nor  was  the 
general  health  affected.  All  the  creatures  thus 
operated  on  got  well  as  soon  as  those  from  which  the 
stapes  alone  had  been  removed  In  pigeons  the  sense 
of  hearing  was  re-established  also  in  these  conditions. 
It  is  extremely  difficult  to  judge  of  the  acuteness  of 
the  sense  of  hearing  in  the  rabbit.  The  wounds 
healed  just  as  well  when  no  antiseptic  precautions 
were  taken  as  when  these  were  observed. 

In  view  of  the  important  results  to  be  derived  from 
the  operation,  M.  Qamault  considers  that  his  experi- 
ments justify  extraction  of  the  ackylosed  stapes  in 
the  human  subject  when  the  rest  of  the  necessary 
auditory  apparatus  is  intact.  Of  course,  the  operation 
would  be  done  with  strict  antiseptic  precautions, 
and  lesions  of  the  membranous  labyrinth,  of  which 
there  is  danger,  could  not  possibly  approach  in  gravity 
such  as  M.  Qamault  made  experimentally  on  animals 
which,  nevertheless,  invariably  recovered. 

M.  Qamault  promises  in  a  later  paper  f uUv  to 
describe  the  stracture  of  the  membrane  which  closes 
the  fenestrum  ovale. 


REArPEARANCE    OF    MALARIAL 

AFFECTIOKS     IN'    DUBLIN:    A 

WARNING. 

By.    W.    FRAZEB,    F.R.C.S.I.,    M.R.I.A.. 

Malarial  diseases  were  formerly  known  to  occur  in 
many  parts  of  Ireland,  and  were  reckoned  among  the 
common  maladies  that  might  be  expected.  I  do  not 
PDoak  of  the  so-called  **  Malignant  Feavers  "  termed  by 
Qerard  Boate,  in  1652,  *'  Irish  Agues,"  some  of  which 
were  possibly  due  to  other  forms  of  fever,  and  some 
also,  it  is  probable,  to  malaria,  as  his  description  ap- 
pears to  show.  He  also  distinctly  mentions  agues, ior 
he  states  :  '*  As  for  the  tertian  ague — some  years  since, 
I  know  not  through  what  secret  changes,  it  hath  found 
access  into  the  island,  so  that  at  this  time  some  are 
taken  with  it."  Certain  it  is  that  it  continued  in  some 
damp  districts,  as  for  instance  near  Dublin  at  Swords, 


along  the  banks  of  the  river  Liffey,  at  Island  Bridge, 
at  Bantry,  and  at  the  rere  of  Phoenix  Park,  where  there 
was  a  wide  extent  of  land  saturated  with  water, 
first  drained  about  forty  years  ago.  The  milder  form 
of  malarial  disease,  known  as  "  Brow  Ague."  common 
in  the  city  of  Cork,  and  of  late  years,  more  frequent  in 
parts  of  Dublin  than  it  used  to  be,  has  never  left  us, 
out  for  a  considerable  time  past,  ague  in  any  form 
would  be  thought  more  than  rare, 

I  regret  to  say  that  an  nnmistakeable  example  of 
summer-autumnal  remittent  fever,  as  witnessed  in 
the  South  of  Europe^  came  this  autumn  under  my  care, 
succeeded  in  its  decline  by  symptoms  of  ordinary  ague, 
and  I  have  heard  of  another  remittent  attack,  DOth 
patients  living  in  Dublin.  Possibly,  if  watched  for, 
more  of  these  unpleasant  affections  may  be  recognised. 
My  case  occurring  in  private  practice,  it  is  neecUess  to 
^ive  the  detailed  course  of  the  malady.  It  was  seen 
m  constant  consultation  with  another  phj^sician,  and 
as  the  patient  was  unable  to  take  quinine  m  any  form, 
other  treatment  had  to  be  employed.  The  remittent 
fever  nearly  lasted  three  weeks,  then  came  a  lull  of 
about  ten  days.  Subsequent  to  this  marked  attacks 
of  ague  set  in.  The  patient  is  now  convalescent. 


PERFORATION  IN  ENTERIC  F  EVER 

ITS  SURGICAL  TREATMENT. 

By  FREDERICK  HOLME  WIGQIN,  M.D., 

Visiting  BargeoD,  JHew  York  City  HoipitaL 

There  is  no  comi>lication  of  enteric  fever  more 
dreaded  by  the  physician  than  perforation.  It  occurs 
in  about  two  per  cent,  of  all  cases.  Its  most  frequent 
causes  are  improper  diet,  distension  of  the  bowel  from 
any  cause,  or  too  early  and  sudden  movements  of  the 
patient  It  is  present  as  often  in  mild  cases  as  in  those 
which  are  severe  and  is  most  frequently  met  with  in 
young  adult  males.  As  is  well  known,  its  recognition 
is  not  difficult.  Its  occurrence  is  announced  by  the 
advent  in  the  course  of  the  fever  of  sudden  severe 
pain  in  the  right  iliac  region,  accompanied  bv  sym- 
ptoms of  collapse,  this  being  soon  followed  by  the 
symptoms  of  peritonitis,  and  almost  invariably  on  the 
second  or  third  da:^  the  case  terminates  fatally.  The 
site  of  the  perforation  is  (generally  found  to  be  in  the 
last  twelve  inches  of  the  ileum. 

The  late  Prof.  Loomis,  in  the  course  of  the  discussion 
on  Dr.  Reeve's  paper  on  typhoid  fever,  read  before  the 
Association  of  American  rhysicians  in  1890  said  :  ^*I 
do  not  remember  to  have  seen  a  single  recovery  after 
there  were  unmistakable  evidences  of  intestinal  per- 
foration. Recovery  from  a  localised  peritonitis,  compli- 
cating typhoid  fever,  is  not  uncommon,  but  when  charac- 
teristic symptoms  of  intestinal  perforation  are  present, 
in  my  experience  a  fatal  issue  soon  follows."  With  such 
evidence  and  our  own  individual  experience  of  the 
hc^elessness  of  the  patient's  condition  when  reliance 
is  placed  on  Nature's  efiPorta  at  repair  (spontaneous 
recovery  resulting  less  frequently  in  this  than  in  other 
forms  of  perforation,  on  account  of  the  central  loca- 
tion of  the  injury),  it  is  not  to  be  wondered  at  that 
with  the  constant  reports  of  successful  operations  for 
the  relief  of  perforation  from  other  causes  and  in  other 
locations,  the  physician  should  turn  toward  the  sur- 
geon, asking  if  among  the  good  tidings  modem  surgery 
is  proclaiming  to  many  sufferers  there  is  not  some 
message  of  hope  for  the  unfortunates  whose  condition 
we  are  considering,  who  seem  at  present  to  be  con- 
demned to  an  untimely  death,  and  by  whose  bedsides 
he  has  so  often  stood  with  folded  hands,  helpless  to 
aid  them.  Dr.  Bontecou,  of  Troy,  who  was  the  first 
in  the  United  States  to  operate  for  this  form  of  perfor- 
ation, claimed  that  *^  when  this  mortal  accident  occurs. 


Jak.  1,1896. 


ORIGINAL  COMMUNICATIONS. 


THI  MlDTCAL  PRFfW.      7 


laparatomv  cannot  impair,  but  may  improye  the 
patient's  chance  of  recovery."  Dr.  Van  Hook,  in  his 
admirable  paper  reporting  the  first  snccesafnl  case  of 
operation  for  perforation  occurring  in  the  course  of  a 
doeely  diagnosticated  case  of  enteric  fever,  remarked : 
**  It  ia  strange,  nevertheless,  that  a  Question  involving 
the  only  promise  of  help  for  five  ana  seven-tenths  per 
cent,  of  all  those  dying  of  typhoid  fever  should  not 
have  excited  even  more  interest  and  discussion."  Dr. 
Bobert  Abbe,  (a)  in  a  recent  report  of  a  case,  also 
snccesBfully  operated  upon^  said  :  ''Why  one  class  of 
cases  ahould  be  left  to  die.  while  we  operate  on  all 
appendicitis  cases,  when  perforation  can  be  recognised, 
does  not  appear."  Again,  Ftof.  Eussmaul,  of  Stras- 
burg,  some  time  sinc^  said  :  **  Granted  that  the  chance 
of  a  successful  issue  is  heavilv  against  vou,  that  the 
patient  is  in  the  midst  or  at  the  end  of  a  long  sickness, 
that  bis  tissue  are  in  the  worst  state  to  stand  the 
injuries  of  the  sur^pon's  knife,  that  the  lesions  of  the 
gut  may  be  extensive,  that  the  vital  forces  are  at  the 
lowest  ebb,  no  one  yet  has  hesitated  to  perform  tracheo- 
tomy in  the  laryngeal  complications  of  enteric  fever 
which  reouire  it  to  save  life,  for  these  reasons." 

With  this  testimony  and  much  more  that  could  be 
offered  in  favour  of  operation,  one  cannot  help  being 
surpdsed  in  looking  over  the  literature  of  this  subject, 
to  nnd  on  record  only  twenty-four  cases^  of  which  six 
recovered.  If  those  cases  are  rejected  m  which  there 
IB  doubt  of  the  diagnosis,  we  find  only  seventeen  cases 
where  an  attempt  has  been  made  to  relieve  the  patienl^s 
desperate  strait  by  surgical  means.  Of  these  three  re- 
covered. Allusion  has  already  been  made  to  the  first 
and  third,  and  the  second  recovery  belongs  to  Dr. 
Netschajau,  of  St  Petersburff.  The  writer's  opinion, 
formed  after  a  careful  study  of  the  subject,  and  from  a 
considerable  experience  in  abdominal  operations  when 
the  patients  were  septic  and  conseciuently  in  bad  con- 
dition, is  that  the  physician  on  taking  charge  of  a  case 
of  enteric  fever  should  prepare  himself  to  act  with 
promptness  on  the  occurrence  of  perforation.  It  is 
wdl  to  remember  that  while  there  should  be  the  least 
delay  possible  these  patients  rarely  die  in  the  first  state 
of  collapse,  and  that  this  condition  is  not  one  favour- 
able for  operation.  The  patient  as  soon  as  the  diagno- 
sis is  made  should  be  stimulated  by  means  of  strychnia 
and  morphia.  If  the  patient  rallies  then  the  operation 
should  he  performed  without  loss  of  time,  and  under 
favourable  conditions  there  is  a  fair  chance  of  success, 
espedaily  in  those  cases  in  which  the  course  of  the 
fever  has  been  mild  or  where  the  perforation  has 
occurred  during  convalescence.  Of  course,  if  the 
patient  refused  to  respond  to  the  stimulation  the 
operation  would  be  useless.  Dr.  Abbe,  in  the  paper 
previously  alluded  to,  said  :  ''  Very  essential  do  I  con- 
sider it  that  the  surgeon  should  never  be  so  hasty  in 
getting  at  his  work  that  he  enters  upon  it  handicapped 
byimr  assistance,  poor  light,  or  poor  arrangements 
for  irrigation."  Wnile  the  patient  is  being  stimulated 
the  necessary  arrangements  for  the  operation  can  be 
made.  The  writer's  experience  has  shown  him  that  a 
laparatomy,  although  the  personal  care  and  trouble  is 
greater,  can  be  even  more  safely  performed  in  a  farm- 
house with  good  surroundings  than  in  a  city  hospital. 
All  that  is  requiedte  is  a  dean  light  room,  without 
carpet  or  furniture,  except  two  or  three  wooden  tables, 
an  abundant  supply  of  hot  and  cold  soft  spring  water 
which  has  been  sterilised  by  boiling,  and  a  dozen 
towels. 

FiELtients  of  this  class  do  not  bear  ansesthesia  well, 
and,  in  fact,  the  great  danger  comes  from  this  source, 
^th  a  dosed  inhaler  of  tbe  Clover  tyye,  or  Dawbam's 
modification,  which  the  writer  has  used  with  satisfac- 
tion for  some  years,  patients  can  be  readily  anaesthe- 
tiaed  and  kept  unconsdous  for  an  hour  with  four 
ounces  of  ether.  The  incision  should  usually  be  in  the 
median  line  between  the  umbilicus  and  the  pubes, 

(a)  Medical  Record,  Jtokvmrj  6Ui,  1896. 


rather  than  over  the  site  of  the  paSh,  true  as  this  guide 
generally  is  to  the  point  of  perforation,  for  from  this 
point  one  has  the  abdominal  and  pdvic  contents  under 
command.  Search  should  first  be  made  in  the  pdvis 
because  collapsed  small  gut  and  extravasated  matter 
tend  to  fall  into  this  cavity,  as  has  been  pointed  out 
by  Bland  Sutton  (a).  If  the  inflamed  and  perforated 
intestine  is  not  found  here  the  cseoum  should  be  sought, 
and  the  last  foot  of  Ueum  is  then  easily  located  and 
looked  over.  When  the  injured  point  is  found,  the 
perforation  should  be  closed  if  possible  by  Lemberf  s 
or  Halsted's  mattrass  sutures  and  should  then  be 
covered  by  an  omental  graft.  The  sutures  for  closing 
the  abdominal  wound  should  now  be  placed,  all  the 
layers  of  this  wall  being  included.  These  sutures 
should  be  of  silk  worm  gut  When  this  has  been 
accomplished  the  abdominal  cavity  should  be  freely 
iirigated  with  a  hot  saline  solution  (half  a  drachm  to  the 
pint),  about  two  gallons  being  used,  the  temperature 
of  the  water  being  from  one  nundred  and  ten  to  one 
hundred  and  fifteen  degrees  Fahrenheit,  according  te 
the  degree  of  shock  the  patient  is  suffering  from 
and  in  most  cases  the  abdominal  cavity  should 
be  left  filled  with  the  irrigating  fluid,  and  the 
sutures  already  passed  should  be  drawn  and  tied. 
If  effort  has  oeen  made  by  nature  to  shut  off 
the  perforated  point  by  adhesions  before  they  are 
disturbed  the  general  cavity  should  be  shut  off  by 
sponges  or  gauze.  In  some  cases  all  that  would  be 
advisable  to  do  would  be  to  draw  the  perforated  intes- 
tine into  the  wound,  and  after  free  irrigation  of  the 
abdominal  cavity  it  should  be  stitched  to  the  wound 
or  surrounded  by  gauze,  further  procedure  being 
delayed  till  a  future  occasion.  In  a  still  more  despa- 
rate  case,  one  occurrine  earlier^  when  the  fever  was  at 
its  height,  or  in  which  the  fever  had  run  a  severer 
course,  one  might  with  the  aid  of  cocaine  anaesthesia 
rapidly  open  the  abdominal  cavity  over  the  site  of 
ffreatest  pain,  and  after  irrigating,  surround  the  per- 
forated intestine  bv  gauze,  thus  shutting;  off  the  general 
cavity,  favourins  the  formation  of  adhesions  and  secur- 
ing drainage,  as  has  been  suggested  by  my  friend,  Dr. 
K  D.  Ferguson.  In  one  of  the  successful  cases 
previously  alluded  to,  Netschajaus,  a  portion  of  the 
perforated  intestine  was  excised,  and  now  that  an 
anastomosis  by  means  of  the  Murphy  button  can  be 
easily  effected  in  five  minutes^  it  may  in  favourable 
cases,  especially  in  those  in  which  a  number  of  ulcers 
are  near  together  and  in  a  dangerous  condition,  be 
quicker  and  wiser  to  excise  the  diseased  intestine. 
The  decision  as  to  the  best  procedure  must  be  deter- 
mined by  the  circumstances  of  each  case  and  by  each 
operator  for  himself.  It  is  here  that  skill  and  experi- 
ence count  for  the  most  Personally,  I  favour  closing 
the  abdominal  wound  after  free  irrijnition,  leaving  the 
abdominal  cavit]^  full  of  the  hot  fluid,  as  I  know  from 
many  past  experiences  how  much  this  procedure  does 
to  lessen  shock  and  to  prevent  the  danger  of  septic 
infection  of  the  peritoneum.  If  at  this  time  shock 
were  still  great,  it  would  be  wise  to  follow  Dr.  Abbe's 
advice  to  administer  an  enema  of  black  coffee  and 
whiskey  on  the  operating  table. 

In  conclusion,  may  we  not  all  agree  that  in  many 
cases  of  perforation  occurring  in  the  course  of  enteric 
fever  an  attempt  should  be  made  to  save  the  patient 
by  operation.  The  patient  should  be  freely  stimulated 
on  the  occurrence  ot  this  accident  and  careful  prepara- 
tion ought  at  once  to  be  made  for  the  operation.  Time 
should  not  be  purchased  at  the  expense  of  experience, 
light  or  competent  assistance.  The  smallest  possible 
amount  of  ether  should  be  used.  The  surgical  proce- 
dure should  be  the  least  that  offers  hope  of  recovery 
to  the  patient.  We  must  remember  that  the  chance 
of  a  successful  termination  of  our  work  increases  with 
every  drachm  of  ether  and  every  minute  saved.  Finally, 
the  physician  must  realise  more  fully  that  the  surgeon 


(a)  "  Uioical  Societj  Reporte,"  London,  Maroh  9th,  1894. 


'8     Tint  MvDTCAL  Vtas^ 


TRANSACnONS  OF  SOCIETIES. 


Jan.  1,  1890. 


U  his  assistaDt  and  not  bis  iiTal  and  moat  give  him  as 
well  as  tbe  patient  a  fighting  chance  by  calling  him 
early  and  not  after  several  days  of  hesitation  which 
has  too  often  been  the  case  in  this  and  other  forms  of 
intra-abdominal  disease. 

Under  favourable  conditions  I  am  convinced  that 
modem  snrgery  has  a  remedy  to  offer  these  patients 
and  that  in  the  near  fatnre  the  mortality  from  perfora- 
tion occurring  in  the  course  of  enteric  fever  will  be 
markedly  lessened. 


^Vrtiuttcfions  of  SotittitB. 

BOITAL  ACAD£MT  OF   MEDICINE  IN  IRELAND. 

SBCTIOH  07  SUBOBRT. 

Kmrivo  hbld  Fbidat,  Dbc.  Gth. 


The  Pkesident,  Sir  Thobrlst  Stoksb,  in  the  Chair. 


Thk  Sicbrabt,  Mr.  Kendftl  Franks,  asked  if  Mr.  R. 
H.  Woods  would  favour  the  Section  with  details  of  the 
▼ery  interesting  case  he  had  shown  previoas  to  the  meet- 
ing, and  apon  the  snroeesfiil  treatment  of  which  he  wished 
to  con^ratolate  Mr.  Woods. 

Mr.  Woods  gave  an  acooant  of  the  case  of  the  man,  sBt. 
28,  upon  whom  he  operated  for  extra-dnral  abscess  in  tbe 
cerebellar  fossa  on  the  left  side,  complicated  hj  thrombosis 
of  the  lateral  sinos,  following  middle  ear  disease.  Two 
days  later  he  again  trephined  him  and  evacnated  an 
abscess  in  the'^kft  temporo-sphenoidal  lobe.  The  man 
made  an  nnintemipted  recovery. 

Mr.  Whxblxb  asked  several  qnestions  aboat  the  case,  to 
which  Mr.  Woods  replied. 

Mr.  Woods  then  read  a  paper  on 

■XdSIOH  or  HALT  THX  LABTNX. 

The  case  described,  said  to  be  the  first  of  its  kind  in 
Ireland,  was  one  of  malignant  disease  of  the  larynx  in  a 
man,  »t.  32,  whose  dominant  symptom  was  great  pain  in 
swaUowins.  There  was  no  previous  illness  or  history  of 
syphilis ;  liis  father  died  of  cancer  of  tbe  neck.  There 
was  a  tamonr  occnpying  the  right  half  of  the  larynx  and 
growing  throngh  toe  ala  of  the  thyroid  earfcila^,  so  as  to 
present  externally.  The  glands  were  secondarily  engaged ; 
a  piece  of  the  tnmoar  torn  off  proved  to  be  a  sqDamoas 
epithelioma.  Preliminary  tracheotomy  was  performed 
and  the  right  half  of  the  larynx  then  raised.  All  the 
tissaes  from  the  great  coma  of  the  byoid  bone  to  tbe 
arytenoid  cartilage,  inclusive,  were  removed.  Two  chains 
of  glands  were  dissected  out,  a  stomach  tube  was  tied  in, 
and  tbe  cavity  plugged  with  iodoform  g^nze.  The  follow- 
ing day  tbe  temperature  was  100 '8"*  F.,  from  whence  it 
steiftdily  fell  to  normal.  Tbe  tracheotomy  tube  was  dis- 
pensed with  on  the  third  day ;  on  the  28bh  day  the  patient 
swallowed.  After  four  months  recurrence  took  plaoe  in 
a  gland  behind  the  clavicle.  Its  removal  was  attempted 
but  without  success,  owing  to  air  entering  the  veins.  The 
patient  died  of  pneumonia  shortly  afterwards,  nearly  five 
months  after  tbe  excision. 

Mr.  Cbolt  thought  that  filling  the  wound  with  water 
was  the  best  way  of  preventing  canalisation.  The  diffi- 
culty of  havinji^  oxygen  always  at  hand  was  very  much 
against  its  use  m  cases  of  emergency,  such  as  of  air  enter- 
iDg  a  vein.  He  was  rather  sceptical  as  to  the  value  of 
oxygen  in  such  cases.  He  (Mr.  Crolv)  desired  to  put 
three  questions  to  Dr.  Woods:— 1.  Whv  he  did  not  re- 
move tne  whole  larynx  ?  2.  Why  he  did  not  use  water  to 
prevent  canalisation?  3.  Why  be  did  not  ligate  the 
jugular  vein  before  proceeding  to  remove  the  glands  ad- 
herent to  its  walls  ? 

Mr.  Kkkdal  Franks  said  Mr.  Woods  deserved  to  be 
congnratulated  on  having  described  in  a  very  interesting 
manner  the  details  of  an  exceptionally  brilliant  operation. 
Unfortunately,  tbe  result  was  fatal,  but  death  could  not 
be  ascribed  to  excision  of  the  larynx  ;  it  was  due  to  an 
extension  of  the  disease,  for  the  removal  of  which  tbe 
operation  had  been  undertaken.  He  believed  be  was  right 
in  describing  Mr.  Woods'  case  as  the  first  undertaken  in 
this  country  for  the  partial  removal  of  the  larynx.  He 
had  seen,  in  such  a  case,  ether  adminisliered  by  the  rectum. 


but  the  patient  died  within  forty-eight  hou^  from  colli- 
quative diarrhcea,  and  the  po9t-mortem  showed  acute 
inflammation  of  tbe  whole  of  thelarge  intestine. 
The  administration  of  chloroform  by  means  of  Trendelen- 
burg's apparatus  through  an  opening  in  the  trachea,  as 
performea  by  Mr.  Wo^,  was  far  JEetter.  He  entirely 
dieaffreed  with  Mr.  Crol/s  view  that  the  whole  larynx 
shomd  have  been  excised.  It  made  a  great  difference  to 
the  patient  whether  he  lost  his  whole  brynx  or  onlv  half. 
Reenrrence  did  not  take  plaoe  in  the  healthv  side,  but  in 
the  cicatrix,  or  in  the  glands  of  the  neck  of  the  affected 
side.  Moreover,  partial  excision  was  far  from  being  as 
dangerous  as  complete  excision.  Mr.  Franks  asked  why 
Mr.  Woods,  in  the  second  operation,  did  not  tie  the  vein 
above  and  below,  and  remove  tbe  indnded  portion  with 
the  adherent  implicated  glands. 

Mr.  Whbbleb  said  that  the  rectal  method  of  adminis- 
tering ansBstbetics  was  not  to  be  recommended.  In  one 
case  that  he  had  ether  thus  administered,  the  intestines 
became  distended,  pressed  on  tbe  diaphragm,  and  con- 
siderably embarrassed  breathing. 

Profesor  Bbnkbtt  thought  that  a  great  source  of  danger 
in  the  administration  of  ether  by  the  rectum  was  that  the 
efher  was  apt  to  accumulate  in  the  intestines,  and  there- 
fore the  quantity  given  was  not  easily  controlled. 

Mr.  Woods,  in  reply  to  Mr.  Croly,  said  that  his  fin^ 
introduced  into  the  wound  completely  controlled  the  vein, 
and  prevented  the  further  entrance  of  air,  and  was  much 
more  rapidly  effectual  than  filling  the  wound  with  water. 
The  immediate  improvement  in  the  condition  of  the 
patient  dfter  the  administration  of  oxygen,  suggested 
oxyffen  as  perhaps  the  best  remedy  for  canatisation.  The 
implicated  glands  were  adherent  not  only  to  the  internal 
jugular,  but  also  to  the  subclavian  and  innominate  veins, 
and  the  condition  of  the  patient  would  not  permit  of  such 
a  serious  nroceeding  as  ligature  and  excision  of  these 
veins  woula  involve. 

A  DISCUSSION  or  BOMB  0¥    THB  MBTHODS  OV  CmSTnTAL 
AMASTOMOSIS. 

Mr.  Mtlbs  in  his  communication  described  at  length, 
and  illustrated  bv  a  series  of  preparations,  the  methods 
introduced  by  Senn,  Murphy,  Mayo-Robson,  &c.  He 
discussed  the  merits  and  demerits  of  these  various  methods 
at  some  length,  pointing  out  the  special  circumstances 
which  seemra  to  nim  to  be  factors  in  determining  the 
choice  of  any  one  method  in  any  given  case.  His  general 
conclusions  were  that  simple  suture  alone,  where  possible, 
was  the  best  method  for  end  to  end  anastomosis.  That 
for  gastro-enterostomy,  Senn's  plates,  fortified  by  a  peri- 
pheral row  of  Lembert's  sutures,  seemed  most  promising  : 
that  the  Murphy  button  was  tbe  readiest  method  of  lateral 
anastomosis  in  the  small  intestine,  and  with  care  might 
be  used  for  end  to  end  anastomosis  in  the  same  situation, 
but  that  especial  attention  should  be  given  to  the  turned- 
in  portion  of  the  mesentery  when  used  for  this  purpose  ; 
that  it  should  not  be  used  for  the  laree  intestine  at  aU, 
owing  to  the  contents  of  the  bowel  being  solid  there. 
The  operator  should  take  great  care  to  use  a  button  not 
large  enough  to  stretch  the  wall  of  the  gut. 

Mr.  MvLBS  pointed  out  that  all  the  methods  now  in  use 
produced  as  a  substitute  for  the  contractile  bowel  an 
mert  tube  of  cicatricial  tissue  at  the  point  of  junction. 

Tbe  Pbbsidbvt  said  that  one  of  the  great  questions  as 
yet  unsettled  in  surgery  was  whetber  we  should  prefer 
end  to  end  or  lateral  anastomosis.  For  lateral  anastomosis 
he  was  in  favour  of  Senn's  plates.  He  would  not  care  to 
use  Murphy's  button  to  procure  anastomosis  above  the 
ileocfBcal  valve.  The  button  made  of  aluminium  he  con- 
sidered superior  to  others.  In  a  case  in  which  he  used 
Murphy's  button  in  the  colon,  the  patient  died  of  septic 
peritonitis,  which  the  post-mortem  showed  was  due  to 
sloughing  of  tbe  intestine,  extending  both  upwards  and 
downwanls,  from  tbe  place  ivbere  the  button  was 
inserted. 

Mr.  AJ'Ardlb  believed  that  by  far  tbe  best  method  of 
intestinal  anastomosis  was  by  tbe  use  of  Murphy's  button. 
The  statistics  which  he  ban  received  from  Mr.  Murphy 
himself  proved  ihi9.  In  76  cases  treated  by  methods 
other  than  Murphy's,  41  died.  In  12  cases  that  were 
operated  on  for  gangrenous  hernia,  and  where  Murpby'i« 
button  was  used,  only  two  deaths  occurred  ;  and  in  14 
cases  of  internal  strangulation  its  adoption  was  followed 


Jak.  1.  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Mbdioal  PlRlSS,     9 


by  only  one  death.  Takiof?  78  conaecutive  case*,  we  find 
toere  were  only  10  deaths,  idthoneh  the  liat  included  many 
of  great  gravity.  Mr.  Mnrphy  lays  great  etreea  on  the 
neoeaaity  for  dosingthe  little  triangular  wonnd  at  the 
mesenteric  border.  JBy  this  means  puckering  is  lessened 
and  leakage  prevented.  A  single  case  of  stncture  of  the 
bowel  following  Murphy's  method  has  not  been  recorded. 
Mr.  Murphy  insists  on  the  button  fitting  easily  into  the 
lumen  of  the  intestine.  It  should  not,  he  says,  be  more 
than  15>16ths  of  an  inch  in  diameter  for  smiJl  intestine. 
In  hie  opinion  Bonn's  plates  were  far  inferior  to  Murphy's 
button.  In  returning  the  bowels  into  the  abdomen  the 
bowels  should  be  pla^  in  parallel  rows,  and  the  end  con- 
taining the  button  should  be  placed  most  snperficiid. 

Mr.  KExn>AL  Franks  said  tnat  end  to  end  anastomosis 
by  a  continuous  suture  was  the  ideal  method  of  treatment, 
and  should  be  employed  in  all  cases  where  urgency  was 
not  extreme.  He  did  not  attach  much  importance  to  the 
material  of  which  the  sutures  were  maae,  nor  to  the 
peculiar  method  of  suture  employed  ;  but  what  he  thought 
meet  important  was,  that  the  sutures  should  be  made  to 
pass  through  healthy  tissue.  Leakage  was  nearly  always 
due  to  placing  sutures  in  unhealthy  bowel.  A  large 
amount  of  intestine— three,  four,  or  five  feet — could  be 
safeW  removed  if  neceasarv,  and  it  was  better  to  take  too 
much  than  too  little.  In  cases  of  urgency,  where  the 
satore  might  take  too  long  and  might  endanger  the 
patient's  life,  he  thought  Murphy's  button  was  the  most 
useful  contrivance,  and  deeerved  the  place  it  occupied  in 
surgery. 

Mr.  Obolt  was  favourably  impressed  by  the  small 
experience  he  had  of  Murphy's  button. 

Mr.  Mtles  having  replied, 

Tbe  Section  adjourned. 


EDINBURGH  MEDICOCHIRURGICAL  SOCIETY. 
MxiTiNO  HVLD  Wbdnesdat,  Dscembsr  18tu. 

Dr.   W.  Craig,  Vice-President,  in  the  Chair. 

This  meeting  was  devoted  entirely  to  the  exhibition  of 
patients  and  specimens. 

OASES. 

Dr.  Allan  Jamieson  showed  a  girl,  aet  3,  with  Xero- 
denna  pigmentosa.  He  explained  that  this  was  the  second 
case  of  this  disease  reported  from  Scotland.  The  disease 
ooounenced  in  this  child  with  some  itchiness  of  the  face 
fdbwed  by  freckling.  At  present  the  skin  of  the  face 
was  much  pigmented,  with,  in  some  parte,  atrophic  spots 
and  wartT  growths.  These  warts  were  a  special  charac- 
teristic o!  the  disease,  and  later  on,  became  epithelioma- 
tons,  sometimes  sarcomatous.  In  this  case  the  face  alone 
wasaffsoted. 

Dr.  MoOiLLTVRAT  showed :  1.  A  girl,  sat.  7,  in  whom  he 
had  excised  tbe  condyles  of  tbe  humerus  for  dislocation 
and  fracture.  2.  A  Ud.  after  thyrotomy  for  papillomata 
of  the  larynx.  He  generally  performed  a  preliminary 
tracheotomy,  and  left  the  tube  m  for  twenty-four  hours 
aftsr  the  other  operation.  The  growths  on  the  cords  were 
easily  removed,  but  those  that  sprang  from  the  pouch  be- 
tween the  cords  presented  much  more  difiSculty.  The 
bases  of  the  warts  were  touched  with  faming  nitric  acid. 

Mr.  J.  M.  CoTTERiLL  showed— 1.  A  girl  on  whom  he 
had  operated  for  a  cyst  of  the  pancreas.  She  had  been  ill 
for  twelve  weeks  and  exhibited  a  large  swelling  in  the 
left  hypochondrinm  about  the  sisse  o^  a  hand.  Aspiration 
ramoved  fluid.  Following  Mr.  Cathoart  he  had  operated 
from  behind,  making  an  moision  just  outside  the  erector 
spnuB,  and  below  the  renal  vessels.  The  cyst  had  thick 
nbrone  walls.  The  patient  was  now  quite  well,  for  after 
three  months  drainage  of  the  cyst,  the  wound  had  closed 
up  very  satisfactoruy.  2.  A  boy,  aet.  4,  with  a  swelling 
in  the  sacral  region  which  disappeared  on  pressure.  The 
finger  could  be  inserted  into  a  hole  in  the  posterior  aspect 
of  the  sacrum,  and,  if  introduced  into  the  rectum  could 
be  felt  passing  through  a  large  patency  in  the  bone  near 
where  the  swelling  projected.  Examination  of  the  fluid 
drawn  oflf  from  the  swelling  proved  it  to  possess  the 
chanetere  of  cerebfo-spinal  £iid.    The  boy  was  in  other 


wavs  deformed,  in  fact  he  was  a  museum  in  himself,  for 
he  had  a  clubfoot,  a  congenital  inguinal  hernia,  ill-deve- 
loped ears,  some  cardiac  lesion,  and  an  abnormally  flexible 
elbow-joint,  probably  the  result  of  an  old  fracture.  3.  A 
woman  who  had  come  to  him  with  a  swelling  of  the  cheek 
commencing  in  front  of  the  ear.  The  presence  of  pus  was 
diaenosed  and  evacuated.  Later  on  granulations  appoMred 
at  Uie  mouth  of  the  wound  which  on  examination  were 
found  to  contain  the  fung^  of  actino-myoosis.  The 
swelling  had  subsided  to  a  great  extent,  but  the  question 
was,  what  was  the  correct  treatment  in  the  future  ? 

Mr.  Caird  also  showed  three  patients — 1.  A  lad  in 
whom  a  part  of  the  humerus  had  been  wanting  owing  to 
acute  myelitis,  and  on  whom  he  had  operated  success- 
fully. 2.  A  boy,  sBt.  14,  whose  skull  he  had  trephined 
for  supposed  meningitis  over  Broca's  convolution  on  the 
left  side.  The  patient  had  had  a  mastoid  abscess  which 
had  been  opened,  and  later  on  symptoms  of  meningitis  set 
in.  Nothing  was  found  at  the  operation,  but  &e  boy 
became  perfectly  well  a  short  time  afterwitfds.  3.  A  lad 
on  whom  he  had  operated  for  dilated  stomach.  The 
pylorus  was  one  inch  in  length  and  of  the  thickness  of  a 
slate  pencil.  The  stomach  held  80  ok.  A  longitudinal 
incision  was  made  in  the  pylorus  and  stitched  transversely 
U^ether,  while  the  stomach  was  made  smaller  by  the 
stitching  together  of  its  redu'^licated  walls.  The  patient 
had  been  benefited  by  the  operation. 

Dr.  J.  Thomson  showed  a  case  of  Neuritis  following 
measles,  and  one  of  Elephantiasis  of  the  face,  scalp,  and 
neck. 

Mr.  Wallace  showed  a  patient  who  had  made  a  perfect 
recovery  after  the  evacuation  of  a  large  cerebral  abscess 
involving  the  left  temporo-jsphenoidal  lobe.  The  abscess 
had  followed  suppuration  in  the  mastoid,  cells. 

Mr.  Stiles  show  three  patients  ;  1.  A  child  with  com- 
plete arrest  of  development  of  both  ears.  2.  A  child  with 
a  cervical  rib.  3.  A  child  with  symmetrical  tubercular 
lesions,  namely,  osseous  tubercles  of  the  floor  of  the  orbit. 

Mr.  Alexis  Thomson  showed  two  men  in  whom  he  had 
excised  portions  of  the  fifth  nerve  for  neuralgia.  In  one 
he  had  performed  Rose's  operation  and  callea  attention  to 
the  small  amount  of  deformity  resulting. 

Dr.  Norman  Walker  showed  four  cases  of  lichen  planus, 
one  of  leucoderma,  and  one  of  lupus  vulgaris. 

SPECIMENS. 

Dr.  Burn  Murdoch  showed  a  piece  of  raw  rhubarb 
which  had  caused  intestinal  obstruction  in  a  child,  and  a 
specimen  of  caries  of  the  atlo-axoid  articulation. 

Dr.  A.  Jamuson  showed  the  two  parasites  of  ringworm 
under  the  microscope* 

Dr.  Mackenzie  Johnston  showed  a  boot  button  which 
had  formed  the  centre  of  a  rhinolith. 

Dr.  Wallace  :  1.  Epithelioma  of  larynx,  after  complete 
laryngectomy.  2.  Malignant  double  stricture  of  the  oaso- 
phagus. 

Dr.  Leith  :  Specimens  illustrating  a  case  of  coincident 
siknple  perforating  ulcer  of  the  sbomach,  and  primary 
colloid  cancer  of  c»cnm.  2.  Two  cases  of  malignant 
disease  of  the  terminations  of  the  common  bile  duct. 

EXHIBITS. 

Mr.  Caird  exhibited  a  portable  steriliser  for  inttm- 
ments. 
Mr.  Stiles  an  improved  tonsillotome  (Mathieu). 


LIVERPOOL  MEDICAL  SOCIETY 
Meeting  held  Friday,  December  12th. 


Mr.  Chaunct  Puzet  in  the  Chair. 


THROAT   GASES. 

Mr.  Bark  showed  two  patients  after  endo-laryngeal 
removal  of  Singer's  nodule.  They  were  both  professional 
voice  users.  The  first,  a  *<  star  oomique,"  had  completely 
lost  his  singing  voice.  The  growth  had  been  removed  in 
1892,  by  another  specialist,  but  recurred  in  about  a  year. 
He  presented  himself  in  July,  1893,  and  the  growth  was 
completely  removed  by  means  of  Grant's  guanled  laryn- 
geal forceps.  Two  weeks  after  the  operation  he  fulfilled 
an  engagement  at  Brighton,  and  wrote  « that  his  voice  had 


10  .  The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


5as,  I9  18B6. 


never  been  better."  Two  years  have  elapsed  withoat  ( 
recurrence.  The  second  patient,  a  choirmaster,  had 
suffered  from  hoarseness  and  loss  of  singing:  voice  for  over 
two  years.  The  growth  in  this  case  also  was  removed  by 
Grant's  forceps,  on  the  29bh  Jane,  1894.  His  voice  had 
been  good  ever  since.  Mr.  Bark  also  showed  a  papilloma 
removed  from  the  anterior  commissure  of  the  uu^nx  by 
means  of  Gibb'B  snare,  and  a  patient  suffering  from 
trachoma  of  the  larynx. 
Dr.  Stbbves  read  a  short  note  on 

A  BESPONSIBILrnr  TO  THE  LYING-IK  PATIENT  FBOM  A 
SANITABT  POINT  OF  VIEW. 

Puerperal  fever  now  being  a  "  notifiable  disease  "  we  no 
longer  question  the  nomenclature  from  a  public  health 
standpoint,  so  lone  as  the  practititioner  and  sanitary 
authority  do  their  duty  under  the  Act :  remarks  confined 
to  that  variety  of  puerperal  fever  whi(^  exists  as  the 
result  of  defective  sanitation.  Dr.  Steeves  referred  to 
instances  where  puerperal  septictdmia  existed  as  the 
result  of  atmospheric  infection  by  sewer-gas.  He 
touched  on  the  result  of  removal  of  patients  suffering 
from  puerperal  fever  to  healthy  surrounoings.  In  the  city 
of  Liverpool,  one-third  of  the  cases  of  puerperal  fever 
reported  occurred  in  houses  which  came  under  the  category 
of  insanitary.  The  prevalence  of  puerperal  fever  is  no 
necessary  index  of  the  amount  of  zymotic  disease.  In 
Liverpool,  in  1893, 82  cases  of  puerperal  fever ;  in  1874, 68 
oases.  But  there  were  many  more  cases  of  zymotic  disease 
in  1894.  A  total  of  nearly  1,000  more  in  the  latter  year. 
The  medical  attendant  when  engaged  to  attend  confine- 
ments rarely  proceeds  to  the  i^remises  of  the  patient  to 
investi^te  the  sanitary  conditions  likely  to  affect  the 
case  ultimately.  He  pointed  out  the  necessity  where  the 
owner  refuses  to  abate  a  nuisance,  of  the  p^sician  cidling 
the  attention  of  the  sanitary  authority.  Where  the  phy- 
sician is  without  experience  in  sanitary  detail,  he  should 
not  hesitate  to  obtain  a  skilled  opinion,  a  protracted  period 
of  ill-health,  often  conveniently  passed  as  ''general 
debility"  frequently  results  after  a  confinement,  the 
victim  suffering  from  chronic  sewer  gas-poisoning,  only 
got  rid  of  by  change  of  residence  or  alteration  of  sanitary 
arrangements.  He  then  moved  the  following  resolution, 
viz. :  "  That  in  the  opinion  of  the  membera  of  the  Liver- 
pool  Medical  Institution,  it  is  the  duty  of  every  medical 
practitioner  when  eng^aged  to  attendT  a  confinement  to 
forthwith  inspect,  or  cause  to  be  inspected,  the  premises 
of  the  patient,  with  a  view  of  having  any  sanitary  defects 
which  may  exist  corrected^  and  so  further  the  stcmiping 
out  of  puerperal  septionmia  by  the  methods  of  preventive 
medicine." 

SPIKAL  LOCALISATION. 

Prof.  Shbbbington,  in  a  paper  on  this  subject,  drew 
attention  to  the  localisation  of  function  in  the  spiniJ  cord, 
as  illustrated  by  the  distribution  to  the  skin  of  tne  sensory 
spinal  nerve  pairs  arisinff  from  the  cord.  He  pointed  out 
that  experiments  show  the  field  of  skin  supplied  by  each 
sensory  spinal  nerve-root  to  be  a  large  area  of  somewhat 
simple  configuration.  Where  simplest,  e^.,  in  the  trunk 
and  neck  the  segmental  skin-fluid  is  band-like,  wrapping 
transversely  round  one  lateral  half  of  the  body.  In  the 
limbs  the  spinal  skin-fields  are  distorted  from  the  simple 
band-Uke  type.  Further,  in  the  limbs  the  spinal  skm- 
fields  are  disconnected  from  attachment  to  ^e  median  line 
of  the  body,  although  in  the  trunk  and  neck  each  of  the 
special  skin-fields  always  extends  from  the  mid- 
dorsal  line  to  the  mid-ventoal  line.  In  the  regions  of  the 
limbs  the  mid-dorsal  line  of  the  body  may  be  said 
to  extend  laterally  in  a  side-branch  forming  a 
secondary  axis  almost  at  right  angles  to  the  main  axis ; 
upon  this  secondary  axis,  mich  may  be  called  the  limb- 
axis,  the  spinal  skin  fields  are  ranged*  as  though  upon 
folded  portions  of  the  axial  lines  of  the  trunk  itself. 
Each  spinal  skin-field  spreads  out  to  a  marked  extent 
into  neighbouring  spinal  skin-fields.  Each  spinal  skin- 
field  has  in  this  way  an  overlap  into  the  next  field  in 
front  and  into  that  next  behind.  There  is,  therefore,  no 
area  of  skin  which  is  supplied  by  one  spinal  nerve  above, 
and  the  supply  is  from  two  roots,  in  some  places,  e.^.,  the 
palm  |f  rom  three  spinal  roots,  although  in  a  plexus  each 
sensory  spinal  root  gives  separate  contributions  to  many 
nerve  trunks,  the  cuteneoue  oistribution  of  the  root  com- 
\  a  field  not  of  disorete  or  disjoined  patches,  but  of 


patches  so-joined  that  the  distribution  of  the  entire  root 
forms  one  continuous  field. 

Prof.  Patebson  described  the  distribution  of  special 
nerves  to  the  skin  and  muscles  of  the  trunk  and  limbs  of 
man.  He  pointed  out  that  while  superficially  segmental 
in  origin,  tne  spinal  nerves  are  truly  segmental  in  distri- 
bution only  to  the  muscles  of  the  thoracic  wall ;  and  that 
where  the  segmental  elements  forming  muscles  have  com- 
bined, the  segmental  nerves  combine  also,  forming 
plexuses.  With  regard  to  cutaneous  innervation  it  was 
certain  that  a  certain  overlapping  takes  place  in  the 
distribution  of  the  simplest  type  of  the  nerve,  so  that  it 
was  possible  to  affirm  that  no  spot  of  skin  and  no  muscle 
(except  the  intercostal  muscle)  is  supplied  by  a  single 
spinal  nerve.  With  this  qualification  the  cutaneous  inner- 
vation of  tlie  trunk  between  the  limbs  is  zonular; 
continuous  belts  of  skin  are  supplied  from  back  to  front  by 
the  branches  of  the  third  to  the  twelfth  thoracic  nerves. 
The  nipple  lies  in  the  track  of  the  fourth,  the  umbilicus  in 
that  of  the  tenth,  nerve.  The  growth  of  the  head  and 
limbs  causes  the  adjacent  nerves  to  be  drawn  out  of  their 
primitive  positions,  so  that  the  back  of  the  head  is  inner- 
vated by  C.  2  and  3  ;  the  buttock  receives  nerves  from  T 
12  and  Li ;  and  the  buttock  and  back  of  the  thigh  nerves 
from  8.  2  and  3.  In  the  limbs  lines  (dorsal  and  ventral 
axial  lines  of  Sherrington)  could  ^he  drawn  from 
the  middle  line  of  the  body  down  the  limbs,  and 
indicated  the  meeting  place  of  widely  separated 
nerves.  In  the  area  the  dorsal  line  separates  the 
area  supplied  by  third  and  fourth  cervical  from  that 
suppUea  hy  second  and  third  thoracic.  The  central  line 
extends  to  the  wrist,  and  separates  the  areas  of  distribu- 
tion of  C  3.  4.  5.  6.  from  those  of  721.  G.  8,  and  it  is  only 
at  the  ends  of  these  lines  that  a  continuity  of  distribution 
appean,  and  the  seventh  cervical  nerve  takes  its  proper 

Slice  in  cutaneous  innervation.  In  the  lower  limb  the 
orsal  line  traceable  over  the  buttock  to  the  head  of  the 
fibula  separates  L  1.  2.  3.  from  S  1.  2.  3.  The  ventral  line 
extends  from  the  penis  (supplied  by  L  1.  and  8  2.  3.)  to 
the  inner  ankle  and  separate  from  above  down,  the  areas 
in  Uie  front  of  the  limb  supplied  by  L  1.  2.  3.  4.  from 
those  on  the  back  supplied  by  8  3.  2. 1.  At  the  ends 
of  these  lines  as  in  the  arm  the  intervening  nerves 
L.  4  and  5  or  L.  5  make  Uieir  appearance,  and  cause  regu- 
lar continuity  of  innervation  of  the  leg  and  foot.  It  is 
wen  in  the  limbs  that  in  spite  of  the  apparent  complexity 
due  to  the  combination  of  the  spinal  nerve  in  the  plexuses 
and  in  the  nerves  of  distribution,  a  definite  arranjp^ment 
exists  by  which  the  skin  and  muscles  are  supplied  by  a 
gradually  descending  series  of  spinal  nerves  proceeding 
from  the  preaxial  to  the  postaxial  Dorders  of  the  limbs. 


LARYNGOLOGICAL  SOCIETY  OF  LONDON. 
Obdinabt  Meeting,  Wednesday,  Deo.  11th. 


The  President,  Dr.  Feux  Semon,  in  the  Chair. 


OASES. 


Mb.  C.  Babeb  gave  a  further  report  of  the  case  of 
papilloma  of  the  nose  shown  befor  Che  Society  last  April. 
It  nad  been  thoroughly  removed,  and  up  to  Nov.  29th  nad 
showed  no  sign  of  recurrence.  Microscopical  examination 
showed  the  «rowth  to  be  a  true  papilloma. 

Dr.  J.  B.  Ball  showed  a  case  of  soft  fibroma  of  the  left 
vocal  cord. 

Dr.  CuFFOBD  Beale  showed  two  pathological  specimens 
of  tubercular  infiltration  of  the  pharjnix  and  tongue. 

Dr.  Bennett  showed  a  microscopical  section  of  a  round- 
celled  sarcoma  of  the  thyroid. 

Mr.  L.  Lawbence  showed  a  case  of  naso-pharyngeal 
polypus  with  nasal  polypi. 

Mr.  DB  Santi  suggested  splitting  the  soft  palate,  and 
thus  removing  the  growth. 

Mr.  C.  Baber,  Mr.  Spencer,  Dr.  Dundas  Grant,  Dr« 
Permewan,  Mr.  Waggett,  and  Dr.  Scanee  Spicer  all  con- 
sidered this  a  simple  case  of  mucous  polypi  capable  of 
being  removed  by  the  snare  or  polypus  forceps. 

Mr.  DE  Santi  showed  two  pathological  specimens  of 
tubercular  ulceration  of  the  trachea,  larynx,  and  pharynx. 

Dr.  Semon  brought  f orwi»d  a  case  of  a  gentleman  sent 


JA2r.  1,  1896. 


GERMANY. 


from  Aodtralia,  who  had  some  ulcerative  process  in  the 
larynx. 

Br.  ScAKss  Spioeb  thought  it  was  syphilitic. 

Br.  W.  Hill  did  not  think  it  was  either  tubercnlar  or 
Byphilitie,  and  suggested  it  might  be  a  kind  of  ulcerative 
larvngitis  seen  in  some  parts  of  Europe. 

Br.  SiMONy  in  reply,  said  he  had  not  yet  made  up  his 
mind  what  it  was. 

Mr.  W.  6.  Spsnokr  showed  a  case  of  stenosis  of  the  larynx 
caused  by  a  chronic  inflammatory  thickening. 

A  discussion  arose  as  to  whether  the  chronic  inflamma- 
tory condition  was  caused  by  the  nasal  obstruction  exist- 
ing. Dr.  BeHavillandHall  and  Br.  Scanee  Spicer  thought 
this  was  the  case,  but  the  President,  Mr.  Baber,  Br.  Per- 
mewan,  Br.  HUl,  and  Br.  Bundas  Grant  were  of  the 
opposite  opinion. 

Mr.  Stabb  again  brought  forward  the  case  of  enlarged 
thyroid  shown  at  the  last  meeting  of  the  Society,  the 
tumour  had  been  removed,  and  the  lad  was  doing  well. 

Mb.  W.  R.  W.  Stewart  showed  a  man,  between  50  and 
60,  who  had  suffered  from  a  very  large  tumour  of  the  nose 
for  twen^-five  years.  Last  May,  after  an  endeavour  had 
been  made  to  remove  the  growth  by  the  ecraseur,  Mr. 
Macready  turned  by  the  upper  jaw  performing  a  slightly 
modified  Mansell  MouUin  operation.  The  tumour  was 
found  to  be  growing  from  the  nasal  septum,  and  on 
removal  was  found  to  measure  4  in.  x  2^  in.  x  If  in. 
Microscopical  examination  showed  it  to  be  a  true  fibroma. 
It  ie  by  far  the  largest  tumour  of  the  kind  on  record. 

The  Pbisidsnt  sug^gested  that  a  woodcut  should  be 
obtained  forlinsertion  in  the  Society's  proceedings  as  the 
case  was  evidently  unique. 

Mr.  J.  Stmonds  gave  a  further  report  of  two  cases  of 
teionof  the  septum  shown  at  the  October  meeting. 

Mr.  C.  B.  Waoghtt  brought  forward  a  case  for  diagno- 
sis, a  woman,  sat.  54,  giving  a  history  of  impacted  fish 
bone  with  symptoms  persistmg  for  fourteen  months. 

Br.  W.  A.  WILLS  showed  a  case  of  inspiratory  spasm  of 
the  vocal  cords. 


^^XWftU. 


[fBOM  OUK  own  CX)KaBSPONDENT.] 

PABI6,  Dec.  28. 
SlEFTIC^MIA. 

At  the  meeting  of  the  Surgical  Society,  M.  Pozzi  read  a 
p^per  from  a  coUeagne  at  Nice,  on  a  case  of  septic»mia, 
treated  successfully  by  intravenous  injections  of  serum. 
A  lady,  on  whom  hysterectomy  had  been  performed  per 
▼aginam,  was  seized  on  the  third  day  with  the  gravest 
symptoms:  enlarged  abdomen,  dyspnoea,  intense  low 
temperature,  and  vomiting.  On  the  following  day,  the 
death  agony  seemed  to  have  set  in,  when  the  surgeon  made 
an  injection  of  twenty  ounces  of  serum  prepared  according 
to  the  formula  of  M.  Hayem,  and  soon  afterwards,  an- 
other of  thirty  ounces.  The  patient  for  a  short  time  was 
in  a  critical  condition  as  a  consequence  of  the  injections, 
but  soon  rallied,  and  eventually  made  a  good  recovery. 

M.  Segond  said  that  for  a  long  time  he  was  in  the  habit 
of  improving  the  general  condition  of  his  patients  who  lost 
a  good  deal  of  blood  from  operations,  by  intravenous  or 
sabcntaoeons  injections  of  artificial  serum.  For  the  last 
four  years,  he  did  not  perform  any  great  operation  with- 
out having  recourse  to  these  injections.  He  had  injected 
as  much  as  forty  ounces  of  serum  into  the  subcutaneous 
oeQular  tissue^  and  resuscitated  in  this  manner  many 
pateits  who  would  have  otherwise  succumbed. 

M.  Monod  observed  that  he  saw  his  house  surgeon,  last 
year,  inject  from  twenty  to  forty  ounces  of  serum  with 
excellent  results  and  without  causing  any  accidents. 

M.  Michanx  had  frequently  had  recourse  to  intravenous 
iojeotioDfl  in  operations  for  fibroma  when  the  loss  of  blood 


The  ^Itdical  Press.     11 

was  very  great,  and  also  in  csises  of  grave  septicemia.  M. 
Terrier  thought  that  it  was  immaterial  to  make  injections 
into  the  veins  or  cellular  tissue,  and  recognised  their 
efficacy. 

TCJBBKCULOUS  PERITONITIS. 

M.  Rendu  communicated  to  the  Medical  Society  a  case 
of  tuberculous  peritonitis  with  ascites,  in  a  lad  of  17,  in 
whom  all  bad  symptoms  had  disappeared  after  tapping, 
followed  by  washing  out  the  peritoneal  cavity  with  eight 
quarts  of  hot  sterilised  water. 

M.  Sireday  had  a  similar  case  in  a  girl,  which  he  was 
going  to  treat  by  injections  of  camphorated  naphthol  as 
recommended  by  his  colleague,  M.  Rendu,  but  remem- 
bering the  remarks  recently  made  by  M.  Netter,  on  the 
danger  of  this  treatment,  he  put  it  off  for  some  days,  and 
in  the  meanwhile,  to  his  great  surprise,  the  symptoms 
began  to  disappear,  and  finally  the  patient  left  the  hos- 
pital entirely  well,  without  any  interference. 


Sermanp. 

[from  our  own  oorrbspondent.] 

Bbrlin,  Dec.  27th. 
At  the  Society  for  Nervous  Biseases  Hr.  Brasch  showed 
preparations  of 

Early  Syphilitic  Biseasb  of  the  Central  Nervous 

System 
taken  from  a  man,  sdt.  47.  The  man  was  a  gilder,  and 
worked  a  good  deal  in  lead.  In  his  family  there  had  been 
both  mental  disease  and  phthisis.  The  wife  and  children 
were  healthy.  He  became  infected  in  1891.  After  three  to 
four  weeks  a  sore  formed,  which  was  of  a  phagedenic 
kind.  He  had  acute  stomatitis  after  a  course  of  inunction, 
and  the  course  had  to  be  interrupted.  Six  weeks  after 
inunction  the  patient  had  facial  paralysis,  which  showed  a 
severe  reaction  of  degeneration.  There  was  no  lead  line. 
In  the  beginning  of  November  he  complained  of  headache 
and  giddiness.  His  appearance  was  bad,  and  he  became 
still  more  cachectic.  The  paralysis  showed  no  tendency  to 
disappear.  Transient  contractions  and  Westphal's  sign 
were  observed.  The  paralysis  was  at  first  thought  to  be 
rheumatic,  but  when  later  auditory  disturbances  set  in  the 
suspicion  of  brain  mischief  arose.  The  patient  had  taken 
potass,  iodidi.  Small  doses  of  mercury  w6re  now  given 
internally.  As  the  headache  and  giddiness  got  worse  he 
was  admitted  into  hospital.  The  disease  affected  the 
labyrinth,  and  was  more  on  the  right  than  on  the  left 
side.  In  about  two  months  time  he  was  discharged  free 
from  trouble,  but  in  a  fortnight  the  headache  and  giddiness 
returned.  Inunction  and  pot.  iodidi  were  ordered,  and 
whilst  these  were  being  given  left  hemiplegia  came  on. 
The  patient  finally  died  with  bulbar  symptoms. 

The  autopsy  was  a  surprise.  Basilar  meningitis  and 
disease  of  the  vessels  were  expected,  but  were  not  present, 
but  instead,  a  purely  vascular  form  of  cerebral  syphilis.  The 
right  pons  was  smaller  than  the  left,  the  central  ganglia 
normal.  All  the  basilar  arteries  were  greatly  changed. 
There  was  secondary  degeneration  in  the  pyramidal  tract, 
from  the  cervical  medulla  to  the  pons,  but  not  passing 
beyond  this.  The  peripheral  nerves  also  showed  changes. 
The  period  of  the  commencement  of  the  disease  was  of 
special  interest.  The  division  into  the  three  stages  of  the 
disease  was  not  justifiable.  The  chief  form  of  cerebral 
syphilis    was   the   vascular   and    meningitio,    and   this 


12     Thk  Mrdical  Pkkss. 


AUSTRIA. 


Jan.  1,  1896. 


was  an  etirly  form.  The  infiltrations  that  formed 
at  the  base  of  the  brain  might  later  on  thicken 
into  gammatous  formation.  In  other  respects  also  we 
were  not  justified  in  distingaishing  a  seoondary  from  a 
tertiary  syphilis.  In  condasion,  the  speaker  formulated 
the  following : — 

1.  Disease  of  the  central  nervous  system  is  possible  in 
every  stage  of  syphilis. 

2.  This  appears  so  much  the  earlier,  as  the  treatment 
has  been  insufficient  and  attention  to  bodily  wants  defec- 
tive. 

3.  As  regarded  disease  of  the  nervous  system  there  was 
no  distinction  between  early  and  late  periods. 

At  the  Darmatological  Society  (Dec.  3rd)  Hr.  Litten 
showed  a  case  of 

Diffuse  Intkistitial  Syphilitic  Hepatitis. 

The  speaker  remarked  that  syphilis  of  the  internal 
organs  rarely  came  before  the  syphiologist,  it  generally 
went  to  the  physician.  Syphilitic  disease  of  the  liver 
was  the  common  form  of  internal  syphilitic  disease,  the 
easiest  to  examine,  and  the  safest  to  diagnose. 

Four  forms  of  liver  syphilis  could  be  distinguished  :— 
1 )  Perihepatitic  syphilis,  (2)  the  amyloid  form  of  syphi- 
litic disease  of  the  liver,  (3)  syphilitic  cirrhosis  of  the 
liver,  and  (4)  difi'use  interstitial  syphilitic  hepatitis.  This 
latter  form  was  first  described  by  Wagner.  The  speaker 
had  seen  three  cases.  Anatomically  there  was  diffuse 
growth  of  the  connective  tissue,  which  gradually  pressed 
upon  and  took  the  place  of  the  liver  tissue.  The  newly- 
formed  connective  tissue  had  no  tendency  to  shrink. 

The  consistence  of  the  liver  was  that  of  a  shoe  sole 
(Trousseau)  or  that  of  a  hearthstone  (Gabler).  He  (the 
speaker)  would  describe  it  as  polished  ivory.  This  form 
developed  for  years  without  symptoms.  Jaundice  might 
or  might  not  be  present.  Retrogression  of  the  enlarged 
liver  would  take  at  least  years.  He  had  never  proved 
that  it  took  place.  The  patient  shown  acquired  syphilis 
in  1870.  Two  years  ago  a  relapse  took  place  in  the 
throat :  the  patient  had  then  been  under  treatment  eight 
weeks.  He  had  felt  the  hardness  in  his  abdomen  for 
years.  He  had  been  treated  by  sublimate  injection. 
Objectively,  no  change  had  been  observed  in  the  liver. 
The  Imperial  Health  Office. 

In  the  Reichsgesundheitsamt  the  work  to  be  done  has 
ncreased  so  much  that  it  is  already  beyond  the  powers 
of  thelpresent  ordinary  members.  In  addition  to  the 
duties  already  undertaken,  experimental  investigations 
have  to  be  made  into  toxicological,  pharmacological,  and 
pbyeiologico-ohemical  matters.  Inquiries  have  to  be  made 
as  to  injurious  consequsnces  to  health  of  certain  industries, 
and  in  the  preparation  of  certain  foods  and  articles  of  con- 
sumption, and  the  skilled  examination  of  drugs,  with,  the 
view  to  another  pharmacopoeia-medical-statistics,  also 
require  attention.  Next  year,  another  member,  making 
the  ninth,  will  be  appointed,  with  a  salary  of  4,500  marks. 
The  whole  cost  of  the  office  for  the  year  1896-7  will  be 
277,550  marks,  or  11,116  more  than  the  year  now  ending. 
The  Sale  or  Diphtheria  Sebum  and  the 
Government. 

The  Minister  for  Medical  Affairs  has  made  the  public 
announcement  that  after  conferring  with  the  principal 
manufacturers  of  diphtheria-curative  serum,  the  Hochst 
Company  and  the  Chemische  Fabrik  serum  of  higher 
strength  than  was  formerly  made  may  now  be  procured 
at  the  apothecaries.    That  for  semm  oontaining  300  units 


per  cubic  centimetre,  the  price  is  1*35  m.  per  centimetre ; 
for  that  containing  400  units,  the  price  is  2*40  m. ;  and  for 
that  containing  500  units,  the  price  is  4  marks.  It  is  not 
expected  that  the  price  wiU  be  reduced  at  present,  even 
for  charitable  institutions. 

Locomotion  or  Gonooocci. 

At  the  Medical  Society  (Dec.  11th)  Hr.  Merre,  of  Chile, 
showed  some  mieroecopio  preparation  of  pus  cells  contain- 
ing gonooocci.  The  latter  showed  an  active  movement 
independent  of  the  current  under  the  oover-glass.  He 
made  the  observation  that  gonooocci  possessed  independ- 
ent movement  in  Hr.  Lassar's  klinik. 

Hr.  Hirsohfeld  gave  an  address  on  the 

Diagnosis  and  CorBSS  or  Dubbtbs. 
He  did  not  distinguish  the  easily  curable  and  the  incur- 
able form  as  two  distinct  groups  of  the  disease,  but  only 
recognised  one  form  in  which  variations  for  the  better  or 
worse  were  observed.  Many  intercurrent  diseases  increased 
the  excretion  of  sugar,  f  urunculosis,  for  example,  whilst 
others,  such  as  phthisis,  diminished  the  proportion  of 
sugar  in  the  urine.  Therapeutically,  great  individualisa- 
tion  was  necessary,  as  the  therapeutic  factor  acted  differ- 
ently in  different  individuals.  A  diminution  of  the 
excretion  of  sugar  always  followed  the  withdrawal  of 
carbohydrates,  but  this  result  followed  quickly  in  some 
eases  and  later  in  others.  This  diminished  glycosuria,  how- 
ever, was  not  at  the  same  time  an  improvement  of  the  condi- 
tion, for  many  patients  with  an  almost  exclusive  meat  diet 
had  serious  attacks,  especially  coma.  Over-feeding  acted 
in  the  same  way  as  under-feeding,  %.e*,  unequally  upon 
patients,  and  it  was  the  same  with  muscular  movement. 
The  speaker  then  passed  on  to  discuss  drug  treatment , 
and  showed  how  uncertain  this  was  alsa 


^xtBtm. 


[raOM  OVB  OWN  oobbeepondbnt.] 

Vienna,  Dec.  27tli. 
Extirpation  of  the  Uterus  with  Parametria. 
At  the  Oesellschaft  der  Aerzte,  Latzko  exhibited 
a  woman  from  whom  he  had  removed  the  uterus  with 
the  adnexa.  The  patient  had  suffered  from  epithe- 
lioma of  the  portio  which  he  determined  to  remove  by  a 
method  which  he  claims  to  be  his  own.  The  principle  on 
which  he  rests  the  claim  of  operation  is  the  re- 
moval of  the  parametria  which  he  believes  to  be 
the  residual  centre  of  a  new  outbreak  of  the  can- 
cerous condition,  as  the  poison  is  carried  to  the 
lymphatics  where  new  deposits  are  formed.  For  the 
perfect  execution  of  the  operation  laparotomy  is  essential. 
When  cutting  round  the  ureters  the  sound  should  be 
used  for  their  protection,  the  bladder  dissected  from 
behind,  and  the  folds  of  ligament  carefully  removed 
from  the  ureter ;  the  peritoneal  covering  of  the  poeterior 
wall  of  the  pelvis  may  then  be  carefully  stripped, 
with  the  glands  from  the  large  blood  vessels  extending 
from  the  iliac  down  to  the  mouth  of  the  ureters, 
while  the  broad  ligament  should  be  followed  to  its 
insertion  in  the  walls  and  closely  removed.  The  operation 
may  be  termed  a  general  surgical  one,  recognised  in 
removing  a  neoplasm,  as  the  greatest  care  is  necessary  in 
taking  away  all  probable  centres  of  future  origin.     |He 


Jan.  h  1886. 


THE  OPERATINQ  THEATEE8. 


Ths  Mxdigal  Titvs^      13 


I  it  impossible  to  remove  as  thoroughly  as  abonld 
be,  per  vaginam,  the  whole  eztensioo  of  carcinoma  a« 
poisooooB  coDtiee  are  sure  to  be  left  in  the  broad  ligament 
Vertheim  in  criticising  Latzko's  operation  said  he  ooald. 
aee  very  little  novelty  in  the  method  as  he  thonght  Rampf 
of  Berlin  had  long  sinoe  practised  this  form  of  removal 
For  the  ap{ilioatioo  of  the  sound  in  the  nreter  he  could  see 
little  advantage  of  this  as  a  careful  dissection  of  the  ureter 
can  be  easily  performed  without  this  difficult  procedure. 
Again,  he  objected  to  laparotomy  being  combined  with 
the  vaginal  method  if  no  infiltration  of  the  parametria 
eusted.  The  opening  of  the  abdomen  was  too  serious 
an  experiment  to  carry  out  on  mere  supposition.  In 
seven  of  the  oases  thus  treated  by  Schauta  in  his  clinic, 
only  two  recovered  and  five  died.  It  is  even  possible  to 
remove  by  the  vagina  inflammatory  or  carcinomatous  in- 
filtrated parametria.  Again,  total  extirpation  by  this 
operation  will  net  secure  immunity.  A  radical  operation 
most  include  resection  of  the  ureters  which  is  not  likely 
to  be  removed. 

ScBPHBVNic  Abscess. 
At  the  Doktoren  KoUegium  Hermann  Schlesinger 
tnoed  the  history  of  this  morbid  condition  from  the  time 
of  Barlao,  1845>  to  the  present.  He  pointed  out  the  diffi- 
culty of  diagnosis  and  the  necessity  of  confirmation  by 
post-mortem.  Leyden  had  put  on  record  many  useful 
observations,  while  France,  in  1880,  had  added  more  diffi- 
culty by  applying  the  term  of  false  pneumothorax.  The 
best  monograph  on  the  subject  to-day  is  Maydl's.  In  the 
diagnosis  there  was  no  true  point  in  auscultation  or  per- 
cussion to  be  relied  on  as  the  disease  might  arise  from 
neighbouring  organs  lying  in  the  vicinity  of  the 
diaphragm,  such  as  the  liver,  pancreas,  kidneys, 
retro-pharyngeal  lymphatics,  while  the  spleen  is  not  to 
be  neglected.  On  tiie  upper  side  of  the  diaphragm 
the  lungs,  pleura,  pericardia,  and  heart  may  be  the 
starting-point  of  subphrenio  absoeeses.  More  remote 
causes  may  be  found  in  the  vermiform  process  or  female 
organs— perforating  injuries  or  metastatic  causes.  Winter- 
nitz  showed  a  patient,  on  whom  Maydl  had  operated  on 
fire  years  ago  for  subphrenic  abscess.  In  July,  1890,  she 
came  to  him  with  the  phenomena  of  muscular  rheumatism 
and  left-sided  pleuritis.  The  temperature  was  38  degrees. 
Upon  auscultation  there  was  catarrhal  vesicular  breath- 
ing, with  snoring  and  whistling  rMes ;  posteriorly  there 
was  a  band-breadth  of  dulnees ;  the  fever  increased  while 
pain  continued.  The  persistance  of  the  dulness,  and  the 
continQance  of  fever  with  asthenic  pulse,  and  the  absence 
of  tuberde  bacilli  in  the  sputa,  negatived  the  diagnosis  of 
pbthisu ;  neither  did  the  bacilli  lend  any  confidence  to 
the  diagnosis  of  the  latter.  By  exclusion  the  subphrenic 
process  was  diagnosed,  but  whether  the  morbid  condition 
bad  its  origin  above  or  below  the  diaphragm. was  not  so 
clear.  Aspiration  under  the  twelfth  rib  gave  exit  to 
a  purulent  discharge  ;  a  free  incision  was  afterwards  made. 
Washing  applications  of  iodoform  and  glycerine  with 
drainage  brought  about  a  good  result. 


ST.  THOMAS'S  HOSPITAL. 

OfeRATION  fob  SuPPURATIVB  PlKITONITIS,  SHOWING  THK 
ADVAiniGB  OY  PBOMPT    SuBOIOAL     lNTBRRBBNGI.-Mr. 

Barlb  Operated  on  a  young  man,  fst.  about  21,  who  had 
been  admitted  a  few  hours  before  with  symptoms  of  acute 


abdominal  mischief.  He  stated  that  three  days  before  he 
had  been  opening  a  door  and  had  struck  himself  a  blow 
over  his  hip,  which  caused  him  to  sit  down  rather  suddenly 
on  the  ground.  Soon  afterwards  he  felt  pain  in  the  abdo- 
men, which  had  since  increased  in  severity,  so  that  for  two 
days  he  had  been  obliged  to  keep  in  bed.  His  bowels  had 
acted  and  there  had  been  no  vomiting.  When  seen  by  the 
doctor  he  complained  of  the  above  symptoms,  and  was 
sent  to  the  hospital,  as  the  medical  man  teld  the  patient 
he  did  not  quite  understand  the  nature  of  the  case.  On 
arrival  in  the  wards  he  lay  on  his  back,  with  his  knees 
drawn  up,  complaining  of  pain  in  the  abdomen,  which  was 
subject  to  marked  exacerbations,  during  which  he  threw 
his  head  backwards  and  held  his  breath ;  he  had  a  look  of 
anxiety,  and  respiration  was  entirely  thoracic,  though 
fairly  regular.  The  tongue  and  mouth  were  dry,  pulse 
quick,  and  temperature  102*4 ;  the  abdomen  looked  normal, 
not  being  distended  ;  the  walls  were  rigid,  and  he  com- 
plained of  excessive  tenderness,  so  that  it  was  hardly 
possible  to  touch  him.  Light  percussion  was  possible, 
however,  and  showed  an  area  of  dulness  extending  from 
the  pubes  outwards  to  about  the  middle  of  Poupart's  liga- 
ment on  the  right  side.  This  dulness  was  about  an  inch 
and  a  half  wide  above  the  spine  of  the  pubee, 
gradually  diminishing  to  the  right.  These  sym- 
ptoms were  considered  to  be  due  to  an  early 
stage  of  suppurative  peritonitis  and  operation  waa 
advised.  The  patient  readily  consented,  so  a  median  inci- 
sien  was  made  above  the  pubes  in  the  middle  line,  the 
peritoneum  opened  and  a  quantity  of  pus  about  equal  to 
half  a  pint  evacuated  ;  this  occupied  the  pelvis  and  ex- 
tended into  the  right  iliac  fosse,  but  was  not  shut  off  by 
adhesions  from  the  general  peritoneal  cavity.  The  source 
of  the  mischief  could  not  be  demonstrated,  but  it  was  sup- 
posed that  it  was  in  the  appendix  vermiformis.  The 
abdomen  was  washed  out  with  sterilised  water  and  a  glass 
drainage  tube  put  in.  Mr.  Battle  remarked  that  this 
patient  had  been  submitted  to  operation  at  an  earlier 
period  than  was  usually  the  case  in  suppurative 
peritonitis,  as  it  was  the  custom  for  the  physician 
to  wait  until  the  classical  signs,  including  vomiting,  had 
unmistakably  proved  the  presence  of  peritonitis,  when 
the  patient  was  therefore  exhausted,  and  unable  to  stand 
the  necessary  surgical  procedures,  when  also  considerable 
changes  had  taken  place  on  the  surface  of  the  peritoneum ; 
when  the  suppuration  was  widely  diffused  throughout  the 
serous  membrane,  and  it  was  difficult  to  disinfect  the 
large  surface  affected,  and  the  patient  was  suffering  from 
the  efiects  of  absorption  from  such  an  extensive  area. 
Many  physicians  would  probably  not  consent  to  operation 
before  vomiting  had  declared  itself,  but  this  case  proved, 
he  thought,  the  value  of  a  combination  of  symptoms  indi- 
cating suppurative  peritonitis,  which,  taken  together,  form 
an  urgent  call  for  operation  ;  this  latter  can  abne  save  the 
patient,  whose  chances  are  greatly  increased  by  prompti- 
tude in  carrying  out  the  necessary  procedures.  Only  the 
week  before  be  had,  he  said,  been  called  upon  to  see  a 
case  of  suppurative  peritonitis  while  the  symptoms  were 
undoubted,  but  the  patient,  a  boy,  sst.  14,  was  so  exhausted 
that  he  died  twelve  hours  after  a  simple  incision  through 
the  abdominal  wall.  In  this  latter  case  there  had  been 
two  dajTs'  severe  abdominal  pain  and  then  vomiting,  which, 
at  the  time  the  boy  was  seen  by  Mr.  Battle,  was  one  of 
several  symptoms  which,  while  thev  indicated  without 
doubt  the  nature  of  the  case,  showed  also  the  extremely 
bad  condition  of  the  patient.  This  state  is  one,  he  though^ 
with  which  surgeons  are  only  too  f  am  iUar* 


14     TiiF.  Mfdical  Vnr^. 


LEADING  AKHCLES 


5as,  If  1890. 


TrBPHINIKOFORGoMPOUND  (yOMMIKUTCD  AITD  DlPBBSSlD 

Fbaotvrb  of  thb  Skull.— The  same  Burgeon  operated  on 
a  boy,  set  10,  who  had  been  kicked  on  the  forehead  by  a 
horse  an  hoar  or  two  before.  The  hoof  of  the  horse  had 
struck  him  in  the  npper  part  of  the  frontal  region, 
causing  a  transverse  wound  of  the  scalp,  at  the  bottom  of 
which  a  gutter-shaped  fracture  about  three  inches  long 
and  an  inch  and  a  half  wide  in  its  centre  was  visible. 
After  the  patient  had  been  placed  under  chloroform  the 
head  was  shaved  and  the  wound  and  adjacent  parts  ren- 
dered as  aseptic  as  possible.  An  incision  was  made  at 
right  angles  to  the  wound  and  flaps  reflected  on  each  side 
above  the  fracture.  A  small  trephine  was  then  applied  to 
the  right  of  the  middle  line,  and  through  the  opening  made 
by  it  an  elevator  was  passed  and  the  fragments  of  the 
bone  elevated  and  removed.  The  inner  table  was  espe- 
cially comminuted.  When  the  fragments  were  removed 
they  were  placed  in  warm  solution  of  boracic  acid.  The 
removal  of  one  fragment  to  the  right  of  the  middle  line 
permitted  free  bleeding  from  a  laceration  in  a  large  vein 
which  was  entering  the  superior  longitudinal  sinus  ;  thia 
was  temporarily  arrested  by  pressure  and  permanently  by 
passing  a  suture  round  it  so  as  tjo  close  tiie  hple  in  the 
dura  mater.  The  edges  were  smoothed  with  Hoffinan's 
forceps,  several  fragments  of  bone,  including  the  trephine 
crown,  replaced,  and  the  wound  closed  without  drainage. 
Mr.  Battle  said  that  this  was  apparently  another 
example  of  the  ill  results  attending  the  pursuit  of 
a  game  which  was,  so  far  as  he  knew,  confined  to  Ijambeth, 
and  of  which  he  had  seen  three  previous  examples,  each 
of  which  might  be  described  by  the  account  given  above 
of  this  patient ;  the  game  coneists  in  striking  a  tethered 
horse  on  the  hind  quarters  with  a  piece  of  rope  or  a  stick 
and  escaping  before  the  animal  has  time  to  kick  the 
striker.  This  proves  the  attraction  which  a  game  involv- 
ing a  considerable  spice  of  danger  has  for  the  British 
urchin.    All  these  boys,  he  said,  ultimately  recovered. 

It  is  interesting  to  record,  with  regard  to  the  case  just 
described,  that  implantation  of  the  bone  was  unsuccessful 
as  the  wound  became  septic,  and  a  week  after  operation 
the  boy  developed  symptoms  of  serious  intra-cranial  pres- 
sure, unconsciousness,  dilated  pupils,  loss  of  power,  especi- 
ally on  the  left  side,  and  lateral  deviation  of  the  eyes  to 
the  left  with  nystagmus;  he  was  again  taken  to  the 
operating  theatre  and  the  brain  explored  on  both  sides  of 
the  middle  line.  A  small  trochar  and  cannula  was  used; 
this  was  passed  in  all  directions  with  a  negative  result. 
The  former  opening  in  the  dura  mater  was  then  enlarged 
and  a  searcher  passed  between  the  dura  mater  and  the 
brain  ;  again  the  result  was  negative.  The  boy  next  day 
showed  marked  improvement  and  is  at  present  conva- 
lescent. 

By  the  appointment  of  Dr.  David  NicholBon  as 
yisitor  of  lunatics  by  the  Lord  Chancellor,  the  import- 
ant appointment  of  medical  superintendent  of  the 
Broadmoor  Criminal  Lunatic  Asylum  will  become 
vacant  We  congratulate  Dr.  Nicholson  and  the  Lord 
Chancellor  on  the  appointment 


Db.  Bertram  Hitnt,  of  Harrow-on-the-Hill,  com- 
mitted suicide  last  week  while  in  bed  by  sever- 
ing the  femoral  artery.  Dr.  Hunt  was  staying  at 
Christchurchi  at  the  residence  of  a  medical  man, 
and  he  was  suflbring  from  depression. 


BMIBflRID  VOB  TBAV8KIBBI0I  ABBOAB. 


^hc  JRcbual  fxtBB  ami  Cirxtito. 


,  MmML   FottlM,6H- 

iDTiBTisiiinn. 

lOB  on  IBBBBSOB  X-Wbols  PSSS.  A6  Oi.  Od.S  Ball  Psgt,  4t  100.  C« 
QuurtorPsfS,416s.;  Oiw-slsIitB,  Ua  6<L 

Fob  a  Sbbdh  ov  Ivsbbceois  :— inioto  Page,  thlrtseii  Inieiiloiit 
(wMkly,  forlniglitly,  or  montlily)  at  itt  10a  (ML ;  twwty-six  lamt- 
tlODi  (WMkly  or  f ottnlglitly)  ■*  itt  Si.  (ML ;  flUf-two  laaortloiis 
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reel  TBn  VO  ABVVAL  SUBSOBIBBBS      .        .  «i   1   D 

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„  IVDU,  CIOMA,  AVD  JTAPAB  .  .     ill    B    6 

Post-olBoa  Ordon  aod  Cheones  to  be  drawn  In  taToni  of— ' 
A.  A.  TnnuLL,  »-ll  Kins  William  fitraat,  Sttaiid,  LoodMi. 
A.  H.  JACOB,  80  Molasworth  Stnet,  DabUn. 

SUBSQBIFTIOBS  fOB  Vbabob  are  teoelved  bj  Meana.  BinJiTBai,  Sua 
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SUBSOBiFnoiis  FOB  fHH  UBiiSD  SifiACBB,  poat  free  Id  advanoa 
(41  Ob.  Od.  per  annom),  ahoald  be  sent  dlreot  to  Iha  OAcaa  la 
thla  oonntrjr  by  International  Foat  Ollloe  Order. 

W.  ^.  Loimcsai.(OflM  of  the  BerUmmrAirm^tisk), 

BmaU  Annonnoementi  of  Praotlcea,  Aasistanclea,  Vaeanelea,  Bork 
Ai.— Sefea Uaea or iiaid«r,te. per ImerOon ;  Od. per Uae beyond. 

Lettera  In  iAila  daparCmeBt  ihoiild  be  addxeaMd  to  tlie  Pabliahar. 


^t  Sitlicul  ^tm  ^  CircnlapT. 


'SALUS  POPULI  SUPRBICA  LEXj 


WEDNESDAY,  JANUARY  1,  1896. 


EXTRA-GENTTAL  SYPHILK. 
There  appears  to  be  a  very  general  impression  that 
the  consequences  of  syphilis  contracted  elsewhere  than 
on  the  genital  organs  are  grayer  than  after  the  usual 
method  of  inoculation.  The  question  has  been  very 
fully  dealt  with  by  Dr.  Foumier,  in  a  recent  article, 
published  in  La  Semaine  MedicaU,  from  which  it  would 
appear  that  extra-genital  chancres  do  not  inyoWe  a 
degree  of  severity  or  duration  greater  than  in  the  ordi- 
nary form.  Statistics  show  that  the  proportion  of 
extra-genital  to  genital  chancres  is  about  seven  per 
cent,  that  is  to  say,  of  a  hundred  cases  of  chancre  of 
every  description,  the  lesion  is  located  on  the  genitals 
in  ninety-three,  and  at  some  other  spot,  in  six  or  seven. 
It  would  not  be  surprising  if  extra-genital  efaaneres 
did  really  give  rise  to  severer  manifestations  than  those 
following  lesions  on  the  genitals  where  their  appearance 
is  sure  to  attract  attention  with  a  view  to  recognition 
and  treatment  Owing  to  their  unusual  situation  and 
other  circumstances,  it  is  a  fact  that  extra-genital 
chancres  often  remain  unrecognised,  and,  therefore, 
untreated,  much  longer  than  would  be  the  case  under 
ordinary  circumstances.  Syphilis  from  vaccination  is 
universaUj  in  bad  repute,  and  the  history  and  the 


jav.  1,  imi. 


LEADING  AETICLES. 


Thr  Mrdtoaii  Prkss.     15 


mortality  of  certain  epidemics  which  have  occurred  in 
Fhmee  tend  to  sapport  this  view.    On  examination, 
however,  we  find  that  it  is  the  age  and  condition  of  the 
litile  patients  that  are  responsible  for  themortality,  ;^2tM 
of  course  the  fact  that  in  the  earlier  cases  no  treatment 
vas  institated  for  a  long  time,  simply  because  the 
disease  was    not  identified.      Digital  infection   in 
medical  men  has  furnished  a  harrowing  list  of  unto- 
vaid  results,  but  here  too  there  are  circumstances 
independent  of  the  method  of  inoculation  which  may 
serve  to  explain  why  it  is  that  digital  syphilis  some- 
times paves   the   way  to  unusually  severe  tertiary 
BymptomSi    First  of  all  a  medical  man  is  invariably  a 
bad  patient    He  either  has  not  treatment  enough  or  he 
has  too  much,  to  which  must  be  added  the  profound 
mental  depression  which  the  discovery  can  hardly  fail 
to  produce  in  one  who  is  fully  cognisant  of  the  far- 
resehing  possibilities  of  the  disease.    Then,  too,  it  is 
In^ily  probable  that  the  generally  received  opinion  has 
been  built  up  on  a  few  striking  instances.    The  only 
lEsy  to  settle  the  question  was  evidently  to  collect  a 
sufficiently  large  number  of  figures  and  proceed  to 
make  a  rdiable  comparison.    The  method  selected  by 
Dr.  Foamier  consisted  in  collecting  a  large  number  of 
cases  of  syphilis  of  all  kinds  at  the  tertiary  stage,  in 
which  the  symptoms  were  grave,  and  ascertaining  ho^ 
many  of  extra-genital  origin.    Now,  of  1,200  cases  with 
teitiaiy  eymptoms,  1,125  were  due  to  genital  syphilis, 
and  only  75  to  extra-genital  chancre.    This  gives  a 
proportion  of  6*25  per  cent,  of  extra-genital  chancres ; 
in  other  words,  the  proportion  of  patients  suffering  from 
tertiary  symptoms  is  almost  exactly  the  same  as  that 
of  its  occurrence,  on  an  estimate  based  on  some  10,000 
cases.   Jost  as  there  are  six  or  seven  extra-genital 
chancres  among  a  hundred  cases  of  chancre  of  every 
deacdptioa,  so  in  every  6  or  7  per  cent,  of  every  hun- 
dred casesof  syphilis,  the  disease  runs  its  course  to  the 
tertiary  stage.    Had  the  ratio  of  tertiary  symptoms 
oeeoning  in  persons  whose  chancres  were  extra-genital 
been   hi^ha    than    the     ratio    of    their    initial 
proportion,  then    there    would    have    been    some 
ground  for  supposing  that  this  form  of  infection  was 
more  disastrous,  but  this  has  been  shown  not  to  be  the 
case.   The  gravity  of  syphilis  in  a  given  case  is  mani- 
fested in  two  ways,  either  by  the  premature  outbreak 
at  an  early  date  of  tertiary,  usually  multiple,  symptoms, 
npervening  immediately,  or  within  a  short  time,  after 
^  appearance  of  the  chancre,  or  by  the  supervention 
It  a  later  date  of  tertiary  phenomena,  which  are  serious 
in  that  they  attack  one  or  other  of  the  vital  organs. 
Of  242  cases  of  prematurely  grave  syphilis  Dr.  Four- 
nier  found  that  the  disease  originated  in  the  genital 
organs  in  223  cases,  and  in  only  19  inssances  in  some 
other  part  of  the  body.    Extra-genital  syphilis  thus 
comes  out  at  7**8  per  cent,  a  result  not  materially 
different  from  that  of  the  comparative  frequency  of 
the  two  methods  of  inoculation.  .  Still  another  test  is 
aTsilable  in  respect    of  the    proportion  of  syphi- 
litics    who    suffer    from     syphilis    of    the    brain. 
Collecting  all  the  eases  of  cerebral  syphilis  in  which 
the  situation  of  the  primary  chancre  was  known  the 
anthor  found  that  of.  707  caaeft  31  were  of  extra-genital 


I 


^origin,,  that  is  to  say,  5  per  cent.  It  appears,  therefore, 
that  the  proportion  of  cases  of  cerebral  syphilis  follow- 
ing extra-genital  chancre  is  less  than  it  should  be  if  its 
gravity  were  even  equal  to  that  of  ordinary  syphilis. 
Dr.  Fournier  is  careful  to  observe  that  he  does  not 
;  express  any  opinion  that  there  is  no  difference  between 
! genital  and  extra-genital  infection,  but  he  points  out 
;that  though  the  two  varieties  of  infection  are  strictiy 
lalike  in  symptomatology  and  prognosis,  certain  special 
cases  of  extra-genital  syphilis  do  not  follow  the  usual 
course.  This  peculiarity,  however,  in  no  wise  depends 
on  the  localisation  of  the  initial  chancre,  but  upon  the 
greater  or  less  f acOity  of  diagnosing  the  condition  and 
treating  it.  From  this  point  of  view  tonsillary  chancre 
is  particularly  dangerous,  but  the  observation  is  also 
applicable  in  a  less  degree  in  respect  of  mammary  and 
digital  chancres.  Dr.  Founder  concludes  that  unqaes- 
tionably  syphilis  of  extra-genital  origin  does  in  some 
cases  assume  an  unusually  grave  character,  but  taking 
them  altogether  the  prognosis  is  not  more  gloomy  than 
that  of  syphilis  of  any  origin.  When  such  cases  prove 
unusually  grave  the  exceptional  gravity  is  due  not  so 
much  to  the  extra-genital  localisation  of  the  primary 
chancre  as  to  variable  conditions  under  which  the 
sufferer  happens  to  be  placed  in  respect  of  age,  predis- 
position, individual  power  of  resistance,  soil  and 
surroundings. 


THE  GIANT  STRIDE  OF  SCIENCE. 
One  of  the  most  striking  characteristics  of  the  pre- 
sent age  is  the  rapidity  with  which  mankind  adopts 
new  ideas  and  discoveries.  The  scientific  toy  or 
marvel  of  to-day  becomes  the  established  necessity  of 
to-morrow,  and  is  exploited  by  a  thousand  speculators 
in  a  keen  commercial  world.  Although  of  late  years 
men  of  science  undoubtedly  secure  a  larger  portion  of 
the  wealth  they  are  the  means  of  creating,  yet  in  the 
majority  of  instances  it  is  still  true  that  the  lion's 
share  f cdls  to  the  mere  manufacturer  and  distributor  of 
their  scientific  wares.  The  latter  fact  has  been  over 
and  over  again  illustrated  in  the  history  of  inventions. 
To  take  a  single  instance,  a  few  months  since  the  death 
of  the  inventor  of  lucifer  matches  was  reported  from 
Saint-Lothaire,  in  Jura»  This  benefactor  of  his  species 
was  a  poor  country  doctor,  named  Sauria,  who,  when 
a  student  at  the  (College  of  Ddle,  conceived  the  idea  of 
making  matches  with  chlorate  of  potash,  sulphur,  and 
phosphorus.  He  was,  however,  unable  to  raise  the 
1,500  francs  necessary  to  patent  his  discovery.  His 
researches  became  known  to  M.  Nicolet,  Professor  of 
'Physics  at  the  college,  who  afterwards  lectured  upon 
[the  subject  in  Germany.  The  Germans  developed  the 
idea  and  ultimately  imported  matches  into  France, 
iwhere  they  were  called  aUemandes.  It  would  be 
difficult  to  hazard  a  conjecture  as  to  the  enormous  sums 
.of  money  that  have  been  made  out  of  this  invention. 
But  the  discoverer  of  the  gold  ndne  died  in  poverty  at 
the  age  of  84.  When  an  old  and  worn-out  man  he  ob- 
tained from  M.  Or^vy,  at  that  time  President  of  the 
'French  Republic,  a  government  appointment  as  the 
jkeeper  of  a  tobacco  shop.    It  would  nowadays  be  hard 


16       ''tth  Mvdical  PR«88. 


LEADING  AETICLES. 


JAk.  1,  1885. 


to  imagine  a  civilised  world  without  matches,  yet,  if 
we  may  accept  the  foregoing  acconnt  as  tme,  it  is 
sizty-fonr  years  only  since  the  time  of  their  first  pro- 
duction by  Dr.  Spuria.    Nor  is  the  present  generation 
much  further  removed  from  the  birth  of  another  mar- 
vellous invention,  namely,  the  steam  engine,  which  has 
probably  had  more  to  do  with  the  giant  stride  of 
modern  science  and  civilisation  than  any  other  single 
product  of  the  human   brain.     Yet  it   was    only 
last  summer  that  the  death  of  the  driver  of  the  first 
*Mocomotive"  in  England  was  commented  upon  in 
the  public  newspapers.    It  would  take  a  large  volume 
to  describe  even  briefly  the  wonderful  inventions  in 
machinery  of  all  kinds  that  have  been  issued  in  a  steady 
stream  of  upward  evolution  since  the  days  of  the 
primitive  engine  "  Puffing  Billy,"  which  is  still  pre- 
served as  a  sacred  landmark  and   relic  among  the 
national  treasures  at  South  Kensington.    Curiously 
enough,  the  date  of  the  first  meeting  of  the  British 
Association  coincides  with  the  year  assigned  for  the 
discovery  of  lucifer  matches.    The  progress  of  scien- 
tific knowledge  during  the  ninety  odd  years  that 
have  since  elapsed   has   been  simply  phenomenal. 
This  attractive   topic  furnished   the  theme  of  the 
address  by  Sir   Douglas   Qalton,  President   of  the 
Norwich  meeting  in   1895.     He  pointed  out   that 
the  Association  early  recognised  the  importance  of 
uniformity  in  the  record  of  sdeiitific  facts,  as  well  as 
the  necessity  for  an  easy  method  of  comparing  standards 
and  of   correcting    differences    between   individual 
observers.    Indeed,  the  provision  of  accurate  standards, 
not  only  of  length,  but  of  weight,  capacity,  temperature, 
force,  and   energy,  are  amongst  the  foundations  of 
scientific    investigation.     In   a  former    presidential 
address,  speaking  on  this  point.  Lord  Kelvin  said, 
*^  Nearly  all  the  grandest  discoveries  of  science  have 
been  but  the  rewards  of  accurate  measurement  and 
patient,   long-continued    labour    in    the    sifting   of 
numerical  results."    It  is  not  our  intention  to  review, 
or  even   to    enumerate,    the    chief    scientific    dis- 
coveries    of    the     century    that    is     now    draw- 
ing   to    a    close.     The    world    is    utilitarian,  and 
men  of  science,  by  the  very  nature  of  their  pursuits, 
dwell  in  the  future  rather  than  in  the  past  Sir  Douglas 
Galton,  in  his  Norwich  Address,  hinted  at  the  lines  of 
further  physical  research  in  the  following  eloquent 
passage :  *  Who,  at  the  foundation  of  the  Association, 
would  have  believed  some  far-seeing  philosopher  if  he 
had  foretold  that  the  spectroscope  would  analyse  the 
constituents  of  the  sun  and  measure  the  movements  of 
the  stars  ;  that  we  should  liquefy  air  and  utilise  tem- 
peratures approaching  to  the  absolute  zero  for  experi- 
mental research ;    that,  like   the  magician  of  the 
*  Arabian  Nights,'  we  should  annihilate  distance  by 
means  of  the  electric  telegraph  and  the  telephone ; 
that   we  should  illuminate  our    largest    buildings 
instantaneously,  with  the  clearness  of  day,  by  means 
of    the    electric    current ;     that     hy    the    electric 
transmission     of     power     we     should     be     able 
to     utilise     the     Falls     of     Niagara     to    work 
factories  at  distant  places ;  that  we  should  extract 
metals  from  the  crust  of  the  earth  by  the  same  electri- 


cal agency  to  which,  in  some  cases,  their  deposition  has 
been  attributed  f  These  discoveries  have  been  brought 
to  their  present  condition  by  the  researches  of  a  long 
line  of  scientific  explorers,  such  as  Dalton,  Joule, 
Maxwell,  Helmholtz,  Hens,  Kelvin  and  Rayleigh,  aided 
by  vast  strides  made  in  mechanical  skilL  But  what 
will  our  successors  be  discussing  sixty  years  hence  f 
How  little  do  we  yet  know  of  the  vibrations  irfiich 
communicate  light  and  heat !  Far  as  we  have  advanced 
in  the  application  of  electricity  to  the  uses  of  life,  we 
know  but  little  even  yet  as  to  its  real  nature.  We  are 
only  on  the  threshold  of  the  knowledge  of  molecular 
action,  or  of  the  constitution  of  the  all-pervadiiig 
»ther."  This  confession  of  humility  and  ignorance 
made  by  a  veteran  scientist  may  well  find  an  echo  in 
the  schools  of  medicine.  Although  marvellous  advances 
have  been  made  during  the  past  generation  towards 
the  goal  of  full  and  adequate  knowledge,  yet  it  may 
be  doubted  whether  the  pioneers  of  the  medical  pro- 
fession have  done  more  than  catch  the  farniff  glimpses 
of  a  glorious  dawn. 


THE  DIRECT  REPRESENTATION  OF  IRELAND 
IN  THE  GENERAL  MEDICAL  COUNCIL. 
The  contest  for  the  podtion  vacated  by  the  death  of 
Dr.  Kidd  is  likdy  to  be  very  acute.  The  Uatui  quo^ 
plainly  stated,  is  as  f  oQows.  The  Dublin  vote  is,  to  a 
great  extent,  concentrated  upon  Mr.  Thomson,  who  is 
in  intimate  relation  with  the  College  of  Physicians  and 
with  the  Trinity  College  Medical  School,  by  virtue  of 
his  position  as  Secretary  of  the  Royal  Academy  of 
Medicine,  and  he  has,  also,  the  sympathy  of  the  same 
parties  in  the  Council  of  the  College  of  Surgeons.  He 
is  supported  by  these  parties  with  additional  enthu- 
siasm, because  he  is  believed  to  be  the  most  dangerous 
opponent  of  Dr.  Jacob,  whom  th^  desire,  by  all  means, 
to  defeat  because  he  has  striven  to  secure  fair  and 
honourable  treatment  for  the  Apothecaries'  Hall  in  the 
recent  controversy  between  that  Body  and  the  General 
Medical  Council,  in  which  dispute  the.'  Coll^  of  Phy- 
sicians has  been  the  prosecutor.  Mr.  Thomson,  being 
a  Queen's  University  graduate,  an  alumnus  of  Gkdway 
College,  and  a  Senator  of  the  Royal  University,  had 
calculated  upon  receiving  the  solid  vote  of  the  Queen's 
College  par^  in  Bdfast,  Cork,  aiid.Galway,huthis 
hopes  have  been  to  a  great  extent  frustrated  by  the 
starting  of  Professor  Cuming,  of  Belfast,  who  probably 
will  carry  off,  from  every  candidate,  the  section  of 
voters  who  are  offidally  interested  in  the  Queen's 
Colleges.  Dr.  Thomson  has  also  such  following  through- 
out the  country  as  can.  be  picked  up  by  the  personal 
canvass  of  his  friends. 

Dr.  Archibald  Jacob  will  have  in  Dublin  the  follow- 
ing only  of  those  who  are  disposed  to  give  their  vote 
apart  fromjcollegiateor  school  interests,  and  whoare  will- 
ing to  believe  that,  rightly  or  wrongly,  he  has  honestly 
tried  to  advocate  what  he  thought  best  for  the  profes- 
sion and  just  to  all  concerned.  His  chief  dependence 
is  upon  the  provindalists,  whose  battles  he  has  been 
fitting  for  the  past  thirty  years,  and  if  he  obtains 
1  their  ODited  support  he  will  beat  Mr.  Thomsoa. 


jiv.  1,  laM. 


NOTES  ON  CUERENT  TOPICS. 


'^  '"    MrncAL  PRFSS.      17 


'  Tlia  denie  HuX  the  direct  repraeentative  shoold  be 
oiieof  tiie  lank  and  file  of  the  profession  is  represented 
hf  three  candidstfls,  Professor  Cuming,  of  Belfast,  Mr. 
Hsfcnles  MacDonnell,  of  Dnndalk,  and  Dr.  Qreene, 
an  esteened  pnetitioner  at  Ferns,  and  County  Coun- 
cillor in  the  Irish  Medical  Association,  of  whose  can- 
didaftiiie  we  were  not  aware  when  we  last  wrote.  Pro- 
fcsnr  Coming  naj  be  eliminated  from  thecat^gory  of 
lepresentatifes  of  the  Irish  country  doctors.  As  a 
thoQ^itful,  experienced  teacher  and  practitioner,  and 
a  genial  gwntleman,  no  one  could  be  fitter  for  the 
Geneial  Medical  Council,  but  his  past  record  presents 
no  endence  that  he  has  anything  in  common  with  the 
woddng  piactitioner.  If  the  Belfast,  Galway,  and 
Ooik  OollegeB  can  bring  about  his  election  they  will 
hsTedone  an  excellent  stroke  of  business  for  them- 
sdves,  and  the  Medical  Coundl  will  be  enriched  by 
the  aeeession  of  a  membor  creditable  to  it  as  a 
collegiate  representative.  The  other  provindalist 
csndidateii  are  Dr.  MacDonneU,  of  Dnndalk,  and 
Dr.  Greene,  of.  Ferns,  of  whom  the  only  remark  that 
needbe  made  is  that  neither  of  them  are  likely  to 
iocceed,  whatever  their  merits  may  be.  We  hope  we 
ahsll  not  be  mistaken  when  we  mi^e  this  observation. 
It  must  always  be  difficult  to  find  a  candidate 
outride  the  great  teaching  centres  who  will  be  au 
anawU  with  the  subjects  of  education,  examination, 
and  qualification  with  which  the  Medical  Council  is 
dnefly  empl<^yed,  and,  at  the  same  time  well-informed 
sod  qrmpathetic  with  reference  to  the  wants  and  wishes 
of  the  working  pnetitioner ;  but  if  such  a  combination 
can  be  found  in  any  competitor,  and  that  areasonable 
diance  of  snooess  exists  for  such  candidate,  we  think 
die  aspiration  of  the  provincialists  to  have  a  man  of 
their  own  sort  is  very  commendable.  If,  therefore, 
there  is  any  way  of  concentrating  the  country  votes  of 
Mr.  Thomson,  Dr.  Jacob,  Professor  Cuming,  and  Dr. 
Greene  upon  Dr.  MacDonnell,  or  vice  versa,  we  do  not 
doubt  that  auch  candidate  will  win.  Failing  such 
Beans  of  concentration,  it  seems  to  us  that  the  provin* 
dslists,  by  dividing  their  suffrages  between  four  candi- 
dates, sie  mmjfiy  making  a  present  of  the  Direct  Bepre* 
lentation  to  aDublin  Collegiate  nominee. 


JUrtes  m  Citrrtnt  ^Soytct* 

Hydrophobia  near  London. 
Although  no  deaths  have  occurred  from  hydro- 
pholna  m  the  Metropolitan  district,  yet  it  is  reported 
tikat40  labid  dogs  have  been  killed  therein  as  against 
12  in  1894,  and  8  in  1803.  These  figures  must  be  re- 
eeived  witti  a  certain  amount  of  caution,  as  it  is  a  com- 
mon thing  to  pronounce  a  dog  mad  if  he  bite  anyone 
end  to  kin  the  unfortunate  animal  forthwith,  lliere 
can  be  DO  doubt,  however,  when  a  human  being  dies 
from  so  strongly  marked  and  terrible  a  malady  as 
hydrcq^bia.  Last  week,  a  case  of  the  kind  formed 
the  subject  of  an  inquest  at  Croydon.  A  City  solicitor 
liring  at  that  place  was  bitten  on  October  27th  last, 
Ij  his  own  fox  terrier.  He  recovered  from  the  wound 
and  did  well  untfl  five  days  before  his  death,  when  he 


suddenly  became  unable  to  driok.  His  medical  atten- 
dant recognised  the  malady  as  hydrophobia,  a  diagnosis 
which  was  confirmed  by  Professor  Ferrier.  The  same 
terrier  bit  other  dogs  and  also  several  persons,  of  whom 
one,  a  girl,  has  been  sent  to  Paris  for  treatment.  A 
number  of  cases  of  rabies  have  been  reported  at  Wil- 
lesden,  and  a  panic  prevails  amongst  the  inhabitants 
of  the  place.  Up  till  the  present  time,  no  muzzling 
order  has  been  issued  in  the  County  of  London, 
although  it  is  being  enforced  in  the  boroughs  of  King- 
ston, Richmond  and  QuOdf ord,  and  in  the  counties  of 
Middlesex  and  Surrey. 

The  London  AsyluinB  Board  and  Its  Fever 
Acoommodation. 

At  length  the  Metropolitan  Asylums  Board  has 
made  some  practical  effort  to  accommodate  the  fever- 
stricken  poor  of  London.  This  winter  there  is  very 
little  small-pox,  and  the  Board  has  for  months  past 
been  urged  to  throw  open  the  Oore  Farm  (small-pox) 
Hospital  for  Convalescents  to  ordinary  fever  patients. 
It  was  decided,  however,  a  month  ago,  not  to  adopt  that 
course.  But  further  reflection  has  brought  wisdom  to 
the  counsels  of  the  members,  and  on  Saturday  last  they 
determined,  by  a  majority  of  38  to  8,  to  admit  scarla- 
tina and  diphtheria  patients  to  Qore  Farm.  As  the 
institution  in  question  has  permanent  accommodation 
for  1,000  patients,  its  opening  wiU  materially  reduce  the 
immediate  pressure.  At  the  end  of  last  week  the 
Board  reported  3,502  patients  in  the  district  hospitals, 
2,786  of  whom  were  suffering  from  scarlet  fever,  and 
664  from  diphtheria. 

The  Scientiflo  Administration  of  Chloroform. 

The  cause  of  those  who  advocate  the  careful  and 
accurate  administration  of  chloroform  has  received  a 
lift  at  the  hands  of  the  Society  of  Anesthetists,  where 
the  subject  was  recently  discussed  very  fully  on  a  paper 
read  by  Dr.  Carter,  of  Weymouth,  whose  thoughtful 
contributions  on  this  subject  our  readers  have  on 
various  occasions  had  opportunities  of  considering. 
The  question  is  really  so  very  simple  that  it  is  a  matter 
for  some  surprise  that  it  should  still  be  necessary  to 
discuss  it  Are  we  to  go  on  administering  a  powerful 
and  lethal  drug  such  as  chloroform  in  a  haphazard 
way,  trusting  to  the  patient  to  give  us  due  warning  of 
an  impending  catastrophe,or  is  the  anaosthetist  to  calcu- 
late the  quantity  required  to  bring  about  narcosis  by 
means  of  a  suitable  apparatus  ?  The  fact  that  chloro- 
form is  given  in  thousands  of  instances  by  the  rough 
and  ready  methods  so  frequently  employed  without  a 
fatal  result  is  not  per  te  any  reason  why  advantage 
should  not  be  taken  of  the  ingenious  and  convenient 
apparatus  at  our  disposal,  which  allows  of  our  control- 
ling effectually  and  certainly  the  output  of  the  vapour. 
Once  again  it  must  be  repeated  as  a  cardinal  principle 
that  death  from  chloroform  means  that  the  patient  has 
succumbed  to  an  overdose.  In  some  cases,  the  over- 
dose is  singularly  small  in  point  of  quantity,  but 
that  is,  if  anything,  an  additional  reason  for  displaying 
the  greatest  possible  care.  Dr.  Carter's  paper  was 
well  received  by  the  Society,  and  virtually  received  the 


18     Tee  ytmnoAL  Fbxbb. 


NOTES  ON  CURRENT  TOPICS. 


Jan.  1,  189S. 


assent  of  nearly  all  present.  We  do  not  wish  to  tie 
anyone  down  to  a  particnlar  procedure.  It  is  rather  IJie 
principle  of  accurate  dosage  that  we  are  contending  for, 
and  in  such  a  matter  common  sense  ought,  if  necessary, 
to  oyerride  special  experience.  A  bad  method  in 
expert  hands  may  give  better  results  than  a  good 
method  in  careless  or  unskilled  hands,  but  these  con- 
siderations are  ultra  viret  in  discussing  the  principles 
that  should  underlie  the  administration  of  an  anaes- 
thetic. The  fact,  too,  that  the  quantity  of  chloroform 
required  to  induce  and  maintain  anassthesia  with  a 
regulating  inhaler  is  vastly  less  than  by  ordinary  means, 
is  of  importance,  for  it  is  evident  that  ccBteris  po/ribuSf 
the  less  chloroform  absorbed  by  the  patient  the 
greater  will  be  the  freedom  from  risk  and  the  various 
uncomfortable  sequelae. 


The  Begistrarshipofthe  London  University. 
The  Keglstrarship  of  the  University  of  London  will 
shortly  be  declared  vacant  by  the  retirement  of  Dr. 
Milman  who  has  filled  the  office  with  great  satisfaction 
to  the  authorities,  the  examiners,  and  all  with  whom 
he  was  brought  in  contact  for  many  years  past.  The 
vacancy  is  likely  to  create  a  considerable  amount  of 
competition  as  there  are  naturally  many  privileges 
connected  with  such  an  appointment,  added  to  which 
is  the  salary  of  £800,  increasing  to  £1,000  per  annum. 
The  new  Registrar  will  enter  on  his  duties  on  May  1st, 
1896,  full  particulars  of  which  will  be  furnished  by 
the  present  Registrar. 


"Powders"  for  Cerebral  Vomiting. 
SoHs  curious  facets  were  disclosed  at  an  inquest  held 
last  week  by  a  London  Coroner.  A  lad,  aged  ten, 
entered  into  a  competition  with  some  playmates  as  to 
which  of  them  could  stand  longest  on  his  head.  He 
subsequently  grew  dull  and  heavy  and  vomited.  His 
parents  procured  some  powders  from  the  chemist  to 
stay  the  sickness,  but  they  had  not  the  desired  effect, 
and  the  child  died  soon  afterwards.  Medical  evidence 
was  given  to  the  effect  that  the  cause  of  death  was 
serous  apoplexy.  The  case  is  certainly  an  unusual 
one,  and  probably  death  might  have  been  averted  by 
prompt  medical  treatment.  It  illustrates  the  absurd 
faith  pinned  by  ignorant  folk  to  the  prescribing  powers 
of  the  dispensing  chemist.  For  our  own  part  we  hold 
that  a  chemist  like  the  above  who  gives  medicines  to 
treat  serious  specific  conditions  is  deserving  of  short 
shrift  and  condign  punishment  The  coroner  pointed 
out  that  the  death  could  hardly  be  caUed  accidental, 
while  it  certainly  was  not  a  natural  one. 


How  Fever  is  Sprecul 
An  extraordinary  state  of  affairs  was  brought  to 
light  a  few  days  since  before  a  metropolitan  coroner. 
The  object  of  the  inquest  was  to  inquire  into  the 
death  of  a  child  five  months  old.  The  mother  said 
that  all  her  children  had  been  taken  ill  one  after  the 
other— the  first  about  three  weeks  since,  that  they 
had  come  out  in  a  rash,  and  had  been  about  the  whole 
time.  Her  baby  seemed  poorly,  so  she  called  in  a 
doctor,  who  said  the   children  were  suffering  from 


scarlet  fever.  The  father  had  been  going  to  work, 
and  the  mother  asserted  she  did  not  know  the  nature 
of  the  disease  until  the  doctor  was  called.  It  is 
tolerably  certain  that  thia  family  must  have  spread 
the  fever  broadcast  over  a  considerable  area.  In  the 
face  of  such  a  revelation  the  labours  of  preventive 
medicine  may  well  appear  Sisyphean  and  hopeless. 
But  the  preventive  machinery  itself  is  at  fault,  for 
even  after  the  discovery  of  this  nest  of  infection  there 
appears  to  have  been  the  usual  doubt  as  to  their 
removal  to  an  infectious  hospital.  A  doctor  present  in 
court  stated  that  he  had  two  or  three  cases  where  he 
was  unable  to  get  the  authorities  to  remove  fever- 
stricken  patients  from  one-room  tenements.  It  would 
be  more  reassuring  to  the  general  public  if  the  asylums 
board  issued  circulars  dealing  definitely  with  public 
statements  of  this  nature. 

Malaria. 
Opiate,  the  subject  of  malaria  has  been  attracting 
a  good  d^  of  attention.  The  recent  experiences  of 
the  French  in  Madagascar  emphasise  the  havoc  that 
this  pestilential  malady  can  work  among  troops  that 
have  not  become  acclimatiBed  to  its  poisonous  influ- 
ence. It  remains  to  be  seen  how  our  British  soldiers 
will  pass  through  a  similar  ordeal  in  their  march  of 
many  mUes  through  the  heart  of  a  tropical  forest 
Fortunately,  the  home  authorities  are  alive  to  the  ne- 
cessity of  fighting  King  Fever  as  well  as  the  King  of 
Ashanti.  They  have  sent  forward  native  bearers  to 
prepare  camps  at  stated  intervals  along  the  forest 
route.  In  every  case  the  soldiers  will  be  provided  vrith 
huts,  where  they  can  sleep  at  a  distance  of  at  least  two 
feet  from  the  ground.  Malaria  is  almost  invariably 
contracted  at  night,  but  it  would  be  clearly  impossible 
to  prevent  the  occasional  exposure  of  men  to  night  duty. 
Of  course,  the  value  of  quinine  taken  as  a  routine 
prophylactic  is  well  recognised.  Eucalyptus  is  also 
recommended  by  some  authorities  for  a  similar  pur- 
pose. News  comes  of  a  new  remedy  for  malaria  which 
has  been  brought  before  the  notice  of  the  French 
Academy  of  Medicine  in  Paris.  It  is  an  extract  called 
Pombotano-Midi,  obtained  from  a  Mexican  plant. 
Fortunately  malaria,  as  a  disease,  is  fairly  tractable  to 
treatment.  Our  War  Office  may  reasonably  hope  for 
a  minimum  sacrifice  of  life  from  climatic  causes.  It 
has  selected  picked  men  and  supplied  them  with  the 
best  of  material  for  comfort  and  ss^ety  in  camp,  on  the 
march,  and  in  the  field.  With  good  food,  suitable 
clothing,  dry  camps,  proper  pumps,  and  sterilising 
filters,  we  may  hope  for  an  instructive  object  lesson  in 
the  advances  of  modem  military  hygiene.  The  Indian 
sanitary  authorities  will  do  well  to  follow  closely  the 
history  and  experiences  of  the  Ashanti  expedition. 


An  Anti-V€bccinationist  Theory. 
The  physician  to  a  well-known  London  hospital  for 
diseases  of  the  skin  vouches  for  the  truth  of  the  follow- 
ing incident :— A  gir],  of  about  seventeen  years  of  age, 
was  brought  to  him  to  be  treated  for  irritation  of  the 
scalp  of  long  standing.  The  friends  of  the  patient 
declared  that  the  condition  first  appeared  after  vaccin- 
ation ;  that  up  to  that  time  the  girl  had  been  perfectly 


jAif.  1,  lg96. 


NOTES  ON  CUBREMT  TOPICS. 


Tnn  Mftitcal  Press. 


19 


healthy,  bat  that  she  had  been  ailing  ever  since.  On 
examination  the  scalp  was  found  to  be  in  a  shocking 
condition,  coTered  with  numerous  ulcers  and  decom- 
posing debris^  and  simply  swarming  with  pedictdi  capir 
Hs.  There  oonld  be  little  doubt  that  the  parasites 
were  thereal  /onset  origo  moUi^  and  had  kept  up  the 
trouble^  which  hy  its  constant  pain,  irritation  and  dis- 
charges had  considerably  impaired  the  health  of  the 
unfortunate  sufferer.  This  view  of  the  case  was  pre- 
sented to  the  patient's  friends,  but  they  refused  to 
abandon  their  Taccination  theory.  Their  story  had 
been  told  so  often  and  for  so  long  a  period,  and  had 
become  so  deeply  rooted  in  their  convictions,  that  it 
was  not  to  be  gainsaid  by  the  simple  statement  of  a 
hospital  physician.  Thdrtheory  amounts  to  the  trans- 
mission of  pediculi  capitis  or  their  ova  in  vaccine 
matter.  In  any  case,  it  is  not  much  more  absurd  than 
much  of  the  evidence  advanced  byanti-vaccinationists. 
Unfortunately  it  is  a  fact  that  some  rashes,  for  the 
most  part  fleeting  and  harmless,  accompany  or  follow 
wfcffcination.  There  can  be  no  doubt  that  the  observ- 
ance of  strict  aseptic  precautions  before,  during,  and 
after  vaccination  would  do  much  to  lessen  these  little 
complications,  and  to  restore  the  confidence  of  that 
small  but  mischievous  section  of  the  communily  that 
constitutes  the  schismatic  camp  of  the  anti-vaccina- 


Ladies  as  Hospital  Managera 

A  MOVEMENT  is  ou  f oot  in  Edinburgh,  and  one  which 
will,  no  donbt,  £^ve  rise  to  a  great  deal  of  opposition 
on  tiie  part  of  those  members  of  the  profession  who 
are  anti-feminine  in  everything;  to  nominate  a  lady 
for  the  one  vacancy  on  the  boud  of  the  Edinbuigh 
Boyal  Infirmary.  The  vacancy  is  among  those  elected 
hf  the  contributors,  Mr.  FL  A.  Lockhart's  term  of 
fMoa  having  expired.  Miss  F.  Stevenson,  who  has  al- 
ready done  ezcdlent  work  on  the  School  Board,  has, 
we  believe,  consented  to  be  nominated,  and  there  is  no 
doubt  that,  if  elected,  she  would  make  an  admirable 
member  of  the  board.  It  is  reported  that  the  present 
memben  of  the  board  do  not  relish  the  idea  of  having 
a  lady  eoUeagne.  The  infirmary  board  has  long  and 
justiy  been  celebrated  for  the  splendid  manner  in  which 
the  a&UTB  of  tins  huge  charity  have  been  conducted  by 
them,  but  it  is  no  disparagement  to  them  to  suggest 
that,  in  some  matters,  feminine  advice  would  prove  of 
great  value.  It  might  be  so  in  connection  with  the 
hundry,  with  the  nurses^  and  perhaps  with  the  cook- 
ing anangements.  The  Board  has  hitherto  left  purely 
medical  questions  in  a  large  measure  to  be  settied  by 
the  medical  managers,  and  this  would  probably  con- 
tinue to  be  the  ease  in  the  future,  so  that  the  election 
of  a  lady  on  the  board  should  not  concern  or  affect  the 
sQsceptibOities  of  the  staff  to  any  great  extent.  A  lady 
manager  will  be  an  innovation,  and  it,  maybe,  wiQ 
prove  a  blessing,  but  in  order  to  preserve  the  infirmary 
from  a  ladies'  committee  independent  of  the  regular 
board,  such  a  timely  concession  will  be  of  value. 


Medical  Certiflcates  and  the  School  Boards. 
The  granting  of  medical  certificates  of  inability  to 
attend  school  where  the  facts  of  the  case  do  not  warrant 
any  such  certification  must  surely  be  an  exceptional 
occurrence.  This  alleged  practice,  however,  has  formed 
the  subject  of  a  discussion  in  the  public  newspapers, 
and  as  usual  several  medical  men  have  been  found 
ready  to  rush  into  the  breach.  The  Chairman  of  the 
Attendance  Committee  of  the  London  School  Board 
admits  that  it  is  only  in  rare  cases  that  medical  cer- 
tificates are  signed  without  due  care,  and  he  is  careful 
to  say  he  does  not  impute  a  want  of  confidence,  skill, 
or  good  faith  on  the  part  of  the  profession  generaUy. 
At  the  same  time  he  brings  forward  the  specific  case 
of  a  certificate  granted  by  a  duly  qualified  practitioner, 
which  was  produced  before  a  magistrate  as  evidence  of 
the  inability  of  a  child  to  attend  school.  After  pro- 
longed inquiry,  the  School  Board  officer  ascertained 
from  the  doctor  himself  that  he  had  not  seen  the 
child,  and  that  he  gave  the  certificate  on  the 
strength  of  the  mother's  assertions.  As  might 
be  expected,  this  statement  of  affairs  drew  a 
strong  expression  of  opinion  from  the  magistrate 
at  the  adjourned  hearing,  as  to  the  worthlessness  of 
such  testimony.  Now  that  attention  has  been  drawn 
to  the  point  it  will  be  well  in  future  for  all  medical 
practitioners  to  be  most  careful  how  they  grant  certifi- 
cates dealing  with  the  health  of  school  children.  In 
the  hurry  of  practice  the  busy  doctor  is  often  inclined 
to  accept  his  patients'  statements  without  putting  them 
to  further  proof.  Such  a  disclosure  as  the  one  above 
mentioned,  however,  not  only  brings  discredit  to  the 
profession  generally,  but  is  also  likely  to  involve  the 
individual  practitioner  in  a  regular  whirlpool  of  worry 
and  annoyance. 

Professional  Bthics  and  the  British 
GyneecologiccJ  Society. 
This  society  is  now  established  on  so  firm  a  basis 
that  it  doubtiess  feels  itself  strong  enough  to  promul- 
gate a  code  of  honour  for  its  Fellows  which  it  might  be 
well  perhaps  for  certain  other  societies  to  imitate.  We 
understand  that  at  the  annual  meeting  to  be  held  on 
Thursday  in  n^ct  week,  the  following  resolutions  of 
Council  (dated  February  28th  and  April  4th,  1895, 
respectively)  will  be  submitted  to  the  Fellows,  with  a 
view  to  their  being  added  to  the  bye-laws  of  the 
Society :— 1.  That  it  is  undesirable  that  any  member 
of  themedical  profession  practisinghomoeopathyshould 
be  proposed  as  a  Fellow  of  the  Society.  2.  That  it  is 
contrary  to  the  ethics  of  the  British  Gynaecological 
Society  that  any  of  its  Fellows  should  advertise  their 
publications,  or  otherwise  bring  themselves  before  the 
notice  of  the  public  by  advertising  in  any  way  through 
the  medium  of  the  lay  papers.  That  circulars  of  the 
nature  of  an  advertisement  sent  even  to  members  of 
the  medical  profession  generally  would  be  regarded 
with  disapprobation  by  the  Council  Doubtless,  the 
discussion  of  such ''  burning  questions  "  will  attract  a 
very  full  attendance. 


20       ''"'T'*  ^TwTTOU.  Pwrss 


NOTES  ON  CURRENT  TOPICS. 


Jak.  1,  1S96. 


The  Oyster  Scare.  I 

At  a  meeting  of  the  Health  Committee  of  the 
Glasgow  Town  Council  held  last  week,  Dr.  Chalmers, 
one  of  the  medical  officers  of  health  for  the  city,  sab- 
mitted  a  report  containing  his  investigations  into  the 
canse  of  the  outbreak  of  typhoid  fever  which  followed 
the  Stirling  County  Ball.  He  considered  that  no 
reasonable  grounds  exist  for  supposing  that  the  oysters 
which  were  supplied  at  the  ball,  or  any  other  article  of 
diet  which  was  consumed  at  it,  had  been  contaminated 
before  being  sent  to  Stirling.  It  might  be  presumed 
that  whatever  had  been  the  cause  of  the  outbreak  had 
been  infected  in  that  town  by  sewage  gas  or  other  foul 
air,  and  had  thus  led  to  the  outbreak  of  fever.  This 
report  is  only  in  part  reassuring.  The  original  cause 
has  not  been  discovered,  and  the  good  name  of  the 
oyster  is  still  left  under  a  cloud. 


The  Army  Medical  Servica 
Owing  to  the  recent  death  of  four  retired  medical 
officers  no  less  than  seven  honours  or  rewards  have 
been  distributed  in  the  Army  Medical  Service.  One 
of  the  good  service  rewards  of  £100  has  been  divided 
between  two  retired  Quartermasters  of  the  Army 
Medical  Staff—Honorary  M&gor  L.  Qorman  and 
Honorary  Captain  E.  Enright.  Two  other  rewards  of 
j£lOO  each  go  to  Surgeon-General  J.  O'Nial,  C.B., 
retired  pay ;  and  Surgeon-Migor-General  J.  Warren, 
Principal  Medical  Officer,  Bombay.  The  appointment 
of  Honorary  Physician  to  the  Queen,  vacant  by  the 
death  of  Surgeon-General-  J.  Irvine,  goes  to  Deputy 
Inspector-General  R.  Domenichetti,  late  Army  Medical 
Department;  and  the  two  vacancies  for  Honorary 
Surgeons  to  her  Majesty,  in  succession  to  the  late 
Director-General  Sir  T.  Crawford  and  the  late  Surgeon- 
General  Sir  T.  Longmore,  go  to  Surgeon-Migor-General 
C.  D.  Madden,  and  Surgeon-General  H.  T.  Reade, 
V.C.,  C.B.,late  Medical  Staff 


Exit  the  Andrew  Clark  Memorial. 
Thx  unhappy  attempt  to  promote  a  memorial  on 
behalf  of  the  late  Sir  Andrew  Clark,  to  which  we 
referred  some  weeks  ago,  has  now  become  a  matter  of 
history,  The  Committee  of  the  Memorial  have  closed 
the  Fund,  and  have  handed  the  amount  of  £2,500, 
raised  by  subscriptions,  to  the  Governors  of  the  London 
HospitaJ  to  be  funded  for  the  present,  as  the  nucleus 
of  a  sum  for  the  provision  of  a  new  isolation  block 
at  the  above  hospital.  The  cost  of  this  new 
block  will  be  upwards  of  ill2,000,  so  that  there 
does  not  appear  to  be  any  likelihood  of  the 
undertaking  being  carried  out  for  some  time 
to  come.  A  good  deal  of  satisfaction  will  probably 
be  felt  at  this  result,  and  that  the  busy  bodies  who 
interested  themselves  to  perpetuate  Sir  Andrew  Clark's 
memory  by  inveighling  contributions  for  such  a  purpose 
have  f idled  in  their  attempt,  for,  obviously,  to  apply  for 
subscriptions  for  a  memorial  to  the  late  President  of  the 
College  of  Physicians,  who  wai  admittedly  not  a  univer- 
sal genius,  seemed  to  be  unnecessary,  and  a  step  which 
savoured  more  of  too  severely  taxing  the  living  for  the 
dead  than  anything  else.    Sir  Andrew  Clark  had  his 


reward  in  this  life, which,  we  are  quite  prepared  to  admit, 
he  thoroughly  deserved.  But  he  was  only,  after  all,  one 
of  many  who  in  their  various  spheres  of  life  have  simply 
done  their  duty.  The  principle  of  taxing  the  living  for 
the  dead  is  undeniably  a  bad  one,  and  we  trust  that  the 
faUure,  conspicuous  as  it  has  been  in  this  instance,  to 
promote  a  memorial  object,  will,  from  the  publicity 
which  it  has  obtained,  act  as  a  corrective  on  future 
occasions  of  the  kind. 


The  Next  Annual  Meeting  of  the  Britiah 
Medical  Association. 

A  SPECIAL  meeting  of  the  Council  of  the  British 
Medical  Association  was  held  in  London  last  week,  at 
which  it  was  decided  that  the  Annual  Meeting  of  the 
Association  should  be  held  at  Carlisle  on  the  28th, 
29th,  30th,  and  31st  July  next,  and  the  Council 
approved  of  the  nomination  of  the  Border  Counties 
branch  that  Dr.  Barnes,  of  Carlisle,  be  the  President 
of  the  Association  next  year.  It  is  proposed  to  have 
nine  sections  in  Carlisle,  and  Dr.  Barnes,  Dr.  Helm, 
and  Dr.  Maclaren,  representing  the  local  arrangements 
committee,  have  secured  from  the  Carlisle  School 
Board  the  use  of  the  Lowther  Street  Board  Schools  for 
the  occasion.  They  have  also  obtained  from  the 
governors  of  the  Grammar  School  permission  to  use  a 
portion  of  that  commodious  building. 

Royalty  and  Continental  Hospitals. 
The  hospitals  in  Berlin  were  especially  favoured 
during  the  season  of  Christmas  just  passed.  The 
Empress  Frederic,  according  to  her  annual  custom, 
paid  a  round  of  visits  to  them  and  other  charitable 
institutions.  At  the  Emperor  and  Empress  Frederic's 
Children's  Hospital  her  Majesty  was  present  at  the 
distribution  of  the  Christmas  gifts.  One  hundred  and 
fifty-six  chOdren  received  their  presents  from  the 
Empress  Frederic's  own  hands,  and  these  included  for 
each  little  patient  a  complete  outfit  of  new  clothes. 
After  the  ceremony  Professor  7irchow  gave  a  brief 
account  of  the  results  achieved  in  the  hospital  with  the 
antitoxin  serum  in  the  treatment  of  diphtheria.  In  the 
period  from  April  to  November,  out  of  335  children 
who  suffered  from  diphtheria  305  had  been  cured.  The 
mortality,  which  had  formerly  amounted  to  43  per 
cent,  had  fallen  to  9i  per  cent.  This  testimony  of  the 
efficacy  of  the  new  treatment,  coming  from  so  high  an 
authority,  is  noteworthy,  and  should  be  borne  in  mind 
by  those  who  are  disposed  to  question  the  results 
which  have  so  far  been  published  in  this  regard. 

The  Metropolitan  Asylums  Board  have  decided  to 
open  the  Gore  Farm  Small-pox  Hospital  to  convales- 
cent fever  patients. 

The  life  of  public  officers  is  not  all  smiles  and 
harmony.  Dr.  E.  O.  Pryce,  of  Bangor,  last  week 
resigned  his  medical  officership  of  the  workhouse, 
owing  to  ''  the  worry  and  petty  annoyances  he  had  to 
put  up  with,  which  he  had  neither  time  nor  patience  to 
endure."  It  is  a  pity  that  our  confrere  did  not  post- 
pone his  resignation  till  after  the  soothing  influence  of 
Christmastide  had  been  tried. 


JAir.  1,  1890- 


CORRESPOHDKNCE. 


Ths  BIsdtoal  Pbbss.   .  21 


The  New  Factory  Bill 
Today,  Jannaiy  Irt,  1896,  the  new  Factory 
and  WorknhopB  Act  will  come  into  operation.  The 
mtrodnction  of  this  measure,  it  will  be  remembered, 
was  one  of  thehst  introduced  by  the  lato  Qovemment 
under  the  aoipices  of  Mr.  Asqnith,  the  then  Home 
Secretaiy.  The  new  Act  is  far  more  stringent  and 
far-ieaddng  than  any  that  have  yet  been  in  operation 
in  this  or  in  any  other  coontry.  The  important  prin- 
oqde  of  a  cubic  space  allowance  for  workmen  has  been 
adopted  for  the  first  time.  The  main  points  of  this 
fresh  and  important  departure  in  modem  factory  legis- 
ktion  will  be  discussed  at  length  in  an  early  issue. 

The  Case  of  Surgeon-Major  Olarenoe  Smith. 
Ths  Commission  that  has  been  sitting  to  deal  with 
the csseof  Sorgeon-Major QIarenoeSmith  has  concluded 
its  inquiry^  and  the  verdict  will  now  be  awaited  with 
much  interest.  Although  the  hearing  was  in  camerd^  it 
is  possible  that  a  report  of  the  proceedings  may  e>en- 
toally  be  published. 

A  CoMXiTTBB  will  assemble  in  Calcutta  this  month 
to  rerae  the  present  Army  ehdera  rules.  The  Com- 
mittee will  be  composed  of  the  Quartermaster-General 
in  India,  the  Principal  Medical  Officer  with  Her 
Miaesty's  Forces  in  India,  and  the  Sanitary  Com- 
missioner with  the  Government  of  India,  associated 
vith  Mr.  Hankin,  the  bacteriologist 

Thi  Local  Government  Board  has  assented  to  the 
proposal  of  the  Chelsea  Board  of  Guardians  to  appoint 
a  aecond  assistant  medical  officer  at  a  salary  of  £70  a 
year  and  the  usual  emoluments,  and  that  females  be 
eligible  as  well  as  males  for  the  post 


SiC0tktd). 


[rXOM  0T7B  OWK  COBBBSPOKDBNT.] 


1895  IN  EDINBUBGH. 
Ths  psst  3rear  has  been  marked  in  Edinburgh  by  great 
▼ariatioDS  both  in  tbe  death-rate  and  the  weather.  A 
severe  epidemic  of  inflnenza  in  the  Spring,  commencing 
doling  a  period  ef  intense  cold,  caused  the  mortality, 
^ipeoiany  in  the  month  of  March,  to  rise  to  a  very  unusual 
height,  while  the  amount  of  sickness  in  the  dty  was  enor- 
mous, hi  tbe  latter  months  of  the  year,  notwithstanding 
s  widespread  epidemic  of  scarlet  fever  of  a  mild  type,  the 
Biortality  was  very  low  and  the  health  of  the  inhabitonte 
eiceUent  For  several  weeks  the  death-rate  varied  between 
14  and  16  per  thousand,  and  in  the  last  week  of  the  year 
was  as  low  as  14  per  thousand,  a  very  low  rate  for  the 
ttmo  of  year.  Little  of  importance  occurred  in  connection 
with  the  hospitals  of  the  city  except  the  opening  of  the 
sew  buOdings  for  the  Royal  Hospital  for  Sick  Children. 
The  Infirmary  managers  decided  in  the  course  of  the  year 
to  proceed  with  the  extension  of  the  present  buildings, 
cliaDka  to  some  munifioent  legacies  received  by  them,  and 
in  doing  so  determined  that  the  special  departments,  at 
present  much  cramped  for  want  of  space,  should  be  first 
attended  to.  The  Town  Council  purchased  ground  for  a 
new  few  hospital  in  the  southern  suburbs  of  the  city,  and 


propose  to  build  a  large  hospital  on  it  In  connection 
with  the  Medical  School  of  Edhiburgh,  the  various  extra- 
mural lecturers  combined  to  form  under  the  segis  of  the 
Royal  CoUeges  a  single  corporation.  It  has  not  been  a 
very  successful  year  in  the  matter  of  students ;  the 
numbers,  perhaps,  have  not  fallen  from  those  of  the  year 
before,  but  are  much  below  high- water  mark.  The  pro- 
fession has  lost  several  well-known  members,  among  whom 
may  be  mentioned  Dr.  Brakenridge,  Dr.  T.  A.  G.  Balfour, 
and  Dr.  Bruce  Bremner. 

DisTBuonoN  or  th»  Edinbubgh  Small-pox  Hospital. 
—The  temporary  building— a  wooden  structure— in  the 
Queen's  Park,  which  for  a  long  time  past  has  been  used  as 
an  isolation  hospital  for  small-pox  patiento,  was  destroyed 
by  the  fire  brigade  on  Thursday  last  by  order  of  the 
Public  Health  Committee.  The  woodwork  was  saturated 
with  paraffin  oil,  and  a  large  quantity  of  shavings  was 
laid  down  beneath  the  fiooring  at  the  east  end  of  the  two 
pavilions.  Shortly  after  midnight,  when  the  neighbour- 
hood was  quiet,  a  match  was  applied  to  the  shavings,  and 
in  a  few  minutes  the  buildings  were  ablaze.  The  flames, 
in  incredibly  short  time,  travelled  along  the  buildings, 
the  wind  being  from  the  east ;  a  lurid  glare  was  cast  upon 
the  sky,  and  the  general  impression  was  that  a  disastrous 
fire  had  accurred.  Many  set  out  in  the  direction  from 
which  the  blase  prooeeded ;  and  to  them  it  was  somewhat 
of  a  disappointment  when  the  precise  stote  of  matters  was 
explained. 


(Wis  do  Bofe  bold  oniMlves  reqponaiUe  for  the  opinionB  of  our 


PROPOSED  MEDICAL  TITLES  BILL. 

To  the  Editor  of  the  Mxdigal  Pbess  akd  Cibcvlab. 

Sib,— Your  correspondent  ''H.  S.,"  in  the  last  number 
of  your  valuable  journal,  makes  a  stetement  which  is 
certainly  not  borne  out  by  facts.  He  asserts  that  "  at 
present  there  is  nothing  whatever  to  prevent  an  unquali- 
fied quack  from  assuming  the  title  of  doctor  and  adding 
M.D.  to  his  name."  I  can  only  state  tihat  many  success- 
ful prosecutions  for  this  ofience  under  tbe  Medical  Act 
have  been  conducted  by  the  Medical  Defence  Union  each 

{^ear  for  many  years,  and  that,  in  fact,  we  have  never 
oet  a  single  case.  With  reference  to  the  appeal  now 
pending,  he  also,  with  singular  want  of  judgment,  refers 
to,  as  it  is,  however,  at  present  "sub  judioe,"I  will 
not  follow  his  example,  but  await  the  result  with 
equanimity.  The  Medical  Act  properly  used  is  a  valuable 
weapon,  and  our  success  with  it  up  to  the  present  time 
oertainly  does  not  cause  us  to  regard  ic  in  the  same  light 
as  your  correspondent. 

I  am,  Sir,  yours,  &c., 

A.  G.  Batsmak,  M.B., 
Geo.  Sec.  Hedical  Defence  Union. 
Dec.  24, 1805. 


THE  GENERAL  MEDICAL  COUNCIL. 

To  the  Sdiior  ofTux  Mbdical  Fbbss  and  Circular. 

Sib, — On  reading  in  your  columns  the  remarks  of  Sir 
Richtfd  Quain,  as  to  the  disabilities  of  the  legal  profession, 
I  could  not  see  that  there  was  any  reason  for  our  being 
content  with  the  present  constitution  of  our  Council. 
Some  of  us  from  Lancashire  and  Cheshire,  who  were 
present  at  its  session  in  May  last,  certainly  were  not 
tavourably  impressed  with  what  we  witnessed.  Had  we 
been  shareholders  in  an  undertaking  havine  in  its  employ- 
ment or  government  32,000  hands,  we  should  not  have  felt 
saUtfied  in  leaving  it  in  the  hands  and  under  the  control 
of  such  a  body  of  men,  neither  should  we  have  felt  content 
that  even  the  affairs  of  a  city  would  be  e£fectually  managed 
with  a  similar  body  of  men  in  its  CounciL    We  certainly 


Tbb  MlDIOAL  PS188. 


OBITUARY. 


Jan.  1,  1896. 


do  hope  that  thoee  members  of  oar  profeasion  who  can 
▼i8it  the  Gooncil  Chamber  duriDg  the  eession  will  avail 
themselves  of  the  opportunity,  for  ike  public  hcbve  free 
access,  as  they  will  then  see  how  and  by  whom  the  business 
of  the  government  of  our  profession  in  these  realms  is 
conductod.  Sorely  there  ought  to  be  some  limit  as  to  ase 
when  elected.  At  our  Manchester  Royal  Infirmary  the 
limit  for  holding  appointments  is  sixty.  Is  there  any 
reason  why  some  such  restriction  should  not  be  adopted  in 
our  governing  body?  Surely  hundreds  of  capable  and 
reliable  men  can  be  found  in  the  countrv  under  that  age 
who  have  the  necessary  energy  and  ability  which  would 
command  the  respect  and  conndenoe  of  every  man. 

As  to  Sir  Richard's  remarks  about  the  direct  representa- 
tives many  of  us  in  this  part  of  the  country  are  of  opinion 
that,  if  we  had  bad  more,  we  should  have  bad  a  far  more 

Eraetical  outcome  of  the  investigation  in   reference  to 
[edioal  Aid  Associations  than  we  can  find  in  their  report 
on  that  question. 

One  effectual  n^eans  of  bringing  the  medical  ofBcere  of 
such  trading  institutions  into  line  would  be  to  have  an 
annual  registration,  as  in  the  legal  profession  that  the 
president  referred  to.  If  the  amount  of  the  fee  were  five 
shillings,  the  Council  would  have  an  additional  income  of 
about  £8,000.  This  would  provide  us  with  ten  additional 
direct  representatives,  and  leave  a  large  balance  to  be 
applied  to  some  other  useful  purpose  for  the  benefit  of  the 
profession  at  large. 

It  is  not  necessary  to  dwell  at  length  on  the  advantages 
that  would  be  derived  from  an  annual  registration,  but 
this  one  miffht  be  stated,  that  such  men  that  I  have  men- 
tioned would  at  once  begin  seriously  to  refiect  that  it 
would  be  absolutely  necessary  to  put  their  he  uses  in  order, 
For  the  first  year  or  two,  there  might  have  to  be  a  pro- 
longed eession  of  the  Council  or  its  executive  to  inquire 
into  the  reasons  why  certain  men  should  not  be  again 
licensed  to  practice,  or  whether  their  licences  should  be 
endorsed,  both  as  a  record  and  a  warning,  as  is  done  by 
the  magistrates  in  certain  other  licences.  But  as  time 
went  on  and  better  discipline  resulted,  the  extra  sessions 
would  become  small  matters,  for  members  would  always 
feel  that  they  were  under  the  direct  control  and  supervision 
of  the  General  Medical  Council. 

Yours  faithfully, 

O.  H.  BaOADBBfT. 

Manchester,  December  17th,  1895. 

[Our  correspondent  appends  to  his  letter,  the  names  and 
approximate  ages  of  the  various  members  of  the  Council, 
varying  from  35  to  76  years,  but  as  this  must  necessarily 
be  guess  work,  we  have  deleted  this  portion.— Ed.] 


THE    NOTIFICATION    OF    DISEASES    ACT- 
MASON  T.  HADDEN. 
To  the  Editor  qf  Thi  Midioal  Pbkss  and  Ciboulab. 

Sm,-— The  particulars  of  this  action  at  law,  in  which  a 
medical  man  was  sued  for  damages  in  consecjuence  of  bis 
having  notified  a  case,  under  the  Infectious  Diseases 
(Notification)  Act,  which  he  had  reasonable  grounds 
for  regardinff  as  one  of  small-pox,  will  be  within  your  re- 
collection, also  that  a  jurv  awarded  damages  to  the 
plainUfi^  but  that  on  appeal,  the  verdict  was  reversed  by 
the  full  court. 

We  were  previously  advised  that  any  public  discussion 
of  the  matter  by  the  medical  profeeslon  would  be  undesir- 
able, fearing  that  doing  so  might  in  any  way  prejudice 
the  case. 

The  judgment  of  the  full  court  justifies  Dr.  Hadden  and 
relieves  him  from  any  imputation  whatever.  In  addition 
to  the  anxiety  and  trouble  necessarily  caused  to  him  while 
the  action  was  pending,  the  question  of  expense  has  to  be 
oonsideitKl.  Dr.  Hadden  has  already  incurred  a  large 
pecuniary  liability,  and  as  he  has  fought  this  case  on  pro- 
fessional and  public,  as  well  as  on  private  grounds,  we 
feel  that  he  should  not  be  allowed  to  suffer  any  loss.  There- 
fore, we  readily  ask  our  professional  brethren  to  join  in  a 
subscription  to  meet  any  such  expense. 

The  issues  raised  have  had  an  interest  far  beyond  an 
individual  one,  and  have  induced  Dr.  Hadden  to  contest 
the  case  on  broad  public  grounds,  for  had  the  contention 


of  the  plaintiff  in  this  matter  remained  unchallenged,  a 
blow  would  have  been  struck  at  public  safety,  as  well  as 
at  the  independence  of  medical  men.  If  a  physicisn  is  to 
be  proceeded  against  for  the  discharge  of  a  duty  csftt  on 
him  by  an  Act  of  Parliament  paesed  for  the  protection  of 
the  public  at  large,  it  would  seriously  inter  fere  with  th<( 
profession  in  carrying  out  the  law  and  in  protecting  the 
public  as  they  are  bound  to  da 

We  feel  that  both  the  moral  and  substantial  support  of 
his  profession  should  be  accorded  to  Dr.  Hadden  in  the 
trying  position  in  which  he  has  been  placed.  The  Act 
referrea  to  is  already  unpopular  enough  with  many 
persons,  and  if  a  new  terror  in  the  ehspe  of  actions 
lor  damages  against  medical  men  for  carrying  out  the 
duties  cast  on  them,  and  for  which  they  are  made  legally 
liable,  be  introduced,  it  is  to  be  featdd  tbatmsny  might 
be  detened  from  obeying  the  law  to  its  full  extent. 

Subscriptions,  limited  to  one  guinea,  will  be  received  and 
acknowledged  by  Jsmes  Craig,  M.D.,  35  York  Btteet, 
Dublin,  who  has  consented  to  act  as  Hon.  Treasurer. 
Signed^ 

Tho6.  W.  Gbihshaw,  President  R.C.P.L 

Thobnlkt  Stokxb,  Kt.,  President  R.C.S.I. 

Jamks  Liitli,  President  Roy.  Acad,  of  Med. 
IreL 

Austin  Mxldoit,  President  Irish  Med.  Assoc. 

HsKBT  R.  SwAKZY,  President  Dub.  Branch, 
B.M.A. 

£.  H.  BxNNftTT,  Professor  of  Surgery,  Dab. 
Univ. 

Wm.  Thomson,  Senator  R.U.L 


DR.  GEORGE  HUGH  KIDD. 
WiTBiN  the  past  week  the  profession  in  Ireland  has 
lost  one  of  its  most  notable  men  by  the  death  of  Dr. 
George  Hugh  Eadd,  its  Direct  Representative    in  the 
General  Medical  Council.    He  was  bom  in  Armagh  in  the 
year   1824,   the   desoendant    of    a    family   of,  Scotch 
settlers.  He  first  entered  on  the  medical  stage  as  a  student 
of  the  College  of  Surgeons  and  Trinity  College  Schools  in 
Dublin,  afterwards  at  Edinburgh  University,  where  he 
took  his  M.D.,  obtaining  a  gold  medal  as  the  reward  of  his 
intelligence  and  exceptional  diligence.    On  his  return  to 
Dublin  he  was  at  once  appointed  to  be  a  Demonstrator  in 
the  Park  Street  Schools,  where  he  lectured  on  Anatomy 
and  Physiology  until,  in  1849,  he  was  translated  to  the 
Peter  Street  School  of  Medicine,  with  which  institution  he 
maintained  bis  connection  as  a  lecturer  for  eight  years. 
During  this  period  of  his  career  as  a  teacher  he  was  rapidly 
building  up  the  reputation  as  a  practitioner  and  operator 
in  obstetrics,  which  eventually  develoi)ed  iuto  a  Euro- 
pean celebrity.     Having  been  attadied  for  some  time 
to  the  Goombe  Lying-in  Hoppital  as  Obstetric  Surgeon, 
he  became  its  Master  in  1876,  and  held  that  office  until 
1883,  with  such  satisfaction  to  those  connected  with  the 
Hospital  that,  if  the  law  had  permitted,  he  would  have 
been  re  elected  to  the  Mastership  for  a  further  term.  The 
roll  of  the  distinctions  which  he  received  at  the  hands  of 
the  profession  and  of  scientific  institutions  is  almost  too 
long  for  the  space  at  our  disposal    He  filled  the  office  <tf 
President  of  both  the  Royal  CoUeffe  of  Surgeons  and  the 
Royal  Academy  of  Medicine,  and,  m  1883,  was  '*  capped" 
by  the  University  of  Dublin  with  the  degree  of  Master  in 
Obstetric  Surgery  (Aoa.  caus.).    His  pre-eminent  quality 
as  a  diagnostician,  and  his  unrivalled  experience  as  an 
obstetric  surgeon,  secured  for  him  the  position  of  Con- 
sulting Obstetrician  to  several  of  the  Dublin  hospitals, 
and  the  appreciation  of  his  attainments  by  bodies  outside 
Great  Britain  was  manifested  by  the  co-option  of  him  ss 
corresponding    Member  of  the   Obstetnc    Societies  of 
Boston,  Washington,  Berlin,   and  Edinburgh.     Finally, 
the  rank  and  file  of  his  working  brethren  in  Ireland  testi- 
fied their  respect  and  confidence  in  him  by  electing  him 
their  Direct  Representative  in  the  General  Medical  Coun- 
cil in  1886,  when  that  office  was  first  created.    Dr.  Kidd's 
contribution  to  the  knowledge  of  his  speciality  presents  a 
remarkable  record  of  originality  of  conception,  expert 
judgment,  and  earnest  work.    He  may  be  designated, 


Jiir.  1, 18K 


MEDICAL  NEWB. 


Tbi  Msdtcat.  Prsss.     23 


with  tnith,  the  originAtor  of  puerperal  antiseptia  ;  he  was 
the  mosfe  tncoeMf nl  operator  of  his  time  for  veeico-vaginal 
iUtola,  having  tcorea  a  aeries  of  17  saoceesive  Buccesaf  ul 
eMea  wilh  a  aingle  operatioii.  He  waa  the  pioneer  in 
Ireluid  of  the  nae  of  the  laminaria  digitalia  for  dilatation 
of  the  OB  uteri,  and  alao  of  lumbar  eSotomy,  and  he  alao 
mtrodnoed  the  nae  of  nitrio  add  for  intra-uterine  medica- 
tion. Br.  Kidd  was  one  of  a  type  of  Irishmen  who  make 
their  mark  wherever  they  i^  He  had  many  of  the 
oharaeteriatioa  of  Sir  Dominie  Gorrigan,  being  atrong- 
baaded  and  strong-minded,  not  very  regiurdf  al  of  obetadea, 
hot  very  determined  to  overoome  them.  He  reaided  in 
the  house  fonnariy  ocenpied  bv  Dan  (XCkmnell,  and  might 
have  been  a  doae  relative  of  the  Liberator,  for  he  evinced 
madi  of  tiie  same  capadty  for  governing  men.  He  will  be 
kog  rememberBd  by  his  professional  mthren  and  1^  the 
imUie  in  Dablin,  in  Ireland,  and  even  throughout  Great 
Britain. 

MR.  JAMES  ROUSE,  F.R.G.S. 
Wi  regret  to  aanoiinoe  the  death,  at  the  comparatively 
early  age  of  sixW-siz,  of  this  gentleman  at  his  residence 
in  Lflooon,  2  Wilton  Street,  Grosvenor  Place.  He  was 
senior  surgeon  ol  St.  George's  Hospital,  and  consulting 
tsrgeoD  to  the  Royal  Westminster  Ophthalmic  HospitaL 
He  leoelved  hie  medical  education  at  the  school  of  St. 
George'a  Hoepita],  was  admitted  a  member  of  the  Royal 
GoDsge  of  Surgeons,  England,  in  1851,  and  elected  a 
fbOow  by  examination  in  1883.  He  was  a  member  of  the 
Pfctbotogical  and  Glmical  Societies  of  London.  Beside 
tiis  foregoing  hospital  appointments,  he  held  the  post  of 
ophthalmic  enrgeon  to  the  Eastern  Counties  Asylum  for 
Idiots,  oonmilting  surgeon  to  the  Hospital  of  St.  Elizabeth 
and  St.  John,  to  the  Sk  Anne's  Ro^  Asylum,  and  to  the 
School  for  the  Indigent  Blind.  Me  was  the  author  of 
pftpen  on  Rhenmatic  Iritis,  and  Acute  Orchitis  in  the  St. 
George's  Hoepital  Reports,  and  of  various  other  contribu- 
tiaos  to  the  medical  journals.  Deceased  has  not  been  in 
loboft  health  lor  some  time  past,  and  much  of  hia  time 
had  to  be  passed  at  his  seaside  residence  near  Worthing. 

MR.  JOHN  CHIPPENDALE,  F.R.C.S. 
By  the  death  last  week  of  this  gentleman  one  of  the 
oUset,  if  not  the  oldest,  member  m  the  profeeaion  haa 
Dsaeed  away  at  the  age  of  ninety.  Deceaaed  became  a 
Member  of  the  Royal  College  of  Surgeona  of  England  ao 
fir  back  aa  1836,  and  in  1843,  the  Honorary  FeUowahip 
vaa  bestowed  on  him.  He  received  hia  medical  education 
it  Univeraity  Ck>llege  and  Paris,  and  after  takins  his 
If  .R.CS.  be  served  for  seven  years  as  Surgeon  in  the  Royal 
West  Indian  and  Brazil  BAail  Steamship  Company,  on  re- 
tiring from  which  he  aettled  down  to  practiae  m  London. 
Mr.  Qiippendale  waa  the  first  annual  President  of  the 
Medical  Society  of  Universitv  College,  London ;  was  for 
isventeen  years  surgeon  to  the  Famngdon  General  Dis- 
psDsary,  and  for  six  years  lecturer  on  Anatomy  and  Phyaio- 
loqr  St  the  Hnntenan  School  of  Medicine.  During  the 
kkt  few  years  he  had  retired  from  the  practice  of  his  pro« 
fseaion  to  XJppot  Phillimore  Place,  Kensington,  where  he 
died  f  uU  of  years  and  much  respected. 

literature. 

BACH'S  NERVOUS  DISEASES   OF  CHILDREN,  (a) 

Wb  have  been  attracted  from  the  outset  by  this  work. 

Ii  is  a  ooneeption  on  a  fairly  large  scale  of  what  ia  known 

aad  what  ought  to  be  taught  regarding  the   nervous 


I  of  children.  The  author  ia  evidently  well  up  in 
fail  aubiect,  and  takea  a  comprebenaive,  maaterly  view  of 
it,  fo  that  much  of  the  beat  that  haa  been  contributed  by 
writers  at  home  and  abroad  is  here  referred  to.  Functional 
and  organic  diseases  are  arranged  feparately.  Anatomy 
without  cumbering  the  book,  is  made  to  elucidate  the 
tsifc  by  graphic  diagrams  and  a  not  too  elaborate  text. 
Ibe  author  rightly  enlarges  on  the  best  method  of  ezamin- 
iag  children,  on  the  scheme  of  examination  to  be  adopted, 
and  lays  down  rules.  He  wisely  treats  of  dieeaaea  rare  aa 
well  as  frequent,  merely  to  keep  in  view  their  poaaibility 


iil!li!l?^E2f«^*'5!^*'^^^^^J^^-  *"^»'  M-D.    London: 
Bd  Hasp,  TiBd«Il,tnd  Cox.    U96.   frioelSi. 


when  ^ueationa  of  differential  diagnoaia  ariae.  Works  of 
thia  kind  are  frequently  overload^  with  anatomicafand 
physiological  descriptionp,  which  are  moatly  transpoaitiona 
and  are  not  brought  into  coherent  relationahip  with  the 
reat  of  the  aubject.  Here  we  have  a  chapter  on  the  ana- 
tomy,  phyaiology,  and  pathology  of  the  brain,  which  ia 
remarkably  intereatiog  and  more  inatructive  than  uaual, 
beoauae  of  the  author'a  beautiful  arrangement  of  diagrama. 
Localiaation  of  functiona,  of  atranda  of  nerve  fibrea,  of  nerve 
paths,  and  vascular  supply  are  rendered  comparatively 
easy.  If  we  might  take  exception  to  anything  in  this  por- 
tion of  the  book,  it  would  be  the  rej^oduction  of  SchSter's 
illustration  of  the  "  Distribution  oiBlood  Supply  at  Base," 
which  is  rather  perplexing  alongside  of  Thane  and  Char- 
cot's illustration  on  the  opposite  page.  We  looked  for  a 
larger  exposition  of  the  subject  of  tubercular  meningitis, 
but  on  further  consideration  it  seems  that  the  author  has 
given  the  salient  points  of  the  subject.  The  treatment  of 
the  nature  and  varieties  of  idiocy  and  imbecility  ought 
certainly  to  have  been  more  fully  entered  upon  in  a  work 
of  this  kind,  for  these  diseases  belong  veiy  uurgely  to  the 
group  comprised  in  the  author's  titk.  These  objections 
apart,  we  mustaoknoi^ledge  that  this  work  is  one  of  con- 
siderable merit  and  originMity,  and  one  especially  adapted 
to  be  readable  and  serviceable  in  the  hands  of  busy 
practitioners. 


Vital  SUtistics. 

Thb  deaths  registered  last  week  in  thirtv-three  great 

towns  of  England  and  Wales  oorrespondea  to  an  annual 

rate  of  18*6  per  1,000  of  their  aggregate  population,  which 

is  estimated  at  10,501,530  persons  in  the  middle  of  this 

Star.    The  deaths  registered  in  each  of  the  last  four  weeks 
the  several  towns,  alphabetically  arranged,    corres- 
ponded to  the  following  annual  rates  per  1,00^  :— 

Birkenhead  17,  Bhmdngham  23,  Blackbum  16,  Bolton 
10,  Bradford  18,  Brighton  11,  Bristol  13,  Burnley  16, 
Cardiff  15,  Croydon  13,  Derby  13,  Dublin  20,  Edinburgh 
16,  Glasgow  19,  Gateshead  14,  Halifax  15,  Hnddersfield 
15,  Hull  15,  Leeds  18,  Leicester  19,  Liverpool  27,  London 
18,  Manchester  19,  Newcastle-on-Tyne  19,  Norwich  21, 
Nottingham  18,  Oldham  21,  Plymouth  16,  Portsmouth  12, 
Preston  20,  Salford  24,  Sheffield  18,  Sunderland  20, 
Swansea  17,  West  Ham  15,  Wolverhampton  23.  The 
highest  annual  death-rates  per  1,000  living,  as  measured 
b^  last  week's  mortality  were:— From  measles,  2*4  in 
Birmingham  and  in  Liverpool,  2-9  in  Norwich  and  in 
Blackbum,  and  5*5  in  Salford ;  from  acarlet  fever,  1*3  in 
Salford;  from  whooping-coueh,  1*5  in  Birkenhead,  and 
1*6  hi  Leeda;  and  from  **  fever,"  10  in  Salford  1*5  in 
Norwich  and  in  Sunderland,  and  2*4  in  Birkenhead.  The 
death-rate  from  diarrhoea  did  not  reach  1*0  per  1,000  in 
any  of  the  large  towna.  The  105  deatha  from  diphtheria 
included  62  in  London,  6  in  Birmingham,  5  in  Edinburgh, 
5  in  Liverpool,  4  in  Mancheater  and  in  Newcaatle-on-Tyne, 
and  3  in  Sheffield.  No  death  from  amall-pox  waa  regia- 
tered  in  any  part  of  the  Kingdom. 


PASS    LISTS. 


M.D. 


Royal  College  of  Surgeons  of  Engl&nd. 
Thi  following  gentlemen  having  passed  the  necessary 
examinations  have  been  admitted  Fellows  of  the  College. 
The  names  are  arranged  in  order  of  seniority  as  Members 
of  the  College  :— 

lUndAll,  Ibrt'n,  M.D.,  L.K.C.P. 

SatoUffe,  William  G.,  L.R.C.P. 

Barnard,  Harold  L.,L.&.C.P.Load. 

Smitb,  T.  B.  H.,  M.B.Camb. 

Tomer.  William,  H.B.,  L.B.C.P. 

Klwortlur,    Henry    8.,    L.R.aP. 

Arnold,  Gilbert  J..  L.B.C.P.Iiond. 
iHckion.  H.  A.  D.,  L.&.C.P.Lond. 
Colby,  Frandi  E.  A.,  liaCamb. 
Brown,   Ralph    C,   M.B.,  Cli.a 

Melb. 
Brodie,  William  Halg  H.I>.Ed. 


E..  L.E.O.P. 


Ferrand.  iEdward  (I.M.SX 

Foolerton,  Alex.  G. 

Lnnd. 

Tanner,  Herbert,  L.B.C^.Lond. 
Pliani,  Lionel  John.  L.8.A. 
Eidley.  NlcholatCJarlee.  H.B. 
Laoe,  Frederick,  L.K,C.P.Lond. 
Leaf.  CecU  B.,  M.B..  B.aCamb. 
Cnrtli,  Henry-  J.,  L.E.C.P.Lond. 
Addison,  Chrletopher,  L.&.C.F. 
Ballance,  Hamilton  A..  M.D. 
Hainworlh,  E.  M.,  M.B.,  B.S. 


24 


Xii«-   >T— ^THM,   TrFPS. 


NOTICES  TO  COBREBPONDENTS. 


Jav.  1,  IM. 


CorrtBpmtbentB,  §kprt  %ttttts,  i^c. 

9Bf  COBRiSPOBfDiHTB  requiring  %  reply  In  fhli  oolmnn  are  ptr- 
tionlarly  reqneited  to  make  vme  of  a  ditHnetive  tignature  or  initiaUt 
and  avoid  the  praotloe  of  dgningtbenuelTee  "  Beader,"  "  Snbtcrlber," 
"  Old  Snbaoriber,"  Ao.  Mnoh  oonfniion  wQl  be  ipared  by  attention 
tothiBmle. 

OuoniAL  ABTiOLisIor  Liims  Intended  for  pablloation  ihonld  be 
written  on  one  ilde  of  the  paper  only,  and  mnet  be  anthentloated  with 
the  name  and  addren  of  the  writer,  not  neceeiarily  forpablioatton, 
bnt  aa  evidence  of  identity* 

LOCAL  BlFOBTB  IBD  KSWS^-Oorrtqpoiidenti  deefrooi  of  drawing 
attention  to  theee  are  requested  kindly  to  mark  the  newipapetv  when 
■ending  them  to  the  Bdltor. 

RRFRiiiTa— Authors  of  papers  requiring  reprints  in  pamphlet  form 
after  they  have  appeared  in  these  columns  can  have  them  at  half  the 
usual  cost,  on  application  to  the  printers  before  tTPO  i>  broken  up. 

BiADnra  Caais.  -Cloth  board  cases,  gUt-lettered,  oontainiDg  twenty- 
six  strings  for  holding,  the  numbers  of  Teoh  MsdiOal  Prsss  ahd 
GIBOULAB,  may  now  be  had  at  either  office  of  this  Journal,  price  fs.  ed. 
These  oases  will  be  found  very  useful  to  keep  each  weekly  number 
Intact,  clean,  and  flat  after  it  has  passed  through  the  post. 

Dr.  Jab.  Shaw  is  thanked  for  his  cases  iUustratiog  "  The  Localiaing 
Yalae  oi  the  Prominent  Symptoms  of  Bncephallo  Disease,"  which  will 
appear  in  an  early  number. 

ANTITOXIN  AND  DIPHTHE&IA. 

To  (he  Editor  c/  TBI  MXDIOAL  PB188  AND  ClBCULAB. 

SIB,— The  following  extract  has  been  made  from  the  *'  Monthly 

AniiljBis  of  Sickness  and  Mortality  Statistics  in  London  "  with  aview 

to  compare  the  moxtality  from  diphtheria  before  and  after  the  Intro* 

d notion  of  antitoxin  treatment  :— 


Deaths.  Per  oenl 

806  20*1 

819  ..  IQ'O 

485  ..  24-5 

186  ..  17-« 

80/  ..  l»-5 

206  ...  21-4 

I  am,  fiir,  yours,  Ac, 

M.  ALTDOBFIB,  M.D. 

St.  Ann's  Hill,  Dec.  28th,  1896. 

Db.  Mubbbll.— We  hope  to  haye  space  for  your  paper  on  "  The 
Pharmaoologloal  Action  of  Puigatiyes"  in  our  next. 

Mb.  C.  B.  S.  i%  thanked  for  the  information  which  we  hope  to  be  in 
a  position  to  supplement  next  week. 

DB.  B.  A.  L.-  The  facts  appear  to  us  to  be  unquestionable,  but  we 
shall  be  glad  of  Yeriflcatlon  to  avoid  the  possibility  of  a  mistake. 
CUBI0U8  IF  TBUB. 

AH  eminent  West  End  plnsidan  the  other  evening  kindly  gave  a  lec- 
ture of  a  professional  tlwugn  popular  character  in  a  poor  neighbour- 
hood, where  wholesome  medical  •drioe  might  be  deemed  acceptable. 
For  ladk  of  other  aooommodadon  the  lecture  was  given  in  a  ohapeL  As 
some  of  the  physician's  patients  and  friends  had  got  word  of  the  lec- 
ture, a  number  of  them  drove  down  to  hear  it.  The  audience  was 
sprinkled  with  fashionable  people,  and  there  was  so  mnoh  money  in  the 
"  house  "  that  the  cupidity  of  the  deacon  who  bad  to  move  a  vote  of 
thanks  to  theleotnrer  could  not  be  restrained.  Here  were  sheep  to  be 
sham  for  the  good  of  the  cause,  and  he  was  the  man  to  do  it.  Accord- 
ingly, the  worthy  deacon  nnblushlngly  announced  that  he  thought,  as 
so  msjiy  of  their  friends  were  present,  they  would  like  to  help  the  cause, 
and  to  give  them  an  opportnmty  of  doing  so  a  collection  would  be  made. 
X7p  roeethe  physician  in  a  state  of  fiery  indignation  to  inform  the 
audisnce  that  when  he  consented  to  deliver  the  leotore  it  was  on  the 
condition  that  it  was  to  be  ftte  in  every  respect.  Slapping  his  pocket 
with  his  hand,  he  added  he  did  not  intend  to  give  one  penny,  and  ho 
hoped  no  one  else  would  do  so.  Of  oonrae  this  outburst  was  received 
with  cheers,  and  another  deacon  was  put  up  to  apologise  to  the  leetnrer 
and  to  withdraw  the  obnoxioos  proposal  of  his  brother.— T/ie£trmin(7- 
ham  Oazette. 

JiCeetmsB  of  the  ^oaettea 

Friday,  Jah.  sbd. 
Wbst  Lobdon  MEDico-CaiBOBOiOAL  SooiBTT,  West  London  Hos- 
pital, W.— 8.3U  p.m.    Dr.  McCaon :  Diagnoais  of  Gouorrhceai  Inflam- 
mations (wtth  lime-lignt  demonstratiODX    Dr.  Ciemou :  xbe  Treat- 
ment of  Euterocolitis  in  Infants. 


1803. 

Months, 
tept. 
Oct. 
Nov. 

Notified  Cases  of 

Diphtheria. 

1,628 

l,ft98 

1,770 

1806. 

Nov. 

1,012 
1,672 
1,288          .. 

city  of  Dublin  Hospital.— Housekeeper.  Applications  beiore  January 
15th.  1690,  to  the  Secretary  at  the  HospftaL    (6ee  advert.) 

City  of  London  tnion  Infirmary.— Dispenser.  Salary  £100  per  annum 
and  dinner  dally.  Applicatiou  furuis  and  further  partionlars  of 
the  duties  of  F.  W.  Craut»,  Clerk  to  the  Guardians,  61  Bartholomew 
Cluee,  London,  B.C. 

Oootehiil  Union,  Drum  Dispensary.— Medical  Officer.  Salary  £100per 
annum,  and  £M  per  annum  as  Sanitary  Ofllcer,  with  fees.  Bieo- 
tion  January  etb,  1896.    (See  advert.) 


Coonfer  Anrlum,  Prettwieh,  near  Maneheiter.^Asristanl  Medical 
Offloer  (unmarried).  Salary  oommeoelng  at  £100  a  year,  increasing 
to  £200,  with  board,  attendance,  and  washing.  Applioatlons  to 
the  Superintendent. 

County  Asylum,  Bainhill,  near  Llverpool.—Assistant  Medical  Offlosr. 
Salary  oommeooes  at  £100,  with  an  annual  rise  of  £26  up  to  £200, 
with  board,  attendance,  and  .waahlng.  Full  particulars  of  the 
Medical  Superintendent. 

Hospital  for  Women,  Soho  Square.  London.— Begistrar.  Honorarium 
26  gulneaa.    Full  particulars  ox  David  Cannon,  Secretary. 

King's  College,  London.^ Demonstratorship  in  the  Bacteriological 
Laboratory.  For  conditions  of  appointment  i^n^ly  to  Walter 
Smith,  Secretary. 

North  London  Hospital  for  Consumption/  Hampstead.— Best  dent 
Medical  Officer.  Honorarium  £40 per  annum,  with  board,  lodging, 
Ac.,  In  the  hospital.  Applications  to  the  Seoratary  before 
Jau.  6th  at  41  Fitzroy  Sqnare. 

Owens  College,  Manchester.— Junior  Demonstratorship  in  Physiologv 
and  Histology.  Salary  £100.  Applications  before  January  4kh  to 
the  Beglitrar,  who  will  furnish  f unher  Information. 

Poplar  Hospital  for  Accidents,  BLaokwalL- Besident  Assistant  Houn 
Snrueon.  Salary  £80  per  annum,  with  board  ani  lodging.  Appli- 
cations to  the  Secretaiy  before  Jan  8th. 

Univeraity  of  London.  —  The  Beglstrarship.- Candidates  for  the 
appointment  must  send  in  their  applications  not  later  than  Jan. 
*26ui.  Balary  commenotfa  at  £800,  and  rises  by  aonnal  inorementt 
to  £1,000  per  annum.  Further  information  may  be  obtained  id 
Arthur  Mllman,  M.A.,  LL.D.,  Begiitrar,  University  of  Londoo, 
Burlington  Gardens,  W. 

Victoria  Hospital  for  Sick  Children.  Chelsea.— House  Surgeon.  Sslary 
£50  per  annum,  with  board  and  lodging.  There  la  also  a  vacancy 
lor  Houae  Fhyaidan  on  aame  terma.  Applioatlons  before  Jan. 
11th  to  the  Secretary  at  the  hospital. 


S^ppointmtnH 

CAXBB09,  E.  D.,  L.B.C.P.,  L.B.C.8.,  Edln.,  Medical  Officer  for  the 

Waliingfen  Sanitary  District  of  the  Howden  Union. 
CBBTWOOD-AIUH,  K.C.,  M.B.  Aberd.,  House  Surgeon  to  the  Central 

Loudon  Ophthalmic  Hospital. 
CHRICBTON,  U..  M.B.,  B.S.  Durh.,  Besident  House  Surgeon  to  the 

Ingham  Infirmary,  South  Shielda. 
COOKB,  W.  H ,  M.D.  Bmx.,  M.B.C.8.,  LJLC.P.,  L.8.A.,    Besident 

Medical  Ofllcer  to  the  Boyal  United  HoaplUl,  Bath. 
Cboss,  £.   J.,  L.B.C.P.,  Loud.,  M.B.O.8.,  D.P.H.,  Camb..  Medical 

officer  for  the  Second  Sanitary  District  of  the  St.  Keou  iTnloo. 
DkWAB,   T.  F.,  M.D.,  Aberd.,  CM.,  B.Sc.  (Pub.  Health),    Medical 

Officer  for  the  Burgh  of  Monifleth,  N.B. 
Elliott,  Thos^  M.D.  Dub.,L.M.,L.B.C.S.,  Medical  Officer  for  the  No. 

1  Sanitary  Dfatrlct  of  the  Tonbridge  Union. 
HAWORTH,  J.  J..  L.B.C.P.Edln.,  L.B.C.S.,  LF.P.S.  Olasi^,  Medical 

Offleer  for  the  Filey  Sanitary  District  of  the  Scarborou^  Union. 
HUMTON,  Fred.,  M.D.,  B.S.  Durh.,  Medical  Officer  of  Health  for  the 

Stockton  Sanitary  District  and  the  Workhouse  of  the  Stockton 

Union. 
JOBkS,  Jas.  H.,  M.B.,  M.S.  Edln.,  Medical  Offloer  of  Health  for  the 

Newport  (Mon.)  Port  Sanitary  Authority. 
MiLLBR,    Waltbb,    F.,    M.B.,  Durh.,  L.B.C.P.,  M.B.CS.,  Medleal 

Officer  for  the  Alwinton  Sanitary  District  of  the  Bothbnry  Union. 
Oliver,  William.  M.B.,  M.S.  Edln.,  District  Medical  Officer  for  the 

Sadileworth  union. 
PBFPER.  U.M.,  M.B.C.S.,  L..B.C.P.,  Loud.,  Besident  Assistant  Medl. 

cal  Officer  to  the  Boyal  Berkshire  Hospital,  Beading. 
Shitb,  Baoinald,  M.R.C.S.,L.B.0.P.,  Blouae  Surgeon  to  ths   West 

Norfolk  and  Lynn  Hoapital,  King's  Lynn. 


girths. 


Jollt— Dec.  25th«  at  Gk>dstone  Home,  Sydenham,  the  wife  of  S.  Blake 
Joll>,  M.B.v^antab.,  M.B.C.8.,  of  a  daughter. 


^AtttaqtB, 

Borrstt-Stbwabt.— On  Dec  19th,  at  All  Saint's  Bayswater,  Oeorjre 
O.  Borrett,  Surgeon,  Boyal  Navy,  eidees  son  of  the  late  Bev^ 
George  K.  Borrett,  of  Hastings,  to  Orace  Gwendoline  H«ldane, 
onlv  chil  I  of  the  late  James  Stewart,  Powis  Square.  Bayswater. 

PILLINQ-TOPHAM.— Dec  28th,  at  the  Parish  Church,  Matlock. 
Charles  Ernest  Piuing,  of  Norwich,  solicitor,  son  of  the  late  Bev. 
J.  B.  Pilling,  Bector  of  Wells,  Norfolk,  to  Emma,  daughter  of 
Herbert  Topham,  M.B.O.S.Lond  ,  of  Tor  House,  Matlock  Bttn. 


PtathB. 


Chippbndalb.— Dec  ?3rd,  John  Chippendale,  F.B.C.S.,  of  Upper 

Pnillimore  Place,  Kensington,  aged  91. 
Fbhkskm.-Nov.  28,  at  Sea  Point,  Cape  Colony,  O.  G.  de  Wet.Fehr8en, 

M.L>.,  only  surviving  son  of  CaptAin  A.  Fehrsen,  H.M.  «lst  Light 

Dragoons,  ageU  80. 
Grove.— Christmas    i£ve,   at  St.   Ives,   Huntingdonshhre,   William 

Kichard  Grove,  M.D.,  a^ed  67. 
HARRitf.  -Dec  2iat,  at  nis  reaiJenoe,  Trengweath,  Bedruth,  Cornwall, 

Uenry  darrls,  F.K.C.S.,  la  the  Sdthyear  of  his  age. 
EiDD.— Dec.  26th,  at  o8  Merrion  Square,  Dublin,  George  Hush  Kidd, 

M.D.,  Pane  i^esidenc  Boyal  College  of  Sergeons,  Ireland,  and 

Boytd  Irish  Academy  of  Medlcioe,  a^ed  71. 
WiLXOT.— Dec.  19th,  at  8  Bichmond  if  ill,  Bath,  PhlUp  Mann  (^llmit, 

M.D.,aged90. 

Hi/liCJi—Announo^mentM  of  Birtfuf^  Marrioffu,  and  Dtatha  in CAs 
familiet  of  SubiteriUra  to  Uum  Journal  ore  interUd  frte,  and  mmtL 
rwoh  the  publithan  not  later  than  the  Monday  pr^coding  puhUeuHaiL 


l^b  ^dm\  ^us6  mH  €ivmiM, 


•SALXTS    POPULI    SUFREMA    LEX." 


Yoi^CXII. 


WEDNKSDA5^,    JANUARY     8,     1896. 


JNo.  2. 


^ynQtimi  CS:oinmunic?itt(rns. 

THE   PHARMACOLOGICAL    ACTION 

OF  PURGATIVES. 

By  WILLIAM  MURRELL,  M.D„  F-RCP., 

Lecliwr  ob  yharmtcidioKy  and  Thag^jwqtfciat  Wertmlniteg  H<wttol. 

Thxre  is  much  difference  of  opinion  respectiDg  the 
mode  of  action  of  parjiatiyea,  and  eBpecuJljr  of  the 
gronp— the  latest  aadition  to  onr  list— which  includes 
tiie  natural  aperient  mineral  waters. 

One  thing  is  perfectly  clear,  and  that  is  that  the 
m^jonty  of  purgatives  derivea  from  the  Testable 
kmgdom  belong  to  the  dass  of  cutaneous  irritants. 
The  imtatiye  effects  of  such  drugs  as  croton  oil,  gam- 
boge, and  elaterium  when  applied  to  the  skin  is  well 
known.  Croton  oil  irritates  the  skin,  not  only  when 
u>plied  toi>iGally.  but  even  when  taken  internally. 
Elaterium  is  such  a  powerful  cutaneous  irritant  that 
people  engai^ed  in  luuadling  the  drug  suffer  severely 
from  ulceration  of  the  naus  and  adjacent  tissues. 
Oolocynih^  although  less  distinctlv  an  irritant,  pro- 
duces persistent  sneezing  when  inhaled,  accompanied 
in  the  case  of  many  people  by  attacks  of  dyspnoea 
resembling  those  of  asthma.  A  similar  conoition 
results  from  inhaling  powdered  ipecacuanha,  which  is  | 
a  common  constituent  of  most  of  the  ordbary  aperient 
piUa  This  irritative  effect  leads,  when  the  arug  is 
taken  internally,  to  increased  peristaltic  movement  and 
to  a  rapid  evacuation  of  the  mtestinal  contents.  The 
itimulation  may  be  exerted  on  the  mucous  membrane 
itself  or  on  the  motor  ganglia  which  preside  over  the  j 
contractions  of  the  intestines.  If  it  is  irregular  or  : 
intermittent  it  is  apt  to  cause  the  patient  much  dis- 
comfort 

From  a  purely  pharmacological  point  of  view,  any 
cutaneous  irritants,  with  the  exception  of  those  which, 
by  their  general  action  produce  symptoms  of  poisoning, 
might  be  employed  as  purgatives,  provided  only  that 
they  were  not  absorbed  by  the  stomach  and  reached 
the  intestines  in  safety. 

Saline  puigatives  have  an  enormous  advantage  over 
nnrgatives  of  vegetable  origin  in  not  being  irritants. 
It  IB  probable  that  most  of  them  act  simply  in  virtue 
of  their  bitterness.  The  intensely  bitter  taste,  both  of 
sulphate  of  magnedum  and  of  sulphate  of  sodium  is 
well  known,  and  is  readily  appreciated  even  in  very 
dilute  solutions.  Bitters  excite  the  secretions  both  of 
the  stomach  and  of  the  intestines.  Familiar  examples 
are  afforded  by  the  action  of  such  drugs  as  gentian, 
Quaasia^  calumba,  and  angustura  administered  imme- 
dtttelv  before  meals  in  improving  the  appetite  and 
stimulating  the  powers  of  digestion.  These  drugs  fail 
to  act  as  purgatives  for  two  reasons :  first,  because 
many  of  them  contain  astringent  principles,  andL 
secondly,  because  they  are  commonly  taken  in  smaJl 
doMs  mixed  with  sherry  or  gin,  or  some  other  form  of 
aloohd  which,  by  dilating  the  blood-vessels  of  the 
muooas  membrane  of  the  stomach,  facilitates  absorp- 
tion. 

Bucheim  and  other  observers,  both  in  France  and  in 
Germany,  at  one  time  maintained  that  the  action  of 


saline  purgatives  was  due  solely  to  increased  peristalsis, 
and  even  went  so  far  as  to  suggest  that  the  watery 
evacuation  was  the  result,  not  oPincreased  secretion 
from  the  intestinal  mucous  membrane,  but  was  fiimplv 
the  fluid  in  which  the  salt  was  administered  or  with 
which  it  came  in  contact  in  the  alimentary  canal.  This 
theory  is  now  exploded.  It  is  true  that  purgative 
salts  do  not  produce  catharsis  when  siven  in  a  concen- 
trated form  to  animals  fed  for  some  days  previously  on 
absolutely  dry  food,  but  this  is  due  not  to  the  absence 
of  water  in  the  alimentary  canal  but  to  its  deficiency 
in  the  blood. 

Every  clinical  observer  is  aware  of  the  fact  that  the 
natural  purgative  waters  fail  to  exert  their  character- 
istic action  when  the  patient  is  confined  to  bed,  and 
from  his  recumbent  position  is  less  favourably  placed 
for  the  passage  of  the  fluid  into  the  intestines  than 
whsn  he  is  foUowiujyp  his  ordinary  avocations.  It  is 
also  a  common  experience  that  in  these  cases  the  action 
of  the  aperient  is  materially  assisted  by  massaffe  of  the 
abdomen,  which  facilitates  the  passage  of  tne  fluid 
through  the  pyloric  orifice.  At  Carlsbad  and  other 
places,  where  aperient  waters  are  drunk,  the  patient  is 
instructed  to  walk  so  many  hundred  yards  after  each 
cup  of  the  beverage,  and  this  undoubtedly  greatly 
assists  the  progress  of  the  fluid  down  the  intestinal 
tract. 

There  is  no  doubt  that  the  effect  exerted  by  bitter 
waters  on  the  stomach  is  beneficial  quite  apait  from 
the  pur^tive  action,  and  it  is  a  common  experience 
that  patients  whose  breakfast  ordinarily  consists  of  a 
cup  of  tea  and  a  piece  of  dry  toast  find  that  they  can 
eat  a  good  meal  and  digest  it  after  a  glass  of  Hunyadi 
Janos  water  sipped  slowly  whilst  dressing. 

With  re^rd  to  the  purgative  effect  the  bitterness  of 
the  water  is  responsible  for  its  excito-secretory  action, 
whilst  its  low diffusibility impedes  the  reatlsorption 
of  the  fluid.  As  a  joint  result  of  the  stimulated  secre- 
tion and  the  diminished  absorption  there  is  a  largely 
increased  accumulation  of  fluid  in  the  intestinal  tract, 
which  partly  from  the  effects  of  gravit^r  and  partly 
from  a  gentle  stimulation  of  the  peristaltic  movement 
excited  by  distension  reaches  the  rectum  and  produces 
a  copious  and  comfortable  evacuation. 

Some  saline  purgatives  affect  the  peristaltic  move- 
ments so  slightly  that  they  are  powerless  to  give  the 
secreted  fluid  the  necessary  impetus  downwards,  the 
result  being  that  there  is  a  risk  of  re-absorption  with 
the  attendant  dangers  of  griping  and  discomfort.  It  is 
rarely  expedient  to  employ  a  single  member  of  this 
group,  it  being  found  by  experience  that  much  better 
results  are  obtained  by  jnoicious  combinations,  such 
as  occur  in  the  natural  purgative  waters. 

The  mode  of  employment  of  an  aperient  water 
materially  influences  its  action.  In  the  case  of  Hun- 
yadi Janos  water,  the  member  of  this  group  which  I 
most  commonly  prescribe,  I  direct  the  patient  to  dilute 
half  a  tumblerful  with  an  equal  quantity  of  boiling 
water^  and  to  sip  it  slowly  whilst  dressing  in  the 
morning.  The  result  is  that  there  is  one  copious  and 
easy  evacuation  immediately  after  breakfast,  and  no 
further  trouble  during  the  day.  The  dose  can  be  regu- 
lated to  a  nicety,  and  it  can  be  taken  day  after  day  and 
I  month  after  month  without  the  slightest  risk  of  excit- 
I  ing  a  catarrhal  condition  of  the  intestines. 


26     Thb  Mbdhul  Pbess. 


ORIGINAL  COMMUNICATIONS. 


Jaf.  8,  1898. 


ON 

THE  DIAGNOSIS   OF  INSANITY. 
By  THEO.  B.  HYSLOP,  M.D., 

Lecturer  on  Mental  DlBeaaes  to  St.  Mary'i  Hospital  Medical  Bohool, 
Aasietant  Phyilcian  to  Bethlem  Boyu  Hoepital. 

Lecture  IL 

Ix  mj  first  lecture  I  mentioned  several  sources  of 
fallacy  m  our  estimation  of  the  influence  of  heredity. 
I  now  propose  to  treat  somewhat  more  in  detail  those 
factors  which  are  regarded  as  giving  rise  to  morbid 
mental  states  in  the  life  history  of  a  family.  The 
mental  tendency  or  disposition  to  think,  feel,  or  act  in 
some  particular  way,  is  usually  the  result  of  a  trans- 
mitted tendency  gained  by  ancestral  experience.  This 
tendency  is  termed  an  "inherited  disposition.'*  A 
complete  account  of  all  the  factors  which  form  the 
data  for  a  theory  of  development  and  heredity  would 
include  the  facts  of  embryology,  and  this  would  also 
necessitate  an  account  of  the  relationship  between  the 
more  or  less  isolated  germinal  cells  and  the  develop- 
ment of  new  individuals.  It  is  not  part  of  our  object, 
however,  to  conjecture  as  to  how  thepotentia  activities 
of  the  germinal  cells  are  derived.  It  must  suffice  to 
state  that  it  appears  highly  probable  that  the  germinal 
substance  does  contain  certain  specific  characters  which 
manifest  themselves  in  the  offspring. 

Evolutionists  assert  that  the  psychical  development 
of  the  individual  is  mainly  conditioned  by  that  of  the 
race— i.^.,  owing  to  the  principle  of  hereditary  trans- 
mission, the  nerve  centres  and  the  corresponding 
psychical  activities  tend  to  unfold  in  the  individueJ 
in  the  order  in  which  they  have  been  developed  in  the 
history  of  the  race.  They  also  maintain  tnat  in  the 
evolution  or  protn'essive  development  of  the  race  any 
improvement  of  faculty  or  capability  tends  to  transmit 
itself  as  a  fundamentiu  capacity  or  inherited  dis]X)6i- 
tions.  In  studying  every  case  of  mental  disease  it  is 
essential  that  we  take  account  of  all  the  internal  and 
external  factors  which  tend  to  give  rise  to  or  favour 
the  development  of  abnormal  mentation.  These  factors 
may  be  grouped  as  follows  :— 

(1)  Internal. 

(a)  The  variations  or  inequalities  of  the  indi- 
vidual's original  capacities. 

(b)  The  influence  of  heredity. 

(2)  External, 

(a)  Variations  in  the  social  environment. 

(b)  Variations  in  the  physical  environment 
Original  capacities  are  not  to  be  explained  entirely  as 

mere  results  of  growth  and  adaptation  to  external  sur- 
roundngs.  The  physical  organism  does  appear  to  pK>8sess 
certain  fundamental  capacities  which  predetermine  its 
adaptability  to  external  conditions,  and  as  I  have  stated 
elsewhere,  (a)  mental  development  must  start  from 
some  inherent  state  differing^  in  character  from  any 
bodily  state,  and  the  operation  of  the  mental  causes 
and  influences  of  the  development  is  often  only  to  be 
estimated  by  observing  those  mental  laws,  facilities,  or 
prohibitions,  which  do  not  directly  depend  upon  what 
we  know  of  the  physical  successions.  Mental  develop- 
ment is  undoubtedly  dependent  upon  physical  develop- 
ment in  its  ultimate  aspects,  and,  arrest  or  interference 
with  the  latter  will  arrest  or  modify  the  former. 
Other  things  bein^  eaual,  however,  the  mind  possesses 
within  itself  certain  fundamental  attributes,  which,  so 
far  as  we  know,  cannot  be  explained  in  physiological 
terms,  and  which  manifest  themselves  throughout  the 
process  of  development  apart  from  adaptive  reactions 
of  the  physical  organism  to  any  environment.    That 

(a)  '*  Mental  Fhyidology.'    p.  Ml 


the  mind  itnelf  really  possesses  fundamental  intellec- 
tual functions  of  discrimination  and  assimilation,  also 
primary  capacities  of  feeling  and  willing,  which 
manifest  themselves  out  of  all  proportion  to  any 
apparent  phynical  development,  is  evidenced  over  and 
over  again  in  the  moulding  of  genius.  A  full  inquiry 
into  the  life  histories  of  geniuses,  and  of  some  forms 
of  abnormal  mentation  would  apparently  lead  to  the 
conclusions  that  ancestral  experiences  or  acquisitions 
made  in  the  life  history  of  the  race  do  not  necessarily 
always  enter  into  consideration  as  factors  ;  nor  do  the 
conditionings  of  such  mental  developments  invariably 
follow  what  we  imagine  to  be  the  proper  laws  of  organic 
and  nervous  development.  It  is  also  important  to 
remember  that  these  capabilities  need  not  neces- 
sarily manifest  themselves  at  the  early  periods  of  an 
individual's  life  ;  nor  are  they  entirely  dependent  upon 
the  environment  which  acts  upon  the  mind  through 
the  nervous  structures.  An  investigation  of  toe 
original  capacities  of  an  insane  patient  not  infre- 
quently gives  a  clue  to  the  whole  nature  of  the  case. 
Thus,  for  example,  it  is  not  uncommon  to  meet  with 
an  individual  who  at  the  period  of  puberty  or  of 
adolescence  has  broken  down  mentally,  overwork  being 
assigned  as  the  cause.  The  friends  inform  you  that, 
as  a  child,  the  patient  was  precocious  and  possessed  a 
marvellous  memory.  This  excessive  physiological 
retentiveness  has  in  reality  been  the  leaaing  factor  in 
causing  the  breakdown.  The  parents,  in  their  emula- 
tion at  the  possession  of  such  an  apparently  intelligent 
child,  have  not  only  sanctioned,  but  even  applauded, 
an  undue  amount  of  mental  cramming,  with  the  unfor- 
tunate result  that  the  whole  brain  and  mind  have 
suddenly  become  a  wreck.  In  the  educational  ques- 
tion there  is  no  point  of  more  importance  than  that 
of  distinguishing  between  mental  ^wth  and  develop- 
ment. Mind  is  said  to  grow  when  it  increases  its  stock 
of  material!* ;  when  it  assimilates  its  materials,  it 
develops.  With  abnormal  growth,  true  development 
is  apt  to  be  impeded ~«.^.,  in  preparing  for  examina- 
tions the  excessive  growth  of  the  bulk  of  retentions 
may,  for  a  time,  impede  true  mental  development, 
just  as  an  excessive  amount  of  nutriment  may  produce 
fatness,  while,  at  the  same  time,  rendering  the  pnysiologi- 
cal  activities  more  sluggish,  t.e.^  with  physical  corpulency 
we  have  lessened  bodily  activity,  and  with  mentiu 
agglomeration  we  have  diminished  power  of  thought 
The  possession  of  abnormal  retentiveness  of  memory 
mav  serve  to  explain  the  early  victories  (as  students) 
and  later  failures  (as  men)  of  numerous  individuals. 
Many  a  so- called  senius  may  be  likened  unto  a  well- 
ballasted  barge,  whose  bulk  of  retention  necessitates 
slowness  of  movement.  In  true  genius  there  ought  to 
be  a  just  proportion  between  growth  and  development, 
otherwise  the  genius  is  apt  to  end  in  degeneration. 

(b)  Inherited  Dispositions. — Much  stress  is  laid  upon 
the  hereditary  factors  in  insanity,  but  an  imperfect 
conception  as  to  what  constitutes  an  hereditary  predis- 
position gives  rise  to  much  inaccuracy  and  confusion. 
These  causes  of  confusion  I  have  already  stated  to  be 
due  either  to  a  too  narrow  notion  as  to  the  neurotic 
factors  in  the  ancestry,  or,  on  the  other  hand,  to  a  too 
wide  notion  which  includes  hereditary  factors  which, 
in  reality  are  of  little  practical  significance.  The  trans- 
mission of  abnormal  or  diseased  modes  of  thought  is  a 
subject  which,  in  its  theoretical  aspects,  is  too  wide  for 
our  consideration  ;  we  have  merely  to  do  with  the 
data  as  we  find  them.  In  speaking  of  hereditary  in- 
fluences, we  limit  the  influences  to  those  which 
primarily  aflfect  the  nervous  system  and  are  termed 
neuroses,  and  to  such  diseases  as  are  intimately  asso- 
ciated with  neuroses  or  which  affect  the  life  history  by 
developing  a  tendeccy  to  the  production  of  neuroeee. 

Dunng  the  five  years  1889  to  1894,  inclusive,  the 
yearly  average  number  of  insane  patients  admitted  to 
asylums  in  England  and  Wales  was  8,058  males  and 
8,557  females.    Hereditary  influence  was  ascertained 


Jav.  8, 1896. 


ORIGINAL  COMMUJyiCATIONtt. 


Ths  Mbdioal  Pbbss.     27 


to  bo  present  in  1,699  males  and  2,171  females,  or  in 
the  i^oportion  of  21*1  and  25*4  per  cent  respectively. 
Gongenital  defect  was  found  in  470  males  and  361 
emales,  or  in  the  proportion  of  5'8  per  cent,  males  and 
of  4-1  per  cent  females  (a).  Of  the  1,167  males  and 
281  female  general  paralytics,  186  males  and  54  females 
(15*9  per  cent  ana  19*2  per  cent  respectively)  were 
found  to  have  some  hereditary  influence.  Of  patients 
with  suicidal  propensity  the  yearly  average  was  1,818 
and  2,433  females,  and  of  these,  481  males  (26*5  per 
cent)  and  734  females  (30*2  per  cent)  had  a  neurotic 
family  history.  These  figures  appear  to  demonstrate 
that  heredity  enters  as  a  possible  factor  of  causation 
in  more  than  20  per  cent  of  all  cases  of  insanity,  and, 
inasmuch  as  the  hereditary  factor  sometimes  consider- 
ably modifies  the  nature  and  course  of  the  morbid 
mental  state  it  is  essential  that  this  factor  should  be 
fully  investigated  and  duly  appreciated,  otherwise  our 
•diagnoeis  is  apt  to  be  astray. 

bpeaking  (^erally,  the  offspring  tends  to  inherit 
the  characteristicB  of  both  parents.  In  some  instances, 
however,  there  may  be  a  preponderance  of  the  charac- 
teristica  of  one  or  other  parent,  or  there  may  be  a 
.combination  of  some  of  the  parents'  qualities,  which 
manifest  themselves  coincidentally  or  alternately 
during  the  lifetime  of  the  oflFspring.  Defect  in  the 
germ  or  sperm  may  result  in  abnormality  of  structure 
or  energy,  or  both.  As  yet  we  know  little  of  the  con- 
ditions which  render  the  germ  and  sperm  suitable  to 
each  other.  There  are  several  practical  points  to  be 
noted  in  the  consideration  of  heredity.  (1)  An  indi- 
vidual may  develop  or  acquire  a  neurosis  which  affects 
his  own  life  or  the  life  historjr  of  his  family.  (2)  The 
nenroaiB  may  increase  or  diminish  in  strengtii  from 
generation  to  generation,  or  it  may  skip  a  generation. 
(3)  The  neurosis  may  appear  at  a  later  period  of  life 
m  the  offspring  than  in  the  ancestors.  U)  The  forms 
of  the  nenroeis  may  alternate  in  the  life  nistory  of  the 
individual  or  in  that  of  the  family.  (5)  The  type  of 
neurosis  may  be  determined  bv  one  or  other  parent 
with  or  without  transmission  of  identical  tenoencies. 
<6)  The  inheritance  of  a  slight  neurosis  connotes  a 
ready  breakdown  but  rapid  recovery.  (7)  A  strong 
neurotic  tendency  connotes  either  early  and  complete 
breakdown  or  perpetual  instability.  (8)  An  inherited 
neurosis  often  manifests  itself  as  epilepsy,  compara- 
tively infrequently  in  general  paralysis. 

Some  observers  believe  that  general  paralysis  of  the 
insane  is  not  commonty  attributable  to  a  neurotic  in- 
heritance. This  opinion  is  not  confirmed  by  the 
statuBtics  of  England  and  Wales,  although  the  propor- 
tion is  somewhat  less  in  general  paralysis  than  in  in- 
sanity generally.  Revington  believes  that  some  cases 
point  strongly  to  the  theory  that,  while  both  hereditary 
and  acquired  neuroses,  if  strong,  tend  to  the  develop- 
ment of  general  paralysis  at  an  early  age,  the  tendency 
of  the  former  is  to  protract,  and  that  of  the  latter  to 
shorten  the  duration  of  the  disease.  One  fact  is  cer- 
tain, namely,  that  the  offspring  of  general  paralytics 
are  liable  to  suffer  from  all  sorts  of  neuroses,  and  more 
especially  epilepsy. 

The  otter  factors  which  tend  to  determine  neuroses 
in  the  offspring  are,  phthisis,  scrofula,  gout,  rheuma- 
tism, syrMaBy  alcohol,  paralysis,  spasmodic  asthma, 
and  diabetes.  Undoubtedly,  insanity,  epilepsy,  and 
other  nervous  disorders  do  occur  in  the  offspring  of 
phthisical  persons,  bat  whether  it  is  comparatively 
more  common  for  an  insane  inheritance  to  lead  to 
phthisis,  I  am  unable  to  sajr.  The  strumous  diathesis 
IS  a  most  important  factor  m  the  production  of  idiocy 
uid  imbecility ;  gout  and  rheumatism  are  regarded  as 
liable  to  start  a  neurotic  diathesis.  Syphilis  is  apt  to 
predispose  the  o£&pring  to  the  occurrence  of  minor 
nervous  disorders,  convulsions,  epilepsy,  and  even 
insanity  during  childhood.    Such  children  may  be  de- 

(a)  Tortj-Bioth  Seport  of  tbe  OommiHloDen  in  Luuusj. 


fective  intellectually  and  morally.  Sometimes  only 
these  mental  features  are  noticeable.  In  other  cases, 
however,  early  blindness  or  deafness  may  lead  to  com- 
plete idiocy  by  deprivation  of  the  senses.  Epilepsy  may 
lead  to  complete  fatuity,  or  definite  paralysis  may 
result  from  local  lesions  in  the  brain  structures.  Some 
cases  resemble  general  paralysis  in  their  main  sym- 
ptoms inasmuch  as  there  is  progressive  mental  degener- 
ation associated  with  the  steady  development  of 
generalised  paralysis  with  emaciation. 

The  consequences  of  alcoholism  are  not  only  impur- 
ment  of  the  parents'  own  mental  faculties  but  also  in 
the  offspring  a  tendency  to  drink,  epilepsy,  insanity, 
neuroses,  idiocy  or  imbecilitv,  and  in  a  word,  extinc- 
tion of  the  race.  From  the  social  point  of  view, 
mortality  is  increased,  births  diminished,  moral 
energies  decreased,  and  development  of  intelligence 
retarded  ;  in  fact,  weakness  of  the  vital  and  intellec- 
tual energies  of  the  race.  A  predisposition  to  alcoholism 
may  be  suspected  under  the  following  circumstances  : — 
(a)  When  alcoholic  symptoms  appear  too  readily ;  (b\ 
when  there  is  a  tendencjr  to  drink  at  an  early  age  ;  (c) 
when  the  mental  condition  during  drunkenness  reveals 
the  inheritance  of  ideas  or  tendencies  which  normally 
were  kept  in  subjection;  {d)  when  the  mental  symptoms 
are  characterised  by  impulsiveness  and  the  tendency 
to  commit  rash  acts ;  (e)  when  delirium  tremens, 
transitory  mania,  and  even  epileptiform  convulsions 
manifest  themselves  with  extreme  readiness ;  (/)  when, 
in  addition  to  susceptibility  to  alcohol,  mental  perver- 
sions are  caused  suddenly  by  exciting  agents  other 
than  alcohol ;  {g)  when  alcohol  determines  an  inherited 
psychosis  ;  (A)  when  the  salient  features  of  the  case 
are  misinterpretations  of  sensory  impressions ;  (i) 
when  the  mental  states  or  ideas  are  changeable  and 
constantly  interrupted  by  lucid  intervals. 

Some  observers  attach  much  importance  to  the 
existence  of  suicidal  tendencies.  Lc^Bprain  gives  four 
varieties  of  the  special  predisposition  to  suicide  in 
these  cases,  viz.,  (1)  Instead  of  having  the  form  of 
genuine  alcoholic  suicide  (an  accidental  act,  or  caused 
by  fright  in  consequence  of  special  hallucinations),  the 
tendency  is  logically  connected  with  the  melancnolic 
idea  as  expressed  by  the  patient ;  (2)  sometimes  those 
who  relapse  in  delirium  tremens  attempt  suicide  at 
each  attack :  (3)  in  the  course  of  one  and  the  same 
attack  of  delirium  tremens,  several  attempts  may  be 
made ;  (4)  in  the  ancestors  of  drinkers  who  become 
melancholiacs  and  commit  suicide  during  an  act  of 
delirium  tremens,  a  special  predisposition  to  melancholia 
exists.  It  is  of  importance  to  remember  that  in  a 
predisposed  individual  it  is  not  uncommon  to  meet 
with  maniacal  conditions  of  an  ambitious  or  an  exalted 
kind.  Delirium  tremens  occurring  in  such  a  predis- 
posed person  lasts  longer  and  is  more  apt  to  be  followed 
by  another  psychosis  than  in  the  case  of  one  who  has 
not  the  predisposition. 

There  are  other  functional  and  organic  diseases  of 
the  nervous  system  which  appear  to  be  the  result  of 
ancestral  taint,  and  which  alternate  or  interchange  in 
the  life  history  of  the  individual  or  of  the  race. 
Briefly  enumerated  these  are  ;— 

1.  Eccentricities,  longings,  cravings,  morbid  impul 
sive  tendencies. 

2.  Suicide,  crime,  moral  depravities. 

3.  Hysteria,  trance,  somnambulism. 

4.  Neuralgia,  angina,  megrim,  tic  douloureux. 

5.  Occupation  spasms,  stuttering,  chorea,  epilepsy. 

6.  Premature  baldness,  greyness,  and  senility. 

7.  Asthma,  diabetes,  goitre,  deaf-mutism,  paralyses. 

8.  Excitability,  want  of  control,  intemperance  in 
love  and  religion. 

Some  inherited  neurotic  tendencies  do  not  manifest 
themselves  unless  the  individual  is  subjected  to  excit- 
ing causes.  Such  individuals  are  excitable,  eccentria 
very  susceptible  to  shock,  passionate,  and  easily  affected 
by  alcohol  or  by  injury  to  the  head.  Others  are  readily 


28    Thi  Mbdtoat.  Pbvss. 


ORIGINAL  COMMTTNICATIONS. 


Jaw.  8.  1896. 


pffected  by  migraine,  nenralgia,  headache,  eensory 
epilepsy,  spasmcdic  asthma,  nenrasthenia,  phren- 
asthenia^  and  other  neurotic  manifeBtations.  Most  of 
the  cases  with  a  family  history  of  diabetes  are  of  the 
melancholic  or  hypochondriacal  type,  and  this  is 
especially  apt  to  develop  at  the  perioas  of  adolescence 
or  at  the  chmacterinm. 

These  preliminary  data  are  essential  to  the^  just  esti- 
mation of  every  case  of  insanity,  and  faUnre  to  appre- 
ciate the  family  relationships  ma^  result  in  complete 
failure  in  diagnosis.  Moreover,  it  must  not  be  for- 
gotten that,  although  an  insane  person  may  suffer  from 
a  diseased  brain  which  requires  medi<»d  treatment^  the 
diseased  brain  is  not  the  only  object  for  study. 
Insanity  is  a  disorder  of  the  individual ;  and,  in  order 
to  grasp  the  full  significance  of  the  disorder,  the 
individual  must  be  studied  not  only  physically  but 
mentally,  and  this  involves  a  far  reaching  estimate  of 
all  the  sociological  and  environmental  relations  which 
tend  to  modi^  the  development  and  experience  of  the 
•  ndividnal. 


IBicntia  Cihtical  JUttuxt,  . 

MOEBUS  MENIEREI. 
By  PROiP.  J.  GRUBER, 

Otologlcal  CUbIo,  Vienna  Uniranity. 
[fSOM   OUB  AUSTRIAN  COSBSSPONDENT.] 

Gentlemen, — ^From  the  recent  interest  excited 
by  Frankl-Hochwart  in  this  disease  of  M^ni^re  it 
appears  to  me  opportune  to  review  the  latest  opinions 
expressed  on  the  subject  A  large  number  of  specialists 
have  devoted  much  time  and  attention  to  the  differen- 
tiation of  the  disease  with  a  view  to  more  correctly 
diagnosing  and  forming  a  better  prognosis  of  different 
cases  coming  under  treatment.  Bince  the  time  that 
Charcot  propounded  his  test  drug  guinine  for  the 
disease,  we  have  become  clearlv  convinced  that  there 
is  a  M^ni^re  disease  pure  and  simple ;  but  we  have 
also  a  s^ptomatic  disease  with  M^ni^re's  phenomena 
(Nossessmg  all  the  trias- vertigo,  subjective  hyper-sensa- 
tion, and  deafness,  anyone  of  which  were  considered 
to  be  the  true  symbol  of  M6ni^re's  disease.  We  are 
now  satisfied  that  these  symptoms  are  associated  with 
other  morbid  conditions  of  the  ear.  Aurists  have 
therefore  an  important  duty  to  perform  in  distinguish- 
ing between  the  diseases  of  M^ni^re's  phenomena  and 
ffenuine  morbus  M^ni^lrei,  which  is  now  acknowledged 
mr  all  practical  aurists.  My  own  opbion  is  that  a 
clear  notion  should  be  formed  and  the  terms  properly 
defined  ''M^ni^re's  Phenomena"  and  ''Morbus 
Meni^reL''  This  I  conceive  would  better  express  the 
opinion  of  M^nidre  himself  in  locating  the  site  of  the 
disease.  It  is  well  known  that  his  attention  was 
directed  towards  this  subject  by  the  laboratory  experi- 
ments of  Flourens  who  discovered  the  symptoms  after 
cutting  the  semi-circular  canals  in  rabbits.  The  origin 
of  the  vertigo  long  lay  in  obscurity  after  this  time  from 
the  doubts  expressed  in  the  phenomena.  M^ni^re,  at 
a  later  period,  obtained  the  same  phenomena  when  the 
middle  ear  was  affected,  which  probably  in  a  secondary 
manner  affects  the  labyrinth.  At  a  later  period  still  it 
was  proved  that  the  same  phenomena  could  be  produced 
by  disease  in  the  extemaiear  which  even  now  cannot 
be  impugned.  From  recent  i>hysiological  examina- 
tions it  has  now  been  conclusivel^r  shown  that  any 
pressure  on  the  ampullae  or  semi-circular  canals  will 
produce  this  feeling  of  vertigo,  which  may  be  easily 
conducted  from  any  morbid  changes  in  the  middle  or 
outer  ear.  Our  du^  therefore  in  diagnosis  seems  clear. 
We  must  determine  exactlv  in  every  case  with  such 
symptoms  whether  the  morbid  change  is  located  in  the 
ear  itself ;  whether  it  is  a  labyrinth  affection  pure  and 


simple,  or  a  disease  following  another ;  whether  it  is  a 
morbid  condition  of  Uie  middle  ear  or  complicated 
with  a  primary  labyrinth  affection.  The  latter  portion 
of  the  diajniosis  is  now  an  easy  matter  for  aunsts,  as 
the  objective  examination  with  our  improved  methods 
of  diagnosis  will  soon  determine  witn  precision  the 
possibility  of  the  ori^n  and  the  probable  changes  that 
nave  occurred.  By  careful  examination  of  every  caaa 
where  the  so-called  M^ni^te's  phenomena  are  preseDt 
we  are  more  able  to  locate  the  morbid  changes  in  the 
auditory  organ  and  designate  the  diwease  by  the 
changes  or  complications  to  the  primary  disease. 

Having  now  diagnosed  a  case  of  Mdni^re^s  diseaM^ 
we  have  next  to  inquire  in  to  the  nature  of  the  primaij 
morbid  change  in  the  labyrinth ;  whether  it  iiaa  ori- 
ginated from  hemorrhage  or,  what  I  consider  more 
common,  a  secretory  exudative  process.  I  am  of 
opinion  that  haemorrhage  of  the  labyrinth  is  a  venr 
rare  lesion  in  the  production  of  iM^nidre's  disease.  I 
admit  that  we  do  meet  with  slight  hematic  extravasa- 
tions in  the  labyrinth  after  death,  as  eveijone  at  the 
post-mortem  table  can  convince  himself.  We  aiao 
find  in  ampullffi,  the  cochlea,or  the  semi-circular  canals,. 
a  sufficient  amount  of  pigment  to  attract  attenti(m» 
which  has  been  extravasated  from  the  blood  in  the 
first  place,  but  the  most  convincing[  fact  that  this 
foreign  bod^  is  an  innocent  factor  is  the  fact,  that 
every  individual  so  examined  will  have  been  found 
during  life  to  have  been  perfectly  free  from  verfcigOr 
hyper-sensation,  or  deafness.  Large  extravasataona, 
however,  occur  after  severe  accidents,  such  as  fracture 
of  the  skull,  or  in  cases  where  men  are  engaged  in 
spaces  under  high  atmospheric  pressure,  such  as  cuvero. 
A  case  of  the  latter  came  under  my  observation  in  the 
person  of  a  worker  who  had  been  confined  in  a^  caisson'^ 
tor  a  short  time  and  was  suddenly  attacked  with 
M6nidre's  affection.    Although  he  was  confined  to  hoe- 

gital  for  several  months,  and  in  spite  of  all  onr  efforts, 
e  was  dismissed  unrelieved. 

I  have  next  to  dispose  of  the  secretory  and  exudative 
processes  which  I  consider  the  more  common  cause* 
It  has  been  already  noticed  that  the  principal  point  of 
diagnosis  turns  on  the  different  parts  of  the  labyrinth, 
viz.,  the  ampullae,  semi-circular  canals,  and  the  cochlea* 
Along  with  these  different  portions  of  the  internal  ear 
the  adnexa  of  the  iabvrinth  may  be  noted,  sudi  aa 
communicating  ducts  which  have  recently  been  shown 
in  anatomy  to  be  of  physiological  interest  The 
recessus  cotugni  of  the  dura  mater  is  a  cistern  or 
reservoir  which  is  connected  with  the  aqueductus  vesti- 
bulL  I  have  taken  the  trouble  on  my  own  account  ta 
examine  more  l^an  one  hundred  temporal  bones  to 
satisfy  myself  of  the  importance  of  this  saccus  cotugni,. 
which  has  convinced  me  that  it  ia  a  connection  of  the 
highest  importance  in  this  disease.  In  different  sub- 
jects, according  to  nutrition  and  age,  we  find  this 
saccus  cotugni  of  different  sizes  and  conditions.  In 
some  adults,  when  carefully  examined,  a  small  hole- 
that  might  admit  a  hemp  seed  will  be  found  in  every 
case;  in  other  bones  the  same  recess  will  admit  an 
ordinary-sized  bean.  Here  is  a  preparation  where  the 
saccus  cotugni  b  obliterated  and  the  aqueductus  con* 
necting  therewith  is  filled  with  a  solid  column  of  dura 
mater.  In  another  preparation  you  will  find  the  cover- 
ings of  the  sac  soldered  together  as  if  some  morbid 
change  had  taken  place.  In  the  aqueductus  vestibuli 
we  have  great  variations  and  anomalies.  I  have  met 
with  bones  when  macerated  where  no  opening  at  the 
end  of  the  canal  could  be  found,  and  no  reduction  of 
the  endolymph  could  take  place. 

From  what  has  been  said  with  respect  to  the  adnexa 
of  the  labyrinth,  we  might  easily  picture  to  ourselves 
with  out  much  strain  of  the  imaginationhow  the  morbid 
changes  could  be  brou(;ht  about  in  the  ampullse  and  the 
semi-circular  canals  with  the  foregoing  phenomena.  Ji 
the  flow  of  endolymph  by  the  closure  of  the  aaueductus 
vestibuli,  is  affect^  by  the  adhesions  in  the  saocua 


Jav.  8>  18S6. 


TKANSACTIONS  OF  SOCIETIIS. 


TtTB!    MlBl>TnAT    PniCRAl 


eotngni  or  the  obliteration  of  RUdinger's  discharge 
caDaJs  of  tiie  saocas  cotngni,  an  accnmuTation  of  endo- 
lymph  will  take  place,  caasing  a  great  amount  of  pros- 
snre  and  inrobably  tearing  of  the  finer  Btmctaree  with 
extravasauonB  of  blood  which  would  produce  all  the 
phenomena  necessary  for  morbus  Menieri ;  this  con- 
dition usually  takes  place  after  injury  to  the  organ. 
Another  form  of  consiaerable  importance  in  the  produc- 
tion of  the  disease  may  arise  from  a  too  liberal  use  of 
alcoholic  drinks,  giving  rise  to  congestion  and  increased 
eado-lymph  which  may  be  denied  easy  discharge  owing 
to  the  closure  of  the  canals,  and  thus  produce  the  same 
symptoms.  We  cannot,  therefore,  dispose  of  the  sub- 
ject without  faithfully  considering  many  of  these  con- 
tingencies that  are  probably  actiVe  in  M6ni^re's 
disease. 

There  is  another  condition  in  the  form  of  inflamma- 
tory exudations  which  is  now  placed  beyond  doubt  by 
the  recent  investigations  of  Yoltolini  that  may  be  very 
fruitful  in  the  production  of  the  disease  and  which  he 
has  termed  labyrintbitis.  From  the  various  hypotheses 
advanced,  it  may  be  easily  understood  that  M^nidre's 
phenomena  will  accompany  different  morbid  changes 
m  the  auditory  oi]gan,  but  in  the  future  we  must  re- 
cognise morbus  M^ni^rei  as  a  primary  labyrinthal 
morbid  process  having  all  the  trias-vertigo,  with  faint- 
ing and  Tomiting,  the  subjective  hvper-sensorv  hearing 
and  difficulty  of  hearing  or  even  deafness.  The  laby- 
rinthitis may  easily  be  distinguished  from  the  other 
morbid  processes  producing  Meniere's  disease  by  the 
preceding  or  associating  febrile  condition.  The  apo- 
plectic form  may  be  further  separated  as  the  secretory 
category,  while  a  remaining  number  of  the  cases  will 
«till  be  unable  to  be  disposed  during  life  and  retain 
4he  name  though  the  lesion  may  be  hypothetical. 


THE  OBSTETRICAL  SOCIETY  OF  LONDON. 
Mkktikg  hsld  Wkdnxsdat,  Jabuabt  1st,  1896. 


The  President,  Dr.  Champnxts,  F.R.C.P.,  in  the  Chair, 
•oir  THi  mnuKfCB  of  thb  rkmoval  of  thb  ovasibs  on 

MBTABOLISM  IN  ITS  BIASING  ON   08TE0-MALA0IA. 

Pbofssscb  Cubatula  (Rome),  represented  by  Dr. 
Oriffiths,  contribated  a  paper  embodying  the  reault  of  his 
rosearchee  in  connection  with  the  treatment  of  08teo-mala> 
•da  by  the  removal  of  the  ovaries.  Proceeding  on  what 
he  described  as  "  the  now  ascertained  fact,"  that  patients 
suffering  from  osteo-malacia  may  be  cured  by  castration, 
he  had  studied  the  changes  which  take  place  in  the  naeta- 
4x>liBm  the  healthy  animal  after  castration,  with  the 
object  of  ascertaining  the  nltimace  changes  in  the  meta- 
bolic activity  of  respiration  and  the  composition  of  the 
«rine  after  castration.  In  the  communication  made  by 
him,  through  Dr.  Barboar,  to  the  Edinburgh  Obstetrical 
Society,  it  was  stated  that  after  removal  of  the  ovaries  the 
•quantity  of  phosphoric  anhvdride  excreted  in  the  urine 
was  greatly  aiminisbed,  and  this  for  a  considerable  time, 
nrfaile  the  quantity  of  nitrogen  remained  unaltered.  The 
diminution  of  phosphates  beean  about  the  seventh  day 
and  continued  for  three  or  four  months.  This  he  bad 
attributed  to  a  diminished  oxidation  of  phosphorus  exist- 
ing as  aa  organic  compound  in  the  tissues  presumably 
combined  wmk  calcium  and  magnesium  and  stored  in  the 
bones.  He  supposed  that  the  ovaries,  like  other  glands  of 
the  animal  economy  according  to  the  general  doctrine  of 
Brown-S^uard  had  some  internal  secretion  thus  pouring 
constantly  into  the  blood  a  product  of  which  the  chemical 
composition  was  still  unknown,  capable  of  facilitating  the 
•o&iaation  of  the  phosphorated  organic  substances  which 
supply  the  material  for  forming  the  salts  of  the  bones. 
On  this  assumption  the  removal  of  the  ovaries  would 
entail  a  larger  retention  of  organic  phosphorus,  and 
oonsequeotly  a  greater  accumulation  of  earthy  salts  in 
ithe  form  of  phosSiates  until  the  skeleton  finally  resumed 


its  normal  solidity.  Experiments  performed  since  that 
date  had  proved  t(his  hypothesis  to  be  correct.  In  bitches 
in  which  after  castration  the  excretion  of  phosphorus  in 
the  urine  had  considerably  diminished,  the  subcutaneous 
injection  of  from  10  to  40  cc.  of  ovarian-elycerine  juice 
immediately  increased  the  elimination  of  phosphorus* 
The  injection  of  larger  quantities  of  the  ovarian  juice  was 
followed  by  an.  even  more  remarkable  augmentation  of 
phosphates.  The  same  results  were  obtained  in  experi- 
ments on  dogs.  In  support  of  the  view  that  the  sexual 
glands  had  a  moderating  influence  on  the  development 
of  the  skeleton,  he  mentioned  the  fact  that  all  giants 
reported  on  by  anatomists  had  been  found  to  have  atro- 
phied testicles,  and,  on  the  other  hand,  the  eunuch-ehor- 
isters  at  the  Sixtine  Chapel  all  possessed  a  remarkably  well- 
developed  skeleton.  The  experiments  in  respect  of  the 
metabolic  activity  of  respiration  were  carried  out  on  mice, 
usine  an  ingenious  apparatus  invented  by  Prof.  Luciani.  He 
had  lound  that  the  quantity  of  carbonioanhydride  elimin- 
ated after  the  removal  of  the  ovaries  was  diminished  and  this 
diminution  might,  he  suggested  assist  them  in  explaining  the 
abnormal  accumulation  of  fat  in  the  system,  which  always 
follows  castration.  It  was  probable,  indeed,  that  a 
similar  influence  was  exerted  by  the  ovaries  in  respect  of 
the  oxidation  of  adipose  substances.  The  question  arose 
whether  this  diminution  in  the  elimination  of  carbonic 
anhydride  was  due  to  the  non-introduction  into  the  blood 
of  a  secretive  product  capable  of  promoting  the  oxidation 
of  fat,  or  wheuier  it  was  due  to  the  fact  that  after  cas- 
tration animals  became  comparatively  quiet  and  calm. 
According  to  Petrane's  theory  osteo-malacia  was  due  to  a 
modification  of  the  system  caused  by  the  fermentum 
nitrioum.  He  had  injected  into  dogspure  cultures  of  one 
of  the  micro-oraanisms  proved  by  Winogradsky  to  bring 
about  the  nitrification  of  the  soil,  but,  so  far,  with  negative 
results. 

Mr.  Bland  Sutton  regretted  that  the  details  of  the 
experiments  alluded  to  by  the  author  had  not  been  given 
in  greater  detail,  themore  60,seein|f  that  snch|investigations 
notoriously  involved  great  techmcal  difficulty.  Judging 
from  his  own  experience  osteo-malacia  was  a  very  rare 
disease  in  this  country.  He  pointed  out  that  patients 
with  osteo-malacia  usually  suffered  excruciating  pains, 
which  he  formerly  believed  to  be  due  to  pressure  on  the 
nerve  roots  brought  about  b^  changes  in  the  vertebrs,  but 
if,  as  was  stated,  these  pains  disappeared  within  a  few 
hours  of  the  injections,  it  was  evident  that  this  preesure 
could  not  be  the  cause  of  the  pain.  It  had  been  stated 
that  in  castrated  domestic  animals  the  skeleton  was  bigger 
than  usual,  but  he  would  pcint  out  that  such  animals 
had  been  attened  for  a  special  purpose,  which 
miebt  explain  the  extreme  development  of  the  bones.  He 
haa,  moreover,  noted  that  in  animals  kept  in  confinement, 
as  in  the  Zoological  Gardens,  there  was  often  very  marked 
development  ofthe  skeleton,  in  fact,  he  had,  on  inspecting 
the  skeletons  of  lions  and  tigers,  been  enabled  to  say  at 
once  that  they  had  been  kept  in  captivity  simply  from  the 
size  of  the  bones,  yet,  he  remarked,  one  did  not  venture  to 
castrate  lions. 

Dr.  A.  RoTTTH  suggested,  in  view  of  the  relationship 
between  hypertrophy  or  removal  of  the  thyroid  gland  and 
special  symptoms ;  between  the  supra-renals  and  Addi- 
son's disease ;  between  the  hypertrophied  spleen  and 
leucocythffimia  ;  the  pituitary  gland  and  acromegaly,  and 
so  on,  it  was  not  at  all  improlmble  on  the  face  of  it  that 
some  similar  influence  might  be  exerted  by  the  sexual 
glands. 

Dr.  Gbitfith  said  there  was  one  marked  difference 
between  osteo-malacia  as  observed  in  this  country  and 
the  disease  described  by  that  name  on  the  Oontinent,!viz. : 
that  while  over  here  it  was  exclusively  a  disease  of 
advanced  life,  on  the  Continent  it  occurred  at  a  compara- 
tively early  age.  He  pointed  out  that  examples  of  various 
degrees  of  osteo-malacia  might  be  met  with  in  the  bones 
of  the  aged  women  who  died  in  the  infirmaries.  He  did 
not  think  that  the  ovaries  could  be  credited  with  any 
share  in  the  production  of  the  disease  in  advanced  life  at 
any  rate.  He  mentioned  that  in  the  museum  of  St. 
George's  Hospital  there  was  the  skeleton  of  a  young  person 
of  which  the  bones  presented  the  characteristic  changes  of 
osteo-malacia,  and  there  was  a  similar  specimen  at 
Cambridge.  The  disease,  moreover,  was  one  which 
occurred  in  man.    He  thought  they  ought  to  take  a « 

C 


80     Tm  Mbdioal  Prkss 


TRANSACTIONS  OF  SOCIETIES. 


Jak.  8,  ISM 


what  wider  view  of  the  qaeation  and  not  asoribe  it  simply 
to  the  influeoce  of  atropoy  of  the  ovaries. 

Mr.  Blakd  Sutton  ezplaioed  that  the  changee  in  the 
bones  of  old  people  to  which  the  last  speaker  had  referred 
were  purely  senile.  They  were  totally  different  from 
those  of  osteo-malacia,  whidi  was  an  acate  affection  occur- 
ring principally,  if  not  exclusively,  during;  the  child- 
bearing  period  of  women's  life.  He  was,  however,  not 
prepared  to  deny  that  it  miffht  occur  in  man. 

Dr.  I>UNOAN  was  inclined  to  think  that  the  cases  de- 
scribed as  occurring  in  the  young  were  really  instances 
of  pseudo  osteo-malacia  occurring  in  subjects  whose  bones 
had  been  deformed  by  rickets  in  early  life. 

THE  BPFXCTS  OF  LAOTATION  ON  MBNSTBUATION   AND 
IMPaSONATION. 

Dr.  Leonard  Rbnfrt,  referring  to  what  he  said  wss 
one  of  the  most  popular  beliefs  among  married  women, 
viz.,  that  suckling  prevents  conception,  explained  that  in 
order  to  ascertain  the  truth,  or  otherwise,  of  this  belief, 
he  had  taken  notes  of  several  hundred  cases,  with  the 
result  of  eliciting  many  interesting  facts.  The  intimate 
connection  between  the  function  of  the  breast  and  that  of 
the  uterus  was  well-known.  When  the  breasts  were 
actively  secreting,  menstruation  was  commonly  absent. 
As  Boon  as  the  mother  ceased  to  suckle,  menstrua- 
tion usually  returned  as  before  pregnancy.  The 
breast  function,  moreover,  had  an  admitted  relation  with 
the  process  of  involution,  sub-involution  being  frequently 
met  with  in  mothers  who  did  not  suckle  their  children. 
Again,  after  miscarriage  sub-involution  was  more  fre- 
quently met  with  than  ^ter  full-time  labour,  in  the  pro- 
duction of  which  non -lactation  doubtless  took  a  share. 
Suckling  often  gave  rise  to  pain  in  the  region  of  the 
uterus,  due  to  uterine  contraction,  and,  according  to 
Galabin,  suckling  a  child  after  pregnancy  might  lead  to 
abortion.  With  regard  to  the  condition  of  the  uterine 
mucous  membrane  during  suckling,  amenorrhoea  under 
the  circumstances  must,  he  urged,  m  due  to  anaemia,  pre- 
sumably associated  with  little  or  no  growth.  On  the 
other  hand,  when  menstruation  was  complete  and  regu- 
lar during  lactation  the  mucous  membrane  had  probably 
undergone  the  changes  associated  with  the  catamenia 
under  ordinary  conditions.  He  had  questioned  a  large 
number  of  women  on  the  following  points  :>  (1)  NumMr 
of  pregnancies,  (2)  number  of  chilch^n  nursed,  and  for 
how  long,  (3)  whether  amenorrhoea  during  suckling,  and 
how  soon  catamenia  returned,  (4)  wheUier  pregnancy 
commenced  during  suckling,  (5)  wiiether,  when  present, 
menstruation  was  regular  or  otherwise.  He  had  collected 
the  histories  of  about  900  lactations,  from  which  he  had 
drawn  the  following  results :— Of  the  900  lactations  502 
were  attended  by  amenorrhoda,  while  in  388  the  menses 
returned  in  a  more  or  less  marked  degree.  It  followed 
that  57  per  cent  of  the  lactations  were  associated  with 
complete  amenorrhcea,  and  43  per  cent,  with  menstrua- 
tion at  some  time  during  the  period.  Of  the  388  men- 
strual cases  226  became  pregnant  during  suckling  (equal  to 
three-fifths).  In  245  of  the  388  cases  menstruation  bekan 
within  three  months  jXMf  jMxWum,  and  continued  reguLur, 
until,  in  the  majority  of  instances,  conception  occurred, 
or,  in  others,  until  the  weaning  of  the  child.  In  the 
remaining  143  the  menstruation  was  irregular. 
He  suggested  that  the  245  should  be  called  cases  of 
*' absolute  regularitv,"  and  the  143  cases  of  <*  relative 
regularity,"  and  "  relative  amenorrhcaa."  In  57  per  cent, 
of  the  cases  there  was  absolute  amenorrhcea,  and  in  26 
per  cent,  absolute  regularity,  that  is  to  say,  nearly  twice 
as  man^r  women  had  amenorrhoea  as  had  regular  menstrua- 
tion while  suckling.  Dealing  with  the  figures  in  another 
way,  he  pointed  out  that  in  5U3  lactation  periods  asso- 
ciated with  absolute  amenorrhoea,  only  29  impregnations 
took  place,  while  of  388  associated  with  more  or  less  men- 
struation there  occurred  226  menstruations,  in  percentages 
the  proportion  being  as  6  to  60.  The  explanation  of  these 
facts  would  seem  to  be  that  in  the  menstruation  cases  the 
mucous  membrane  had  grown  to  such  an  extent  as  to  be  a 
suitable  nidus  for  the  impregnated  ovum  and  vice  ffersti. 
As  bearing  on  the  association  of  amenorrhoea  and  non- 
impregnation,  he  mentioned  that  a  woman  often  became 
pregnant  on  weaning  her  baby  without  having  any  cata- 
menia at  all.  From  the  foregoing,  he  deduced  the  fol- 
lowing conclusions  :  -(1)  that  of  suckling  women  only  57 


per  cent,  had  absolute  amenorrhoea ;  (2)  that  43  per  cent, 
menstruated  more  or  less,  including  26  per  cent,  who  bad 
"absolute  regularity";  (3)  that  impregnation  did  not 
take  place  as  readily  during  lactation  as  at  other  times, 
though  this  was  not  true  to  the  extent  generally  supposed; 
(4)  the  chances  of  impregnation  with  absolute  amenorrhoea 
during  lactation  was  only  6  per  cent. ;  (5)  with  menstrua- 
tion during  lactation  the  chances  were  60  per  cent. ;  (6) 
the  more  regular  a  woman  during  lactation  the  more 
likely  was  ehe  to  become  pregnant  ;  (7)  in  the  woman  who 
did  not  suckle  at  all  the  menses  usually  appeared  some 
time  during  the  first  six  weeks  after  delivery. 

Dr.  EoBN  did  not  think  the  author  had  established  the 
existence  of  a  functional  association  between  the  mammae 
and  the  uterus.  In  any  case  the  activity  of  the  mammary 
gland  did  not  seem  to  have  had  any  marked  effect  on  the 
menstruation,  for  the  cases  were  pretty  equally  divided. 
iVforeover,  menstruation  should  not  ho  looked  upon  as 
merely  a  function  of  the  uterus,  for  it  was  now  regarded 
as  a  function  of  the  entire  organism.  He  admitted  that  it 
was  not  easy  to  say  why  some  women  should  menstruate 
during  lactation  and  others  not,  but  the  suggestion  as  to 
the  r^ative  redevelopment  of  the  uterine  mucous  mem- 
brane did  not  carry  them  much  further  seeing  that  this 
was  always  reproduced  during  the  first  two  or  three  weeks 
after  the  confinement  whether  the  mother  suckled  or  not. 
He  pointed  out  that  menstruation  and  ovulation  were  no 
loneer  regarded  as  indispensable  concomitants,  and  one 
might  take  place  without  the  other.  Nothing  was  known 
of  the  condition  of  the  mucous  membrane  during  amenor- 
rhoea, and  it  was  quite  conceivable  that  the  preliminary 
changes  in  the  mucous  membrane  which  were  associated 
with  normal  menstruation  might  take  place  without  the 
final  effusion  of  blood. 

Dr.  MgGann  said  that  the  author  had  forestalled  him, 
for  he  too  had  been  carrying  out  researches  on  this  subject. 
His  conclusions  in  the  main  agreed  with  those  obtained  by 
the  author.  In  respect  of  the  theory  that  the  mnoous 
membrane  of  the  uterus  durine  the  amenorrhoea  of  lactation 
was  not  developed,  he  pointed  out  that  a  certain  propor- 
tion of  such  women  did  become  pregnant.  The  majoritv 
of  pregnancies  during  lactation  occurred  after  the  eighth 
month  even  if  the  mothers  continued  to  suckle.  Fro- 
longed  lactation,  especially  when  the  supply  of  milk 
continued  to  be  abundant-,  favoured  hyper- involution,  and 
he  had  seen  cases  of  lactation  continued  for  upwards  of 
two  years,  in  which  the  supply  of  milk  had  not  oeased 
even  when  the  child  was  weaned  and  the  menses  had  not 
returned.  He  had  notes  of  three  such  cases.  In  one  of 
them  the  uterus  only 'measured  between  1}  and  2  inches. 
He  pointed  out  that  a  woman  might  menstruate  regularly 
during  one  lactation  and  have  amenorrhoea  after  the  next. 
He  hM  carefully  excluded  collateral  sources  of  blood  effu- 
sion during  lactation,  such  as  cervical  erosion,  &c  He 
did  not  beueve  that  sub-involution  could  be  brought  about 
by  non-suckling,  and  he  thought  that  too  much  bad  been 
made  of  the  relation  between  the  mammary  gland  and  the  ^ 
uteras. 

Dr.  BoxALL  asked  if  there  was  an v  table  appended  to  the 
paper  bearing  out  the  conclusion  that  "  the  more  regular 
the  woman  during  lactation,  the  more  liable  was  she  to 
become  pregnant."  In  respect  of  the  tendency  to  sub* 
involution  titer  miscarriage  it  might  be  that  the  tendency 
was  due  to  the  same  cause  as  determined  the  miscarriage. 

Dr.  LiWERS  said  that  in  his  experience,  prolonged  lac- 
tation not  unfrequently  gave  rise  to  monorrhagia,  even 
when  the  uterus  was  of  normal  size. 


ROYAL  ACADEMY  OF    MEDICINE  IN  IRELAND. 
Sbction  of  Medioinb. 
MxxTiNo  HSLD  Fbidat,  Dbo.  13th. 


The  President  Dr.  Gbimsuaw,  in  the  Chair. 

EXHIBIT. 

Db.  M.  M'Huoh  exhibited  a  young  man  with  syringe* 
myelia. 

UNCOMMON  HTHFTONS  IN  TWO    OASES    OF  THBOAT    DlbEASB. 

Dr.  J.  J.  BuBOESS  said  the  first  was  a  case  of  extremely 
acute  tonsillitis,  in  which  frequent  hemorrhage  from  the 
surface  affected    was    the   prominent   symptom.      This 


J*H.  8>  1H86. 


TRAITSACTIONvS  OF  SOCIETIES. 


Thw  MvniOAL  PUHB.      31 


resisted  all  hemoetatic  drugti,  wae  independent  of  an 
abfloen  which  waa  opened,  and  persisted  for  some  days 
after  the  acute  symptoms  had  disappeared,  until,  as  he 
belieyee,  exhaustion  finally  causes  its  cessation.  The 
saoood  was  a  case  of  spasm  of  the  larynx.  The  patient 
was  a  youne  gentleman  in  apparent  health,  who,  after  he 
was  suddenly  seized  with  a  choking  fit.  was  believed  by 
his  parents  to  be  dead.  Artificial  respiration  brought  him 
partly  too,  bat  on  some  brandy  being  poured  down  his 
throat  an  intense  spasm  came  on  and  apparent  asphyxia  ; 
the  symptoms  were  so  sudden  that  death  was  believed  to 
have  taken  place.  Artificial  respiration  was  preferred  by 
the  parents  to  tracheotomy.  After  six  hoars'  artificial 
lesiHration  he  came  to,  the  rash  of  measles  followed,  and 
the  patient  made  a  rapid  recovery. 

Dr.  Jambs  Littlb  said  he  had  seen  some  cases  of  which 
Dr.  Burgess'  paper  reminded  him  strongly.  He  thought 
the  fact  should  always  be  kept  in  mind,  that  very  severe 
and  anomaloas  symptoms  sometimes  occur  when  the 
exanthemata  (scarlet  fever  and  measles)  are  aboat  to 
a^^ear.  He  wae  sure  he  had  seen  cases  of  this  nature  in 
which  it  was  impossible  to  make  a  diagnosis  or  to  account 
for  the  violent  symptoms  which  ushered  in  the  illness 
until  twenty-four  boors  or  more  had  passed. 

Mr.  Whsslsb  believed  that  Dr.  Burgess  would  find 
two  cases  similar  to  his  mentioned  in  l£e  now  defunct 
Medical  Times  and  Gazette.  He  was  not  sure  of  the  date 
of  the  number  containing  the  reports,  but  be  believed  it 
was  one  of  the  numbers  of  1859  or  1860.  As  well  as  he 
eould  remember,  one  of  the  reports  was  by  a  Mr.  Stanley. 
Daring  the  discussion  on  one  of  the  cases  a  gentleman 
made  the  strange  remark,  that  the  plexus  of  veins  external 
to  the  tonsils  communicated  with  the  internal  jugular 
vem,  and  that  the  bleeding  was  from  the  lateral  sinus. 
He  thought  bleeding  in  Dr.  Burgess'  case  was  from  the 
ssoendinffpharyngeal  artery. 

Dr.  J.  W.  MooBS  said  they  had  all  every  reason  to  be 
natefnl  to  Dr.  Burgess  for  having  saved  a  most  valuable 
fife  by  his  ontirinff  perseverance.  Dr.  Burgess  had  com- 
municated to  him  the  name  of  the  patient,  who  was  now 
a  medical  man  in  England,  and  an  ornament  to  his  profes- 
aioD. 

Dr.  W.  J.  Smith  believed  that  the  explanation  of  the 
eevere  htsmorrhage  was  the  division  of  the  vertical  arteries 
that  run  in  the  pharyngeal  folds.  Those  vessels  cannot 
contract  as  well  as  other  arteries,  hence  the  severity  of  the 
hsamorrhage.  As  to  ergot  for  intemsd  h»morrha^ 
except  that  from  the  uterus,  he  considered  the  drug  qmte 


Dr.  Woods  wished  to  ask  Dr.  Burgess  if  he  were  present 
at  the  actual  time  homorrhage  took  place  in  the  fint  case. 
He  considered  that  a  vessel  had  been  opened  by  an  ulcera- 
tive process.  He  was  not  sure  that  it  must  have  been 
necessarily  an  artery.  Venous  bleeding  he  thought  was  a 
much  more  serious  matter  than  arterial  bleeding.  The 
artery  can  contract  properly,  and  retreat  in  its  sheath ; 
but  this  was  not  the  case  with  veins,  at  least  not  to  the 
same  extent.  He  could  not  infer  from  Dr.  Burgees'  paper 
that  he  applied  any  local  remedv.  His  experience  was 
that  local  remedies  are  the  best ;  but  this  did  not  mean 
that  the  necessity  of  the  position  of  the  body,  so  as  to 
calm  the  circulation,  should  be  neglected.  With  regard 
to  the  second  case,  he.  Dr.  Woods,  thought  that  tracheo- 
tomy might  have  been  performed  with  much  benefit. 

Dr.  BoBoxss,  in  replying,  thanked  the  Academy  for  the 
way  his  paper  was  received.  In  reply  to  Dr.  Woods  he 
8aid  he  was  not  present  at  the  actual  time  of  the  occur- 
rence of  the  hsmorrhage  in  the  first  case.  He  arrived 
just  after  it  occurred.  He  did  not  see  the  bleeding  points, 
and  his  difficulty  had  he  used  styptics  was,  where  to 
spply  them.  With  regard  to  the  second  case  he  admitted 
that  tracheotomy  was  the  proper  cour^  to  be  adopted. 

A  GABS  07    STBHrOOMYBLIA. 

Dr.  M.  M*HirGH  devoted  a  few  introductory  remarks  to 
a  brief  aoooant  of  the  pathology  and  symptomatok^ry  of 
th«  affiBction.  The  t«rm  syringomyelia  was  now  restricted 
to  cavities  produced  in  the  cord  by  the  liquefactive  or 
^tic  degeneration  of  a  gliomatous  neoplasm.  The  glio- 
matosis  results  from  a  proliferation  of  embryonic  tissue 
reuiaining  over  in  that  part  of  the  cord  developmentally 
the  weakest,  viz.,  posterior    grey    commissure  and  its 


vicinity.  Schultze  first  pointed  out  the  symptoms  charac- 
teristic of  the  disease,  and  with  an  accumulated  clinical 
experience  it  was  now  possible  to  diagnose  cavities  in  the 
cord  from  the  patient's  symptoms  with  almost  the  same 
facility  and  accuracy  as  posterior  sclerosis,  in  a  case  of 
locomotor  ataxy.  The  patient  (exhibited  •,  a  male,  aged 
tweoty-five  years,  and  a  native  of  County  Mayo,  presented 
the  following  symptoms,  viz.  :  trophic  lesions  in  the 
hands,  consisting  in  loss  of  the  terminal  phalanx  of  each 
middle  finger,  with  the  cicatricial  remains  of  cutaneous 
fissures,  and  transversely  corrugated  nails,  also  remark- 
able thickening  of  certain  phalanges  (cheiromegaly  of 
Charcot).  Muscular  atrophy  of  the  ulnar  type  was  also 
present,  well-marked  in  scapular  muscles  and  trapezius, 
which  showed  fibrillatioo;  Faradio  contractility  impaired; 
sensory  dissociation,  i.e.,  analgesia  and  thermo- anaesthesia, 
together  with  retention  of  tactile  sensibility  and  the  mus- 
cular sense,  well-marked,  with  a  wide  symmetrical  distri- 
bution. The  patient  also  exhibited  scoliosis,  with  con- 
vexity towards  the  rififht,  and  spastic  symptoms  in  the 
lower  extiemities;  very  slight  vaso- motor  disturbances 
and  no  ataxia  nor  ocular  derangements,  nor  visceral 
troubles.  The  author  referred  to  the  trophic  lesions  in 
the  hands,  painless  whitlows  with  cheiromegaly,  as  similar 
to  those  found  in  Morvan's  disease.  The  latter,  however, 
was  now  considered  to  be  only  a  type  of  syringomyelia, 
and  the  case  exhibited  was  a  true  example  of  the  disease, 
showing  Morvan's  symptom — sensory  dissociation,  the 
most  remarkable  feature  of  the  disease,  and  difficult  to 
explain.  A  study  of  the  ascending  degenerations  in  cases 
of  syringomyelia  continued  with  careful  clinical  records, 
would  probably  throw  considerable  light  on  centripetal 
conduction  in  the  cord.  Having  referred  to  the  other  sym- 
ptoms, the  author  drew  attention  to  the  remarkable  sym- 
metry in  the  symptoms.  One  might  infer  that  there  was 
a  single  symmetrically-placed  cavity  with  a  lateral  wing, 
extending  into  each  posterior  cornu,  and  occupying  the 
cervical  and  upper  dorsal  regions. 

Dr.  Cbaig  remarked  that  the  symptoms  of  the  case  were 
most  classical  from  the  fact  that  they  occurred  in  a  patient 
from  twenty  to  twenty-five  years  of  age ;  that  dissociation 
symptoms  were  so  well  marked,  that  muscular  atrophy 
attacked  the  upper  extremity,  causing  weakness ;  that 
there  was  spastic  paralysis  of  the  lower  limbs  and  curva- 
ture of  the  spine. 

Dr.  BoTD  congratulated  Dr.  M'Hugh  on  having  pre- 
sented  to  the  Academy  a  most  typi^  example  of  this 
rare  form  of  spinal  disease.  Dr.  Boyd  drew  attention  to 
the  soolioflis  which  is  so  often  a  marked  feature  in  atrophv 
of  the  muscles  of  the  shoulder  and  back.  In  Dr.  M'Hueh^s 
case  the  dorso-lumbar  curve  principally  involved  the  left 
side,  in  contradistinction  to  the  usual  right-sided  sooliosie 
in  the  dorsal  region  of  growing  youths  and  children.  The 
pathology  of  the  disease  touched  on  by  Dr.  M'Hugh  would 
point  to  the  involvement  of  the  posterior  commissures  of 
grey  matter,  principally  due  to  the  dilatation  of  the  central 
canal.  Why,  under  such  circumstances,  ataxv  did  not 
show  itself  as  a  more  frequent  symptom  in  these  cases 
was  not  easy  to  explidn  Possibly  the  ataxic  symptoms  had 
often  been  overlooked  in  the  earlier  stages  of  the  disease; 
and  we  know  that  they  often  disappear  when  the  lateral 
columns  become  involved  in  association  with  the  posterior 
columns  in  other  afiections  of  the  spine. 

Mr.  SwAKZT  said  Dr.  M'Hugh  told  them!  that  in  this 
case  there  was  no  ocular  symptoms,  and  no  doubt  Dr. 
M'Hugh  had  investigated  the  matter.  He  would  like  to 
know  if  there  was  contraction  of  the  field  of  vision, 
because  that  is  no  uncommon  symptom  in  syringomyelia. 
But  whether  the  contraction  belonged  essentially  to  the 
disease  or  whether  it  was  of  a  hysterical  character  and 
only  grafted  on  the  disease,  was  not  easy  to  decide.  Some 
observers  had  found  a  peculiar  neuritis  in  this  affectioD, 
but  he  (Mr.  Swanzy)  thought  it  was  not  of  common  occur- 
rence and  it  was  not  present  in  Dr.  M'Hugh's  caee^ 

Dr.  M'HuoH,  in  reply,  said  that  the  fact  which  Dr. 
Boyd  emphasised— namely,  that  the  scoliosis  was  to  the 
left  and  not  to  the  right  side,  was  remarkable.  The 
patient's  eyes  were  examined  by  Mr.  O'Devaine  of  Sk 
Vincent's  HospitaL 

The  Section  then  adjourned. 


32       Tun  M^T^THAt.  PWFPS 


TEANSACni»N8  OF  SOCIETIES. 


Jan.  8,. 188^ 


SOCIETY   OF   ANAESTHETISTS. 
Mbbtino  held  Thursday,  Degbmbbb  19th. 

[The  President,  Mr.  F.  Woodhouse  Brainb,  F.R.C.S., 
in  the  Chair. 

A  PBBCI8E  AND  80IBMTIFI0  METHOD    OF  ADMINI8TEBINO 
OHLOKOFORM  AND  ETHEB. 

Db.  R.  W.  Carter,  of  Weymouth,  demonstrated  methods 
of  administering  chloroform  or  ether  which  he  claimed 
were  at  once  precise  and  scientific.  He  said  he  had  no 
pet  fad  which  he  desired  to  ventilate.  He  warned  anass- 
thetists  never  to  allow  their  thoughts  to  wander  from  their 
important  undertaking,  the  administration  of  an  antosthe- 
tio  in  a  light  and  frivolous  spirit  amounting  to  a  criminal 
misdemeanour.  He  insisted  on  the  claim  of  the  anaesthe- 
tist to  complete  silence  on  the  part  of  those  present  at  the 
operation  and  he  urged  that  tne  anssethetiet  ought  never 
to  allow  himself  to  be  hurried.  He  preferred  to  have  the 
patient  in  the  position  in  which  he  was  to  undergo  the 
operation  in  order  to  avoid  subsequent  changes  of  position. 
With  the  patient  supine  be  preferred  the  hesyd  to  be 
inclined  to  one  side,  making  forward  pressure  on  the  man- 
dible, taking  care  not  to  remove  him  too  hastilyfrom  the 
operating  tahle  after  the  operation  was  over.  He  classi- 
fied subjects  into  three  groups :  (1)  those  who  took  the 
ansBsthetic  freelv  but  were  a  long  time  getting  under,  0.^., 
the  stalwart  and  the  free  liver  ;  (2)  those  who  took  it  well, 
were  soon  under  its  influence,  and  could  stand  a  good  deal 
of  it ;  (3)  those  who  took  it  badly,  and  who  showwl  danger 
signals  even  before  the  vapour  was  administered.  This 
last  condition  was  determined  by  a  multitude  of  different 
causes.  In  administering  chloroform  he  himself  always  used 
Krohne's  Regulating  Inhaler  with  Duncan  and  Flockhart's 
chloroform,  and  he  would  object  to  giving  it  in  any  other 
way  unless  constrained  thereto.  For  ether  he  had  used  two 
inhalers,  viz..  Clover's,  and  the  thermo-ether  apparatus 
which  bore  his  own  name,  using  Salamon's  ether.  Hie  reason 
for  introducing  yet  another  inhaler  was  that  after  using 
Clover's  inhaler  many  hundreds  of  times  he  had  be«n 
struck  by  certain  drawbacks  which  it  presented.  His 
plan  was  to  bring  the  ansBsthesia  up  to  Snow's  third 
degree,  and,  if  carried  to  the  fourth,  to  relax  it  and  bring 
it  back  to  between  the  second  and  third  and  to  maintain 
it  there,  occasionally  removing  the  mouthpiece  awhile  for 
the  purpose  of  having  a  ^neral  observation  as  to  breath- 
ing, pupils,  colour,  condition  of  skin  as  to  perspiration, 
and  pulse.  He  left  it  to  the  operator  to  tell  him  when 
to  desist,  and  he  carefully  avoided  allowing  his  attention 
to  be  distracted  from  the  inhaler.  He  pomted  out  that 
the  quantity  required  to  effect  complete  annsthetisation 
varied  considerably  in  different  subjects,  but  in  a  pro- 
longed operation  more  of  theanaBsthetic  was  usually  given 
during  the  first  twenty  minutes  than  afterwMds,  though 
this  was  notquitesoapparent  with  chloroform  as  with  ether. 
Little  more  than  halt  the  quantity  of  ether  was  required 


with  the  thermo-apparatuB  than  with  a  Clover's  innaler. 
He  referred  to  a  series  of  twenty  cases  published  in  the 
British  Medical  Journal  for  December  16th,  1893,  in  which 
the  air  breathed  never  contained  more  than  1  per  cent,  of 
chloroform  vapour,  and  to  one  case  in  particulaur,  in  which 
a  boy  who  was  under  operation  for  fifty  minutes  did  not 
consume  more  than  seventy  minims  01  chlorofonn.  In 
twenty-eight  other  cases  the  proportion  of  chloroform 
had  varied  from  1  22  per  cent,  to  2 '76  per  cent.  He  com- 
menced the  administration  with  an  infinitesimal  dose, 
gradually  increasing  the  dose  up  to,  but  never  exceeding, 
nom  4i  to  5  per  cent,  at  any  stiaore  of  the  narcosis.  He 
observed  that  these  figure's  spoke  for  themselves,  and 
opened  out  a  wide  field  for  reflection  as  to  how  far  they 
were  justified  in  giving  such  heroic  doses  as  many  gave. 
He  cautioned  them  against  ever  holding  the  hand  over 
the  open  end  of  the  inhaler  for  the  purpose  of  getting  the 
patient  more  quickly  under,  adding  that  nothing  was 
more  likely  to  bring  about  a  fatal  result.  He  protested 
against  the  use  of  the  term  "  open  method,"  as  applied  to 
any  other  method  than  that  involving  the  use  of  such  an 
inhaler.  He  pointed  out  that  an  imperfect  system  might 
be  fairly  well  conducted  for  a  while  in  good  hands,  and, 
jMT  cofUra,  a  good  method  might  be  badly  carried  out  in 
bad  hands.  When  anything  went  wrong  with  the  method 
he  had  described,  the  fault  could  only  be  the  administra- 


tion of  an  overdose,  certainly  not  of  an  underdone  as  had 
been  suggested.  He  urged  that  the  one  method  was  the 
giving  of  an  unmeasured  quantity  of  a  most  potent  drug, 
and  the  other  was  supplying  wliat  the  ansesthetiit  con- 
sidered to  be  sufficient  and  watching  its  effects.  He  asked 
how  it  oould  be  possible  for  any  one  to  give  adequate 
instructions  in  the  administration  of  anaesthetics  by  the 
old  methoda  It  was  necessary  to  calculate  the  temperature 
of  the  air,  the  density  of  the  vapour,  atnd  the  patient's 
face,  all  being  conditions  which  materially  affected  the 
safety  of  the  patient. 

Dr.  DuDLBT  Buxton  pointed  out  that  the  cases  com- 
prised in  the  tables  published  by  the  author  all  seemed 
to  have  been  of  comparatively  short  duration,  cases,  in 
fact,  which  did  not  appear  to  present  any  particniaur  diffi- 
culty. He  himself  had  used  the  Junker  inhaler  for  ten 
yearp,  and  had  every  reason  to  be  satisfied  with  it.  He 
was  quite  convinced  of  its  snperioritv  to  the  rough  amd 
ready  methods  of  administering  chloroform  with  the 
towel  or  handkerchief.  The  MCt  that  these  methods 
of  giving  chloroform  had  been  attended  with  a  fair 
measure  of  success  did  not,  however,  warrant  them  in 
abstaining  from  using  a  reliable  apparatus  sudi  as  that 
described  and  demonstrated  by  the  author.  At  the  saune 
time  no  apparatus  for  giving  chloroform  afforded  abeolnte 
protection  against  auscident,  in  support  of  which  state- 
ment he  instanced  the  fact  that  two  deaths  hcul  taken 
place  at  the  Samiaritan  Hospitad  with  a  Junker  inhader. 
As  to  the  use  of  the  feather  as  an  indicator  td  the  state  of 
the  respiration,  he  said  this  was  a  matter  of  opinion,  but 
the  other  modifications  spoke  for  themselves.  He  was 
glad  to  see  that  an  old  suggestion  of  his,  to  put  an  air- 
cushion  between  the  facepiece  and  the  patient's  fause,  had 
at  last  been  adopted.  His  experience  of  the  apparatus 
for  the  administration  of  ether  had  been  all  in  its  favour, 
but  he  said  all  such  apparatus  were  open  to  the  objection 
that  one  oould  not  crowd  on  the  amsosthetic  as  one  oould 
wish  under  special  circumstamoes.  It  wats  sometimes  very 
desirable  to  give  large  quamtitied  in  order  to  abridge 
or  avert  the  stage  of  excitement  under  elher.  When 
these  apparatus  failed  to  prove  satisfactory  he  said  it  was 
due  to  a  want  of  experience.  The  fault  wais  not  with  the 
appakratus,  but  with  the  administrator.  He  sadd  thai  as 
a  body,  anaesthetists  hakd  no  petty  jeadonsies  in  the  matter, 
their  only  object  being  to  know  the  best  method  of 
administering  the  anaoswetic  to  complete  naurcosis  without 
unpleaksant  or  dangerous  symptoms. 

Dr.  Cabtbr  said  that  there  was  a  tendency  for  saliva  to 
atccumulate  in  the  reservoir  of  the  Clover  appaumtus, 
especially  with  the  patient's  heaid  turned  to  one  side. 

Mr.  Davis  wished  to  protest  against  the  use  of  the 
feather  in  Junker's  inhaler,  seeing  that  the  faintest  breath 
of  an  expiring  patient  would  be  quite  sufficient  to  lift  it 
up ;  and,  in  fact,  to  protest  aigainst  any  mask  whatever 
covering  the  face  in  the  administration  of  chloroform,  it 
being  0?  paramount  importance  to  watch  the  colour  of  tht 
act  8ks  well  as  the  breathing. 

Mr.  Tom  Bird  said  that  Mr.  Clover  had  used  the  prin- 
ciple over  twenty  yeairs  ago,  amd  that  he  himself  had  used 
the  same  apparatus  for  the  last  twenty-two  years,  and 
preferred  it  to  any  other.  '*  Pressing  the  bulb  "  at  eau^ 
inppiration  of  the  patient  was  an  old  practice  of  economy. 
With  regard  to  ether  apparatus  Mr.  Clover  adways  con- 
sidered the  free  surfaice  of  ether  the  beet  for  evaporation, 
amd  in  that  he  agreed  with  him  Mr.  Clover  complained 
that  ether  came  off  too  freely  at  first,  but  not  sufficiently 
so  when  wanted,  and  this  seemed  to  be  the  time  when  some 
"  thermo "  appliance  might  be  useful.  He  agreed  that 
sometimes  one  required  a  superfluity  of  the  vapour  for 
certain  patients,  and  he  doubted  the  possibility  of  refipi- 
lating  the  supply  of  heat  according  to  the  necessity  of  the 
individual  case.  The  temperature  of  am  operating-room 
ought  to  be  65  degrees  Fah.  for  ether  exnibition.  He 
pointed  out  that  the  Junker  inhaler  before  it  was  used 
might  contain  between  the  ether  surfaice  and  the  exit  pipe 
a  pretty  strong  amount  of  vapour  He  asked  whether 
this  amount  was  accounted  for  in  the  caJculation  of  per- 
centages which  had  been  given  them;  it  ought  to  be 
blown  away  or  used  very  slowly,  or  it  would  be  extremely 
unpleasant  to  the  patient.  Some  yeaurs  ago  he  had  tried 
the  saune  principle,  in  which  air  was  blown  through  etiier, 
using  his  own  nody  to  produce  the  necessary  waurmUi, 
but  adft«r  four  successive   atdministrations  felt   ais  if  he 


JAir.  8,  1896. 


FRANCE. 


Thb  Mbdioal  Prsss.     33 


h*d  BwaUuwed  a  iinowb«li.  He  referred  to  the  face  piece 
of  Mr.  Morgan,  bj  which  the  expiration  of  the  patient  was 
piiined  rooDd  the  ether  for  ite  evaporation,  bat,  of  coarse, 
everyone  mast  be  aware  that  the  air  breathed  by  patients 
was  very  shortly  as  cold  as  the  ether  itself.  He  had  once 
collected  for  lecture  parpoeee  at  Guy's  over  40  inhalers 
used  for  these  substances,  since  whicn  time  he  believed 
that  the  number  had  been  added  to  considerably.  He 
said  that  a  Oerqaan  review  of  20  years  ago  (in  one  of  their 
year-booke)  contained  a  list  of  over  90  works  on  chloroform 
and  ether,  so  that  administrators  eeeme(f  to  be  moving, 
even  if  slowly.  With  two  bottles  on  this  system,  one  for 
18  years,  and  tho  other  for  four  and  over,  he  had  had  no 
trouble  or  accident.  He  was  constantly  giving  it  to 
patients  sitting  upright  in  dental  chairs,  for^  minutes  at 
a  time»  and«  as  a  rule,  no  longer  time  was  required,  and 
this  without  much  subsequent  annoyance  to  the  patient. 
He  gave  gas  before  the  chloroform  because  it  shortened 
b(^  the  time  required  and  the  amount  of  the  vapour. 
The  intimate  mixture  of  the  two,  gas  and  vapour,  was  the 
•■ecret  of  the  beet  anaBsthesia.  He  also  added  that 
Junker's  apparatus  was  first  made  by  Mr.  Krohne  (the 
instrument  maker)  for  bichloride  of  methylene.  With 
Wolfs  bottle  chloroform  was  administered  at  Guy's  many 
years  before  ;  the  principle  in  both  is  the  same. 

Dr.  Llotd  said  his  experience  did  not  confirm  what  the 
author  had  said  about  the  saliva  getting  into  the  ether 
nservoir  of  Glover's  inhaler,  though  it  was,  he  admitted, 
Doauble  for  the  ether  to  get  mixed  with  vapours  con- 
oensed  from  the  patient's  breath. 

Dr.  Stohmont  Mubbay  said  he  alwayi*  watched  the 
respiration,  and  not  the  pulse.  He  himself  often  found  it 
neceesary  to  cover  in  the  open  end  of  the  inhaler  because  too 
much  air  entered  and  the  patient  could  not  be  got  under. 
He  said  he  liked  Junker's  inhaler,  but  he  had  found  that  >f 
u"ed  for  several  administraions  the  chloroform  was  apt  to 
freeze  in  the  pipe  and  prevent  the  vapour  entering  the 
faoepiece.  He  had  remedied  this  to  some  extent  by  sub- 
ebtuting  a  bone  tube  for  the  metal  one  usually  employed. 
Referring  to  the  two  deaths  with  the  Junker  inhaler  that 
had  taken  place  at  the  Samaritan  Hospital,  he  explained 
thai:  the  patients,  in  both  instances,  were  in  such  a  condi- 
tion that  in  all  pi  obability,  however  the  anaesthetic  had 
bean  administered,  the  result  would  have  been  the  same. 
One  was  a  deformeid  woman  with  advanced  kidney  disease 
and  a  large  abdominal  malignant  tumour,  and  at  the 
autopsy  she  proved  to  have  only  one  coronanr  artery.  The 
ot^er  was  the  case  of  a  patient  suffering  from  ruptured 
extra-uterine  gestation,  who,  as  the  result  of  several  days' 
bleeding,  was  in  a  condition  of  extreme  collapse. 

Mr.  Ttbrsll  said  he  had  used  Junker's  inhaler  for 
chloroform  for  the  past  fifteen  years,  and  had  adopted  all 
the  various  improvements  by  Buxton,  Hewitt,  Garter, 
Braine,  Krohne,  and  others,  and  he  was  a  strong  advocate 
of  its  use,  but  he  thought  that  teachers  should  also  in- 
struct in  the  administration  of  chloroform  with  the 
simplest  possible  apparatus.  The  country  practitioner,  who 
might  have  no  occasion  to  use  chloroform  for  a  month, 
would  find  india-rubber  apparatus  quite  hard  and  unusable 
when  wanted  in  a  hurry.  A  drop  bottle  and  a  flannel 
mask  were  always  ready  and  in  order ;  a  single  layer  of 
flannel  he  oonsiaered  far  preferable  to  folds  of  Tint,  and  he 
Btrongly  advocated  dropping  the  chloroform  slowly  on  to 
the  centre  of  the  outside  of  the  flannel  mask,  where  the 
wet  mark  of  the  chloroform  could  always  be  seen. 
He  did  not  a^ree  that  three  minutes  was  a  long 
time,  but  considered  five  or  six  minutes  or  even 
more  should  be  employed  in  inducing  anaesthesia.  For 
ether  he  almost  invariaoly  used  Glover's  small  inhaler,  but 
oecasionB  might  arise  when  pumping  air  through  ether  in 
a  Junker's  apparatus  was  of  great  service.  Snoh  an  occa- 
sion occurred  to  him  recently,  when  a  man  who  had 
broken  his  neck  twelve  months  previously,  and  had  during 
that  time  only  breathed  with  his  diaphragm,  was 
ansBsthetised  by  a  Glover's  ether  inhaler  while  lying  on  his 
hack ;  he  was  then  turned  over  on  his  face  for  the  purpose 
of  performing  laminectomy.  Precautions  were  taken  to 
Mp  off  pressure  from  the  thorax  and  abdomen,  but  in 
this  position  the  respiration  was  shallow,  and  before  the 
operation  had  proceeded  far  breathing  suddenly  ceased, 
and  artificial  respiration  had  to  be  resorted  to.  Breathing 
was  soon  reestablished,  the  patient  placed  again  on  his 
face,  and  etherisation  was  oontinuM  with  a  Junker's 


apparatus,  the  operation  lasting  forty  minutei»  without 
further  respiratory  embarrassment. 
~  Dr.  DuDLBT  BcrxTOK  recalled  that  many  years  ago  he 
had  used  a  foot  bellows  with  the  Junker  inht^er  in  order 
to  free  one  hand,  and  he  added  that  this  gave  just  as  good 
oontrolas  with  the  hand  bellows. 

Mr.  Gasdines  asked  how  the  percentages  of  vapour 
were  calculated  ? 

Dr.  Gartcb,  in  reply,  said  he  did  not  think  there  could 
be  any  mistake  as  to  the  saliva  finding  its  way  into  the 
reservoir  of  Glover's  inhaler,  for  it  formed  a  separate  layer 
beneath  the  ether.  He  timed  the  moment  of  complete 
ansesthesia  when  the  corneal  reflex  disappeared.  The  per- 
centages were  arrived  at  by  comparing  the  amount  of 
chloroform  consumed  with  the  respirations  of  the  patient. 
That  might  not  be  mathematically  correct,  but  it  only 
professecTto  be  an  approximation.  He  added  that  Mr. 
Krohne  made  an  inhaler  which  could  be  used  with  one 
hand  only. 

Mr.  BiBD  said  the  facepiece  could  be  fixed  on  with  a 
piece  of  tape,  thus  setting  one  hand  free. 

The  meeting  concluded  with  a  cordial  vote  of  thanks  tc 
the  author  for  his  paper,  moved  by  Dr.  Silk. 


BRITISH  ORTHGPiEDIC  SOGIBTY. 

Thv  first  Annual  Meeting  of  this  Society  was  held  a& 
the  Royal  OrthopMBdic  Hocpital,  Oxford  Street,  on  Wed- 
nesday, December  I8th.  1895.  Present:  Mr.  B.  E. 
Brodhurst  (in  the  chair),  Messrs  Ewene,  Moxey,  Jackson, 
Glarke,  Openshaw,  IXArcy  Power,  E^ves,  Keetley, 
Sunderland,  Little,  and  Luke  Freer  and  Tubby  (Hon. 
Sfcrtitanes),  together  with  Messrs.  Baker,  Sayers,  and 
Tombd,  and  Drs.  Moulonguit  (Amiens)  and  GaloD  (Berch- 
sur-Mer)  as  visitors. 

The  Hon.  Treasurer's  and  Hon.  Secretaries'  reports  were 
read  and  adopted ;  in  the  latter,  after  speaking  of  the 
inauguration  of  the  Society  and  the  three  successful  meet- 
ings held,  especially  that  at  Liverpool,  where  the  members 
had  been  most  hospitably  entertained  by  Mr.  Robert  Jones 
and    the    Liverpool  members,  the  Hon.  Secretaries  ex- 

Eressed  a  hope  that  the  Society  would  be  enabled  to  pub- 
sh  its  transactions  annually  in  book-form. 

Messrs.  Keetley,  Power,  Reeves,  and  the  Hon.  Secre- 
taries were  elected  as  a  sub-committee  to  deal  with  the 
latter  subject. 

Mr.  Keetley  was  re-elected  Treasurer,  and  Messrs. 
Openshaw,  Brodhurst,  and  Rawflon  were  elected  to  fill 
vacancies  on  the  Gouncil.  At  the  invitation  of  Mr.  Luke 
Freer,  the  next  ordinary  meeting  was  decided  to  be  held 
in  Birmingham  in  May  next. 

An  ordinary  meeting  was  held  immediately  after  the 
annual  meeting. 

Mr.  Rbevbs  and  Mr.  ELbbtlbt  showed  cases  of  congenital 
hip  dislocation,  the  former  demonstrating  his  instrument 
for  extension. 

In  the  discussion  that  followed,  Messrs.  Bbodhubst  and 
Galot  took  part,  mainly  dealing  with  operative  inter- 
ference in  such  cases. 

Messrs.  Baksb  and  Walsham  had  on  view  some  inter- 
esting cases  of  congenital  absence  of  fibula. 

Mr.  Brodhubst  showed  a  cast  of  a  severe  cape  of  talipes 
equino-varus,  and  Mr.  Ewens  one  of  a  case  of  severe 
taiipes-calcaneo-valgus  in  an  infant. 

Mr.  Baeeb  demonstrated  the  action  of  his  wrench  for 
talipes-equinus  and  varus. 

The  meeting  terminated  with  a  vote  of  thanks  to  the 
Gommittee  of  the  Royal  Orthopsdic  Hospital  for  the  use 
of  their  board-room  for  the  meeting. 


Jrancc. 


[from  our  own  cobrespondbnt.] 


Pabis,  Jan.  4, 1898. 
iMFAyriLB  Vaoikitis. 
Dr.   Marx    recommends  the  following  treatment  for 
vaginitis  in  children,  which  has  given  him  the  best  results  : 
— Practise  vaginal  injections  morning  and  evening  with 


34     "^HB  Umomkh  rkna 


AUgTKIA. 


Jan.  8   1896. 


a  soft  catheter,  to  which  is  attached  an  elastic  ball  of  the 
capacity  of  ten  ounces.  The  liquid  used  for  the  injec- 
tions is  a  solution  of  permanganate  of  potash  (1 — 1,000). 
The  catheter  should  be  inserted  as  far  as  possible  into  the 
▼agina,  and  the  solution  injected  with  a  certain  amount 
of  pressure,  so  as  to  thoroughly  wash  out  the  cavity. 
About  twenty  ounces  may  be  employed  at  each  sitting. 
After  the  injection  the  vulva  is  washed  with  a  warm  solu- 
tion of  boric  acid  and  renewed  every  three  hours.  A 
piece  of  cotton  wool  is  placed  between  the  labii  to  pre- 
vent friction  in  walking. 

In  rebellious  cases  the  permanganate  of  potash  can  be 
replaced  by  a  solution  of  nitrate  of  silver  (1—500). 

AOUTB  GONOBBHOSA   IN  WOMBN. 

According  to  M.  Strassman  vaginal  injections  should  be 
forbidden  in  acute  gonorrhcea  as  favouring  the  dissemina- 
tion of  gonococci  and  notably  their  penetration  into  the 
uterine  cavity  producing  complications  that  might  other- 
wise be  avoided.  The  honourable  professor  distinguishes 
in  woman  two  varities  of  acute  blenorrhafifia.  In  the  first, 
which  is  localised  essentially  in  the  vulva  and  the  urethra, 
all  injections  should  be  absolutely  proscribed.  The  treat- 
ment of  these  cases  comprises  rest  in  bed,  a  light  alimen- 
tary rifftme,  the  employment  of  purgatives,  and  the  internal 
use  of  balsams.  Locidly,  a  warm  solution  of  sulphate  of 
zinc  is  applied,  and  after  each  application  a  compress  of 
vaseline  and  ichthyol  as  ointment  (15  per  cent.)  The 
second  variety  commences  by  the  neck  of  the  uterus  and 
manifests  itself  by  a  muco-purulent  discharge  as  well  as 
by  an  erosion  of  the  os.  In  this  case  the  vagina  is  gently 
swabbed  out  with  a  sublimate  solution  of  1-1000  and  a 
plug  of  gauze  steeped  in  a  mixture  of  glycerine  and  iodo- 
form (5  per  cent.)  placed  in  situ.  It  is  only  after  a  few 
days  of  the  above  treatment  that  injections  might  be 
prescribed. 

TlO    DOULOUBEUX. 

The  treatment  of  this  terrible  affection,  which  Trousseau 
affirmed  never  to  have  seen  get  well,  is  so  difficult  that  a 
description  of  the  method  practised  by  M.  Gilles  de  la 
J  curette  may  not  be  out  of  place.  This  treatment 
is  very  simple,  but  none  the  less  efficacious. 
It  consists  in  giving  progressive  increasing  and  progres- 
sive decreasing  doses  of  extract  of  opium,  treatment 
recommended  also  by  the  late  Dr.  Charcot.  The  first  day 
two  piUs  of  half  a  grain  each  are  given,  the  following  day 
three  pills,  and  so  on  progressively  until  four  grains  and  a 
half  are  reached,  which  is  the  maximum  dose.  Little  by 
little  the  pain  diminishes  in  intensity,  the  attacks  do  not 
last  so  long,  and  the  intervals  between  them  are  of  greater 
duration,  and,  finally,  the  attacks  cease  altogether. 

It  is  a  remarkable  fact  that  the  patients  show  an  extra- 
ordinary tolerance  for  opium.  M.  de  la  Jourette  says  he 
never  saw  a  case  of  poisoning  from  the  maximum  doses, 
not  even  somnolence.  The  only  drawback  is  the  obstinate 
constipation  that  the  treatment  provokes. 

Once  the  attacks  cease,  the  patient  is  allowed  to  rest 
for  a  few  days,  after  which  the  progressive  decreasing  doses 
are  given. 

The  IdBDiCAL  Pbofsssion  in  Fbanob. 

According  to  the  report  presented  by  M.Brouardel  to 
the^Paris  Academy,  the  number  of  students  registered  at 
the  Paris  Faculty,  is  6,000. 

Of  this  total,  1,046  m  foreigners ;  879  men  and  167 
women. 

In  the  last  session  there  were  8,238  examinations,  of 
which,  1,394  were  adjourned. 


The  number  of  studentu  in  the  Provincial  Faculties 
number  in  the  aggregate,  4,000,  representing  thus  a  grand 
total  of  10,000  medical  students 

The  number  of  fully  qualified  men  in  the  whole  of  France 
is  from  13,000  to  14,000.  In  five  years  they  will  be  nearly 
doubled. 

A  Powerful  Antithebmio. 

^   Antipyrine,  Sss  ; 
Phenacetine,  3  j ; 
Acetanilide,  x  grs. 
Divide  into  four  wafers,  one  every  three  hours. 


^ustm 


(FUuM   OITB  OWN    0OBBB8P0NDENT.] 

Vienna,  Jan.  Srd,  1896. 
EXPEBIHENTAL  DiABBTBS. 

At  the  Geeellschaf  t  der  Aerzte  Biedl  gave  a  short  renani 
of  his  experiments  in  connection  with  diabetes.  Hie  first 
effort  was  to  produce  adiuresisby  means  of  grape  sugar.  In 
the  case  of  animals  he  injected  grape  sugar  into  the  bowel, 
and  after  a  short  time  found  sugar  in  the  urine  taken  from 
the  ureters.  The  same  experiment  was  performed  on  the 
human  subject,  but  the  results  were  negative.  Three 
litres  of  a  ten  per  cent,  solution  were  applied  without  any 
success.  Needless  to  say  that  alimentary  glycosuria  in 
man  met  with  the  same  result.  He  next  injected  the 
solution  into  the  venous  system  ;  200  to  300  ccm.  of  a  ten 
per  cent,  solution  were  injected  into  a  vein  of  the  arm, 
but  the  expected  polyuria  failed  to  appear,  as  the  daily 
amount  for  three  days  after  was  unchanged.  Neither 
could  sugar  be  found  in  the  urine,  although  Trommer's 
test  showed  a  reaction  indicating  the  presence  of  other 
substances. 

These  results  lead  us  to  two  conclusions.  The  absence 
of  the  polyuria  tends  to  show  that  the  sugar  is  not  an  irri- 
tant on  the  human  kidney,  as  the  secretion  is  in  no  way 
increased ;  or  we  may  conclude  that  the  sugar  is  so 
rapidly  altered  that  it  has  lost  all  specific  action  in  pro- 
ducing any  acute  hypersemia  of  the  kidneys.  The  first 
supposition  is  the  more  probable,  as  the  constant  coinci- 
dence of  glycosuria  with  polyuria  in  diabetes  makee  it 
likely  in  the  human  subject  that  the  elimination  of  sugar 
by  the  kidneys  increases  the  urine.  With  the  object  of 
more  closely  investigating  this  hypothesis  two  patients 
were  selected,  into  whom  sugar  solution  was  injected,  and 
in  order  to  obtain  the  urinary  secretion  direct  from  the 
kidneys  the  ureters  were  catheterised.  It  was  found  that 
the  rapidity  of  the  secretion  increased  within  the  first  ten 
minutes  from  6  or  8  drops  to  24  or  40  drops,  but  both 
kidneys  were  not  equally  affected,  sometimes  alcemating 
in  the  flow.  In  other  two  cases  shortly  after  the  injection 
a  rigor  was  experienced  and  the  temperature  rose  to  38 '9*' 
or  102"  Fahr.,  but  suddenly  fell  without  any  apparent  cause 
as  it  could  not  be  termed  a  septic  fever  although  some 
experimenters  have  applied  the  term  apeptic  It  is  now 
twenty  years  ago  since  Albert  and  Strieker  observed  these 
rigors  in  animals  in  the  operation  of  transfusion,  they  also 
produced  it  by  taking  the  blood  stream  of  an  artery  and 
directly  connecting  it  with  a  vein  in  the  same  animal. 
Domenices  has  more  recently  demonstrated  the  same 
phenomenon  in  transfusion  into  dogs. 

As  observed  above  there  was  a  peculiar  change  in  the 


Jah.  8,  im. 


THE  OPERATING  THEATRES. 


Thv  MsnioAi.  Fltts.     85 


wiiie^  a  potttiTO  reaction  oonld  be  obtained  by  Trommor's 
test  after  looj;  boiling.  With  phenyl-hydrazin  a  peculiar 
pointed  crystal  which  could  not  be  identified  with  sngar 
was  present.  The  fermentation  test  was  negative,  neither 
did  polarisation  show  any  change  in  the  angle.  The  asser- 
tion that  polyuria  and  glycosuria  was  absent  must  be 
qualified,  for  we  find  by  these  experiments  that  the  urine 
taken  immediately  by  the  catheters  were  increased,  and 
when  examined  contained  from  0*5  to  2  per  cent,  of  sugar, 
which  wonld  give  a  different  result  in  twenty-four  hours 
odUection.  It  is  generally  understood  that  the  polyuria  is 
canaed  by  the  elimination  of  the  sugar  from  the  blood 
while  circulating  through  the  kidney.  In  our  experiments 
it  18  probable  that  immediately  after  the  injection  the 
glyooenria  existed  for  a  very  brief  period,  during  which 
polyuria  appears  to  have  lasted. 

Claude  Bernard  was  the  first  to  attempt  the  experi- 
ment of  calculating  the  intensity  of  glyknmia  of 
diabetes.  He  concluded  that  sugar  was  eliminated  in 
the  urine  when  the  sugar  in  the  blood  reached  0*25  per 
cent.  These  figures  were  modified  by  subsequent  investi- 
gators, although  Claude  Bernard's  were  confirmed  in  the 
dog,  which  led  to  the  source  of  error.  When  20  oc.  of  a 
10  per  cent,  solution  of  sugar  was  injected  in  a  dog  the 
sugar  roee  in  the  blood  to  6-8  per  cent.,  5*2  per  cent., 
&C.  In  the  human  subject,  however,  it  did  not  rise  above 
012,  or  0*3  per  cent,  as  the  greatest  injections  Frerichs 
records  cases  where  he  was  able  to  raise  the  percentage  in 
the  blood  to  0*6  and  0*7  per  cent,  after  extraordinary  quan- 


It  was  evident  from  what  the  bouse  surgeon  said  that  the 
fiuid  which  this  dulness  evidenced  was  increasing  rapidly, 
and  the  duration  of  time  which  had  elapsed  since  the 
accident  made  it  certain  that  it  was  blood  free  in  the  peri- 
toneal cavity.  The  condition  of  the  man  was  evidently 
very  bad  and  unfitted  for  a  prolonged  operation,  but  it 
was  also  evident  that  he  would  not  be  improved  if  the 
haemorrhage  went  on  unchecked.  The  patient  was 
anxious  to  have  something  done,  and  as  Mr.  Battle 
thought  his  symptoms  were  due  to  a  ruptured  kidney, 
with  laceration  of  the  overlying  peritoneum,  thus  per- 
mitting the  blood  to  escape  into  the  peritoneal  cavity, 
abdominal  section  was  performed.  The  abdominal  wall 
was  muscular  and  well  developed,  and  the  subperitoneal 
fat  thick.  The  peritoneum  bulged  slightly,  and  was  of  a 
blackish  tint,  due  to  the  presence  of  blood  behind  it. 
When  this  last  was  incised  the  intestine  was  immediately 
underneath  it,  and  the  quantity  of  blood  appeared  small, 
but  when  the  intestine  had  been  moved  upwards  the  pelvis 
was  found  full  of  blood,  which  ran  out  of  the  wound 
in  a  thick  stream.  The  region  of  the  left  kidney 
on  the  side  supposed  to  be  damaged  was  rapidly  explored 
but  no  tear  in  the  peritoneum  could  be  felt,  neither  could 
the  kidney  be  localised ;  the  splenic  region  appeared 
normal,  the  right  kidney  appeared  to  be  uninjured.  On 
passing  the  hand  upwards  towards  the  spleen  a  second 
time  the  fingers  became  entangled  with  some  streddy 
bands,  the  exact  nature  of  which  could  not  be  immediately 
ascertained,  and  entered  a  cavity  in  which  a  body  very 


titiee  of  sugar  had  been  administered.  In  twenty-four  hours  \  li^^  ^«  spleen  could  be  grasped;  this  was  clearly  the 


after  no  sugar  in  the  blood  could  be  detected.  Whether 
the  sugar  is  transformed  in  the  human  blood  or  is  rapidly 
burnt  up  in  the  muscles,  when  it  is  thus  injected,  no 
definite  prosf  is  yet  forthcoming.  This  peculiar  condition 
of  the  urine  after  injection  still  awaits  explanation.  Facts 
point  to  the  blood  being  the  first  point  saturated  before 
glyooeuria  occurs,  but  what  change  in  the  organism  prior 
(o  this  is  necessary  has  yet  to  be  determined. 


-Rup- 


ROYAL  FREE  HOSPITAL. 
Abdoxinal  Section  atter  Railway  Injubt. 
TTTRB  OF  KiDNBT.— Nbphbsgtomt.— Mr.  Battle  Operated 
on  a  young  man,  set.  about  30,  who  had  been  brought  to 
the  hospital  from  King's  Cross,  having  been  found  lying 
on  the  line  after  the  passage  of  a  train.  He  was  suffering 
a  good  deal  from  shock,  and  complained  of  injury  to  his 
right  shoulder,  also  pain  in  the  abdomen.  Examination 
revealed  conmiinuted  fracture  of  the  right  humerus  in 
its  upper  third  and  a  rupture  of  the  pectoralis  major 
muscle.     The   abdomen    was    tender,    and    respiration 


chiefly  thoracic.    A  catheter  was  passed,  and  a  few  ounces 

of  urine  drawn  off;    this  was  clear  at  first,   but  later  '  aidered  the  kidney  the  most  likely  source  for  the  blood  in 


kidney  separated  from  its  bed  and  considerably  lacerated  ; 
the  capsule  was  still  attached  to  the  surrounding  struc- 
tures in  the  lower  part.  The  wound  had  to  be  consider- 
ably enlarged  before  the  kidney  could  be  brought  within 
reach  ;  a  ligature  of  strong  silk  was  then  tied  round  the 
renal  vessels  and  ureter  and  the  kidney  removed.  It  was  not 
possible  to  do  anything  towards  closing  the  laceration 
through  which  the  kidney  had  been  drawn  ;  the  perito- 
neum was  rapidly  sponged  and  the  wound  in  the  abdomen 
closed.  During  the  operation  saline  infusion  (5j  to  the 
pint)  to  the  extent  of  seven  pints  was  given  into  the  left 
internal  saphena  vein  with  considerable  advantage  to  the 
patient^  whose  pulse  became  steadier  and  more  full.  No 
attempt  was  made  to  measure  the  quantity  of  blood  in 
the  peritoneal  cavity,  but  there  must  have  been  several 
pints.  The  case,  Mr.  Battle  said,  was  very  interesting 
because  it  was  very  seldom  that  such  a  severe  injury  to  the 
kidney  was  seen  ;  as  a  rule,  when  the  kidney  was  ruptured 
the  only  sign  was  hadmorrhage  in  the  bladder,  and  possibly 
some  effusion  of  blood  round  the  kidney,  but  behind  the 
peritoneum.  Hiemorrhage  into  the  peritoneal  cavity  from 
a  ruptured  kidney  could  only  take  place  after  laceration  of 
the  overlying  peritoneum.  Mr.  Battle  had  never  seen 
such  a  Isjrge  amount  of  blood  in  the  peritoneal  cavity, 
excepting  after  severe  rupture  of  liver  or  spleen,  but  con- 


became  deeply  tinged  with  blood.  It  was  noticed  that 
dulness  on  percussion  was  present  in  the  lower  abdomen. 
About  an  hour  later,  when  Mr.  Battle  arrived,  the  patient 
was  still  suffering  from  shock,  and  complained  very 
much  of  pain  in  the  abdomen,  chiefly  referred  to  a  point 
below  the  umbilicus.  He  had  vomited  once  or  twice. 
Dulness  on  percussion  was  found  in  the  hypogastric 
region  extending  into  the  left  flank,  the  patient  being 
partly  turned  towards  the  left  side,  and  this  probably 
accoanted  for  the  difference  in  dulness  on  the  two  sides. 


this  patient,  because  it  had  undoubtedly  been  ruptured  as 
evidenced  by  the  blood  in  the  urine,  and  stress  of  the 
injury  had  been  felt  below  the  level  of  the  two  organs  just 
mentioned. 

Removal  of  Lakob  Mollusoum  Fibbosuh  from  thb 
Thigh. — ^The  same  surgeon  operated  on  a  very  large 
plicated  tumour  of  a  fibro-cellular  character  in  a  young 
girl,  »t.  about  21.  It  consisted  of  a  pigmented  brown 
plicated  mass  extending  from  the  right  buttock  down  the 
outer  side  of  the  thigh  and  across  the  middle  of  the  thigh 


•3.6    Thb  MsDioAL  Prvs^. 


LEADING  ABTICLEq, 


Jan.  8,  1896^ 


to  the  inner  side.  The  width  at  ite  baae  varied  from 
about  three  to  five  or  six  inches,  and  when  the  patient 
stood  up  the  folds  reached  almost  to  the  knee-joint.  There 
was  a  faint  band  of  a  brownish  pigmentation  extending 
into  the  healthy  skin  round  the  tumour.  On  the 
body  the  patienf*  had  many  brown  spots  and  one 
small  moUuscum  fibrosnm.  She  wished  to  get  rid 
of  the  tumour  which  she  had  had  since  the  age  of 
4,  as  it  was  inconvenient  and  caused  her  some  pain. 
The  incision  required  was  a  long  one,  probably  about  20 
inches,  but  the  whole  growth  was  removed  down  to  the 
deep  fascia,  and  it  was  found  possible  to  bring  the  two 
edges  of  the  skin  together  by  means  of  interrupted  sutures. 
A  curious  series  of  structures  was  met  with  in  the  deeper 
parts  of  the  tumour,  the  nature  of  which  will  be  investi- 
gated. Several  beaded  irregular  bodies  of  whitish  appear- 
ance, like  a  chain  of  beads  of  very  irregular  size,  were 
removed,  some  with  and  some  after  the  principal  mass  ; 
they  resembled  more  the  condition  spoken  of  by  agricul- 
turists as  fingers  and  toes.  On  section  these  were  solid, 
but  presented  no  particular  structure  that  was  character- 
istic of  new  growth. 

BMQUSTMKMD  FOa  TBUIBMISSIOB  ▲BaOAD 

%\tt  Jft^bkal  JrMB  atib  (Eirtulan 

Pabllihed  eTory  Wednesday  morning,  Price  M.   Poet  free,  S^d. 
▲DVEBTIBBMEim. 

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A.  H.  Jacob,  so  liolesworth  Btreet,  Ihiblin. 

BUB80BIFTI0B8  BOB  Fbabob  are  receiTed  by  Messrs.  Baillibbb,  Bue 
Hautofeuille,  Paris— post  free  in  adTanoe,  £1  te.  Od.  per  annum. 

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Sole  AgefU$  for  Germamy  and  Auttro-Hungarff-^ 
W.  A  B.  LowBBTHAL(Ofiice  of  the  Berliner  Adreatbttck),  Omnstraase 
4,  Berlin. 

Small  Announcement*  of  Practices,  Assistancies,  Vacancies,  Book 
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Letters  In  this  department  should  be  addressed  to  the  Publisher* 


%^t  ^tUml  §ress  ^  Cirrwlar. 


'balub  populi  suprema  lbx.' 


WEDNESDAY,  JANUARY  8,  1896. 


THE   ROYAL   COLLEGE   OF  SURGEONS, 

ENGLAND. 
The  half-yearly  meetiDg  of  the  Fellows  of  the  Royal 
College  of  Surgeons,  EDgland,  which  was  held  on  the 


2iid  instant,  was  in  several  respects  a  most  important 
one.  The  agenda  paper,  to  begin  with,  contained 
notices  of  motion  relative  to  qneetions  of  such  a  con- 
tentious nature  that  it  was  only  to  have  been  expected 
that  the  discussions  thereon  would  be  animated  and 
well  sustained.  In  truth  a  great  deal  of  interest 
throughout  the  proceedings  was  evinced  by  those 
present,  both  on  account  of  the  important  issue* 
involved,  as  well  as  by  reason  of  the  diversity  of 
opinions  expressed  by  the  various  speakers.  Again, 
the  meeting  was  in  one  respect  at  least  an  epoch- 
making  one,  inasmuch  as  it  passed  a  resolution  so 
strongly  in  favour  of  the  claims  of  the  Members  to  a 
share  in  the  government  of  the  College,  that  it  may  bo 
safely  asserted  that  nothing  of  the  kind  has  e>er  taken 
place  before.  This  point  is  especially  worthy  of  note, 
for  it  shows  in  an  unmistakably  practical  form  how 
time  has  brought  about  among  the  Fellows  a  feeling 
favourable  to  the  Members  and  their  claims.  A  few 
years  ago  any  such  resolution  as  that  which  was 
almost  unanimously  passed  by  the  Fellows  last  week 
would  have  been  contemptuously  cast  aside.  We  may 
here  point  out  that  the  resolution  in  question  was  as 
follows  :— '*  That  it  is  desirable  to  give  to  the  Members 
of  the  College  direct  representation  upon  the  ConnciL" 
Practically,  this  means  that  the  Fellows  are  now  will- 
ing to  share  with  the  Members  the  privilege,  hitherto 
enjoyed  by  the  Fellows  alone,  of  electing  the  governing 
body  of  the  College.  The  precise  manner  in  which 
the  privilege  should  be  exercised  by  the  Members,  in 
electing  some  of  their  own  body  to  the  Council,  is 
merely  a  question  of  detail,  which  can  be  easily  dis- 
cussed at  the  proper  moment.  It  was  felt  that  the 
first  step  to  be  taken  was  to  recommend  to  the 
Council  that  Members  of  the  College  should  be 
directly  represented  on  that  body ;  this  was  quite 
enough  as  a  commencement  in  this  particular 
measure  of  reform.  To  have  rendered  the  reso- 
lution more  explicit  at  the  present  moment 
was  certainly  unnecessary  and  inexpedient.  As  the 
matter  now  stands,  the  Council  have  a  definite 
recommendation  to  consider,  which  has  been  nar- 
rowed down  to  one  question,  and  it  will  be 
interesting  to  learn  how  they  will  deal  with  it 
when,  in  the  ordinary  course  of  things,  it  comes  before 
them.  The  next  matter  of  importance  which  was 
brought  forward  for  discussion  was  a  resolution  to  the 
effect,  **  That,  in  the  opinion  of  the  Fellows  of  this 
College,  women  should  be  admitted  to  the  diplomas  of 
the  College."  After  an  animated  discussion,  this  was 
passed  by  45  votes  to  10,  and  thus  the  decision  of  the 
annual  meeting  of  the  Fellows  and  Members  in 
November  last  i^as  reversed.  We  are  glad  that  the 
Fellows  have  arrived  at  this  sensible  conclusion.  In 
this  respect  the  Council  and  the  Fellows  are  in  accord,, 
inasmuch  as  the  former  have  already  intimated  to  the 
memorialists  of  the  Women's  Medical  School  their 
willingness  to  admit  women  to  the  College  examina- 
tions. When  the  question  was  discussed  at  the  meet- 
ing in  November  last,  many  speakers  based  their  ob- 
jection to  the  admission  of  women  to  the  examinations 
on  the  grounds  that  women  were  not  fitted  to  become 


Jav.  8,  1888. 


LEADING  AETICLE8. 


Tbs  Msdioal  Pubs.    37 


medical  praetilioDer«.  Bac  this  was  a  mere  side  issue, 
wbich  had  DothiDg  to  do  with  the  case ;  the  suitability  or 
otherwise  of  women  for  medical  work  was  not  a  matter 
which  the  meeting  was  called  upon  to  decide,  for  the 
State  has  already  pronounced  that  women  may  become 
medical  practitioners  if  they  feel  so  inclined.  Under 
these  circumstances,  then,  the  duty  of  the  College,  as 
of  ail  Ck>rpoTation8,  is  to  undertake  the  examination  of 
women.  The  State  has  expressed  its  approval  of 
women  being  admitted  to  all  medical  examinations, 
and  the  College  cannot  therefore  shirk  its  responsibility 
of  carrying  out  the  requirements  of  the  State  in  this 
regard.  Undeniably,  the  important  feature  of  the 
case  is  that  if  the  examinations  for  medical  degrees 
and  diplomas  is  not  provided  for  women  by  the 
Corporation,  the  State  will  interfere  and  compel 
the  latter  to  make  the  necessary  provision.  The 
carious  point,  however,  is  that  in  the  event  of 
the  Council  agreeing  to  the  above  resolution  they 
will  belprevented  from  carrying  it  out  by  reason 
of  the  adverse  vote  recently  recorded  by  the  Fellows 
of  the  Royal  College  of  Physicians.  Clearly,  there- 
fore, some  steps  should  be  taken  to  remedy  this 
undesirable  state  of  things.  In  our  opinion  it  now 
becomes  necessary  for  the  Council  to  approach  the 
College  of  Physicians  and  to  represent  to  the  latter 
the  expediency  of  immediately  reconsidering  their  posi- 
tion with  regard  to  the  women  question.  It  was  only 
by  a  majority  of  nine  that  the  College  of  Physicians 
refused  the  application  of  the  memorialists,  and,  bear- 
ing in  mind  the  fact  that  this  insignificant  number  is 
probably  the  only  obstacle  in  the  way  of  the  women 
being  admitted  to  the  examinations  of  the  conjoint 
board,  it  is  obvious  that  pressure  should  be  brought 
to  bear  upon  the  College  of  Physicians  with  a  view  to 
the  question  being  reopened  at  an  early  date. 

THE  NEW  FACTORY  ACT. 
On  the  first  day  of  January,  1896,  the  new  Factory 
and  Workshop  Act,  passed  by  the  late  Liberal  Qovern- 
ment,  came  into  operation.  Its  general  effect  is  to 
increase  to  a  great  extent,  and  in  many  ways,  the 
safety  of  the  workers.  So  far  as  sanitary  precautions 
are  concerned,  Mr.  Asquith's  measure  constitutes  a  con- 
siderable advance  upon  all  previous  enactments  of  a 
similar  nature.  First  and  foremost  the  great  principle 
of  the  prevention  of  overcrowding  in  workplaces  has 
at  length  been  formally  recognised  by  the  legislature 
of  this  country.  The  Act  provides  that  a  factory  or 
workshop  shall  be  deemed  overcrowded,  so  as  to  be 
mjurious  to  the  health  of  its  inmates,  if  there 
be  less  than  260  cubic  feet  of  space  to  each 
person  during  the  hours  of  work,  and  of  400 
cubic  feet  during  overtime.  At  the  same  time, 
there  is  an  important  rider  to  the  effect  that  the  Secre- 
tary of  State  may  modify  this  proportion  for  any  period 
daring  which  other  than  electric  light  is  used,  and  may 
as  regards  any  particular  manufacturing  process  or 
handicraft  substitute  any  higher  cubical  figures  than 
those  mentioned.  The  necessity  for  such  a  proviso  in 
many  trades-^uch  as  baking— will  be  at  once  evident 


to  all  who  are  familiar  with  industrial  processes. 
Then  we  find  that  the  powers  of  the  administrative- 
authorities  are  greatly  increased.  Thus,  a  court  of 
summary  jurisdiction,  meaning,  in  London,  a  police- 
court,  may  on  complaint  by  an  inspector,  and  on  being 
satisfied  that  a  factory  or  workshop  is  in  a  dangerous 
or  insanitary  condition,  prohibit  the  place  from  being^ 
used  until  such  works  as  are  necessary  to  remove  the 
danger  have  been  executed.  This  provision  will 
strengthen  the  hands  of  the  factory  inspector  to  an  almost 
incalculable  extent.  Adequate  penalties  are  provided 
for  the  employment  of  persons  in  places  injurious  to 
health,  or  for  allowing  wearing  apparel  to  be  made  up,, 
cleaned  or  repaired  in  places  where  there  is  scarlet- 
fever  or  small-pox.  The  last  clause  is  so  directly 
practical,  so  obvious,  and  so  elementary  as  a  common- 
sense  first  step  in  prevention  of  the  spread  of  infectious 
disease,  that  the  only  wonder  is  why  it  was  not  placed 
on  the  Statute  Book  a  generation  ago.  Further  im- 
portant provisions  are  made  in  the  case  of  death  from 
accident  in  a  factory  or  workshop.  Notice  of  occur- 
rences must  be  given  and  a  full  register  of  them  kept 
by  the  owner  or  occupier.  A  factory  inspector  must 
also  attend  the  subsequent  inquest,  and  the  Home 
Secretary  is  furnished  with  powers  for  additional 
investigation  should  he  think  fit  Another  most 
salutary  feature  of  the  new  Bill  is  that  laundriea 
carried  on  by  way  of  trade,  or  for  purpose  of  gain,, 
are  brought  under  the  control  of  the  Factory  Act. 
In  steam  laundries  fans  must  be  provided  to  regulate 
the  temperature  of  ironing  rooms  and  to  carry  off  the 
steam  of  wash-houses  ;  stoves  are  to  be  separated  from- 
workrooms ;  the  use  of  gas- irons  emitting  noxious- 
fumes  \b  forbidden  ;  and  floors  are  to  be  kept  in  good- 
condition  and  properly  drained.  These  improved  con- 
ditions cannot  fail  to  confer  an  immense  boon  upon  a 
hitherto  neglected  and  oppressed  class  of  workwomen. 
At  the  same  time  it  is  not  a  little  curious  that  women 
engaged  in  this  laborious  and  unhealthy  trade  are 
allowed  to  be  employed  for  excessive  hours  of  labour.^ 
The  Act  provides  ^*  that  no  woman  shall  work  more 
than  fourteen  hours  in  any  day,  that  the  overtime 
shall  not  exceed  two  hours  in  any  day,  and  that  it 
shall  not  be  worked  more  than  three  days  in  any 
week,  or  more  than  thirty  days  in  any 
year.''  Another  important  point  about  the  laundry 
clauses  is  the  exception  of  '*  any  such  place  where  the 
only  persons  employed'  are  inmates  of  any  prison,  re- 
formatory, or  industrial  school ;  inmates  of  any  insti- 
tution conducted  in  good  faith  for  religious  or  charit- 
able purposes ;  or  where  the  only  persons  employed 
are  members  of  the  same  family,  dwelling  at  the 
laundry ;  or  in  which  not  more  than  two  persons 
dwelling  elsewhere  are  employed."  A  number  of  pro- 
visions are  made  with  a  view  to  enforcing  the  duties 
of  employers  in  the  observance  of  sanitation,  of  the 
fencing  of  machinery,  of  the  affixing  of  notices,  and  of 
the  general  carrying  out  of  his  responsibilities  under 
the  Act.  In  the  case  of  tenement  factories  we  note 
the  practical  point  that  the  owner  is  made  responsible 
in  place  of  the  occupier,  who  is  often  a  man  of  straw.. 
This  Act  is  worthy  of  careful  study  by  all  who  are 


38      '*  fJfmntCAL  PbMB. 


NOTES  ON  CURRENT  TOPICS. 


dAS.  8»  1896. 


interested  in  the  progreae  of  preventive  saniUry  legia-  which  seeks  to  explain  the  greater  liability  of  the  mcn- 
lation.  It  must  infallibly  constitute  a  notoble  land-  struating  suckling  mother  to  re-impregnation  on  the 
mark  in  the  history  of  the  subject  as  a  strenuous  effort   assumption  of  the  more  perfect  regeneration  of  the 


to  solve  a  complicated  and  highly  important  social 
problem. 


LACTATION  AND  PREGNANCY. 
It  is  a  matter  of  common  belief  that  women  are  less 
liable  to  become  pregnant  de  novo  when  suckling  than 
'Uoder  ordinary  circumstances,  but,  curiously  enough, 
ruo  methodical  investigation  of  the  truth  or  otherwise  of 
this  tradition  seems  to  have  been  made  until  recently, 
.  and  last  week  Dr.  Renfry  brought  the  results  of  his 
enquiries  before  the  Obstetrical  Society,  and  reported 
by  us  in  another  column.  The  subject,  however,  is  one 
of  peculiar  and  practical  interest  to  married  people 
generally,  and  it  is  satisfactory  to  find  that  the  belief 
is  founded  on  fact  to  a  much  larger  degree  than  is, 
perhaps,  the  case  with  sundry  other  old-wives'  tradi- 
tions.   We  are  accustomed  to  look  upon  menstruation 
during  lactatioa  as  a  comparatively  rare,  or  at  any 
rate  quite  an  exceptional,  occurrence,  but  the  author's 
,  figures  show  clearly  enough  that,  as  a  matter  of  fact, 

•  nearly  one  half  of  suckling  women  menstruate  more 
.  or  less  regularly  during  the  lactation  period,  and  in  no 

•  less  than  245  out  of  900  the  menses  returned  during 
the  first  three  months  after  the  confinement  and  con- 
tinued regularly,  unless,  indeed,  re-impregnation  once 

,more  determined  a  temporary  suspension.    More  to 
the  point  is  the  fact  that  of  the  388  women  in  whom 
more  or  less  menstruation  took  place  during  lactation, 
226  became  pregnant  while  still  suckling.  This  special 
liability  of  menstruating  lactifers  to  re-impregnation 
is  brought  out  even  more  distinctiy  in  the  case  of  the 
women  who  menstruated  with  regularity  during  the 
lactation  period.    Looking  at  the  figures  in  another 
aspect,  we  find  that  57  per  cent  of  the  women  had 
absolute  amenorrhoea  during  lactation,  and  only  26  per 
cent,  regular  menstruation,  so  that  the  amenorrhoaic 
women  were  twice  as  numerous  as  those  who  menstru- 
ated with  regularity ;  yet  the   proportion   of  preg- 
nancies during  lactation  were  ten  times  as  numerous 
among  the  latter  category  as  compared  with  the  former. 
These  figures  place  the  comparative  exemption  of  what 
we  must  consider  as  the  normal   suckling   mother 
beyond  question,  though  it  considerably  detracts  from 
the  accuracy  of  the  popular  belief  if  we  consider  suck- 
ling women  as  a  class  without  regard  to  menstrual 
peculiarities.     No  plausible  explanation  seems  to  be 
forthcoming  of  the  reason  why  some  women  menstruate 
during  lactation  and  others  not,  and  the  obscurity 
which  envelops  this  question  is  enhanced  by  the  fact 
that  a  woman  may  menstruate  more  or  less  regularly 
during  one  lactation  period  and  be  amenorrhosic  during 
the  next.    It  is  generally  supposed  that  the  mucous 
membrane  lining  the  uterus  is  regenerated  during  the 
first  two  or  three  weeks  following  labour,  but  reliable 
observations  are  altogether  wanting  in  respect  of  the 
condition  of  the  mucous  membrane  in  amenorrhoeic  as 
contrasted  with  menstruating  suckling  mothers.    This 
considerably  diminishes  the  value  of  the  hypothesis 


uterine  mucous  membrane.  Whether  menstruation 
during  lactation  corresponds  to  a  more  advanced 
degree  of  reintegration  of  the  membrane,  such  as 
would  fit  it  to  become  the  nidus  for  the  fertiUsed 
ovum,  Lb  a  matter  of  conjecture.  We  know  that  women 
may  fall  pregnant  again  without  having  had  any 
return  of  menstruation^  and  it  is  quite  conceivable  that 
the  uterine  mucosa  in  such  cases  may  have  undergone 
the  changes  associated  with  normal  menstruation  short 
of  the  final  effusion  of  blood.  There  is  no  doubt  a 
somewhat  intimate  relationship  between  the  mammaiy 
and  uterine  functions,  but  it  is  easy  to  exaggerate  this 
influence.  We  have  seen  that  it  is  certainly  not  abso- 
lute. Unduly  prolonged  lactation,  on  the  other  hand, 
has  been  known  to  produce  hyper-involution  of 
the  uterus,  with  consequent  arrest  of  the  meDstmal 
function,  but  in  other  cases  it  has  appeared  to  deter- 
mine monorrhagia,  even  with  a  uterus  of  normal  *size. 
It  Lb  stated  that  the  tendency  to  subinvolution  is 
greater  in  non-suckling  mothers,  and  after  miscarriages, 
than  in  suckling  mothers  after  ifull-time  labour,  but 
this  is  an  ingenious  suggestion  which  does  not  appear 
to  have  any  solid  substratum  of  fact  to  support  it  The 
subject  is  an  interesting  one,  and  some  credit  is  due  to 
the  author  for  having,  at  considerable  pains,  placed  the 
matter  on  a  scientific  basis. 


JUntM  on   dLmrmt  ^omca. 

Newapapers  as  the  Medium  for  ObBoenity. 
We  have  much  satisfaction  in  announcing  to  our 
readers  that  the  person  calling  himself  "  F.  D'Aubey," 
who  was  committed  for  trial  to  the  Gloucester  Quarter 
Sessions  for  issuing  grossly  indecent  circulars,  was  con- 
victed on  the  1st  instant,  and  sentenced  to  six  months' 
imprisonment,  the  chairman  at  the  time  remarking 
that  '*he  considered  the  circular  upon  which  the 
indictment  rested  one  of  the  filthiest  he  had  ever  seen." 
In  drawing  the  attention  of  the  police  authorities  to 
this  case,  we  felt  that  we  were  only  discharging  a 
public  duty  which  the  circumstances  of  the  case  im- 
peratively demanded.  It  is  certainly  worthy  of  note, 
that  within  three  weeks  of  the  circular  in  question 
being  placed  in  our  hands  the  author  of  it  should 
have  been  convicted  and  sentenced  to  six  months'  im- 
prisonment Great  praise  is  due  to  the  Medical 
Defence  Association  and  the  police  authorities  for 
having  acted  so  promptiy  upon  the  information  ooa- 
veyed  to  them  by  The  Medical  Peess  and  CntcuuLB, 
and  we  trust  that  the  summary  punishment  inflicted 
upon  this  man  will  go  far  towards  deterring  similar 
offenders  from  carrying  on  their  disgusting  business 
Meanwhile  we  would  again  give  expression  to  the 
regret  which  all  must  feel,  that  certain  of  the  news- 
paper Press,  especially  the  religious  section,  seem  to  be 
unable  to  resist  the  temptation  of  a  few  shillingsworth 
of  advertisements,  and,  yielding  to  that  temptation, 
are   found  willing   to  place  the  announcements  of 


Jav.  8,  188& 


NOTES  ON  CURRENT  TOPICS. 


'^^ns  MuDIOAX.  PbVSI      86 


tndera  in  obscenity  befofe  their  readers  from  day  to 
daj.  Ab  regards  this  particular  case  we  can  present  a 
•ease  in  point  Some  few  years  ago  his  nasty  circulars 
were  broo^j^t  to  our  notice,  and  it  was  pointed  ont  to 
OS  that  they  were  advertised  in  two  of  the  leading 
•dailiee.  We  at  once  commnnicated  with  the  editors  of 
thoee  papers,  stating,  in  plain  language,  the  nature  of 
the  abominable  traffic  for  which  their  columns  were 
made  the  medium.  Neither  of  the  editors  even 
acknowledged  our  communication,  but  one  of  them 
discontinued  the  advertisement,  and  the  other  serenely 
continued  the  announcement,  and,  for  aught  we  know, 
eontinues  it  to  this  day.  We  venture  to  submit  that 
there  is  a  point  at  which  a  censorship  of  advertise- 
ments by  the  publisher  of  a  newspaper  becomes  neces- 
sary, and  that  do  such  officer  ought  to  be  allowed  to  plead 
ignorance  when  accused  of  inserting  an  advertisement 
which  on  the  ^f ace  of  it  is  suspicious.  We  really  fail  to 
see  any  material  difference  in  culpability  between  the 
obscene  quaok  who  concocts  and  circulates  dirty  but 
profitable  circulars  and  the  publisher  who  aids  him  by 
knowingly  .publishing  attractive  invitations  to  pur- 
chase the  sud  abominations. 


VSTbaii  IB  <the  Dose  of  Sulphonal? 
An  inquest  was  held  last  week  in  Eilburn  which  in 
several  respects  was  remarkable.  But  perhaps  the 
most  noteworthy  feature  in  the  whole  case  was  the 
numbw  of  medical  men  concerned  in  it  The  wife  of 
a  medical  practitioner  became  seriously  ill  from 
emphysema  and  cardiac  failure.  A  medical  friend  was 
accordingly  summoned  to  attend  her ;  for  the  sleepless- 
ness which  was  present  he  prescribed  for  the  patient 
two  powders  of  twenty-five  grains  each  of  sulphonal. 
Two  days  afterwards  death  occurred,  and  the  two 
medical  men  in  attendance,  namely,  the  husband  of 
the  deceased  and  his  friend,  drew  up  a  report  of  the 
facts  of  the  case  and  submitted  them  to  a  third  medi- 
cal man,  requesting  him  to  decide  what  the  precise 
form  of  the  death  certificate  should  be.  The  latter 
gave  his  decision  that  death  ''from  ansemia  and  influ- 
enza" ought  to  be  certified.  This  was  accordingly 
done.  But,  meanwhile,  the  medical  friend  who  had 
attended  the  case  began  to  have  some  suspicions  that  the 
■patient  had  died  of  some  narcotic  poison,  and  upon  the 
•strength  of  this  conviction  he  communicated  with  the 
coroner,  also  a  medical  man.  So  an  inquest  was  or- 
•  dered  and  a  post-mortem  examination  made.  The 
result  of  the  latter  was  definite  enough;  much 
organic  disease  was  shown  to  be  present  in  the  various 
-organs, and  in  view  of  the  suspicions  aroused,  the  con- 
tents of  the  stomach  were  saved,  of  which,  however^ 
•it  may  here  be  remarked  that  nothing  more  has  been 
heard.  The  evidence  at  the  inquest  was  entirely  con- 
'fined  to  medical  witnesses,  and  the  paint  de  renstance 
thereat  was  the  question  of  the  proper  dose  of  sul- 
,phonal  under  the  circumstances  of  the  case.  The  hus- 
band admitted  that  he  considered  the  doses,  25  grains, 
•large  ones.  The  report,  however,  before  us  does 
not  state  any  details  as  to  their  administration.  The 
opinion,  moreover,  of  the  medical  man  who  made  the 
^poitmortem  was  apparently  to  the  effect  that  these 


doses  were  sufficient  to  cause  death,  whereupon  the 
jury  returned  a  verdict  of  death  from  failure 
of  the  heart's  action,  and  requested  the 
coroner  to  censure  the  attending  practitioner. 
The  medical  coroner  immediately  acted  upon  the  in- 
structions of  the  jury,  and  "severely  censured"  his 
confr^e  for  prescribing  so  large  a  dose  of  sulphonal 
swithout  first  making  a  proper  examination.  Qearly, 
so  far  as  the  latter  practitioner  is  concerned,  it  would 
have  been  better  for  himself  if  he  had  said  nothing  about 
having  an  inquiry.  Moreover,  as  the  inquiry  has  been 
closed  without  anything  having  been  heard  of  the 
contents  of  the  stomach,  which  were  saved  and  for- 
warded to  the  police  with  a  view  to  an  analysis  being 
inade,  it  is  conceivable  that  the  object  for  which  the 
inquest  was  ordered  was  not  attained.  Lastly,  we 
cannot  agree  with  the  remark  of  the  coroner  that  the 
doses  of  sulphonal  were  "large."  The  limits  of  the 
doses  of  this  drug  are  16  to  40  grains,  but  perhaps  the 
coroner,  as  a  medical  man,  meant  that  before  any  sul- 
phonal was  administered  the  attending  practitioner 
should  have  made  a  close  and  careful  examination  of 
the  patient's  condition,  which,  according  to  the  evi- 
dence, does  not  appear  to  have  been  done. 


Who  is  to  Blame? 
Ths  disclosures  made  after  the  sanitary  inspection 
of  the  St  Peter's  Home,  Woking,  of  the  disgraceful 
condition  of  the  drainage  of  the  Institution,  calls  for 
something  more  than  a  passing  notice.  Here  was  a 
building  designed  by  a  modem  architect  on  modern  lines, 
with  presumably  every  modern  contrivance  and  advan- 
tage which  it  was  possible  to  make  use  of  for  the 
perfect  carrying  out  of  the  undertaking.  Within  ten 
years'  time— that  is  to  say  last  year — there  was  an  out- 
break of  typhoid  fever,  and  after  the  elimination  of 
all  other  causes  the  source  of  the  outbreak  was  directly 
traced  to  the  drainage,  which  was  found  to  be  grossly 
defective.  Imagine  for  one  moment  a  modern  institu- 
tion, built  at  great  expense,  having  the  following 
defects  in  its  sanitation  :— "  Defective  valves  in  the 
water-closets ;  the  drain  ventilating  pipes,  running  up 
the  outside  walls  of  the  building,  having  serious 
leakages  at  the  junction  of  the  wrought-iron  with  the 
lead  pipes  ;^the  lead  soil  pipes  being  received  into  the 
sockets  of  the  earthenware  drain  pipes  without  any 
attempt  at  cementing,  the  former  being  four  inches  in 
size  and  the  latter  six  inches ;  the  drains  not  being 
laid  in  concrete,  so  that  the  ground  and  adjoining 
walls  of  the  building  were  saturated  with  sewage ; 
only  one  f  re^  air  inlet  to  some  three  hundred  yards  of 
drain,  the  contrivance  being  merely  an  open  grating, 
twelve  feet  and  a  half  above  the  invert  of  the  drain, 
and  serving,  as  the  stench  from  it  proved,  more  as  a 
vent  for  foul  air  than  an  inlet  for  fresh."  What  a 
hideous  record  of  defects  is  this,  as  testified  to  by  the 
experts  who  examined  the  building !  The  Medical 
Officer  of  Health  of  the  district  reports  as  follows  :— 
"  I  desire  to  emphasise  the  lesson  to  be  derived  from 
this  outbreak.  Here  we  have  a  comparatively  new  and 
most  expensively  built  Convalescent  Home  provin 
itself  to  be  a  veritable  fever  trap.    It  is  quite  obvious 


40     Thb  limoAi. 


NOTES  ON  CUKRENT  TOPICJ^. 


Ja9.  8,  1896. 


that  this  serious  epideiiiic  arose  from  the  very  care- 
less way  in  which  modem  principles  of  sanitation 
were  carried  ont;  and  the  result  goes  far  to  prove  that 
neglect  in  carrying  ont  such  a  modem  qrstem  of  drain- 
age renders  it  as  dangerous  as  the  most  ancient 
methods."  Such  are  the  facts,  and  it  may  well  be  asked, 
is  there  to  be  no  sequel  ?  How  was  it  that  the  architect 
of  the  building  permitted  all  these  defects  to  be  per- 
petrated? Who  is  responsible  for  the  scandalous 
condition  of  things  which  has  been  revealed  t  The 
answer  to  these  questions  should  be  songht  for  by  the 
authorities  of  the  Home,  who  now  find  that  in  order 
to  place  the  institution  upon  a  proper  sanitary  basis, 
an  expenditure  of  £2,000  will  have  to  be  incurred 


Bad  Meat  Traffic  in  Dublin. 
On  December  18th  a  Dublia  correspondent,  writing 
under  the  signature  ''One  Who  Knows,"  made  some 
extraordinary  and  startling  statements  as  to  the  dis- 
posal of  diseased  meat  in  Dublio.  He  asserted  that 
the  carcases  of  animals  condemned  by  the  veterinary 
inspector,  and  paid  for  by  the  Union,  were  syste- 
matically sold  to  two  butchers,  who  re-sold  them  to 
middlemen,  eo  that  the  meat  ultimately  reached  the 
public  in  the  form  of  ''finest  Irish  beef."  This 
abominable  traffic,  so  our  correspondent  stated,  has 
been  carried  on  for  years  with  the  full  knowledge  of 
the  boards  of  guardians,  of  the  Public  Health  Com- 
mittee of  the  Corporation,  of  the  Veterinary  Depart- 
ment at  Dublin  Castle,  and  of  the  Local  Qovemment 
Board.  The  matter  advanced  by  our  correspondent 
is  of  vital  importance,  and  it  seems  hardly  possible 
that  one  or  other  of  the  high  official  bodies  named  will 
fail  to  answer  so  serious  a  charge.  The  Meat  Trades 
Journal  quotes  the  letter  in  question,  but  appears  to  think 
it  Lb  little  or  do  good  to  expect  inquiry  or  explanation 
from  official  bodies,  for  it  merely  advises  the  Dublin 
victuallers  to  bear  in  mind  the  possibilities  of  the  case. 
It  is  to  be  hoped  that  the  subject  will  be  thoroughly 
threshed  out,  and  that  a  question  will  be  asked  in  the 
House  as  soon  m  Parliament  meets. 


Professor  Ray  Lankester. 
The  Lankester-Fraser  fight  referred  to  in  our  issue 
of  the  18th  ult.,  nearly  ended  in  a  fizzle.  Much  to  the 
surprise  of  the  backers  of  the  Oxford  Professor  he 
exhibited  a  decided  disiDclination  to  come  up  to  the 
scratch  and  put  in  a  tardy  appearance  for  the  second 
round.  The  display  of  science  and  hard  hitting  of  his 
northern  opponent  seem  to  have  disconcerted  him,  and 
his  letter  of  the  22Dd  ult.,  from  the  AtheDseum  Club— 
which  seems  destined  to  achieve  notoriety— was  a 
mere  repetition  of  his  former  communication,  and  was 
certainly  lacking  in  force.  Possibly  he  may  have  relied 
on  the  support  of  Professor  Calmette,  but  if  so,  his 
confidence  was  misplaced.  Professor  Lankester  is  no- 
thing if  he  is  not  pugnacious,  but  to  attack  a  man  like 
Professor  Eraser  on  a  purely  pharmacological  question 
was  the  height  of  folly,  and  could  lead  to  nothing  but 
disaster.  Professor  Lankester  has  done  some  good 
work  in  the  past,  and  we  should  be  sorry  if  he  were 
to  disappear  from  the  arena  of  practical  politics,  but 


he  should  be  cautious,  and  should  not  attempt 
to  "bluff"  people  who  are  but  little  inclined 
to  submit  to  the  process.  His  latest  escapade 
has  done  him  no  good  and  has  not  increased 
the  confidence  of  his  friends  in  his  judgment.  He 
has  not  done  well  in  1895,  but  with  the  onset  of  the 
new  year,  we  trust  that  he  will  be  more  fortunate,  and 
by  sound  scientific  work,  will  do  something  worthy  of 
hLs  position  as  linacre  Professor  of  Comparative  Ana* 
tomy  in  the  University  of  Oxford. 


Dr.  Jameson. 
Fob  the  second  time  within  twelve  months  a  medi- 
cal man  is  attracting  the  attention  of  the  whole  civilised 
world  by  his  military  exploits.  There  is  a  considerable 
difference,  however,  between  the  defence  of  Chitral 
and  the  invasion  of  the  Transvaal.  In  the  one  case 
the  central  figure  has  won  the  name  of  '*  hero,"  and  is 
the  other  he  has  been  freely  stigmatised  in  the  public 
press  as  ''  rebel "  and  "  filibuster."  It  is  to  be  sincerely 
hoped  that  Dr.  Jameson  will  not  be  called  upon  to  pay 
the  extreme  penalty  which  is  affixed  by  civilised 
countries  to  the  offence  of  leading  an  armed  force  into 
a  peaceful  territory.  Dr.  Jameson  is  a  Scotchman  by 
birth,  and  was  educated  at  University  College,  London. 
He  became  a  Member  of  the  Royal  College  of  Surgeons 
in  1876,  Bachelor  of  Medicine  and  Surgery  of  London 
University  in  the  same  year,  and  graduated  as  doctor 
in  1877.  Shortly  afterwards  he  went  out  to  Kimberiey, 
where  for  many  years  he  was  the  leading  physician. 
He  then  formed  the  friendship  of  Mr.  Cecil  Rhodes, 
who  came  to  him  as  a  patient.  He  has  been  created  a 
Companion  of  the  Bath,  and  is  the  administrator  for 
the  British  South  Africa  Company. 

The  Danger  of  Artificial  Emaciation. 
Some  people  are  born  to  be  fat,  just  as  others  are 
born  to  be  great,  and  it  is  not  always  desirable  or 
even  safe  to  fly  in  the  face  of  Providence  by  seeking  to 
diminish  a  single  cubit  of  one's  sectional  dimensions. 
The  principle  to  bear  in^mind  is  that  everyone  has  his 
normal  weight,  though  circumstances  may  determine  a 
more  or  less  temporary  increase  or  diminution  thereof. 
A  departure  from  the  normal  in  either  direction  is,  pn> 
tantOy  incompatible  with  perfect  health.  This,  of 
course,  leaves  in  suspense  the  question  as  to  what  is 
one's  normal  weight,  and  those  who  are  afflicted  with 
what  appears  to  the  dispassionate  observer  to  be  a 
superfluity  of  adipose  tissue  usually  resent  the  impu- 
tation that  their  obesity  is  other  than  an  acci- 
dental and  unavoidable  circumstance.  This  point  is 
easily  settled  by  trying  the  effects  of  a  carefully  regu- 
lated but  not  over-strict  regimen  associated  with 
daily  exercise  in  the  open  air.  All  really  superfluous 
tissue  will  disappear,  eJthough  actual  weight  may  not 
be  palpably  diminished,  firm  muscle  taking  the  place 
of  useless  and  burdensome  fat.  Obesity,  however,  is 
essentially  a  condition  to  be  dealt  with  on  an  exclu- 
sively physiological  basis.  It  is,  of  course,  more  or 
less  amenable  to  medication,  but  the  influence  of  drugs 
involves  a  brutal  disturbance  of  the  processes  of 
nutrition,  which  cannot  but  be  prejudicial  to  health. 


Jan.  8,  1806. 


NOTEH  OS  CURRENT  TOPICS: 


Thb  I^a>igai.  Pbxss.       4r 


ThiB  is  partieiilarly  the  c&se  in  respect  of  the  employ- 
ment of  thyroid  gland  in  extract,  which,  in  effectual 
doaee,  often  entails  symptoms  of  a  very  disquieting 
and  even  serious  nature.  A  sufficient  number  of 
cases  have  already  been  recorded  to  justify  a  note  of 
warning,  and  it  cannot  be  too  strongly  impressed  upon 
practitioners  that  the  thyroid  treatment  of  obesity  is 
«ne  attended  by  a  tangible  amount  of  risk.  In  a 
Oennan  contemporary  the  case  is  recorded  of  a  certain 
well-known  dramatic  artist,  who  sought  to  combat 
the  opulence  of  form  with  which  Nature  had  endowed 
him,  and  died  in  consequence.  On  ceasing  to  be 
obese— for  the  treatment  was  so  far  successful— he 
lost  the  placid  temperament  which  previously  charac- 
terised him,  and  became  the  prey  of  an  unhappy 
irritability,  consequent  on  an  acute  sensation  of 
malaise;  in  short,  he  became  nervous,  impressionable, 
and  as  unrecognisable  from  a  moral  as  from  a  physical 
point  of  view.  This  story  has  a  moral :  Nature  creates 
the  fat  and  the  lean,  and  wisdom  lies  in  a  voluntary 
adaptation  to  altered  circumstances,  For  a  fat  man  to 
^  fly  in  the  face  of  Providence"  is  a  fact  which  ought 
to  be  discouraged,  the  more  so  as  evidence  is  still  want- 
ing of  the  aesthetic  superiority  of  the  thin  over  the  fat 


The  Death  of  a  lion  Tamer. 
Anothxb  victim  has  been  sacrificed  on  the  vicious 
altar  of  sensationalism.  On  Christmas  Eve  a  lion 
tamer  was  going  through  a  performance  at  the  Agri- 
cultural Hall,  Islington,  when  one  of  the  beasts  in  the 
cage  tore  a  piece  out  of  his  arm  and  injured  his  spine. 
The  unfortunate  man  was  carried  off  to  St.  Bartholo- 
mew's Hospital,  where  he  died  six  days  later  with 
symptoms  reported  as  resembling  hydrophobia.  From 
evidence  given  at  the  inquest  it  appeared  that  deceased 
had  been  three  years  in  the  employ  of  the  owners  of 
the  menagerie.  The  three  lions  in  the  cage  at  the 
time  of  the  attack  had  been  performing  together  for 
eighteen  months,  and  not  one  of  them  had  shown  the 
slightest  trace  of  temper.  The  simple  report  of  this 
dreadful  affair  points  its  own  moral.  The  repetition 
from  time  to  time  of  these  tragic  deaths  is  nothing 
less  than  a  scandal  and  a  disgrace  to  our  boasted  nine- 
teenth century  civilisation.  Why  does  not  some 
humane  member  of  Parliament  take  up  the  subject  and 
introduce  a  short  bill  throwing  the  whole  responsibility 
on  the  employers  of  the  unfortunate ''tamers"?  It 
would  be  interesting  to  learn  the  exact  nature  of  the 
fatal  illness,  and  whether  any  bacteriological  investiga- 
tion was  made  at  St.  Bartholomew's. 


The  *'  Commission  "  of  a  Hospital  Secretary. 
A  LABOSLY  attended  meeting  of  the  Governors  and 
the  Committee  of  the  Great  Northern  Central  Hospitsl 
was  held  in  London  last  week.  Its  object  was  *'  to 
consider  the  question  of  secret  commission  and  other 
emdoments  paid  to  the  late  secretary,  and  the  im- 
proper dealing  with  the  same  in  the  balance  sheets  of 
ten  annual  reports  from  1885  to  1894/'  An  official 
statement  showed  that  the  salary  and  emoluments  of 
the  late  secretary  were  in  1886,  £499  ;  in  1887,  £899  ; 
in  1888,  £593  ;  in  1889,  £980  ;  in  1890,  ^£805  ;  in  1891, 


£551 ;  in  1892,  £583 ;  in  1893,  £1,011  ;  in  1894,  £521  ; 
equal  to  an  average  of  £750  per  annum.  The  chair- 
man, Mr.  Murdoch,  M.P.,  explained  that  at  the  time 
of  the  late  secretary's  election,  at  a  salary  of  £300, 
the  hospital  contained  only  thirty-two  beds.  An 
able  man  was  required  for  the  development  of  the 
institution.  The  first  arrangement  was  that  the 
secretary  should  be  paid  H  per  cent  on  such  legacies 
and  donations  as  he  influenced.  This  was  afterwards 
reduced  to  2i  per  cent  The  meeting  finally  ex- 
pressed its  confidence  in  the  committee,  and 
its  satisfaction  that  steps  had  been  taken  to 
prevent  a  recurrence  of  such  a  state  of  affairs 
in  the  future.  Many  who  are  conversant  with  hospital 
matters  altogether  doubt  whether  a  secretary  should  be 
paid  any  commission  on  receipts,  and  certainly  very 
few  persons  would  attempt  to  defend  the  practice  m 
the  case  of  legacies.  It  is  desirable  that  the  charitable 
public  should  be  placed  in  the  full  possession  of  facts 
regarding  the  salaries  of  other  secretaries.  At  the 
meeting  Mr.  Murdoch  stated  that  the  average  amount 
paid  to  their  late  secretary  was  exceeded  by  that  paid 
to  similar  officials  by  other  London  hospitals. 


Vivisectioii. 
Thb  question  of  the  prohibition  of  vivisection  which, 
we  know,  excites  certain  people  in  our  own  country, 
has  been  submitted  to  the  test  of  popular  opinion  in 
a  country  which  governs  itself  upon  communistic 
principles^  and,  which,  therefore,  might  be  expected  to 
give  expression  to  the  popular  feeling  on  the  subject 
A  measure  for  the  total  prohibition  of  vivisection  was 
submitted  ad  referendum  to  the  population  of  the 
Canton  of  Schwyz  in  Switzerland  with  the  result  that 
40,000  votes  were  given  against  such  prohibition,  and 
only  17,000  for  it,  while  a  proposal  to  allow  the  pro- 
cedure for  scientific  purposes  was  carried  by  an 
equally  conclusive  majority.  Apropos  of  this  decision 
it  may  be  noted  that  a  company  has  recently  been 
formed  in  Paris  for  the  purpose  of  popularising  the 
Pasteur  inoculations.  It  proposes  to  ereot  a  hospital 
in  which  the  inoculation  treatment  will  be  made  a 
speciality,  and  the  capital  necessary  has  been  sub- 
scribed on  the  moment  Itthus  appears  that  all  the  bray- 
ing of  the  anti-vivisection  organisations  in  this  country 
and  elsewhere  has  been  attended  with  no  more  sub- 
stantial result  than  noise  if,  indeed,  it  has  not  had  the 
effect  of  disgusting  the  public  with  such  a  melancholy 
exhibition. 


The  Begistrarship  of  the  Gkeneral  Medical 
Council  in  Ireland. 

We  understand  that  Dr.  Robert  Lynn  Heard, 
Registrar  of  the  Irish  Branch  of  the  General  Medical 
Council,  has  resigned  that  position,  which  he  has  held 
with  great  satisfaction  to  the  Branch  Council  and  to 
the  profession  since  the  death  of  Dr.  Steele  manyyears 
ago.  Dr.  Heard  has  taken  this  step,  which  he  has 
contemplated  for  some  time,  in  order  that  the  Branch 
Council  might  be  free  to  select  a  new  man  to  under- 
take the  labourand  responsibility  of  the  coming  election 
of  Direct  Representative  for  Ireland.    In  our  columns 


42       TVp!  MrrnoAf.  Pteww. 


NOTES  ON  CXJKBENT  TOPICS. 


Jah.  8.  1896. 


to-day  will  be  fouod  the  aDOonncement  that  ihe 
election  of  his  successor  will  take  place  on  the  16th  of 
this  month,  the  choice  being  in  the  hands  of  the  Irish 
members  of  the  Conncil,  Dr.  William  Moore,  Sir  John 
BankR,  Dr.  Hanghton,  Dr.  AtthiU,  Sir  Philip  Smyly, 
and  Dr.  Charles  Moore.  The  salary,  we  believe,  !-< 
£200  a  year.  Dr.  Heard  has  acquired  universal  esteem 
by  the  courteous  and  efficient  discharge  of  his  duties 
during  the  long  period  of  his  service. 

The  Operative  Treatment  of  Traumatic 
Insanity. 

The  question  of  the  operative  treatment  of  insanity 
of  traumatic  origin  is  an  interesting  one,  although 
mental  alienation  due  to  injuries  of  the  head  is  of 
somewhat  infrequent  occurrence.  In  2,200  cases  of 
insanity  treated  by  Eiernan,  46  were  of  traumatic 
origin,  while  Hay  records  61  as  due  to  the  same  cause 
out  of  2,500  cases,  thus  showing  practically  almost  the 
same  proportion.  In  an  interesting  discussion  which 
recently  took  place  at  a  meeting  of  the  Mississippi 
Valley  Medical  Association,  several  speakers  referred 
to  cases  under  their  care  of  traumatic  iudanity  which 
had  been  operated  on  successfully.  Dr.  Qeorge  Gale, 
of  St  Louis,  reported  two  cases,  both  of  which  made  | 
good  recoveries  after  operation  ;  one  was  that  of  a 
patient  suffering  from  acute  mania,  the  result  of  an  i 
injury.  Dr.  Frank,  of  Chicago,  also  mentioned  an 
interesting  case  in  which  he  trephined,  removing  a 
large  piece  of  bone.  The  patient,  after  having  been  in 
a  lunatic  asylum  for  five  years,  made  an  excellent  re- 
covery and  took  up  the  thread  of  her  life  where  it  had 
been  suddenly  interrupted  at  the  time  of  the  receipt 
of  the  injury.  A  relapse,  however,  took  place  some 
time  afterwards. 

Modem  Medicine  on  the  Stage.  | 

A  Fkench  dramatic  author,  M.  de  Curel,  has  dis- 
tinguished himself  by  writing  a  play  with  a  plot  turn- 1 
ing  on  a  most  advanced  modern  method  of  surgical  • 
treatment  His  hero  is  the  discoverer  of  a  new  vaccine  ' 
for  cancer,  and  with  this  precious  remedy  he  inoculates  | 
a  young  girl,  who  incontinently  dies.    How  any  sane  ' 
mortal   could   choose   such  a  repellant  subject  for  < 
dramatic  treatment  is  beyond   comprehension.    Yet  I 
M.  de  Curel  is  a  shining  light  of  the  Theatre  Libre, 
and  is  regarded  by  many  competent  critics  as  one  of 
the   most   promising  of   the  younger  French  play-  ' 
Wrights.    It  is  to  be  hoped  that  in  future  he  will  seek 
for   sensations  in    realism  from  other  than   medical 
sources.    We  are  glad  to  learn  that,  although  the  play 
has  been  published,  the  author  has  not  ventured  to  put 
it  on  the  stage. 

An  Antidote  for  Erysipelas  and  Puerperal 
Fever. 
Dr  Mabmorbck,  a  young  Austrian  aavcmt^  working 
in  the  Pasteur  Institute,  claims  to  have  discovered  a 
serum  which  extinguishes  the  streptococcus  and  all 
diseases  produced  by  that  bacillus.  Professor 
Chantemasse  has  given  a  full  trial  to  the  remedy,  after 
it  had  been  fully  tested  on  animals,  in  the  hospitals, 


and  states  his  belief  that,  by  its  means,  the  mortality 
from  erysipelas  will  be  reduced  by  three-fourtha.  He 
made,  last  week,  a  formal  report  to  that  effect  to  the 
Paris  Municipal  Council. 

The  New  Year's  Honours. 
The  medical  profession  are  represented  in  tin  ISst  of 
New  Year's  Honouro  by  Sir  Joseph  Fayrer,  Dr. 
Willoughby  Wade,  Mr.  Robert  Martin  Craven,  and 
Dr.  T.  A.  MacCullagh.  Sir  Joseph  Fayrer  receives  a 
Baronetcy,  a  reward  which  very  apUy  follows  hia  retire- 
ment from  official  life.  Dr.  Wade  is  the  well  known  phy- 
sician of  Birmingham,  and  he  has  obtained  the  honoop 
of  knighthood.  The  same  honour  has  been  conferred 
upon  Mr.  Craven,  a  general  practitioner  in  Hull,  wkoee- 
active  work  in  connection  with  the  Conservative  partji^ 
there  has  probably  been  the  means  of  his  gainini^ 
Ms  distinction-  Dr.  James  Acheeon  MacCullagh,  who- 
has  also  been  made  a  knight,  is  an  alumnus  of  Trini^ 
College,  Dublin,  and  has  thrice  been  elected  Mayor  oi 
Derry.  He  is  Medical  Officer  of  the  City  of  Deny 
Dispensary  District  We  beg  to  offer  to  each  of  oar 
con/rdrM,  here  named,  our  congratulations  in  respect 
to  the  honours  to  which  severaUy  they  have  attained^ 

Eieotrical  Photography  in  Surgery.. 
The  news  of  a  remarkable  discovery  in  photography 
is  reported  from  Vienna.  Briefly,  it  consists  in  the 
discovery  of  a  new  conductor  of  light.  Professor 
Routgen,  the  well-known  professor  of  the  Wurzburg 
University,  has  succeeded  in  photographing  metal 
weights  shut  up  in  a  wooden  box,  without  showing 
anything  of  the  casing  on  his  negative.  He  is  aleo^ 
said  to  have  photographed  the  bones  of  the  hand,  all 
the  soft  parts  being  invisible.  He  photographs  by 
means  of  light  of  an  exhausted  Crooke's  pipe,  through 
which  an  inductive  current  is  passed.  The  discovery 
appears  to  be  so  far  that  the  rays  in  question  penetrate 
wood  and  flesh,  but  not  bone  or  metal.  It  is  surmised 
that  photographs  of  the  kind  mentioned  may  have 
a  valuable  practical  application  in  the  discovery  and* 
location  both  of  fractures  and  of  bullets.  If  this  dis> 
covery  be  sustained  it  will  certainly  take  a  first  place 
among  the  many  marvels  of  this  scientific  age.  Those 
of  our  readers  who  are  versed  in  electrical  research  may 
have  already  heard  of  Professor  Routgen's  interesting 
researches. 


liondon  Death  ttom  Hydrophobia. 
An  inquest  was  held  last  week  on  the  body  of  a 
child  at  Bow.  Deceased  was  bitten  by  a  dog.  and 
seven  weeks  later  developed  symptoms  from  which 
she  died  in  a  day  or  two  at  the  Poplar  Hospital.  Be- 
fore the  coroner  the  private  practitioner  who  had  been 
in  attendance  on  deceased,  and  the  house  phycidan  at 
the  hospital,  swore  that  the  child  died  from  hydro- 
phobia. Yet  the  police  brought  forward  the  evidence 
of  a  veterinary  surgeon,  named  Shaw,  stated  to  be  an 
inspector  of  the  Board  of  Agriculture,  to  the  effect 
that  the  dog  was  not  suffering  from  rabies.  At  the 
jx^st-mortem  a  piece  of  rag  was  found  in  the  stomach 
of  the  dog,  a  fact  which  affords  strong  corroborative 


Jah.  8.  1806 


SCOTLAND. 


Thb  Midioal  Pbvs.     43 


proof  of  madness.  Mr.  Shaw  must  indeed  be  a  bold 
man  if,  in  face  of  the  medical  evidence  and  his  own 
post-mortem  examination,  he  can  maintain  that  the 
animal  was  not  affected  with  hydrophobia.  There 
conld  be  only  one  positive  test,  namely,  the  bacterio- 
logical. Without  snch  a  tria],  Mr.  Shaw's  testimony 
is  without  valne.  One  is  at  a  loss  to  know  why  the 
police  should  bring  forward  unscientific  and  worthless 
evidence  of  the  kind.  Again,  what  has  the  Board  of 
Agriculture  to  do  with  the  matter  f  If  the  police  and 
Mr.  Ritchie  are  relying  on  loose  and  unscientific  asser- 
tions of  this  nature,  they  are  likely  to  land  the  public 
into  a  pretty  quandary  of  epidemic  hydrophobia.  The 
injection  of  an  infusion  of  the  animal's  brain  into  a 
gunea  pig  or  two,  would  have  speedily  settled  the 
question  as  to  the  iJleged  madness  of  the  dog  beyond 
tiie  possibility  of  doubt.  Surely,  the  Local  Qovern- 
ment  Board  has  laboratories  and  bacteriologists  enough 
at  command  to  settle  a  point  of  this  kind  off-hand. 
Can  it  be  that  the  police  wish  to  avoid  the  enforcing 
of  the  muzzling  order?  It  is  always  open  to  the 
aathorities  if  they  cannot  trust  English  scientific 
men  to  send  the  brdn  of  the  animal  to  be  tested  over 
to  Paris  for  a  report. 


Garbolic  Acid  Poisoning. 
ScASCELY  a  day  passes  but  someone  takes  carbolic 
acid  by  mistake  for  a  more  innocuous  beverage.  In 
Scotland  it  is  generally  instead  of  the  national  drink, 
whiskey.  A  few  weeks  ago  the  death  of  a  nurse  in  the 
Glasgow  Boyal  Infirmary  took  place,  where  the  victim 
had  wished  to  take  a  dose  of  castor  oU,  but  took 
carbolic  add  instead,  a  strange  commentary  on  her 
powers  of  taste  and  smell,  to  say  nothing  of  the  want 
of  care  displayed  by  the  responsible  official.  On  Friday 
last  aseaman  died  from  the  same  cause  in  Leith.  A 
steamer  came  into  Leith  from  Grangemouth  where  one 
of  the  sailors  had  bought  a  gill  of  whiskey,  and  put 
it  in  his  locker.  Not  far  from  Leith  he  gave  the  victim 
a  drink  from  a  similar  bottle  to  that  in  which  the 
iHiiskey  had  been  put,  but  which  contained  carbolic 
add  The  man  died  as  he  was  being  removed  to  Leith 
Hospital.  It  seems  an  extraordinary  piece  of  careless- 
ness to  have  carbolic  add  in  a  similar  bottle  to  that  in 
which  whiskey  is  generaly  sold  in  Scotland,  and,  in 
addition  to  keep  them  both  in  the  same  locker.  Some- 
how or  other,  notwithstanding  the  number  of  acpidents 
which  are  due  to  the  careless  usage  of  carbolic  add, 
the  public  do  not  seem  to  be  able  to  grasp  its  danger- 
ous qualities,  or  that  a  very  small  quantity  may  lead  to 
fatal  results.  Unfortunately,  such  cases  as  that  of  the 
seaman  can  hardly  be  reached  by  the  law,  but  in  the 
first  case  if  the  castor  oil  and  the  acid  were  kept  in 
similar  bottles  one  of  the  elementary  rules  with  regard 
to  the  dispendng  of  poisons  must  have  been  disre- 
garded.   Of  that  we  have  no  knowledge. 

The  Development  of  the  Compulsory 

Notification  System. 

A  FUBTHSR  extension  of  the  pains  and  penalties 

attaching  to   the  notification  system  was   sneaked 

through  the  House  of  Commons  last  session,  and  the 


law  has  become  operative  on  the  1st  of  January.    By 
the  Factory  and  Workshop  Act  of  1895  every  medical  < 
practitioner  is  bound,  under  a  penalty  of  forty  shillings . 
fine,  to  notify  to  the  Chief  Factory  Inspector  at  the 
Home  Office,  London,  every  case  of  lead,  phosphorous, . 
or  arsenical  poisoning  which  he  "  is  called  in  to  visit," 
and  for  that  function  he  is  to  receive  the  customary 
half-a-crown  fee.    There  is  no  department,  as   yet 
charged  with  the  detection  of  syphilis  and  gonorrhoea, 
but  we  are  awaiting  the  inevitable   Bill,  promoted 
by  the  sanitarian   faddists,   which  will  compel  the 
unhappy  practitioner  to  publuh  these  diseases  also  or 
else  go  to  gaol. 

Hospital  Accommodation  m  Leeds. 
The  Leeds  Corporation  have  been  compelled  to 
recognise  the  need  of  providing  further  hospital  accom- 
modation within  their  jurisdiction.  The  Local  Govern- 
ment Board  have  just  sanctioned  the  borrowing  by 
the  Corporation  of  sums  of  £51,600  and  £11,000  for 
hospital  purposes. 

Among  the  successful  candidates  who  recently- 
passed  the  Intermediate  Medical  Examination,  at  the 
Medical  Faculty  in  Lisbon,  was  the  Queen  of  Portugal. 
The  Queen  has  now  been  studying  medicine  for  two . 
years,  has  passed  all  the  preliminary  examinations,^ 
and  intends  to  complete  her  course  and  fully  qualify 
herself  for  the  diploma  of  the  Faculty. 


Thb  Annual  Qeneral  Meeting  of  Subscribers  to  the 
British  Medical  Benovelent  Fund  will  be  held  at  the 
residence  of  the  Treasurer,  84  Brook  Street,  London, 
on  Tuesday,  the  14th  inst,  at  4  p.m.,  the  President, 
Sir  James  Paget,  Bart,  in  the  chair. 

Typhoid  fever  is  again  prevalent  in  the  different, 
barracks  in  Dublin.    The  bulk  of  the   cases   have 
occurred   at    Island   Bridge   Barracks.     Boards    of 
officers  are  inquiring  into  the  causes  of  the  outbreak. 

The  will  of  Sir  Qeorge  Martin  Holloway,  co-proprie- 
tor of  the  celebrated  pill  business,  was  proved  last  week,, 
the  personalty  being  something  over  i^6,000. 


Db.  Sganes  Spiceb  has  been  appointed  an  Honorary 
Physician  to  the  Boyal  Society  of  Musicians  of  Great 
Britain. 


Thb  French  Gk>vemment  have  voted  a  sum  of  £4oO< 
towards  the  fund  for  erecting  a  statue  in  Paris  to  the 
memory  of  Pasteur. 


[from  our  own  OOBBBSPONDm.] 
NUBSE     AOOIDBNTALLT     PoiSONBD     AT     THE    GLASGOW 

RoTAL  iNTmMAST.— An  occnrrenoe  of  a  most  distressing 
natnre,  castiDg  a  gloom  over  the  inmates  of  the  RoysJ  In- 
firmary, took  place  on  Tuesday  night,  31  st  December. 
Mies  Shaw,  a  nuree  in  Dr.  Clark's  ward,  feeling  unwell, 
went  to  the  medicine  press  and  took  what  she  thought 


44     Thw  Mkdtoal  Prsss. 


CQRRE9P0NDENCE. 


Jan.  8,  1896. 


to  be  a  dose  of  castor  oil,  instead  of  which,  she  swallowed 
oarbolic  acid  in  mistake.  Shortly  after,  Nnrse  Shaw  was 
noticed  to  sts^gger  and  inclined  to  fall.  Assistance  was 
At  hand,  and  immediate  remedies  used,  but  unfortunately, 
the  nurse  expired  within  fifteen  minutes  after  taking  toe 
fatal  dose.  Mies  Shaw,  who  was  a  daughter  of  an  English 
Bishop,  had  been  connected  with  the  infirmary  for  several 
Tears,  was  about  23  years  of  age,  and  a  great  and  freneral 
favourite  with  all  the  officials  of  the  institution.  Her  un> 
timely  death  is  made  particularly  sad  by  the  fact  that  she 
was  about  to  be  married  to  a  clergyman.  This  sad  event 
eug^fests  the  followioff  queries  : — How  is  it,  that  a  nurse, 
famiUar  with  the  odour  of  carbolic  acid,  which  is  used 
•daily  in  a  surgical  ward,  could  possibly  mistake  it  for 
castor  oil  ?  How  is  it  she  did  not  in  the  act  of  swallowing 
discover  her  mistake  ?  Was  it  due  to  the  fact  of  her  sus- 
pending her  inspiration  at  the  time  of  swallowing?  These 
are  points  which  should  be  inquired  into,  and  means 
adopted  whereby  such  lamentable  accidents  may  be  efiec- 
tually  avoided  in  the  future. 

VioTORiA  Infirmabt,  Glasoow.-  Death  whilb  ukdek 
Chloroform.— A  girl,  named  Helen  Watson,  a  domestic 
servant,  died  in  the  Victoria  Infirmary  on  the  28th  ult., 
where  she  had  been  admitted  for  the  purpose  of  being 
■operated  on.  The  four  resident  surgeons  were  present  at 
the  operation,  one  of  whom  administered  chloroform, 
while  the  others.proceeded  with  the  operation,,  but  before 
its  completion  the  patient  died  while  under  the  ansBSthetic. 
The  police  authorities  in  their  report  state  that  "the 
•doctors  are  unanimous  in  the  opinion  that  death  would 
have  ensued  within  ttoo  hours,  whether  the  patient  had 
been  operated  on  or  not." 

Chbmistrt  in  Schools— The  Conjoint  Examination 
Board  of  the  Scottish  Triple  Qualification  have  resolved 
on  a  new  and  important  departure.  The  Board  has 
•decided  to  recognise  Blairlodge  School,  a  public  school 
after  the  English  models,  for  the  teaching  of  chemistry  and 
physics.  The  school  has  well-equipped  laboratories  and 
•competent  teachers,  and  is  the  first  Scottish  school  to  be  < 
so  recognised.  It  is  a  sign  that  schools  are  moving  with 
the  times,  for  not  very  long  ago  the  teaching  of  these 
subjects  in  the  best  schools  was  simply  a  farce,  and  was  | 
almost  entirely  subordinated  to  the  cramming  of  foreign 
languages.  I 

The   Rotal    Infirmary  Board,    Edinburgh. — Miss  i 
Stevenson's  name  was  the  only  one  put  forward  last  week  | 
at  the  dose  of  the  time  fer  nominations  for  the  vacancy  ' 
on  the  Board  of  the  Infirmary,  and  although  the  actual 
election  does  not  take  place  until  this  week,  there  is  no 
doubt  that  she  will  be  the  first  lady  on  the  Board. 


precautionary  measure  the  patient  attached  a  string   to 
the  member. 

Lenior,  in  1849,  placed  on  record  a  case  of  ooneenitel 
luxation ;  and  in  1886  Dr.  Raven  reported  the  followmg 
remarkable  case  of  spontaneous  luxation:  "A  healthy, 
steady,  single  man,  aged  twenty-seven  years,  short^ly  alter 
he  had  gone  to  bed  one  night  felt  a  sensation  of  oold  in  the 
region  of  the  penis.  .  He  was  agitated  to  find  that  the 
organ,  a  fairly  developed  one,  was  rapidly  shrinking,  and 
was,  be  thought,  finally  disappearing."  On  the  arrival  of 
Dr.  Raven  he  found  that  "the  penis  had  almost  disap- 
peared, the  glans  being  just  perceptible  under  the  pnbic 
arch.  The  skin  of  the  penis  alone  was  visible,  and  looking 
as  it  does  when  the  orsan  is  buried  in  a  hydrocele." 

Baumgarten,  of  Buda-Pest,  reported  a  case  as  following 
on  the  site  of  circumcision  in  which  reduction  of  the  luxa- 
tion was  efiected  until  the  child  was  eight  years  old.  This 
case  in  many  respects  resembles  Leniors. 

Malinooski  reports  a  case  of  Professor  Levshin's,  of 
Kazan.  The  trousers  of  the  patient  were  drawn  between 
a  horizontal  and  a  vertical  cog-wheel  of  a  mill ;  the  akin 
of  the  scrotum  and  penis  got  torn,  and  the  penis  was  dis- 
located under  the  pubic  arch. 

Cases  have  been  recorded  by  Moldenhaur,  N^laton, 
Petersen,  and  Wagner,  and  Dr.  Richard  Neale  in  the 
third  edition  of  his  invaluable  "  Disest "  gives  references 
to  three  cases  of  luxation,  and  inciudes  the  cases  of  Ivanoff 
and  Raven  under  the  title  of  "  vanishing,"  a  name  which 
is  applied  to  a  similar  condition  in  the  '*  Arabian  Nights 
Entertainments,"  Burton's  edition. 

I  am,  Sir,  yours,  &c , 

George  Fot. 

January  6th,  1896. 


€oxxtBffonbtnct. 


CWe  do  not  hold  onnelvei  respoiulble  for  the  opinions  of  our 
oorretpondents.]  

LUXATIO    PENIS. 
To  the  Editor  of  the  Medical  Press  and  Ciroular. 

Sir,—  The  recent  publication  of  a  case  of  **  Luxatio  Penis" 
has  drawn  a  good  deal  of  attention  to  this  rare  accident, 
and  thinking  the  subject  might  interest  your  readers  I 
take  the  liberty  of  summarising  some  of  the  recorded 
cases. 

In  The  Medioal  Press  for  Nov.  5th,  1879,  we  have  the 
testimony  of  Mr.  David  W'lson  that  **  the  penis  (of  the 
Tichbome  Claimant)  retracts  in  a  most  unusual  degree,  so 
that  on  one  occasion  when  he  passed  water,  which  had 
been  retained  for  some  hours  at  my  expressed  wish,  the 
penis  was  absolutely  out  of  view,  and  nothing  whatever  of 
It  could  be  seen  but  the  ozifice  from  which  the  stream 
issued.  Yesterday  I  found  the  membrane  more  turgid, 
but  I  endeavoured  to  push  it  back  towards  the  neck  of  the 
bladder  with  which  it  is  continuous,  and  found  it  perfectly 
easy  to  push  the  whole  member  out  of  sight." 

Ivanoff,  whose  name  tells  his  nationality,  in  1885 
reported  the  case  of  the  total  disappearance  of  the  penis  of 
a  patient,  aged  twenty-three  years,  who  was  a  married 
man  and  father  of  a  family.  After  prolonged  manipulation 
the  part  was  restored  to  its  normal  position  ;  and  as  a 


PROPOSED    MEDICAL    TITLES    BILL. 

To  the  Editor  o/'The  Medioal  Press  and  Ciroulab. 

Sir, — The  aim  of  my  too  brief  previous  letter  was  to 
help  check  what  would  surely  prove  a  great  waste  of  force, 
namely,  an  attempt  to  carry  through  Parliament  a  Bill 
with  the  sole  object  of  preventing  legally-qualified  medicai 
men  not  in  poraession  of  an  M.D.  degree  from  styling 
themselves  doctor.  Amendment  and  consolidation  of 
medical  laws  are  ur^ntly  called  for  in  the  interest  alike 
of  public  and  profession.  If  these  are  to  be  attained  the 
united  forces  of  the  whole  profession  must  be  brought  to 
bear,  and  I  hold  it  would  oe  a  misfortune  if,  instead  of 
joining  with  the  main  body,  men  of  influence  like  Dr. 
Glynne  Whittle  should  fritter  away  their  strength  in 
efforts  foredoomed  to  failure.  Can  anyone  with  a  rudi- 
mentary knowledge  of  the  historv  of  medical  legislation  in 
recent  years  believe  that  any  Cabinet  or  any  statesmen  of 
ministerial  rank  will  take  up  a  project  of  law  such  as  Dr. 
Whittle  suggests  ?  And  can  anyone  believe  that  such  a 
Bill  could  have  the  least  chance  in  the  hands  of  any  ordi- 
nary member  of  Parliament  ? 

The  abuse  for  which  a  remedy  is  sought  is  surely  a 
matter  of  internal  professional  discipline.  Colleges  and 
diploma-giving  bodies  can  frame  by-laws*  and  the  General 
Medical  Council  can  declare  **  disgraceful"  the  offence  of 
assuming  a  qualification  without  valid  claim. 

It  cannot  be  said  that  the  interests  of  the  public  are 
materially  affected  by  commission  of  the  offence  in  ques- 
tion, and  the  difficulties  of  getting  new  laws  merely  for 
the  advantage  or  protection  of  any  profession  are  almost 
insurmountable.  Can  it  be  alleged  tlwt  practitioners  hold- 
ing say,  for  example,  quaufications  like  L.R.C  P., 
M  R.C.S.,  are  one  whit  inferior  to  holders  of  M.D. 
Durham,  Aberdeen,  or  Brussels?  Now  every  medical 
practitioner  is,  and  always  will  be,  to  the  public  a 
'*  doctor,"  and  on  all  these  grounds  it  is,  I  hold,  out  of  the 
question  that  Parliament  will  go  out  of  its  way  to  frame 
and  discuss  a  prohibitive  law  of  the  kind  suggested  by  Dr. 
Whittle. 

If  the  Medical  Act  were  sufficient  to  prevent  unqualified 
pretenders  from  assuming  medical  titles,  the  question  at 
issue  would  not  be  affected.  I  am  certainly  astonished 
to  learn  from  Dr.  Bateman  that  the  Medical  Defence 
Union  has  been  in  existence  many  years,  and  has  con- 
ducted successfully  many   prosecutions  every  year.    It 


iAB.  8,  1806. 


LITERARY  NOTES  AND  GOSSIP. 


Thb  Midioal  Fbkb.     45 


voold    be    intarattiog,    and   would   attimet   many   new 
*■     I  to  the  Union,  iljbe  wonld  pobliAh  a  sammarj  of 


The  Mrooeedinga  mav  firave  appeared  in  pro- 
▼meba  pMMn,  bvt  l  do  net  tbink  they  have  been  publiehed 
innwwiioafor  leading  joornab.  At  any  rate,  there  are  eeores 
oi  fwwke  pmetiflfaig  under  ftJse  prelenees  in  London ;  and 
vp  to  wHhhi  the  laet  few  weeka  (and  for  all  I  know  np  to 
to<4iay>  an  hifanioae  nniepetered  yenereal  qnaok  who  baa 
eftvi  been  expoeed  in  pdliee-conrtB  has  dispLRyed  his  name 
with  the  title  doctor  in  letteremaay  inchea  high  on  a  shop 
wincioi#  In  ene  of  the  prineipid  thoronghlafee  of  t&e  metro- 
potteL 

I  am,  Sir,  years,  Ac., 
H.  S. 
JttL  Snd,  1896. 

♦ 

LUNATIO  ASYLUMS.— THE  RELIGIOUS 
QUESTION. 
To  the  Editor  qf  Thb  VLxdiokl  PBBfis  akd  GnunriAB. 
Sia^ — ^HaTJng  read»  as  a  general  practitioner,  Dr.  Thea 
B.  HTslop'a  inetractive  lecture  in  the  last  number  of  Thb 
lisMiaai^FBKa  on  "  The  Diagnosis  of  Insanity,"  in  which 
he  toncbea  with  considerable  tact  and  refinement  upon 
tlw  leligioos  element  so  often  associated  with  these  sad 
easas^  I  trust  you  will  allow'  me  to  broach  a  question 
idiieh  ia  certainly  one  off  extreme  delicaoy,  but  which 
nsrertheiess  tto  medical  profession,  a^  guardians  of  the 
pnUio  health— mentallT  and  physically — are  bound   to 
tike  oognisanee.    I  refer  to  the  religious  question  aa  a 
ladBor  in  insanity.    We  cannot  shut  our  eyes  to  the  fact 
that  many  eaaes  of  insanity  are  eyol^ed  from  or  caused 
W  raligioas  enthusiasm  outside  our  asylums ;  the  question 
tMA  arises  as  to  how  far  it  can  be  oonaucive  to  the  welfare 
of  these  institutions  to  allow  the  clerical  influence,  which 
is  by  no  means  calculated  to  strengthen   the  enieebled 
■liaa,  to  have  its  sway  ?  Some  years  a^  I  happened,  as  a 
stadsnt  amongst  others,  to  have  the  privilege  of  attending 
one  of  our  large  asylums,  and  a  st(»ry  was  related  by  one 
of  the  attendant  physicians  in  which  the  chaplain   was 
rqxnrted  to  have  made  some  reference  on  a  religious  topic 
in  his  discourse  in  the  chapel,  and  which  touched  the 
weak  point  of  one  of  the  inmates ;  whereupon  the  patient 
stood  up  and  commenced  a  violent  harangue,  whereby  it 
became  obvious  that  religion  was  no  jpart  of  his  cure. 
However  this  may  illustrate  my  meanug,  there  can  be 
DO  question  but  that  we  live  in  a  restless  and  excitable 
sge,  when  the  "  struggle  for  existence  "  becomes  daily 
wire  intense,  And  when  it  behoves  all  to  keep  their  wits 
about  thcnn.    No  doubt  the  efforts  of  relisious  enthusiasts, 
whether  in  a  salvation  army  or  a  churdi  brigade  or  any 
other  sectarian  denomination,  to  cope  with  public  immo- 
rality are  commendable  enough,  but  we  cannot  shut  our 
eyes  to  the  fact  that  a  good  deal  of  insanity  and  its 
tvin-sister  hysteria   must    necessarily   arise   from   any 
vUent  disturbance  of  the  public  mental  equilibrium  owing 
to  religious  excitement,  and  it  therefore  behoves  experts  in 
hmacy  to  be  on  the  alert  and  use  their  influence,  lest  the 
good  intentions  of  these  enthusiasts  should  defeat  their 


I  am.  Sir,  yours,  Ac, 

Clbmxnt  H. 
Queen's  Road,  Peckham,  Jan,  3rd,  1896. 


Dr.  MiTXBMLL  has  a  new  work  in  the  press  entitled 
"Pharmarotegy  and  Therapeutics,"^  specially  written  to 


}  the  requirements  of  the  Ck>n  joint  Board  of  the  Bioyal 
Colleges  of  Physicians  and  Surgeons. 

Hr.  Alukoham  is  now  engaged  6n  a  sixth  edition  of 
biB  wen  known  work  on  *'  Diseases  of  the  Rectum."  In 
this  edition  Uie  author  will  be  associated  with  his  son  Mr. 
Herbert  AHingham,  the  author  of  '*  Ck>lotomy." 

Dft.  J.  CowAX  WooDBUKK,  Lccturor  on  Dental  Surgery 
St  the  Glasgow  Royal  Infirmary,  will  shortly  issue  a 
handbook  specially  designed  for  medical  students,  on 


"Tooth  Extraction,"  with  notes  on  the  Phyeiology  aikd> 
Anatomy  of  the  Teeth.'' 

Wa  understand  that  the  first  edition  of  Mr.  Lennoif 
Browne's  "Diphtheria  and  its  Associates,"  is  already 
exhausted,  and  that  a  second  is  in  the  press.  The  sale- 
havinf^  been  so  rapid,  very  few  alterations  wlU  be  neoes-- 
sary  m  the  text,  but  the  value  of  the  plates  will  br 
enhanced  by  two  additional  colour  printings. 

Thb  Government  of  India  has  ordered  that  oo^es  of  Mr. 
Hankin's  pamphlet,  entitled,  '*  The  Cause  and  Prevention 
of  Cholera,"  shall  be  issued  to  all  medical  ofSoers  with* 
instructions  to  record  the  result  of  any  experiments  made^ 
bv  them,  and  to  communicate  the  results  direct  to  Mr. 
Ttankin  at  Agra. 

Thb  season  has  been  more  marked  than  anv  previous 
one  iu  the  variety  and  number  of  diaries,  viritrng-lists, 
&c.;  l>esides  those  previously  noticed  in  these  columns,  a 
neat  little  vest-pocket  diary,  bound  in  leather,  with  gilt 
edges,  has  been  sent  us  by  Messrs.  Lever  Brothers,  of 
Sunlight  and  Lifebuoy  Soap  celebrity.  This  miniature 
volume  will  be  found  very  useful  to  carry  about  for  ready 
reference  and  short  memoranda. 

•  ♦ 

Of  European  libraries,  only  four  have  over  1,000,000' 
volumes,  namely,  Bibliotheque  National,  Paris,  2,290,000 
books  and  80.000  HSS. ;  Bntish  Museum,  1,500,000  books 
and  100,000  MSS.  ;  Public  Libratv,  Munich,  1,000,000' 
books,  and  26,000  MSS. ;  Imperial  Public  Library,  St. 
Petersburg,  1,000,000  books  and  26,000  MSS. 

Thb  great  Biennial  Prize  of  £800,  granted  by  the* 
Academy  of  Sciences  of  Parie,  has  been  awarded  to  Pro- 
fessor Ravult,  of  Grenoble,  in  respect  of  his  researches  in' 
physics  and  diemistry.  His  methods  of  investigation  of 
the  constitution  of  molecular  bodies  have  been  adopted 
by  scientists  throughout  the  world. 

Thb  January  number  of  the  JSdinlmrgh  Medical  JowmaV 
contains  a  goodly  array  of  interesting  original  communica- 
tions. Dr.  Ballantyne  writes  on  *'  Teratogenesis :  an 
inquiry  into  the  Causes  of  Monstrosities " ;  Surgeon^ 
Major  Macdonald  on  "  A  Case  of  '  Bore '  of  the  Abdomen 
hj  an  Elephant's  Tusk  " ;  and  Dr.  Robertson  continues 
his  paper  on  the  '*  Pathology  of  the  Nervous  System  in 
Relation  to  Mental  Diseases."  Altogether  the  number  is- 
a  good  one. 

*•* 

Thb  importation  of  two  American  books—one  onr 
anatomy,  the  other  on  sursery—  has  been  stopped  in  this 
country  under  the  Copyright  Act,  whole  chapters  having 
been  taken  from  Bneush  works  without  acknowledement. 
We  had  hoped  our  American  friends  were  getting  Myond' 
literary  piracy,  and  were  intent  on  original  work  on  their 
own  account. 

• 

"  Sflanohnoloot,"  being  the  fourth  part.  Vol.  III.,  of 
'*Qnain's  Elements  of  Anatomy,"  has  just  made  its 
appearance  under  the  editorship  of  Professor  Sohafer  and 
Symington.  This  now  classical  work  was  first  published 
in  the  early  part  of  the  present  century.  In  1845  Dr. 
Quain  died,  and  the  fifth  edition  was  undertaken  by  Mr. 
Richard  Quain  and  Dr.  Sbarpey.  Subsequent! v  Dr.  Allen 
Thomson  and  Dr.  Cleland  became  editors,  all  of  whom, 
with  the  exception  of  the  latter,  have  gone  over  to  the 
majority.  With  the  issue  of  the  present  part  the  work  is 
completed  in  three  volumes  of  eight  parte,  the  publishers 
beins:  Messrs.  Longmans,  Green  &;  Co. 

•  ♦ 

"  Hbalth  Notes  for  the  Sea-side  "  is  a  little  hrochurtr 
by  Dr.  A.  C.  Dutt,  late  Senior  House  Surgeon  at  the  Scar- 
borough Hospital.  It  contains  short  chapters  on  various 
subjects  relating  to  the  preservation  of  the  health.  In 
the  chapter  "  on  smoking  '  he  defines  what  he  considers 
to  be  the  maximum  amount  of  smoking  in  which  a  man 
above  twenty-five  may  indulge  daily  as  follows :— '*  Six 
pipes  of  good  tobacco  or  six  good  cigars,  or  twelve  to 
fifteen  cigarettes  made  of  ^ood  tobacco."  The  statement 
about  the  cigars  is  interesting.  Most  people  who  are  not 
millionaires  have  probably  few  opportunities  of  judging 


46     The  Mfpical  Prfss. 


LITERARY  N0TE8  AKD    GOSSIP. 


Jam.  8,  1896. 


what  a  good  cigar  is.  The  author  writes  in  a  chatty 
popular  Btyle,  and  we  can  commend  his  contribution  to 
the  subject  of  personal  health. 

•  • 

UNDisUie  title  of  "  The  *Studente'  Practical  Materia 
Medica"  Mr.  Gi£fen  has  published  a  short  compendium  of 
useful  notes.  For  some  mysterious  reason,  best  known 
to  themselves,  the  originators  of  our  official  materia 
medica  have  adopted  a  most  haphazard  syscem  of  dosage. 
In  order  to  overcome  this  stumbling-block  the  author  has 
introduced  a  method  of  grouping  together  various  prepara- 
tions according  to  the  dose.  Thu0,  he  divides  the  tinc- 
tures into  four  groups,  namely,  those  that  can  be  taken  in 
doses  of  (1)  i— 1  ct.;  (2)  10—30  min. ;  (3)  5—10  min.; 
and  (4)  those  not  taken  internally.  This  little  book  is 
issued  by  Messrs.  Livingstone,  at  the  modest  sum  of  2s. 
It  contains  much  usefulinformation  for  those  wishing  to 
arrange  and  revise  their  knowledge  for  examination 
purposes. 

V 

Undss  the  title  of  "  The  Home  of  the  Jackdaws  "  the 
well-known  and  popular  Registrar  of  the  General  Medical 
Council  has  issued  a  reprint  of  one  of  his  chatty  and 
interesting  little  articles  on  bird  life.  The  jackdaw,  as 
pointed  out  by  Mr.  Miller,  has  been  patronif>ed  by  writers 
of  every  kind,  ancient  and  modem.  The  particular 
"  Home  **  which  is  spoken  of  in  the  pamphlet  is  not  men- 
tioned by  name,  but  simply  alluded  to  as  a  "  perfectly 
ideal  bay  on  our  South  Coast."  The  jackdaw  is  among 
our  most  characteristic  British  birds,  and  one  can  weU 
understand  the  interest  and  admiration  which  it  has  evi- 
dently excited  in  the  mind  of  the  author.  fVom  time  to 
time  it  has  been  our  pleasant  duty  to  welcome  similar 
essi^s  from  the  same  pen.  Mr.  Miller  has  been  a  life-long 
stuoent  of  birds  and  of  bird -lore.  The  present  article  is 
reprinted  from  Nature  Notes. 

* 
A  NBW  quarterly  journal  has  recently  made  its  appear- 
ance in  London  under  the  title  of  Th9  West  London  Medical 
Journal,  It  is  edited  by  Mr.  Percy  Dunn,  and  is  pub- 
lished under  the  auspices  of  the  West  London  Meaico- 
Chirurgical  Society,  of  which  well-known  body  it  is  the 
official  organ.  There  is  certainly  room  for  such  a  publi- 
cation, which  will  preserve  in  book-form  many  valuable 
clinical  observations,  the  waste  of  which  in  the  smaller 
societies  throughout  the  country  has  long  been  a  common- 
place subject  for  recurrent  editorial  regret.  The  main 
part  of  the  initial  number  of  the  West  London  is  taken  up 
by  the  Presidential  address  and  by  papers  and  a  discussion 
on  the  eminently  practical  subject  of  gastric  ulcer,  most 
of  which  has  already  appeared  in  our  columns.  The 
*' Mirror"  of  clinical  reports  is  a  useful  feature  of  the 
journal.  The  editor  may  be  heartily  congratulated  on 
the  excellence  of  his  first  issue,  and  the  Society  on  its 
enterprise  in  undertaking  a  somewhat  arduous  task. 
•  • 
« 

Avert  amusing  discussion  is  at  present  in  progress 
between  the  editor  of  the  New  York  Medical  Record  and 
the  editor  of  the  Philadelphia  Medical  News  upon  the  sub- 
ject of  spelling.  In  a  very  modest  way  we  have  ventured 
ourselves  on  many  occasions  to  animadvert  upon  the 
method  of  spelling  adopted  by  our  latter  esteemed  con- 
temporary, and  the  following  is  what  the  New  York  Medi- 
cal Record  has  to  say  on  the  subject :  "  Our  contemporary, 
the  Medical  News,  has  a  reprehensible  habit  of  misspelling 
a  good  many  words  and  an  obstinacy  in  holding  out,  even 
when  convicted  of  error  by  every  other  authority,  as  well  as 
by  incontrovertible  facts."  The  discussion  has  turned  in 
this  instance  upon  the  words  **  uranalysis  "  and  "  symphy- 
S0Otomy."  The  editor  of  the  Medical  Netes  objects  to  each, 
while  the  editor  of  the  Record,  in  an  interesting  leading 
article,  justifies  their  existence  etymologically,  and  points 
to  the  fact  that  the  "  e "  in  symphyseotomy  is  correct, 
inasmuch  as  the  stem  of  the  word  is  <>urc.  It  is  refresh- 
ing to  see  that  at  least  one  of  our  contemporaries  on  the 
other  side  of  the  Atlantic  has  made  a  stand  against  the 
policy  of  "clipping  and  changing"  which  at  present 
disfigures  the  words  in  many  American  medical  journals. 

"Ouida"  is  nothing  if  she  is  not  up-to-date.  In  her 
last  novel,  euphemistically  called  "Toxin,"  she  takes 
full  advantage  of  the  anti-toxin  treatment  of  diphtheria, 


and  evolves  out  of  it  all  sorts  of  "  horrors  "  by  the  aid  of 
her  imagination.  The  novel  receives  its  title  from  the 
fact  that  the  toxin  of  diphtheria  is  employed  bv  the 
villain  to  rid  himself  of  bis  rival.  OhanusteristicaUy  of 
"  Ouida,"  the  villain  is  no  puppet  or  insignificant  person 
of  low  birth  and  intelligence,  but  a  man  of  science,  concern- 
ing whom  she  says  "  the  infliction  of  death  was  nothing 
to  him.  He  was  used  to  kill  as  he  was  used  to  torture, 
with  profound  indifference — with  no  more  hesitation  than 
he  ate  or  drank  or  fulfilled  any  natural  function  of  his 
body.  To  obtain  knowledge,  even  the  approach  of  know- 
ledge, he  would  inflict  the  most  agonising  and  moet  end- 
less suffering  without  a  moment's  doubt  or  regret." 
After  this  it  is  easy  to  understand  how  "  Ouida"  makes 
the  scientist  inject  into  the  veins  of  his  sleeping  friend, 
who  was  recovering  from  diphtheria,  the  toxin  of  the 
disease  instead  of  the  antitoxin.  Poor  *<  Ouida"  !  What 
can  be  the  matter  with  her?  Has  shebeen  reading  Max 
Nordau  on  "Degeneration,"  and  imbibed  some  of  his 
ideas  of  "  going  "  for  everybody  ? 

Undss  the  specious  title  of  '*  Our  Treasures  and  How  to 
Keep  Them  "  we  are  favoured  with  a  synopsis  of  Uie  prin- 
ciples  of  nutrition  and  diet,  in  which  special  emjpnaaiB 
is  laid  upon  the  importance  of  an  adequate  proportion  of 
fat.  It  is  a  matter  of  common  experience  that  the  very 
persons  who  stand  most  in  need  of  fat  are  precisely  those 
in  whom  this  alimentary  substance  excites  positive  loath- 
ing, and  the  problem  arises  how  best  to  coaxe  them  into 
aMorbing  a  sufficient  quantity  of  a  necessary  but,  to  them, 
repulsive  article  of  diet.  The  writer  of  this  pamphlet 
claims  to  have  solved  the  problem  by  showing  tnat  Virol 
is  a  very  palatable  and  digestible  form  of  nutritive  fat. 
Without  endorsing  the  writer's  thesis  in  all  its  details,  we 
may  concede  that  he  eloquently  pleads  the  advantages  of 
a  dietary  comprising  bone-marrow  duly  prepared  for  con- 
sumption in  the  form  of  "  Virol."  Virol,  we  are  told, 
contains  a  large  proportion  of  the  red  marrow  which, 
while  it  adds  to  the  cost,  materially  enhances  the  value  of 
the  preparation.  Marrol,  on  the  other  hand,  is  a  combi- 
nation, in  physiological  proportions,  of  the  yellow  marrow 
of  ox-bones,  with  extract  of  malt.  This  is  not  the  place  to 
discuss  the  value  of  food  preparations,  but  the  brochure  (a 
copy  of  which  can  be  had  on  application  to  the  Liquor 
Camis  Co.)  contains  a  number  of  useful  recipes  which  will 
prove  serviceable  in  arranging  the  dietary  of  invalids 
requiring  substantial  and  easily  assimilable  nourishment. 

We  have  received  from  Messrs.  Burroughs,  Wellcome 
and  Co.,  an  *' Anti-diphtheritic  Treatment  Chart,"  for 
the  purpose  of  recording  the  progress  of  cases  treated  by 
serum  injections.  The  chart  will  doubtless  prove  useful, 
and  for  the  most  part  the  points  to  be  observed  are  perti- 
nent and  well  selected.  In  any  future  issue,  however,  we 
would  suggest— First,  that  the  term  '*  Diphtherial " 
should  be  substituted  for  <*  Diphtheritic,"  the  latter  word 
tending  to  perpetuate  the  assumption  of  a  grade  of  inflam- 
mation which,  as  Trousseau  pointed  out  nearly  forty  years 
agO|  does  not  exist.     Secondly,  it  is  not  the  '*  mamillary 

f lands"  which  are  primarily  or  ordinarily  enlarged  in 
ipbtheria,  but  the  cervical,  and  under  this  heading  it 
would  be  well  to  ask  which  set  of  glands  were  enlarged,  as 
clinical  distinction  is  thereby  given  to  the  nature  and 
severity  of  an  attack.  There  is  also  another  omission  in 
that  no  provision  is  made  for  the  recording  oi  concomitant 
general  or  local  treatment,  nor  of  alcoholic  stimulants. 
Lastly,  while  approving  of  "the  adoption  of  physiological 
rather  than  a  mechanical  means  of  dosage,"  we  would 
point  out  that  we  are  not  thereby  further  helped  than 
formerly,  with  information  as  to  what  proportion  of  "  a 
therapeutic  adult  dose  "  should  be  adopted  for  an  infant 
As  a  matter  of  fact,  larger  doses  are  being  used  for 
children  than  for  the  adult,  and  the  only  standard  of 
dosage  seems  to  be  that  of  the  malignancy  of  the  attack, 
the  intensity  of  which  is  usually  in  an  inverse  proportion  to 
the  age  of  the  patient. 

*# 
New  Books  and  New  Editions.— The  following  have 
been  received  for  review  since  the  publication  of  our  last 
monthly  list :— Quain's  Elements  of  Anatomy,  Edited  by 
E.  A.  Sch&fer,  F.R.S.,  and  Gea  D.  Thane,  VoL  iii,  Taut 
IV.  The  Year-Book  of  Treatment  for  18M.  History 
of    the  Cholera  Controversy,   by   Sir  Qeorge  Johnson, 


Jak.  8»  1M»6. 


MEDICAL  NEWS. 


Thb  Msdioaii  Pbbbs.     ^7 


Hyeiene,    by     J.     Lane     Notter,      M  D.Dub., 
L  Firth,  F.R.C.S.    A  History  of  the  Chronic  De- 


JLD. 

aiMlR.  H. 

seneratiTe  Diseaaoa  of  the  Central  Kervoos  System,  by 
ThoB.  K.  Monro,  M^,  M.D.  The  Physiology  of  the  Car- 
bohydntee  ;  An  Epicriticism,  by  F.  W.  Favy,  M.D., F.R.S. 
Appendix  to  the  Medical  Bijrat  from  1891  to  1895,  by 
Budiard  Neale,  M.D.Lond.  Skiascopy  and  its  Practical 
Application  to  the  Study  of  Refraction,  by  Edward 
JaAnon,  A  M.,  MB.  Lsctores  on  Appendicitis,  by  Robert 
T.  Morris,  A.M.,  M.D.,  New  York.  Modem  Medicine  and 
HomoBope^y.  by  John  B.  Roberts,  A.M.,  M.D.,  New 
York.  The  Thyroid  Treatment  of  Myxcedema,  by  Byrom 
Bramwell,  M.I>.  Local  Government  Board  Reports  and 
P^)e^B  of  the  Port  and  Riparian  Sanatory  Sarvey  of  Eng- 
land and  Wales.  The  Middlesex  Hospital  Reports  for 
1894.  The  Inebriety  of  Insanity  from  a  Medico-Legal 
Point  of  View,  By  T.  B.  Croshers,  M  J). 


MR.  ARTHUR  JACKSON,  M.R.C.S.,  OF  SHEFFIELB. 
Wx  have  with  much  regret  to  announce  the  death  of 
Mr.  Arthur  Jackson,  the  well-known  and  popular  surgeon 
of  ShefiSeld,  which  took  place,  on  the  29th  ult.,  after  a 
ihori  illness.  Up  to  the  10th  of  last  month  he  appeared 
to  be  in  his  nsnal  health.  On  the  evening  of  the  8th  he 
presided  over  an  important  meeting  oi  the  Sheffield 
kedioal  School  having  relation  to  the  amalgamation  of 
the  School  with  Firth  College  and  the  Technical  School 
for  the  pnrpoeee  of  the  Victoria  University  scheme.  The 
day  followin||r,  among  other  meetings,  he  attended  a  meet- 
ing of  the  Council  at  Firth  College,  when  the  arrange- 
ment for  amalgamation  was  concluded.  On  the  morning 
of  the  10th,  however,  he  complained  of  feeling  unwell,  and 
suffered  from  severe  abdominal  pun.  This  continued 
throufpbont  the  day,  but  despite  this  Mr.  Jackson  con- 
tinued to  attend  to  his  professional  duties.  Subsequently 
the  pain  increased,  and  his  condition  became  serious. 
The  symptoms  at  first  yielded  to  treatment,  but  a  relapse 
followed*  complications  ensued,  and  death  took  place  as 
recorded  above.    His  age  was  51. 

Mr.  Arthur  Jackson  was  born  on  February  21st,  1844. 
He  was  the  second  son  of  the  late  Mr.  Henry  Jackson, 
M.R.C.S.,  of  Sheffield.  Mr.  Henry  Jack»on,  it  may  be 
stated,  was  the  only  son  of  the  eminent  surgeon  of  that 
name.  The  subject  of  our  memoir  received  his  early 
edncatioo  at  the  Collegiate  School,  and  afterwards  studied 
at  Cheltenham  College.  His  medical  knowledge  was 
sained  at  the  Sheffield  School  of  Medicine,  at  the  General 
uifirmary,  where  he  was  pupil  under  his  father,  and  at  St. 
Bartholomew's  Hospital,  London.  In  the  year  1866  he 
had  gained  his  surgical  qualification  (M.R.C.S.Eng.),  and 
no  doubt  would  have  won  further  degrees,  but  in  tliat  year 
his  father  died,  and  it  becune  necessary  for  him  to  take 
up  the  practice. 

Like  his  father,  Mr.  Arthur  Jackson  was  a  great 
collector  of  rare  and  curious  books,  and  possessed  an 
extensive  knowledge  of  local  antiquities.  Early  in  life 
he  turned  his  attention  to  the  history  of  his  native  city,  of 
which  he  was  intensely  proud,  and  he  frequently  gave 
lectures  upon  this  subject.  His  exertions  on  behalf  of  the 
medical  charities  of  Sheffield  were  such  as  to  endear  him 
to  sU  those  who  were  obliged  to  use  those  insdtutions. 
For  several  years  he  was  surgeon  at  the  Sheffield  Royal 
Hospital,  and  continued  to  occupy  that  post  until  he 
became  surgeon  at  the  General  Infirmary.  At  the  time  of 
his  death  he  was  senior  surgeon  at  the  latter  institution, 
and  also  consulting  surgeon  at  the  Hospital.  He  succeeded 
the  late  Mr.  Bernard  Wake  as  treasurer  to  the  Royal  Hos- 
pital in  1891. 

His  contributions  to  the  medical  journals  were  not 
numerous ;  the  last  that  appeared  from  his  pen  was  pub- 
lished by  the  Msdical  Pbxss  and  Cibculab  in  1884,  the 
Siper  being  entitled  *'  A  Quarter  of  a  Century's  Surgery." 
e  took  a  large  share  in  the  public  duties  of  his  town, 
and  he  held  many  appointments  in  connection  therewith. 
Moreover,  he  was  the  lecturer  on  Surgery  at  the  Sheffield 
Medical  School  He  lived  an  active,  busy  life,  and 
enjoyed  a  large  measure  of  popularity  among  those  with 
whom  he  came  into  contact.  His  untimely  decease  has 
led  to  widely  spread  expressions  of  regret  in  Sheffield, 
where  among  all  classes  he  was  held  in  high  esteem. 


The  Jenner  Memorial  Fund. 
Wa  are  asked  to  announce  that  the  collection  of 
'*  Jenner  Relics  "  got  together  by  Mr.  Frederick  Mockler, 
of  Wotton-under-Edge,  has  been  accepted  by  the  Dean 
and  Faculty  of  Medicine,  University  College.  Bristol,  to 
be  located  there,  provided  that  the  necessai^  amount  to 
purchase  it  from  the  owner  can  be  raised  by  public  or 
other  subscription.  The  fact  that  Dr.  Edward  Jenner, 
who  was  bom  (1749),  lived,  made  his  famous  discovery  of 
vaccination,  practised,  and  died  (1823)  at  Berkeley,  in 
Gloucestershire,  has  suggested  the  idea  that  this  unique 
collection  of  memorials  of  the  life  and  career  of  one  of  the 
three  greatest  names  in  English  medical  science  should  be 
secur^  for  the  county  and  located  in  its  capital  dty, 
BriBtoL  A  large  number  of  gentlemen  have  already  pro- 
mised to  subscribe  to  the  Fond — Earl  Fitz-Hardinee  con- 
tributed £10  lOs. — and  further  subscriptions  are  solicited. 
We  think  it  a  mistake,  however,  that  no  sum  is  mentioned 
in  the  appeal,  because  if  the  purchase  of  the  relics  have 
for  its  object  the  putting  of  a  profit  into  the  pockets  of  a 
collector  of  antiquities,  we  profession  will  not  so  readilv 
subscribe.  The  centenary  of  Jenner's  experiment,  whi<m 
gave  the  incalculable  benefits  of  vaccination  to  the  world, 
will  be  May  14th,  1896.  In  Russia  preparations  are  being 
made  on  an  extensive  scale  to  commemorate  this  event, 
and  it  is  to  be  hoped  by  the  committee  of  this  fund  that 
the  collection  may  be  placed  in  the  College  in  anticipation 
of  that  period,  so  as  to  worthily  celebrate  the  event  here. 
Cheques  should  be  made  payable  to  "  The  Jenner  Memorial 
Fund,"  and  crossed  "  Messrs.  Prescott,  Dimsdale,  Cave, 
Tugwell  &  Co.,  Ld.,  Bankers,  Bristol." 

Formation  of  a  Medical  Society  at  Bedford. 

A  MVETiNO  of  the  medical  men  of  Bedford  and  district 
was  held  at  the  Infirmary  on  Thursday,  January  2nd.  Mr. 
Hughes  Hearming,  of  Kimbolton,  occupied  the  chair. 
It  was  decided  to  form  a  medical  society  in  Bedford  <*  for 
the  promotion  of  professional  intercourse,  for  the  reading 
of  papers,  for  the  exhibition  of  cases,  patientn,  psychological 
specimens.  &c.,  and  for  the  discussion  of  all  questions 
affecting  the  welfare  of  the  profession."  Meetings  will  be 
held  at  the  Infirmary  quarterly  at  3.30  p.m.  The  following 
officers  were  elected  for  the  ensuing  year  : — President,  Dr. 
G.  P.  Goldsmith  ;  Treasurer,  Mr.  A  ChilUngworth ;  Secre- 
tary, Mr.  W.  Gifford  Nash. 

The  Laryngological  Society  of  London. 

Ths  Laryngological  Society  of  London,  under  the  presi- 
dency of  Dr.  Felix  Semon,  has  made  great  progress,  and 
at  its  annual  meeting,  which  will  be  held  to-oay  (Wednes- 
day), a  very  satisfactory  report  will  be  read  of  its  work 
during  the  past  year.  The  following  is  the  list  of  officers 
for  the  year  1896,  nominated  by  the  Council :— President^ 
Dr.  Felix  Semon ;  Vice-Presidents,  Dr.  Creeswell  Baker, 
Mr.  Charters  Symonds,  Dr.  Hodfrkinson  ;  Treasurer,  Mr. 
W.  T.  Walsham  ;  Librarian,  Dr.  Clifford  Beale ;  Honorary 
Secretaries,  Mr.  W.  R.  Stewart  and  Dr.  St.  Clair  Thomp- 
son ;  Council,  Dr.  J.  B.  Ball,  Dr.  F.  W.  Bennett,  Dr.  T. 
W.  Bond,  Dr.  Scanes  Spicer,  and  Dr.  Watson  Williams. 
The  meeting  will  be  followed  by  a  dinner  in  the  Caf^ 
Royal,  the  President  in  the  chair. 

PASS    LISTS. 

University  of  London,  1895,  B.S.  Examination. 
The  following  is  an  Official  List  of  Candidates  who 
passed  the  recent  Examination  for  Honours  in  Surgery, 
arranged  in  the  order  of  merit. 

First  Class. 

Turner,  William,  (Scholanblp  and  Gold  Hedal)  King's  CoUoge. 

KiUMll,  Alfred  Ernest,  ((iold  Medal)  St.  Thomas's  HospitaL 
(a)  Shaw,  Harold  Bstty,  University  College. 

Hnll,  Charlotte  Elizabeth.  Royal  Free  BoepltaL 

Hant,  George  Bertram,  University  College. 

Sloane,  John  Stretton.  B.Sc,  St.  Bartholomew's  HospitaL 

Pagh,  William  Thomas  Gordon,  Middlesex  Hospital. 

Barnard,  Hszold  Leslie,  London  Hospital. 

SSOOHD  CLASS 

Thomas.  Thomas  Morrel ,  Gay's  HospitaL 

Berry,  Franoas  May  D.,  M.D.,  London  School   of  Medicine  to 

Women  andBoyal  Free  Hospital. 
Chaning-Pearoe,  David  Arnold,  Guy's  Hospital 
(a)  Obtained  the  Number  of  Marks  qoalii^iig  for  a  Gold  Medal 


48      Tbx  Mimoal  Pbhs. 


NOTICES  TO  C»BKE8P0M)ENTS. 


Jak.  8,  ia»> 


CxrrrtByowbfirtg,  §\mt  'ptttxe,  &c 

§^  OosBHFOVDnrTB  mqaMng  a  reply  In  thla  oolimiii  are  par* 
tloularly  requeued  to  make  um  of  a  dCtMneMM  rignaitw  er  iMtkOt, 
and  aTold  the  praotloe  of  ilgnlng  themMlTee  *'  Beader,"  "  BnbeornMr," 
'*  OldBnlMaifberi''  Ao.  Much  oonfoskm  win  be  ipared  hf  attention 
to  thla  rule. 

0Biara4L  ABnouB  or  LmiM  intended  for  pnbUoatton  dioiild  be 
written  on  one  dde  of  the  paoer  only,  and  nut  be  anthentioated  with 
the  name  and  addren  off  the  writer,  not  BeoeenrOy  for  pnfaUoaMoa, 
but  aa  evldenoe  of  Identity. 

LOOAL  BiFOBn  AMD  KiWB-OoneepoDdoBte 
•ttentloB  to  theee  are  rsqaeited  kindlf  to  mark  the 
•ending  them  to  the  Idltor. 

KRPBms.— Anttaon  of  pepen  reqniifng  reprlnta  In  pamphlet  form 
after  they  have  appeared  In  theie  oolnmna  ean  have  tiiem  at  half  the 
nioal  coet,  on  applloatlon  to  the  printen before  type  li  broken  np. 

BSADiNO  GA81S. -Cloth  board  oaiei,  gilt^ettered,  oootelaingtwenty- 
■Iz  ■trlngi  for  holding  the  nambere  of  Thi  Midioal  PU08  AHD 
CISOULAB,  may  now  be  had  at  either  oflloe  of  tUa  Journal,  prIeeSi.  6d. 
Theie  casee  will  be  found  yery  naefni  to  keep  eaoh  weehtrnnmber 
Intaot,  olean,  and  flat  after  It  haa  paaaed  through  the  poet. 

M.D.Loin>.— We  have  heard  of  the  anggeaUon  before ;  It  la,  there- 
fore, not  new,  aa  onr  oorreipondent  anppoeea.  A  praotitlom  r  In  Bir- 
mingham, we  believe,  waa  the  flnt  to  draw  attention  to  the  matter. 

O.  L.  T.— Oar  correapondent  la  thanked  for  hia  oommnnlcatlon, 
which  will  be  dnly  comddered. 

GBU8BBD  AOAIH.— "  lao't  it  awfol  r  "  aaid  Mn.  Jenka  to  her  hnaband. 
"  Ian*t  what  awful  t  *'  qaerled  Jenka^  "  Honaton'a  boy  waa  nm  over 
and  reodred  iDfemal  iojnriea."  "  Internal,  yon  mean."  "  Ko.  I 
mean  infernal.  I  know  wliat  I  am  talUng  abont"  After  a  qnarrel  of 
fire  minatea,  Jenka  prodnoed  a  diofiionary,  and  with  oonalderable 
trouble  managed  to  find  "  InferoaL"  '<  There  I "  he  ezolatmed,  "  I 
told  yon  ao.  Infernal  meana,  'relating  to  the  lower  regiona."' 
*'  Well,"  replied  Mia.  Jenka,  and  there  waa  a  ring  of  triumph  in  her 
▼oioe,"aln1  that  where  he  waa  injoredt" 

Dr.  S.— ^e  hare  referred  to  the  matter  In  another  oolumn.  Onr 
oorreapondent  la  thanked  for  hla  oommunloatloo. 

aruDMHT.—Dr.  Bwanzy'a  book  on  the  Eye  will  anawer  erery  porpoae. 
It  ia  publiahed  by  Mr.  Lewii,  Gower  Street,  London,  W.G. 

De.  BLADi  (Torquay)  la  thanked  for  hia  note. 

MR.  B.  S.  G.  will  find  the  aubjeot  ref enedto  In  our '  •  Literary  ITotea  " 
column. 

Dr.  jAOKflON.— The  matter  la  likely  to  occupy  the  attention  of  the 
G-eneral  Medical  Gouncil  at  Ita  next  meeting. 

MR.  WIL80H  la  thanked  for  hla  contribution,  but  It  ia  acaroely  auited 
for  the  columna  of  a  medical  JonmaL 

F.R.a8.I.— No  information  upon  the  aabjeot  haa  reached  ua  ao  tar, 

M.D.  (Leloeater).— Before  taklog  any  aotion  in  the  matter  we  ahoald 
recommend  our  correapondent  to  make  farther  Inquiriea. 
THE  GLIMATS  07  ENGLAND. 

THOSE  of  our  readera  who  are  apecially  intereated  in  thla  aubject  will 
be  glad  to  be  informed  that  Dr.  E.  Symea  Thompaon,  Oreaham  Profea- 
aor  of  Medicine,  will  deliver  a  free  courae  of  Lecturea  oo  the  aubject  at 
Greaham  College,  London,  on  Jan.  21at,  22nd,  28rd,  and  24th,  at  e  p.m. 
each  evening. 

PnrsAiOR  (London).~We  do  not  beUere  that  any  aotion  at  law  oould 
be  commenced  with  auch  an  object. 

GiNiRAL  Practitionir  (ExeterX— Our  oorreapoodent'a  letter  haa 
been  handed  to  our  publiahera.  who  will  attend  to  hia  reqneat 

^etrnga  of  tht  ^oarttea 

WlDiraaDAT,  JAM.  8IB. 

HUHTIRIAH  SodBTT.— 8.80  p.m.  Dr.  J.  H.  Bequeira :  Chronic 
Pnaryngeal  Atfectiona  and  their  Relation  to  Diphtheria.  Dr.  Fortea- 
cue  Fox :  Localised  Rbeamatold  ArthritU.— Mr.  Percy  Warner :  Some 
Notea  of  a  cjise  of  Typhlitis.  „  ^  „ 

Lartaooloqical  BoontT  OS  LoNDOH  (20  Hanover  Sqaare,  W.).— 
4.80  p.m.  Annual  General  Meeting.  Gasea,  Bpecimena,  Ac,  by  the 
President,  Dr.  Barclay  Baron,  Dr.  J.  W.  Bond,  Dr.  Bronnor,  Dr. 
Cooper  Crippa,  Dr.  William  Htli,  Dr.  David  Newman,  Mr.  G.  A.  Parker, 
Dr.  Soanea  Spioer,  Dr.  Ht  Clair  Ttiomson,  and  Dr.  Herbert  TUley. 
8  p.m.    Annual  Dinner  (Otf^  Royal). 

BouTB-WxsT  LoNDOH  Medioal  BocfiBTT  (Windmill  Houae,  Clapham 
Common).  8.80  p.m.  Mr.  W.  G.  Dickluaon :  Profeaalonal  tJnioniam. 
A  Diacuaaion  will  follow. 

Thursday,  Jar.  9th. 

British  Gtiijboolooioal  Booirtt  (20  Hanover  Square,  W.).— 6.80 
p.m.  Mr.  Fredk  Edge  (Wolverhampton) :  Notes  on  a  caae  of  a  Para- 
atero  Vaginal  Fibroid  Tumour  treated  by  Removal  of  the  Appendagea 
and  Diaaection  oat  of  the  Growth.  Mr.  Bowreman  Jeaaett :  The  Diffl- 
colting  of  Diagnoaing  Early  Carcinoma  of  the  Body  of  the  tJterna  (with 
apecimenX 

Harvriar  Sooiett.— Mr.  Edmund  Owen:  Children'a  Spinea- 
Healihy,  Unhealthy  and  Otherwiae. 

North  Lomdoh  Medioal  ard  Chiruroioal  Booiitt  (Great  Northern 
Central  Hoapital,  Hoiioway).  -  8.80  p.m.  Bpedmena  and  Clinical 
Caaea.  Dr.  Arthur  Wilson:  Caae  of  Perforating  Ulcer  of  the  Stomach. 
Dr.  G.  B.  Beevor :  Caae  of  Arsenical  Neuritia.    And  other  caaea. 


rirtt.— 4  p.m.  A  Qnartnrhr  Oanewl 
Ken,  M.D.,  F.L,&,  In  UM  Chair. 
}.» Member:  The  Pknper  MflChodof 


BOOIBTT  FOR  THl  STUDTOF  InBRnTT.— 4  p.m. 

Meeting,  the  Pnaldent,  Norman  K(       --  -^    - 
Paper  :-W.  H.  Eeeteven,  M.B.G.8.. 
Dealing  with  Habitual  Dmnkarda. 

FRIDAT,  JAV.  lOTff. 

OURiflAZ  Sooorr  or  Lorpov.— Dr.  David  Vewman 
Bydtfo^ephrosia  and  Tranilene  iUbumlnurla  in  oaaea 
KUney.—Dr.  Lee  Dicklnaon :  Qhnea  of  Bpontaneona  IlireiBbMlaoC  the 
Cerebral  Veina  and  Binnaee  In  Chloroala.— Dr  Ringer  and  Dr.  A.  G. 
Fhear :  A  caae  of  Addlaoo'a  Dlaeaae,  treated  with  Supra-Renal  SxT  -^ 
(with  an  abatract  of  prevtooaly  raeorded  eaaee>  Dr.  Hale  Wliile : 
oaaea  of  Pneumo-Thoraz  In  the  oeoiae  cf  I^phoid  FVrer,  hmI  beii 
to  itraiiringat  atooL 

MORDAT,  Jar.  lanL 

Odovtolooioal  SoomT  OF  Grras  BmiAnr.— gp.aB.    Dr. 
W.  Buxton  will  read  a  paper  entitled  "  An  Appended  Note  aa.  An 
Aeala."    Oaanal  Gommnmeatlon:-  "  .^^      - 

OpenBne." 


.  J.  F.  Colyer:  •' Aome  Obmb  ef 


l^tti&nttzB. 


UpWiHk 


1 10th 


Carrlok^n-Sulr  UDlon.~inght  Noraea.    Salary  £26  j. 

rationa  and  apartmenta.    Eleotion  11th  January  (aee  tArtX 
Medioal  Reglatrar.-Branoh  Medioal  ConnoU,  Ireland.    ~~ 

January  (aee  advt.). 
Metropolitan  Aaylnma  Board.— Aaslatant  Medioal  OAosr  for  the 

Small-pox  Hoapital  Shipa  on  the  Ihamea.    Salary  oommenelng  at 

£180,  with  board,  lodging,  and  attaodaade.     ApplleactkMia  to  the 

Clerk  of  the  Boerd  (see  advt.). 


S^ppatmmtxttB 


Bru>ir«.  D.  T;.  £.R.aPXoBd..  M.R  G.8.,  Medical  OAeer  hj  ttw  Ra* 

Derenam  Urban  Dlatrict  Council. 
Garstaro,  T.  W.  H.,  M.  K.C.S.,  Medioal  Offlcercf  Health  by  the  Back- 
low  Rural  Dtotriot  Coancfl. 
HALR.  G.  E.,  M.B.,  B.C.OambL,  L.R.C.P.Lond.,  MJLa&,  Medioal 

Officer  by  the  Eton  Board  of  Guardians. 
PaRR0TT,C.l.  L.R.G.P.,  L.R.C.S.Irel..  Medical  Officer  of  Health  by 

the  Klngawood  Urban  District  Council. 
Pnun,  R.  S..  L.R.G.P.,  L.R.as.Bdia.,  L.F.P.B.01aag.,  Aaalatflai Medi- 
cal Officer  of  the  St.  Andrew's  Dlatrict,  and  Medioal  Officer  of 

the  Ovenatont  Hoapital. 
Rorrrts,  a.  H.,  L.R.O.P.Lond.,  M.R.O.&,  Medical  Officer  of  Health 

for  the  Mailing  Raral  Sanitary  Dlatrict. 
ROR,  A.  J.  S.,  L.R.G.P.,  L.R  CS.IreL,  Realdent  Surgeon  to  the  HnO 

and  BuloGMtee  IMapenaary. 
RoR,  A.  L.,  L.R.G.P.,  L.R.C.S.I.,  Honorary  Ophthalmic  Suiveon  to  the 

Hull  and  Scalcoatea  Dispensary. 
SADLIR,  F.  J.,  K.&,  B.Oh.,  Oxon..  Aaalatant  Medical  Ofloer  of  Heath 

by  the  Bamaley  Town  Council. 
Srowrall,  W.,  M.B.,  Ch.&>A«lb.,  L.R.C.S.EdIn.,  a  Member  of  the 

Medical  Board  of  Victoria,  Australia. 
SFldR,  S.,  M.D.Lond.,  M  R.G.S.,  an  Honorary  Phyaleian  to  the  Royal 

Society  of  Mnaleiana  of  <ireat  Britain. 
STEWART,  G.  K,  M.B.,  C.M.E^ln.,  AsalaUnt  Houae  Surgeon  to  the 

S«iart>orough  Hoapital  and  Diapenaary. 
THOMPSOH,  H.  «;.,  lf.D.Lond.,  M.li.U.P.,  Medical  Regtotrar  to  the 

Middleaex  HoapitaL 


firtltd. 


ALRZAHDRR.-Jan.  5th,  atXeoumaeh  Houae,  Southaea,  the  wife  of  B 

P.  Alexander,  M.D.,  M.R.as.,  of  aaon. 
ALLPORT.~Dec.  24th,  at  Wilsham.  Oaaewlck  Road,  Norwood,  thewlfe 

of  Alfred  Allport,  M.R.G.&,  of  a  daughter. 
Errt.— Dec.  28rd,  at  8  Mlnard  Terrace,  Partlok  HOI,  Ola«gow,  the 

wife  of  R.  T.  Kent.  M.  AOxon.,  F.R.C.S.,  of  a  aon. 
WiLRiRSOR.— Dec.  2eth.  at  Kirton.  Boaton,  Unoohiahire,  the  wife  of 

John  Wilkinaon,  M.&,  G.M.Bdln.,  of  a  daughter. 


GR08S-HARKRR.~Dec  28th,  at  the  Pariah  Ohurch,  Blaxhall,  SaffoUc, 
Charlea  Frederick  Groea,  M.R.(:.B.,  L.R.C.P.,  aon  of  Arthur  B|mr- 
ling  Groaa,  of  Woodbridge,  to  Dorothy  Lucy,  younger  danghter  of 
the  late  Jamea  Camming  Barker,  of  LiverpooL 


§znt}xB. 


FTRRROH-MnLLER.— Dec.  28th,  at  hla  reaidence.  at  16  Warringtoo 
Place,  Dublin,  Fleet-Sorgeon  St.  Lawrence  Ffrench-MuUen,  R.N.r 
M.D.  (retired). 

FlBOH.— Jan.  2nd,  ISM,  at  Weatvllle,  St.  Mary  Churoh,  Torquay, 
Thoa.  Finch,  M.D.,  M.R.C.S. 

HiLLES.— Dec.  Slat,  at  his  reaidence,  Elm  View,  Highfleld  Road  Rath- 
gar,  Malcolm  WiUiam  HiUea,  L.R.C.S.I ,  in  the  80th  year  of  hli^ 
age. 

HURT.— Dec  27th,  suddenly,  at  Cbriatchureh,  Hanta,  Bertram  Hunt,. 
M.B.Oxon.,  M.R.C.S.,  i«ed  89. 

Jaoksov.-  Dec.  29th,  at  53  Wilkinaon  Street,  Sheffield,  Arthur  Ja^aon^ 
M.R.G.S.Eng.,  in  hia  52Dd  year.  _ 

Jaorsor.— Dec.  22nd,  at  Shepherd's  Bnah,  London,  Richard  Jadooiu 
M.R.C.8.  (Eng .).  L.R.C.P.  (Lend.).  L.S.A.  (Lond.^  fourth  aon  of 
the  Ute  Richard  Jackaon,  Beechwood  Houae,  Fnlford  Soad» 
York. 

NOTICE— AmumnctinenU  0/  JJiriluf,  Marriaget,  and  DeaUa  iat*4 
famUiei  cf  Subeeriben  to  this  Journal  at*  inMerUd  fr«e,  amd  aMtfl 
naeh  ihepnUitken  not  later  than  the  Monday  prtc$ding  piOUeutim, 


Wkt  ^dml  ^m6  mA  dmrnht 


>SALX7B    POPULI    SUPREMA    LEX." 


Youcxn. 


WEDNESDAY,    JANUARY    15,     1896. 


Na3. 


OK 

THE  DIAGNOSIS   OF  INSANITY. 

By  THEO.  B.  HYSLOP,  M.D., 


lo  St  Mary'f  Hotpttal  Medioal  School, 
Fhjiielaii  to  Bettilem  Bojtt  Ho«pitaL 

Lbctube  ni. 

OVB  social  eoYironmeiit  may  influence  us  morally 
Mad  mteUecfenally,  and  it  is  nndoabtedly  owing  to  oar 
eoofennity  to  the  relatiye  dnties  of  social  life  that  we 
idopt  our  prevailing  tone  of  thoag[ht  and  condnct  As 
we  adTanoe  in  life  these  social  inflnences  j^radoally 
incroano  in  comjAezity.  How  moral  law  mflnences 
social  lif  e»  organisation,  and  goyemment  is  too  complex 
s  qaeBtion;to  consider ;  here  we  have  but  to  note  that 
Dsmbers  of  a  society  may  combine  to  predispose  the 
ireneration  of  a  morbid  p^hosis.  Epidemics  of 
feverish  ezcitenient,  ezcesdye  religions  enthusiasm, 
ind  even  insanity,  at  times  affect  vast  numbers  of 
psople.  These  neurotic  storms  have  been  described 
elaewh«re(a)  as  having  been  characterised  as  purely 
msntal  or  moral  perversions,  or  as  physical  aberrations 
secondary  to  physical  contagion. 

The  insane  are  apt  to  derive  their  delusions  from 
vhstever  excites  much  public  attention.  The  revolting 
erimes  as  recorded  in  our  daily  paf)ers  are  apt  to  infla- 
eoce  the  direction  of  the  morbid  thoughts  of  the 
ineane.    Thus,  for  instance,  during  the  period  of  the 
Whitechapel  murders  innumerable  patients  accused 
themselves  or   others  of   being   Jack   the   Ripper, 
loaani^  may  be  endemic,  or  it  may  extend  and  become 
epidemic    The  perversions  may  manifest  themselves 
m  the  form   ot    illusions    or  pure   hallucinations 
which  affect   many  persons  at  the  same  moment ; 
Borbid  peychoses  in  which  there  may  be  melancholia ; 
exeessive  retigions  seal,  political  or  pseudo-scientific 
intemperance;  sensoi^  perversions  with ecstacy, im- 
pulses and  morbid  activities ;  actual  convulsive  attacks 
M  in  the  various  epidemics  of  hysteria,  epilepsy,  and 
efaorea.    In  dealing  with  insane  people,  tnerefore,  we 
have  to  remember  that  what  we  accept  as  evidence  of 
insanity  may  be  but  an  endemic  or  epidemicpnrcopathy 
which  exists  throughout  a  large  number  of  inoividuals. 
Some  religioas  delusions  are  confined  to  the  members 
of  particular  religious  bodies,  but^  however  widely 
thej  differ  from  our  standard  of  truth  it  is  well  to 
estimate  them  as  possibly  fallacious  beUefs  and  not  as 
inane  delusions.    Later  we  shall  have  to  speak  more 
particolarly  about  insane  delusions,  so  now  we  have 
meraly  to  note  that  religious  delusions  mav  arise  in 
ooonection  with  various  evolutionary  epochs  and  in 
•noeiation  with  various  physical  states.    Thus,  they 
•ocompany  the  mental  development  of  over-stimulated 
and  iiyudieiously  educated  children  (fear,  remorse,  <fec.), 
ih^  characterise  the  insanity  of   pubescence  (fear, 
depression,  and  wish  to  do  penance) ;  they  are  caused 
\ij  self-abose   (self-HX>nBciou8,   unpajrdonable  sinners, 
weak-minded,  auditory  hallucinations,  trances,  ecsta- 
nesy  suicides) ;  in  association  with  so-called  paronia 


(a)  '•  Montal  Fhjilology.' 


(delusions  of  superior  spirituality,  fanaticism) ;  with 
epilepsy,  dementia,  and  general  paralysis  (rarely  fear, 
usually  unworthiness,  or  exalted  idess) ;  in  melan- 
cholia and  climacteric  insanity  (unworthiness^  fear  of 
endless  life) ;  in  chronic  mania  or  toxic  insanity 
(usually  exalted). 

Having  now  ascertained  as  far  as  possible  whether 
there  has  existed  any  hereditary  or  social  factors  which 
would  tend  to  influence  the  nature  of  the  case  under 
consideration,  we  next  proceed  to  the  study  of  other 
factors  which  tend  to  modif:[r  the  life-lustorv  of  the 
individual.    These  factors,  briefly  enumerated,  are  :— 

1.  Causes  acting  on  the  parents  at  time  of  preg- 
nancnr:— 

(a)  Maternal  impressions. 

(b)  Moral  causes,  shock,  g;ynagogues,  &c. 

(c)  Disease  of  parent  during  pregnancy.    (Fevers, 

((f)  Accidental  causes  at  birth,  such  as,  prema- 
ture, difficult,  or  instrumental  delivery, 
asphyxia  neonatorum,  primogeniture. 

2.  The  temperament,  constitution,  or  diathesis  of  the 
patient. 

3.  The  influence  of  general  surroundings : — 

(a)  Seasons  and  climate,  moon,  &c. 

(b)  Occupations. 

(c)  Town  and  country  life. 

4.  Accidental  factors,  such  as  :— 

a)  Domestic  troubles  and  grief. 

[h)  Religious  anxiety  and  excitement 

c)  Disappointed  affections. 

.  ')  Fear  and  fright 

»  Intense  study. 

if)  Political  and  other  excitement 

(^)  Wounded  f eeUnjss. 

Considered  in  detail,  it  will  be  noted  that  most  of 
these  factors  give  some  clue  to  the  nature  of  the  case 
before  you,  and^  therefore,  their  consideration  cannot 
be  dispensed  with. 

Maternal  vnpresaiona  are  regarded  as  giving  rise  to 
morbid,  mental,  and  bodily  defects.  In  a  paper  read 
before  the  Obstetrical  Society  of  London,  May  7th, 
1884,  Dr.,  now  Sir,  Arthur  Mitchell,  Commissioner  in 
Lunacy  for  Scotland,  stated  that  in  6  cases  out  of  443 
in  which  an  effort  was  made  to  establish  a  cause  for 
idiocv,  the  influence  of  maternal  impressions  was 
clearly  traceable.  Any  prolonged  distress  is  more  apt 
to  produce  bad  effects  than  a  sudden  shock  or  fright, 
and  this  more  readily  during  the  later  months  of  preg- 
nancy. Undoubtedly  bodily  defects  attributable  to 
maternal  impressions  are  far  morecommon  than  mental. 
Whether  the  mental  or  bodily  defects  are  accidental, 
and  whether  there  is  direct  relation  between  the  brain 
structures  of  the  parent  and  child,  are  Questions  which 
we  are  unable  to  answer.  With  regard  to  Uie  defect 
in  the  child  simulating  the  object  causing  the  impres- 
sion upon  the  mother  it  has  been  pointed  out  by 
Dabney  that  out  of  90  cases  there  was  quite  a  dose 
correspondence  in  69.  Another  point  urged  by  the 
same  observer  is,  that  it  is  not  necessary  for  a  mother 
to  expect  a  defect  in  the  child  for  such  a  defect  to 
occur,  whether  this  defect  be  mental  or  bodily.  The 
various  conditions  that  unfavourably  influence  the 
footus  in  utero  may  be :— (a)  Nervous  disturbance  in 
the  mother.    Hirst  records  a  case  in  which  a  woman. 


50     Ths  Msdioal  Press. 


ORIGINAL  COMMUNICATIONS. 


3as.  15.  1896- 


while  carrying  her  child  in  utero.  took  delight  in 
watching  her  husband,  a  batcher,  ply  his  trade,  the 
child  subseqaently  developing  an  irresistible  inclina- 
tion to  torture  and  slay,  (o)  Malnutrition  in  the 
mother  is  sometimes  accountable  for  defective  children, 
(c)  Diseases  of  the  endometrium,  the  womb  and  its 
aanexa.  (d)  Alterations  in  tiie  maternal  blood 
pressure,  and  (e)  Poisons  in  the  maternal  blood 
may  bring  about  morbid  results  in  the  child. 
Various  diseases  are  said  to  occur  to  the  f CBtus  in  utero. 
Variola,  rubeola,  scarlatina,  erysipelas,  malaria,  tuber- 
culosis, septicaemia,  sjrphilis,  cholera,  typhoid,  articular 
rheumatism,  recurrent  fever,  yellow  fever,  pneumonia, 
rachitis,  anasarca,  spontaneous  fractures,  luxations 
and  ankylosis,  intra-uterine  amputations,  perforations 
of  intestines,  are  described  as  affecting  the  growth  and 
development  of  the  foetus.  Intracranial  injuries  are 
liable  to  occur  in  difficult  deliveries  whether  the 
labours  are  spontaneous  or  instrumental.  Meningeal 
haemorrhage,  rupture  of  the  longitudinal  sinus,  with 
extravasation  ol  blood  over  the  convolutions  may  give 
rise  to  convulsions,  asphyxia,  and  in  some 
spastic  hemiplegia.  Prolonged  labour  and  i 
delivery  is  the  assigned  cause  of  many  cases  of 
Shuttleworth  found  that  prolonged  labour 
instrumental  interference  was  the  cause  of 
29  per  cent,  of  the  cases  admitted  to  the  RoyI 
Asylum.  iHe  believes  that  judicious  insi 
interference  will  sometimes  prevent  such  evi 
don  Down  traced  in  twentjr  per  cent,  of  2,i 
suspended  animation  at  birth.  Griesinger  lays 
stress  upon  great  ansemia  of  the  mother  as  a  casual 
element  of  idiocy.  Primogeniture  is  regarded  by  some 
as  a  predisposing  element. 

Those  psycho-physical  differences  between  men  which 
are  designated  as  temperaments  are  of  interest.  When 
we  consider  the  four  temperaments  described  by  the 
ancients,  we  find  that  pathological  conditions  of  the 
mind  can  be  assigned  to  them  wi^  a  certain  amount 
of  appropriateness.  In  general,  the  ancients  found 
either  a  predominant  spontaneity  or  a  predominant 
receptivity.  The  former  gave  the  active,  the 
latter  the  passive  temperament,  whilst  from  the 
Cheater  or  less  permanency  of  actions  or  impres- 
sions, they  devised  a  fourfold  subdivision.  These  four 
temperaments  were  :  The  sanguine  with  receptivity 
easily  but  not  deeply  affected ;  the  melancholic 
with  receptivity  capaole  of  being  deeply  affected ; 
the  choleric  with  quick,  vigorous  but  not  durable 
activity,  and  the  phlegmatic  with  slow  but  endur- 
ing activity.  Vive  la  bagatelle,  as  the  motto  of  the 
sanguine  type,  carries  its  own  consequences.  The 
general  paralytic,  who  believes  that  he  is  the  happy 
possessor  of  fabulous  wealth,  and  seeks  to  benefit 
mankind  in  general,  is  frequently  an  individual  of 
the  sanguine  type,  who  formerly  built  castles  in  the 
air,  but  who  now  realises  them  pathologically.  The 
feeling  of  well-being,  and  the  desire  to  benefit  others, 
are  but  part  of  the  individual.  H^'s  perverted  and 
exalted  notions  have  their  root  in  th>it  sympathetic 
feeling  and  inclination  for  sociability  so  prevalent  in 
this  temperament.  General  paralysis  occurring  in 
a  person  of  the  melancholic  temperament  is  rarely  of 
the  expansive  and  benevolent  type.  The  delusions 
are  of  a  melancholic  complexion,  or,  if  they  are  exalted, 
the  exaltation  is  of  a  selfish  and  egotistical  kind. 

The  influence  of  seasons  and  climate  in  the  produc- 
tion of  mental  disease  is  a  subject  of  considerable 
interest  and  one  to  which  a  good  deal  of  attention 
has  been  given.  Parchappe,  EsquiroL  Guislain. 
Aubanel,  Thore,  and  others,  observe  as  tne  result  ot 
their  investi^tions  that  attacks  of  insanity  are  more 
frequent  during  the  summer  months.  Guislain  believes 
there  is  a  relation  between  the  warmth  of  the  atmo- 
sphere and  mental  disturbance.  A  lenji^hy  considera- 
tion of  the  atmospheric  influences,  with  the  relative 


value  of  heat,  humidity,  and  the  influence  of  the  variooa 
winds  as  a  cause  of  cerebral  injury,  would  be  out  of 
place  here,  so  I  propose  merely  to  mention  a  few  points 
of  interest.  Although  high  temperature  and  rarefica- 
tion  of  the  air,  with  its  direct  sedative  effects 
—quick  evaporation  from  and  inspissatioQ  of 
the  blood,  results  in  venalisation  and  diminished 
supply  of  oxygen  at  each  inspiration,  yet  fatigue, 
bodilv  excesses,  alcoholic,  oietetic,  or  sexoal, 
and  the  existence  of  other  constitutional  maladies,  con- 
stitute by  far  the  most  important  factors  in  the  pro- 
duction of  mental  disorders.  Wallther's  experiments 
show  that  the  heat  from  the  streaming  rays  of  the  son 
can  be  actually  absorbed  by  the  skin.  It  would 
appear  more  probable,  however,  that  it  is  by  the  com- 
bination of  the  sun's  rap,  a  heated  atmosphere,  and  a 
relative  amount  of  humidity,  acting  tof^ther,  that  heat 
is  retained  in  the  body.  As  a  true  exciting  cause,  heat, 
direct  and  indirect,  may  be  an  effective  cause,  bat 
hygrometric  and  barometric  states  of  the  atmosphere 
have  a  special  influence  upon  the  general  vigour  of  the 
and  render  a  person  more  or  less  sns- 
i,  and  in  this  wa^  predispose  him  to 
When  sunstroke  is  being  conaidered  I 
attention  to  its  factors  of  causation, 
if  occupation  in  the  production  of 
it  of  interest,  but  one  to  which  we 
scant  attention.  The  ratio  (i)er 
ly  average  of  the  number  of  lunatics 
or  occupation,  admitted  to  asylums 
years  1889  to  1893  inclusive)  to  the 
ion  in  each  profession,  or  occai>ation,  at 
the  time"  of  the  Census  of  1891  (CommiBsionen' 
Report)  was  as  follows  :— Hucksters,  costermon^eis, 
hawkers,  pedlars,  201  males,  36*9  females.  Physicians, 
surgeons,  and  general  practitioners,  15*8  males.  Wool- 
staplers,  cloth,  worsted,  stuff,  flannel,  blanket,  silk 
merchants  and  dealers,  cotton  and  calico  warehouse- 
men and  dealers,  linen,  lace,  fustian,  tape,  thread 
dealers,  Manchester  warehousemen,  18*2  males,  24*4 
females.  Chimney  sweeps  and  soot  merchants,  14'2 
males.  Chemists  and  druggists,  141  miales.  The 
other  occupations  all  range  below  12*6.  The 
reason  why  hawkers  head  the  list  is  uncertain.  The 
medical  profession  stands  midway  between  warehouse 
work  and  chimney-sweeping.  One  point  to  be  noted  is, 
that  althou{;h  general  paralysis  is  scarcely  known  in 
some  localities,  when  the  people  from  theselocaliiiesgo 
to  towns  and  large  centres  of  civilisation  they  are  just 
as  liable  to  suffer  as  others. 

Of  the  accidental  factors  which  cause  insanity  the 
most  common  are  : — Domestic  trouble  (including  loss 
of  relatives  and  friends) ;  adverse  circamsta&oes 
(including  business  anxieties  and  pecuniary  difficul- 
ties). About  5  per  cent,  of  all  cases  of  insanity  are 
due  to  such  causes.  Overwork  is  not  infrequently  the 
assigned  cause,  and  undoubtedly  too  lon^  hours,  or  too 
close  occupation,  with  neglect  of  the  ordinary  rules  for 
health,  will  result  in  mental  breakdown.  The  friends 
of  patients  are  very  apt  to  assign  this  as  a  cause ;  but 
it  is  more  common  to  find  that  worry  or  anxiety  has  been 
the  more  important  factor.  One  patient  was  admitted 
to  Bethlem  suffering  from  acute  mania,  supposed  to  be 
due  to  overwork ;  an  amended  certificate^  however, 
assigned  as  the  cause  "over-religious  conscientiousness 
and  pediculosis.*'  Careful  investigation  will  generally 
result  in  the  discovery  of  a  combination  of  causes 
which  together  act  as  factors  in  the  production  of 
stress  or  strain. 

Religious  excitement  is  alao  not  infrequently  an 
assigned  cause.  I  have  stated  elsewhere  m^  belief  that 
the  philosophy  of  the  infinite,  far  from  bein^  a  source 
of  aberrations  of  thought,  is  the  ultimate  point  of  our 
evolution.  A  true  and  philosophical  reli^on  raises  the 
mind  above  a  mere  incidental  emotionalism,  and  givw 
stability.    With  no  religion,  and  no  valval  obligation 


Jak.  15,1896. 


ORIGINAL  COMMUNICATIONS. 


Thb  Medioal  Pans.     51 


the  organiam  is  apt  to  become  a  prey  to  the  lasts  of  the 
flesh  and  their  consequences.  Gasquet  observes,  that 
rriigioD  may  either  produce  or  tend  to  hinder  unsound- 
ness of  mind  ;  that  it  may  cause  certain  symptoms  of 
ioflanity  or  modify  them ;  and  lastly,  that  it  may  be 
employed  as  a  means  of  moral  prevention  and  treat- 
ment He  believes  that  every  form  of  religion,  how- 
ever widely  it  may  differ  from  our  standard  of  the 
truth,  if  it  enforces  the  precepts  of  moralitv,  is  a  source 
of  strength  to  the  sound  mind  that  sincerely  accepts  it. 
Clouston  has  justly  observed  that  far  more  depends 
npon  the  brain  that  goes  to  church  than  upon  what  it 
may  obtain  in  the  church.  That  is  to  say,  there  must 
be  the  predisposition  to  break  down^  the  religious 
infiuenoe  being  often  merely  an  accident.  It  must 
also  be  remembered  that  religious  over-enthusiasm 
m^  be  merely  a  symptom  and  not  a  cause. 

Love  affairs  do  sometimes  act  as  exciting  causes  of 
insanity.  Disappointment  at  being  jilted  has  been 
the  main  factor  of  causation  in  several  cases  recently 
admitted  to  Bethlem.  Some  youths  breakdown  when 
they  become  engaged  to  be  m'^rried,  owing  to  nervous- 
ness and  fear  lest  they  should  not  be  able  to  perform 
their  sexual  f auctions  satisfactorily.  I  have  seen  not 
a  few  of  theee  cases,  and  possibly  some  of  the  suicides 
iriiich  occnr  just  before  marriage  was  to  have  taken 
place  may  be  explained  in  this  way. 

Widowhood,  with  its  unsatisfied  cravings ;  too 
lonely  and  isolated  a  life  ;  the  worries  and  wounded 
feelings  in  the  trying  life  of  a  governess,  all  may  be 
assigned  as  potent  factors  in  the  production  of  morbid 
psychoses. 

{To  he  ccmttnued,) 


DIMINISHED  RE3PIRA.T0RY  FUNG- 
TION  AND  FATTY  D EGENER  A.TION 
IN  TROPICAL  CLIMATES. 

I      By  SuRQW)N-GBifBRi.L  CHAS.  R  FRA.NCIS,  M.B., 
I  M.R.C.P.  Lend., 

)        rannetly  of  H.lf.  Indiftu  Army,  and  OfflcUttng  Profeasor  of  Medicine 
i  in  the  Medical  College,  Calcatta. 

In  his  paper  on  "The  Effects  of  Cliange  of  Climate 
on  the  Human  Economy,"  published  in  the  *'  Proceed- 
ings of  the  Royal  Society"  (1869-72),  Surgeon  A. 
Bittray,  B.N.,  states  that  there  is  a  diminution  of  the 
respiratory  function  in  persons  going  from  a  cold  to  a 
hot  climate,  causing  thereby  a  reduced  elimination  of 
carbon  by  the  lungs,  It  had  already  been  shown  by 
Tieiordt  and  Ludwig  (quoted  hj[  Professor  Parkes)  that 
heat  lessens  the  number  of  respirations  in  animals. 

When  attached  to  the  Medical  College,  Calcutta,  in 
1865-66, 1  observed  (and  recorded  the  observation  in 
ih»  Indian  Medical  Gazette)  that  the  lungs  of  Euro- 
peans who  had  lived  and  died  in  the  plains  of  India 
were  lighter  than  the  average  weight  of  these  organs 
in  England.  Noticing  this  statement  in  his  "  Practical 
Hyffiene,"  Parkes,  who  some  years  previously,  when  in 
Lidia,  had  remarked  the  same  condition  in  the  lungs  of 
persons  dying  from  cholera,  expressed  his  opinion  that, 
if  these  observations  could  be  verified  by  further  inquiry 
—so  far,  thev  were  toofew--Battray's  experiences  would 
be  confirmed.  Acting  upon  this  hint,  I  applied  to  Sir  A. 
D.  Home,  at  that  time  Director-C^neral  of  the  Army 
Medical  Department,  Bengal ;  to  Dr.  Coates,  Principal 
of  the  Medical  CoUege,  Calcutta ;  to  Dr.  S.  C. 
Mackenzie,  Superintendent  of  the  Presidency  jail 
there ;  and  to  Surgeon-Mcyor  W.  R  Cornish,  Sanitary 
Oomnussioner  for  Madras ;  all  of  whom  not  only 
famished  me  with  the  information  that  I  sought,  but 
procured  for  me,  also,  the  assistance  of  other  medical 
offioera— of  Dr.  J.  F.  P.  McConnell,  Professor  of 
Pithology  in  the  Medical  Cjllege,  Odklcutta  ;  of  Drs. 


Hugh  Johnstone  and  Saffne]^  attached  to  the  College 
Hospital ;  and  of  Surgeon-Major  A.  Porter,  Surgeon  4tn 
District,  Madras,  who  had  contributed  some  notes  on 
the  pathology  of  famine  disease,  including  the  weights 
of  various  organs.  Sir  Anthony  Home  furnished  a 
table  showing  the  weights  of  the  lungs,  liver,  spleen, 
kidneys,  as  also  the  heights,  of  147  European  soldiers, 
who  had  resided,  on  an  avera^,  from  5  to  6  years— the 
maximum  being  24  years  and  the  minimum  1  month 
—in  the  plains  of  India.  It  is  perhaps  to  be  regretted 
that  the  weight  of  the  entire  body,  with  the  propor- 
tionate weight  of  the  lungs,  was  not  given  in  each  case, 
I  applied  for  information  on  the  subject  to  Netley. 
where  the  body  weight,  as  well  as  that  of  organs,  is 
always  taken  ;  but,  unf ortunatelv,  it  was  not  available. 

The  average  weight  of  the  lungs  in  a  temperate 
climate  is,  according  to  Gray,  43  ounces  in  males,  that 
in  females  being  something  less.  According  to  Dr. 
Home's  table,  the  average  weight  in  India  is  38  ounces. 
All  the  phthisical  cases — 12  in  number— in  which 
the  average  weight  was  76  ounces,  (in  one 
case  the  weight  was  114  ounces,  in  another  100 
ounces,  in  three  above  80  ounces,  the  others  also  being 
very  high)— were,  of  course,  excluded  in  striking  the 
average,  together  with  those  in  which  there  was  fnueh 
engorgement— slight  hypostatic  conation  was  not 
considered— from  pneumonia,  from  interference  with 
the  circulation,  or  from  other  causes.  There  mav  have 
been  some  few  cases  due  to  feebleness  of  the  heart's 
action  shortly  before  death.  It  is  probable  that,  if  the 
lungs  had  been  carefully  drained  in  each  case,  the 
weight  would  have  been  even  less.  In  the  tables 
furnished  bv  Drs.  Coates  and  McConnell  the  average 
weight,  excluding  a  case  of  gangrene  (77  ounces),  and 
the  phthisical  cases,  with  those  of  extensive  engoree- 
ment^as  38^  ounces.  Whilst  in  those  prepared  by 
Drs.  Hugh  Johnstone  and  Saffney  it  was  30  and  27 
ounces  respectively.  Among  these  last  most  of  the 
men  had  resided  several  years  in  the  plains  of  India. 
The  European  soldier's  is,  normally,  a  healthy  life  ;  the 
Europeans,  who  resort  in  sickness  to  the  Medical 
College  Hospital,  vary  in  constitution.  A  few  may  be 
hale  and  hearty  sailors  who,  living  for  the  most  part 
at  sea,  are  struck  down  on  arrival  in  a  tropical  port  by 
some  fell  disease— cholera  it  may  be— and  present 
lungs  which,  from  the  sailor's  mode  of  life,  kept  in- 
flated to  the  full,  are  above  the  average  weight.  But 
the  larger  number  are  degenerated  Europeans  who,  for 
many  years,  have  lived  a  life  of  dissipation  in  the  back 
slums  of  Calcutta — a  life  calculated,  in  such  a  climate, 
to  considerably  diminish  the  weight  of  the  lungs.  Eura- 
sians, being  for  the  most  part  born  in  the  country  and 
approximating  to  the  natives  in  habits  and  physique, 
and  whose  lungs  would,  therefore,  be  lighter  than  those 
of  Europeans,  nave  not  been  included.  The  lun^  of 
natives  living  iu  the  plains,  except  in  cases  of  phtmsis, 
or  engorgement,  or  solidification  from  pneumonia,  &c., 
are  always  lighter.  In  the  table  of  82  natives  (ex- 
cluding Chinese,  Portuguese,  and  natives  of  otner 
countries)— there  were  none  from  the  Indian  hills,  un- 
fortunate! v,  for  comparison— furnished  from  the  college 
hospital,  the  average  was  under  30  ounces ;  and,  in  one 
of  d9  males  from  the  presidency  jail,  it  was  29  ounces. 
The  average  weight  ot  the  lungs  in  220  males,  examined 
by  Surgeon-Major  Porter,  was  14'9  ounces  and  12*69 
ounces  in  those  of  152  females,  fiut,  being  famine 
cases,  they  were  not,  of  course,  included, 

The  diminished  weight  of  European  lungs  in  a 
tropical  climate  is  thus— the  size  and  weight  of  an 
organ  being  in  proportion  to  its  activity— in  harmony 
with  Rattray's  observation  of  the  diminished  respira- 
tor;^  function  there.  (Another  inquiry,  however^  is 
desirable,  as  well  in  temperate  and  cold  as  in  tropical 
regions.)  Rattray  founa  that  the  inspirations  were,  in 
the  last,  gentler  and  less  deep— more  superficial  in 
fact — causing  a  difference  of  38*66  cubic  leet  of  car- 


52     Thi  Mbdioai,  Prtbss. 


ORIGINAL  COMMUNICATIONS. 


Jan.  16,  1890. 


bonic  dioxide  eliminated  in  24  hoara,  or  8*157  ounces  of 
carbon  in  a  tropical,  against  10  ounces  in  a  temperate, 
climate  ;  givins  18*43  percent  in  favour  of  the  latter. 
It  is  remarkable  that,  whilst  the  respirations  were 
fewer,  the  spirometic  measurements  were  greater,  due. 
Battrav  belieyed,  to  there  being  more  i^r  but  less  olood 
in  the  lungs. 

The  question  naturally  arises,  What  becomes  of  the 
non-eliminated  carbon  f  Unhappily,  Europeans  with 
means,  so  far  from  reducing  the  quantity  of  food  and 
apportioning  the  q^uality  to  the  requirements  of  the 
system  in  a  not  climate,  are  too  apt  to  increase  the 
former  and  altogether  ignore  the  latter.  Consequently, 
unless  the  excess  of  carbon  be  eliminated  through 
some  emunctory,  it  must  remain  in  the  body,  causing 
fatty  deposits  or  fatty  degeneration  of  tissue.  The 
liver  is  usually  regard^  as  an  organ  that,  in  a  tropical 
climate,  acts  vicariously  for  the  lungs.  But  there  is 
no  decided  evidence  of  this.  It  does  not  appear  that 
there  is  a  daily  compensative  flow  of  bile,  though 
Lawson  ((]^uotes  Parkes)  maintains  that  there  is  an  in- 
creased discharge  of  colouring  matter  through  the 
intestinal  canal.  Undoubtedly,  in  imprudent  indi- 
viduals there  is  a  tendency  to  nepatic  derangements, 
accompanied .  by  an  increased  biliary  flow.  But  they 
do  not  occur  m  a  matter  of  course.  We  cannot  affirm 
tliat  liver  disorder  is  invariably  due  to  climate  which, 
rather,  as  a  rule,  tells  more  upon  the  nervous  system 
in  the  form  of  initiatory,  and— so-called— enteric,  fever. 
One  occasionally  meets  with  Anglo-Indians  who,  ail- 
ing perhaps  from  other  causes,  or,  it  may  be,  not  at 
all,  have  gone  through  a  lengthened  career  in  India 
without  experiencing  any  form  of  hepatic  disorder. 
Increased  perspiration,  especially  in  those  whose  skin 
acts  very  freely,  may,  indeed,  carry  off  some  of  the 
excessive  carbon  ;  but,  after  all,  its  capacity  for  doing 
so  is  limited,  for,  as  compared  with  the  lungs,  its  pro- 
portion is  onl^  1  to  38.  The  fact  of  the  average  weight 
of  the  liver  being  slightly  higher  than  in  the  147 
Europeans  (it  was  a  fraction  over  4  pounds)  proves 
nothing ;  as,  in  a  large  number  there  had  been  irregu- 
larity of  life,  from  which,  especially  as  re^rds  alco- 
holic beverages,  the  liver  would  primarily  suffer. 
There  were  ten  cases  of  abscess,  the  weight  in  one 
being  10  pounds,  of  which  2  nounds  8  ounces  were 
due  to  pus.  Several  had  been  uie  victims  of  malarious 
attacks,  in  which  there  would  be  conation  of  this 
organ  as  well  as  of  the  spleen— all  tending  to  increase 
the  average  weight ;  as  such  cases,  except  where  the 
congestion  was  not  excessive,  were  not  excluded. 

The  kidneys  act  less  freely  than  in  a  temperate 
climate ;  but  as  they  serve  as  a  channel  for  the  removal 
of  waste  lUtrogenous  products,  their  action  in  this  con- 
nection need  not  be  considered.  There  is,  in  fact,  no 
sufficient  outlet  for  the  extra  carbon  which  accumulates, 
not  only  from  diminished  respiration,  but  from  reduced 
ingress  of  oxygen— the  result  of  the  air  becoming  more 
rarefied  in  the  not  season,  especially  in  sandy  districts. 

Sudden  death  in  India  has  been  frequently  found  to 
be  due  to  fatty  degeneration  of  the  heart— more  so  than 
in  a  temperate  climate— the  consequence,  doubtiess,  of 
reduced  combustion.  These  facts  point  to  the  disad- 
vantage of  a  prolonged  continuous  residence  in  the 
pl<Un8  of  India,  and  the  great  benefit  to  be  derived 
from  occasional  changes  to  cooler  climates.  All  cannot 
eigoy  these  climates,  but  all  can  enjoy  free  exercise  in 
the  open  air  in  the  cold  weather,  thus  partially  neutra- 
lising by  freer  expansion  of  the  lunffs  the  diminution 
in  the  hot  months.  It  is  necessary  for  the  lady  who. 
soon  after  sunrise  at  this  season,  has  the  house  darkened 
(all  doors  being  closed),  and  thus  goes  through  a  process 
of  bleaching  for  six  months  or  more ;  for  the  merchant 
in  his  office,  and  for  the  civilian  in  kuU^ierry  (law 
court)  who  spend  their  days  in  a  foul  and  unventilated 
atmosphere.  Herein  the  indigo  and  tea-planters  (pro- 
vided the  localities  where  they  live  are  not  midarious) 


who  are  much  in  the  open  air  all  the  year  round — even 
the  racquet  player  if  an  abstainer  from  pc^s  in  the  hot 
season— have  a  great  advantage.  They,  of  course,  who 
can  get  away  to  the  hills  or  home  from  time  to  time  (as 
in  the  case  of  military  officers  and  civilians)— happv 
they  who  hold  appointments  in  the  former,  are  much 
better  off ;  but,  from  the  European  soldier — except  in 
the  case  of  deserving  non-commissioned  officers  who 
are  sometimes  granted  temporary  leave  of  absence, 
these  facilities  are  withheld.  During  the  last  halt 
century  the  Himalayas  and  other  hills  have  been 
explored  for  the  location  of  European  troops— in 
depdts  for  convalescents,  as  also  in  cantonments  for 
wings  of,  or  for  full,  regiments.  The  last  is  a  most 
important  point  and  cannot  be  too  strongly  inslBted 
upon.  It  would  be  a  great  gain  to  the  Army  in  a 
sanitarv  sense  if,  as  has  been  frequently 
pointed  out,  troops,  instead  of  being  sent  to 
the  hills  after  a  few  years'  residence  in  the  plains 
—a  period  when  sickness  mostly  occurs  from  fevers, 
amongst  the  ^oung  men  especially — were  cantoned,  as 
soon  as  possible  after  landing,  in  a  hill  station,  and 
allowed  to  remain  there  for  two  or  three  years.  Jja  the 
enjoyment  of  the  fine  hill  air  the  men  would  roam 
about,  collect  butterflies  (for  boxes  of  which  there  is 
an  occasional  market  in  India  or  at  home)  and  other 
insects,  or  get  a  day's  shootinff ;  and,  by  thus  giving 
freer  play  to  their  lungs,  contribute  to  further  diminish 
the  loss  to  the  Army,  which,  nearly  7  per  cent 
by  invaliding  and  death,  50  years  ago,  nas  now 
been  reduced  to  less  than  a  third  of  that  figara  In 
barracks  in  the  plains  the  soldier,  in  the  hot  weather, 
spends  half  the  dav  asleep  on  his  back,  and  supplements 
his  rations,  already  rich  in  carbonaceous  ingredients, 
with  fat  bacon  from  the  bazaar.  Such  practices,  com- 
bined with  the  diminished  ingress  of  oxygen  into  the 
lungs,  tend  to  induce  the  fatt^  degeneration,  which 
injures  or  carries  off  so  many  lives,  as  has  been  Mj 
demonstrated  bv  Dr.  N.  C.  Macnamara,  when  in 
medical  charge  of  a  European  regiment,  in  the  10th 
volume  of  the  "  Indian  Annals  of  Medical  Science." 
And  experience  has  shown  that,  if  suddenly  summoned 
from  the  mountains  to  duty  in  the  plains,  European 
troops  do  not  suffer  in  hedth  as  might,  perhaps,  be 
expected-^witness  the  101st  Be^ment.  ordered  from 
Suoathoo  to  take  part  in  the  Siege  of  Delhi  in  tiie 
middle  of  the  hot  weather  of  1857. 

Not  only  does  the  p^rolonged  exposure  to  heat  year 
after  year,  coupled  with  the  monotonous  unezcitiog 
life  in  a  military  cantonment,  tend  to  curtail  the 
healthy  action  of  the  lungs,  but  it  weakens  the  inhibi- 
tory function  of  the  nervous  system,  thus  opening  the 
door  for  the  invasion  of  disease. 

A  word  in  refutation  of  the  theory  that  India,  tht 
hiUs  included^  is  unsuited  for  the  colonisation  of  Earo- 
peans.  I  venture  to  differ  from  their  view,  as  I  think 
we  have  hardly,  as  yet,  had  experience  sufficient  to 
justify  it.  Until  within  the  last  few  years  the  prac- 
tice was  to  send  convcJescent  soldiers  to  a  hill  sana- 
torium for  the  hot  season,  and  to  bring  them  back  to 
the  plains  at  the  commencement  of  the  cold  weather. 
The  salutary  result  of  this  arrangement  was  only  par- 
tial. The  convalescent,  in  his  deucate  state  of  heal^ 
was,  indeed,  saved  from  the  probable  consequences  of 
the  heat  below— doubtless  in  some  cases  he  derived 
considerable  benefit  from  the  cooler  air  above — ^bnt  he 
lost  the  tonic  effect  of  a  continuously  bracing  cold 
weather  in  the  hills,  so  superior  to  the  uncertain  winter 
at  home.  Officers  and  othenL  whose  occupations  have 
required  residence  there  au  the  year  round,  hesi- 
tate, when  the  time  comes  for  retirement,  to  leave  their 
mountain  homes,  where  they  have  enjoyed  uninte^ 
rupted  good  health,  for  the  variable  climate  of  tiie 
British  Isles.  But  the  attraction  of  family  ties  usually 
prevails,  and  the  risk  is  run.  A  case  in  point  reoentqr 
I  occurred  in  my  own  experience.    After  many  years' 


Jan.  15,  1806. 


OBIGINAL  COMMUNICATIONS. 


Triv  Mfdtoal  Pros.   63 


reddence  with  nnbroken  health  in  the  Himalayas,  a 
military  officer,  when  writing  to  me,  expressed  his 
doubt  whether  he  was  wise  in  thus  giving  up  a  cer- 
tainty of  health,  humanly  speaking,  for  the  reverse. 
He  came  contracted  an  illness,  and  died  within  the 
year.  Hill  climates  vary  greatly  in  character.  AU  are 
not  bracing ;  some,  indeed,  in  the  hot  season,  being 
lelaxing.  The  climates  of  Nynee  Tal  and  Almorah — 
the  two  stations  are  only  30  miles  apart  by  road  and 
considerably  less  as  the  crow  flies — are  illustrations  of 
ti^ia, — ^the  former,  though  damp  in  the  rains,  being  in- 
vigorating ;  the  latter,  in  the  warm  months  especially, 
depressing.  To  a  certain  extent,  the  hills  have  in  tbe 
past  acquired  a  bad  reputation,  partly  because  this 
variableness  of  climate  has  not  been  sufficiently  recog- 
nised, Uiesick  being  sent  to  an  unsuitable  station,  and 
partly  because  cases  have  been  sent  to  the  hills  which 
would  have  done  better  at  sea,  at  home,  or  even, 
during  the  cold  weather,  in  the  plains.  It 
is     very     desirable     that,     amid     the     numerous 


ridges      and     s^nrs     in     the     Himalayas,      more 
suitable  sites,  within  a  reasonable  distance  of  the 
plains,    should  be  opened   up   for   the  location  of 
Europiean  troops,  and  for  convalescent  depdrs.    As  the 
characteristics    of    the  various    hill   stations  — the 
liability  to  induce  hill  diarrhoea,  for  example— become 
better  understood,  this  location  and  adapting  of  sites 
to  individual  constitutions  need  be  a  matter  of  no 
difficul^.    The  British  soldier's,  speaking  generally, 
is  a  picked  life,  supposed  to  be  capable  of  going  any- 
where ;  but  it  may  be  that,  when  enlisted,  latent  seeds 
of  disease  had  not  declared  themselves,  but   been 
developed  subsequently  as  Uie  result  of  residence  in  a 
malarious  station — e.^.,  in  the  36th,  many  of  the  men 
in  which  regiment  manifested  tuberculous  disease  of 
the  lungs  during  the   second  year  of  their  stay  in 
¥>Eabad.    For  9ome  of  these  cases  a  hill  climate  would 
probably  be  beneficiiJ— not,  however,  a  relaxing  one. 
It  will  BometimeB  happen— tiiough  rarely  with  soldiers 
in  health— that  elevation  does  not  agree  with  a  man, 
and  that  he  is  better  below.     The  acumen  of  the 
medical  officer  will  discover  this.    It  is  hardly  likely, 
however,  that  malingering  would  assume  such  a  shape ! 
I  venture  to  predict  that,  in  the  not  very  distant 
future,  it  will  be  demonstrated  that,  with  certain  pre- 
cautions, many  of  the  hills  in  India  in  each  presidency 
— ^in  the  Himalayas  especially— will  be  found  very 
suitable  for  the  colonisation  of  Europeans.    The  hill- 
vallejv— attractive  chiefly  to  the  sportsman  or  the 
botanist— which  are  apt  to  be  very  unhealthy,  giving 
rise  to  the  worst  types  of  fever,  cholera,  even  the 
plague  itself  (amongst  the  natives)^  constitute  one  of 
the  principal  dangers.    But  cultivation  would  greatly 
improve  tnem  ;  and  they  need  not  be  visited  except  in 
the  cold  season.      At  afi  seasons  they  should  be  ap- 
proached with  care— never  before  sunrise  or  after 
sundown,  nor  on  an  empty  stomach. 

**  Authorities,"  generally  speaking,  do  not  encourage 
Europeans  who  are  not  well  known  to  settle  in  the 
hills,  especiallv  where  the  intending  settler  has  the 
reputation  of  havinjy^  a  garm  mizai  (abort  temper)— a 
man  **irdacunus,  irritabilip,  acer."  They,  not  un- 
naturally, fear  that  labour  may  be  driven  awav,  the  na- 
tives in  those  parts  being  so  readily  intimidated.  It  may, 
however,  reasonably  be  hoped  that  with  the  decrease 
of  intemperance  in  the  army  and  the  rousing  of  angry 
passions  thereby  induced  the  European  treatment  of  the 
native  may  become  more  conciliatory,  and  more  worthy 
of  a  conquering  race. 

WandnvoTtli,  Jan.  2nd,  1866. 


PSEUDO-COXALGIA. 
By    Pkofessor    DUPLAY,   M.D.Pakis   Univ, 

Motel  Dieu. 


Hi8  Excellency  the  Lord  Lieutenant  has  appointed 
Dr.  John  Eustace,  J.P.,  to  be  a  Qovemor  of  the  Rich- 
mond IKstrict  Lunatic  Asylum. 


[fBOH  OUB  PARIS  COSRESPONDSNT.] 

I  PROPOSE  to  discuss  with  you  a  group  of  maladies 
which  are  not  habitually  considered  in  Uieir  ensemble 
by  clinicians.  I  refer  to  those  affections,  so  diverse  in 
their  nature,  which  simulate  coxalgia,  although  in 
reality  there  does  not  exist  the  slightest  lesion  of  coxo- 
tuberculosis.  Let  us,  to  begin  with,  take  the 
case  of  the  woman,  set  43,  whom  you  have 
seen  in  the  wards,  and  who  entered  the  hos- 
pital quite  recently.  Her  antecedents  offer  nothing 
very  striking.  The  debut  of  the  affection  dates  from 
three  or  four  months  ago,  when  she  felt  pain  in  the 
ri^ht  hip  which  made  her  limp  in  wcJking.  She  ap- 
plied various  remedies  without  relief,  and  as  her  con- 
dition grew  gradually  worse,  she  consulted  a  surgeon, 
who  diagnosed  coxalgia  and  sent  her  here.  If  we  ex- 
amine this  woman  in  the  horizontal  position,  with  Uie 
legs  parallel,  we  fail  to  find  what  we  should  have  a  right 
to  expect  in  a  true  case  of  coxalgia,  viz ,  either  abduc- 
tion or  flexion  of  the  thigh  on  the  pelvis.  There  exists, 
it  is  true,  a  certain  amount  of  rotation  outwaids,  while 
rotation  inwards  is  impossible.  All  other  movements 
are  more  or  less  suppressed  and  excite  great  pain 
when  attempted.  Palpation  of  the  joint  reveals  two 
very  painful  spots :  one  over  the  great  trochanter, 
the  other  inside,  corresponding  to  the  obturator 
foramen.  The  inguino-crural  region  is  the  seat  of  a 
tumour  of  the  size  of  an  egg,  indolent  and  fluctuating, 
not  increased  in  volume  by  effort  or  coughing,  ana 
irreducible. 

A  first  and  superficial  examination  might  incline  ns 
to  believe  it  was  a  case  of  coxalgia,  but  closer  attention 
shows  that  such  symptoms  as  pain  in  the  knee,  so 
characteristic  of  coxo-tuberculous  disease,  and  abduc- 
tion and  flexion  of  the  thigh  on  the  pelvis,  are  wanting. 
To  make  our  diagnosis  sure  we  chloroformed  the  patient, 
and  we  found  that  all  the  movements  of  the  joint 
were  possible,  consequently  the  integrity  of  the  articu- 
lation was  preservpd.  Let  us  turn  now  our  attention 
to  the  tumour.  We  find  that  it  is  liquid,  but  devoid  of 
pulsation,  consequently  it  is  not  an  aneurysm ; 
further,  it  does  not  communicate  with  the  abdominal 
cavity,  eliminating  thus  the  idea  of  inflammatory 
abscess  or  hernia.  Might  it  be  a  cold  abscess  of  the 
ganglions  t  The  hypothesis  seems  to  be  doubtful,  as 
the  origin  of  the  tumour  seems  to  me  to  be  deep ;  it  is 
either  a  hygroma  of  the  bursa  of  the  psoas  muscle  or  a 
hydatid  cyst  of  the  neck  of  the  femur.  Our  doubts  on 
the  matter,  in  any  case,  will  be  cleared  up  when  we 
proceed  to  operate. 

As  I  told  you  at  the  beginning  of  this  lecture,  m^ 
intention  in  giving  you  the  cursory  history  of  this 
woman,  is  to  present  to  you  some  pertinent  and  prac- 
tical observations  on  cases  of  pseudo-coxalgia.  We 
have  here  a  patient  who,  suffering  from  a 
hygroma  of  the  psoas  muscle  or  an  hydatid  cyst, 
entered  the  hospital  for  a  presumed  coxalgia.  Now, 
you  will  certainly  meet  with  such  cases  in  your  private 
practice  in  which  the  symptoms  of  coxalgia  will  be 
even  more  accentuated,  and  may  lead  you  to  believe 
in  the  existence  of  tuberculous  mseaae  of  the  joint  It 
is  necessary  conseauently  that  vou  should  recognise 
these  cases  of  pseuao-coxalgia,  which  are  more  frequent 
than  you  imagine,  and  of  which  I  have  made  a  special 
study. 

We  may  dividepseudo-coxalgias into  two  great  classes, 
the  first  where  tne  articulation  is  healthy,  but  where 
there  exists,  as  in  the  patient  before  us,  a  lesion  in  the 

0 


64     Thb  Mxdioal  Pbiss. 


TRANSACnONB  OF  SOCIETIES. 


Jav.  16,  18KL 


neighbonrhood,  and  the  second,  still  more  interest- 
ing, in  wMch  not  only  is  the  joint  intact,  but  no 
concomitant  lesion  is  apparent.  The  lesions  of  the 
first  fproup  depend  most  Ireqnently  on  inflammatory 
affection  of  the  skeleton,  and  more  especially  of  the 
pelvis  or  the  great  trochanter  of  the  femur.  I  remem- 
oer  havinff  treated  successfully  a  voung  man  for 
osteitis  of  the  great  trochanter,  who  had  been  previously 
treated  for  coxalgia  by  an  eminent  surgeon.  In  another 
case,  ihskt  of  a  boy  from  Melbourne,  the  doctors  of  his 
country  diagnosed  coxo-tuberculosis.  Examined  by 
my  former  pupU,  Dr.  Crivelli,  the  case  was  pronounced 
to  be  one  of  osteitis  of  the  epiphvsis  of  the  superior 
extremity  of  the  femur.  I  was  called  in  and  connrmed 
the  opinion  of  Dr.  CriveUi ;  the  child  got  well  without 
the  slightest  claudication.  One  or  two  years  after- 
wards the  same  symptoms  returned  during  a  voyage 
through  Europe,  and  his  parents  this  time  consulted 
the  first  surgeons  in  Lille,  who  unanimously  pronounced 
the  case  to  be  tuberculous  disease  of  the  joint,  and 
recommended  the  treatment  usual  in  such  cases.  The 
patient,  however,  recovered  quickly,  and  when  I  last 
saw  him  I  was  able  to  satisfy  myself  in  respect  of  the 
integrity  of  the  articulation. 

At  other  times,  affections  of  the  serous  bursse  of  the 
neighbourhood  of  the  articulation  may  exist ;  I  met 
thus  with  two  cases  of  suppuration  of  the  serous  bursse 
of  the  gluteus  maximus  simulating  in  every  respect  the 
dinicu  aspect  of  coxalgia. 

How  are  we  to  arrive  at  a  correct  diagnosis  of  such 
affections?  Most  frequently  you  will  be  struck  with 
the  fact  that  there  is  something  wanting  to  the  usual 
symptoms  of  coxalgia ;  it  is  thus  in  our  patient— you 
will  find  neither  abduction  nor  flexion  of  the  thigh  on 
the  pelvis,  nor  the  lar^  lumbar  excavation.  Or  you 
ma;^  remark  other  signs  in  contradiction  with  the 
ordinary  symptoms  of  coxalgia,  and  it  is  in  the  atten- 
tive study  of  all  these  details  that  you  will  arrive  at 
the  truth  of  the  case.  Where  doubt  still  exists  you 
must  examine  your  patient  under  chloroform,  by 
which  you  will  be  able,  if  the  articulation  is  healthy,  to 
establish  motions  in  every  sense  without  provoking  the 
slightest  grating. 

The  second  group,  as  I  have  already  pointed  out,  con- 
sists of  cases  in  which  the  symptoms  of  coxalgia  are  pre- 
sent, but  without  any  lesion  of  the  articulation  or  of  the 
parts.  It  was  Brodie  who,  in  1837,  drew  special  atten- 
tion to  this  form,  which  he  describe  under  the  head 
of  spasmodic  coxalgia  or  articular  neuralgia.  These 
terms  were  replaced  later  on  by  Vemeuil  and  Charcot, 
by  that  of  hysterical  coxalgia.  The  i^ection  ia  met 
with  more  frequently  in  women,  and  may  supervene  at 
any  afije,  but  generally  at  or  about  puberty.  T^e  malady 
usually  declares  itself  suddenljr  from  some  insigni- 
fioant  cause  in  a  person  presenting  generally  signs  of 
hysteria.  In  certain  cases  imitation  plays  a  principal 
7'6le,  as  in  the  case  mentioned  by  Paget,  where  a  young 
fnrl  Huflered  from  hysterical  coxalgia  whose  brother 
was  being  treated  for  a  true  tuberculous  coxalgia.  The 
principal  symptoms  of  hysterical  coxalgia  are :  pain, 
muscular  contractions,  and  abnormal  attitude  of  Uie 
limb.  The  pain  resembles  frequently  that  of  true 
coxalj^ia,  being  felt  in  the  knee  as  well  as  in  the  hip, 
but  the  peat  varies  greatly,  the  patient  complaining 
now  in  front,  now  behind.  Frequently  also,  there 
exists  extreme  sensitiveness  of  the  skin,  the  slifthtest 
touch  provoking  a  typical  nervous  crisis.  Further, 
the  pain  i«  superficial,  whereas  in  true  coxalgia  it  is  deep- 
seated.  The  muscular  contractions  in  psendo-coxalpia 
are  resistant,  con  trarily  to  what  obtains  in  the  true  form, 
where  they  can  be  surmounted  with  a  little  patience 
in  provoking  certain  movements  of  the  joint.  Loco- 
motion in  both  affections  presents  characteristic  signs. 
In  coxo-tuberculosis,  the  patient  suffers  agony  from 
the  slightest  attempt  at  walking,  and  will  refuse  to 
leave  the  bed,  while  the  hysterical  patient  will  limp 


about  readily  enough  and  does  not  complain  of  pain. 
This  is  an  important  sign  and  should  be  borne  in  mind. 

Except  in  rare  cases,  and  remembering  the  sym- 
ptoms I  have  just  mentioned,  you  will  be  able  to  dia- 
gnose hysteri<^  coxalgia  witnout  difliculty.  Ton  will 
take  into  account  the  debut^  generally  sudden ;  the 
attitude,  flexion,  adduction  and  rotation  inwards;  the 
inconstancy  of  the  seat  of  pain  and  its  supeifidal 
character.  Besides,  muscular  atrophy,  which  is  one 
of  the  most  importunt  signs  of  tuberculous  coxalgia, 
is  usually  absent,  and  there  is  no  fever. 

The  prognosis  of  hysterical  coxalgia  is  in  most 
cases  benign.  The  affection  is  always  recovered  from, 
often  spontaneously,  but  you  must  not  forget  that 
it  is  liable  to  return  on  the  slightest  cause. 

In  what  does  the  treatment  consist?  Everything 
has  been  tried  from  most  rational  to  most  empirical 
therapeutics,  and  frequently  the  patient  recovers  after 
all  treatment  has  been  abandoned.  Charcot  insisted  on 
the  necessity  of  renouncing  all  violent  measures  from 
a  surgical  point  of  view,  and  of  treating  the  affection 
by  bromides  and  general  nerve  sedatives,  and  especially 
hy  those  means  which  appeal  strongly  to  the  imagina- 
tion, such  as  magnetism,  nypnotism,  suggestion. 

I  quite  agree  with  this  advice  as  long  as  the  limb 
has  not  assumed  an  abnormcJ  position.  If  the  contrary 
be  the  case,  however,  it  will  be  necessary  to  correct  the 
attitude  under  chloroform,  and  maintain  the  position 
thus  obtained  by  some  suitable  apparatus. 


CLINICAL  SOCIETY  OF  LONDON. 
Mbbtik»  hbld  Fbidat,  Januabt  10th. 


The  President,  Dr.  Buzzard,  in  the  Chair. 

FoTTB  Casks  of  Movable  Kidnxt. 
Dr.  David  Newman  (Glasgow)  described  four  oases  of 
movable  kidney,  in  two  of  which  he  performed  nephror- 
rbaphy  for  the  cure  of  transitory  hydronepbroeis,  and 
other  two  caras  in  which  the  same  operation  was  resorted 
to  for  the  relief  of  torsion  of  tbe  renal  blood-vessels,  oaos- 
inz  albaminuria  and  the  presence  of  tube^casts  in  the 
unne.  Case  1. — Transitory  hydronephroslB  and  sliffht 
albuminuria  daring  paroxysmal  attacks  of  pMun.  Wben 
first  seen  patient  bad  developed  all  the  characteristic 
symptoms  and  pbysical  signs  of  movable  kidney.  Parox- 
ysmal attacks,  at  first  occasional,  afterwards  frequent  and 
sudden.  Sacb  paroxysms  sometimes  lasted  as  lon^  as  28 
boars,  during  wbicb  time  m  much  as  36  oze.  of  urine  acca- 
mulated  in  the  renal  pelvis ;  wben  it  escaped  tbe  pain  passed 
away  slowly.  Case  2.  — Right  movable  kidney,  with  transi- 
tory bydronepbrosis  from  kinkins:  of  tbe  ureter,  no  albu- 
minuria. Operation — cure.  Tbe  hydronepbrosis  was  seldom 
absent  for  more  tban  a  few  days,  and  was  eometimeff  dis- 
tended to  contain  40  ounces  of  urine.  Cote  3. — Right 
movable  kidney,  causing  torsion  of  tbe  ureter,  and  lad- 
ing to  hydronepbrosis,  albuminuria,  and  the  presence  of 
tube  caste  in  urine.  With  tbe  onset  of  tbe  paroxysms  of 
pain  sometimes  there  was  present  hydronephrosis :  pome- 
times  it  was  absent  or  not  observable,  but  high  specifio 
gravity  of  tbe  urine,  and  albuminuria  and  tube  casts 
always  appeared  in  tbe  urine  at  tbe  same  time  as  the  pain. 
Since  operation  no  albumen  or  tube  casts  have  been 
found.  Ccue  4.^ Left  movable  kidney,  causing  torsion 
of  renal  blood-vessels,  albuminuria,  tube  casts,  severe 
pain  and  suppression  of  urine.  No  hydronephrosia 
Operation  ;  cure.  Tbe  kidney  was  only  freely  movable, 
but  no  increase  in  size  could  at  any  time  be  made  out.  In 
cases  of  transitory  hydronephrosis  the  usual  course  of 
events  is  a  sudden  suppression  of  urine,aImost  immediately 
followed  by  paroxysms  of  severe  pain,  which  continue  ud 
steadily  increase  in  severity  until  suddenly  relieved  by  the 
passage  of  a  copious  flow  of  dilute  urine.  Sometimes  the 
urine  is  free  from  albumen,  in  other  instances  a  trace  or 
even  a  considerable  amount  of  albumen  may  be  fonnd  to 


Jte.  15  18M.' 


TOANSAOTIOJft  di'  'Bo&Hsms. 


Tttt!  Mft>toat,  Pbj 


05 


be  Mmt  Thifl  albnminiiria  usaally  dicttppean  within  a 
few  boon.  Darin|ir  the  attack  the  patient  is  generally 
compelled  to  go  to  bed,  but  ie  seldom  able  to  occupy  the 
reeombent  position,  preferring  rather  to  sit  up  with  the 
kneea  flexed  over  the  abdomen,  aiad  the  chest  thrown  well 
fcttward.  Thia  position  is  assumed  for  the  purpose  of 
relieving  the  abdominal  pressure.  In  eases  of  torsion  of 
the  renal  blood-vessels  the  pain  is  equally  severe  during 
the  whole  period  d  attack.  There  is  little  or  no  increased 
swelling  in  the  renal  region.  In  transitory  hydronephrosis 
the  relief  of  pain  is  coincident  with  the  sudden  flow  of  a 
large  qoantity  of  dilute  urine,  whereas  in  torsion  of  the 
renal  blood-vessels  the  termination  of  the  paroxysms  is 
accompanied  by  the  escape  of  a  comparatively  small  quan- 
tity of  concentrated  urine*  One  of  the  most  difficult 
points  to  explain  is  the  presence  of  tube-casts.  The  gene- 
rally accepted  opinion  is  that  the  presence  of  tube-casts  in 
the  urine  mdicatee  the  existence  of  an  inflammatory  lesion 
in  the  kidney,  but  in  the  cases  shown  the  tube-casts  were 
caused  by  &  mechanical  hyperaunia. 

Mr.  Bbucs  Glaske  said  the  author  had  raised  two 
points  of  considerable  interest,  one  being  the  frequent 
presence  in  the  urine  of  albumen  and  tube-casts,  and  the 
other  the  method  of  suture.  A  certain  amount  of  albumen 
was  usually  found  in  the  urine  in  caaee  of  hydronephrosis. 
Though  transienii  this  was  fairly  constant.  In.  nej^rer- 
rhaphy  it  had  never  been  bis  practice  to  pack  the  wounds 
with  gauze.  Nevertheless,  in  the  cases  in  which 
nephrectomy  had  afterwards  been  required,  he  had  found 
great  difliculty  in  removing  the  kidney,  so  firmly  was  it 
fixed.  In  perforxning  nephrorrhaphy  he  cut  through  the 
capsule,  excoriating  the  renal  substance  by  several 
scntches  with  the  knife,  and  then  fixed  the  organ  by  two 
or  three  sutures  passed  through  the  kidney  substance.  He 
congratulated  the  author  upon  the  excellence  of  his  results 
in  the  presence  of  such  a  great  dome  of  antecedent 
nephrosis.  He  himself  had  not  succeeded  so  well  in  cases 
d  Urge  hydronephrosis,  but  he  did  not  fix  the  kidney  as 
^-Vh  up. 


^KWicAF,  in  reply,  said  his  paper  dealt  rather  with 
cases  of  occasional  hydronephrosis,  than  with  cases  in  which 
the  hydronephrosis  was  constantly  present,  these  being  only 
occasicmally  relieved.  In  the  latter  cases  the  kidney  was 
usually  diseased  and  albumen  was  consequently  present  in 
the  urine.  In  the  cases  of  occasional  hydronephrosis,  on 
the  other  hand,  the  presence  of  albumen  and  tube-casts 
in  the  urine  was  more  difficult  to  explain.  He  asked  why 
indeed  should  transient  passive  hyperemia  lead  to  the 
presence  of  tube-casts,  the  occurrence  of  which  physicians 
were  in  the  habit  of  regarding  as  of  ^rave  import,  and  as 
an  indication  of  inflammatory  trouble.  The  principal 
points  in  the  operation  were  to  fix  the  kidney  as  high  up 
as  possible,  and  to  fix  it  firmly,  and  in  doing  this  to  get 
away  as  much  of  the  adipose  capsule  as  possible. 
Mr.  Lib  Dickinson  on 

SPOKTANEOUS  THROMBOSIS   OF  THB     CBRSBRAL    VEINS     AND 
SINUSES  IN  CHLOBOSIS. 

Three  fatal  cases^  in  cblorotic  young  women  were 
described  and  othere  were  referred  to.  Thrombosis  of  this 
kind,  as  an  event  of  clinical  import-ance.  he  pointed 
oat^  occurs  more  often  in  chlorosis  than  in  any  other 
one  disease.  That  cblorotic  blood  is  morbidly  prone 
to  ootgulate  within  the  vessels  is  evident  from  the 
frequency  with  which  it  does  so  in  the  veins  of  the 
bwer  eztremitiee.  In  one  of  the  cases  described  a 
pQeamonio  state  of  part  of  one  lung  was  found  post- 
mortem, a  thing  worth  remarking,  because  in  pneu- 
monia the  blood  is  highly  fibrinous  and  coagulation  in  the 
right  heart  a  reco^^ised  danger.  Sinus  thrombosis,  how- 
ever, IB  very  rare  m  pneumonia,  and  of  367  cases  of  pneu- 
monia observed  by  the  author,  other  forms  of  venous 
l^urombosis  occurred  in  only  seven.  Of  these  seven,  four 
were  yoong  women,  and  two  were  cblorotic.  The  distri- 
bution of  intravascular  coagulation  brought  about  in 
animals  by  injection  of  foreign  substances  into  the  circula- 
tion is  largely  determined  by  the  amount  of  carbonic  acid 
in  the  blood.  Cblorotic  blood  is  probably  overloaded  with 
carbonic  acid.  The  comparative  infrequency  of  throm- 
bosis in  the  sinuses,  where  the  mechanical  conditions  are 
BO  favourable,  may  be  explained  by  the  recent  observation 
that  the  cerebral  venous  blood  is 'but  slightly  carbonised. 
The  lener  degrees  of  sinus-thrombosis   are   not  always 


fatal,  and  are,  perhaps,  less  rare  than  is  supposed.  In 
some  recorded  cases  of  optic  neuritis  as  a  complication 
of  non-fatal  chlorosis  the  severity  of  the  headache  was  out 
of  all  proportion  to  the  degree  of  ansemia.  Optic  neuritis 
and  severe  headache  are  the  two  most  prominent  sym- 
ptoms of  sinus-thrombosis.  A  fourth  fatal  case  is  described 
in  a  young  but  not  cblorotic  woman.  The  thrombosis 
was  limited  to  the  vense  Galeni  and  their  tributaries. 

Sir  Dtce  Duckworth  said  his  attention  had  been  called 
25  years  since  to  a  typical  case  of  the  kind,  and  since  that 
time  he  had  taken  considerable  interest  in  the  subject. 
He  related  the  ca^e  of  a  young  woman  who  presentea  all 
the  ordinary  aspects  of  chlorosis,  with  very  severe  and 
distressing  headache.  The  case  ended  fatally,  and  post- 
mortem they  found  it  to  be  an  excellent  exampk  of 
thrombosis  of  the  cerebral  sinuses.  Since  then  he  had 
looked  out  in  all  cases  of  severe  chlorosis  in  women  for 
the  occurrence  of  severe  rebellious  headache  as  possibly 
indicating  the  onset  of  such  a  condition.  He  aid  not, 
however,  meet  with  another  case  until  some  three  years 
ago.  The  patient  was  a  woman,  set.  35,  who  came  in 
about  three  weeks  after  her  confinement,  looking  very  ill, 
and  suffering  from  white  leg,  due,  no  doubt,  to  thrombosis 
of  the  corresponding  femoral  vein.  In  like  manner  she 
had  severe  and  torturing  headache,  along  with  optic 
neuritis  and  slight  convulsive  attacks.  He  made  the 
diagnosis  of  thrombosis  of  the  cerebral  sinuses,  basing  his 
diagnosis  on  the  severe  headache,  the  profound  an»mia, 
and  the  optic  neuritis,  together  with  the  convulsive 
movements. 

Dr.  Spubbell  recalled  a  case  which  came  under  his 
notice  12  months'ago.the  patient  being  a  girl,  1.3  years  of  age 
who  was  admitted  with  a  diagnosis  of  scarlet  fever  which 
however,  ptroved  to  be  erroneous.  She  complidned  of 
great  pain  in  the  head  and  the  temperature  rose  to  104^ 
and  105^  F,  There  was  some  rigidity  of  the  neck  and 
retraction.  She  had  been  taken  ill  three  or  four  days 
previously  to  admission,  and  gradually  got  worse,  became 
comatose,  the  pupils  being  equally  dilatM  but  not  reacting 
to  light.  The  existence  of  optic  neuritis  was  doubtful. 
She  died  at  the  end  of  a  week  and  post-mortem  the  cerebro- 
spinal fluid  was  found  to  be  greatly  in  excess,  the  right 
optic  thalamus  was  much  enlarged,  the  choroid  plexus  was 
covered  with  a  thick  film  of  fibrinous  exudation  and  the 
right  vein  of  Galen  and  the  great  vein  of  Galen  behind 
were  occupied  by  clot  projecting  1-lOth  of  an  inch  into  the 
great  sinus.  The  optic  thalamus  had  undergone  white 
softening  throughout.  The  child  was  anaemic  but  not 
markedly  so  and  there  was  no  heart  disease. 

The  Pbesidskt  said  the  cases  so  far  narrated  appeared 
without  exception  to  have  had  a  fatal  termination.  It 
happened,  however,  that  he  had  in  hospital  at  the  present 
time  a  girl,  st.  18,  who  was  admitted  a  month  since 
with  symptoms  pointing  to  this  affection.  She  was  how- 
ever, at  present  on  the  road  to  recovery.  Her  history  was 
that  after  having  had  a  good  deal  of  pain  in  both  sides  of 
the  face  for  12  months  she  was  taken  two  months  ago  with 
a  series  of  screaming  fits  followed  by  loss  of  consciousness 
for  several  hours.  She  also  complained  of  intense  headache. 
Three  weeks  before  admission,  her  right  lower  extremity 
swelled  up  to  twice  the  size  of  the  other.  She  was  markedly 
cblorotic  and  could  scaroely  stand  or  walk,  although  there 
was  no  definite  paralysis.  She  presented  double  optic  neuri- 
tis. On  examining  the  blood,  the  proportion  of  hsemoglobin 
was'f ound  to  be  r^uced  by  50  per  cent.  She  was  put  upon 
iron  immediately,  and  at  once  began  to  improve.  He 
suggested  that  thev  ought  to  bear  in  mind  that  cases 
might  occur  in  which  the  symptoms  were  less  pronounced, 
and  these  minor  cases  were  far  more  likely  to  come  under 
their  notice.  He  had  no  doubt  that  many  such  cases 
currinsr  in  young  women  were  put  down  to  simple  hysteria. 
Dr.  Dickinson,  in  reply,  said  a  somewhat  similar  case 
had  been  reported  by  Dr.  Bristowe,  in  which  the  patient 
was  also  exceedingly  hysterical. 

Addison's  disease  treated  with  supra- bekal  extract. 
Dr.  Sydney  Ringer  and  Dr>  Arthur  Pheab  contributed 
an  account  of  a  case  of  Addison's  disease  treated  with 
supra-renal  extract,  and  also  gave  a  brief  rdmm&  of 
recorded  cases  for  which  similar  treatment  had  been 
adopted.  It  appeared  that  of  nine  cases,  five  had  shown 
improvement,  although  in  some  of  these  a  sufficient  time 
had  not  elapsed  to  determine  whether  or  not  the  benefit 


56      ThI  MwDTfUT.  T*P*r«^ 


TRANSACTIONS  OF  SOCTKnES. 


Jav.  is.  1808. 


was  permanent.  In  two  cases  no  improvement  was  noted ; 
in  one  case  the  treatment  was  given  onlj^  a  very  lim'  ^ed 
trial ;  in  one  the  disease  ended  fatally  m  spite  of  supra- 
renal treatment.  The  supra-renal  tissue  was  in  some 
cases  administered  by  the  mouth,  in  other  cases  hypoder- 
mically.  Details  were  then  c^ven  of  a  case  lately  under 
this  treatment  in  University  College  Hospital.  A  woman, 
et.  28,  bad  been  suffering  from  symptoms  of  Addison's 
disease  for  a  period  of  two  years,  progressive  weakness  with 
some  loss  of  flesh,  vomiting  without  special  relation  to  food, 
and  pigmentation  of  the  ssin.  Exoes^i  ve  pigment  was  pre- 
sent on  the  face,  hands,  forearms,  axills,  about  the  nipple, 
over  the  knee-cap,  and  in  the  neighbourhood  of  the  toes  and 
ankles.  The  discolouration  was  well  marked  in  the  arm- 
pits and  around  the  mouth.  There  were  deeply  pigmented 
inky  patches  on  the  mucous  membrane  of  the  mouth, 
opposite  the  teeth.  There  was  no  evidpnoeof  tubercle  in 
the  lungs  or  elsewhere.  Treatment  wirh  supra- renal  ex- 
tract was  commenced,  in  doses  equivalent  to  45  grains  of 
suprarenal  body  daily  ;  this  was  gradually  increased  to  a 
daily  dose  of  120  grains.  There  rapidly  followed  im- 
provement in  the  general  condition,  and  the  pigmentation 
became  notably  lessened  in  degree.  Vomiting,  however, 
remained  troublesome.  No  rise  of  arterial  tension  was 
noted.  The  improvement  continued  for  four  weeks, 
when  there  was  a  rapid  change  for  the  worse  There  was 
no  increase  of  pigmentation,  but  the  general  condition 
Quickly  deteriorated,  cardiac  action  became  feeble,  and 
aeath  occurred  within  six  weeks  of  the  commencement  of 
the  treatment,  and  lust  over  two  years  from  the  earliest 
symptoms  of  the  aiseaae.  The  temperature  rose  to  102 
degrees  on  the  day  before  death.  During  the  last  few 
days  arsenic  and  strychnine  were  given  in  the  place  of  the 
supra-renal  extract  The  autopsy  showed  the  supra-renal 
bodies  to  be  shrunken  and  flattened  about  a  thira  of  their 
normal  size,  and  exhibiting  no  traoe  of  the  normal 
structure. 

Dr.  Parkinson  related  a  case  recently  admitted  to  the 
Westminster  Hospital  under  Dr.  Murrell,  in  which  the 
treatment  by  supra-renal  gland  was  tried.  The  patient 
was  a  man,  st.  31,  who  for  three  mon^s  past  had  been 
complaining  of  weakness  and  bronzing  of  the  skin.  He 
presented  no  signs  of  phthisis.  The  treatment  with 
extract  (5  grains)  was  begun  on  November  26th.  Twelve 
days  later  he  began  to  vomit  rather  frequently.  He  was 
then  given  fresh  sheep's  gland  in  doses  of  one  drachm 
three  times  a  day,  after  which  the  vomiting  increased  in 
severity.  The  dose  was  then  reduced  to  15  grains  thrice 
daily,  and  the  vomiting  diminished.  The  patient  gradu- 
ally sank  and  died,  and  post-mortem  they  found  the  usual 
caseation  and  enlargement  of  the  supra-renal  glands. 

Dr.  TuBNST  related  the  case  of  a  young  man  who  had 
had  an  attack  of  syncope.  There  was  slight  pigmentation 
but  it  was  quite  enough  to  make  sure  of  the  diagnosis, 
being  particalarly  marked  on  the  backs  of  the  hands.  He 
was  given  a  glycerine  extract  of  supra-renal  gland,  equal 
to  a  third  of  a  gland,  a  day,  but  he  only  lived  about  a  fort- 
night after  the  treatment  bad  been  begun,  and  no  definite 
reeult  was  obtained.  Vomiting  however,  became  a  promi- 
nent symptom.  Post-mortem  both  supra- renal  capsules 
were  found  to  be  caseous.  The  last  case  of  the  kind  in 
which  the  treatment  had  been  tried  died  two  days  after 
admission  when  he  had  only  received  four  doses,  so  that  it 
could  not  be  said  to  throw  any  light  upon  the  effecto  of 
the  treatment. 

Dr.  Hals  Whits  said  they  had  had  an  experience  of 
the  treatment  in  a  patient  who  was  treated  for  Addi"on's 
disease  because  it  was  at  first  thought  he  had  it.  They 
noticed  that  he  invariably  got  a  temperature  of  about  10*2 
degrees  Fahrenheit  after  the  administration  of  the  drug, 
which  subsided  when  it  was  discontinued.  It  was  dis- 
continued when  it  was  noticed  that  he  was  passing  the 
dark  urine,  rich  in  iron,  characteristic  of  pernicious 
ansmia,  from  which  he  proved  to  be  suffering. 

Dr.  RiNOSB  in  reply,  pointed  out  that  Addison's  disease 
notoriously  ran  a  very  variable  course,  so  that  an  experi- 
ence of  one  case  could  not  go  far  in  deciding  the  value  of 
the  treatment  or  otherwise. 

Dr.  Phsak  in  reply,  said  he  did  not  think  the  vomiting 
in  this  case  was  due  to  the  treatment,  because  it  was 
equally  well  marked  before  it  was  begun.  The  patient's 
temperature  was  normal  throughout,  except  immediately 
before  death. 


ROfAL  ACADEMY  OF   MEDICINE  IN  IRELAND. 
Sbction  ot  Obststbiob. 

MSSTINO  HELD  FbIDAT,  DsO.  20TH. 


The  President,  Dr.  Loxbs  Attuill,  in  the  Chair. 

8PB0IMBNB  SXHIBITBD. 

Db.  Alfbbd  Smith  showed  the  following  specimens  :— 

(1.)  An  abscess  of  the  ovarv  with  pyosalpinx,  which 
he  removed  from  a  patient  who  suffered  from  a  eevere 
attack  of  puerperal  fever,  twelve  months  previously; 
ovarian  abscess  burst  during  removal ;  contente  particu- 
larly foetid.  Peritoneal  oavity  was  protected  by  thin 
gauze  sponges :  pelvis  douched  out  with  gallons  of  saline 
solution  ;  drainage ;  rapid  recovery.  (2  )  A  iBife  multi- 
locular  ovarian  tumour,  with  extremely  extensive  adhe- 
sions. The  entire  cyst-wall  was  intimately  adherent  all 
round,  and  in  the  lower  zone  coils  of  small  intestinee  were 
embedded  in  ito  walls,  and  could  only  be  separated  by  dis- 
section at  the  expense  of  the  cyst,  tekin^  care  to  remove 
the  cellular  layer.  There  was  extensive  hemorrhage 
after  separation  of  the  adhesions  from  the  abdominal 
wall,  easily  controlled  by  the  purse-string  suture; 
douched  with  saline  solution  ;  drainage  ;  recovery.  (3  )  A 
pair  of  tubes  and  ovaries  removed  from  a  patient,  et. 
28,  who  had  a  multinodular  fibro-myomatons  uterus,  and 
suffered  from  severe  haemorrhage.  The  outlet  of  the 
pelvis  was  very  contracted,  and  not  favourable  for  mor- 
oellement. 

Dr.  Macan  exhibited  (1)  a  case  of  hysterectomy  done 
for  a  large  fibroid  ;  (2)  a  vaginal  polypus ;  and  (3)  uterine 
fibroid  polypus. 

Dr.  Hastihos  Twssdt  exhibited  a  dermoid  tumour  of 
right  ovary,  which  he  removed  from  a  patient,  aged  forty- 
five  years.  The  woman  only  noticed  the  abdomen 
enlarging  for  three  months  previous  to  operation,  dnring 
which  time  she  suffered  intense  pain.  The  cyst  extended 
above  the  umbilicus  for  two  inches.  The  patient  made  an 
afebrile  recovery.  The  tumour  is  an  interesting  one,  not 
alone  on  account  of  ito  large  size,  but  also  from  the  fact 
that  it  contains  much  hair  and  a  portion  of  lower  jaw,  with 
many  teeth  embedded  in  it.  He  aleo  showed  a  cyst  of 
left  ovary,  which  he  had  removed  from  a  .women,  aged 
twenty-five,  who  had  had  two  children,  the  last  seven 
weeks  previous  to  operation.  According  to  the  patient's 
stetement,  the  tumour  had  increased  enormously  in  siss 
since  the  birth  of  her  last  child,  and  was  accompanied  by 
great  pain.  Dense  adhesions  made  the  operation  difficult, 
necessiteting  in  one  spot  the  leaving  behind  a  piece  of  the 
tumour  wall  attached  to  the  intestine.  The  patient  made 
a  rapid  and  uneventful  recovery.  He  also  showed  a  very 
large  sub-mucous  myoma,  which  had  almost  become  a 
polypus,  and  was  in  a  sloughing  condition  on  ita  outer 
surface.  The  patient  had  sufferwl  for  seven  months  from 
great  pain  and  a  foetid  discharge.  The  tumour  completely 
occluded  the  vagina,  and  weighed  over  2  lbs.  In  conse- 
quence of  its  great  bulk,  it  was  quite  impossible  to  reach 
its  base.  He  removed  the  tumour  piecemeal  by  means  of 
Dr.  W.  Smyly's  spoon  forceps  and  stout  scissors,  without 
the  exhibition  of  force,  or  any  injury  to  the  soft  parts. 
The  patient  made  a  rapid  recovery. 

AN  INTKBSSTING  SOLID    OVABIAM  TUMOUB. 

Dr.  Alfbbd  Smith  read  a  paper  on  an  interesting  solid 
ovarian  tumour.  The  patient,  aged  twenty-five,  unmar- 
ried, was  admitted  on  Oct.  1st,  to  the  gynecological 
wards  of  St.  Vincent's  Hospital  She  was  unable  to 
recline  on  the  bed,  so  enormously  distended  was  the  abdo- 
men. She  had  to  be  supported  in  the  semi-erect  position 
by  an  arrangement  of  pillows,  any  attempt  to  lie  down  on 
the  bed  caused  intense  dyspnoea.  Abdominal  palpation 
revealed  an  immense  collection  of  free  ascitic  fiuid,  and  no 
tumour  could  be  made  out.  Vaginal  examination  g^vo 
negative  reeulto.  In  consultetion  with  Dr.  M'Hugh,  a 
diagnosis  was  made  of  ascites,  from  portal  obstruction. 
Patient  was  removed  to  medical  ward,  and  paracentesis 
was  performed,  removing  fourteen  pinto  of  thin,  semne 
fluid.  A  tumour  occupying  the  left  inguinal  and  lumbar 
regions  was  then  distinctly  palpable,  it  floated  freely 
about  the  abdominal  cavity,  its  range  of  motion  being  very 
remarkable ;  it  touched  the  ribs  easily  on  either  side.  The 
diagnosis  was  made  of  long-peduncnlated,  solid  ovarian. 


Jak.  Iff,  18M. 


TRANSACTIONS  OF  SOCIETIES- 


ThI  MbDIOAL  PBB8S.       57 


Aacites  retnrned  very  quickly  after  tapping,  and  disten- 
aion  became  again  enormoas.  Tumour  was  removed  by 
ooeliotomy  ;  the  pedicle  was  very  broad  and  yascular,  was 
ligatured  by  the  inter-locking  chain  suture.  Patient's 
reoovery  was  interrupted  by  a  severe  internal  h»mor- 
rhi^g^  which  took  place  thirty-six  hours  after  operation, 
which  was  controlled  by  re-opening  the  abdomen  and 
secaring  the  bleeding  vessel  The  blanched  and  pulseless 
oonditioD  of  the  patient  required  the  use  of  saline  solution 
as  a  pieritoneal  douche.  This  caused  a  marked  and  imme- 
diate im(>rovement ;  no  drainage ;  recovery  slow.  There 
has  bean  no  return  of  the  ascites  since  the  operation,  now 
seven  weeks  ago.  The  points  of  special  interest  for  dis- 
CQBsioD  were— (1)  the  cause  of  the  ascites,  (2)  the  cause  of 
the  hemorrhage,  (3)  the  value  of  immediate  operation,  and 
(4)  the  promonB, 

A  pathotogical  examination  of  specmien  by  Professor 
M*  weeoey  revealed  the  tumour  to  be  a  myo-sarooma,  its 
sixe  that  of  the  adult  head. 

PAFBS  ON  OYABIOTOMT. 

This  paper,  by  Dr.  R.  J.  Kinkiad,  was  read  for  him  by 
the  Hon.  Sac.  It  enumerated  the  details  of  an  interesting 
ovariotomy  performed  on  a  patient,  »t.  60.  There  were 
aztensiva  adhesions  to  abdominal  wall,  and  the  omentum 
was  adherent  so  firmly  that  the  adhesion  had  to  be  double 
ligatured  and  then  cut  between  the  ligatures.  The  pedicle 
was  vary  short— so  short  that  a  portion  had  to  be  dissected 
from  outer  surface  of  the  tumour  to  form  a  stump.  The 
pedicle  was  rotated  and  had  to  be  twice  turned  completely 
round  from  right  to  left  to  untwist  it.  Wound  dosed  by 
intarrapted  sutures  passed  through  entire  thickness  of 
abdominal  wall.  Wound  healed  by  first  intention  ;  patient 
sat  up  in  bed  on  the  10th  day,  was  out  of  bed  on  the  ISbh 
day.  The  cyst  contained  640  ozs.  of  dark- brown  fluid. 
There  were  many  smaller  cysts  inside  parent  cyst ;  it  was 
deaaribad  as  an  unilocular  oophoritic  cyst. 

MULnLOOULAB  OVABIAV  TUMOUR. 

Mr.  Hbhbt  Gray  Csolt  exhibited  a  large  multilocular 
ovarian  tumour  which  he  removed  from  a  girl,  set.  16,  in 
the  City  of  Dublin  Hospital,  on  July  2ncf,  1895.  The 
tumour  commenced  to  grow  about  nine  months  before  her 
admission  to  hospital,  and  was  first  observed  on  the  right 
ride.  The  abdomen  was  very  laree,  and  numerous  veins 
ramified  over  the  tumour.  The  fluctuation  was  very  dis- 
tinct, high  in  the  abdomen — ^less  so  towards  the  pelvis, 
where  solid  masses  were  felt.  Menstruation  was  irregular 
of  latOy  and  the  ''ovarian  face"  was  very  marked.  The 
girl  lost  flesh  considerably.  The  measurements  were  38 
inches  in  circumference  at  level  of  umbilicus,  90)  inches 
at  ensiform  oartilap^e,  8)  inches  from  umbilicus  to  right 
anterior  superior  spine,  9i  inches  from  ensiform  cartilage 
to  left  anterior  superior  spine.  The  usual  incieion  was 
made,  and  Mr.  Croly  found  it  necessary  to  prolong  the 
incision  upwards  and  to  the  left  of  the  umbilicus.  A  very 
large  and  distended  vein  in  the  broad  ligament  lay  across 
the  upper  part  of  the  cyst.  The  vein  was  secured  by 
double  steruised  silk  ligature,  and  divided  between  them. 
Two  gallons  of  eelatinous,  greenish  fluid  were  drawn  from 
thelitfge  cyst  which  Mr.  Croly  then  opened,  when  several 
more  solid  tumours  were  found,  and  are  well  seen  in  the 
specimen  now  on  the  table.  Mr.  Croly  found  some  diffi- 
culty in  removing  the  tumour  from  the  pelvis.  This  was 
caused  by  the  losing  of  the  smaller  cysts  in  the  pelvis. 
These  cysts  were  opened  with  a  scalpel  and  by  finger, 
and  a  boiled  starch  substance  escaped.  The  pedide  was 
tied  in  the  usual  way,  and  no  drainage  was  adopted. 
There  was  no  hemorrhage.  The  girl  was  fed  *'per 
rectum"  for  several  days,  and  made  a  rapid  recovery  and 
ffot  fat.    She  returned  to  the  country,  and  is  in  periect 

MISPIiAOBD  AKD  BOTATID  8PLBBN  WmOH   8IMULATBD  AIT 
OTAKIAN  TUMOUB. 

Mr.  HxHBT  Orat  Crolt  exhibited  a  spleen,  which  he 
removed  from  a  married  woman,  »t.  40,  in  the  City  of 
Dublin  Hospital,  on  December  7th.  The  woman  had  had 
several  children  ;  but  never  noticed  any  abnormal  tumour 
until  last  summer.  The  swelling  commenced  at  the  left 
side,  and  gradually  extended  towards  the  riffht ;  was  not 
painfuL  She  lost  fiesh  and  her  features  changed.  She 
thought  at  first  she  was  pregnant.  The  doctor  who 
*  her  pcavioosly  navar  observed  any  abdominal 


tumour  until  he  was  consulted  after  her  last  confinement. 
She  aborted  shortly  after  her  admission  to  hospital.  On 
palpation  tiie  tumour  was  firm,  and  gave  the  sensation  of 
fluctuation,  and,  though  apparently  larger  on  the  left  side, 
crossed  well  over  to  the  rieht,  and  could  not  be  moved 
upwards  or  downwards.  There  was  no  historv  of  ague, 
and  the  woman  was  never  out  of  her  native  place.  The 
usual  vaginal  and  uterine  ,examinations  were  made  by  the 
skilled  gynecologists  to  the  hospital  and  the  dis- 
tinguishS  Master  of  the  Rotunda  Hospital.  When 
the  patient  was  flrst  admitted  to  hospital  no 
decided  opinion  was  expressed  beyond  that  it  was  an 
"  abdominal  tumour,"  and  no  clinique  was  given,  but  the 
case  was  carefully  palpated,  and  attention  paid  to  improv- 
ing the  lowered  condition  of  the  patient's  health.  She 
was  w^  fed,  and  allowed  into  fresh  air,  and  walked  as 
much  as  she  felt  inclined  or  equal  to.  After  the  final 
examination  of  the  tumour  by  the  gvnecologists,  the 
unanimous  opinion  expressed  was  the  belief  of  its  beine 
ovarian.  The  question  of  the  difficulty  of  diagnosis  <3 
abdominal  tumours  of  all  sorts  is  well  known,  and 
this  proved  no  exception,  and,  though  doubts 
were  at  first  expressed  on  the  case,  all  at  the 
final  examination  htUeved  the  case  to  be  ovarian. 
Mr,  Croly  performed  laparotomy,  and  came  down  on  a 
large,  solid,  fleshy  mass,  with  purpuric  mottling  on  the 
surface.  The  small  intestines  were  adherent  to  and  flxed 
by  the  tumour,  but  were  freed  by  the  flngers.  There  was 
no  hemorrhage ;  as  the  mass  was  firmly  fixed  and  could 
not  be  raised,  the  pedicle  was  sought  for  in  the  usual 
position  but  not  found ;  the  wounoT  was  then  extended 
above  and  to  the  left  of  the  umbilicus,  where  a  f nnis-Uke 
pedide  was  discovered,  feeling  like  a  bar  of  iron.  This 
was  surrounded  by  omentum.  The  hand  was  now  passed 
along  the  pedicle  and  the  spleen  space  was  empty.  The 
pedicle  was  secured  by  a  stout  double-silk  ligature  (steri- 
lised). On  section,  the  mouths  of  vessels  were  seen  as 
in  an  "  Esmarched  limb."  There  was  no  blood  lost ;  no 
vessel  required  ligation,  torsion  or  clip.  The  peritoneal 
cavity  and  pouches  were  sponged.  The  abdomen  was  not 
dosed  until  all  risk  of  bleeding  points  was  made  certain. 
The  patient  bore  the  aniesthetic  and  operation,  which  was 
rapidly  done,  well,  and  went  on  most  favourably  for  some 
days,  when  vomiting  set  in  (of  a  greenish  fluid),  and 
symptoms  of  collapse,  and  she  succumbed.  No  post- 
mortem examination  was  obtained. 

The  following  disoussion  took  place  on  the  three 
papers  :— 

Dr.  TwKBDT  remarked  that  Dr.  Smith,  in  his  paper,  said 
nothing  about  having  examined  the  second  ovaiy.  Sar- 
comatous tumours  occurred,  as  a  rule,  in  both  ovaries : 
here  sarcoma  only  occurred  in  one.  He  was  not  quite  clear 
that  Dr.  Smith's  case  was  one  of  ordinary  sarcoma. 
Referring  to  Dr.  Croly's  case,  he  said  that  unless  the  pedi- 
de couldbe  fdt  no  certain— at  least  only  an  approximate 
—diagnosis  could  be  made. 

The  PfiKSiDBirr  said,  that  Dr.  Smith's  paper  put  him  in 
mind  of  a  case  that  came  under  his  care  fifteen  years  a^. 
She  had  what  he  dii^osed  to  be  an  ovarian  tumour  with 
asdtee.  After  opening  the  abdomen  it  became  so  wedged 
in  the  brim  of  the  pelvis  that  he  could  not  well  set  it  out, 
and  it  was  so  soft  tnat  it  broke  down.  One  of  his  assis- 
tants had  to  force  the  tumour  up  from  the  vagina  before 
he  could  remove  it.  It  proved  to  be  a  sarcoma.  She  is 
now  married,  and  her  only  cause  of  regret  is  that  she  has 
no  children.  He  asked  Mr.  Knowsley  Thornton  his  experi- 
ence, and  he  was  of  opinion  that,  without  exception,  in 
every  case  in  which  the  disease  had  occurred,  the  patient 
died  within  twelve  months.  His  case  was  important, 
inasmuch  as  it  proved  that  sarcoma  of  the  ovary  was  not 
necessarily  fatal  and  that  onlv  one  ovary  may  be  affected. 
In  the  absence  of  malignant  disease  there  must  be  some 
constitutional  cause  of  the  asdtes.  When  he  (the  Presi- 
dent) was  a  student,  some  twenty  years  ago,  Ur,  Stokes 
laid  it  down  as  a  law  that  if  ascites  were  present  the  disease 
was  most  likely  malignant,  and  he  (the  ^resident)  thought 
that  law  hdd  good  at  the  present  day. 

Dr.GuBNN  said  that  in  differentiating  between  an  ovarian 
and  splenic  tumour,  the  points  to  he  relied  on  were— (1) 
the  presence  of  a  notch  ;  (2)  the  consistency  of  the  tumour ; 
(3)  and  its  position. 

Dr.  Macan  could  not  see  whv  Dr.  Smith  did  not  make 
his  diagnosis  himself  instead  of  handing  the  case  over  to 


58     Ths  Midical  Pbm. 


TRANSACTIONS  OF  SOCIETIES. 


Jak.  15,  1898, 


his  medioal  colleague.  He  thoaght  another  diagnosis 
might  have  been  made,  and  that  there  was  another  cause 
for  the  ascites,  that  was  tubercle.  He  had  opened  an 
abdomen  himself  and  found  not  a  trace  of  fluid,  where 
there  was  no  doubt  that  the  disease  was  carcinomatous. 
He  congratulated  Dr.  Smith  on  his  paper.  He  could  not 
gratber  the  evidence  on  which  it  was  stated  that  the  spleen 
was  likely  to  suppurate  in  Mr.  Groly's  case.  His  diagnosis 
of  the  case  was  that  the  woman  had  been  going  about 
with  a  twisted  spleen  for  many  months,  and  t£bt  enlarge- 
ment was  due  to  the  twist. 

Dr.  Lake,  speaking  of  the  tumour,  said  Mr.  Groly 
referred  to  pregnancy.  He  asked  the  patient  was  she 
pregnant  and  she  said  no.  He  was  under  the  impression 
that  it  was  a  fibro-cystic  tumour.  On  examination,  per 
vaeinam,  he  found  the  cervix  softer  and  more  congested 
than  is  the  case  in  pregnancy.  The  uterus  was  also  more 
increased  in  size  than  it  would  be  in  pregnancy.  To  his 
mind  it  had  a  very  elastic  and  fluctuating  feel.  When 
the  abdomen  was  opened  the  tumour  had  gone  up  to  the 
diaphragm,  and  it  seemed  that  the  pedicle  was  going 
down  into  the  pelvis,  and  that  it  was  not  going  upwards 
towards  the  left  side. 

Mr.  M'Abdlb  congratulated  Dr.  Smith.  He  mentioned 
three  cases  of  sudden  hemorrhage.  One  was  from  a 
friable  pedicle.  In  all  three  cases  referred  to  the  rapidity 
with  which  the  pulse  returned  was  well-marked  after 
injection  of  saline  solution.  At  the  time  they  were  secur- 
ing the  bleeding  points  the  patient  was  blanched,  and 
large  beads  of  perspiration  stood  on  the  forehead.  The 
shock  that  was  often  spoken  of  in  connection  with  these 
operations  meant  often  that  inflammation  had  spread 
along  the  pelvic  veins.  He  was  acquainted  with  two  cases 
where  death  was  attributed  to  shock ;  but  the  fact  was, 
in  each  case,  a  cast  of  the  inferior  vena  cava  was  found  in 
the  right  side  of  the  heart.  He  believed  the  use  of  the 
clamp  forceps  set  up  phlebitis,  and  was  a  cause  of  the  high 
mortality  in  those  operations.  He  pointed  out  the  advan- 
tage of  digital  pressure  practised  in  a  manner  shown.  In 
the  diagnosis  of  abdominal  tumours  he  laid  stress  on 
elevating  the  patient  in  the  Trendelenberg  position. 
Unless  the  tumour  was  adherent  to  the  rectum  it  would 
move  upwards  towards  the  diaphragm.  He  thought 
thrombosis  of  the  splenic  vein  accounted  for  the  hard  cord. 

Dr.  WiKiFBBD  DiCKSOK  mentioned  a  case  in  which 
there  was  ascites,  vet  the  case  was  an  ordinary  cyst.  Dr. 
Dickson  mentioned  the  fact,  as  a  good  deal  had  been  said 
as  regards  ascites  accompanying  malignancy. 

Dr.  HosNB  said,  when  they  were  examining  the  case, 
they  were  struck  by  the  amount  of  ascites  predent.  With 
regard  to  the  bleeding  occurring  36  hours  uter  the  opera- 
tion, they  should  remember  that  Dr.  Smith  pointed  out 
that  the  pedicle  was  very  broad— it  measured  5  inches  in 
breadth.  He  connected  the  bleeding  with  the  vomiting. 
He  also  made  some  remarks  on  the  histological  character 
of  the  tumour. 

Dr.  Smith,  in  reply  to  the  remarks  made  on  his  paper, 
said  he  could  ^ve  no  explanation  of  the  ascites.  The  fact 
that  Dr.  AtthiU's  case  is  still  living  gave  him  hope.  He 
did  not  clearly  understand  what  Dr.  Atthill  meant  by 
saying  the  cause  of  the  ascites  in  his  (Dr.  Smith's)  case 
was  constitutional.  He  commented  on  Dr.  Macau's  view  as 
to  the  tubercular  nature  of  the  disease. 

Mr.  Cbolt  replied  to  the  observations  of  Dr.  Macan  and 
other  members.  He  could  not  a^pree  with  Mr.  M'Ardle  as 
to  the  value  of  turning  the  patient  upside  down,  seeing 
that  the  tumour  was  a<uerent  in  all  directions. 

The  Section  then  adjourned. 


WEST-LONDON  MEDICO-CHIRURGICAL  SOCIETY. 
MsBTiNG  HiLD  Fbidat,  Januabt  3bd.  1896. 

A.  Stmons  EooLiSy  M.B.,  President,  in  the  Cbair. 

THB  DIAGNOSIS  OF  QOKOKKHOSAL  IKTLAMMATIOHS. 

Dr.  FaxDKBioK  John  MoCann,  read  a  paper  on  this 
subject,  in  which  he  described  in  detail  the  method  of 
obtaining  pus.  He  recommended  f  usohin  as  the  best  stain- 
ing reagent  for  the  gonoooocus,  and  eosin  and  methylene 
Une  for  contrast  status.  The  appeanuioe  of  the  gonoooooos 


under  the  microscope  was  detailed.  The  relation  of  the 
gonococcns  to  the  pus  and  epithelial  cells  was 
narrated  and  demonstrated  by  photo-micrographs.  A 
gradual  process  oi  pus  cell  aestruction  had  been 
traced  wnich  was  partly  antagonistic  to  the  theory  of 
Metchnikoff.  The  same  destructive  process  was  seen  in 
epithelial  cells.  The  author  emphasised  the  fact  that  a 
large  number  of  eonococci  is  never  seen  in  conjunction 
with  a  large  number  of  pus  organisms.  He  offered  the 
following  propositions  :    (1)  Gonococci  are  present  in  the 

gus  of  every  untreated  case  at  some  period.  (2)  Secretion 
■ee  from  gonococci  does  not  cause  a  gonorrhoeal  inflam- 
mation. (3)  Secretion  containing  gonococci  even  in  small 
quantities  affects  sensitive  mucosa  with  absolute  cer- 
tainty. He  insisted  on  systematic  examination  of  the  pus 
in  all  cases  of  supposed  gonorrhosa,  and  referred  to  the 
medico-legal  aspects  of  Niesser's  discovery.  The  seats  of 
gonorrhoeal  inflammation,  and  the  reasons  for  the  special 
positions  were  given.  The  pathology  of  inflammation  of 
the  Fallopian  tubes  was  next  discuned.  The  concluding 
remarks  were  devoted  to  the  cultivation  test. 

The  i:'KBSiDSNT  said  that  in  his  experience  there  was 
not  much  hope  of  dealing  successfully  with  gonorrhoeal 
arthritis  while  gonococci  lurked  in  the  urethral  discharge. 

Mr.  McAdam  Eoclbs  remarked  on  the  uncertainties  of 
diagnosis  by  means  of  the  microscope,  and  the  difficulty 
of  making  cultivations. 

Mr.  Llotd  quoted  a  case  of  gonorrhoeal  arthritis  which 
was  followed  by  pyemia  and  an  early  fatal  iasue. 

Mr.  KxKTLEY  thought  many  rheumatoid  cases,  both  in 
men  and  women,  were  of  gonorrhosal  origin,  in  which  no 
history  of  infection  coulcT  be  got.  The  complications  of 
gonorrhosa  in  women  were  a  great  source  of  mental,  as 
well  as  physical  suffering,  and  of  moral  degradation. 
Owing  to  the  difficulty  of  cure,  we  ought  to  do  our  utmost 
to  prevent  this  virginal  infection. 

Dr.  MoCann,  in  reply,  said  that  though  regarding  most 
cases  of  gonorrhoeal  arthritis  as  pvemic,  yet,  since  each 
good  observers  as  Neisser  hii  found  gonococci  in 
the  pus  joints  in  these  cases,  he  was  bound  to  admit  that 
certain  proportions  were  caused  by  the  gonococcus. 

Dr.  Glucow,  in  some  observations  upon  the 

taiatmknt  of  kntutoooutis  in  infaitts  and  touvo 
chh:j>kin, 

drew  attention  first,  to  the  undoubted  bacterial  origin 
of  the  disease.  Upon  the  recognition  of  this  depended  tne 
adoption  of  rational  methods  of  treatment,  the  mdications 
for  which  were— (1)  to  evacuate  the  intestinee  of  their 
fermenting  contents  ;  (2)  to  combat  the  processes  of  de- 
composition by  appropriate  drugs ;  ^3)  to  administer  such 
food  to  the  child  as  shall  be  best  calculated  to  maintain 
its  strength,  and  of  such  a  nature  as  to  minimise  the 
introduction  of  fresh  micro  organisms,  and  least  favour- 
able, therefore,  to  a  furtherance  of  the  processes  of  de- 
composition ;  (4)  to  treat  symptoms  and  complicationa  as 
they  may  arise.  As  regards  antiseptic  drugs,  he  con- 
sidered the  subnitrate  of  bismuth  and  mercurials,  espe- 
cially calomel,  as  the  most  trustworthy,  and  deprecated 
the  general  use  of  astringents  and  opiates.  He  had  been 
much  impressed  with  the  value,  in  certain  cases,  of 
intestinal  irrieation,  with  regrard  to  the  employment  of 
which  he  had  formed  the  following  conclusions: — 1.  The 
operation  exercises  no  influence  upon  the  course  of  tuber- 
culous ulceration  of  the  intestine.  2.  It  is  probably  of 
little  or  ne  benefit  in  the  ordinarv  cases  of  dyspeptic  oiar- 
rhoea  of  infants,  where  the  small  intestine  is  wholly  or 
mainly  affected.  3.  It  may  be  expected  to  exercise  a 
beneficial  influence  upon  tne  course  of  the  disease  in 
general  cases  of  enterocolitis,  and  especially  in  those  in 
which  the  colon  is  lurgely  involved.  4.  It  requires  to  be 
carried  out  with  great  caution,  and  more  especially  eo  in 
those  cases  in  which  there  is  considerable  prostration. 

Dr.  GoLMAN  referred  to  the  possibility  of  accidents  in 
irrigation  and  their  prevention.  From  post-mortem  ex- 
periments it  appeared  that  in  softened  states  of  the  colon, 
two  feet  was  a  safe  level  to  which  the  can  might  be 
elevated. 

Mr.  MoAdam  Eoolbs  cited  two  cases  in  which  rupture 
of  the  sut  had  occurred  when  the  operation  had  been  per- 
formeafor  invagination. 
i     The  PsBUDBNS  held  that  in  theee  ctmm,  milk  in  any 


Jav.  is,  1896. 


FB^i^CB. 


Tsa  MsT^ioAL  PBX8&     69 


farm  sBdnld'Se  excluded  from  the  dietary  for  twenty -four 
helt^.  'H«  eaidtbatm  catarrhal  coiiditioDS  of  the  email 
intoetiDe,  with  moch  acidity,  salol  would  be  inert  since  it 
18  insoluble  io  each  «  medium.  He  prescribed  irrigation 
hi  colitis,  lyad  laid  stress  on  the  value  of  cinnamon  water 
as  an  antiseptic;  The  inflow  might  be  observed  by 
ausenlto-percoaeion. 

Dr.  Glkmow  replied. 

Mr.  SiXFJOir  Pagst  exhibited  a  specimen  of  carcinoma 
of  the  cBsbphagus  with  perforation  gf  the. posterior  wall  of 
thetraohAu  -^  *-- 


SOUTH-WEST  IiONDON  MEDICAL  SOCIETY. 


Dr,  GxLBVBT  BiGHABDSON  in  the  Chair. 

Thb  meeting  was  held  at  Windmill  Hoose,  Clapham 
Common,  by  tEe  kind  permission  of  Dr.  Benjamin  Duke. 
A  paper  on 

TUOFWBSIOIfjdj  UKIOKISM 

VM  read  by  Mr^  W.  O.  Diokikson,  and  was  followed  by  a 
dieeiudon,  in  the  Jsonree  of  which 

Mr.  T.  a.  G.  Howkll  referred  to  thtf  difficulties  which 
stuTOOnd  the  whole  question,  and  pointed  out  that  local 
medical  sodetide  f iSl  to  attract  men  who  are  brintcing  dis- 
credit on  the  pcoffiMon. 

Dr.  Mqboah  Bookbbll  alluded  to  cheap  practice  and 
andereelling,  and  et^ted  the  root  of  the  evil  to  be  that  the 
v^PI^y  o^  medUcal  men  .is  trreater  than,  the  demand  ;  he 
thought  that  means  should  be  taken  to  check  the  influx  of 
medical  students,  and  of  educating  them  in  medical  ethics  ; 
he  further  alluded  to  the  necessity  .•  for  reforming  the 
British  Medical  Associi^tion.    . 

Dr.  BbB  and  Dr.  Babkwbll  referred  to  the  touting  of 
insurance  ebmpany  and  dispensary  agents,  and 

Mr.  A.  .£.  l)oB80F'*mentioned  the  evils  of  the  out- 
patient ^stem,  and  the  lay  medical  aid  societies,  at  tha 
same  time  expressing  sympathy  with  the  difficulties  of 
those  commencing  practice. 

Mr.  DiGKiNeoK  having  briefly  repUed, 

The  meeting  terminated  with  a  hearty  vote  of  thanks 
to  Dr.  Duke  for  the  nee  (tf  l^s  house.  • 

4frante. 


[nOM  OUB  OWN  OOB&ttPOllDBrT.] 

PAfiia,  Jan.  11,  ISM. 
OwLLTivM  TBSATUxzrr  OF  PboobsssiybMyopia. 
At  the  last  meeting  of  the  Academic  de  MMecine  M. 
S.  Valude  read  a  paper  on  this  subject.    He  pointed  ont 
that  when  myopia  becomes  extreme,  and  particularly  when 
it  assumes  a  progressive  form,  the  ordinary  means  of 
combating  it  are  often  quite  powerless.    Best  [and  even 
certain  operations  such  as  tenotomy,  rarely  serve  to  stay 
the  advance  of  the  malady,  and  glasses  are,  as  a  rule, 
insufficient  to  improve  vision  owing  to  increase  in  the 
defect  of  refraction.     Many  patients   are   thus   almost 
entbely  prevented  from  following  occupations  demand- 
ing eyesight.     In  these  conditions  M.  Valude  strongly 
advocates    extraction    of     the     crystalline    lens,     an 
operataoo  which  has  come  to   the  front  of  late  years, 
believing  it  produces   the   happiest   results,    since  by 
removal  of  the  lens  refraction  of  a  very  myopic  eye  is 
brought  back  nearly  to  emmetropia.     If,  especially  in 
France,  a  large  number  of  surgeons  are  not  too  fond  of 
Ibis  operation,  it  is,  perhaps,  because  the  indications  for 
it  have  not  been  sufficiently  well  deflned,  and  because  so 
nsny  dangers  surround  operative  interference  with  an 
organ  so  delicate  as  an  eye  afflicted  with  extreme  myopia. 
M.  Valude  related  two  cases   which  illustrated  the 
safety  which  might  be  secured  to  the  operation  and  the 
neeUeat  resqlto  which  might  be  achieyed* 


The  first  was  a  man,  sat.  35,  affected  with  progressive 
myopia  such  that  he  could  qot  read  at  any  distance  ordi- 
nary characters,  and  counted* fingers  at  0'50  centimetres. 
M.  Valude  extracted  the  crystalline  lens  of  both  eyes,  and 
the  patient  wds  able  to  read  the  smallest  type  at  0*30 
kentiitietres.  This  man  is  at  present  employed  in  the 
laboratory  at  the  Salpetri^re  Hospital.  He  can  see  at  a 
distance  inathout  glasses.  The  operation  was  done  two 
years  ago. 

:  The  second  case,  a  farm  servant,  was  almost  identical 
With  the  first,  and  like  it  was  not  caused  by  close  use  of 
ithe  eyes.  The  malady  had  advanced  rapidly  and  pre- 
vented him  from  following  his  avocation.  Glasses  did  not 
help  him,  and  he  counted  fingers  on  one  side  at  one  metre, 
on  the  other  at  0*60  centimetres.  Double  extraction  was 
performed,  ^ith  the  result  that  he  was  enabled  to  read 
small  type  with  convex  glasses ;  and  for  distance  with 
Hreak  concave  glasses  his  vision  was  sufficiently  good. 

Operative  treatment  of  progressive  myopia  is  thus 
shown  to  be  desirable  treatment  in  certain  cases  where 
other  measu^res  fail ;  and  if  proper  precautions  be  observed 
M.  Valude  believes  that  the  dangers  to  the  eye  from  the 
operation  are  not  sufficient  to  deter  the  surgeon  from 
Undertaking  it. 

Scarlatina. 
>  At  the  Soci^t4  des  Hbpitaux  M.  Lemoine  spoke  on  the 
period  of  contagion  of  scarlatina  which  is  commonly 
assigneid'  to  the  termiiMition  of  the  nialady,  that  is  to  say, 
when  desquamation  sets  in.  For  him  that  idea  is  errone- 
ous, he  places  it,  on  the  contrary,  at  the  dibut,  and  ascribes 
the  seitt  of  it  to  the  mouth  and  pharynx,  from  which  the 
skin^  the  clothes,  and  every  object  surrounding  the  patient 
'is  infected.  For  this  reason  the  speaker  considered  that 
disinfection  of  these  cavities  should  take  the  first  rank 
,among8t  prophylactic  measures,  by  which  also  the  isola- 
tion at  present  so  prolonged'of  patients  suffering  from  scar- 
latina can  be  shortened  considerably. 

M.  Legendre  agreed  with  his  colleague  in  placing  the 
contagion  at  the  first  period  of  the  malady,  but  was  a 
partisan  of  prolonged  isolation. 

The  view  taken  by  M.  Lemoine  is  important,  being  very 
probable,  and  perhaps  in  other  eruptive  affections,  as 
measles  and  small-pox,  the  specific  agents  of  which  are 
still  unknown,  the  contagion  arises  from  the  same 
source,  the  mouth  and  the  pharynx.  It  seems  conse- 
quently to  be  rational  treatment  to  disinfect  these  parts, 
rendering  thus  a  double  service,  the  first  to  the  patient, 
the  second  to  the  attendants. 

DiSIM  FICTION  OF  THX  MoUTH. 

9    Salicylic  acid,  xx  grs. ; 
Menthol,  ivgrs.  ; 
Eau  de  Cologne,  3ij ; 
Glycerine,  5j » 
Water,  ad,  5  zij< 

LOGAUSBD  NSUBALOIA. 

9    Menthol,  xxx  gra. ; 
Guaiacol,  xxx  grs.  ; 
Proof  spirit,  Sj* 
Paint  the  parts  twice  a  day. 


QuAOSJSBY  in  America  bas  taken  the  form  of 
"lajring  on  of  bands."  It  is  doubtful,  however, 
whether  this  will  become  very  popular,  because  so  many 
other  persons  can  play  at  the  game— and  one  is  quite 
enongn,  if  ha  happens  to  be  a  police  officer— as  has 
been  proved  in  several  instances. 


60     Thb  Hsdhul  FkBM. 


GERMANY. 


Jak.  15.  18M. 


dtrauntg. 


[rBOM  ovB  owv  ocnnaB?oirDniT.] 

0MLDI,  Jul  lOCh. 
At  the  maetiD^  of  the  Socfety  for  Iniiere  Medizin,  Hr. 
Sebwalbe  raUtod  a  cmo  of 

RUTTDBB  OF  THB  HlABT. 

The  eaae  was  that  of  a  mao,  »t.  66,  who  ooninltad  him 
In  March  of  last  year,  on  aoooant  of  breathlMmeM  and 
palpitatUm.  Eiaminatum  revealed  emphyaema  and  oon- 
■iderable  dilatation  of  the  heart  on  the  left,  and  a  systolic 
murmur  over  the  aorta.  The  poise  was  regalar  and  not 
accelerated,  slight  dalness  at  the  apices  of  both  langs. 
Thirty  years  ago  the  patient  had  syphilis,  bat  had  been 
in  good  health  since.  He  was  married  and  his  children 
were  healthy,  and  his  wife  had  never  aborted.'  He  was  a 
fairly  free  drinker  of  wine  as  he  was  agent  for  a  wine 
hoose.  Four  weeks  before  seeking  advice  he  had  haemo- 
ptysii  with  copious  expectoration  of  dark-coloured  blood. 
A  diagnosis  of  stenosis  of  the  aorta  from  arterio-sderosis 
was  made.  In  April  and  Jaly  the  patient  had  serioas 
attacksof  serous  plenriUs  with  a  good  deal  of  exudation,  bat 
this  was  absorbed.  Thespeakerthoaght  salicylate  of  soda 
was  very  asef  ul  on  this  occasion.  Digitalis  also  was  asef  al. 
On  De&  6th  he  had  an  attack  of  angina  pectoris  that  lasted 
eight  hoars,  daring  which  the  patient  became  collapsed 
and  cyanotic,  bat  from  which  he  recovered.  On  Dec. 
16th  he  died  suddenly  whilst  walking  across  the  room. 
The  aatopsy  showed  that  the  heart  was  two  and  a  half 
times  the  normal  size,  and  weighed  five  poands.  It^was 
extensively  covered  by  emphysematoas  lang  tissae,  so 
that  the  dalness  on  percnssion  did  not  correspond  to  the 
size  of  the  heart.  The  pericardiam  contained  aboatten 
table-spoonfuls  of  dark  clotted  blood ;  the  apex  of  the 
greatly  dilated  left  ventricle  was  the  site  of  a  rent  3  centi- 
metres in  length  ;  the  aortic  valves  were  sclerosed,  and 
two  of  them  grown  together. 
Herr  Mendelsohn  then  grave  a&  address  on 

Ctouno  akd  its  Ikflumnob  oh  HsAuns. 
As  regrarded  the  muscles,  two  g^roups  came  into  con- 
sideration, first  that  used  for  pedaling,  and  that  for  keep- 
ing the  body  erect  The  working  of  the  pedals  might  be 
compared  to  the  action  of  mounting  steps  whilst  in  the 
sitting  iXMture,  the  actual  work  lay  in  the  downward 
movement,  in  which  all  the  extensors  of  the  leg  came  into 
play.  The  flexors  were  only  moderately  exeroiBcd.  For 
maintenance  of  the  position  the  muscles  of  the  trunk,  and 
especially  those  of  the  arms,  were  called  into  exercise, 
and  this  constantly.  In  conseqaence  of  this  these  muscles 
soon  became  tired,  especially  in  beginners,  and  hyper- 
trophy of  them  took  place.  The  extensors  of  the' lower 
extremities  especially  became  hypertrophied.  To  a  less 
extent  the  muscles  of  the  arms  and  shoulders  also  enlarged, 
but  in  this  case  it  was  the  flexors  and  not  the  extemors. 

As  regarded  tissue  changes,  the  urea  was  considerably 
increased,  but  the  excretion  g^radually  returned  to  the 
normal  in  spite  of  oontinoed  excretion.  The  excretion  of 
aric  acid  increased  at  fiwt,  but  sank  again  to  the  medium 
amount. 

The  appetite  and  thirst  were  increased.  Before  com- 
mencing the  exercise  it  was  not  well  too  eat  too  much,  as 
the  body  bent  forward  pressed  on  the  stomach,  and  again 
during  the  exercise  much  less  gastric  juice  was  secreted. 
Assimilation  and  defecation  were  favoorably  influenced. 
Hnmorrhmds,  however,  developed  by  immoderate  exer- 


Dyspnosa  was  set  up  by  exhanstion  of  the  reeinratlon 
and  the  heart.  Above  all  thing's  an  art  in  breathing  was 
necessary,  the  breathing  shoold  be  deeper  bat  not  more 
frequent.  It  was  also  advisable  to  breathe  through  the  nose 
as  then  the  expired  air  from  the  lungs  had  not  to  over- 
come the  heightened  pressure  produced  by  the  rapid 
movement.  The  more  the  head  was  beno  downwards,  the 
better  the  air  passing  through  the  noee  took  the  direction 
of  the  opposite  streaming  outside  current. 

The  heart's  action  was  acoelsratad.  Danger  was 
generally  avoided  by  dilatation  of  the  vessels.  The  pulse 
frequence  migh  reach  even  as  high  as  250,  and  even  after 
a  ten  hours'  rest  the  pulse  might  still  be  accelerated— a 
sigrn  of  commencing  cardiac  insufficiency.  The  advantages 
of  cycling  with  moderate  exertion  were  obvious,  and  need 
not  be  dwelt  on. 

Overdriving  was  to  be  avoided.  The  dangers  of  a 
mechanical  nature  were— 1.  Injuries,  which,  however,  were 
less  with  safeties  than  with  the  high  machines.  2.  Inflam- 
mation of  the  knee-joint  might  be  set  up  by  over-exertion, 
especially  in  the  case  of  children.  3.  Lesions  of  the 
g^eral  apparatus  might  be  caused,  especially  inflammation 
of  the  prostate  and  the  pars-nrethr»-posterior.  In  women 
mechanical  irritation  of  the  ovaries  might  becansed  by 
pressure  of  the  ileo-psoas  muscle,  ^erefore  loose  clothing 
shoald  be  worn  and  no  corset. 

A  deforming  influence  of  excessive  cycling  was  not 
impossible ;  in  the  case  of  the  very  young,  Pott's  kyphosis 
had  resulted.  The  general  results  of  excessiye  exercise 
were  emaciation,  increased  tendency  to  infective  diseases 
and  colds,  especially  irritation  of  the  larynx  and  trachea. 
A  good  preventive  of  these  colds  was,  in  the  case  of 
professionals,  a  cold  douche  of  12'5''  C,  immediately  after 
riding. 

It  is  certain  that  injurious  effects  may  be  prodaced  on 
the  heart  from  cycling.  Sudden  deaths  during  or  imme- 
diately after  a  journey  are  not  rarities.  This  is  not  to  be 
wondered  at  when  we  call  to  mind  that  for  short  distanoss 
at  the  rate  of  61  kilometres  per  hour  has  been  reached. 
At  such  a  rate  of  speed  overtiring  of  the  heart  is  unavoid- 
able. 

Opium  nr  Stwosb  of  thb  Labthx  in  GmLDBBzr. 
Dr.  G.  Stemof  theMarianHospital,I>u89eldorf,hasapaper 
on  the  subject  in  the  Ther.  MotuUsch.  V,  He  commenoss 
with  the  remark  that  it  is  an  old  experience  that  children 
suffering  from  diphtheria  or  croupous  stenosis  of  the  larynx 
breathe  with  much  greater  difficulty  when  they  are  excited 
than  when  they  arearieep,  and  that  the  breathing  of  children 
who  have  had  tracheotomy  performed  is  rendered  easier 
by  opium.  On  these  grounds  the  author  has  given  opium 
to  children  for  whom  tracheotomy  was  intended,  and  has 
found  that  the  respiration  had  become  calmer,  and  that 
the  cyanosis  had  diminished .  The  action,  according  to  the 
writer,  is  readily  explained,  as  more  air  will  pass  through 
the  narrowed  passage  when  the  inspiration  is  slow  than 
when  it  is  rendered  difficult  by  an  intense  feeling  of 
impeded  respiration.  By  this  calm  breathing  also  the 
carbonic  acid  intoxication  is  relieved.  He  gives  the 
history  of  three  cases  that  demonstrate  in  his  opinion  the 
excellent  effect  of  opium  treatment.  One  patient,  a  child 
of  15  months,  was  sent  into  hospital  for  tracheotomy. 
There  were  excessive  cyanosis,  loud  stridor,  resonant 
cough,  and  retraction  of  the  zyphoid  cartilage ;  3  minims 
of  tr.  opii  were  given  in  sweetened  water  at  3  o'clock.  At 
6  the  child  had  slept  peacefolly,  breathed  eadly  with 


Jau.  15,  18M. 


THE  OtEftATtNG  THEATBE8. 


Thk  MmtioAL  Pbssb.     61 


diafciiiet  rtridar,  Uie  oon^  was  lees,  the  oyanoeis  dietiiiotly 
lees ;  2  more  drope  of  the  tr.  opii  were  given.  The  night 
was  peooed  quietly.  The  following  day  2  to  3  drops  were 
given  3  tunee^  and  also  on  the  two  following  days.  On  the 
Uiird  day  the  retracstion  of  the  zyphoid  had  disappeared, 
and  on  the  eighth  day  the  patient  was  discharged.  The 
aathor  thinks  that  opiom  ought  always  to  have  a  trial 
before  leoonrse  is  had  to  tracheotomy. 

Death  of  Mb.  Juuus  Skamfsh. 
I  regret  to  have  to  notice  the  death  of  Br.  Julias 
Skamper,  from  its  commencement  one  of  the  most  inde- 
fatigahle  collaborators  of  the  DmtUeke  Medizinal  Zeitung. 
A  very  familiar  name  will  no  longer  meet  the  eyes  of  the 
readers  of  this  extensively  circolated  joumaL  Those  who 
have  been  accustomed  to  seeing  it  for  so  many  years  will 
sympathise  with  those  more  nearly  associated  wi&h  him  in 
the  loee  they  have  sustained. 


[VBOM  CUB  OWir  OOBBIBFOirDHNV.] 

Ylenna,  Jan.  10th,  1896. 
Labtbihth  Exfsbimkits. 
Kbxidl  showed,  at  the  *<  Gesellschaft,'*  two  cats  on 
which  he  had  operated  experimentally.  One  of  them  had 
been  operated  on  nine  months  ago,  the  other  four  months. 
Both  exhibited  Golts's  phenomena,  usuaUy  met  with  when 
the  function  of  the  labyrinth  is  interfered  with.  It  is  now 
twenty  years  ago  since  Breuer  drew  the  attention  of  this 
Society  to  the  same  subject,  which  does  not  appear  to 
have  advanced  in  knowledge  since  that  time,  as  the  same 
opinion  is  still  retained  concerning  the  semi-circular 
canals  and  the  otolithic  apparatus  of  the  ear.  The 
destrueUon  of  the  portio 'mollis  and  the  llabyrinth  in 
the  mammalia  has  rarely  been  performed.  The  principal 
experiments  on  record  are  those  on  the  dog  by  Sehiff,  and 
more  recently  by  Evald.  Hitherto  no  experiments  have 
been  made  on  oats. 

Kreidl  at  this  point  described  his  own  method  of  opera- 
tion, which  differs  somewhat  from  the  preceding  experi- 
menters. The  latter  have  always  performed  their  opera- 
tions by  removing  a  part  of  the  cranium  or  dividing  the 
aoditory  nerve  with  a  knife. 

He  p«fonned2the  present  operations  by  carefully  remov- 
ing all  the  coverings  of  the  foramen  rotundum,  through 
which  he  reached  tiie  cochlea,  by  means  of  a  finely  con- 
ttruoted  Paquelin,  whose  point  was  no  larger  than  the 
opening  of  the  canal  for  the  auditory  nerve  in  the  cochlea, 
nie  wound  dosed  up  perfectly  without  any  bad  effects. 
During  the  operation,  it  was  observed  that  tiie  animal  was 
quiet  till  the  auditory  nerve  was  reached,  when  it  strug- 
gled and  screamed  piteonsly  ;  at  the  same  time  nystagmic 
movements  of  a  horisontal  character  were  observed 
in  both  eyes.  This  phenomenon  lasted  from  24  to 
48  hours  after  the  operation,  and  could  be  repeated 
with  any  slight  irritant  fluid,  such  as  carbolic  lotion,  in 
(he  wound.  This  phenomenon  of  the  binocular  auditory 
nerve  nystagmus  caused  by  injury  to  the  auditory  nerve  is 
in  perfect  harmony  with  the  results  of  Breuer  ;and  Mach's 
experiments.  An  important  consideration  in  these  experi- 
mentsis  thespeedy  return  of  the  equilibrium,  a  result  which 
Biglit  be  expected  in  a  highly-developed  animal  like  the 
crt .  In  the  case  of  the  animal  operated  on  four  weeks  ago 
(he  head  was  observed  to  incline  towards  the  cqperated 
side.    When  placed  on  the  table  and  food  within  sight  of 


it  on   the  floor   she  would  not  venture  to  leap  down, 
having  no  confidence  in  herself.    In  the  other  cat,  nine 
months  operated  on,  the  labyrinth  having  been  perfectly 
destroyed,  there  were  still  &igns  of  disorganisation.    She 
walked  with  a  heavy  gait,  making  pendulum  movement-s 
with  her  head,  and  took  her  food  awkwardly,  from  the 
peculiar  movements  of  the  head.    When  lifted  in  the  air 
she  clung  tightly  to  the  arm,  owing  probably  to  the  dis- 
organised sensation  of  the  extremities. 
Sanitaby  Inspbction. 
In  the  Austrian  House  of  Commons  the  reorganising 
sanitary  bill  was  warmly   discussed.    It  is  proposed  to 
create   sanitary   inspection   districts   in    Bohemia    and 
Galida,  as  well  as  a  centralised  sanitary  inspectorate 
which  is  to  be  divided  into  four  classes.    It  was  finally 
resolved  to  retain  a  district  surgeon  in  this  oflSoe,  and  dis- 
pense with  the  present  form  of  a  sanitary  derk. 


ST.  THOMAS'S  HOSPITAL. 
Plabtio  Opkbations  upon  Etiuds  bt  Thibbsch  Gbafi- 
INQ.— Mr.  Andbbson  operated  on  a  girl,  et.  9",  who  had  at  the 
age  of  nine  months  suffered  from  a  severe  bum  of  the 
face,  the  cicatricial  contraction  from  which  had  resulted  in 
eversion  of  the  upper  and  lower  eyelids  and  other  deformi- 
ties. Operations  had  already  been  performed  by  Mr. 
Anderson  for  remedying  the  palpebral  deformity  by  the 
transplantation  of  Thiersch  grafts  into  the  raw  surface 
left  by  an  incision  freeing  the  lids,  and  allowing  their  • 
replacement  into  the  normal  position  ;  the  effect  of  these 
operations  had  been  almost  entirely  successful,  but  as 
slight  eversion  still  remained  a  second  operation  was 
undertaken.  A  small  incision  was  made  at  the  free  border 
of  the  upper  lid  immediately  above  the  eyelashes  ;  by  dis- 
section the  lid  was  then  drawn  completely  down,  carrying 
with  it  the  fibres  of  the  orbicularis,  leaving  an  eliptical 
raw  surface  ;  the  lids  were  held  in  place  by  means  of  fine 
wire  passed  through  the  free  border  and  fixed  below  to 
the  cheek  by  means  of  American  plaster  ;  into  the  gap 
now  exposed  were  transplanted  Thiersch  grafts  of  suit- 
able size  and  shape  taken  from  the  thigh  of  the  patient ; 
the  graft  and  adjacent  portion  of  the  integument  were  then 
covered  with  a  thin  layer  of  cotton-wool  steeped  in  collo- 
dion. After  a  similar  operation  on  the  upper  lid  of  the 
opposite  eye  the  retracted  upper  lip  was  freed  by  an 
incision  through  the  cicatricial  tissue  at  the  root  of  the 
nose  and  the  fi^p  exposed  on  drawing  the  lip  downwards 
was  filled  in  with  a  Thiersch  graft  and  dressed  in  the  same 


The  second  case  was  that  of  a  girl,  »t.  19,  who  had 
suffered  from  a  tubercular  sypbilide  of  congenital  origin 
which  had  destroyed  the  whole  of  the  nose,  and  had  pro- 
duced by  itsdcatrisation  a  great  eversion  of  the  lower  lids. 
The  patient,  when  admitted,  was  suffering  from  extensive 
ulceration  of  the  cheeks,  upper  lip,  and  of  the  interior  of 
the  nose ;  this  was  rapidly  cured  by  large  doses  of  iodide 
of  potassium.  The  present  operation  was  undertaken  as 
a  first  step  in  the  relief  of  the  horrible  disfigurement  which 
the  disease  had  produced.  An  incision  was  made  imme- 
diately bdow  the  border  of  the  everted  lid ;  the  lid  was 
then  drawn  tip  with  the  orbicularis  fibres  and  fixed  in  an 
upward  direction  by  fine  wires  passed  through  the  border 
and  fastened  to  the  forehead  by  means  of  strapping ;  the 
raw  gap  so  exposed  was  filled  in  by  Thiersch's  graft  as  In 


M       TmrMiDTOAL  Vkk». 


LEADJNO  ARHCEES. 


JAV.  15,  U06. 


the-lMt  OMO,  and  drened  with  coUodicB  and  botton  waol  $ 
the  lowei  eyelid  of  the  opposite  eye  waa  theD  tseated  in. 
the  aame  manner.    Mr.  Anderson  remarked  that  the  nse 
of  Thiersch's  graft  in  ectropion  promised  good[resQlts.    In 
the  first  case  an  ectropion  of  both  lids  in  both  eyes  had 
been   almost'  completely  relieved  by  a  single  operation, 
and  the  repalsive  as^iect  of  the  little  patient  had  been 
removed.    It  was  at  first  nnoertain,  he  said,  how  far  con- 
traction woold  oocnr  under  a  Thiersch  graft  in  such  a 
case,  bttt  the  result  proved  tha^  a  very  little  of  this  took 
place.    A  second  operation  would  probably,  he  thought, 
be  necessary  in  most  cases.    The  lip  deformity  in  the  first 
patient  would  very  likely  be  relieved  to  an  equal  extent  by 
the  method  of  grafting,  but  in  the  spoond  ca^e  it  was  prp^ 
posed  to  remedy  the  retraction  of  the  upper  lip,  while 
restoring  the  nose  by  a  Tagliacotian  operation. 
GREAT  NORTHERN  HOSPITAL. 
Casm  of  Intdssubgeption.  —  Gakobbnous   Intxbtikx 
WITHOUT  UBOBNT  SYMPTOMS.— Mb.  H.  Alling  HAM  Operated 
on  a  boy,  set.  3,  who  presented  very  few  symptoms  of  abdo- 
minal trouble.     He  only  vomited  occasionally,  the  bowels 
had  acted,  the  abdomen  was  not  at  all  distended  nor 
tender,  pressure  on  it  being  well  borne  over  its  whole  sur- 
face.   The  child  had  been  carefully  watched  in  the  hos- 
pital for   two  days,  but  as   the  vague  symptoms  still 
continued  it  was  thought  advisable  to  open  the  abdomen 
to  explore.    It  was  found  that  there  was  an  intussuscep- 
tion of  the  small  intestine.    Repeated  attempts  were  made 
to  reduce  it  but  as  these  failed  the  intestine  was  opened , 
when  it  was  discovered  that  the  intussnscepted  gut  was  in  a 
semi-gangrenous  condition,  so  that  it  waa  necessary  to 
resect  about  eight  inoiMs  of  the  bowel ;  the  divided  ends 
were  united  over  Allingham^a  h0bbin»  thia  being  easily 
and  ^sgy  quickly  accomplished  t  a  few  Lembert's  sutures 
were  inserted.    The  intestine  was  thorQughly  washed  with 
earboHc  solution  and  returned  into  the  abdomen,  and  the 
external  wound  dosed.    Mr.  Allingham  remarked  on  the 
paueity  of  symptoms  in  this  case ;  the  only  points  that 
caused  the  performance  of  abdominal  section  were  the 
aspect  of  the  patient  and  the  rapidity  of  the  pulse.    He 
also  commented  on  the  great  facility  with  which  the  ends 
of  the  gut  were  brought  together  over  the  bobbin  employed. 
On  opening  the  piece  of  resected  intestine  it  was  found 
that  the  intussusception  was  due  to  the  presence  of  a 
polypus  somewhat  of  a  sessile  nature. 

Tbbfhiniiio  iob  Ctobral  Tumoub.— The  same  sur- 
geon operated  on  a  case  of  Dr.  Beaver's,  a  woman,  set. 
about  38,  who  was  paralysed  down  the  leftside,  and  who 
complained  of  intense  headache  and  double  optic  neuritis. 
As  all  these  symptoms  were  gradually  getting  worse,  Dr. 
Beevor  thought  an  exploration  was  necessary.  Mr. 
Allinghan^  made  a  large  semilunar  fiap  on  the  right  side 
of  the  head,  exposing  the  area  of  the  Rolando  fissure.  A 
large  croim  of  bone  was  then  removed  with  a  large  tre. 
phine»  and*  as  the  dura  mater  bulged  into  the  wound  and 
didnot  pnisat9»  Dr.  JM^or  advised, that  a  larger  portion 
of  the  bone  should  be.Aaken^.away,;  this  was  done  with 
Heyfs  saw.  and  Horsleyfs  Jbone  forceps,  so  as  to  remove  an 
^reaof  bene  lour  inches  squara  Th^dara  mater  waa  not 
opened  .fA  this  the  first  operation,  the  skin  ^^p  being 
sutured  back  in  position.,.  Ten  days  later,  the  patient 
having  satiffacfrorily  recovered  from  the  first  part  of  the 
operationt  the  flap  was  tonied  down  again  and  the  dura 
mater  incised  all  round  the  bone  opening  and  tum^ 
down  ia.a.laige  flap..  Xhe  brain  wae  then  oacdhdly  pal- 
iwl^itei4|apwrti  any  }a(Pi:eMeAmrirtiM¥is^  Horn. 


found  theexposed  brain  Wae  indeed  in  Variote parts  and 
the  finger  inserted  well  into  the  hemsspteres^  but  no 
tumour  being  discovered  tha  dura  mater -flap  was  replaced 
and  the  skin  wound  united.  Mr.  Allingham  remarked 
that  the  interesting  part  of  the  operation  fro»  a  eargicil 
point  of  view  was  it  having  been  done  in  two  parte,  thus 
avoiding  excessive  shock,  which  often  followed  the 
removal  of  a  large  mass  of  bone  and  the  exploration  of 
the  brain  or  a  removal  of  a  tumour  at  the  same  sitting. 

It  is  interesting  to  note  that  the  tension  was  completely 
relieved,  and  the  patient  is  in  some  points  improved. 
The  optic-  neuritis  has  gone  and  the  headache  has  dis- 
appeared, but  the  paralysis  still  remains. 


i  FOB  TBABSHISSIOB  A3B0AD. 


PabUahsd  every  Wsdneidsj  moninff ,  PHoe  Bd.   Post  tree,  i|d. 


roBOnUrBBBnoB:-WholePaffe,MOi.Od.;  HalfPags,  ttlttkOd. 
<)iuwtarPaffe,A16i.;  On*-«i|^tli,  Ui.  6d. 

roB  A  SiaiBS  or  Ibbbbtioxs  :— Wkols  Page,  UilrtMn  Inaertlooi 
(wtiUj,  fottoighliy,  or  monUilj)  at  £S  lOi.  Od. ;  tvwUy-sIx  iaMV- 
ttona  (waokly  or  f ortniglitly)  at  £S  Si.  Od. ;  llf|r-two  IimmUum 
(waaUj)  at  £S  mmIl  Half-page,  tkiiteea  Inaartloiii  aft  Sfia.; 
twentf-dzat  na. ;  flftr-twolnaertiooa  at  tOa.  eaeh.  Qoarler-paffe, 
Udrteeninaertions  at  1ft. ;  tvwUy-alz  Inaerttoaa  at  16a. ;  flfl7-atz 
lnBertioBaatlSa.eadh 


POSf 


to  AmrVAL  8PBB01IBB1S 

▲BBOAI),  WRHDI  THB  POSIAL  UHIOB 

laniA,  cbbba,  ahi^  Japab  . 


Mi    1 

£1    B 

«1  i 


d  Oheqiiealo  be  dnwxi  In  favour  of— 
A  A  TZHDALL.Sa-Sl  King  WlUiam  Street,  StnadiliODdsa. 
A'  1.  JAOOB,  »  Moleeworth  Btrtet,  Dnblls. 

SrasouFnovfl  iob  PBAJTOb  are  received  by  Meeari.  Bailld 
HaatefealUe,  Barfa-poatfree  In  advanoe,  iU  Si.  6d.  pera 

BussqaiFTion  iob  chb  UHrbd  SCAOB,  poet  tree  in  advanoe 
(£1  Si.  Qd.  per  annum),  ahoald  be  aent  d&ect  to  the  OScea  in 
thli  oouatij  by  Iatematk>nal  Poet  Ottoe  Order. 

86U  AgmUB  fw  GMvuiny  antf  iliMfre-jarufioaffy— 
W.  A  B.  LowmHALCOmoe  of  the  BwMwerildPMrtMdfc),  GnoMlnaBe 
i,  Berlin. 

BmaU  Annonnoementi  of  Praottoea,  Awlatanelea.  Vacancies,  Book 
M.— Seven  llnee  or  under,  H.  per  Inaertlon ;  U.  per  Une  bejoad. 

Letten  In  thia  department  ihonXd  be  addreeaed  to  the  PabUaheri 


Vs^t  IB^jeMrsI  %n%%  k  ^irmlar. 


<8ALU8  POFULI  80PBSMA  LBX.' 


WEDNESDAY,  JANUAEY  15,  1896. 


GLANDULAR  THERAPEUTICS. 
Oni  of  the  most  promising  departures  in  modem 
therapeutics  is  certainly  the  utilisation  of  the  internal 
secretions  0^  certain  glands  to  sppplement  their. lack  in 
the  individual  as  a  consequence  of  disease  or  removal 
of  the  corresponding  organs.  The  field  of  what  majf  be 
termed  ''g^4^^...^flWOQi^ic8"  u  beiQg  giadnally 
extended,  and  the  excellent  results  so  far  obtained 
warrant  hopes  of  stiU  more  brilliant  results  in  the  near 
futnro.  AooordiDg  to  the  theory  held  and  enthnaiasti- 
callygtomnlQitwi  l^4ha  kte  Dr.  BmrnS^qiiard,  all 


3am,  16,  1896. 


LEADING  AKTICLES. 


ThV  MsDICAL  t^BBS.       63 


^BndB,  in  addition  to  their  obvious  secretions,  elaborate 
aobstanoea  which  pass  into  the  blood,  there  to  perform 
eertain  functions  which,  as  well  as  their  chemical  com- 
poflitiony  was  still  hugely  obscure.  We  knowsuch  to  be 
die  case  with  the  thyroid  gland,  we  suspect  as  much  in 
lajnct  of  the  thymus,  and  it  is  extremely  probable 
tiist  other  ^ands  exert  an  influence  over  distant  parts 
ef  theorganism  not  as  yet  even  suspected.    The dis- 
toferj  that  aUation  of  the  testicles  determines  retro- 
groBsion  of  the  hypertrophied   prostate    opens   up 
a    field    for    speculation    in    the    opposite    direc- 
tion,  thongh    experiments    are    still    in    progress 
irith  extracts   of    the    prostate  gland  having  the 
ame  object  in  view.    The  latest  discovery  of  the  kind 
» that  removal  of  the  ovaries  will  cure  that  ill-under- 
itood and fortunfttply rare disease^osteo-mal^eia.  One 
of  the  first.efiects  of  this  discpveiy  -will  probably  be  to 
throw  more  light  on  the  exact  nature  of  this  affection, 
for  there  is  reason  to  believe  that  under  this  designa- 
tkm  various  pathogenic  modifications  of  the  osseous 
qfstsm  are  at  present  included.    In  this  country  we 
tie  only  familiar  with  osteo-malada  as  an  affection  of 
sdvanesd  life  in  spite  of  the  fact  ;that  it  .Lb  usually 
described  as  a  disease  occurring  mainly,  if  not  exclu- 
mtf,  during  the  child-bearing  period  of  women's  life. 
The  cases  reported  abroad,  moreover,  usually  comply 
viththis  definition,  but  tiie  disparity  is  one  which 
moat  be  explained  before  we  can  get  much  further  with 
tfaa  treatment  of  the  disease.    Osteo-malada,  or  what 
is  described  as  such  in  the  aged,  cannot  very  well 
deiive  its  origin  from  changes  involving  the  ovaries 
ifttfasir  poaU  de  depart^  and  there  are  many  other 
ciiues  which  may  influence  the   nutrition   of  the 
aUelon  without  any  reference  to  the  sexual  glands. 
Ihfi  effect    of    removal   of    the    ovaries    in  arrest- 
mg  osteo-malacsa    has   led   Professor   Curatula,  of 
Boms,  to  cany  out  some  very  elaborate  investigations 
OD  the  effects  of  castration  on   the  metabolism  of 
hesKhy  animals.  It  is  a  matter  of  common  observation 
thil  castrated  animals  usually  put  on  fat,  and  one  of 
tkolgects  of  the  professor's  researches  was  to  ascer- 
tela  whether  this    accumulation   of    adipose  tissue 
ii  doe  merely  to  lessened  vital  activity  or  to  the  absence 
of  some  secretion  formerly  poured  into  the  blood  which 
bcilitated  the  oxidation  of  fats.    His  results  appear  to 
point  to  the  truth  of  the  latter  hypothesis.    He  found, 
for  instance,   that  castration  was   followed  by  an 
immediate  diminution  in  the  amount  of  phosphorus 
eliminated  in  the  urine,  the  proportion  of  nitrogen  re- 
nsining  the  same.  Thesubsequent.subcutaneoustixgec- 
tbn  of  ovarian  juice  at  once  brought  about  an  increase 
intheproportionof  phosphates,  the  increase  varyingmore 
or  less  according  to  the  amount  of  the  juice  injected. 
Moreover,  the  elimination  of  carbonic  anhydride  by  the 
hmgn  undergoes  a  similar  diminution  after  castration, 
conesponding  possibly  to  a  diminished  oxidation  of 
to,  and  this  doubtless  explains  the  accumulation  of 
idipose  substances  in   the  organisms   of   castrated 
uiinals.    In  support  of  the  view  that  the  internal 
Moetaon  of  the  sexual  glands  is  concerned,  indirectiy 
it  uiy  rate,  in  the  development  of  the  osseous  system, 
tte  MthoriBfltttiQos  that  giants  usually  h»?e  aitroi^ed 


testicles,  while,  as  a  point  of  personal  observation,  the 
eunuch  choristers  of  the  Sixtine  Chapel  all  have 
massive  skeletons.  Cases  of  osteo-malacia,  especially 
of  the  variety  which  alone  can  be  supposed  to  be 
amenable  to  this  treatment,  are  rare  in  this  country — 
indeed  almost  unknown,  but  the  principle  involved,  ii 
substantiated,  is  one  capable  of  extension,  and  is  of 
great  scientific  interest 


THE  OPERATIVE  TREATMENT  FOR  IDIOCY. 
DuBiNG  the  past  year  the  question  of  the  operative 
treatment  of  idiocy  came  Wgely  under  notice.  Since 
the  results  of  this  treatment,  recorded  by  the  French 
surgeons,  were  published  some  few  years  ago,  a  good 
deal  of  attention  has  been  paid  to  the  matter.  Unfor- 
tunatelyy  however,  while  the  French  oases  seemed  to 
hold  out  great  prospects  of  much  usefulness  resulting 
from  operative  interference^- the  experience  of  other 
surgeons,  both  in  this  and  other  countries,  was  by  no 
means  encouraging  in  this  regard.  Part  of  this  want 
of  success  has  been  attributed  to  the  fact  that  the  cases 
in  question  were  not  recognised  as  belonging  to  two 
classes— those  in  which  the  idiopy  is  due  to  arrest  of 
development  of  the  brain,  as  the  result  of  which  the 
skull  remains  small,  and  those  where  there  has  been 
premature  union  of  the  bones  of  the  skull,  in  conse- 
quence of  which  the  brain  is  unable  to  develop.  In 
the  latter  cases  the  treatment  advocated  by  the  French 
surgeons  would,  in  all  probability,  prove  successful. 
But  experience  has  taught  that  such  cases  are  ex- 
tremely rare,  and  that  the  bulk  of  those  which  come 
under  the  notice  of  the  surgeon  belong  to  the  former 
category,  for  which  operative  treatment  is  clearly  con- 
tra-indicated. Thus  it  may  be  sud  that  a  distinct 
advance  has  been  made  in  respect  to  the  treatment  of 
these  unfortunate  cases,  inasmuch  as  the  recognition 
of  the  two  classes  of  these  patients  will  tend  to  prevent 
indiscriminate  operating,  a  procedure  which  has  in 
the  past  been  attended  with  many  untoward  results. 
The  latest  contribution,  however,  to  the  subject  is  that 
of  a  comprehensive  article  by  Dr.  Charles  Dana,  of  New 
York,  published  in  the  current  number  of  the  American 
Jovmal  of  the  Medical  Sciences.  Upon  the  whole,  this 
surgeon  takes  a  more  favourable  view  of  the  operative 
treatment  of  these  cases.  He  claims  that  inasmuch 
as  statistics  now  prove  that  the  mortality  from  craniec- 
tomy has  been  reduced  from  forty  to  five  per  cent,  it 
wocdd  be  unjust  to  our  art  and  inhumane  to  a  large 
class  of  most  unfortunate  sufferers  were  surgeons  to 
cease  attempting  operative  interference.  But  the 
views  which  he  holds  with  respect  to  the  rationale  of 
the  operation  are  somewhat  novel.  His  opinion  is  that 
it  has  a  profound  disciplinary  effect  upon  the  idiot, 
and  that  it  is  mainly  through  this  that  an  improve- 
ment in  these  cases  takes  place.  **  The  operation,''  he 
says,  "is  allied  in  its  effect  to  a  severe  piece  of  castiga- 
tion.  In  the  very  low  type  of  criminals  it  is  a  well 
recognised  fact  by  philanthropists  that  discipline  and 
systematic  work  can  only  be  obtained  by  actual  corporal 
punishment  in  many  instances,  for  nothing  else  seems 
aetoaUy  to  appeal  to  them.     In  the  very  lowest 


64     Tub  Mkdioal  Pbw^ 


LEADING  ABTICLia 


grades  of  iotelligeDce,  snch  as  we  find  in  idiots 
and  imbeciles,  it  b  probable  that  only  these  very 
powerful  inhibitory  inflnences,  such  as  accompany 
the  performance  of  a  capital  operation,  can  i^ect 
materially  the  intellect  of  the  child.  It  is  through 
some  buch  explanation  as  this  that  I  would  explain 
the  fact  that  a  second  operation  on  these  children  is 
attended  by  further  good  results,  and  that  sometimes 
the  second  operation  is  absolutely  necessary  before 
any  result  Ir  obtained  at  all."  Of  course  it  is  not  im- 
possible that  some  effect  of  the  kind  cUimed  by  the 
author  is  produced  by  operative  interference  in  these 
cases,  but  we  are  not  prepared  to  accept  his  explana' 
tion  in  its  entirety.  We  should  be  much  more  in- 
clined to  attribute  most  of  the  good  which  results 
from  the  improvement  in  the  circulation  and  nutrition 
of  the  brain,  arising  from  the  release  of  some  of  the 
compression  to  which  it  has  been  subject  It  may 
here  be  remarked  that  two^  specially  important  points 
are  insisted  upon  by  the  author,  nam  ly,  the  age  of  the 
idiots  and  the  types  of  cases  in  espect  to  which 
operative  interference  is  indicated.  So  far  as  the 
former  b  concerned,  experience  has  shown  that  the 
simple  forms  of  idiocy  with  microcephalus  are  certainly 
not  benefited  unless  operative  interference  b  under- 
taken early  in  life,  that  b  to  say,  under  the  age  of  four 
years,  while  with  regard  to  the  latter  the  chief  indica- 
tion for  the  operation  b  a  moderate  amount  of  micro- 
cephalus. Wlien,  however,  dbtinct  microcephalus  b 
present  the  operation  b  not  likely  to  be  of  any  service, 
inasmuch  as  in  these  cases  there  b  very  great  lack  of 
brain  development  The  perusal,  we  may  add,  of  the 
author's  practical  contribution  to  thb  subject,  despite 
its  somewhat  sanguine  tone,  certainly  tends  to  confirm 
the  impression  that  in  certain  selected  cases  craniec- 
tomy may  be  attended  with  benefit  in  idiocy,  but  that 
in  the  majority  of  cases  of  the  kind  operative  interfer- 
ence b  contra-indicated. 


THE  FUTURE  OF  MEDICINE. 
MoDESN  scientific  medicine  strikes  its  predominant 
keynote  in  the  word ''  progressiveness."  Its  bter  hb- 
tory  has  been  one  long  record  of  triumphs  won  by 
continuous  and  undaunted  intellectual  labour.  The 
logical  groundwork  which  the  early  Fathers  lacked,  in 
spite  of  all  their  subtle  reasonings,  was  first  formally 
supplied  by  Bacon,  who  undoubtedly  laid  the  foun- 
dations of  Uie  marvellous  superstructure  of  knowledge 
that  b  now  being  brought  within  the  reach  of  every 
board-school  pupil.  The  experimental  testing  of  phe- 
nomena tinsbted  upon  by  our  illustrious  countryman 
has  been  steadily  conducted  ever  [since  by  workers  in 
every  part  of  the  civilised  world,  and  so  great  has  been 
the  result  that  in  many  instances  Ithe  romance  of  one 
generation  has  become  the  realised  and  prosaic  fact  of 
the  next  Increased  accuracy  of  observation  and  of 
means  of  measurement  has  led  to  the  accumuUtion  of 
an  enormous  mass  of  ascertained  phenomena,  from 
which,  every  now  and  then,  some  master-mind  has  been 
able  to  deduct  a  great  general  law.  Many  examples 
will  donbtleM  ooeor  to  readers,  such  as  Newton's  dis* 


Jah.  15,  im. 

coveryof  the  law  of  gravitation,Darwin's  famous  genenl- 
isation  of  the  evolution  of  species,  and  Lbter's  giest 
practical  deduction  of  antiseptic  surgery.  The  art  of 
medicine,  which  depends  on  the  support  of 
many  subsidbry  sciences,  has  advanced  step  hj 
step  with  the  onward  march  of  its  Mth- 
ful  henchmen.  Indeed,  it  may  be  broadlr 
stated  that  there  b  hardly  any  dboovery  in  the  field  of 
science  that  may  not  sooner  or  later  be  pressed  mto 
the  service  of  thb  most  comprehensive  art  of  healiaj^ 
What  the  future  of  scientific  medicine  may  be  it  ii  far 
from  easy  to  conjecture.  Within  the  past  twenty  yein 
many  changes  have  become  part  and  parcel  of  eTerydaj 
practice.  The  introduction  of  antiseptics  has-revda- 
tionised  surgery,  and  has  enabled  the  surgeon  to  ]smk 
many  regions  of  the  human  body,  hitherto  sacred  to 
the  physidan.  Bacteriology,  again,  in  itself  an  exact 
demonstrator  of  initial  facts,  has  opened  up  an  enor- 
mous field  in  the  prevention  of  disease.  Indeed,  there 
seems  to  be  no  end  to  the  fresh  weapons  of  prediion 
that  are  constantiy  being  placed  in  the  haodi  of 
members  of  the  medical  profession.  One  of  the  moat 
marvellous  of  the  whole  series  b  that  of  organic  then- 
peutics,  as  yet  ill-understood  and  tentative,  but  fall  of 
promise  of  a  brillbnt  future.  Until  more  b  known  of 
thb  as  yet  evasive  branch  of  special  knowledge  it  wffl 
be  well  for  all  who  are  interested  in  the  welfaie  and 
reputation  of  scientific  medicine  to  suspend  their  judg- 
ment for  the  time  being.  To  jump  at  oondusioDS  is 
one  of  the  most  deeply-rooted  of  human  tendendoB, 
but  such  a  course,  however  natural,  b  simply  fatal  to 
scientific  life  and  development  So  far  as  it  u  posiiUa 
to  draw  a  general  conclusion  from  the  near  peispeetive 
of  current  events,  one  might  be  tempted  to  suggest 
that  the  trend  of  professional  affairs  lies  mainly  in  the 
path  of  prevention.  In  othw  words,  eadk 
fresh  advance  in  the  various  departments 
of  medicine,  whether  in  methods  of  treatment,  in 
improved  faftbits  and  environment,  will  tend  to 
lessen  the  amount  of  mortality  and  sickness  incident 
to  mankind.  The  dream  of  the  public  health  enthusiast 
b  to  improve  matters  so  that  the  majority  of  men  shall 
live  to  tiiree  score  and  ten,  while  the  death-rate  shall 
be  brought  down  to  the  irreducible  minimum  of  fire 
or  seven  per  thousand  of  population.  Nor  does  such 
a  forecast  seem  altogethw  fantastic  and  extravagant 
when  we  consider  the  enormous  saving  of  life  that  has 
already  been  effected  since  the  introduction  of  system- 
atic and  scientific  protection  of  the  public  health.  On 
the  whole,  the  future  of  medicine  appears  to  promise 
a  field  of  conquest  which  will  end  only  when  there  are 
no  more  worlds  to  conquer,  and  the  human  race  shall 
have  worked  out  its  own  physical  and  preventiye 
salvation. 


Dr.  J.  H.  McAttlet,  of  Drumcondra,  has  been  ap- 
pointed medical  officer  of  the  Summerhill  dbpensaiy 
dbtrict  of  the  North  Dublin  Union. 

A  JACKBT  made  of  aluminium  has  now  been  highly 
recommended  as  a  spinal  support  in  the  treatment  of 
lateral  oorvatwe. 


Jiir.  ]5»  1896. 


NOTES  ON  CUKBENT  TOPICS. 


Thb  Mvdioal  Fbsss.     65 


#otCB  0n  (ZUtrrtni  ^ojruja. 

Poblio  liibrarieB  and  the  Dissemination  of 

Disease. 
Public  HbrarieB  l^  meaoB  of  the  drcnlation  of  their 
books  have  repeatedly  been  accused  of  disseminatiDg 
iniectioiiB  disease.    But,  as  a  matter  of  fact,  readily  as 
inch  infectioa  ooold  be  conveyed,  no  authentic  cases 
have  ever  been  recorded  by  which  the  accusation  could 
be  sabetantiated.    Still  the  fact  that  this  is  the  case 
does  not  by  any  means  exonerate  the  library  authori- 
ties from  the  responsibility  of  protecting  the  public. 
As  bearing  upon  this  point  it  is  worthy  of  note  that  a 
hbiarian  of  a  library  in  London,  in  a  communication  to 
a  racent  issue  of  the  Westminster  Gazette^  shows  that 
prteantions  of  a  definite  nature  are  adopted  in  the 
paUic  libraries,  both  of  London  and  the  provinces.  In 
tiis  first  place  there  is  sent  to  the  library  each  day  a 
lilt  of  all  the  dwellings  in  the  parish  where  cases  of 
infectious  disease  exist,  and  this  list  owing  to  the 
operation  of  the  Infectious  Diseases  Act,  is  always  com- 
plete. No  books,  under  any  circumstances,  are  issued  to 
feeders  in  the  infected  houses,  and  it  is  possible  to 
iBcertain   thoee   cases  in   which  books   have    been 
borrowed  befOTO    the  disease  was  notified.     Again 
iimediate  notice  is  sent  to  the  respective  borrowers  to 
tiie  effect  that  the  books  must  not  be  returned  to  the 
fibnynTi  bnt  that  th^  are  to  be  retained  and  delivered 
to  the  sanitary  anthorities,  who  undertake  to  collect 
the  volumes  mthout  delay  and  afterwards  to  thoroughly 
diainfeet  them.     If  any  book  should  happen  to   be 
imed  to  a  reader  in  a  house  where  a  case  of  small-pox 
biS  oecurced  the  volume  is  at  once  burnt.    The  whole 
tnsaaction  in  regard  to  collecting  the  books  from  an 
infected  house  occupies  but  a  few  hours,  and  thus  in 
tbe  event  of  a  ecarlet  fever  case,  there  is  no  danger  of 
a  wlume  being  left  until  the  period  of  desquamation 
begins.    The  enforcement  of  such  an  admirable  system 
Mthie  should  undoubtedly  be  carried  out  at  all  public 
libraries  throughout  the  country.     As  a  matter  of 
nming,  it  may  further  be  added  that  borrowers  who 
ntom  to  the  library  books  which  have  been  exposed 
to  infection  without  properly  duiofecting  them  are 
fi&Ue,  under  the  Public  Health  Act  (1876),  to  a  penalty 
not  exceeding  £b. 

Judgment  in  the  Salicylic  Adulteration  Case. 
Mr.  Ds  Rutzen,  the  presiding  magistrate  at  the 
Westminster  Police  Court,  after  taking  some  weeks  for 
eooiideration,  has  delivered  an  elaborate  and  important 
judgment  affecting  the  sale  of  British  wines.  It  will  be 
lemembered  (Medical  Press  and  Circxtlab,  Nov.  13th, 
18d5)thatthec&8earose  outof  aprosecution  by  the  Vestry 
of  St  Qeorge,  Hanover  Square,  against  Messrs.  Walton, 
HasBell,  and  Port,  under  the  6th  Section  of  tiie  Food 
and  Drugs  Act,  for  selling  orange  wine  containing 
lalieylic  acid.  The  public  analyst  gave  evidence  that 
he  bad  examined  a  sample  of  the  wine,  and  found 
that  it  contained  '038  per  cent  of  salicylic  acid,  equiva- 
leot  to  26*6  grains  per  gallon,  a  statement  which  was 
not  disputed.  He  stated  that  even  in  this  small  pro- 
portion it  was  iiguiious  to  health,  but  admitted  in 


cross-examination  by  Mr.  Rose  Innes  that  he  was  not 
a  qualified  medical  man,  and  that  he  had  never  had  an 
opportunity  of  prescribing  it  for  patients.  Prof.  W. 
H.  Corfield,  the  well-known  sanitary  authority,  said 
that  the  chief  use  of  salicylic  acid  was  as  an  application 
for  corns,  and  proceeded  to  argue  that  a  drug  which 
would  remove  these  excrescences  must,  of  necessity,  act 
injuriously  on  the  mucous  membrane  of  the  stomach. 
He  was  apparently  unaware  of  its  use  as  a  remedy  for 
rheumatism  and  other  joint  affections,  and  maintained 
that  it  was  not  given  internally.  For  the  defence  Dr. 
Murrell,  of  the  Westminster  Hospital,  gave  evi- 
dence as  to  its  pharmacological  action,  and 
Mr.  Thomas  Bond,  F.RC.S.,  stated  that  he  had  not 
only  taken  it  himself,  but  had  prescribed  it  in  hundreds 
of  cases,  both  in  hospital  and  in  private  practice. 
During  a  recent  epidemic  of  sore-throat  amoug  the 
police  of  the  district  he  had  used  it  largely  and  with 
undoubted  success.  An  element  of  humour  was  intro- 
duced into  the  proceedings  by  the  statement  of  the 
analyst  that  he  had  never  heard  of  Mr.  Boud,  and  that 
he  was  under  the  impression  that  Dr.  Murrell  kept  a 
chemist's  shop  in  the  neighbourhood !  Mr.  De  Rutzen, 
in  giving  judgment,  said  that  he  had  no  hesitation  in 
dismissing  the  summons  on  the  ground  that  the  case 
came  within  the  Act,  that  the  drug  in  the  quantity 
used  was  not  injurious  to  health,  and  had  not  been 
added  to  the  wine  to  increase  its  bulk  or  conceal  infe- 
riority of  quality,  but  solely  as  a  preservative  and  for 
the  sake  of  its  antiseptic  properties.  Mr.  A.  Gill,  the 
counsel  for  the  prosecution,  said  that  the  Vestry  could 
not  appeal,  as  his  Worship  had  decided  on  the  question 
of  the  facts.  The  case  is  of  interest  not  only  to  manu- 
facturers, but  to  medical  men,  and  as  salicylic  acid  in 
varying  quantities  is  largely  employed  for  the  preser- 
vation not  only  of  wines,  temperance  drinks,  and 
German  beers,  but  of  cream,  milk,  extract  of  malt,  and 
especially  jam,  it  is  not  improbable  that  further  prose- 
cutions will  be  instituted  in  different  parts  of  the 
country,  and  that  the  whole  question  will  be  fought 
out  on  somewhat  different  grounds. 


The  Direct  Representatives  for  Irelcuid  in 
the  GFeneral  Medioal  Council 
The  competition  for  the  position  vacated  by  the  late 
Dr.  Kiddy  continues  to  be  acute  and  interesting, 
although  the  necessity  for  the  prior  election  of  a  new 
Registrar  of  the  Branch  Council  will  cause  the  polling 
to  be  deferred  to  the  end  of  February.  The  only  light 
which  has  been  thrown  upon  the  position  of  t^e  various 
candidates  since  we  last  wrote  has  been  shed  by  the 
issue  of  the  list  of  the  Committee  of  Professor  Cuming, 
of  Belfast,  which  is,  in  itself,  an  instructive  document 
The  Committee  which  represents  Dr.  Cuming  says  to 
the  reader :  **  You  will  learn  from  this  list  how  very 
extensive  and  strong  the  feeling  is  in  favour  of  the 
principle  of  returning  a  provincial  practitioner.  We 
thiuk  that  a  favourable  opportunity  now  exists  for 
wresting  the  representation  from  a  metropolitan  candi- 
date.'' Let  us  see  how  far  the  Dr.  Cuming  list  indi- 
cates this  ^  extensive  and  strong  feeling."  We  rather 
think  that  it  proclaims  Dr.  Cuming  to  be  the  most 


06     Thic  Mwdtcal  Pbm8. 


NOTES  OK  CtrSBENT  TOPICS. 


^Ax,  i5»  im. 


oeal  and  the  least  pro^  Dcial  of  all  the  candidatee  in 
the  field.  It  contains  altogether  343  names.  Of  these, 
Belfast  City  returns  142,  mostly  Professors  and 
teachers  in  the  Queen's  (Tollege,  and  in  the  Local 
Hospitals,  and  outside  the  City  walls.  The  counties 
of  Antrim  and  Down,  which  may  be  called  the  suburbs 
of  Belfast,  return  119  other  names.  The  adjoining 
counties  of  Derry,  Tyrone,  Monaghan,  Armagh,  and 
Donegal  return  47  names,  and  Dublin  sends  eleven. 
Dr.  Cuming's  following  throughout  the  whole  of  Ire- 
land, outside  Belfast,  and  the  half-dozen  northern 
counties,  numbers  exactly  24  persons,  out  of  a  possible 
total  of  about  1,800.  We  recommend  the  study  of 
these  figures  to  Dr.  Cuming's  Committee  and  advise 
them,  in  their  next  address,  to  offer  him  to  the  working 
medical  practitioners  of  Ireland  as  a  much  esteemed 
teacher  and  consultant,  and  as  the  incarnation  of  the 
educational  interests  of  the  Belfast  Queen's  College.  In 
these  capacities  no  one  can  cavil  at  his  pretensions. 

Bupemtitioxi  and  Insanity. 
Pkbsonb  who  unwisely  allow  themselves  to  become 
very  superstitious  are  commonly  disposed  at  times  to 
be  highly  emotional,  a  condition  of  things  which  may 
result  in  the  over-balancing  of  their  mental  equilib- 
rium. The  following  case,  related  by  Dr.  James 
Eieman,  of  Chicago,  which  may  be  described  as  a 
'*  True  Ghost  Story,"  is  of  interest  in  this  connection. 
A  young  man  brought  up  on  a  farm  was  much  given  to 
the  perusal  of  sensational  literature.  He  was  very 
superstitious  and  frequently  expressed  a  fear  of  ghosts. 
The  boys  of  the  neighbourhood,  becoming  acquainted 
with  his  weakness,  devised  a  plan  to  frighten  him  with 
a  pretended  si>eetre  at  midnight.  He  always  slept 
with  a  large  revolver  in  easy  reach.  Daring  the  day 
the  ball  cartridges  were  replaced  by  blank  cartridges 
and  the  weapon  restored  to  its  usuiJ  place.  At  mid- 
night the  victim  of  the  practical  joke  was  awakened  by 
a  seeming  spectre  which  stealthily  entered  the  room 
and  stood  with  outstretched  arms,  muttering  unintelli- 
gibly. The  victim  hurriedly  grasped  the  revolver  and 
sat  upright  in  bed,  dumb  with  fear.  The  ghost 
advanced  a  step ;  the  muttering  continued.  When  the 
young  man,  wrought  up  to  almost  a  frenzy,  drew  the 
weapon  and  stammered,  *'  If  you  are  a  man,  I  shall  kill 
you ;  if  you  are  a  ghost,  this  won't  hurt  you,''  and 
fired.  .  There  was  a  quick  motion  of  the  shrouded  arm 
and  the  bullet  was  thrown  back,  striking  the  head  of 
tbiB  bed.  A  second  time  he  took  deliberate  aim  at  the 
figure  and  fired.  Again  a  motion  as  if  catching  the 
biollet,  and  it  also  was  thrown  back  upon  the  bed.  He 
fixed  a  third,  a  fourth,  and  a  fifth  shot,  only  to  have  the 
bullets,  hurled  back,  with  noiseless  motion  from  the 
ghostly  figure.  :  Then  for  a  brief  oioment  he  sat  as  <  if 
transfixed,  gazing  wkh  mute  bewilderment,  when  with 
a^wild  shriek,  of  terror  he  fired  the  laat  blank  cartridge 
and  hurled  the  pistol  at  the  ghost  When  the  pre- 
tended ghost  revealed  himself,  the  victim  was  found  in  a 
state,  of  unconsciousness,  which  gave  way  to  an  inco* 
hece^t  frenzy  aocompanied  by  marked  initial  hallucina- 
tions of  sight  and  hearing.  He  recovered  after  three 
monlhs'  treatment  in  an  Asylum.    One  of  .th^  planners 


of  this  senseless  practical  joke  became  insane  thnmgh 
remorse,  and  exhibited  similar  symptoms  ;  but,  unlike 
the  ending  which  a  novelist  would  probably  have 
accorded  him,  he  also  made  a  good  recovery. 


The  Oaloutta  Medioal  SchooL 
Rai  Lal  Madhub  Mookibjbb,  Bahabur,  is  the 
chairman  of  the  Calcutta  Medical  School  Committee, 
and  he  had  the  honour  recently  of  giving  an  addreas 
before  Sir  Charles  £lliot,  of  the  Bengal  Presidency, 
who  had  undertaken  to  preside  at  the  annual  distriim- 
tion  of  prizes  at  the  school.  We  learn  from  the  first- 
named  gentleman  that  the  '*  eight  long  years  tiist 
have  passed  since  we  first  started  have  been  slao 
chequered  (sic)  with  many  happy  and  encouraging 
incidents.  During  these  years  the  Calcutta  Medical 
School  has  been  fortunate  to  secure  the  confidence  of 
parents  and  guardians  throughout  Bengal,  as  the  roll  of 
students  amply  testifies.  We  have  now  on  our  rolla 
more  than  five  handred  students  from  the  different 
districts  of  Bengal,  and  we  have  sent  forth  from  oar 
institution  medical  practitioners  who  are  now  doing 
their  angelic  (sic)  work  in  ministering  to  the  sick  and 
infirm  and  bringing  joy  and  happiness  to  the  homes  of 
our  rural  population."  It  must  be  confessed  that  this 
is  a  very  encouraging  report,  and  shows  the  great  pro- 
gress that  has  been  made  by  the  Calcutta  Medical 
School,  *'  chequered  "  though  that  progress  may  have 
been  *'by  many  happy  incidents."  We  can  qnite 
believe  that  a  still  further  prosperous  career  is  in  store 
for  thb  school,  and  everyone  must  hope  that  for 
many  generations  to  come  it  will  continue  to  pass  oat 
into  this  suffering  world  a  numerous  body  of  its 
alumni,  fully  capable  of  maintaining  the  ^  angelic " 
standard  of  work  which  appears  to  have  been  alrea47 
attained  by  its  students. 

Experimental  Diabetes. 
Thb  series  of  experiments  carried  out  by  Frofeasor 
Biedl,  of  which  our  Austrian  correspondent  gave  a 
synopsis  last  week,  in  reference  to  the  experimental 
production  of  diabetes,  show  that  much  work  remains 
to  be  done  before  we  shall  understand,  even  approxi- 
mately, the  mechanism  of  the  production  of  glycosoria 
and  diabetes.  One  point,  however,  is  made  clear,  vis.,  the 
untrustworthiness,  in  this  particular  branch  of  investi- 
gation, of  experiments  made  on  dogs.  Counter-observa- 
tions on  the  human  subject  proved  that  the  procesBes 
of  disintegration  and  elimination  of  sugar  in  doge  can- 
not safely  be  trusted  to  furnish  data  capable  of 
application  to  man.  The  general  result  of  Dr.  fiiedi's 
experiments  is  to  show  either  thataugar  does  not,  as 
is  usually  supposed,  act  as  an  irritant  to  the  glandular 
structure,  of  the  kidneys,  or  that,  in  the  healthy  indi* 
vidual,it  is  so  promptly  changed  as  not  to  exercise 
these  effects.  The  injection  of  sugar  in  several  cases 
determined  a  more  or  less  pronounced  rise  of  tempera- 
ture of  the  nature  of  a  rigor,  similar  to  that  ohserved 
during  the  transfusion  of  blood.  He  never  succeeded 
in  demonstrating  the  presence  in  the  urine  oi  sogar 
injected  into  the  veins,  and  even  when,  in  the  hands 
o£  otbor  .observers,  this  <  has  been  accomplished,  all* 


Jig.  1»  UK, 


K0TE8  OS  CUBBENT  TOPICS. 


Tttu!   Mi'PTCAt*  TeISS.      OT 


trace  thereof  bad  disappeared  at  the  expiration  of 
twenty-four  hours.  There  remains  for  study  certain 
peculiarities  in  the  urine  of  the  subjects  of  these  ex- 
periments, the  nature  and  significance  of  which  we 
stall  obserye. 


Pompeian  Surgery  and  Surgical 
Instramenis. 
NsABLT  two  thousand  years  have  elapsed  since  the 
Pompeian  surgeons  practised  their  art  in  their  ill-fated 
town,  and  yet  many  objects  of  interest  to  the  surgeon 
have  since  then  been  brought  to  light  during  the  vast 
excavations  undertaken  for  the  purpose  of  exposing  the 
ruins  of  Pompeii.  In  an  interesting  paper  on  this 
subject  in  the  last  number  of  the  PHiladelphia  M^ical 
New9  Dr.  K^Senn  gives  a  description  of  a  recent  visit 
that  he  made  to  the  ruins  of  Pompeii  and  the  Naples 
Moseum,  and  enters  fully  into  the  account  of  what  he 
aaw  in  the  nature  of  Pompeian  surgical  instruments. 
The  instruments  were  found  in  a  house  which  has 
been  called  the  "  Surgeon's  House."  They  are  made  of 
bronze,  and  some  of  them  show  ^  high  degree  of  work- 
manship. Some  of  them  indicate  also  the  destructive 
effect  of  heat  and  oxidation,  while  others  are  in  a 
state  of  excellent  preservation.  Careful  search  was 
made  among  the  instruments  for  traces  of  needles 
or  any  appliance  which  would  indicate  that  at  that 
time  wounds  were  sutured.  But  nothing  of  the 
kind  was  found.  The  collection,  moreover,  did 
not  contain  any  saws,  trephines,  chisels,  or  instru- 
ments for  operations  upon  bones.  Again,  with  the 
exception  of  the  specula  and  catheters,  it  is  curious  to 
note  that  the  instruments  were  of  a  diminutive  size  in 
eomparison  with  those  of  less  remote  and  more 
modem  times.  Judging  from  his  instruments,  the 
F6mpeian  surgeon  plainly  confined  his  '* cutting" 
operations  to  bleeding,  cupping,  extraction  of  foreign 
bodies,  and  the  opening  of  abscesses.  Dr.  Senn  con- 
dudes  his  paper  by  pointing  out  that  the  surgeon  of 
Pompeii  must  have  been  a  man  of  means  and  good 
social  position  ;  the  position  of  his  house  in  the  most 
aiistocratic  part  of  the  city,  and  its  capaciousness,  both 
testify  to  this  fact.  A  liberal  income,  therefore,  pro- 
bably rewarded  his  labours  and  placed  him  in  a  position 
to  enjoy  the  luxuries  of  life,  which  seem  to  have  been 
the  midn  object  in  life  of  the  mass  of  the  Pompeian 
people  before  the  destruction  of  their  city. 


^  The  Mystery  of  Hearing. 
PKOFsssoBMcE£in)KicK,inoneofhiBJuvenilelectures 
last  week  at  the  Eoyal  Institution,  enunciated  some 
new  views  upon  the  interesting  subject  of  "  Hearing." 
h  bis  description  of  the  internal  ear  the  opinion  was 
expressed  that  the  latter  was  a  complex  labyrinth  of 
winding  staircases  containing  flaid.  In  the  innermost 
recesses  were  the  essential  organs  of  hearing,  a  wonder- 
fully arranged  mass  of  fibres  and  cells,  from  which  fine 
hairs  were  suspended  in  the  fluid  ;  and  his  belief  was 
that  each  of  these  hairs  w^  in  direct  connection,  by  its 
Dorve  thread,  with  the  brain.  This  point  is  of  much 
interest  because  it  shows  how  Nature  gets  over 
the    difScolty    of    transmitting    an     air    vibration 


into  a  fluid.  But  the  problem  which  Pro- 
fessor McKendrick  put  forward  to  splve  before 
liis  audience  was  how  this  complex  apparatus 
picked  out  and  analysed  the  infinitude  of  shades  of 
tone  that  are  borne  upon  it.  He  suggested  .that  each 
of  the  delicate  hairs  or  fibres  was  attuned  to  respond 
to  a  certain  shade  of  tone,  and  picked  up  the  Epte  to 
which  it  was  attuned  precisely  as  one  tuning  fork 
picked  up  the  sound  of  another  if  they  both  l^appened 
to  be  of  the  same  pitch.  The. number  of  different 
shades  of  sound  in  Nature  is  probably  enormous,  but  as 
Professor  McKendrick  pointed  out  the  number  of  these 
sensitive  hairs  is  enormous  too.  In  proof  of  this  it 
may  be  asserted  that  an  acute  musician  will  detect  so 
slight  a  difference  in  tone  between  two  notes  as  the 
one-sixth  of  a  semitone.  This  means  that  in  the 
eleven  octaves  that  the  human  ear  compasses  there  are 
some  8,000 or  9,000  consciously  different  tones  at  least. 
There  are  about  two  hair  cells  to  each  one-sixty-fourth 
of  a  semitone. 

Infected  Heirlooms:  * 
To  become  the  possessor  of  old  family  relics,  to  step 
into  the  shoes  of  one's  ancestors,  to  inherit  the  family 
mansion  with  all  its  old  associations,  its  antique  furni- 
ture, its  ancient  tapestry,  is  usually  regarded  as  an 
enviable  lot.  But  this  is  a  prying,  enterprising, 
unromantic  age,  which  is  not  apt  to  be  deeply 
impressed  with  things  as  they  seem.  Sometimes  in 
this  connection  cruel  discoveries  have  been  made  by 
science,  cruel  in  the  sense  of  bursting  like  a  bubble 
cherished  traditions,  romantic  beliefs,  and  the  rationa- 
lity of  time-honoured  customs.  Something  in  that 
senise  has  just  transpired  in  regard  to  the  almost  sacred 
possession  of  certain  heirlooms.  Some  cool-headed,  cal- 
culating, severely  matter-of-fact  bacteriologist  has 
actually  had  the  audacity  to  examine  into  the  bacterio- 
logy of  some  old,  beautif  ul,and  otherwise  priceless  tapes- 
tries in  an  old  country  mansion.  What  were  the  results 
of  his  investigations  ?  Must  the  truth  be  revealed  ?  What 
good,  it  may  be  asked,  can  come  from  concealing  it  t 
This  bacteriologist  found  that  the  tapestries  were 
teeming  with  micro- organic  life,  and  that  they  were 
nothing  less  than  hot-beds  for  the  culture  of  tubercle 
bacilli  WUl  the  mural  adornments  of  the  ''  tapestried 
chambers  "  throughout  the  country  survive  this  terrible 
indictment.  It  may  be  that  they  wOl.  But  who  after 
this  will  be  able  to  look  upon  the  '^  tapestried "  pre- 
sentments of,  say,  the  lively  "Adventures of  Dionysius," 
the  wonderful  career  of  '*  Medea,"  or  the  patriotic 
manoeuvre  of  '*Mettius  Curtius,**  without  some  feeling 
of  repulsion  which  such  a  revelation  could  not  fail  to 
create ! 

The  Salvation  Army  Shelter  Oase. 
Most  of  our  readers  will  probably  remember  that 
the  action  of  the  Vestry  of  St.  George  the  Martyr, 
London,  as  regards  the  Blackfriars  Salvation  Army 
Shelter,  resulted  in  a  magistrate's  order  against  future 
overcrowding.  After  an  interval  of  six  weeks  the  de- 
fendants have  obtained  a  rulingfrom  the  Queen's  Bench 
calling  upon  the  magistrate  concerned  to  show  reason 


68     Thi  Mbdioal  Pmh. 


NOTES  ON  CTJRRENT  TOPICS. 


Jav.  15,  1896. 


why  his  order  should  not  be  quashed.  The  disputed 
order  was  to  the  effect  that  the  defendants  should 
abate  the  nuisance  of  overcipwding,  which  was  danger- 
ous and  injurious  to  the  health  of  the  inmates.  In 
asking  for  the  rule  counsel  for  the  late  defendants 
contended  that  those  who  made  use  of  the  shelter  could 
not  be  called  inmates,  on  the  ground  that  a  person  who 
passed  one  night  in  a  house  was  not  an  inmate  in  the 
sense  in  which  the  wording  of  the  Act  was  used.  The 
fault  of  the  magistrate's  order,  according  to  applicant's 
contention,  was  that  it  did  not  state  what  was  to  be 
done  to  abate  the  nuisance,  and  an  order  could  not  be 
good  unless  it  stated  what  they  had  done  and  the 
remedy  were  specified.  From  this  application  it  seems 
evident  that  the  Salvation  authorities  will  leave  no 
stone  unturned  in  their  strenuous  efforts  to  upset  an 
adverse  legal  decision.  The  unprejudiced  onlooker 
would  probably  reflect  that  the  best  thing  for  the  Army 
would  be  to  bring  their  night  shelters^into  line  with  the 
views  of  local  sanitary  authorities. 


Houses  Built  on  Ash  Heapa 
Thb  Medical  Officer  of  Health  for  Hackney  has  once 
more  called  attention  to  a  besetting  sin  of  jerry-built 
houses.  In  a  lately  issued  report  he  pointed  out  that 
many  of  the  houses  in  his  district  were  built  upon  a 
layer  of  house  refuse,  which  in  turn  rested  upon  a  bed 
of  clay.  Such  a  condition  of  affairs  naturally  leads  to 
the  drawing  into  the  house  of  various  gases  of  decom- 
position and  of  other  components  of  ground  air.  This 
danger  has  been  discussed  in  our  own  columns  for 
many  years  past.  That  it  is  a  common  and  fruitful 
source  of  disease  can  hardly  be  doubted.  In  many 
parts  of  the  suburbs  of  London  it  is  a  constant 
practice  of  the  enterprising  buUder  to  fill  up 
with  ash-pit  refuse  any  pit  that  has  been  quarried 
for  stone,  sand,  or  other  material.  He  then 
proceeds  to  run  up  a  more  or  less  showy  villa  on  this 
green  mass  of  miscellaneous  animal,  vegetable,  and 
mineral  stuff.  As  a  rule,  the  basement  is  not  provided 
with  an  impermeable  concrete  flooring,  so  that  the 
house  settles,  the  drains  are  dislocated,  and  the  inside 
of  the  house  becomes  permeated  with  poisonous  ground 
air.  The  remedy  is  simple.  No  new  house  should  be 
occupied  until  it  has  been  duly  inspected  and  certified 
as  properly  constructed  by  a  competent  sanitary  autho- 
rity. At  present,  the  remedy  which  the  tenant  of  an 
unhealthy  dwelling  has  against  his  landlord  is  slow, 
tedious,  and  uncertain.  The  advent  of  some  searching 
and  practical  domestic  legislation  would  speedily  put 
an  end  to  the  ghoulish  race  of  jerry-builders. 

Serious  Charge  against  a  Londo  n  Scuiitary 
Inspector. 
DuBma  the  past  few  weeks  considerable  sensation 
has  been  caused  in  a  South  London  district  in  conse- 
quence of  certain  charges  brought  in  the  first  place 
against  an  assbtant  sanitary  inspector.  This  official, 
so  it  appears  from  a  published  letter,  wrote  to  a  house 
agent  asking  (1)  for  full  particulars  regarding  the  dis- 
posal of  certain  houses  in  the  parish,  and  (2)  what 
commission  the  agent  was  prepared  to  pay.    His  com- 


munication was  laid  before  the  health  committee  d 
the  Vestry,  and,  as  the  result,  that  body  shortly  after- 
wards accepted  the  sub  inspector's  resignation.  Subse- 
quently, however,  the  ex-official  wrote  to  the  Souik 
London  Press  a  letter  in  which  he  asserted  that  he  had 
written  letters  like  the  one  complained  of  to  other 
house  owners  in  Bermondsey.  This  grave  charge  «u 
brought  before  the  Vestry  for  discussion,  and  the 
inspector  was  exonerated.  At  the  same  time  it  wis 
freely  asserted  that  the  officials  were  allowed  to  act 
without  sufficient  control,  and  that  the  sanitary  com- 
mittee itself  was  not  free  from  blame.  It  seems  clear 
to  us  that  charges  of  this  extremely  serious  nature  can 
be  properly  sifted  only  by  an  independent  inquiry.  It 
b  equally  clear  to  us  that  the  Local  Government  Boaid 
should  undertake  the  investigation  forthwith.  The 
question  of  the  purity  and  honesty  of  the  servants  of 
the  medical  officers  of  health  is  one  of  vital  importance 
to  the  future  of  public  health  in  the  metropolis.  The 
fact  that  the  chief  official  implicated  is  the  chairman 
of  the  Sanitary  Inspectors'  Association  makes  it  all  the 
more  imperative  that  an  independent  Qovemment 
inquiry  should  be  made  upon  every  one  of  the  issues 

raised.  

The  Oompoeition  of  Microbes. 
Some  investigations  have  been  recently  undertaken 
with  a  view  of  ascertaining  the  proximate  and  ulti- 
mate composition  of  micro-organisms.  Tuberde 
bacilli  were  found  to  contain  cellulose,  together  with 
palmitic  and  arachidic  acids  ;  on  the  other  hand,  the 
bacillus  of  glanders  appeared  to  contain  no  celluloee, 
while  the  acids  present  were  oleic  and  palmitic.  The 
microbes  of  these  experiments  were  cultivated  on  the 
same  media,  and,  with  the  exception  of  the  nitrogen, 
there  seemed  to  be  but  little  variation  in  their  compo- 
sition when  the  medium  was  varied.  The  results  of 
elementary  analyses  of  three  forms  (the  two  above 
mentioned  and  the  bacillus  of  swine  fever)  showed 
marked  differences  in  the  proportions  of  nitrogen, 
carbon,  hydrogen,  and  ash  present. 

Sir  Thomas  Moffett. 
The  honour  of  knighthood  conferred,  last  week,  upon 
Dr.  Moffett,  President  of  the  Queen's  College,  Qal- 
way,  has  been,  as  will  be  universally  admitted,  most 
deservedly  given.  There  is,  we  believe,  no  man  in 
Her  Majesty's  Civil  Service  in  Ireland  to  whose 
advancement,  if  it  may  be  called  so,  less  exception 
could  be  taken  by  any  person  or  party  than  Dr.  Moffett 
He  has  shown  himself  to  be  not  only  the  possessor  of 
exceptional  attainments,  but  a  most  able  adminbuator 
and  a  gentleman  in  every  sense  of  the  word.  We  con- 
gratulate the  Lord  Lieutenant  on  having  discerned 
his  merit  and  rewarded  it,  as  far  as  he  has  been  able. 

The  St.  Helens'  Corporation  decided  some  time  ago 
to  conduct  a  series  of  bacteriological  investigations 
into  the  origin  and  spread  of  typhoid  fever,  with 
special  reference  to  the  St  Helens'  district^  and  at  a 
meeting  of  the  Health  Committee  last  week  a  bacterio- 
logical assistant  was  appointed,  at  the  salary  of  £12  per 
month. 


Jam.  15,  180ft. 


NOTES  ON  CURRENT  T0MC8. 


Thb  Mvdioaii 


69 


The  FteBonal  Bertstes  left  by  Medioal  Men 

in  1805. 
Teb  f oUowxng  18  the  list  of  the  well-known  physiciaas 
and  sargeoDs  who  died  last  year,  and  the  value  of  their 
penonal  estates :— Sir  William  Scovell  Savory,  Bart., 
FJELSb,  sixty-eight,  Snrgeon-Extraordinary  to  the 
Qneeo,  and  ez-President  of  the  Royal  College  of  Sar- 
geoDSy  £93.190 ;  Sir  George  Homidge  Porter,  Bart., 
aeveoty-tluree,  Regitu  Professor  of  Snrgery  in  Dublin 
University,  £57,326  ;  Sir  John  Tomes,  F.RS.,  F.RO.S., 
L.D.&,  ei^t7>  £51^7  ;  Sir  George  Buchanan,  F.R.S., 
lixty-foar,  medical  officer  to  the  Local  Government 
Bosrd,  ^£7,738 ;  Sir  Thomas  Crawford,  KC.B.,  seventy- 
one^  Hon.  Surgeon  to  the  Queen,  Director-General  of 
the  Army  Medical  Department,  £7,036;  Dr.  John 
Syer  Bristowe,  F.RS.,  sixty-eight,  consulting  phys- 
idan  to  St  Thomas's  Hospital,  £15,734 ;  Dr.  Daniel 
Hack  Take,  sixty-seven,  ELanwell,  £29,460 ;  Surgeon- 
General  %  Thomas  Longmore,  seventy-nine,  professor, 
Netley,  £19,659;  Surgeon-General  (retired)  John 
Irvine,  sixty-seven,  who  was  with  Havelock's  column 
at  the  Siege  of  Lncknow  in  1857,  £4,285.  It  has  been 
estimated  that  the  average  of  the  personal  estates  of 
sixty-aeven  physicians  and  surgeons  whose  wills  were 
noticed  during  six  or  seven  years  was  £60,614,  or  less 
than  half  of  that  of  forty-four  solicitors.  Of  course, 
the  sdlieitor  has  the  advantage  ovw  the  medical  man  in 
having  opportunities  of  investing  his  money  safely  at 
good  rates  of  interest  Again,  the  expenses  of  carrying 
on  his  professional  calling  are  much  higher,  pro  raUL^ 
m  the  case  of  the  medical  man  than  in  that  of  the 
solicitor.  ¥ot  these  and  othw  reasons,  wealthy 
medical  men  are  much  less  common  than  wealthy 
solicitors. 


The  Ck>nyiction  of  John  Ferdinand. 
Thb  quacb  John  Ferdinand,  **  M.D.,n.S.A .,"  who 
appealed  against  the  conviction  by  Mr.  Shell  for  **  un- 
lawfully and  falsely  representing  himself  to  be,  and 
using  the  name  and  title  of,  a  doctor  of  medicine,''  and 
by  whom  he  was  ordered  to  pay  a  fine  of  £20  and  £10 
costs,  has  come  to  grief  for  the  second  time.  The 
appeal  was  heard  last  week  at  the  Clerkenwell 
Sessions  before  Sir  Peter  Edlin  and  a  bench  of  magis- 
trates. After  a  short  statement  of  the  case  had  been 
made  by  Mr.  Mackenzie  for  the  Medical  Defence 
Union,  and  the  appellant  had  been  heard,  the  magis- 
tiates  at  once  confirmed  the  conviction.  The  idle  boast 
of  John  Ferdinand,  "*  M.D.,n.aA,''  that  he  would 
prove  his  daim  to  be  a  medical  man,  has  thus  been 
severely  disposed  of. 

The  Post  of  Director-General  of  the  Army 

Medical  Department. 
Ths  post  of  Director-General  of  the  Army  Medical 
Department  will  shortly  fall  vacant,  Surgeon-Migor- 
General  Sir  W.  A.  Mackinnon  retiring,  after  being  at 
tiie  head  of  the  department  since  1889.  It  Ib  stated 
tbat  he  will  be  succeeded  as  Director-General  by 
Sugeon-Migor-General  Jameson,  MD.,  who  Ib  now 
serving  at  head-quarters  as  professional  assistant  to  the 
Dhector-Genecal,  a  post  he  has  occupied  since  April, 


when  he  succeeded  Surgeon-Major-GenenJ 
Beade.  Surgeon-Major-General  Jameson  joined  the 
Army  Medical  Staff  in  1857,  and  served  as  principal 
medical  officer  in  Egypt  before  joining  the  head- 
quarter staff.  He  served  with  the  Enf^Ush  ambulance 
in  the  Franco-German  War  of  1870. 


The  Royal  College  of  Surgeons,  Ehigland. 

At  the  quarterly  meeting  of  the  Council  of  the  Royal 
College  of  Surgeons,  England,held  last  week,  some  im- 
portant business,  was  transacted  One  of  the  principal 
matters  dealt  with  was  that  relating  to  the  resolution 
passed  at  the  meeting  of  Fellows  in  regard  to  the 
representation  of  the  Members  on  the  Council.  The 
Council  decided  to  refer  the  resolution  to  their  Deputa- 
tion Committee  to  consider  and  report  thereon ;  pro- 
bably, therefore,  some  time  will  have  to  elapse  before 
any  final  decision  is  arrived  at  upon  this  important 
question.  The  Deputation  Committee  consists  of  the 
President  (Mr.  Heath),  the  two  Vice-Presidents,  Mr. 
Reginald  Harrison  and  Mr.  Pick,  also  Mr.  Rivington, 
Mr.  Morris,  Mr.  Bryant,  Mr.  Howse,  and  Mr.  Tweedy. 
Another  resolution  paned  at  the  Fellows'  meeting, 
''That  in  the  opinion  of  the  Fellows  of  this 
College  women  should  be  admitted  to  the  Diploma 
of  the  College,''  was  briefly  discussed,  but  no  definite 
action  was  taken  in  regard  thereto ;  all  that  was  done 
was  to  instruct  the  Secretary  to  enter  it  upon  the 
Minutes. 


The  Small-Pox  in  Dublin. 
Thk  epidemic  of  small-pox  has  nearly,  but  not 
altogether,  disappeared  from  Dublin.  In  the  week 
before  last  no  case  was  admitted  into  hospital,  but 
last  week  one  case  was  admitted.  Eight  cases  stiU 
remain  under  treatment,  being  three  under  the 
number  for  the  preceding  week. 


Leprosy  in  Norway. 
Ths  latest  accounts  seem  to  show  that  lepro^  is 
decreasing  in  Norway.  In  1856  there  were  about 
3,000  lepers  in  that  country ;  in  the  latter  end  of  1892 
there  were  only  900  cases.  The  statistics  of  Dr.  Eaurius 
recently  published  on  the  subject,  show  that  a  strict 
segregation  of  lepers  is  an  important  element  in  the  sup- 
pression of  the  disease. 


Ths  Sun  newspaper  last  week  informed  its  readers 
that  a  man  unknown  died  in  the  Park,  Croydon,  from 
terunu  apoplexy  from  over-exertion. 


Pbofsssob  Rat  Lanksstsr,  of  Oxford,  has  been 
elected  a  corresponding  member  of  the  Russian 
Academy  of  Sciences. 


Ths  Cheyne  Hospital  for  Children,  Cheyne  Walk, 
Chelsea,  has  received  a  present  of  game  from  the 
Princess  of  Wales,  who  is  the  President  of  the  HoepitaL 
Captain  Frederick  Saunders  has  forwarded  a  cheque 
for  £SM  to  the  Committee  as  a  grant  from  the  estate 
of  the  late  ^iGss  Caroline  Saunders. 


70      This  WiftJtdAii  Prkss. 


MEDICAL  SOCIETY  OF  LONDOK. 


Jak.  10, 18M. 


§i:atlattb. 

[IBOM    OUB  OWN  00BBB8P0KDINT.] 

Notification  Difficulties  at  Dumfries.  —  Still 
another  instance  of  friction  in  the  working  of  the  Notifi- 
cation Act  comes  from  Dumfries.  In  that  town  measles 
is  not  one  of  the  notifiable  diseases,  and  the  Medical 
Officer  called  on  the  Sanitary  Inspector  to  remove  a 
servant  of  his  who  was  suffering  from  this  disease  to  the 
fever  hospital  The  inspector  refused  to  order  her 
removal,  whereupon  the  doctor  had  her  taken  on  his  own 
order.  The  Dumfries  Town  Council,  on  a  report  of  the 
Committee,  have  repudiated  the  liability  for  the  cost  of 
maintenance  of  the  patient  on  the  ground  above  stated, 
that  measles  is  not  notifiable  in  the  town,  and  have 
resolved  that  no  case  be  removed  to  the  fever  hospital  at 
their  charge  without  an  order  signed  both  by  the  sanitary 
inspector  and  the  medical  officer  of  health,  the  Committee 
also  to  have  a  word  to  say  in  the  business,  if  the  patient  is 
to  be  kept  at  the  expense  of  the  town.  In  time  the  poor 
patients  of  Dumfries  will  have  to  conduct  a  sort  of  per^nal 
canvass  of  the  members  of  the  Council  before  they  will  be 
able  to  gain  admittance  into  the  town's  hospital.  The 
Committee  characterised  the  action  of  the  doctor  as  high- 
handed, but  surely  the  medical  officer  of  health  should  be 
able  to  tell  whether  he  can  isolate  a  case  of  merles  in  his 
own  house  or  not.  A  doctor's  house  should  always  be 
kept  free  of  infection  more  than  other  houses,  especially 
the  dwelling  of  the  local  officer  of  health.  Fancy  what  a 
noise  these  same  busybodies  would  have  made  if  they  had 
discovered  later  that  measles  was  being  spread  from  the 
house  of  their  own  medical  officer  ! 

Edinbuboh  Univbbsitt  Annual  Report. —Of  the  total 
number  of  students  at  the  University  of  Edinburgh  in 
1895  (2,836),  1,475,  or  practically  the  half,  were  students 
of  medicine ;  of  these,  43  per  cent,  belonged  to  Scotland, 
31  per  cent,  to  England  and  Wales,  5  per  cent,  to  Ireland, 
and  fully  13  per  cent,  to  the  British  Colonies.  Thirty- 
nine  women  students  attended  eztra-murid  lectures  with 
a  view  to  graduating  in  the  University.  The  over-crowded 
ranks  of  the  profession  were  further  re-inforced  by  the 
addition  of  221  M.B.'s,  C.M.'s,  while  71  physicians  took 
their  M.D.  degree.  The  General  Council  of  the  University 
now  numbers  7,891  members.  The  annual  value  of  the 
university  scholarships,  bursaries,  and  prizes  in  the 
Faculty  of  Medicine  amounts  to  £2,800. 

The  Edinbuboh  Rotal  Infirmary.— The  Edinburgh 
Royal  Infirmary  report  is  a  most  satisfactory  one.  The 
number  of  patients  treated  during  1894  95  exceeded  all 
previous  records,  the  total  being  10,032,  while  thtf  cost  of 
maintenance  is  less  by  17s.  5d.,and  the  cost  of  medical  nc 
cessaries  by  £1 15s.  8a.  per  occupied  bed,  than  was  the  case 
last  year.  The  total  cost  per  annum  of  each  patient  works 
out  at  £55  8s.  2d.,  or  £S  28.  2^6.  below  last  year's  figures. 
A  net  surplus  of  £2,627  remains  from  the  year's  accounts. 
Besides  this  large  legacies  are  due  in  spring,  when  the 
whole  of  the  existing  debt  on  the  building  will  Sb  wiped  out. 
We  wonder  how  many  hospital  managers  and  secretaries 
will  be  tempted  to  break  the  tenth  commandment  when 
they  read  these  details. 

The  Royal  Mbdical  Sooibty,  Edinburgh.— Dr.  T.  S. 
Clouston  delivered  the  inaugural  address  of  this  society  on 
the8thin8t.  Owing  to  his  being  indisposed  the  address 
had  been  postponed  from  last  November.  Dr.  Clouston 
said  that  it  was  of  immense  value  to  get  firm  hold  of  prin- 
ciples of  general  application.  Such  an  enormous  multi- 
plicity of  facts  were  presented  to  the  student  that  he  was  in 
danger  of  missing  the  great  principles  which  explained  those 
facts  and  brought  them  into  relationship  with  each  other. 
The  principle  which  he  wished  to  impress  upon  them  was 
that  the  cortex  of  the  brain,  its  higher  and  ultimate  part, 
with  the  highest  function  of  mind,  must  be  taken  into 
account  in  the  diagnosis,  prognosis,  and  treatment  of 
almost  all  diseases  and  injuries.  It  was  an  important  fact 
that  a  merry  heart  would  always  act  as  a  medicine  in  everv 
disease  and  be  a  help  to  every  kind  of  treatment  adopted, 
and  that  cheerful  impressions  on  all  the  senses— light, 
colour,  pleasant  society,  and  confidence  in  their  doctor — 
would  by  their  tonic  influence  help  the  cure  of  every  cur- 
able disease,  and  make  every  wound  and  injury  heal  the 
faster.  Dr.  Laycock  was  the  first  to  point  out  the  enor- 
moiiB  inflooDoe  of  the  brain  and  of  diataesis  on  disease. 


The  Lsith  Hospital  Casr. — As  was  expected,  the  Ooort 
oi  Session  have  repelled  the  pleas  of  the  Leith  Dean  of 
Guild  Court  on  which  they  relied  when  they  refused  to 
allow  the  Corporation  of  Edinburgh  to  build  a  temporary 
hospital  within  their  boundaries.  The  matter  ha%  there- 
fore, been  again  remitted  to  the  Leith  authorities  to  deii 
with,  the  Lord  President  of  the  Court  of  Session  signifi- 
cantly remarking  that  he  could  not  doubt  that  now  ths 
matters  would  be  treated  in  a  business-like  spirit  proper 
to  a  Dean  of  Guild  Court.  As  the  Leith  authorities  havs 
to  pay  the  costs  of  the  appeal,  and  probably  of  the  preced- 
ing petition,  they  must  now  be  exceeding  sorry  that  an 
unreasoning  jealousy  of  their  larger  neighbour  led  them 
into  such  a  false  and  puerile  position. 

Women's  Medical  School,  Glasgow.— Woman  doctors 
who  are  to  be  educated  in  Glasgow  now  have  an  Anatomical 
College  building  complete  in  itself  devoted  exclusively  to 
their  use  in  the  study  of  anatomy  and  physiology  in  con- 
nection with  Queen  Margarets  College.  Funds  to  the 
extent  of  £5,000  for  the  building  have  been  handed  to  the 
University  Court  of  Glasgow  by  the  Bellahouston  trustees. 


MEDICAL  SOCIETY  {OF  LONDON. 

The  meeting  on  Monday  evening  last  (January  13th) 
was  devoted  to  the  reading  of  and  discussion  upon  a  paper 
by  Dr.  Savage  on  *'  The  Treatment  and  Classification  of 
the  Insanity  of  Preeaancy  and  the  Puerperium.'*  He 
suggested  their  classification  into  mental  disorders  occur- 
ring in  pregnancy  (1)  in  the  earlier  months,  and  (2)  in  the 
later  months  of  pregnancy  ;  the  insanity  of  labour,  (1) 
hysterical  and  transient,  and  (2)  more  lasting  and  perma- 
nent ;  ephemeral  insanity  [associated  with  the  onset  of 
milk ;  insanity  during  the  first  fortnight  after  labour ; 
insanity  coming  between  fourteen  days  and  six  weeks 
after  labour  ;  the  insanity  of  lactation  ;  and  the  insanity 
of  weaning.  He  pointed  out  that  there  was  no  special 
well-defined  form  of  insanity  deserving  the  name  of  puer- 
peral insanity.  Only  a  small  proportion  of  patients  had 
suffered  from  hysteria,  but  some  had  had  previous  attacks 
of  insanity,  the  liability  being  apparently  in  direct  pro- 
portion to  the  frequency  of  the  previous  attacks.  He 
raised  the  question  as  to  how  far  one  was  justified  in 
recommending  or  discountenancing  marriage  in  the  case 
of  neurotic  women.  He  mentionea  that  first  pregnanciee 
were  most  dang^erous  in  respect  of  the  supervention  of 
insanity,  especi^y  when  they  took  place  alter  30  years 
of  aee.  He  added  that  one  variety  of  puerperal  mania 
coming  on  soon  after  labour  was  believed  to  be  due  to 
sepsis.  Early  insanity  was  usually  maniacal,  while  if 
later,  it  tended  to  take  the  melanchoUc  type.  About  3  per 
cent,  of  patients  died  from  puerperal  mania,  but  upwards 
of  20  per  cent,  remained  more  or  lees  permanently  weak- 
minded. 

The  President  (Sir  J.  Crichton  Browne)  orlticised  the 
classification,  which  he  said,  if  practical,  was  certainly  not 
scientific.  He  related  two  cases  of 'girls  with  marked 
hysteria  respecting  whom  he  had  foretold  trouble  on 
child-bearing,  but  nothing  of  the  kind  had  occurred. 

Dr.  Blanoford  pointed  out  that  80  per  cent,  of  these 
cases  recovered  pretty  soon,  and  the  proportion  would 
probably  be  higher  if  alllontside  cases  were  included.  He 
did  not  believe  that  hysteria  bad  much  to  do  with  its  pro- 
duction. 

Dr  G.  Herman  believed  that  puerperal  mania  was  a  dis- 
tinct form  of  insanity  deserving  of  a  special  designation. 
He  declined  to  admit  that  marriage  could  ever  be  safely 
recommended  for  the  cure  of  any  nervous  trouble.  Of 
hypnotics  for  the  relief  of  Uie  initial  sleeplessness  he  pre- 
ferred full  doses  of  alcohol. 

Dr.  Robert  Jones,  of  the  Claybury  Asylum,  said  the 
asy  lumhad  only  been  open  two  years  since,  which  time  they 
had  had  60  cases  Of  insanity  associated  with  pregnancy  or 
parturition  out  of  2,400  female  patients,  the  proportion  of 
puerperal  to  the  female  insane  being  1  to  48.  There  bad 
Been  30  confinements,  in  only  two  of  which  was  albumen 
present  in  the  urine,  and  in  neither  of  these  cases  did  convul- 
sions take  place.  There  were  7  oases  of  mania  from  lacta- 
tion, and  1  case  of  melancholia,  while  of  patients  with 
insanity  associated  with  pregnancy  6  were  maniacal  and 
4  melanchoUc.  The  average  age  of  the  melancholies  was 
over  30,  while  in  mania  the  usual  age  was  about  25.  Of  the 
60  patients  82  appeared  to  have  reooveredi  and  16  might 


jAir.  10,  igM. 


MEDICAL  NEWS. 


Thb  MBDioAii  Prvss.     71, 


be  nid  to  be  convalescent.  It  was  rare  to  meet  with  ele- 
vation of  temperatare  in  these  patients,  and  he  pointed 
oat  that  thia  fact  was  inconsistent  with  the  view  that 
amis  was  a  oommon  eaose. 

Dr.  Andrieeen,  Dr.  Leibh  Napier,  and  Dr.  Bower  also 
•poke,  and  Dr.  Savage  briefly  replied. 


€orrespronb£ttce. 


fWe  do  not  hold  onnelves  responsible  for  the  opinions  of  our 
•omipondeatL] 

WHAT  IS  A  NATURAL  LABOUR  ? 
To  the  Editor  oj  Thk  Mbdical  Pbess  and  Cibgttlab. 
Sir. — ^The  amount  of  comfort  which  certain  members  of 
oar  profeasioii  derive  from  the  consideration  of  the  term 
^  nacaral  iabaar  ''  remiads  me  of  an  old  Scotch  lady  who 
was  often  heard  to  say  that  her  existence  would  be  quite 
insapportable  bat  for  that  blessed  word  "  Mesopotamia." 

Having  occasion  to  speak  on  this  subject  at  the  meet- 
ing of  the  Lancashire  and  Cheshire  Branch  of  the  British 
Medical  A^ociation  held  at  Liverpool,  on  January  8th,  to 
consider  the  draft  Midwifery  Nurses'  Bill  of  the  Council, 
I  thoaght  it  wise  to  submit  the  definition  clause  of  tbat 
Bill,  which  contains  the  term  in  question,  and  also  some 
others  of  very  vi^e  import,  to  Messrs.  Boote  and  Edgar, 
soUcitora,  Booth  Street,  Manchester,  who  kindly  furnished 
me  with  a  valuable  l^al  opinion . 

The  definition  clause  of  the  Bill  reads  thus  : — 
CiAlTSB  2. — DsFiNiTi0N4.~In  this  Act. 
The    term    "midwifery  nurse"  means  a  woman  who 
attends  cases  of  natural  labour,  and  afterwards  tends 
the    mother  and  child  daring  the  lying-in  period, 
onder  such  rules,  regulations,  and  medical  control  or 
sapervision,  as  may  be  from  time  to  time  laid  down  by 
the  Midwifery  Nurses  Board. 
The  questions  submitted  and  the  legal  answers  to  the 
same  I  append. 
QuKsnoNs — 
What  is  the  legal  significance  of  the  term   "natural 
labour"   and   the  words  *' medical  supervision  and 
control"?     Do  the  latter  words   necessarily  imply 
medical  assistance  ? 
Having  regard  to  the  meaning  of  these  terms,  what 
legal  powers  in  restraint  or  regulation.of  practice, 
have  the  Midwifery  Nurses'  Board  under  this  Bill  ? 
LiGAi.  OFnaoir— 
It  is  impossible  to  say  what  is  the  legal  significance  of 
the  term  "  natural  labour/'    If  any  question  arose  in 
a  Coart  of  Law  as  to  its  significance  the  Court  would 
have  to  rely  upon  the  evidence  of  experts, ».«.,  medical 
gendemen.    In  all  probability  the  words  '*  natural 
Uboor  "  would  be  defined  to  mean  a  Ubour  which 
originated  other  than  artificially,  t.e.,  by  the  means  of 
accident,  drugs,  or  instruments,  or  other  than  in  the 
ordinary  coarse  of  nature. 
There    s  no  special  legal  significance  attached  to  the 
words  "medical  supervision    and    control."     These 
words  do  not  necessarily  imply  medical  assistance,  and 
it   wonld    be  qaite  competent   for  the    Midwifery 
NuTses'  Board  to  dispense  with  the  same. 
How  the  ease  or  difficulty  of  a  labour  afiects  its  perfect 
natandneas  is  hard  to  understand,  and  I  hope,  in  con- 
nection with  any  proposed  midwifery  legislation,  to 
hear  no  more  of  saob  a  blockhead  of  a  term  as  "  natural 
laboor." 
It  is    also  very  desirable  that  the  Midwives'  Board 
shoold  not  have  power  to  dispense  with  medical  assist- 
anoei  bat  that  the  obstetric  functions  of  the  midwife 
shoold  be  very  dearly  stated  in  the  Act  itself, 
lam,  Sir,  yours,  ^., 

Wm.  Fbasbb* 
SaHord,  Jan.  11th,  1896. 


MEDICAL  TITLES  AND  THE  MEDICAL  DEFENCE 
UNION. 

To  the  BdUor  of  Thb  Msdioal  Priss  and  Ciboulab. 

8iii,—YoBr  correspondent  "H  S."  will  be,  perhaps, 

lorpriied  to  learn  that  the    conviction  of    Ferdinand, 


''  M.D.,  U.S.  A,"  was  confirmed  on  appeal  this  day  at  the 
Clerkenwell  Sessions,  with  costs ;  personally,  neither  the 
law  officers  of  the  Medical  Defence  Union  nor  I  expected 
otherwise.  If  your  correspondent  will  communicate  his 
address  I  shall  be  very  glMl  to  forward  to  him  copies  of 
our  Annual  Report,  which  will  show  the  number  of  convic- 
tions we  have  obtained  in  1895 ;  the  earlier  reports  he  can 
also  obtain. 

I  am,  Sir,  yours,  &c., 

A.  G.  Bateman. 

Oen.  Sec.,  AI.D.U 
London,  January  11th,  1896. 


DR.  CARTER'S  THERMO-INHALER  FOR  ETHER. 

To  the  Editor  of  The  Medical  Press  and  Cibgulab. 

Sib, — In  your  report  of  my  remarks  made  upon  the 
subject  of  Inhalers  before  the  Society  of  AnsBsthetists,  and 
appearing  in  your  impression  of  January  8th,  at  pase  32 
your  reporter  has  misunderstood  what  I  said.  Speaking 
of  the  ether  inhaler  shown  by  Dr.  Carter,  and  made  by 
Mr.  Krobne,  I  said  ''My  experience  of  the  apparatus  Is 
not  all  in  its  favour."  The  omission  of  the  *'  not "  makes 
me  express  approval  of  an  apparatus  which  I  consider  has 
many  grave  defects.  Before  the  words  "When  these 
apparatuses  failed  to  prove  satisfactory,  he  said  it  was 
due  to  a  want  of  experience  "  an  important  omission  has 
taken  place.  I  was  speakmg  of  the  apparatuses  devised 
by  Mr.  Clover,  and  it  was  to  these  I  referred,  and  not  to 
Dr.  Carter's.  The  failure  to  obtain  sufficient  anesthesia 
with  the  "Thermo-Ether-Inhaler"  is  due,  I  contend,  to 
inherent  defects  in  its  construction,  and  not  necessarily  to 
the  manner  in  which  it  is  manipulated. 

I  am.  Sir,  yours,  &c., 

DuDLBT  Buxton. 

82  Mortimer  Street,  W. 


The  Apothecaries'  Hall,  Ireland. 

The  Apothecaries'  Hall  conferred  its  Licence  (hon.'caus.) 
last  week  upon  Sir  Charles  Cameron,  a  distinction  which 
is  the  more  appreciable  because  of  its  rarity,  for  we  believe 
that  the  honour  was  conferred  on  but,  one,  or  at  most,  two 
previous  occasions  in  the  history  of  the  "  HalL" 

The  Compounding  of  Medicines  in  Workhouse 
Hospitals. 
At  the  meeting  of  the  Enniskillen  Board  of  Guardians 
last  week,  the  Right  Hon.  the  Earl  of  Belmore  presiding, 
Mr.  William  Wilson  said  that  at  a  meeting  of  the  com- 
mittee appointed  to  fix  the  salary  of  the  medical  officer  to 
the  workhouse,  it  was  stated  by  the  Master  that  the  nurse 
was  in  the  habit  of  compounding  the  medicines.  He  said 
if  this  was  the  custom  in  the  past  it  ought  not  to  be  con- 
tinued in  the  future.  He  considered  that  in  the  advertise- 
ments they  were  about  to  issue  for  a  medical  officer  to  the 
workhouse  it  should  be  stated  that  the  doctor  would  have 
to  compound  the  medicines.  After  some  further  discus- 
sion the  Master  stated  that  the  doctor-  simply  wrote  out 
the  prescriptions,  and  the  nurse  cempounded  the  medi- 
cines. Mr.  Brown,  J.P.,  said  it  was  a  very  important 
question.  The  chairman  said  that  it  was,  as  if  anything 
happened  the  guardians  might  be  held  responsible.  It 
was  decided  to  state  in  the  advertisements  that  the 
doctor  appointed  would  be  held  responsible  for  the  com 
pounding  of  the  medicines. 

Professional   Ethics   and   the    British    Gynsscologioal 
Society. 

At  the  last  meeting  of  this  Society,  held  on  the  7th  inst., 
the  following  resolutions  were  submitted  to  a  large  meet- 
ing:— 

1.  That  it  is  undesirablti  that  any  member  of  the  medical 

Srofession  practising  homoeopathy  should  be  proposed  as  a 
'ellow  of  the  Society.    This  was  carried  with  only  four 
dissentients. 

2.  That  it  is  contrary  to  the  ethics  of  the  British 
Oynsecological  Society  that  any  of  its  Fellows  should 
advertise  their  publications,  or  otherwise  bring  themselves 
before  the  notice  of  the  public  by  advertising  in  any  way 
through  the  medium  of  the  lay  papers.  This  was  carried 
Onanimonsly> 


72      The  Mtoioal 


NOnCES  TO  C0RRE8P0NDENT& 


jAir.  16,  IWk 


<j^4rttce0  to 
€ottzBponbttdB,  giliort  yetter0,  &c 

t9*  OOBSMPOVDim  raqvlrlng  a  nplj  In  tbli  ootamn  an  par- 
tfonlarly  raqaaitod  to  maka  ua  of  a  dUtimUm  fCgpiMriiirf  or  innUtaU, 
and  avoid  tlia  praotloa  of  ■Ignlng thanaolTM  "Baadir,"  "BubfornMr," 
'•(ndSabMrlbOT,"  Ao.  Mnoh  oonfniloa  wffl  b«  ipaiad  bf  attantlon 
toUUanla. 

TOB  LATE  DR.  KISBT,  OV  0AEBTCKUA0B0S9-.A  DISBBYIKG 
APPEAL. 
BiR,— Donbtl«ii  yon  have  already  bowd  of  the  lad  death  of  Dr.  W. 
J.  KUby,  IfeHcal  Offloer.  Baf •ni«b  DlipeuMnr  DUtrtol  whlUt  at  the 
poet  of  datr.  Ai  he  bee  left  behind  htm  a  widow  and  large  f  emily  of 
young  ehlldr-n  almoet  wholly  noprovided  for,  a  oommlttee,  at 
menUoned  be'ow,  bai  been  fornMi  for  the  pnrpoee  of  aeiliting  them 
In  their  helplen  condition. 

Sabeorlpttoni  will  be  gladly  reoeired  by  any  of  the  oommlttee  or  by 
myielf. 

Iam«Blr.  yonnAc.. 

P.  ITKnniA,  M 3.,  Hod.  See. 
OtnlekmMroei, 

Veer  Bot.  Dean  Banning- 

Ber.  P.O.O'Neinib.O.!! 
Ber.  J.  J.  Mohan,  ac.   .. 
Dr.  T.  P.  Conkm 
K  D.  BImeL  If  .P.S.L     .. 
Bamnel  Oordon,  ILD. 


£  ■ 

20 
1  0 
1  0 
10 
10 
10  0 


L  8.  P'Gredy,  Eiq ,  F.R.0.8.  6  5 
amei  Kelly 


The  Editor  of  the  MIDIOAL 
PaV8  Am)  CIROOLAB 

Mr.  KJ.O'KelU  .. 

Dr.  M'Kenna 

Bar.  W.O'Dobarty,C.a.. 

Dr.  P.O.  Walker  .. 

J.  L  MacNftUy,  Biq. 
BoUoitor. 


A  ■ 

1  1 
10 
1  0 
10 
1  0 

1  0 


Mr.JameeKaUy  ..       ..SO 

Errata.— The  new  wofk  on  the  Teeth,  annonnoed  In  oar  **  Literary 
Notee  "  oolamn,  Uet  week,  ai  in  the  Preie,  by  Dr.  J,  G.  Woodbam,  of 
the  QlMgow  Boyal  Infirmary,  thonld  retd  b?  W.  D.  Woodbnm,  of 
OUegow  Weetem  [nflrmary.  In  the  annotetion  on  *'  Neweptperi  ■• 
theMedlnn  for  Obeoenltyp"  the  Medloal  Defence  AmooUttoo  ihould 
have  been  Medical  Detenoe  Union. 

TBR  DUTIES  or  DIBPBI7BABY  MBDIOAL  0FFICEB3. 

Ehqoirir  ask«— A.  Ta  It  part  of  the  dotlee  of  a  Medloal  Oflloer  to 
(1)  a  u  Qton  Hoepttal,  (8)  to  a  Diepeniary,  to  compound  the  mediotnea 
required? 

A.  Neither  the  PootwBeUef  Aota  nor  the  Baffnietlona  made  by  the 
Local  OoTemmeot  Board  to  defloe  the  duty  ot  the  Workbonie  M«dleel 
(ifllcer  apedfjf  the  oomponnding  of  medldaea  aa  part  of  that  dnty.  In 
fact,  the  only  doty  Impoaed  upon  him  wblch  might  imply  the  adminla- 
tratlon  ot  medldne  la  that  which  reqntrea  him  ^*  to  gl?e  all  neoeeaaiy 
directlona  .  .  aa  to  the  treatment  of  the  aick  panpera."  Cnatom, 
howerer,  in  many  inatancea,  anpporta  the  ayatem  of  componndiog  by 
Woffkhonae    Medloal  OOoafv.     The  fMcpeniary  Medical  Ofllcerii 

J  by  the  Medloal  Gharltiei '     "     '    '      "' 

adTioe." 


veqaired  by  the  Medloal  Gharltiea'  Act  (Bee  9).  -'toafford  medldne  and 
advioe."  The  regnlatiooa,  howeTcr,  only  impoie  on  him  the  daty  of 
aapolying  "  aUreqnlalte  medical  and  rargloal  adrioe  and  aaaiatanoe.' 


Nothing  la  aald  o'f  medicine  nor  la  It  aet  down  anywhere  that— la 
mediolnea  are  to  be  given— they  are  to  be  componnded  by  the  Medloal 
Ottcer. 

B.  Are  DIapeaaary  Commltteea  and  Boarda  of  CHiardlana  not  raqnired 
to  provide  a  legally  qoallAed  compounder?  aa  defined  by  the  Local 
GoTomment  Board. 

A.  There  la  no  obligatory  proftalon  for  the  appointment  of  a  oom- 
poondar  whldi  la  left  to  the  dlioretlon  of  the  Onardiana  and  tiie 
aanction  of  the  Local  Government  Board. 

0.  Where  the  Medloal  Ofllcer  la  not  legally  qualified  aa  required  by 
the  Local  Ooveroment  Board  aa  a  compoander,  can  the  B)ard  ot 
Onaidiani  impoae  the  datlea  of  eomponader  on  him?  (Thia  query 
refera  to  both  DIapenaary  and  Unioa  BLoaplUl  Medical  Offlcera). 

A.  A  reffiatereit  medical  praotitioaer  can  lawfully  compound  medi- 
olnea for  hla  own  patienta— whether  p-iblio  or  priTate— though  he  may 
not  poaaeaa  any  apeolal  pharmaceutic  qualiflcatioo.  Therefore  the 
Ouaraiana  may  Impoae  that  dnty  upon  him  if  ihey  make  it  part  of  hla 
original  contraot,  but.  If  they  have  not  doce  ao,  they  caanot  after, 
warda  add  that  function  to  hit  duty,  nor  could  ha  be  reoiofed  from 
ofilce  If  he  refoaed  to  perform  It. 

Dr.  Goddard.— Tour  letter  baa  been  forwarded  to  the  addraaa  of 
the  gaatleman  referred  to. 

JleetmgB  of  Vxt  ggctctttg 

Wrdhisdat,  Jan.  ifira. 
BOTAL  MI0RO80OPIOAL  BoonTT,  (3D  Hanover  Bquare,  W.)— 8  p.m. 
Prealdential  Addrew  by  Mr.  A.  0.  MicbaeL 
North- Wist  Lovdoh  Clinioal  Bogirt.  —  8.80    p-m.     Olinloal 


THVR8DAT,  JAH.  lOlH. 

Harvkan  BoonTT.  ~  8  p.m.  Preaident'B  Addreaa  and  Annual 
Oonveraaioine. 

SOGUTT  or  AirJi3THiTiSTi,  (tt  Hauover  Square,  W.).>8.80  p.m. 
Dr.  Sydney  Short,  (Blrmlngha  a) :  ObeervAtlooa  on  a  Bartea  of  UO 
Timed  Nitrona  Oxide  Gaaea . 

Fridat,  Jah.  17TB. 

BRTTIBH  LARTROOLOaiOAIi,  BHIVOLOaiOAL  AVB  OTOLOGIOAL  A8800IA 

TfOR,  (11  Cnandoa  Street,  W.X— 8.80  p.m.  Ceaea,  Ulnatrated  by 
mlcroecopio  aectiona,  Ac.,  will  be  ahown  by  the  Preddent,  (Dr. 
Stoker),  Mr.  Mayo  CoUier,  Dr.  Pegler,  and  Dr.  MiUigan.  Mr.  Mayo 
ColUer  will  open  a  Dlacniaion  on  the  Oauaea  and  Ooniequencea  of 
Chronic  Naaal  Obttruotion.  Mr.  Lennoc  Browne  will  read:  A 
Buggeation  to  Aboilah  Gargling  in  the  Tre«tmeni  .of  Acaie  Inflam- 
matlona  of  the  Throaty 

EPDUfOLoaiOAL  SoQiirT  or  LoRDOR,  (11  Chandoe  Street,  Gaven- 
dbh Square). -8  p.m.  Bnrgeoi-Oaoaral  C  A.  Gordon:  Ezperiancea 
in  Bdatlon  to  Cholera  In  India  from  1848-7A. 


IBtcnntUB. 


_     I.   BaIanr£lMp«r 

annnm  (with  an  allowanoe  of  £80  per  annum  far  cab  hire),  and 
fnmiahed  rooma,  fire,  Ughta,  and  atteadaaoe.    AppUoaftiona  befcia 


the  90th  Inat.,  to  Ales.  Foneat,  Beoretaiy. 


Bradford  Inflrmaiy.— Dtapenaary  Sntaeoa.  Baluy  £100 
1  and  reddance.  Applioatlona  endoraed 
on  or  befoi«  Jan.  sftti,  to  William  Maw,  Saeratary. 


with  board  and  reddance. 


Bee. 


'DIapenaary 

. ,  «o  wuiiam  Maw.  If " — 

aty  of  ^bUn  HoepttaL-Bealdent  Bu 

with  apartmenU.  light,  fad,  and  i 

ooplea  of  teatlmoalala  on  or  before  Jan.  18th.  to  tha  Mon. 

Medloal  Board,  City  of  Dublin  Hoapital.  Upper  Baggot  Strad^ 

DttbUn. 
Flaherton  Honae  Aaylnm.—Aaalatant  Medloal  Oliloer.    Salary  £100  par 

annnm,  with  board,  lodgUig,  and  waahlng.    Anply  to  Dr.  Fbieh, 

the  Aaylnm,  Baliabary. 
Great  Northern  Ctntrd  Hoapftat— Junior  Honae  Burgaoo.     Board, 

lodging,  and  laundry  provided  in  the  hoapitaL   No  aalary.   Forma 

of  applioation  and  fnll  partloulara  may  be  obtained  from  Lewie  H. 

Glenton  Kerr,  Beoretary. 
London  HoepttaL-Two  Aaaiatant  Anmathatiate.     Salary  £l 

annnm.    Appilcationa  not  later  than  Jan.  18th,  to  Dr. 

Scott,  Warden. 
Margate  Boyal  Bea-Bathlng  Infirmary.— Superintendent,  not  i 

aarily  Medical.    Salary  £180,  with  partlaUy  fnmiahed  honae  and 

gaa.    Full  partlonlara  on  application  to  the  Seoretacy  of  tha 

Charity,  60  Charing  Croaa,  London. 
NotUngfaam  ahildrenl  Hoapital- -Honae  Bnrgaoa   (non   reddeat). 

Salary  £100  par  annnm.    Applloattona  to  be  aent  to  tlia  Baorataiy 

byJacfOth. 

S^VVoinimtntB 

BARRT.  J.,  M.D JML,  L.B.OJB.BdfaL.  Medloal  Ofllcer  lor  tha  BaMiff 

DIapenaary. 
BIRRT,  Wm.,  J.P.,F.B.03.I.,  D.P.H.,  Medical  Ofllcer  of  H«althaad 

Sapevfntendent  of  the  Sanatorium,  County  Borough  of  Wigaa. 
PiSP/iRD.  MisaB.  C,  MB.Lond.,  Junior  AaaUtant  IMIeal  Ofleard 

the  dolloway  Sanatorium  Hoaoltd  for  the  Inaane,  Virginia  Water. 
DOHHAR,  W.  U.,  M.Bw,  B.Ca.,  B.U.I.,  Houae  Phyaldan  to  the  Belfad 

Boyal  HoapitaL 
DUHDAS.  M.  G.,  M.B.C.B..  Medical  Ofllcer  by  the  Mltfoid  and  Lasa- 

ditch  Burd  DIatrict  GonoolL 
Harooort,  G»>..B.,   L.B.C.P.Lond.,   M.B.C.&,  Aaaiatant   Medtel 

Ofllcer  and  DIapenaer  at  the  Infirmary  of  the  Pariah  of  ramhatii. 
Hodqr.    Alrbrt,   M.B.C.B.Bng.,    L.B.O.P.Lond.,  Beddant   Medied 

Ofllcer  to  the  Ghoriton-upon-Medlock  DIapenaary,  Mancheatar. 
LAlcn,  J.  H.,  M.B.,  C.M.Edhi.,  Honae  Phyddaa  to  the  B^yd  Barb 

Hoepital,  Beadlnc. 
LVB,  J.  FiROUflOH.  MB.,  C.M.GIaag.,  Honae  Bnzgeoa  to  the  Haitle- 

podHoepitaL 
MAaowAV.B.  M,  M.Bw.  B.Ch.,  B.n.L,  Senior  Hooae  Snrgaon  to  the 

Belfad  Boyd  HoapitaL 
M0RRI80R.  A.,  L.B.C.P.Lond.,  M.B.C.8.,  Aaaiatant  Medical  Ofllcer  for 

the  Infirmary  of  the  Pariah  of  St.  Panoraa. 
PAIVH,  H.  B.  U,  L.B.aP.Lond.,  M.B.aB..  Medksd  OflkMT  for  the 

Chndldgh  Sanitary  Diatrict  of  the  Newton  Abbot  Union. 
BUBTOR-aARRDOR,  G.  H..  M.B.,  C.MBdln.,  Honae  Sargoon  to  tha 

Boyd  Berks  Hoepital,  Beading. 
BAVHDHaa,  Brrtram,  M.B..  CMAberd.,  Junior  Honae  Phyatdaato 

the  North-Baatam  Hoapital  for  Children. 


TORRIRO,  /.  H.,  M.B.Lond.,  L.B.C.P..  M.B.a8.,  MedlodOOoer  lor 
the  Oambome  Sanitary  Dlatriot  of  the  Bedmth  Union. 

Walsh,  B.  P.,  L.B.aP.,D.B.C.B.lrd.,  pro (m.,  MedlodOflloer  forttie 
Bniilakinen  Union  Workhonae. 

WiLBOH,  B.,  L.F.P.^,  UMOIaag.,  Madlod  Ofllcer  for  the  Newuhoreh 
Banltrry  Diatriet  of  the  Haalingdon  Union. 

MiRTRR.-On  Jan.  Mb,  at  Maadon  Bow,  Chatham,  the  wile  of  Bnad 

D.  MInter,  Butmou  B.N.,  H.M.S.  R^tpert,  of  a  eon. 
M0L80R.-0n  Jan.  7Ch,  at  18  Ungfleld  Bond,  Wimbledon,  the  wife  d 

J.  CavendUh  Molaon,  LbB.o.P.Lond.,  of  a  daughter. 
OuvR.— On  Jan.  7th,  at  Leamington,  the  wife  of  Eaataoa  J.  P.  OUvt^ 

M.  A..  M.D.,  F.B.aB.,  of  twin  dangbtara. 
VOILOKRr;— On  Jan.  8th,  at  81  Harley  Street,  London,  tha  wUa  d 

Arthar  F.  Vodcker,  M.B.,  of  a  daughter. 


^^xtx^qtB. 


CL4RK-MATKHIW8.-On  Jan.  8th,  at  St  Paul*a,  New  Baekeaham 
Arthur  Deehorough,  L.R.C.S.,  L.B.aP.,  eon  of  the  late  Thomai 
Ctark,  of  Backennam,  to  Annie  Bathecfwd,  only  daoghiar  d 
George  Kelly  Matthewa,  of  Beckcnlun. 

J0VR8  -WoODMAH.  -On  Jan.  7th,  at  Olirld  Chnroh,  Foreet  Hill, 
Wilfred  lEdward  Jonea,  MB.CJB .  L.B.C.P.,  aeoond  aon  d  C 
StnrReaJonee,  M.B.ad.,  of  Chichaaiar,  to  Ellea  Baaka,  third 
daughter  of  wintam  Woodman,  of  Woodbank.  Fored  HOL 

NiAB— DathRll.— On  Jan.  8th  atSt.  Jade'a  Church,  South  Kendnr- 
ton,  Joaeob Bddwin  Niaa,  M.D., ddeet  aon  of  the Ute  AdmhdNr 
Joaeph  Niaa,  K  C.B.,  to  Francea  Miriam  Clare,  aeoond  danghiar  d 
C4»taln  Edmund  Dayrell.  B.N. 


StathB. 


DiX0H.-On  Jan.  Srd,  at  Harrow  Landa,    Dorking,  Jamee  Uion 

F.B.CB.,  aged  bS. 
HnAOH.-On  Jaa.  ath,  at  MUeatone  Honae.  Upper   Deal,   Thooa 

Denne  Hilton,  M.  B.O«ntab ,  aged  74. 
L01IA8.— On  Jan.  Srd,  at  Bdpar,  Henry  Lomaa,  L.B.4.,ln  hia  08ndyBar. 
MAT.-On  Jan.  8nd,  at  Bonmaoaouth,  W.  CoataU  May,   M.B.a&,  Ida 

o  Bonthr     ■  '  ^ 


W>h  ^dml  Wm$  mA  diimhv. 


'SALUS  POPULI  SUPREMA  LEX" 


V0L.CXIL 


WEDNESDAY,    JANUARY    22,     1896. 


No.  4. 


ON 

THE   DIAGNOSIS  OF  INSANITY. 
By  THEO.  B.  HYSLOP,  M.D., 

Leetuer  on  Maotml  DlaeMes  to  St.  Bf  ary'i  Hotpital  Medical  School, 
AMktant  Fhyiielan  to  Bethlem  Boytl  HospltaL 

Lectuse  IV. 
In  this  lectare  I  propoae  to  deal  with  some  additional 
factors  which  either  tend  to  predispose  towards  or 
modify  attacks  of  insanity.    Considered  seriatim  these 
fiactors  are :  — 

(5)  Habits  of  Life :  (a)  intemperance  in  alcohol,  (h) 
seznal  excesses,  (c)  excessive  meat  eating,  and  other 
dietetic  irregularities,  (<2)  irregalarity  as  to  sleep  and 
bodily  hygiene,  non-cultivation  of  control,  (fee 

(6)  Periodst  of  Life :  birth,  dentition,  infancy, 
puberty,  adolescence,  maturity,  pregnancy,  puerperium, 
dimacterium,  and  senility. 

(7)  Previous  lUnesses:  fevers,  malaria,  rheumatism, 
gout,  rickets,  syphilis,  scurvy,  struma,  tuberculosis, 
cancer,  aosmia,  chlorosis,  diabetes,  goitre,  &c. 

(8)  AedderUs  or  Injuries:  shocks,  wounds,  local 
injuries,  sunstroke. 

(9)  The  Effects  of  Drugs:  alcohol,  opium,  haschisch, 
belladonna,  chloroform,  ether,  lead,  &c. 

Alcohol  undoubtedly  produces  far-reaching  effects 
upon  the  equisite  structures  of  the  brain,  and  conse- 
quently upon  the  mental  faculties  which  these  struc- 
tures subserve.     The  derangements  due  to  alcohol 
may  be  mainly  sensory,  motor,  or  intellectual.  Alcohol 
may  produce  a  temporaij  disturbance  of  the  intellect 
by  means  of  its  direct  poisoning  influence  on  the  brain, 
or  it  may  cause  structural .  alterations  of  the  brain 
which  are  chAracterised  by  progressive  weakening  of 
the  mental  faculties,  and  finally  dementia.    The  sym- 
ptoms of  direct  poisoning  are  doubtless  well  known  to 
all ;  the  features  of  slow  decay  of  the  brain  and  mind 
will  be  dealt  with  later. 
The  main  types  of  alcoholic  insanity  are  as  follows  : 
(l)Thepurelysensorytype8in  which  there  is  perversion 
of  the  common,  visceral,  or  special  senses.  Perhaps  one 
of  the  most  common  causes  of  delusional  insanity  is 
alcohol.    Not  infrequentljr  recurrent  attacks  of  alcoho- 
lic mania  ultimately  pass  into  delusional  states  with 
ideas  of  persecation.    Several  patients  now  in  Bethlem 
are  of  this  type,  they  have  been  admitted  and  re-ad- 
mitted suffering  from  the  effects  of  intoxicants  from 
which  they  have  recovered.    Sooner  or  later,  however, 
there  has  come  a  time  when  sensory  disturbances  have 
predominated  and  these  followed  by  delusions  of  per- 
Boeution  have  rendered  the  cases  incurable  and  destined 
to  remain  for   ever  under  asj^lum  supervision.    (2) 
Motorial  types,  in  which  the  intoxicant  affects   the 
motor  apparatus,  are  also  very  common,  and  it  is  with 
these  cases  ^t  the  greatest  number  of  mistakes  in 
diagnosiB  are  made.    Not  infrequently  persons  suffer- 
ing from  tongue  tremors  and  inability  to  co-ordinate 
movements  are  diagnosed  as  general  paralytics.    They 
may  besufferinj^  from  general  paralysis,  but  it  is  better 
to  ffive  a  provisional  diagnosis  and  state  that  the  effects, 
if  due  entirdy  to  alcohol,  may  pass  off  and  end  in 


Sometimes  it  is  difficult  to  obtain  a  history  of  alcohol- 
ism. The  wives  of  commercial  travellers  and  city  men 
have  never  seen  their  husbands  intoxicated,  and 
possibly  they  may  not  have  been  really  so ;  neverthe- 
less, they  have  been  accustomed  to  drink  copiously  and 
constantly  so  that  their  brains  have  become  predis- 
posed to  break  down  under  some  other  exciting  cause. 
Sometimes  such  individuals  are  keenly  conscious  of 
their  motor  unsteadiness,  and  resort  to  ''  a  hair  of 
the  dog  that  bit  them  "  to  regain  stability.  Cases  in 
which  there  are  marked  tremors  on  admission  and 
which  appear  to  increase  during  the  next  few  days  are 
always  suggestive  of  alcohoUsm,  and  more  particularly 
so  if  subsequently  they  tend  to  disappear.  In  this 
relation  it  is  of  the  utmost  importance  to  remember 
that  alcohol  may  produce  temporary  disturbance 
of  the  cerebro-spinal  system  which  cannot  be 
distinguished  from  general  paralysis  with  spastic 
or  ataxic  symptoms.  (3)  Alcohol  may  produce 
very  varied  mental  defects.  The  chief  defect  is 
impairment  of  memory.     The  impairment  may  be 

Srimary  and  progressive  in  nature,  leading  to  a  con- 
ition  of  dementia.  Some  observers  believe  that 
amnesia  is  the  earliest  evidence  of  structural  change 
in  the  brain,  and  that  absolute  recoverability  is  rarely 
(if  ever)  obtained  in  this  stage  of  alcoholism.  This, 
however,  is  an  opinion  whicn  we  are  unable  to  con- 
firm, and  I  believe  we  are  not  warranted  in  ^ring  an 
unfavourable  prognosis  solely  from  the  consideration 
of  a  defective  memory.  In  alcoholic  insanity,  just  as 
in  other  forms  of  insanity,  the  memory  is  liable  to  be 
temporarily  affected;  and  at  present  we  are  not  well 
enough  acquainted  with  the  laws  of  memory  to  be  able 
to  definitely  prognose  as  to  curabilit]^.  In  old  standing 
cases  in  whicn  there  is  complete  failure  to  re-educate 
the  memory,  and  in  senile  cases,  we  may  be  able  to 
give  an  unfavourable  prognosis  ;  out  I  repeat  that,  in 
acute  cases  it  is  wiser  to  give  a  provisional  diagnosis. 
The  more  one  sees  of  alcoholics  tiie  more  one  realises 
that  to  them  all  things  appear  to  be  possible,  even 
recovery  from  the  lowest  depths  of  degradation. 

Alcoholic  insanity  is  most  apt  to  supervene  during 
the  periods  of  activity  when  there  is  the  greatest 
amount  of  wear  and  tear.  Thus  it  is  more  commonly 
met  with  between  the  ages  of  25  to  30  and  35  to  45. 
It  has  been  estimated  that  37*2  per  cent,  of  alcoholics 
are  predisposed  to  it  by  inheritance.  Sometimes 
children  have  a  morbid  craving  for  alcohol.  In  nearly 
all  the  t^pes  of  alcoholic  insanity  the  most  noticeable 
feature  is  that  of  impulsiveness.  Subsequently,  how- 
ever, we  shall  devote  more  attention  to  the  varieties 
of  morbid  impulse  associated  with  epilepsv  and  other 
neuroses,  cranial  injuries,  syphilis,  sunstroke,  &c. 

Hallucinations  may  be  visual,  aural,  general,  sys- 
temic, visceral,  or  relating  to  the  senses  of  smell  or 
taste.  One  alcoholic  patient  in  Bethlem  used  to  believe 
that  his  legs  were  being  bitten  by  fishes,  the  belief 
arising  in  connection  with  a  cutaneous  patch  of  hyper- 
seathesia.  Others  im^ne  themselves  to  be  persecuted 
by  electricity,  <&c.,  owing  to  some  cutaneous  disturb- 
ance. The  other  features  of  alcoholic  insanity  will  be 
dealt  with  more  conveniently  when  we  come  to  con- 
sider the  points  of  differential  dia^i^osis  between 
general  paralysis  and  other  forms  of  insanity. 

Sexual  excess  is  undoubtedly  a  cause  of  some  forms 


74     Thx  Msdical  Prbbs. 


ORIGINAL  rOMMUNICATIONS. 


Jan.  22,  1896. 


of  mentdl  disorder,  while  in  others  it  is  merely  a  sym- 
ptom of  a  predisposition  or  nervous  instability.  The 
Husbands  of  amatory  and  volaptuoos  women  are  not 
infrequently  the  viotims  of  general  paralysis.  It  is 
important  to  note,  however,  that,  although  it  is  fairly 
certain  that  sexual  excess  does  cause  general  paralysis, 
yet  there  are  some  cases  in  which  the  sexual  excess  is 
a  s};mptom  and  not  a  cause.  I  have  seen  a  man  who, 
during  his  adolescence  and  manhood,  had  led  a  tem- 
perate life  sexually,  yet  who,  when  he  got  on  in  years, 
beqame  unstable  and  developed  a  tendency  to  excessive 
venery,  which  was  regarded  rather  as  a  symptom  of 
early  senility  than  a  cause  of  the  morbid  mental  sym- 
ptom. Another  patient,  formerly  in  Bethlem,  broke 
down  after  exposure  to  a  tropical  sun,  and  developed 
an  ambition  to  get  black  babies,  which  ambition  he 
pursued  to  the  point  of  extreme  exhaustion  and 
mental  ruin.  Although  some  authors  maintain  that 
Hexual  excess  is  almost  invariably  a  cauee  of  general 
paralysis,  it  is  fairly  evident  that  in  some  cases,  at 
least,  there  has  not  been  any  sexual  excess.  Mastur- 
bation seldom  causes  it.  The  influence  of  sexual 
exoess  in  the  production  of  mental  diseases  is  very 
dilii'.ult  to  estimate  correctly.  In  adolescents  the 
disorder  is  usually  characterised  by  certain  well- 
marked  features.  The  individuals  are  usually  dul', 
phlegmatic,  and  lacking  io  energy,  they  hold  them- 
s jives  aloof  from  others,  and  may  be  seen  sitting  in  a 
'-orner  with  their  liands  lying  between  their  thighs. 
The  dull  luok  and  the  obvious  sluggish  circulation  are 
iairly  constant  characteristics.  Unfortunately,  patients 
of  this  class  are  exceedingly  apt  to  degenerate  and 
become  demented.  Their  delusions  are  commonly 
connected  with  the  sexual  organs,  and  not  a  few  of 
them  have  perversions  of  taste  and  smell.  A  person  of 
the  above  type,  who  complains  of  pain  in  the  back  of 
his  head,  foul  smells  or  tastes,  and  delusions  as  to 
nexual  persecution  is  generally  a  masturbator.  In  my 
experience  such  cases  seldom  recover.  Thev  may 
improve  up  to  a  certain  point,  but  ultimately  they 
tdDd  to  become  demented,  Impulsiveness  is  also  a 
common  symptom,  and  in  my  opinion  the  development 
of  impulsive  tendencies  in  such  cases  is  a  very  un- 
favourable omen.  Dr.  Skae  has  graphically  described 
this  vice  as  producing  a  group  of  symptoms  which  are 
quite  characteristic  and  easily  recognised,  and  give  to 
the  case  a  special  natural  history  ;  the  peculiar  imbe- 
cility and  shy  habits  of  the  very  youthful  victim  ;  the 
suspicion,  fear,  dread,  suicidal  and  other  impulsive 
tendencies,  the  palpitations,  scared  look,  and  feeble 
body  of  the  older  offenders,  passing  gradually  into 
dementia  or  fatuity. 

The  influence  of  diet  in  the  production  of  mental 
diseases  can  scarcely  be  over-estimated.  Insufficient 
nutritive  substances,  irregularities  in  the  habits  of 
feeding,  injudicious  diets,  and  other  strains  upon  the 
digestive  organs  are  extremely  apt  to  disturb  the  cere 
bral  circulation,  and  consequently  the  nutrition  of  the 
cortical  structures.  Insufficient  food  during  early  life 
has  been  assigned  as  the  cause  of  imbecility  and  idiocy. 
At  the  present  day  there  is  considerable  uncertainty 
as  to  the  origin  of  some  of  the  scorbutic  types  of  imbe- 
ciles and  idiots  in  our  asylums,  and  we  do  not  as  yet 
know  the  relations  between  scurvy  and  rickets  and 
mental  defects.  Not  a  few  of  these  types  are  difficult 
to  estimate,  and  more  especially  so  when  no  hereditary 
tendency  can  be  traced.  Dr.  Cheadle  was  one  of  the 
first  to  point  out  to  the  medical  world  the  clinical 
affinities  of  infantile  scurvy.  Seventeen  years  ago  he 
published  his  investigations  upon  cases  of  scurvy  super- 
vening on  rickets  in  young  children,  and  later  some 
important  observations  on  osteal  and  periosteal  ca- 
chexia and  scurvy.  There  are  still,  however,  many 
observations  wanted  upon  these  subjects.  We  do  not 
know  whether  the  acute  rickets  of  the  German  authors, 
which  is  now  commonly  regarded  as  a  combination  of 


scurvy  and  rickets,  is  in  reality  a  combinatioo  ;  audi 
if  so,  whether  the  scurvjr  is  an  essential  and  the  rickets 
a  variable  element,  or  vice  versa.  The  points  of  differ- 
ence between  infantile  and  adult  affections  are  not 
clearly  defined.  No  explanation  has  been  offered, 
although  frequent  mention  has  been  made,  of  the 
hvsterical  objection  to  vegetable  diets  in  these  cases. 
The  fainting  fits  reported  as  occurring  in  association 
with  these  cases  are  of  doubtful  nature.  It  would  also 
be  of  great  value  to  have  some  definite  information  as 
to  the  value  of  Swiss  milk,  Nestl^'s  food,  Robb's 
biscuits,  Liebig's  extract,  and  other  preparations, 
which  at  present  appear  to  be  household  words  to  the 
possibly  uninitiated.  At  present  we  do  not  know  what 
proportion  of  children  fed  on  these  foods  have  &alty 
nutritional  changes. 

In  adult  life  the  peculiar  distribution  of  (^nersl 
paralysis  has  been  thought  to  be  due  to  variations  in 
diet.  The  large  consumption  of  potatoes  in  Ireland, 
and  of  oatmeal  in  Scotland,  has  been  regarded  as  a 
cause  of  exemption  from  general  paralysis.  Whether 
tbA  peculiarities  of  diet  are  the  causes,  or  whether  the 
influence  of  syphilis,  sexual  excess,  and  alcohol  are  the 
chief  factors,  we  are  at  present  unable  to  determine. 

£xcessive  meat  eating  is  sometimes  assigned  as  a 
cause  of  general  paralysis,  but  this  is  a  conjecture 
which  we  are  unable  to  verify.  Commercial  travellers 
and  others  who  are  liable  to  take  their  meals  at  irre- 
gular intervals,  and  who  freely  indulge  in  nitroicenous 
diets,  not  unf  requently  become  general  paralytics. 

Insomnia  is  undoubtedly  one  of  the  most  common  of 
the  causes  of  insanity.  Loss  of  rest  and  failure  to 
recuperate  cerebral  energy  has  insidious  and  far- 
reaching  effects,  which  may  lead  to  temporary  mental 
instability  or  even  to  total  dementia  and  death. 
Eiffhty  per  cent,  of  the  cases  admitted  to  Bethlem  have 
suffered  from  want  of  proper  sleep. 

I  now  nropoee  to  mention  some  of  the  phpstological 
periods  of  life  which  are  most  f  ratight  with  dan^  to 
an  individual.  Durinj^  infancy  various  forms  of  idioCT 
and  imbecility  may  arise.  The  causes  acting  at  birth 
may  be,  premature  birth,  difficult  labour,  instrumental 
delivery,  accident,  asphyxia  neonatorum,  or  primogeni- 
ture. Those  acting  subsequently  to  birth  may  be, 
infantile  convulsions,  epilepsy,  cerebral  affections, 
febrile  disturbances,  paralytic  affections,  sunstroke, 
nervous  shock,  or  physical  injury  to  the  head. 

Among  the  more  important  factors  which  determine 
mental  defects  or  aberrations  in  the  infant,  we  have  to 
note  the  following  structural  abnormalities  of  the  bnio 
and  spinal  cord  :— (a)  Anencephalus  in  which  the  vault 
of  the  cranium  is  absent,  the  base  being  occupied  by  a 
mass  of  connective  tissue  and  blood  vessels,  formed  from 
iagrowUis  of  the  pia  mater  ;  (b)  ahsense  of  the  pros- 
Hncephalon  in  which  there  is  a  rudimentary  thalamce- 
phalon,  the  cerebellum,  pons,  and  medulla,  being 
reduced  in  size  owing  to  the  absence  of  development 
of  the  prosencephalic  fibres ;  (c)  cyclops,  in  which 
there  is  an  undivided  anterior  cerebral  vesicle  occupied 
by  only  one  ventricle,  and  in  some  cases  the  presents, 
of  only  a  single  optic  nerve  and  a  single  eye. 

Other  abnormalities  of  the  brain  and  spinal  coed 
have  been  grouped  as  follows  ;— 

(1)  Abnormalities  accompanied  by  defects  in  the 
envelopes  of  the  part  :— 
(a)  Cranioschisis  : — 

Encephalocele. 

Hydrencephalocele. 

Meningocele. 
(6)  Rachischisis  :— 

Myelocele. 

Meningocele  spinalis. 

Spina  bifida  occulta, 
Abnormalities    in    which 


(2) 
entire  :— 


the   envelopeB  art 


Hydrocephalus. 


Ja  .  22, 1896. 


ORIGINAL  COMMUNICATIONS. 


Thi  Mkdioal  PRiis.      75 


Microcephalns. 

Porencephalus. 

Hypertrophy. 

Aberrant  arrangemept  of  fissured  and  convo- 

lationa. 
Agenesis  of  cortical  elements,  commissures, 
and  associative  tracts. 
Of  the  v^rioas  types  of  congenital   and  acquired 
imbecility  which  m\j  be  diagnosed  during  infancy,  we 
have  to  note  the  following  : — 

(1)  Coni^dnical,  in  which  the  individual  is  usually  of 
a  low  type,  with  a  tendency  to  physical  weakness, 
strabismus  or  oystagmus,  a  highly  arched  or  elongated 
palate,  also  automatic  movements,  contractures,  or 
Bp&stic  rigidity.  Such  patients  not  uncommonly 
slaver,  and  appear  to  be  incapable  of  caring  for  them- 
selves. Their  special  senses  may  be  defective  or  only 
partially  developed,  and  there  may  be  little  or  no  power 
of  attention  or  volition. 

The  typed  of  congenital  imbecility  have  been  classi- 
fied as  follows:— (a)  Simple  congenital,  which  include 
those  forms  without  any  obvious  physical  deformity  of 
the  head  or  limbs.  The  Mongol  or  Kalmuc  idiot 
belongs  to  Uus  class.  A  typical  Mongol  idiot,  however, 
i^  usually  of  stunted  growth  and  brachvcephalic.  His 
fingers  and  hands  are  short  and  dwarfed.  Their  defec- 
tive circulation  and  inability  to  resist  acute  diseases 
usually  incapacitate  them  from  attaining  to  adult  age. 
(fi)  Microcephalic,  in  which  the  brain  has  ceased  to 
grow,  due  either  to  some  internal  cause  or  to  the  pre- 
mature closure  of  the  sutures  of  the  skull.  As  a 
general  rule,  heads  below  17  inches  in  circumference 
are  held  to  be  too  small  for  ordinary  intelligence. 
(e)  Hydrocephalic,  in  which  the  fontanelle  is  raised, 
the  head  is  globular,  with  the  widest  circumference  at 
the  temples,  and  occasionally  a  slight  bulging  above 
the  superciliary  ridges,  (d)  Scaphocephalic,  in  which 
the  head  is  keel-shaped,  (e)  Paralytic,  in  which  there 
is  arrest  of  development  of  part  of  the  brain,  due  to 
inJQTy*  disease,  or  apoplexy.  In  such  cases  the 
mentel  powers  can  sometimes  be  cultivated  to  a  cer- 
tain extent,  but  the  phvsical  development  is  locally 
arrested.  Usually  one  hemisphere  only  is  afiected. 
(/)  Cretinism,  which  may  be  sporadic  or  endemic. 

The  types  of  acquired  imbecility  are  as  follows  :— 
(a)  Eclampsic,  in  which  there  is  arrest  of  development 
of  the  mental  functions  due  to  the  occurrence  of  con- 
valsions  soon  after  birth,  and  which  have  damaged  the 
structures  of  the  brain,    (b)  Epileptic,  in  which,  as  the 
result  of  frequent  fits,  the  intellect  becomes  dull,  and 
the  individnal  becomes  incapable  of  advancing  intel- 
lectually,   (c)  Paralytic,  in   which  the   paralysis  is 
loquired  at  some  period  after  birth.    Some  of  the 
cases  are  due  to  the  occurrence  of  fits,  or  to  cerebral 
apoplexy,   (d)  Inflammatory,  is  usually  a  sequel  to 
Bome  acute  illness,  nuch  »s  measles,  typhoid,  whooping- 
cough,  sunstroke.  &c.    The  amount  of  impairment  cf 
the  mental  faculties  depends  in  great  part  upon  the 
amount  of  damage  to  the  brain-tissues,    (e)  Hyper- 
trophic, which  may  or  may  not  be  associated  with 
rickets.    Usuedly,  the  brain    is  not  so  large  as  in 
hydrocephalus.    The  head  is  somewhat  square  and 
bulges  above  the  superciliary  ridges.    Hypertrophy  is 
said  todififer  from  hydrocephalus  in  the  fact  that  in 
the  former  there  is  no  elasticity  over  the  late  c1o<ied 
fontanelle  as  in  the  latter.    In  hydrocephalus  the  dis- 
tance between  the  eyes  is  increased ;  in  hypertroohy 
this  is  not  the  case.    (/)  Traumatic,  due  to  a  fall  or 
blow  on  the  head.    Sometimes  the  injury  has  caused 
the  occurrence  of  fit««  which  serve  to  prevent  mental 
improvement    (ff)  Endemic  cretinism,  in  which  there 
are  none  of  the  fatty  tumours  in  the  posterior  triangle 
of  the  neck  like  those  found  in  sporadic  cretinism. 
Usually,  cretins  are  classified  according  to  their  degree 
of  dev^opment.      The    lowest    type<i    are   termed 
''crdtloi";  th^se  with  a  certain   amount  of  intelli- 


gence '* semi-cretins";  while  those  who  have  a  fair 
amount  of  mental  power  are  termed  •*  cretineux.** 

Insanity  is  rare  in  early  infancy.  It  occurs  in 
children  who  have  a  strong  neurotic  inheritance,  and 
manifests  itself  by  terrors,  nightmares,  nocturnal 
delirium,  and  visual  hallucinations.  Some  childr«>n 
have  morbid  and  often  dangerous  impulses.  Attacks 
of  melancholia  or  of  mania  are  rare.  Night  terrors 
usually  occur  an  hour  or  two  after  going  to  sleep.  The 
attacks  are  characterised  by  excessive  fears,  screaming, 
and  usually  some  terrifying  hallucinations.  They 
occur  in  children  of  a  neurotic,  scrofulous,  or  amemic 
type.  The  immediate  exciting  causes  may  be  indiges- 
tion, worms,  teething,  enlarged  tonsils,  ear  disease, 
catarrh  of  the  respiratory  passages,  irritation  of  the 
skin,  ill-ventilated  bedrooms,  fevers,  or  to  various 
conditions  of  mental  excitement  during  the  day.  The 
attack  may  be  idiopathic,  in  the  form  of  a  transitory 
hallucination  of  sight,  due  to  increased  irritation  of 
the  brain  cortex,  or  symptomatic,  as  a  reflex  neurosis 
of  the  pulmonary  vagus  resulting  in  dyspnoea^  and 
thereby  in  a  sensation  of  subjective  terror.  It  u  not 
common  for  night-terrors  to  be  associated  with  organic 
brain  disease  or  with  epilepsy.  Occasionally,  now- 
ever,  children  affected  with  night- terrors  become 
epileptic.  One  case  has  been  reported  in  which  night - 
terrors  took  the  place  of  epilepsy. 

Dreams,  nightmare,  and  somnambulism  occur  in 
children,  due  to  causes  similar  to  those  of  night- 
terrors.  Over-fatigue  or  nervous  excitement  durinir 
the  daytime  tend  to  produce  these  affections,  and,  ss 
the  consequence,  there  is  imperfect  brain-rest  with  its 
disastrous  seqnelss.  Of  the  other  factors  which  deter- 
mine  an  attack  of  insanity  in  a  child,  we  shall  take 
account  in  the  next  lecture. 


POST-GRADUATE 

CLINICAL  DEMONSTRATIONS. 

By  JONATHAN  HUTCHINSON,  LL.D.,  F.R.S., 
F.R.C.S., 

Ooninlttng  Suseon  to  the  London  HospiUl,  viA  Ut«  Preiident  of  the 
Roval  College  of  Soi^eoDs,  Bngland. 

[Specially  Eeparted  for  the  MEDICAL  PRESS 
AND  CIRCULAR.] 

AMONa  the  cases  recently  illustrated  by  Mr.  Hutchin- 
son at  his  Clinical  Museum  was  an  interesting  one  of 
Dbstbuction  op  the  Soft  Palatb,  of  doubtful 
OBiom,  IN  A  BOT. 

The  boy  who  was  in  fair  health,  was  8  years  of  age, 
and  had  lost  the  greater  part  of  his  soft  palate.  T%e 
point  of  chipf  interest  in  the  case  was  whether  or  not  he 
was  the  subject  of  any  taint  of  inherited  syphilis.  The 
history  showed  that  the  disease  had  been  two  years  in 
progress,  it  was,  therefore,  slow,  and  nothing  of  a 
phagedsenic  nature  had  ever  been  present  Thus  its 
persistence  was  against  the  diagnosis  of  lupus,  for,  had 
the  disease  been  lupus,  the  duration  of  the  case  would 
not  have  been  so  long.  Two  years  ago  the  patient 
suffered  from  synovitis  of  both  knees— that  is  hydrops 
articuli.  The  effusion  lasted  for  six  months,  was 
unaccompanied  by  pain  and  was  followed  by  complete 
recovery  of  the  joints.  The  joints  were  now  quite 
healthy.  It  was  of  interest  to  note  that  in  cases  of 
inherited  syphilis  effusion  into  the  knee-joints  was  of 
common  occurrence.  It  usually  occurred  about  the 
same  time  as  the  interstitial  keratitis.  But  the  patient's 
eyes  were  quite  healthy,  and  he  had  no  interstitial 
keratitis  nor  choroiditis.  His  teeth,  moreover,  were 
large  and  good,  and  neither  mercurial  nor  syphilitic. 
That,  however,  would  he  likely  to  he  the  case  provided 
that  he  had  been  h^lthy  as  an  infant.   As  a  matter  ot 


^6     Thb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  22,  18M. 


fact  his  mother  stated  that  he  had  been  quite  well 
durioff  infancy,  and  had  not  required  any  medicine. 
Mr.  Hutchinson  differentiated  between  the  effusion 
into  joints  the  result  of  inherited  syphilis  and  that 
due  to  a  rheumatic  cause.  In  the  former  there  was 
no  pain  and  perfect  recovery  followed  without  any 
relapses,  while  in  the  latter  pain  was  always  present, 
and  secondary  changes  occurred  in  the  joints.  The 
boy's  face  was  not  suspicious  of  syphilis  ;  and  although 
the  head  was  '*  a  little  lumpy,"  there  was  nothing  which 
anyone  could,  in  this  respect,  be  certain  about.  Some 
enlarged  glands  were  present  under  the  jaw.  Mr. 
Hutchinson,  upon  the  whole,  regarded  the  diagnosis 
as  an  open  one.  His  suspicion,  however,  was  in 
favour  of  syphilis.  The  boy  had  been  better  since 
taking  iodide  of  potassium.  But  if  interstitial  kerati- 
tis were  to  develop,  the  diagnosis,  of  course,  would  be 
set  at  rest 

The  next  case  was  that  of  a  woman  suffering  from  a 
Relapsing  Sore  Tongue. 

There  were  large  abraded  patches  upon  the  surface 
of  the  organ  and  these  resembled  a  severe  attack  of 
herpes.  Herpes  of  the  tongue  occurred  chiefly  along 
the  margin  and  tip ;  herpes  of  the  tip  was  exceiedingly 
common.  Sometimes  these  attacks  supervened  with 
such  frequency  that  the  patients  were  scarcely  ever 
free  from  them.  The  history  of  the  present  case 
was  that  the  disease  had  persisted  off  and  on 
for  twenty  years.  At  intervcus  the  tongue  would 
be  quite  sound,  but  after  some  months  a  relapse 
would  occur.  The  present  attack,  which  had  lasted 
for  four  months,  was  the  most  severe  which  the  patient 
could  remember.  On  examination  of  her  teeth,  one 
tooth  was  seen  in  which  an  amalgam  stopping  had 
been  used.  Mr.  Hutchinson  here  remarked  that  he 
entertained  great  prejudice  against  amalgam  stoppings 
in  teeth,  especially  m  mouths  which  were  sore.  In 
such  cases  he  always  insisted  upon  the  amalgam  being 
removed  and  gold  inserted  in  its  place.  Dentists,  he 
stated,  would  not  believe  that  any  harm  arose  from 
amalgam  stoppings.  But  he  was  satisfied  that  in  cer- 
tain conditions  some  chemical  solution  of  the  amalgam 
took  place.  Most  often  the  tongue  became  sore 
opposite  the  tooth  in  which  the  amalgam  was  present. 
Moreover,  he  had  often  found  that  patients  could  tell 
by  means  of  a  slight  metallic  taste  in  their  mouths 
which  tooth  it  was  in  which  the  amalgam  had  been 
placed.  Again,  he  had  often  seen  cases  of  sore  mouth 
where  all  the  symptoms  had  been  relieved  h^  replacing 
the  amalgam  with  gold  stopping.  The  pellicular  con- 
dition of  the  patient's  moutn  was  most  interesting.  In 
some  respects  the  leucophakia  somewhat  resembled 
that  seen  in  smoker's  tongue,  but  more  inflammation 
was  present  than  was  usually  observed  in  the  latter 
condition.  It  was  worthy  of  note  that  the  filiform 
papillae  had  disappeared  over  a  large  area,  The  patient, 
on  being  asked  if  any  particular  articles  of  diet  caused 
irritation  to  her  tongue,  replied  that  anything 
*'  sharp  **  did  so,  and  in  this  connection  she  instanced 
vinegar.  She  also  avoided  walnuts.  Mr.  Hutchin- 
son was  interested  to  find  that  she  had 
herself  discovered  the  irritating  effect  of  walnuts.  He 
pointed  out  that  walnuts  were  especially  harmful  in 
these  cases.  The  old  dry  walnuts  were  possibly  not 
much  to  be  blamed  in  this  connection,  but  the  juice 
of  the  rind  of  the  young  moist  walnuts  was  especially 
irritating.  He  had  seen  many  cases  of  sore  mouths 
arising  from  this  cause.  Again,  such  patients  should 
avoid  all  effervescing  waters,  and  sugar  in  combina- 
tion with  vegetable  acids  was  very  harmful.  The 
remedy  for  these  cases  was  arsenic. 

His  next  case  was  a  very  interesting  one  of 

Double  Incomplete  Paralysis  of  the  Third 
Nerve. 

The  patient  was  a  lad,  »t.  10.    Mr.  Hutchinson 


pointed  out  the  sleepy  aspect  which  the  drooping  of 
the  lids  caused.  The  boy  instinctively  thrust  nis  chin 
forwards  and  wrinkled  his  brow  in  order  to  try  and 
overcome  the  effects  of  the  ptosis.  Besides  the  double 
incomplete  ptosis  there  was  double  divergence;,  more 
marked  on  the  left  than  on  the  right  side,  owing  to 
weakness  of  both  internal  recti  muscles.  It  was  evi- 
dent that  certain  branches  of  the  third  nerve  were 
involved,  but  it  was  also  clear  that  some  of  the 
branches  were  unaffected,  inasmuch  as  the  pupils  were 
of  normal  size,  and  freely  active  to  accommodation  and 
light.  The  other  recti  muscles  were  normal.  The 
case,  Mr.  Hutchinson  observed,  was  a  very  carious 
and  interesting  one.  There  was  nothing  in  the  boy's 
history  to  throw  any  light  upon  its  etiology. 
No  evidence  could  be  produced  showing  an 
inherited  syphilitic  taint.  The  main  features  in  the 
onset  of  the  attack  were  that  about  three  weeks  before 
he  came  under  notice  he  was  suddenlv  seized  with 
severe  pains  in  his  head,  and  seven  days  later  the  para- 
lytic signs  appeared.  At  first  he  was  supposed  to  have 
had  diphtheria,  but  this  appeared  to  be  negatived  by 
the  fact  that  the  movements  of  the  palate  were  free, 
and  that  there  was  no  nasal  voice.  The  patient  could 
fix  with  either  eye,  but  he  usually  looked  with  the  right 
His  tongue  was  clean,  his  appetite  good.  He  could 
walk  quite  well.  His  head  was  occasionally  iiainfnl ; 
he  did  not  complain  of  sickness.  The  etiology  of  the 
case  was  very  obscure. 

Kaposi's  Disease. 

The  patient  was  a  little  girl,  set  8,  the  yonngest  of 
three  sisters  ;  she  was  Quite  well  until  two  years  of  a^e, 
and  then  the  signs  of  Kaposi'R  disease,  from  which  she 
was  now  suffering,  began.  Xeroderma  pigmentosa— 
which  was  another  name  for  this  disease— was  a  rare 
malady.  As  a  rule,  it  became  manifest  early  in  the  life 
of  the  patient  It  was  due  to  congenital  weakness  of 
the  tissues,  which  could  not  stand  more  than  a  certain 
amount  of  stimulation  by  sun-light  Cases  were 
sometimes  met  with  in  which  the  whole  body  was 
affected.  It  was  a  family  disease,  almost  always 
attacking  three  or  four  members  of  the  same  family. 
Its  first  stage  was  one  of  extensive  freckling,  affecting 
the  face  and  hands.  Next  followed  a  stage  of  nlcera- 
tion,  and  bossy  masses  of  granulation  grew  out ;  and, 
finally,  there  was  a  strong  tendency  to  develop  fangat- 
ing  masses,  which  were  of  the  character  of  epithelial 
cancer.  In  most  of  these  features  it  had  close  parallels 
to  certain  cases  of  lupus.  A  point  of  some  interest  in 
the  present  case  was  that  the  patient  was  the  offspring 
of  a  consanguineous  marriage.  In  that  respect  there 
was  some  parallelism  between  it  and  cases  of  retinitis 
pigmentosa,  m  which  a  history  of  consanguineous  mar- 
riage was  not  infrequently  to  be  obtained.  Bat  Mr. 
Hutchinson  stated  that  he  had  never  seen  Kaposi's 
disease  associated  with  retinitis  pigmentosa,  and  it 
was  probable  that  the  cases  were  quite  distinct.  In 
cases  of  retinitis  pigmentosa  the  retina  began  to  take 
on  pigmentation  from  exposure  to  light,  in  other 
words,  the  retina  became  freckled,  mainly  at  first  at 
the  periphery,  the  pigmentation,  however,  extended, 
and  gradually  approached  the  yellow  spot  region,  and 
at  a^ut  early  middle  life  much  loss  of  vision  was  the 
result  So  far  as  treatment  was  concerned  in  Kaposi's 
disease,  a  great  deal  could  be  done  by  protecting  the 
skin  with  some  ointment,  and  by  keeping  the  patient 
out  of  the  sun.  It  was  worthy  of  note  that  the  disease 
was  the  same  in  all  climates. 


The  West  London  Hospital  has  been  recognised  as 
a  place  of  study  during  the  fifth  year  ^f  the  corrica- 
lum  by  the  Council  of  the  Boyal  College  of  Surgeons, 
England. 


Oab.  22,  1896. 


ORIGINAL  COMMUNICATIONS. 


The  Mkpical  Pre-s.     77 


ON 

CHILDREN'S    SPINES: 
HEALTHY,    UNHEALTHY -AND 

OTHERWISE 
By  EDMUND  OWEN,  M.B.Lond.,  F.RCS., 

to  Si.  IfMT'i  Hotpital.  Heolor  Surgeon  to  the  Hoepital  lor 
ttick  ChUdreo,  Ac 

The  author  (a)direeted  attention  to  the  great  range  of 
movement  poeaeseed  by  the  spine  of  the  healthy  child, 
demooBtratiiig  its  extent  by  diagrams  and  photographs. 
which    he    had  jwepared  from  various  pictures  and 
stataas  in  gallenes  of  ancient  and  modern  art.    He 
then  showed  photographs  of  children  who  had  been 
under  his  care  for  tuberculous  inflammation  of  the  ver- 
tebre,  caUing  attention  to  the  fact  that  in  every  such 
case  the  first  symptom  of  the  disease  was  stiffoess. 
After  duly  discussmg  the  need  of  having  the  child 
stripped  naked  before  attempting  to  examine  the  back, 
he  urged  that  the  medical  attendant  should  be  con- 
stantly on  the  look-out  for  the  occurrence  of  suppura- 
tion, as  abscess  often  approached  the  surface  of  the 
chest,  the  loin,  or  the  irrom,  without  giving  any  warn- 
ing ot  its  formation.    Such  abscesses  were  best  treated 
by  incision,  erasion,  and  immediate  suturing.    It  was 
a  mistake  to  use  a  drainage-tube  unless  Uie  subse- 
quent oonrse  of  events  crowed  that  its  presence  could 
DOt  be    dispensed  with.    As  regards   the  value  of 
laminectomy  in  those  cases  in  which  paraplegia  fol- 
lowed collapse  of  the  vertebrae,  Mr.  Owen  said  that  it 
had  at  first   been   sadly  over-estimated.     He  gave 
clinical  records  of  paraplegic  cases  in  which  he  had 
refrained  from  interfering,  and  had  been  rewarded  by 
slow  but  steady  return  of  the  power  of  locomotion.  In 
one  of  these  cases  there  had  been  motor  parsdysis  in 
the  upper  extremities  as  well  as  the  lower,  and  paralysis 
slso  of  the  intercostal  and  abdominal  muscles.    He 
compared   the  operation   of  laminectomy   with  the 
heroine  of  the  modem  society-drama,  in  that  it  had  a 
discredited  past  and  a  hopeless  future.    He  had  a  good 
deal  to  say  about  a  class  of  children  whose  spines  he 
dedined  to  regard  as  **  diseased,"  though  other  prac- 
titiooers  refused  to  consider  them  healthy;  so,  with  the 
^w  of  avoiding  unpleasantness,  he  placed  them  in  a 
Bpectal  class,  calling  them  '*  otherwise."    He  insisted 
that  too  much  fuss  was  being  made  about  a  slight 
lateral  deviation  of  the   spine  of   a  growing   child. 
People,  it  seemed,  were  inclined  to  look  at  a  child's 
npine,  to  speak,  and  to  write  of  it,  and  also  to  treat  it 
u  if  it  were  something  apart  from  the  child  itself.  And 
he  delicately  hinted  that  such  impressions  were  apt  to 
engender  a  species  of  irregular  practice.  He  instanced  a 
cs^in  which  a  practitioner  had  advised  a  lady  to  place  a 
ynioger  child— whose  back  the  said  practitioner  admit- 
ted wa^  (luite  healthy— under  his  prolonsed  and  close 
moervision,  lest  this  healthy  child  should  ultimately 
a^uire  a  deflected  spine  like  that  of  its  elder  brother  ! 
He  thought  that  such  *'  prophylactic  "  treatment  of 
healthy  spines  was  an  unworthy  occupation  for  a  sur- 
pvm,  and,  quoting  George  Eliot,  he  remarked  that 
mdidne   should  be  honoured  as  a  profession  but 
despised  as  a  trade.    He  thought  that  if  medical 
I      mea  occupied  themselves  too  exclusively  with   the 
treatment  of  slight  deflections  of  a  limp  spine  their 
mrgical  visi'^n  was  apt  to  become  distorted,  and  that 
tbey  were  likely  to  lose  the  necessary  sense  of  perspec- 
tifs  and  proportion.    He  reported  another  case  of  a 
w^k-spined  child  whose  mother  had  been  terribly 
aJsrmed  by  tdiat  had  been  told  her  by  a  gentleman 
whom  she  had  consulted  in    reference  to  it.    This 
gentleman  had  told  the  mother  that  her  child  must  at 

(  )  AbttriMf*  nf  ovpffT  read  before  tde  HanreUn  4oc<«ty  of  Lo-doD, 
hn.  »U^  1896;  Pmldent,  Str  John  WlllUuni,  fiut.,  M.O.,  in  the 


once  come  into  lodgings  near  him  for  exerciBes  and 
treatment  or  he  would  not  be  responsible  for  the  con- 
sequences. Mr.  Owen  had  not  been  able  to  find  much 
wrong  with  the  spine  ;  but  the  mother  had  apparently 
been  made  to  think  that  unless  the  child  were  at  once 
taken  in  hand  she  would  grow  up  into  a  woman  some- 
what like  that  described  by  Barns  :  — 

**  She's  twisted  ri^ht,  she's  twisted  left. 

To  balance  fair  m  ilka  quarter : 
She  has  a  hump  upon  her  nreast, 

The  twin  o'  that  upon  her  shouther — 
Sic  a  wife  as  Willie  bad, 
I  wadna  gie  a  button  for  her." 


AT    THE    ANNUAL    MBETINO     OP 

THE  BRITISH  GYNAECOLOGICAL   SOCIETY. 
By  CLEMENT  GODSON.  M.D., 

Oonsnltin^  Physician  to  the  City  of  London  Lying-in  Hoepital 
and  late  Assist-Physician  Accoucheur  to  St.  Bartholomew's  Hoepital, 
Physician  to  the  Samaritan  Hospital  for  Women. 

Afteb  thanking  the  Society  for  the  honour  bestowed 
on  him  by  his  re-election  as  President,  he  referred  to 
the  fact  that  during  the  past  year  no  less  than  ninety- 
three  new  ordinary  Fellows  had  been  added,  which 
was  the  greatest  number  elected  in  any  one  year  since 
the  society  was  founded.  They  had  also  elected  two 
Honorary  Fellows — Professor  Leopold,  of  Dresden, 
and  Dr.  Lombe  Atthill,  of  Dublin. 

He  then  referred  to  the  losses  by  death  the  Society 
and  the  profession  at  large  had  sustained  during  the 
year.    By  the  death  of  Dr.  Thomas  Keith,  on  October 
9th,  he  was  reminded  of  the  great  influence  for  good 
which  he  brought  to  bear  upon  the  development  and 
perfection  of  abdominal  surgery.    His  name  must  for 
ever  live  as  one  of  th^  greatest  of  British  ovariotomists. 
He  next  alluded  to  Kobert  Battey,  of  Rome,  Georgia, 
U.S.A.,  who  died  at  his  home  on  November  8th  last. 
Battey  was  a  country  practitioner,  who   after  much 
thought  and  consideration,  performed  oophorectomy 
in  a  case  of  pronounced  neurosis.    He  fully  explained 
his  methods  and  reasons :  and,  while  it  is  admitted 
that  nowadays  such  operations  can  only  very  rarely  be 
justified,  there  can  be  little  doubt  but  that  Robert 
Battey  aeserves  to  rank  as  a  pioneer  in  modern  gynae- 
cology. Another  Fellow  of  the  Society  who  had  pnssf  d 
away  was  Henry  Widenham  Maunsell,   MA.,  M.D., 
(T.C.D.)     They  would  miss  him  in  their  debates  ;  his 
strength  of  argumentative  power  was  evidenced  in  his 
remarks  on  "  The  Extra-peritoneal  Method  of  Dealing 
with  Uterine  Myomata''  at  the  meeting  on  Feb.  25tb, 
1892,  which  he  concluded  in  these  worda    .    .    .    '*  It  is 
my  opinion  that  extra-peritoneal  myomectomy  should 
be  at  once,  and  for  ever,  abandoned,  as  it  is  a  disgrace 
to  the  surgery  of  the  latter  end  of  the  nineteenth  cen- 
turv  ;  and  all  forms  of  uterine  clamps,  pedicle  skewers. 
and  wire  ecraseurs  should  be  forwarded  without  delay 
to  a  museum  for  antiouated  and  barbarous  surgical 
instruments."     Maunsell  was  an   apt  and  ingenious 
surgeon    who   instituted    various  ^  novel  procedures, 
especially   in   connection    with    intestinal     surgery. 
Mr.    Hugh    Thomas,  of  Birmingham,    M.R.C.S.En^. 
and  L.S.A.,  who  was  a  life  Fellow  of  our  Society,  died 
at  his  residence,  Grange  Road,  Coventry  Park,  on  May 
23rd  last.  He  was  a  past  President  of  the  Queen's  Col- 
lege Medical  Society,  the  author  of  ''  Uterine  Hydatids'' 
Q883),    besideR  many    contributions  to  the    medical 
journals.  Dr.  Robert  Alexander  Jamieson,  of  Shanghai, 
was  bom  in  Cork  in  1842,  and  died  at  Shanghai  in  1895. 
In    1869  he    was  appointed    Medical  Officer  to    the 
Imperial  Chinese  Maritime  Customs,  anH  edited  the 
Castoms  Medical  Reports.    Dr.  Patrick  Mani?on  tells 
me  that  through  this  medium  together  with  many 

D 


78      ThB  MlDIOAL  PB18& 


ORIGINAL  C0MMUOTCATI0N8. 


Jav.  22^  1866. 


excellent  papers  on  diseaae  in  China  he  contributed 
▼ery  largely  to  oar  knowledge  of  diseases  of  the  East. 

The  President  then  ])roceeded  to  review  the  work 
done  by  the  Society  dnring  the  past  year. 

At  the  March  meeting,  Dr.  Macnanghton-Jones  con- 
tributed a  paper  on  ^^The  Dangers  of  Morphia  in 
QyDiecologi(»l  Practice,"  showing  forcibly  the  disas- 
trous effects  produced  by  the  abuse  of  one  of  the  most 
useful  of  druffs.    The  paper  displayed  great  labour  and 
research  in  the  literature  of  Uie  subject,  and  was  con- 
sidered so  important  Uiat  the  discussion  upon  it  was 
adjourned  to  the  next  meeting,  when  several  visitors, 
distinguished  specialists  in  mental  diseases,  took  part 
in  it.    At  the  May  meeting,  a  most  important  paper 
was  read  by  Dr.  Michie,  of  Nottingham,  on  "Preg- 
nancy complicated  by  Suppuration  within  the  Pelvis." 
He  rekted  six  cases  which  had  come  under  his  obser- 
vation.   He  divided  them  into  Uiree  groufis,  the  first 
perforation  of  the  vermiform  appendix  giving  rise  to 
abscess  extending  into  the  pelvis,  ol  which  he  had  only 
one  example,  operated  upon  by  him  at  the  end  of  the 
fourth  month  of  pre^ancy  ;  the  second  group,  where 
suppurative  peritonitis  had  been  set  up  shortlv  before 
or  during  delivery,  and  having  its  origin  probably  in 
pre-existing  disease  of  the  uterus  or  its  appendages,  of 
which  he  gave  two  examples,  both  of  pyosalpinx  which 
gave  rise  to  puerperal  peritonitis,  in  both  of  which 
he  opened  the  abdomen  and  found  in  the  peritoneal 
cavity  a  quantity  of  thin  offensive  pus  which  was  proved 
to  have  escaped  from  the  Fallopian  tubes.     Of  the 
third  ffroup—suppuration  of  the  appendages  operated 
upon  during  pregnancy,  i.e.,  before  delivery— he  gave 
threecases.   In  my  remarks  during  the  discussion  on  this 
paper  I  mentioned  a  case  identic^  in  the  symptoms  to 
those  of  the  second  group  :— A  lady,  well-known  in  the 
fashionable  circles  of  London,  who  when  she  asked  me 
to  attend  her  in  her  first  confinement,  told  me  she  had 
been  laid  up  in  Italy  soon  after  her  marriage  with 
some  inflammation  about  the  womb,  and  had  suffered 
pain  in  the  lower  abdomen  more  or  less  ever  since.  She 
was  confined  in  December,  1890,  and  I  saw  her  on 
account  of  this  pain  frequently  before  she  was  taken 
in  labour.    She  had  a  natural  laboar,  conducted  by 
myself  on  the  most  strict  antiseptic  principles,  as 
explained  by  me  in  a  lecture  on  Antiseptic  Midwifery, 
delivered  at  the   Midwives'    Institute   and   Trained 
Nurses'  Club  in  1887.    In  less  than  30  hours  after  her 
delivery  she  was  seized  with  acute  abdominal  pain  ; 
distension  of  the  abdomen,  with  great   tenderness, 
ensued,  with  rise  of  temperature  and  vomiting.    She 
was  seen  by  several  eminent  physicians  in  consultation 
with  me,  all  of  whom  agreed  that  she  was  suffering 
from  septic  peritonitis.    It  was  only  towards  the  end 
that  a  surgeon,  a  friend  of  the  family,  Mr.  Astley 
Bloxam,  was  asked  to  meet  us  to  consider  if  any  sur- 
gical operation    might   be   undertaken.    Abdominal 
incision  and  flushing  out  the  peritoneal  cavity  was  dis- 
cussed by  uf",  but  the  tympanites  was  so  great,  and  the 
patient  almost  moribund,  so  it  was  decided  not  to 
operate.    She  died  on  the  eighth  day  after  delivery.    I 
have  never  ceased  to  regret  that  Mr.  Bloxam  did  not 
see  her  at  the  commencement  of  the  illness,  when  I  feel 
convinced,  had  her  abdomen  been  opened,  a  similar 
condition  to  that  recorded  by  Dr.  Michie,  in  his  second 
group,  would  have  been  found,  and  the  patient  pos- 
sibly might  have  been  alive  dow.  Fashionable  London 
said  she  died  of  puerperal  fever,  and  the  husbands  of 
all  the  ladies  of  this  circle  that  I  was  about  to  attend 
politely   intimated    to    me    that   they   would    not 
like  me  to    do   so,  and   no   wonder.     There    were 
two     patients,    however,    not     cognisant     of     the 
occurrence,     and     these     I     had     no     hesitation 
in  attending,  and,  needless  to  Ray,  no  fever  was  com- 

municat*»d  to  them  :    they  did  perfectly  well,  and  I    ^^.^.j  .« „„v.  ^^»m^.     *«  nu./«.«  », 
have  had  no  case  of  puerperal  illness  io   my  practice    in  the  attractiveness  of  its  meetings.    Theirs  was,  ns 
since.    The  loss  of  this  patient  did  my  obstetric  prac- '  considered,  a  sociable  body,  with  no  petty  jealousies. 


tice  serious  injury  for  a  time.  I  have  hopes  that  Dr. 
Michie's  paper,  following  that  of  Dr.  Grigg,  read  at 
this  Society  in  ^'ovember,  1890,  recorded  in  Vol.  YL, 
No.  24,  of  the  British  OynaecdogicaZ  Journal,  may 
demonstrate  the  importance  of  early  surgical  inter- 
ference in  cases  of  puerperal  peritonitis,  and  that  they 
may  be  recognised  as  aistinct  from  puerperal  septie- 
emia  arising  from  absorption  of  septic  matter  from 
without,  the  symptoms  of  which  widely  differ. 

At  the  June  meeting  the  subject  of  curetting  tlis 
uterus  was  brought  forward  in  the  form  of  a  paper  for 
the  first  time  before  this  Society  by  Dr.  Fanoout 
Barnes,  under  the  title  of  ''  On  Some  Difficulties  is 
the  Use  of  the  Curette.''  He  concluded  by  submittiog 
five  questions  :  1.  What  are  the  symptoms  which 
point  to  the  clear  necessity  of  curetting  the  uteriul 
2.  Which  is  the  safest  and  most  natural  method  of 
dilating  the  cervix  f  3.  Should  the  curette  be  used  in 
cancer  of  the  uterus— more  especially  when  thegrowth 
is  at  the  fundus  7  4.  Is  it  advisable  to  resort  to  the 
use  of  the  curette  as  a  means  of  making  a  diagnoBiBl 
5.  Is  it  possible  to  establuh  a  satisfactor]^  system  of 
drainage  of  the  uterine  cavity  after  curetting  1   Sar- 

Sx>n-Qeneral  Harvey,  Professor  Japp  Sinclair,  Mr. 
reig  Smith,  and  Mr.  Christopher  Martin  took  part 
in  the  discussion,  which  was  adjourned  to  the  next 
meetinff. 

At  the  October  meeting  Mr.  Jessett  contributed  an 
instructive  paper — *'  Suggestions  for  Performing  Abdo- 
minal Hysterectomv  by  Total  Extirpation  of  the 
Uterus."  This,  with  the  notes  of  eight  cases  operated 
upon  by  him,  and  illustrated  by  excellent  sketches, 
showing  the  several  stages  in  the  operation,  will  be 
found  in  the  November  number  of  the  JoumaJ. 

At  the  November  meeting  a  valuable  paper  by  Dr. 
J.  Halliday  Croom  on  "  Glycosuria  Complicatin^r  an 
Ovarian  Tumour,  and  Ovanotomy,*'  was  read.  (Pob- 
lished  in  Ths  Medical  Peebs  and  Cibculab, 
December  4th,  1895.)  The  subject  is  one  of  import- 
ance to  general  practionersas  well  as  to  gynsecologists, 
and  will  well  repay  future  study. 

The  President  next  referred  to  the  man;^  instmctiYS 
specimens  that  had  been  exhibited  during  the  psst 
year,  all  of  which  have  been  recorded  in  these  colnmna 
He  concluded  this  portion  of  his  address  by  referring 
to  the  last  meeting  of  the  Society,  December  12th, 
when  Dr.  Smyly,  of  Dublin,  showed  some  very  in- 
tereuBting  specimens— one  a  pyosalpinx  removed  by 
vaginal  colotomy,  and  three  myomatous  uteri  removed 
per  vaginam  by  morcellement— the  results  in  all  being 
apparently  excellent.  A  discussion,  in  which  Dr. 
Bantock  took  a  warm  part,  as  to  the  relative  merits  of 
the  removal  of  such  by  abdominal  section,  or  per 
vaginam  ensued,  and  he  thought  it  would  be  well  if 
the  subject  were  brought  up  again  during  the  ensuing 
year  for  discussion. 

The  President  next  congratulated  Dr.  Leith  Napier 
and  thanked  him  on  behalf  of  the  Society  for  the  great 
improvements  he  had  wrought  in  their  journal  as  editor, 
and  which  had  become  a  permanent  record  of  the  good 
work  of  the  Society.  Since  the  last  annual  meeting 
an  American  edition  of  the  journal  had  been  estab- 
lished, which  primarily  involved  the  Society  in 
additional  expense,  but  there  would  now  be  a  substan- 
tial gain  to  the  funds  by  the  arrangement  which 
had  been  made  with  the  American  publishers. 

In  conclusion,  he  urged  upon  the  Fellows  the  great 
importance  of  regular  attendance.  Those  who  had 
not  time  to  write  papers,  nor  had  material  in  the  shape 
of  specimens  to  exhibit,  might  take  part  in  the  discus- 
Bions ;  or,  if  they  did  not  care  to  speak,  they  could  not 
fail  to  profit  by  being  present.  One  had  only  to  look 
thmuflrh  the  liRt  of  Ft^llows  to  rpa  what  a  strong 
Society  it  had  becomp.     It  8bould  be  nerond  to  none 


Jav.  22,  ItM 


TBANSACTIONS  OF  SOCIETIES. 


Ths  Mbdioal  Pbbss.     79 


They  did  not  prof esB  to  be  better  than  their  neifihbonrs, 
bat  they  endeftvonred,  by  upholding  all  that  is  noble, 
by  nippressing  eyerything  that  is  dishonourable,  and 
by  the  earnest  character  of  their  work,  to  maintain  a 
high  place  among  the  learoed  Societies. 

A  CASE  OF  PARA-UTERINE  AND  PARA  VAGINAL 

TUMOUR  EXTENDING  INTO  THE  LEFT 

BUTTOCK. 

By  Mr.  Fun.  Edge,  F.R  C.S., 

OyiMDool  ifdeal  Sargeon  to  the  Wolvwbamptoii  Boapltal  for  Women. 

Mbs.  C,  mt,  35,  married  11  years,  came  to  me  on  Jane 

18lh,  1894.     Some  three  or  four  years  previously  she  had 

seeo  Mr.  Lawaon  Tait.    She  began  to  menstruate  at  13, 

baa  been  regular  every  2S  days,   lasting  one  day,  and 

aoeompanied  by  sharp  pain  for  about  three  hours  on  left 

tide.    The   loss    was    always  scanty.     She  has  had  no 

childreo  n<Mr  abortions. 

Pftyticoi  Examination,  "Oeneral,— 'Patient  is  a  well- 
Douriahed  sound  woman,  with  no  perceptible  disease  of 
general  systems. 

Local, — ^Tbe  left  labia  and  the  tissues  overlying  the 
isehio-reotal  fossa  are  bulged  out  evenly  to  a  marked 
extent.  The  bulging  is  firm  and  not  nodulated,  and  can 
be  pushed  inwards  and  upwards.  There  are  no  signs  ol 
inflammation.  The  vulva  is  displaced  to  the  right,  and  is 
ooDvex  to  right  from  before  bacK,  The  finger  passes  into 
tngina  over  rounded  surface  bulging  left  vaginal  wall 
inwarda  and  forwards,  and  implicating  lateral  and  back 
part  more  than  anterior  part  of  vagina.  Vagina  is  narrow 
snd  mgce  marked  The  cervix  is  high  up,  is  elongated, 
slightly  pointed,  and  has  distinctly  rounded  sm^l  os. 
Tee  uterine  sound  is  deflected  to  right  side  ;  uterus 
normal  in  leng<b.  The  appendages  are  not  to  be  made 
out,  nor  the  upper  part  of  uterus,  since  parietes  are  tense 
and  fat.  The  para- vaginal  mass  feels  slightly  fluctuant  or 
yitddini;. 

Per  Rectum — ^The  large  fluctuant  tumour  is  well-defined 
and  lies  on  the  left  wall  of  the  pelvis,  running  as  high  as 
the  uterus  and  not  to  be  defined  above,  On  combined  rectal 
sod  vaginal  examination  the  tumour  feels  rather  fluctuant. 
The  diagnosis  was  made  of  a  fibro-cystic  tumour  of 
uncertain  oriein,  but  there  was  a  doubt  as  to  its  being 
due  to  pathological  growth  of  fcetal  remnants.  It  was 
decided  to  remove  as  much  as  possible  to  ease  the  sitting. 
OpercUion  in  JtUy,  1 894. — An  incision  four  inches  loni; 
on  the  inner  border  of  gluteal  fold  and  running  up  to  left 
labium  minus  was  made  and  carried  through  adventitious 
capsule  of  growth.  This  was  found  to  consist  of  rounded 
dark  masses  very  like  the  gizzard  of  a  fowl  in  section.  A 
good  quantity  of  the  growth  was  removed  and  in  posterior 
part  a  small  central  looser  reticular  space  was  seen.  A 
uterine  sound  passed  into  this  was  carried  without  any 
force  parallel  to  the  vagina  in  the  ascending  portion  of 
the  tumour  up  to  the  uterine  level.  (An  inciqion  was 
made  half  way  up  the  vaginal  wall  through  this  and  down 
TO  the  uterine  sound.  A  small  drainage  tube  was  left  in 
this  opening  and  the  external  incision  was  closed.) 

Patient  made  a  quick  recovery  and  was  much  relieved 
at  the  time,  especially  in  sitting  down. 

In  December  it  was  evident  that  the  growth  was  pro- 
gressing, one  cannot  say  recurring,  becautie  it  was  not  all 
removecl.  I  could  make  out  a  mass  on  the  left  of  the 
uterus  which  felt  firm  and  regular,  not  lender.  In  fact,  a 
broad  ligament  tumour.  Having  the  view  now  that  I  was 
dealing  with  a  growth  from  the  canal  of  Gaertner,  and  that 
the  upper  end  formed  a  digtinct  para- uterine  tumour  I 
determiued  to  treat  it  as  a  fibro- myoma  and  endeavour  to 
brinf?  about  its  retrogression  by  removal  of  the  tubes  and 
ovaries. 

Operation  in  December,  1894.— There  was  found  to  be  a 
floccuating  rounded  orange-nzed  tumour  on  the  left  of  the 
nterus,  and  the  appendages  on  this  8ide  were  rudimentary. 
The  ovary  was  small  and  so  loosely  attached  that  it  almoc^t 
came  away  while  I  was  I'gaturing  this  side  and  without 
any  force. 

She  made  an  uneven tiul.recoveiy,  and  was  much  re- 
lieved both  as  regards  the  short  acute   dyemenorrhocic 


pain  and  the  feeling  of  tension  in  the  pelvis.  The  lower 
end  of  the  growth,  however,  was  not  affiected  by  the 
removal  of  the  appendages  and  cessation  of  menstruation, 
so  on  October  8th,  1895, 1  performdd  a  third  operation. 

Under  ansBSthesia  one  could  feel  that  the  para- uterine 
tumour  was  imperceptible  to  bimanual  examination. 

A  long  antero-posterior  incision  over  the  first  incision, 
but  more  extensive,  was  made  up  to  the  middle  of  left 
vulvo-vaginal  border,  and  then  the  labia  and  vaginal 
walls  were  cut  through  up  to  the  left  vaginal  fornix. 
The  growth  was  dissected  out,  and  in  doing  this  the 
internal  pudic  vein  was  torn,  but  was  easily  controlled. 
The  ascending  portion  gradually  tapered  off  and  was  dis- 
tinctly softer  and  more  friable  than  the  lower  part.  It 
was  followed  up  into  the  broad  ligament  and  removed, 
no  mass  of  firm  tissue  being  felt  to  oe  lefc  behind. 

The  patient  has  done  well  and  can  now  sit  easily  and 
perform  her  marital  functions,  which  were  quite  inhibited. 

Microscopically,  the  growth  presented  no  special  char- 
acters beyond  thope  of  ordinary  fibrous  tissue. 

The  part  removed  in  the  first  operation  and  the  append- 
ages have  unfortunately  been  lost,  but  I  have -here  the 
growth  as  removed  finally,  and  the  tapering  off  of  the 
ascending  para-vaginal  limit  is  well  seen.  I  think  that  this 
case  presents  many  interesting  points — (1)  as  to  its  origin. 
(2)  as  to  treatment,  (3)  as  co  the  limitation  of  the  effect  of 
removal  of  the  appendages. 


ILranBartioriB   of  Sncitlitf.. 

BRITISH  GYNiECOLOGICAL  SOCIETY. 
Annual  Meetino  hkld  Januabt  Qth,  1898^ 

Glimb2)t  Godsok,  M.D.,  Prt'sident,  in  the  Chair. 

Ths  Trbasubeb  (Br.  Mansell-Moullin)  having  read 
his  annual  report,  which  was  of  a  highly  satisfactory 
character,  the  ballot  for  the  election  of  officers  for  the 
ensuing  year  was  announced.  The  list  will  be  found  in 
our  *'  News''  column. 

C/ordial  votes  of  thanks  were  accorded  to  the  Treasurer, 
the  Editor  of  the  Journal,  the  Librarian,  Secretaries,  and 
Auditors,  all  of  whom  were  unanimously  re-eleeted. 

THB  EXCLUSION  OF  H0M(E0PATHIC  PBACTITIONEBS. 

The  President  moved  the  adoption  of  the  following 
new  by-laws  recommended  by  the  Council: — 1.  That  it 
is  undesirable  that  any  member  of  the  medical  profession 
practising  homosopathy  should  be  proposed  as  a  fellow  of 
the  Society. 

Dr.  G.  H.  BuBFORD  hoped  this  was  intended  merely  as 
an  academic  expresf^ion  of  opinion,  and  not  a  matter  of 
society  policy.  When  the  society  was  founded,  invita- 
tions weie  sent  to  many  men  interested  in  gynaecology, 
inviting  them  to  join  ;  and  no  test  of  opinions  was  hinted 
at.  To  introduce  such  a  test  now  would  be,  he  thought, 
a  putting  back  of  the  hands  of  the  clock  ;  it  would  be  a 
reversal  of  the  wholf  policy  of  the  society.  He  would  like 
to  know  what  had  occurred  to  warrant  this  proposal. 

The  President  stated  that  the  proposal  had  roBulted 
from  a  letter  received  from  the  Editor  oV  The  Lancet, 
asking  how  many  homoeopaths  there  were  in  the  society, 
and  suggesting  that  it  was  undesirable  that  such  should 
be  admitted  fellows. 

Dr.  Cabfbae  moved  as  an  amendment  that  this  by- 
law be  not  adopted. 

The  amendment  having  been  secended.  Dr.  Hetwood 
Smith  said  he  did  not  champion  the  cause  of  homoeo- 
pathy, but  he  thought  it  would  be  a  mistake  for  a  gyna^^co 
1' jfical  society  to  adopt  tuch  a  by-law.  Surgical  princi- 
ples were  the  pa  me  whether  practised  by  allopaths  or 
homoeopaths.  If  it  were  a  pharmaceutical  or  clinio»l 
pociety,  where  medicinal  treatment  was  a  prominent  sub- 
ject of  discussion,  it  might  be  different. 

The  amendment  was  put  to  the  meetinj^  and  negatived, 
being  supported  by  only  4  votes.  The  anginal  motion  wad 
then  put  and  carried. 

ADVBBTISING  IN  THE  LAY  PRESS. 

2.  That  it  is  contrary  to  the  ethics  of  the  British  Gyn(e- 
rnlogical  Society  that  any  of  its  FpI lows  should  adverri-e 
their  publioHtioiii>,  or  orherwise  bfing  themeelveo  btfote 
the  notice  of  the  public  by  advert  iting  in  any  way  through 


80    Thx  Medical  PRsaa. 


TRANSACnOKS  OF  80C3IETIE8. 


Jah.  22,  1896. 


tbe  mediam  of  fhe  lay  pa  pen.  The  Coancil  would  look 
with  ditfavoar  also  on  anooanof^meDts  sent  round  to 
the  medical  profeeeion  generally.  This  was  carried  unani- 
moosly. 

The  Prssidxht,  after  being  re-elected  for  another  year 
f*f  office,  delivered  an  addrew,  a  abstract  of  which  will  be 
foand  in  another  oolnmn.    After  which 

Dr.  RouTH  moved  a  vote  of  thanks  to  the  President  for 
his  address,  and  oongratalated  him  on  his  re-election  ;  by 
his  direct  inflaence  a  larger  namber  of  Fellows  had  been 
eli^'^red  than  in  any  preceding  year 

Tbe  vote  was  seconded  by  Dr.  Magam,  and  carried  with 
acclamation. 

8PBGIMBN8. 

The  following  specimens  were  shown  by  Professor  Mato 
RoBSON,  F.R.C.8.,  of  Leeds  :— 

1.  Myoma  removed  hy  HytUreetomy,  A  Method  oftr^cti- 
ing  a  Divided  Ureter — The  patient  was  »t.  50.  The 
I  iimour  was  a  large  one,  weighing  after  removal  20  lbs. 
When  slitting  the  peritonenm  in  front  of  the  tnmoar  he 
found  that  tbe  left  ureter  passed  round  in  front,  and  that 
he  had  rnmoved  2  inches  of  it.  He  had  three  courses 
before  him :  to  remove  the  kidnev,  to  establish  a  fistula, 
or  to  produce  anastomotic  union  of  the  cut  ends.  Having 
formerly  considered  what  he  should  do  in  the  event  of  such 
an  accident,  he  lost  no  time,  but  made  a  small  vertical 
hlit  in  the  lower  piece,  so  as  to  open  it  funnel-wise,  and 
passed  the  end  of  the  upper  portion  into  it,  retaining  it  in 
position  with  a  few  fine  sutures.  This  procedure  caused 
DO  difficulty,  and  the  patient  made  an  uninterrupted 
recovery,  without  any  blood  in  the  urine,  or  any  other 
urinanr  symptoms. 

2.  Ectopic  Qettation  in  Left  Fallopian  Tftbe.—The  pri- 
mary rupture  occurred  at  the  sixth  week,  with  formation 
cif  hsematooele.  She  was  admitted  a  week  later,  the 
history  being  clearly  that  of  extra-uterine  gestation.  The 
left  broad  ligament  was  distended.  The  fluid  gradually 
absorbed,  ana  the  tube  could  Uien  be  felt  This  began  to 
get  larger,  and  so,  in  the  twelfth  week,  f»he  was  operated 
upon  and  the  gravid  tube  removed.  No  foetus  was  dis- 
covered, but  chorionic  villi  were  found  on  microscopic 
examination.     The  patient  had  made  a  good  recovery. 

3.  Sarcomatous  alteration  of  Myoma,  Uyeterectomy. 
Jutra-peritaneal  treatment  of  peditle  by  a  method  not  pre- 
viouely  described,— This  was  one  of  several  cases  in  which 
h»9  had  removed  large  solid  uterine  tumours  after  the 
menopause.  There  was  evidence  that  the  upper  part  of 
the  tumour  was  malignant,  and  he  believeoT  that  this 
occurrence  was  not  very  uncommon  at  that  time.  The 
patient  had  had  the  tumour  for  several  years ;  when  she 
wiM  51  years  old  it  started  increasing  rather  quickly. 
He  performed  hysterectomy,  by  a  method  he  had  used  in 
several  cases,  viz,  amputating  above  the  cervix,  and 
forming  anterior  and  posterior  flaps.  In  this  ca^e  there 
feemecTto  be  some  oozing  from  one  of  the  flaps  ;  he  there- 
fore brought  the  uterus  up  and  fastened  the  peritoneum 
round  it,  making  the  uterine  wound  actually  extra- peri- 
r '  neal ;  he  then  closed  the  fascia  and  skin  over  it  entirely. 
Rooovery  was  rapid. 

4.  Fibro-Cystic  tumour  removed  from  between  the  layers  of 
the  sigmoid  meso  colon. — The  patient  was  est.  43.  The 
t  iimour  had  been  growing  rapidly.  On  opening  the  abdo- 
men, the  uterus  and  ovaries  were  all  separate  from  the 
Tumour.  Passing  over  the  top  of  the  latter  was  a  coil 
ff  large  bowel  which  seemed  to  be  transverse  colon.  It 
Id  ikea  as  if  it  could  not  be  got  away  ;  however,  he  incised 
ihe  peritoneum  over  it,  and  it  then  shelled  out  fairly 
easily  from  between  what  turned  out  to  be  the  layers  of 
r  h  6  sigmoid  meso-colon.  He  feared  gangrene  of  the  bowel, 
but  no  accidents  occurred  and  the  patient  made  a  satis- 
Notory  recovery. 

5.  Myoma  Uteri  filling  Pelvis  in  %th  month  of  pregnancy, 
— Removal  per  vaginamioithout  interference  with  pregnancy. 
— When  seen,  at  the  8th  month  of  pregnancy,  tbe  patient 
fold  a  myoma  involving  the  lower  part  of  the  uterus,  and 
tilling  the  pelvis.  It  was  not  polypoid.  In  a  similar  ca»e 
he  had  done  a  Porro's  operation.  In  thi>4  case  be  slit 
through  the  capsule  of  tbe  tumour,  which  was  on  tbe 
posterior  lip  of  the  cervix,  and  e>belled  out.  one  after 
another,  a  number  of  small  fibro-myomata.  Tbe  patient 
did  not  miscarry,  but  went  on  to  tern  and  had  a  normal 
0Oiifi]iem«Dt, 


6.  Myoma  Uteri  removed  by  the  Vagina,— Owmg  to  pro- 
fuse hnmorrhage,  the  patient  was  very  blanched,  xhe 
cervix  was  expanded  and  the  oe  could  only  be  felt  as  a 
hht  high  in  the  vagina  behind  the  pnbes.  The  tumour 
filled  the  vagina  and  reached  to  the  umbilicna.  It  was 
enucleated  through  the  vagina,  after  incising  tbe  poeterior 
lip  of  the  cervix.    There  were  no  bad  symptoms,  and 

Ettient  made  a  good  recovery.    When  the  patient  left  for 
ome,  at  the  end  of  the  month,  no  remnant  of  tbe  tumour 
could  be  felt. 

Tbe  Pbbsidxnt  thanked  Professor  Mayo  Robeon  in  the 
name  of  the  Society  for  his  interesting  specimene,  and  con- 
gratulated him  on  his  brilliant  results.  He  thoaght  that 
his  treatment  of  the  ureter  would  be  of  the  greatest 
advantage  to  any  surgeon  who  should  meet  witb  a  similar 
accident. 

Mr.  BowRSMAV  Jbbsstt  thought  the  first  specimen  wis 
of  special  interest ;  the  method  adopted  for  repairing  the 
ureter  was  novel,  simple,  and  ingenious  ;  it  was  an  acci- 
dent that  might  happen  at  any  time,  and  if  it  occurred  to 
him  he  would  use  Professor  Mayo  Robson's  method.  As 
regards  the  second  case,  he  thought  that  total  removal  of 
the  uterus  was  better,  because  it  was  simpler,  and  drainage 
could  be  secured  more  efficaciously.  But  both  pan- 
hysterectomy and  Professor  Mayo  Robson's  plan  were 
better  than  the  use  of  the  serre^4umd,  and  he  was  one  of 
those  who  hoped  to  see  this  instrument  relented  to  tbe 
museums  of  antiquities.  He  agreed  with  Profeeeor  Mayo 
Robeon  that  fibroids  not  unoommonly  took  on  malignant 
characters  after  the  menopause. 

Dr.  HxTWooD  Smith  said  he  was  not  yet  satisfied  as  to 
whether  pan-hysterectomy  or  partial  hysterectomy  were 
the  better  treatment  for  nbroids.  It  would  form  a  good 
subject  for  discussion  during  the  coming  year.  At  present 
the  mortality  of  pan-hysterectomy  seemed  to  be  the 
greater. 

Dr.  LiiTH  Kapisb  congratulated  Professor  Mayo 
Robson  on  his  excellent  results.  The  first  ease  was  a  very 
teaching  one ;  he  was  not  prepared  to  say  whether  the 
means  adopted  for  the  ureter  were  unique,  but  it  was 
better  than  any  other  method  hitherto  recommended.  It 
was  questionable,  however,  if  it  would  be  available  if  the 
accident  were  not  discovered  at  the  time,  or  if  a  large 
piece  of  ureter  had  been  removed.  In  a  case  lately  re- 
ported by  Roth,  of  Beilin,  he  found  it  necessary  to  pass  a 
catheter  into  the  ureter,  but  if  this  had  to  be  done  every 
time  a  ureter  was  injured  it  would  greatly  add  to  the 
difficulties  of  abdominal  surgeons.  As  regards  the  increase 
in  the  growth  of  fibroids  after  the  menopause,  he  had, 
during  the  laMt  four  or  five. years,  seen  fourteen  cases 
where  this  had  happened.  Probably  some  of  these  cases 
which  became  sarcomatous  might  be  regarded  as  origina- 
tirg  as  soft  glandular  adenoid  tumours.  The  hard  fibroids 
generally  atrophied. 

Professor  Mato  Robson,  in  reply,  said  it  only  remained 
for  him  to  thank  the  Society  for  tbe  cordial  reception  they 
bad  given  to  his  contributions  He  bad  read  with  great 
interest  Mr.  Bowreman  Jessett's  paper  on  Pan- hysterec- 
tomy ;  he  believed  that  Mr.  Jessett's  procedure  broogbt 
the  operation  under  the  category  of  practical  surgery ;  he 
did  not,  however,  think  it  would  do  for  all  cases. 

Mr.  Fred.  Edob,  of  Wolverhmapton,  showed  a 
specimen  of 

PABA-UTSBINE  AND  PARA-VAOIVAL  TUMOOB  SXTBNDIKO 
INTO  THS  LBFT  BOTTOGK, 

the  note  of  which  will  be  found  under  the  heading  of 
"Clinical  Records." 


EDINBURGH  MEDICO  CHIRURGICAL  SOCIETY. 

MXBTINO  HELD  WXDNBSDAT,  JaBUABT   IGTH. 


The  President,  Dr.  Abotll  Robb&tson,  in  the  Chair. 

Db.  Caibd  showed  a  boy  in  whom  he  had  pet  formed 
supra-pubic  cystotomy  for  rupture  of  the  uretb>a  with  no 
excrava«ation  of  urine.  In  order  to  find  the  urethra  be 
bad  to  pass  an  instrument  from  above  and  cut  down 
upon  it. 

Specimens. 

Dr.  W.  Eldbb  showed -1.  A  brain  from  a  case  of 
aphasia  of  17  years'  duration.  The  patient,  a  female,  bad 
a  shock  of  paralysis  14  days  after  childbirth  with  rigbt- 


JAir.  22;  189e. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medioal  Press.     31 


oded  bemipleKia.  Oa  two  different  occadiooe  afcer wards 
she  was  treated  in  an  asylnm  for  mental  symptoms,  and 
abortly  before  death  she  had  what  appeared  to  have  been  a 
coogeetive  attack.  Daring  her  illness  she  was  able  to  speak, 
but  ooold  not  use  the  proper  words ;  her  hearine  for  sounds 
was  perfect,  for  words  very  defective  ;  she  conid  not  write 
Dor  add  apsnms,  although  she  seemed  to  be  able  to  check 
mistakes  in  bills.  The  brain  was  normal,  save  for  atrophy 
of  the  lefc  tempore  sphenoidal  lobe ;  the  snpra-marginal 
eyros  was  affected,  accoantinii:  for  the  visual  dttect. 
2.  Hypertrophied  bladder  wall  with  dilated  ureter  follow- 
ingstrictare of  the  urethra. 

I>r.  F.  BoTD  showed  an  aneurysm  of  the  aorta,  with  rnp- 
tore  into  the  lane.  There  were  no  previous  symptoms  in 
the  ease  before  the  rupture  took  place,  and  the  pleura  on 
one  side  was  found  adherent  aloo  without  any  previous 
history  of  disease. 

l>r-  D.  Orug  showed  a  "Cathoartine"  cast  of  lupus 
▼wrocQsosi. 

Dr.  NoKL  Patch  read  a  paper  on 

THE  ACTION  OF  THE  UVSR  ON  FATS. 

Dr.  P^ton  commenced  by  renewing  our  present  know- 
ledge from  previous  work  on  this  subject.     He  pointed 
out  that  it  was  generally  held  that  the  liver  caught  the 
Bogars  and  proteids  of  the  food,  while  the  fats  were  thrown 
directly  inte  the   venous  circulation   by  means  of  the 
hrmphatic   duct.    Nasse   thought    that   the   liver   was 
directly  connected  with  the  metabolism  of  fats,  but  used 
errooeooa  data  in  his  observations.     Langley,  from  a 
mieroeoopic  examination  of  the  livers  of  frogs,  thought 
that  the  fiver  must  have  to  do  with  fats.     With  regard  to 
methods,  the  old  way  of  estimating  the  amount  of  fat  in 
the  liver  by  means  of  extracting  with  ether  was  fallacious, 
as  the  amoant  of  fattv  acids  in  the  liver  was  very  great. 
Thefaitty  acids  must  be  separated  from  the  ether  extract 
In  the  liver  the  solid  fatty  acids,  palmitic  and  stearic, 
fnedominated.    The  change  in  the  percentage  of  fats  in 
the  liver  might  be  due  to  accumulation  of  fats  or  to 
increase  in  decomposition.     Remembering,  however,  that 
change  in  the  other  constituents  of  the  liver  might  alter 
the  percentage  of  the  fats,  he  had  investigated  the  effect 
I        of  starvation  on  the  fats  of  the  liver  in  cats,  kittens  and 
I        pigeons,    and   found    that   after    four   days   the   aver- 
^    of    fat   remained    practically    the   same.     Gould 
this   be    because   the   liver   acted  as   a  storehouse   of 
^       phospboros?     In    order     to     settle    the    question    of 
storage,  kittens  were  fed  on  cream.    The  melting  point  of 
I        cream  fat  is  lower  than  that  of  the  liver,  and  it  was 
found  that  the  fat  stored  in  the  liver  did  present  a  lower 
I        melting  point  sixty  to  seventy  hmrs  after  the  melting 
point  c3  the  stored  cream  fat  rose.    Fats  were,  therefore, 
scored  in  the  liver  in  some  animals.    In  the  salmon  it  was 
stored  in  the  muscles,  in  the  pig  in  the  adipose  tissue,  and 
I        in  the  cod,  sheep,  rabbit  and  cat  in  the  liver.    If  there 
I        was  a  relation  between  the  ingestion  of  carbohydrates  and 
I        the   formation  of  fats,   as  there   undoubtedly    was,  we 
I        dionld  get  an  increase  of  fats  in  the  liver  when  the  glyco- 
gSD  was  disappearing  from  it.     He  found  that  this  was 
the  case  in  raobits  fed  on  a  carbohydrate  diet  and  then 
starved.    It  had  been  suggested  that  the  body  fate  took 
the  place  of  those  in  the  liver  under  those  circumstances 
as  occurred  in  phloridzin  poisoning.     In  the  latter  case 
the  blood  became  milky,  but  did  not  do  so  in  starvation. 
Probably  glycogen  can,  therefore,  be  transformed  into  fats 
as  well  as  into  sugar  in  the  liver.    Pfluger's  researches 
showed  that  there  was  no  evidence  to  support  the  theory 
that  proteids  were  a  source  of  fats.    A  protetd  diet  in* 
ersased  the  metabolism  in  the  liver,  and  fats,  if  formed  in 
greater  quantity,  might  be  broken  down  faster.    Evidence 
of  this  might  be  found  in  the  results  of  feeding  with  pro- 
teids, and.  therefore,  it  might  possibly  be  true  that  fats 
were  formed  from  these  bodies. 

Dr.  G.  A.  Gibson  asked  why  in  phosphorus  poisoning 
the  liver  decreased  in  size  if  the  fats  were  kept  at  the 
normal  ?  and  suggested  that  Ebstein  and  his  school  were 
wrong,  if  Dr.  Paton  was  right,  in  treating  obesity  with 
fatty  food. 

Dr.  DuNiiOP  said  that  Dr.  Paton  had  proved  that 
lecithin  was  present  in  the  liver  in  much  greater  quantities 
than  former  observers,  and  statied  that  at  his  suggestion 
be  had  investigated  the  fats  in  the  liver  in  fatty  infiltra- 
tion  and  degeneration  of  that  organ.  He  could  find  no 
diSBranoe  b^aen  the  &t0  present  in  the  twa 


Dr.  LoGKHABT  Gillespie  atked  if  the  phosphates  in  the 
urine  during  starvation  had  been  estimated,  as,  if  there 
was  no  phosphorus  ingested  and  some  being  eliminated,  he 
failed  to  see  how  the  phosphorus  in  the  liver  could  remain 
constant  without  grave  changes  throughout  the  body.  He 
also  asked  if  Dr.  Paton  believed  with  Pavy  that  fats  were 
formed  in  the  cells  of  the  wall  of  the  intestine,  and  if  so 
what  effect  that  would  have  on  his  theory  ci  the  liver 
storage  of  fat. 

Drs.  GuLLAND  and  Stockman  also  spoke. 

Dr.  Paton,  in  reply,  thought  that  in  phosphorus  poison- 
ing the  liver  substance  became  disintegrated  from  the 
action  of  the  poison.  He  did  not  believe  that  fat  was 
formed  in  the  intestinal  cells,  that  in  starvation  phosphates 
were  excreted  in  the  urine  in  verv  small  amount,  and  that 
the  storage  of  them  in  the  liver  did  not  undergo  a  relative 
decrease. 

Dr.  Leith  read  a  paper  entitled,  "  An  Inquiry  into  the 
Physiology  of  the  Action  of  the  Thermal  Saline  Baths  and 
Resistance  Exercisee  in  Chronic  Heart  Disease  (the  Bad 
Nauheim  and  Scbott  System)."  The  principal  point  he 
brought  out  was  that  the  marvellous  reports  of  decrease  in 
the  cardiac  dulness  were  not  to  be  implicitly  trusted. 

Drs.  Gibson  and  Balfoue  discussed  the  paper. 


THE  HUNTERIAN  SOdETY. 

Msetino  held  Wednesday,  Januabt,  ^th  (at  the 

London  Institution). 


The  President,  Mr.  CThablbs  J.  Sthonds,  F.R.C.S.,  in 
the  Chair. 


After  the  election  of  an  unusuallv  large  number  of  new 
members.  Dr.  Jas.  H.  Sequbira  read  a  paper  entitled : — 

CHRONIO  pharyngeal   AFFECTIONS  AND  THEIR   RELATION 
TO    DIPHTHERIA 

Admitting  diphtheria  to  be  a  specific  bacillary  disease, 
he  wished  to  consider  the  entrance  of  the -bacillus  by  the 
air  passages :  he  referred  to  the  fact  established  by  Drs. 
Thompson  and  Hewlett  that  air  filtered  through  the  nares 
was  practically  germ  free,  and  hence  deduced  as  a  corollary 
that  anything  which  contributed  to  oral  breathing  must 
be  a  predisposing  factor  in  the  onset  of  diphtheria.  He 
then  drew  attention  to  the  depth  of  the  crypts  of  the 
tonsils  where  bacilli  could  rest  undisturbed,  and  to  the 
altered  vitality  of  the  tonsillar  mucous-membrane  in 
catarrh.  From  these  two  premises  he  then  proceeded  to 
draw  conclusions  and  summed  them  up  as  follows  : — 
1.  Tonsillar  [hypertrophy  and  post-nasal  adenoids  are 
found  chiefly  in  children  from  the  age  of  two  to  puberty, 
and  80  per  cent,  of  the  cases  of  diphtheria  are  found 
between  those  ages.  2.  These  pharyngeal  affections  are 
rare  after  90,  while  only  3  per  cent,  of  diphtheria  casoH 
occur  at  this  period  of  life.  3.  72-5  per  cent,  out  of  40 
cases  of  diphtheria  that  he  had  examined  presented 
evidence  of  tonsillar  hypertrophy.  4.  Diphtheria  is  a 
commoi  sequela  of  scarlet  fever,  which  severely  affects  the 
tonsils  and  often  leads  to  mouth  breathing. 

Dr.  Fred  J.  Smith  said  he  thought  that  adenoids  and 
enlarged  tonsils  with  catarrhal  conditions  did  not  account 
for  the  whole  increase  in  vulnerability  to  diphtheria, 
something  more  must  be  added  in  the  shape  of  general 
consti'utional  weakness  of  resistance  to  infection. 

Dr.  HiNObTON  Fox  laid  stress  upon  family  disposition  to 
the  incidence  of  specific  diseases,  and  said  he  knew  of  many 
cases  in  which  immunity  seemed  to  run  in  families. 

Dr.  A.  Davies  referred  to  his  experience  of  the 
frequency  of  diphtheria  as  a  sequel  of  scarlatina. 

Dr.  F.  Warner  quoted  a  case  of  simple  tonsillitis 
(occuring  in  the  nurse  of  a  diphtheria  patient)  in  which  no 
diphtheria  bacilli  were  found. 

Dr.  GooDALL  was  not  at  all  convinced  that  throat 
diseases  did  predispose  to  diphtheria.  He  referred  to  the 
difficulty  of  obtaining  reliable  histories  of  the  previous 
condition  of  the  throats  of  the  patients  in  the  fever 
hospitals,  and  he  suspected  that  it  might  prove  that 
diphtheria  was  the  cause  and  not  the  consequence  of 
chronic  throat  trouble.  He  recognised  diphtheria  as  a 
sequel  of  scarlet  fever,  but  said  it  oocurred  very  irregularly. 
,  now  attacking  very  few  and  then  a  large  proportion  of 
i  convaleeoent  scarlatina  patients. 


B2     Trs  Medical  Psbss. 


FRANCE. 


Jak.  22,  1896 


The  President  mentioned  two  cases  of  removal  of 
adenoids  which  had  unfortunately  saccumbed  to  diphtheria 
after  operation  for  removal  of  the  growths. 

Dr.  Sequpiba  briefly  replied. 

Dr.  FoRTESOUE  Fox  then  read  a  paper  entitled, 

LOCALISED  RHEUMATOID  ARTURITI«. 

Simple  local  arthritis,  he  considered,  was  distingQisbed 
from  all  other  forms  of  degenerative  joint  lesion,  specific, 
septic  or  nervoas.  Whilst  the  latter  are  parte  of  genera- 
lised disease,  simple  arthritis  was  a  local  disease,  excited 
by  injurv,  in  those  in  whom  from  hereditary  causes  or 
senility  the  joints  were  vulnerable.  Hence  it  affected  by 
preference  exposed  joints,  and  the  right  side  of  the  body. 
A  summary  was  given  of  thirty-nine  oases  of  local  arth- 
ritis met  with  at  Scrathpeffer  Spa,  and  affecting  the 
shoulder,  knee  or  hand.  In  the  hand  the  basal  jomt  of 
the  thumb  was  most  commonly  involved,  "  typical  senile 
local  arthritis'*  causing  a  cupping  of  the  palm.  *'  Last 
joint  arthritis*'  was  regarded  as  a  form  of  gout  in  women. 
**  Residual  arthritis,"  the  result  of  bygone  acute  rheuma- 
tism, &c.,  was  also  distinguished  from  proper  local  arth- 
ritis. The  latter  belongs  to  the  climacteric  and  the  senile 
periods.  The  treatment  consists  in  active  irritation  in  the 
early  stages,  rest,  and  later  some  form  of  thermal  treat- 
ment. Tne  methods  in  use  at  Strath peffer  were  described. 
The  prognosis  in  most  oases  is  not  unfavourable. 

» 

HARVEIAN  SOCIETY  OF  LONDON. 

The  Annual  Mbetiko   and  Gonyersazionb  held  on 

Thursday,  Jan.  16th. 


The  President,  Sib  John  Williams,  Bart.,  in  the  Chair. 

The  Annual  Reports  of  the  Council  and  Treasurer  were 
read  and  unanimously  received  by  the  Society. 
Presidential  Address. 
The  President  then  delivered  his  Annual  Address,  in  the 
course  of  which  he  dealt  with  the  changes  that  had 
occurred  in  the  various  Examining  Bodies  with  regard  to 
their  examinations  in  Midwifery,  snowing  how  some  thirty 
years  aeo  this  subject  received  but  scant  attention  at  their 
hands  He  pointed  out  how  important  it  was  that  those  who 
presented  themselves  for  examination  in  midwifery  should  be 
able  to  satisfy  the  examiners  as  to  their  knowledge  of  the 
shape  and  diameter  of  the  female  pelvis,  the  anatomy  of  the 
pelvic  organs  and  the  size  of  the  f(Btus  at  various  times 
during  gestation,  and  particularly  at  term.  He  said  that 
upon  these  data  rested  the  science  and  art  of  midwifery, 
and  they  were  the  first  essentials  of  that  science.  Sir 
John  Williams  went  on  to  describe  the  changes  which  had 
taken  place  during  the  last  forty  ^ears  in  various  opera- 
tions, and  showedhow  the  recognition  of  the  relative  sizes 
of  the  pelvis  and  of  the  foetus  had  influenced  the  manner 
in  which  these  operations  should  be  performed,  and  the 
period  at  which  they  should  be  undertaken.  He  con- 
cluded with  a  criticism  of  the  term  <*  Meddlesome 
Midwifery,"  and  showed  how  proper  interference  under- 
taken at  the  proper  time,  during  gestation  or  labour, 
might  be  juseifiable  and  even  imperative  so  long  as  its 
aims  were  the  saving  of  the  life  of  the  mother  and  child. 
The  officers  for  the  ensuing  year  were  then  balloted  for 
and  elected.  The  list  will  be  found  in  our  "News" 
column. 

Cordial  votes  of  thanks  were  accorded  to  the  President, 
Treasurer,  the  retiring  members  of  Council,  and  to  Mr. 
Peyton  Beale,  the  indefatigable  Honorary   Secretary. 

These  formalities  were  followed  by  a  conversazione, 
which,  we  understand,  was  a  success,  but,  as  the  usual 
courtesy  was  not  extended  to  the  medical  press,  we  are 
unable  personally  to  vouch  for. 


4fraiia. 


[from  our  OWK  00RBI8r0NDFi!?T.] 

PABiS,  Jan.  18, 1896. 
Artificial  Serum. 

At  the  meeting  of  the  Soci^t^  de  Chirnrgie,  M.   P. 

Michanz  gave  his  experience  on  the  treatment  of  post- 


operative peritoneal  septicsmia  by  intravenous  injections 
of  artificial  serum.  For  the  last  three  years  he  has  used 
these  injections  twenty-five  times  after  major  operations, 
and  more  or  less  frequently  for  shock  or  abundant  hemor- 
rhage, and  in  .these  later  cases  with  marvellous  results, 
regular  resurrections  were  operated  before  hiseyee.  Of 
the  twenty-five  cases  he  had  kept  a  detailed  account  of 
fifteen,  which  he  submitted  to  the  meeting.  In  all  the 
cases  the  septic  symptoms  were  very  grave  ;  distension  of 
the  abdomen,  pulse  quick  and  wiry,  temperature  low,  or 
scarcely  above  the  normal,  gripped  faoe,  eyes  sunken, 
nose  pinched,  &c.  Five  of  the  fifteen  oases  recovered,  and 
amongst  them  the  most  interesting  was  that  of  a  woman 
of  fifty,  on  whom  he  had  performed  six  weeks  ago 
vaginal  hysterectomy  for  an  enormous  fibroma.  The 
operation  lasted  an  hour  and  a  half.  The  evening 
of  the  second  day  the  general  condition  warn  not 
satisfactory,  and  the  following  morning,  in  spite 
of  the  antiseptic  dressing  unmistakable  signs  of  peritoneal 
septiciemia  had  set  in.  Seeing  that  there  was  no  time  to 
lose,  M.  Michanx  removed  the  instruments  from  the 
vagina,  applied  ice  to  the  abdomen  and  injected  into  tbe 
cephalic  vein  a  quart  of  artificial  serum.  The  temperature, 
which  had  been  under  the  normal,  rose  hourly  up  to  103* 
and  then  gradually  went  down,  so  that  on  tbe  foUowing 
day  it  stood  at  98^  or  thereabouts.  Injections  of  the 
serum  were  also  made  five  or  six  times  in  the  oellnlar  tissue. 
After  five  or  six  days  of  this  active  treatment  matters  took 
a  good  turn,  and  at  the  time  of  speaking,  the  patient  was 
out  of  danger.  In  another  woman,  nt.  33,  who  had  under- 
gone a  similar  operation  for  pyosalpinx,septic8Bmia  set  in  on 
the  third  day.  After  injecting  into  the  veins  of  the  arm 
over  a  quart  of  serum  the  speaker  re-opened  the  abdomen 
and  by  means  of  a  large  drain  in  the  vagina,  washed  out 
the  cavity  with  warm  salted  water.  Two  days  afterwards 
a  marked  improvement  took  place  ;  the  washings  of  salt 
water  were  continued  for  eight  days  and  the  patient 
recovered  completely. 

In  two  othor  cases  the  patients  were  literally  dragged 
from  the  jaws  of  death.  Where  death  does  ensue,  M. 
Michaux  remarked  that  the  injections  of  artificial  serum 
retarded  for  four  or  five  days  at  least  the  fatal  denouement. 
Nearly  all  the  injections  were  made  with  the  serum  of 
Hayem,  but  more  than  once  be  contented  himself  with  ' 
boiled  water,  and  from  two  to  three  drachms  of  sea  salt. 
The  liquid  is  filtered  through  hydrophile  cotton  and 
boiled  for  fifteen  minutes  in  a  bottle  and  then  hermetically 
sealed  until  ready  for  use.  The  operation,  as  practised 
by  M.  Michaux,  is  simple  enough.  After  cleaning,  anti- 
septically,  the  region,  he  incises  the  teguments  directly 
over  the  cephalic  or  basilic  vein,  which,  when  properly 
exposed,  be  opens  by  a  V-shaped  incision,  and  intro- 
duces the  canula  of  the  syringe,  taking  care  that  no  babble 
of  air  is  injected.  The  liquid,  heated  to  lOS^',  is  slowly 
injected.  The  effisct  on  the  patient  is  immediate ;  the 
respiration  becomes  deeper  and  more  expansive,  the 
pulse  becomes  full  and  diminishes  in  frequency,  and 
a  general  hien  etre  is  experienced.  Sometimes  a  certain 
amount  of  dyspnoea  is  observed  and  vomiting,  but  ouly 
after  large  doses.  The  quantity  of  urine  is  greatly  in- 
creased by  the  transfusion  when  repeated  for  a  few  days. 
Besides  the  intra-venous  injections,  M.  Michaux  said  be 
was  in  the  habit  of  injecting  into  the  subcutaneous  tisrae 
small  quantities  of  the  serum  with  good  effect,  and  even 
exclusively  in  the  least  grave  cases. 
Although  he  was  confident  that  intra-F«D0US  injeotioiii 


Jav.  22,  18M. 


OERMAKY. 


Thb  Medical  Pbbbs.     ^8 


of  artificial  aeriim  coitftitiited  a  precious  resource  in  the 
traatment  of  peritoneal  eepticemia,  he  was  far  from  being 
indifferent  to  the  important  aervioea  rendered  by  the  other 
meana  usually  employed  against  this  grave  oomplication, 
in  the  front  rank  of  which  should  be  plaoed  purgatives 
and  enemas^  applications  of  ice  to  the  abdomen,  and  a 
large  abdomino-vaginal  drainage. 

Gabdiac   Liyxb. 

Under  the  above  title  Prof.  Lupine,  of  Lyons,  has  just 
publiohed  an  article  on  the  treatment  of  hepatic  affections 
as  a  eequenoe  to  certain  forms  of  heart  disease.  It  is  well 
known,  says  the  writer,  that  t-he  liver  in  its  normal  condi- 
tion ia  a  very  soft  organ,  and  distends  like  a  sponge  under 
the  influence  of  the  sanguine  flux.  Consequently,  when 
for  any  reason  the  tension  increases  in  the  right  auriculum, 
the  liver  increases  rapidly  in  volume,  provided,  however, 
that  no  cirrhosis  exists  which,  by  the  development  of  the 
eonjunctival  tissue,  deprives  the  organ  of  its  softness  and 
elasticity. 

The  edge,  which  is  scarcely  visible  in  the  normal  state 
can  be  felt  far  below  the  false  ribs,  hard  and  resistiog. 
If,  on  the  other  hand,  the  tension  in  the  right  auriculum 
disappears,  almost  immediately  the  liver  disgorges  itself 
and  retnms  to  its  primitive  volume.  This  great  permeabi- 
lity and  softness  of  the  liver  explains  sufSciently  the 
fsciltty  with  which  can  be  observed  the  hepatic  pulsationa 
described  by  Prof.  Potain,  and  met  with  in  each  case  of 
insufficiency  of  the  tricuspid  valves.  It  follows  naturally 
that  the  treatment  of  cardiac  liver  should  consist  in  dimin- 
iibing  as  much  as  possible  the  tension  existing  in  the 
auriculum  and  the  inferior  vena  cava. 

I  had  recently,  relates  M.  Iiepine,  in  my  wards,  simul- 
taneously three  patients  suffering  from  insufficiency  of  the 
tricuspid  valves,  and  presenting,  each  of  them,  an  enor- 
mous liver,  the  lower  edge  reaching  as  far  down  as  the 
umbilicus.  In  one  of  them  the  affection  was  of  recent 
date.  Under  the  influence  of  digitaline  the  dilatation  of 
the  right  heart  diminished  considerably,  but  the  lower 
edge  of  the  liver  remained  in  the  same  position,  at  which 
I  was  much  surprised.  In  seeking  the  cause  of  this 
anomaly,  I  found  that  all  the  patients  ate  well,  and  espe- 
daUy  a  good  deal  of  meat.  I  put  them  immediately  on  a 
milk  diet,  and  soon  I  had  the  satisfaction  of  seeing 
the  liver  reeede  almost  completely  under  the  false  ribs. 
After  all,  the  fact  was  not  very  extraordinary,  as  digestion 
and  above  all  that  of  meat,  produces  a  notable  congestion 
of  the  liver,  as  may  be  proved  by  opening  the  abdomen  of 
a  dcg  after  a  heavy  meal ;  the  portal  vein  will  be  found  to 
be  enormously  distended  and  the  mesenteric  arteries  to 
beat  with  violence  and  the  liver  considerably  distended. 
The  natural  inference  to  be  drawn  from  this  physiological 
fact  is  the  necessity  of  excluding  meat  from  the  diet  of 
patients  suffering  from  tricuspid  disease. 


^tXtMXtJi* 

[VBOM  OVE  OWV  OOSBBSPOKDBIIT.] 

fiEBLur,  Jan.  I7th. 
The  Title  ot  Pboiessob. 
The  title  of  Professor,  until  a  few  years  ago,  was  never 
confemd  on  medical  men  having  no  teaching  connection 
with  a  university.  The  highest  rank  men  who  were  not 
teachflrs  could  then  attain  to  was  that  of  Geheimer  Sani- 
titsrathor  Privy  Sanitary  Councillor  or  in  the  case  of 
medlQaloiBaals,Geh«aMrMediiinalrath,  or  Privy  Medical 


Councillor.  The  first  occasion,  therefore,  on  which  the 
title  was  bestowed  naturally  gave  rise  to  a  good  deal  of 
talk  on  the  part  of  members  of  the  profession.  The 
dinicist  Dr.  Paul  Bhrlich  was  the  first  to  receive  the 
titular  distinction,  and  it  was  bestowed  on  him  in  conse- 
quence of  hia  studies  into  the  colour-analysis  of  blood.  He 
was  then  an  assistant  in  the  French  Klinik.  Since  that 
time  a  number  of  non-teaching  practitioners  have  been  the 
recipients  of  the  distinction.  Benvers,  then  assistant  in 
Leyden's  Klinik,  and  now  Director  of  the  Moabit  Hospital, 
was  among  the  earlier  ones  thus  distinguished.  Albert 
Kohler,  assistant  in  Bardeleben's  Klinik,  soon  followed, 
then  Emil  Behring,  the  so-called  founder  of  blood-serum 
therapeutics,  and  now  ordinary  in  Marburg.  Then  came 
Btaff-surgeon  B.  Pfuhl,  for  many  years  assistant  to 
Robert  Koch,  and  now  organiser  of  the  bacteriological 
laboratories  in  connection  with  the  army  sanitary  officials. 
Dr.  George  Comet,  known  for  his  investigation  into  the 
spread  and  prophylaxis  of  tuberculosis,  and  Dr.  Kitasato, 
of  Japan,  both  for  several  years  volunteers  in  the  Koch 
Institute,  then  followed.  These  were  followed  by  a 
number  of  others,  mostly  men  of  distinction  and  connected 
as  directors  with  public  institutions.  Amongst  them  may 
be  mentioned  Eagen  Hahn,  of  the  City  Hospital,  Fried- 
richshain  ;  Langenbuch,  of  the  Lazarus  Hospital ;  James 
Israel,  of  the  Jewish  Hospital  ;  Wagner,  of  Konigshiitte, 
and  a  number  of  distinguished  provincial  medical  men. 
Finally,  the  title  has  been  bestowed  on  Dr.  Baume,  a 
dentist  and  a  member  of  the  Dental  Examination  Board  of 
this  city.  The  conditions  of  the  bestowal  of  the  title  are 
now  so  far  changed  that  the  Cultus  Minister  grants  this 
or  that  of  Sanit&tsrath  as  seems  the  most  suitable  for  any 
given  case. 
At  the  Berlin  Medical  Society,  Hr.  Saul  read  a  note  on 

the 

Sterilisation  of  Catqut. 

After  numerous  experiments  he  came  to  the  conclusion 
that  this  was  best  effected  by  storing  it  in  a  solution 
containing  eighty -five  parts  of  alcohol,  five  parts  of  car- 
bolic add,  and  ten  of  water.  In  this  solution  the  spores 
of  anthrax  were  killed  in  ten  minutes.  He  showed  an 
apparatus  for  the  purpose  made  under  hia  direction  by  the 
firm  of  Oebriider  Lautenschlager. 

Herr  0.  Israel  then  showed  two  preparations  of 

DiriEBENT  Forms  of  Canoeb  fbom  one  Inditidual. 

The  patient,  a  man,  »t.  60,  was  admitted  into  hospital, 
suffering  from  cholelithiaeis.  The  gall  bladder  was 
sutured  and  fifteen  stones  removed  from  it.  The  patient 
was  also  suffering  from  mitral  stenosis,  and  died  soon  after 
from  his  cardiac  trouble.  The  autopsy  and  microscopical 
examination  showed  that  the  anterior  wall  of  the  gall 
bladder  was  the  seat  of  a  cylindrioal-celled  carcinoma, 
and  that  a  cancroid  sprang  from  the  head  of  the  pan- 
creas and  projected  into  the  duodenum.  He  said  that 
the  form  of  growth  in  the  pancreas  was  a  great  rarity, 
but  the  presence  of  two  cancerous  growths  of  different 
kinds  in  one  individual  was  a  very  great  rarity.  He  saw 
such  a  case,  however,  in  1883,  in  a  man,  set  69,  who  had 
cancroid  of  the  tongue  and  cylinder-celled  carcinoma  of 
the  jejunum. 

At  the  Hufeland  Society  Hr.  Llebreich  showed  a 
patient  in  illustration  of  the 

Stimulatino  AonoN  of  Canthahidine. 

The  man,  who  had  suffered  from  ayphilia,  was  not  im- 
proved in  any  way  by  a  course  of  mercurial  treatment.  It 
was  only  after  taking  cantharidine  that  the  mercury  had 


84     The  Medical  Press. 


AUSTRIA. 


Jan.  ^  1996. 


any  effecD.  Tne  eympDoms  of  nyphilia  had  then  mostly 
disappeared.  In  a  similar  cape  the  speaker  had  also  tried 
cantharidine  with  a  good  result. 

Hr.  Saalfeld  said  that  he  had  also  treated  a  number  of 
cases  with  mercury  and  cantharides  simultaneously,  some 
of  them  being  indinduals  with  distinct  evidences  of  tuber- 
culosis. In  these  cases  it  was  known  that  one  had  to  be 
very  cautious  with  mercury.  Some  were  cases  that  had 
not  improved  either  under  mercury  alone  or  under 
mercury  and  potass  iodide  combined.  In  the  case  of  the 
phthisical  patients,  mercury  could  be  given  in  the  usual 
quantities  when  the  cantharidine  was  given  at  the  same 
time.  In  the  second  group  of  oases  with  torpid  ulcers  and 
no  tendency  to  heal,  improvement  set  in  with  increased 
flow  of  serum  after  cantharidine  had  been  given. 

The  same  speaker  then  showed  a  patient  with  a 
Syphilitic  Gumma  of  thb  Forehead. 

The  diseased  parts  had  a  certain  resemblance  to  lupus 
gummosa.  On  application  of  the  phaneroscope,  however, 
and  glass  pressure  the  diagnosis  was  verj  clear  ;  there  was 
then  no  trace  of  lupus  vulgaris. 

Hr.  Hausemann  then  spoke  on 

.  An  Unusual  Case  of  Morbus  Addisonii. 

He  said  that  the  significance  of  the  supra *renal  capsules 
in  Addison's  disease  was  not  yet  sufficiently  recognised. 
Some  inquirers  looked  upon  the  supra-renal  affection  as 
secondary,  and  thought  the  primary  disease  lay  in  the 
solar  plexus,  the  splanchnic  nerves,  and  the  spinal  cord. 
There  was  no  doubt  the  capsules  might  be  completely 
.  destroyed  without  the  onset  of  Addison's  disease,  as  in  the 
case  of  a  woman,  »t.  53,  both  of  whose  supra-renal  cap- 
sules were  completely  destroyed  by  cancer  metastases 
without  a  trace  of  Addison's  disease  appeariufr.  The 
same  thing  occurred  as  regarded  the  pancreas  and  dia- 
betes. All  disease  of  the  pancreas  might  lead  accidentally 
to  diabetes,  but  there  was  a  diabetes  independent  of  the 
pancreas.  Granular  atrophy  of  the  pancreas  led  on  to 
diabetes  with  great  regularity. 

The  case  he  brought  forward  was  that  of  a  man  of  90,  of 
healthy  parentage  and  always  healthy  himself.  He  was 
admitted  into  hospital  in  June  last  suffering  from  impaired 
nutrition,  slight  jaundice,  great  weakness,  that  was 
increased  by  vomiting  and  deficient  ingestion  of  food. 
The  lungs,  heart,  spleen,  and  kidneys  were  sound.  Pig- 
mentation was  well-marked,  especially  in  cicatrices  and  on 
the  edges  of  the  velum  palati.  He  died  in  14  days.  The 
autopsy  showed  brown  atrophy  of  the  heart,  in  the  lungs 
small  cicatrices  with  small  caseous  patches,  swelling  of  the 
follicles  of  the  intestines,  patchy  swelling  and  redness  of 
the  mucous  membrane,  and  some  hemorrhages.  All  the 
organs  except  the  supra-renal  capsules  were  unchanged. 
These  were  united  to  the  adjoining  parts  by  fibrous 
bandi*.  As  fiat  surfaces  they  were  of  fair  size,  but  they 
were  very  thin.  Every  trace  of  yellow  cortical  substance 
had  disappecured.  In  some  fevers  a  round- celled  infiltration 
was  present.  There  were  no  neoplasms.  There  was  no 
positive  change  in  the  nervous  apparatus,  except  a  few 
pigmented  ganglion  cells  in  the  solar  plexus.  There  were 
no  changes  in  the  cord.  The  absence  of  the  cortical  sub- 
stance of  the  supra- renal  capsules  must,  therefore,  be  the 
sole  cause  of  the  disease. 


^**^4^^^l»X. 


EiQHTEEN  fatal  accidents  occurred  in  the  Alps  last 
summer,  4  in  the  French  Alps,  6  in  the  Swiss,  6  in  the 
German  and  Austrian,  and  2  in  the  Italian  Alps. 


[IBOM  OUB  OWN   OOBBISPOKDIKT.] 

"^"^         Yleniia,  Jan.  17Ui.  ItM. 
LiEPBOST. 

Prof.  Kaposi  opened  his  Clinic  by  showing  a  few  oases 
of  leprosy  that  have  lately  come  under  his  notice.  In 
recounting  the  early  history  of  the  disease,  which  he  ad- 
mitted was  of  great  antiquity,  he  assured  his  andieooe 
that  we  were  indebted  to  the  Arabian  medical  schools  for 
the  most  of  our  knowledge  concerning  its  ancient  history. 
In  the  Latin  translation  of  these  works  the  Arabian  term 
"Dal  fil,"  which,  correctly  rendered,  is  '< an  elephant's 
foot,"  has  been  translated  "Elephantiasis,"  or  «<elephan- 
topus,"  but  more  recent  investigations  have  classed 
it  as  a  thickening  of  the  skin,  or  pachydermia, 
or  "Elephantiasis  Arabum."  In  the  original  Arabian 
works  of  medicine  we  meet  with  another  term  "  Djudzan  " 
which  appears  to  have  included  a  number  of  diseases 
with  nodules  on  tbe  surface  of  the  body,  assooiatad  with 
shedding  of  the  nails,  and  subsequently  proceeding  to  a 
fatal  termination.  These  could  be  more  correctly  trans- 
lated as  leprosy.  It  was  not  until  the  Renaissance  period 
that  these  works,  whose  contents  have  thrown  much  light 
on  the  disease,  were  discovered  in  the  cloisters.  In  tbe 
Greek  language  there  is  another  disease  described  under 
leprosy  corresponding  to  the  Arabic  term,  but  from  doeer 
inquiry  it  appears  that  the  disease  has  no  grave  oonse- 
quenoes,  only  attacking  the  skin  and  leaving  large  whits 
patches,  which  we  are  inclined  to  believe  was  psoriasis ; 
indeed,  the  late  Sir  Erasmus  Wilson,  termed  it  *"  creeoentic 
lepra  psoriasis."  The  Arabians  appear  to  have  had 
another  allied  disease  which  they  called  "Albarras" 
represented  in  tbe  Greek  by  "  Morphoea,"  which  was 
either  "Albos"  or  **Melafl"  or  black  and  white,  agree- 
ing in  some  measure  to  our  "  Vitelligo." 

The  constitutional  disease  or  general  lepra  appears  to 
have  reached  extraordinary  dimensions  in  Europe  between 
the  10th  and  12th  centuries  when  hospitals  were  every- 
where provided  for  their  isolation.  At  that  time  the  leper 
was  under  the  necessity  of  carrying  a  bell  to  give  notice 
of  his  presence,  so  that  the  healthy  might  pass  without 
coming  in  contact  with  the  diseased  person.  The  word 
"  Zarad  "  in  the  Bible  is  translated  by  the  "  Septoa^^nta ' ' 
as  Leper,  but  this  indudedjother  diseases.  After  this  time 
the  epidemic  seems  to  have  gradually  disappeared,  when 
syphilis  made  its  appearance,  which  was  for  some  time 
considered  as  another  form  of  leprosy.  It  has  now  dip- 
appeared,  except  in  limited  localities,  such  as  Norway  • 
Sweden,  Finland,  South  of  Spain,  Constantinople,  and 
South  America.  Leprosy  may  be  correctly  divided 
into  "  Tuberose,"  '<  Maculosa,"  and  "  Annsthetica."  Tbe 
"Tuberosa"  form  appears  like  large  papular  syphilides 
over  the  hands,  feet,  and  various  parts  of  the  body,  ulti- 
mately passing  on  to  ulceration.  The  "Maculosa" 
appears  as  bronzed  or  brown  spots  on  the  surface, 
which  soon  become  ansssthetic  and  atrophied.  Tbe 
third,  or  "Anesthetic,"  often  begins  with  a  "Macs- 
lose  "  appearance,  subsequently  forming  vesicles  and  ter- 
minating in  complete  anasstbesia.  The  neurilemma  of  the 
fibriUsB  first  becomes  infiltrated  and  thickened  till  the 
tactile  sensation  is  quite  lost  as  well  as  that  of  heat 
and  cold.  There  is  one  peculiarity  that  still  remains  to 
distinguish  this  disease  and  that  is  the  muscular  sensation 
of  the  feet  is  retained  as  the  patient  is  able  to  stand  quite 
steady  when  the  eyes  are  closed . 


Jav.  22,  1806. 


THE  OPERATING  THEATRES. 


Thb  Mxdical  Pbbss.     85 


MXDIGAL  FaOULTT  TOR  LiNZ. 

The  inhabitants  of  Lower  Anstria  have  petitioned  the 
Ao«trian  Oovemment  for  a  new  medical  school  at  Linz. 
Tliey  complain  of  the  wide  area  in  their  province  which  is 
wicboat  medical  aid,  and  assore  the  €U)vemment  that  a 
belter  provision  conld  be  made  if  a  centre  of  education 
were  established  in  their  midst.  Another  complaint  is  the 
defective  arrangements  of  the  Government  for  carrying 
oat  sanitary  reforms  which  they  think  would  be  better 
accomplished  by  a  Faculty  of  their  own. 

Pbop.  Albbbt  has  again  returned  to  bis  clinic  after  a 
eevece  illneea  from  gout.  Prof.  Hochenegg  has  been  per- 
fonning  the  duties  of  lecturer,  and  will  continue  through- 
out  the  session  to  do  so. 


^hc  (Dptratinfl  theatres. 

MIDDLESEX  HOSPITAL. 
Stkphsk  Smith's  Amputation  at  the  KnebJoikt 
FOR  Gakg&eke  of  the  Lbg  akd  Thrombosis  of  the 
Femoral  Artert.— Mr.  Pearcs  Gould  operated  on  a 
man,  set.  57,  but  looking  considerably  older.  Occupying 
the  middle  third  of  the  outer  surface  of  the  patient's  right 
I  1^  was  an  uloer  more  than  six  inches  long,  extending 
I  down  to  the  interosseous  membrane,  to  the  tibia  and  to 
the  fibula ;  this  was  caused  by  gangrenous  inflammation  ; 
the  slough  had  nearly  all  separated,  but  the  exposed  outer, 
eorface  of  the  tibia  was  necrosed.  The  foot  was  very 
(Edematous.  Pulsation  was  felt  in  the  femoral  artery 
I  down  to  the  apex  of  Scarpa's  triangle,  below  which  no 
arterial  pulsation  could  be  detected.  The  leg  was  removed 
at  the  knee-joint  below  the  semi-lunar  fibro-cartilages,  the 
jtump  being  covered  in  by  lateral  flaps  taken  from  the  leg 
according  to  the  method  of  Stephen  Smith.  The  femoral 
artery  was  found  filled  with  a  dark  red  thrombus ;  the 
arterial  wall  was  not  notably  thickened  or  otherwise 
diseased.  Mr.  Gould  said  it  was  necessary  in  these  days 
for  a  surgeon  to  justify  very  completely  every  amputation, 
bot  he  believed  that  in  this  case  there  was  no  other 
course  open  to  him  to  pursue*  The  existence  of  the 
thrombosis,  together  with  the  feeble  state  of  the  patient, 
rendered  it  probable  that  the  ulceration  would  never  heal, 
hot,  even  were  healing  to  be  obtained,  the  man  would  be 
left  with  a  useless  and  troublesome  leg.  The  extensor 
and  perooei  muscles  were  destroyed,  so  that  the  foot  would 
be  in  a  condition  of  paralytic  equino-varus ;  and  the 
anterior  tibial  and  musculo-cutaneous  nerves  having  also 
been  destroyed,  the  dorsum  of  the  foot  would  be  deprived 
of  all  sensation,  and  would  probably  become  quickly  the 
Beat  of  trophic  sores.  Having  decided  to  amputate,  the 
question  arose  as  to.  the  best  method  to  adopt :  he  had 
chosen  Stephen  Smith's  amputation  through  the  knee- 
joint  because  it  was  attended  with  lees  shock  and  less 
hemorrhage  than  any  amputation  through  the  lower  part 
of  the  thigh  ;  if  successful  it  would  leave  the  man  a  better 
ftamp  than  an  amputation  higher  up.  In  the 
patient's  feeble  8tat«  Mr.  Gould  attached  great 
importance  to  the  little  shock  and  trifling  haemor- 
ihage  (in  this  case  not  amounting  to  half-an-ounce), 
and  this  was  the  chief  reason  that  had  weighed  with  him 
in  hie  dedsion.  He  was  aware,  however,  that  this  opera- 
tion was  in  this  partieular  patient  attended  with  risk; 
the  flaps  of  skin  and  fascia  which  he  had  reflected  from 
the  leg  were  very  thin,  and  at  the  same  time  were  of 
neoessi^  long,  and  with  thrombosis  of  the  popliteal  and 


femoral  arteries  there  was  danger  that  one  or  both  these 
flaps  would  slough.  He  pointed  out  that  the  outer  flap, 
owing  to  its  less  free  blood  supply,  was  more  liable  to 
slough  than  the  inner  flap  In  speaking  of  the  thrombosis, 
he  drew  attention  to  the  probability  of  its  being  due  to  an 
extension  of  clot  from  the  anterior  tibial  artery,  the  seat 
of  disease,  and  not  to  extensive  disease  of  the  arterial  wall* 
the  cAse  difiering  wholly  from  another  he  mentioned,  u 
which  he  had  recently  performed  the  same  operation  for 
gangrene  of  the  leg  due  to  obliterative  arteritis,  and  in 
which  the  popliteal  artery  was  found  to  be  filled,  not  with 
a  thrombus,  but  with  organised  fibro-cellular  tissue. 
KING'S  COLLEGE  HOSPITAL. 

Secondary  Nerve  Suture  after  Diyision  of  thi 
Ulnar  Nbrve  — Mr.  Carless  operated  on  a  young  womar, 
»t.  about  20,  who  sustained  a  glass  wound  of  the  wn's*-! 
four  months  previously,  severing  the  ulnar  nerve.  An 
attempt  had  been  at  once  made  by  the  medical  attendant 
to  suture  the  divided  ends,  but  the  result  was  unsatisfac- 
tory, as  also  were  two  subsequent  operations  performed  by 
the  same  medical  man.  On  admission  the  usual  signs  cf 
division  of  the  ulnar  nerve  at  the  wrist  were  markedly 
evident,  namely,  complete  anaesthesia  of  the  little  finger 
and  adjacent  side  of  the  ring  finger,  flexion  of  the  fingers, 
especially  sustained,  flexion  particularly  of  the  little  and 
ring  fingers,  inability  to  adduct  and  abduct  the  fingers,  and 
defective  mobility  of  the  thumb.  The  muscles  were  ex- 
ceedingly wasted,  and  the  electrical  reaction  very  imper- 
fect After  exsanguinating  the  limb  by  Lister's  method 
of  elevation  the  nerve  was  exposed  by  an  incision  ex- 
tending along  the  radial  side  of  the  flexor  carpi  ulnaris 
and  pisiform  bone;  there  was  a  large  amount  of  cica- 
tricial deposit  in  the  neighbourhood  of  the  injury,  but 
the  ends  of  the  nerve  were  readily  found  above  and  below 
this.  The  mass  of  cicatricial  tissue  constituting  the  bulb 
was  freely  dissected  away  and  the  nerve  ends  divided 
trsnsversely  so  as  to  expose  the  nervous  fibrillaa.  It  was 
then  found  that  although  over  three-quarters  of  an  inch 
of  tissue  had  been  removed  the  divided  ends  conld  be 
brought  into  apposition  with  scarcely  any  tension.  One 
deep  stitch  was  passed  through  the  whole  substance  of  the 
nerve  at  about  a  centimetre  distance  from  the  divided  end». 
This,  when  tied,  acted  as  a  traction  stitch  to  diminish 
tension  upon  the  ends  when  united.  Four  fine  sutures  were 
next  inserted  so  as  to  secure  accurate  apposition  of  the 
incised  extremities,  which  were  brought  into  accurate 
apposition  by  this  means.  The  wound  was  now  closed  and 
dressed  in  the  usual  way,  and  a  plaster-of- Paris  splint  was 
put  on  the  dorsal  aspect  of  the  forearm  and  hand  so  as  to 
keep  the  latter  well  flexed.  Mr.  Carless  commented  on  the 
necessity  uf  free  and  complete  removal  of  the  whole  mass  of 
cicatricial  tissue  which  intervened  between  the  nerve  endtf 
in  these  old-standiug  cases  ;  it  is  absolutely  essential,  he 
said,  that  the  actual  nerve  fibrill®  free  from  infiltration 
should  be  brought  into  contact.  In  many  cases  it  in 
impossible  to  accomplish  this  owing  to  there  being  insuffi- 
cient tissue,  and  when  such  a  condition  exists  the  ultimate 
prognosis  is  very  unsaUsfactory,  whatever  precautions  are 
taken  to  make  up  for  the  defect.  In  this  case  fortunately 
the  ends  were  easily  brought  into  contact  and  the  pro- 
gnosis was  consequently  increasingly  hopefuL 

It  is  satisfactory  to  state  that  by  the  eighth  day  sensa- 
tion had  been  almost  entirely  reg^ned  in  the  anaesthetic 
area,  that  the  fingers  were  not  quite  so  much  flexed,  and 
that  the  movement  of  opposition  of  the  thumb  to  each  of 
the  finger  tipe  conld  be  accomplished. 


86      Thb  Mebical  Psns. 


LEADING  ARTICLES. 


u  AV*  22^  1896. 


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^t  gJjeMral  f  was  ^  €mn\zr. 


'SALUS  POPULI  BUPREMA  LBX.' 


WEDNESDAY,  JANUARY  22,  1896. 


THE  INSANITIES  OF  PREGNANCY  AND  THE 
PUERPERIUM. 
The  subject  of  the  iasanities  of  pregnancy  and  the 
paerperium  ranks,  in  the  matter  of  obscurity,  with 
that  of  puerperal  feyers,  but  while  the  latter  have 
profited  by  the  greater  knowledge  at  present  possessed 
in  respect  of  the  influence  of  pathogenic  organisms  in 
their  causation,  the  insanities  have  remained  in  the 
chaotic  condition  in  which  they  were  bequeathed  to  us 
by  our  professional  ancestors.  Before  attempting  a 
classification  it  behoyes  us  to  decide  whether  or  not 
there  are  really  forms  of  insanity  peculiar  to  the  preg- 
nant or  the  puerperal  states.  We  are  fully  aware  of  the 
fact  that  women  are  more  prone  to  mental  disturb- 
ances at  particular  epochs  of  their  life's  history,  but 
this  alone  does  not  establish  any  special  relationship. 
Certain  persons  inherit  or  acquire  a  liability  to  mental 
disturbance  under  comparatively  slight  stress,  and  it 
is  presumably  only  in  such  persons  that  any  form  of 
insanity  can  decla^  itself  either  during  the  puerperal 
period  or  at  other  times.  It  would  not  seem 
that  these  attacks  present  any  features  which 
enable  us  to  differentiate  them  from  cases  of 
insanity  due  to  other  causes  and  if  the  puerperium 
acts  only  as  a  determining  factor  in  yirtue  of  the 
"veat  demands  which  maternity  imposes  on  the  female 


organism  it  follows  that  we  have  to  do  only  with  this 
or  that  variety  of  ordinary  insanity,  although  in  the 
cases  under  discussion  the  attack  may  have  been  pre- 
cipitated by  the  physiological  strain  of  conception  and 
delivery.    There  is,  however,  good  reason  for  believing 
that  a  large  number  of  cases  of  puerperal  insanity  are 
the  direct  and  immediate  result  of  septic  infection,  and, 
as  might  be  expected,  these  cases  are  at  present  far  less 
frequently  met  with  than  in  the  old  days  of  midwifery 
before  the  introduction  of  antiseptic  methods.     These 
are  the  cases,  if  any,  which  really  merit  the  designation 
of  puerperal  insanity.    But  even  if  all  eases  could 
reasonably  be  referred  to  this  source,  which  is  certainly 
not  true,  insanity  thus  induced  does  not  differ  essen- 
tially from  the  forms  which  are  constantly  met  with  as 
the  result  of  toxic  influences  generally.    Indeed,  the 
pathological  appearances  would  appear  to  be  virtually 
iodistinguiBhable    from    those   due    to    phosphorus 
poisoning,  for  instance.    They  ought,  therefore,  strictly 
speaking,  to  be  classed  as  toxic  insanities,  and  not  ss 
puerperal  insanities.     All  classifications  hitherto  pro- 
posed,   including    that    brought    forward    by    Dr. 
Savage,  at  the  last  meeting  of  the  Medical  Society 
of  London,  are   ostentatiously  unscientific.      Some 
varieties    are    classified  in   accordance    with   their 
supposed  etiology,  others    again,  according  to    the 
period  at  which  they  occur,  and  lastly,  by  way  of  a 
reductio  ad  dbturdumj  by  their  duration.    Such  a  clas- 
sification sins  against  all  the  canons  of  scientific  con- 
sistency, and  if  this  be  really  the  beet  that  specialists 
can  offer  us,  it  only  emphasises  the  fact  that  we  have 
still  much  to  learn  in  this  department  before  we  can 
get  a  clear  view  of  the  nature  and  relationship  of  the 
various  forms  of  mental  disease  which  occur  in  con- 
nection with  pregnancy  and  labour.    The  most  salient 
feature  of  all  these  forms  of  insanity,  so-called  puerperal, 
is  their  curability.    This  is  someUiing  to  be  thankful 
for,  seeiag  that,  according  to  most  statistics,  one  oat 
of  every  forty  cases  of  insanity  occurring  in  females  \b 
due  to  this  cause.  The  proportion  of  recoveries  is  given 
at  80  per  cent,  and  these  figures  only  deal  with  cases,  pre- 
sumably the  moresevere,  which  have  been  treated  in 
asylums.  A  complete  return,  including  the  more  maoige- 
ablecases  which  are  successfully  treated  at  home,  would 
certainly  give  a  much  larger  proportion  of  recoveries. 
One  curious  fact  was  brought  out  in  the  discussion 
which  followed  on  Dr.  Savage's  paper,  viz.,  that  ille- 
gitimacy is  far  from  having  the  influence  usually  attri- 
buted to  it.    Theoretically,  the  mental  distress  which 
is  entailed  by  an  illegitimate  pregnancy  ought  to  result 
in  the  overthrow  of  all  unstable  minds,  but  the  figures 
show  that,  as  a  matter  of  fact,  girl-mothers  contribute 
but  an  infinitesimal  proportion  of  the  cases  of  so-called 
puerperal  insanity.    The  explanation  is  probably  that 
women  who  ''  fall  "^  in  this  way  are  persons  with  stroog 
animal  passions  and  a  physique  to  correspond.    More- 
over, they  belong  for  the  most  part  to  the  uneducated 
classes  and  feel  less  acutely  than  might  be  imagined 
the  irksomeness  of  their  position  in  society.    It  is  an 
open  question  how  far  treatment  may  be  relied  upon 
to  avert  or    attenuate    an    attack.     In  view  of 
the  fact  that  such  attacks  are  almost  infaiiably 


mJJS.  22^  1806. 


LEADING  ABTICLES. 


Thi  Msdigal  Pbbbb.     8T 


Qfthered    in    by    a    period     of     sleepledsaess    and 
watchful  aDgaiah,  there  is  a  great  temptation  to  seek 
to  remedy  this  symptom  by  the   administration    of 
narcotics.    Those  who  have  had  most  experience  of 
such  cases  are  confident  that  an  attack  may  sometimes 
be  averted  by  such  treatment,  and  it  is  impossible  to 
challenge  the  accuracy  of  their  statements.    Whatever 
the  effect  may  be  in  the  stage  of  incipiency  it  is  plain 
that  little  is  to  be  gained  by  the  use  of  sedatives  in 
large  doses  once  the  attack  is  fully  developed.    Each 
physician  has  his  favourite  panacea,  one  gives  chloral 
and  bromides,  another  Indian  hemp,  and  another  alcohol, 
in  full  doses,  the  last  named  being  of  questionable 
wisdom,  unless  the  precaution  be  taken  to  render  the 
drug  sufficiently  repulsive  to  the  taste,  and  unless  the 
patient  be  left  in  ignorance  of  its  nature.  There  remains 
the  delicate  question  of  the  attitude  of  the  physician  in 
respect  of  marriageof  markedly  neurotic  women.  Taking 
as  a  cardinal  principle  that  there  is  no  form  of  mental 
disease  in  which  marriage  can  safely  be  recommended 
as  likely  to  prove  of  benefit,  bearing  in  mind  also  that 
in  discussing  such  a  question  one  ought  in  fairness  to 
remember  the  possible  consequences   to   the  unfor- 
tunate husband,  it  is  evident  that  the  responsibility 
of  the  physician  is  exceedingly  grave.  It  is  comforting 
to  know  that  mere  hysteria,  per  se,  does  not  appear  to 
have  any  predisposing  influence  in  this  direction,  and 
b  the  event  of  a  woman  suffering  from  any  other  form 
of  nervous  instability,  the  physician's  advice  ought  un- 
hesitatingly to  be  in  favour  of  abstention. 


PUBLIC  SCHOOL  SURGERY. 

The  Presidential  Address  delivered  before  the  Bristol 
Medico-Chirurgical  Society  by  Mr.  Arthur  W.Pritchard, 
and  published  in  the  current  number  of  the  Bristol 
Medteo-ChirurgiccU  Journal,  deals  with  a  subject  whicbt 
for  many  reasons,  entitles  it  to  be  carefully  read  by 
practitioners.  Under  the  heading  of ''  School  Surgery," 
Mr.  Pfitchard  discusses  at  length  his  professional 
experience  as  medical  officer  to  a  large  public  school— 
Clifton  College—and  gives  an  interesting  description  of 
the  accidents  and  other  surgical  emergencies,  in  con- 
nection with  the  School  games,  which  have  come  under 
his  notice  during  the  past  few  years,  The  games  men- 
tioned are  football,  runs,  athletics,  and  cricket,  and 
speaking  of  the  first  he  admits  that  when  played  under 
tiie  Rugby  rules  it  is  marvellous  that  serious  mishaps 
do  not  occur  more  frequently  than  they  do.  Still,  he 
adds  that  most  of  these  contests  finish  without 
anyone  complaining  of  any  serious  hurt.  Fractures 
in  football  games  are  stated  to  be  comparatively  rare. 
The  most  common  injuries  are  to  the  muscles,  and  of 
aQ  those  in  the  body  the  muscles  of  the  thigh  suffer 
most  It  is  interesting  to  note  that  separation  of  the 
antmor  superior  spine  of  the  ilium  by  muscular  action 
IS  a  well-known  accident ;  the  symptoms  of  this  are 
very  definite— namely,  loss  of  power  in  the  thigh  and 
a  sensation  of  something  having  given  way  near  the 

hip  during  a  violent  muscular  effort  The  injury  in 
question  is  one  which  is  probably  seldom  seen  outside 
a  public  school,  and  hence  the  text-books  on  surgery 

have  bat  little  to  say  about  it    One  of  the  commonest 


lesions  met  with  in  the  football  field  is  hsematoma  of 
the  ear,  in  consequence  of  the  ears  being  severely 
crushed  in  the  '*  scrimmages.''  Simple  as  this  affec- 
tion might  seem  to  be,  Mr.  Pritchard  points  out  that  it 
is  by  no  means  simple  in  reality,  inasmuch  as,  unless 
it  be  successfully  treated,  the  patient  will  be  left  with 
one  very  ugly  ear  for  the  rest  of  his  life.  Despite,  how- 
ever the  best  care  in  some  cases,  an  unsightly  thicken- 
ing of  the  affected  auricle  remains.  It  is  worthy  of 
note  that  on  one  occasion  the  author  was  called  upon 
to  treat  an  alarming  accident,  namely,  a  rupture  or 
fracture  of  the  trachea.  In  this  case  there  was  a 
tender  spot  about  three  rings  below  the  cricoid,  the 
throat,  neck,  face,  and  chest  quickly  became  emphyse- 
matous, and  there  was  great  difficulty  in  swallowing 
but  not  in  breathing.  Fortunately,  however,  in  ten 
days  time  the  symptoms  had  entirely  disappeared.  In 
regard  to  the  question  as  to  the  comparative  danger  to 
life  and  limb  between  Rugby  and  Association  football, 
Mr.  Pritchard  holds  that  as  far  as  his  experience  goes, 
the  former  is  more  dangerous  in  respect  to  injuries  to 
muscles  and  joints,  while  in  the  latter  accidents  occur 
less  frequently,  but  when  they  do  take  place  they  are 
often  more  serious.  In  one  Association  game,  for 
example,  a  boy's  cornea  was  cut  across  by  the  ball, 
from  which  a  loose  tag  was  hanging,  as  a  consequence 
of  which  the  eye  was  ultimately  lost.  Coming 
next  to  the  question  of  "school  runs,"  Mr. 
Pritchard  is  of  the  opinion  that  this  form  of 
exercise  does  more  good  than  harm,  and  that 
in  healthy  boys  it  is  seldom  that  any  mischief 
results  therefrom.  He  holds  that  the  value  of  the 
lesson  of  endurance  taught  by  the  runs  more  than 
compensates  for  the  fatigue  and  the  few  accidents 
which  they  cause.  This  testimony  upon  a  much- 
debated  point  should  be  borne  in  mind  by  those  who 
have  been  accustomed  to  find  fault  with  the  head 
masters  of  schools  for  allowing  "  runs  "  to  take  place. 
Under  proper  safe-guards,  we  quite  agree  with  the 
author,  that  the  form  of  exercise  in  question  is  both 
salutary  and  expedient.  In  comparison  with  football, 
cricket  is  remarkably  free  from  danger,  and  the  author 
points  out  that  it  is  seldom  that  any  accidents  occur 
during  a  match  at  cricket.  This  testimony  is  in  accord 
with  that  of  the  greatest  of  living  cricketers  Mr.  W. 
G.  Orace.  Injuries  to  the  hands  from  playing  fast 
bowling  without  gloves,  broken  noses,  and  cut  lips  are 
the  usual  forms  of  injury  met  with  at  cricket.  Of 
course,  it  is  only  to  be  expected  that  out  of 
a  large  community  of  boys  in  a  public  school,  there 
should  be  some  whose  inclinations  would  prompt  them 
to  malinger.  But  it  is  of  interest  to  learn  that  at 
Clifton  the  tendency  of  the  boys  is  to  make  the  best  of 
any  injury,  so  as  to  return  to  their  work  and  to  the 
games  with  as  little  delay  as  possible.  However,  the 
author  relates  his  experience  of  one  malingerer.  The 
patient  was  a  small  boy  who  had  an  abrasion  of  his 
skin  which  positively  refused  to  heal.  After  some  time 
it  was  found  that  the  wound  was  kept  from  healing  by 
the  boy  brushing  it  with  some  developing  solution 
used  in  photography.  The  same  boy,  on  other  occasion, 
alleged  that  he  had  swallowed  the  bulb  of  a  thermo- 


88    Thb  Mbdical  Pbesr. 


NOTES  ON  CURRENT  TOPICS. 


Jak.  22,  189S. 


meter  which  had  been  placed  in  his  month,  the  bnlb 
having  he  stated  broken  off.  fint  his  pre  vions  history  was 
against  him,  and  after  four  days  quarantine,  nothing  ha  v- 
ing  occurred,  he  was  despatched  to  school  again  and 
properly  punished.  Space  will  not  permit  us  to  refer 
further  to  the  many  other  features  of  surgical  interest 
contained  in  this  address  on  "  School  Sargery."  Never- 
theless, we  are  glad  to  see  that  Mr.  Prichard's  experi- 
eoce  leads  him  to  the  conviction  that  school  games, 
although  necessarily  associated  with  some  risks,  are 
neverth<:]ess  highly  advantageous,  and  that  the 
advantages  far  outweigh  the  risks  by  reason  of  the 
immense  gain  which  ensues  both  to  the  health  and 
strength  of  body,  mind,  and  character  of  the  boys. 


STREET  PAVING. 
Thekb  can  be  no  more  certain  index  of  the  degree 
of  administrative  evolution  attained  by  any  civilised 
community  than  the  state  of  its  roads  and  streets.  In 
the  country  the  question  of  the  best  material  for  the 
highway  paving  has  long  ago  been  settled  by  the 
adoption  of  the  broken  stone  introduced  by  the  Scotch- 
man, MacAdam.  In  busy  towns,  however,  where  the 
macadamised  roadway  and  its  congener,  the  granite 
cube,  has  been  generally  abandoned,  the  problem  has 
yet  to  be  solved.  Of  late  years  great  advances 
have  been  made  by  the  construction  of  street- 
ways  made  of  asphalte,  wood,  or  concrete,  but 
the  general  verdict  as  to  the  most  suitable  of  the 
various  rival  plans  is  still  nnpronounoed.  In  one  form 
or  another  the  question  is  continually  cropping  up  at 
the  meetings  of  Vestries  and  of  other  bodies  charged 
with  the  details  of  local  administration.  Its  settlement 
in  the  present  imperfect  stage  of  knowledge  and  experi- 
ence is  surrounded  with  many  doubts  and  difficulties. 
The  various  arguments  advanced  in  favour  of  this  or 
that  particular  material  may  be  classed  under  two 
main  headings,  the  popular  and  the  scientific.  To  the 
average  man  the  chief  points  to  be  considered  as 
regards  the  roadway  would  be  cost,  cleanliness,  noisi- 
ness  or  otherwise,  and  its  suitability  for  horses. 
Turning  to  the  three  staple  substitutes  for  macadam 
introduced  in  recent  years  we  find  that  both  asphalte 
and  concrete,  in  certain  states  of  the  weather,  are  dan- 
gerous to  horses.  On  the  whole,  wood  offers  a  better 
foothold  than  either  if  properly  looked  after,  and  it  is 
also  less  noisy.  There  are,  however,  certain  objections 
against  wood,  such  as,  for  instance,  its  cost,  the 
rapidity  with  which  it  wears  out,  and  its 
bad  smell  in  hot  and  damp  weather. 
This  last-mentioned  drawback  brings  us  to 
the  scientific  aspects  of  wood-paving,  apart  from 
the  mere  lesseniDg  of  noise  and  the  indirect  saving  in 
wear  and  tear  of  horse-flesh.  There  can  be  no  doubt 
that  the  popular  mind  has  become  possessed  of  a  firm 
belief  that  the  effect  of  the  wooden  roadway  is  to 
cause  a  large  amount  of  disease.  This  idea  has 
probably  sprung  in  the  first  instance  from  a  vague 
general  association  on  the  part  of  most  people  of  evil 
smells  with  noxious  diseases.  There  is,  however,  an 
absolute  lack   of    evidence    that  the  wood-paving 


encourages  the  development  of  pathogenic  micro- 
organisms. So  far  from  that,  it  seems  likely 
that  the  majority  of  microbes  exposed  on  an  imperme- 
able pavement  would  be  speedily  destroyed  by  the 
combined  action  of  sunlight  and  air.  The  aesthetic 
objection  would,  doubtless,  be  to  a  great  extent  over- 
come by  a  more  systematic  and  thorough  system  of 
scavenging.  Indeed,  it  may  be  broadly  stated,  without 
much  fear  of  contradiction,  that  an  evil  street  smell  is 
almost  invariably  the  result  of  neglect  on  the  part  of 
the  local  authorities.  For  all  that,  no  positive  proof 
exists  against  the  agency  of  wooden  streets  in  the 
spread  of  infection.  Indeed,  so  far  as  we  know, 
the  only  scientific  investigation  made  into  the 
special  conditions  of  wood-paving  are  those  of 
Dr.  Wynter  BIyth,  who  showed  there  was  more 
ammonia  in  the  under  layers  of  the  gutter  than  of  the 
central  blocks.  A  welMaid  paving  of  hard  wood,  how- 
ever, should  be  practically  waterproof,  and  would  not 
permit  the  percolation  of  moisture  which  presumably 
lies  at  the  root  of  the  phenomenon  ascertained  by  Dr. 
Blyth.  Further  investigation  into  the  facts  of  the 
case  by  scientists  is  much  !ieeded,  for  the  subject  in- 
volved is  one  of  great  practical  importance  to  the  com- 
munity. At  present  there  are  no  established  con- 
clusions, and  the  ratepayer  is  consequently  too  often 
at  the  mercy  of  the  interested  commercial  specu- 
lator and  of  official  wire-pullers.  The  result  of 
this  chaotic  confusion  and  bewilderment  is  to  be  seen 
in  the  patchwork  state  of  the  streets  of  oar  great 
cities.  The  road  area  of  an  average  London  district, 
for  instance,  presents  a  veritable  mosaic  of  wood, 
macadam,  granite  cubes,  asphalte,  and  concrete,  that 
cannot  fail  to  exact  an  immense  unnecessary  tax  from 
the  unfortunate  horses  condemned  to  travel  over  such 
constantly  varying  surfaces.  The  cost  of  the  annual 
maintenance  and  repair  of  roads  is  hardly  realised  by 
the  ordinary  citizen,  who  rarely  troubles  himself  about 
the  administrative  economics  of  his  peculiar  locality. 
Still  less  does  he  form  any  adequate  conception  of  the 
vast  sums  of  money  required  to  carry  out  the  substi- 
tution of  modem  paving  for  the  old  macadam  roads  o^ 
a  district 


^tts  on  dturrcnt  %oficB. 

A  E(amtary  Death-Trap. 

A  FEW  weeks  since  a  remarkable  action  was  tried 
hefore  the  Edinburgh  Court  of  Session.  It  illustrates 
^n  a  startling  manner  how  householders  are  at  the 
mercy  of  landlords  and  workmen,  as  regards  the 
wholesome  condition  of  their  dwellings.  The  pursuer 
claimed  damages  from  a  property  company  through 
their  failure  to  put  a  house  let  to  him  in  proper  sani- 
tary repair.  The  evidence  showed  that  two  drains 
were  cut  off  and  sealed  by  the  company's  workmen, 
who,  however,  did  not  disconnect  the  drains  from  the 
main  sewer.  The  sealed  drains  ran,  one  under  the 
lobby,  and  the  other  under  the  kitchen  and  sitting- 
room.  One  of  the  disused  drains  had  an  opening 
immediately  under  the  kitchen  sink.    The  pursuei^i 


NOTES  ON  CUKKENT  TOPICS. 


jiK.  88.  ia». 

femily  vaSend  from  much  illneBS,  and  two  of  his 
cfaOdreD  died  of  diphtheria.  Lord  Kincaimey, 
before  whom  the  case  was  tried,  awarded 
damages  to  pnrsner  to  the  extent  of  £150 
aod  expensea.  His  remarks  on  the  scientific 
endMice  are  worthy  of  careful  note.  One  medical 
man  attributed,  without  any  hesitation,  the  death  of 
the  children  to  the  bad  drainage.  Two  other  doctors, 
although  they  agreed  that  diphtheria  and  bad  drainage 
were  often  concurrent,  gave  more  hesitating  evidence. 
Bat,  said  the  judge,  at  present  the  origin  of  the  dis- 
ease was  a  moot  point,  and  it  did  not  matter  vitally 
whether  the  sewage  gas  acted  directly  in  producbg 
diphtheria^  or  indirectly  by  lowering  the  system  and 
rendering  a  person  more  prone  to  attack.  This  appears 
to  be  a  just  and  common- sense  view  of  the  case.  The 
defendants,  it  should  be  noted,  made  no  attempt  to 
bring  forward  expert  evidence  to  controvert  the  view 
that  the  bad  drainage  led  to  the  illness. 


T&B  MsniOAL  ^^BMS. 


Ltmatic  or  CTrimixia]  ? 
Last  week  an  elderly  maiden  lady  was  sent  to 
prison  for  twenty- one  days  by  a  London  magistrate, 
under  the  following  extraordinary  circumstances.  The 
evidence  showed  that  for  upwards  of  three  years  she 
had  subjected  the  congregation  of  a  Clapham  church 
to  persistent  annoyance.    She  was  in  the  habit  of  pro- 
menading the  aisles  during  the  service,  and  of  singing 
discordantly,  commencing  before  the  rest  of  the  wor- 
shippers and  continuing  after  they  had  ceased.    The 
prisoner  had  no  excuse  to  offer  for  her  conduct,  but 
complained  that  the  clergy  refused  to  administer  to 
her  the  Holy  Communion.    Now,  it  appears  to  us  that 
8Qch  conduct  as  that  of  the  accused  is  not  that  of  a 
aane  and  responsible  person.    Yet  the  magistrate,  by 
sending   this  poor  eccentric  old    woman  to  prison, 
rirtually  declared  she  was  responsible  for  her  action  in 
disturbing  the  service.     Then,  again,  why  was   the 
defendant  refused  admission  to  the  Holy  Communion  t 
If  on  account  of  her  eccentric  mental  condition,  then 
the  clergymen  who  brought  the  charge  cannot  fail  to 
see  the  injustice  of    the  magistrate's  decision.    Of 
course,  it  is  clear  that  congregations  must  be  pro- 
tected   against   disturbers,    but   it    certainly  seems 
cm     the      face     of      it     that     this     unfortunate 
lady    should    have    been    consigned    to   a   lunatic 
•8)lnm    rather    than    to    a    gaol.     At    any    rate, 
the  case   should   be    carefully    inquired  into,   and 
deserves  the  immediate  attention  of  the  Home  Secre- 
tary.   It  has  been  pointed  out  in  these  columns  time 
after  time  that  a  great  many  cases  which  are  sentecced 
in  the  police  courts  offer  prima  facie  evidence  of 
insanity.    As  a  rule,  magixtrates  are  utterly  ignorant 
"f  the  most  elementary  facts  of  mental  aberration. 
Wb&t  is  wanted  is  an  independent  official  expert  in 
insanity,  to  whom  all  doubtful  cases  should  be  referred 
for  investigation  and  report    If  some  such  course 
were  adopted  there  can  be  no  doubt  that  the  shadow 
r4  a  grave  reproach  would  be  lifted  from  the  police- 
court  administration  of  this  country. 


The  Irish  Cot^oint  Bxamltiations. 
The  return  of  the  Committee  of  Management  for 
the  Dublin  Colleges,  with  respect  to  the  last  summer 
examinations,  has  just  been  presented,  and  no  explana- 
tion is  offered  for  its  issue  more  than  six  months  after 
date.  The  preparation  of  so  meagre  a  statement  could 
not  occupy  more  than  a  few  hours,  and  its  presentation 
to  the  Colleges  after  such  a  delay  is  an  absurdity  which» 
it  is  to  be  hoped,  will  not  be  repeated.  The  return 
shows  a  slight  decrease  in  the  number  examined,  from 
219  in  July,  of  1804,  to  212  in  July,  1896,  the  falling 
off  being  especially  visible  in  the  third  and  fourth 
examinations,  owing  to  the  operation  of  the  five  years 
system,  which  encourages  the  student  to  waste  his 
third  year,  inasmuch  as  there  is  no  examination  to  be 
passed  in  that  period.  The  rejection  percentage, 
taking  all  the  examinations  together,  reached  the 
high  ratio  of  67*5  per  cent.,  but  the  explanation  of  that 
high  "  mortality''  is  to  be  found  in  the  preposterous 
severity  of  the  physiology  test  at  the  second  and  third 
examinations.  The  return  does  not  give  the  proportion 
of  candidates  victimised  in  that  subject,  but  it  shows 
that  the  rejections  at  these  two  examinations  at  which 
it  is  the  salient  subject  were  respectively  65*1  and 
75*7  per  cent.,  and  it  is  notorious  among  students  and 
teachers  that  the  physiology  and  histology  tests  are 
responsible  for  this  heavy  slaughter.  We  observe  that 
the  Committee  of  Management  proposes  to  remedy 
this  abnormal  severity  of  the  test  by  defining  and 
limiting  the  subject  by  a  syllabus,  but  we  do  not 
anticipate  that  the  adoption  of  such  expedient  will 
have  any  material  effect  until  a  root  and  branch  reform 
of  the  method  of  examination  is  effected.  Any 
examiner  who  is  minded  to  submit  candidates  to  an 
unanswerable  examination  and  to  frighten  and  dis- 
courage them,  can  do  so  as  effectually  within  the  scope 
of  a  syllabus  as  in  any  other  way.  This  part  of  the 
examination  has  been  for  years  a  scandal  and  a  blot 
upon  the  Dublin  conjoint  system.  ?fe  do  not  believe, 
no  one  believes,  that  the  Dublin  student  presents  him- 
self in  physiology  in  so  unprepared  a  state  as  to 
justify  the  persistently  excessive  rejections,  and  we 
submit  that  it  is  high  time  that  the  colleges  should 
intervene  for  the  protection  of  the  students. 


Antiseptic  Books. 
The  Paris  Academy  of  Medicine  has  been  engaged 
upon  the  discussion  of  a  communication  by  M.  du 
Cazal,  in  which  he  rocords  his  experiments  respecting 
the  danger  of  infection  from  books.  It  goes  without 
saying  that  he  found  abundant  microbes  on  the  pages 
of  books,  especially  those  lent  out  from  libraries,  and 
that  he  found  it  impossible  to  effectually  disinfect 
them.  The  sequence,  we  assume,  is  that  no  one  should 
read  a  book  unless  it  is  uncut  and  fresh  from  the 
press,  and  that,  even  in  that  case,  the  reader  will  have 
to  run  the  gauntlet  of  a  lesser  army  of  microbes.  The 
question  suggests  itself,  where  is  this  microbe  craze  to 
stop  ?  or  at  what  point  does  it  become  ridiculous  ?  Is 
there  any  article  touched  froni  morning  to  night  in 
our  daily  life  which  is  not  open  to  the  same  objection 
in  a  greater  or  lesser  degree  than  the  circulating  library 


90     Thi  Mbdical^Press. 


NOTES  ON  CUEBENT  TOPICS. 


Jak.  22»  1896. 


book  ?  The  most  rabid  antisepticiat  accepts  with  satis- 
faction a  bank  note  reeking  and  saturated  with  germs, 
and  carries  it  about  with  him  into  every  sick  chamber 
into  which  he  enters.    Where  ia  the  consistency  ? 

Appointment  of  Begistrar  of  the  Branch 
Medical  Council  for  Ireland. 
The  election  of  a  successor  to  Dr.  Heard,  the  Regis- 
trar, who  recently  resigned,  took  place  on  the  16th 
inst.  Several  candidates  presented  themseWes,  includ- 
ing Mr.  Houghton,  the  Assistant  Registrar,  Mr.  Green- 
wood Pirn,  Secretary  of  the  Conjoint  Examination  Board, 
and  Mr.  Wilson,  sometime  Librarian  and  Assistant  Secre- 
tary at  the  Royal  College  of  Physicians.  Mr.  Wilson 
was  the  only  one  of  these  candidates  who  possesses  a 
medical  qualification,  and  he  was  eventually  elected. 
We  understand  that  Mr.  Houghton  has  resigned  his 
office  as  Assistant  Registrar,  the  salary  of  which  office 
is  £60  a  year. 

The  "Mother's  Friend." 
The  extent  of  the  trade  in  infant  hypnotics  may  be 
judged  from  the  evidence  presented  in  a  recent  prose- 
cution by  the  Pharmaceutical  Society  of  England 
against  a  grocer  for  selling  one  of  these  nostrums.  This 
concoction,  which  is  called  the  '*  Mother's  True  Friend,'' 
was  a  mixture  of  Epsom  salts  and  morphia,to  the  amount 
of  one  grain  of  the  latter  to  the  ounce  of  water.  The 
defendant  pleaded  that  he  had  sold  two  gallons  a  week 
of  the  liquid  for  the  last  twelve  years,  but  he  admitted 
that,  for  the  privilege  of  doing  so,  he  had  paid  already 
£25  as  fines  to  the  Pharmaceutical  Society  upon  five 
separate  convictions.    He  was  fined  another  £5. 


The  Bisks  of  Anaesthesia. 
It  is  stated  that  61  deaths  have  occurred  within  the 
past  year  in  the  United  Kingdom,  of  which  52  were 
from  the  administration  of  chloroform.  This  would 
be  a  fearful  indictment  against  the  use  of  that  anses- 
thetic  if  we  only  knew  what  was  the  relative  propor- 
tion of  patients  submitted  to  its  influence  and  to  the 
influence  of  other  anaesthetics.  In  other  words,  if  the 
number  of  chloroform  cases  were  fifty-two  times  the 
number  of  nitrous  oxide  cases  chloroform  would  be 
no  more  dangerous,  although  it  might  have  caused  52 
deaths  for  one  death  caused  by  the  latter  anesthetic. 

The  Study  of  Pharmacy— Important  Judg- 
ment. 
Thb  Dublin  Queen's  Bench  Court  delivered  judg- 
ment last  week  upon  a  question  which  has  been  the 
subject  of  much  controversy  for  years.  The  Pharma- 
ceutical Society  of  Ireland  had  refused  to  admit  to 
examination  a  student  who  presented  a  certificate  of 
apprenticeship  not  from  a  recognisable  firm  of  qualified 
chemists,  but  from  the  manager  of  the  pharmaceutical 
department  of  a  limited  liability  company  in  the 
general  trading  line.  The  candidate  appealed  to  the 
Ck)urt  against  the  decision  of  the  Society,  but  the 
result  has  been  unfavourable  to  him.  The  judges 
agreed  that  the  certificate  of  the  manager  was  not  a 
logal  compliance  with  the  regulations,  but  some  of 


them  expressed  their  opinion  that  the  regulation  might 
operate  harshly  towards  candidates,  and  that  a  more 
elastic  arrangement  might  be  advantageously  made. 


ThQ  Viavi  Treatment. 
At  an  inquest  held  recently  at  Brighton  it  trans- 
pired  that  the  deceased  had  died  from  apoplexy, 
although  she  was  only  24  years  of  age.  She  had  been 
subjected  to  the  "Viavi*'  treatment  for  aniemia,  and 
had  taken  medicines  in  accordance  therewith,  but  the 
agent,  who  was  examined,  did  not  know  what  those 
medicines  contained.  The  points  in  the  case  worthy 
of  notice  were  that  a  sympathetic  lady  paid  out  £3  66. 
for  the  Viavi  medicines,  and  that  the  jury,  without 
having  the  medicines  analysed,  returned  a  white- 
washing verdict. 

The  Health  of  Johannesburg. 
Now  that  the  eye^  of  the  world  are  concen- 
trated upon  Johannesburg,  it  may  be  of  some 
interest  to  refer  to  the  latest  reports  respecting  the 
salubrity  of  the  city,  as  testified  to  by  the  medical 
officer  of  health.  The  latter  holds  that  the  climate  of 
Johannesburg  is  good  and  conducive  to  health.  On 
the  other  hand,  his  reports  show  that  the  place  ia 
most  unhealthy,  owing  to  defective  sanitation.  During 
the  month  of  October  last  the  total  death-rate  for  ail 
diseases  corresponded  to  38*4  per  1,000  per  annum,  or 
9*6  per  1,000  more  than  for  the  previous  month.  In 
the  first  month  named  no  less  than  331  interments 
took  place  in  the  public  cemetery,  of  which  193  were 
natives  and  coloured  people  and  132  Europeans,  while 
six  only  belonged  to  the  Jewish  population.  It  may 
here  be  observed  that  the  total  black  population  in 
Johannesburg  has  been  estimated  at  60,000,  and  the 
whites  at  70,000.  So  far  as  the  drainage  is  concerned, 
there  is  no  efficient  sewerage  system,  hence  the  sani- 
tary arrangements  are  appallingly  horrible  in  some 
parts  of  the  town.  For  the  most  part  the  bucket 
sjrstem  prevails  with  all  its  attendant  evils.  Again,  a 
general  consensus  of  opinion  shows  that  'he  water 
supply  \b  very  much  at  fault,  that  a  scarcity  often 
occurs,  and  that  the  water  is  far  from  wholesome. 
It  is  further  pointed  out  that  the  death-rate  among 
the  Kaffirs  is  exceptionally  high,  the  causes  being  acci- 
dents, pulmonary  disorders,  and  typhoid  fever.  After 
all  Johannesburg,  for  many  reasons,  does  not  appear  to 
be  a  desirable  place  in  which  to  reside  at  the  present 
time. 

Should  Medical  Men  Wear  Beards. 
There  is  no  doubt  that  the  hirsute  appendages 
of    men,    no  matter  where  they    may  be,    can  and 
do  become  the  convenient  resting-places  for  micro- 
organisms.   It  is  for  this  reason  that  the  process  of 
I  shaving  becomes  so  necessary  before  the  surgeon,  a 
I  true  disciple  of  Lister,  proceeds  to  cleanse  the  skin  of 
I  the  part  upon  which  he  is  about  to  operate.  The  recog- 
nition of  these  facts  has  drawn  attention  to  the  alleged 
inexpediency  of  medical  men  weariLg  beards.  A  corre- 
spondent to  an  American  medical  contemporary  has 
.  pointed  out  that  in  a  medical  man's  beard  the  infection 


Jak,  gg,  ISM. 


NOTES  ON  CUERENT  TOPICS. 


Tbm  Mbdioal  Pbbw.     91 


of  zymotic  disease  can  be  readily  conveyed  to  healthy 
hoQiieholda.  He  eyen  cites  cases  in  which  the  infection 
of  diphtheria  and  scarlet  fever  have  been  so 
commanicated.  The  New  York  Medical  Record  referred 
to  the  same  subject  some  time  ago,  and  our  contem- 
porary raised  a  storm  around  its  editorial  sanctum  by 
suggesting  that  medical  men  woulct  be  wise  to  restrict 
their  beards  to  modest  and  sanitary  limits.  Indignant 
oorrespondents,  however,  wrote  to  say  that  they  had 
for  years  worn  long  and  breezy  whiskers  and  beards, 
and  that  they  had  no  intention  of  depriving  them 
selves  of  these  appendages.  After  this  no  more  was 
said  on  the  subject^  but  since  then  it  has  been  revived 
hf  the  correspondent  above  referred  to,  in  a  somewhat 
active  manner.  Of  course,  we  do  not  deny  the  possi- 
bility of .  infection  being  conveyed  by  means  of  a 
medical  man's  beard  or  whiskers,  but  such  a  mode  of 
infection  is,  to  say  the  least,  highly  improbable. 


The  Untrathfalness  of  Morphinomaniacs 
The  mental  and  moral  destruction  which  occurs  in  a 
victim  to  the  morphia  habit  is  a  fact  which  unfortu- 
nately has  been  only  too  frequently  demonstrated. 
This  point  has  led  to  some  discussion  respecting  the 
expediency  of  rejecting  the  testimony  in  a  court  of  law 
of  those  who  are  known  to  be  addicted  to  the  use  of 
morphia.  One  authority  has  even  gone  so  far  as  to 
say,  **  I  would  not  believe  a  man  who  is 
a  victim  of  the  morphia  habit  on  oath."  No  doubt  the 
moral  obliquity  as  to  truthfulness  present  in  such  a 
person  would  be  perfectly  uncontrollable,  under  any 
circumstances,  and  unrestrained,  even  although  he  had 
sworn  to  tell  the  truth.  But  before  coming  to  any* 
definite  dedsion  upon  the  question  of  receiving  or 
rejecting  the  evidence  of  such  a  witness,  it  would  first 
of  all  be  only  expedient  to  determine  what  constitutes 
a  person  whose  mental  and  moral  capacities  have  been 
tainted  by  the  use  of  morphia. 

The  Adrenal  Treatment  of  Addison's  Disease. 
It  must  be  admitted  that  the  supra-ranal-capsule 
treatment  has  failed  to  answer  the  expectations  origin- 
ally formed  of  it    In  addition  to  the  case  read  last 
week  by  Dr.  Ringer,  before  the  Clinical  Society,  we 
have   received  particulars   of   an  unsuccessful   case 
treated  by  Dr.  Murrell,  at  the  Westminster  Hospital. 
The  patient  was  a  comparatively  young  man,  and  as 
the  symptoms  were  of  less  than  six  months'  duration 
the  failure  is  the  more  remarkable.    There  could  be 
no  question  as  to  the   activity   of  the   preparation 
employed,  as   special    precautions     were    taken    to 
obtain  a  supply  of  absolutely  fresh  adrenals.     The 
animals  were  slaughtered  daily  in  the  presence  of  Dr. 
Copeland,  the  house  physician,  by  whom  the  glands 
were  at  once  removed. and  administered  to  the  patient. 
Both  sheep  and  calves  were  used,  and  thanks  to  the 
kindly  co-operation  of  ^a  friendly  butcher  interested  in 
the  amelioration  of  suffering,  an  ample  supply  was 
always  at  hand.    The  initial  dose  was  a  drachm,  but 
this  intensified  the  nausea  and  vomiting,  and  failed 
to  increase  the  blood  pressure.    The  dose  was  then 
reduced  to  fifteen  grains  three  times  a  day,  but 


the  pigmentation  became  more  pronounced,  and 
the  patient  gradually  lost  flesh  and  strength,  and  died 
on  the  thirty- seventh  day  of  treatment.  The  correct- 
ness of  the  diagnosis  was  confirmed  by  the  post-mortem 
examination.  Addison's  disease  is  of  somewhat  rare 
occurrence,  but  there  must  be  many  cases  scattered 
throughout  the  country,  and  it  would  be  interesting  to 
learn  if  other  observers  have  failed  to  obtain  good 
results  from  the  new  treatment,  and  especially  if  any 
untoward  effects  have  been  noted.  The  na*ural  ten- 
dency is  to  report  successful  cases  and  to  ignore  those 
terminating  unfavourably. 

"  The  University  of  Philadelphia. 
Db.  Bateman,  the  active  general  secretary  of  the 
Medical  Defence  Union,  did  good  service  in  pointing  out 
last  week  in  the  Times  the  precise  facts  in  regard  to 
the  status  of  the  so-called  "  University  of  Philadelphia,"" 
of  which  so  much  has  recently  been  heard.  He  states 
that  this  so-called  university  had  its  Charter  revoked 
in  1879  under  the  following  circumstances  :  "By  the 
Legislature  of  1871,  a  joint  special  committee  was 
appointed  to  investigate  the  alleged  issue  of  diplomas 
by  the  '  American  University  of  Philadelphia '  and  the 
'Philadelphia  University  of  Medicine  and  Surgery.' 
This  committee,  after  taking  evidence  in  the  City  of 
Philadelphia,  recommended  that  the  Charters  of  the 
two  so-called  universities  should  be  revoked,  both 
institutions  having  been  guilty,  in  the  opinion  of  the 
committee,  of  selling  their  diplomas  to  persons  who 
had  not  followed  the  prescribed  course  of  studies  and 
of  violating  the  franchises  granted  them.''  Subse- 
quently proceedings  were  taken  against  the  Universi- 
ties and  the  Charters  forfeited.  The  Charters  also  of 
the  Electric  Medical  College  of  Pennsylvania  were 
similarly  revoked  on  September  30,  1880.  It  is  to  be 
hoped  that  the  newspaper  press  throughout  the  country 
will  take  note  of  these  facts,  and  bring  home  to  their 
readers  how  American  quacks  coming  to  this  country 
are  able  to  deceive  the  public.  Quacks  of  this  ilk  can 
only  be  successful  in  their  campaigns  by  means  of  the 
fraudulent  assumption  of  titles ;  without  titles  they 
would  be  "  nowhere ;"  hence,  in  order  to  counteract 
their  practices,  it  is  clearly  expedient  that  the  public 
should  know  all  about  the  value  of  these  American 
M.D.'8. 


Eye  Troubles  of  Bicyclists. 
That  some  ocular  troubles  should  be  associated  with 
bicycle  riding  is  perhaps  not  surprising,  but  so  far  only 
two  cases  of  the  kind  seem  to  have  been  placed  on 
record.  One  is  recorded  by  Duboys  in  the  AnnaZes 
d'Ocvlistique  for  last  year.  The  patient  was  a  profes- 
sional rider,  aged  twenty-four,  who  was  attacked  with 
a  peculiar  visual  disturbance  during  a  twenty-four 
hours'  race  in  very  cold  weather.  About  the 
eighteenth  hour  he  noticed  that  his  vision  was  dis- 
turbed, that  he  steered  badly,  and  that  he  ran  into 
other  machines.  A  diffuse  haziness  of  both  corneaB  was 
found,  without  superficial  lesion.  Under  the  influence 
of  warmth  and  rest  the  vision  began  to  improve,  and 
the  next  day  the  corne»  had  regained  their  normal 


02    Tub  Mxdioal  t>BWfi. 


NOTES  ON  CtTERENT  TOPICS. 


Jan.  22,  1896 


appearance,  and  the  vision  its  usnal  acaity.  The 
trouble,  in  the  opinion  of  the  author,  was  due  to  the 
cold-— a  possible  explanation  in  view  of  the  fact  that 
during  the  race  the  thermometer  fell  to  10'  below  zero 
Centigrade.  The  second  case  is  published  in  the 
Arekiv.  Med.  de  Toulouse,  also  for  last  year.  Clavelier, 
under  whose  care  the  patient  was,  records  that  a  man, 
aged  32,  consulted  him  after  he  had  ridden  a  race  of 
twelve  kilometres,  in  which  a  very  rapid  pace  was 
accomplished  in  the  latter  half  of  the  ride.  The  patient 
had  been  seized  with  severe  palpitations,  which  had 
scarcely  terminated  when  a  sudden  diminution  in  the 
vision  of  the  left  eye  supervened,  the  sight  falling  to 
one  fourth.  The  right  eye  remained  normal.  Ophthal- 
moscopic examination  showed  traces  of  numerous 
retinal  hemorrhages.  Examination  of  the  heart  yielded 
nothing,  and  the  urine  was  perfectly  normal.  There 
was  no  rheumatic,  syphilitic,  or  alcoholic  history  ;  no 
aniemia,  and  no  disease  of  the  digestive  organs.  The 
conclusion  was  then  arrived  at  that  in  some  way  the 
bicycle  race  had  caused  the  lesions. 

The  Abolition  of  the  Garble. 
The  length  of  time  which  it  takes  for  any  scientific 
fact  to  receive  general  recognition  is  equalled,  possibly 
even  exceeded,  by  the  difficulty  experienced  in  inducing 
practitioners  to  discard  measures  or  methods  which 
more  recent  experience  has  shown  to  be  inadequate, 
inefficient,  or  even  injurious.  It  is  to  be  feared  that 
the  time-honoured  gargle  falls  into  this  category,  but 
even  its  antiquity,  coeval  though  it  be  with  the  poul- 
tice and  the  leech,  cannot  blind  us  to  the  fact  that  it 
necessarily  falls  short  of  the  mark  when  the  diseased 
tissues  are  on  a  plane  behind  the  posterior  pillars  of  the 
fauces.  Even  a  casual  study  of  the  conditions  which 
obtain  in  the  act  of  gargling  as  usually  understood, 
will  show  that  the  fiuid  is  kept  in  front  of  the  lowered 
soft  palate,  so  that  it  is  impossible  for  any  effects  to  be 
exercised  on  tissues  posterior  to  that  structure.  A 
gargle,  as  ordinarily  employed,  is,  therefore,  only  a 
mouth  wash.  Under  these  circumstances,  it  is  really 
surprising  that  it  should  have  been  reserved  for  Mr. 
Lennox  Browne  to  enter  a  protest  against  the  continu- 
ance of  a  practice  which  is  not  only  useless  but,  in 
presence  of  actual  inflammation,  is  exceedingly  painful, 
and  may  be  injurious.  Mr.  Browne  describes,  how 
ever,  another  method  of  gargling,  using  the  term 
gargling  in  the  sense  of  trickling  a  fluid  through  the 
mouth  into  the  pharynx,  which  is  free  from  one,  at  any 
rate,  of  the  objections  already  alluded  to,  viz.,  the 
method  of  Von  Troelstch,  for  which  the  directions  are 
as  follows  :—**  Take  a  tablespoonful  of  the  gargle  in 
the  mouth,  hold  it  in  the  back  of  the  throat  with  the 
head  thrown  back,  then,  dosing  the  nose  with  the  finger 
and  thumb  to  prevent  entrance  of  air,  open  the 
mouth  and  make  the  movements  of  swallowing 
without  letting  the  liquid  go  down  the  throat"  By 
this  means  the  medicated  fluid  can,  it  is  true,  be 
brought  into  contact  with  the  pharyngeal  tissues,  but 
the  process  is  by  no  means  easy  to  carry  out  in  an 
effectual  manner,  and  in  the  majority  of  instances  it  is 
quite  out  of  the  question.    Qarglea,  again,  are  quite 


inadmissible  in  cases  entailing  the  dorsal  decubitus, 
such  as  diphtheria,  in  which  cardiac  failure  has  tu  be 
sedulously  guarded  against.  Another  obvious  objec- 
tion to  gargles  is  that  they  must  perforce  comprise  only 
the  most  harmless  ingredients,  if  we  are  to  avoid  sub- 
jecting the  patient  to  the  danger  of  poisoning  in  the 
not  improbable  event  of  any  portion  of  the  fluid 
escaping  control  and  finding  its  way  down  the 
oesophagus.  Moreover,  solutions  thus  employed  must 
not  contain  any  considerable  quantity  of  an  active 
ingredient,  because  they  will  come  into  contact  with 
vastly  more  healthy,  than  diseased,  tissue.  The  moral 
is  that  gargles  should  give  place  to  more  scientific  and 
precise  methods  of  applying  topical  agents  to  diseased 
surfaces  in  the  throat,  especially  in  children,  in  whom 
gargling  of  any  sort  is  virtually  an  impossibility. 
The  future,  therefore,  is  toward  irrigations,  sprays, 
lozenges,  and,  in  the  case  of  chUdren,  to  medicated 
confections. 


Calomel—A  Warning. 
Our  contemporary,  the  Chetnut  and  Druggist^  calls 
attention  to  the  liability  on  the  part  of  calomel  to 
undergo  decomposition  under  certain  conditions,  with 
the  result  of  the  production  of  a  certain  proportion  of 
corrosive  sublimate.  Reiterated  observation  and 
experiment  have  shown  clearly  enough  that  if  mixed 
with  sugar  and  put  up  in  powders  an  appreciable  quan- 
tity of  the  more  active  salt  sooner  or  later  makes  its 
appearance,  although  the  amount,  it  is  comforting  to 
know,  has  never  been  large  enough  to  permit  of  exact 
estimation  of  the  amount  present.  The  nature  of  the 
decomposition  is,  however,  such  that  the  eye  can 
detect  the  change  in  a  trace  of  black  mercurous  oxide, 
formed  simultaneously  with  the  mercuric  salt,  giving 
the  white  calomel  a  grey  tint,  and  it  is  quite  conceiv- 
able that  such  a  powder  might  produce  unwished  for 
effects  in  an  infant.  Our  contemporary  ndsee  the 
further  question  as  to  whether  chemically  pure  calomel 
is  a  trustworthy  therapeutical  agent.  As  a  cholagogue 
the  sublimate  is  stated  to  be  far  more  active  than  the 
sub-chloride,  and  it  is  hinted  that  the  efficacy  of  calomel 
in  the  past  may  have  been  dependent  on  its  admixture 
with  or  conversion  into  the  more  active  compound. 
This  is  a  point  which  it  is  worth  while  clearing  up, 
because,  if  the  effects  attributed  to  calomel  are  really 
due  to  the  presence  of  an  impurity,  it  is  as  well 
that  we  should  be  made  aware  of  the  fact 


The  First  Female  "  Master  in  Surgery." 
Miss  Louisa  Aldrich-Blakb  has  achieved  the 
distinction  of  becoming  the  first  Master  in  Surgery  of 
the  University  of  London.  She  has,  by  winning  this 
distinction,  capped  an  honourable  career  as  a  student 
at  the  London  School  of  Medicine  for  Women,  having 
distinguished  herself  in  every  part  of  her  student 
course.  Miss  Blake  is  Curator  of  the  Anatomical 
Museum  at  the  Royal  Free  Hospital,  London. 

As  epidemic  of  measles  is  at  present  raging  in  Maid- 
stone, which  has  necessitated  the  closing  of  ail  the 
elementary  schools  in  the  town. 


Jak.  S2,  18M. 


NOTES  ON  CURRENT  TOPICS. 


The  MsDiCiJL  Press.     98 


l^hoid  from  Ice. 
Some  months  ago  we  published  an  abstract  of  the 
report  of  the  Paris  municipal  analyst  whioh  revealed 
the  fact  that  much  of  the  ice  served  out  in  clubs  and 
restaurants  is  of  inconceivably  filthy  origin  and  laden 
with  nameless  abominations.  It  is  now  stated  that 
the  mUitary  officers  at  Rennes  have  suffered  from  a 
typhoid  epidemic  which  has  been  traced  to  the  ice  which 
was  used  to  cool  the  champagne  at  a  banquet.  The 
ioe  had  been  taken  from  the  neighbouring  river  at  a 
point  where  the  town  sewers  empty  themselves. 


Over-zealous  Sanitation. 
We  have  many  times  deprecated  the  interference  of 
public  analysts  in  cases  of  adulteration  of  a  technical 
and  legal  character,  but  which  injure  nobody  and  are 
of  homoeopathic  dimensions  as  regards  the  amount  of 
the  adulterant  We  note  that  traders  have  been  pro- 
secuted, within  the  past  week,  for  selling  lemonade 
containing  a  sixth  of  a  grain  of  lead  to  the  pint, 
and  for  selling  preserved  peas  with  less  than  a 
giain  of  copper  to  the  pound.  It  must  be  admitted  that 
if  an  individual  swallowed  a  keg  of  lemonade  or  con- 
Bomed  a  dozen  tins  of  preserved  peas,  he  would  probably 
become  sick,  but  it  may  be  doubted  that  the  most 
gluttonous  person  would,  take  enough  of  either  article 
to  harm  him  in-  the  slightest  degree.  It  is  surely 
not  necessary  for  analysts  to  go  in  search  of  such 
infinitesimal  adulterations,  considering  that  almost 
every  article  of  consumption  is  largely  sophisticated, 
lad  it  appears  that  the  only  effect  of  such  prosecu- 
tions is  to  bring  the  law  into  contempt  and  to  deter 
asnitary  authorities  from  activity  in  the  suppression 
ol  adulteration. 

A  Bengali  Professor. 
Mr.  J.  C.  BosE,  Professor  of  Physical  Science  in  the 
Presidency  College,  Calcutta,  is  almost  the  first 
Bengali  to  distinguish  himself  in  the  field  of  original 
research.  A  paper  he  has.  recently  written  on  the 
polarisation  of  light  has  been  accepted  for  publication 
by  the  Royal  Society,  and  a  grant,  it  is  understood,  is 
to  be  made  from  the  funds  of  the  institution  to  assist 
the  investigations  he  is  conducting  in  the  Presidency 
Collie  Laboratory. 

The  Inter-Colonial  Medical  Congress. 
Qbiat  preparations  have  been  made  for  the  meeting 
of  the  Inter-Colonial  Medical  Congress  at  Dunedin, 
New  Zealand,  in  February  next.  From  Australia 
steamers  have  been  arranged  to  leave  all  the  chief 
ports  In  time  for  the  opening  of  the  Congress.  The 
attractive  programme  of  the  ''trips"  available  for 
those  who  attend  the  Congress  has  probably  inflaenced 
a  good  many  of  the  members  of  the  profession  in  Aus- 
tralia to  make  their  journey  to  Dunedin.  New  Zealand 
seems  to  abound  in  scenery  of  the  loveliest  descrip- 
tion. 


Pasteur. 
A  STATUS  is  to  be  erected  to  Pasteur,  in  Paris,  and 
the  French  Government  have  started  the  subscription 
with  a  oontribntioD  of  £400. 


Infectious  Disease  in  Birmingham. 
Birmingham  is  particularly  unfortunate  in  its 
experience  of  infectious  disease,  and  appears  to  be  in 
a  chronic  condition  of  epidemic  visitations.  Last 
week  the  Health  Committee  of  the  Aston  B^^ard 
reported  a  continued  outbreak  of  measles,  in  conse- 
quence of  which  a  Board  School  had  been  closed. 
Diphtheria  had  broken  out  in  another  school ;  there 
had  been  sixty  cases  altogether,  forty-five  of  which  had 
been  of  persons  directly  or  indirectly  connected  with  a 
certain  school,  and  there  had  been  fourteen  deaths 
among  them.  Scarlet-fever  showed  no  abatement.  All 
these  disquieting  reports  from  a  city  so  advanced  in 
intelligent  local  administration  as  the  capital  of  the 
Midlands,  simply  emphasises  the  imperfection  of  our 
sanitary  preventive  methods.  From  the  modern  point 
of  view  the  whole  of  this  lamentable  sickness,  with  its 
consequent  suffering  and  death,  is  preventable,  and 
every  single  life  lost  in  this  way  is  an  unnecessary  loss 
to  the  community. 

River  Fish  and  River  Pollution. 
The  good  folks  of  Carmarthen  are  bewailing  the 
decrease  of  salmon  in  the  Towy.  Their  story  is  the 
familiar  one  of  a  once  prosperous  fishery  failing  steadily 
beneath  the  fostering  hands  of  a  Board  of  Conservators. 
The  complaint  they  make  is  not  without  humour, 
namely,  that  before  the  guardian  body  was  created 
there  were  many  more  salmon  in  the  river.  The  lead- 
ing Carmarthenshire  newspaper  asks  whether  the 
breeding  of  fish  cannot  be  reduced  to  a  science  as  well 
as  the  breeding  of  dogs  and  horses.  Certainly,  there 
is  a  great  future  awaiting  scientific  pisciculture.  It 
would  be  extremely  illogical,  however,  to  turn  shoals 
of  fish  into  water  that  for  some  reason  or  other  fails 
to  support  its  present  quota  of  fish.  Nor  is  it  of  much 
use  to  limit  the  number  of  anglers  on  the  river.  What 
we  would  advise  the  Carmarthen  Bay  Board  of  Con- 
servators to  do  is  to  enforce  the  Eivers.  Pollution  Act 
to  the  utmost  letter,  so  as  to  restore  the  purity  of  their 
beautiful  river.  If  this  is  done,  the  salmon  will  soon 
regain  their  former  supremacy  in  the  struggle  for  exis- 
tence, which  is  specially  keen  in  river  life. 


Public  Health  Examinations. 
Of  late  years  the  standard  of  requirements  in  public 
health  examinations  has  been  considerably  raised.  It 
will  be  of  interest,  therefore,  to  the  profession  gener- 
ally and  to  medical  officers  of  health,  students  of 
sanitary  science,  and  those  who  contemplate  taking 
out  the  D.P.H.,  to  have  an  idea  of  the  increasing 
scope  and  tendency  of  the  examination  tests.  It  is 
with  much  pleasure  that  we  publish  in  another  column 
complete  sets  of  questions  lately  put  to  candidates  for 
the  diploma  in  public  health  in  no  less  than  three  of 
our  leading  Universities— Oxford,  Cambridge,  and 
Durham,  and  at  the  London  Conjoint  Board.  These 
papers  have  been  specially  forwarded  to  us  for  publi- 
cation by  a  gentleman  who  holds  two  of  the  qualifica- 
tions for  which  they  were  set,  and  they  will  appear  in 
a  series  extending  over  the  next  few  weeks. 


94     Thb  Mbdioal  Pbkbs. 


EXAMINATION  PAPERS. 


Jan.  22,  18M 


Miss  M^ry  Darbt  Stubge,  who  passed  the  exami- 
natioa  for  the  degree  of  M.D.Loadon,  last  month, 
received  her  early  training  at  Mason  College,  Birming- 
ham, proceeding  afterwards  (in  1888)  to  the  London 
School  of  Medicine  for  Women,  and  the  Royal  Free 
Hospital.  She  took  Honours  in  Anatomy  at  the  First 
M.B.Ezamination,  and  was  subsequently  appointed 
Demonstrator  of  Anatomy  at  the  London  School  of 
Medicine  for  Women. 

An  old  Anglo-Indian  officer  attributes  the  increase 
of  tynhoid  fever  among  the  young  soldiers  in  India  to 
their  pronounced  teetotal  habits.  They  drink,  he 
claims,  a  great  deal  too  much  lemonade  and  other 
simii^ir  beverages,  and  he  is  of  the  opinion  that  every 
Englishman  under  the  age  of  25  who  lands  in  India 
should  go  through  a  course  of  whisky  and  soda. 

A  Medical  Club,  Limited,  has  been  founded  in 
Liverpool,  with  a  capital  of  £1,000  in  £2  shares.  The 
objects  are  to  establish  and  maintain  a  club  for 
members  of  the  medical  profession,  in  particular  those 
practising  in  Liverpool  and  its  vicinity.  The  directors 
have  been  decided  upon  to  the  number  of  16,  of  whom 
10  are  general  practitioners. 

It  has  been  estimated  that  a  case  of  quadruplets 
occurs  but  once  in  three  hundred  and  fifty  thousand  to 
four  hundred  thousand  births.  But  if  the  proportion 
were  one  in  a  million,  or  even  a  billion,  there  would 
always  be  two  persons  who  would  regard  the  prodiga- 
lity of  Nature  as  an  act  of  unkindness. 

Dr.  Wm.  Berry  has  been  unanimously  appointed 
Medical  Officer  of  Health  for  the  important  Borough 
of  Wigan,  Lancashire.  The  appointment  is  a  popular 
one,  as  Dr.  Berry  was  born  there,  is  a  justice  of  the 
peace,  and  highly  respected. 

Mb.  H.  a.  Albutt  has  been  fined  at  Leeds  for  using 
the  titles  M.RC.P.,  L.S.A.,  his  name  having  been 
removed  from  the  Medical  Register  some  time  ago. 

We  regret  to  learn  that  Dr.  C.  R.  lUing worth  is  now 
an  inmate  of  St.  Luke's  Asylum. 


[fbom  oub  own  oobbispondiitt.] 

New  AppaiNTMBNTS  IN  THE  UrnvEBSiTiT  OF  Edinbubob. 
— The  Eiioburgh  UQiver<«itv  Oourb  ha^  appointed  Mr. 
George  Berry,  M.B  ,  C.  B1.F.R.C.S.E.,  &c.,  senior  ophthal- 
mic surgeon  to  the  Royal  Infirmary,  to  the  po-st  of 
Ijeotarer  to  the  University  in  Ophtbalmologryt  vaoUed  by 
the  resignation  of  Dr  Argyll  Robertson.  Dr.  Atflaok  was 
appointed  an  additional  examiner  In  medicine  in  its  bear- 
ings to  public  health. 

AIeoioal  Fees  and  Shipownibs.— An  important  case 
affecting  doctors  and  shipowners  has  recently  been  decided 
in  Ayr  Sheriff  Court.  The  question  raised  was  as  to  the 
liability  ot  a  shipowner  for  surgical  attendance  rendered 
to.  a  seaman  on  board  ship  in  a  hame  por^.  Dr.  Charles 
M.  Stewart, of  Glasgow,  sued  the  Garnock  Steam  Shipping 
Company,  Limited,  for  £1  Is.  for  professional  «ervices 
rendered  to  a  fireman  on  board  the  company's  s.s.  Burnock, 
who  had  sustained  injuries  through  falliptj^  down  into  the 
hold  of  the  steamer  while  she  was  lying  in  the  harbour  of 


Glasgow.  The  defenders  denied  liability  on  thegroond 
that  the  ship  being  in  a  home  poro  the  master  was  not 
entitled  to  pledge  the  shipowner'')  credit  for  surgical 
attendance  The  Sheriff,  howerar,  found  that  Uia 
Merchant  Shipping  Act  of  1854,  section  2:^8,  subsection  3 
(re-enacted  in  the  Act),  and  which  provides  that  "the 
expense  of  all  medicines  and  surgical  or  medical  advice 
and  attendance  given  to  any  master,  seaman,  or  apprentioe 
whilst  on  board  his  ship,  shall  be  defrayed  by  the  owner 
of  such  ship,"  applied  to  the  present  case ;  judgment 
with  costs,  was  given  accordingly. 

Stux  About  the  Otstebs.— -At  a  meeting  of  the 
Stirling  Police  Commission  on  thn  14th  in^t.  a  letter  was 
read  from  the  Junior  Health  Officer  of  Glasf^w  to  the 
Secretary  of  the  Local  Government  Board,  stating  that  be 
had  been  informed  by  the  cook  who  wa^  ehgagdd  at  the 
County  Ball  that  some  water  which  he  drew  from  the  tap 
in  the  hall  kitchen  both  smelt  and  tasted  badly,  and  that 
if  the  subsoil  was  exposed  to  pollution  there  appeared  to 
him  fair  grounds  for  conjecture  that  the  epidemic  attri- 
buted to  oysters  might  be  traced  to  defective  dr<uns  The 
Master  of  ^orks,  Stirling,  however,  submitted  a  report 
on  the  condition  of  the  water-pipes  at  the  Public  Hall,  in 
which  be  states  that  the  service  pipe  was  opened  and 
found  to  be  petfectly  dry  throughout  its  whole  length, 
there  being  no  appearance  of  sewage  or  subsoil  water. 
The  service  pipe  was  perfectly  sound  and  the  pre««ure  of 
water  at  its  maximum.  Dr.  Wilson,  Medical  Officer  of 
Health,  Stirling,  also  submitted  a  report  dealing  with  the 
whole  subject,  concluding  his  report  by  stating  that  the 
cause  of  the  outbreak  of  the  fever  still  remained  a  mystery. 

BXAMINATION  PAPERS  FOR  THE  DIPLOMA  IN 
PUBLIC    HEALTH   AT  THE  UNIVERSmES 
OF  OXFORD,  CAMBRIDGE,  AND  DURHAM, 
AND  THE  CONJOINT  BOARD  OF  ENGLAND.(o) 
Oxford,  November  25th,  1895— Part  I. 
No.  I.  —  Chemittry  and  PhysicM. 
1.  Describe  the  treatment  of  raw  sewage  (a)  by  means 
of  slaked  lime  ;  and  (b)  by  means  of  ferrous  sulphate  or 
ordinary  green  vitriol,  with  or  without  the  supplementary 
use  of  lime.     What  proportions  of  the  respective  precipi- 
tants    are    usually  employed  per  1,000   gallons   of   raw 
sewaffo,  and  what  are  the  chemical  and  other  effecM  pro- 
duced?   How  do  the  results  compare  with  those  obtain- 
able by  sewage  irrigation? 

2  What  are  the  difficulties  attendant  on  the  combustion 
of  house-refuse  in  the  class  of  furnaces  known  as  "de- 
structors ? ''  What  are  the  conditions  requisite  for  com- 
plete combustion  ;  how  are  they  sought  to  be  effected ; 
and  with  what  results  ? 

3.  Within  what  range  of  pioportion  is  common  salt 
usually  met  with  as  a  constituent  of  drinking  water? 
What  are  the  sources  of  the  common  fialt  present  in 
different  varieties  of  drinkicg- water?  Under  what  cir- 
cumstances does  the  presence  of  a  somewhat  high 
proportion  of  common  salt  indicate  probable  sewage  con- 
tamination ? 

4.  (a)  State  approximately  the  relative  proportions  by 
volume  of  oxygen  and  nitrogen  in  atmospheric  air,  and  in 
the  air  dissolvM  by  uncontaminated  river-water,  (b)  As- 
suming that  at  mean  temperature,  and  under  an  effective 
pressure  of  30  inches  or  760  m.m.  of  mercury  100  volumes 
of  water  dissolve  approximately  3  volumes  of  oxygen, 
what,  under  standard  atmospheric  conditions,  is  approxi- 
mately the  actual  volume  of  oxygen  dissolved  in  100 
volumes  of  water,  in  accordance  with  Dalton's  law  of 
p%rtial  pressures?  (c)  What  is  approximately  the  weight 
of  oxygen  diflsnlved,  under  standard  atmospheric  condi- 
tions, in  1,000,000  gallons  of  water,  taking  1  cubic  foot  of 
oxygen  to  weigh  0*115  lb.,  and  1  cubic  foot  to  equal  6*23 
gallons  ? 

5.  Set  forth  and  discuss  the  discordant  statements  that 
have  been  made  with  regard  to  the  rapidity  and  extent  of 
the  disappearance  of  contaminating  organic  matter,  taking 
place  in  running  water.  What  evidence  is  there  as  to  the 
means  by  which  the  removal  of  the  organic  matter  ii 
effected  ? 


(a)  Bximi  ••ition  fo^the  Degree  •>{  BACtielor  m  Uygieoe,  diidfarthe 
Diploma  ia  Pat>lic  Health  (D.P.H.)  Durham. 


Jak.  22,  1890. 


EXAMINATION  PAPERS. 


Thx  Medical  Pkbbs. 


95 


6.  In  what  pmrtieolara  does  the  atmosphere  of  a  closely - 
Uteked  room  differ  from  that  of  the  open  ooontry  ?  How 
ftf  are  tbeee  difiiBrenoee  capable  of  eetimation  ?  What  are 
die  chief  agenciee  by  which  the  intermixture  of  different 
kindr  of  air  is  effected  ? 

N.B.  Candidates  are  not  expected  to  answer  more  than 
four  qneetiona 

No.  IL— Chemistry  and  Physics  {Practical). 

I.  Determine  the  hardnees  of  the  specimens  of  water,  A» 
acdB. 

2  Determine  the  amount  of  oxygen  absorbed  in  one 
hoar  from  *'  permanganate  "  in  the  specimen  of  water,  G. 

3.  Determine  the  amount  of  lead,  as  metal,  present  in 
the  specimen  of  water,  D. 

4.  Determine  bv  means  of  the  specific  gravity  bottle  the 
epecific  gravity  of  the  specimen  of  dilute  spirit,  £. 


Cambbidgk,  Tukdat,  Ootobbb  lar,  1895.— Past  I. 
No.  I. 

1.  Diecnae  critically  the  respective  values  of  (1)  a 
chemical  and  (2)  a  bacteriological  examination  of  drinking* 
wftter. 

2.  What  qoantities  of  carbon-dioxide,  water,  and  com- 
bined nitroeren  are  excreted  daily  by  an  adult  man  ? 
What  amount  of  fresh  air  is  required  per  diem  to  main- 
uin  in  health  a  person  continuously  Inhabiting  a  room  ? 
What  quantity  of  water  does  an  adult  need  per  diem  for 
drinking,  cooking,  ablution,  and  other  domestic  purposes  ? 

3  Discuss  the  value  of  att^empts  at  the  disinfection  of 
boosee  by  means  of  fumigation.  What  disinfectants  are 
nensOy  employed  for  tlus  purpose,  and  how  are  they 
rwpectively  prepared?  How  many  grains  of  sulphur 
dioxide  are  evolv^ed  by  the  action  of  150  grains  of  sulphuric 
add  on  copper  ? 

4.  Describe  the  process  of  bread-making,  and  explain 
the  changes  which  take  place  in  the  flour.  Upon  what 
data  would  yon  give  an  opinion  of  a  sample  of  flour  sub- 
mitted to  yon  ?  Explain  briefly  any  analytical  procedure 
you  would  adopt  in  order  to  arrive  at  an  opinion. 

5.  Explain  the  various  methods  in  use  for  the  softening 
of  hard  water.  Describe  accurately  how  you  would  pre- 
pve  the  reagents  for  determining  the  hardness  of  wa^er, 
and  also  bow  the  determination  of  hardness  is  made,  cal- 
eolated,  and  expreseed. 

6  In  a  town  of  100.000  inhabitants  there  are  2,600 
dssths  per  annum,  of  whioh  350  were  ascribed  to  diseases 
nf  the  respiratory  organs,  250  to  phthisis,  110  todiarrh<»«, 
1^  to  convulsions,  50  to  enteric  fever,  and  10  to 
ifeohoUsm.  Point  out  any  deviation  from  the  average 
ind  any  aonrces  of  fallacy  in  those  figures. 

Pabt  I.— Na  11. 

1.  A  cubic  foot  of  air  measured  at  32  degrees  Fah.  is 
allowed  to  remain  at  the  same  barometric  pressure  of  30 
inches  in  contact  with  water  until  saturated  at  the  tempe- 
ntore  of  60  degrees  Fah.  How  and  to  what  extent  would 
tbe  volume  of  the  air  be  chans^?  Give  calculations. 
(Vapour  tension  of  water  at  60  degrees  Fah.  :=  0*52 
ioch.) 

2.  What  are  the  meanings  of  the  terme  isobars  and 
isothermal  lines?  In  what  respects  physically  and  chemi- 
nUy  does  the  atmosphere  at  the  seaside  differ  from  that 
of  inland  towns  in  summer  and  winter  respectively  ? 

3.  What  means  are  commonly  adopted  for  the  preser- 
Tation  of  articles  of  food  for  considerable  periods,  and  how 
and  in  what  way  are  these  methods  liable  to  affect  the 
bealth  of  persons  habitually  consuming  such  food  ? 

4.  Describe  the  food-stuffs  neceasary  for  the  main  ten - 
Moe  of  life.  State  the  quantities  of  them  requisite  for  an 
idalt  for  subsistence  only,  for  average  work,  and  for 
severe  labour  respectively.  How  mu^  bread  and  how 
■neh  milk,  taken  together,  would  suffice  for  the  subsist- 
CDce  diet  of  a  man  ? 

5.  Discuss  the  significance  of  the  presence  of  compounds 
of  iron,  zinc,  and  magnesium  in  water  supplies,  and  state 
vhat  proportions  of  these  are  admissible  in  drinking- 
vstsr. 

6.  In  what  ways  may  the  atmosphere  in  a  house  become 
ooQtaoiinated  with  carbonic  oxide,  and  how  may  its 
pca«Doe  be  detected  in  such  an  atmoephere  t 


Wbdnbsdat,  Ootobir  2nd,  1895, 
Practiced  Chemistry. 

1.  Make  an  examination  of  the  sample  of  water  marked 
A  or  B,  and  write  your  opinion  as  to  its  fitness  for  domes- 
tic us«^,  giving  reasons.    (Scate  the  letter  on  the  bottle. ) 

2.  Examine  the  samples  of  air  marked  1,  2,  and  3,  and 
state  what,  if  any,  gaseous  impurities  they  contain. 

N.B. — Describe  in  each  case  the  operations  you  per- 
form, as  well  as  the  results  obtained. 

Ddbham,  Wsdhbsday,  April  17th,  1895. 
No.  III. — Sanitary  Chemistry  and  Physics. 
[I.  Describe  and  explain  how  you  would  prepare  a  solu- 
tion of  Potassium  Permanganate,  of  such  a  strength  that 
1  cc.  is  equivalent  to  1  mgrm.  of  oxygen 

K.  =391,  Mn.  =55,  0    =16,  Fe.  =66. 
2   In  what  forms  may  nitrogen  occur  in  a  polluted  well- 
water? 

3.  How  would  you  recognise  the  presence  of  each  of  the 
following  gases  when  mixed  with  air;  (a)  Sulphur 
dioxide :  (d)  carbon  monoxide :  (c)  sulphuretted  hydro- 
gen :  (d)  hydrochloric  acid  gas.] 

[4.  What  is  meant  by  the  **  height  of  the  barometer  "  ? 
In  a  siphon  barometer,  in  which  the  section  of  the  limb 
open  to  the  air  is  twice  that  of  the  closed  limb,  through 
what  distance  will  the  mercury  fall  in  the  closed  limb 
when  the  "  height  of  the. barometer"  falls  one  inch  ? 

5.  Explain  the  relation  between  the  *'head"  producing 
circulation  of  air  in  a  ventilating  system  and  the  '*  flow '^ 
of  air' produced.  State  the  vanous  means  available  for 
producing  the  requisite  head. 

6.  Define  the  dew-point.  Describe  Mason*s  wet  and  diy 
bulb  hygrometer,  and  explain  how  the  dew-point  is 
determined  by  its  means.] 

Directions : — The  answers  are  to  be  made  up  into  two 
sets,  indicated  by  the  brackets  on  the  questions.  Each 
set  is  to  bear  the  Candidate's  number . 

PrcicticcU  Chemistry, 

Examine  a  sample  of  water  (A)  for  poisonous  metals 
(lead). 

S&andarise  a  solution  of  silver  nitrate  by  means  of  a 
given  solution  oontainiuff  3*3  grammes  sodium  chlonde 
per  litre,  then  estimate  chlorides  in  a  sample  of  water  (B). 

Examine  solution  C  for  an  acid  (nitric).  Determine  the 
amount  of  acid  volumetrically  by  means  of  a  solution  of 
sodium  hydroxide  of.  known  aonormai  streogch. 

Standarise  a  solution  of  soap  by  me%ns  of  a  solution  of 
calcium  salt  of  known  strength.     Ascertain  the  hardness 
of  water  (D).  usinK  your  standarised  soap  solution. 
(The  above  paper  was  not  printed.) 

Conjoint  Board  of  Enqlavd,  July  1st,  1895. — Part  I. 
l.'What  is  an  Isobar?    What  inferences  may  be  drawn 
from  the  examination  of  Synoptic  Charts  ? 

2.  Define  Latent  Heat  and  Specific  Heat.  How  may 
the  latent  and  specific  heat  of  the  various  forms  of  Water 
be  measured,  and  what  influences  do  they  exert  on  the 
meteorology  of  this  country  ? 

3.  Describe  Bramah's  Hydraulic  Press.  The  smaller 
piston  of  such  a  pre^s  is  half  an  inch  in  diameter,  the 
larger  piston  is  ten  inches  in  diameter  ;  a  weight  of  1*2  lb. 
is  placed  on  the  smalL  What  will  be  the  weight  placed 
on  the  larger  ? 

4.  Name  the  salts  of  Calcium  and  Magnesium  most  fre- 
quently found  in  potable  water.  How  would  you  determine 
tbe  presence  of  these  salts,  and  what  practical  processes 
would  you  employ  to  remove  them  when  present  in  incon- 
veniently large  quantities  ? 

5.  What  are  the  processes  employed  to  preserve  Meat 
and  Milk  ?  Discuss  the  advantages  and  disadvantages  of 
each. 

6-  In  what  substancw  have  the  organisms  oausine 
Diphtheria  and  Tetanus  been  discovered  ?  How  would 
you  detect  each  of  them,  and  describe  them  ? 

Pabt  II. 
1.  You  are  requested  to  construct  a  class-room  to  hold 
25  youn^  adults.    With  a  view  to  economy  of  constrac- 
tiouy  artificial  ventilation  has  to  be  retorted  to.    State  the 


^^     The  Mbdioal  Pbb^s. 


eORRESPONDENCii. 


Jak.  28,1S)i 


initial  cubic  capacity  you  would  allow,  and  the  amount 
of  f roph  air  that  would  have  to  be  introdnced  per  hour  ; 
and  sketch  the  general  plau  you  would  adopt  for  warming 
and  ventilation 

2.  What  are  the  differences  between  atmospheric  air  and 
the  air  of  soil  ?    How  are  these  chanees  produced  ? 

3.  You  have  to  advise  with  reeard  to  the  Water-supply 
of  a  rural  town.  What  data  will  you  require  as  to  the 
amount  necessary,  the  amount  possible  to  be  obtained,  and 
the  reserve  necessary  for  storaipe  in  case  of  drought? 

4.  Describe  the  process  of  Bread-making.  What  dele- 
tenons  products  may  arise  during  its  manufacture,  and 
what  are  the  chief  adulterations  ? 

5.  Describe  some  of  the  principal  means  of  treatinf^ 
Sewage,  with  a  view  to  its  best  application  to  land.  How 
would  you  arrange  for  the  dippoealof  urine  and  slop- water 
on  premises  used  as  a  dwelling-house  distant  '--n  any 
Public  Sewer,  and  what  precautions  would  you  teoommend 
to  ensure  safety  to  the  inhabitants  ? 

6.  Describe  the  construction  of  the  Syphon  Barometer, 
and  how  would  you  make  an  accurate  record  of  its  varia- 
tions? 

July  3bd,  1885.— Past  III.— Pbaohcal  Chbmistbt. 

1.  Submit  the  sample  of  Water  marked  I.  to  quantitative 
and  qualitative  examination,  so  as  to  pass  an  opinion  as  to 
the  fitness  of  the  water  for  drinking  and  cooking  purposes. 
The  reasons  for  your  opinion  and  the  methods  oy  which 
you  arrive  at  those  reasons  are  to  be  briefly  stated  in  your 
report. 

[N.B.  The  total  solid  matter  of  the  Water  and  the 
absorbed  Oxygen  need  not  be  estimated.] 

2.  Make  a  qualitative  examination  of  the  samples  of  Air 
marked  A  and  B,  with  the  view  of  detecting  gaseous 
impurities,  and  report  thereon. 


THE  TWELFTH  INTERNATIONAL  MEDICAL 
CONGRESS. 

Wb  have  been  officially  informed  that  the  Executive 
Committee  has  now  fixed  on  the  19th  of  August,  1897,  as 
the  first  day  of  the  Congress,  which  will  continue  for  a 
week  thereafter.  Moscow,  as  previously  announced,  is 
selected  as  the  meeting  place.  The  Congrei>s  will  be  under 
the  patronage  of  the  Grand  Duke  Sergius  Alexandro- 
witsch.  Prof.  F.  Klein  has  been  elected  president, 
Rcnewnikow  vice-president,  Erismann  generflJ  secretary, 
and  Filatow  treasurer.  Every  qualified  medical  man  is 
eligible  ;  but  those  who  do  not  belong  to  the  profession,  if 
they  possess  a  scientific  qualification,  will  also  be 
admitted.  Members  can  be  enrolled  by  forwarding  their 
visiting  card  to  the  treasurer  Filatow,  accompanied  with  a 
remittance  for  10  roubles  or  25  francs.  This  entitles  the 
ordinary  member  to  all  the  privileges  of  visiting  or  taking 
part  in  all  or  any  one  of  the  sections.  The  extraordinary 
member  or  member  with  scientific  qualification  alone,  can 
only  visit  the  section  in  which  he  is  most  interested.  The 
Congress  is  to  be  devoted  entirely  to  scientific  work,  and 
will  be  divided  into  twelve  sections.  Contributors  are 
requested  to  forward  a  copy  of  the  papers  they  desire  to 
read  at  the  meeting,  not  later  than  Januarr  13,  1897. 
Time  allowed  for  each  paper  is  strictly  limited  to  twenty 
minutes  in  reading,  while  five  minutes  will  be  allowed  to 
any  wishing  to  make  remarks.  The  official  language  of 
the  Congress  will  be  French.  In  the  three  plenary  meet- 
ings any  European  language  will  be  acknowledged,  but 
the  sections  are  supposed  to  be  conducted  in  German, 
French,  and  Russian. 


[We  do  not  hold  ounelvei  reqtoniible  for  the  opinionB  of  our 
corretpondeDta.]  

THE  GB.VERAL  MEDICAL  COUNCIL  ELECTION. 
To  the  Editor  of  Thi  Medical  Pbbss  akd  Ciboolar. 
Sib,— Nothing  astonishes  me  more  than  the  indifierenoe 
or,  at  any  rate,  the  silence  of  the  mass  of  the  Irish  medical 
profession  at  this  moment  Let  me  remindthem  that  our 
profoeiion    ia   nnhi^plly    divided    into  the  governing 


few  and  the  governed  many.  Let  me  further  remind  them 
that  the  interests  of  the  many  have  been  and  are  daily 
sacriOced  to  those  of  the  few,  and  that  every  ill  we  Labour 
under  is  due  to  those  ruling  few.  Sixpenny  dispenaaries, 
and  advice  free  with  a  pound  of  tea,  mark  toe  lowest 
depths  to  which  any  callinp^  could  sink.  Yet  in  tlie  &oe 
of  all  these,  one  of  the  mhng  few  in  the  person  of  Mr. 
Thompson,  of  Dublin,  has  the  modesty  to  seek  our  eofiirages, 
and  I  note  that  some  of  the  masses  are  to  be  found  in  his 
train.  Intelligent  Englishmen  and  Scotchmen  strove  for 
}  ears  to  obtain  a  remedy  for  the  grievances  of  the  bulk  of 
Ihe  profession,  and  thev  did  obtain  a  partial  remedy  in 
^886,  bv  the  addition  of  six  direct  representatives  to  the 
Medical  Council.  They  intelligentlv  used  that  power  but 
we  in  Ireland,  like  the  Roman  pfebs.  of  old,  elected 
a  patrician.  Come  now,  tell  me,  ye  rural  snpporten 
C'f  nim,  whst  did  he  so  much  as  even  attempt 
to  do  for  you  during  his  tenure  of  office???  There 
are  four  men  now  in  the  field  who  appeal  to 
the  outraged  and  much- wronged  rank  and  file.  If  tboM 
four  men  go  to  the  poll  the  audacious  representative  of  the 
oligarchy  must  win.  I  appeal  to  Drs  Jacob,  Greene, 
Cuming,  and  McDonnell  to  meet  in  Dublin  and  to  produce 
their  list  of  promises,  and  let  him  who  has  the  largest 
number  of  promises  be  selected  to  fight  the  fight  for  the 
mass  of  the  profession.  I  do  not  think  that  it  ought  to  be 
Dublin  V.  Ferns  or  Dublin  v.  Dundalk,  but  it  on^t  to  be 
the  case  of  one  of  the  working  Bees  v.  one  of  the  Diploma- 
vending  Drones  who  have  heretofore  battened  on  our 
debasement,  robbery  and  degradation. 

I  am.  Sir,  yours.  &c , 

Thomas  Laffait. 
Cashel,  Jan.  13th.  1896. 

To  ihe  Bditor  of  Thb  Medical  Priss  and  Ciboulab. 

Sir, — As  two  practitioners  have  discussed  In  the  Dublin 
daily  papers  the  claims  of  individual  candidates  to  succeed 
Dr.  Kidd  as  Direct  Representative  of  the  Irish  medical 
profession,  we  feel  called  upon,  in  justice  to  Th,  Jacob,  to 
point  out  to  the  Poor-law  medical  officers  of  Ireland  that, 
whatever  claims  upon  their  votes  Mr.  Thomson  may  have 
—and  we  do  not  wish  to  depreciate  them — Dr.  Jacob's 
services  to  those  officers  transcend  such  claims  tenfold  in 
duration,  in  earnestness,  and  in  self-sacrificing  patience 
and  industry. 

It  is  true  that  Mr.  Thomson  acted,  three  years  ago.  for 
the  British  Medical  Journal  in  collating  inform»tioD  col- 
lected by  it  with  reference  to  the  abuses  and  hardships  of 
the  Poor-law  medical  system,  and  that  he  compiled  a 
useful  report  on  the  subject ;  but  for  many  long  yean 
before  this  was  done  Dr.  Jacob  had  been  persistently 
engaged  in  preparing  the  ground  which  was  subeeqaently 
occupied  b^  the  British  Medical  Journal  and  Mr.  Thomson 
in  instructing  and  advising  the  Poor-law  medical  officers 
as  to  their  rights— legal  and  moral — and  as  to  the  means 
to  be  employed  to  obtain  redress  of  their  manifoki 
grievances.  Under  his  infiuence  chiefly  the  Irish  Medical 
Association  has  been  engaired  for  twenty  yeara  before  any 
other  champion  of  these  officers  took  the  field  in  vindicat- 
ing their  legal  rights  and  enlarging  and  protecting  their 
privileges. 

Under  the  influence,  to  a  great  extent,  of  his  untiring 
and  unremunerated  labour,  additional  emoluments  to  the 
amount  of  many  thousands  a  year  have  accrued  to  the 
Poor-law  medical  officers  of  Ireland,  and  these  officers  have 
been  placed  in  many  respects  in  a  position  of  independence 
which  was  previously  unknown  either  to  themselves  or 
their  employers. 

In  iJl  t^ese  yean  let  us  ask  what  were  Mr.  Thomson's 
services  to  the  Poor-law  medical  officera  ?  Nay,  mor^ 
what  has  he  done  within  the  three  yean  since  he  com- 
pleted his  report  which  should  efface  the  repollection  of 
Dr.  Jacob's  work  ?  He  was  co-opted  as  a  member  of  the 
Council  of  the  Irish  Medical  Association,  but  he  rarely 
attended  its  meetings  or  afforded  any  assistance  in  its 
deliberations,  and  he  is  now  not  even  a  membw  of  the 
organisation.  Meanwhile  Dr.  Jacob  has  been  working 
hard  to  secure  superannuation  allowances  for  these 
officers,  and  with  his  own  hand  drafted  the  Bill  for  the 
redress  of  their  grievances  which  was  introduced  to  Par- 
liament in  the  session  of  1894  by  Mr.  T.  W.  Russell,  M.P. 

So  much  for  the  relative  pretensions  of  these  candidates 
to  represent  the  woridng  ooontcy  pmctitionen.   Air»- 


Jam.  22,  IgMw 


COBDESPONDENCE. 


Thb  Mbdzoal  Vsma,     07 


guda  the  banoMBof  the  Genenl  Medical  CohdoU  in  rega- 
btintp  edacatton  mod  examination,  we  need  only  say  that 
Br.  Jaoob  wae  one  ci  those  who,  before  Mr.  Thomson 
ocGOiued  any  public  position,  reconstructed  and  reformed 
the  Irish  syslem  of  medical  qnabfication,  and  he  thereby 
aoquired  nuniliarity  with  every  detail  such  as  no  other 
candidate  can  lay  claim  to. 

We  are  ocmvinoed  that  your  sense  of  justice  will  secure 
to  us  the  opporti     -       •       •  •        ■ 
thus  preventing  l>r.  Jacob's  great  i 
gotten  or  overshadowed. 

We  are.  Sir,  yours,  &c., 
Hknry  W  Oultok,  M.D., Univ.  Dub.,  L.R.C.S.I., 

Medical  Officer  Na  1  North  City  Dispensary. 

John  P.  Gaklasd,  L.R.C.P.I.,  L.B.C  S.I.,  Medical 

Officer  No.  3  North  City  Dispensary. 


opportanity  of  making  these  facts  known,  and 
enting  Dr.  Jacob's  great  services  from  fc>eing  for- 


LUNATIC  ASYLUMS— THE  REUGIOUS  QUESTION. 

To  the  Editor  of  Twt  Mbdical  Pbiss  add  Circulab. 

Sib, — In  yonr  issue  of  the  8th  inst.,  you  kindly  inserted 
a  few  remarks  of  mine  on  thin  important  question.  Thtse 
iiave  been  followed  by  an  interesting  lecture  in  your  last 
iflsae,  by  Dr.  Thos.  B.  Hyslop,  in  which  he  deals  with  the 
religious  aspect  of  Insanity,  and  he  remarks  that  **  A  trae 
and  philoeophical  religion  raises  the  mind  above  a  mere 
incidental  emotionalism."  Now,  granting  the  truth  of 
this  assertion,  the  difficulty  arises  which  I  for  one  should 
be  content  to  leave  ezpeits  in  lunacy  to  determine — viz., 
which,  out  of  the  mulufarious  foims  of  leligious  belief  or 
saperstitioD  which  pervades  all  types  of  humanity,  is  **  the 
tme  and  philoeophical  one"?  becau^  it  must  be  evident  to 
all,  in  the  vast  msjority  of  cases,  that  religious  belief,  of 
whatever  kind,  is  thefresult  of  impressions  drilled  into  the 
infantile  mind  through  the  influence  of  the  maternal 
SDcestry,  who,  therefore,  is  to  decide  whether  the  maternal 
tocalcations  of  one  individual  or  another  is  '*  the  true  and 
philosophic  religion."  Probably  the  safest  type  of  mind 
is  that  which  is  grounded  on  common  sense  ana  harnessed 
sod  disciplined  in  search  after  tiutb,  and  therefore  less 
likely  to  soar  in  regions  of  imagination  and  superstition. 

Dr.  Hyslop  also  asserts  that,  **  With  no  religious  and  no 
moral  obligation  the  organism  is  apt  to  become  a  prey  lo 
the  lueta  of  the  flesb.'^  This  is,  I  am  aware,  a  geoeially 
accepted  view,  but  is  there  not  a  good  deal  ot  fallacy 
eonnected  with  it,  and  is  it  not  frequently  put  forward  a«> 
a  dangerous  and  plausible  plea  to  excuse  religious  super- 
stition on  such  grounds  ?  Whatever  our  pergonal  religious 
beliefs  may  be,  we  are  bound,  in  dealing  with  insanity,  to 
take  into  account  every  factor,  and  it  may  be  open  to 
question  whether  the  cases  of  religious  enthusiasm  vihicb 
culminate  in  insanity  are  not  greater  than  those  which 
•rise  from  intemperance  in  alcoholic  stimulants.  No 
doubt  in  the  old  stagecoach  days,  before  the  incroduc  ion 
of  steam,  when  the  public  mind  was  in  a  comparatively 
torpid  state,  there  was  some  excuse  for  religions  excite- 
ment, but  since  then  life  in  its  every  phase  bas  changed, 
and  with  education,  rapid  means  of  transit,  public  enter- 
tainments, free  libraries,  &c.,  which  afford  a  healthy 
Btimultts  to  those  who  choose  to  avail  themselves  of  them, 
theie  is,  I  think,  no  longer  any  grounds  for  religious 
SDthusiasm  or  excitement,  which  so  frequently  culminate 
in  mental  aberration.  But  wh . lever  differences  of  opinion 
there  may  be  on  this  point,  it  is  io  be  hoped  our  exp  rts  in 
lunacy  will  speak  out  in  no  muffled  tone  in  repressing  the 
danger  arising  from  this  source. 

I  am.  Sir,  yours,  &c., 

Clsmbnt  H.  Sbrs. 
Queen's  Rd.,  Peckham,  Jan.  17th,  1896. 


THE  NOTIFICATION  CASE— HADDEN  FUND. 
To  the  Editor  of  the  Medical  Press  and  Cikoulah. 
S^^— Will  you  kindly  insert  in  your  next  issue  enclosed 
Ust  of  subscribers  to  the  above  Fund  ?  In  answer  to  many 
mquiries,  I  may  say  that  Dr.  Hadden  was  unable  to 
recover  any  costs  from  the  plaintiff,  so  that  his  expenses 
tTv*^  ^•'y  «"•*•  '^*^®  docision  of  the  full  Court  on 
ifr.  Uadden  s  appeal  ie  of  such  importance  to  the  entire 


profession  that  I  would  ask  all  who  wish  to  support  the 
movement  to  do  so  without  delay. 

I  am.  Sir,  yours,  &c., 

James  Cbaio,  Hon.  Trees. 


23  York  Street,  Dublin. 

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DR.  CARTER'S  THERMOINHALER  FOR  ETHER. 

To  the  Editor  of  the  Medical  Pbsss  and  Ciboulab. 

Sir,— Referring  to  some  corrections  made  by  Dr. 
Dudley  Buxton  in  your  last  week's  issue,  we,  who  had  the 
great  pleasure  of  manufacturing  the  inhaler  in  conjunction 
with  Dr.  Carter,  are  much  pleased  to  see  it  criticised  in 
the  MxdioalPriss  and  Cibctjlab.  As,  however,  general 
statements  are  unsatisfactory.  Dr.  Dudley  Buxton  would 
gieatly  oblige  by  pointing  out  in  your  next  week's  issue, 
each  of  the  many  grave  defects  which  he  considers  and, 
it  appears,  found  in  practice  inherent  in  its  construction. 
This  information  forthcoming  may  enable  us  to  explain  in 
a  plain  and,  we  believe,  eatisfactory  way  the  cause  of  the 
difference  of  opinion  held  and  ei pressed  bv  Dr.  Dudley 
Buxton  to  that  held  by  Dr.  Carter  and  ourselves  regarding 
mechanics  in  the  administration  of  anesthetics. 

Meanwhile  we  enclose  a  table  of  Dr.  Carter's  first  22 
cases  of  normal  etherisations  effected  by  means  of  the 
inhaler  under  discussion,  showing  an  unprecedented  uni- 
formity in  the  quantity  of  ether  expended  on  an  average 
per  minute,  viz. : — 

In  the  first  series  of  18  administrations  31*5  minims. 
„      second    „       4  „  814 


Thi  Mbdioal  Piwn. 


NEW  ARTICLES. 


Jan.  22,  1896 


Are  the  DDifoim  reBulttobtaioed  by  Dr.  Carter  in  bia 

oi  85  aod  86  facts  conaitteDt  with  tbe  general  atatementa 

Dsde  by  ycur  correfpoodeot  f 

1  haxikiDf;  you  in  anticipation  for  ineerting  this  letter 
ir  }  our  next  week's  is»ue, 

We  are,  8ir,  yours,  &c., 

Kbohni  akd  Sssemanh. 
Lrndon,  January  18th.  1896. 


TURNERS  GUIDE  TO  THE  MEDICAL  AND 
DENTAL  PROFESSIONS,  (a) 
This  little  book  may  be  strongly  recommended  to  all 
tho^e  about  to  enter  the  medical  or  denLal  professions, 
except  to  those  very  rare  examples  in  tbe  ranki»  of  medi- 
cine, men  of  fortune,  who  are  not  likely  to  be  mainly  or 
entirely  dependent  upon  their  calling  for  a  livelihood. 
The  book  gives  full  information  and  is  a  trustworthy  guide 
in  all  matters  bearing  upon  a  start  in  professional  life.  It 
elearly  explains  the  commercial  details  as  to  purchasing 
and  selling  practices,  partnerships,  &c.,  details  on  which 
the  average  professional  man,  through  lack  of  business 
training,  is  commonly  in  sore  need  of  guidance.  If  we 
have  any  fault  with  the  book,  it  is  that  these  objecte 
which  it  admirably  fulfills  are  not  clearly  indicated  in  ite 
principal  title. 


ANDXRSON  ON  DISEASES  OF  THE  SKIN,  {b) 
Thb  second  edition  of  this  important  work  ia  consider- 
ably larger  than  the  original  volume.  It  contains  a 
number  of  articles  specially  contfibuted,  as,  for  example, 
one  by  Prof.  Unna  on  Eczema  seborrhoicum.  The  text  is 
illustrated  by  numerous  illustrations  and  by  several  well- 
executed  chromo-lithographa.  It  deals  systematically 
with  diseases  of  the  skin,  a  subject  whicn  has  of  late  years 
attained  considerable  importance,  and  is  firmly  dovetailed 
into  the  literature  not  only  of  general  medicine,  bat  also 
of  other  higbly-develooed  specialties.  There  is  no  need  to 
discuss  exhaustively  the  contents  of  the  present  volume. 
The  author  has  presented  a  general  view  of  the  subject, 
sod  has  incorporated  the  results  of  his  own  wideexperi- 
•nee.  Indeed,  the  individuality  of  the  Scotch  methods 
t  nd  teaching  is  traceable  thioughout  thete  pages.  As  a 
wot  k  of  reference  the  book  might  perhaps  be  made  more 
valuable  by  condensing  some  P«rte  and  enlarging  others. 
The  interesting  condition  of  Plica  Polonica,  for  instance, 
deserves  more  than  a  couple  of  lines.  Again,  we  fail  to 
find  any  mention  of  the  important  group  of  associated 
symptoms  known  as  Raynaud's  Diseai«e.  The  author  has 
wisely  placed  a  description  of  various  rare  dermatoses  to 
an  appendix.  The  book  is  well  mounted,  and  should  be  on 
the  shelves  of  every  practitioner  of  medicine  who  is  inte 
rested  in  dermatology. 


STOCKEN'S  DENTAL  MATERIA  MEDICA.  (c) 

This  little  book  has  been  in  earlier  editions  favourably 
reviewed  in  the  Medioal  Pbbss  aiyd  Circular,  and  calls 
for  little  notice  now.  It  probably  contains  enough  infor- 
mation on  the  subject  for  the  practice  of  dentistry 
in  which  the  role  of  materia  medioa  has  a  very  small 
place  indeed.  Is  is  the  salutary  rule  among  dentists, 
moluding  those  medically  qualified  never  to  prescribe  other 
than  strictly  local  medication.  Dentists  need  practically  a 
knowledge  merely  of  the  properties  and  uses  of  such  drugs 
as  are  employed  in  local  applications  within  and  without 
the  teeth,  or  in  the  cavity  of  the  mouth,  as  antiseptic, 
or  other  forme  of  lotions  and  gargles.  This  know- 
ledge may  be  acquired  from  Messrs.  Stocken's  book. 

(a)  "  Ouide  to  (he  Medioal  sod  Dental  Profeesiont,  with  a  Chap, 
tor  on  Lady  Doctors  by  MIm  F.  M.  Stratt-Cavell."  By  Perclv»l 
Tamer.    Loudon :  Ballliere,  Tindall,  A  Cox. 

(6)  "  Dlieatei  of  (he  Skin."    By  T.  McCall  Anderson,  M.D.,  Profei- 
sor  of  Clinical  Medicine,  Glasgow.    Snd  Edition.    London:    Chae 
Qrilllnft  Co. 

(0)  "  Dental  Materia  Medlca  and  Therapeutics."  By  J.  Stooken 
Ii.D.8.  Eevlaed  by  Leslie  m.  Stooken,  L.B.C.P.  and  J.  O.  BuudiAr 
J..D.8.,  *&    fOnrlh  BdilioB.    Londoa :  Lewis.    1886.  ^^' 


Jl£tD  ^rtiatB. 


ELASTIC    CLOTH  BANDAGES  AND  BELTS. 

SoMB  time  since  we  received  from  the  klcxiDgiO'g 
Patent  Hygienic  end  Elsstic  Cloth  Syndicate,  Limited, 
samplea  of  materiala  for  undercIothiDg  and  elsf^tic  beltr. 
We  have  taken  advantage  of  the  interval  to  pat  tbe  latter 
to  a  practical  test,  and  we  are  now  enabled  to  epeak  from 
experience.  The  materials  comprise  ribbed  ana  anribbed 
cloths,  the  former  being  lighter  in  texture  and  better 
adapted  for  summer  use  or  in  hot  climates.  These  cloths 
can  be  made  up  into  vesta  or  used  in  the  shape  of  chest 
protectors,  belts,  and  the  like.  They  have  a  soft  velvety 
Aurface,  are  extremely  elastic,  and  their  texture  allows  of 
free  cutaneous  ventilation,  while  securing  adcqnste 
warmth;  and,  in  addition,  garments  and  other  anides 
made  thereof  can  be  washed  with  soap  in  hot  water  with- 
out detriment  to  their  structure  or  elasticity.  In  tbe 
form  of  bandagea  the  cloth  afiorda  a  uniform  and  comfort- 
able mechanical  support,  and  its  porosity,  by  facilitating 
perspiration,  obviates  the  disagreeable  sensations  associ- 
ated with  the  use  of  ordinarv  elastic  bandages,  than  wbick 
moreover  it  is  cheaper,  and  it  can  be  efficiently  deansed 
when  required. 

Belts  made  of  thia  material,  whether  for  men  or  women, 
are  ideally  comfortable,  and  such  belts  are  Incomparably 
superior  to  similar  articles  made  of  the  materiala  osnally 
employed.  Those  submitted  to  us  were  neatly  made 
and  finished  off  in  the  most  workmanlike  manner.  Their 
elasticity  does  not  appear  to  have  suffered  appreciably 
even  after  two  washings,  and  we  cannot  imagine  anyoDs 
who  baa  given  these  a  trial  ever  reverting  to  the  ohi- 
fashioned  appliances. 

The  materials  lend  themselves  to  oompressiveappliaooM 
of  every  description,  and  we  are  promised  a  lady  s  corset 
which,  will  fulfil  a  long  felt  want,  among  lady  cycUste. 
They  are  intended  to  be  worn  next  to  the  ^kio,  for  which 
their  softness  of  texture  and  pliability  admirably  adapt 
them.  The  elaatioity,  moreover,  can  be  increased  or 
diminished  in  the  course  of  manufacture  according  to  the 
purpose  for  which  the  particular  cloth  is  to  be  used. 

THE  "ALLENBURYS  •  BABY  FEEDER 
'  Thi8,  the  most  modern  form  of  the  feeding-bottle  dear 
to  our  infancy,  represents  a  period  of  evolution  extending 
over  many  years, 
during  which  the 
ingenuity  of  invent- 
ors has  been  ran- 
sacked in  the 
endeavour  toobviate 
the  inconvenience 
and  the  dangers  of  the  original  feeding-bottle.  The 
**  Allenburys"  feeder  consists  of  simply  a  bottle,  a  valve, 
and  a  teat.  The  bottle,  which  is  graduated  to  show  the 
amount  of  fluid  intiodaced,  has  an  opening  at  both  mdi, 
and  it  can  be  tho-  ~ 

roughly  and  easily 
cleansed  by  running 
water  through  it 
from  a  tap.  Verb, 
sap.  The  teat,  being 
of  pure  rubber,  can 
be  turned  inside  out, 
thus  rendering  pet- 
feet  cleansing  possi- 
ble. The  valve 
stopper  has  a  slit, 
which  allows  air  to 
enter  as  the  fluid 
is  withdrawn,  and 
the  flow  can  be 
regulated  by  modi- 
fying the  dimen- 
Biods  of  the  slit. 
Verily,  the  baby  of 
the  present  day  has 
much  to  be  thankful 

for,  because,  if  some  mothers  still  wantonly  reooanoe 
the  pleasurable  duty  of  suckling  their  offspring,  th«y 
have,  as  an  alternative,  a  feeding-bottle  which,  with 
ordinary  care,  is  incapable  of  harbouring  the,  gems « 


JAif.  22,  1896. 


WEDTCAL  NEWS. 


The  Medical  Pbxss.     99 


decwmpcMitioD,  tbiu  aTorting  the  coUo  which  past  genera- 
tioDs  of  haDdfed  babies  have  hai  to  grin  and  bear. 


Societj  for  the  Relief  of  Widows  and  Orphans  of 
Medical  Men. 
A  QUARTKRiY  coQrt  ot  the  Directors  of  this  Society  was 
held  Janaary  8th,  Dr.  Pollock  in  the  Chair.  Three  new 
members  were  elected,  and  the  deaths  of  five  reported. 
There  were  no  freeh  applications  for  grants.  It  was 
resolveci  that  a  sum  of  £1,162  be  diatfibnted  among  the 
51  widow*,  the  8  orphann,  and  the  4  orphans  on  the  Cope- 
land  Fttod.  The  expenses  <  f  the  quarter  were  £76  The 
Cbristmas  present,  £452,  had  been  given  on  December 
2Dcb.  A  further  sum  of  £500  had  been  received  from  the 
MOentors  of  Miss  Parpue,  making  in  all  £3,000. 

British  Medical  Benevolent  Fund. 
Thx  AnnuAl  General  Meeting  of  subscribers  to  this  fund 
was  held  on  Tuesday,  January  14th,  at  the  residence  of 
the  Treasurer.     The  chair  was  taken  by  Mr.  J.  T.  Mould, 
F.R.C.S.,  Yioe-president,  in  the  absence   of   Sir   James 
Pafcet,   Bart.,   President,    unavoidably   prevented    from 
preeidinK.    Amongst   the  subscribers  present  were  Drs. 
Sidney  PhUlips,  Bright.  Baines,  Felce,  Bowles,  Holman, 
and  Lowe,  and  Messrs.  Parker  Young,  Page  Kiallmark, 
Rofdie  Lynch,  Byam,  Moigan,  and  SowaKl  Marsh ;  the 
Treaeorer,  Sir  Wm.  Broadbent,  Bart. ;  and  the  Honorary 
Secretaiiea,  Dr.  Samuel  ^est  (finance)  and  Mr.  Edward 
Eaet  (cases).    The  financial  statement  was  submitted  and 
the   report   of  the  Committee  read,  and  from  them  it 
appeared     that     subscriptions,    £991    8s.,    and    dona- 
tions,   £700    18s.    8d.,   together,    £1.692   3s.    8d.    had 
been   received,  the   income   from   investments  amount- 
ing   to     £2,333.      £1,548     had     been    distributed    in 
grants,  and  i07  annuitants  had  received  £2,114  6s.  8d. 
The  distribution  had  been  efiected  mainly  through  the 
agency  of  the  Cheque  Bank  m  mom  hly  instalments,  a 
mode  found  by  tie  Committee  exceedingly  advantageous. 
Eighteen  new  annuitants   had  been  elected  to  supply 
vacaneiea  caused  by  death,  and  grants  had  been  made  to 
158  applicants,  the  total  number  of  applications  received 
bomg  212.     Three  legacies  bad  been  received  durine  the 
>ear— £500  from  the  estate  of  the  late  T.  M.  Stone,  Efq., 
£45  from  that  of  Miss  Wallace,  and  £.300  from  the  Ute 
Miss  Brigstocke.    During  the  year  the  trust*  es  had  asked 
lo  be  relieved  from  the  respa|nsibiiity  which  they  had 
borne  for  so  long,  and  had  resigned  their  office.    Their 
resignation  was  received  by  the  Committee  with  regret 
and  an  expression  of  thanks  for  their  services  in  that 
capacity.    Sir  William  Broadbent,  Mr.  John  H.  Morgan, 
and    Dr.    Samuel     West    had   accepted  office   in   their 
place.    Several  changes   in    the    useful   office   of   Hon. 
Local     Secretary    haid     taken     place.      Dr.    Markham 
Skerritt      had      been      succeeded      by      Dr.     Michell 
Clarke,  at  BristoL     Dr.  Duncan  succeeded  Dr.  Miller  at 
Dundee,  and  new  Secretaries  had  been   appointed  for 
Tottenham,  Hampstead,  and  Kilbum,   viz..  Dr.  G.  A 
Watson,  J.  W.  Piloher,  Esq.,  and  Dr.  Thurton,  and  Mrs. 
£.  E.  Palmer  had  accepted  the  post  of  Lady  Collector  at 
Norwich.     Dr.  Baxter  Forman,  Dr.  Marmaduke  Prickett, 
and  Mr.  Edward  East  joined  the  Committee,  and  Sir  Henry 
Adand,  Sir  Edward  Sieveking,  and  Mr.  Herbert  rage 
were   appointed    Vice-Presidents.      Mr.    Edward    East 
resigned  his  appointment  as  Secretary  for  case«,  and  received 
the  thanks  of  the  meeting  for  his  long  services,  and  is 
pucceeded  by  Mr.  Joseph  white,  6  Southwell  Gardens,  S.  W. 
Votes  of  thanks  were  passed  by    acclamation    to   the 
Treasurer,.    Secretaries,    Auditors,    and  to  the   Medicai 
Press,  and  Mr.  Mould  was  thanked  for  his  services  to  the 
fund  and  for  his  conduct  in  the  chair. 

The  Britisli  Gyn»cological  Society. 

The  following  us  tne  roeult  of  tha  ballot  fur  officers  of 
the  above  Society  : — 

Hooonry  President:  R.  Barnes,  M.D ,  FRCP" 
(London).  President:  Clement  Godson^  M.D.,  M.R.C.P. 
(London).      Vice-Presidents;    0.      H.    Bennett,     MP. 


(London),  Professor  J.  W.  Byers,  M.D.  (Belfast),  H. 
Macnaugh ton- Jones,  M.D.  (London),  Leith  Napier,  M.D. 
(London),  A.  A.  Rasch,  M.D.  (London),  Professor  W.  L. 
Reid,  M.D.  (Glasgow),  Professor  A  W.  MayoRobeon, 
FR.CS.  (Leeds),  C.  H.  F.  Ronth,  M.D.,  M.R.C.P. 
(London),  J.  W.  Taylor,  F.RC.S.  (Birmingham),  Pro- 
fessor J.  Wallace,  M.D.  (Liverpool),  W.  Gill  Wylie,  M.D. 
(New  York).  Treasurer  :  J.  A.  Mansell-Moullin,  M.D. 
(London).  Librarian :  George  Granville  Bantock, 
M.D.  (London).  Council:  Dudley  Buxton,  M.D. 
(London),  T.  Kilner  Clarke,  F.R.C.S.  (Hudderefield), 
E  Teni-on  Collins,  F.RC.S.  (Cardiff),  W.  Dingley, 
M.RC.S.  (London),  T.  B.  Gimsdale,  M.B.  (Liverpool), 
F.  N.  Haultain,  M.D.,  F.R.C  PEd.  (Edinburgh),  W. 
Balls  Headley.  M.D.,  F.R.C.P.  (Melbourne).  P.  L.  Hebert. 
M.D  (London),  R.  A  Hodgson,  M.R.C  S.  (London),  F. 
Bowreman  JesBOtt,  F.R.C.S.  (London),  Lewis  Jones,  M.D. 
(London',  J.  Macph Arson  Lawrie,  M.D.  (Weymouth), 
Henry  Lewif>,  M.D.  (Folkestone),  R.  Marsden  Low,  M.B. 
(London),  J.  J.  Macan,  M.D.  (London),  H.  Michie,  MB., 
(Nottingham),  J.  R.  Morison,  F.R.C  S.  (Newcastle),  James 
Oliver,  M.D.  (London),  H.  W.  F.  Powell,  F.R.C.S  Ed. 
(London),  T.  Savage,  M.D.,  F.R.C.S.  (Birmingham),  Pro- 
fessor  A.  J.  Smith,  M.D.  (Dublin),  S.  Sunderiand,  M.D. 
(London),  W.  Travers,  M.D.,  F.RC.S.  (London),  A 
Wallace,  M.D.  (London).  Editor  of  Journal:  Leith 
Napier,  M.D.,  F.RS.Ed.  Honorary  Secretaries:  F.  F. 
Schacht,  M.D.  (London),    John  Shaw,    M.D.   (London). 

The  Horveian  Society. 

Ths  following  gentlemen  were  elected  to  office  at  the 
last  meeting  of  this  Society  : — 

President :  Mr.  J.  Knowsley  Thornton,  M.B.,  CM 
Vice  Presidents :  Dr.  W.  Hill,  Dr.  E.  Clifford  Beale,  Mr. 
£.  W.  Roughton,  Dr.  Lamb.  Treasurer  :  Mr.  H.  Cripps 
Lawrence.  Council :  Sir  John  Williams,  Bart ,  Mr.  R.  S. 
Armstrong,  Mr.  E.  Bartlett,  Mr.  Peyton  Beale,  Dr. 
Boxall,  Mr.  Henry  Davis,  Mr.  George  Eastes,  Dr.  L. 
Guthrie,  Mr.  F.  W.  Hazel,  Mr.  S.  Hurlbutfc,  Mr.  Henry 
Juler,  Dr.  J.  E  Squire.  Hon.  Secretaries :  Dr.  Cagney, 
Dr.  F.  W.  Cock. 

Society  of  Members  of  the  Royal  College  of  Surgeons  of 
England. 

A  MBETivo  of  the  Executive  Committee  of  this  Society 
was  held  on  the  16th  inet.,  at  which  the  following  resolu- 
tion was  carried  unanimously,  and  ordered  to  be  commu- 
n  cated  to  the  medical  journals  : — *'The  Executive  Com- 
mittee of  the  Society  M.R.C.S.  desires  to  thank  the 
Fellows  most  heartily  for  their  recent  vote  affirming  the 
principle  of  the  direct  representation  of  Members  upon 
the  Council,  and  the  Committee  hope  that  this  vote  will 
mark  the  commencement  of  a  new  era,  in  which  the 
Fellows  and  Members  will  work  together  for  the  good  of 
the  College. 

Compnlaory  Notification  Fees  for  Ireland. 

We  note  that  the  Local  Gk>vernment  Board  for  Ireland 
has  intimated  to  the  Lurgan  Town  Commissioners  that 
they  are  at  liberty  to  pay  to  the  medical  officer  of  the 
workhouse  the  munificent  fee  of  one  shilling  for  notifying 
to  the  medical  officer  of  health  any  case  of  infectious 
disease  which  occurs  in  the  workhousa  It  appears  that 
the  Act  of  Parliament  which  fixts  the  fee  payable  to  a 
private  practitioner  at  2b.  6d.  does  not  allow  more  than  Is. 
for  a  public  medical  officer. 

The  Health  of  Ireland. 

Thb  last  quarter  of  the  year  which  has  just  closed  is  re- 
ported by  the  Registrar- General  to  have  been  exceptionally 
healthy,  the  death-rate  for  Dublin  being  for  that  period 
23*9,  or  2'9  below  the  average.  This  ratio  compares  with 
18  0  for  London,  19*2  for  Glasgow,  and  171  for  Edinburgh 
for  the  same  quarter.  The  improved  health  of  .the  city  has 
been  due  to  the  exceptional  small  number  of  zymotic 
deaths,  which  numbered  36  per  cent,  below  average.  There 
was  a  rapid  declension  in  the  frequency  of  small  pox.  The 
ratio  for  the  15  towns  outside  Dublin  was  22'8  per  1,0(X)  of 
population,  measles  having  been  severe  in  Belfast  anci 
scarlatina  in  other  towns. 


100      The  Mtoioal  Pr„..        NOTICES  TO  OOBBEBPOyDENTS, 


jav.  fi2,  im. 


^OtiUB  to 

Corrcgpanbtntg,  j^hort  fetters,  &c. 

|!^  CORRMPOHDEHTB  requiring  a  wply  In  thii  oolnmn  are  i^- 
tlcnlarly  reqneited  to  make  um  of  a  dittinoHve  tignature  or  <t.iitoI«, 
and  aToid  the  practice  of  signing  tbemielvee  "  Reader,"  "  Snbsoriber/' 
•  Old  Snbaoriber,"  Ac.  Much  oonfnilon  will  be  ti»ared  by  attention 
to  this  role. 

Orioival  artiolis  or  Urtbrs  intended  for  imblleatlon  ilionld  te 
written  on  one  tide  of  the  paper  only,  and  mnit  be  anthenlicated  with 
the  name  and  addreaaof  the  writer,  not  neeeeearilyforpnblloatloD, 
bat  as  eridenoe  of  Identity. 

LOCAL  SRPORIB  AHB  NlWS— Oorreipondente  deelrou  of  drawing 
attention  to  theee  are  reqneeted  kindly  to  mark  the  ntwtpapen  when 
•ending  them  to  the  Bdltor. 

GEHERAL  PRACTiTlONlR  (Lteds).-  A  good  English  aitlflcfal  eje  wUl 
last  ebout  twelre  months.  Although  glBSS-eyes  j  f  lot*i»n  mannfaj. 
tnie  are  cheaper,  thiy  will  ret  Bt>i.d  w»ar  as  Irng  as  Enali»h  made 
eye-.  It  is  the  solvent  action  of  the  tears  upon  the  gla»s  that  »  uses 
elass-eyes  to  becon'e  roi  gh  and  ui  sultaMe  for  furiler  use.  A  large 
manufacturer  has  stated  that  about  50,(00  of  ihtse  » ppUances  are  used 
up  annuidly. 

BE  CAREFUL  OF  SODA  WATER  I 
MAVK  TWAIN  has  been  giving  a  lectnie  on  soda  water.  He  said 
thai  be  could  notrtcommend  It-i^s  a  steady  drink.  After  drinkli  g 
thirty-eight  bottlea  he  found  hlwsfeU  full  of  gi-s  and  as  tight  as  a 
balloon.  He  had  orly  one  ai  tide  of  clothit  g  left  that  he  could  wear, 
and  tbat  waa  his  umbrella. 

MR.  C.  C.  L.— The  matter  shall  be  cai*lully  considejred,  but  we 
think  you  have  taken  an  extreme  view  of  >our  neighbour  s  poslUon. 
Dr.  Sobwartz,  (CenstantinoplirX-J**PM  received. 
M.R.C.S..L.ir.C.P.  (Cre^kerne).-Pnre  cow's  milk  should  have  a 
specific  gravity  of  1U30,  and  should  yield  from  ten  to  fourteen  volumes 
percent,  of  cream,  and  never  less  than  three  per  c  ent  by  weight.    The 
normal  amount  oi  water  should  be  atout  eighty-seven  per  cent. 
TB£  ARMY  MEDICAL  SERVICE. 
A  cOMPiTinvR  examination  for  levcnteen  commisalonsin  the  Army 
Medical  Btatt  win  be  held  on  the  7th  Febmaiy  and  following  days. 
Particulars  thereof  will  be  found  in  our  adveitisemtnt  columns. 

DR.  DooKRELL.-The  paper  u  a  fairly  wide  one.  well  suited  to  test 
the  candidate  s  knowledge. 

A  MEDICAL  CLUB  FOR  LIVERPOOL. 
A  LIXITBD  company  has  been  formed  in  Liverpool,  with  a  capital  of 
£1,00U,  for  the  purpose  of  aiarling  a  medical  club.    There  are  fifteen 
dlrtctoU,  all  medical  practitlontrs  in  the  city. 

A  MfMBER.— We  do  not  intend  to  take  sides  in  the  contention  ;  it 
is  a  purely  commercial  question  between  opposins:  iuleresto  and  we 
thluk  it  a  mifeteke  to  have  raia«d  it  In  the  nrbt  lustance. 
MBDICAL  DKFE^CE  INSURANCE. 
Thr  defence  of  the  profession  In  respect  of  Ito  '*  character  and 
financial  InteresU  "  has  been  tek«  n  up  by  a  company  recently  formed 
in  London  with  a  capital  of  £10,OtO.  It  is  to  comome  insurance  in  its 
function,  but  of  what  nature  does  not  transpire  save  that  it  is  not  to 
be  lusurance  on  life.    Ihe  first  kubscriber  is  a  chemist. 

Dr.  Mortimer  has  missed  the  point  coLtended  for,  if  he  wiU  re-read 
the  article  it  will  be  readily  seen. 

A  QUACK'S  LIBEL  CASE. 
Wi  chronicled  In  our  last  number  the  conviction  of  John  Ferdinand 
M.D.,  U.S  A.,  who  has  been  for  sou.e  time  in  *"««•!  P'^*'^"?.-.,™ 
said  individual  has  le.t  aggrieved  be<  au»e  a  lealtimain  practitioner 
;jferredtohimaa"adai^ableliar,  a  daylight  robber,  and  one  of 
the  ^oist  impostors  that  ever  came  to  London.  Of  course  tnu  waa 
hardly  polite  language  to  use  even  when  rtferring  to  a  qua.  k.  "'J  «> 
the  matter  b.id  fo  be  tbrefched  out  at  the  ftheriffs  Court;  ou  Friday 
last.     FerdlnsLd  sought  £2,0OO  damages,  and  rtceived  6s. 

DR  Fleming  (Livtrpool).-No  information  upon  the  subject  has 
so  far  reached  us.  If  our  correspondent  will  forward  ua  the  papers  we 
will  be  glad  to  comply  with  his  request. 

SOCIkTY  OF  ANiESTBETISTS. 

The  secretary  of  this  society  asks  us  to  point  out  that  Mr.  G.  Bew- 

lett  Bailey.  President,  was  in  the  chair  at  the  meeting  reported  In  our 

columns  in  the  8th  Inst,  not  Mr.  F.  Woodhouse  Brame,  whose  term 

of  office  has  expired. 

F.R.C.8.L- The  offices  of  the  General  Medical  Council  are  at  299 
Oxford  Street,  London,  W. 

HINTS  TO  A  CYCU8T. 
Do  not  be  stubborn  with  a  balky  wheeL  If  the  front  wheel  gels  In 
a  rut  Koiufl  east,  and  the  hind  wheel  in  another  going  west,  dismount 
and  aiiue  the  matter  standing,  unless  you  are  iired  and  want  t*.  lie 
down  by  ihe  roadside  without  mbkli  g  the  effort  to  do  so  «»»a»k{»ied. 
Keep  3  our  lamp  lit  when  riding  at  night.  The  b*  y  who  thought  he 
was  safe  because  he  had  a  parlour-match  in  his  pocl-et  came  home 
with  a  spoke  in  his  wheel  which  didn't  belong  tbtre.-  Harptr. 

JEUetingB  of  the  Sodeties. 

Wedmbsdat,  Jan.  22nd. 

D  ERMATOLOOlCAl  SOCIETY  OP  GREAT    BRITADI    AHP    IRELAHP.— « 


p.nL    Cawf  by  Drs.  Stowera,  Abraham,   Walah,  and  othm.    Pr. 

sii.    D^jf?  Woods  :  Cerrical  Neuralgia  treated  by  Bnggertlon  wilh- 
out  Bypnotic  Sleep.    And  other  cases.  o„««i,«#ft4. 

i)CliTT  OF  ART8.-8  p.m.    Mr.  Frank  W.  Orierwn  :  Supply  of  Ma- 
water  to  London. 

FBIDAT.  JAH.  24TH. 

CUBICAL  SOCUTT  OF  LO»DOH.-Dr.  A.  WiUon  :  A  Girl  •^^J^ 
gltUln  BysteKMjpileptlc  state  with  Dual  M'tf  "ce-  5'/«™« 
Dalton :  rfyopathfc  jfiscular  Atroi  hy  in  an  Adult. ,  Mr.  J^-  ^™  • 
Suppuration  of  the  Shoulder -Joint  in  a  Man  aged  f  rty^Sf*;  I™ 
IncSed  Excision  of  the  Temporo-maxillaiy  Joint  for  Ai^ 
Deformans,  Charcofa  Disease  of  Shoulder-Joint,  •'i*  ^^.S^rSi; 
A  Case  of  Extenalve  Skin  Grafting.  Mr.  H.  »,^^H^- 5^ 
Injm  to  Upper  E^remity  of  Femur.  Mr.  C.  M»«»f^  ^^^• 
Impaired  Oroi^Th  of  Lower  Epiphysis  of  ™»»  gJTff f«™ 
Mr:  Raymond  Johnson  :  Caae  of  Traumatic  Orbital  Anenryam. 


Vacancies. 

Bootie  Borough   HospitsL-Senlor  House  ,^;V^-^^^^lZ 

annum,  with  board,  washing.  Ac,    Appllcatlona  to  be  addressed 

"  Chairman,"  Hooile  Borough  Bospltal.  ^wtle. 
Bradfr  rd  Inflniary.-Diapenfary  Surgeon.    Salary  £V0  per  annna, 
%hl>o«randreaidSnce.    Appllcatlona  endorsed  "Dispensary 

Sunreon."  before  Jan.  27th.  __         ^  _  ,_^__  -_^ 

Dorset X^ty  Poapltal,  Dorchest«.-  Houae  \^^^'    ^"PJ^ 

with  hoard  and  lesldinoe.    Further  partlculara  of  V» .  E.  orovts, 

Icenwav.  Dorchester.  Clerk  to  the  Committee. 
Samaritan  fiee  Hospital  for  Women  and  Children.  London  -Saiwj 

to  the  Out-Depariment.    AppUrations  and  testlmonUls  to  be  seat 

to  tiie  Secretary  not  Inter  than  Feb.  4th. 
TheMmrtlesexHOTpltal  Medical  t»ohooL-l ectureahlpa  on  Anatooy 

and  Ph^riolw     APPlicatl^^^  to  the  D«an  o»  the  Medical  Scho*t 

from  wbom  all  further  «n'^f^*«n  ""^J®,''^*!*;?!?-  u^t^  £.« 
Tower  Hamleia'  Dianensary.-Re^lnent  Medical  ^^«^«^-/»™JsJ? 

per  annum,  fuinishedroon^s./'oals  gw.  »njl  attendapoe.    A^taj- 

tionrto  tiie  Secretary.  Tower  Hamlets'  White  Hoft<»  btreet, 

Stepney. 


Jlppotnttncni» 


BARKER    G.  C,    M.A.Camb..  M.D.Bmx..  L.R.C.P.Lond.,   M.R.C8. 

Physician  to  the  Brighton  and  Bove  Dispeniary. 
Garrad  F  W.,  M.B.,  B  C.C*i  tab..  House  surgeon  to  the  Wameford 

and  South  WarwiikshlreHoapital.Leamlrijion. 
GILES  B  OH.,  M.B..  Ch-BAdeL.  Health  Ofllcer  to  the  Wyndhsm 

QREEi*rSf¥.?^fG;SSLlrwn.Ennl..  Aaalstant  Medical  Officer  to 

HEA^'a"i'w'K'pt^^^^^ 

by  the  Mlnehead  Urban  District  Council. ,.    ,  ^^         ^  „    ,^.  . 
HoliTkh,  J.  8.,  M  D.IreL,  L.R.C.S.Eoln.,  Medical  Offloer  of  Health  by 

the  Belchamp  and  Melford  Rural  District  Council. 
JcHK8T..HE,W.  B.,  M.A.,  M.B..  C.M.Edln.,  House  Surgeon  toths 

Darlinjrton  Hospital  and  DIsptUMiry.        ^.  «    ,  «^       -    ,, 
MAUBY  B.  P.,  M.D?.  D.P.H.CamK  Assistant  Medical  Officer  for Uw 

PHlJuPS.  J.  N.,  L.R,C.P.Lond..  M.R.C.S.,  M.dical  Ofllcer  of  Health 

tor  the  Cannock  BuralSanltaTyDiatnct.    ,.  _  ^  „     „       ,        . 

PoRiER,W.  S.,  M.D.Duih.,  UR.CP.Lond.,  M.R.C.8.,  Examtoer  of 

RElDT*ir,M'B.\""M:Aberd..  Health  Ofllcer  f or  the  Heytesbmy 

8TRrK«;I!tRXJ.F:L^^%.R.C.^  medical  Oilcerfor 

the  lufirmary  of  the  Whltechapel  CJfion. 


I^ixttib. 


HOWELL. -Jan  18th  at  Mlddlesbrough^n -Tees,  the  wife  of  R.  Edw. 

Howell,  M.B.Edln..  M.R.C.8.  L.K.C.P.,  of  acaughter. 
HUXPBRSTB  —Jan.  16th,  at  60  Falrholme  Road,  West  Ktnsingtoo, 

the  wife  of  Chitrlcs  htyle  Humphreys,  M.D.,  ofa  son. 
Parr-Dldlby  -Jan.  IHh,  at  The  Grove,  Oosaington,  Leicester,  t&e 

Wife  of  Arthur  D.  Pan-Dudlev  M  B.C.8..  L.H.C.P.^f  a  soir. 
SAHDEB8.-  Jan  9th.  at  Ch&let  St.  Vincent,  Oannea,  the  wife..f  Gordon 

^anders,  M.B.,  FR.«.P.Bdlnj,ofa6on.  *»..«  nm 

WooLLETT.-^ian.    16th,  at    36  felford     Avenue,    StreaUiam  HDL 

London,  the  wife  of  C.  J.  WooUett,  M.D.Lond  ,  F.R.C.S.Eng..  tfa 

daughter. 


JRatnagcB. 


COATIS-  FREBi  AHD.-Jan  Hth,  at  the  Cathi^dral,  Chlcheater.  W  ini«m 

to  Le<»iiora  Stilwetl.  sixth  daughter  of  the  late  /redone  Jonn 

SHaW-lSId:- JaSi'b^rat  ^  Parish  Church,  George  Shaw  f-B. 
Lond^of  me  Dnve  Hove,  to  Annie  Louise,  third  ^"ghUrol  C. 
W.  Lord,  Jjsq.,  of  The  Drive,  late  of  Acton  Hall,  Sudbury. 


^tathB. 


TUPPBH  -Jan.  9th.  at  Nagaaaki,  Wfst  aiff  Road,  W.,  BoumemoBtli, 
Hairy  atiwey  luppenVM.A..  M.B.Oamb  ,  aged  3i  years. 

WAm!-Jan^?h:itobertGeori^  M.ast  And.,Albioa 

House,  Quadrant  Road,  Canoubury,  aged  62  yoan^ 


Mt  ^diml  ^uM  mA  €ttmhv. 


*«SALUS    POPULI    SUPREMA    LEX.* 


VouCXIL 


WEDNESDAY,    JANUARY    29,     1896. 


No.  5. 


iDrigntal  Communt£att0n& 
A  SERIES  OF  CASES 

OF 

INTESTINAL    RESECTION. 

By  HERBERT  W.  ALLINGHAM,  F.R.C.S., 

te  the  Great  Northern  Hospital,  Aaaistant  Surgeon  to  St. 
St.  George's  HospitaL 

In  this  paper  will  be  recorded  all  the  cases  in  which 
I  have  resected  portions  of  the  intestines,  although  the 
results,  as  will  be  seen,  are  not  as  satisfactorjr  as  one 
could  wish ;  still,  I  feel,  that  only  by  narrating  both 
«uoDe8aful  and  unsuccessful  cases  is  it  possible  to 
arrive  at  any  definite  conclusion  as  to  the  correct  way 
of  treating  cases  of  this  kind  under  the  various  con- 
ditions which  they  may  present.  After  narrating  the 
cases,  I  shall  discuss  them  and  endeavour  to  indicate  the 
procedure  which  I  shall  adopt  in  the  future. 

Case  I.  Jtesection  of  Stricture  of  the  Sigmoid 
Flexure. — (A  full  report  of  this  case  appeared  in  the 
Clinical  Society's  Transactions  for  1893.)  In  October, 
1892,  I  saw,  in  consultation  with  Dr.  William  Neale, 
Mrs.  S.,  set  64.  The  patient  had  always  been  subject 
to  constipation,  especially  during  the  last  year.  For 
six  weeks  the  bowels  had  ceased  to  act,  and  for  a 
month  before  tliat  they  had  acted  with  difficulty. 
Purgatives  and  enemata  only  caused  the  occasional 
passage  of  a  little  flatus  and  one  liquid  motion.  She 
nad  never  passed  blood  or  slime. 

When  we  saw  her  she  had  vomited  for  some  days. 
The  abdomen  was  greatly  distended.  There  was  no 
growth  to  be  felt,  and  an  examination  per  rectum  re- 
vealed nothing. 

As  the  length  of  time  of  the  obstruction  seemed  to 
indicate  that  the  stricture  was  low  down  in  the  large 
intestine,  it  was  agreed  to  make  an  incision  in  the  left 


resected,  and  a  cure  effected.  She  said  that  she  was  so 
comfortable  with  the  colotomy  that  she  did  not  feel 
inclined  to  run  any  further  risk. 

Case  II.  Resection  of  Stricture  of  Descendinq  Golon. 
—(This  case  was  published  in  full  in  the  MedicaJ 
Society's  Transactions  for  1894.)  William  C,  aet.  30, 
was  admitted  into  the  Great  Northern  Hospital,  on 
January  9th,  1893.  No  family  history  of  cancer  or 
phthisis — never  had  typhoid  or  resided  in  any  foreign 
parts.  For  the  last  two  years  had  suffered  from  con- 
stipation, and  about  six  months  prior  to  this  attack 
had  had  abdominal  obstruction  lasting  for  about  a 
week,  relieved  by  purgatives  and  enemata. 

For  the  last  te?  days  before  admission  he  had  not 
had  an  action  of  the  bowels.  On  admission  the 
abdomen  was  greatly  distended,  no  tumour  to  be  felt ; 
nothing  had  passed  by  the  rectum  even  after  repeated 
enemato,  no  rectal  stricture.  On  January  11th,  the 
abdomen  was  opened  in  the  middle  line  below  the 
umbilicus,  and  the  csecum  and  small  intestines  were 
found  to  be  enormously  distended.  The  intestines 
were  so  stretched  that  I  was  afraid  very  carefully  to 
explore  the  abdominal  cavity  for  fear  of  bursting  the 
guts.  Accordingly,  the  csecum  was  well  drawn  into 
the  wound  in  the  belly- wall,  opened,  and  a  quantity  of 
faecal  matter  came  away.  When  more  than  two  quarts 
of  liquid  feeces  had  escaped,  the  opening  in  the  csecum 
was  closed  with  pressure  forceps.  The  csecum  was 
then  thoroughly  washed  and  returned  into  the  abdo- 
men, and  the  part  of  the  csecum  around  the  clip  on 
the  opening  was  carefully  sutured  to  the  edges  of  the 
abdominal  wound  about  its  lower  part. 

The  next  day,  as  the  csecum  seemed  weU  glued  up 
to  the  belly-wall  and  the  cavity  thoroughly  blocked  off 
by  lymph,  the  clip  on  the  opening  in  the  csBcum  was 
removed.  From  this  time  the  patient  made  an  un- 
interrupted recovery,  the  bowels  acting  daily  by  the 
artificial  anus,  nothing  whatever  passing  by  the  rectum. 
On  May  29th  he  returned  to  the  hospital  greatly  im- 


inguinal  region  for  the  purpose  of  examining  the  colon  |  proved  in  health  ;  he  was  fat  and  looking  well. '  The 
in  opening  It,  if  it  wasaistended.  ;  bowels  acted  daily  by  the  artificial  anus,  in  fact  the 

I  made  an  incision  three  inches  long,  about  an  inch  fseces  were  constantly  running  away, 
inside  the  left  antero-superior  spine  of  the  ilium,  I  On  May  31st  I  made  an  incision  five  inches  long 
opened  the  peritoneal  cavity,  and  found  that  the  large  ,  along  the  left  linea  semilunaris,  meaning  to  hunt  care- 
intestine  was  greatly  distended.  The  gut  was  brought  fully  through  the  sigmoid  flexure  and  all  the  colon  to 
up  to  the  inguinal  opening,  and  when  the  hand  was !  find  the  cause  of  tiie  obstruction  and  remove  it  if 
inserted  into  the  peritoneal  cavity  a  mass  was  felt  in  |  possible.  I  introduced  my  hand,  and  commenced  by 
Douglas's  pouch.  This  was  brought  to  the  inguinal  i  passing  the  sigmoid  flexure  through  my  fingers.  This 
opening,  and  was  found  to  be  a  malignant  growth  iu  I  being  normal,  I  continued  my  search  up  the  descend- 
ue  sigmoid  flexure,  This  growth  and  about  fourteen  I  in^  colon,  and  about  its  centre  found  a  hard  tight 
inches  of  the  gut  were  pulled  through  the  inguinal  in-    stncture.    The  gut  above  and  below  the  stricture  was 


cision,  the  parietal  peritoneum  was  stitched  to  the 
fSon  all  around  the  abdominal  incision,  and  the  mass 
of  sigmoid  flexure  and  growth  was  fixed  outside  the 
belly  wall.  The  gut  was  then  opened  above  the  can- 
oerous  mass,  but,  as  no  fseces  passed  away,  the  intes- 
tine had  to  be  opened  below  the  growth,  and  fseces 
were  at  once  discharged.  A  Paul's  tube  was  inserted, 
and  was  kept  there  for  three  days. 

Ten  days  after  the  operation  the  mass  of  gut  and 
the  growth  were  clamped  and  cut  away,  the  mass  re- 
moired  weighing  ten  and  a  half  ounces.  In  a  month's 
time  the  patient  was  ^uite  recovered,  the  bowels  acting 
duly  from  the  inguinal  opening.  I  have  seen  this 
patient  lately,  and  advised  that  the  artificial  anus  be 


secured  by  india-rubber  tubes  passed  through  the 
mesentery.  A  large  piece  of  the  gut  and  the  stricture 
between  the  tubes  (about  four  inches  in  length)  was 
then  excised.  The  proximal  and  distal  openings  in 
the  gut  were  carefully  joined  over  a  Mayo  Bobson's 
bobbin,  the  mucous  membrane  of  the  intestines  being 
first  sutured  together  as  described  by  Mayo  Robson 
by  silk  sutures,  and  lastiy,  the  serous  surfaces  of  the 
gut  united  with  Lembert's  sutures. 

The  patient  recovered  without  interruption  from 
this  resection,  and  on  June  I4th  I  closed  the  opening 
in  the  csecum. 

On  the  21st  of  June  the  wound  in  the  csecum  was 
healed,  tiie  bowels  acting  by  the  rectum. 


102     The  Medical  Pbbss. 


ORIGINAL  COMMFNICATIONS. 


Jan.  29.  1896. 


The  patient  remained  in  perfect  health  until  Sept 
18th,  when  he  returned  to  the  hospital  complaining  of 
pain  in  the  abdomen  and  of  being  sick.  The  abdomen 
was  distended.  As  after  several  doses  of  castor  oil 
and  injections,  he  was  no  better,  on  September  24th, 
I  determined  to  explore  again  the  part  where  the 
stricture  had  been  resected,  thinking  that  perhaps  the 
^t  had  contracted  at  the  seat  of  resection.  Accord- 
iQgl7»  an  incision  was  made  parallel  to  the  one  about 
the  left  linea  semilunaris,  but  a  little  inside  it.  When 
the  abdomen  was  opened,  it  was  found  that  the  peri- 
toneum was  studded  with  hard  nodules,  and  that  there 
were  masses  in  the  walls  of  the  small  intestines,  and 
great  thickening  and  nodulation  of  the  mesentery 
generally.  The  part  where  the  resection  was  done  was 
perfect— no  stricture  or   contraction  whatever.    The 

gatient  recovered  from  operation,  and  stayed  in  the 
ospital  until  October  13th.  He  was  taken  to  his 
home  at  Southampton,  and  was  placed  under  the  care 
of  Dr.  Bobert  Walch,  to  whom  1  am  greatly  indebted 
for  the 'post-mortem  examination  and  the  specimens. 
The  patient  died  on  November  9th,  ten  months  after 
the  first  operation. 

Cass    III.  Resection  of  Inguinal  Artificial  Anus, — 
(This  case   was   published   in    full    in    the  Lancet, 
June  23rd,  1894.)    A  woman,  set.  48,  came  under  the 
care  of  my  colleague,  Dr.  C.  E.  Beevor,  at  the  Great 
Northern  Hospital,  on  March,  8th,  1894.   About  three 
months  before  she  was  suddenly  seized  with  pains  m 
the  abdomen  after  a  cup  of  tea,  and  was  treated  for 
dyspepsia.  Ever  since  that  attack  she  had  had  violent 
abdominal  pains  from  time  to  time.     A  fortnight  ago, 
she  noticed  her  abdomen  swollen.    She  had  been  sick 
several  tiroes  the  last  fortnight,   and   had  constant 
griping  pains  about  the  abdomen.    On  her  admission 
to  hospital  the  abdomen  was  found  to  be  considerably 
distended,  principally  over  the  lower  part.    Deep  pal- 
pation excited  peristaltic  action,  and  the  distended 
coils  stood  out  very  diHtinctly  through  the  abdominal 
wall.    Per  rectum  and  vaginam,    nothing    abnormal 
was  to  be  felt    On  March  10th,  at  the  request  of  Dr. 
Beevor,  I  saw  her,  and,  concluding  from  the  history 
that  there  was  some  obstruction  in  the  large  intestine, 
decided  to  open  the  abdomen  in    the  left   inguinal 
region.    This  I  did,  and  found  the  sigmoid  flexure 
greatly  distended.    Before,  however,  fixing  it  to  the 
abdominal  wall  and  opening  it,  I  determined  to  explore 
the  abdomen  with  the  hand,  in  order  to  (if  poasible^ 
find  out  the  nature  of  the  stricture.    Accordingly  the 
inguinal  incision  was  slightly  enlarged,  and  then  the 
hand  was  passed  into  the  abdomen,  the  pelvis  being 
thoroughly  explored.    To  my  surprise,  no  growth  or 
band  could  be  found  about  the  intestine  in  the  pelvic. 
Accordingly  the  search  was  pursued  along  the  descend- 
ing and  transverse  colon  ;  there  again,  nothing  was 
found.    The  sigmoid  flexure  being   so  distended,  I 
thought  I  might  have  overlooked  son^e  band  in  the 
pelvis,  or  that  the  distension  and  symptoms  were  due 
to  an  over -distended  and  so  paralysed  gut.  Presuming 
this  to  be  the  case,  the  larse  gut  was  fixed  to  the 
incision  and  opened.    A  PauPs  tube  was  inserted  into 
the  gut.    The  next  morning,  March  11th,  nothing  had 
passed    through    the   Paul's    tube.     Accordingly,   I 
decided  to  open  the  abdomen  on  the  right  side  over 
the  caecum.    This  was  done  b^  a  vertical  incision 
about  the  right  linea  semilunaris.    The  caecum  was 
found  to  be  greatly  distended.    I  passed  my   hand 
into  the  abdomen  and  explored  the  caecum  and  the 
ascending  and  transverse  colon,  but  was  unable  to  find 
any  cause  for  the  obstruction.    Here,  again,  as  on  the 
left  side,  the  large  gut  was  found  to  be   distended. 
This  beinff  the  case,  I  determined  not  to  be  misled 
again  by  tne  distended  appearance  of  the  lar^e  gut,  so 
resolved  to  investigate  the  small  intestine.    The  small 
intestine  was  traced  upwards,  and  at  about  the  juncture 
of  the  jejunum  with  the  ileum,  were  found  two  coils  of 
gut  firmly  adb<>rent  to  one  another  to  the  extent  of 


about  two  inches.    The  adhesions  were  firm  and  old,, 
and  it  was  with  ffreat   difficulty  that  one  loop  waa 
separated    from   the  other.     When    the  coils    were 
separated,  in  one  was  found  a  stricture  about  half  an 
inch  broad  at  the  i>art  where  it  had  been  adherent  to 
the  other  coil.    This  stricture  was  treated  by  entero- 
plasty.    The  patient  recovered,  and  all  the  motiona 
passed  by  the  inguinal  colotomy  opening.    The  spar 
about  the  colotomy  opening,  being  well  formed,  pre- 
vented any  motion  passing  beyond  it,  and  so  on  to 
the  rectum.    The  spur  about  the  opening  began  to  get 
more  prominent,  m  spite  of  an  attempt  to  reduce  it  by 
pressure  with  the  finger  daily.    This  being  the  case,  it 
appeared  to  me  useless  to  attempt  any  plastic  opera- 
tion to  close  the  artificial  anus.    On  April  16th  the 
patient  was  put  under  chloroform.    The  skin  around 
the  artificial  anus  was  divided  and  the  peritonenm 
opened,  and  the  gut  pulled  well  out  of  the  abdomeo. 
The  sigmoid  flexure  having  a  fairly  long  mesentery,  it 
was  easily  drawn  out  of  the  abdomen.    Two  drainage- 
tubes  were  passed  through  the  mesentery  and  secured 
with  clip -forceps  around  the  gut,  about  three  inches 
above  and  below  the  artificial  anus.  Above  four  inches 
of  the  gut,  with  the  anal  opening,  were  then  cut  away. 
Then  a  Mayo  Bobson's  bobbin  was  inserted  between 
the  ends  of  the  divided  gut,  and  the  gut  united  over  it 
in  the  usual  manner.    On  the  27th  some  glutiDon» 
material  was  seen  in  the  motions  (bobbin  ?).     She  was 
seen  again  lately  (July,  1895),  and  she  was  quite  well 
in  every  respect. 

Case  IV.  Resection  of  Stricture ^ Sigmoid  Flesmre, 
—I  saw,  with  Dr.  Tyson,  a  Mr.  GL,  aet.  67.  who  gave 
the  following  history.  He  had  always  suffered  from 
constipation,  but  for  the  last  six  months  his  trouble 
had  become  much  worse,  the  bowels  never  acting  with- 
out strong  purgatives.  It  was  not  uncommon  for  hin> 
to  go  a  fortnight  or  longer  without  an  action.  There 
was  no  history  of  cancer,  fie  had  lost  fieshandat 
times  suffered  from  severe  colic  pains.  Upon  exami- 
nation, the  abdomen  was  rather  distended,  haviog  a 
doughy  feel.  There  wa.s  dulness  alon£[  the  course  of 
the  large  intestine,  and  about  the  sigmoid  flexure  there 
was  a  hardish  mass,  rather  tender  to  the  touch.  Ad 
examination  per  rectum  revealed  nothing. 

An  inspection  of  feeces  passed  after  a  strong  purge, 
showed  them  to  be  liquid  and  offensive,  but  not  con- 
taining blood  or  slime.  After  having  him  under  oHcer- 
vation  for  about  ten  days,  and  trying  the  effect  of  par- 
gatives,  belladonna,  <&sc.,  without  any  result,  on  May ' 
15th,  1894, 1  opened  the  abdomen  on  the  left  side,  the- 
centre  of  the  incision  being  about  an  inch  from  the  left 
anterior  superior  spine  of  the  ilium.  On  opening  the- 
abdomen  there  was  found  at  the  upper  part  of  the  sig^ 
moid  flexure  a  hard,  annular,  malignant  stricture.  The 
intestines  above  the  stricture  were  distended  with 
doughy  fseces.  As  the  mesentery  appeared  to  be  free 
of  malignant  disease,  and  there  was  no  evidence  of  en- 
largement of  glands  about  the  abdomen,  I  decided  to- 
resect  the  stricture.  Drainage*tubes  were  pai>^ed 
through  the  mesentery,  so  as  to  constrict  the  intestine 
above  and  below  the  stricture,  which  was  then  removed. 
The  ends  of  the  gut  were  then  united  by  Mounsell'^ 
method.  The  gut  was  washed  and  returned  into  the 
abdomen,  and  the  abdominal  wound  was  closed  in  the 
usual  way.  There  was  no  sickness  ;  the  temperature 
that  night  was  102^  ;  the  patient  slept,  and  he  pawed 
water ;  the  pulse  was  88  ;  the  abdomen  was  not  dis- 
tended or  tender. 

On  May  16th  he  had  had  a  good  night  The  palse 
was  84  ;  the  tongue  was  moist ;  the  temperature  do's"*; 
there  was  no  pain  whatever,  and  the  facial  aspect  waa 
good. 

On  May  17th,  in  the  morning,  the  report  was  that 
he  had  had  a  good  night,  the  temperature  was  99^  tb<Etre 
was  no  pain,  the  pulse  was  88,  the  tongue  was  moist, 
there  was  no  tenderness  or  disteuhion  about  the 
abdomen  :  at  10*30  a.m.  the  patient  said  that  be  felt 


JAH.  29.  1896. 


ORIGINAL  COMMUNICATIONS. 


This  Mvdioax  Prb^s.     103 


rambling  about  his  stomach,  and  described  a  sudden 
boTBt  of  wind,  accompanied  with  great  pain  in  the 
abdomen.  The  pulse  became  rapid,  the  aspect 
Ranged,  the  abdomen  soon  became  tympanitic  and 
tender,  and  he  died  late  that  night  Evidently  some 
of  the  stitches  gave  way. 

Cass  V.  Be^eciion  of  Stricture  of  Ascending  Colon, 
— John  R,  aet  66,  was  admitted  into  the  Great 
Northern  Hospital.  Three  months  previously  he  had 
<iiarrboea  and  pains  in  the  abdomen.  The  pain  had 
oontinned  more  or  less  ever  since.  For  t he  last  fourteen 
•days  he  had  been  constipated,  and  the  pain  was  growing 
mnch  worse. 

On  admission  the  abdomen  was  distended  and  tense, 
with  marked  peristaltic  contractions  and  great  griping 
abdominal  pain. 

As  I  thought  from  the  history  of  diarrhoea  that  the 
atricture  might  be  low  down  in  the  large  intestine,  on 
May  23rd,  1894,  an  incision  was  made  in  the  left 
ingoinal  region.  On  introducing  the  hand  into  the 
abdomen,  the  sigmoid  flexure,  descending  and  trans- 
Terse  colons  were  found  to  be  enipty.  A  hard  mass 
was  felt  in  the  ascending  colon.  Accordingly  the  left 
inguinal  abdominal  opening  was  closed,  the  patient 
was  turned  over  on  to  his  left  side,  and  an  incision  was 
made  for  right  lumbar  colotomy.  The  ascending  colon 
"was  found  and  drawn  out  of  the  wound,  and  towards 
its  upper  part  was  a  hard,  localised  growth.  This  was 
drawn  out  of  the  wound,  the  bowel  clamped  above  and 
below,  and  the  growth  resected.  The  distal  end  of  the 
colon  fras  closed  and  stitched  to  the  end  of  the  wound. 
The  proximal  end  was  left  open,  and  a  Paul's  tube  was 
fixed  in  it.  The  bowel  was  stitched  to  the  end  of  the 
wound. 

The  patient  made  an  uninterrupted  recovery,  the 
bowels  acting  daily  from  the  lumbar  opening.  On 
June  20th  I  opened  the  abdomen  in  the  middle  line 
.and  anastomosed  the  transverse  colon  to  the  ileum 
about  13  inches  from  the  caecum  with  a  Mayo  Kobson's 
•bobbin.  By  thus  anastomosing  the  small  intestine  to 
the  transverse  colon  I  hoped  that  I  should,  at  a  later 
•date,  be  able  to  close  the  right  lumbar  opening.  The 
patient  recovered  from  this  operation,  some  of  the 
faeces  passing  from  the  lumbar  opening,  others  passing 
•down  to  the  rectum. 

On  September  26th  an  endeavour  was  made  to  close 
the  colutomy  opening,  an  incision  being  made  round 
tiie  colotomy  opening,  includin»^  the  edge  of  the  skin, 
about  ^  inch  in  breadth,  and  the  gut  was  freed  all 
•round  with  some  difficulty,  and  was  well  drawn  out  of 
the  lumbar  wound.  The  end  of  the  gut,  including  the 
•akin,  was  cut  off.  The  end  of  the  gut  was  next  firmly 
sutured  up,  and  its  peritoneal  surifacen  were  brought 
into  contact  by  Lembert's  sutures.  The  skin  edges 
were  then  united,  the  blind  end  of  the  gut  being  left 
near  the  surface,  so  that  if  leaking  took  place  the 
'faeces  might  find  their  way  outside  the  belly. 

On  October  2nd  I  was  sorry  to  notice  that  the 
lumbar  wound  had  broken  down  and  that  some  faeces 
were  leaking.  This  leaking  continued,  some  of  the 
faeces  escaping  by  this  opening,  and  others  passing  by 
the  rectum. 

He  was  kept  in  the  hospital  till  January  25th,  1895. 
The  opening  in  the  lumbar  region  had  contracted  up  to 
quite  a  smsdl  fistula,  but  some  faeces  still  escaped  by 
tbat  orifice.  He  was  then  discharged,  his  general 
rhealth  being  good.    I  have  not  heard  of  him  since. 

{To  he  concluded  in  our  next) 


Thi  Islington  Vestry  has  just  caused  two  buildings 
to  be  erected  in  the  parish  in  which  to  accommodate, 
free  of  charge,  families  among  whom  dangerous  infec- 
tious disease  has  appeared,  and  who  have  been  com- 
piled to  leave  their  dwellings  for  the  purpose  of 
«6nabling  the  sanitary  authority  to  disinfect  the  same. 


%zcimts 

ON 

THE   DIAGNOSIS   OF  I^^ SANITY. 
By  THEO.  B.  HYSLOP,  M,D., 

Lecturer  on  Mental  Diseases  to  St.  Mary's  Hospital  Medical  School, 
Assistant  Phj'slolan  to  Bethlem  Boyal  Hospital. 

Lectuee  V. 

Insanity  in  Children,— Atte^ks  of  insanity  in  chil- 
dren are  sometimes  caused  by  sudden  changes  in 
temperature,  or  by  over-exposure  to  the  sun.  In 
children,  as  in  adults,  the  neuroses  following  sunstroke 
are  somewhat  similar  to,  and  have  much  in  common 
with,  the  traumatic  neuroses.  The  chief  clinical 
features  in  children  whose  mental  perversions  had 
been  attributed  to  sunstroke  are: — (a)  absence  of 
bodily  infirmity ;  (b)  full  development  and  compara- 
tively normsd  dimensions  of  the  muscular  and  osseous 
systems  (includiog  the  shape  of  the  head,  jaws,  and 
teeth) ;  (c)  special  affections  of  speech,  either  of  a  tem- 
porary character  immediately  following  the  attack,  or 
as  a  continued  impairment  or  failure  in  development 
of  the  faculty  ;  (d)  frequent  occurrence  of  fits  immedi- 
ately after  the  attacks,  lasting  for  a  short  period,  but 
not  continued  through  life ;  (e)  defective  or  perverted 
moral  states,  as  seen  in  various  grades,  from  mere  dis- 
obedience, to  propensities  peculiar,  dangerous,  or  even 
homicidal,  and  sometimes,  though  rarely,  habits  of  a 
degraded  nature ;  (f)  limited  meutal  capacity,  with 
failure  to  improve  much  by  the  ordinary  educational 
methods  ;  (g)  attachments,  antipathies,  and  peculiari-  . 
ties,  which  are  in  most  cases  retained  through  life ; 
idso  an  absolute  inability  to  compete  with  their  fellow 
beings,  or  to  look  after  their  own  interests. 

Head  injuries,  affections  of  the  peripheral  nerves, 
diseases  of  the  throat,  nose,  or  ears,  digestive  troubles, 
and  the  presence  of  intestinal  worms,  also  tend  to  act 
directly  or  indirectly  on  the  nerve  centres  and  cause 
insanity.  Of  febrile  diseases,  scarlet,  ■  typhoid,  and 
rheumatic  fevers,  and  measles,  are  apt  to  be  attended 
by  grave  mental  disturbances.  Whether  the  psychical 
disorders  are  the  direct  result  of  the  noxious  influence 
of  the  specific  disease-germs,  or  whether  only  indirectly 
owing  to  nutritive  disturbance,  is  at  present  doubtful. 
Spitzka  believes  in  the  former  theory  on  the  grounds 
that  (a)  analogous  affections,  such  as  the  progressive 
sopor  following  diphtheria,  are  suscompanied  by  evi- 
dences of  microparasitic  invasion  of  the  nerve-centres  ; 
(b)  the  psychical  results  of  postfebrile  insanity  are 
different  from  those  resulting  from  simple  nutritive 
disturbance ;  (c)  the  organic  nervous  diseases  excep- 
tionally following  essential  and  exanthematous  fevers 
are  usually  multilocular,  and  indicate  the  operation  of 
an  irritant  distinct  from  a  mere  deprivation  of  nutri- 
ment. 

At  puberty,  individuals  of  both  sexes  are  prone  to 
break  down  mentally,  and  more  especially  so  if  there 
is  an  inherited  tendency.  The  majority  of  cases  are 
of  the  maniacal  and  exalted  types.  Another  feature 
is  the  tendency  to  remission  and  periodic  recurrence 
of  the  symptoms.  Such  p>atients  seldom  become 
actually  delirious.  The  relation  of  menstrual  derange- 
ments to  the  mental  state  is  inconstant.  Usually 
there  is  impoverishment  of  the  blood  in  adolescent 
and  pubescent  insanity. 

Fuerj^eral  Insanity,  —  The  puerperal  period  is 
fraught  with  danger  to  individuals  who  are  predisposed 
to  neuroses.  The  causes  of  puerperal  insanity  may  be 
grouped  as  follows  : — 

(1)  Predisposing: 

(a)  Heredity. 

(b)  Expectancy  (a  woman  who  has  had  a  pre- 

vious attack  of  puerperal  insanity  may 
dwell  on  that  fact  and  predispose  herselr 
to  another  attack). 


104     The  Medical  Press. 


OKIGINAL  COMMUNICATIONS. 


Jan.  29,  1896w 


(2)  Exciting : 

(a)  Physical  causes,  such  as  debility,  consequent 

on  labour,  or  prolon§;ed  lactation. 
(6)  Suppression  of  tne  lochia  or  milk,  with  con- 
sequent blood  poisoning, 
(c)  Subinvolution  of  the  uterus,  metrorrhagia, 
or  leucorrhoea  which  may  act  as  exciting 
factors. 
I  agree  with  Dr.  Savage  in  believing  that  there  is  no 
well-defined  form  of  insanity  deserving  the  name  of 
puerperal  insanity.  Mental  disorders  may  arise  at 
any  time  from  the  earliest  stages  of  pregnancy  to  late 
periods  of  weaning.  The  condition  of  the  patient  at 
the  time  of  the  onset  of  the  mental  symptoms  nas  much 
to  do  with  the  nature  of  the  case.  Thus,  a  patient 
who  is  undergoing  a  natural  pregnancy  or  labour,  but 
who  is  subjected  to  some  sudaen  shock  or  worry,  is,  in 
my  opinion,  more  likely  to  suffer  from  an  acute  mental 
disturbance  of  a  maniacal  nature.  A  patient,  on  the 
other  hand,  exhausted  by  the  drain  on  her  system, 
subjected  to  many  worries  and  cares,  is  more 
likely  to  be  melancholic.  A  diagnosis  of  the 
true  nature  of  the  case  can  only  be  made  by 
taking  into  account  all  the  possible  factors  of  causa- 
tion. An  acute  onset  due  t^  outside  existing 
factors  is  more  favourable  as  regards  the  length  of  the 
illness,  than  a  gradual  onset  due  to  physical  exhaus- 
tion. In  the  former  state  the  patient  frequently 
recovers  within  a  few  months,  whereas  in  the  latter 
the  period  may  extend  to  a  year  or  even  more,  Some 
of  these  patients  do  not  entirely  recover  in  asylums, 
and  it  is  only  after  returning  to  their  homes  that  they 
gradually  regain  their  mental  power.  Some  cases  do 
not  recover.  The  prognosis  is  influenced  bv  several 
considerations.  The  puerperal  state  may  be  the  means 
of  determining  an  incurable  state  to  which  the  indivi- 
dual was  predisposed  by  heredity.  It  must  be 
remembered,  however,  that  hereditary  predisposition, 
although  unfavourable  to  permanent  recovery  does  not 
necessarily  imply  that  the  patient  will  not  recover 
from  the  first  attack,  ^s  a  rule,  puerperal  insanity  is 
very  curable.  Perversions  of  the  moral  character,  and 
impulsive  tendencies,  are  far  from  being  symptoms  of 
incurability.  Alternations  of  excitement  ana  depres- 
sion are  usually  unfavourable  si^s,  Remissions  and 
relapses  are  common,  but  the  patients  sometimes  ulti- 
mately recover  from  them.  Perhaps  the  most  un- 
favourable symptoms  are  the  development  of  delusions 
of  persecution,  or  of  grandeur,  the  systematic  growth 
of  hallucinations,  especially  those  of  hearing,  the 
recovery  of  physical  health,  unaccompanied  by  improve- 
ment of  the  mental  condition. 

There  is  no  uniform  rule  with  regard  to  the  return 
of  the  mensep.  Some  melancholiacs  pass  into  a  con- 
dition of  mania  on  the  return  of  menstruation  ;  others 
pass  into  dementia,  in  spite  of  the  restoration  of 
physical  health.  Restoration  of  sleep  is  a  good  sign, 
whilst  prolonged  insomnia  is  unfavourable.  The  ter- 
minations of  puerperal  insanity  are  therefore  either 
(a)  complete  and  early  recovery,  (6)  prolonged  and 
gradual  recovery,  (c)  permanent  piCrtial  weak-minded- 
ness, (d)  chronic  delusional  insanity,  (e)  dementia,  or 
(/ )  death,  due  to  the  acuteness  of  the  attack  or  to 
intercurrent  affections. 

The  menopause  is  an  important  epoch  in  the  life  of 
women.  The  factors  causing  insanity  at  this  period 
may  be  grouped  as  follows  .—(1)  Predisposing :  (a) 
Heredity— the  actual  attack  of  insanity  being  deter- 
mined by  causes  operating  at  the  time  ;  (h)  previous 
attacks  of  insanity  ;  (c)  the  physical  and  psychical 
transformations  associated  with  the  termination  of  the 
reproductive  period.  (2)  Exciting  causes,  as  (a)  worry 
or  anxiety,  (h)  accidental  circumstances,  such  as  shock, 
bodily  disease,  &c. ;  (c)  sudden  cessation  of  the  men- 
struation, producing  physical  ill -health.  In  some 
cases,  it  must  be  remembered,  the  physical  change 


and  the  mental  affection  may  be  merely  coincidental^ 
and  not  necessarily  causal. 

The  mental  condition  at  the  climacterium  is  uBoally 
one  of  subacute  melancholia  or  mild  mania.    Maoy^ 

gatients  recover  with  the  restitution  of  their  physical 
ealth ;  others  however,  do  not  recover,  but  pass  into- 
a  chronic  delusional  state,  usually  with  ideaa  of 
persecution.  When  the  condition  is  one  of  mild  mania 
or  subacute  melancholia  the  prognosis  is  generally 
favourable.  Illusions  or  hallucinations  of  any  of  the 
senses,  and  more  especially  of  common  sensation^ 
together  with  a  tendency  to  form  delusions  aa  to* 
persecution,  form  unfavourable  indications  aa  to 
curability. 

Senile  /n^mey.— Abnormal  mental  manifestationa- 
in  old  age  ma^  arise  in  connection  with  slowly 
developing  constitutional  changes,  or  with  athero- 
matous degeneration  of  the  vascular  system,  and  an 
increasing  atrophy  of  aU  the  organs.  The  symptoms 
may  be  functional  or  organic.  The  functional  disorders 
may  resemble  the  affections  of  earlier  life  in  every 
particular.  Hypochondriasis,  melancholia,  mania,  and 
delusional  states  are  common  t^s  of  disorder  in  the 
senile  person,  and  these  affections  may  be  recovered' 
from,  just  as  in  youth.  Affections  associated^  with 
organic  senile  degeneration  are  usualljr  progressive  in 
nature  and  indicate  arterial  degeneration  and  disinte- 
gration of  the  nerve  structures.  Interstitial  change  or 
gross  cerebral  disease  such  as  occurs  in  chronic  cerebral 
atrophy  with  sclerosis,  haemorrhage,  or  softening  from 
thrombi,  may  be  attended  by  an  attack  of  melancholia^, 
mania,  convulsions,  epilepsy,  or  dementia.  The 
condition  of  the  memory  m  senile  cases  is  of  great 
importance.  In  progressive  degeneration  the  memory 
undergoes  retrogression,  and  recent  events  tend  to 
become  obliterated.  I  have  seen  several  cases  of  senile 
mania  in  which  man^  vears  of  the  individuals^ 
memories  have  been  entirely  obliterated .  One  patient,, 
aged  79,  maintained  that  his  age  was  35,  and  failed  to 
recollect  events  of  more  recent  years.  Another  patient, 
aged  67,  maintained  that  he  could  remember  being  a 
child,  but  that  he  never  grew  up,  in  fact,  he  still 
regarded  himself  as  a  child  in  spite  of  a  grey  beard  and 
other  indications  of  his  advanced  age.  Another 
patient  maintained  that  he  was  still  in  Ireland,  and 
that  he  had  never  been  on  the  sea  in  his  life.  He  hadon 
reality,  crossed  over  to  England  some  fifteen  years  pre- 
viously, but  had  forgotten  the  circumstance  ;  he  also 
failed  to  recall  events  since  that  period.  We  are  all 
acquainted  with  the  features  of  old  age,  and  know  how 
the  agedperson  delights  in  recalling  the  events  of  his 
youth.  He  dwells  in  the  past,  and  entertains  those 
around  him  with  anecdotes  of  childhood.  He  also* 
fails  to  remember  that  he  had  recently  told  the  sanae 
story,  consequently  the  tendency  to  repetition  is 
characteristic.  Some  senile  persons  are  so  solicitous- 
as  to  the  welfare  of  their  stomach  and  bowels  that  their 
minds  constantly  dwell  upon  their  own  digestive  facul- 
ties. One  sees  the  more  characteristic  manifestations 
of  this  type  in  asylums,  and  associated  with  this  ten- 
dency is  uie  readiness  to  become  hypochondriacal  and' 
hypersensitive  as  to  the  functions  of  the  digestive 
tract 

The  main  features  of  senility,  therefore,  tend  tO' 
group  themselves  into  three  main  types,  which  have 
been  termed  respectively,  dotage,  anecdotage,  and 
table  d'h6te-Age,  Before  leaving  the  subject  of  senility, 
mention  must  be  made  of  a  symptom  which  is  one  of' 
vital  importance^  namely,  the  occurrence  of  sexual* 
excess  as  an  indication  of  brain  decay.  The  victims 
of  senile  brain  decay  are  not  uncommonly  the  victims 
also  of  morbid  sexual  propensities.  Thus,  some  men,, 
who  have  held  their  passions  well  under  control  during 
earlier  life,  become  sexually  erotic,  and  indulge  their 
morbid  propensities  to  the  fullest  extent.  Not  a  few 
of  such  unfortunate  beings  bring  discredit  and  shamet 


Jan.  29, 1896. 


ORIGINAL  rOMMUNICATIOKS. 


The  MkdicaTi  Press.      105 


upon  a  hitherto  blameleas  Uf e,  and  involTe  themselves 
in  troubles  which  end  in  nun  and  disgrace.  The  early 
recognition  of  such  morbid  tendencies  ought  to  be  the 
duty  of  every  medical  man,  and  were  more  careful 
ittentioD  given  to  this  subject,  I  feel  sure  that  the 
mind  of  society  would  not  suffer  in  the  future  so  much 
18  it  has  done  in  the  past  from  the  narration  of  revolt- 
ing aexoal  details. 

In  studying  the  previous  history  of  the  insane,  it  is 
essential  that  we  should  take  some  account  of  the  pre- 
vious iilneeeeB  of  the  patients.  I  propose,  therefore, 
to  deal  with  such  affections  as  fevers,  malaria,  rheu- 
matism, gout,  anaemia,  syphilis,  tuberculosis,  cancer, 
ansmia,  chlorosis,  diabetes,  ffoltre,  <kc.,  and  when 
considering  these  subjects  it  wfll  readily  be  seen  how 
thej  may  modify  the  diagnosis  and  prognosis  in  cases 
of  insanity  in  which  they  have  been  factors  of  causa- 
tion. 

Febrile  Affections  are  not  uncommonly  complicated 
with,  or  followed  by,  mental  disturbances.  The  mental 
disorder  may  appear  as  the  earliest  symptom  ;  more 
commonly,  however,  it  appears  during  a  later  stage  of 
the  fever,  especially  during  convalescence.  Bristowe 
and  Murchison  have  recorded  cases  in  which  acute 
mania  occurred  as  the  earliest  symptom  of  typhoid 
fever.  Thore  has  mentioned  acute  mania  as  occurr- 
ing before  an  attack  of  pneumonia,  and  Greenfield  the 
occurrence  of  melancholia  followed  by  general  excite- 
ment with  hallucinations  of  sight  and  hearing  appear- 
ing and  subsiding  pari  passu  with  an  attack  of  pneu- 
monia. The  symptomatic  delirium  or  febrile  delirium 
is  often  difficult  to  distinguish  from  true  insanity,  and 
iJmoet  any  of  the  affective  states  of  mental  disorder 
may  be  completely  simulated  in  febrile  delirium. 
The  intensity  of  the  fever  bears  no  constant  relation 
in  the  production  of  insanity.  Nasse  classified  the 
mental  affections  originating  in  fever  according  as  they 
are  the  immediate  result  of  the  fever  itself,  as  they 
constitute  a  prolongation  of  the  delirium  when  the 
fever  has  subsided,  or  as  they  arise  during  convales- 
cence. With  regard  to  the  first  two  conditions  we  are 
in  want  of  data  ;  the  actual  relation  of  high  tempera- 
tare  to  delirium  is  but  imperfectly  known. 

The  forms  of  acute  disease  commonly  followed  by 
ioBanity  are  the  specific  infectious  fevers,  intermittent 
fevers,  and  long  agues  (especially  if  they  be  quartan, 
and  this  forms  sui  generis  a  peculiar  form  of  mania), 
erysipelas,  acute  pyrexia  of  phlogoses,  articular  rheu- 
matisin,  acute  angina,  diphtheria,  erythema  nodosum, 
miliary  roseola,  purpura,  febrile  urticaria,  guttural 
herpes,  kc.  Of  the  forms  of  acute  disease  enteric 
fevers,  pneumonia  and  rheumatism  are  nearly  on  an 
equality  as  causes,  (a) 

At  present  we  cannot  demonstrate  any  definite 
relation  between  the  forms  of  insanity  and  the  nature 
of  the  febrile  disease  :  nor  do  we  know  the  relative 
frequency  of  the  various  forms  of  mental  disorder 
after  any  particular  class  of  diseases.  This  subject, 
however,  is  of  such  importance  that  it  may  be  advisable 
to  repeat  what  I  have  already  said  in  the  **  Diction- 
ary of  Fbychological  Medicine."  Thore  believes  the 
commonest  form  of  insanity  consists  in  the  sudden 
onset  of  acute  maniacal  delirium,  characterised  by 
peat  agitation  with  hallucination  of  sight  and  hearing, 
its  duration  varjdng  from  fifteen  hours  to  three  or 
four  days,  and  the  termination  often  occurring  as 
tbniptly  as  the  onset  This  form  occurs  chiefly  after 
rapid  acute  diseases,  such  as  pneumonia  and  tonsillitis 
and  much  more  rarely  after  typhoid  fever. 

One  point  of  clinical  interest  to  be  noted  is,  that 
after  tyi^hoid.  typhus,  small-pox,  scarlatina,  cholenk 
diphtheria,  influenza,  or  malaria,  there  may  be  phvsical 
symptoms  which,  when  associated  with  insanity,  closely 
immUte  general  paralysis  of  the  insane.    The  general 

(a) "  Fdit-robrile  Insanity."  Bj  Hyalop.  in  Take'i  Dictionary  of 


constitutional  disturbances  and  degeneration  of  the 
tissues  of  the  body  (especially  of  the  cerebro-spinal 
system)  which  occur  in  pellagra,  are  frequently  attended 
by  morbid  mental  states.  These  mental  states,  how- 
ever, have  nothin£[  unusual  or  characteristic  in  their 
nature  to  distinguish  them  from  those  of  other  exhaus- 
tive diseases.  Influenza  has  frequently  proved  itself  to 
be  a  determining  causeof  insanity,  and  this  more  readily 
in  individuals  who  are  predisposed  to  neurosis. 

Considered  seriatim,  after  typhoid  the  cerebral  con- 
dition ma]^  be  one  of  torpor  mingled  with  agitation  and 
hallucinations.  This  condition  may  be  transitory,  or 
may  pass  from  melancholia  into  mania  and  chronic 
dementia.  In  many  of  the  more  chronic  cases,  especi- 
ally those  which  arise  early,  there  is  often  great  moral 
pMsrversion  with  extreme  irritability  of  temper,  some- 
times there  is  weakened  memory  or  general  apathy  and 
failure  to  form  clear  conceptions  as  to  the  objective 
significance  of  things.  Conditions  of  confusion, 
anergia,  ambitious  monomania,  and  partial  dementia 
are  not  uncommonly  developed  during  convalescence. 
These  conditions  may  be  temporary  and  curable,  and 
they  may  present  no  difliculties  from  a  diagnostic 
point  of  view.  There  are  other  conditions,  however, 
which  do  present  considerable  difficulties,  and  to  these 
I  now  desire  to  draw  your  attention.  Occasionally, 
typhoid  fever  is  attended  by  symptoms  which  closely 
resemble  those  of  acute  delirious  mania.  These  are 
dry  tongue,  sordes  on  the  teeth  and  lips,  constipation 
or  diarrhoea,  foul  and  offensive  stools,  quick  pulse, 
temperature  100°  or  even  105',  prostration,  low  mutter- 
ing, delirium.  d:c.  Sometimes  an  accurate  diagnopis  is 
almost  impossible.  The  chief  points  for  guidance  are 
the  mode  of  onset  of  the  symptoms,  the  presence  of 
the  characteristic  rash  of  typhoid,  the  temperature 
curve,  and  the  presence  of  abaominal  pain  in  typhoid, 
&c.  Ehrlich's  test,  or  the  Diazo  reaction  witn  the 
urine  in  cases  of  typhoid  is  not  confined  to  such  cases  ; 
hence,  as  a  diagnostic  sign,  it  is  at  present  of  only  com- 
parative value.  A  careful  consideration  of  the  case  is 
of  the  utmost  value,  for  in  acute  delirious  mania  it  is 
important  to  administer  stimulants  and  to  give  an 
abundance  of  easily  assimilated  food,  which,  in  the 
case  of  typhoid  might  prove  disastrous. 

A  form  of  insanity  has  been  described  by  many 
writers,  in  which  there  are  many  physical  symptoms 
closely  resembling  those  of  general  paralysis.  These 
symptoms  may  be  affections  of  speech,  or  ataxy  of 
movement.  The  sp^eech  is  sometimes  slow,  and 
exhibits  a  characteristic  drawl ;  the  syllables  are 
articulated  in  a  monotonous  tone,  and  with  a  nasal 
twang.  The  affections  of  the  motor  system  may 
further  be  evidenced  by  muscular  weakness,  with  or 
without  tremors  or  tremblings  of  the  lips,  facial 
muscles,  or  even  limbF.  Westphal  has  described  a 
peculiar  trembling  of  the  head  when  unsupported  in  a 
case  in  which  there  were  no  lip  tremors,  and  in  which 
sensation  was  unaffected.  The  pathology  of  this  con- 
dition is  little  known.  In  chronic  cases  terminated  by 
death  in  asylums,  anaemia  of  the  brain,  or  atrophy  of 
the  cortical  substance,  opacity  of  the  pia  mater,  and 
excess  of  the  subarachnoid  fluid  have  been  found. 
Jaccoud  ascribes  the  paraplegia  following  typhoid  to 
congestion  of  the  cord. 

In  connection  with  these  cases,  it  is  important  to 
remember  that  they  resemble  general  paralysis  in  some 
respects  only,  i.e.,  they  do  not  run  the  usual  course  of 
general  paralysis,  but  may  become  chronic  in  the  form 
of  partial  dementia,  dementia,  or  of  paralysis  associated 
with  insanity,  and  termed  by  some  **  pseudo-general 
paralysis." 

» 

Mbmorials  to  the  Home  Secretary  are  being  signed 
in  Cardiff  in  favour  of  the  appointment  of  a  woman 
doctor  at  the  local  gaol,  in  addition  to  the  usual 
medical  officer. 


106    The  Mbdioal  Press. 


ORIGINAL  rOMMUNTCATTONS. 


Jan.  29,  1896. 


TREATMENT   OF 

UTERINE  RETRODISPLACEMENTS. 

BY  VAGINO-FIXATION. 

WITH  REPORTS  OF  CASES. 

By   FREDERICK   HOLME   WIGGIN,   M.D., 

Gynvoological  Surgeon  to  the  New  York  City  Hoipital. 

There  are  numerous  cases  of  uterine  retrodisplaoements 
giving  rise  to  symptoms  which  for  various  reasons  are  not 
amenable  to  the  ordinary  routine  treatment  of  massage, 
followed  by  the  application  of  the  tampon  or  pessary,  and 
for  these  several  operative  procedures  have  been  devised. 
The  principal  ones  are,  that  known  as  the  Alexander 
(Liverpool)  operation,  suspensio  uteri,  brought  forward 
largely  by  Howard  Kelly,  of  Baltimore,  and  that  of 
Mackenrodt,  of  Berlin. 

To  this  latter  operation  it  is  the  purpose  of  this  paper  to 
particularly  call  attention.  The  simplicity  of  its  tech- 
nique, the  safety,  ease,  and  rapidity  with  which  it  can  be 
performed,  and  the  good  results  obtained,  make  it,  in  the 
writer'^  opinion,  a  formidable  rival  of  the  other  methods 
mentioned  for  the  relief  of  the  class  of  cases  under  con- 
sideration. The  technique  described  will  be  that  em- 
ployed in  the  ca^es  about  to  be  narrated.  The  patient  in 
prepared  as  for  a  vaginal  hysterectomy  and  is  placed  on 
the  table  in  the  dorsal  position  with  the  thighs  flexed  and 
held  in  place  by  a  clover  crutch.  As  in  this  class  of  cases 
there  is  more  or  less  endometritis,  it  if*  well  to  begin  the 
operation  by  curetting  the  uterus  with  a  sharp  curette, 
gauze  not  being  placed  in  the  cavity.  Any  existing 
laceration  of  the  cervix  should  be  repaired,  sutures  of  cat- 
gut being  used.  These  steps  having  been  taken,  the 
cervix  is  grasped  and  drawn  downward  and  forward  by 
the  aid  of  a  pair  of  bullet  forceps.  Then  a  portion  of  the 
anterior  vaginal  wall  about  three  quarters  of  an  inch 
below  the  meatus  urinarius  is  taken  up  in  the  same  way 
and  drawn  forward  and  upward,  thus  stretching  the  wall. 
An  incision  is  made  beginning  at  the  last-named  point  and 
continuing  to  the  cervix.  If  this  wall  is  more  or  less  pro- 
lapsed, the  incision,  instead  of  being  straight,  should  be 
oval,  allowing  for  the  removal  of  sufficient  tissue  to  over- 
come this  defect  when  the  sutures  which  close  the  vaginal 
wound  are  placed.  These  flaps  are  dissected  from  the 
inferior  surface  of  the  bladder  into  which  a  sound  is  passed 
and  by  its  aid  the  thickness  of  the  bladder  wall  is  esti- 
mated and  its  lower  border  defined.  A  needle  threaded 
with  pedicle  silk  is  passed  through  the  inferior  edge  of 
either  flap  and  tied,  the  ends  being  kept  long.  These  serve 
as  retractors,  and  the  flaps  being  held  aside,  a  curved 
transverse  incision  is  made  at  the  cervico-vesical  junction. 
The  bladder  is  freely  separated  from  the  uterus  by  blunt 
dissection  with  the  finger,  the  vesico-uterine  fold  of 
peritoneum  being  divid^  by  the  aid  of  scissors.  The 
patient's  hips  are  elevated,  which  allows  the  bladder 
and  intestines  to  gravitate  from  the  uterus,  the  fundus 
of  which  is  brought  into  view  and  is  seized  by  a  pair 
of  bullet  forceps  and  drawn  forward.  The  ovaries 
and  tubes  are  inspected  after  any  existing  adhesions 
have  been  broken  up  and  if  diseased  are  removed.  A 
suture  of  pedicle  silk  (No.  12)  is  passed  by  means  of  a 
curved  Hagedorn  needle  through  the  left  vaginal  flap  at  a 
point  slightly  distant  from  its  superior  margin,  then 
through  the  muscular  cissne  of  the  anterior  uterine  wall 
olese  to  the  fundus  and  then  through  the  right  vaginal 
flap  near  its  upper  margin.  A  second  suture  of  silkworm 
gut  is  passed  in  the  same  way  about  one- third  of  an  inch 
below  the  first.  The  uterus  being  well  anteverted,  the 
first  suture  is  tied  loosely  in  the  ordinary  way  and  the 
second  is  passed  through  an  opening  in  a  small  lead  shield 
and  is  fastened  by  a  perforated  shot,  which  is  closed  by 
pinching  it  with  a  pair  of  artery  damps.  The  balance  of 
the  wound  in  the  anterior  vaginal  wall,  after  free  irriga- 
tion with  saline  solution  and  the  application  of  hydrogen 
dioxide  if  there  is  much  oozing,  is  CH)sed  by  means  of  inter- 
rupted sutures  of  horse  hair  and  the  wound  is  sealed  by 
painting  it  over  with  a  10  per  cent,  solution  of  iodoform 
in  ether.  A  small  quantity  of  eauze  is  placed  in  the 
vagina  for  the  purpose  of  efTecting  drainage,  and  an  anti- 
septic pad  is  applied  to  the  vulva.  The  time  occupied  by 
the  operation  is  usually  twenty  minutes.    The  patient's 


urine  is  drawn  bv  the  aid  of  a  new  catheter,  which  eboukl 
preferably  be  a  short  one  of  glass  to  which  is  attached  a 
rubber  tube,  till  it  can  be  voided  voluntarily:  which  is 
generally  at  the  end  of  the  third  day.  The  vaginsJ  gauze 
is  removed  about  this  time,  and  is  not  replaced.  A  dailv 
douche  of  a  weak  bichloride  solution  is  given,  after  whieh 
the  iodoform  solution  is  again  painted  over  the  wound. 
The  vaginal  sutures  are  removed  at  the  end  of  a  week,  or 
sooner,  if  they  begin  to  cut  the  tissues.  The  eatuies 
which  hold  the  uterus  in  place  are  allowed  to  remain  for 
as  long  a  time  as  is  possible.  The  patient  is  retained  in 
the  horizontal  position  for  two  weeks,  and  is  then  allowed 
to  assume  a  sitting  posture,  and  at  the  end  of  the  third  or 
fourth  week  is  permitted  to  leave  the  bed  and  move 
about. 

GasiI.  Oophorectomy  and  Vaginal  Fixation. — C.  R.,  a 
single  woman,  est.  20,  was  admitted  to  hospital  on  OdL 
27th,  1894.  She  stated  that  her  first  menbtrual  period 
occurred  during  her  sixteenth  year,  that  it  had  been 
somewhat  painiul,  but  regular,  and  of  the  monthly  type. 
She  had  never  been  pregnant.  For  the  past  eighteen 
months  she  had  had  constant  pain  in  her  back.  She  had 
recently  suffered  from  vaginitis,  and  since  this  attack  her 
menstrual  periods  had  been  accompanied  by  severe  pain. 
A  bimanual  vaginal  examination  revealed  an  enlarged 
tender,  and  retroplaced  uterus,  also  bilateral  enlargement, 
and  tenderness  of  the  tubes  and  ovaries.  On  November 
7  th,  after  proper  preparation,  the  patient  having  been  placed 
under  ether  anaesthesia,  the  uterus  was  drawn  forward  and 
after  dilatation  of  the  cervix  its  cavity  was  curetted  and 
irrigated.  The  anterior  vaginal  wall  was  incised,  the 
bladder  separated,  and  the  uterus  anteverted,  as  previously 
described.  Both  ovaries  were  found  to  be  somewhat 
adherent  and  cystic,  and  were  removed.  The  nelvic 
cavity  was  flushed  with  hot  saline  solution,  and  the 
uterus  was  attached  to  the  anterior  vaginal  wail,  and  the 
vaginal  wound  closed,  drainage  not  being  employed.  The 
patient's  convalescence  was  uneventful.  Her  highest 
bodily  temperature,  100*4^  F.,  occurring  on  the  second 
day,  the  highest  pulse  rate  was  90,  and  her  respirations 
24,  all  beoeming  normal  on  the  third  day  and  remaining 
so.  The  patient  was  catbeterised  till  the  evening  of  the 
second  day,  when  she  voided  her  urine  voluntarily.  The 
wound  healed  primarily.  On  the  twenty-ninth  day  the 
uterine  sutures  were  removed.  The  uterus  was  found  to 
be  anterior.  The  patient  had  had  no  pain  or  bladder 
symptoms. 

Casb  II.  Vagino- Fixation, — B.  A.,  a  widow,  set.  34,  was 
admitted  to  hospital  on  Sep.  4th,  1894.  She  stated  that 
her  first  menstrual  period  occurred  during  her  sixteenth 
year,  and  that  it  has  been  painless,  regular  and  of  the 
monthly  type  ;  she  had  had  no  miscarriages.  One  year 
ago  she  had  given  birth  to  a  child.  About  nine  months 
later  menstruation  bad  become  irregular  and  painful  and 
of  late  she  had  had  a  constant  pain  in  her  back  and  left 
side.  A  vaginiJ  examination  revealed  a  retroplaced  and 
tender  uterus. 

As  it  was  evident  that  the  patient  was  suffering  from 
endometritis,  an  operation  was  advised,  consented  to,  and 
was  performed  on  November  27th»  1894.  The  uterus, 
after  curettage  and  irrigation  of  its  cavity  and  the  usual 
incision  of  the  vaginal  wall,  was  anteverted  and  its  fundus 
attached  to  the  wall.  The  patient's  convalescence  was 
uneventful.  She  voided  her  urine  naturally  on  the  third 
day.  Her  highest  bodily  teniperature  was  99*4%  her  pulse 
ranging  from  80  to  97.  On  December  4th,  it  was  noted 
that  the  vaginal  wound  had  healed  primarily,  that  the 
patient  had  complained  of  no  pain  or  bladder  symptoms. 
On  the  thirty-first  day  the  deep  sutures  were  removed  and 
the  uterus  was  forward  in  a  good  position.  The  following 
day  the  patient  was  allowed  to  leave  the  bed.  Her 
menstruation  recurred  on  January  1st,  lasting  four  days 
and  was  almmost  free  from  pain. 

Case  III.  Trachelorrhaphy  —  Oophorectomy — Vagino- 
Fixation  — H.  D.,  a  single  woman,  was  admitted  to  hos- 
piUl  on  Nov.  16th,  1895.  She  stated  that  her  first 
menstrual  period  had  occurred  during  her  nineteenth 
year  and  that  it  had  been  somewhat  irregular.  She  bad 
been  costive.  She  had  recently  been  confined,  einoe 
which  time  she  had  had  a  constant  dull  pain  in  her  side 
and  back  radiating  into  her  lower  extremities.  On  mak- 
ing abdominal  preesiire  a  localised  tenderness  was  found 
to  exist  in  the  right  inguinal  region.    Vaginal  examina- 


Jav.  20,  lg96 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Mbdical  Pbbss.     107 


tion  repealed  an  enlarged  retroplaced  and  tender  nterne 
vith  a  oervioal  laoeration  on  its  right  side,  alao  an 
enlaiged  and  tender  tabe  and  ovary  on  the  same  side. 
Tlie  operation  was  performed  on  the  24th  of  January  and 
coneirted  of  a  trachelorrhaphy.  Carettage  followed  by  the 
tneieion  of  the  anterior  vaginal  wall,  anteversion  of  the 
vtenw,  the  removal  of  the  right  tube  and  ovaiy  and  the 
fixation  of  the  f  nndns  to  the  anterior  vaginal  waU.  The 
pataeot's  hieheet  bodily  temperature  following  the  opera- 
tion was  100^  F.,  on  the  day  following  that  on  which  the 
operation  took  place  and  became  normal  on  the  afternoon 
of  the  eacoeedini;  day.  The  patient  voided  her  urine 
norntally  on  the  fourth  day.  The  paUent  complained  of 
nojpain  or  bladder  symptoms. 

Cask  IV.  Amputation  of  the  Cervix  and  Vagino- Fixc^ 
tio; — T.  P.  •  a  single  woman,  was  admitted  to  hospital  on 
Dec.  lOth,  1894.  She  stated  that  her  first  menstrual 
period  oocurred  during  her  fifteenth  year,  that  it  bad  been 
regular  and  of  the  monthly  type,  but  accompanied  by 
severe  pain.  She  had  given  birth  to  one  child  seven  years 
previoualT.  About  three  months  prior  to  her  admission 
she  bad  had  an  instrumental  abortion  performed.  This 
had  given  rire  to  a  severe  pelvic  pain  which  was  accom- 
panied by  a  bloody  vaginal  discharge.  A  bimanual  vaginal 
examination  reveled  an  enlarged  and  tender  uterus  with 
•n  hypertrophied  cervix.  An  operation  was  advised  and 
was  {Performed  on  Dec.  11th,  and  consisted  of  curettage, 
smpntation  of  the  cervix  and  fixation  of  the  uterine  fundus 
to  the  anterior  vaginal  wall.  The  patient^s  highest  bodHy 
temperature  100-2^  F  ,  was  on  the  day  following  that  on 
which  the  operation  was  performed.  The  patient  passed 
her  urine  voluntarily  on  the  fourth  day.  The  vaginal 
wound  healed  primarily.  There  were  no  bladder  sym- 
ptoms. On  the  38th  day  the  uterine  sutures  were  removed 
•ad  the  patient  was  allowed  to  sit  up.  On  Jan.  dOth,  1895, 
it  was  noted  that  the  patient  had  had  no  pain  or  bladder 
symptom?,  that  the  uterus  was  anterior  and  that  her 
menstraation  following  the  operation,  while  rather  profuse 
bad  been  painless. 

The  notes  of  several  other  cases  in  which  similar  opera- 
tions were  performed,  from  Oct.  1894,  to  Feb.  1895,  have 
unfortunately  been  lost  but  their  stories  were  of  the  same 
tSDOur  as  thef oregoing.  It  is  unfortunate  that  these  patients 
could  not  have  been  observed  for  a  longer  period  of  time 
but  it  has  been  shown  that  this  operation  Im  not  one 
difficult  of  performance,  that  it  permits  of  the  examination 
of  the  uterus  and  its  adnexa  and  their  removal  even  if 
somewhat  adherent.  If,  however,  bilateral  disease  of 
these  organs  exists,  the  writer's  experience  leads  him  to 
believe  uat  instead  of  fixation  of  the  uterus  following 
their  removal  a  hysterectomy  should  be  performed.  That 
vagino-fization  ie  followed  by  little  constitutional  disturb- 
saoe  and  no  danger  to  life,  so  far  there  having  been  no 
fatid  cases  recorded  ;  that  it  can  be  quickly  performed  ; 
that  it  places  the  uterus  in  Kood  position  ;  that  it  is  not 
osnsly  followed  by  pain  or  bladder  symptoms ;  that  it 
leaves  no  soar  or  liability  to  hernia  and  that  it  lessens  the 
danger  of  inteetinal  adhesions.  Others  have  found  that 
the  uterus  placed  anteriorly  by  this  operation  remained 
ie  good  position  even  after  pregnancy  and  delivery  at  full 
term. 

While  more  time  must  elapse  before  we  can  pass  final 
lodgement  on  the  value  of  this  procedure,  the  writer 
believes  that  it  will  eventually  bo  recognised  as  the  proper 
msans  of  treatmept  for  many  cases  of  uterine  retroais- 
plaoements  which  give  rise  to  symptoms. 


^elettfb    Jormttl^. 


The  following  prescriptions  are  taken  chiefly  from  Dr. 
Morrell's forthcoming  work  on  "Pharmacology  and  There- 
peocics,"  an  advance  copy  of  which  is  before  us  : — 

lOOIDK  OF  SODITJM  MiXTCTRS. 

Iodide  of  Sodium,  15  grains ; 
Water,  half*an-ounce. 
To  betaken  in  a  cup  of  black  coffee  at  bed-time  in  cases 
o(  asthma. 

Bbnzol  Dbops. 
Benzol,  three  dnohms. 
Oil  of  Peppermint,  one  drachm  ; 
Olive  Oil,  two  ounces. 


Ten  drops  on  sugar  every  four  hours  in  chronic  bronchial 
catarrh. 

Afomobphihe  Miztdrx. 
Solution  of  Apomorphine  (1  in  50),  10  minims  ; 
Dilute  nitro-hydrochloric  acid,  5  minims  ; 
Tincture  of  Viri^inian  Prune,  20  minims  ; 
Syrup  of  Virginian  Prune,  20  minims  ; 
Water  to  an  ounce. 
A  useful  expectorant  in  cases  of  chronic  bronchitis  and 
winter  cough. 

Ahbkb  Mixtdbb. 
Oil  of  Amber,  10  minims. 
Powdered  Gum  Acacia,  1  drachm. 
Syrup  of  Orange  Flower,  2  drachma. 
Oil  of  Anise,  3  minims. 
Water  to  an  ounce. 
Uieful  in  chronic  bronchial  catarrh,  and  in  whooping- 
cough. 

Sbnxoio  Mixtobx. 
Tincture  of  Seneoio,  1  drachm. 
Syrup  of  Lemons,  15  minims. 
Spirit  of  Chloroform,  15  minims. 
Water  to  an  ounce. 
For  amenorrhoea.    To  be  taken  three  times  a  da^  for 
four  days  before  the  time  of  the  expeoted  period.    Either 
the  Senecio  Jaooboea  or    the  Senecio  vulgaris  may  be 
used. 

Pabaldbhydb  Mixtubb. 
Paraldehyde,  half-an-ounce ; 
Tincture  of  Vanilla,  20  minims  ; 
Rectified  Spirit,  half-an-ounoe ; 
Syrup,  one  ounce ; 
Water  to  four  ounces. 
A  tablespoonful  at  bed-time  in  cases  of  sleeplessness. 
Amtispasiiodio  Dbops. 
Oil  of  Oajeput,  two  drachms ; 
Oil  of  Cloves.  hf>lf-a-drachm  ; 
Oil  of  Peppermint,  half-a-draohm ; 
Rectified  Spirit  to  two  ounces. 
Ten  drops  occasionally  on  sugar  for  flatulence. 


CLINICAL  SOCIETY  OF  LONDON. 
Mbbtikm  hkld  Fbidat,  Jastitaby  24th,  1896. 

The  President,  Dr.  Buzzabd,  in  the  Chair. 


Clinical  Evenjko. 
abthbitis  dbfobhaks  with  closobb  of  thb  jaw  fbom 

ANKYLOSIS  OF  BOTH  TBHPOBO-IIAXILLABY  ABTIOUIJITIONS. 

Db.  John  R.  Lunn  showed  a  patient,  aec.  45,  a  cabman, 
who  was  admitted  into  St.  Marylebone  Infirmary  July 
17th,  1894.  Past  history :  Twenty-five  years  ago  he  had 
rheumatic  fever,  and  from  that  time  most  of  his  joints 
began  to  be  affected,  the  knees  being  the  first  to  be- 
come swollen.  Two  years  later  his  jaw  became  stiff, 
and  for  the  last  twelve  months  he  has  been  unable 
to  separate  his  teeth  at  all  or  to  take  solid  food. 
On  admission :  It  was  noticed  that  both  the  patient's 
knees  were  swollen,  and  distended  with  fluia,  osteo- 
pbytio  outgrowths  surrounded  the  joints,  and  most  of 
the  articulations  in  the  body  were  affected  with  rheumatic 
arthritis ;  his  neck  was  stiff,  and  it  could  not  bH  turned 
towards  the  right  or  left.  Both  hip-joints  were  stiff,  and 
the  jaw  could  not  be  opened.  The  upper  row  of  teeth 
overlapped  the  lower  ones,  the  latter  were  loose.  On 
August  1 8th,  1894,  the  patient  was  put  under  CH  Clz,  and 
considerable  force  was  used  to  try  and  open  his  mouth, 
but  without  success.  An  incision,  two  inches  lone,  was 
then  made  on  the  right  side  in  a  vertical  direction,  a  finger  a 
breadth  in  front  of  the  ear ;  after  tying  a  few  bleeding 
vessels,  bone  was  hit  upon,  ana  was  thought  to 
be  the  neck  of  the  condyle,  but  was  the  zygomatic  process 
of  the  malar  bone ;  the  neck  of  the  jaw  was  then  divided, 
but  there  was  no  movement  of  the  jaw  after  its  division, 
so  a  wedge-shape  piece  of  bone  was  freely  chiselled 
out,     and     the     wound     was     temporarily     plugged. 

D 


108     Thb  Medical  Pbms. 


TRANSACTIONS  OF  SOCIETIES. 


Jan.  29,  1896. 


A  similar  process  was  gone  through  on  the  left 
side  with  the  exception  that  the  incision  on  the  latter  was 
obliqne  instead  of  vertical  J  a  considerable  portion  of  the 
parotid  gland  over-laying  the  maxilla.  The  jaw  was 
then  forcibly  opened  by  the  screw-gag  so  that  the  teeth 
were  separated  an  inch.  Two  teeth  were  accidentally 
forced  out  during  the  operation.  Both  wounds  were  dosed 
and  healed  by  primary  union.  A  wooden  gag  was  put 
between  the  teeth  and  was  tied  in  the  mouth  to  keep  the 
teeth  apart,  the  whole  operation  lasted  nearly  two  hours. 

HTSTEEO-BPILEPST— A  0A8B  RIPRBSENTENG  THE  CONDITION 
OF  DUAL  EXISTENCE. 

Dr.  Albert  Wilson,  of  Leytonstone,  showed  a  girl, 
»t  12,  who,  in  April,  1895,  had  severe  influenza,  followed 
by  meningitis  and  mania.    After  m  weeks  the  cephalalgia 
disappeared,  and  mupcular  symptoms  developed— twitch- 
ings,  opisthotonos,  with  Uvidity  and  coma.    She  had  many 
fits  a  day.      In  June,  1895,  the  old  symptoms  subsided  and 
a  fresh  train  of  phenomena  appeared.  When  in  apparently 
her  normal  state  she  would  suddenly  shake,  turn  a  somer- 
sault, and  enter  a  new  and  diflferent  mental  state.    Her 
memory  for  all  events  during  health  was  quite  gone— even 
forgetting  the  names  of  things,  of  the  parts  of  her  body, 
and  her  own  name  and  identity,  and  those  of  her  parents. 
But  she  would  remember  in  one  such  fit  what  happened 
in  a  previous  one.    Thus  was  established  a  complete  dual 
existence.    By  education  she  learned  the  names  of  most 
things,  but  always  employed  baby  pronunciation.      She 
would  write  backwards  and  that  quickly.     When  these 
attacks  developed  she  lost  all  power  of  walking  or  standing 
till  about  August,  1895.     At  the  early  stage  she  had   fits 
of  catalepsy— chiefly  rigidity  of  ths  flexors.    At  times  she 
had  five  or  six  fits  a  day,  lasting  a  few  minutes,  and  at  ber 
worst  period  they  lasted  for  days.     She  recovers  from  them 
quite  suddenly,  is  never  surprised  at  her  surroundings,  but 
is  very  composed,  and  says  she  remembers  nothing  of  what 
transpired  during  the  attack.     The  most  striking  feature 
showed  itself  once  when  she  had  severe  toothache  during  an 
attack.    He  gave  chloroform,  and  removed  two  teeth.    On 
regaining  conecioupness  she  recognised  that  the  teeth  and 
pun  were  gone.     Her  father  hypnotised  her  and  brought 
her  to  the  normal  state,  when  she  made  the  discovery  of 
the  blood  and  the  loss  of  the  teeth,  but  never  remembered 
the  previous  pain  or  his  giving  her  chloroform.    She  had 
then  been  in  the  abnormal  state  for  about  three  days. 
There  have  been  many    variations,  and    she  has  four 
different  existences  besides  the  normal— (1)  "Nib"  for 
*'old  Nick"  when  she  has  had  violent  passion,  and  biting, 
and  slides  down  the  banisters.     (2)    '<  Dreadful  wicked 
thing  ''—when  everything  is  reversed— black  being  white, 
asleep  being  awake,  the  head  being  the  foot,  and  so  on. 
(3)  *^Allie,^'  when    she  is  amiable  and  good.     (4)  Her 
ordinary  fits,  as  already  described.     Other  phenomena 
occasionally  occur.    Thus,  she  is  at  times  completely  deaf 
and  dumb,  or  there  may  be  loss  of  memory,  so  that  she 
does  not  know  during  the  fits  those  whom  she  ordinarily 
knows.    The  last  three  or  four  weeks  a  fresh  phase  has 
occurred    She  is  now  (in  January,  1896)  living  mentally 
in  July  1895,  this  having  followed  on  a  mental  blank  of  a 
fortnight's  duration.    This  is  shown  by  her  imagining 
events  to  have  jusr. happened  which  happened  in  July,  and 
other  circumstances.    Her  general  he  1th  and  nutrition 
are  good.    She  has  not  vet  menstruated.     Treatment  has 
been  rest  and  quiet  and  fresh  air.    Tea  and  coffee  cause 
attacks  of  mania.     The  thyroid  treatment  has  had  no 
apparent  effect. 

Dr.  Althaus  said  the  case  resembled  those  recorded  as 
instances  of  "double  consciousness"  in  patients  who 
aftera  brief  period  of  unconsciousness  change  in  character 
from  reticent  and  morose  to  gay  and  merry,  with  appar- 
ently hieher  faculties  than  before.  Then,  after  another 
period.  <n  unconsciousness  the  character  changed  back 
again.  In  a  case  of  the  kind  recorded  by  a  French  author 
it  was  ultimately  thought  to  be  an  example  of  somnambu- 
lism. Somnambulism,  he  pointed  out,  was  comparatively 
frequent  in  children,  especially  girls,  and  it  was  conceiv- 
able that  a  slight  exaggeration  of  this  aberration  might 
determine  symptoms  similar  to  those  described.  In  another 
recorded  case  in  which  the  patient  when  24  years  of  age 
suddenly  developed  this  curious  quality  of  personality. 
She  was  usually  short- sighted  and  used  spectacles,  but  in 
^e  alternative  condition  she  would  fling  her  spectacles 


away  and  developed  wonderful  visual  powers.  After  two 
or  three  hours  in  this  condition  she  would  fall  aaleep  and 
wake  up  her  former  self.  These  alternations  cx>ntuiiied 
for  several  years.  He  pointed  out  everyone  led  dual 
existences  more  or  less.  There  was  a  waking  and  a  sleep- 
ing (dreaming)  condition  and  they  were  not  the  same 
drunk  as  so&r.  Moreover,  one  could  often  remember 
things  in  one  condition  which  one  was  quite  unable  to 
recall  in  the  other.  It  seemed  as  if  there  were  two  separate 
cerebral  centres  conoemed  which  came  alternately  into 
play. 

Dr.  Ormsbod  asked  whether  the  author  was  in  a  posi- 
tion to  affirm  that  the  original  atUck,  which  waa  the 
starting  point  of  the  symptoms,  was  really  meningfitis.  He 
suggested  that  it  might  have  been  a  febrile  attack  with 
nervous  symptoms  due  to  the  same  cause  as  the  symptoms 
in  question,  which,  for  want  of  a  better  name,  one  would 
be  inclined  to  call  hysterical. 

Dr.  Robert  Jos^bs  observed  that  theiie  cases  of  double 
consciousness  usually  came  on  suddenly,  often  after 
epilepsy.  He  mentioned  the  case  of  a  patient  who  lapsed 
after  an  epileptic  attack  into  a  condition  in  which  she 
remembered  nothing  of  what  happened  t^  her  previously, 
and  vice  versa,  and  he  recalled  a  case  of  the  kind  that  had 
been  placed  on  record  in  which  this  condition  of  forgetful- 
ness  of  events  in  the  ordinary  condition  lasted  for  a  year, 
and  on  the  patient  having  another  fit  and  becoming 
restored  to  her  ordinary  self  the  events  of  that  year  were, 
so  to  speak,  blotted  out.  He  remarked  that  when  the 
author's  patient  tried  mirror  writing  she  did  not  begin  as 
usual  with  the  first  letter  of  the  name  but  wrote  back- 
wards, beginning  with  the  last  letter.  This  made  hun 
think  that  she  was  acting  under  the  influence  of  "  sugges- 
tion." The  patient  appeared  to  be  unduly  precocious, 
and  she  apparently  acted  on  suggestion  rather  than  from 
epilepsy  or  genuine  dual  consciousness.  , 

Dr.  Wilson,  in  reply,  said  he  did  not  attend  her  dun^ 
the  alleged  attack  of  meningitis,  when  she  had  arise  of 
temperature  followed  by  headache  and  she  became  very 
intolerant  of  light  and  sound.  There  was  also  some  deli- 
rium and  excitement,  and  he  thoucrht  probably  there  was 
some  meningitis.  When  first  asked  to  try  mirror  writing 
she  was  quite  unable  to  originate  an  idea  and  could  only 
copy.  Ue  did  not  think  she  was  acting  under  Buggestion 
now.  He  had  been  very  particular  at  first  not  to  discuss 
her  case  before  her,  but  later  on  when  this  waa  done  by 
others  it  did  not  seem  to  make  any  difference. 

A  OASB   OF  MYOPATHIC  MUSCULAR  ATROPHY  IN  THE  ADULT. 

Dr.  Norman  Dalton  showed  a  patient  who  was  quite 
well  until  twenty  years  of  age.  There  was  no  family  hifr 
tory  of  any  trouble  of  the  kind.  At  present  he  presented 
marked  indications  of  general  muscular  atrophy.  When 
put  on  his  back  and  told  to  rise,  he  first  turned  on  his 
right  elbow  and  on  to  the  palm  of  his  right  hand.  Then 
he  got  on  all  fours,  but  could  not  rise  any  more  without 
the  aid  of  a  chair.  The  pectorales  majores  were  atrophied 
at  the  lower  part,  but  intact  above.  The  serrati  were 
intact,  but  the  deltoids  were  weak. 

A  OASl  OP  KXTKNSIVK  SKIN  GRAFTING. 

Mr.  H.  Patbrson  showed  a  man,  sat.  58,  who,  in  con- 
sequence of  extensive  cellulitis, 


lost  the  skin  from  the 
entire  front  of  the  thigh  and  leg.  He  had  recourse  to 
large  grafts  by  Thirsoh's  method,  some  of  the  flaos 
measuring  5  by  Si  inches.  Tbe  result  had  been  extremely 
successful- 
Mr.  A.  Prargi  Goxxd  asked  whether  the  author  hsd 
discovered  the  necessity  of  keeping  these  patients  recum- 
bent for  a  long  time  after  cicatrisation  had  taken  place. 
He  pointed  out  that  some  surgeons  had  expressed  grast 
dissatisfaction  with  this  mode  of  treatment,  because  after 
healing,  the  newly-formed  tissue  easily  broke  down  sgain. 
In  his  own  experience  that  was  due  to  the  patient  havug 
been  allowed  to  get  up  too  soon.  ^^ 

Mr.  Patsrson,  in  reply,  ad  mi  teed  that  this  hsd  beeo 
his  experience.  .The  cases  that  broke  down  were  thosem 
which,  healing  having  taken  place,  the  patients  refused 
to  remain  in  bed. 

SUPPURATION     OF   THE    LBFT    SHOULDKR-JOINT,    WHH 
ARTHRITIS  DEFORMANS. 

Dr.  J.  R.  LuNN  showed  a  man,  at.  66,  admitted  Novem- 
ber   27tb,    1893,  with  chronic  arthritis  deformans  sod 


Jajt.  29,  1M6 


TRAjrSACTIONS  OF  S0CIETTE8. 


The  Medical  Pbess>.     109 


8W«3ing  of  left  sbonlder-joint.  He  had  enjoyed  iifood 
beelth  antil  fifteeo  yeaie  t^^  when  he  had  his  first  attack 
of  iheomatum.  Since  then  he  had  repeated  attacks  in 
most  of  his  joints.  On  admission  the  man  appeared  to  be 
ilL  He  was  feverish,  restless,  and  inclined  to  be  delirioas. 
He  complained  of  intense  pain  in  the  left  shoulder* joint 
with  limited  movements,  which  was  very  large,  tense,  and 
▼eiy  painful  to  tooch.  His  temperature  was  103*2'^ ; 
{mlse,  110.  He  was  treated  with  rest,  ice-bag,  and  salicy- 
late of  soda,  bot  he  did  not  improve.  His  temperature 
rose  higher,  and  he  begged  for  something  to  be  done. 
The  joint  was  tapped  by  an  ezplorin^^  needle,  and  pus  was 
withdrawn.  On  ueoember  Sri  an  incision  was  made  in 
front  of  the  left  shoulder-joint,  commencing  at  the  outer 
side  of  the  ooraooid  process,  pus  was  let  out,  and  the  joint 
explored  with  the  fin^rs,  and  a  counter  opening  made 
bsbind.  The  head  of  the  humerus  was  rough  and 
diseased,  which  was  curetted  with  Barker's  gouge, 
and  the  shoulder-joint  being  washed  out  with  hot 
water.  Iodoform  emulsion  was  introduced,  aud .  the 
incision  dosed  in  front,  and  a  small  drainage  tube  was 
fastened  in  the  posterior  wound,  which  was  removed  the 
following  day  and  the  wounds  healed  very  soon,  and  the 
patientrapidly  recovered.  In  June,  1894,  thesame  shoulder 
again  be|^  to  swell  and  his  temperature  rose  to  102*4'* 
and  the  man  seemed  as  bad  as  ever,  the  pus  was 
sgain  let  out  and  the  joint  treated  as  before. 
8uioe  the  second  operation  the  patient  has  enjoyed  good 
health.  He  has  now  marked  wasting  of  the  left  deltoid 
muscle  and  other  muscles  about  the  joint,  the  movements 
are  very  limited.  He  can  only  abduct  his  arm  slightly, 
end  can  raise  his  arm  nearly  to  a  right  angle  to  his  trunk, 
but  has  no  power  to  keep  it  theie. 

A  CASK  OF  TRAUMATIC  OBBITAL  AKIUSISM. 

Mr.  Raymond  Johnson  showed  a  woman,  »t.  44,  who 
fall  on  the  back  of  her  head  four  months  ago,  and  was  un- 
conscious for  seven  hours.  On  recovering  she  vomited, 
sod  at  once  noticed  that  the  left  eye  was  blood- shot,  and 
the  eyelids  swollen.  On  the  following  day  she  noticed  a 
bofztng  noise  in  the  left  side  of  the  head,  and  this  had 
been  oontinnoas  ever  since.  Then  the  eye  became  un- 
usoaUy  prominent.  During  the  four  weeks  she  had  been 
under  observation  there  hMl  not  been  any  chanee.  The 
principal  points  were  the  prominence  of  the  left  eye, 
without  congestion  of  the  conjuctiva  or  distension  of  the 
veins.  No  pulsation  could  be  either  seen  or  felt,  but 
sronnd  the  orbit  a  loud  murmur  was  audible.  This  was 
continuous,  but  was  influenced  by  the  rapidity  of  the 
heart  beat.  There  was  no  evidence  of  neuritis,  and  no 
obvious  dilat-ation  of  the  veins  of  the  fundus.  Vision  was 
Bonnal  except  for  diplopia,  which  was  dependent  upon 
paralysis  of  the  sixth  nerve.  He  had  called  it  a  case  of 
traumatic  orbital  aneurism,  but  in  the  absence  of  the  usual 
indications  he  admitted  that  the  diagnosis  was  open  to  dis- 
cussion. He  thought  that  probably  there  was  aneurismal 
vsrix  of  the  internal  carotid  artery  and  cavernous  sinus. 
The  fall  probably  caused  a  fissured  fracture  of  the  base  of 
the  skull,  for  hnmorrhage  at  the  back  of  the  orbit  was 
notioed  within  a  few  hours  of  the  accident.  He  mentioned 
that  she  was  at  present  nursinff  her  child,  who  had  double 
proptosis,  due  to  a  neoplasm  m  the  interior  of  the  skulL 
Ckimpression  of  the  left  carotid  did  not  cause  the  noise  or 
the  pfoptosis  to  subside,  though  both  were  somewhat 
leseened  thereby. 

Mr.  Gonu)  remarked  that  under  the  circumstances  a 
communication  between  the  internal  carotid  and  the  cavern- 
ous sinus  would  be  extraordinary.  It  must  in  any  case 
be  very  minute  or  there  must  be  some  other  special 
eoodition  for  the  artery  to  communicate  with  the  vein 
without  causing  dilatation  of  the  veins.  He  pointed  tout 
that  these  cases  often  got  well  spontaneouly  with  rest, 
tad  he  recalled  a  case  at  Middlesex  Hospital  two  years 
a^  of  a  man  who  came  in  immediatelv  after  the  '  injury 
with  symptoms  of  acute  obstruction  of  toe  cavernous  sinus, 
polntioD,  proptosis,  interference  with  vision,  and  a  loud 
bruit.  Under  rest  in  bed,  without  any  particular  treat- 
mont,  he  ultimately  quite  recovered. 

Mr.  W.  6.  Spekobk  doubted  the  existence  of  a  direct 
eommunication  between  the  internal  carotid  and  the 
cavernous  sinus,  but  suggested  that  there  might  be  a  com- 
monication  with  one  of  toe  smaller  branches.  This  would 
szplaiu  the  absence  of  venous  dietension. 


Mr.  BowLBT  observed  that  the  diagnosis  of  these  cases 
was  rendered  more  difficult  by  the  fact  that  in  some 
nothing  whatever  was  found  to  account  for  the  symptoms. 
He  remembered  one  such  case,  worse  than  this  one,  which 
got  perfectly  well  without  treatment.  The  paralysis  of 
toe  sixth  nerve  seemed  to  point  to  actual  pressure.  He 
thought  there  might  possibly  be  a  communication  between 
the  carotid  artery  and  the  sinus,  probably  very  minute. 
Under  any  circumstances,  he  said  they  would  probably  all 
agree  that  the  treatment  should  be  of  the  nature  of 
"  masterly  inactivity." 

IMPAIRBD  OBOWTH  OF  LOWER  BPIPHYblS  OF  TIBIA 
OONSBQUBNT  ON  STRAIN. 

Mr.  Mansell-Moullin  showed  a  lad  who  five  years  a^, 
got  his  foot  in  a  wheel,  and  it  was  severely  twisted.  He 
was  confined  to  bed  for  some  weeks,  and  the  case  was 
treated  as  a  simple  sprain.  The  lower  end  of  the  fibula 
had  eone  on  growing  out  the  growth  of  the  lower  part  of 
the  shaft,  as  well  as  the  epiphysis,  of  the  tibia  had  not 
grown  and  there  had  resulted  aa  extraordinary  malleolar 

g rejection  twistine  the  foot  into  a  position  of  false  talipes, 
[h  could  only  walk  a  short  distance  and  that  with  great 
suffering  so  that  something  seemed  to  be  required  in  the 
way  of  operative  treatment.  He  suggested  excising  about 
an  inch  of  the  fibula  and  bringing  the  foot  into  the  normal 
position. 

THREB  oases  OF  PSBUDO-HYPBRTROPHIC  PALSY. 

Dr.  Fletchbr  Littlb  showed  three  brothers,  respec- 
tively 5,  10  and  13,  years  of  age,  all  suffering  from  pseudo- 
hypertrophic palsy.  They  were  the  only  children  and 
there  was  no  history  of  nervous  disease  in  the  family.  The 
eldest  had  been  suffering  for  seven  years,  the  second  for 
three  years  and  theyouneest  for  nine  months.  The  two 
older  boys  were  quite  unable  to  walk.  The  second  had 
contracture  of  both  the  lower  limbs. 


ROYAL  ACADEMY  OFj  MEDICINE  IN  IRELAND. 

SbCTION  of  PATHOLOOr. 

Meeting  held  Friday,  Jan.  3rd,  1896. 


The  President,  Dr.  Conolly  Norman,  in  the  Chair. 

LEUGHJSMIA  SPLENICA.      (LIVING   EXHIBIT.) 

Db.  Dbnham  showed  the  case  of  a  gentleman  from  Kil- 
kenny suffering  from  a  very  lurge  splenic  tumour.  He  was 
set.  41,  with  a  good  family  history,   and  had  always  en- 


joyed good  health.  Five  years  ago  he  returned  from 
QueenSand,  where  he  had  resided  some  years.  The 
patient  first  observed  the  tumour  six  months  ago,  and  was 
treated  for  indigestion.  He  came  under  his  (Dr.  Den- 
ham's)  care  at  the  beginning  of  December.  He  (Dr.  Den- 
ham)  had  made  four  examinations  of  the  blood  with 
Gower's  hnmatometer  at  intervals  of  a  week,  with  the 
following  results : — 

Red  corpuscles.  White  corpuscles. 

1st  -        -    70  per  cent.  9  per  cent. 

2nd         -    73        19  8        „ 

drd-        -    82        „  2 

4th  -        -    85        „  2        „ 

Dr.  M'Weeney  had  made  stained  preparations,  which 
were  under  the  microscope.  In  these  numerous  eosino- 
phile  cells  were  to  be  seen,  but  Dr.  M*Weeney  had  been 
unable  to  find  any  myelogenic  cells.  It  was  remarkable 
that  notwithstanding  the  size  of  the  tumour  and  the 
altered  condition  of  the  blood  the  patient  enjoyed  very  fair 
health,  sufiering  little  or  no  discomfort.  Slight  constipa- 
tion and  breathlessness  only  on  severe  exertion.  The  fact 
that  under  treatment  the  number  of  white  corpuscles  had 
markedly  diminished,  and  that  no  blood  marrow  cells 
were  discoverable,  gave  the  case  decidedly  a  less  hopeless 
appearance. 

CANCER  or  THE    LIVBR. 

Dr.  PuRSBR  exhibited  a  specimen  of  columnar-celled 
cancer  of  the  liver,  which  was  remarkably  firm  in  its  mode 
of  growth.  The  morbid  mass  filled  the  portal  vein  from 
about  an  inch  below  its  bifurcation,  to  branches  so  small 
that  they  could  be  barely  followed  by  the  naked  eye.  No 
primary  growth  could  be  detected,  unless  a  small  nodule 
in  the  mucous  membrane  of  the  gall  bladder  could  be 


110     Thb  Mbdioal  PR»ft. 


TRANSACTIONS  OF  SOCIETIES. 


Jan.  29.   1898. 


taken  as  e>ach.  The  bile  duot  was  flattened  by  the  growth 
in  the  portal  vein,  bat  did  not  seem  to  have  bMn  the 
starting  point  of  the  tumour.  In  places  hemorrhage  bad 
occurr^  into  the  alveoli  of  the  cancer,  bat  there  were 
few  signs  of  degeneration. 

Dr.  M'WsEKBT  thought,  from  the  examination  he  had 
jost  made,  that  the  growth  was  one  of  papillary  adenoma, 
in  the  sense  in  which  that  term  is  used  by  Ziegler.  He 
traced  delicate  strands  of  connective  tissae  running  out- 
wards towards  the  periphery.  It  was  a  remarkable 
fact,  he  thought,  that  Professor  Purser  did  not  find  any 
primary  growth.  He  remarked  on  the  case  of  a  man 
from  whose  chin  a  tumour  was  removed — a  week  after  the 
operation  he  died,  and  a  post  mortem  revealed  a  nodule 
in  the  fissure  of  the  liver,  but  the  nodule  did  not  im- 
plicate the  substance  of  the  organ.  He  considered  the 
nlling  up  of  the  portal  vein  and  its  branches  in  the  case 
under  consideration  as  very  singular.  He  contrasted  the 
growth  with  a  growth  of  supra-renal  structure  in  the  sub- 
stance of  the  kidney,  two  instances  of  which  he,  on  a  former 
occasion,  had  brought  before  the  Academy. 

The  President  wished  to  ascertain  what  was  the  vas- 
cular supply  of  the  growth,  and  whence  came  the  hemor- 
rhage referred  to. 

Dr.  Pttbsbr,  in  reply  to  Dr.  M'Weeney,  said  that  the 
tumour  most  certainly  was  not  a  papilloma.  It  might  be 
called  an  adenoma,  but  he  considered  the  difference 
between  so-called  malignant  adenoma  and  cancer  was  not 
very  great.  In  reply  to  the  President,  he  said  that  the 
tumour  had  a  blooa  supply  of  its  own — a  fact  sufficient  to 
explain  the  hemorrhage.  Whether  the  blood-vessels  of 
the  tumour  were  derived  from  the  hepatic  artery  he  (Dr. 
Purser)  could  not  say. 

Dr.  M'Weeket  said  be  did  not  assert  that  the  tumour 
was  a  papilloma.  What  he  did  say  was  that  he  believed 
that  it  was  a  papillary  adenoma  in  the  sense  in  which 
Zieeler  used  that  term. 

The  Prfsidbnt  at  this  point  vacated  the  chair,  which 
was  occupied  by  Dr.  Purser  during  the  remainder  of  the 
proceedings. 

CAKOKB  OV  OALL-BLADDKB, 

Dr.  CoNOLLY  Norman  described,  as  a  pendant  to  Dr. 
Purser's  care,  three  cases  of  cancer  of  the  gall  bladder. 
In  all  three  the  interest  was  chiefly  clinical.  In  the  first 
fhe  liver  was  greatly  enlarged.  The  border  was  sharply 
defined,  and  the  right  lobe  was  extremely  and  uniformly 
hard.  The  patient  war  not  jaundiced,  was  not  markedly 
conptipated ;  there  was  no  absence  of  bile  from  the 
motions.  The  post-mortem  revealed  some  degree  of  adhe- 
sive peritonitis  over  the  surface  of  the  liver,  the  right  lobe 
of  which  was  infiltrated  with  cancerous  srowth.  The  left 
lobe  was  studdei  with  a  growth  mani&tly  of  the  same 
nature.  The  gall  bladder  was  filled  with  ropy  pus,  and 
contained  sixteen  small  faceted  stones.  A  rough  and 
ulcerated  mass  projected  into  the  viscus,  but  did  no 
damAge  to  the  cystic  duct.  In  most  of  its  aspects  the 
case  was  an  ordinary  one  ;  still  the  entire  absence  of 
jaundice  was  remarkable.  Microscopic  examination 
proved  th«t  the  case  was  one  of  the  ususl  columnar-celled 
epithelial  variety.  He  (Dr.  G.  Norman)  knew  no 
ante-mortem  symptoms  by  which  a  diagnosis  of  cancer 
of  thr  (rail  bladder  could  be  arrivecT  at  in  such  a 
case.  Second  case,  ^  A  woman,  forty  years  of  age, 
had  suffered  for  some  months  from  constipation  and 
abdominal  pain.  There  was  no  fever.  The  pain, 
shr  said,  was  most  marked  at  night,  and  she  attributed  it 
to  .  ie  fact  that  there  were  demons  in  her  inside.  On  the 
8th  of  September,  1899,  she  got  a  severe  attack  of  vomit- 
ing. On  examination  she  was  found  to  present  an 
enlarged  area  of  hepatic  dulness.  There  was  also  found  a 
well-defined  small  knob  in  the  position  of  the  gaU  bladder. 
The  diagnosis  wsis  made  of  g^l-stones.  The  patient 
sufiered  from  obstinate  constipation.  There  was  slight 
jaundice  which  never  increased.  Vomiting  continued 
very  troublesome,  but  was  never  feculent.  Though  the 
diagnosis  of  gall-stones  was  ventured  upon,  it  was  not 
deemed  oxpeaient  to  take  any  operative  measures  against 
this  condition.  She  died  on  the  28th  of  September.  The 
poet-mortem  appearances  were  as  follows  : — There  was  a 
good  deal  of  eeneral  peritonitis.  At  the  notch  for  the 
gall  bladder  there  was,  in  the  substance  of  the  liver,  a 
mass  of  cancerous  infiltration.    The  point  of  interest  to 


him  (Dr.  Norman)  was  that  he  made  the  mistake  of  sup- 
posing  that  this  hard,  small  knob  was  somethin|^  in  the 
gall  bladder.  Third  caee, — An  old  woman,  aboat  aixty 
years  of  age,  who  got  a  rather  sudden  attack  of  janndioe. 
On  examination  the  liver  was  found  to  be  enlarged,  and 
at  a  point  corresponding  to  the  notch  of  the  gall  bladder 
there  was  a  large,  pear-shaped  prominence,  easily  felt  by 
the  hand,  and  diagnosed  to  be  aeall  bladder  full  of  stonaa. 
She  gradually  be^une  more  and  more  deeply  jaandiced, 
but  the  area  of  hepatic  dulness  became  less.  She  never 
had  hematemesis.  She  died  apparently  from  exbanation. 
Th^  poet-morttm  revealed  no  traces  of  previous  peritonitis,, 
and  the  tumour  felt  atiUmortem  proved  to  be  the  gall 
bladder,  but  its  distension  was  due  to  a  cancerous  masa 
blocking  up  the  ducts  and  not  to  gall-stones. 
The  Motion  then  adjourned. 


LIVERPOOL  MEDICAL  SOCIETY. 

'MXXTINO  HELD  FRIDAY,  JANUARY   16tH.    1896. 


The  President,  Db.  Catoit,  in  the  Chair. 


Cask. 

Mb.  Nswbolt  reported  a  case  of  "  Traumatic  EpilepN^*^ 
resulting  from  a  compound  fracture  of  the  skulL  The 
original  injury  occurred  on  Dec.  13th,  1888,  at  Boeton, 
U.S.  The  man  was  trephined  and  bone  and  brain  sub- 
stance were  removed.  He  remained  well  for  two  years, 
except  for  the  presence  of  hemianopia.  At  the  end  of  this 
time  epileptic  Pts  commenced  and  occurred  at  intervals, 
varying  from  two  weeks  to  two  months  and  a  half.  The 
fits  invariably  started  in  the  left  wrist  and  the  injury  waa 
on  the  right  side.  On  admission  there  was  a  depression 
of  the  right  side  of  the  skull,  three-quarters  of  an  inch 
deep,  two  inches  from  above  downwards,  and  one  and  a 
half  inches  from  before  backwards,  the  centre  of  the 
depression  beicg  about  two  inches  above  the  right  ear.  ao 
the  bottom  of  this  depression  there  was  pulsation.  Mr. 
Newbolt  trephined  over  the  wrist  centre  and  finding 
nothing,  removed  the  bone  between  the  trephine  centre 
and  the  original  depression.  The  edges  of  the  depression 
were  pared  and  the  adherent  parts  separated  and  a  sharp 
spicule  of  bone  found  in  tbe  anterior  comn  removed. 
The  bone  was  replaced  and  the  wound  entirely  dosed, 
everything  did  well.  The  man  had  no  fit  for  seven  months 
when  he  had  a  slight  one  ;  another,  seven  months  later ; 
and  a  third,  four  months  after  this,  so  that  there  is,  so  fsr. 
decided  improvement.    Patient  was  shown. 

Mr.  BoBK&T  Jones  related  a  case  of  '*  Rapid  Gangrene 
of  a  Hernial  Sac."  The  patient,  a  man,  et.  48,  had  lieen 
ruptured  for  some  months,  and  had  worn  a  truss.  With 
this  exception  he  had  been  perfectly  well  until  December 
18th,  1895.  On  this  date  the  hernia  came  down  and  be 
vomited,  at  the  same  time  suffering  intense  agony.  The 
gut  was  reduced  without  the  slighest  difficulty  by  a 
neighbouring  surgeon  ;  the  patient,  however,  was  not 
relieved,  and  was  admitted  to  the  Southern  Hospital.  On 
admission,  the  hernia  was  down,  and  was  again  reduced 
with  ease,  but  as  the  symptoms  became  intensified  it  was 
decided  to  operate.  Five  hours  after  the  first  onret  of 
symptoms  the  sac  was  exposed  ;  it  was  perfectly  black, 
though  it  partially  retained  its  consistence  and  its  shining 
peritoneal  appearance.  On  opening  it,  thick  and  curdy 
discharge  containing  particles  of  vegetable  matter,  some- 
what like  pieces  of  ^r^pe  skin  escaped.  The  bowel  was 
congested  and  otherwise  sound,  but  on  lifting  it  np  care- 
fully a  tear,  f  in.  long,  was  found  on  its  posterior  aspect^ 
apparently  of  quite  recent  occurrence.  There  was  no 
abnormal  constriction  at  the  internal  ring,  but  a  quantity 
of  discharge  escaped  from  the  peritoneal  cavity,  and  tbe 
gangrene  of  the  sac  extended  to  the  internal  abdominal 
rinff.  The  sac  was  excised,  the  tear  in  the  gut  closed 
with  sutures,  and  the  abdominal  cavity  washed  out, 
but  the  man  only  survived  a  few  hours.  Post-mortem, 
the    intestines    were    greatly    distended,    much    con* 

Seated,  and  here  and  there  bathed  with  pumleDt 
uid.  The  sutured  portion  was  quite  watertight. 
This  case,  as  far  as  could  be  discovered,  was  unique  in 
surgical  literature.  It  was  extraordinary  that  a  hernial  esc, 
not  strangulated,  should  slough  in  less  than  ^v^  hoars 


Jav.  29.  1896. 


TRANSACTIOKS  OF  SOCIETIES. 


The  Mbdioal  Press.     Ill 


withoat  tbe  participation  in  the  process  of  any  of  its  con- 
tents, and  is  anggestiye  of  micro-orgsnism. 

Mr.  R.  H.  MiTBBAT  showed  two  children  upon  whom  he 
had  operated  for  *'  Extroversion  of  the  Bladder."  He  had 
used  lateral  skin  flaps  so  arranged  that  their  raw  surfaces 
were  next  the  bladder  macons  membrane.  He  greatly  pre- 
ferred this  method  to  the  more  usual  plan  of  a  reversed 
skin  flap,  as  it  was  much  more  simple  and  there  was  no 
fear  of  phoephatic  deposit,  which,  however,  was  a  frequent 
cause  of  annoyance  when  the  reversed  skin  flap  was  em- 
ployed, owing  to  the  increased  growth  of  hair  in  this 
^p. 

Mr.  RusHTON  Parker  remarked  that  a  number  of  years 
ago  he  had  operated  successfully  in  three  cases  of  boys,  by  a 
meUiod  devised  and  described  by  Mr.  Greig  Smith  in  the 
Briiigk  Medical  Journal,  a  great  improvement  on  the  plan 
of  the  late  Mr.  John  Wood.  A  pear-shaped  flap  of  ekin 
was  dissected  off  the  abdomen  and  turned  down  as  a  front 
lining  to  the  bladder  and  urethra.  The  raw  surface  of  this 
flap  was  then  covered  with  skin  detached  from  the  sides  of 
the  previous  wound,  and  stretched  to  meet  over  it.  The 
result  in  each  case  was  union  almost  throughout  by  first 
intention,  the  patients  sitting  in  a  hip-bath  of  warm 
twracic  lotion.  In  a  fourth  boy  he  had  failed,  owing 
to  sloughing  of  the  entire  flaps,  due  apparently  to  absence 
of  subcutaneous  fat,  although  the  operation  was  perfectly 
satisfactory.  In  a  female  child  he  had  also  done  a  very 
satisfactory  operation,  but  the  child  died  in  two  days  from 
summer  diarrhoea.  He  complimented  Mr.  Murray  upon 
tbe  gcKxl  results  attained  by  him  in  the  examples  of  Tren- 
delenburg's operation  exhibited  at  the  meeting. 

Mr.  Arthitr  Wilson  had  performed  the  operation  advo- 
cated by  Mr. '  Murray,  but  not  with  such  success.  He 
thought,  however,  that  it  was  the  best  of  the  operations 
now  advocated,  but  that  a  certain  selection  in  the  cases 
would  be  necessary.  He  suggested  that  for  those  in  the 
better  classefi  U  would  be  found  that  a  skilful  surgical 
meohanician  was  as  useful  as  the  surgeon. 

Br.  Ihlach  asked  the  surgeons  who  had  practical  expedi- 
ence of  the  operation,  what  age  they  preferred  the  child 
to  be,  whether  tbey  would  always  operate  at  once  or 
wait  until  the  child  was  two  years  old  or  more  ?  He  had 
teoently  advised  a  mother,  with  an  infant  only  six  weeks 
old,  to  wait  at  least  six  months. 

Mr.  Arthur  Wilson  showed  the  longs  from  a  case  of 
sarooma,  the  primary  growth  being  over  tbe  internal 
condyle  of  the  femur.  The  specimen  demonstrated  with 
how  small  a  quantity  of  healthy  lung  tissue  it  was  possible 
to  aerate  the  blood. 

Br.  Buchanan  read  a  paper  on 

LBUOOGYTHiEMIA. 

After  giving  a  brief  rMum^*.  of  etiology  and  clinical  features 
the  disease.  The  histology  of  the  normal  blood  difcossed, 
particularly  in  r^ation  to  the  leucocytes,  introducing  the 
classification  of  Wharton  Jones,  Max  Scbultze,  and 
'Erlich ;  the  latter's  methods  of  examination  were  dis- 
•CQSsed  relative  to  the  chemistry  of  dyes  and  solvents  of 
the  same.  Finally,  as  a  basis  for  comparison  in  diseased 
•conditions,  the  classification  of  the  wandering  cells  of 
mammalia  as  layed  down  by  Kanthack  and  &rdy  was 
adopted.  Comparing  blood  in  six  cases  of  leukaamia, 
examined  by  the  most  approved  methods,  two  forms  may 
1>e  recognised,  possessing  definite  hnmatological  features. 
1)  Characterised  by :  Great  leucocytosis  and  the  presence 
of  certain  cellular  elements  not  usually  found  in  normal 
blood :  (a)  Large  atypical  eosinophils  cells,  with  coarse 
granules,  in  extraordinary  numbers  ;  (b)  Large  uniclear 
-oeUs,  ^'  myelocytic"  similar  to  normal  marrow  cells ;  (o) 
Transitional  forms  from  (b)  through  (a)  to  the  ordinary 
finely  granular  eosinophile  cell,  the  latter  variably 
increased  or  diminished ;  (d^  Forms  of  (c)  devoid  of 
granules,  and  many  so  shrunken  as  to  suggest  a  retro- 
grsssive  change ;  (e)  Lymphocytes  and  small  basophile 
eslls  in  the  later  stages,  with  many  atypical  large  basophile 
•ceUs :  these  are  found  in  cases  accompanied  by  enlarge- 
ment oi  lymphatic  glands  ;  (f)  Many  nucleated  red  bl^>d 
corpuscles  of  the  megaloblastic  and  normoblastic  type. 
(2)  Lymphatio  form,  great  leucocytosis  with :  Ta)  Small 
Ijmphooytes  in  great  f3>undance ;  (b)  Large  hyaline  cells 
mcreased;  (c)  Transition  forms  from  *<a"  through  "b" 
to  large  atypical  basophile  cells  ;  (d)  Nucleated  rad  blood 
^orpoeoles  numerous ;  (e)  Eosinophiles,  coarse  and  fine 


diminished ;  (f )  also  of  myelocytes.  Mixed  types  of  both 
exist.  Class  2  may  be  associated  with  Class  1  in  the  latter 
stages.  Class  2.  Earl.  Two  pure  cases  were  illustrated. 
The  use  of  colour  preparations  of  the  blood  is  necessary  to 
distinguish  either  form, .  and  to  differentiate  tbe  disease 
from  any  other  associated  with  similar  clinical  signs.  Two 
cases  of  greatly  enlarged  spleen  and  lymphatic  glands 
were  illustrated,  showing  none  of  the  above  peculiarities 
in  the  blood. 

Br.  Gltnn  remarked  upon  the  rarity  of  the  lymphatic 
form  of  lenksBmia  and  considered  it  curious  that  it  should 
be  so,  since,  if  the  disease  originated  in  some  form  of  irrita- 
tion, the  lymph  glands  seem«l.  more  likely  to  be  exposed 
to  such  irritation  than  the  spleen  or  bone  marrow.  He 
had  examined  the  blood  in  several  oases  of  pneumonia, 
with  the  view  of  determine  the  existence  or  otherwise,  of 
leucocvtosis,  but  so  far  had  not  formed  a  definite  opinion 
as  to  the  value  of  this  procedure  as  an  aid  to  prognosis  in 
such  cases. 

Br.  Abram  said  that  Virchow  had  long  ago  shown  that 
the  thymus  was  persistent  in  leukasma,  and  that  this  no 
doubt  explained  the  presence  of  a  mediastinal  growth  in 
leukemia.  He  admitted  that  Ehrlich's  neutro-phil- 
granule  was  really  a  feebly  oxyphil  granule,  but  thoueht 
the  destruction  of  feebly  and  strongly  oxyphil  granules 
was  useful,  as  the  former  were  mainly  increased  in  leco- 
cytosis,  the  latter  in  leukaBmia.  He  agreed  with  Prof. 
Sherrington  that  the  strongly  oxyphil  mono-nucleated 
cell  represented  the  marrow  cell  and  the  more  readily 
because  it  showed  no  amGsboid  movement.  Leukaamio 
blood  is  deficient  in  alkali  and  contains  no  lecithin.  He 
drew  attention  to  the  excess  of  uric  acid  formed  in  the 
urine  of  leuktemio  patients,  and  pointed  out  that  this 
phenomenon  agreed  with  the  view  of  Horbaczewski  that 
uric  acid  was  derived  from  breaking  down  white  oorpusclee. 

BRITISH    LARYNGOLOGICAL,    RHINOLOGICAL 
ANB  OTOLOGICAL  ASSOCIATION. 

MSSTINO  HKLD  FbIDAT,   JaN.    17tH. 

The  President,  Br.  Stokkel,  in  the  Chair. 

Mb.  Lennox  Bbownb  read  a  paper  suggesting  the 
abolition  of  gargling  in  the  treatment  of  Biseases  of  the 
Throat,  in  which  he  showed  that  fluids  were  not  brought^ 
into  contact  with  the  posterior  surface  of  the  pharynx  if 
used  as  gargles  in  the  ordinary  way,  and  also  expressed 
his  opinion  that  silver  nitrate  swabbings  were  useless,  if 
not  aosolutely  harmfuL 

Brs.  Grant  and  Maonauohton-Jonbs  took  part  in  the 
discussion. 

The  Prksidbnt  showed  the  following  cases,  treated  by 
oxygen  gas. 

A  Case  o/Chhrotic  Ozceiia.— The  patient  had  suffered  for 
two  years  from  a  very  offensive  discharge  and  smell  from 
her  nose.  The  oxygen  was  applied  every  alternate  hour 
during  the  day,  and  on  the  third  day  the  offensive  smell 
had  disappeared.  She  had  been  sixteen  days  under  treat- 
ment and  neither  crusts  nor  discharge  were  to  be  seen. 

A  Case  of  Syphilitic  Ozana, — Patient  had  been  bad  for 
five  years,  and  had  lost  the  septum  and  aU  the  turbinated 
bodies,  and  there  was  a  large  opening  into  the  right 
antrum.  Buring  last  August  she  was  treated  for  four 
weeks  by  oxygen  being  passed  into  her  nose  every  alter- 
nate hour  during  the  day.  At  the  end  of  that  period 
neither  smell  nor  crusts  remained,  and  now,  after  the 
lapse  of  several  months,  without  further  local  treatment, 
she  remains  freer- from  any  sign  or  symptom  of  ozsena. 

A  Case  of  Purulent  Middle  Ear  Disease. —Tbe  patient, 
a  girU  »t.  13,  had  suffered  for  seven  years  with  disease  of 
the  middle  ears,  accompanied  by  profuse  dischaige, 
smell,  and  constant  pain,  and  there  was  great  swelling 
and  ozasna.  She  was  very  deaf  and  there  was  ereat 
bagginess  and  swelling  of  the  meatus.  She  had  now  been 
nine  weeks  under  treatment,  oxygen  having  been  used 
three  hours  daily  at  intervals.  At  the  end  of  the  first 
week  the  discharge,  pain,  and  smell  had  almost  dis- 
appf*ared,  and  now  all  that  remained  was  a  little  watery 
discharge  from  the  outer  part  of  the  meatus.  Her  hearing 
is  vastly  better,  and  she  can  now  hear  a  watch  at  two 
feet,  that  she  could  only  hear  at  two  inches,  eight  weeks 


112       ThB  MbDIGAL  PBKS9. 


FRANCE. 


Jan.  29    1890. 


aga  Before  oxygen  wa«  begun,  almost  every  other  known 
form  of  treatment  had  been  tried  but  without  Buooeee. 

Dr.  St.  Geobgb  Rbid  showed  cultures  of  various  organ- 
isms treated  to  as  to  represent  the  conditions  obtained  in 
oxygen  treatment. 

Drs.  Grant,  Maonaughton-Jones,  and  Milligan  also 
joined  in  the  diacuesion. 

Dr.  MiLUOAN  related  the  notes  of  a  case  of 

COOHLBA  APOPLEXT. 

The  patient^  a  man,  »t.  42,  retired  to  rest  in  his  usual 
good  health,  but  woke  up  the  following^  morning  with 
severe  tinnitus  in  his  lelt  ear,  upon  which  side  ;also  he 
was  perfectly  deaf.  His  previous  health  had  been  good. 
Syphilis  was  denied,  but  an  attack  of  gonorrhoea  twenty 
years  previously  was  admitted.  The  patient  was  a  hard- 
working business  man,  consumed  a  considerable  quantity 
of  alcohol  and  had  a  laree  appetite.  His  arterial  tension 
was  somewhat  high,  and  the  small  vessels  of  his  face  dis- 
tended. There  was  no  nausea,  no  vertiginous  attacks, 
and  his  power  of  caligraphy  was  perfect.  Upon  testing 
with  various  tuning-forks,  it  was  found  that  the  higher 
tonic  limitiS  was  abolished  and  that  he  was  unable  to  hear 
anv  note  from  a  Galton's  whistle.  He  was  put  upon  a 
mild  diet  and  small  doses  of  alcohol.  Iodide  and  bromide 
of  potassium  were  also  ordered,  and  free  counter-irritation 
over  the  left  mastoid  processes.  Subsequently  hypodermic 
injections  of  pilocarpine  were  tried,  but  nothing  gave  the 
least  relief.  Dr.  Milligan  showed  a  rhinolith  removed 
from  the  right  nasal  passage  of  a  young  woman.  It  was 
discovered  quite  accidentally,  and  was  found  to  lie 
between  the  inferior  turbinated  body  and  the  septum. 
There  was  no  history  of  the  previous  int«*oduction  into  the 
nose  of  any  foreign  body,  ana  its  presence  caused  no  in- 
convenience. It  was  removed  by  means  of  a  pair  of 
forceps.  Dr.  Milligan  idso  showed  microscopic  sections 
of  a  tubercular  mass  removed  from  the  right  nasal  passage 
of  a  man  who  bad  previously  suffered  from  lupus  nasiy  and 
also  sections  of  a  fibro-connective  tissue  growth  removed 
from  the  vault  of  the  naso-pharynx  of  a  boy,  set.  11.  Scat- 
tered throughout  the  fibrous  bundles  were  islets  of  some- 
what active  round-celled  growth  as  if  there  was  a  tendency 
to  malignant  defeneration. 

Dr.  Pbolbr  showed  a  section  of  a  polypoid  growth 
from  the  surface  of  the  membrana  tympani.  It  contained 
hairs  embedded  in  its  substance.  Mr.  Lake  and  Dr. 
Milligan  considered  it  an  ordinary  fibrous  polypus. 

Mr.  Mayo  Collikb  opened  a  discupsion  on 

THV  OAUSIS  AND  CONSKQUENOES  OF  CHBONIO  NA^AL  OBSTBUO- 
TION, 

and  exhibited  a  number  of  casts  and  patients  with  great 
distortion  of  palates  and  upper  jaws.  They  illustrated 
the  more  serious  effects  of  neglected  obstruction  of  the 
growing  skull.  The  arguments  were  placed  before  the 
meeting  under  the  following  propopiiions  :—(l)  That  the 
physiological  functions  of  the  normal  nose  are  essential 
to  the  well-being  of  the  respiratory  apparatus.  (2)  That 
stenosis  of  the  nasal  respiratory  tract,  in  varying  degrees, 
is  present  in  a  large  percentage  of  civilised  beings. 
(3)  That  stenosis  of  the  nasal  chambers  are  seldom  or 
never  hereditary.  (4)  That  temporary  nasal  obstruction 
precedes  and  determines  chronic  nasal  obstruction  in 
most  cases.  (5)  That  temporary  and  permanent  nasal 
obstruction  induce,  sooner  or  later,  collapse  of  one  or  more 
of  the  walls  of  the  nasal  chambers.  (6)  That  most  of  the 
commoner  diseases  of  the  nose,  naso-pharynx,  larynx,  and 
ear,  are  subsequent  to  and  consequent  on  chronic  nasal 
obstruction. 

The  opening  was  well  received,  and  led  to  an  animated 
discussion. 


THE  HUNTERIAN  SOCIETY. 
CLimoAL  Meeting  held  Wednesday,  Januaey,  22nd. 


The  President,  Mk.  Chables  J.  Symonds,  F.BC.S.,  in 
the  Chair. 

Db.  Shadwsll  showed  a  case  of  unilateral  spasm  of  the 
face  in  a  woman ;  there  was  a  history  of  previous  hemi- 
plegia of  the  same  side.  The  spasms  came  on  after  confine- 
ment. 

Sir  Hugh  Bxevob  showed  a  ease  of  tremor  of  the  hand 


in  a  girl  of  16 ;  the  movements  were  athetoid  in  charactflr 
and  probably  functional  in  origin. 

Dr.  F.  J.  Smith,  Dr.  Davibs,  Dr.  Cotmak»  and  Dr. 
Bawbs  discussed  these  cases. 

Dr.  Woods  then  showed  two  cases  of  poet-faerpetic  neu- 
ralgia of  some  years'  standing,  which  he  had  treated  with 
very  marked  improvement  by  suggestion. 

Sir  H.  Bbeyob  said  these  oases  were  two  of  his,  previously 
shown  at  the  Society,  and  corroborated  the  statements  of 
Dr.  Woods  as  to  their  improvement,  which  wae  indeed 
manifest  to  all  the  Fellows  present. 

Dr.  Fbxd.  J.  Smith  showed-  (1)  a  case  of  hemianopsia ; 

(2)  a  case  of  motor  aphasia ;  and  discussed  the  seat  and 
nature  of  the  lesions. 

Dr.  I  Hope  Gbant  shewed  a  case  of  seborrhoeic  eczema  in 
a  man  of  30. 

Dr.  Ettlbs  showed  a  case  of  severe  acne. 

Mr.  Openshaw  showed — (1)  a  case  of  congenital  dislo- 
cation of  the  hip;  (2)  a  microcephalic  idiot  with  talipes ; 

(3)  a  case  of  Potts'  fracture,  with  dislocation  ol  the  foot 
backwards. 

A  case  of  contracture  of  the  arm  following  severe  injury* 
and  treated  by  division  of  tendons  above  the  wrist,  wae 
shown  for  Mr.  Tubby. 

♦ 


[VBOM  OUB  own  C0BBB8P01IPE1!?T.] 

Pabis,  Jao.  2Mh,  1890. 

Theobbominb. 

Db.  Huohabd,  the  great  authority  on  cardiac  affections, 
spoke  on  the  properties  of  theobromine  before  the  meeting 
of  the  Hospital  Society.  He  said  that  for  the  laat  two 
years  he  had  employed  theobromine  as  a  diuretic  in  cardiac 
and  renal  affections,  and  considered  it  to  be  much  euperior 
in  this  respect  to  digitalis  and  caffeine.  His  mode  of  pre- 
scribing it  was  to  ^ive  the  first  day  six  powders  of  ten 
grains  each,  the  second  day  eight  powders,  and  the  third 
day,  ten.  This  dose,  which  he  considered  a  maximam, 
be  continued  for  three  more  days.  Sometimes,  in  order 
to  prolong  the  diuretic  effect,  he  gave  the  day  following 
one-fiftieth  of  a  grain  of  digitaline.  Theobromine  is  no^ 
toxic  nor  does  it  injure  the  renal  epithelium ;  it  is  especi- 
ally useful  in  interstitial  nephritis  and  those  heart  diseases 
complicated  with  kidney  lesions. 

A  Ring  on  thb  Penis  fob  Foubteen  Ybabs  ! 

A  most  extraordinary  case  of  a  ring  buried  in  the  perns 
for  fourteen  years  has  been  reported  in  the  Bulletin  Medkai 
by  Dr.  Leflaive.  In  September  last  he  was  called  to  a 
patient  who  complained  of  not  being  able  to  urinate  except 
by  drops  and  with  exquisite  suffering.  On  being  ques- 
tioned the  patient  confessed  that  when  12  years  old  and  at 
school  he  passed  his  penis  through  a  brass  curtain  ring. 
The  organ  having  swelled  considerably  the  ring  could  not 
be  withdrawn.  In  spite  of  his  sufferings  the  boy  kept  the 
matter  quiet-  By  degrees  the  ring  ate  its  way  through 
thp  skin  into  a  circular  groove,  and  in  course  of  time  the 
parte  healed  completely  over  it,  so  that  it  was  lost  to  sight, 
his  sufferings  being  all  the  while  intolerable  !  Twelve 
years  afterwards  the  patient  married,  but  at  the  first 
attempt  to  fulfil  his  marital  duties,  the  penis  became 
greatly  inflamed  and  contact  very  painful.  He  bore 
valiantly  with  his  infirmity  for  two  years  longer,  but 
at  last  had  to  appeal  for  medical  aid.  When  examinedf 
the  prepuce  and  the  glans  were  found  to  be  enormously 
swollen  and  of  a  phlegmonous  aspect.  It  was  impos- 
sible to  find  the  meatus  and  all  attempt  at  catheteriBm 
increased  the  agony.  About  the  middle  of  the  penis  could 
be  seen  a  circular  white  band  representing  a  cicatrix  and 
at  this  point  could  be  felt  the  ring  embracing  the 
{  cavernous  bodies. 


jAir.  29,  1895. 


GEllMANY. 


The  Mkdioal  Press.      1 13 


Aftar  liaving  ehloroformed  the  patient  Dr.  Leflaive 
made  a  loDgitiidmal  incision  through  the  dense  oicatrioial 
tietne^  which  gave  itane  to  a  certain  amount  of  put ;  at  the 
hoUom  of  the  wound  could  be  seen  the  ring.  A  director 
wae  pmeed  under  it  and  the  foreign  body  was  cut  through 
by  means  of  a  bone  forceps  and  thus  removed.  The 
patient  recovered  very  quickly. 

In  commenting  on  this  almost  incredible  case  the 
author  obeerved  that  nowhere  could  be  found  [in  the 
annals  of  medicine  a  case  in  which  a  metallic  ring  had 
been  baried  in  the  penis  for  fourteen  years  without  calling 
for  surgical  interference. 

Hebb  Roktgbn's  Sensational  Disoovbby. 

Herr  Bontgen,  of  the  University  of  Wfirtzburgto  whose 
discovery,  a  new  conducting  agent  of  light,  you  have 
already  drawn  attention,  is  attracting  considerable  atten- 
tion in  French  medical  circles.  We  now  know  that  to 
arrive  at  this  unexpected  discovery  tie  tavant  employed 
tubes  of  glass  in  which  the  void  was  as  perfectly  made  as 
possible.  Through  these  tubes  a  current  of  induction  was 
passed  and  it  was  by  the  prolonged  light  of  the  electric 
spark  that  Prof.  Bontgen  was  able  to  photograph  a  series 
of  i»vuible  objects,  such  as  copper  coins  in  a  wooden  box 
tightly  doeed,  and  the  bones  of  the  hand  of  a  person  who 
was  working  with  him  in  his  laboratory.  In  both  cases 
the  effect  was  marvellous ;  the  photographic  proofs  showed 
distinctly  the  money  and  the  nails  of  the  box,  but  of  the 
wood  there  was  no  trace  ;  in  that  of  the  hand  all  the  bones 
could  be  plainly  counted,  it  was  that  of  a  skeleton  and  not 
of  a  living  person. 

M.  Poincaire,  the  illustrious  mathematician,  presented 
last  week  to  the  Academy  of  Sciences  at  Paris,  a  certain 
number  of  these  photographic  proofs,  which,  naturally 
excited  no  small  amount  of  curiosity. 

Prof.  Lannelongue  thinks  that  this  discovery  will  be  of 
immense  advantage  to  surgeons  as  by  it  it  will  befpossible 
tolocaUse  foreign  bodies,  as  bullets  in  the  muscular  tissue 
and  calculi  in  the  bladder,  without  having  to  use  the 
sound.    He  proposes  to  try  it  in  his  hospital  service. 

Foreign  Doctobs. 

A  press  campaign  has  been  set  on  foot  within  the  last 
few  weeks  against  the  invasion  of  foreign  students,  and 
eipeeially  those  who  intend,  after  obtaining  the  diploma  of 
Doctor  of  Medicine,  to  live  and  practise  in  the  country. 
The  actual  number  of  foreign  students  in  the  medical 
facolties  of  France  is  1,200,  of  which  1,000  are  in  Paris 
alone.  In  Germany  the  numbers  are  four  times  as  many. 
Nevertheless,  our  French  cotiflrires  believe  tbat  the  prin- 
ciple of  protectioniem  should  extend  to  the  Universities, 
and  many  propositions  have  been  formulated  to  check  the 
aal  of  foreign  competition  on  their  own  ground.  The 
Gazette  des  Hopitaaux^  for  instance,  proposes  that  the  dip- 
loma of  Doctor  be  granted  to  any  foreigner  who  passes  the 
nweanary  examinations  as  a  purely  honorary  title,  and 
without  the  right  to  practise  in  France. 

Another  paper  suggests  that  a  decree  should  be  pro- 
malgated  to  the  eifect  that  "no  person  can  practise 
medicine  in  France  unless  he  be  French  bom  or  natural- 
iisd."  It  is  very  possible  that  this  movement  may  take  a 
practical  shape,  and  that  the  M.D.France  will,  in  the  near 
fntore,  constitute,  in  fact,  only  an  honorary  title  for 
foreigners.    The  result  is  not  difficult  to  foresee. 


(itrmmiB- 

[ntOM  OUB  OWN  C0SBB8P0NDBNT.] 

filRUH,  Jan.  2ith. 

Ths  Mbdioal  Sooistt. 
Thx  first  meeting  of  the  year  was  held  on  the  8th  inst, 
when  nearly  all  the  officers  of  the  former  jear  were  re- 
elected— Prof.    Virobow    as   President,   and   Herren   v. 
Bergmann,  Senator,  and   Abraham   as    Vice-presidents. 
Although  no  decision  has  yet  been  reached  as  to  the  em- 
ployment of  the   Bleichroder   legacy,  which,  it  will  be 
remembered,  amounted    to   a   million    marks,  and  was 
intended  for  the  benefit  of  consumptive  patients,  the  sub- 
ject of  an  institution  for  the  special  treatment  of  tubercu- 
losis has  not  been  lost  sight  of.    In  fact,  euch  institutions 
founded  by  the  city  are  in  actual  existence,  but  their  sites 
have    been    unfortunately  selected.      They   have    been 
erected  on  the  city  drainage  fields  at  Malchow  and  Blan- 
kenfelde,  and  not  unnaturally  the  nature  of  their  sur- 
roundings has  marred  their  ueefnlnees.    Patients  object 
to  be  treated  in  such  localities,  and  the  consequence  is  tbat 
the  institutions  are  left  severely  alone.    The  present  posi- 
tion of  the  subject,  therefore,  is  not  a  satisfactory  one,  and 
a  desire  has  been  felt  in  more  than  one  quarter  to  improve 
it.      Two     distinct     committees     have     already    been 
formed  for  the  furtherance  of   the   object   aimed   at — 
viz.,  the  best  treatment  for  tuberculous  patients  in  suit- 
able localities.     The  first  committee  has    been   formed 
under  the  protection  of  the  Imperial  Chancellor,  and  in 
connection  with  the  Bed  Crors  Society,  with  the  object  of 
erecting  and  supporting  in  various  parts  of   Germany 
institutions  for  the  treatment  of  sufferers  from  tubercu- 
losis.   A  second  committee  under  the  direction  of  Prof. 
Leyden,  Charity  Director  Spinola,  Gebeimrath  Althoff,  of 
the  Cultusminieterium,  and  Prof.  B.  Fraenkel  will  take 
special  charge  of  the  city  of  Berlin,  and  Mark  Branden- 
burg to  provide  it  with  institutions  for  a  similar  purpose 
for  those  of  limited  means.     A  considerable  sum  has 
already  been  subscribed  for  the  purpose.    These  institu- 
tions will  be    entirely    for  sufferers  without  means,  or 
with  limited  means ;  those  who  are  able  to  provide  all 
treatment    for  themselves  will    be    left   to   their    own 
resources. 

At  the  meeting  of  the  Hufeland  Society,  Hr.  Schleich 
read  a  note  on 

The  Thbbapbutio  Usx  of  Anjesthxtisino  Fluids. 
He  said  it  was  known  that  Karl  Htiter  had  injected  a  3 
per  cent,  solution  of  carbolic  acid  into  the  neurilemma 
in  a  case  of  sciatica  in  a  patient  who  had  suffered 
from  a  very  painful  and  intractable  form  of  the  disease 
with  the  result  that  it  had  not  returned  twelve  years  after 
the  treatment.  Solution  of  methyl  violet  showed  a  similar 
action  depending  on  its  aniesthetisiDg  power.  In  the 
speaker's  first  attempts  at  injecting  such  solutions  his 
object  was,  by  continuous  mechanical  pressure  by  the 
fluids  injected,  to  produce  atrophy  of  the  part.  Since 
1893,  he  had  treated  inoperable  tumours  in  this  way,  and 
found  that,  in  addition  to  the  atrophy  thus  brought 
about,  a  distinct  allaying  of  pain  was  observed.  Even  a 
shrinkage  in  n»vi  was  observed  after  the  "  hydraulic  tissue 
massage."  He  had  treated  many  cases  of  tic-douloureux 
and  trigeminal  neuralgia  successfully  by  such  injections. 
He  had  used  hydrochlorates  for  the  injections.  In  one 
case  of  gout,  in  which  the  pain  did  not  return  for  a  year, 
it  was  possible  that  some  chemical  change  contributed  to 
the  result.    If  fresh  solutions  made  from  recently  treated 


114     The  Midigal  P&ws. 


AUSTRIA. 


Jan.  29.  1S96. 


salt  were  made  use  of  there  was  never  any  after  pain,  and 

no  injnriooa  results  had  ever  followed. 

Thx  CoLUBonvB  IvvBsnoATioN  niTO  THB  Sbbum  Tbxat- 

MXNT  OF  DiPBTHBBIA. 

The  Imperial  Health  Office  has  jatt  issned  its  report  for 
the  second  quarter  of  last  year.  In  that  period  2,130 
sheets  were  returned,  from  which  the  following  figures 
were  obtained  :~In  1,278  cases  the  diagnosis  was  con- 
firmed bacteriologically.  Out  of  the  toUl  number  1,812 
or  85-1  per  cent,  recovered,  and  306  or  14*3  per  cent.  died. 
When  the  hopeless  cases  are  taken  out  of  the  calculation, 
i.e.,  tuch  as  died  within  12  hours  of  the  commencement  of 
the  treatment,  the  mortality  is  reduced  to  13*3  per  oent 
This  rate  is  lower  than  even  that  of  the  previous 
quarter.  A  comparison  of  this  rate  with  that  of  previous 
years  will  show  that  a  decided  change  for  the  better  has 
Uken  place  whatever  be  iU  cause.  Since  1883  the  morta- 
lity in  diphtheria  has  been  as  follows  : — 


1883  . 

..  28-9  per 

cent. 

1889  . 

..  25*4  per  cent. 

1884  . 

..  26-2 

1890  . 

..  28-6 

1886  . 

.  23-4 

1891  . 

..  271    „ 

1886  . 

.  24-5 

1892  . 

.  29-6 

1887  . 

.  23-7 

1893  . 

.  30-1 

1888  . 

.  260 

In  the  fifpt  quarter  of  1895  it  was  17*3,  and  in  the  second 
14*4  per  dent.,  and  for  the  half  year  15  9  per  cent.,  and 
amongst  those  cases  in  which  the  injections  were  begun 
on  the  first  or  second  day  of  the  disease  the  mortality 
was  6-4  per  cent. 

In  the  DeuUch  Med,  JTochenschr,,  50/95,  Prof.  Brieger 
has  an  article  on 

Thv  Typhoid  Baoillus. 

It  is  known  that  Eisner  discovered  a  method  of  culti- 
vating the  typhoid  bacillus  on  a  nutrient  soil  to  which 
potassic  iodide  had  been  added,  and  Prof.  Brieger  has  been 
recently  engaged  in  putting  the  method  of  diagnosis  pro- 
vided by  the  process  into  practice.  The  results  obtained 
were  '*  extremely"  satisfactory  as  in  all  the  suspected  cases 
of  typhoid  the  bacteriological  investigation  confirmed  the 
diagnosis  within  48  hours.  That  it  really  was  the  typhoid 
bacillus  that  was  being  cultivated  was  proved  by  Pfeifler's 
test.  A  moment's  consideration  will  show  the  great  value 
of  such  a  discovery,  especially  when  a  method  of  distin- 
guishing the  bacterium  ooli  from  the  typhoid  bacillus,  and 
which  grows  with  it,  has  been  discovered.  This  method 
of  diagnosis  was  employed  in  eleven  cases.  That  three 
out  cf  the  eleven  cases  were  those  of  nurses  shows  the 
necessity  of  having  the  dejecta  of  those  having  dealings 
with  typhoid  cases  examined  when  illness  of  any  form 
makes  itself  evident. 

Ths  Nkw  Photograput. 

At  the  meeting  of  the  Society  fur  InnereMedizin  of 
the  6th  inst.  Hr.  Jastrowitz  made  a  reference  to  the 
discovery  of  Prof.  W.  C.  Rontgen,  of  Wiirzburg,  and  drew 
attention  to  the  vast  importance  this  wonderful  discovery 
would  have  in  medicine.  He  showed  a  photogramme 
taken  by  Prof.  Rontgen  that  Prof.  Goldstein,  of  the  Obser- 
vatory, had  placed  at  his  disposal  On  it  was  shown  the 
skeleton  of  the  human  hand  plainly  shown,  even  to  the 
finest  details,  surrounded  by  the  shadowy  but  still  easily 
recognisable  soft  parts.  The  photogramme  loas  taken  from 
a  living  man.  He  then  explained  the  method  in  which  the 
photograph  was  taken  as  communicated  to  the  Wiirzburg 
Physical  Society.  The  discoverer  was  dischai^ng  a 
Ruhmkorff  apparatus  through  a  tube  containing  no  air 


This  tube  was  covered  with  a  dark  paper  or  cardboard*  so 
that  the  luminosity  occurring  at  the  cathode  at  the  dis- 
charge could  not  be  seen.  As  he  was  working  in  a  dark 
room  he  noticed  a  fluorescence  lighted  up  on  a  plate  charged 
with  barium  platino-cyannr  when  the  discharge  from 
the  cathode  took  place,  whichever  side  of  the  plate  was 
turned  to  the  tube.  It  was  evident  that  rays  that  were 
invisible  to  the  human  eye  parsed  through  the  dark 
paper  to  the  plate.  This  happened  even  when  the  plate 
was  removed  a  distance  of  2  metres.  The  finoresoence 
lighted  up  at  every  discharge.  He  then  replaced  the 
paper  by  other  and  various  media,  by  an  oak  board  2  to  8 
centimetres  thick,  by  a  book  of  1,000  pages,  by  thin 
metallic  plates,  by  india-rubber  plates,  and  the  rsys 
passed  through  all. 

As  the  discoverer  continued  his  investigations  with  the 
structure  of  these  rays  he  found  them  possessed  of  active 
chemical  properties,  and  he  was  able  to  take  the  photo- 
gramme shown.  The  rays  passed  through  the  soft  parts 
and  were  arrested  by  the  denser  bones  whence  a  distinct 
image  of  them  was  formed  on  the  sensitive  plate.  He 
photographed  the  contents  of  a  wooden  box.  He  photo- 
graphed from  one  room  into  another,  the  door  being 
closed  ;  in  short,  he  could  see  through  closed  doors  and 
into  closed  chests,  for  the  rays  passed  through  the  wood. 
This  will  surely  be  a  wonderful  aid  in  cases  difiScult  of 
diagnosis. 


[#M01f  OUE  OWy   OOEBBSPONDBITT.] 

Vlenaa,  Jan.  24th,  18M. 
i£noLOGT  OF  Lepbost. 
Kaposi  resumed  his  clinical  lecture  by  reviewing  the 
diflerent  opinions  which  have  been  entertained  in  the  past 
concerning  the  aetiology  of  this  persistent  disease.    All  our 
rational  opinions  must  be  founded  on  its  pathology,  but  the 
morbid  changes  observed  have  been  variously  interpreted. 
For  a  long  time  the  disease  was  conclusively  shown  to  be 
hereditary,  which  was  satisfactorily  admitted  from  the  his- 
tories obtained  of  families  residing  in  districts  where  the 
genealogy  of  different  stocks  could    be   traced  in  the 
registers  of  diflerent  parishes.    Daniellsen  and  Boeck  have 
spent  much  time  in  endeavouring  to  disprove  or  estabhsli 
this  doctrine.    The  latter  followed  healthy  children,  who 
had  been  bom  of  leprous  parents,  to  America,  who  after  a 
time  had  settled  on  that  Continent,  and  became  afflicted 
with  the  disease.    There  may  be  a  certain   amount  of 
error  in  connection  with  this  question   of  heredity,  as 
many  of  the  families  had  intermarried  and  resided  in  the 
same  neighbourhood  for  generations,  thus  fixing  the  trans- 
mission   temporarily,    as   we   find    it   disappearing  in 
many   districts    without   any   apparent    cause,    which 
would  not  occur  if  heredity  was  the  base  of  transmiuioD. 
Climate  and  seaboard  residences  have  also  been  aocosed  of 
producing  the  disease,  but  when  we  find  inhabitants  of 
Lebanon  far  removed  from  sea  or  low  elevations  being 
attacked,  we  are  forced  to  change  our  opinion  concerning 
this  origin.     We  have  another  strong  proof  against  here- 
dity, which  long  survived  in  cases  of  people  who  had 
reached  their  fortieth  and  fiftieth  years,  who  had  slwayt 
enjoyed  perfect  health    and  having  descended  from  s 
healthy  stock,  subsequently  decided  to  visit  St.  Lous  or 
Rio  Janeiro  where  leprosy  is  prevalent,   and   retaming 
home  after  a  short  residence,  become  afilicted  with  tht 


Ja9.  29,  1806. 


THE  OPERATING  THEATRES. 


Thb  Medical  Press.     Ih'* 


We  have  maDy  cases  recorded  of  this  nature 
where  bealdiy  people  visit  affected  countries  returning 
home  with  the  disease.  These  facts  point  strongly  to  an 
infectious  character  which  may  be  miaematic  in  its  origin, 
but  of  this  we  cannot  say  more.  Following  this  part  of 
the  investigation  the  badllns  lepra  has  been  isolated  and 
is  affinned  to  be  regularly  found  in  the  morbid  patients 
as  the  bacillus  of  tuberculosis  is  found  in  the  sputum. 
But  another  difficulty  presents  itself  in  the  feebleness  of 
infection.  Animals  have  been  operated  on  by  vaccinating 
with  the  bacillus  lepre,  but  the  results  have  always  been 
negative.  We  are  not,  however,  justified  in  accept- 
ing these  results  as  conclusive  against  traqsmiseion, 
that  syphilis  cannot  be  produced  in  animals  any 
than  leprosy.  We  have  on  record  cases 
where  the  human  subject  has  been  inoculated  and  con- 
tinued perfectly  healthy.  There  is  another  interesting 
•esse  of  a  culprit  who  was  condemned  to  death,  and 
having  the  sentence  commuted  to  a  vaccination  experi- 
ment with  leprosy  ;  he  remained  perfectly  free  from  the 
diBoaoo  for  three  years  after  operation  ;  but  on  cutting 
out  the  skin  at  the  seat  of  vaccination  the  bacillus  lepm 
could  be  found  in  abundance.  In  the  course  of  eight 
years  after  leprosy  showed  itself.  This  case,  though  care- 
fully observed,  is  found  to  be  of  little  value  when  we  con- 
sider that  he  was  transported  to  a  neighbourhood  where 
the  disease  was  epidemic,  and  it  was  further  shown  that 
he  had  descended  from  a  leprous  family.  We  have  another 
•dass  of  cases  to  relate  where  medical  men,  their  wives, 
.end  families  have  gone  to  leprous  districts  and  established 
leprona  hospitals,  there  associated  with  the  diseased 
people,  and  no  transmissions  of  leprosy  have  been  observed. 
There  are  many  nurses  who  have  attended  to  patients  of 
this  class  without  any  bad  results. 

Not  long  ago  the  medical  world  was  startled  by  an 
jAuouncement  that  leprosy  was  rapidly  increasing.  It  is 
needless  to  add  that  this  is  a  fallacy  which  often  occurs 
when  public  attention  is  earnestly  applied  to  investigate  a 
subject  long  forgotten  or  neglected  by  its  unobtrueive 
presence.  At  the  present  time  official  regulations  are 
stringent,  and  closely  scrutinise  subjects  that  would  in  all 
jpcobability  have  escaped  notice  had  some  fertile  mind  not 
inflamed  the  enthusiast  to  collect  statistics.  These 
numbers  are  jrreatly  increased  by  the  accuracy  of  dia- 
gnosis in  our  own  time  as  compared  with  the  past  We 
are  now  convinced  that  many  obscure  cases  were  unrecog- 
nised, and  thus  escaped  the  vigilant  eye  of  the  accurate 


With  regard  to  the  treatment  of  these  lepers  it  is  argued 
that  isolation  is  the  primordial  agent  in  the  remedy. 
Nothing  could  be  more  opposed  to  the  truth  as  daily 
ezperienoe  amply  testifies  to  the  low  infectivity  of  the 
diwase.  The  bacillus  may  be  transmitted  by  wounds,  but 
it  is  denied  iMlmission  to  a  new  host  if  this  condition  be 
sbtent.  It  should  be  olearly  understood  that  there  is  a 
difference  between  'Mnfection"  and  "contagion."  We 
sU  know  that  pityriasis  versicolor  depends  upon  the  fungus 
mierosporon  furf ur,  but  none  of  us  would  venture  to  affirm 
that  the  disease  was  infectious  though  it  might  be  granted 
that  it  was  contagious.  All  our  experience  shows  that  it  is 
a  difficult  task  to  make  the  micro-organism  strike  and 
-devetop  in  a  new  soil  after  it  has  been  transferred,  which 
should  convince  us  that  the  disease  is  not  infectious.  It 
■ems  more  reasonable,  if  we  had  fewer  of  them,  to  lock 
■p  sll  the  syphilitic  subjects  in  order  to  banish  an  easier 
icansmitted  disease. 


Hftohinsok's  Summer  Ebuftion. 
Prof.  Jarisch  showed  a  case  of  this  character  to  the 
Dermatological  Gesellschaft,  and  added  that  this  disease 
was  not  of  recent  date,  although  Bazin  appears  to  have 
been  the  first  to  isolate  it  under  the  name  of  Hydroa 
Vacciniforme  which  Hutchinson  later  renamed  Summer 
Eruption.  The  patient  appeared  to  have  both  ears 
shrunken  or  eaten  away,  while  the  surface  had  a  smooth 
blue  coloured  appearance  with  notches  here  and  there 
making  deep  depressions.  According  to  the  history  of  the 
patient  the  progress  of  the  disease  stood  still  during  the 
winter,  but  under  the  influence  of  the  sun's  rays  in  summer 
both  ears  became  intensely  red,  inflamcid,  and  swollen, 
forming  nodules  and  vesicles,  subsequently  forming  scabs 
that  fell  off  leaving  deep  crater-like  pits.  The  hands 
also  bore  testimony  of  a  similar  phenomenon  as  deep 
indentations  and  thickening  are  still  prominently  visible. 


^he  (JDptraiing  ^h^atrtB. 

MIDDLESEX  HOSPITAL, 
luo- PSOAS  Absoe&s. — Mr.  Pbarcb  Gould  operated  on  a 
woman,  set  34,  who  had  been  admitted  with  a  fluc- 
tuating swelling  in  the  right  iliac  fossa,  which  had  slowly 
grown  during  the  previous  twelve  months.  The  tumour 
consisted  of  a  superficial  portion  the  size  of  a  duck's  egg 
bulging  forwards  above  the  outer  part  of  the  iliac  crest. 
Deep  in  the  iliac  fossa  fulness  was  detected  extending 
back  to  the  brim  of  the  pelvis  and  towards  the  sacral  pro- 
montory ;  fluid  could  be  displaced  between  these  two 
parts  of  the  swelling.  There  was  no  extension  of  the 
abscess  into  the  thigh,  and  no  signs  of  disease  of  the 
spine,  sacroiliac  joint,  ilium,  or  pelvic  organs,  nor  was 
there  any  evidence  that  pus  had  reached  the  iliac  fossa, 
the  pleura,  the  kidney,  or  the  peri-cffical  peritoneum.  Mr. 
Gould  pointed  out  that  the  absence  of  the  known  signs  of 
disease  of  the  spine  and  sacro-iliac  joint  did  not  enable 
him  to  negative  the  existence  of  either  of  these  diseases 
as  the  origin  of  the  tubercular  abscess  before  him.  He 
opened  the  abscess  by  an  incision  two  inches  long  into  the 
superficial  swelling  parallel  to  and  jnet  above  the  front  of 
the  iliac  crest.  A  large  amount  of  very  thick  curdy  pus 
escaped.  He  found  that  at  the  bottom  of  the  superficial 
cavity  there  was  an  opening  that  just  admitted  his  finger  into 
the  deeper  abscess,  which  appeared  to  be  behind  the  psoas 
muscle  and  extended  to  the  sacro-iliac  joint,  the  front  of 
which  was  bare.  With  a  flushing  tpoon  he  carefully  and 
systematically  removed  the  entire  Uning  of  the  abscess,  and 
after  a  prolonged  flushing  of  the  cavity  with  bichloride  of 
mercury  solution  he  wiped  it  out  with  antiseptic  swabs 
and  removed  in  so  doing  several  portions  of  the  scraped-off 
lining  of  the  abscess  which  had  not  been  brought  away  by 
the  very  free  flushing.  He  then  applied  iodoform  paste 
to  the  exposed  tissues  and  closed  the  wound  without 
drainage.  Mr.  Gould  alluded  to  the  importance  of  wiping 
out  such  cavities  after  even  the  most  thorough  flushing  if 
the  surgeon  wished  to  make  sure  of  removing  all  the 
tubercular  tissue,  upon  such  complete  removal  the  success 
of  the  treatment  depended.  Although  the  sacro-iliac 
joint  was  exposed  in  the  wall  of  the  abscess  it  was  not 
impossible,  he  thought,  that  the  treatment  adopted  might 
be  entirely  successful ;  the  issue  would  depend  upon  the 
extent  and  activity  of  the  disease  of  that  joint  Should 
the  abscess  refill,  and  it  became  plain  that  the  disease  in 


116     Thi  Medical  Pbkp8. 


LEADING  ARTICLES. 


jAir.  29,  1886. 


the  joiDt  was  active,  he  should  propoee  to  arthrectomise 
the  joint  in  the  way  advocated  by  Mr.  Golding  Bird. 
ST.  THOMASES  HOSPITAL. 
Gastrostomt.— Mr.  Battle  operated  on  a  man,  set  60, 
who  had  a  malignant  strictaro  of  the  lower  part  of  the 
oesophagus  from  which  he  had  been  suffering  for  some  six 
months.  He  was  unable  to  swallow  solid  food  of  any  kind, 
but  could  still  swallow  fluids  ;  he  did  not  suffer  any  pain, 
but  was  emaciating  rapidly  and  losing  strength.  No 
bougie  could  be  passed  through  the  stricture.  One  had 
been  passed  on  a  former  visit  about  a  fortnight  before. 
There  were  no  signs  of  disease  elsewhere,  and  the  patient 
agreed  to  submit  to  operation  after  the  nature  of  it  had 
been  explained  to  him.  It  was  decided  to  perform  the 
operation  in  two  stages,  and  by  a  method  which  permitted 
of  quick  operation.  The  oblique  incision  was  made  in  the 
usual  situation  parallel  to  the  left  lower  ribs  and  deepened 
down  to  the  rectus  muscle,  the  fibres  of  which  were 
separated,  and  the  remainder  of  the  incision  continued  in 
the  longitudinal  direction.  The  abdominal  wall  was 
unusually  thick  for  a  case  of  gastrostomy,  as  there  had 
been  comparatively  little  loss  of  the  subcutaneous  tissue. 
The  stomach  was  easily  found  and  drawn  into  the  wound. 
The  portion  selected  for  the  opening  was  carried  to  the 
extreme  right  of  the  oblique  incision,  and  then  two  stitches 
passed  through  the  peritoneum  and  walls  of  the  stomach, 
one  above  and  the  other  below,  so  as  to  shut  off  the  peri- 
toneal cavity.  The  highest  point  selected  for  the  open- 
ing was  drawn  through  a  Senn's  bone  plate  and  transfixed 
with  two  hare-lip  pins,  which  did  not,  however,  enter  the 
interior  of  the  stomach.  A  trocar  and  cannula  were  then 
passed  between  the  pins  into  the  stomach,  and  on  with- 
drawal of  the  trocar  a  number  one  catheter  was  introduced 
though  the  cannula  into  the  stomach,  and  the  cannula  with- 
drawn over  it.  A  stitch  was  then  passed  through  part  of 
the  stomach  wall,  and  the  ends  tied  round  the  catheter. 
The  external  wound  was  dosed  with  interrupted  sutures, 
the  bone  plate  being  left  across  the  upper  part  and  at 
right  angles  to  it.  Cyanide  gauze  was  applied  to  the 
wound,  and  a  many-tailed  bandage  put  on.  The  end  of 
the  catheter  was  plugged  and  brought  into  the  cotton 
wool  of  the  dressing.  Two  points,  Mr.  Battle  said,  were 
of  importance  in  performing  the  operation :  first  of  all,  by 
going  between  the  fibres  of  the  rectus  muscle,  he  hoped 
to  obtain  a  kind  of  sphincter  action  ;  secondly,  by  carry- 
ing the  opening  as  high  up  as  possible,  he  hoped  that 
further  obstacles  to  the  escape  of  gastric  contents  would 
be  presented  as  the  mouth  into  the  stomach  would  be 
considerably  higher  than  was  usually  the  case  after  gas- 
trostomy. The  patient's  great  complaint  after  this  opera- 
tion is  of  the  irritation  caused  by  the  escape  of  gastric 
juice,  which  produces  troublesome  eczema  and  much  sore- 
ness for  some  distance  round  the  opening. 


>  FOB  TBAV8KI8S10B  ABaOAH. 


^he  JRtbkal  JrjtBB  anb  Cirjctilar. 

FnbUslMd  tveiy  Wsdnasday  momliif ,  Prlos  Bd.   Post  trM,  Hd« 
ADTBRTIIBIOMTI. 

ros  on  Ivsnnov :— Whole  Psgs,  A6  Ot.  Od. ;  Half  Psf  e,  M  lOs.  od. 
QnaitOTPsga,  Al  6i. ;  ODs-dghth,  Its.  Sd. 

ros  A  Snns  or  Ivsnziovs :— Whole  Paga,  thIrtMn  Insntioat 
(wMUy,  fortnightly,  or  moothlj)  at  itt  IOl  Od. ;  twmtj-slz  luMt^ 
ttom  (WMklj  or  fortnightly)  at  MS  U,  Od. ;  flft7-two  inMrttou 
(weakly)  at  MZ  aaoh.  Half-paga,  thirtaan  Imartlons  at  lit.; 
tw«ntj-ilzat8aL;flft7-twoliiaarttoiiaat80kaaoh.  <)nartar-pi«t, 
thirtaan  inaartloiM  at  ISi. ;  tiraDty.alz  InaortloBS  at  16a. ;  tttsr-dz 
Insartlons  at  16a.  aaoh 

SVBSOBimOHB. 
roei  Wmmm  to  ahmval  bubsobibbbs  £1   i  o 

„  ABBOAD.WITHIHTHB  POSKALUBIOI         £l     S    6 

n  IBDXA,  CHIHA,  ABD  JAPAB  .  .£116 

Poit-ollloa  Ordan  and  Chaquai  to  ba  drawn  in  favonr  of— 

A.  A.  TiBDALL,  80-Sl  King  WiUiam  8tnat,  Strand,  London 
A.  H.  Jacob,  to  liolaaworth  Btraat,  Dublin. 

SVBSOBiPnoBS  BOB  Fbabob  ara  raoalvad  by  Maasn.  Bailubbb,  Bm 
HantafaniUa,  Paria— poattraa  In  advanoa,  Al  Sa.  Od.  pat  annum. 

8VBBGBZFTI0BS  FOB  THB  Ubitbd  Statbb,  post  tree  In  advanet 
(£1  Sa.  Od.  par  annum),  ahonld  ba  aant  diraet  to  tba  OIBeaa  Is 
this  ooontiy  by  Intamational  Poat  Offlaa  Order. 

8oU  AffmU  for  Oermmn^  and  Auttro-Hungmry-^ 
W.  *  8.  LOWBBXBAL  (OSoa  of  tha  BMrHnar  Adreatbuek), 
4,Barlin. 

Small  Annoonoamanta  of  Praetleaa,  Aaalatanelat.  'Vaeanolat,  Book 
Ao.— Saran  Unaa  or  nndar,  4a  par  Inaartlon  ;  Od.  par  Un*  bayond. 

Lattara  In  this  dapartmant  ahonld  ba  addraaaad  to  tba  PubUahati 


%l^t  JpiiMjCHl  f  ri8s  ^  €itm\m. 


'SALUB  POPULI  SUPRKMA  LEX.' 


WIDNESDAY,  JANUARY  29,  1896. 


It  is  not  often  that  the  Local  Goyemment  Board 
has  to  deal  with  cases  of  cholera  in  England,  but  last 
week  an  official  report  reached  the  authorities  that  a 
steamship,  the  Garlands,  had  pnt  into  Holyhead 
harbour  with  several  cases  of  cholera  on  board.  Two 
of  the  crew  had  died  from  the  disease  during  the 
voyage  from  the  Black  Sea  to  Constantinople.  Dr. 
Thorne  Thorne  promptly  despatched  Dr.  T.  Thomson, 
one  of  the  medical  inspectors,  to  Holvhead,  and  after 
ample  disinfection  of  the  ship  had  oeen  carried  out, 
the  Garlands  was  allowed  to  proceed  to  Barrow-in- 
Furness,  where  she  will  be  closely  watched  by  the 
local  medical  officers  and  the  authorities  of  that  port, 
in  view  of  any  outbreak  of  the  disease. 


THE  DEATH  OF  PRINCE  HENRY  AND  ITS 

LESSONS. 
DuBiNO  the  past  week  the  news  of  the  death  of 
Prince  Henry  of  Battenberg  created  a  profound  sensa- 
tion among  the  inhabitants  of  his  adopted  countryr 
Great  Britain.  It  was  known  that  the  Prince  had 
reached  the  scene  of  operations  up  country,  and  had 
witnessed  the  consummation  of  the  bloodless  campaign 
against  King  Prempeh  of  Ashanti.  On  January  lOtb 
a  telegram  was  sent  to  England  stating  that  Prince 
Henry  was  suffering  from  a  slight  attack  of  fever,  and 
had  gone  back  to  the  base  of  operations.  Five 
days  later  a  Renter's  telegram  stated  that  his 
temperature  was  lower  after  a  restless  night,  and  that 
he  would  continue  his  journey  to  the  coast.  On  the 
17th  it  was  further  announced  that  he  had  embarked 
on  the  cruiser  Blonde  for  Madeira,  and  that,  although 
I  weak,  his  symptoms  were  not  grave.  Three  days  later, 
however,  he  died  at  sea,  and  the  cruiser  Blonde  put 
into  Sierra  Leone  on  Wednesday  last  in  order  to 
telegraph  home.  The  sad  news,  it  need  hardly  be  aaidr 
caused  the  deepest  consternation  and  grief  in  the  Royal 
household.  No  words  of  ours  can  add  to  the  wide- 
spread national  sympathy  which  has  been  expressed 
with  the  calamity  that  has  overtaken  the  Queen  and 
the  Princess  Beatrice.  At  such  a  time  of  bereavement 
silence  is  often  far  more  eloquent  than  speecL   Oft 


Jak.  29.  1896. 


LEADING  ARTICLES. 


TviK  Medical  Pbbss.     117 


the  other  hand,  from  a  medical  point  of  yiew,  many 
points  natnraUy  present  themselves  to  oar  considera- 
tion, and  it  woald  be  mere  affectation  to  avoid  their 
diacossion  because  of  the  nature  of  the  sad  event  to 
which  they  owe  their  present  prominence.  As  to  the 
course  of  the  "Prince's  illness,  everyone  who  is  familiar 
with  tropical  sickness  will  recognise  the  fact  that 
nothing  is  more  common  than  for  relapses  to  occur 
when  a  patient  has  been  brought  down  to  the  coast  or 
after  he  has  got  out  to  sea.  Furthermore,  it  is  a  fact 
that  strong  persons  succumb  to  tropical  disease  as  readily 
as  the  weak.  When  we  come  to  consider  the  nature 
of  malaria  itself,  we  are  compelled  to  admit  our  almost 
complete  ignorance  upon  many  points  of  its  etiology 
and  pathology,  as  well  as  our  inability  to  treat  the 
condition  with  any  certainty  from  a  curative  stand- 
point Speaking  generaUy,  it  seems  clear  that  the 
group  of  acute  specific  fevers  known  as  malarial  are 
due  to  a  poison  that  emanates  from  marshy  lands, 
more  especially  in  hot  countries.  This  particular 
poison  may  be  carried  for  long  distances  by  the  wind, 
I  but  its  progress  may  be  stopped  by  such  obstacles  as  a 
belt  of  trees,  a  broad  sheet  of  water,  or  a  chain  of 
bills.  The  materies  morhi  is  now  generally  regarded 
as  being  a  protozoon,  the  pkismodaisse  malarial,  which 
was  first  demonstrated  by  Laveran  in  1882.  This  para- 
site is  found  in  the  blood,  where  it  invades  and  disinte- 
gtates  the  red  blood  cells,  but  its  causal  relationship 
to  malaria  has  not  yet  been  proved.  If  the  protozoon 
flourish  in  damp  districts,  it  seems  likely  that  it  may, 
m  common  with  the  micro-organisms  of  cholera  and 
other  specific  affections,  enter  the  body  through  the 
medium  of  drinking  water.  All  that  can  be  said  at 
present  on  these  and  other  points  is  that  a  great 
deal  can  be  done  in  the  way  of  prevention.  The 
truth  of  that  statement  may  be  found  in  a  comparison 
of  two  recent  campaigns  in  malarial  countries, 
namely,  Madagascar  and  Ashanti.  In  Madagascar 
the  French  army  was  badly  equipped  from  a  medical 
point  of  view  and  the  soldiers  had  to  undergo  great 
hardships  and  exposure  in  the  dense  tropical  forests. 
As  a  result  their  ranks  were  simply  decimated  by 
malaria.  In  our  own  march  to  Ashanti,  on  the  other 
hand  every  possible  precaution  was  taken  to  secure  the 
safety  of  our  soldiers.  The  camps  were  prepared 
beforehand  at  certain  intervals  along  the  line  of  march, 
and  the  soldiers  slept  in  huts  raised  several  feet 
above  the  ground.  In  consequence  of  these  measures 
the  general  health  of  our  troops  has  been  excellent.  It 
has  been  elsewhere  remarked  that  one  good  result  that 
may  accrue  from  the  lamented  death  of  Prince  Henry 
is  Uie  more  careful  study  that  the  subject  of  malaria 
will  probably  receive.  Now  that  a  fresh  impetus  has 
been  given  to  the  investigation  of  tropical  disease  by 
the  appointment  of  special  lecturers  in  some  of  our 
chief  medical  schools  we  may  look  for  much  informa- 
tion and  valuable  progress  in  that  direction.  One  may 
confidently  assume  that  the  working  out  of  knotty 
points  in  the  diseases  peculiar  to  the  tropics  would 
sooner  or  later  throw  many  a  sidelight  on  the  number- 
less obscure  problems  that  lie  around  us  on  every 
band  in  our  own  northern  clime. 


A  CRUCLyL.  POINT  IN  SANITARY  PROGRESS. 
Of  late  years  London  has  been  making  great  strides 
in  the  onward  march  of  preventive  medicine,  a  fact 
upon  which  the  inhabitants  of  the  greatest  and  richest 
city  in  the  world  may  well  be  congratulated.  In 
various  ways,  however,  the  metropolis  is  a  laggard  in 
the  scientific  race,  and  compares  unfavourably  with 
many  provincial  towns,  such  as,  for  instance.  New-* 
castle  and  Glasgow.  There  can  be  little  doubt  that 
the  lack  of  intelligent  public  interest  has  lain  at  the 
root  of  this  lamentable  backwardness  in  a  matter  ao 
deeply  affecting  the  welfare  of  the  community  as  the 
administration  of  sanitary  affairs.  Until  recently 
Londoners  have  been  content  to  leave  the  management 
of  their  roads,  of  their  water-supply,  of  their  sanita^ 
tion>  of  their  Poor-law  service,  in  the  hands  of  local 
bodies,  which  were  only  too  often  corrupt  nests  of 
nepotism  and  jobbery.  With  the  advent  of  the 
London  County  Council,  however,  and  an  awakening 
of  general  interest  in  municipal  matters,  the  promise 
of  a  purer  and  a  fairer  future  was  gladly  welcomed  by 
the  sanitary  reformer.  But  the  .day  of  full  salvation 
is  not  yet  with  us.  In  many  of  our  metropolitan 
dbtricts,  rich  and  poor  alike,  the  Vestrymen  or 
Councillors  are  chosen  by  small  hole  and  corner  cliqueSf 
and  are  elected  as  local  rulers  and  administrators  of 
vast  sums  of  money  without  even  the  formality  of  a 
public  election.  For  such  a  travesty  of  representative 
local  government  the  citizens  have  themselves  to  thanks 
The  voters  hold  the  key  to  the  situation,  and  if  they 
choose  to  organise  their  ranks,  nothing  would  be  easier 
than  to  return  to  the  Vestries  men  of  good  standing 
and  unblemished  character,  in  whose  hands  the  public- 
weal  would  oust  all  mere  party  purposes  and  the  sordid 
filching  and  diversion  of  the  ratepayers'  money,  which 
is,  perhaps,  best  described  by  the  terse  and  expressive 
term  "jobbery."  Turning  to  details  of  practical  health 
work,  we  are  at  once  struck  with  the  importance  of  the 
sanitary  inspector,  who  is,  as  it  were,  the  policeman  of 
preventive  medicine.  As  the  servant,  first  of  the 
medical  officer  and  then  of  the  Vestry  or  Council,  it  i» 
his  duty  to  investigate  and  to  report  upon  the  multi' 
farious  details  that  are  brought  within  the  purview  of 
local  health  committees*  Sanitary  inspectors  as  a 
whole,  we  are  glad  to  believe,  constitute  an  honourable 
and  useful  body  of  public  servants.  On  the  other 
hand,  it  is  matter  of  common  knowledge  that  a  certain 
number  of  them  are  unfit  for  their  position,  and  may 
be  regarded  as  inheriting  the  traditions  of  the  bad  old 
days  of  vestrydom.  But,  apart  from  the  black  sheep, 
it  may  bd  fairly  questioned  whether  the  whole 
position  taken  up  by  the  sanitary  inspectors 
does  not  require  serious  consideration.  The  claims 
of  these  subordinate  officials,  as  it  would  appear  from  a 
perusal  of  the  reports  of  their  Association  meetings, 
have  grown  until  the  liliputian  body  imagines  itself 
nothing  less  than  a  giant  of  Brobdignag.  The  Sani- 
tary Inspector,  as  pictured  by  the  Association,  is  in 
future  to  become  a  kind  of  inspector,  lawyer,  medical 
officer  of  health,  doctor,  and  engineer,  who  is  to  act 
under  and  report  to  the  Vestry ;  to  carry  on  his  own 
scientific  investigations ;  to  be  his  own  hygienic  law- 


118     Thx  Msdioal  Pr«s8. 


LEADING  ARTICLES. 


Jan   29.  1896. 


giver ;  and  to  fulfil  the  office  of  gtude,  ooaDsellor, 
and  moving  spirit  generally  in  the  public  health 
administration  of  the  parish  to  which  he  has  been 
appointed.  Without  doubt,  this  aggressive  attitude,  so 
far  as  London  is  concerned,  has  been  allowed  to  spring 
up  by  the  apathy  of  the  medical  officers  of  health 
known  as  "half-time"  men,  who  leave  the  main  part 
of  their  public  work  to  be  discharged  by  their  inspec- 
tors, while  they  themselves  are  engrossed  by  the  busy 
cares  of  general  medical  practice.  A  case  in  point  is 
to  be  found  in  the  heart  of  London,  where  only  a  few 
months  since  the  authorities  of  one  of  the  most 
crowded  districts  chose  a  medical  officer  of  health,  who 
was  permitted  not  only  to  carry  on  private  practice, 
but  to  hold  a  similar  "  half  time "  post  in  another 
metropolitan  parish.  And  this  arrangement,  mirabile 
dictuy  was  sanctioned  by  the  Local  Government  Board. 
Under  such  circumstances,  it  seems  hardly  possible  that 
the  medical  officer  of  health  can  be  otherwise  than  at 
the  mercy  of  his  inspectors,  and  it  is  a  matter  for  con- 
gratulation that  evil  results  are  not  more  frequently 
heard  of.  During  the  past  few  weeks  London  has  had 
an  object-lesson  as  to  the  possibilities  of  the  case  in 
the  person  of  a  sub-inspector  of  a  Southern  district. 
This  official  was  known  to  have  written  to  a  house- 
agent,  asking  for  full  particulars  as  to  certain  houses 
in  the  parish  and  what  commission  on  sale  the  agent 
was  prepared  to  pay.  He  was  subsequently  requested 
to  resign  by  the  health  committee  of  his  Vestry,  which 
he  did.  Shortly  afterwards  he  brought  forward  a 
charge  implicating  his  former  chief  inspector  in 
offences  of  a  similar  nature.  The  chief  inspector  was 
exonerated  by  his  Vestry,  but  the  matter  appears  to 
usnonethelessimperatively  todemand  afurther  inquiry 
by  the  Local  Government  Board  into  the  whole  cir- 
cumstances of  the  case.  'In  no  other  way  can  the 
confidence  of  the  public  and  of  the  medical  profession 
be  restored  as  regards  the  purity  of  local  sanitary  ad- 
ministration. The  fact  that  the  chief  official  in 
question  is  President  of  the  Sanitary  Inspectors' 
Association  makes  it  all  the  more  necessary  that 
a  searching  departmental  inquiry  should  be  under- 
taken forthwith.  In  making  that  demand  we 
confidently  assume  that  the  main  body  of  the 
inspectors,  upon  whose  honesty  and  good  faith  we 
rely  implicitly,  will  be  with  us  in  seeking  to 
clear  up  the  grave  stigma  which  has  been  cast  upon 
them  in  the  person  of  their  President.  In  the 
interests  of  the  future  of  the  public  health 
service  we  suggest  that  such  an  inquiry  might 
conveniently  be  extended  or  supplemented  so  as  to 
take  into  consideration  the  position  and  powers  of 
what  we  have  ventured  to  call  our  ''  sanitary  police." 
Our  own  view  on  the  question  is  simple,  and  has  been 
more  than  once  emphatically  recorded  in  these 
columns.  To  put  the  matter  in  a  nutshell,  it  is  that 
the  choice  and  control  of  his  subordinate  sanitary 
inspectors  should  be  centred  absolutely  in  the  MediceJ 
Officer  of  Health.  Past  experience  has  proved  over 
and  over  again  that  of  all  men  the  sanitary  inspector  is 
east  fitted  to  serve  two  masters. 


INFANT  MORTALITY. 
The  great  waste  of  infant  life  which  at  present  obtains 
in  the  Metropolis  and  other  parts  of  the  kingdom  is  a 
scandal  and  a  disgrace  to  our  civilisation.    To  say  that 
such  waste  is  unpreventable  is  simply  to  argue  against 
the  logic  of  facts.  That  it  can  and  should  be  prevented 
is  indisputable,  and  no  sensible  person  who  has  pud 
any  attention  to  the  subject  can  deny  that  if  the  Legis- 
lature were  to  take  it  properly  in  hand  a  better  order 
of  things  could  soon  be  made  to  prevail.     There  are 
societies  at  work  which  have  for  their  object  the  pro- 
tection of  little  children  against  cruelty,  and  it  seems 
somewhat  curious  that  they  have  not  included  in  the 
sphereof  their  usefulnesssome  measures  for  the  preven- 
tion of  the  causes  which  lead  to  the  enormous  mortality 
among  infants.    Surely  the  officers  of  these  societies 
must  come  in  contact    with   the   many    deleterious 
influences  concerned  in  the  production  of  the  excessive 
infant  death-rate.      Who,  better   than   they,  would 
be  in  a  position  to  see  the  evils  which  prevail,  or  better 
qualified  to  draw  attention  to  them  in  the  proper 
quarters  ?    As  a  matter  of  fact,  this  question  of  infant 
mortality  is  becoming  more  and  more  serious  every 
year.    During  last  year  no  less  than  22,000  children 
under  twelve  months  of  age  died  in  London  a1on&  The 
total  number  of  deaths  in  the  metropolis  for  the  same 
period  was  86,d40  ;  in  other  words,  upwards  of  25  per 
cent  of  the  death-rate  occurred  among  children  who 
had  not  passed  the  first  year  of  their  life.    The  serious- 
ness of  this  position  of  affairs,  in  our  opinion,  calls  for 
a  public  inquiry.    The  matter  should  be  brought  under 
the   notice    of    Parliament    early    in    the    coming 
session,     and     a     Royal     Commission     asked    for 
with  a   view  to    ascertaining    all    the  evidence  in 
connection    therewith,    and    the    passing    of    some 
legislative  enactment  by  which  this  waste  of  life  would 
be  much  curtailed.  Within  the  past  week  or  so  two  im- 
portant references  have  been  made  to  this  subject  Dr. 
Rabagliati  pointed  out  in  a  public  lecture  delivered  in 
Bradford  that  in  that  town  the  birth-rate  was  lower 
than  in  other  Yorkshire  towns,  and  that  of  all  the 
children  born  in  Bradford  in  1894  one  in  five  died 
under  the  age  of  one  year.     These  facts,  were  so 
remarkable  that  he  could  not  avoid  asking  the  ques- 
tion, "  Is  this  civilisation  ;  can  it  be  that  we  who  pride 
ourselves  on  being  in  the  van  of  civilisation  can  be  so 
reckless   of   our   children's  lives  that  we  lose  one-  . 
fifth     of     those    born    before     they    are    a   year 
old  1"    The  other  reference  to  the  subject  occurs  in 
the  report  just  issued,  of  Dr.  Waldo,  Medical  Officer  of 
Health  for  St  George's,  Southwark.    He  points  out 
that  the  highest  infant  mortality  is  in  the  Strand, 
I  Holbom,  St  George's  in  the  East,  St.  George's  (South- 
wark), Limehouse  and  Clerkenwell,  where  one  out  of 
'  every  five  children  bom  dies  before  it  is  twelve  months 
old.    This  statement  it  will  be  seen  represents  exactly 
the  condition  of  affairs  which  prevails  at  Bradford.        | 
In  Dr.  Waldo's  opinion  the  causes  of  infant  deaths       | 
in   his   district  are :    (1)   Bad    environment,    such 
as  insanitary  conditions,  overcrowding,  acd  absence       | 
of  parks  and  open    spaces  ;   (2)   improper  and  in-       | 
sufficient  food;    (3)    mismanagement    by   mothers       I 


Jan.  S9.  1896 


NOTES  ON  CURRENT  TOPICS. 


Thr  Mbdical  Press.     119 


throngh  ignorance  ;  (4)  early  marriages  ;  (5)  debility 
of  mothers ;  (6)  maternal  neglect,  due  to  mothers 
being  more  or  lees  employed  away  from  home  in  fac- 
tories and  workshops  ;  (7)  the  use  of  opiates,  usually 
in  the  form  of  patent  medicines,  given  to  lull  or  satisfy 
the  hunger  of  the  child.  Two  important  suggestions 
are  made  for  the  remedying  in  some  degree  of  these 
defects.  The  first  is  the  establishment  of  ''open 
breathing  spaces,"  and  secondly  "creches,"  or  day 
norseriee  for  the  better  protection  of  infants  during 
the  hours  that  they  are  deprived  of  the  maternal  care. 
This  latter  suggestion  introduces  an  important  ques- 
tion. It  would  be  well  if  every  parish  had  its  crdche, 
in  the  same  way  as  there  is  attached  to  every  large 
onion  an  infirmary  for  the  treatment  of  sick  paupers. 
The  union  cr^he  might  be  an  institution  provided  out 
of  the  rates— but  partly  self-supporting  by  the  sums 
charged  for  the  care  of  the  children.  Under  this  plan 
there  would  be  the  certainty  that  the  children  would 
be  properly  looked  after,  and  a  marked  diminution  in 
the  infant  mortality  rate  would  follow  as  a  matter  of 
coarse. 


,^WeB  on  €ttrrtttt  ^ojrirs. 

Diphtheria  Bacilli  and  Their  Products. 
A  PAPEB  read  by  Drs.  Eanthack  and  Stephens  at 
the  last   meeting  of    the   Pathological   Society    of 
London  throws    a   new    light   on   the    production 
of   the    diphtheria   toxin  within  the  living   organ- 
ism.     On    the    strength    of   the    very   interesting 
researches  carried  out  by  Dr.  Sidney  Martin  it  was 
believed  that  the  bacillus  developed  exclusively  in  the 
false  membranes  which  form  in  the  throat,  and  the 
presence  of  poisonous  albnmoses  in  the  viscera  was 
explained  on  the  assumption  of  the  elaboration  by  the 
di^theria  bacillus,  located  in  the  throat,  of  a  ferment 
or  ferments  which  acted  on  the  tissue  proteid  and  con- 
verted it  into  the  albnmoses  aforesaid.  The  more  recent 
investigations  of  Drs.  Kanthack  and  Stephens  confirm 
the  observations  of  others  that,  as  a  matter  of  fact,  the 
badllns  is  often  to  be  found  in  the  organs,  especially 
in  the  lungs  and  spleen.    Their  investigations,  it  is 
true,  were  carried  out  on  the  subjects  of  fatal  diphthe- 
ria, with  laryngeal  complications,  and  this  may  possibly 
account  for  the  presence  of  the  bacillus  in  the  lungs. 
Broncho-pneumonia,  it  is  well  known,  is  a  fairly  fre- 
quent and  always  dangerous  complication  of  diphthe- 
ria, and  in  the  light  of  this  discovery  of  the  ubiquity 
(tf  the  pathogenic  organism  it  is  highly  probable  that  the 
pulmonary  disease  is  really  of  diphtheritic  origin.    It  is 
possibly  only  in  the  most  severe  cases  that  the  bacillus 
breaks  bounds  and  wanders  far  and  wide  through  the 
tiflsnes  and  enters  the  lymphatic  and  blood  circulations, 
bat  this  is  a  point  which  demands  further  inquiry.  The 
fact  has  an  important  clinical  and  therapeutical  bearing, 
because  it  follows  that  the  quantity  of  toxin  requiring  to 
beneatralisedis  far  greater  than  has  hitherto  been  sup- 
posed, and  this  points  to  the  desirability  of  employing 
antitoxin  freely  in  large  doses  in  all  cases  which  mani- 
fest any  degree  of  severity. 


The  Bacteriological  Diphtheria  Test. 
The  experiment  now  being  carried  out  in  Maryle- 
bone  of  furnishing  apparatus  and  opportunity  for  free 
bacteriological  examination  in  doubtful  diphtheria  will 
be  watched  with  much  interest  by  all  who  are  interested 
in  public  health  progress.  Its  results  during  the 
quarter  have  been  as  follows  : — Twenty-one  cases  of 
presumed  diphtheria  have  been  examined,  and  of 
these  11,  or  rather  more  than  half,  showed  the  typical 
microphyte.  The  actual  number  of  cases  of  diphtheria 
notified  during  the  period  in  question  was  75,  of  which 
number  41  were  removed  to  hospital.  These  figures 
show  a  marked  increase  over  the  corresponding  period 
of  1894,  when  67  cases  were  officially  reported.  In 
view  of  the  alarming  spread  of  this  fatal,  but  quite 
preventable  disease.  Dr.  Wynter  Blyth  is  to  be  con- 
gratulated on  his  action  in  affording  medical  men  in 
his  district  an  opportunity  of  arriving  at  an  absolute 
and  early  diagnoais  in  doubtful  cases  of  sore  throat. 


Remarkable  Death  of  a  Medical  Practitioner. 
The  death  of  a  medical  practitioner,  Mr.  John  Eobin- 
son,  of  Bridlington  Quay,  Yorkshire,  last  week  under 
peculiar  circumstances  has  been  largely  commented 
on  in  the  local  press.  Briefly,  the  facts  are  as  follows  :— 
Mr.  Eobinson  had  under  his  care  a  young  man  suffering 
from  some  slight  ailment  for  whom  he  prescribed 
a  bottle  of  medicine.  After  one  dose,  however,  owing^ 
to  the  ''  agonising  effects  "  caused,  the  patient  refused 
to  take  any  more  of  the  mixture.  This  surprised  his 
medical  attendant,  but  it  led  to  the  latter  taking  the 
bottle  away  and  promising  to  send  another  mixture  of 
less  strength  than  the  first.  However,  the  same  effects 
were  produced  in  the  patient  after  a  single  dose  of  the 
second  medicine,  and  again  he  declined  to  take  any 
more.  This  havingbeen  brought  under  the  notice  of  Mr.. 
Robinson,  he  visited  the  patient,  and  stated  that  the 
prescription  from  which  the  medicine  had  been  prepared 
was  one  that  he  was  accustomed  to  use  every  day,  and 
that  he  himself  would  not  object  to  swallowing  the 
whole  of  the  contents  of  the  bottle  at  once.  Suiting 
the  action  to  his  word,  he  called  for  some  water  and 
proceeded  to  pour  out  a  large  dose  of  the  mixture, 
which  he  promptly  swallowed.  Soon  afterwards  he 
began  to  feel  ill.  He  accordingly  proceeded  home  at 
once,  and  sent  for  two  confrh'es.  Everything  that  was 
possible  was  done  for  him ;  but  the  symptoms  of 
poisoning  rapidly  developed,  and  death  took  place  two 
hours  later.  His  belief,  at  firsts  was  that  the  medicine 
had  contained  a  strong  dose  of  tincture  of  ginger,  but 
before  he  died  he  expressed  the  opinion  that  aconite 
had  somehow  been  dispensed  by  mistake  in  the  mix- 
ture. Mr.  Robinson  had.  been  forty  years  in  practice 
in  Bridlington,  and  had  reached  the  age  of  sixty-four. 

The  Sale  of  Poisonous  Fly-Papers. 
The  enterprise  and  activity  of  the  Pharmaceutical 
Society  of  Great  Britain  in  prosecuting  ^yilicensed 
sellers  of  poisonous  preparations  has  very  properly 
been  extended  in  the  direction  of  bringing  actions 
against  grocers  who  deal  in  poisonous  fly-papers.  A 
case  of  this  description  was  heard  last  week  in  the 


120     The   Medioal  Press. 


XOTES  ON  CURRENT  TOPICS. 


Jan.  29    1896. 


Bloomsbary  County  Court.  The  action  was  brought 
in  respect  to  the  sale  of  twenty-five  fly-papers,  the 
composition  of  which  on  analysis  showed  an  average 
of  eight  grains  of  arsenic  in  each.  Dr.  Thomas  Steven- 
son, analyst  to  the  Home  Office,  was  called  for  the 
prosecution,  and  agreed  with  the  analysis  that  had 
been  made ;  and  he  also  pointed  out  that  two  grains 
of  arsenic  was  a  fatal  dose  for  an  adult.  The  only 
defence  made  was  that  wall-papers,  posters,  and  various 
fabrics  contained  arsenic.  But  the  judge  declined  to 
admit  this  evidence,  and  gave  judgment  for  the  plain- 
tiffs, namely,  £5  and  costs.  In  regard  to  poisonous 
fly-papers,  the  use  to  which  they  are  put  for  suicidal 
purposes  has  been  repeatedly  brought  under  public 
notice,  and  it  is,  therefore,  highly  essential  that  their 
sale  should  be  restricted,  at  all  events  to  those  trades- 
men whose  business  it  is  to  deal  in  drugs. 


The  Direct  Bepreeentatioii  for  Ireland  in  the 
General  Medical  Council. 
We  understand  that  it  has  been  arranged  that  notice 
of  the  forthcoming  election  shall  be  issued  on  the  1st 
of  February— that  the  Rescript  shall  be  presented  on 
the  12th— that  the  nominations  of  candidates  shall  be 
handed  in,  at  the  latest,  on  the  I5th— that  the  voting 
shall  take  place  between  the  20th  and  27th,  and  that 
the  result  will  be  declared  on  the  2nd  of  March. 
Meanwhile  the  mancBuvreing  of  parties  is  interesting. 
Mr.  Thomson,  Dr.  Jacob,  and  Professor  Cuming  are, 
at  present,  apparently  at  rest,  but  no  doubt  every 
nerve  is  being  strained  to  exercise  private  influence  on 
voters.  Dr.  MacDonnelFs  party,  on  the  other  hand, 
are  making  herculean  efforts  to  get  other  candidates 
out  of  the  field,  which,  indeed,  it  is  wise  of  them 
to  do.  With  this  purpose  they  are  flooding  the  news- 
papers with  a4jurations  to  the  ''provincial"  candi- 
dates (in  which  category  they  include  only  Dr. 
MacDonnell,  Professor  Cuming,  and  Dr.  Greene), 
to  take  a  preliminary  plebiscite  for  the  purpose  of 
deciding  who  shall  withdraw  and  who  shall  go  to  the 
poll.  It  is  to  be  supposed  that  they  know  pretty  well 
that  Professor  Cuming,  being  pledged  to  the  Belfast 
School,  cannot  withdraw,  and  their  plebiscite  could, 
therefore,  only  result  in  a  poll  between  their  own  can- 
didate. Dr.  MacDonnell,  and  Dr.  Greene,  in  which, 
without  a  shadow  of  doubt,  Dr.  MacDonnell  would  come 
out  with  a  lead,  thus  acquiring  all  Dr.  Greene's  votes 
without  much  trouble.  We  desire  to  speak  with  every 
respect  of  the  anxiety  of  certain  of  the  country  practi- 
tioners to  send  one  of  themselves  to  the  General  Medical 
Council,  but  if  this  aspiration  is  only  a  sentiment  it 
seems  unwise  to  lose  the  game  for  the  sake  of  gratify- 
ing it.  A  provincial  is,  in  respect  of  that  fact,  neither 
better  nor  worse  than  a  townsman.  What  would  be 
the  fate  of  a  government  which  selected  its  ministers, 
not  for  special  aptitude  or  experience,  but  because  ! 
they  lived  in  Birmingham,  or  Cork,  or  Glasgow  t  It  I 
is,  thus,  neither  a  recommendation  nor  a  detraction  ' 
that  a  candidate  lives  in  any  particular  place,  the  only  | 
question  to  consider  is  whether  he  is  the  very  best 
person  who  can  be  had  to  represent  the  special  , 
interests  of  the  country  doctor.    If  he  is  not  the  right 


man  he  cannot  be  so  even  if  he  resided  in  the  mooo. 
Some  may  think  that  it  would  be  better  to  have  a 
mediocre  provincialist  than  a  specially  qualified  towns- 
man, and  then  the  question  arises  whether  the  medio- 
crity can  be  secured  by  any  means.  If  it  appears  that 
he  cannot  succeed  what  is  the  sense  of  voting  for  him, 
and  thus  placing  the  coveted  position  in  the  hands  of 
the  townsman  whom  it  is  desired  to  keep  out  1  The 
provincial  idea  is  an  excellent  sentiment  upon  which 
it  is  not  wise  to  wreck  the  cause. 


The  Weather,  Influenza^  and  Disease. 
It  is  hardly  realised,  as  yet,   how   seriously  the 
repeated  attacks  of  influenza  during  the  last  six  yean 
may  have  modified  the  incidence  of  disease  for  that 
period.    At  no  other  period  of  the  world's  history,  and 
we  can  go  as  far  back  as  1173  in  this  respect,  have  so 
many  attacks  of  this  malady  followed  each  other  in 
such    quick  succession.     If  we  remember  that  the 
poison  of  influenza  acts  vigorously  on  nearly  all  the 
systems  of  the  body,  we  may  easily  conclude  that  the 
constantly  recurring  outbreaks  which  have  scourged 
this  country  in  common  with  most  of  the  civilised 
countries  of  the  globe  must  have  had  a  great  inflaenee 
on  the  public  health.    In  a  paper  read  at  the  Royal 
Society  of  Edinburgh  on  Monday,  last  week,  Dr.  Lock- 
hart  Gillespie  summarised  the  results  of  an  inqniiy 
into  the  effect  of  the  weather  and  of  influenza  on  the 
admissions  into  the  medical  wards  of  the  Edinburgh 
Royal  Infirmary.    He  found  that  the  type  of  weather, 
i  e.f  cyclonic  or  anti-cyclonic,  had  had  a  very  consider- 
able influence  on  the  admissions  of  certain  diseases. 
Patients  with  respiratory  disorders  were  adnutted  in 
greater  numbers  during  cyclonic  weather,  althon/^ 
those  suffering  from  acute  pneumonia  were  in  ^e 
majority  when  the  conditions  were  anti-cyclonic.  Cases 
of  acute  rheumatism,  chorea,  and  digestive  diseases 
were  more  numerous  in  anti-cyclonic  weather.    With 
regard  to  influenza,  he  pointed  out  that  this  scourge 
had  been  epidemic  in  Edinburgh  during  68  weeks 
in  the  last  six  years,  or  one  week  in  every  four  and  a 
half.    From  the  infirmary  records  it  was  clear  that 
ccnncident  with  the  onset  of  the  attacks  a  great  increase 
occurred  in  the  number  of  respiratory  cases  admitted, 
especially  in  cases  of  pneumonia,  but  that  the  figares 
for  the  periods  following  the  epidemics  were  almost 
of  greater  importance,  showing,  as  they  did,  a  very 
considerable  increase  in  the  number  of  heart  and 
nervous  cases.    The  importance  of  this  latter  fact  lay 
in  the  insidious  onset  of  these  sequelae,  generally  after 
the  patient  had  left  the  doctor's  hands  for  the  original 
malady,  if,  indeed,  he  had  ever  been  treated  for  it  An 
examination  into  the  weather  conditions  before  and 
during  the   epidemic  periods   showed  that  the  six 
attacks,  as  a  rule,  had  been  preceded  by  cyclonic,  cold, 
and  wet  weather,  had  commenced  in  anti-cyclonic, 
cold,  and  dry  weather,  had  persisted  in  weather  which 
was  normal  for  the  time  of  the  year,  and  had  declined 
under  cyclonic,  wet,  and  warmer  conditions.    No  sug- 
gestion was  made  that  the  type  of  weather  had  any- 
thing more  to  do  with  the  onset  of  the  malady  in 
epidemic  form  than  to  afford  facilities  for  its  rapid 


jAir.  29.  1890. 


NOTES  ON  CURRENT  TOPICS. 


Ths  Mbdigal  Pbsss.     121 


BpntA.  The  four  previous  attacks  for  1848-49, 1851, 
1855, 1857-58,  exhibited  the  same  peculiarities  with 
regaid  to  the  nature  of  the  cases  admitted  into  the 
jpfirmary,  the  percentages  to  the  total  admissions  being 
in  all  these  instances  remarkably  similar. 


Death 


Patty 


from     Aocident     or     from 
Oogeneration  of  the  Heart  1 
A  CASS  which  presents  some  very  interesting  medical 
points  was  decided  in  the  Scottish  Court  of  Session 
last  week.    A  man,  aged  about  45,  who  had  previously 
enjoyed   excellent   health,  fell  off  the   bridge  of  a 
steamer,  a  distance  of  about  9  feet    He  was  a  stout 
man,  of  about  15  stone.  When  picked  up  he  was  found 
to  be  insensible.    On  recovering   consciousness,    he 
began  to  spit  blood,  and  later,  he  was  found  to  have  a 
broken    rib.      Subcutaneous   emphysema   made   its 
appearance  a  day  or  two  afterwards.    Five  days  after 
the  accident  he  died  suddenly  with  symptoms  which 
pointed  rather  to  asphyxia  than  to  syncope.  At  a  post- 
mortem examination  the  broken  rib,  with  some  con- 
gestion of  the  lung,  was  discovered— and  a  fatty  heart. 
A  certificate  was  granted  to  the  effect  that  the  death 
was  due  to  syncope  from  the  effects  of  fatty  degenera- 
tion of  the  heart  accelerated  by  an   accident.    The 
deceased  had  been  insured  in  the  Scottish  Accident 
Insurance  Company  for  ^£1,000.    On  applying  for  pay- 
ment of  this  sum  his  trustees  were  met  with  a  refusal,  the 
company  alleging  that  one  of  the  terms  of  the  policy, 
to  the  effect  that  death  by  disease,  if  accelerated  by  an 
aeddent,  rendered  it  void,  precluded  the  trustees  from 
recovering  the  sum.    At  the  trial  the  onus  was  laid 
on    the    company    to    prove    that    the    man    did 
die    of    a    fattily    degenerated     heart,    the    other 
aide  suggesting  that  the  heart  was   only  infiltrated 
with  fat,  as  was  to  be  expected  in  a  stout  man  of  that 
age,  and  that  his  active  habits  and  uniform  health 
precluded  or  rendered  very  improbable  the  pre-exist- 
ence  of  such  an  extreme  degree  of  fatty  degeneration 
as  was  described.    A  great  point  was  made  of  the 
difficulty  in  diagnosing  between  fatty  degeneration  and 
infiltration  without  the  aid  of  the  microscope,  which 
had  not  been  used  in  this  case.    Judgment  was  given 
against  the  Insurance  Company,  with  expenses.    The 
pomt  which  seemed  to  strike  the  judge  more  than  any- 
thing eke  was  the  question,  where  insurance  companies 
would  stop  under  the  condition   inserted    in   their 
policies,  which  has  been  mentioned  above.  It  certainly 
should  be  better  known  that  in  the  policies  of  some 
msniance  offices  such  conditions  are  present,  for  there 
are  few  men  above  forty  who  have  not  got  some  little 
thing  wrong  with  them,  which  might  be  held  to  precipi- 
tate the  fatal  result  after   an  accident,  and  which 
might  be  all^^  to  be  the  actual  cause  of  death.    No 
one  would  care  to  insure  their  lives  against  accident 
when  they  knew  that  there  was  such  a  chance  of 
expensive  litigation  on  the  flimsiest   pretexts   after 
death. 

The  Case  of  Mr.  R  B.  Anderson. 
The  Civil   Rights   Defence   Committee   are  still 
working  hard  to  obtain  justice  for  Mr.  R.  B.  Anderson. 


It  is  a  matter  of  surprise  to  us  that  the  public  hav  e 
hitherto  paid  so  little  attention  to  this  case.  The 
principles  involved,  for  which  Mr.  Anderson  and  those 
associated  with  him  have  for  upwards  of  four  years 
been  so  pluckily  striving,  are  those  in  which  every 
person  in  the  kingdom  has  an  interest.  No  one  who 
has  taken  the  trouble  to  read  the  facts  of  the  case— 
and  they  are  eminently  worth  perusal — can  help  being 
astounded  at  the  illegal  persecution  to  which  Mr. 
Anderson  was  compelled  to  submit  However,  we  are 
glad  to  see  that  the  apathy  in  this  connection  is  less 
than  it  was,  and  that  public  bodies  are  beginning  to 
realise  the  greatness  of  the  issues  at  stake.  The  Civil 
Eights  Defence  Committee,  with  Mr.  Anderson, 
deserve  every  encouragement  in  their  arduous  crusade ; 
but  it  .may  be  pointed  out  that  practical  assistance  in 
the  form  of  contributions  to  the  General  Fund  is 
urgently  needed.  Within  the  past  week  a  donation  of 
£10  has  been  received  from  the  Barbadoes  branch  of 
the  British  Medical  Association,  and  the  medical  men 
of  Exeter  have  subscribed  upwards  of  £28.  These 
examples  might  be  emulated  by  bodies  of  medical  men 
throughout  the  country.  It  is  only  by  united  action 
of  this  kind  that  the  victory  can  be  won. 


The  British  Balneological  Association. 
The  British  Balneological  Association  held  its 
inaugural  meeting  at  Limmer's  Hotel  on  the  22nd 
inst  The  Association  came  into  existence  in  November 
last,  and  everything,  so  far,  points  to  the  fact  that  a 
useful  and  prosperous  career  lies  before  it.  The  inau- 
gural address  was  to  have  been  delivered  by  Dr.  W. 
M.  Ord,  but  in  his  unavoidable  absence  this  duty  was 
discharged  by  Dr.  Symes  Thompson.  A  discussion 
followed  the  address,  no  doubt  for  the  useful  purpose 
of  showing  more  plainly  the  objects  and  aims  of  the 
Association.  If  the  Association  succeeds  in  impressing 
upon  the  medical  profession  and  upon  the  public  in  the 
United  Kingdom  that  many  of  our  spas  possess  just  as 
much  therapeutic  value  as  those  to  be  found  abroad,  a 
great  point  will  have  been  gained.  The  business  of 
**  working  "  these  health  resorts  has  never  been  properly 
understood  in  this  country,  but  a  great  improvement 
has  recently  taken  place  in  this  regard,  and,  with  the 
events  of  the  past  few  weeks  in  view,  the  opportunity 
is  a  good  one  for  patriotic  English  people  in  search  of 
health  to  elect  to  remain  in  their  own  country,  and  visit 
the  spas  over  which  their  own  countrymen  preside. 

Alterations  in  the  Edinburgh  M  D. 
Readers  may  be  reminded  that  the  new  regulations 
as  regards  the  degree  of  Doctor  in  Medicine  are  now 
in  force.  First  and  foremost,  the  government  stamp 
of  ten  pounds  has  been  repealed,  the  late  hberal  ad- 
ministration having;decreed  the  repeal  of  that  parti- 
cular form  of  taxation  upon  knowledge.  Further, 
those  who  have  passed  the  M.B.  examination  under 
the  regulations  in  force  before  5th  August,  1892,  may 
now  proceed  to  the  degree  of  Doctor  of  Medicine  under 
the  old  or  under  the  new  regulations.  The  old  regula- 
tions required  the  candidate  to  send  in  a  thesis,  and  to 
have  passed  a  preliminary  examination  in  three  of  the 


122    Th«  MiDioAt  Pbiss.  NOTER  ON  CURRENT  TOPICS. 


jAir.  39.  1896. 


foUowingsubjects :-— French, German,  Higher  Mathema- 
tics, Natural  Philosophy,  Greek,  Logic,  and  Moral[Philo- 
sophy.  Two  of  these  mast  be  Greek,  and  either  Logic 
or  Moral  Philosophy.  Under  the  new  regulations,  the 
candidate  for  the  M.D.  may  pass  a  further  examination 
in  Clinical  Medicine,  and  thus  escape  the  ordeal  of  fur- 
bishing up  Greek,  Logic,  or  Moral  Philosophy.  There 
can  be  no  doubt  that  a  great  many  men  in  busy  prac- 
tice haye  failed  to  take  their  degree  of  ^  Doctor  "  in 
the  University  because  of  the  bugbear  of  reading  up 
one  of  the  necessary  preliminary  subjects.  To  such 
men  a  revision  of  their  clinical  medicine  would  not 
only  be  a  pleasure  but  also  a  valuable  practical  means 
of  testing  their  experience  and  of  bringing  them  in 
touch  with  the  most  recent  advances  of  professional 
knowledge.  The  University  of  Edinburgh  appears  to 
be  acting  wisely  in  making  the  path  of  its  alumni  as 
smooth  as  may  be  from  starting  point  to  goal.  The 
unavoidable  obstacles  are  quite  hard  enough  in  them- 
selves without  adding  to  their  number.  The  Senate 
would  do  well,  as  a  next  step,  to  revise  and  lessen  fees, 
which  have  increased  considerably  of  late  years. 


Emergenoy  War  HospitalB. 
According  to  the  Leeds  Aferctf/ry,  several  of  the 
Hull  medical  charities  have  received  communications 
from  York,  asking  whether  beds  could  be  provided  at 
the  institutions  for  the  use  of  those  engaged  in  the 
defence  of  the  Humber  in  time  of  war.  The  Hull 
Royal  Lifirmary  replied  in  the  negative,  as  they  felt 
they  had  a  duty  to  perform  to  the  sick  and  hurt  poor 
that  must  not  be  neglected-  At  the  same  time,  they 
intimated  their  willingness  to  assist  to  the  utmost  if 
occasion  should  arise.  It  is  further  stated  that  the  In- 
firmary people  were  of  opinion  that  many  buildings 
might  be  utilised  in  time  of  need  ;  whUe  the  charities 
would  continue  to  fulfil  the  mission  for  which  they 
were  established.  With  the  view  thus  expressed  we 
certainly  agree.  We  fail  to  see  the  slightest  necessity 
for  disorganising  the  ordinary  public  hospital  service 
in  time  of  war.  Nothing  could  be  easier  than  to  adapt 
existing  buildings,  such  as  churches,  factories,  domestic 
houses,  or  farm  buildings,  so  as  to  convert  them  into 
serviceable  hospitals.  Moreover,  in  the  present  day 
many  alternative  temporary  structures  are  available. 
Tents,  ambulance  waggons,  huts  of  wood  and  iron,  and 
ships  could  be  provided  within  the  space  of  a  few 
days  to  meet  every  possible  demand.  The  whole 
question  thus  raised  appears  to  be  of  too  puerile  a 
nature  to  have  come  from  the  War  Office  authorities. 


Female  Medical  Blducation  in  India. 
The  cause  of  the  lady  doctors  in  India  is  being 
carried  on  with  an  energy  that  must  sooner  or  later 
achieve  success.  Some  time  since  the  Campbell  Medi- 
cal School  at  Calcutta  was  thrown  open  to  native 
students.  The  women  who  formed  the  class  lived  for 
the  most  part  at  a  distance  from  the  colleges,  and  had 
to  be  brought  to  and  fro  every  day  in  native  omnibuses. 
In  spite  of  these  and  other  drawbacks,  however,  the 
movement  continued  to  flourish.  It  has  now 
received  a  great  impetus  in  the  shape  of  an  hostel, 


which  has  been  built  as  a  residence  for  stndeoti 
in  term  time.  The  native  attitude  towards  the  schems 
may  be  inferred  from  the  fact  that  the  Nawab  Begum 
of  Murshidabad  contributed  25,000  rupees  to  the  fund. 
The  new  building  bears  the  name  of  Lady  Elliott,  who 
has  had  a  large  practical  share  in  the  organisation  of 
women's  work  in  India. 

Foreign  Medical  Men  in  France. 
The  medical  profession  in  France  has  its  trials  asd 
difficulties,  similarly  as  is  the  case  in  other  countries, 
but  the  fact  which  appears  chiefly  to  be  disturbing  the 
minds  of  members  of  the  profession  there  at  the  present 
moment  is  the  invasion  of  the  country  by  foreign 
medical  men.  In  a  recent  number  of  the  Jotemd 
de  Med,  de  Paris  a  most  doleful  article  appeared 
lamenting  this  state  of  things.  The  writer  points  out 
that  in  former  years  foreign  medical  students  simply 
came  to  France  for  their  education,  and  afterwards 
returned  to  their  own  country  to  practise.  But, 
latterly,  this  has  not  been  the  case.  The  foreign* 
students  have  liked  France  so  well  that  they  have  made 
up  their  minds  to  remain.  According  to  the  last 
official  medical  census,  a  large  number  of  foreign 
medical  men  are  now  practising  in  Paris,  that  is  to 
say  about  521,  which  represents  more  than  one  sixth  of 
the  total  number  of  medical  men,  namely  2,992,  with 
whom  Fftris  is  provided.  The  foreign  residents  iit 
Paris  have  been  estimated  at  180,000 ;  the  proportion 
of  foreign  medical  men  to  foreign  population  is  about 
3  to  1,000,  that  of  French  practitioners  to  the  native 
population,  properly  speaking,  is  only  1  to  1,000.  Bat 
this  foreign  medical  element  is  beginning  to  invade  the 
rural  districts  in  France,  a  fact  which  is  causing  still 
further  dismay  to  the  French  medical  profession. 
After  all,  perhaps,  our  confreres  across  the  Channel 
may  have  some  grounds  of  complaint  in  this  respect 


A  Central  Hospital  Board  for  London. 
Although  there  was  nothing  especially  new  in  the 
paper  read  by  Colonel  Montifiore  last  week  before  a 
large  meeting  of  the  Charity  Organisation  Societyr 
upon   the  subject  of  the  organisation  of  a  central 
hospital  board  for  London,  yet  all  must  admit  that 
good  can  only  come  from  pressing  forward  the  scheme 
upon  every  available  opportunity.    There  can  be  no- 
doubt  whatever  that  if  such  a  board  were  to  be  estab- 
lished its  field  for  usefulness  would  be  a  wide  ona 
The  philanthropic  public  would  gain  by  its  ministrations^ 
and  so  would  the  bona  fide  hospital  patient  and  the 
medical  profession.    Of  course,  it  would  meet  with 
some  opposition  on  the  part  of  those  whose  interests  it 
would  affect,  but  this  would  only  be  in  the  natural 
order  of  things.  Every  great  reform  has  been  opposed, 
and  a  scheme  such  as  that  under  discussion  would 
be  of  so  reforming  a  nature  that  more  or  less  opposi' 
tion  against  it  must  from  the  first  be  anticipated.    The 
question  is  decidedly   a  good  one  for  the  Charity 
Organisation  Society  to  have  raised,  and  we  trust  that 
they  will  make  every  effort  to  keep  it  before  the  public 
and  '*  peg  away ''  at  it  until    some  really  practical 
result  has  been  achieved.    So  far  as  the  medical  pro- 


Jav.  29,  1896 


SCOTLAND. 


Tbb  I4KDICAL  Pbxss.    123 


^eanon  is  ooocerned  there  is  no  doubt  that  general 
«ipport  would  be  accorded  the  scheme. 


Doable  Ck>nsciousne88. 
We  are  reminded  now  and  then  by  facts  that  come 
under  onr  observation  that  Nature  comprises  forces 
and  conditioiis  of  which  we  have  as  yet  but  little, 
if  SDy,    conception.     The   last  uew  discovery  that 
-certain  rays  can  penetrate  the  proverbial  deal  plaok  is  a 
philosophical  trifle  compared  to  the  curious  mental  con- 
ditions which  are  occasionally  revealed  to  us  in  the 
humblest  of  individualF,  to  explain  which  the  medical 
scientist  is  fain  to  take  refuge  in  the  most  hare-brained 
hypotheses,  which,   after  all,   only  make   confusion 
worse  confounded.     At  last  week's  meeting  of  the 
•Clinical  Society,  a  distinguished  suburban  practitioner, 
whose  name  we  withhold  in  order  not  to  afford  any 
^e  to  the  identity  of  the  patient,  showed  a  girl,  12 
yeare  of  age,  who  exhibited  in  the  most  complete  and 
indubitable  form  the  condition  known  as  **  dual  exis- 
tence "  or  ^  double  consciousness."    Last  year,  after  a 
isTere  illness  which  was  diagnosed  to  be  meningitis, 
she  became  subject  to  temporary  attacks  of  unconscious- 
nets,  on  awakening  from  which  she  appeared  in  an 
entirely  different  character.    In  her  normal  condition 
she  could  read  and  write  and  speak  fluently  and  with 
comparative  correctness.    In  the  altered  mental  con- 
dition following  the  attack  she  loses  all  memory  for 
ordinary  events,  though  she  can  recall  things  that  have 
taken  place  during  previous  attacks.  So  complete  is  this 
•Iteration  of  memory  that  at  first  ehe  was  unable  to 
remember  even  her  own  name  or  to  identify  herself  or 
her  parents.    By  patient  training  in  the  abnormal  con- 
dition she  has  been  enabled  to  give  things  their  names, 
Plough  she  still  preserves  a  baby  fashion  of  pronouncing. 
:She  sometimes  remains  in  the  abnormal  condition  for 
days  together  and  the  change  to  her  real  self  takes  place 
suddenly  without  exciting  surprise  or  dismay,  and  she 
forthwith  resumes  possession  of  her  memory  for  events 
of   her    ordinary    life  to    the    exclusion   of  those 
which  have  transpired   during   the  abnormal   state. 
During  the  last  month  or  so  she  appears   to   have 
entered  on  a  new  phase,  for,  after  a  mental  blank  of  a 
fortnight's  duration,  she  awakened  completely  oblivious 
of  all  that  has  happened  since  June,  1895,  and  she 
allndes  to  events  that  took  place  just  anterior  to  that 
date,  as  though  tbey  were  of  quite  recent  occurrence  ; 
in  fact,  she  is  living  mentally  in  July,  1895.    These 
-csBes,  though  rare,  are  of  course  not  unfrequently  met 
with,  and  they  have  been  carefuUy  studied,  especially 
in  France,  where  women  appear  more  prone  to  neurotic 
manifestations.  The  hypothesis  that  finds  most  favour 
IB  that  the  two  halves  of  the  brain  do  not  work  in 
QDiBon,  in  other  words,  that  there  has  been  some  inter- 
ference with  the  connections  which,  in  the  ordinary 
normal  being,  make  of  a  wonderfully  composite  organ 
like  the  brain  one  Organic  whole.    Sometimes  one  part 
of  the  braui  and  sometimes  the  other  takes  possession 
of  the  field  of  psychical  activity,  and,  as  each  part 
irorb  to  the  exclusion  of  the  other,  we  get  the  Dr 
Jekyll  and  Mr.  Hyde  transformations.    Verily,  truth 
is  stranger  than  fiction,  and  it  seems  highly  probable 


that  Kobert  Louis  Stevenson,  in  writing  his  enthral- 
ling story,  must  have  taken  for  his  theme  some  such 
case  as  the  one  which  we  have  briefly  described. 


[vbom  oub  own  00bbx8p0kdx1vt.] 

Thx  Fatal  Accident  Inqthby  Act  fob  Scotland. — 
At  the  time  that  this  bill  was  iDtroduced  by  the  late  ad- 
miDietration,  we  puggested  that  it  would  eerve  no  useful 
purpose.  Sufficient  time  has  now  elapsed  since  it  became 
law  to  judge  of  its  usefulness.  On  all  bands  it  is  regarded 
as  an  intolerable  nuisance.  The  tkill  of  our  legislators  in 
drawing  up  bills  which  do  not  act  as  they  were  meant  to 
act  is  proverbial,  but  it  is  still  more  marvellous  in  this 
case,  as  the  bill  was  introduced  by  the  then  Law  officers 
for  Scotland.  What  they  intended  it  to  do  is  not  quite 
clear,  what  it  does  do  is  clearer,  and  that  is  nil.  The 
diflerent  sheriffs  who  have  conducted  inquiries  into  fatal 
accidents,  as  provided  for  by  the  statute,  can  find  no 
authority  in  it  to  enable  the  jury  to  express  any  opinion 
in  the  ma^ter  except  the  bare  and  actnal  cause  of  death  ; 
no  rider  of  any  description  seems  to  be  allowable.  Conse- 
quently, a  court  is  summoned,  considerable  expense 
incurred,  in  order  that  a  jury  may  have  the  pleasure  of 
saying  that  John  Jones,  »ay,  died  from  an  accident  at  a 
certain  place  and  time,  a  tbing  which  ever>  one  knew  very 
well  before.  Even  the  caupe  of  the  accident,  it  seems, 
cannot  be  investigated.  Such  an  inquiry  would  appear 
to  be  quite  superfluous,  and,  at  any  rate,  of 
no  use  in  medico-legal  cases,  which  would  have 
to    be   begun    from   the   leginning   in    another  court. 

A  Pabtialitt  fob  High  Meat. — There  is  no  account- 
ing for  tastes,  and  to  some,  meat  which  is  tainted  may  be 
more  acceptable  to  the  palate  than  when  fresh.  The 
authorities  of  Dollar  would  appear  to  have  strong  diges- 
tions and  an  excess  of  hydrochloric  acid  in  their  gastric 
juice.  A  report  by  the  local  sanitary  inspector,  to  the 
effect  that  be  had  seized  some  unwholesome  meat  in  two 
butchers'  ehops  in  the  burgh,  was  leoeived  by  the  Burgh 
Commissioners  with  a  great  phew  of  indignation.  The 
inspector  stated  that  the  meat  was  in  a  very  putrid  condi- 
tion, pale,  wet,  greenish  in  parts,  and  with  a  very  bad 
pmell.  The  Provost  corroborated  these  statements.  A 
majority  of  the  Ck>mmis8ion,  however,  thought  that  it  was 
a  mean  thing  for  the  inspector  to  investigate  the  condi- 
tion of  the  meat  without  first  giving  notice  beforehand  to 
the  butchers.  One  member  remarked  that  *'  putrid  meat 
was  not  bad  meat !  "  It  appears  that  these  eame  butchers 
have  been  repeatedly  warned  already,  but  the  Ck)mmis- 
sioners  refused  to  prosecute.  A  very  bad  point  in  the 
inspector's  report  is  the  statement  that  the  worst  pieces 
of  the  meat  were  being  used  for  mincing  purposes.  We 
do  not  envy  the  people  of  Dollar  their  meat,  and  they 
would  be  wise  if  uiey  avoided  minced  meat  in  the  future, 
until  what  time  their  worthy  commissioners  have  recovered 
a  proper  sense  of  their  duties,  or  made  way  for  others  to 
whom  putrid  meat  is  putrid  and  disagreeable. 

I^txsBKTATioN  TO  SiB  Abthub  Mitohell  —Sir  Arthur 
Mitchell,  K.C  B.,  M.D.,  M.A.,  LL  D.,  was  presented  with 
his  portrait,  painted  by  Sir  George  Reid,  on  the  occasion 
of  bis  retirement  from  the  Scottish  Lunacy  Board.  Lord 
Kinnear  presided  at  the  meeting,  and,  in  making  the 
presentation,  referred  to  Sir  Arthur's  long  services  in 
connection  with  the  Lunacy  Board,  and  to  uie  admirable 
tact,  judgment,  good  senee,  and  kind  feeling  which  he 
had  always  exhibited  ;  to  his  services  in  other  oranches  of 
science ;  and  to  wish  him  health  and  happiness  in  his 
retirement. — Sir  Arthur  Mitchell,  in  replv,  said  that  his 
life  had  been  full  of  bard,  earnest  work.  He  thought 
that  he  had  had  some  success,  and  it  gave  him  pleasure  to 
think  how  abundantly  he  had  been  helped.  Of  the  col- 
leagues with  whom  he  began  his  lunacy  work  not  one 
now  remained :  they  had  all  gone  into  the  world  of  light. 
He  said  nothing  of  the  insane,  except  that  all  of  them  had 
a  fast  friend  in  him.  His  official  work  was  ended.  As 
regarded  it,  he  had  reached  old  age,  but  he  was  not  yet 
conscious  of  decrepitude.  He  hoped  there  was  still  some 
work  in  him,  and  he  meant  to  do  it.  In  addition  to  the 
portrait.  Lady  Mitohell  was  presented  with  50  goineas  to 


124     The  Medical  Press. 


EXAMINATION  PAPERS. 


Jan.  29.  1896. 


buy  a  Boovenir  of  the  occasion,  while  the  balance  of  the 
sabecriptions,  probablv  about  £190,  was  handed  to  Sir 
Arthur  Mitchell  for  the  purchase  of  books  to  add  to  his 
library. 

Thb  Infectious  Diseases  Hospital  Question.  —The  Cor- 
poration of  Leith  intend  to  appeal  to  the  House  of  Lords 
against  the  decision  of  the  Court  of  Session  anent  the 
erection  of  a  hospital  by  the  Edinburgh  authorities  in  the 
burffh,  a  decision  which  was  given  in  these  column  s  two 
weeks  aeo. 

Sir  Douolas  Maclaoan  and  the  Prison  Commission 
FOR  Scotland. — We  understand  that  Sir  Douglas  Mac- 
lagan  has  tendered  his  resignation  of  the  offices  held  by 
him  under  the  Prison  Commissioners,  The  resignation 
has  been  accepted  by  Lord  Balfour  of  Burleigh,  with 
an  expression  of  his  Lordship's  regret  at  the  severance 
of  Sir  Douglas  Maclagan's  long  connection  with  the 
Prisons  Department  in  Scotland.  Sir  Douglas  succeeded 
the  late  Sir  Robert  Christison  in  the  post  of  visiting 
physician  to  Perth  General  Prison  in  the  year  1877,  and 
since  all  the  prisons  in  Scotland  came  under  the  charge 
of  the  Prison  Commissioners  in  1878  he  has  acted  as  their 
medical  adviser. 


EXAMINATION  PAPERS  FOR  THE  DIPLOMA  IN 
PUBLIC  HEALTH  AT  THE  UNIVERSITIES 
OF  OXFORD,  CAMBRIDGE,  DURHAM.  AND 
VICTORIA.  AND  THE  CONJOINT  BOARD  OF 
ENGLAND,  (a) 

{Continued  from  page  95.) 

Victoria,*  July  17th,  1895.— Part  I. 

Sanitary  Appliances,  d:c. 

1.  In  a  town  of  100,000  inhabitants  there  are  2,600 
deaths  per  annum,  of  which  350  were  ascribed  to  Diseases 
of  theResDiratory  Organs,  250  to  Phthisis,  100  to  Diarrhoea, 
100  to  Convulsions,  50  to  Enteric  Fever,  and  5  to 
Alcoholism. 

Point  out  any  deviation  from  the  average,  and  any 
possible  sources  of  fallacy  in  these  figures. 

2.  Describe  the  steps  to  be  tsken  in  the  course  of  an 
undertaking  for :  he  supply  of{ water  to  an  urban  population, 
and  state  the  conditions  that  must  be  fulfilled  in  any  such 
supply. 

3.  Enumerate  the  provisions  (f  the  Public  Health 
(Amendment)  Act,  1891,  as  to  the  disposal  of  all  kinds  of 
refuse  of  towns. 

4.  What  are  the  causes  of  dampness  in  houses  ?  What 
are  the  regulations  of  the  Model  Bye-laws  of  the  Local 
Government  Board,  with  respect  to  the  thickness  of  walls 
and  the  mesne  of  keeping  them  dry  ? 

0.  What  forms  of  Hospital  are  best  adapted  for  the 
isolation  of  infectious  disease  for  towns  of  20,000  inhabi- 
tants ?  State  in  detail  the  requirements  of  such  Hospitals, 
and  the  regula  tions  by  whico  they  should  be  managed. 

*  This  psper  should  have  been  given  on  page  95.  The 
Chemistry  paper  our  coi respondent  has  been  unable  to 
obtain. 

Oxford,  November  26th,  1895.— Part  II. 
No.  I. — Pathhlogy  and  Bacteriology. 

1.  The  following  terms  have  been  used  by  writers  on 
Bacteriology;  explain  each  of  them  fuliv:— (a)  "Anae- 
robe" ;  (6)  "Facultative  parasite"  ;  (r)  *'*Obli gate  Sapro- 
phyte"; (d)  "Leptothrix";  (e)  Staphylococcus;  (/) 
Plate-culture. 

2.  Give  an  account  of  the  method  which  ought  to  be 
followed  in  the  investigation  of  the  bacterial  origin  of  any 
disease  or  group  of  symptoms. 

3.  Give  a  short  account  of  the  treatment  of  diphtheria 
with  antitoxic  serum. 

4.  What  are  the  usual  incubation  period  of— (a)  Small- 
pox ;  {h)  Scarlatina,  and  {c)  Measles  ?  What  precautions 
must  be  kept  in  mind  in  certifying  in  reepe«^t  of  each  of 
these  diseases  that  a  dwelling  is  free  from  infection  or 
contagion  ? 

5.  Give  two  examples  of  diseases  beUeved  to  be  "  water- 
borne."  In  respect  of  one  of  these,  state  fully  the  ground 
on  which  this  belief  is  founded.  How  do  the  facts  referred 
to  bear  on  the  prophylactic  measures  to  be  adopted  ? 

(a)  Examination  for  the  Degree  of  Bachelor  in  Hygiene,  and  for  the 
Diploma  in  Public  Bealth  (D.P.H.)  Durham. 


6.  Give  a  short  account  of  Anthrax  and  of  the  micRK 
organisms  associated  with  the  disease,  giving  epecial 
attention  to  those  points  that  relate  to  the  aetimogy  and 
spread  of  the  disease. 

Not  more  than  five  questions  to  be  answered. 

Prcictieal   Bacteriology. 
Examine  and  describe  the  growth  in  this  teat  tube. 
Make  a  microsoopic  preparation  of  the  growth,  fiTamine 
it  carefully,  and  give  a  short  description  of  the  ornnism  or 
organisms  present,  stain  either  by  Gram's  metboa  or  with 
methylene  blue.     Viva  twenty  minutes. 

(This  paper  was  not  printed.) 

Cambbidgb,  Tubsdat,  Ootobbr  Ist,  1895. 

(No  written  paper.) 

Practiced  Bacteriology. 

1.  Name  the  objects  under  the  microscope  1  to  5. 

2.  Examine  the  plate  cultivations  provided,  and  prepare 
cover-glass  specimens  from  any  of  the  colonies  of  micco- 
organisms  which  you  may  be  able  to  recog^se.  Label 
your  preparations,  and  draw  and  describe  a  rough  sketch 
of  the  colonies  from  which  they  are  derived. 

3.  From  a  mixture  of  micro-organisms  in  the  tube  pro- 
vided you  are  required  to  make  cover-glass  preparations 
and  describe  the  peculiarities  of  the  organiema  present, 
and  to  prepare  a  gelatine  and  agar  plate  for  the  purpose 
of  separating  the  micro-organisms.  With  eacn  plate 
leave  directions  as  to  its  after-treatment. 

4.  Make  preparations  of,  and  write  a  report  upon,  tlie 
microscopic  appearance  of  the  sample  of  epntum  pro- 
vided. 


Durham,  Tuesday,  April  16th,  1895. 
No.  n. — Comparative  Paiholoffy, 

1.  Describe  the  structure  of  the  Trichina  Spirali*.  Give 
the  life  history  of  this  parasite,  and  point  out  how  man 
may  become  infected  by  it. 

2.  Describe  fully  how  you  would  obtain  and  make  a 
bacteriological  Examination  of  a  piece  of  membrane 
from  the  throat  of  a  person  who  is  suspected  to  be  Buffer- 
ing  from  Diphtheria.  What  results  would  lead  you  to 
conclude  that  the  case  was  one  of  true  Diphtheria? 

3.  Give  the  characters  of  the  Plaemodium  Malaria,  Hor 
would  you  demonstrate  its  presence  in  the  blood  of  a  msn 
suffering  from  malaiial  fever  ? 

4.  Give  an  account  of  how  you  would  examine  a  filter, 
so  as  to  test  its  efficiency  in  removing  bacteria  from  the 
water  passing  through  it. 

5.  D)escribe  the  Bacillus  of  Tetanus.  How  would  yot 
stain  it  to  show  the  spore  most  clearly  ?  Where  are  the 
bacilli  most  frequently  found,  and  what  conditions  favour 
their  growth  in  the  body  ? 

6.  How  would  you  examine  a  sample  of  milk  for  tuberdd' 
bacilli? 


Practical  Bacteriology, 

1.  Stain  section  C  so  as  to  show  the  bacteria  in  the 
tissues.  Draw,  describe,  and  identify  what  yon  find  in  the 
specimen, 

2.  Demonstrate  to  the  examiner  how  yon  would  obtain 
pure  cultivations  of  each  of  the  six  different  kinds  of 
bacteria  which  are  contained  in  a  sample  of  water  B. 

3.  Describe  and  identify  specimens  A  and  D. 

4.  Demonstrate  to  the  examiner  how  you  would  make  a 
bacteriological  examination  of  the  air  of  the  laboratory. 

Conjoint  Board  of  England,  July  3rd,  1S95. 
Bacteriology, 
(No  written  paper.) 
Microscopical    Work, 
The  tubes  A  containing  agar  agar, 
„  B         „  gelatine, 

„  G         „  broth, 

„  D         „  milk, 

have  all  been  inoculated  with  one  organism. 

Examine,  make  preparations  of,  describe,  and  name  the 
organism.  Mention  the  facts  which  influenced  yov 
opinion. 

The  tubes  E  containing  agar  agar. 


Jav.  S9,  18d5w 


MEDICAL  SOCIETY. 


The  Medical  Pbsss.     126 


TlM  tubes  F  oonudning  gelatine, 
tf  O         t,  brofch, 

»,  D         .,  milk, 

hftTe  abo  been  iDoeiilated  with  one  organiam.      Examine, 
make  preparatioDa  of,  deecribe,  and  name  the  organiam. 
Meotioo  the  faieia  which  infloenoed  yoor  opinion. 
[N.B.  Do  not  taste  the  contents  of  any  of  the  tnbe^.] 

VOLUNTEER  MEDICAL  ORGANISATION. 
The  report  of  the  sub-committee  appointed  by  the 
GooBcil  of  the  Volunteer  Medical  Association,  and  oon- 
of  Soripeon -Lieutenant-Colonel  Baines,  V.D.,  Sur- 
q|nire.  Surgeon- Lieutenant  Fletcher,  and 
-Major  Watson,  V.  D.,  secretary,  has  unanimously 
ezpcessed  the  opinion  that  the  departmental,  as  distin- 
giushed  from  the  regimental,  aid  should  be  delegated  to  a 
departmental  corps,  and  that  all  bearer  companies  should 
be  specially  recruited,  uniformed,  and  administered  as 
kid  down  in  the  Regulations  for  Volunteer  Medical  Staff 
Corps,  and  that  they  should  be  styled  bearer  companies, 
V.M&C,  bat  that  the  existing  regulations  for  regimental 
aid  axe  sufficient  and  should  not  be  interfered  with,  all 
that  is  reqoired  beine  to  bring  it  into  touch  with  head- 
quarters and  to  provide  for  its  efficient  inspection.  The 
Volunteer  Medical  Service,  being  the  junior  branch  of  the 
Medical  Department  of  Her  Majesty's  army,  is  under  the 
Director-Goieral  as  the  responsible  head  of  the  Depart- 
ment. The  committee  considers  that  the  gap  between  the 
Aimy  Medical  Department  and  the  Volunteer  Medical 
Sernoe  is  too  wide,  and  suggests  (1)  that  a  medical  officer 
with  adnunistrative  rank  ebould  be  attached  to  the  head- 
quarters of  the  Army  Medical  Department  as  responsible 
head  of  the  Volunteer  Medical  Service,  and  (2)  that  in  each 
diatnct  command  a  Volunteer  medical  officer  should  be 

ranted  by  selection  from  the  senior  medical  officers  of 
district,  and  preferably  for  a  limited  period,  by  the 
Director-General  as  Volunteer  principal  medical  officer  of 
the  district,  with  adminiatrative  rank. 

With  regard  to  executive  officers  the  committee  express 
the  following  opinion  : — 

Brigade-Surgeons-Lieutenant-Colonel :  While  this  rank 
ehould  be  open  to  all  medical  officers  of  the  Volunteer 
force  who  by  length  of  service  or  other  merit  should  have 
deserved  it,  it  should  not  necessarily  attach  to  the  senior 
medical  officer  of  an  infantry  brigade,  as  it  does  at  pre- 
amt.  Snrgeon-Lieutenant-Colonel :  In  the  regulations 
for  promotion  to  this  rank  no  changes  are  suggested. 
SnigeoD-Major :  The  length  of  service  required  for  pro- 
motion to  this  rank  should,  with  certain  conditions,  be 
somewhat  reduced  in  the  case  of  an  officer  commanding  a 
baarer  company.  Surgeon-Captain  and  Surgeon-Lieu- 
tenant :  No  suggestions  are  offered  with  regard  to  the 
prepont  regulations  aA  to  these  appointments.  Regimental 
Medical  Officers  generally :  Rc^mental  medical  officers 
ahoold  never  be  detached  from  their  corps  for  other  duty, 
except  under  the  circumstances  when  more  medical  officers 
than  are  necessary  for  the  woik  of  that  unit  are  present,  in 
vJiich  case  the  senior  medical  officer  of  the  brigade,  with 
the  approval  of  the  commanding  officer,  may  utilise  the 
earvices  of  such  additional  officers  as  he  may  require.  The 
oommittee  are  unanimously  of  opinion  that,  under  no  oir- 
cumrtancee  whatever,  should  regimental  bearers  ever  be 
detached  from  their  regiments. 

Regimental  Stretcher-bearers  :  There  is  a  tendency  to 
forget  that  the  duties  of  a  Volunteer  regimental  bearer  are 
entirely  secondary  to  his  duties  in  his  company  ranks. 
They  ahould  never  be  withdrawn  from  the  ranxs  unneces- 
airily.  Stretcher  drill  should  never  take  place  during 
a  battalion  drill,  and  the  inspection  of  the  stretcher 
detachment  should  never  take  place  during  the  annuid 
inapection  of  the  regiment.  Volunteers  should  not  be 
aUowed  to  wear  the  "S.B."  badge  unless  they  have  re- 
ported themselves  to,  and  been  accepted  by,  the  regimental 
medical  officer. 


MEDICAL  SOCIETY  OF  LONDON. 
Thb  meeting  on  Monday  evening  last  (January  27tb) 
wiB  devoted  to  hepatic  diagnosis  and  hepatic  surgery. 
The  difficulties  met  with  in  the  diagnosis  of  hepatic  disease 
were  excellently  indicated  by  Dr.  Lauder  Brunton,  who 
related  ten  cases  in  which  the  symptoms  were  either  very 
dodbtfal  or  were  positively  misleading. 


Mr.  Knowsley  Thornton  followed  with  a  list  of  cases  in* 
which  he  had  operated  on  cases  of  liver  disease,  thus  com- 
pletine  his  record  of  cases  ap  to  date.  His  cases  oon-- 
nrmed  the  thesis  formulated  by  the  previous  speaker,  viz.,. 
that  the  moet  skilled  not  unf  reqnently  go  wrong  in  matters* 
of  diagnosing  liver  tumours.  He  pointed  out  that  for  the 
surgeon  to  obtain  the  best  possible  results,  it  was  essen- 
tial that  he  should  be  able  to  think  the  case  over  before- 
hand, and  plan  his  line  of  action  in  view  of  the  poesible 
and  probable  contingencies,  a  thing  which,  he  remarked, 
was  impossible,  unless  he  had  a  reasonably  correct  dia-- 
gnosis  to  work  upon. 

Mr.  Frederick  Treves  commented  on  the  fact  that  while 
in  the  event  of  a  diagnosis  of  cancer  it  but  rarely' 
happened  that  the  diagnosis  had  to  be  revised  it  was  very 
common  for  the  diagnosis  of  impacted  gallstone  and  the* 
Uke  to  have  subsequently  to  be  changed  into  one  of  cancer* 
of  the  liver.  He  mentioned,  however,  a  case  in  which, 
even  after  inspecting  the  liver,  the  diagnosis  of  cancer* 
which  was  then  made  had  ultimately  to  be  abandoned. 
Thia  led  him  to  remark  that  even  on  examining  the  liver* 
de  visu  it  was  not  always  easy  or  even  possible  to  arrive  at 
an  immediate  and  correct  diagnosis.  He  discouraged  too* 
persistent  attempts  to  dislodge  impacted  gallstones  after 
operation,  pointing  out  that  they  would  often  come  away 
spontaneously  if  left  to  themselves.  He  believed  that 
many  patients  lost  their  lives  by  reason  of  these  attempts.- 
He  concluded  with  a  word  of  praise  in  favour  of  the  use  of 
iodoform  gauze  for  packing  the  wound. 

Dr.  Sansom  pointed  out  that  under  ordinaiy  circum- 
stances the  area  of  cardiac  dulness  was  coterminous  with 
the  hepatic  dulness  and  the  existence  of  an  interval  of 
resonance  authorised  the  inference  of  shrinkage  of  the^ 
liver  q«a  cirrhosis. 

Mr.  Marmaduke  Sheild  followed  with  notes  of  three* 
cases  of  hepatic  trouble  in  which  he  had  operated  and  Mr. 
Turner  related  another. 

THE  FORTHCOMING  INTERNATIONAL  PERIOD- 
ICAL CONGRESS  OF  GYNiECOLOGY  AND- 
OBSTETRICS. 

Ths  Second  Session  of  thin  Congress  is  to  be  held  at 
Geneva,  Switzerland,  in  the  first  week  of  September. 

In  the  Section  for  Gynecology  the  following  is  the* 
official  programme: — (1)  Treatment  of  Pelvic  Suppura- 
tions—Reporters :  Dr.  Bouilly,  Paris ;  Dr.  Kelly,  Balti- 
more ;  Dr.  ZweifeU  Leipsia  (2)  Surgical  Treatment  of 
Uterine  Retro- deviations— Reporters  :  Dr.  Kostner,  Bres- 
Uu  ;  Dr.  Pozzi,  Paris ;  Dr.  Polk,  New  York.  (.3)  What 
method  of  closing  the  Abdomen  presents  the  best 
guarantee  against  Abscesses,  Eventrations  and  Hernias  ?' 
— Reporters :  Dr.  Granville-Bantock,  London  ;  Dr.  La 
Torre,  Rome. 

In  the  Section  for  Obstetrics  :— (1)  Relative  frequency 
and  most  common  forms  of  Pelvic  Contractions  in  different* 
races,  groups  of  countries  or  continents — Reporters  :  Dr. 
Fancourt  Barnes,  London  ;  Dr.  Dohm,  Konigsberg  ;  Dr. 
Fochior,  Lyons :  Dr.  Kufierath,  Brussels  ;  Dr.  Jentzer,. 
Geneva :  Dr.  Lusk,  New  York  ;  Dr.  Rein,  St.  Petersburg  ;• 
Dr.  Pawlick,  Prague  ;  Dr.  PasUlozza,  Pevia ;  Dr.  Traub, 
Ley  den.  (2)  Tieatment  of  Eclampsia  Reporters :  Dr. 
Charles,  Brussels  ;  Dr.  Charpentier,  Paris  ;  Dr.  Halberts-- 
ma,  Utrecht ;  Dr.  Loehlein,  Giessen  ;  Dr.  Mangiagalli,. 
Milan  Pavia;  Dr.  Parvin,  Philadelphia;  Dr.  Smyly,. 
Dublin. 

As  indicated  by  the  number  and  choice  of  reporters,  the' 
Committee,  desirous  of  provoking  upon  certain  questions, 
investigations,  and  debates  as  general  as  possible,  has* 
endeavourei  to  present  the  opinions  of  the  principal- 
schools  for  discussion,  and  it  is  hoped  by  the  Committee* 
members  of  the  profession  engaged  in  this  speciality  will 
attend  in  large  numbers  and  take  part  in  its  discussions* 
or  read  original  communications.  Switzerland  has  always- 
extended  a  cordial  welcome  to  Congresses  held  in  that 
country,  and  this  may  be  taken  as  a  guarantee  that  the* 
reception  which  will  be  given  will  be  worthy  of  its  tradi- 
tional hospitality.  The  Committee  of  Organisation  will 
make  all  preparations  that  members  of  the  Congress  and 
their  families  may  be  assisted  in  combining  their  journey 
to  Geneva  with  other  excursions  in  different  parts  of 
Switzerland. 

The  regulations  are  briefly  these  -.—The  founders  and 


126     Thb  MEDTHAr,  Phic«s. 


CORRKSPONDENCE 


Jak.  29.  1«96 


permanent  or  life  members  pay  a  eingle  initiacioD  fee  of 
.SOOf.  (^12),  which  absolves  them  from  the  payment  of  any 
future  does.  Members  for  one  session  only  pay  a  fee  of 
.30f.  (24s.),  upon  the  receipt  of  which  they  will  receive  a 
card  of  membership  to  the  Ck>ngres«,  entitling  them  to  all 
privileges  during  that  session,  as  well  as  a  copy  of  the 
Proceedings  of  the  Transactions  of  the  Conflrress. 

Those  desirous  of  taking  part  in  the  discussions  are 
requested  to  inform  the  Secretary  before  the  fifth  day 
of  July,  1896,  stating  definitely  the  questions  they  desire 
to  discuss. 

All  oral  or  written  communications  must  be  in  English, 
iFrench,  or  German. 

The  Congress  will  bd  held  in  the  University  Halls, 
placed  at  its  disposal  by  the  Department  of  Public  In- 
struction. Sessions  will  continue  from  9  to  11.30  a.m., 
and  from  3  to  6  p.m.  Morning  sessions  will  be  devoted  to 
original  communications ;  those  of  the  afternoon  to  the 
official  programme.  If  necessary,  the  Committee  will 
decide  upon  the  forming  of  sections. 

The  General  Secretaries  are :  Dr.  Betrix,  for  Gynss- 
cology ;  Dr.  Cordefa,  for  Obstetrics.  Treasurer  of  the 
•Committee :  Dr.  Bourcart. 

Secretary  General  for  Great  Britain  (through  whom  all 
correspondence  and  business  will  be  directed) :  Dr.  Leith 
Napier,  67  Grosvenor  Street,  London,  VV. 


QTorresponiititcc. 

(We  do  not  hold  oorselves  reiponaible  for  ths  opinions  of  our 
isoirespondenta.]  

LUNATIC    ASYLUMS.      THE    RELIGIOUS 
QUESTION. 
To  the  Editor  of  the  Medical  Pbbss  and  Cii>onLAB. 
Sir, — I  have  read  with  interest  the  two  letters  addressed 
to  your  journal  by  Dr.   Clement  H.  Sers,  containing  some 
bservations  upon  the  relationship  of  religion  to  insanity, 
uggested  by  my  lectures.     The  ground  covered  by  t  he 
letters  appears  to  suggest  the  following  two  questions : — 
.(1)  Religious  functions  in  connection  with  sane  life  ;  (2) 
.  religious  excitement  and  enthusiasm  as  a  cause  or  symptom 
of  insanity. 

In  regard  to  the  former,  I  believe  that,  from  a  general 
4)oint  of  view,  if  religion  under  determined  conditions  is 
lonnd  useful  or  essential  for  the  sane,  it  is  likely  to  be  so 
•under  conditions  otherwise  determined  and  arranged  for 
the  insane.  Many  insane  patients,  of  course,  are  totally 
incapable  of  attending  any  religious  function.  Some 
must  be  prohibited  ;  others  may  be  encouraged.  I  may 
state  my  opinion,  as  an  asylum  physician,  that  a  generic 
•case  of  religious  excitement  or  enthusiasm  may  most 
advisedly  be  restrained  from  religious  functions  until  at 
least  the  scute  symptoms  have  subsided.  I  should  imagine 
that  the  case  referred  to  by  Dr.  Sers,  in  which  a  chaplain 
is  reported  to  have  made  some  reference  in  his  sermon 
'Which  caused  a  patient  to  commence  a  violent  harangue, 
probably  illustrates  an  exception  to  this  rule.  On  the 
•other  band,  I  presume  there  can  be  little  doubt  that  no 
religious  officer  will  be  likely  to  succeed  in  accomplishing 
much  for  patients  without  accurate  knowledge  of  insanity 
and  the  mental  experiences  of  those  whom  he  seeks  to  in- 
fluence. The  fact  that  mental  aberration  forms  a  special 
study  and  phase  of  life  of  course  increases  his  difficulties 
and  limits  his  possibilities.  Otherwise  where  there  is 
apparent  failure,  and  Dr.  Sers  seems  to  suggest  very 
strongly  that  failure  there  is,  both  inside  asylums  and 
without,  such  failures  may  very  possibly  be  attributed  to 
the  deficiencies  of  the  doctrines  and  discipline  of  the 
religion  itself  and  the  organisations  peculiar  to  it,  and  the 
functionaries  associated  with  it  in  our  day.  I  oannot, 
however,  agree  with  Dr.  Sera  that  it  should  be  left  to  a 
medical  officer  to  determine  and  state  what  he  believes  to 
ibe  the  true  and  philosophical  faith  capable  of  application  1 
to  these  and  other  cases.  Nor  in  a  medical  journal  will  I 
seek  to  add  more  to  what  I  have  stated  upon  this  point  | 
^han  a  saying  I  have  beard  somewhere,  that  the  Christian  .< 
religion  rightly  understood  is  the  truest  piece  of  philosophy  '| 
which  is  !  If  so.  I  doubt  not  we  fchall  be  told  that  it  is  the 
•duty  of  all  medical  officers  who  profess  Christianity  to 
assist  in  the  practical  application  of  its  precepts  where 
jBuch  can  be  judiciously  and  safely  applieo,  taking  religi- 


ons things  perforce  as  they  find  them,  and  utilising  their 
own  special  knowledge  to  the  best  possible  advantage 
according  to  the  conditions  they  find. 

In  stating  that  "  a  true  and  philosophical  religion  raiees 
the  mind  above  a  mere  incidental  emotionalism,"  I  used 
the  word  "religion  "in  its  literal  sense,  as  derived  from 
re  and  Isgo.  to  gather  and  consider,  as  opposed  to  ne^ligemt, 
I  have  in  no  way  extended  its  connotation  so  as  to  indnde 
fanaticism.  When  witnessing  the  outbursts  of  fanati- 
cism in  Morocco  and  in  the  East  I  regarded  the 
demonstrations  as  examples  of  "  incidental  emotionalism," 
but  I  have  expressed  no  opinion  upon  the  question  of  the 
sanity  of  sucn  emotional  outbursts.  So  far  as  I  am 
personally  concerned  I  disclaim  any  plea  on  behalf  of 
religious  superstition.  Mv  words  were  *'  with  no  religion, 
and  no  moral  obligation,  the  orsranism  is  apt  to  become  a 
prey  to  the  lust  ofthe  flesh."  Religion  and  moral  obliga- 
tion I  take  to  be  almost  convertible  terms,  and  to  me  both 
are  equally  compatible  with  intuitionalism,  utilitarianism, 
or  any  other  '*  ism  "  derived  from  the  study  of  the  laws  of 
life  aod  mind.  Moral  laws  are  general  principles  (^  acti(m, 
which  an  intelligent  being  must  apply  for  himself  in  the 
guidance  of  his  conduct,  and  the  translation  of  such  genenl 
principles  (expressed  either  in  general  abstract  form  or 
in  the  form  of  a  command)  into  particular  actions.  Con- 
formity with  such  precepts  of  morality  I  take  to  be  ths 
safeguard  against  the  "  lusts  of  the  flesh." 

In  regard  to  the  second  point,  a  study  of  the  phenomena 
of  insanity  has  taught  me  one  thing— that  great  care 
must  be  exercised  not  to  form  rash  or  prejudicial  con- 
clusions. I  apprehend  that  religious  enthusiasm  in  itsslf 
cannot  justly  be  called  an  evil  Rather  I  suppose  does  it 
embody  the  most  healthy  and  preservative  development 
of  our  social  forces.  Like  many  other  tendencies  of 
the  mind  it  is  subject  to  exaggeration,  misapplicatioo, 
and  a  predominance  of  tne  emotional  over  the  intellectuaL 
I  cannot  at  all,  with  Dr.  Sers,  think  it  open  to  question 
that  "the  cases  of  religious  enthusiasm  which  culminate 
in  insanity  are  greater  than  those  which  arise  from  intem- 
perance in  alcoholic  stimulants."  As  a  matter  of  fact,  the 
typical  cases  of  religious  insanity  directly  developable 
from  sectarian  or  even  undenominational  religious  en- 
thusiasm, from  religious  meditations,  exercises,  devotioni, 
or  superstitions,  are  by  no  means  fo  common  as  they  are 
supposed  to  be  by  the  uninitiated  observer.  The  true 
point  lies  in  this,  that  very  many  mental  casee  bear  a 
strongly  marked  religious,  or  at  least,  mor^  aspect 
The  psychology  of  the  subject  will  show,  for  example, 
that  acute  depression,  a  predominant  phase  of  abnormsl 
emotional  life,  leads  almost  necessarily  to  a  religioat 
interpretation.  And  this  is  even  more  the  case  with  many 
actual  sense-perversions.  Such,  I  mean,  as  bave  ever 
been  associated  with  ideas  of  the  supernatural.  These  are 
not  necessarily  cauted  by  religious  over-excitement  or 
enthusiasm.  They  may  assume  the  appeara*ioe  of  it 
because,  being  the  deepest  and  most  real  feelings,  desires, 
and  convictions  of  the  perverted  organic  life  or  of  the 
moral  reaction  which  accompanies  it,  they  cannot  well  be 
expressed  or  described  except  in  strong  serious  moral 
terms.  Over  and  over  again  does  this  appear,  and  often 
among  those  least  likely  to  be  suspected  of  any  religiou 
predisposition.  That  these  feelings  should  be  cl^ed 
according  to  the  prevailing  ideas  and  creed  of  the  pataent 
is  an  essential  reproduction  of  the  mind.  But  after  all 
this  only  relates  to  the  form  of  their  appearance,  and 
there  are  many  things  which  lie  deeper. 

However,  I  cannot  ask  space  to  pursue  this  subject 
further.  1  can  only  add,  and  I  have  no  doubt  Dr.  Sers 
will  agree  with  me,  that  it  is  our  object  as  physiciana  to 
fight  against  all  those  influences  which  tend  to  prodooe 
sense-perversions  and  emotional  intemperance,  and  to 
subscribe  as  best  we  may  to  that  form  of  religious  belief 
so  far  as  we  can  find  it  practically  embodied  and  effective, 
which  believes  in  "  the  larger  hops  "  though  it  condemns 
unrese'vedly  the  demonstrable  superstition  and  senti- 
mentality which  impede  its  progress  and  i^s  power. 
With  many  thanks  to  Dr.  Sers  for  his  complimentaiy 
treatment  of  my  remarks  npon  a  subject  which  is  not 
only  fraught  with  extreme  difficulty,  but  also  requires 
more  skilful  handling  than  I  am  able  to  give  it. 
I  am.  Sir,  yours,  &c., 

Bethlem  Royal  Hospital,  S.E.        Tumo.  B.  Htslop. 
January  25th,  1896. 


i 


Jak.  S9.  1896. 


MEDICAL  NEWS. 


The  Mkdioal  Pkbbs.     127 


THE  TITLE  OF  DOCTOR. 

To  ike  Sdiiar  ^  Tbs  Mju>igal  Press  akd  Cibgulab. 

Sib,— It  appears  from  the  caae  of  John  Ferdinand, 
M.D.»  U.S. A.,  to  which  you  directed  attention  in 
yoor  last  impreeeioD,  that  the  pooeeceor  of  an  '*M.D." 
diploma  not  legistered  in  England,  no  matter  what 
QuJifying  letters  he  may  append,  cannot  le«dly  in 
thie  country  aseome  the  title  of  "Doctor."  Now  it 
it  lo  me  not  a  little  remarkable,  that  in  the  medical 
,  if  a  nuun  poeseaa  any  qualification  at  all  he 

r  amome  the  title  of  '*  Doctor  "  without  any  doctor's 
k  from  a  nniTeraity.  In  the  city  of  Glasgow  there 
SIS  many  instances  where  possessors  of  the  single  qoali- 
'fieaiion  of  "  the  Faculty  "  which  is  merely  a  qualification 

to  pnctiee  surgery,  call  themselves  Dr.  ,  Sargeon. 

Now  I  hold  that  these  men  have  as  little  right  morally 
or  legally  to  the  title  of  "  Doctor "  as  the  American 
qoacks.  Again,  if  a  man  possesses  a  degree  of  *'Pb.D," 
no  natter  from  what  college  or  diploma  shop  he  may  pro- 
core  it,  in  Scotland,  at  least,  he  is  permitted  without  ques- 
tion, to  assnme  the  title  of  "  Doctor."  If  this  be  contrary 
to  the  law,  I  invite  the  attention  of  Dr.  Bateman  and  the 
Medical  Dt-fenoe  Union  to  extend  their  vigilance  to 
Obfgow,  and  respectfully  suggest  that  before  pt-rsecuting 
asd  proeecnting  vulgar  quacks  outside  the  profession  we 
»jioiiid  exhibit  clean  hands  in  the  matter  of  honesty 
within. 

I  am.  Sir,  yours,  Ac, 

D.  Campbell  Black. 

GlsFgow,  Jan.  23rd,  18%. 


ELECTION  OF  DIRECT  REPRESENTATIVE  FOR 
IRELAND. 

fo  t\e  Editor  of  Tbm  IJedical  Pbess  asd  CiBcrLAB. 

Sol, — As  the  election  of  Direct  Representative  for 
Inkad  to  the  Medical  Council  takes  place  shortly,  and 
IB  no  definite  programme  has  been  placed  before  the 
electors,  may  I,  as  one  deeply  interested  in  the  subject  of 
Diiect  KepresentatioD,  toggest  that  the  candidates  should 
give  answers  in  this  journ^  to  the  following  questions,  so 
that  their  views  may  be  fuUy  understood  ? 
Questions. 

Will  yon  actively  oppose  : 

Firttfy,  any  proposal  which  has  for  its  object  the  for- 
malion  of  any  inferior  order  of  medical,  surgical,  or  mid- 
wifciy  practitioDCTP,  and  so  oppoce  the  proposed  repeal  of 
the  Medical  Act  1886? 

Will  you  actively  support : 

Secondly,  the  piopoeed  increase  in  the  present  number 
of  Direct  Represent ativee  on  the  Idedical  Council  ? 

Thirdly,  any  measure  which  will  make  the  entrance 
examination  much  more  stringent  than  it  is  now,  so  that 
andesirable  persons  may  he  **  weeded  out"  at  the  begin- 
niog  of  the  medical  curriculum  and  not  at  its  termination, 
snd  80  that  the  present  large  supply  of  unqualified  prac- 
titioners by  the  medical  schools  and  examining  bodies 
m^  be  greatly  lessened  ? 

fourthly,  any  proposal  which  will  bring  back  the  system 
of  apprenticeship,  so  that  practitioners  may  be  supplied 
with  assistants  ? 

[By  an  "  apprentice  *'  is  meant  a  person  who  has  passed 
the  entrance  examination,  pot  in  three  years  of  his 
medical  curriculum,  passed  the  first  and  second  medical 
examinations,  who  is  not  more  than  twenty-four  years  old, 
who  must  not  act  as  an  apprentice  for  more  than  two 
jears,  and  where  not  more  than  one  such  is  employed  by 
a  nactitioner]. 

fifthly,  the  formation  of  one  medical  Examining 
Board  in  each  of  the  three  divisions  of  the  United  King- 
dom, to  conduct  the  final  examination  only,  all  the 
previous  examinations  to  be  conducted  as  at  present 
arraoMd? 

Sixthly,  the  proposal  that  no  person  shall  be  permitted 
to  begin  bis  or  her  medical  curriculum  until  such  person 
has  completed  the  age  of  eighteen  years  ? 

Seventhly,  the  opening  of  Poor-law  infirmaries  for  the 
ctinical  instruction  of  medical  students,  and  the  recogni- 
tion of  such  places  of  instruction  by  the  medical  examin- 
iog  bodies  ? 

Eighthly,  the  compulsory  registration  of  all  stillbcrn 
infaDts? 


Ninthly,  the  amending  of  the  Births  and  Deaths  Regis*- 
tration  Act,  and  the  providing  for  the  payment  out  of  the* 
public  funds  of  practitioners  for  medical  certificates  of  the* 
cause  of  death  ? 

Answers  to  these  questions  would  concentrate  discus- 
sion,  provide  a  definite  programme,  and  allow  of  a  complete 
understanding  of  the  views  held  by  the  candidates  upon 
some  of  the  most  anxious  questions  of  to-day. 
I  am,  Sir,  yours,  &c, 

Liverpool  Robebt  R.  Rkntoul. 

A  BASIN  ENEMA  CLIP. 

This  ingenious  litttle  appliance  is  likely  to  become- 
widely  used.  It  has  been  designed  to  hold  the  tail  of  an 
enema  syringe  firmly  at  the  bottom  of  the  basin,  beneath- 
the  liquid,  making  the  entrance  of  air  impossible.  We 
have  found  that  it  fulfills  the  purpose  for  which  it  has  been 
introduoea  admirably.  Nurses  will  find  the  (dip  especially 
usefuL  We  may  also  point  out  another  feature  in  its 
construction.  It  can  be  made  to  act  as  a  reet  for  the  bone 
rectal  (or  vaginal)  tube  after  the  enema  had  been  ad- 
ministwed,  by  which  is  avoided  the  wetting  of  bed  linen 
or  soiling  of  the  floor  or  table.  The  two  illustrations 
which  we  append  will  show  more  definitely  how  the  dip 
acts.  The  makers  are  Messrs  Reynolds  and  Branson, 
Leeds. 


TERROL. 
Tsbrol  is  a  therapeutic  body  produced  firom*  crudb* 
petroleum.  It  is  a  bland,  perfectly  tasteless  and  odour- 
less bydrocaurbon,  viscid  at  16°  C,  but  slight  warming  suf- 
fices to  convert  it  into  a  clear  yellow  oil  having  a  sp.  gr. 
of  0-864  at  100**  F.  The  chief  claim  putforwaid  in  favour 
of  Terrol  is  that  it  can  be  taken  as  a  substitute  for  cod 
liver  oil,  and  numerous  testimonials  have  been  given  by- 
English  and  American  medical  men  attesting  its  efficacy^ 
in  pulmonary  complaints,  phthisis,  and  other  wasting  dis- 
eases ;  butceteri»  paribus,  its  great  advantage  seems  to  be  the* 
indubitable  fact  of  its  being  perfectly  tasteless  and  odour- 
less, therefore  it  would  m  exceedingly  useful  in  those 
numerous  cases  in  which  cod  liver  oil  gives  rise  to  nausea- 
and  eructations,  as  we  have  found  that  Terrol  can  be 
tolerated  by  the  most  sensitive  stomach.  Another  point 
in  its  favour — and  this  would  appeal  to  the  masses — ^is  its* 


Sir  Willoughby  Wade. 
In  response  to  an  invitation  circulated  by  Dr.  E^ 
Richards  and  Mr.  T.  F.  Chavuse  (Senior  Physician  and 
Surgeon  respectively  to  the  Oeneral  Hospital),  a  large^ 
nuinber  of  professional  and  lay  friends  of  Sir  Willoughby 
Wade  met  at  the  Birmingham  Medical  Institute  last- 
week  for  the  purpose  of  toking  steps  to  publicly  con- 
gratulate the  new  knight  on  the  honour  recently  con- 
ferred upon  him.  Sir  Henry  Wiggin  presided,  and  was 
»upported  by  a  representative  assemblage  of  leading  prac- 
titioners and  other  prominent  citizens.  The  Chairman 
spoke  of  the  general  gratification  felt  throughout  the  city 
at  the  latest  recognition  of  Sir  Willoughby's  eminent 
services,  not  only  to  the  medical  profession,  hoc  to  society 
at  large,  and  said  that  there  was  a  general  feeling  that 
the  occasion  of  his  elevation  to  a  knighthood  offered  a 
fitting  opportunity  to  his  many  friends  to  testify  their 
appreciation  of  his  honourable  character.  These  obser- 
vations were  sndorsed  by  a  number  of  other  gentlemen 
present,  including  Dr.  Agar,  Mr.  Oliver  Pemberton,  Dr» 
Lloyd  Owen,  Dr.  A.  Oatee,  &c. 


128    Thb  Mbdical  PB«^«. 


NOTICES  TO  CORRESPONDENTS. 


Jan.  29.  iaP6. 


^otiaB  to 
CorrcBponbcnts,  §hort  %t\itVB,  &c. 

CSr  CoBKMPOHBiim  requiring  a  reply  In  tbli  oolamn  are  par- 
ticularly requMted  to  make  uae  of  a  ditUnetiv  iignaitwre  or  iniHals, 
and  aTold  the  practice  of  lignlnc  thenuelTea  "  Beader,"  "  SatMorfber," 
'*  Old  SobMsrlber, "  Ac.  Much  oonfoslon  wUl  be  spared  by  attention 
totblirole. 

OBiaxvAL  ARTIOLM  or  LamBS  Intended  for  pablloatlon  ahoald  be 
written  on  one  tide  of  the  paper  only,  and  mutt  be  authenticated  with 
the  name  and  addreisot  the  writer,  not  neoenarHy  for  pnblioatloo, 
but  aa  erldence  of  identity. 

LOOAL  BXFOETl  AMD  Niw»— Oonmpondenti  dealroua  of  drawing 
attention  to  these  are  requested  kindly  to  mark  the  newspapen  when 
sending  them  to  the  Editor. 

KKPRUm.— Authors  of  papers  requiring  reprints  In  pamphlet  form 
After  they  have  appeared  In  these  columns  can  have  them  at  half  the 
asual  cost,  on  application  to  the  printers  before  type  Is  broken  up. 

THB  LATE  DB.  KISBY-A  DESERVING  APPBAJL 

Sir,— The  following  is  a  reTi»ed  list  of  subscriptions  receiTed  to  date' 
-The  appeal  was  inserted  in  Tax  Medical  Pbiss  and  Circular,  Jan' 
16th. 

Subscriptions  will  be  gladly  recelTed  by  any  of  the  committee  or  by 
jnysell 

I  am,  Sir,  yours.  4c., 

Garrlokmacross.  P.  M'Kehna,  M.B.,  Hon.  Sec. 


£  s.  d. 
Yery  Rot.    Dean    Ber- 

miDsham  ..200 

Bev.  P.O.  ONelU.C.'^...  10  0 
Bev.  J.J.  Mohan,  CO.  ..  10  0 
Dr.  T.  P.  Conlon  . .  ..100 
B.  D.  Eiroes,  M.P.8.I.  ..100 
.Samuel  Gordon.  M.D.  ..10  0  0 
E.     S.     O'Grady,    Esq., 

F.E.G.S  ..660 

Mr.  James  Kelly..        ..200 

Editor  of  THB  MXDTCAL 

PRR8S  AND  CiROVLAR    110 

Mr.  E.  J.  ONelll..  ..100 
Dr.  M'Kenna  ..100 

RcT.  W.  O'Doberty,  CC.  10  0 
Dr.  P.C.Walker  .  ..100 
J.  I.  MacNally,  Esq.  ..100 
.StrJ.  Banks.  M.D.        ..100 


£  s.d. 
Est.  B.  Moffett.  Garrick- 

macros«                  ..10 
Dr.  M.  Kearney,  Dundalk    1    0 
Mr.  Jos.  Finegsn,  Dun- 
dalk      10 

Dr.  J.  P.  Clarke,  Castle- 

blayney  ..10 

BoT.  Jas.  Meegan,  P.P., 

Castleblayney  ..10 
Mr.  J.  Cranston  . .  ..10 
Bev.   M.    dinton,    C.G., 

Bundoran  ..100 

Bev.    P.    Callan,    P.P., 

Tmagh  ..    0  10    0 

T.  C.  Strachan,  M.P.S. ..  0  10  0 
J.  H.  Blacksder,  Esq.  ..100 
Mr.     Lane,    Carrlckma- 

cross 10    0 


A  Colonial  Subsoribbr.— We  are  sorry  you  ventured  to  make  a  bet 
•  with  a  brother  practitioner,  as  your  authorship  Is  wrong,  and  there  is 
.  a  mistake  in  the  quotation.  The  lines  are  by  J.  E.  Lowell,  and  the 
.  correct  quotation  is :— 

'*  The  w(frld  advances,  and  In  time  outgrows 

The  laws  that  in  our  fathers'  time  were  beat ; 
And  doubtless  afterward,  some  purer  scheme 
Will  be  shaped  out  by  Setter  men  than  we. 
Made  wiser  by  the  steady  growth  of  time." 

Dr.  Watson.— 1.  Stewart's  new  physiologv  is  the  latort  book  on  the 
.  subject,  and  can  be  highly  commended.    2.  The  book  you  mention  is 

not  to  be  compared  with  Gray.  8.  It  is,  we  uoderstand,  of  American 
.  origin,  but  we  can  express  no  opinion  of  its  merits,  not  having 

s  en  it 

THB   INCREASE  OF    THE   MEDICAL    PROFESS  [OK. 

In  a  chatty  article  entitled  "  How  People  live,"  in  the  January 

.  number  of  The  Leitun  Hour  magazine,  the  writer  has  compiled  his 

statistics  from  the  official  census  returns  of  the  last  twenty  yeara,  ami 

stetes  that  whereas  Uwyers  have  failed  to  keep  pace  with  the  normal 

growth  of  population  medical  men  and  dentists  have  Increased  beyond 

the    normal    proportion,    lady    doctors   have    Increased    fourfold 

.  during  the  last  ten  years,  and  lady  dentista  doubled  their  numbers 

during  the  same  period. 


J5lcctingj5  of  the  godetteg 

Wbdnbsdat,  Jan.  soth. 
SoomTT  or  arts.— 8  p.m.    Mr.  W.  J.  Dibdln  :  Standards  of  Light. 

Thursdat,  Jan.  80th. 
Ofsthalmolooical  Sooibtt  or  thb  United  Kinqdom  (Rooms  of 
the  Medical  Society  of  LondonX-~8  p.m.  Card  Spedment :  -Mr. 
Simeon  Sneil :  Alveolar  Carcinoma  of  Upper  Eyelid.— Mr.  J.  R.  Lunn : 
Ifystagmus  foUowiog  an  Injury  to  the  Forehead. —Mr.  C.  D.  MarshaU : 
,  (1)  Beault  of  Removal  of  Chip  of  Metal  from  the  Vitreous  by  the  Uectro- 
magnet ;  (2)  Cholesterin  in  the  Anterior  Chamber.— Jiessrs.  Holthouse 
and  Batten :  Peculiar  Condition  of  Optic  Discs  in  a  case  of  Choroido- 
retinitis.  8.80  p.m.— Papers  :>Dr.  Geo.  J.  Bull :  The  Camera  in  rela- 
tion to  Refractive  Error.— Messrs.  Bales  and  Sinclair :  Moral  Cyst  of 
Iris.— Dr.  F.  M.  OgUvIe  :  Optic  Nerve  Atrophy  In  Three  Brothers.— 
Mr.  Holmes  Splcer :  Recurrent  Paralysis  of  Thhnl  Nerve  with  Migraine. 

MONDAT,  FBB.  8RD. 

THB  Mbdioal  Socibit  ov  LONDON.— 8  80  p.m.    The  first  of  the 
Lettsomian  Lectures  by  Bir.  W.  Watson  Cheyne,  F.E.C.S.,  F.R.S. :  The 
.  Objecte  and  limite  of  Operations  for  Cancer. 


Chlcester  Infirmary.— House  fturgeon.  Salary  £80  per  annum,  with 
board,  lodging,  and  wsshing.  Applications  to  the  Secretety  on  or 
before  February  17th  next. 

Metropollten  Asylums  Board.— Dispenser  at  the  Eastern  Fever  Ho^. 
tal,  flomerton.  Salary  85s  per  week,  with  dinner  daily.  Printed 
forms,  upon  which  only  applications  will  be  received,  maj  be 
obteined  at  the  ofilces  of  the  Board,  Norfolk  House,  Koifolk 
Street,  Strand,  W.C. 

Oldham  Infirmary.— Junior  House  Surgeon.  Salary  £60  per  aanoa, 
with  board  and  r^dence.  Applications  before  the  4th  di^  of 
February  to  the  Seeretery,  E.  Lionel  Biake. 

Sllgo  Union. -Trained  Nurse  wanted.— Salary  £26  per  annum,  viUi 
rations.  Ac,    Election  11th  Feb.    (Se9  advert.) 

St  Gile's.  Camberwell.— First  and  Second  Assistant  Medical  Offlecn 
for  Infirmary  at  Camberwell  and  their  Workhouse  at  PeekhssL 
Salary  of  the  First  Assistont  £120  per  annum,  rising  to  £1M.  with 
apartments,  board,  and  washing ;  that  for  the  Seoood  Asshtsat 
£fi0.  with  apartmenta,  board,  and  wsshing.  Forms  of  appUestton 
of  Charles  S.  Stevens.  Clerk  to  the  Guardians,  Peokham,  S.E. 


St.  Thomas's  Hospital.-  Assistant  Ophthalmic  Surgeon.    Applit 

with  testimonials  should  be  forwarded  to  Mr.  E.  M.  Bardy, 
Treasurer's  Clerk,  before  Saterday,  1st  Feb.,  from  whom  all  neeei- 
sary  Information  may  be  obtained. 

Univ*rsity  of  Glasgow.— Four  Ezaminerships  in  Anatomy,  Mldwifsvy, 
Medical  Jurisprudence,  and  Botany  lespectively.  The  sslsiy 
attached  to  the  Bxaminership  in  anatomy  is  £40  per  annum,  and 
to  the  01  hers  £80  per  annum.  Immediate  application  to  the  Seers* 
Ury  of  the  Glasgow  University  Conrt 

The  Middlesex  Hospital  Msdioal  School.— Lectureships  on  , 
and  Physiology.    Applications  to  the  Dean  of  the  Medical  £ 
from  whom  all  further  information  may  be  obtained. 


Bridobr,  S.,  L-RCP-Lond.,  M.R.C.S.,  Assistant  Honae  Surgeoa  to 

the  Devonshire  Bospltol,  Buxton. 
Deans.  W.,  M.ti..  C.M.Aberd.,  Medicd  Officer  for  the  Swood  Bridge 

Sanitary  District  uf  the  ba^lingden  Union. 
FOULRRTON,  A.  G.  B.,  F.B.C.S.l!.og.,  D.P.U.Camb.  Demonstrator  o( 

Biological  Chemistry  to  the  Institute  of  preventive  Medidne. 
Gould,  J.  E.,  M.D.Loud.,  D.P.H.Camb.,  Medical  Officer  of  Health  sad 

Physician  to  the  Fever  Hospital  for  Bolton. 
Gaovrs,   U.  C,   L  R.C.P.,  L.R.C.S.IreL,  Deputy  Medical  Officer  of 

Health  for  the  Borouvh  of  Monmoath. 
HORHBR.  W.  E.  L.,  M.I^Lond.,  House  Physician  to  the  Derbjskiie 

Boyal  Infirmary. 
Erllt.  T.  G..  &A.,  M.D.Dubl.,  Examiner  to  the  St.  John  Ambulaoce 

Assoclstion. 
Miles,  a.,  M  D.,  F.B.C.S.E4..  Surgeon  to  the  Leith  Hospital. 
N<>RQAiB,  R.  B..  L.R.U.P.L'md.,  MR.O.S.,  Resident  Medical  Offiott to 

the  Fishponds  Workhouse  of  ttie  Bristol  Union. 
Olybk,  R.  S.,  M.RC.S.,  House  Surgeon  to  the  Derbyshire  Edsl 

Intlrmary. 
Prinolb.  G.  L.  R.,  M.a,  r.M.Edio.,  Medical  Officer  for  the  TUid 

Sanitary  District  of  th^  B^ida«»ater  Uoioo. 
Sayill,  T.  D.,  M.D.Lond..  M.R.C.S.,  D.P.H.Camb..  Physldan  to  the 

Hoipi«al  for  Nervous  Diseases,  Weibeck  Street  London. 
THOMAtf,  J.  T.,  L.R.<\P.Lond.,  M.£UC.S.,  Medical  Officer  of  Health  to 

the  Camborne  District  CouoclL 
Wilkinson,  J.,  M.B.,  C  M.Bdin.,  Medical  Officer  of  Health  for  tbs 

Boston  Rural  Sanitary  District. 


iLUoT.— Jan.  21st,  at  Madras,  the  wife  of  Surgeon-Captain  R.  I. 

Klliot,  Indian  Medical  Service,  of  a  son. 
SBDOWIOK.- Jan.  26th.  at  St.  Medards,  Cambridge,  the  wife  of  Adsm 

Sedgwick,  F.11.S.,  of  a  son. 


M^ 


LODOB— FOLKBR.-Jsn.  28rd,  at  St  Mark's  Church,  Shelton,  StokeHHi. 
Trent,  Alexander  John,  fourth  surviving  son  of  the  Rev.  SsmiMl 
Lodge,  canon  of  Lincoln,  to  ifidith  Emily,  eldesi  daughter  of  W.  fl. 
Folker,  Esq.,  F.R.C  S.,  of  Bedford  House,  Hanley,  Stalls. 

StattiB. 

^^fF^T^*"*-    ^^^    **  Osmaaton    Eoad,   Derby,   John  Adsetti, 

M.R.C.S. ,  Surgeon-Major  (retired) .  aged  59. 
BRrDOwpoD.— Jan.  20th,  at  the  residence  of  his  father,  The  Oreea, 

Stafford,   John    Francis    Bridgwood,    M.R.C.S.Eng.,    L.&C.P., 

aged  32. 
BTRNB  -Dec  18th,  ia>5.  at  Ross,  Tasmania,  Hugh  J.  Byrne.  J.P., 

L.B.C.&I.,  Besideut  Surgeon,  Boss,   Tasmania,  youngest  loa  of 

the  late  Hugh  Byrne,  F.R.I.  A,  ot  l>ublln- 
^^■^r***^-  ^^*  ^^  ^*  residence,  27  iritzwililam  Stieet,  Dublin. 

William  Robert,  eldest  son  of  the  lato  Anthony  E.  Otaves,  ol 

RosberooQ  Castle,  aged  41. 
M0WHiNaiB.-Jan.  24th,  at  The  Chimes,  Streatham  Common.  Bsnfsi, 

wife  of  John  McWhinnie,  M.D.,  R.N. 
WBBKB8.-Jan.  27th,  at  Mansion  Uouse,  Brompton,  Chatham.  By. 

Weekes,  M.R.U.b..  L.R.C.P.,  J.P.,  aged  61. 

^^^H"-'*"-  ^^^^  •^"^*  <>»  *  ▼»«**  to  Dioard,  Brittany,  Frandi  a 

Whito.  M.B  C.!J..  L.S.A..  aged  89. 
^"f^^r^*°-  22nd.  at  BroughviUe,   Gheltonham,  Edward  WDioa, 

L.R.C.P.Lond.,  M.R.C.S.Eng.,  aged  88. 

NOTICE — AtiTwunc^vieiui  o,  t,.i  lu.^  Marriage*^  lund  Deaths  inthi 
jamUies  of  Sub9eriber9  to  this  Journal  art  interted  free^  and  wut 
reach  the  publuheri  not  later  than,  the  Monday  preceding  publioatioiL 


Uht  ^efci  §tt$$  mA  iiwttlat 


'SALUS    POPUM    8UPREMA    LEX." 


Voi^CXIL 


WEDNESDAY,    FEBRUARY    5,     1896. 


No.  6. 


€)riflinal  Olommunicationa 

POST-GRADUATE 

CLINICAL  DEMONSTRATIOxVS. 

'By  JONATHAN  HUTCHINSON,  LL.D.,  F.RS., 
F.RCS., 

Gomnltlng  Singeon  to  the  L'lndoa  Hospital,  aiKl  late  Preiident  of  tke 
Bojal  College  of  Sorgeoni,  Bn^land. 

[Specially  Reported  f(yr  the  MEDICAL  PRESS 
AND  CIRCULAR.] 

Among  the  caaes  shown  and  demonstrated  upon 
recently  was  one  of 

DKRMATinS  AND  DISEASE  OF  NaILS 

in  connection  with  occnpation.  The  patient  was  a 
man  of  50,  whose  occupation  was  that'  of  a  groom,  and 
the  affection  of  the  skin  of  the  hands  and  of  the  nails  had 
deTeloped  in  consequence  of  his  hands  having  been  con- 
linnally  soaked  in  water  while  washing  carriages.  The 
iiands  were  tremulous,  cold,  and  the  circulation  in  them 
feeble.  He  had  been  liable  to  chilblains  in  childhood. 
This  case  was  similar  to  one  which  Mr.  Hutchinson  had 
just  seen.  An  old  gentleman  came  to  him  who  had 
dusky  cold  hands,  and  an  unhealed  sore  on  the  back  of 
the  le|:.  This  sore  had  remained  unhealed  for  a  very 
longtime  ;  nothing  seemed  to  be  of  any  use  in  getting 
it  to  heal.  All  sorts  of  remedies  had  been  tried,  but  in 
vain.  The  medical  men  who  had  seen  it  had  told  the 
oatient  that  it  was  due  to  unhealthy  blood,  but  Mr. 
Hutchinson  believed  that  the  unhealthy  condition  of 
the  wound  was  the  result  of  feebleness  of  circulation. 
A  very  interesting  ]x>int  in  the  history  of  the  case  was 
that  neither  the  patient  nor  his  father  had  ever  been 
able  to  tolerate  a  cold  bath.  A  cold  bath  always  made 
their  fingers  livid,  and  afterwards  turn  quite  white. 
And  yet  the  patient  was  in  other  respects  a  strong 
robust  man.  Another  case,  which  Mr.  Hutchinson  had 
lately  seen,  of  this  affection  of  the  hands  was  that  of 
an  old  gentleman,  who  took  to  gardening  in  cold 
weather.  In  the  treatment  of  these  cases  good  nutri- 
tious food  was  requisite,  and  it  was  highl;^  essential 
that  an  indoor,  instead  of  an  outdoor,  occupation  should 
be  foUowed.  Again,  minute  doses  of  opium  seemed  to 
act  wonderfully  well. 

Eablt  Stage  of  Raynaud's  Disease. 

The  patient  was  a  woman,  set.  about  36,  in  whom 
the  early  symptoms  of  Raynaud's  phenomena  were 
present  upon  the  hands.  Her  fingers  first  began  to  go 
''white"  about  two  years  ago.  She  noticed  that  one 
finger  at  a  time  became  cold  and  stiff.  To  bend  her 
fingers  quite  straight  was  now  impossible.  There  was 
no  change  in  the  nutrition  of  the  skin  as  yet,  and  the 
nails  were  quite  healthy.  The  coldness  of  the  fingers 
was  always  worse  in  the  mornings,  but  if  anythiuff 
''upset"  her— that  is,  if  she  suffered  any  emotional 
disturbance,  the  symptoms  at  once  became  worse.  There 
was  nothing  noticeable  about  the  ears  or  toes.  She 
had  not  suffered  much  from  chilblains  in  earlv  life. 
About  three  yj&un  ago  there  was  a  history  of  syphilitic 
infection  having  occurred. 


Peculiar  Sore  upon  the  Forearm. 

This  patient,  a  healthy  old  man,  set,  80,  came  from 
the  Union  Infirmary  of  St.  Pancras.  The  sore  upon 
his  forearm  was  a  very  peculiar  one.  About  Decemoer 
1894,  something  like  a  ooil  appeared  on  the  outer  and 
front  aspects  of  the  right  forearm,  a  little  below  the 
elbow.  In  July  1895,  the  disease  had  considerablv 
increased  in  size  and  a  discharging  wound  had  formed. 
The  measurements  now  were  four  inches  and  one-eighth 
by  four  inches.  The  wound  had  a  distinctly  spread- 
ing edge,  the  latter  beiDg sinuous  and  remarkably  bossy, 
but  not  very  hard,  the  skin  had  been  destroyed  in  the 
centre  of  the  sore,  the  ulceration  having  been  quite 
superficial.  The  point  of  interest  was— what  was  the 
nature  of  the  disease.  Was  it  allied  to  a  senile  form 
of  lupus,  or  was  it  malignant.  There  were  no  enlarged 
glands  in  the  axilla.  The  exact  diagnosis  was  very 
doubtful. 

Bazin's  Malady. 

The  patient  was  a  girl,  aet.  17,  who  partly  came  to 
show  herself  with  a  large  patch  of  Bazin's  disease  over 
the  middle  of  the  back  of  the  left  leg.  Her  case,  how- 
ever, was  chiefly  interesting  because  of  the  sequelae  of 
infantile  paralysis  which  were  present.  There  was  a 
complete  absence  of  the  left  deltoid  muscle,  conse- 
quently, she  had  no  power  to  raise  the  affected  limb. 
When  she  wanted  to  raise  the  latter,  she  grasped  the 
limb  with  the  other  arm,  and  so  lifted  it  up.  Infantile 
paralysis  of  the  deltoid  was  very  common,  indeed,  it 
was  the  deltoid  which  of  all  the  muscles  was  most 
liable  to  be  paralysed  alone.  And  the  present  case  was 
a  good  example  of  the  kind.  Mr.  Hutchinson  stated 
that  he  recently  saw  a  gentleman  in  whom  there  was 
infantile  paralvsis  of  both  deltoids,  and  it  was  inter- 
esting to  watch  how  by  the  use  of  his  pectoral  and 
other  muscles  the  patient  was  able  so  to  raise  his  arms 
as  to  reach  down  a  book  from  a  top  shelf  in  a  library. 
The  head  of  the  humerus  in  the  patient  under  discus- 
sion could  be  freely  moved  in  all  directions,  and  ex- 
amination showed  that  the  biceps  was  scarcely  at  all 
to  be  felt,  while  there  was  exceedingly  little  power  in 
the  triceps,  and  brachialis  anticus  of  the  affected  arm. 
But  there  was  no  loss  of  nutrition  so  far  as  the  hands 
were  concern^.  This  was  the  rule,  motor  paralysis 
was  generally  not  associated  with  nutritional  changes. 

The  next  case  was  one  of 

Lichen  Planus. 

The  patient,  a  woman  of  fifty-six,  had  for  six  weeks 
noticed  some  flat  patches,  polished  on  the  top,  on  the 
front  of  her  wrists.  The  smooth  polished  top  was 
characteristic  of  the  disease  from  which  she  was  suffer- 
ing, namely,  lichen  {planus.  The  disease  was  a  very 
peculiar  one.  Sometimes  it  appeared  suddenly,  some- 
times more  slowly,  and  lasting  a  few  weeks  or  months, 
then  spreading  over  the  body.  It  was  especially  prone 
to  develop  at  the  wrists  and  ankles,  and  at  the  waist, 
where  the  corsets  pressed.  It  differed  from  psoriasis  in 
the  mode  of  its  onset ;  moreover,  whether  treated  or 
not  lichen  planus  would  get  absolutely  well ;  psoriasis, 
on  the  other  hand,  never  disappeared  spontaneously. 
Again,  a  patient  who  had  had  one  attack  of  lichen 
planus  might  become  perfectly  well,  and  remain  so  for 
several  years,  and  then  have  a  relapse.  It  had  been 
said  that  there  were  cases  which  did  not  recover.    But 


130    Thb  Mbdigal  Pkks. 


ORIGINAL  COMMUNICATIONS. 


Fib.  5,  1886. 


that  was  an  experience  which  had  not  come  under  Mr. 
Hutchinson's  notice.  The  tendency  in  cases  of  lichen 
planus  was  to  spontaneous  cure.    Still,  the  disease 

Soved  very  intractable  in  some  instances.  Mr. 
utchinson  stated  that  he  pablished  the  notes  of  a 
case  of  lichen  planus  which  he  had  cured  with  anti- 
mony. The  disease  was  very  extensive,  the  patient 
having  been  covered  from  head  to  foot  with  the  charac- 
teristic patches.  Treatment  with  arsenic  only  made 
matters  worse.  Quite  by  accident  antimony  was  given, 
and  then  a  rapid  cure  resulted.  The  cure  was  so 
quickly  brought  about  that  Mr.  Hutchinson  did  not 
see  the  patient  asain,  although  some  years  had  elapsed, 
until  three  months  ago,  and  then  he  returned  with  a 
relape  of  his  former  malady.  There  was  never  any 
tendency  to  desquamation  present  in  cases  of  lichen 
planus.  It  was  somewhat  curious  that  the  patches  of 
the  disease  had  their  long  axes  transverse  to  the  limbs 
upon  which  they  developed. 

Lupus  Ertthsmatosus. 

The  patient  was  a  man,  set  36,  whose  face  was 
covered  with  lupus  erythematosus;  the  disease  first 
appeared  on  his  left  ear,  and  then  gradually  involved 
the  whole  of  his  face.  One  of  his  sisters  had  died  of 
phthisis,  but  no  other  member  of  his  family  had 
seemed  ever  to  have  suffered  from  tuberculosis.  Some 
years  ago  he  was  out  of  health,  had  a  cough,  and  lost 
flesh,  and  he  was  ordered  a  sea  voyage.  Since  then  he 
had  enjoyed  good  health,  except  for  his  face.  Mr. 
Hutchinson  stated  that  the  association  of  great  ten- 
dency to  chilblains  in  early  life  was  almost  constant  in 
cases  of  lupus  erythematosus.  This  feature,  together 
with  an  inherited  tendency  to  tuberculosis,  formed  the 
two  elements  which  chiefly  contributed  to  the  develop- 
ment of  this  disease.  It  was  commonly  said  that 
lupus  erythematosus  was  often  fteen  on  the  scalp,  while 
lupus  vulgaris  was  never  seen  in  that  situation.  But 
in  Mr.  Hutchinson's  opinion  the  distinction  was  an 
arbitrary  one  ;  his  belief  was  that  lupus  vulgaris  did 
affect  the  scalp.  There  were  several  marked  points  of 
distinction  between  these  two  varieties  of  lupus.  In 
lupus  vulgaris,  after  the  lapse  of  a  certain  period,  no 
increase  in  the  number  of  patches  occurred,  but  the 
disease  remained  ;  the  disease,  if  unrelieved  by  treat- 
ment, was  a  life-long  malady,  although  it  only  con- 
tinue to  spread  after  a  certain  time.  Lupus  erythema- 
tosus, on  the  other  hand,  for  long  maintained  its  infec- 
tive qualities,  and  spread  largely.  Nevertheless,  in 
time,  its  infectiveness  ceased ;  the  disease  appeared  to 
wear  itself  out,  it  declined  spontaneously,  and  then 
became  cured.  Moreover,  it  was  nearly  always  pos- 
sible to  obtain  a  tuberculous  history  in  the  patient  in 
these  cases.  Despite,  however,  this  connection,  so  far, 
no  evidence  of  tubercle  bacilli  had  been  obtained  from 
a  bacteriological  examination  of  the  patches  of  lupus 
erythematosus. 

Sycosis. 

This  patient  was  a  young  man  upon  whose  left  cheek 
there  was  a  patch  of  sycosis,  which  had  first  been 
noticed  about  four  months  ago.  Mr.  Hutchinson 
observed  that  this  disease  was  characterised  by  pustu- 
lar inflammation  of  the  hair  follicles,  toiirether  with 
inflammatory  exudation  about  the  hairs.  The  adjacent 
tissues  were  ''baggy,*'  and  a  glutinous  material  was 
exuded,  as  in  kerion.  Some  of  the  most  typical  cases 
of  sycosis  were  not  parasitic,  but,  on  the  contrary,  were 
more  allied  to  lupus.  The  disease  spread  in  patients 
suffering  from  it  by  continuity  and  contiguity  of 
tissue ;  it  was,  therefore,  infective  to  the  patient's  own 
skin.  The  treatment  of  these  cases  was  based  upon 
the  recognition  that  the  disease  depended  upon  some 
infective  material.  The  first  thing,  therefore,  to  be 
done  was  to  pull  the  hairs  out  of  their  follicles,  then 
thoroughly  wash  the  part  with  soap  and  hot  water,  so 
as  to  make  the  skin  quite  soft,  and  then  rub  in  well 
-'ome  mercurial  ointment. 


Alopecia  Abbata. 
Two  small  children  were  next  shown,  suffering  hoa^ 
alopecia  areata,  in  whom  from  the  beginning  of  th» 
cases  no  evidence  of  ringworm  had  been  obtainable. 
The  treatment  which  had  been  followed  was  that  of 
rubbing  the  bare  patches  with  chrysophanic  acid 
ointment. 


A  SEEIES  OF  CASES 

OF 

INTESTINAL    RESECTION. 
By  HERBERT  W.  ALLINGHAM,  F.R.C5., 

SnigeoD  to  the  Great  Noriheni  Hospital.  Awintiint  Soigeon  to  8t» 
St.  George's  HospitaL 

{Condtidedfrom  page  103.) 

Case  VI.  Resection  of  Stricture  o/Trcmaverse  Colom, 
—Jane  S.,  set.  66,  was  admitted  on  October,  1894,  into 
the  Great  Northern  Hospital.  She  was  extremely  ill, 
and  from  what  we  could  gather  she  had  had  for  a  lonif 
time  great  trouble  in  getting  the  bowels  to  act  For 
the  last  month  they  had  acted  only  on  three  occasions,, 
and  then  with  very  small  motions. 

On  examination  the  abdomen  was  greatly  distended, 
there  was  dulness  all  along  the  ascending  colon,  but  the 
descending  colon  and  sigmoid  flexure  appeared  to  b& 
empty.  An  incision,  therefore,  was  made  at  once,  about 
the  umbilicus.  On  the  abdomen  being  opened  it  wa» 
seen  that  the  intestines  were  enormously  distended^ 
and  that  the  transTerse  colon  presented.  This  was 
empt^,  and  on  passing  it  through  one*s  fingers,  and 
examining  towards  the  ascending  colon,  I  found 
towards  its  hepatic  end  a  hard,  tight,  annular  malig- 
nant stricture.  The  abdominal  wound  was  theo 
enlarged  upwards  so  as  to  give  a  good  view  of  the 
stricture,  and  as  the  disease  was  found  to  be  so  limited 
in  its  extent  and  the  stricture  small,  I  determined  to 
resect.  This  was  done  with  difficulty  on  account  of 
the  distension,  the  ends  of  the  bowel  being  brought 
together  over  Mayo  Robson's  bobbin.  In  putting  in 
the  additional  Lembert's  sutures  it  was  discovered  that 
the  peritoneum  about  the  distended  portion  of  the 
intestine  was  extremely  rotten,  so  that  the  stitches  had 
a  tendencjr  to  tear  through. 

The  patient  died  thirty  hours  afterwards,  and  never 
appeared  to  recover  from  the  shock  of  the  operatioi^ 
upon  one  so  seriously  ill. 

The  post-mortem  showed  that  there  was  no  leaking 
about  the  bobbin,  but  the  intestines  were  so  enor- 
mously distended  as  to  seem  to  have  been  unable  to 
empty  themselves. 

Case  VIL  Resection  of  Stricture  of  Sigmoid  Flexure^ 
— Miss  R,  et.  56,  had  always  had  urood  health,  but  for 
the  last  eight  months  had  great  difficulty  in  getting  the 
bowels  to  act  Of  late  the  bowels  never  acted  without 
purgatives,  and  when  these  were  administered  they 
occasioned  griping  pains  in  the  abdomen,  and  the* 
patient  described  that  there  was  a  feeling  of  stoppage 
about  the  sigmoid  region.  When  I  saw  her  the  bowela 
had  not  actal  for  about  ten  days.  About  the  large 
intestine  could  be  felt  hard  scybalous  masses,  and 
there  was  a  hardish  tender  mass  to  be  made  out  in  the 
left  iliac  fossa.  On  examination  per  rectum  nothing 
abnormal  was  to  be  noted.  Injections  and  medicines- 
failing  to  relieve  the  obstruction,  on  October  21  at,. 
1894,  on  opening  the  abdomen  by  an  incision  five  inches- 
long  and  introducing  the  hand  into  the  interior  of  the 
large  intestine,  commencing  at  the  lower  part  of  the 
sigmoid  flexure,  and  tracing  it  through  my  nand  I  dis- 
covered about  tbA  nnddle  of  it  a  hard  annular,  malig- 
nant stricture.  The  intestines  above  the  stricture  were 
filled  with  old,  scybalous  masses. 

As  this  seemed  to  be  a  very  favourable  case  for  exci- 
sion of  the  stricture,  with  india-rubber  drainage  tubes 
above  and  below,  I  resected   the   stricture   and  a 


JTbb.  5,1896. 


ORIGINAL  COMMUNICATIONS. 


Tbb  Mimoix  Press.      131 


Y-fhaped  piece  of  the  meeentery,  and  brought  the  ends 
of  the  gat  together  over  a  large-sized  Mayo  Bobeon's 
bobbin* 

After  the  operation  the  patient  complained  of  a  good 
deal  id  pain  and  was  slightly  sick.  The  abdomen  was 
in  no  way  distended.  On  the  22nd  the  patient  was 
reported  to  have  had  a  fair  night,  the  palBe  was  100, 
the  temperatnre  99^  ;  the  aspect  was  good ;  there  was 
DO  distension  or  tenderness  ;  flatns  had  been  passed. 

On  the  23rd  the  patient  vras  said  to  have  had  griping 
pain  in  the  stomach,  temperatnre  was  99*6'',  the  abdo- 
men was  not  distended,  and  she  passed  a  quantity  of 
wind. 

On  the  24th  she  had  had  more  pain  in  the  abdomen 
over  the  seat  of  the  operation,  and  the  abdomen  was 
ntiier  tender  about  that  part  Temperature  was  101*, 
the  aspect  was  not  so  good. 

On  the  25th  the  patient  had  had  a  bad  night  with 
gnat  pain  about  the  seat  of  the  wound,  the  tempera- 
tore  had  fallen,  there  was  no  general  distension  in  the 
abdomen,  and  the  pain  was  confined  to  the  left  iliac 
fona.  I  therefore  took  out  two  skin  stitches  and 
passed  a  probe  down  towards  the  seat  of  the  union  of 
the  gut.  This  allowed  a  little  gas  and  some  serous 
fluid  to  exude.  I  did  this  in  the  hope  that  had  any  of 
the  suturing  given  way  (which  evidently  was  the  case) 
flatos  or  fseoes  might  pass  through  the  abdominal 
vtmod  rather  than  into  the  general  peritoneal  cavity. 

On  the  26th  she  had  had  a  better  night  and  seemed 
to  he  relieved  by  what  had  been  done.  She  said  she 
felt  as  if  her  bowels  wished  to  act,  and  on  examining 
the  rectum,  I  found  the  bobbin  there  and  some 
hudened  masses  of  faeces.  Some  fiatus  had  passed  by 
the  abdominal  wound.  About  the  middle  of  the  day 
she  complained  of  sudden  pain  in  the  abdomen,  became 
coUtpeed,  and  soon  died.  I  have  no  doubt  that  this 
Wis  due  to  some  other  part  of  the  suturing  in  the  gut 
hsTing  given  way  into  the  peritoneal  cavity. 

Case  VIIL  Be^ection  of  Stricture  of  the  Sigmoid 
Flexure — Harriet  T.,  »t.  34,  was  admitted  into  the 
Qreat  Northern  Hospital  under  the  care  of  my 
ooUeague,  Dr.  C.  E.  Beevor.  She  gave  the  following 
history.  For  about  eight  months  she  had  been 
troabled  with  her  bowels,  at  first  by  diarrhoea,  but  for 
thelast  two  months  with  constipation,  together  with  fre- 
quent attacks  of  colicky  pains  and  occasional  vomiting. 
Various  drugs  were  given  in  the  attempt  to  relieve 
her,  but  with  little  or  no  result ;  on  some  hardness 
bdsg  discovered  in  the  left  luminal  region,  Dr.  Beevor 
asked  me  to  see  the  patient  with  him.  I  observed  the 
ahdomen  to  be  somewhat  distended,  any  manipulation 
of  the  abdomen  caused  peristaltic  action  of  the  intes- 
tbes,  and  in  the  left  inguinal  region  could  be  felt  a 
hard,  irregular  maas. 

As  the  patient  was  getting  worse,  on  January  30th, 
18d6,  I  opened  the  abdomen  by  a  curved  incision  in 
the  left  inguinal  region,  and  on  exposing  the  sigmoid 
flexure,  notvd  a  hard,  annular,  malignant  stricture 
involving  the  gut.  This  was  resected  and  the  ends  of 
the  intestine  were  approximated  by  Murphy's  button. 
The  next  day  the  patient  appeared  to  be  fairly  comf ort- 
aUe,  some  flatns  bad  been  passed  by  the  rectum,  the 
abdomen  was  in  no  degree  tender,  and  the  temperature 
was  good. 

On  February  let  the  patient  began  to  get  somewhat 
distoaded,  so  a  small  turpentine  enema  was  given,  but 
with  no  result.  There  was  no  tenderness  about  the 
abdomen  and  the  Bsjpect  was  good.  On  February  2nd, 
as  Uie  distension  was  increasing,  another  turpentine 
enema  was  given  and  repeated  doses  of  sulphate  of 
loda  administered;  there  was  still  no  result  On 
February  3rd,  as  this  state  of  things  continued,  the 
patient  died,  complaining  a  few  hours  before  death  of 
great  pain  in  the  abdomen. 

At  the  post-mortem  it  was  seen  that  at  one  part  of 
the  gut  the  intestine  had  sloughed  and  there  was  some 
extravasation  of  fsces  into  the  peritoneal  cavity.    The 


intestine  above  the  button  was  greatly  distended  and 
the  hole  through  the  button  was  absolutely  blocked 
by  a  hard  mass  of  feces. 

Casb  IX.  Eesection  of  Stricture  of  the  Small  Intes- 
<»n6.~£llen  H.,  set.  44^  was  admitted  into  the  Great 
Northern  Hospital  with  the  following  history.  For 
twelve  years  she  had  had  an  umbilical  hernia,  which 
became  strangulated  and  remained  strangulated  for 
five  days  before  it  had  been  operated  upon.  Fourteen 
days  after  the  operation  fseces  commenced  to  come 
through  the  abdominal  incision,  and  had  done  so  ever 
since.  The  bowels  also  acted  occasionally  per  rectum. 
Since  the  operation  she  had  been  subject  to  continued 
griping  pains  in  the  belly. 

On  admission,  the  abdomen  was  flaccid,  and  occa- 
sional peristaltic  action  of  the  intestines  could  be  per- 
ceived through  the  abdominal  wall.  Situated  in  tiie 
position  of  the  operation  wound,  about  the  umbilicus, 
were  two  small  openings  through  which  came  liquid 
intestinal  contents. 

The  patient  was  well  purged  every  day  for  a  week 
prior  to  the  operation,  which  I  performed  on  April  24th, 
1895. 

An  incision  was  made  five  or  six  inches  long  just  to 
the  right  of  the  middle  line,  the  feecal  fistula  being 
about  the  centre.  A  probe  was  passed  through  the 
fistula  previous  to  the  incision.  Having  cut  through 
the  abdominal  wall,  and  the  peritoneal  cavity  being 
opened,  I  found  that  the  intestines,  both  large  ana 
small,  were  extensively  matted  together  about  the 
umbilicus.  Situated  in  one  part  of  the  small  intes- 
tine was  discovered  a  very  tight  stricture.  The  proxi- 
mal end  of  this  part  of  the  intestine  was  considerably 
dilated,  the  distal  end  quite  collapsed. 

Great  diflSculty  was  experienced  in  separating  the 
adherent  coils  one  from  the  other,  and  in  doing  this 
in  several  places  rents  were  made  in  the  intestines. 
These  rents  were  immediately  closed  by  a  continuous 
suture,  uniting  the  mucous  surfaces,  the  serous  sur- 
faces being  brought  together  by  Lembert's  sutures. 
When  the  intestines  were  separated  one  from  the 
other  attention  was  then  turnea  to  the  strictured  small 
intestine.  The  strictured  gut  was  brought  well  out  of 
the  abdomen,  the  fibrous  stricture,  with  about  an  inch 
of  gut  on  each  side,  was  resected,  and  the  fluid  con^ 
tents  of  the  upper  distended  portion  of  the  gut,  were 
allowed  to  run  out  into  a  basin.  Then  the  two  ends 
of  the  gut  from  which  the  stricture  had  been  removed 
were  united  over  a  Mayo  Robson's  bobbin.  The  old 
sinus  in  the  abdominal  wall  was  cut  away,  and  the 
abdominal  incision  was  brought  together  with  silk- 
worm gut  sutures. 

It  is  needless  in  a  successful  case  to  narrate  the  after 
treatment.  The  patient  made  an  uninterrupted 
recovery,  and  left  the  hospital  on  May  28th  perfectly 
cured. 

Case  X.  Besedion  of  a  Piece  of  the  Small  Intestine 
for  Large  l^w<i//a.— Emily  D„  set,  18,  in  January,  1895, 
was  in  the  Chelsea  Hospital,  where  she  hsd  the 
abdomen  opened  and  flushed  out,  and  a  drainage  tube 
inserted  for  tubercular  peritonitis.  A  few  days  after 
the  operation  faeces  began  to  come  through  the 
abdominal  wound  and  continued  to  do  so  ever  since. 

There  was  no  tubercular  history  in  the  family.  The 
patient  was  a  very  thin  and  hectic-looking  girl.  There 
was  no  evidence  of  tubercle  about  the  lungs. 

On  examination  of  the  abdomen  it  was  noticed  that 
midway  between  the  umbDicus  and  the  pubes  was  an 
irregular  unhealthy-looking  wound  from  which  faeces 
exuded  in  considerable  quantities.  At  the  lower  part 
of  the  wound  also  was  a  large  sinus,  through  which  pus 
flowed.  This  sinus  apparently  led  down  towards  the 
pelvis. 

Temperature  at  night  was  usuallv  about  102°.    The 
bowels  acted  two  or  three  times  through  this  fistula, 
and  the  patient  was  evidently  losing  ground. 
On  June  5th  I  explored  these  sinuses  by  making  two 


132    Thb  Mxdical  Pbxss. 


OKIGINAL  COMMUNICATIONS. 


Fbb.  5,  18M. 


horizontal  inciBioDS  oatvards,  which  exposed  a  large 
abscess  cavity  dippiDi;  right  down  into  the  pelvis,  and 
on  the  floor  of  the  cavity  was  a  i»ece  of  small  intestine, 
in  which  there  was  a  large  perforation.  The  intestine 
was  freed  from  adhesions  and  was  noticed  to  be 
atadded  with  tubercles.  This  was  then  brought  well 
out  of  the  wound,  and  I  resected  about  two  inches  of  the 
^ut  which  contained  the  perforation.  The  ends  of  the 
gut  were  then  brought  together  over  one  of  my  bobbins, 
and  Lembert's  sutures  were  applied  outside.  The 
large  abscess  running  down  into  the  pelvis  was  then 
thoroughly  scraped  out,  and  the  gut  with  the  bobbin 
was  put  back  into  the  abdomen,  llie  belly  wound  was 
left  open  so  as  to  allow  of  thorough  drainage. 

On  June  15th  the  now  decalcified  part  of  my  bobbin 
-was  passed  by  the  rectum.  The  next  day,  just  below 
the  seat  of  enterostomy,  a  small  pinhole  opening  was 
observed,  from  which  feces  exuded  at  times. 

The  patient  was  putting  on  flesh  rapidly  and  her 
-appetite  was  good. 

From  this  small  opening  fseces  have  ever  since 
exuded.  These  irritate  the  wound  and  the  tissues 
around,  and  seem  to  prevent  sound  healing.  Also,  at 
times,  from  the  large  pelvic  cavity  some  pus  exudes. 
Considering  the  tubercular  condition  of  the  intestines 
it  is  a  wonder  that  any  union  took  place  over  the 
bobbin.  I  hope  that,  as  the  external  wound  heals  and 
contracts,  the  small  opening  into  the  intestine  will 
eventuallv  close. 

It  will  be  seen  that  I  have  operated  upon  ten  cases 
reouiring  resection,  six  recovering  and  fourdyinir. 

In  four  of  the  cases  that  recovered,  Caaes  II,  III,  IX, 
and  X,  the  intestines  had  been  emptied  prior  to  the 
operation  of  resection. 

In  the  four  cases  that  died,  Cases  IV,  V,  VI,  and 
YIII,  resection  of  the  diseased  portion  was  done  when 
the  intestines  were  loaded  with  feces.  From  this,  it 
"will  be  perceived  that  distension  of  the  intestines  at 
the  time  of  the  resection  enormously  increases  the  risk  of 
the  operation.  Thefollowing  appears  to  be  the  explana- 
tion :— When  the  intestines  are  distended  large  quanti- 
ties of  feces  are  pressed  down  towards  the  seat  of  union, 
and  no  doubt  are  constantly  disturbing  it  by  the  peris- 
talsis they  set  up.  Further,  the  patient  is,  in  a  wa^, 
poisoned  by  the  fecal  accumulation,  and  when  he  is  in 
«uch  a  state,  it  is  easy  to  understand  that  union  between 
the  divided  ends  of  the  intestine  may  be  delayed,  or 
take  place  in  a  feeble,  and  even  imperfect,  manner. 

To  look  at  the  matter  in  another  light : — 

When  the  large  intestine  is  dealt  with  obstruction 
lias  been  present  for  some  time,  and  the  feces  are 
«olid  or  semi- solid.  Thev  therefore  may  press  upon 
the  seat  of  union,  or  if  a  bobbin  has  been  used,  may 
block  it  as  in  Case  VIII,  or  tear  it  away,  as  in 
Case  VII. 

With  the  small  intestine,  however,  the  case  is 
different.  For  in  this  part,  however  long  the  obstruc- 
tion may  have  existed,  the  contents  are  always  fluid  ; 
hence  there  is  less  danger  of  the  bobbin  or  button 
being  blocked,  or  of  pressure  causing  it  to  break  away 
from  its  situation. 

We  may  therefore  arrive  at  the  following  con- 
clusions : — 

Stricture  of  the  large  intestine  must  not  be  resected 
when  the  intestine  about  the  stricture  is  distended  with 
feces. 

Stricture  of  the  mnaZ^  intestine  may  be  resected  even 
when  the  gut  is  distended,  for  the  faeces  are  liquid. 

I  have,  therefore,  modified  my  methods  when  dealing 
with  strictures  of  the  large  intestine. 

The  gut,  quite  close  to  and  just  above  the  stricture, 
should  be  fixed  into  the  abdominal  wound  ;  in  fact,  a 
colotomy  should  be  performed,  so  that  the  intestines 
\>Y  means  of  purgatives  may  be  thoroughly  cleared  of 
their  contents.  When  this  has  been  effected,  and  the 
patient  has  recovered  in  general  health,  a  second 
operation  should  be  performed,  which  consists  of  free- 


ins  the  artificial  mass  from  its  attachment  to  the  bdly 
wall,  and  resecting  it  and  the  stricture  in  one  piece. 

Sometimes  it  maybe  poesible  to  brins  the  strictnred 
piece  of  gut  out  through  the  abdominal  wound,  and  to 
open  the  gut  on  the  proximal  side  of  the  stricture.  In 
this  way  the  intestines  can  be  thorou|;hly  emptied. 
About  ten  days  afterwards,  the  opening  m  uie  gut  and 
the  stricture  can  be  removed  in  one  piece  by  applying 
a  strong  clamp  to  the  protruding  portion  of  the  gut 
This  is  exemplified  by  Case  I.  Some  months  later  the 
artificial  anus  may  be  freed  from  the  beUy  wall  and 
resected,  the  ends  of  the  gut  being  united  over  a 
bobbin. 

Some  surgeons  at  the  time  when  the  artificial  anus 
and  stricture  are  removed— that  is  to  say,  about  ten 
days  after  the  first  operation — advire  that  the  ends  of 
the  divided  gut  should  be  united  at  once  over  a 
bobbin.  This  procedure  appears  to  me  to  be  unwise, 
for,  as  a  rule,  a  patient  requires  some  weeks  or  even 
months  for  thorough  recovery,  and  until  then  the 
making  of  an  end-to-end  union  is  not  safe. 

It  is  now  evident  to  my  mind  that  with  these  re- 
sections, as  with  all  other  cases  of  intestinal  anastomo- 
sis, the  use  of  some  form  of  button  or  bobbin  is  abso- 
lutely imperative.  These  appliances  prevent  contrac- 
tion or  dilatation  of  the  gut  at  the  seat  of  union,  and 
there  is  less  likelihood  of  leakage  in  the  line  of  sutur 
ing.  If  no  bobbin  is  employed,  and  Mounsell's  method 
is  used,  as  in  Case  IV.,  the  seat  of  suturing  is  unsup- 
ported, and  aleak  between  the  sutures  may  occur. 

Another  use  of  a  bobbin  is  to  secure  the  rest  for  the 
parts  which  is  necessary  for  sound  healing,  for,  as  with 
other  portions  of  the  bodjr,  union  is  favoured  when  the 
divided  pieces  of  intestine  are  kept  fixed  and  in  a 
state  of  rest 

In  the  Lancet  for  August  31st,  1896, 1  discussed  the 
various  kinds  of  bobbins  and  buttons  which  are  used 
in  intestinal  surgery,  and  described  a  new  bobbin  of 
my  own,  which  I  used  in  Case  X.  and  have  used  in 
several  cases  since  with  marked  success. 


ON 

THE  DIAGNOSIS  OF  INSANITY. 

By  THEO.  B.  HYSLOP,  M.D., 

L«etixr«r  on  Mental  Dlaeases  to  St.  Mary'i  Hoapital  Medtoal  School, 
Aiolitant  Phjilctan  to  Bethlem  Ko^al  Uo^ltaL 

Lectube  VI. 

Ths  mental  distubances  which  follow  typhus  fever 
are  not  unlike  those  following  typhoid.  Some  cases 
exhibit  moral  perversions,  others  are  maniacal,  with  or 
without  hallucinations  or  delusions.  Thore  found  that 
the  more  common  sequelae  were  dementia,  general 
maniacal  delirium  (continuous  or  intermittent,  and  of 
varying  duration,  with  or  withoutt  hallucinations}, 
partial  insanity,  or  monomania  usually  of  the  ambitions 
type.  The  onset  of  acute  transitory  mania  may  occor 
during  the  early  stages  of  convalescence,  and  thisii 
believed  by  some  to  be  due  to  some  sudden  change  in 
the  cerebral  circulation.  Weber  calls  this  the 
*' delirium  of  collapse,"  and  states  that  with  the 
symptoms  of  prostration  the  pulse  is  feeble,  rapid,  and 
irregular :  further,  that  this  condition  is  common  at 
the  period  of  crisis  and  mav  be  due  to  sudden  anaemia 
of  the  brain  from  heart  failure.  Westphal  and  Foville, 
observed  intellectuid  weakness  in  relation  to  variola 
and  typhus,  and  such  symptoms  as  change  in  physio- 
gnomy, slow  clumsy  movements,  movements  by  fits 
and  starts,  trembling  of  the  limbs,  partial  or  general 
ataxy  of  limbs,  stiff  gait,  disorders  of  speech,  impaired 
deglutition,  and  in  one  case  loss  of  power  of  sneeziog, 
whilst  mentally  there  was  a  certain  amount  of  excite- 
ment   Westphal  has  also  noted  the  scanned,  nasal, 


Fd.  5,  1896. 


ORIGINAL  COMMUKICATIONS. 


Ths  Mbdioil  Prks.     133 


and  moDotODOO:!  speech,  in  which  the  letters  and 
fl^lables  were  not  displaced,  bat  separated  by  intervals 
and  nttered  jerkily,  or  with  visible  efforts,  yet,  as  after 
typhoid,  without  co-existing  tremblings  of  the  lips  and 
face.  Foville,  on  the  other  hand,  has  noted  the  occar- 
renoe  not  only  of  marked  twitchinj^  of  the  face,  but 
also  a  tendency  to  convulsive  projection  of  saliva  or 
the  return  of  fluids  by  the  nose  during  the  act  of 
deglutition.  The  mthology  of  this  condition  is  at 
present  unknown.  The  frequent  substitution  of  con- 
vulsions for  rigors  in  children  is  said  to  indicate  the 
eariv  implication  of  the  nervous  centres,  and,  according 
to  Grreenfield,  the  acute  transitory  mania  may  be  the 
analogue  of  these  convulsions  affecting  the  psychical, 
instead  of  the  motor,  centres.  In  tne  early  stage  of 
tyi^UB  there  is  said  to  be  an  increase  of  the  watery 
eoDstituenta  of  the  white  matter  of  the  brain.  There 
may  be  no  appreciable  organic  lesions,  the  symptoms 
depending  chiefly  upon  cerebral  anaemia  and  debility. 
The  atony,  exhaustion,  and  anaemia  of  the  brain  may 
be  furthcnred  by  other  influences  such  as  moral  shock, 
&C.  The  hebetude  due  to  wasting  of  the  nervous 
matter  and  nerve  tubules  may  occur  as  a  sequel  to  any 
of  the  more  severe  fevers. 

The  most  frequent  form  of  insanity  following  erup- 
tive fevers  is  said  to  be  maniacal  delirium  with  or 
without  hallucinations.  In  children  the  exanthematous 
diseases  play  an  important  part  in  the  aetiolc^  of 
deafness,  and  secondarily  in  the  causation  of  idiocy 
and  imbecility  by  deprivation  of  the  sense  of  hearing. 
Bullarger  has  recorded  a  case  of  delire  amhiiieux  of 
fifteen  days'  duration  following  scarlatina.  Melan- 
cholia with  refusal  of  food  and  insomnia  have  been 
noted  after  small-pox. 

Cholera  may  be  followed  by  transient  delirium, 
psrox^sms  of  mania,  or  melancholia.  In  all  febrile 
conditions  insanity  may  occur,  owin^to  toxic  conditions 
of  the  blood,or  to  congestion  of  the  mternal  organs  and 
bnin.  These  altered  vascular  conditions  may  be  active 
or  passive,  general  or  partial,  chronic  or  acute.  Some- 
times the  mental  symptoms  may  be  attributable  to 
direct  excitation  from  peripheral  irritation,  the  exist- 
ence of  pain,  organic  disease,  (fee.,  producing  central 
ezfaaustion  or  irritability ;  or  to  reflex  irritation,  or 
peripheral  irritation  acting  in  a  reflex  manner,  either 
on  the  vessels  or  the  nervous  tissue  itself.  Other  con- 
ditions, such  as  sub-acute  inflammation  of  the  cortical 
mbBtance  or  membranes  of  the  brain,  capillary  embo- 
lism, or  thrombosis  (as  in  the  melansemia  following 
asne),  have  been  cited  as  probable  factors  of  causation. 
Some  of  the  mental  disorders  may  be  regarded  as 
ioBtanoes  of  metastasis,  in  which  the  mental  symptoms 
alternate  with  the  symptoms  of  the  bodily  disease. 

Bheumatic  affections  are  sometimes  followed  by 
insanity.  ^^^  development  of  the  insanity  generally 
cmncides  with  the  fall  of  temperature,  cessation  of 
jomt  affections,  and  subsidence  of  the  physical  sym- 
ptoms. The  form  of  insanitv  is  usually  one  of  depres- 
8100.  Sometimes  mania  with  chorea  supervenes.  In 
some  cases  there  is  agitation  with  sensorv  disturbance, 
refusal  of  food,  and  a  tendency  to  aelirium;  the 
m^oiity,  however,  suffer  from  melancholia^  with  or 
without  hypochondriasis,  or  there  may  oe  some 
ddnabna  present,  which  either  gradually  jmuu  off  or 
assume  the  character  of  ideas  of  persecution.  The 
more  severe  forms  of  insanity,  such  as  dementia,  para- 
lytic insanity,  and  general  paralysis,  have  been  observed 
mtt  rarely.  Any  form  of  insani^  may  occur  at  any 
age,  associated  with  rheumatic  affections.  Transitory 
mania,  in  a  child^  does  not  generally  appear  so  serious 
IB  in  an  adult  The  male  sex  appears  to  be  mostly 
affected,  and  the  liability  to  affection  is  increased  by 
heredity,  previous  mental  strain,  or  intemperance. 

Ftaeiunoniais  sometimes  followed  by  insanity;  but 
the  tendency  to  mental  disturbance  is  not  proportionate 
to  the  severil^  of  the  disease.  The  onset  of  acute 
maniacal  delinum  usually  occurs  suddenly  tot^ards  the 


period  of  crisis,  or  early  in  convalescence,  and  first 
manifests  itself  early  in  the  morning  after  waking  from 
slee^.  Many  of  the  more  chronic  forms  have  no  pre- 
monitorv  symptoms,  or  there  may  be  loss  of  sleep  and 
want  of  mental  rest  In  addition  to  the  ordinary 
symptoms  of  exhaustion  following  an  attack  of  pneu- 
monia there  may  be  local  or  general  hypersesthesia,  loss 
of  electro-contractility  of  muscles,  and  of  reflex  excita- 
bility, paralysis  of  special  nerves  or  of  systems  of 
nerves,  various  forms  of  spasm  and  convulsions,  ata^ 
of  movement,  hemiplegia  or  parapleffia.  Griesinger 
has  also  described  a  transient  form  of  hemiplegia,  and 
Mickle  mentions  the  occurrence  of  general  paralysis. 

Many  other  febrile  conditions  are  followed  by  various 
paralyses  or  insanity.  It  would  involve  too  much  time 
to  enter  upon  the  consideration  of  the  various 
paralyses  which  follow  febrile  affections.  Oeneial 
paraljrsis  does  sometimes  follow  typhus,  cholera, 
typhoid,  dysentery,  diphtheria,  pneumonia,  articular 
rheumatism,  erysipelas,  &c^  Much  more  commonly, 
however,  these  affections  are  followed  by  localised  or 
diffused  paralyses  which  simulate  general  paralysis. 
According  to  Mickle,  the  diffuse  form  may  be  dis- 
tinguished from  general  paralysis  by  the  more  frequent 
andf  obvious  preceding  anaesthesia,  analeesia,  numbness, 
pricking  and  arthritic  pains,  and  by  the  circumstance 
that  it  often  begins  in  the  velum  paJati,  almost  always 
undergoes  recovery  in  the  space  of  a  few  weeks,  and  is 
rarely  accompanied  by  intellectual  trouble.  He  further 
states  that  "should  the  paralysis  be  diphtheritic  (and 
even  in  some  other  cases)  it  is  apt  to  extend  from  the 
velum  palati  to  the  pharynx,  thence  to  the  lower  limbs, 
then  sight  and  hearing  become  affected,  then  the  upper 
limbs,  and  finally  the  trunk  and  respiratory  muscles, 
while  the  premonitory  signs  mentioned  above  are  often 
present.  The  diagnosis  of  these  conditions  is  often 
attended  with  extreme  difficulty,  and  it  is  often  only 
late  in  the  course  of  the  disease  that  its  true  nature 
can  be  ascertained. 

Inflaenza  is  frequently  followed  by  prominent  nervous 
symptoms.  The  symptoms  may  be  those  of  intense 
nervous  exhaustion,  sensory  or  motor  affections,  para- 
lyses of  the  oculo-motor  apparatas,  or  of  the  extremi- 
ties, usually  referable  to  degenerative  neuritis.  In 
some  cases  hysteria,  or  neurasthenia  supervenes,  and  a 
few  cases  have  been  recorded  of  severe  organic  changes 
in  the  central  nervous  system.  The  mental  symptoms 
may  take  the  form  of  acute  febrile  delirium  or  the 
mental  derangement  may  continue  for  some  weeks  or 
months.  Most  of  the  mental  disorders  following 
influenza  tend  to  disappear  with  improvement  in 
general  health.  The  graver  cases,  however,  are  pro- 
tracted in  their  course,  and  eventually  resolve  them- 
selves  into  paralytic  or  chronic  delusional  affections. 

An  attack  of  malaria  may  be  attended  with,  or  fol- 
lowed by,  extreme  collapse,  coma  or  delirium,  epi- 
leptiform or  tetaniform  convulsions,  or  mental  sym- 
ptoms of  varying^  intensity  and  kind.  In  some  cases 
the  occurrence  of  insanity  is  a  chance  coincidence,  and 
not  dependent  upon  malaria  as  a  causal  agent  Simple 
uncomplicated  attacks  of  malaria  are  rarely  followed 
by  mental  disturbance ;  but  when  the  nervous  system 
has  been  weakened  by  syphilis,  alcohol,  and  various 
excesses,  not  only  is  some  neurosis  likely  to  supervene, 
but  it  is  likely  to  be  of  a  serious  and  intractable  nature, 
dimple  cases^  where  no  cause  beyond  the  malaria  has 
been  ascertained,  generally  recover. 

Writing  uiK>n  the  influence  of  malaria  in  the  produc- 
tion of  insanity  (Tnke's  "  Dictionary  of  Psydiological 
Medicine")  I  pointed  out  that  some  neuroses  appear 
to  be  forms  of  ague,  and  may  be  recoffuised  as  malarial, 
partly  by  their  periodic  nature,  partly  by  their  super- 
vention on  a  more  or  less  distinct  cold  stage,  partly  by 
their  occurrence  in  a  malarious  district,  and  partly  by 
the  fact  that  the  patient  has  already  been  the  subject 
of  ague.  Severe  or  long-continued  mtermittents  pro- 
duce a  very  deleterious  effect  on  nervous  power,  and 

D 


134    Thi  Mbdioal  Pbiss. 


ORIGINAL  COMMUNICATIONS. 


Fbb.  5,  1996. 


lead  to  almost  any  degree  of  mental  deterioration.  In 
addition  to  mascolar  weakness,  a  partial  paralysis  of 
one  or  more  limbs  is  not  an  uncommon  occarrence 
Dr.  Manson,  in  his  medical  report  on  the  health  of 
Amoy,  quotes  a  case  of  gradual  impairment  of  sight 
following  an  attack  of  dengue  fever.  Amongst  the 
Chinese  he  also  noted  many  instances  of  dyspepsia, 
debility,  rheumatism,  paralysis  of  certain  groups  of 
muscles,  and  insanity,  as  consequences  of  dengue. 
One  case  admitted  to  Bethlem  was  suffering  from  the 
ataxic  form  of  general  paralysis  the  sequel  to  dengue. 
Pinel  has  recorded  a  case  of  recurring  suicidal  ten- 
dencies after  an  attack  of  tertian  fever,  and  Baillarger 
considers  that  intermittent  fevers  predispose  to  insanity 
in  two  ways,  first  by  acting  like  all  nervous  affections, 
and  secondly  by  producing  ansemia.  Sullivan,  writing 
on  the  endemic  diseases  of  tropical  climates,  states 
that  in  one  patient  the  effect  of  miasma  produces 
prostration,  in  another  it  produces  over-excitement, 
or  increased  muscular  sensibility ;  one  man  may  be 
seized  with  delirium,  another  falls  into  a  state  of 
stupor  ;  some  are  seized  with  local  paralytic  affections, 
or  general  hypersesthesia,  while  others  do  not  complain 
of  pain. 

Neuralgic  affections  of  one  or  other  branches  of  the 
fifth  pair,  as  in  that  involving  the  supraorbital,  and 
constituting  one  form  of  the  malady  known  as  "  brow- 
a^e,"  is  adduced  as  an  example  of  a  neurosis  being  a 
distinct  form  of  ague.  Seversu  authors  have  described 
intermittent  paroxysmal  mania  or  maniacal  delirium 
occurring  in  the  place  of  an  attack  of  ague,  or  as  its 
principal  symptom.  Of  the  form  which  follows  ague, 
Sydenham,  who  first  described  it,  states  that  acute 
mania  tending  to  pass  into  chronic,  occurs  chiefly  after 
protracted  quartans.  Sebastian,  however,  states  that 
insanity  occurs  as  frequently  after  attacks  of  tertian 
or  double  quartan  type,  and  that,  in  these  cases,  it  is 
more  commonly  of  an  acute  delirious  character,  whilst 
after  quartan  it  takes  on  a  more  chronic  form,  and 
tends  to  pass  into  stupidity  or  melancholia. 

Daring  an  attack  of  intermittent  fever  there  may  be 
delirium  in  persons  predisposed  thereto,  and  this 
delirium  is  not  always  in  proportion  to  the  intensity 
of  the  fever ;  or  there  may  be  a  condition  with  exhaus- 
tion analogous  to  the  typhoid  state  of  other  acute 
disorders.  In  severe  and  prolonged  cases  of  malarial 
disease  there  is  a  tendency  to  intermittent  mental 
affections,  or  chronic  insanity  with  or  without  paralysis. 
The  more  important  mental  conditions  are  met  with  as 
sequelae,  in  persons  who  have  passed  into  convalescence 
after  a  very  acute  or  prolonged  attack  of  malaria. 
These  symptoms  at  such  period  may  be  transitory  and 
curable,  in  the  form  of  quiet  delirium,  melancholia 
with  or  without  stupor,  or,  simple  mania  with  or 
without  impulsive  tendencies,  or  occasional  outbursts 
of  excitement.  These  conditions  are  generally  con- 
sidered incurable.  The  pseudo-general  paralytic  type 
has  been  frequently  observed.  It  sometimes  presents 
most  of  the  features  of  general  paralysis,  with  mental 
and  ph}[sical  symptoms,  which,  although  difficult  to 
distinguish  from  tnose  of  general  paralysis,  are,  never- 
theless, somewhat  different  in  their  course  and  duration. 
Mentally,  there  is  frequently  weak-mindedness  or  slight 
exaltation,  with  or  without  marked  delusions.  In  one 
case  admitted  to  Bethlem  there  was  partial  dementia 
with  confusion,  and  in  another,  confusion  and  hallu- 
cinations of  hearing.  The  physical  symptoms  may  be 
those  of  nervous  debility  with  tremors,  alteration  of 
the  reflexes,  or  even  definite  symptoms  of  a  system- 
lesion  in  the  spinal  cord.  In  some  cases  there  is  a 
peculiar  appearance  of  the  margin  of  the  touffue  after 
attacks  of  malaria.  This  is  termed  the  'Mnalarial 
margin.^  Its  colour  is  faintly  blue^  and  there  is  marked 
transverse  indentation  or  crimping,  apparently  con- 
fined to  the  submucous  tissue,  while  the  superficial 
integument  continues  smooth,  moist,  and  transparent. 

It  msy  be  of  advantage  here  to  speak  of  some  of  the 


pathological  features  of  malarial  affections  of  the 
nervous  system.  Suggestions  have  been  made  as  to 
the  presence  of  micro-organisms  in  the  blood,  and  the 
existence  of  pigment  in  the  blood  and  vessels,  but 
their  relation  to  the  mental  disorder  is  at  present  in- 
definite. The  occurrence  of  a  large  amount  of  pigment 
in  the  blood  has  lon^  been  known.  Brescnet  and 
Cruveilhier  detected  it  m  the  blood  vessels  in  the  form 
of  black,  sharply  cut  masses.  Halliday  found  black 
pigment  in  the  vessels  at  the  base  of  the  brain,  and  in 
those  of  the  choroid  plexus.  As  early  as  1825,  Billard 
and  Baily  observed  obstruction  of  the  capillaries  of 
the  brain  by  pigment  Bright  described  and  figured 
the  brain  of  a  man  who  had  died  from  cerebral  para- 
lysis, which  appeared  to  have  resulted  from  an  attack 
of  fever.  The  cortical  substance  was  of  a  dark  colour 
like  black  lead.  In  1874,  Hammond  had  a  fAtient 
sufferin^f  from  deafness,  pains  in  the  head,  and  epileptic 
convulsions,  in  whom  an  ophthalmoscopic  examination 
showed  the  existence  of  double  optic  neuritis,  with 
pigmentary  deposit.  There  was  a  history  of  malarial 
fever  in  the  case,  and  recovery  from  these  symptoms, 
including  the  deafness,  followed  the  use  of  arsenic. 
Planer  found  that  in  cases  in  which  there  were  cere- 
bral symptoms,  the  pigment  in  the  blood  was  found  in 
a  state  of  black,  or  more  commonly  of  brown-yellow, 
brown,  or  (very  rarely)  red  granules,  many  of  which 
were  united  together  by  a  dear  hyaline  substance, 
which  was  soluble  in  acids  and  alkalies.  Meckel 
observed  pigment  cells  very  rarely ;  Yirchow  more 
frequently.    Planer  never  saw  in  the  pigment 


anything  like  a  nucleus.  The  aggregation  of  the  pig- 
ment grains  sometimes  formed  black  or  brown  flakes  of 
the  most  variable  forms  ;  these  flakes  were  sometimes 
considered  to  be  constituted  by  a  hyaline  substance,  in 
which  black  pi^ent  was  imbedded.  The  relative 
number  of  the  pigment  masses  of  the  blood  globules 
was  not  determined.  In  some  cases  the  capillaries 
seemed  almost  choked  up  with  them.  He  did  not 
find  that  the  colourless  corpuscles  of  the  blood  were 
more  numerous. 

The  cerebral  substanoB  was  often  found  affected 
b^  pigment  change,  and  it  appeared  certain  that  the 
pigment  was  in  uie  vessels.  Meckel  describes  a  case 
in  which  there  were  numerous  punctiform  haemorrhages 
in  the  grey  substance,  produced  by  blocking  of  vessels 
through  pigment,  and  since  then  several  cases  of  the 
same  kind  have  been  seen  by  Planer.  In  some  cases 
the  flakes,  already  referred  to  as  seen  in  the  blood  in 
the  heart  and  large  vessels,  were  in  the  cerebral  capil- 
laries, and  of  such  size  that  it  seemed  impossible  they 
could  pass.  In  fact,  Planer  conjectures  that  the  ex- 
treme abundance  of  pigment  granules  in  the  cerebral 
vessels  must  have  been  owing  to  their  inability  to  pass 
through  the  cerebral  capillaries,  which  (especi^y  in 
the  grey  matter)  are  the  finest  in  the  body. 

From  this  account,  it  is  evident  that  the  pathology 
of  the  affliction  is,  as  yet,  very  indefinite,  and  we  have 
yet  to  learn  whether,  in  these  cases,  excessive  pigmenta- 
tion occurs  in  the  nerve-cells  of  the  brain  and  spinal 
cord,  and  if  so,  in  what  way  the  deg;eneration  differs 
from  the  pigmentaiy  changes  found  in  ordinary  con- 
ditions of  functional  hyperplasia,  as  in  severe  attacks 
of  acute  mania,  epileptic  insanity,  or  in  general 
paralysis. 

From  the  clinical  considerations  already  mentioned 
it  will  be  noted  how  the  diagnosis  is  often  a  matter  of 
extreme  difficulty.  The  periodic  or  intermittent 
nature  of  the  mental  attacks  mav  suggest  a  malarial 
origin.  The  beneficial  effects  producednby  the  adminis- 
tration of  arsenic  ma^  help  to  confirm  the  diagnosis.  I 
usually  prescribe  quinine,  arsenic,  and  phosphorus  for 
such  cases,  and  often  with  beneficial  results.  Some- 
times a  diagnosis  has  to  be  made  between  the  pseudo- 
general  paralysis  following  malaria,  insanity  with 
paralysis,  and  general  paral:^is.  It  may  be  well  to 
remember  that  the  mental  disorders  occurring  during 


Fd.  5,  1H96. 


TKANSACTIOFS  OF  SOCIETIES. 


Thi  Mbdigal  Pbxsb.     135 


•D  attack  of  malaria  are  generally  transitory  and 
curable,  unless  the  malaria  is  of  nndne  severity,  when 
there  is  apt  to  be  permanent  instability  or  a  cnronic 
form  of  insanity.  The  prognosis  in  the  peendo-general 
paialytic  forms  is  nnfavoarable.  They  seldom  terminate 
uke  trae  general  paralysis,  bat  go  on  for  years,  and  die 
of  some  complication,  or  succumb  to  the  advance  of  a 
deigenerative  lesion.  Sometimes,  when  alcohol  has 
formed  an  additional  factor  in  the  causation,  the  case 
may  do  welL  When  syphilis  forms  a  complication 
recovery  is  rare.  In  one  case,  formerly  in  Bethlem, 
with  a  historjr  of  malaria  and  syphilis,  there  was 
partial  dementia,  with  hallucinations  of  hearing  and 
hteral  sclerosis  of  the  cord.  The  mental  symptoms 
on  the  one  hand,  were  of  an  intermittent  type,  and  did 
not  advance  in  severity,  whilst,  on  the  other  hand,  the 
leeion  in  the  cord  progressed  unfavourably,  until  death 


Lftter,  when  I  have  considered  some  of  the  other 
factors  of  causation,  I  shall  better  be  able  to  present  in 
taUdar  form  the  leading  features  for  differential 
diagnosis. 

(Coniinmed  from  poffe  107). 

Tbb  foUowiog  prescriptions  are  taken  chiefly  from  Dr. 
MmelFA  forthcomini^  work  on  *'  Pharmacology  and  Thera- 
praCias"  an  advance  copy  of  which  is  before  os : — 

Apomorphine  Likotos. 
Solution  of  Apomorphine  (1  in  50)  2  drachma  ; 
Solotion  of  Hydrochlorate  of  Morphine,  IJ  drachm  ; 
Dilate  Hydrochloric  Acid,  1  drachm ; 
Symp  of  Lemons,  half-an-oooce  ; 
Spirits  of  Chloroform,  1|  drachm ; 
Water  to  4  ounces. 
A  teaepoonfal  frequently  when  the  cough  is  trouble- 


Ck>DSINX  LiNCTUS. 

Codeine,  4  erains  ; 
Spirits  of  Chloroform,  H  drachm  ; 
Syrup  of  Virginian  Prune,  2  drachms  ; 
Water  to  4  ounces. 
Ateaspoonful  frequently  to  allay  hacking  cough  un- 
atteaded  with  much  secretion. 

PiCROToxiK  Pills. 
Pierotozin,  one-sixtieth  of  a  grain  ; 
Sagar  of  Milk  and  Glycerine  of  Tragacanth,  enough 
to  make  a  pill. 
One  at  bed-time,  repeated  if  necessary,  to  check  the 
Bight-sweating  of  phthisis. 

Musk  Pills. 
Musk,  2  jmins ; 

Sugar  of  Milk,  enough  to  make  12  pills. 
One  or  two,  three  times  a  day,  as  a  nervine  stimulant 
in  cases  of  hyf>teria,  accompanied  with  flatulence.    Good 
I       mwk  costs  halt-a-crown  a  grain. 

Yaqinal  Injection. 

Alum,  1  drachm  ; 
Sulphate  of  Zinc,  1  drachm  ; 
Permanganate  of  Potassium,  1  grain  ; 
Heliotropin,  1  grain. 
The  powder  to  be  dissolved  in  a  pint  of  warm  wjiter  and 
osed  as  a  vaginal  douche. 

FoMiNa  Inhalation. 

Powdered  Stramonium  Leaves,  1  ounce  ; 

Powdered  Anise  Fruit,  half-an-ounoe  ; 

Powdered  Fennel  Fruit,  half-an-ounce ; 

Black  Tea  in  Powder,  1  ounce ; 

Iodide  of  Potassium,  1  ounce  ; 

Nitrate  of  Potassium,  1  ounce. 
The  fumes  of  the  burning  powder  will  afford  relief  in 
the  paroxysm  of  asthma  ana  will  often  induce  sleep  in 
Cttea  of  inramnia. 


Phytolaoca  Gabgls. 
Tincture  of  Phytolacca,  4  drachms  ; 
Carbolic  Acid,  5  minims  ; 
Dilute  Acetic  Acid,  2  drachms  ; 
Tincture  of  Myrrh,  1  drachm ; 
Eau  de  Cologne,  2  drachms ; 
Water  to  8  ounces. 
Useful  in  the  Catarrhal  Laryngitis  from  which,  singers 
and  public  speakers  so  frequently  suffer. 

Chlo&al  and  Camphor  Linimsnt. 

Chloral  Hydrate,  1  drachm  ; 

Menthol,  1  drachm ; 

Camphor,  2  drachms ; 

Chloroform.  2  drachms ; 

Sulphuric  Ether,  1  drachm  ; 

Tincture  of  Aconite,  1  drachm  ; 

Oil  of  Origanum,  half-a-drachm  ; 

Oil  of  Sassafras,  half -a-draohm  ; 

Rectified  Spirit  to  4  ounces. 
The  chloral  menthol  and  camphor  should  be  rubbed  up 
together  and  then  mixed  with  the  oils,  after  which  the  other 
ingredients  should  be  added.  It  is  a  useful  liniment  in 
cases  of  rheumatism  and  neuralgia.  It  should  be  used 
cautiously  and  should  be  labelled  *'  Poison." 

OPHTHALMOLOGICAL  SOCIETY  OF  GREAT 

BRITAIN. 

Mbxtino  held  Thitbsday,  January  SOth. 


The  President,  Mr.  Nbttlkship,  F.R.C.S.,  in  the  Chair. 


THB  VISUAL  BFFEOTS  OF  REFBACTTVS  KRSOK. 

Dr.  G.  J.  Bull  said  it  is  rare  to  meet  with  a  person 
whose  refraction  did  not  in  some  degree  vary  from  the 
normal,  and  every  such  error  unless  cancelled  or  corrected 
muat,  of  course,  produce  some  deformation  of  the  normal 
visual  image.  Hitherto,  however,  it  had  been  the  custom 
to  think  of  all  such  deformations  simply  as  diminutions  of 
the  normal  acuity.  It  had  occurred  to  him  to  analyse 
more  closely  what  really  happened  when  the  acuity  of  a 
patient,  so  far  as  the  ordinary  test  types  were  concerned, 
was  found  to  be  diminished  to  a  greater  or  lesser  degree 
by  refractive  error.  He  had,  therefore,  endeavoured  to 
reproduce  with  the  help  of  the  photographic  camera 
pictures  of  the  test  types,  and  also  of  objects  in  nature  as 
they  would  be  seen  by  patients  suffering  from  given  errors 
of  refraction.  This,  he  thought,  could  be  done  by  taking 
photographs  with  the  plate  more  or  less  out  of  focus  to 
represent  the  vision  of  myopes  and  hypermetropes, 
and  with  the  lens  of  the  objective  obliquely  inclined 
to  show  the  distortion  of  astigmia.  SnbsequenUy 
however  he  adopted  the  easier  plan  of  attaching  the 
spherical  and  cylindrical  lenses  of  hii  tnal  case,  to  the 
objective  of  the  camera.  The  result  had  been  to  fix  upon 
the  photographic  plato  a  very  curious  and  interesting 
record  of  many  of  iJie  features  of  ametropic  visual  error 
applicable  to  the  most  diverse  forms  of  objects  and  the 
most  diverse  conditions  of  sight,  but  at  the  same  time  it 
showed  that  the  ametropia  of  the  camera  exhibited  certain 
characteristic  features.  To  begin  with  the  well-known 
phenomenon  of  "  doubling"  he  said  it  was  not  uncommon 
to  find  patients  who,  on  looking  at  the  test  types,  saw  two 
lines  of  type  instead  of  one.  The  actual  doubling  was 
usually  observed  only  where  the  object  was  a  Ime  of 
relatively  small  dimensions  or  a  simple  system  of 
such  lines,  in  fact  the  troubled  vision  in  such  cases 
appeared  to  be  due  to  imperfect  superposition  of  a 
series  of  faint  multiples  ot  the  original  letter.  He 
bad  tested  his  photographs  carefully  in  various  ways 
by  comparing  them  with  the  appearances  which  are 
observed  by  an  eye  in  which  the  corresponding  refractive 
error  had  been  artificially  produced  by  arming  it  with  the 
appropriate  lenses.  In  thus  comparing  the  photographs 
he  haa  been  enabled  to  observe  more  closely  than  hitherto 
the  action  of  certain  sources  of  error  which  were  of  con- 
siderable practical  importance.  He  remarked  that  the 
apparent  higher  acuity  of  the  eye  armed  with  a  given  lens 
as  compared  with  the  camera  with  the  same  lens  placed  in 


136     Tub  Medical  Pbks. 


TRANSACTTIONS  OF  SOCIETIES. 


Fbb   5,  1806w 


oontact  with  the  objective,  was  the  reanlt  in  great  part  of 
certain  habits  and  cbaraoteristica  of  the  eye  whion  were 
either  always  present  or  were  so  difficult  to  goard  against 
that  even  the  most  caatious  observers  were  more  or  less 
affected  by  them. 

The  Prbsidei^t  observed  that  if  the  phenomenon  of 
monocular  doublinfi;  were  as  universal  as  the  author 
supposed,  it  was  curious  that  patients  did  not  more  fre- 
quently direct  attention  to  the  fact. 

Mr.  Fbost  said  he  had  come  across  these  cases  in 
patients,  and  he  employed  a  special  method,  consistinf^  in 
rotation  of  a  long  line,  in  order  to  discover  if  the  patients 
really  saw  double. 

Dr.  Bull,  in  reply,  thought  everyone  exhibited  this 
phenomenon  if  only  it  were  looked  for.  People  were 
usually  bad  observers,  and,  moreover,  they  did  not  look  at 
objects  well  calculated  to  show  it  up.  Formerly  bethought 
it  was  a  phenomenon  of  advanced  life,  but  a  large  number 
of  recent  obeervations  have  satisfied  him  that  it  might 
always  be  found  even  in  children. 

OASB  OF  UVJBAL  OTST  07  IBIS. 

Drs.  Ealbs  and  Sinolaib  related  the  case  of  a  man, 
set.  47,  who  came  with  the  left  eye  in  a  condition  of  abso-  • 
lute  glaucoma,  the  result  of  chronic  non-inflammatory 
glaucoma  of  some  years'  standing.  Extending  into  the 
pupillary  area  from  behind  the  iris  were  two  £rk  brown 
globular  masses.  These  moved  freely  with  every  move- 
ment of  the  eyeball,  and  on  close  examination  with  a 
magnifying  glass  a  fine  jelly-like  quiver  of  the  surface  of 
each  mass  was  noted.  The  diagnosis  of  cystic  detachment 
of  the  posterior  uveal  layer  of  the  iris  was  made,  and  this 
was  fullv  borne  out  by  pathological  examination.  This 
was,  so  far  as  they  were  aware,  the  first  case  in  which 
cystic  detachment  of  the  uveal  layer  of  the  iris  had  been 
diagnosed  clinically,  though  they  had  records  of  other 
published  cases  in  which  this  condition  was  probably 
present.  They  wished  particularly  to  direct  attention  to 
the  fine  creasing  and  quivering  of  the  cyst  wall  as  a  dia- 
gnostic siero  between  this  condition  and  pedunculated 
sarcoma  of  the  iris. 

Mr.  Treacher  Collins  said  it  was  a  common  thing,  in 
eyes  with  old  inflammatory  trouble,  to  meet  with  slight 
detachment  of  the  pigmentary  layer  at  the  back  of  the 
iris.  This  case,  however,  belonged  to  a  somewhat  differ- 
ent catego^,  because  it  was  non-inflammatory.  In  a  case 
which  he  figured  in  his  own  paper,  the  cyst  was  in  the 
same  situation.  This  was  a  case  of  melanotic  sarcoma  of 
the  ciliary  body  and  the  whole  iris  was  cedematous. 

Dr.  Ealxs  thought  the  absence  of  the  lens  was  due  to 
absorption  and  not  to  congenital  deficiency. 

OPTIC  ATROPHY  IN  THREE  BROTHSBS. 

Dr.  F.  M.  Ogilvib  commenced  by  the  remark  that  the 
title  of  *'  optic  atrophy  in  three  brothers  "  had  tilie  advan- 
tage of  avoiding  the  vexed  question  of  heredity,  and  though 
he  believed  these  to  be  cases  of  Leber's  hereditary  optic 
atrophy  he  had  been  unable  to  prove  that  they  were  any- 
thing more  than  collateral  atrophies.  The  father  and  the 
three  sons,  the  only  living  males,  were  all  employed  in 
some  large  engineering  works  in  Suffolk.  Case  1 :  W.  J., 
89t.  24,  attended  Moorfields  in  October,  1887.  He  had 
always  been  in  good  health  and  temperate  in  respect  of 
alcohol  He  hsd  smoked  since  he  was  18,  four  ounces  of 
••  shae  "  a  week.  Sight  was  good  up  to  July,  1887,  and  at 
that  date,  having  gone  to  bed  seeing  as  usual,  he  awoke 
hardly  able  to  find  his    way  about.    R  V  6/0  L  V  6/0, 

Supils  acted  to  light.  With  the  ophthalmoscope  the  optic 
isc  appeared  a  little  pale  on  the  temporal  siae,  the  rest 
being  a  full  colour.  There  was  slight  oedema  and  thicken- 
ing of  the  sheaths  of  the  arteries  on  the  disc.  The  veins 
were  over  full  and  tortuous  even  to  the  small  branches. 
There  was  a  deep  physiological  cup.  Colour  vision  was 
verv  defective  and  there  was  not  a  very  well-defined  oen- 
tral  sootoma  colour.  The  fields  for  white  were  full  He 
was  treated  for  three  months  at  Moorfields  and  when  dis- 
charged vision  was  R  3/60  L  6/0.  Jaeger  16  at  4".  Seven 
years  later  his  condition  was  found  to  be  practically 
unchanged.  Case  2 :  A.  J.,  sot.  22,  attended  Uie  West- 
minster Ophthalmic  Hoepital  in  June,  1894.  Goodhealthup 
to  commencement  of  visual  failure.  He  had  been  tem- 
perate, but  had  smoked  sinoe  18  years  of  age,  on  an 
average,  H  ounces  of  "shag"  a  week.  In  MsSoh,  1894, 
he  first  noticed  a  difficulty  in  seeing  small  print.    Coind- 


dentlv  with  this,  he  suffered  from  severe  pains  in  the  head 
of  a  sharp  shooting  character,  chiefly  confined  to  the  tem- 
poral regions,  and  worse  at  night.  He  had  had  no  head- 
aches before  this  date.  In  May  he  was  obliged  to  {[^?e 
up  his  employment.  His  sister  stated  that  he  had  been 
"  strange  in  his  manner  **  for  two  weeks.  Vision  R  6/60, 
J  20 ;  L  6/60,  J  16,  pupils  acted.  The  diso  was  of  a  ^iood 
colour,  but  the  vessels  were  extremely  tortuous,  some  of 
the  vessels  dipping  antero-posteriorlv,  as  well  as  curving 
on  the  flat.  Toe  veins  were  over  full.  There  was  a  peri- 
pheral patch  of  superficial  choroidal  atrophy,  with  sueht 
pigmentation,  symmetrically  placed  in  both  eyes.  He- 
traction  emmetropic.  The  fields  for  white  were  contracted. 
Three  months  later  his  vision  had  spne  down  to  hand 
movements  only,  but  he  could  pick  his  wav  about  in  a 
crowded  waiting  room  pretty  easily.  The  fields  for  white, 
repeatedly  taken,  had  always  shown  concentric  oootractioii, 
not  always  constant  in  degree.  There  was  a  central  eootoma 
for  white,  and  his  colour  vision  was  extremely  defective. 
The  discs  were  now  white  all  over.  The  former  headaches 
haye  now  entirely  left  him.  He  has  not  smoked  for  18 
months.  Case  3  :  A.  J.,  »t.  27.  He  examined  this  patient 
in  February,  1895,  for  t^e  purpose  of  comparing  him  with 
his  two  brothers.  He  then  had  excellent  vision,  accord- 
ing to  his  Etatement,  but  on  testing,  it  proved  to  be  R  6/24 
on  both  sidef.  J  2  at  11  cm.  with  great  difficulty.  There 
was  no  blurring  of  the  disc  mar^n,  but  the  vessels 
were  very  tortuous.  Refraction  was  slightly  myopic.  When 
he  came  to  the  hospital,  seven  months  later,  he  said 
he  had  been  subject  to  headaches  with  vomiting  ever 
since  he  could  remember.  He  said  his  mother  suffered  in 
the  same  way,  and  he  described  them  as  ''  bilious.*'  He 
was  temperate,  but  had  smoked  since  18  years  of  age,  at 
first  1  ounce  of  shas  a  week,  afterwards  increased  to  2  or 
3  ounces.  In  March  of  this  year  he  reduced  the  quantity 
to  about  half  an  ounce  a  week.  He  dated  the  oommenoe- 
ment  of  failure  of  vision  from  the  beginning  of  lass  March. 
This  got  steadily  worse,  and  in  September  he  had  to  give 
up  work.  R  2/60,  L  3/60,  J.  20.  Both  discs  were  rather 
pale,  the  outer  half  most  so,  there  was  a  large  physiological 
cup,  the  vessels  were  normal  in  size,  but  very  tortoooa. 
Fields  for  white  full,  ill-defined  central  scotoma  for  oolonn 
in  each  eye.  Could  match  wools  slowly,  but  correctly. 
He  was  treated  for  nine  weeks,  and  improved  to  R  5/60, 
J.  18,  L  6/24,  J.  18.  Both  optic  discs  were  very  atro- 
phic He  had  not  smoked  for  five  months.  The  autiior 
pointed  out  that  all  these  patients  were  attacked  early  in 
adult  life.  They  had  all  been  moderate  in  respect  of 
alcohol,  and  they  were  all  smokers  of  shag  tobacco,  though 
not  in  large  quantities.  There  is  no  history  of  acquired 
syphilis  and  no  trace  of  hereditary  syphilis.  No  history  of 
sexual  excess  or  abuse.  Headaobe  was  absent  in 
Case  1,  coincident  with  failure  in  Case  2,  oeasiog 
on  its  failure  reaching  its  maximum.  Occasionally 
from  childhood  in  the  third,  and  relieved  by  vomiting. 
The  onset  of  visual  failure  was  gradual  in  Cases  2  and  3, 
sudden  in  Case  1.  The  amblyopia  was  equal  in  both 
eyes  in  all  the  cases.  The  father,  let.  57,  was  an  orphan, 
parents  unknown.  Y  6/9,  retinal  vessels  not  tortnoos. 
The  mother,  set  53,  was  the  youngest  of  ten  children, 
five  males  and  five  females.  No  history  in  her  parents  of 
defective  vision.  Three  of  tne  five  brothers  died  unmanried, 
the  two  married  brothers  have  two  and  seven  children,  no 
history  of  defective  vision.  Of  the  four  sisters,  three  died 
unmarried.  The  eldest  had  only  one  child,  a  male,  sight 
not  defective.  Mrs.  J.,  had  V  6/1 2  and  preeented  tortaons 
vessels,  a  condition  which  prevailed  throughout  the  entire 
family,  with  the  exception  of  the  father.  She  has  had  16 
pregnancies  with  two  miscarriages.  Of  the  }4  children 
bom  alive,  eight  died  in  infancy,  none  of  them  surviving 
more  than  six  months.  This  mortality  did  not  resemble 
that  resulting  from  syphilis  in  that  it  was  irregularly 
distributed.  None  of  the  children  present  any  evidence 
of  hereditary  syphilis.  Of  the  six  livug  children  the  three 
males  were  the  subjects  of  this  paper.  Of  the  three 
females  there  was  little  to  note  Thefy  all  preeented  the 
tortuous  vessels  and  one  of  them  suffend  from  fits, 
probably  hystericaL 

Dr.  Habbbshov  remarked  that  one  of  the  only  two 
cases  of  the  kind  he  had  seen  also  preeented  patches  of 
choroidal  atrophy  at  the  periphery,  and,  as  in  the  author's 
case,  there  was  no  history  of  syphilis. 

Dr.  EdoabBbownb  said  he  had  recorded anumber of  these 
eases  in  the  Transactione,  but  unfortunately  they  were  not 


tEK  S.  1896 


TRANSACmONS  OF  SOCIETIES. 


Thb  Mbdical  Pbbbs.     137 


voriced  out  from  m  ^mflr  point  of  view.  All  fche  cases 
ooemred  in  smokers.  He  thong^ht  that  something^  was 
reqaired  to  determine  the  optic  atrophy,  for  people  could 
soHoely  be  bom  foredoomed  to  optic  atrophy  withont  any 
eaaae  in  the  way  of  disease  or  foreign  inflnence.  These  cases 
anodated  with  the  use  of  stroDe  tobacco,  presented  certain 
peenliaritiee.  They  went  on  lor  years  withont  farther 
impairmeot  of  vision,  and  when  examined  they  almost 
ahrays  showed  evidence  of  the  previous  existence  of  acen- 
tml  scotoma,  evidence,  that  is  to  »ay,  that  the  disease 
l)0gan  as  an  axial  neuritis,  and  not  as  peripheral  neuritis. 
In  ordinary  optic  atrophy  the  tenaency  was  for  the 
rision  to  become  progressively  and  surely  less,  and  the  cen- 
tral deficiency  was  not  marked  as  in  the  tobacco  cases. 

The  Pbssidxnt  said  it  was  extremely  desirable  that 
•eases  of  this  condition  occurring  in  non-smokers  should  be 
lilsoed  on  reoord. 

Mr.  JoHHsroN  Taylob  said  he  had  recorded  some  cases 
io  a  family  of  11,  and  they  were  all  in  the  smoking  members 
id  the  family.  It  occurred  to  him  that  violent  counter- 
iiritation  in  the  early  stages  mi^ht  be  productive  of 
moderately  satisfactory  results.  He  noted  that  in  the 
youDgest  case  improvement  followed  openine  of  the 
Dsstoid  antrum  for  middle  ear  disease,  and  in  any 
cue  energetic  treatment  could  do  no  harm. 


BOYAL  ACADEMY  OF   MEDICINE  IN  IRELAND. 

SscnOM  OP  SUBGXBY. 

MsxTiNO  HXLD  Fbidat,  Jak.  IOth,  1896. 


The  Ftesident,  Sir   W.    Thoknlbt   Stokbb,  P.R.CS., 
in  the  Chair. 


OOMPLBTX  XXOISIOK  OF  THB  LABTNX,  WITH    SUBSBQUIKT 
POWBBS  OF   VOCALISATION. 

H&.  R.  H.  Woods  showed  a  man  whose  entire  larynx 
had  been  excised  in  1892  by  Dr.  Solis  Cohen,  of  Phila- 
delphia. The  trachea  opened  externally  in  the  middle  line 
<rf  the  neck  in  front,  and  there  was  no  communication 
whatever  between  the  mouth  and  the  respiratory  organs. 
The  man  was,  however,  able  to  vocalise.  Mr.  Woods 
believed  this  was  accomplished  by  gulping  air  into  the 
oesophagus,  and  that  this  air  was  forced  up  again  by 
srsBBuiefrom  below.  The  sound  was  made  by  muscular 
mnes  or  hands  in  the  oesophagus,  which  had  gradually 
been  trained  to  perform  this  function.  The  case  elicited 
a  great  deal  of  interest. 

A  CASB  OF  OPBBATIOK  FOB  PULSATING  TCMOUB  OF  THB 
TBMPOBAL  BBGION  OF  TWSMTT  TEAB8*  STANDING. 

Prof.  C.  Tblyxbton  Pxabson  (Cork)  showed  a  photo- 
|nph  and  read  a  report  of  a  case  of  pulsating  tumour  of 
vie  left  temporal  region,  on  which  he  had  successfully 
operated  in  October,  1894.  The  tumour  occupied  the 
entire  temporal  fossa,  and  was  bound  down  by  the  tem- 
^^ond  faema.  With  the  exception  of  a  few  fibres,  the 
temporal  mnsde  had  disappearad.  In  structure  it  consisted 
•of  ft  convoluted  mass  of  culated  and  tortuous  thin-walled 
Uood  veaaels,  which  were  so  fragile  that  they  would  bear 
neither  ligatnre  nor  compression  with  forceps.  The  entire 
insfls,  owing  to  the  great  severity  of  the  hsamorrhaf^  was 
est  away  with  the  Paquelin's  cautery-knife,  which  had 
also  to  be  inserted  into  a  fissure  in  the  coronal  suture, 
through  which  laive  vessels  of  communication  passed. 
The  tnmovr,  whicn  probably  originated  from  a  head- 
iDJary,  had  been  nearly  twentv  years  in  existence,  and  the 
■operation  was  undertaken  at  the  earnest  solicitation  of  the 
patient  ovnng  to  the  increasing  severity  of  the  symptoms, 
vhiefa  consisted  of  intense  pain  either  on  stooping  or 
throwing  the  head  back,  insomnia,  dizziness,  throbbing 
eeneations,  and  inability  for  occupation.  The  aneurvsm 
WM  supplied  chiefly  by  the  middle,  meningeal,  and  aeep 
temporu  arteries.  The  patient  is  now  in  excellent  healUi, 
his  no  pain  or  other  disagreeable  sensation,  and  sleeps 

The  Pbbsidbnt  thought  that  it  was  not  possible  to  form 
a  disgnoeis  with  any  great  degree  of  certainty.  He  men- 
ttoeed  the  case  of  a  girl,  aged  seventeen,  with  a  pulsating 
tvmonr  at  the  junction  of  middle  and  lower  third  of  thigh. 
The  tumour  had  a  connection  with  the  bone.  There  was 
tremendons  hsemorrhage,  to  check  which  pressure  on  the 
femoral  trunk  above  the  tumoir  was  ineffectual.    The 


tumour  was  supplied  from  blood  vessels  in  the  bone.  He 
thought  amputation  at  the  hip-joint  was  the  right  pro- 
ceeding in  such  a  case. 

Dr.  BiNNKET  congratulated  Prof.  Pearson  on  his  case. 
He  would  like  to  know  from  Prof.  Pearson  whether  (1) 
there  was  any  bruit  heard  previous  to  operation  ;  (2) 
whether  pressure  on  the  carotid  was  carried  out  with  a 
view  to  stopping  the  bleeding  ?  Pressure  on  the  common 
carotid  couia  be  kept  up  so  completely  under  ansasthesia 
that  it  would  control  the  hssmorrhage,  at  least  for  a  time* 
Pressure  in  Hit  T.  Stoker's  case  would  be  of  no  use,  but 
things  were  different  in  tumours  of  this  kind  occurring  in 
the  head. 

Mr.  Ejendal  Franks  congratulated  Prof.  Pearson  on  his 
extremely  interesting  case.  He  asked  what  was  the  con- 
dition of  the  bone.  From  what  he  could  gather  there  was 
a  fissure  in  the  bone,  through  which  fissure  a  circoid 
aneurysm  existing  within  the  ekuU  was  continuous  with  a 
similar  aneurysm  outside  it. 

Mr.  Thomson  thought  that  one  of  the  most  interesting 
features  of  this  most  interesting  case  was  its  subsequent 
history,  as  detailed  by  Prof.  Pearson.  He  took  it.  of  course, 
that  what  was  removed  was  only  part  of  the  tumour,  for, 
from  what  he  could  gather,  he  believed  there  was  a  tumour 
within  the  skull,  perhaps  not  so  large,  but  of  the  same 
character  as  that  which  appeared  outside.  Now,  when 
Prof.  Pearson  removed  the  outer  portion  of  the  tumour, 
what  became  of  the  inside  portion  if  it  was  of  the  same 
character  ?  What  happened  in  Prof.  Pearson'^  case  pro- 
bably was,  the  sealing  up  of  the  vessels  on  the  outside  had 
the  effect  of  what  was  called  distal  ligature.  Prof.  Pear- 
son's difficulty  with  the  bsemorrbage  was  in  the  fact  that 
the  tumour  was  fed  by  vessels  inside  the  skull.  He  knew 
the  difficulty  of  getting  ligatures  to  hold  in  those  cases, 
but  he  was  not  sure  that  the  application  of  the  cautery 
would  be  a  reliable  method  in  the  next  case. 

Prof.  PsABSON,  in  reply,  expressed  his  thanks  to  the 
Academy  for  the  kind  manner  in  which  his  paper  was 
received.  In  reply  to  Prof.  Bennett,  he  said  thsre  was  no 
bruit  present.  Compression  of  the  common  carotid  was 
resorted  to  to  check  the  haemorrhage.  He  regarded  the 
case  not  as  one  of  pulsating  tumour  of  bone,  but  as  a  case 
of  aneurysm  by  anastomosis.  He  regarded  the  intra- 
cranial aspect  of  the  case  as  very  serious.  He  believed, 
with  Dr.  Thomson,  that  there  was  a  free  communication 
between  the  aneurysm  inside  and  that  outside  the  skulL 
He  mentioned  that,  in  bis  case,  the  bones  were  sound, 
though  much  thinned.  The  arteries  coming  through  the 
squamous  portion  of  the  temporal  bone  were  much 
dUated. 

tttbbbculab  diskasb  of  thb  hip  joint. 

Mr.  Swan  read  a  paper  on  this  subject.  He  reviewed 
the  pathology  of  the  affection,  and  quoted  statistics  from 
the  OrthofMMlic  Hospital  to  show  the  comparative  fre- 
quency of  hip-joint  oisease  in  hospital  beds,  as  opposed 
to  spinal  affections,  which,  although  positively  more 
numerous,  are  capable  of  being  treatea  more  easily  in 
their  own  homes.  This  he  accounted  for  by  the  greater 
frequencv  of  suppuration  and  its  coneequences,  in  hip 
cases.  He  reviewed  the  various  deformities  incidental  to 
the  disease  and  their  mechanics.  He  deprecated  the  pro- 
cedure of  removing  a  tubercular  deposit  m  the  trochanter 
or  neck  of  the  femur,  as  a  routine,  for  a  variety  of  reasons 
— ^the  difficulty  of  accurate  diagnosis,  the  danger  of  sepsis, 
and  the  retrogressive  changes  tending  towards  cure,  being 
a  few.— He  uiowed  an  ingenious  arrangement  for  easilv 
adapting  a  stirrup  extennon,  and  went  at  some  length 
into  the  application  of  that  remedy. 

The  Pbosidbnt  said  that  if  ever  there  was  a  paper 
calculated  to  elicit  discussion  it  was  this.  The  paper  was 
one  of  great  ability  and  the  result  of  great  practical 
experience.  One  of  the  most  interesting  matters  put 
forward  by  Mr.  Swan  was  his  dissertation  on  the  existence 
of  tubercle  in  parts  other  than  where  it  exhibited  itself. 
That  was  a  question  on  which  they  now  felt  certain.  There 
was  another  matter  on  which  he  entertained  a  growing 
opinion,  and  that  is  that  in  the  great  maiority  of  cases  <3 
tubercular  spine  disease  the  braes  are  the  centres  of  the 
affection.  The  disease  of  one  joint — the  knee -confirms 
him  in  this  opinion.  Many  cues,  known  clinically  as 
tubercular  svnovitis,  in  reality  belonged  to  the  osteal 
class ;  and  abscesses  regarded  as  of  the  soft  parts  were  old 
tubercular  abscesses,  originating  in  bone. 


138      ThI  MbDICAL  I'&lBB. 


TRANSACTIONS  OF  SOCIETIES. 


Feb.  5,  189S* 


1 


Prof.  C.  Y.  PXABSON  sapporfced  the  sUtmnmit  of  fche 
President,  that  moet  of  the  ceaee  regarded  aa  tabercular 
disease  of  the  synovial  membrane  have  really  there  origin 
in  the  bone. 

Mr.  Kbvdal  Franks  thought  that  the  bone  was  gener- 
ally the  starting  point  of  taberenlar  mischief.  He  luid  for 
vears  given  np  the  operation  of  arthrectomy.  In  oases  of 
knee-joint  disease,  where  the  ends  of  the  bones  looked 
healthy  and  the  disease  seemed  limited  to  the  soft  tissues, 
section  of  the  bone  generally  showed  an  abscess  in  the 
condyle  of  the  femur  or  head  of  the  tibia. 

Mr.  Thomsov  was  very  strongly  of  opinion  that  in  the 
vast  majority  of  taberenlar  diseases  of  joints,  the  cause 
was  due  to  injury.  But  in  many  cases  tne  injury  was  so 
slight  that  ir.  was  not  complained  of  until  damage  had 
been  done  to  the  bone. 

Dr.  Chavob  oongratalated  Mr.  Swan  on  his  paper.  The 
onlv  point  on  whidi  he  differed  from  him  was  in  regard 
to  his  treatment  by  adduction.  He  thought  Mr.  Swan's 
method  of  extension'  an  excellent  one,  but  inferior  to 
extension  by  a  wire  splint  he  described. 

Mr.  Swan  thanked  the  meeting  for  the  manner  in  which 
they  had  received  his  paper.  The  speakers,  he  said,  were 
unanimous  in  their  condemnation  of  arthrectomy.  He, 
too,  condemned  it. 


LARYNGOLOGICAL  SOCIETY   OF    LONDON. 
Annual  Gsnkral  Mbetino,  Januabt  8th. 

Db.  Fklix  Sbmon,  President,  in  the  Chair. 


Thb  Reports  of  the  Coancil  and  Treasurer,  which  were 
read  and  adopted,  showed  that  the  Society  was  in  a  very 
flourishing  condition,  there  being  now  over  a  handred 
members  belonging  to  the  Society,  and  the  financial  state- 
ment showed  a  very  satisfactory  balance  in  hand.  The 
following  were  elected  to  serve  as  Officers  and  Councillors 
for  the  ensuicg  year: — Prefident:  Felix  Semon,  M.D. ; 
Vice  Presidents  :  £.  Cresswell  Baber,  M.B.,  A.  Hodgkin- 
son,  M.D.,  Charters  Svmonds,  F.R.C.8.  ;  Treasurer :  W. 
Johnson  WaUham,  F.R.C  S. :  Librarian:  £.  Clifford 
BeaK  M.B.;  SeereUries:  W.  R.  H.  Stewart,  F.RC.S, 
St.  Clair  Thomson.  M.D. ;  Council:  J.  B.  Ball,  M.D.,  F. 
W.  Bennett,  M.D.,  J.  W.  Bond,  M.D.,  Scanee  Spicer, 
M.D.,  and  P.  Watson  Williams,  M  D. 

At  the  subsequent  ordinary  meeting  the  following  cases 
were  shown  : — 

Case  of  JSUateral  Abductor  ParalyMs  of  the  Vocal  Cord9 
in  a  case  of  bulbar  paralysis  complicated  by  progressive 
muscular  atrophy,  b^  the  Frvsidbnt.  The  patient,  a  man, 
set.  54.  Duration  of  illness  16  months  ;  commenced  aiter 
influenza  with  difficulty  in  swallowing  and  articulation, 
followed  by  progressive  weakness  of  right  arm  and  leg. 
There  has  been  ever  since  a  gradual  progression  of  the 
disease.  On  Nov  12th  the  following  note  was  made: 
During  quick  respiration  the  vocal  coras  stand  nearer  one 
another  than  under  ordinary  circumstances.  On  deep 
inspiration  no  farther  opening  of  the  glottis  takes  place. 
Movements  of  the  left  cord  are  distinctly  more  defective 
than  those  of  the  right.  On  phonation  complete  closure 
of  the  glottis  occurs. 

Cast  of  Myxo-Xjhondroma  of  Larynx,  by  Dr.  Bond.  A 
man,  st.  50,  had  the  whole  larynx  removed  in  September, 
1892,  the  tumour  weighei  Hi  drachms.  Eight  days  after 
operation  the  patient  eat  a  chop.  Bas  worn  an  artificial 
lu^nx  for  39  months.    There  is  no  sign  of  recurrence. 

Case  of  Epithelioma  of  Larynx,  by  Dr.  Bond,  for  Mr. 
Habyst.  On  August  14th,  1894,  the  whole  larynx  was 
removed,  together  with  numerous  glands.  Two  plastic 
operations  were  performed  later  on  to  cover  the  gap  above 
tne  site  of  the  artificial  larynx.  There  is  no  sign  of  recnr- 
ren<^. 

Case  of  Clonic  Spasm  of  Pharynx  and  Soft  Palate,  by  Dr. 
Bond.  Patien%  a  man,  set.  33.  The  pharynx  moves  in  a 
rapid,  rhythmical  manner  from  side  to  side,  and  the  left 
siae  of  seft  palate  is  drawn  up  and  down.  The  patient 
had  no  idea  the  throat  was  affected. 

Dr.  C.  Bkale  considered  that  corea  of  pharynx  was  a  mis- 
nomer. 

Specimen  of  Nasal  Polypus  of  Unusual  Size  removed  from 
the  Nato-Pharyvx  ofanAdtdt,  by  Dr.  Bbonnsb. 

Case  for  Diagnosis,  by  Dr.  Coupib  Cbipps.    W.  S.,  ast. 


to,  presents  a  smooth  elastic  swelling  about  half  the  saae 
of  a  hasel-nnt  on  the  left  side  of  the  thyroid  cartilage  oc 
several  years'  growth  ;  larynx  normal,  but  there  ii  a  con- 
siderabie  increase  of  the  lymphoid  tissue  at  the  bass  of  the 
tongue. 

Mr.  C.  Sthonds  thought  the  case  one  of  either  a  thyroid 
or  a  hyoid  cyst. 

Microscopical  Specimens  and  Drawings  of  two  Cases  of 
Malignant  Disease  of  Tonsils,  by  Dr.  David  Niwman.  One 
was  a  case  of  epithelioma  of  left  tonsil ;  left  posi«rior 
pillar  and  uvula  in  a  man,  et.  55.  The  other  one,  of  car- 
cinoma of  left  tonsil  and  soft  palate  in  a  woman,  et.  51. 

Mr.C.  Stmonds  congratulated  Dr.  Newman  on  hissoocew 
in  these  cases,  and  asked  how  he  had  operated,  if  it  were 
possible  to  do  so  through  the  mouth  alone  ?  Recur- 
rences so  frequently  occurred  in  the  glands  that  be  had 
determined  to  dissect  out  the  neck  whether  or  no  the 
glands  were  enlarged. 

Dr.  NswMAN,in  reply,  stated  that  in  one  case  under  c» 
caine,  and  in  the  other  under  chloroform,  he  had  removed 
the  growth  and  a  large  amount  of  healthy  tissue  around 
with  the  galvano-oautery. 

Ttco  cases  of  Tubercular  Laryngitis  in  which  complete  re- 
covery took  place,  by  Dr.  David  Nswman.  Both  were  oases 
of  primary  tuberculosis  of  the  larynx  in  which  the  lungs 
became  secondarily  affected.  One  was  et.  29,  the  other,  19. 
The  treatment  adopted  in  both  cases  was  a  carefully  re^j 
lated  diet,  a  warm  moist  atmosphere  impregnated  with 
menthol,  terebene  and  eucalyptus,  spraying  *^®Jf7y 
with  cocaine,  and  when  sufficient  annsthesta  was  produced, 
a  spray  of  a  concentrated  solution  of  iodofonn  in  equal 
parts  of  alcohol  and  ether  was  used— at  first  twice  daily— 
and  afterwards  three  times  a  day. 

Case  of  Abductor  Paralysis  with  Laryngeal  Criaes,  by 
Mr.  C.  A.  Parkik.  W.  W.,  et.  32,  a  porter,  woke  up  one 
night  threeor  four  years  ago  with  difficult  breathing,  benme 
worse,  and  suddenly  lost  consciousness,  and  remained  so 
for  two  minutes,  when  he  recovered  he  could  breathe  quite 
well.  Had  five  other  similar  attacks  at  intervals  of  sn 
months.  Examination  showed  left  vocal  cord  fixed  in  the 
middle  line  right  did  not  abduct  beyond  cadaveric  pon- 
tion  ;  no  knee-jerks,  gait  unsteady,  no  history  of  syphilis. 
Laryngeal  symptoms  still  remain  ^e  same  ;  tabetic  sym- 
ptoms more  marked. 

Microscopical  Sections  qf  WaHy  Growth  oj  Suapiciaus 
Nature  on  Left  Vocal  Cord,  by  Dr.  Soanib  Spicm. 
Patient  was  shown  at  November  meeting.  Growth  wm 
removed  under  cocaine.  Histological  report  by  Dr.  T.  H. 
R.  Crowle  showed  the  nodule  to  be  of  inflammatory  origin, 
the  inflammation  evidently  being  of  a  very  chronic  and 
long  duration. 

Case  of  Fibroma  (  ?  Ftbro-sarcoma)  of  Cartilaginous  Septum 
with  microscopical  section,  by  Dr.  St.  Claib  Thomson. 
Patient,  ©t.  29,  suffered  from  epistaxis  off  and  on  for  poms 
years.  An  irregular  ovoid  lobulated  growth  growing  from 
the  cartilaginous  septum  was  removed  from  the  right 
middle  meatus  with  a  snare,  three  weeks  after  there  waa 
distinct  proliferation  of  the  root. 

Mr.  Spencbb  did  not  think  that  it  was  distinctly 
sarcomatous. 

Mr.  Stmonds,  Dr.  Newman,  Mr.  Wagoitt,  and  Mi: 
Stbwabt  thought  it  was  a  sarcoma.  At  the  suggeetaon  of 
the  latter  it  was  sent  to  the  Morbid  Growths  Committee. 

Case  of  Inter  arytenoid  Pachydermia  laryngis,  by  Dr. 
H.  TiLLKT.  Patient  was  shown  last  year.  Under  aa 
'  application  of  an  80  per  cent,  solution  of  lactic  acid  hsr 
condition  was  much  improved. 
'  Laryngeal  case  for  Diagnosis,  by  Dr.  H.  Tnurr* 
Patient,  a  man,  «t.  61,  has  granulation  masses  on  the 
vocal  processes  lasting  twelve  months.  Vocal  cords  ara 
movable— larynx  very  red  and  congested. 

The  Pbbsidbnt  thought  it  was  either  syphilitic  or  ai» 
ordinary  inflammatory  growth. 

Case  of  Probable  Intrinsic  Carcinoma  of  the  Larynx^ 
by  Dr.  Dundas  Grant.  J.  W.,8Bt.  46.  had  hoarseness  and 
difficulty  of  breathing  for  two  years.  Examination  showed 
a  distortion  of  left  side  of  epiglotis,  swelling  and  immc^ 
bility  of  left  arytenoid,  left  ventricular  band  red  and 
infiltrated,  and  below  it  covering  the  greater  portion  of  the 
cord,  a  pale  granular  swelling. 

The  PBI8IDKNT  suggested  immediate  thyrotomy  sad 
tliorough  removal  of  contents. 


IMB.  5,  1806. 


FRANCE, 


Thb  Mmdioal  Psns.     139 


THE  DSRUAT0L06IGAL  80GIET7  OF  OREAT 

BRITAIN  AND  IRELAND. 

MssnNa  Hjnj>  Wkdmisdat,  Januabt  22En>. 

The  P^pendent,  Dr.  Pts-^Smixh,  in  the  Ghftir. 


Thb  Pshdkit  showed  a  well-marked  caae  of  the  rare 
eonditioQ  known  as 

wrooeas  fuhooidss. 
The  patient,  a  man,  et  27,  had  suffered  from  the  affec- 
tion lor  three  years.  He  was  improving  somewhat  under 
ths  application  of  iodoform  powder  and  a  strong  lead 
bftioo,  and,  so  far,  had  not  saffered  in  general  health. 
Dt.  Pye-Smith  remarked  that  this  was  the  myeosia  fan- 
ffoidee  of  Alibert,  and  others  wonld  call  it  a  sarcoma,  bat 
M  sfaoold  be  inclined  to  call  it  a  granvioma  f  angoidee.  In 
saother  ease  he  foand  sections  of  the  tamoar  resembled  a 
lOond-oeUed  sarcoma. 

Dr.  Datid  Walsh  showed  a  case  of  Symmetrical  Shin- 
Bsldnees  occorring  in  a  man,  who  for  the  past  two  years 
had  areata  patches  on  the  scalp,  chin,  and  sides  of  the 
Ivynx.  The  patient  stated  that  the  hair  was  formerly  so 
hmg  over  the  shins  that  he  was  "able  to  comb  it."  There 
was  some  irritation  in  front  of  the  legs,  and  the  hair  fell 
offshorUy  before  the  bald  patches  appeared  on  the  head. 
Br.  Walsh  remarked  that  this  case  mast  be  regarded  in 
the  ^gfat  of  a  preliminary  commanication.  A  slight  inves- 
tigilion  ahowed  that  the  normal  distribation  <3  hair  on 
kgs  Taried  considerably.  In  some  places  the  hair  became 
labbed  off  by  the  friction  of  clothing.  That  fallacy,  how- 
ever, a{^ieared  to  be  exdaded  in  the  case  shown  before  the 
Sooety,  as  the  man  wore  drawers  and  socki*.  He  had 
Iband  another  similar  case  of  shin-baldness  in  a  patient 
St  the  Western  Skin  Hospital,  who  also  saffered  from 
•bpeda  aieata  of  the  scalp.  Mr.  Waren  Tay  had  also 
observed  a  caae  at  BUckfriars.  In  these  cases  symmetry 
WM  worthy  of  special  notice,  as  pointing  to  a  possible 
tnpho-nenrotic  origin.  If  alopeda  areata  be  a  tropho- 
marosifl,  as  maintained  by  Kaposi  and  others,  and  if  this 
rina-baldnees  be  connected  with  the  scalp  condition,  then 
wihadm  that  definite  symmetrical  affection  a  factor  of 
nlae  bearing  on  the  theory  of  neoro-pathogenesis.  Shin- 
bsldnees  might  possibly  be  connected  with  the  class  of 
CMSS  mentioned  by  McCall  Anderson  and  others,  in 
wiiich  vitiligo  sapervened  on  the  alopecia  areata.  The 
case  was  brooght  before  the  Society  as  saggestive  of  f atare 
iaqairy.  Any  obeervation  on  alopecia  8raat»  seemed 
rathy  of  attention,  becaose  of  the  difference  of  opinion 
tlist  existed  among  dermatologists  as  to  its  real  natare 
aod  origin. 

Dr.  Walsh  also  showed  a  case  of  Alopecia  Areata  in  a 
vQBum,  »t.  39,  in  which  the  bald  patches  had  been  preeent 
for  nine  years.  Some  of  them  had  beomie  covered  with 
bsir,  bat  others  showed  a  deep  atrophic  condition,  and 
ihe  soJp  in  thoee  places  resembled  a  tender  sabcataneoas 
eiestriz.  There  had  been  a  history  of  severe  long-continaed 
aeenlgias  and  migraine.  The  condition  appeared  to  be  a 
mized  one,  doe  to  (1)  alopecia  areata,  with  associated 
■moiy  changes ;  (2)  chronic  seborrhcea  capitis ;  (3) 
■trophy  of  sabcataneoas  tissaes.  Latterly  the  patient  had 
dsTsloped  pedicnli  otitis,  and  had  become  sallow  and 


Dr.  Walsh  showed  a  woman,  st.  43,  with  a  well-marked 
SeborriKBic  Dermatitis  on  the  Body  and  Legs.  The  rash 
b(9gsn  on  the  abdomen.  It  ooneisted  of  nameroas  papales, 
tings  and  gyrate  fawn-coloared  patches  ;  the  rings  were 
nim  at  the  edgee.  which  were  formed  of  small  papales, 
nd  eoaleeoed  in  plaoea.  There  was  little  irritation  with 
the  rash,  which  had  lasted  foar  or  five  weeks,  and  ^iras 
yieUing  rapidly  to  local  antiseptic  treatment.  There  was 
so  associated  seborrhcea  of  the  scalp,  which  was  dry,  scaly, 
sad  initable,  while  the  hair  was  thin,  dry,  and  lastreless. 
The  chief  point  of  interest  about  the  case,  assaming  it  to 
be  aseborrhcuc  dermatitis,  was  its  oocarrence  on  the  legs. 
In  speaking  of  this  affection  Dr.  Crocker  said,  in  the 
ssoond  edition  of  his  book  on  <*  Diseases  of  the  Skin,"  "  the 
Hfflbe,  except  where  they  join  the  trank,  are  never 
•Ifected."  ^ 

Dr.  Abkaham  said  that  two  years  since  he  drew  atten- 
tion to  tiie  common  oocarrence  of  thin- baldness  in  alopecia 
sissta  esses,  which  he  attribated  to  seborrhcea,  tinea,  and 
nerve  lesiona  He  oonoladed  at  the  time  there  was  no 
ennnection  between  the  two  conditions. 


Dr.  BowuB  mentioned  a  case  in  which  the  hair  saddenly 
fell  off  both  legs  after  some  little  itching.  The  condition 
was  limited  to  the  legs. 

Dr.  ISddowb  did  not  recognise  the  term  seborrhoeic 
dermatitis.  The  case  shown  by  Dr.  Walsh  he  shoald  cidl 
the  seborrhoBic  eczema  of  Unna,  an  affection  which  com- 
monly attacked  the  limbs. 

Dr.  Ptb-Smith  pointed  oat  that  Unna  had  extended  the 
term  seborrhoea  fur  beyond  the  limits  nsaally  adopted  by 
English  dermatologists. 

Dr.  Abraham  showed  a  boy  saffering  from  Keratosis 
FoUicalaris.  Nameroas  patches  of  groaped  comedones 
appeared  on  the  back,  thighs,  and  legs.  A  few  were 
scattered  here  and  there  over  the  face.  There  was  a 
history  of  pedicnli  corporis. 

Dr.  Savill  showed  two  yoang  women  from  Mr.  Ta/s 
Clinic  at  Blackf  riars.  Both  exhibited  recnrrent,  chronic, 
and  relapsing  patches  of  erythema  on  the  face.  In  one 
instance  the  condition  had  qaite  cleared  ap  at  times  ander 
the  ase  of  thyroid  gland. 

Dr.  Stowbbs  showed  a  boy  saffering  from  Ckmgenital 
Ichthyosis.  He  was  nine  years  of  age,  and  had  been 
affected  since  he  was  five  months  olcL  There  was  no 
family  history. 

Dr.  Abraham  foand  thyroid  had  a  bettor  effect  in  this 
condition  than  in  psoriasis. 

Dr.  Maokat  advocated  the  innnction  of  simple  vaseline 
and  the  ase  of  thyroid  gland.  He  asked  if  any  members 
knew  cases  among  good  class  patients. 

Dr.  Ptx-Smith  mentioned  a  severe  and  chronic  case  in 
an  Eton  boy. 

Dr.  Stowsbs  showed  two  syphilides,  one  oi  which  had  a 
peoriasis-like  patch  on  back.  He  also  showed  a  patient 
with  a  hypertrophic  or  verrncoee  eczematoas  patch  on  the 
leg,  and  other  oases. 

Dr.  Pebnht  annoanced  a  short  paper  with  some  farther 
details  as  to  the  etiology  of  acate  pemphiffa^ 

A  paper  by  Dr.  Eddowes  on  Warts  of  die  Feet  was  de- 
ferred owing  to  want  of  time. 


J§XBXitZ. 


[niOM  CUB  OWN  GOBBXSFONPBKT.] 

PAJUS,  reb.  lit,  1896. 

Mo&phinomania. 

At  the  Academy  of  Medicine,  M.  Laborde  read  a 
report  from  a  oolleagae  on  the  treatment  of  57  ca^es  of 
morphinomania  by  rapid  sappression  of  the  drag.  Of  the 
total  nnmber  of  persons  addksted  to  this  habits  24  were 
women,  and  amongst  the  men  were  15  doctors.  The  ages 
were  between  twenty-five  and  forty.  In  the  majority  of 
cases  the  habit  was  contracted  by  asing,  at  first,  the  mor' 
phia  for  therapeatic  parposes,  and  the  doses  ranged  from 
2  to  40  grains.  Alcoholism  was  preeent  in  six  cases,  while 
cocaine  was  taken  conoarrently  with  the  morphia  in  eight 
instances.  Of  the  57  patients,  38  were  followed  ap  sinoe 
their  care.  Six  of  these  persons  relapsed,  and  three. of 
them  retnmed  to  snbmit  to  the  treatment,  proving  that 
the  saffering  attribated  to  the  rapid  sappression  of  tJie 
drag  was  not  so  frightf al  as  was  soppoeed. 

To  resame,  the  aathor  of  the  report  and  of  the  treat- 
ment estimates  that  the  method  of  rapid  sappression 
gaarantees  against  relapses,  provided  that  the  patients 
consent  to  remain  ander  treatment  two  months ;  that  the 
method  did  not  reqaire  any  physical  contention,  and  that 
it  provokes  neither  mortal  accidents  nor  violent  pains»  as 
are  sometimes  reported  where  the  sappression  was 
sharp. 

AbSGBSS  Of  THB  LrvxB. 

M.  Ricard  read,  in  the  name  of  an  absent  member,  a 
paper  on  the  treatment  of  hepatic  abscees  before  the  Sur- 
gical Society.  Of  the  six  oases  reported  three  wereconse- 
cative  to  chronic  dysentery.  The  parulent  oeUeetien  in 
each  case  was  seated  behind,  necessitating  a  large  resection 


140    Thb  Mbdical  Psns. 


FRANCE, 


Feb.  5y  1809. 


of  the  ninth  and  tenth  ribe.  la  the  remainder^of  the  ceaee 
the  inoiBioQ  was  made  in  front,  and  the  coverings  attached 
to  the  walls  of  the  wonnd  to  enable  the  pnralent  caWty 
to  be  well  washed  ont  after  section.  Some  of  the  patients 
recovered,  only  in  one  case  did  a  fistula  persist  a  short 
time. 

EXTRA-CTIRINB  PRBOVAVOT. 

M.  Pioqn^  read  an  aoconnt  of  three  cases  of  uterine 
pregnancy.  The  ficst  case  was  that  of  a  woman  of  thirty- 
three  who  entered  the  hospital  for  obstinate  monorrhagia. 
A  closer  examination  revealed  the  existence  of  pregnancy 
in  the  right  tube.  Vaginal  hysterectomy  was  performed, 
and  the  patient  rapidly  recovered.  The  second  case  was 
eomewhat  similar,  but  the  third  was  more  interesting,  in 
that  the  foetus  had  already  attained  seven  months  when 
its  abnormal  position  was  discovered.  The  condition  oi 
the  patient  being  very  critical,  it  was  thought  better  not 
to  defer  interference,  laparotomy  was  performed,  and  the 
foetus  extracted  without  difficulty.  The  placenta  was  not 
touched. 

In  commenting  on  these  cases,  M.  Picqu^  said  that  oon- 
fnsion  frequently  occurred  between  hematocele  and  extra- 
uterine pregnancy,  many  thinking  them  to  be  one  and  the 
same  thing,  whereas  they  are  absolutely  distinct.  As  regards 
intervention  in  extra-uterine  pregnancy,  everyone  was 
agreed  on  the  necessity  of  removing  it  each  time  it  was 
diagnosed  at  its  commencement.  Where  it  was  four  or 
five  months  old,  and  where  the  mother  suflers  no  incon- 
venience from  the  abnormal  position,  a  chance  might  be 
given  to  the  child.  The  accidents  always  to  be  feared  in 
these  cases  are  rupture  and  haemorrhage. 

Extra- Utebins  Pbegnanoy. 

The  last  meeting  of  the  Seci^t^  Ghimrgicale  was 
entirely  aevoted  to  the  discussion  on  the  treatment  of 
extra-uterine  pregnancy. 

M.  Rentier,  who  was  the  first  to  speak,  said  he 
thought  they  were  pretty  well  agreed  on  the  fact  that 
there  existed  only  one  treatment  for  extra- uterine  preg- 
nancy, and  that  was  laparotomy.  For  his  own  part,  and 
with  a  view  of  diminishing  the  danger  for  the  mother, 
he  would  not  allow  such  cases  to  arrive  at  the  seventh  or 
eighth  month  ef  their  evolution.  There  were  cases  where  the 
abdominal  tumour  was  difficult  to  diagnose,  and  where 
one  hesitated  between  a  simple  cyst,  a  fibrome,  a  dermoid 
cyst,  a  salpinx,  or  an  extra-uterine  pregnancy.  It  was 
only  by  the  attentive  study  of  the  concomitant  phenomena 
that  a  correct  diagnosis  could  be  arrived  at.  It  was  thus 
that  he  was  able  in  four  cases  to  arrive  at  a  correct 
opinion,  operate,  and  save  his  patients.  The  first  case 
was  a  pregnancy  of  five  months ;  by  laparotomy  the  whole 
cyst  was  removed  with  its  contents,  the  patient  recovered 
quickly,  and  two  years  after  was  confined  normally.  In 
the  second  case  the  pregnancy  was  about  three  and 
a  half  months,  when  he  had  opened  the  abdomen 
he  found  that  the  foetal  cyst  was  enclosed  in 
a  large  cavity  of  hsematooele,  in  the  middle 
of  which  floated  the  extremity  of  the  Fallopian  tube 
greatly  thickened  by  inflammation.  The  bsematocele  was 
Situated  in  the  right  iliac  fossa,  and  was  only  limited  by 
the  intestines  bound  together  by  false  membranes.  Th® 
third  case  was  somewhat  similar.  He  had  treated  a  patient 
by  rest  after  curettage  for  haemorrhagic  metritis  in  February, 
1894.  On  the  3rd  July  following,  she  was  seissed  with  a 
violent  pain  in  the  abdomen,  and  entered  the  hospital,  i 
The  uterus  was  found  to  be  fixed  by  a  large  tumour,  be-  ! 
g  ing  to  the  Fallopian  tube  on  the  left  side.   A  few  days  ' 


afterwards,  by  laparotomy  he  discovered  that  the  tube  had 
given  way  close  to  its  insertion  into  the  atoms,  and  that  a 
large  haematocele  had  formed  around  the  foetal  cyst.  The 
fourth  and  last  case  presented  no  striking  featare. 

Although  cases  of  extra-uterine  pregnancy  proeenting 
all  the  symptoms  of  an  abdominal  tumour,  and  more  or 
less  easy  to  diagnose,  are  far  from  being  rare,  much  more 
numerous  are  those  of  retro-uterine  hsematooele.  He  did 
not  refer  to  those  cases  which  suppurate,  although  he  was 
satisfied  that  the  greater  number  of  large  retro-nterine 
abscesses  had  no  other  origin.  Of  126,  in  which  he  had 
to  interfere,  he  would  only  speak  of  24  cases  of  hematocele 
which  he  had  opened  through  the  vagina,  removing  black 
clots,  and  with  them,  in  three  instances,  a  foetus  from  five  to 
ten  inches  long.  In  oneof  thesecases,  notably,  he  diagnosed  a 
retro-uterine  hsematocele  in  a  woman  of  thirty-one,  in  whom 
the  menses  had  been  suppressed  already  two  months.  He  in- 
cised the  tumour  in  the  posterior  cul-de-sac,  and  removed  a 
quantity  of  black  clots,  and  although  he  thought  be  had 
felt  a  foetus  he  could  not  find  it.  Fearing  bsmorrhi^e  he 
did  not  dare  to  remove  all  the  clots  and  placed  two  drain- 
age tubes  in  the  cavity.  Twenty  days  afterwards  a  foetus 
of  rix  inches  long  came  away  with  an  injection.  He  lost 
none  of  the  twenty -four  patients  thus  operated,  although 
in  one  case  the  haemorrhage  was  so  serious  as  to  neoessitate 
compression  of  the  aorta,  while  the  cavity  was  being 
plugged.  In  condnding,  M.  Rentier  said  that  when  the 
haematocele  had  not  yielded,  after  four  or  five  weekp,  to 
absolute  rest  in  bed,  ice  on  the  abdomen,  hot  injections, 
and  repeated  purgatives,  the  tumour  should  be  incised 
through  the  vagina,  without,  however,  scraping  too  much 
the  rails  of  the  cavity  for  fear  of  haemorrhage.  Liaparo- 
tomy  should  be  reserved  for  the  abdominal  tumour  leading 
to  believe  the  existence  of  an  extra- uterine  pregnancy. 

M.  Schwartz  said  he  agreed  entirely  with  his  learned 
coUesgue.  When  a  surgeon  was  in  presence  of  a  still 
unbroken  tubal  pregnancy  and  which  might  be  taken  for 
a  salpingitis^  laparotomy  was  the  only  operation  to  be 
thought  of.  When  an  haematocele  followed  a  rupture  of 
the  tube  and  that  the  tumour  pointed  in  the  abdomen,  the 
same  operation  was  indicated,  while  the  vaginal  incision 
was  reserved  for  those  cases  where  the  tumour  was  felt  in 
the  posterior  cul-de-sac. 

Id.  Segond  spoke  on  the  complications  of  extra-uterine 
pregnancy  of  which  the  most  dangerous  was  haemorrhage 
into  the  peritoneal  cavity,  and  for  which  laparotomy 
should  be  performed  without  delay.  Where  the  haemato- 
cele was  found  behind  the  uterus  incision  through  that 
part  should  be  made,  and  the  clots  removed,  paying  do 
attention  to  the  placenta.  Where  the  haematocele  suppu- 
rated vaginal  hysterectomy  was  indicatei. 


At  a  recent  theatrical  performance  given  by  Sir 
Henry  Irving  and  Miss  Ellen  Terry  and  their  Com- 
pany for  the  benefit  of  the  Jefferson  Maternity  Hos- 
pital, Philadelphia,  the  large  sum  of  X600  was  realised. 

In  consequence  of  the  prevalence  of  diphtheria  in 
Strood,  the  sanitary  authorities  have  decided  to  close 
the  Strood  Hill  Schools  for  three  weeks. 

Dr.  G.  Hbrbebt  Hopkins,  of  Swansea,  who  is 
about  to  leave  for  Brisbane.  Australia,  was  last  week 
presented  with  a  purse  of  gold  subscribed  by  his 
fellow  practitioners  in  the  town. 


Fta.  5.  1896. 


THE  NEW  PHDTOGHAPHY. 


Th*  Mbdioal  Pbxss.     1*1 


THE    MEinr    PHOXOGRKPHLY. 


SHADOW  PHOTOGRAPH  OF  A  LIVING  HAND. 
The  above  photograph  (for  which  we  are  indebted  to  the  Royal  Photographic  Society)  was 
produced  by  Mr.  J.  William  Gifford,  with  an  exposure  of  ten  minutes.  In  it  the  bones  and  their 
tfticulations  will  be  readily  seen,  the  peculiarity  of  the  R5ntgen  discovery  being  exhibited  in  the 
penetration  by  the  rays  of  the  fleshy  portion  of  the  hand,  and  its  almost  entire  absence  in  the 
pliotograph.  Thus,  the  ring  on  the  second  finger  stands  prominently  out,  as  though  no  flesh  were 
there  to  support  it.  The  influence  of  this  discovery  on  the  surgery  of  the  future  can  only  be  vaguely 
imagined  in  these  early  days ;  but  its  utility  in  the  search  for  bullets,  splintered  bones,  and  foreign 
bodies  is  already  assured. 


142     Thx  Mxdioal  PbX88. 


GERM  ANY. 


Fib.  6,  1806. 


iVBOU  OUB  OWN  CX>BIUBBP01IDXI1T.] 

BlEUir,  F«b.  Ut. 
lODINB  IN  THB  ThTBOID  GlAND. 

Baumann  recently  reported  that  he  had  found  iodine  in 
large  quantities  in  the  thyroid  glands  of  sheep  and  pigs, 
and  also  in  the  human  subject,  and  that  the  quantity 
amounted  to  10  per  cent.  Hr.  Ewald,  at  the  meeting  of 
the  Society  for  Innere  Medizin  noted  that  as  this  iodine 
must  also  be  present  in  dried  preparations  of  the  gland  he 
had,  therefore,  made  an  examination  of  the  English 
thyroid  tablets.  He  examined  12  of  these  by  Baumann's 
process,  and  arrived  at  results  identical  with  those  of  the 
discoverer,  %,€.,  the  tablets  also  contained  a  large  quantity 
of  iodine. 

RoiiTGKN's  Bats  Aoain. 

Hr.  Jastrowitz,  of  whom  I  wrote  in  my  last,  again 
appeared  before  the  same  society,  and  showed  a  negative 
that  had  been  taken  by  Hr.  Spies,  Director  of  the  Physical 
Department  of  the  Urania.  The  photograph  represented 
a  piece  of  lead  of  an  inverted  V  rhape  that  lay  inside  a 
wooden  box. 

Hr.  Gluck  reported  on  a  series  of  cases  of 
Extirpation  of  the  Labtnx. 

The  cases  were  13  in  number,  and  in  all  the  operation 
was  performed  on  account  of  malignant  disease.  In  some 
the  extirpation  was  only  partial ;  six  of  the  cases  died  and 
seven  recovered  and  remained  along  time  free  from  return 
of  the  disease.  Considering  the  dangers  of  the  operation 
—cardiac  paralysis,  pneumonia  in  consequence  of  sever- 
ance of  the  recurrent  nerve,  and  septic  infection — were 
good.  As  regarded  technique,  the  tampon  cannula  of 
Trendelenburg,  and  Hahn's  cannula  were  of  great  service. 
Three  years  ago  the  speaker  bad  proposed  a  method  of 
operation  whereby  these  appliances  would  be  rendered 
unnecessary  and  the  after  treatment  easier,  viz.,  the  pre- 
liminary transverse  section  of  the  trachea,  and  the  drawing 
of  it  out,  with  the  insertion  of  a  cannula.  After  extirpaticm 
the  larynx  was  tamponnaded.  The  method  had  been 
adopted  in  France  and  carried  out  frequently.  He  then 
showed  a  patient  who  by  means  of  an  artificial  larynx 
could  speak  quite  distinctly. 

Dr.  Gottschalk  then  showed  preparations  from 

A  Cask  of  Intba-Pebitokkal  Betbo-Utebinb  Absosss. 
The  abscess  was  situated  as  already  implied  in  Douglas's 
space,  and  was  the  size  of  the  fist.  It  was  treated  by 
incision  of  the  posterior  laquear  and  drainage.  The 
abscess  cavity  then  dosed.  Shortly  after  this  a  round 
ulcer  of  the  stomach,  that  till  then  had  been  unsuspected, 
burst,  with  internal  hsBmorrhage.  The  uterus  had  been 
pushed  high  up  by  the  abscess  above  the  pelvic  inlet  The 
speaker's  impression  was  that  the  tumour  would  prove  to 
be  an  encapsuled  abscess  of  gonorrhoeal  origin.  The 
abscess  was  incised  on  November  26th.  The  tem- 
perature fell  on  the  second  day,  and  the  case  progressed  so 
rapidly  that  the  drainage  was  not  continued  after  the 
13th.  On  the  16th  she  was  allowed  to  get  up,  but  she  felt 
faint  on  getting  out  of  bed,  and  returned  to  it.  On 
December  12th  black  fasces  were  passed,  and  on  the  follow- 
ing day  she  vomited  blood.  The  diagnosis  of  ruptured 
nlen  ventrionli  was  now  made,  and  rectal  feeding  was 
begun.  The  patient's  condition  got  gradually  worse,  and 
the  abdomen  became  moderately  distended.  Death  took 
place  on  the  30th.    At  the  autopsy  a  moderate  amount  of 


recent  peritonitis  was  found,  but  tztensive  signa  of  dd       ! 
peritonitis,  not  only  in  the  pelvis,  but  over  the  liver.    The       I 
ulcer  of  the  stomach  was  situated  near  the  lesser  cnrra. 
ture,  about  2  otm.  from  the  pylorus,  and  was  3|  by  1  otnu 
in  size. 

A  second,  but  old,  also  perforating  ulcer,  was  aitoatad 
immediately  behind  the  pylorus,  on  the  posterior  wall  d 
the  duodenum.  The  pelvic  inlet  was  so  mnoh  covered  id 
by  adhesions  of  the  sigmoid  flexure  to  the  posterior  pelvic 
walls,  that  the  genital  organs  were  not  visible  until  the 
adhesions  were  separated  and  the  sigmoid  flexure  drawn 
aside.  No  trace  of  the  ovaries  could  be  seen.  The  incision 
wound  in  the  posterior  vaginal  arch  had  contracted,  the 
abscess  cavity  was  quite  obliterated,  and  no  trace  of  pus 
was  present.  The  lesion  in  the  pelvis  was  therefore  quite 
independent  of  the  fatal  one  of  the  upper  part  of  the 
digestive  track. 

At  the  meeting  of  the  Medical  Society  of  the  15th  ult, 
Hr.  Unusemann  showed  an  interesting  specimen  of 

Multiple  iNXEsnitAL  Divxbtioitla. 

The  preparation  was  taken  from  a  man,  sBt.  85,  who  died  , 
of  pneumonia.  There  was  no  history  of  intestinal  catarrh 
or  indeed  intestinal  trouble  of  any  kind.  At  the  autopsy 
also  there  was  no  indication  of  intestinal  catarrfat 
or  other  morbid  changes.  The  intestines  were,  however, 
occupied  by  a  large  number  of  diverticula,  varying 
in  size  from  an  oat  com  to  a  pigeon's  egg.  There  were 
from  3  to  400  of  these  diverticula,  some  in  the  duodenum, 
but  most  of  them  in  the  jejunum,  in  the  ileum  they  were 
less  numerous.  There  were  none  in  the  vermiform  appen- 
dix, but  they  were  present  in  the  ascending  colon,  in  ths 
descending  the  number  increased,  the  number  being 
greatest  in  the  sigmoid  flexure.  In  the  small  intestine 
they  were  mostly  situated  on  each  side  of  the  mesenteric 
attachment.  The  interesting  feature  about  them  was  tbst 
a  certain  relationship  could  be  recognised  between  them 
and  the  blood  vessels,  i.^,,  the  smaller  vessels  either  ran 
over  the  diverticula  or  passed  into  the  mesentery  in  their 
immediate  vicinity.  On  examination  small  vessels  wen 
seen  running  into  the  diverticula,  and  this  was  so  constant 
that  they  could  always  be  felt  with  the  sound.  When  a 
sound  was  passed  along  a  vessel  it  passed  into  a  diverti- 
culum. It  could  be  seen  microscopically  that  where  the 
small  veins  passed  through  the  muscular  coat  a  weak  spot 
presented,  a  loetu  minoris  reeUtentieg,  which  became 
hollowed  out  at  the  spot  where  the  vessel  passed  throngb 
the  serous  coat.  This  condition  was  most  frequently  met  * 
with  in  the  aged. 

Hr.  Peiser  showed  a 

TuMouB  OF  thb  Tonsil, 
taken  from  a  girl  of  15,  in  Baginsky*s  Poliklinik.  The 
girl's  mother  stated  that  the  child  had  suffered  from  re- 
markable attacks,  every  time  it  coughed  it  got  no  air,  and 
it  had  the  feeling  as  if  something  flew  in  from  the  throat. 
Examination  ^oon  explained  the  riddle.  As  soon  ss  the 
tongue  was  depressed,  a  small  tumour  was  seen  attached 
to  the  tonsil  by  a  short  pedicle.  There  were  also  hyper- 
trophy of  the  tonsils  and  rhinopharyngitis.  It  was  dlflsr 
that  during  inspiration  the  tumour  was  drawn  in,  snd 
gave  rise  to  the  sensation  described.  The  tumour  wii 
readily  removed,  when  all  the  symptoms  subsided.  No- 
microscopic  examination  of  the  growth  had  yet  been  made, 
but  it  was  almost  certainly  a  fibroma  papillari  vermcosmn, 
as  in  the  case  described  by  Luschka  and  diagnosed  by 
Waldeyer. 


JPiB.  5,  iHbe. 


THE  OPERATING  THEATRES 


Thb  Mxdigal  Pbxss.     143 


^^nstm 


[FBOM  OUB  own    OOBBMPOITDBNV.] 

Vienna,  Feb.  Ut,  1806. 
Stphiutio  Sclebosib  fbom  a  Bitb. 
Fk>f.  Kxumahn  ebowod  &  patient  to  the  *'  Qenellgchaft " 
with  a  feypioal  Bderoris  on  the  hand  and  prononnoed  en- 
lufemant  of  the  glands  dtnated  immediately  above  the 
elbow,  eome  of  which  were  aa  large  ae  hazel  nata.  The 
hardening  followed  a  bite  from  an  antagoniat  in  a  scuffle 
shoot  fifteen  months  ago,  and  was  rapidly  sncoeeded  by 
a  sjpbilitic  exanthem,  papules  in  the  month,  and  on  the 
tonrils,  for  which  he  attended  the  clinic  as  an  outdoor 
patient. 

FSOROSPSKMOaiS  GUTANSA  VSGKTANS. 

He  presented  an4iier  case,  to  which  he  said  it  was 
diffienlt  to  assign  the  correct  nomendatnre.  Dernier,  at 
tbs  Dermatological  Congress,  1881,  excited  considerable 
I  on  a  similar  ca^e  which  he  designated  on  that 
psorospermosis  follicolaris  vegetans.  The 
appears  on  the  skin  in  the  form  of  a  universal 
enption  of  nodules,  apparently  in  the  foUicules  of  the 
ikio,  and  not  unlike  small  papular  syphilides,  or  favus. 

From  tbese  symptoms  and  carefully  prepared  sections 
of  the  skin.  Dernier  was  led  to  the  conclusion  that  the 
AangM  are  of  a  parasitio  nature,  and  that  the  psoro- 
ipermia  phenomena  are  nothing  else  than  a  degeneration 
of  the  epithelial  cells. 

Seomann  said  the  female  shown  was  »t.  17,  who  had 
always  enjoyed  good  health.  Two  or  three  years  ago 
cirealar  eruptions  appeared  on  the  neck,  breast,  abdomen, 
moie  particularly  in  the  axillary  and  inguinal  regions,  of  a 
groyieh  brown  colour,  and  with  a  good  deal  of  thickening. 
IntsrBpereed  among  these  forms  could  be  found  fine 
poiatsd  nodules,  of  a  dark  colour,  from  which,  when 
soatehed,  a  homy  layer  might  be  lifted  off.  In  some 
piaoes  they  appeared  like  condylomata,  in  others  as 
iDoUwooid  growths.  This  eruption  was  pretty  general 
oi«  the  entire  body,  but  more  abundant  over  the  sternal 
Rgion,  between  the  shoulders,  on  the  lateral  regions  of 
thethoraz,  and  the  dona  of  the  feet. 

It  is  now  evident,  from  the  clinical  and  pathological 
oxaminations,  that  this  disease  may  be  grouped  among  the 
bjpertiophied  cutaneous  maladies  with  implication  of  the 
estii,  epidermis,  and  their  adnexa,  bearing  a  close  relation- 
akip  to  hyperkeratosis,  of  which  ichthyoeis  is  an  example. 

RlTFTUBB  07  THB  BlOBFS. 

Baom  showed  a  case  of  ruptured  biceps  in  a  carpenter. 
Tbe  man  had  worked  for  many  weeks  after  the  acci- 
dsBt,  the  injury  having  been  overlooked  by  his  medical 
attsndant,  who  treated  the  patient  for  a  contusion. 
The  patient  was  55  years  of  age,  and  he  had  had  both  bones 
of  the  forearm  broken  a  year  ago.  This  was  treated  with 
gjpsmn  bandages,  Ac.,  and  union  took  place.  On 
tho  28th  of  November,  1895,  he  was  raising  a  block  of 
tiinbsr  with  rope  and  pulley  when  the  timber  suddenly 
liipped,  coming  in  violent  contact  with  his  arm,  which 
aemin^ytore  the  muscle.  When  viewed  anteriorly,  a 
awolling  about  the  size  of  an  apple  could  be  observed  lying 
in  the  middle  line  of  the  forearm,  with  a  deep  furrow 
ibora  On  searching  for  the  biceps,  the  internal  portion 
eonldbedisoovered  im  siiu,  while  the  external  was  retracted 
far  up  the  aim. 

The  ^rfnoal  subjective  symptom  seems  to  have  been 
pnsont  in  this  case,  viz^  Uie  feeling  of  sharp  pain,  as  if 
the  injured  part  had  been  heavily  struck  with  a  cane. 


He  was  able  to  raise  the  forearm  when  it  was  pronated/ 
but  unable  when  sopinated,  corresponding  with  partial 
rupture  of  the  muscle. 

According  to  Maydl's  statistics,  we  find  that  out  of  ar 
total  number  of  103  ruptures,  17  occurred  in  the  biceps, 
5  of  which  were  total,  6  partial,  and  the  remainder  undc 
termined. 

Htpkktbophy  of  thb  Pbostatb  awd  Castratioji. 

Schnitzler  showed  the  Society  a  case  where  he  had 
removed  both  testes  with  perfect  success  in  the  curing  of 
an  hypertropbied  prostate.  Before  the  operation  the 
patient  was  unable  to  urinate  voluntarily,  but  on  the 
following  day  passed  urine  easily,  and  he  has  not  sincsr 
the  operation  required  a  catheter. 


Wxt  (Dptratittg  ^Iwatrw. 

KING'S  COLLEGE  HOSPITAL. 

Two  Gases  of  Displagbd  Semi-Lunab  Gabtilaob.—  Mr. 
RosB  operated  on  a  young  soldier  who,  four  years  pre^ 
viously,  had  displaced  his  internal  semi-lunar  cartilage 
whilst  wrestling.  It  became  reduced  spontaneously,  but^ 
owing  to  the  limb  not  having  been  immobilised,  he  suffered 
frequent  recurrences,  which  incapacitated  him  from  his 
I  military  duties.  The  joint  was  at  that  time  opened  by  Mr* 
Rose,  and  the  internal  semi-lunar  cartilage,  which  war 
found  loose,  was  stitched  into  position  along  the  border  of 
the  tibia.  The  man  made  a  good  recovery  and  returned  to 
duty.  Eight  months  ago  he  twisted  his  knee,  and  the  dis* 
placement  recurred.  He  was  invalided  home,  and  admitted 
to  Ring's  College  Hospital  for  further  treatment.  The  joint 
was  again  opened  by  a  transverse  incision  along  the  line 
of  the  old  cicatrix,  and  the  dissection  carefully  carried 
down  to  expose  the  periphery  of  the  cartilage,  which  was 
found  contracted,  displaced,  and  shortened.  It  was  evi- 
dently no  longer  possible  to  stitch  it  into  position,  so  the 
ring  was  divided  and  the  two  ends  were  drawn  apart  and* 
stitched  to  the  periosteum  over  the  head  of  the  tibia  m 
such  a  way  as  to  prevent  them  from  slipping  back  between* 
the  ends  of  the  bones.  The  joint  was  carefully  closed,  and" 
the  limb  immobilised  on  a  splint. 

The  second  case  was  that  of  a  schoolmaster,  who  merer 
than  a  year  ago  displaced  his  external  semi-lunar  cartilage* 
at  football.  By  manipulating  hie  knee  he  reduced  the 
displacement,  but  owing  to  the  constant  recurrence  of  the 
accident  he  sought  surgical  advice,  and  was  admitted  to 
hospital.  The  joint  was  opened  in  the  same  way  as  in  the- 
previous  case,  but  on  the  outer  side,  the  ilio-tibial  band 
being,  of  necessity,  partially  divided.  The  margin  of  the 
cartilage  was  defined,  and  found  to  be  so  loosely  connected 
and  so  much  damaged  by  a  kind  of  splitting  process,  that 
it  was  Uiought  advisable  to  excise  nearly  the  whole  of  the 
outer  two-thirds,  a  proceeding  of  some  difficulty  as  regards 
the  posterior  portion.  In  this  case  a  temporary  drain- 
tube  was  left  in  the  joint  for  twenty-four  hours.  Mr.  Rose 
remarked  that  he  had  now  operated  on  several  similar 
cases,  and  with  the  most  gratifying  results,  and  he  looked 
upon  the  performance  of  the  operation  as  a  most  con- 
vincing proof  of  the  immense  advantages  of  antisepsis, 
without  which  such  a  proceeding  would  be  unjustifiable. 
He  laid  stress  on  the  perfect  quiet  and  the  position  of  the* 
limb,  namely,  an  elevation  at  an  angle  of  about  40  degrees,* 
which  should  be  maintained  for  about  ten  days  after  the 
operation. 

It  is  satisfactory  to  state  that  both  cases  are  progressing^ 
favourably. 


^1 


144    Tbb  Medical  Pbips. 


LEADING  AETICLE8. 


Fib.  5,1m. 


MIDDLESEX  HOSPITAL. 
NaPHBO-UTHOTOBfT.— Mr.  Blakd  Sutton  operated  upon 
a  man,  »t.  46,  who  bad  for  the  part  fifteen  years  raffsred 
from  pain  in  his  left  side  extending  to  the  pelvis.  At  first 
these  pains  nsed  to  come  on  at  an  integral  of  a  few  months, 
T>at  for  the  last  two  years  he  was  scarcely  ever  free  from 
them,  and  on  at  least  two  occasions  he  passed  a  small 
fragment  of  calcnlns.  There  was  no  dear  history  at  any 
time  of  hflBmataria.  His  bladder  was  carefully  sounded 
trat  no  stone  detected.  The  left  renal  region  was  very 
tender  to  pressnre,  and  was  fuller  than  osnaL  The  urine 
contained  slight  traces  of  pus.  The  usual  incision  was 
made  in  the  left  ilio-costal  space  and  the  kidney  carefully 
freed  from  its  capsule  and  drawn  into  the  wound  but  no 
stone  was  found  in  its  substance.  On  feeling  the  pelvis 
of  the  kidney  a  number  of  stones  were  detected.  An 
incision  was  then  made  in  the  convex  (posterior)  border 
of  the  organ ;  the  finger  passed  through  into  the  pelvis 
and  seventeen  calculi  were  extracted ;  two  were  equal  in 
size  to  a  shelled  walnut  and  the  remainder  were  as  big  as 
peas.  The  pelvis  was  dilated  but  the  renal  cortex  was  of 
normal  texture  and  the  kidney  itself  was  far  above  the 
average  size.  The  incision  in  the  renal  cortex  was  closed 
with  three  catgut  sutures,  the  divided  muscles  of  the 
back  reunited  with  buried  catgut  sutures,  and  the  skin 
brought  together  by  means  of  silk  ;  a  large  drainage-tube 
was  introduced  and  the  wound  dressed  in  the  usual 
manner.  Mr.  Bland  Sutton  remarked  that  there  was  very 
little  doubt  in  regard  to  the  diagnosis  of  the  case  but  from 
its  long  history  he  expected  to  find  considerable  disorganisa- 
tion of  the  kidney  such  as  extensive  hydro-  or  pyo-nephrosis 
and  it  was  surprising,  he  thought,  considering  the  large 
number  of  stones,  to  find  the  kidney  not  only  healthy  but 
abnormally  larg^.  This  may  be  explained,  be  said,  in 
two  ways  :  Ist,  the  calculi  in  the  pelvis  were  as  loose  as 
marblesina  schoolboy's  pocket,  so  that  the  urine  could  filter 
between  them  and  make  its  way  unobstructed  to  the 
ureter,  had  one  of  these  stones  obstructed  the  ureter  rapid 
hydro  or  pyo-nephrosis  would  have  been  the  immediate 
consequence  ;  2nd,  the  unusual  size  of  the  kidney  made  the 
surgeon  apprehensive  that  its  fellow  had  been  destroyed 
Iby  disease,  and  that  this  was  the  only  renal  organ  that 
the  patient  had  to  depend  upon,  and  this  would  cause  the 
•operator  a  certain  amount  of  anxiety  in  the  subsequent 
•course  of  the  case. 


It  is  stated  by  the  Broad  Arrow  that  in  the  event 
•of  the  required  number  of  candidates  not  being  forth- 
coming at  the  next  examination  for  appointment  in  the 
Army  Medical  Service,  it  is  the  intention  of  the 
authorities  to  re-appoint  thoae  gratuitised  medical 
•officers  with  the  rank  of  Surgeon-Major  on  the  retired 
list  liable  to  be  recalled  to  service.  This  decision  will 
affect  about  seven  or  eight  officers,  and  the  informa- 
tion will  doubtless  be  received  with  great  satisfaction 
1>y  them. 

It  is  stated  that  in  New  Orleans,  about  £200,000  is 
Annually  spent  for  milk.  Since  one-third  of  this  milk 
is  reported  to  be  composed  of  water  from  the  mains, 
the  citizens  of  New  Orleans  are  obviously  paying 
upwards  of  £60,000  for  the  water  contained  in  their 
milk. 


FuUldMA  every  Wsdneidaj  nomlnff,  FHm  id.   Post  fiM,  H<. 


rom  On  imsnsioB :— Wliol«  Pags,  «6  Oi.  Od. ;  Halt  Page,  Jl  lOkOd. 
QiurtarPags,«lBs.;  Ona-dslitti.  ItL  Sd. 

rem  A  Bnns  ov  Ivsnnovs :— Whoto  Psgv,  tWrtsen  Iniwtlniii 
(weekly,  fbitnightly,  or  monthly)  at  4S  Ita.  OS. ;  twentif-six  hmt- 
ttoBa  (weekly  or  f octnli^tlj)  el  4S  St.  Od. ;  llfly-two  IbbmUmi 
(weeUj)  a»  M  eaoh.  Helf-pege,  thirteen  luMtloiie  at  Sfie.; 
Iwentj-elxel  821. ;  llfly-two  Iniertloni  at  80a.  each.  <|iiailer-pi«t, 
thirteen  Inaerttona  at  ISik ;  twenty-elx  inaertiona  at  ISe. ;  tttj-tli 
Inaerttona  at  Ua.  eaoh 


BmaU  Annonnoementa  of  Praotleea,  AaalaUnelee,  Yaeanelee,  Book 
*o.— AeTen  llaea  or  under,  Aa  per  Inaertlon ;  ed.  per  line  beyond. 


Letterainthla 


ahoold  be  addreaaed  to  the  P«ldiBher« 


IVBIOBIPnom. 


Poss  Wbmm  to  AnruAL  Bubsobibsbs 

„  ABBOAD,  WnHn  TBM  POSZAL  UMIOB 

„  In>IA,  OHIHA,  AMD  JAPAS  . 


Al  1  0 
£1  B  S 
£1    S    6 


Post-oflloe  Ordera  and  Cheqnea  to  be  drawn  in  favour  of— 

A.  A.  TnmALL,  SO-U  King  William  Street,  Btnnd,  London. 
A.  H.  JACOB,  IS  MoleaworthBtraet,  Dublin. 


BuasQBiPnoBB  BOB  PBABOB  are  received  by  Mean 

Hantefeuille,  Paila— poattree  in  advance,  £1  Si.  Sd.  parannnm. 

SuBSOBimoBS  BOB  CHB  Ubitbd  Bcatbb,  Doat  tree  In  ndvanoa 
(£1  Si.  Od.  par  annum),  ahould  be  aent  direet  to  the  OOcea  la 
thla  country  by  International  Poet  Ofllce  Order. 

80U  Ag^tUt  for  OanMMiy  end  Auttn-Hungarv— 
W.  A  8.  L0WBBCHAL(0ttce  of  the  Berlins  Adrmbyak), 
4,  Berlin. 


^t  ^Mml  §»88  ^  Circnlsr. 


'8ALU8  POFULI  SDPREMA  LEX.' 


WEDNESDAY,  FEBRUAEY  5,  1896. 


IS  COLLES'  LAW  ABSOLUTE! 
The  discovery  by  CoUes'  fifty  years  ago,  of  the  so- 
called  law  which  bears  his  name,  was  justly  looked 
upon  as  a  highly  important  addition  to  our  clinical 
knowledge  of  syphUis.  Its  interest  is  not  merdy 
scientific  or  even  clinical,  indeed,  as  will  be  seen,  it 
opens  up  on  every  hand  questions  of  the  greatest  prac- 
tical importance  both  from  the  point  of  view  of  daily 
practice  as  from  that  of  the  possibility  of  acquiring 
immunity  therefrom.  If  it  be  really  the  case  that  the 
healthy  mother  of  a  congenitally  syphilitic  chUd  can 
never  contract  the  disease  from  her  offspring,  it  shows 
that  some  influence  has  been  brought  to  bear  in  virtue 
of  which  she  has  become  possessed  of  a  certain  im- 
munity against  an  otherwise  extremely  infectious 
disease.  For  half-a-century  this  '*  law  "  has  served  as 
a  guide  to  practitioners  in  authorising  such  mothers 
to  suckle  their  offspring.  The  advantages  to  the 
offspring  are  obvious  and  the  risk  to  the  mother  fit/, 
always  assuming  that  the  rule  is  absolute.  Every- 
I  thing  turns  upon  the  question  whether  the  law  is  or  is 
not  one  admitting  of  exceptions  because  if  it  could  be 
proved  that,  though  rare,  infection  did  occasionally 
take  place,  practitioners  would  necessarily  become 
more  circumspect  in  the  matter  of  giving  the  requisite 
assurance  against  possible  contamination  on  the  part 


rMB.&.  1896. 


LEADING  AETICLES. 


Thi  Mkdioal  VBaBB.    145 


of  tiie  molher.  S>7pl^is  is  such  a  terrible  disease  and 
exerts  such  far-  readuog  consequences  that  no  conscien- 
tious  practitioDer  would  consent  to  ran  any  tangible 
amount  of  risk  in  the  direction  of  infecting  a  hitherto 
prerionsly  healthy  mother.  Dr.  George  Ogilvie  initi- 
tiated  what  proved  to  be  a  very  interesting  discussion 
at  the  last  meeting  of  the  Royal  Medical  and  Chirar- 
gical  Society  by  a  paper  in  which  he  sought  to  prove 
that  exceptions  to  Colics'  law,  if  rare,  were  by  no 
means  unknown,  and  he  quoted  in  support  of  his  con- 
tention two  inter  alia  of  a  number  of  clinical  observa- 
tioDS,  the  painstaking  accuracy  of  which  apparently 
left  nothing  to  be  desired  in  spite  of  the  fact  that  the 
problem  is  one  which  presents  peculiar  difficulties  in 
leepect  of  the  admissibUity  of  the  various  items  of 
evidence.  Mr.  Hutchinson,  who  is  a  firm  believer 
in  the  law  in  question,  naturally  took  up  the 
cudgels  in  defence  thereof,  but  he  rather  gave 
his  case  away  to  begin  with  by  declaring  that 
a  law  is  usually  proved  by  its  exceptions,  and  to 
tide  rule  CoUes'  law,  according  to  him,  was  no  excei>- 
tioQ ;  in  other  words,  while,  for  all  practical  purposes, 
itvBs  a  rule  of  sufficiently  general  application,  like 
other  rules,  it  admitted  of  exceptions.  Then,  toOi 
there  is  the  possibility  that  some  apparent  exceptions 
mij  really  be  second  attacks  of  the  diseasa  The  rule 
that  one  attack  of  syphilis  renders  immune  against 
fatore  attacks  is  one  which  has  received  the  sanction 
ofecperience,  but  this  same  experience  shows  that 
the  immunity  is  relative  rather  than  absolute.  The 
proportion  of  alleged  exceptions  to  Colles'  law  does 
Dot  appear  to  be  greater  than  that  of  second  attacks  of 
syphilis,  and  viewed  from  this  point  of  view  the  risk 
mi^t  perhaps  be  considered  as  a  qnanttte  negligeMe. 
However  this  may  be,  Golles'  law  is,  with  many,  a 
dog;ma  which  is  now  blindly  accepted,  and  which  it  is 
regiided  as  rank  heresy  to  question,  ignoring  the 
cardinal  principle  that  in  considering  such  complicated 
and  obscure  problems  as  those  furnished  by  medicine 
and  pathology,  everything  of  the  nature  of  dogmas 
oi^t  to  be  avoided  in  order  not  to  place  unnecessary 
barriers  in  the  path  of  subsequent  progress.  We  are 
an  the  more  indebted  to  those  who,  like  Dr.  Ogilvie, 
take  the  trouble  to  point  out  the  weak  points  in  the 
laws  laid  down  for  our  guidance,  even  though,  after 
full  diMussion,  one  comes  to  the  conclusion  that  he  has 
not  succeeded  in  impugning  its  clinical  value.  Ind- 
dentaDy,  a  very  interesting  point  was  raised 
with  regard  to  the  frequency  of  infection  of 
wet  nurses  by  congenitfJly  syphilitic  children. 
OoQeB  described  this  form  of  syphilis  as  vira- 
lently  infectious  to  all  except  the  mother  of  the 
child,  and  it  might  be  inferred  from  his  remarks  that  it 
was  an  exceedingly  exceptional  occurrence  for  a  wet 
nnrse  under  these  conditionsto  escape  contagion.  That, 
however,  is  certainly  not  the  experience  of  the  present 
day,  for  eases  of  the  kind  are  extremely  rare,  so  rare  as 
to  be  almost  unknown.'  Mr.  Hutchinson  adroitly 
•ought  to  daim  the  credit  for  this  rarity  for  CoUes 
law,  which,  hj  calling  attention  to  the  liability  to  infec- 
tion fA  nurses  other  than  the  mother,  made  it  incum- 
bent on  medical  men  to  protest  against  any  woman 


being  exposed  to  the  danger.   This  suggestion,  however,, 
will  not  hold  water,  because  we  know  pertinently  that- 
it  is  a  very  common  practice  among  the  lower  classes 
of  society  for  women  to  nurse  each  others'  children 
more  or  lees  indiscriminately,  without  any  infection  of 
the  nature  under  discussion.    The  rarity  of  infection 
among  hired  or  volunteer  wet  nurses,  even  in  giving 
the  breast  to  syphilitic  children,  pro  tanto  weakens  the. 
force  of  CoUes'  law,  because,  obviously,  the  non-infec- 
tion of  nursing  mothers  might  be  attributable  to  thesame- 
cause  as  that  of  the  strange  nurse.    If  the  mother  of  a 
syphilitic  child  be  immune  against  infection  by  her  own. 
offspring  she  must  pari  passu  be  protected  against  * 
contamination  of  that  kind  from  any  source,  a  point  too- 
often  overlooked  in  discussing  this  subject  and  one,, 
too,  respecting  which  direct  evidence  appears  to  be 
wanting.    As  bearing  on  the  rarity  of  infection  of 
nurses  other  than  the  mothers  of  these  children  it  is 
worth  noting  that  according  to  those  who  have  oppor- 
tunities of  observing  many  cases  of  congenitally  syphi- 
litic children,  mouth  lesions  are  very  uncommon,  so 
infrequent  indeed  as  to  be  something  of  the  nature  of-^ 
a  curiosity.    It  can  hardly  be  supposed  that  a  child 
who  does  not  present  lesions  of  the  mouth  will  infect 
his  nurse,  whether  mother  or  stranger,  and  this  affords . 
us  an  explanation  of  the  immunity  of  nurses  which, 
applies  with  equal  force  to  the  mother  as  to  the  wet . 
nurse.    In  acquired  syphiUs,  on  the  other  hand,  mouth . 
lesions  are  the  rule  instead  of  being  the  exception,  and . 
this  may  enable  us  to  understand  why  acquired  syphilis  - 
has  the  reputation  of  being  vastly  more  infectious  than  ^ 
the  hereditary  form  of  the  disease. 


THE   NEW   PHOTOGRAPHY. 
Pbofessob  Bontoen's  recent  announcement  that 
certain  rays  have  the  power  of  penetrating  substances  . 
commonly  regarded  as  opaque,  continues  to  attract 
world-wide  discussion.    His  discovery  has  roused  the 
earnest  attention  of  all  students  of  physical  science, . 
who  are  busily  investigating  the  nature  of  these  pecu- 
liar rays.    He  has  created  no  little  stir  in  the  medical. . 
world,  where  it  is  hoped  that  the  practical  application  . 
of  his  new  rays  to  "  the  new  photography"  may  ulti- 
mately have  an  important  bearing  on  Uie  diagnosis  of  > 
deep-seated  conditions  in  the  human  body.    Then  he  -^ 
has  plunged   the  scientific   photographers  of   manyr 
countries  into  a  state  of  feverish  excitement,  as  they 
speculate    and  experiment  upon   the  new    wonder 
thus    offered    to    their    already    marveUous    craft. 
Lastly,    his    scientific   ''find"    has    furnished    an 
endless  supply   of    material  for  the  general  news- 
papers and  their    readers.     Indeed,    it    is   simply 
astonishing  with  what  rapidity  the  news  of  Professor  . 
Bontgen's  discovery  has  traversed  the  whole  civOised  • 
world  and  roused  the  universal  interest  of  all  sorts  and 
conditions  of  men.    Another  hardly  less  striking  fact 
is  the  number  of  scientific  men  who  are  to  be  found  • 
in  every  country  ready  and  competent  to  investigate  • 
the  newly-described  phenomena.    It  is  reported  that 
German  men  of  science  have  taken  up  the  task  with  . 
enthusiasm,  and,  among  other  things,  are  searching  for  • 
some  means  of  shortening  the  long  exposure  at  present . 


146     Thb  Msdicul  Pbbss. 


LEADING  ARTICLES. 


Feb  5,  1896. 


needed  to  produce  the  new  photograph.    Some  success 
lias  already  been  attained  in  that  direction,  for  one 
experimenter  has  found  that  by  heating  the  photographic 
plate  to  about  40^  Centigrade,  the  process  occupied 
x>nly  fifteen  instead  of  thirty  minutes.    In  England,  it 
is  gratifying  to  note,  photographers  have  not  been 
behindhand,  some  having   been   engaged  for   many 
months  past  in  the  self -same  pursuit,  as  is  testified 
by  an  advanced   copy  of    the   Royal  Photographic 
jSoGiety's    Journal^    with     which     we     have     been 
favoured.    The  issue   in   question    contains   several  | 
interesting    papers    dealing   with    the    subject,    in . 
addition  to  a  valuable   series  of  photographs  illus- 1 
trating  the  capabilities  of  the  new  procegs.    Goe  of 
these,  which  was  taken  by  Mr.  J.  W.  Gifford  with  an 
exposure  of   ten  minutes  only,  we  have  reproduced 
.on  another  page,  it  being  the  most  perfect  anatomical 
specimen  of   a  living  hand    we  have  as   yet  seen. 
From  the  published   papers  of   Professor  Rontgen, 
it  appears  that  he  himself  does  not  feel  inclined  to 
.classify  his  new  rays  among  those  of  the  ultra-violet 
.spectrum.    He  has,  however,  suggested  the  following 
Jiypothesis  :— "  A  kind  of  relationship  between  the  new 
«rays  and  light  rays  appears  to  exist,  at  least,  the 
formation  of  shadowy  fluorescence  and  the  production 
of  chemical  action  point  in  this  direction.    Now,  it  has 
been  known  for  a  long  time  that  besides  the  trans- 
verse vibrations,  which  account  for  the  phenomena  of 
light,  it  is  possible  that  longitudinal  vibrations  should 
exist  in  the  ether,  and,  according  to  the  view  of  some 
physicists,  must  exist.    It  is  granted  that  their  exist- 
ence has  not  yet  been  made  clear,  and  their  properties 
are  not  experimentally   demonstrated.    Should   not 
.the  new    rays  be  ascribed    to    longitudinal  waves 
in   the   ether?"    An   answer  to  this  question  will 
doubtless  be  speedily  forthcoming.    Professor  Gold- 
stein, of  the  Royal  Observatory  at  Berlin,  in  a  recent 
lecture  pointed  out  that  the  fact  that  Rontgen's  rays 
;are  not  deflected  by  magnets  does  not  prove  that  they 
are  new,  since  there  are  certain  cathode  rays  which  are 
likewise  uninfluenced  by  magnets.  The  main  characters 
of  Rontgen's  rays  are  shared  by  several  other  kinds  of 
rays.    According  to  Goldstein,  the  common  character- 
listics  of  cathode  rays  and  the  new  rays  are  rectilinear 
propagation,  the  production  of  shadow  photographs, 
and  chemical  action.    The  species  of  rays  to  which 
Rontgen's  belong  cannot  yet,  he  thinks,  be  determined, 
but  there  are  many  grounds  for  believing  that  they 
belong  to  the  cathode  species.    Whatever  be  the  out- 
.come  of  further  investigations  into   the  new  pheno- 
menon, it  seems  certain  that  one  more  marvel  has  been 
added  to  the  treasure-house  of  modem  sciecce,  and 
.one  that  bids  fair  to  bring  forth  abundant  fruit  in  due 
season. 


-THE  ELECTION  TO  THE  GENERAL  MEDICAL 
COUNCIL  OF  A  DIRECT  REPRESENTA- 
TIVE FOR  IRELAND. 

By  the  advertisement  which  appears  in  our  columns 
to-day,  the  contest  for  the  vacant  position  enters  upon 
its  final  stage.  It  is  intimated  that  nomination  papers, 


formally  signed  and  executed,  must  be  sent  to  the 
Branch  Registrar,  Dr.  Wilson,  on  or  before  the  15th 
inst,  it  being  provided  that  the  candidate  must  be  a 
registered  medical  practitioner,  and  that  he  shall  be 
nominated  by  at  least  twelve  registered  practitioners 
resident  in  Ireland.  These  details  are,  in  theniRclves, 
interesting.  It  will  be  seen  that  the  candidate  must 
be  a  registered  medical  practitioner,  which  is  an  essen- 
tial requirement  only  in  the  case  of  a  Direct  Repre- 
sentative. A  representative  of  a  university,  or  college, 
or  a  Crown  nominee,  under  the  authority  of  the 
Medical  Act  of  1858,  may  be  any  "  person  *'  whomso- 
ever, male  or  female,  medical,  clerical,  or  legal,  the 
apparent  reason  of  this  anomaly  being  that  several  of 
the  representatives  of  universities  are  elected  by  Con- 
vocation, a  body  which  contains  a  majority  of  non- 
medical members  who,  it  is  quite  possible,  might  please 
to  elect  to  the  Medical  Council  some  distinguished 
educationalist  who  had  never  qualified  in  medicine.  It 
is  not,  however,  essential  that  a  candidate  shall  be 
resident  in  Ireland,  though  his  nominators  must  be  so, 
and  it  would  be  competent  for  any  twelve  registered 
practitioners  living  in  Ireland  to  nominate  an  army 
surgeon  who  is  on  duty  in  India  and,  if  such  nominee 
gave  his  consent  to  the  nomination,  his  name  would 
go  to  the  poll  for  the  Direct  Representation  of  Ireland. 
This  is,  of  course,  a  reduction  of  the  system  to  an 
absurdity,  but  it  is  worthy  of  notice  as  an  illustration 
of  the  vagaries  of  the  law. 

Since  we  last  wrote  on  the  subject,  the  situation  has 
become  more  defined.  The  Cork  Local  Association  has 
issued  voting  cards,  as  we  stated  that  they  would,  to 
every  voter,  for  the  purpose  of  ascertaining  which 
of  the  three  provincial  candidates  (naming  Drs. 
Cuming,  Greene,  and  MacDonnell,  and  excluding  Drs. 
Jacob  and  Thomson)  is  likely  to  score  the  highest  poll, 
it  being  guaranteed  that  the  two  unsuccessful  candi- 
dates shall  retire  in  favour  of  the  candidate  who  re- 
ceived the  greatest  amount  of  support.  It  is  thus 
worth  while  to  speculate  as  to  who  is  most  likely  to 
come  out  successfully  in  this  preliminary  '*  canter,"  and 
a  list  of  his  ''  Committee,"  issued  a  couple  of  days 
since  by  Dr.  MacDonnell,  affords  us  opportunity  for 
doing  so.  His  total  following,  so  far  as  this  list 
divulges  it,  is  168  voters.  Dr.  Cuming's  following,  as 
set  out  in  his  original  list,  numbered  343,  and  no  one 
but  Dr.  Greene  himself  knows  what  his  following  ie, 
inasmuch  as  he.  has  issued  no  list.  Looking  at  these 
figures  by  themselves,  and  recollecting  that  Professor 
Cuming  has,  no  doubt,  gathered  in  some  adherents 
since  he  issued  his  list,  it  seems  most  probable  that  he 
will  head  the  preliminary  poll,  and  that  Dr.  MacDonnell 
and  Dr.  Greene  will  retire.  But,  on  the  other  hand,  it 
should  be  recollected  that  almost  the  whole  of  Dr. 
Cuming's  supporters  are  from  Belfast  and  the  neigh- 
bouring Nor^ern  counties,  and  that  his  list  showed 
only  35  supporters  from  the  whole  of  Ireland  outside 
that  locality.  It  also  seems '  most  likely  that  on  this 
preliminary  vote  Dr.  MacDonnell  will  score  many  more 
votes  than  Professor  Cuming,  inasmuch  as  the  Professor 
is  essentially  a  Belfast  School  and  College  spokesmao, 
and  neither  has,  moreover,  had  anything  in  common 


fn.  5.  1806. 


NOTES  ON  CUBRENT  TOPICS. 


Thi  Mbdioal  Pbxss.     147 


witii  ilie  working  country  practitioner,  while  Dr.  Mac- 
Donnelly  though  he  nerer  served  at  the  plough  as  a 
fbor-law  Medical  Officer,  can  claim  that  he  has  had 
eone  limited  experience  in  rach  afifairs.  It  does  not, 
however,  appear  that  the  voters  think  very  highly  of 
soeh  daun,  seeing  that  within  the  past  month  he  has 
ooly  succeeded  in  accumulating  fifty-eight  votes,  of 
which  the  largest  number  came  from  the  very  un- 
eotfausiastic  compact  of  the  Carlow-Eilkenny  Society 
to  vote  together.  In  the  event  it  seems  most  probable 
tiist  our  forecast  will  be  fulfilled— that  the  contest  will 
lie  between  Drs.  Jacob  and  Thomson,  with  Professor 
Onming  striving  in  a  useless  effort,  the  only  effect  of 
which  will  be  to  withdraw  votes  from  both  these 
competitors. 

As  a  further  contribution  to  the  consideration  of  this 
eontest  we  publish,  in  our  Irish  Supplement  of  this 
day,  a  strongly  expressed  and  forcible  address  by  forty 
Workhouse  and  Dispensary  Medical  Officers,  repre- 
Mating  a  much  larger  number  of  Dr.  Jacob's  supporters 
in  these  services,  in  which  the  Poor-law  Medical  Officers 
d  Ireland  are  appealed  to  not  to  allow  personal  con- 
siderations to  prevent  them  from  giving  that  gentleman 
their  vote.  Dr.  Jacob  also,  in  a  separate  address, 
points  out  that  voters  who  may  have  promised  their 
•safiport  to  one  or  other  of  the  plebiscite  candidates, 
w31  be  entirely  absolved  from  such  promise  if  the 
candidate  to  whom  it  was  given  retires,  and  that  it 
wiD,  in  such  case,  be  quite  open  to  them  to  transfer 
their  votes,  not  to  the  candidate  who  may  come  out 
first  in  the  plebiscite,  but  to  him  whom  they  may  think 
best  fitted  to  represent  their  interests.  We  shall  not 
do  more  than  recommend  those  who  are  interested  to 
nad  the  appeal  of  the  Poor-law  Medical  Officers  which 
appears  in  our  Supplement  of  this  day. 


,^^tB  on  dtttnnt  ^opirB. 

Gonsan^aineous  Marriages  ^q  Relation  to 

Disease. 
Thisx  is  ample  evidence  to  show  that  consanguine- 
•oa  marriages  play  an  important  role  in  the  causation 
of  disease,  and  that  hereditary  diseases  are  much 
aogmented  by  such  marriages.  Among  other  observers 
the  testimony  of  Dr.  Bemiss  is  somewhat  noteworthy 
upon  this  point.  He  gives  an  account  of  833  marriages 
bekween  relations,  in  which  he  finds  the  following 
lenlts :  In  ten  cases  of  incest  with  parents,  or  between 
brother  and  sister,  93  per  cent  of  the  offspring  were 
defective.  In  twelve  marriages  with  niece  or  aunt 
%  per  cent  were  defective.  In  fifty-six  marriages 
between  blood  relations,  the  issue  of  blocd  relations, 
^per  cent,  were  defective.  In  twenty-eeven  marriages 
between  double  first  cousins  27  per  cent  were 
defective.  In  112  marriages  between  second-cousins, 
18  per  cent  were  defective,  while  in  125  marriages 
between  persons  in  no  way  related,  only  2  per  cent 
were  defective.  But  while  these  facts  dearly  display 
the  evile  oi  the  intermarriage  of  blood  relations  in  the 
homsa species,  confirmatory  evidence,  as  is  well  known. 


also  exists  upon  the  same  subject  among  the  lower 
animals.  The  close  breeding-in  of  animals  has  long 
been  known  to  affect  deleteriously  the  qualities  of  the 
offspring.  Darwin  has,  for  example,  remarked  thati 
"  with  respect  to  pigs,  there  ia  more  unanimity  among 
breeders  on  the  evil  effects  of  close  inter-breeding  than, 
perhaps,  in  regard  to  any  other  large  animal."  This  same 
observer  also  relates  that  a  well-known  breeder  bred  a 
famOy  of  pigs  in-and  in  for  seven  generations ;  the 
number  of  pigs  was  reduced  at  each  gestation, 
and  of  the  offspring  thus  produced  many  were  idiotic, 
without  sense  even  to  suck,  and  when  attempting  to  move 
could  not  walk  straight,  until  finally  one  sow  was  the 
sole  offspring ;  she  would  not  become  pregnant  by  her 
sire,  while  to  a  stranger  in  blood  she  bred  at  the  first 
trial.  Among  the  diseases  most  commonly  associated 
with  coDsanguineous  marriages  is  that  of  retinitis  pig- 
mentosa, and  there  does  not  appear  to  be  any  doubt 
that  the  intermarriage  of  blood  relations  largely  con- 
duces to  the  causation  of  this  curious  affection.  In 
ninety-five  sases  reported  by  liebreich,  in  which  the 
parentage  was  traced,  forty-three  were  of  consanguine- 
ous origin,  or  45  per  cent,  and  throughout  the  domain  of 
ophthalmological  literature  repeated  references  may  be 
found  to  the  same  effect,  that  is  to  say,  confirmatory 
of  the  causal  relationship  between  consanguineous 
marriages  and  retinitis  pigmentosa.  The  whole  subject 
under  discussion  is  discussed  in  a  paper  published  in 
a  recent  number  of  the  Medical  Newa^  late  of  Phila- 
delphia, now  of  New  York,  by  Dr.  Oliver  Belt,  of 
Washington.  The  conclusion  arrived  at  by  the  author 
is  that  as  there  are  few  families  entirely  free  from 
constitutional  defects  of  some  kind,  "a  prudent 
person  would  do  well  to  avoid  a  consanguineous 
marriage  in  any  case,  not  necessarily  on  account 
of  deafness,  but  on  account  of  the  danger  of 
weakening  the  constitution  of  the  offspring."  With 
regard  to  deaf-mutism,  statistics  show,  for  the  most 
part,  that  the  closer  the  degree  of  relationship 
between  the  parents  the  more  numerous  are  the 
number  of  the  deaf-mute  children  bom.  For 
example,  one  marriage  between  an  aunt  and 
nephew  produced  three  deaf  mutes.  Four  marriageg 
between  uncle  and  niece  produced  eleven  deaf-mutes. 
Twenty-six  marriages  between  first  cousins  produced 
thirty-eight  deaf-mutes.  Sixteen  marriages  between 
second  cousins  produced  twenty-eight  deaf-mutes* 
Forty-seven  marriages  between  blood-relatives  pro- 
duced seventy-two  deaf-mutes.  These  are  important 
facts  which  leave  no  measure  of  doubt  as  to  the 
influence  of  the  intermarriage  of  blood  relations  in 
causing  the  deaf -mutism.  But  just  in  the  same  way  as 
consanguineous  marriages  should  be  avoided,  so  also 
should  the  intermarriage  of  persons  tainted  with  here 
ditary  disease  be  discouraged.  Heredity  is  a  most 
potent  factor  in  the  matter  of  ^  Visiting  the  sins  of  the 
fathers  upon  the  children,"  by  means  of  which  many 
tainted  and  diseased  offspring  are  brought  forth,  and 
too  much  care,  strictly  speaking,  cannot  be  exercised  in 
this  connection,  despite  the  powerful  incentive  to  over- 
rule all  considerations  which  sentiment  at  the  time  may 
create. 


148     Ths  Mxdioal  Pbjbs. 


NOTES  ON  CUBEENT  TOPICS. 


Fib.  5.  I896t 


A  Carious  Prosecution  under  the  Medical 

Acts. 
The  magistrate  at  Marlborough  Street  Police  Court 
hadacuriouscasebeforehimlaBtweek.  A  person  named 
Albert  BeU,  of  175  Wardour  Street,  Oxford  Street,  was 
summoned,  under  the  Medical  Acts,  for  using  the  letters 
"  M.D.,"  and  the  title  of  "  doctor  "  without  being  a 
duly  qualified  medical  practitioner.  On  the  defendant's 
name  being  called  there  was  no  answer.  In  stentorian 
notes,  resounding  throughout  the  court,  the  defendant 
was  summoned  to  reply  to  his  name,  but  without  avail. 
At  last,  when  all  the  officials  had  made  themseWes 
quite  hoarse  with  shouting,  the  magistrate,  in  order 
to  create  a  diversion,  asked  '*I8  the  defendant  here?*' 
The  solicitor  for  the  defence  said,  "  No,  sir,  he  has  been 
dead  for  several  years.''  This  was  accepted  by  the 
court  as  a  satisfactory  explanation  for  his  non-appear- 
ance, but  in  order  that  the  play  might  proceed  in  an 
orderly  manner,  it  was  necessary  to  find  another 
"  Hamlet."  As  it  happened  this  was  no  great  difficulty. 
A  person  named  "  Henry  Walters "  obligingly,  at  a 
moment's  notice,  took  up  the  part,  and  then  the  curtain 
was  raised,  and  the  serio-comedy  proceeded  without 
further  incident  to  its  termination.  It  appeared  that 
Henry  Walters,  some  years  ago,  bought  the  business 
of  the  late  Mr.  Bell,  which  had  for  long  been  carried  on 
under  the  name  of  "  Dr.  Bell."  Henry  Walters  was, 
therefore,  sailing  under  false  colours  by  allowing  '*  Dr. 
Bell's  "  name  to  remain  on  the  door  of  the  premises. 
However,  it  was  admitted  that  Henry  Walters  did  not 
prescribe  physic  for  those  who  came  to  consult  him. 
His  mode  of  practice  was  of  an  innocent,  simple  des- 
cription, suitably  adapted  for  innocent,  simple  people. 
The  Court  wasiniormed  that  he  recommended  all  his  pa- 
tients to  use  a  belt  which  would  cure  anything  and  every- 
thing in  a  month.  But  the  magistrate  seemed  to  think 
that  Nature  never  intended  that  sick  persons  should 
be  " cured"  in  so  simple  a  manner  as  this,  and  accord- 
ingly Henry  Walters  was  fined  £20,  with  six  guineas 
costs,  with  the  alternative,  in  default  of  distress,  of 
two  months'  imprisonment  The  '*  piece  "  was  so  well 
received  by  the  audience  that  they  were  provoked  to 
frequent  bursts  of  laughter.  Upon  the  whole,  there- 
fore, from  every  point  of  view,  this  little  serio-comedy 
could  be  pronounced  a  distinct  success. 


Medical  Men  and  Dr.  Jameson's  Raid. 
More  than  one  medical  man  has  had  to  submit  to 
arrest  at  the  hands  of  the  Boers  in  connection  with  the 
disturbanceat  Johannesburg,  and  the  son  of  theMedical 
Officer  of  Health  of  Swansea  has  now  found  himself 
in  this  predicament  Dr.  Davies  is  one  of  the  Council 
of  the  UiUanders,  a  matter  of  some  moment,  inasmuch 
as  the  latest  accounts  from  Johannesburg  state  that  the 
Council  has  accepted  the  whole  of  the  responsibility  for 
Dr.  Jameson's  raid.  This,  undeniably,  is  a  serious 
position  for  the  members  of  the  CouncU  to  have 
assumed,  and  if  this  information  be  correct,  the  Boers 
have  still  the  prime  leadeiis  of  the  disturbance  against 
them  in  their  safe  keeping,  despite  the  fact  that  they 
have  released  the  Chartered  Company's  men.  The 
whole  of  this  business  is  a  sad  one,  and  not  least,  by 


!  reason  of  the  fact  that  a  member  of  our  own  ptofeaaxmi 
who  had  won  for  himself  the  admiration  and  respect  of 
all  who  knew  the  great  work  that  he  had  accomidiabed^ 
is  now  on  his  way  home  to  stand  his  trial  for  having 
committed  a  serious  breach  of  International  law,  and 
by  so  doing,  for  the  present,  if  not  for  ever,  arrested 
the  course  of  what  promised  to  be  a  great  career. 

The  Appointment  of  Director-Oeneral  of  tbi» 
Army  Medical  Depcutment. 
Oim  contemporary,  the  United  Service  Gazette,  hits 
the  right  nail  on  the  head  when,  in  discussing  the 
appointment  of  the  Director-General  of  the  Army 
Medical  Department,  it  urges  that  the  tenure  of  this 
office  should  be  limited  to  five  years,  instead  of  seven, 
as  is  the  case  under  the  present  regime^  and 
that  extension,  by  a  3rear  at  most,  should  only 
be  granted  under  the  most  exceptional  dr- 
cumstances.  The  prizes  in  the  Army  Medicri 
Staff  are  all  too  few,  and  slowness  of  promotion  is  not 
only  a  cause  of  universal  complaint  but  of  wide  dis- 
content in  the  Department  But  this  is  only  one  of 
the  reasons  which  can  legitimately  be  urged  in  favour 
of  the  reform  suggested.  Under  the  circumstances, 
however,  with  the  approaching  retirement,  early  in 
May,  of  the  Director-General  of  the  Department,  the 
opportunity  is  admittedly  a  good  one  for  the  War 
Office  to  fully  and  carefully  take  into  consideratioD 
the  need  which  exists  for  revising  the  regulation  for 
the  tenure  of  this  important  post  Such  a  reform  ia 
one  which  might  well  be  taken  in  hand  by  the  new 
Commander-in-Chief,  for  the  expedien<7  of  it  cannot 
but  appeal  to  a  practical-minded  authority  like  him^ 
self. 

Medical  Men  in  Nottingham  and  the  Medical 
Aid  Aasociationa 
In  common  with  their  con/r^ea  in  other  parts,  we 
are  glad  to  see  that  the  medical  men  of  Nottingham 
have  taken  a  firm  stand  against  the  system  of  so-called 
medical  aid  associations.  We  have  repeatedly  referred 
to  this  matter  in  our  columns,  and  pointed  out  the 
derogatory  character  of  the  appointments  associated 
with  these  nothing  more  nor  less  than  trade  oonoensr 
It  is  satisfactory,  then,  to  note  that  at  a  crowded 
meeting  of  the  medical  men  of  Nottingham  held  last 
week  the  following  emphatic  resolution  was  passed  r 
*'That  in  the  opinion  of  this  meeting  it  is 
unprofessional  and  undignified  lor  any  medical 
man  to  accept  the  poet  of  medical  oflioer  of 
any  institution  promoted  by,,  and  for  the  peea- 
niary  benefit  of,  men  outside  the  profession."' 
There  is  no  doubt  that  if  medical  men  throughout  the 
country  would  only  take  a  firm  stand  on  this  question 
and  loyally  support  each  other,  the  medical  aid  aspCK 
dations,  as  at  preeent  conducted,  would  soon  cease  to 
exist  Everything,  however,  has  been  dono,  short  of 
compulsion,  to  bring  thoee  practitionen  to  reason  who 
have  so  far  identified  themselves  with  the  pramotocs' 
of  these  associations,  and  the  time  would  seem  to  have 
arrived  when  the  matter  should  again  be  brocm^t  under 
the  notice  of  the  Oenend  Medical  CoubclL    Had  the? 


fflB.5,  1896. 


NOTES  ON  CURRENT  TOPICS. 


Thi  Medical  Pbbss.     1^9 


Omncfl  only  bad  wiadom  enough  to  see  that  itsdaty  was 
to  oondemn  the  connection  of  members  of  the  prof  es- 
sien  with  these  unprofessional  appointments,  the 
diffiealty  would  soon  have  been  settled.  Bat  such 
wisdom  was  not  to  be  found  in  the  academic  minds  of 
the  majority  of  the  members  of  the  Council,  and  conse- 
•quently,  owing  to  this  absence  of  a  firm  policy,  the 
medical  aid  associations  have  ever  since  flouritihed 
aoszingly,  to  the  serious  and  lasting  detriment  of  the 
lisrd- working  members  of  the  profession. 


The  Physiology  of  the  Carbo-hydrates. 

Ths  appearance  of  a  short  paper  by  Dr.  Noel  Paton 
in  the  February  number  of  the  Edinhv/rgk  Medical 
Jowmctl  on  the  above  subject  in  reply  to  a  book  by  Dr. 
IVvy  entitled  an  "  Epicriticism,"  merits  a  word  of  com- 
meat.  Dr.  Paton,  about  a  year  ago,  criticised  Dr. 
Pftvy's  preYious  book  on  the  same  subject  in  a  some- 
irittt  trenchant  manner.  This  criticism  touched  Dr. 
Aivy  on  so  sensitive  a  point— his  great  and  only  theory 
■of  a  sugar-destroying  liver— that  he  must  needs 
■poMish,  not  a  paper  but  a  book  in  reply.  To  us  his 
bode  is  everything  that  such  a  reply  should  not  be.  It 
ii  personal  when  it  should  deal  with  facts,  it  imputes 
unworthy  motives  on  ridiculous  grounds,  and  it  drags 
in  quite  unnecessarily  a  private  qaarrel  with  the 
dfioals  of  the  Royal  Society  into  what  purports  to  be 
a  Mentific  refutation  of  a  brother  physiologist's  erro- 
aeoQs  ideas  of  an  important  subject  Dr.  Pavy  com- 
.pliiDS  that  Dr.  Paton  takes  him  at  a  d  isad  van  tage  in  quot- 
ing 80  many  authorities  against  his  views,  conf  essing  at 
the  same  time  that  he  is  not  in  the  habit  of  consulting 
Ihe  work  of  others  if  he  can  help  it.  Dr.  Paton's 
fceaent  reply  shows  that  he  has  no  thought  of  retiring 
from  his  opinions  as  previously  expressed,  and  he  adds 
farther  testimony  agafnst  Dr.  Pavy's  theory,  testimony 
which  Dr.  Pavy  will  find  it  very  hard  to  refute.  It  is 
tmiiBing  to  find  that  Dr.  Paton  is  more  than  ever  con- 
vinced of  the  improbability  of  the  truth  of  Pavy's 
hypothesis  ofter  reading  the  "  Epicriticism/'  which  it 
wu  confidently  stated  would  demolish  his  position 
entirely.  Aa  in  another  recent  controversy  the  honours 
•of  the  first  round  rest  with  the  combatant  who  has 
iaken  up  an  impersonal  position. 

The  Population  of  France. 

OFHciAii  statistics  of  the  standing  of  the  population 

IB  France  for  the  past  year  have  just  been  published, 

and  have  given  rise  to  a  considerable  amount  of  dis- 

•ppoiBtment  among  political  econcMnists— the  figures 

Jisas  follows  .—Births,  855,388,  showing  a  decrease  of 

««er  19,000  on  the  previous  year ;  deaths,  814,620,  or  a 

decrease  of  52,000  as  compared  with  the  previous  year. 

JVom  which  it  results  that  the  births  have  decreased 

kf  8*2  per  cent.,  and  the  deaths,  6  per  cent    Con- 

^qnentiy,  the  apparent  increase  of  the  population  is 

-entirely  due  to  a  decrease  in  the  mortality.     The 

anmber  (76,451)  of  illegitimate  births  is  excessively 

Ugh,  showing  a  constant  increase  during  the  last  ten 

yetrs.     The   number  of   marriages   was  286,662,  a 

decrease  of  632  on  the  preceding  year,  while  the 

divorces  are  put  down  at  6,419. 


A  Novel  Method  of  Baiein^  Funds  for 
Charities. 
An  altogether  novel  departure  in  the  cause  of  charity 
has  been  devised  by  the  management  of  the  National 
Hospital  for  the  Paralysed  and  Epileptic  (Albany 
Memorial),  Queen's  Square,  Bloomsbury.  It  is  pro- 
posed, in  the  words  of  the  prospectus  submitted  to  us, 
to  return  to  donora  "  unable  to  sacrifice  present  income, 
but  desirous  to  benefit  the  charity,"  annuities  calculated 
at  from  4  to  5i  per  cent  upon  the  amount  of  the  gift. 
Any  sum  from  £50  upwards  will  be  received  upon  these 
terms,  and  a  gift  of  £1,000  will  be  considered  to  provide 
for  the  future  endowment  of  a  bed,  upon  which  the 
donor  may  at  once  bestow  a  distinctive  name.  The 
scheme  provides  absolute  security  for  the  payment  of 
the  annuities,  aod  may  be  commended  to  the  chari- 
table as  a  sound  and  practical  means  of  perpetuating 
and  extending  the  usefulness  of  an  institution  truly 
national  in  its  scope.  Instead  of  themselves  receiving 
the  annuity,  donors  may  nominate  some  other  person 
as  the  recipient,  and  in  this  way  provision  may  be 
made  for  dependents  and  others  during  their  lives,  with 
an  ultimate  reversion  of  a  substantial  sum  to  the  hos- 
pital. Full  information  will  be  afforded  by  the 
Director  at  the  hospital. 

Culpable  Neglect  of  the  Public  Safety. 
Diphtheria  has  of  late  become  one  of  the  most 
fatal  and  widespread  of  zymotic  diseases,  a  fact  which 
has  been  generally  attributed  to  the  facilities  for 
spreading  the  disease  afforded  by  the  congregation  of 
children  in  Board  Schools.  It  is  a  difficult  disease  to 
control,  a  fact  which  is  in  a  great  measure  accounted 
for  by  the  confusion  of  diagnosis  in  many  cases  between 
ordinary  sore-throat  and  mild  or  early  diphtheria.  In 
a  London  police-court  a  week  since  a  peculiarly  callous 
case  of  reckless  exposure  to  diphtheria  infection  was 
brought  to  light.  The  defendant's  child  was  notified 
to  be  suffering  from  the  disease,  and  the  house  was 
visited  by  a  sanitary  inspector.  Seventeen  days  later, 
however,  he  transferred  the  infected  house  and  business 
to  another  person,  whom  he  did  not  inform  of  the 
existence  of  the  disease.  He  was  summoned  by  the 
St  Pancras  Vestry  for  having  failed  to  have  his  house 
disinfected.  We  are  glad  to  see  that  the  magistrate 
imposed  a  fine  of  £5,  and  two  guineas  cost,  for  what 
he  called  '*a  culpable  negligence  in  regard  to  the 
public  safety." 

Burning  of  a  Small-pox  Hospital 
The  inhabitants  of  a  place  called  Oakridge,  near 
Stroud,  are  evidently  a  practical  minded  race.  Against 
their  will  a  smallpox  hospital  had  been  erected  in  their 
midst,  but  had  not  yet  been  opened.  Thereupon,  the 
good  people  of  the  district  held  a  kind  of  witenagemote, 
and  in  spite  of  the  opposition  of  a  handful  of  local 
police,  proceeded  to  bum  down  the  offending  hospital. 
The  newspapera  report  that  the  ringleaders  of  the  mob 
are  now  lodged  in  Gloucester  Qaol,  where  they  will 
doubtless  have  leisure  for  reflection  npon  the  foolish- 
ness of  taking  the  law  into  their  own  hands.  The  case 
illustrates  in  an  extreme  manner  the  deep-rooted 
objection  most  people  entertain  against  '*  fever  "  hospi- 


150    Thb  Mkdioal  Pbbss. 


NOTES  ON  CURRENT  TOPICS. 


Feb.  5.  1898. 


tals,  that  is  to  say,  in  their  own  neighbourhood.  Many 
of  the  mob  who  destroyed  the  Oakridge  institution 
would  no  doubt,  if  stricken  with  small-poz,  gladly 
avail  themselves  of  a  similar  shelter  in  someone  else's 
district.  So  long  as  infectious  diseases  exist  it  will  be 
necessary  for  the  authorities  to  provide  special  isola- 
tion hospitals.  Of  course,  no  man  would  willingly  have 
a  small-pox  hospital  built  next  door  to  his  dwelling 
house,  but  for  all  that  the  fact  remains  that  in  a 
crowded  neighbourhood  a  secluded  site  is  not  to  be 
procured  at  any  cost.  Fortunately,  modern  investiga- 
tion has  proved  that  infection  round  small-pox  hospi- 
tals is  almost  invariably  conveyed  by  personal  agencies, 
while  the  theory  of  aerial  spread  is  altogether 
exploded. 

Bravery  of  a  Medical  Man. 
The  late  disastrous  explosion  at  Tylorstown,  South 
Wales,  was  the  occasion  of  much  courageous  rescue 
work.  Among  other  noteworthy  incidents  of  the  kind, 
we  are  pleased  to  chronicle  the  bravery  of  Dr.  Thomas 
Morris,  the  Medical  Officer  of  the  collieries  where  the 
disaster  occurred.  As  soon  as  the  state  of  the  gearing 
permitted  the  descent  of  the  rescue  party,  the  doctor 
went  down  and  spent  the  whole  day  underground, 
where  he  did  much  service  among  the  injured  survivors 
In  the  afternoon  he  was  summoned  to  a  wounded  man 
who  lay  a  mile  and  a  quarter  along  one  of  the  work- 
ings. To  reach  him  the  doctor  had  to  scramble  and 
struggle  as  best  he  could  through  many  parts  of  the 
wrecked  workings.  The  injured  man  was  unconscious, 
and  was  kept  alive  by  artificial  respiration,  conducted 
at  intervals  on  the  wearisome  and  dangerous  journey 
back  to  the  pit's  mouth.  The  workmen  of  the  district 
at  a  local  meeting  passed  a  resolution  thanking  Dr. 
Morris  for  the  noble  efforts  he  had  made  in  the  work 
of  exploration,  and  in  saving  the  life  of  the  collier 
Phillips.  This  kind  of  heroism  is  less  conspicuous  but 
not  a  whit  the  less  sterling  than  deeds  of  derring-do 
upon  the  battle-field. 

Suicide  in  Germany. 
A  CURIOUS  series  of  statistics,  collected  from  the 
different  Stated  of  the  Empire,  has  just  been  published 
in  Berlin,  showing  the  number  of  suicides  which  have 
been  committed  in  Germany  during  the  thirteen  years 
from  1881  to  1893  inclusive.  According  to  this  return 
the  number  of  suicides  for  that  period  was  105,327,  the 
totals  ranging  from  8,987  in  1881,  to  10,699  in  1893, 
and  that  rate  per  head  of  the  population  varied  very 
much  being  as  high  as  46  per  100,000  inhabitants  in 
the  Duchy  of  Saxealtenburgh,  and  falling  as  low  as  13 
and  Hi  per  100,000  inhabitants  in  Bavaria  and  Alsace- 
Lorraine.  The  suicides  are  proportionately  more 
numerous  in  the  Prussian  Army  than  in  any  part  of 
the  Empire,  having  been  65  per  100,000,  in  1893. 

OuB  French  correspondent  writes  us  that  consider- 
able commotion  has  arisen  in  one  of  the  small  towns 
in  consequence  of  a  woman  having  just  given  birth  to 
a  female  child  with  two  heads.  The  latest  accounts 
reported  that  the  monstrosity  had  every  intention  of 
living. 


Meaalee  and  the  Notification  Act. 
The  St.  Pancras  Vestry  recently  had  under  conaidem- 
tion  the  question  of  making  measles  a  notifiahlo- 
disease  under  the  Notification  Act.  The  matter  was- 
ultimately  referred  to  the  Medical  Officer  of  Health 
for  the  parish,  and  his  report  has  just  been  issued. 
Among  other  things,  he  states  that  at  least  3,000  beds- 
would  have  to  be  specially  reserved  for  measles  ( 
London,  even  if  only  fifty  per  cent,  of  the  < 
sent  to  the  hospitals.  He  adds,  moreover,  that  ''the 
inevitable  conclusion  is  that  in  large  towns  the  value 
of  the  notification  of  measles  is  small  unless  accom- 
panied by  provision  for  hospital  accommodation  andr 
disinfection."  In  view  of  this  report  the  Vestry 
decided  to  proceed  no  further  with  the  snggestioD 
above  referred  to. 


Alcohol  and  Fever. 
Should  fever  patients  be  given  alcohol  ?  This 
the  question  discussed  last  week  at  the  annual  general 
meeting  of  the  governors  of  Chester  Infirmary,  over 
which  the  Duke  of  Westminster  presided.  His  Grace 
directed  attention  to  the  expenditure  for  wines  and 
spirits,  narrating  his  experiences  as  chairman  of  a  hos- 
pital, and  suggesting  that,  while  in  cases  where  neces- 
sary patients  should  not  be  deprived  of  wine 
and  spirits,  yet  it  required  watching.  Mr.  Taylor,, 
honorary  surgeon  at  the  infirmary,  said  that  it  was 
true  that  the  expenditure  on  stimulants  had  increased^ 
but  that  was  due  to  the  gravity  of  the  fever  cases^ 
treated  in  the  institution.  Such  patients  had  required 
more  stimulants ;  and  Dr.  King  added  that  better 
results  had  been  shown  in  the  treatment  of  fever  caam- 
by  the  use  of  a  certain  amount  of  alcohol  The 
governors  of  medical  charities  should  always  place 
confidence  in  the  medical  staff's  of  the  institutions 
with  respect  to  the  administration  of  alcohol.  No- 
hard  and  fast  rule  can  be  drawn  in  the  matter.  Some 
epidemics  are  more  serious  in  the  effects  than  otherSr 
and,  consequently,  the  patients  do  better  stimu- 
lated by  alcohol  and  vice  versa. 

The  Cigarette  and  its  Disadvantages. 
The  American  Laryngological  Association  at  a 
recent  meeting  had  a  long  discussion  upon  the  subject 
of  cigarette  smoking,  and  in  a  paper  read  at  the  meet- 
ing Dr.  Mulhally  of  St.  Louis,  although  a  smoker  of 
cigarettes  for  twenty-five  years,  makes  some  pertinent 
observations  upon  the  evils  of  the  habit.  The  only 
active  toxic  agent  present  in  a  cigarette  is  nicotine^ 
and  this  may  cause  harm  or  not  according  to  a  variety 
of  circumstances.  The  chief  element  concerned,  when 
without  exception  it  is  productive  of  harm,  is  youth; 
General  experience  shows  that  every  child  who  smokes 
tobacco  habitually  suffers  serious  impairment  of  health.^ 
In  adolescence,  and  practically  this  may  be  said  to  be 
from  puberty  until  eighteen  in  females,  and  twenty- 
one  in  males,  the  evil  is  not  so  great,  but  is  still  a 
great  one,  for,  although  the  nervous  crisis  of  puberty  has- 
been  passed,  the  nervous  system  is  still  rapidly  develop* 
ing.  The  nerves,  after  puberty,  are  more  resistant  tha» 
in  childhood,  but,  on  the  other  hand,  greater  demands  are' 


Fib.  5,  1896. 


SCOTLAND. 


Thb  Mbdigal  Psxss.     151 


eorreipoDdiogly  made  upon  them,  either  by  the  higher 
phases  of  edncatioii  on  the  one  hand,  or  by  the  actual 
diily  struggle  for  existence  on  the  other.  It  seems  to 
he  indispntable  that  the  nee  of  tobacco  is  a  serious 
handicap  in  the  progress  of  youths.  Investigations  so 
hr  seem  to  show  that  the  percentage  of  winners  in 
intellectual  and  athletic  contests  is  considerably 
hj^ier  among  the  total  abstainers  from  tobacco.  In 
ihe  oondemnations  which  Dr.  Mulhall  reiterates  in 
legaid  to  the  cigarette  most  medical  men  will  agree. 
Tlie  seductiveness  of  the  cigarette  is  its  mildness,  by 
whidi  repeated  small  doses  of  nicotine  are  absorbed 
lad  cause  their  toxic  effects  upon  the  nervous  system, 
laeooaequence  of  its  mildness,  too,  the  cigarette  is  fast 
endog  into  favour  with  ladies,  by  whom  neither  pipe 
Bor  agar  smoking  could  be  tolerated  without  direful 
moltB. 

The  Royal  CoDege  of  Physicians,  London. 

Thk ordinary  quarterly  conittia  of  the  Royal  College 
of  Fbjsicians,  London,  was  held  on  the  30th  ult 
wheo  the  following  gentlemen  were  admitted  as 
Members  of  the  College :— Bertram  L  Abrahams, 
ILELand. ;  Cuthbert  C.  Gibbep,  M.D.Aber.  ;  Albert 
S.  F.  Gfiinbaum,  M. A.,  M.KCantab. ;  John  S.  Stanley, 
M,D.Edm. ;  and  Seymour  G.  Toller,  M.D.Lond.  With 
becombg  loyalty  the  Fellows  passed  a  resolution  of 
Bympa&y  with  the  Queen  and  Princess  Beatrice,  upon 
the  deiUi  of  Prince  Henry  of  Battenberg.  Since  the 
last  amiiia  a  memorial  tablet  has  been  placed  in  the 
ibwy.   It  bears  the  following  inscription  : — 

"In  remembrance  of  Sir  Henry  Halford,  Bart, 
aCH.,  M.D.,  F.R.S.,  for  24  years  president  of  the 
fioyal  College  of  Physicians  ;  to  whom  mainly  is  owing 
the  removal  of  the  college  from  the  City  to  this  site  ; 
to  whoee  personal  influence  with  King  George  lY.  was 
doe  the  grant  from  the  Crown  of  the  ground  on  which 
this  edifice  stands  ;  and  who  on  June  25th,  1825, 
opened  it,  with  an  elegant  Latin  oration,  in  presence  of 
an  andieoce  the  most  distinguished  that  has  ever 
iflsembled  within  the  walla  of  the  college.  To  per- 
petuate the  memory  of  these  services,  and  of  Sir  Henry 
Halford'a  untiriDg  efforts  to  maintain  the  culture, 
character,  and  position  of  the  English  physician,  and 
the  welfare  and  dignity  of  this  college,  and  to  mark 
the  admiration  and  gratitude  with  which  he  was 
regarded  by  his  contemporaries,  this  tablet,  by  a  vote 
d  the  college,  has  been  here  placed." 

The  Diplomas  in  Public  Health  were  granted  con- 
jointly by  the  Royal  College  of  Surgeons  to  ten  medical 
men,  aod  Licences  to  practice  Medicine,  Surgery,  and 
Midwifery,  were  conferred  upon   a  large   batch    of 


A  Remarkable  Dermoid  Cyst  of  the  Ovary. 
DisuoiD  cysts  are  simply  freaks  of  Nature,  and  may 
oceor  iD  various  situations  of  the  body,  but  the  ovary 
in  the  female  and  the  coccygeal  and  thyroid  regions  in 
the  male  are  their  favourite  spots  of  selection.  Accord- 
ing to  Paul  Mundd,  who  records  some  interesting 
observations  on  the  subject  in  the  December  number  of 
the  American  Journal  of  Obstetrics,  dermoid  cysts  of 
the  ovary  may  remain  dormant  for  a  number  of  years, 
bat  they  are  apt,  finally,  to  spring  into  activity  at  one 
of  three  chief  periods  of  life,  first,  that  of  puberty,  or 
K<^d,  that  of  marriage,  or  third,  that  of  childbirth. 


Each  of  these  different  periods  seem  to  exert  a  stimu^ 
lating  influence  upon  the  growth  of  these  tumours.- 
The  author  narrates  the  case  of  a  virgin,  let  41,  from 
whom  he  removed  a  dermoid  <^t  of  tiie  ovary,  the 
contents  of  which  consisted  of  a  tress  of  hair,  sur* 
rounded  by  a  small  amount  of  a  pea-soup  like  fluid. 
On  dissolving  the  sebaceous  material  in  ether  the  hair 
was  cleansed,  and  subsequently  it  was  found  that  the- 
tress  actually  measured  no  less  than  seven  feet  in* 
length.  In  colour  it  was  of  a  dark  blonde,  and  in 
structure  was  as  perfect  as  that  of  the  hair  of  the 
female  head,  only  perhaps  a  trifle  finer.  All  this  mass 
of  hair  sprang  from  one  small  nipple,  not  more  than 
one  inch  in  diameter,  situated  upon  the  internal  wall 
of  the  cyst.  Such  a  unique  case  as  this  is  worthy  of 
record. 

The  brother  of  the  late  Canon  Liddon,  Dr.  Edward* 
Liddon,  J.P.,  of  Taunton,  was  presented  a  short  time 
ago  with  a  testimonial  by  the  members  of  the  Tauntoir 
Vale  Harriers,  the  Mastership  of  which  he  had  held  for 
twenty  years.  The  gift  consisted  of  a  large  loving  cup 
of  Georgian  pattern,  mounted  on  an  ebony  standi 
attached  to  which  was  a  silver  plate,  bearing  the  namee* 
of  one  hundred  subscribers. 


[FBOM  OUB  own  COBBBSPONDaNT.] 

Thb  Mbdioal  Advisbb  to  the  Commissionbbs  of* 
Pbisons  for  Sootland.— We  anderstand  that  there  are 
manv  applicants  for  the  office  jaab  vacated  by  Sir  Douglas 
MaclagaD.  Two  medical  knights,  one  of  them  Sir  Henry 
Little  John,  some  University  professors,  and  namerous 
smaller  fry  are  eager  to  win  £200  a  year  with  not  very 
mnch  to  do  for  it.  It  wonld  be  a  great  pity,  however,  if 
the  appointment  were  given  to  anyone  who  already 
occupies  posts,  the  proper  upholding  of  which  entails  con-- 
stant  personal  supervision.  Too  often  posts  with  fixed 
duties  (?o  to  those  who  have,  and  not  to  ethers,  and  quite 
as  good  men,  who  have  not,  owing  to  influence  acquired 
in  the  performance  of  the  duties  of  the  other  appoint* - 
ments. 

Fibb  at  the  Edinbuboh  Botal  Infibhabt. — Early  on 
Saturday  morning  last  a  fire  occurred  in  the  premises  be- 
longing to  the  Edinburgh  Royal  Infirmary,  but  occupied 
by  the  College  of  Physicians  as  a  laboratory.  Luckily  the 
fire  was  confined  to  the  rooms  in  the  top  flat,  and  the  only 
damage  done  to  the  rest  of  the  building  was  caused  by 
water.  Some  of  the  workers  in  the  histological  depart- 
ment in  the  top  flat  have,  however,  lost  much  interesting 
and  valuable  material.  The  work  of  the  laboratory  will 
be  carried  on,  in  the  meantime,  in  a  detached  part  which 
entirely  escaped  the  efiects  of  both  fire  and  water. 

Scottish    Poob-law    Medical     Officebs. — The  first' 
annual  dinner  of  the  members  of  the  Scottish  Poor- law 
Medical  Officers'  Association  took  place  in  Glasgow  on  the< 
30th  January.     The  Chairman,  Dr.  Bruce,  of  Dingwall,  io 
proposing  the  toast  of  the  Association,  said  that  it  was  nearly 
forty  years  since  he  was  chosen  Poor-law  medical  officer* 
for  a  amall  Aberdeenshire  parish,  and  not  long  afterwards 
one  of  his  near  neighbours  was  ousted  from  his  office  be-- 
cause  he  had  asked  for  an  increase  of  salary.     An  attempt 
was  made  by  some  of  the  medical  officers  to  get  the  Board 
of  Supervision  to  lay  down  a  distinct  rule   refusing  to* 
sanction  such  a  proceeding,  but  without  success.     The 
Board  of  Supervision  bad  jurisdiction  bv  law  in  the  case 
of  the  inspector  of  poor,  and  it  wa^  thought  the  law  should 
be  extended  to  the  medical  officer.     There  was  and  is  no* 
law  authorising  them  to  claim  such  authority  to  ensure 
fixity  of  tenure.    The  object  could  be  attained,  however, 
by  making  the  grant  in  aid  for  medical  relief  dependent 


152    Thb  *Mbdioal  Press. 


LITERARY  NOTES  AND  GOSSIP. 


Feb  5,  1896 


•^n  the  right  of  appeal  heing  given  to  every  medical  officer 
participating  in  the  grant.    He  believed  that  the  Local 

'Government  BoMrd  did  unofficially  iet  its  face  againat 
arbitrary  changes  of  Poor-law  medical  officers.  As  to  re- 
maneration,  he  did  not  think  that  the  officers  received 
adequate  payment  in  all  cases  ;  indeed,  in  some  instances, 
of  which  he  knew  he  was  aware  that  the  salary  was  too 
small  for  the  work  expected.    He  considered  that  it  was 

•a  public  duty  to  see  that  the  salary  was  sufficient  to  pay 

'for  generous  medical  treatment.  There  should  also  be  a 
superannuation    fund ;  in  short,   the  Poor-law  medical 

-officer  should  be  put  on  the  footing  of  a  properly  salaried 

lindepeudent  civil  servant. 

A  TRANSLATION  from  the  Swedish  language  of  a  book  on 
*"  Modem  Woman,"  which  has  attracted  much  attention 

on  the  Continent,  is  about  to  appear  in  English.  The 
:  authoress  is  Mrs  Hansson,  wife  of  Prof.Hansson,  a  Swedish 

literary  celebrity. 

Ws  have  received  from  Messrs.  Gassell  and  Oo.  the  first 

•  part  of  '*Ca88^11's  History  of  England"  as  well  as  of 
«  British  Battles  on  Land  and  Sea/'  including,  with  the 
latter,  a  large  presentation  plate.     Both  publications  are 

•  excellent,  and  ehould  command  a  large  sale. 

*  * 

The  **  Chemist's  Compendi*um/'  bv  Mr.  C.  J.  S.  Thomp- 
son, is  a  useful  little  volume,  carefully  compiled,  which 
chemists  and  pharmacy  students  will  appreciate  for  the 
vast  amount  of  information  which  it  contains  in  a  small 

•compass.    We  can  cordially  recommend  it. 

•  * 
• 

At  the  small  price  of  half-a-crown  Messrs.  Philips  & 
XjO.  publish  an  excellent  anatomical  paper  model  of  the 
human  head  and  neck,  illustrated  and  described  by  Dr. 
Schmidt,  and  translated  by  William  S.  Fumeaux.  The 
model,  of  convenient  size,  is  designed  after  the  manner  of 
Witkoweki's  atlases  which  acquired  such  a  wide  repu- 
tation. 

V 

Wk  understand  that  Dr.  John  S.  Billings,  who  is  no 
doubt  known  to  many  of  our  readers  as  editor  of  the  Indeto 
Medicus,  and  compiler  of  the  Index  Catalogue  of  the 
.'Surgeon-General's  Library  at  Washington,  has  TOen  offered 
.  and  has  accepted  the  responsible  and  lucrative  office  of 
librarian  of  the  new  Consolidated  Libraries  of  New  York. 
%• 

Ah  acceptable  calm  seems  to  pervade  the  medico-liter- 
ary atmosphere  in  succession  to  the  storm  of  mental 
activity  evolved  in  the  production  of  new  works  and  new 
^itions  which  prevailed  durine  the  past  few  months.  No 
new  venture  of  importance  has  reached  us  during  the  past 
month,  and  gossip  is  silent  as  to  the  future  in  this 
/direction. 

V 

A  usxruL  little  publication,  "  The  Phonographic  Out- 
lines of  Medical  Terms,"  has  just  been  issued  by  the 
Society  of  Medical  Phonographers.  It  contains  a  list  of 
outlines  and  contractions  for  about  2,500  of  the  more 
.  common  medical  terms.  The  list  is  arranged  in  alphabe- 
tical form,  and  begins  with  <'  abdomen,"  and  enoa  with 
"  zygomatic." 

AoooSDiKG  to  the  Pvhliahera^  Gircvlar,  a  new  book  of 
sermons  is  published  every  day,  five  novels  every  twenty- 
four  hours,  six  histories  or  biographies  each  week,  two 
.educational  books  every  morning ;  art  and  science  only 
get  a  recruit  about  twice  a  week,  law  once  a  fortnight. 
The  grand  total  of  new  publications  in  1895  was  5,581. 
How  many  of  the  authors  of  these  books  are  now  wiser 
and  sadder  persons? 

«  « 

We  have  received  the  half-yearly  volume,  July  to 
December,  1895,  of  "  Braithwaite's  Retrospect  of  Medi- 
cine." As  usual,  the  volume  is  full  from  cover  to  cover 
of  good  material  culled  from  the  best  medical  literature 
throughout  the  world.  We  notice,  however,  some  mis- 
prints in  the  spelling  of  words,  chiefly  in  the  obstetrical 
eection,  which  have  inadvertently  escaped  the  notice  of 
^he  Editors. 


Db.  Bond,  of  Glonceefcer,  sends  us  a  copy  of  a  Qsefal 
leaflet  drawn  up  by  him  and  entitled,  "Our  Duty  in 
Regard  to  Vaccination,  or  fifteen  reasons  why  we  should 
believe  in  the  efficacy  of  vaccination  as  a  preventive  of 
small-pox."  This  might  be  distributed  broaacas1>  in  tbost 
districts  where  recalcitrant  Boards  of  Gaaidiaos  have 
failed  to  do  their  duty  in  prosecuting  defaulters  under  the 
Vaccination  Act.  In  the  Bristol  district  also,  where  Mr. 
Walter  Hadwen  holds  forth,  some  copies  might  be 
useful. 

%• 

SoMB  papers  in  the  Edinburgh  Medical  Journal  for  the 
current  month  aie  "  Remarks  on  the  Results  of  Sargicsl 
Measures  in  a  series  of  Cerebral  Cawes,"  by  Dr.  6.  A.  Gib- 
son ;  "  Diabetes  Mellitusin  Early  Infancy,"  by  Dr.  W.  B. 
Bell ;  '*  Public  Vaccination  in  Edinburgh,''  by  Dr.  W. 
Husband.  It  would  be  a  great  convenience,  boUi  to 
reviewer  and  reader,  if  the  proprietors  of  this  jonriMl 
would  follow  the  lead  of  their  contemporaries,  and  ieene  the 
copies  with  the  leaves  cut. 

V 

The  Scalpel f  although  a  new  claimant  for  the  favour  of 
the  reading  medical  public,  is  really  the  Provincial  Ifedieal 
Journal  under  a  new  name.  The  latter  journal  departed 
its  life  at  the  end  of  last  year,  but  the  Editor  decided  to 
raise  out  of  its  remains  another  journal,  to  which  he  has 
given  the  came  of  The  Scalps  The  first  number  cf  the 
venture  is  before  us.  It  appears  in  an  attractive  cover, 
and  its  contents  are   similar  to  those    with   which  th» 

readers  of  its  predecessor  have  made  themselves  familiar. 

•  ♦ 

Thb  United  Kingdom  Branch  of  the  Dnflerin  Fond  has 
established  four  new  scholarships  of  £50  each,  tenable  for 
two  years,  to  be  held  by  ladies  who,  having  already  prac- 
tised in  India,  were  desirous  of  obtaining  the  higber 
degrees  in  medicine  at  an  Enfirlish  University.  Tw6  of 
these  scholarships,  the  Queen-Empress  and  the  Dnfferin, 
have  now,  respectively,  been  awarded  to  Mies  D.  £. 
Pratt,  Assistant  Surgeon  at  the  Lady  Lyall  Hospital  at 
Agra,  and  Miss  A.  N.  DeSouza  of  Amritear.    Both  ladies 

were  formerly  students  at  the  Calcutta  Medical  College. 

*  • 

• 

RiFBBRiNO  to'the  paragraph  in  our  last  month's  "  Liter* 
ary  Notes"  on  the  piracy  by  American  authors  and 
publishers  ef  English  medical  books,  a  leading  New  York 
publisher  writes  us,  *<  We  quite  agree  with  you  that  it  it 
time  such  pla^^arism  should  be  stopped,  and  one  of  tfas 
ways  to  do  this  is,  to  make  the  facts  as  public  as  possible.'* 
We  would  go  further  than  this,  and  say  that  if  America 
would  consent  to  the  same  Copyright  Act  as  exists  as  a 
matter  of  honour  between  European  nations,  this  piracy 
could  not  take  place,  and  authors  and  publishers  alike 

would  be  protected. 

♦  ♦ 

It  would  appear  that  New  York  is  fast  becoming  the 

Ultima  Thule  of  medical  skill  and  thought  in  the  United 

States.      For  example,  the  centralisation  there    of  the 

leading  professional  journals  is  truly  remarkable.     The 

Medical  Newe^  above  referred  to,  is  the  second  medical 

journal,  the  editorial  offices  of  which  have  been  reoeotly 

removed  from  Philadelphia  to  New  York.    All  this  would 

seem  to  show  that  the  competition  of  New  York  as  a 

centre  of  learning,  enterprise,  and  influence  is  becoming 

too  great  to  be  withstood  by  the  other  large  cities  in  the 

States. 

*  • 

With  the  removal  of  the  PhUaddphia  Medical  News 
to  New  York,  and  a  change  in  the  editorship,  a  notable 
improvement  is  already  apparent  in  the  JonmaL  The 
"  orthographic  atrophy,"  which  under  the  former  rigime 
was  so  marked  a  feature  of  our  esteemed  contemporary, 
has  now  almost  disappeared  from  its  pages.  Evidently  the 
attempt  to  foist  die  new-fangled  system  of  spelling 
scientific  words  does  not  find  any  favour  with  the  editors 
of  the  best  organs  of  the  profession  in  New  York.  We 
congratulate  the  new  Editor  of  the  Newe,  Dr.  J.  Riddle 
Goffe,  upon  his  assumption  of  a  policy  in  his  charge  of  the 
Journal  which  cannot  fail  to  prove  accejltable. 

The  Practitioner  for  February  is  a  good  number,  and 
fully  maintains  its  position  as  one  of  the  best  of  the 
monthly  periodicals  issued.  The  editor  has,  since  the 
commencement  of  the  new  year,  increased  the  size  of  his 


FlF.  5,  lS9fi. 


CORRESPOJSDENCE. 


TaE  Mkdical  Pkvss.     1^^ 


j0QrMltol]2  pAgw,  and  has  andertaken  to  give  every 
Boath  a  portrait,  tofpetber  with  a  short  biogpraphy  of 
a  "hero  in  medicine."  lo  the  Dumber  before  us  this 
hoDoar  w  conferred  apon  Giovanni  Battiitta  IVforgagni. 
Ammg  the  orieinal  commanicationa  Dr.  W.  M.  Ord  die- 
coniflBt  on  **  Renal  Diaeaaee,'  Sir  Tfaomley  Stoker  on 
** Excision  of  the  Knee-joint  for  Tubercnloas  Disease," 
•ad  Dr  Charte^is  on  **  The  Prevention  of  Sea  Sickness  in 
Short  Voyages.'* 

V 

Ths  Editor  of  the  Atuitralaaicm  Medical  OcaeiU,  Dr. 
Knaggs,  has  dedicated  the  use  of  his  library  in  Sydney  to 
the  members  off  the  medical  profession  in  his  district,  and 
for  three  hoars  every  afternoon  his  collection  of  books  will 
be  open  to  any  medical  practitioner  who  may  desire  to 
pay  it  a  visit.  The  formal  dedication  of  the  library  took 
pboe  h»t  month,  at  a  meeting  to  which  special  invitations 
vers  iBsned  by  Dr.  Knaggs  to  the  Presidentii,  Members 
of  Oosncil.  and  officials  of  the  New  South  Wales  branch 
of  the  British  Medical  Association,  the  suburban  medical 
Boeieties  and  the  Newcastle  Medical  Society.  The  fact 
that  such  a  step  as  thin  should  have  been  taken  by  a 
prirtto  member  of  the  profession  rather  shows  that  Sydney 
mut  be  badly  off  for  a  public  medical  library. 

As  evidence  of  the  dishonesty  to  which  English  authors 
uerabject,  we  need  only  mention  the  case  of  a  '*  System 
of  Siigery  by  American  Authors,'  recently  issued.  On 
leosipt  of  the  first  volume  in  this  country,  the  American 
ByflUin  of  surgery  was  discovered  to  be  most  pronounced 
iaiti^bsenoe,  and  English  authors  had  been  so  plsgiarised 
thst  the  sale  was  prohibited  in  Great  Britain,  and  the 
vdlsiiMs  had  to  b«»  promptly  returned  to  the  home  of  their 
birth.  Of  course,  this  might  have  been  a  mere  coinci- 
deooe^  and  the  American  Authors  might  not  have  known 
of  the  existence  of  the  English  works,  but  they  will, 
perbipi,  pardon  oar  suggesting  that  it  would  have  been 
mors  straightforward  had  they  issued  the  work  as  an 
Ammtan  SyHem  (not  in  surgery)  we  should  have  ucder- 
•loodittere. 

•  * 
• 

TBI  medical  officers  of  Schools'  Association  has  done 
veil  in  calling  attention,  by  means  of  a  pamphlet,  to  an 
Attendsat'evil  on  Rugby  football  in  the  shape  of  a  okin 
dLnsw,  communicatea  daring  scrummaging  work.  It  is 
knows  scientifically  as  Football  Impetigo,  and  among 
nhoolboys  by  the  expreseire  idiom  of  "  scrum  pox."  The 
pnphlet  is  the  work  of  Mr.  H.  G.  Armstrong,  M.R.C.S., 
Madittl  Officer  to  Wellintrton  College,  and  the  author 
docribes  how  the  contsgion  is  confined  almost  to  the 
lorwiids,  and  it  seems  as  though  the  hardest  pushers  are 
theoaes  most  certainly  affected.  The  only  possible  means 
of  keeping  down  the  affeeUoD,  if  not  absolutely  abolishing 
'A  !•  serupnlons  attention  to  the  purification  of  jerseys, 
vJueh  abould  be  thoroughly  cleansed  after  each  match. 

Db.  Conan  Dotue,  of  ** Sherlock  Holmes"  fame,  has 
joit  appeared  in  a  new  r6U.  A  firm  of  large  advertisers 
of  •  qnsok  medicine  have  brought  out  a  small  book,  in 
which  the  virtues  of  their  commodity  are  set  forth  in  all 
tlie  Bsoal  blatancy  of  each  purveyors,  but  as  a  special 
indsoement  to  read  the  annonncemenU,  the  book  also 
coBftsins  a  story  by  Dr.  Conan  Doyle,  which  is  said  to 
be  intorestiog.  This  <*  literary  production  "  is  intended 
Mhefirm  to  reach  the  hands  of  the  public  through  the 
dMBiste  who  sell  their  conooction.  No  doubt,  as  an 
anaple  of  bosinesB  enterprise,  this  feature  of  advertising 
is  <iiite  DoveL  At  the  same'time,  we  question  very  much 
tbegood  taste  of  a  medics  1  man,  even  under  the  form  of 
litantare.  having  anything  to  do,  however  remotely,  with 
thsialeof  aqoack  noetrnm. 

,.y«  l»ve  received  the* Appendix  to  Dr.  Neale'e 
"Medical  Digest"  for  the  years  189195,  and  we  must 
eoDgratoUte  ourselves  and  the  profession  on  the  unweary- 
ing setivity  shown  bv  the  author  in  continuing  to 
pcofide  us  with  this  admirable  index  to  current  medical 
u^vatoie.  Such  a  work  of  reference  is  indispensable  to 
wrrteis  on  medical  subjects,  for  without  it  the  task  of 
wmj  up  previoas  allusions  to  a  given  subject  would  be 
^jffpoA  tiis  powers  of  any  individuafiaveetigator.  It  was, 
bmrer,  originally  intended  for  the  asMstance  of  the 
nvy  pnetitiooer  who  finda  therein  a  means  of  ready 


reference  to  such  discoveries,  new  doctrines,  and  difibrent 
modes  of  treatment  in  each  department  of  medical  science 
as  are  likely  to  prove  of  interest.  For  practical  purposes 
a  single  reference  to  the  "  Digest "  will  often  give  all  the 
information  required  without  looking  up  the  particular- 
papers  indicated.  It  is  a  stupendous  work,  and  Dr.  Neale^ 
nas  earned  the  gratitude  of  generations  of  medical  prac- 
titioners as  yet  unborn.  We  see  that  the  "Digest"  may- 
be obtained  in  one  volume  at  the  extremely  moderate- 
price  of  188.  6d.,  and  on  such  terms  it  really  ought  to  find« 
a  place  in  the  library  of  every  medical  man. 

New  Books  and  New  Editions. — The  following  have 
been  received  for  review  since  the  publication  of  our  last 
monthly  list :— International  Eocyclopsedia  of  Surgery^ 
edited  by  John  Ashhurst,  jun.,  M.D  ,  LL.D.  Vol.  Vn. 
Epidemic  Ophthalmia,  by  Sydney  Stephenson,  M.B., 
F.  R  C.S.  Ed.  The  Treatment  of  Pulmonary  Consumption, 
by  V.  D.  Harris,  M.D.,  F.R.C.P  Lond.  The  Theory  and« 
Practice  of  Counter-irritation,  by  H.  Cameron  Gillies, 
M.D.  The  Art  of  Compounding,  by  Wilbur  L.  Scovilie^. 
Ph.G.  Cottage  Hospitals,  by  Hy.  C.  Burdett.  Middlesex; 
Hospital  Reports  for  1894  The  Causes  and  Treatment  of 
Lateral  Curvature  of  the  Spine,  by  R.  Harwell,  F.R.C.S< 
(Fifth  Edition).  Dictionary  of  Treatment,  by  William- 
Whitla,  M  D.  (Third  Edition).  Statistical  Report  of  the* 
Health  of  the  Navy.  1894  5  (Blue  Book).  Formulaire  des 
Medications  Nouvelles,  par  le  Dr.  H.  Gillet.  Deaf -Mutism,, 
a  Clinical  and  Pathological  Study,  by  J.  K.  Love,  M.D. 


(Iorr£0potib£ttce. 

(We  do  not  hold  oonelvM  BuponBible  for  th3  opinions  of  oar 
osrrespondentt.]  

LUNATIC  ASYLUMS-THE  RELIGIOUS  QUESTION.. 
To  the  Editor  of  Tbx  Medical  Press  and  Cibgular. 
Sm,— In  the  few  remanks  I  offered  on  this  delicate* 
subject  I  had  no  idea  of  referring  to  Dr.  Hy  slop's  views* 
in  any  capricious  or  cavilling  spirit,  at  the  same  time  I 
may  repeat  that  if  "  a  true  and  philosophic  religion  "  is- 
conducive  to  a  state  of  canity,  it  is  only  fair  to  aek  whi6h- 
is  the  true  one,  and  for  the  life  of  me,  speaking  personally,. 
I  have  never  been  able  to  find  out.    Dr.  Hyslop  moreover 
denies  that  cases  of  religious  enthusiasm  which  culminate 
in  insanity  are  greater  uian  those  which  arise  from  alco^ 
holic  stimulants.    I  believe  I  am  correct  in  stating  that 
the  question  is  an  open  one,  because,  as  a  matter  of  fact, 
it  is  next  to  impossible  on  any  system  extant,  to  arrive  at 
a  conclusion  as    to  how  many  become  insane  through 
drink,  because  it  so  happens  that  the  causes  of  insanity 
are  in  many  respects  identical  with  those  which  lead  tO' 
alcoholic   intemperance,  and    these    are    often    opera- 
tive  at  the  same  time   in   the  same  individual.     For 
example.   Dr.  Hyslop  has  enumerated  different  factors 
in    insanity    amongst     which     I     recollect    overwork 
is    one.      Now,    let    us   suppose   a    temperate   person 
became  insane  from  overwork,  I  apprehend  lunatic  experts 
would  tabulate  this  as  a  cause  of  the  insanity  ;  but  sup- 
posing further,    another  individual,  in  undergoing  his 
transitional  journey  from  a  sane  to  an  insane  state,  bMame< 
intemperate,  overwork   acting  as  an  incentive  in  this 
direction,    the    cause    asssigned    in    this   case  would, 
I    surmise,     be    alcoholism,    but     according     to     the 
hypothesis  this  individual  was  going  insane  before  he 
commenced  drink,  and  indeed,  so  far  from  the  case  of 
insanity  being  the  effect  of  drink,  it  would  be  much 
nearer  the  truth  to  allege  it  as  the  cause. 

And  here  it  may  be  premised  that  statistics  on  the  point-, 
based  on  any  numeric  calculations  must  be  fallacious,, 
yet  these  are  the  statistics  in  which  the  extreme  teetotal 
party,  an  extremely  dangerous  class  of  faddists,  delighr. 
m  dabbling.    While  on  this  point  permit  me  to  remarkv 
that  for  many  vears  I  have  held  the  opinion  that  alcoholic 
stimulants  judiciously  applied  may  in  some  cases  be  a. 
powerful  factor  in  prevenung  insanity,  and  if  it  be  asked  < 
what  evidence  there  is  in  support  of  such  a  supposition,  Ii. 
answer  that  inasmuch  as  mental  depression  from  any< 
source  is  a  factor  in  insanity,  it  is  impossible  to  escape  the  • 
conviction  that  moderate  stimulation,  of  course,  short  of^ 
producing  pathologiosl  changes-  in  nerve  structure^  .must . 


154     The  Medioal  Pbb«s. 


LABORATORY  NOTES. 


Feb.  5>  1896 


tend  to  ooanteract  such  depreeaion,  and  henoe  may  under 
varied  conditions  of  life  tend  to  maintain  sanity. 
This  view  of  mine  is.  no  doabt,  heterodox  to  asylam 
enperintendents,  bat  I  am  quite  open  to  conviction  on 
the  other  side ;  meanwhile,  I  would  beg  that  our  lunacy 
authorities  should  be  extremely  cautious  in  oommittiog 
themselves  to  statements  as  re^^ards  drink  and  its  relation 
to  insanity,  as  agitators  readily  seize  asylum  statistics 
above  all  others  to  frighten  the  weak  portion  of  the  com- 
munity from  taking  that  which  may,  under  some  condi- 
tions, be  necessary  to  maintain  the  integrity  of  the  nervous 
system,  and  thus  unintentionally  be  doing  detriment  to 
the  public  service.  Thanking  Dr.  Hyvlop  for  his  courteous 
letter, 

I  remain,  sir,  yours  gratefully, 
.Queen's  Road,  Peckham,  Clement  H.  Sibs. 

January  30,  1896. 

♦ 

•THE  NOTIFICATION  CASE-HADDEN  FUND. 

To  the  Editor  of  The  Medioal  Pbess  and  Cibodlao. 

Sis, — The  following  is  a  list  of  subacriptions  received 

'through  various  sources  previous  to  the  bearing  of  the 

Appeal,  in  addition  to  the  list  published  in  this  journal  on 

,Jan.  22nd. 

I  am.  Sir,  yours,  &c., 
J.  Craio,  M.D.,  Hon.  Sec.  and  Treas. 
35  York  Street,  Dublin. 


Dr.  Burgess  (Dub- 
lin)         

Dr.  Atochs  (Dub- 
lin)         

Dr.  R.  McVittie 
(Dublin) 

Dr.  F.  R.  Cruise 
(Dublin) 

jDr.  J.  T.  W.  Allen 
(Dublin) 

Dr.  R.  L.  Heard 
(Merchistown)  .. 

Dr.  T.  P.  Mason 
(Dublin) 

Dr.  Morrison, 
F.R.C.S.I.,(Dun. 
dalk)      

Dr.  W.Ryan  (Dub- 
lin)          

Dr.  T.  T.  Moore 
(Kingstown)     ... 

Dr.  T.  M.  McEvoy 
(Blackrock)      ... 

Dr.  Paton(Fioglas) 

Dr.  J.  W.  Boyce 
(Blackrock)      ... 

R.  Hyde,  Brigade- 
Surg..    (Dublin) 

Dr.  W.  E.  Haddon 
(Portadown)    .. 

Dr.  J.  H.  Benscn 
(Dublin) 

Dr.  H.  W.  Jacob 
(Great  Malverm) 

Dr  H.  R.  Haddon 
(Dublin) 

Dr.  Tushy  (Dublin) 

Dr.  B.  A.  Palmer 
(Armagh) 

A.  H  Jacob,  M.D  , 
(Dublin) 

Dr.  J.  T.  Hamilton 
(Dublin) 

Dr.  W.  J.  Thomp- 
son (Dublin) 

Dr.  R.  B.  H.  (Skib- 
bereen)   

T.  Beaumont,  Dept. 
Sur.Gen.  (Dub- 
Un)        

Dr.  Albert  Croly 
(Rathfarnham) 

Dr.  G.  Nesbitt 
Wynne  (Dublin) 


£  s.  d. 

1  0  0 

1  0  0 

2  2  0 
5  5  0 
1  1  0 

1  1  0 

2  2  0 


1  1  0 
1  0  0 
1     1    0 


1  1  0 

1  0  0 

1  1  0 

1  1  0 

1  1  0 


1     1  0 

1    1  0 

10  0 

1    1  0 

1     1  0 


1  0  0 
1  1  0 
1     1    0 


Dr.  J.  E.  Moffat 
(Dublin)  ...100 

H. •). Harden,  Sar^. 
R.N.iBdrmuHa**)    2    0    0 

Dr.  W.  VernerFur- 
looff  (Dublin)  ...110 

Dr.  G.  P.  Cope 
(Dublin)  ...110 

Dr.C.T.J.G'Rorke 
(KelU) 10    0 

Dr.     John     Crean 

(Wexford)         ...    1     1     0 

Medical  Stiudentd, 
(T.C.D.)  ..         ..  10  10    0 

South-Eas  tern 
Br  nch  Brit.  Med. 
Ass.  Ireland     ...    2    2    0 

Dr.  Cotter  (Cork)      110 

Dr.  J .  Barton 
(Dublin)  ...    0  10    6 

Dr.  Dormer  (New- 
town Berry)     ...110 

Dr.  Martin  (Port- 
rush)      0  10    0 

Dr.  Denham  (Dub- 
lin)          110 

Dr.  M.  CulUgh 
(Belfast)  ..     0  10    6 

Dr.  S.  Gordon(Dub- 
Un)         ...  110 

Dr.  Atthill  (Dublin)   1     1    0 

Brig.Surg.  Potter 
(Dublin)  ...110 

Dr.  W.  J.  Smyly 
(Dublin)  ...    1     10 

Dr.  A.  W.  Baker 
(Dublin)  ...    1     1    0 

Dr.  Heam  (Rath- 
mines)  10    0 

Dr.  Mussen  \Glen- 


avy)       

Dr.   Taylor   (Tan- 

deragee) 
Dr.  Scott  (Kings- 
town)      

Dr.         Kennefick 

(Clonmel) 
Dr.  Bradley  (Drog- 

heda)     

Dr.         Ronaldson 

(Haddington)  ... 
Mr.    R.   L.  Swan 

(DubUn) 


0  10  0 

0  10  6 

1  1  0 
0  10  6 

0  10  0 

1  1  0 
1     1  0 


THE  RECENT  REMARKABLY  LOW  DEATH-RATE 
IN  LONDON. 

To  the  Editor  oj  Ths  Msdioal  Pbxss  and  Giboulab. 

Sib, — During  the  fourth  quarter  of  last  year  the  deaths 
in  the  metropolis  from  all  causes  rose  but  little  above  an 
annual  rate  of  17*7  per  1,000  of  the  population,  which  is 
2  0  below  the  average  for  the  corresponding  periods  of  the 
preceding  ten  years,  being,  in  fact,  l«he  lowest  bat  one  on 
record.  This  is  highly  satisfactory  to  the  community  at 
large,  and  mi^ht  affora  solace  to  the  heavily-taxed  rue- 
payers,  were  it  not  for  the  other  side  of  the  picture. 
Those  who  do  nut  question  the  bene6t  derived  from  im- 
proved sanitation  as  regards  dwelling  houses,  open  spaces, 
&c.,  are  apt  to  grumble  at  the  enormous  expense  attachingto 
the  erection  and  maintenance  of  the  ever-increasing  iada- 
tion  hospitals.  And  this  complaint  is  shown  to  be  not 
without  reason,  by  the  fact  that  notwithstanding  the  above- 
mentioned  large  diminution  in  the  general  death-rate, 
there  was  an  actual  increase  in  the  zymotic  death-rate  of 
0*6  per  1,000  living.  Moreover,  the  deaths  from  notifiable 
diseases  formed  no  lees  than  44  per  cent,  of  the  zymotic 
class,  instead  of  30  per  cent.,  as  formerly. 

I  am.  Sir,  yours,  &&, 

D.  BiDDLE. 

Kingston-on-Thames/ Jan.  31, 1896. 


HUNYADI  JANOS  WATERS. 

It  is  now  many  years  since  we  had  occasion  to  notiee 
this  laxative  mineral  water,  not  inaptly  termed  *'the 
natural  aperient."  Since  that  time  its  popularity  appean 
to  have  extended  on  all  hands  until  its  name  may  be  said, 
«rithout  exaggeration,  to  have  become  a  household  word. 
We  have,  on  more  than  one  occasion,  referred  to  the 
curious  fact,  first  pointed  out  by  Sir  Henry  Thompson,  of 
the  indisputably  greater  efficacy  of  natural  solutions  of 
aperient  salts  over  artificial  preparations,  however  skil- 
fully combined.  Summary  clinical  and  analytical  testa 
prove  that  its  activity  and  chemical  composition  have 
undergone  no  change,  in  fact,  the  results  of  the  most 
recent  investigations  afford  evidence  of  the  care  which,  ws 
are  informed,  is  taken  to  insure  uniformity  of  strength 
and  therapeutical  action.  The  advantages  attending  the 
use  of  natural  mineral  waters  are,  perhaps,  not  sufficiently 
appreciated  in  this  countiy,  but  their  use  has  greatly 
increased  during  the  last  decade  or  so,  especially  among 
the  educated  classes  of  the  community,  who  are  usually 
the  first  to  avail  themselves  of  remedial  innovations. 
Hunyadi  Janoe  is  certainly  the  best  known,  and,  in  oor 
experience,  the  most  trustworthy  of  the  Hungarian  laxative 
mineral  waters -the  so-called  "  bitter- waters."  Taken 
in  the  morning,  either  pure  or  diluted  with  hot  or  cold 
water,  it  produces  a  copious  evacuation  without  leaving 
behind  it  any  intestinal  discomfort  or  exhaustion. 

HARTMANN'S  SANITARY  TOWELETTES. 
Ws  have  already  had  occasion  to  speak  of  theee  deanly 
and  convenient  appliances  in  terms  of  high  commendation, 
and  inspection  of  the  freeh  batch  of  samples  to  hand  justi- 
fies our  repeating  past  expressions  of  satisfaction.  These 
towelettes  are  made  of  wood-wool  (a  good-sucking  matter, 
as  a  German  firm  describes  it),  the  absorbent  properties  of 
which  are  well  known,  secured  in  layers  of  gauze.  They 
are  made  in  various  sices — the  ordinary  sise  at  a  pries 
"  which  defies  competition,"  togetther  with  larger  tasM  for 
menorrhagic  females,  and  a  specially  well-padded  vaii6t7 
for  use  during  the  pnerperium.  The  margin  of  absorb- 
ability is  so  large  that  transudation  is  practically  impoe- 
sible.  Anything  more  hygienic,  cleanly,  and  convenient  it 
is  difficult  to  conceive,  and  they  cannot  fail  in  the  long 
run  to  become  a  national  institution. 


At  a  quarterly  meeting  of  the  Gommifiee  of  the  Central 
London  Throat,  Nose,  and  Ear  Hospital  the  recommenda- 
tion of  the  Medical  Committee  to  inaugurate  a  Bacteriolo- 
gical Department  was  confirmed,  and  Mr.  St.  George  Reid 
was  appointed  to  take  charge  of  it  for  the  ensoing  twelve 
months. 


Fib.  5.  1996. 


MEDICAL  NEWS. 


Thb  Mbdioal  Pbvss.    165 


Briiuh  Medical  Awodation— The  Carlisle  Meeting. 

Dr.  Bablnxs,  Carlisle,  the  Preeidentrnominate  of  the 
Britiab  Medical  Aseociation  for  the  current  year,  has 
neaived  a  tele^um  from  the  Canadian  branch  of  the 
AHOciation  at  Montieal  askine  Carlisle  to  cancel  the 
^itaDgement  for  the  holding  of  Uie  annual  meeting  in  the 
lafctor  €ity  in  July,  in  favour  of  a  proposal  to  hold  it  at 
MontreaL  Dr.  Bamee's  reply  was  to  the  effect  that  the 
^pnparations  for  the  Carlisle  meeting  had  gone  too  far  to 
psnnit  the  request  to  be  enteHained.  The  office-bearers 
fat  the  Carlide  meeting  have  been  appointed,  and  all 
aiTSDgementp  are  prooeeaing  satisfactorily. 

The  Medical  Guild. 
Thb  second  annual  meeting  of  the  Medical  Guild  was 
bald  in  the  Victoria  Hotel,  Manchester,  on  Thursday,  Jan. 
30th,  1896-  Dr.  Henry  Simpson  in  the  chair.  The  annual 
report  of  the  Council  stated  that  62  new  members  had 
joined  during  the  year,  bringing  the  number  to  114,  and 
that  many  matters  of  interest  to  the  profession  had  come 
fasfore  the  Council,  such  as  professional  organization 
gsDsrally,  rate  supported  fever  hospitals,  the  improper 
amiiloyment  of  unqualified  assistants,  unprofessional 
tdfsrtisin^,  the  registration  of  midwives,  '*  Provident 
Hsdical  Aid,**  &c.  The  report  and  statement  of  accounts 
vsfs  received  and  adopted  on  the  motion  of  the  Chair- 
oaa,  seconded  bv  Dr.  Dizon  Mann.  Various  altera- 
tfajDB  of  the  rules  were  discussed  and  agreed  to. 
A  qiedal  report  has  been  drawn  up  by  the  Council  on 
•*Fkovident  Medical  Aid"  dealing  with  the  Friendly 
fiocMes'  Sick  Clubs,  Provident  Dispensaries  and  Medical 
Jtid  Associations,  and  suggesting  methods  by  which  the 
sfib  in  connection  with  such  organizations  might  be 
tenadied.  On  the  motion  of  Dr.  W.  Fraser,  seconded  by 
Dr.  Ratdifi'-Gaylard,  this  report  was  adopted  and  copies 
(Mdsnd  to  be  sent  to  the  medical  preep.  The  following 
Offiosrs  and  Cooneil  were  elected  for  the  ensuing  yecur : — 
CSHdnnan,F.  H.  Walmsley,  J.  P.  ;  Vice-Chairman,  J.  Dizon 
If  SDH,  M.D.,  F.R.C.P. ;  flon.  Treasurer,  C  G.  L.  Skinner, 
M.IX ;  Hon.  Secretary,  Alezander  Stewart,  M.D.  Council, 
J.  Bfsssey  Brierley,  M.D. ;  Wm.  G.  Booth,  G.  H.  Broad- 
bent,  a  Basley,  Colin  Campbell,  W.  Fraser,  M.B.  ;  J.  H. 
43odson,  M.B. ;  C.  R.  O.  Garrard.  J.  Ratdiff-Gaylard,  W. 
Savars  Scott,  M.D. :  James  Hobnee,  M.D. ;  T.  Arthur 
Hflfans,  M.D.  ;  K.  C.  Haring,  M.B. ;  R.  H.  Qnine,  F.  Ley- 
IndKoe,  A.  Brown-Ritohie,  M.B.;  G.  H.  Pinder,  S. 
Woodcock,  M.D.  -,  S.  McNair  and  R.  H.  Wolstenholme. 
Airiitors,  E.  L.  Luckman  and  H.  W.  B.  Monteagle,  M.D. 

Accident  to  a  Medical  Man. 

A  snuGua  accident  occurred  last  week  to  Mr.  F.  W. 
Xandla,  suiseon,  practising  at  Southmolton.  Mr.  Kendle 
«M  being  (uiven  by  his  groom  to  Bishopsnympton,  and 


oo  arriving  at  Bish  Mill  the  horse  shied,  and  the  occupants 
of  the  trap  were  thrown  out.  Mr.  Kendle  unfortunately 
pitefaedon  a  gate  post,  and  received  injuries  which  proved 
to  be  a  fracture  of  the  lower  jaw,  severe  lacerations  of  the 
eheafca,  and  a  severe  fracture  of  the  nose. 

Vital  Statistics. 

The  deaths  registered  last  week  in  thirtv-three  great 
towns  of  England  and  Wales  corresponded  to  an  annuid 
lato  of  19*1  per  1,000  of  their  aggregate  population,  which 
is  aatimated  at  10,591,530  persons  in  the  middle  of  this 
^mt.  The  deaths  regtstered  in  each  of  the  last  four  weeks 
m  the  several  towns,  alphabetically  arranged,  oorres- 
poeded  to  the  following  annual  rates  per  1,0(W  :— 

Btrkeuhead  18,  Birmingham  19,  Blackbum  16,  Bolton 
82,  Bradford  15,  Brighton  13,  Bristol  14,  Burnley  21, 
Cttdiff  12,  Croydon  17,  Derby  19,  Dublin  27,  Edinburgh 
15,  Glasgow  20,  Gateshead  14,  Halifax  17,  Huddersfieid 
15,  Hull  19,  Leeds  18,  Leicester  18,  Liverpool  24,  London 
18,  Manchester  22,  Newoastle-on-Tyne  19,  Norwich  21, 
Kottingham  17,  Oldham  17,  Plymouth  17,  Portsmouth  15, 
Pieston  17,  Salford  26,  Sheffield  18,  Sunderland  16, 
Svanaea  16,  Weat  Ham  14,  Wolverhampton  16.  The 
luKfaeBt  annual  death-rates  per  1,000  living,  aa  meaanred 
by  laat  week'e  mortality  were:— From  measles,  1*0  in 


London  and  in  Leicester,  1  *8  in  Birmingbam,  and  2*7  in 
Salford ;  from  scarlet  fever,  1*2  in  Wolverhampton ; 
from  whooping-cough,  10  in  West  Ham  and  in  Birken- 
head, 1*2  in  Portsmouth,  and  2*2  in  Bolton;  from 
*' fever,"  10  in  Gateshead;  and  from  diarrhoea,  1*0  in 
Birkenbead.  The  deaths  from  diphtheria  included  51  in 
London,  12  in  Birmingham,  4  in  Salford,  3  in  West 
Ham,  3  in  Liverpool,  3  in  Burnley,  and  3  in  HulL 

The  Mortality  of  Foreign  Cities. 
Thi  annual  death-rate  per  1,000  in  the  principal  foreign 
cities  according  to  the  weekly  returns  communicated  to 
the  Registrar-General,  is  as  follows : — Calcutta 41,  Bombay 
32,  Madras  37,  Paris  22,  Brussels  18,  Amsterdam  17, 
Rotterdam,  22,  The  Hague  16,  Copenhagen  15,  Stockholm 
13,  Christiania  14,  St.  Petersburg  35,  Moscow  39,  Ham- 
burg 17,  Dresden  18,  Breslau  22,  Munich  25,  Vienna  23, 
Prague  25,  Buda-Pesth  2»,  Trieste  24,  Rome  24,  Turin  22, 
Venice  35,  Philadelphia  21,  New  Orleans  37. 

Army  Medical  School,  Netley. 
Ths  following  are  official  lists  of  candidates  who  passed 
the  recent  examinations  for  the  Army  and  Indian  Medical 
Services,  and  of  the  prizes  presented  by  General  the  Right 
Honourable  Sir  Redvers  H.  Buller,  V.C,  GC.B., 
K.C.M.G.,  Adjutant-General  to  the  Forces,  on  Friday  last, 
January  3l6t : 

ASMY  MSDIOAL    SSBVIOS. 

The  final  positions  of  these  gentlemen  are  detei  mined 
by  the  marks  gained  in  London  added  to  those  gained  at 
Netley,  and  the  combined  numbers  are  accordingly  shown 
in  the  list  which  follows  :— 
Combined  Marki. 
dBnretoD,  F.  S.  ..    &S11    Waring,  A.  H. 

Suthain.  J.  C.  B 4488    Booper,  A.  W. 

Cooper,  B.  M.  U.  H 4308    Ward,  W.  A.   .. 

Ha\ee,  B.C 4322    Forreet,  E.  a. 

Probyn,  F.  J 4274 

Indian  Medical  Skrvigb. 

Combined  Marks. 

bOochrane,  A.  W.  E.  ..    5i89 

Clemeaha,  W.  W.     ..        ..    5039 

aBakhU,C.  B.  ..    4994 

Black,  J.  A. 4918 

Wilaon^B.  F. 4703 

cLindesay,  v.  E.  H 4670 

Boberteon,  J.  C 4459 

Bainler,  N.  B.  J.      . . 
Kukday,  K.  v. 


Combined  Marks. 
..  4192 
..    41S0 


8876 


Combined  Marks. 

Dawes,  CD 4219 

Ferrv.B.  L 4198 

Finchard,  M.  B 4189 

Niblock,  W.  J 4176 

Harrison,  C.  B.  ..    4178 

Fa>ne,B.  L.  F 4093 

Lalor,  N.  F.  CO 4040 

4430  I  Symons,  T.  H.  ..    4026 

4427  I  Boat.  B.  B 8813 

a  Gained  the  Herbert  Frixe  of  £20,  the  1st  Monteflore  Prise  of  SO 
guineas,  the  Prize  in  Pathology  presented  by  Snrgeon-Major-General 
Hooper,  T.M.S.,  and  the  de  Chanmont  Prize  in  Qy^ene. 
h  Gained  the  2od  Monteflore  Prize, 
e  Gained  the  Maclean  Prize  for  CUnical  and  Ward  Work. 
d  Gained  the  Martin  Memorial  Medal  and  the  Parkes'  Memorial 
MedaL 


OFBBATION  DAYS  AT  THE  LONDONT  HOSPITALS. 

MONDAY.— King's  CoUege,  2  p.m.— Hospital  for  Women,  2  p.m.~ 
Metropolitan  Free.  S  p.m.— Boyal  London  Ophthalmic,  10  a.m. 
— Boyal  Orthopndlo,  2  p.m.— Boyal  Westminster  Ophthalmic, 
L80  p.m.— St.  Mark's,  x  p.m.  -  Chelsea  Hospital  fcr  Women. 

2  p.m. 

TUESDAY- Gny's,  1.80  p.m.-Canoer  Hospital,  Brompton,  2  p.m.— 
St  Maik's,  2.30  p.m.— Boyal  London  Ophthalmic,  10  a.m.- St 
Mary's.  1.80  p.m.— Boyal  Westminster  Ophthalmic,  1.80  p.m.— 
Westminster,  i  pm.— West  London,  2.80  p.m.- Great  Northern 
(Throat  and  Ear  DeptX  2.80  p.m. -Gordon  Hospital  for  FUtnla, 

WEDNESDAY— Children's  Hospital,  G.  Ormond  St,  9.80  a.m.— Great 
Northern.  2  p.m.— London,  2  p.m.— Middlesex,  1  p.m.— National 
Orthopmiio,  10  a.m.— Boyal  London  Ophthalmic,  10  a.m.  -Boyal 
Westminster  Ophthalmic,  1  p.m.— SamariUn  Kree  Boepltal  for 
Women  and  ChUdren,  2.80  p.m.— St  Bartholomew's,  1.80  p.m.— 
St  Peter's,  2  p.nL— St  Thomas's,  L80  p.m.--Unlyer8lty  College, 
2  p^m. 

THUBSDAY— St  George's,  1  p.m.-^ntral  London  Ophthalmic,  1  p.m. 
Charing  Croes,  1  p.m.-BospitaI  for  Diseases  of  the  Throat,  2  p.m., 
—Hospital  for  Women,  2  p.m. -London,  2  p.m.— North-west 
London,  1.80  p.m. -Boyal  London  Ophthalmic,  10  a.m.— Boyal 
Westminster  Ophthahnic,  1.80  p.m.-GheIsea  Hoqiitalfor  Women, 
2  p.m. 

FBIDaY  Guy's,  1.80  p.m.— Central  London  Ophthalmic,  2  p.m. ^East 
London  Hospital  for  ChUdren,  2  p.m.— Boyai  London  Ophthalmia 
10  a.m.— Boyal  South  London  Ophthalmic,  2  p.m.— Boyal  West- 
minster  Ophthalmic.  1.80  p.m.— 8t  Thomas's  (Ophthalmic  Depart- 
ment), 2  p.m.  -  West  London,  2.80  p.m.— Great  iforthem  (Throat 
and  Ear  Department),  8.80  p.m. 

SATUBDAY— Children's  Hoapital,  Great  Ormond  Street,  9.80  a.m.— 
King's  College,  1  p.m.— Cancer  Hospital,  Brompton,  2  pnL— 
London.  2  p.m.— Boyal  Free^O  a.m.  and  2  p.m  -Boyal  London 
Ophthalmio,  10  a.m.— Boyal  Westminster  Ophthalmic,  1.80  p.m.— 
St  Bartholomews,  1.80  p.m.— St  Thomas's,  L80  p.m. 


156     Thb  Mbdioal  Pbi»8. 


NOTICES  10  CORRESPONDENTS. 


Fbb   5..  im>6; 


c^totkeB  to 
Corrcspcntbents,  ^kort  %ttltcs,  &c. 

^fitr  CORMSPORDSifTB  requiring  a  reply  In  this  ootnmn  are  pw- 
tloaUrly  requested  to  make  ujm  of  a  d<tMn«e<w  tigntOuf  or  initidU, 
and  ayoid  the  practice  of  lignlng  themaelTw  "Seadar,"  "  Bnbecrfber," 
"  Old  Subicriber,"  Ao.  Much  oonfoslon  will  be  ipaied  by  attentloD 
to  this  rule. 

Omoival  ARTiOLn  or  LnriBfl  intended  for  pnblloatlon  ihoold  be 
written  on  one  tide  of  the  paper  only,  and  mutt  be  authenticated  with 
the  name  and  addrenot  the  writer,  not  neeeeiarily  for  publteation , 
but  as  eridenoe  of  Identtty. 

liOOAL  BBP0&T8  AITD  NBW»-Oorreiipondonte  deilioQs  of  drawing 
attention  to  these  are  requested  kindly  to  maife  the  newapapen  when 
sending  them  to  the  Bdltor. 

BKPRiNTa— Authors  of  pspers  requiring  reprints  in  pamphlet  form 
after  they  haye  appeared  in  these  columns  can  have  them  at  half  the 
usual  cost,  on  application  to  the  printers  before  type  is  broken  up. 

BSADiiTQ  Cases.  -Cloth  board  cases,  gilt-lettered,  containing  twenty- 
six  strings  for  holding  the  numbers  of  Tn  Mbpioal  Prbsj  and 
ClBCULAB,  may  now  be  had  at  either  offlce  of  this  Journal,  price  Ss.  fid. 
These  cases  will  be  found  very  useful  to  keep  each  weekly  number 
Intact,  clean,  and  flat  after  it  has  passed  through  the  poet. 

Dr.  PBHDLiP(PrestODX-We  are  disposed  to  doubt  theyeracity  of 
the  report. 

PROF.  GairdrCr  (Glasgow) —The  article  on  "Olandnlsr  Therapeu- 
tics "  was  founded  on  the  paper  by  rrof.  Curatnla,  preeesnted  to  the 
Obstetrical  Society  of  London,  on  January  1st,  a  full  report  of  which, 
wlUi  discussion,  will  be  found  Inourlaiue  for  January  8th,  present 
year. 

Mb.  J.  P.  S.— We  will  have  references  locked  up,  and  communicate 
with  you  further. 

Mr.  Krobnb.— Your  letter  is  unayoidably  crowded  out  at  pn  ss. 

J.  v.  O.,  asks  whether  the  proprietor  of  an  hotel  has  the  right  to 
order  a  sick  guest  to  leave— auumiog  the  Ulness  to  have  occurred 
after  arriyal,  una  not  being  an  Infectious  disease  T 

M.B.  (London).— Buch  an  arrangement  wonld  be  contrary  to  prece- 
dent, and  would  ioevitabty  lead  to  disagreeable  soeoes. 

Mr.  Parkinkoh  (Ciitherot-X— Your  oommunicatlon  came  to  hand  as 
we  w«re  at  pi  ess,  too  late  for  consideration  in  this  number. 

ATTSKDANCB  OS  NUBBBS. 

A  BUBSCRIBCR  asks  whether  it  is  customary  to  charge  for  attendance 
on  nurse«  enicsged  m  nnrring  a  patient  of  his,  and  If  so,  oaght  the  em- 
ployer to  be  charged,  or  the  uurse  7 

[It  is  usual  to  attend  nurses  gratia,  but  If  the  patient  happens  to  be 
wtiuto  do,  he  would  probably  not  object  to  pay  for  casual  consulta- 
tions due  to  the  service.— JU>.] 

A  FA8HI0NABLS  COMPLAINT. 

DOOTOR:  "  You  sent  for  me,  madam ;  what  is  tha  nature  of  your 
complaint  ?  " 

Ledy:  '*Ah.  my  dear  dootor,  I  suffer  dreadfolly  ftom— from— 
Whateyer  was  the  illness  for  which  you  sent  my  friend,  Mrs.  Uatris, 
to  Ostend  ?  ^Jtxchar  gt. 

JOettmgB  of  tht  §0aette0. 

Wbdnbsdat,  Fbb.  sth. 
OBsniTRiOAL  SociBTT  OF  LOBDOB.— 8  ikm.    Specimens  by  Dr.  Play- 
fair,  Dr.  Duncan,  and  others.    Paper.— Jir.  Sairison  Cripps :  Abdo- 
minal flysterectonay  with  Intra-perttoneal  Treatment  of  the  Stump, 
with  Notes  of  Blgbt  Cases.    Annual  Meeting.    The  President  (Dr. 
.  Ghampneys)  will  deliver  tbe  Annual  Address. 

800IBTT  OF  ARTS. -8  p.m.  Mr.  Frederick  Henry  Cheeeewright : 
The  Mexican  Drainage  CanaL 

Thursday,  Fbb.  0th. 

Harvbiaii  Sooistt.  —8.80  p.m.    Mr.  C.  Mansell  Moullln :  Some  of 
the  Aeoent  Results  of  Orchotomy  for  Enlarged  Prostate. 
FaiDAT,  Fbb.  7th. 

Wbst  Kbbt  MBDioo-CBiRORaiOAL  SooiBTr  (Boyal  Kent  Dlspen- 
iary,  Greenwich  Road,  S.K).— 8.15  p.m.  Mr.  Poland  will  exhibit  a 
case  of  1  hyroidal  Tumour  after  operation.  Dlsonsston  on  Cough  —Mr. 
Mayo  Oolller,  Drs.  Hemchell.  Tayler,  Uenry,  and  others 

CLIRIOAL  SooiBTx  OF  LOMDOM.— 8.80  p.m.  Dr.  Hale  White  :  Two 
cases  of  Puenmpthorsx  in  the  oour«e  of  !mhoia  Flayer,  and  both  due 
1 1  straining  at  stool.— Mr.  Pitts  and  Mr.  JBalla  on:  <m  Splenectomy 
tor  Kuptnre,  with  turee  sucoessful  c«sea.-Mr.  t  olding  Bird :  A  case 
of  Lymph  Scrotum  and  Lympnatic  Varlx. 

WBSf  London  MBoiao-CuuinROiOAL  Soonrrr  (West  London  Aospl- 
tal,  w  .).-^  80  p.m.  Mr.  J.  Hutchinson :  Thtf  uaw  of  Inheritan  oe  with 
referencetoGout.— Dr.  Archibald Gatfod:  The  RaHonaU  of  the  ac- 
cepted Treatment  of  Gout.  Specimens  of  Renal  Oaiculi  will  be  shown 
by  Messrs.  Keetley,  Bd wards,  BtdweU,aod  others. 

Wbdnbsdat,  Fbb.  isth. 
Lartboolooioal  Sooibtt  of  Lohdoh  (20  Hanover  Sqnarv,  W  ).«. 
6  p.m.  Discussion  on  the  Nature  of  Laryngeal  Cloeratlons  during  the 
course  ofTyphold  Fever,  to  be  introduced  by  Dm.  A.  A.  Kaothack 
and  J.  A.  Drysdale.— Discussion  on  Foreign  Bodies  In  the  Upper  Air 
and  Food  Passages,  to  be  introduced  by  Mr.  Cnartera  Symonds. 


Birmingham  and  Midland  Eye  BosnltaL- Assistant  House  8ar 
geon.  Salary  £60  per  annum,  wltti  apartments  and  board.  Ap^ 
plications  to  the  Secretary,  Church  Street,  Birmingham 

Bury  DlspensaiT  HospltaL— Junior  House  Surgeon.  Salary  £60  per 
annum,  wltn  board,  residence,  and  attendance.  Applkatiooa  to 
the  Hon.  Secretary,  Dispensary,  Knowsley  Street,  Bury,  Lnnob- 
shlre. 

Cardiff  Union. -Assistant  Medical  Ofllcer  for  the  Workhouse,  under 
the  direction  of  the  Medical  OAcer.  Salary,  £100  per  annnmi 
with  rations,  apartments,  attendance,  and  washing.  Appllentlone 
to  Arthur  J.  Harris,  Clerk,  Queen's  Chambers,  t'ardUr. 

Ohelsea.— Assistant  Medical  Ofllcer  for  the  Workhouse  and  Inflnnaiy. 
Salary,  £70  a  year,  with  furnished  apartments,  rations,  waahhog. 
ooals  and  gas.  Application  forms  cu  Wm.  Miller,  Clerk  of  thr 
Goardfans,  860,  Krng,s  Road,  Chelsea. 

Issex  County  Asylum,  Brentwood.— Third  Assistant  Medfoal  Offleer 
and  Pathologist.  Sal«ry  £120,  with  board,  residence  and  waalilng. 
Aiip'ications  to  the  Medical  Superintendent. 

Owens  ColleRC  Manchester.— Junior  Demonstratonhip  In  Phyaiolofar 
and  Histology.  Annual  salary,  £100.  ApptlcaUons  to  the  Jtogii' 
trar,  who  will  forward  further  information. 

Stataes  Union.— Medical  Officer,  Ashford  District. -Salary,  £20  per 
annum,  with  tbe  usual  rxtra  fees  for  surgical  and  naidwifery  caaefc 
Appllcstlons,  John  Anthouy  Kngsll.  iClerk  to  the  GnatduusS} 
SUlufS. 

Walslngham  Union. -Medical  Ofllcer  for  the  No.  6  Wells  DiaMcfc  of 
the  Union.  Salary  £08  10s.  per  annum,  exclusive  of  certain  feee< 
Applications  to  the  Clerk,  Bridge  Street,  Fakenham. 


Jlpp0intmtntf 


Briggs,  Heioy,  M.B.,  CM.,  Bdin.,  F.R.G.S.,  Ens.,  reappolntad  Htar 

orary  Surgeon  to  the  Liverpool  Hospital  for  womeu. 
Brodie,  C.  Gordon,  <r.R.C.S.  kng ,  AssisUnt  Surgeon  to  the  Ortho- 

poMllc  Bespital,  London,  B.C. 
Burton,  J.B.,  L.K.C.P.,  Lond^  M.B.a8.,  L.F.P.S.  Glasg..  Honomy 

Surgeon  to  the  Liverpool  Hospital  for  Womeu. 
Cameron,   A.G.B.,   M.R,  B.S.,    D.P.EI.,  Camh.,  Assistant   Medical 

Officer  to  the  Small-pox  Hoepltal  Shipe,  Metropolitan  Ahylumt 

Board. 
Crawfurd,  Baymond,  H.P.,M.A.,  M.D.,  Oxon.,  M.a.C.P.,  issiatant 

Physician  to  the  Boyal  Free  Hospital,  London. 
Dariea,  E.  T.,  M.U.,  Bdin.,  CM.,  F.E.C.8.,  reappointed  Honomy 

Assistant  Medical  Officer  to  the  Livarpool  Hoepltal  f  ^  Women. 
Dodgson,  B.  W.,  M.E.C.S.,  L.E.C.P.,  House  Physician  to  St.  Mary's 

Hospital,  London. 
Edia,  J.  &,  I  .B.C.P.,  Bdin.,  M.B.C.S.,  re^pointed  Honorary  Svgeon 

to  the  Liverpool  Hospital  for  Women. 
Frsser,  P.,  M.D.,  C  If.  Bdin.,  Medical  Officer  of  Health  for  the  North 

Wales  United  Sanitary  District. 
Grimsdale,  T.  B.,  M.B.,  Cantab.,  M.B.CS.,  reappointed  Hononoy 

Medical  Offictr  to  the  Liverpool  Hospital  for  Women. 
Miller,  W.  a.,  M.U..  B^Ch.  OubL.  Honorary  Suigeon,  West  ConwsD 

Infirmary  and  Dispensary,  Penzanoe. 
Pridmore,  £.  L.  N..  M.B..  Loud.,  L.B.C.P.,  M.B.C.S.,  Medical  Officer 

for  the  Weymouth  S«nitary  District  of  the  Weymouth  Union. 
Smart,  David,  M.B..  t:.M.,  B  8c.  Jfidln.,  reappointed  Honorary  Medicsl 

Officer  to  the  Liverpool  Hospital  for  Women. 

BiiAiB.— Jan.  80,  at  Fnlwood,  Kew,  the  wife  of  Chtrles  Blair.  M,D , 

M.B.C.8.,  of  a  daughter. 
Nbalb.— Jan.  26,  at  Old  Bank  House,  MUford  Haven,  the  wtfi  ol 

Albert  E.  N  sale.  M.  B.,  as.,  of  a  son. 
STUART.-Jan.  81,  at  New  Elvet.  Durham,  the  wife  of  Bobt.  Stuart, 

M.B.as.,  L.K.C.P.  Lond.,  of  a  son. 


^RdttiaatB. 


EtbRBTT-Goodmah.- Jan.  29.  at  Blghbury  Hfll  Chapel,  Ernest  Wil- 
liam Everett,  M.B.C.el.,  L.B.C.P.,  of  Norwich,  to  Fanny  MiM, 
daughter  of  the  Bev  W.  Goodman,  B.A.,  of  Hlghboey.  I 

MlHRS-MoBTOB.— Jan.  20,  at  All  Sninto'  Church,  Sheffield,  Also  J 
Glalsyer  Minns,  M.R.U.S.,  L.R.C.P.  Lond..  of  Thecford,  to  Oel'  J 
trude,  eldest  dauishcer  of  Samuel  Morton,  M.B.C.S.,  of  Sheffield. 

B0BIN80N— WiLLBT.— Jan.  80,  at  Christ  Cnurch.  Westminster,  WUford 
VIdalBobloson,  L.B.C.P.  Lond.,  of  HersUam,  to  Harriet,  yoomer 
daogbtei"  of  the  Ute  Captain  John  Ssltren  Wfllett,  JLif.A.,  of 
Pettteombe,  N.  Devon. 


MABTIN  —Jan.  28th,  at  The  Croft,  London  Bond,  Beading,  BobeitS. 

Marttn,  L.R.C.P.  Ed ,  M.B.C.n.  Eng.,  aged  8L 
COQBILU-Jan.  1st,  killed  In  action  at  Kriigeradorp,  Kenneth  ICsekiy 

Sinclair,  aged  19,  »on  of  Dr.  Slndalr  CmchiU,  of  Vencoor,  I  W. 
Wooi>.-Jau.  26th,  at  Bynge.    New  South  Wales,  Chas.  E.  Wood,  i««d 

89,  youngest  son  of  the  late  Andrew  Wood,  M.D.,  L.UD.,  ol  EdlO' 

bui^. 
ILIJH0W0BTH.-Jan.  25th,  firom  blood-poisoning,  Charies  B.  DUUf' 

wortn,  M.D.,  D  P.H,  of  Upper  Tooting.  London,  aged  4L 
JAOBBON.— Jan.  21st,  at  17  Allan  Park,  Stirilng,  8orgeon-Llent.-C(ilOBel 

T.  W.  Jackson,  M.B.61asg.,  aSo.(Pub.  Health)  ^d.,  i«ed6a 
KELLT.— Jan.  28th,  at^Park  Street,  Groevenor  Maare,  Luudoo,  A*Bb 

Kelly,  M.B.C.SW  Bug..  L.  B.CP.Edin. ,  aged  48. 
OBVB—Jaa.  2sth,  suudenly,  at  his  realdenoe,  Toe  Fin,  Leigh,  Bh^ 

Bobert  Orme,;M.B.C.S,  aged  60.  ^^ 

NOTICE— A^tiunive-^nmi*  01  j^^r'hx,  Mnrnageti^  and  DeQUuvt^ 
jamQieM  i>f  S%tb»eriber»  to  thin  JuurruU  art  ingrrUd  fne,  and  wud 
mzM  (Ae  iHiMisftert  noi  laUr  than  ihe  Monday  pncedmg  paWatfiMk 


@)lie  ^dimi  ^m$  mA  (^itmht 


««SALUS    POPnU    SUPRBMA    LEX.** 


YouCXIL 


WEDNESDAY,    FKBBTJARY    12,    1896. 


No.  7. 


tDriQitml  Cotnmttmcatxona. 

TDBEROULAR    DISEASES    OF    THE 

HIP-JOINT. 

By   IL  L.   SWAN,   RRCaL, 

8aE|w»  to  StoeT«DB'  tnd  The  OrthoptKUo  Hotpiteli,  Dablla. 

Thb  term  **  tab6rciilar,'''as  applied  to  hip  and  other 
joiiit  diaeaAes,  was  antil  recently  a  vagae  though  intel- 
ngiUe  designation.  It  was  apparently  originated  by 
the  writings  of  Nichet,  "  On  Pott's  Disease/'  and  of 
N^iiton,  "^Oq  Tnbercolar  Diseases  of  Bone,"  pab- 
Mfld  more  than  fifty  years  ago. 

Smce  that  time  observation  had  demonstrated  a 
munber  of  facts  which  had  enhanced  the  probability 
of  adisease  common  in  joints,  being  identical  with  a 
diathesis  which  developed  local  manifestations  in  dis- 
nndlAr  tisaaes.  That  disease  of  a  similar  pathoj^o- 
mooic  type  should  attack  in  saccession  various  joints, 
raeh  as  the  knee,  hip,  spine,  or  bones  of  the  carpus  or 
tanos.  The  incidence  or  se9uence  of  pulmonary 
tnbercaloais,  or  tubercular  meningitis,  during  or  i^ter 
the  exiBtence  of  disease  in  those  joints.  These  occur- 
reocsB  did  not,  however,  advance  our  positive  know- 
ledge beyond  that  of  Delpech»  who,  in  1816,  asserted 
the  dose  analogy  of  Pott's  disease  with  pulmonary 
phthisis.  He  stated  that  tuberculosis  was  the  only 
euae  of  that  deformity  which  is  called  Potf  s  disease 
d  the  spine,  and  that,  therefore,  this  affection  should 
be  termed  '^  tobercular  disease  of  the  vertebree."  But 
it  was  not  till  the  discover]^  of  the  tubercle  bacillus 
bv  Koch,  and  its  verification  by  Schuchardt  and 
KmiBe,  Botdlly,  MtQler,  and  many  other  observers, 
that  a  number  of  truths  were  elicited  which  have 
voved  that  what  was  so  Ions  accepted  as  a  clinical 
Belief  had  become  an  undoubted  certainty. 

Kumeroas  cases  have  been  recorded  where  wounds 
in  individuals  who  were  previously  healthy,  having 
become  infected  with  tuberculosis,  bone  and  joint 
djBeases  of  the  tubercular  type  have  subsequently 
become  developed. 

Pfeiffer  reports  a  case  of  a  veterinary  surgeon,  per- 
fectly healthy,  and  with  a  good  family  history,  who, 
liiiledissectmg  atubercnlar  cow,  accidentallv  wounded 
lu8  left  thumb.  The  wound  headed,  but  induration  of 
Uie  scar  took  place.  The  metacarpo-phalangeal  joint 
became  swollen  and  presented  the  appearance  of  a 
tdbercolar  synovitLs.  Some  months  biter  the  signs  of 
ralmonary  tuberculosis  supervened,  and  he  died  of  the 
oisease  in  18  monUis  after  the  receipt  of  the  injury. 
The  joint  after  death  showed  all  the  usual  destructive 
changes  both  in  the  bones  and  svnovial  membrane,  and 
%  large  number  of  tubercle  baciUi  were  present. 

Casemy  records  two  cases  where  skin  grafting  was 
emj^lc^  for  the  treatment  of  large  ulcers,  the  skin 
baling  been  taken  from  limbs  recently  amputated  for 
taberciilar  bone  disease,  and  those  patients  afterwards 
became  ^e  subjects  of  tuberculosis ;  one  died  of 
riifiuais  in  14  months,  the  other  developed  spinal 
maae  with  curvature  and  psoas  abscess.  Cases  of  a 
nmilar  nature  have  been  also  recorded  by  Brandon, 
F^ten,Middledorpf,  and  others. 
A  yoQth,  set  18,  was  under  my  care  in  Steevens' 


Hospital  suffering  from  tubercular  disease  of  the  neck 
of  the  bladder,  characterised  by  the  usual  symptoms 
of  irritability  and  discharge  of  small  quantities  of 
sanious  pus  from  the  urethra.  I  sent  a  specimen  of 
this  to  the  Clinical  Research  Association,  and  received 
in  reply — ^large  number  of  tubercle  bacilli  present ;  he 
is  now,  one  year  after,  in  an  advanced  stage  of  pul- 
monary tuberculosis. 

A  proof  that  those  strumous  diseases  are  tubercular 
is  also  afforded  by  a  histolojpical  examination  of  the 
affected  tissues.  Eonig  examined  72  specimens  in  the 
Qottingen  museum,  and  of  these  67  yielded  confirma- 
tory results.  He  found  tubercles  in  bones  and  joints, 
in  the  walls  of  chronic  abscesses,  and  in  the  soft  tissues 
at  the  reflection  of  the  synovial  membrane,  apd  he 
shows  that  tubercular  tissue  is  not  found  in  granula- 
tions of  ordinary  inflammation,  or  in  acute  osteomye- 
litis. In  addition  to  the  statements  already  made,  that 
pulmonary  tuberculosis  is  a  frequent  result  of  such 
disease  of  the  larger  joints,  it  is  only  when  such  disease 
is  concomitant,  or  in  immediate  sequence  to  the  joint 
affection,  that  the  surgeon  will  recognise  their  patnolo- 
ffical  affinity.  Many  patients,  however,  will  die  at  a 
later  period  from  such  supervention. 

Cheyne  states  that  speaking  roughly  20  to  30  per 
cent  of  the  patients  suffering  from  strumous  diseases 
of  the  larger  joints  ultimately  die  of  internal  tubercu* 
losis.  Eonig  writes  that  only  in  21  per  cent,  is  the 
joint  the  sole  tubercle  trouble,  but  it  is  to  be  supposed 
that  he  includes  in  the  larger  numbers  those  who  have 
implication  of  the  neighbouring  lymphatics  and  conti- 
guous peri-articular  tissues. 

Attention  may  be  directed  to  the  admirable  and 
instructive  paper  in  the  British  Medical  Joumalf 
April,  1890,  by  Mr.  Walter  Cheyne,  in  whidi  he 
demonstrates  the  possibility  of  induction  of  similar 
diseases  in  animals  by  the  injection  of  tubercular 
material  into  bones  and  joints. 

We  approach,  therefore,  the  examination  of  hip- 
joint  disease  on  the  assumption  that  it  is  the  definite 
result  of  the  presence  of  the  tubercle  bacillus,  and  that 
the  individual  so  sheeted  has  not  alone  the  local 
malady  to  endure,  but  is  menaced  with  superadded  and 
possibly  fatal  dangers. 

It  is  interesting  to  consider  at  this  juncture  the 
probable  method  of  localisation  of  the  parasite.  Allu- 
sion has  already  been  made  to  accidental  inoculation, 
and  also  to  the  experimental  injection  of  bacilli  into 
the  tissues  of  animds.  But  in  the  ordinary  cases  of 
strumous  joint  diseases  in  children  we  must  look  for 
some  other  channel. 

The  following  observations  embody,  I  believe,  the 
most  recent  opinions  re^prding  infection  and  the  con- 
ditions which  influence  it  t.       i    .      « 

There  are  some  cases  of  primary  tuberculosis  of 
joints,  kidney,  liver,  spleen,  &c.,  which  appear  to  be 
associated  with  a  foetal  heematogenous  infection 
(Baumgarten.    Gartner).  ,    .      . 

But  in  a  large  proportion  of  cases  the  inoculation  is 
post-fatal— through  the  mucous  membranes  or  skin. 

The  infection  of  the  lymph  glands  is  usually  conse- 
cutive to  tuberculosis  of  the  skin,  but  Lesage  and 
Pascal  consider  that  tubercular  polyadenitis  is  often 
congenital.  .  , 

Begarding  the  infiltration  of  certain  groups  of  lym- 


158     Thb  Mbdigal  Pbiss. 


OKIGINAL  CXiMMLNlCATIONS. 


F  SB.  12,  1896. 


phatics,  it  may  be  looked  upon  as  dae  to  a  definite 
local  caoBe.  These  grotipe  may  practically  be  named 
as  three  in  number :  let  The  cervical  group.  2nd.  The 
bronchial  group.    3rd.  The  meeenteric  group. 

The  cervical  glands  are  superficial  and  aeep.  The 
superficial  lie  under  the  platysma  and  receive  Ivmphatic 
vessels  from  the  external  ear  and  side  of  the  head  and 
neck.  The  deep  lie  along  the  vessels  and  communicate 
with  the  tonsils,  mouth,  palate,  pharynx,  and  larynx. 
There  are  also  submaxillary  glands  which  receive  tri- 
butaries from  the  lower  incisor  gums,  the  tongue,  and 
lower  lips. 

The  bronchial  group  of  glands  are  very  numerous. 
They  may  be  localised  from  the  names  applied  to 
them,  as :  Ist.  Intercostal.  2nd.  Sternal.  3rd.  Anterior 
mediastinal.  4th.  Cardiac.  6th.  Tracheal  and  bron- 
chial proper. 

The  mesenteric  group  are  those  of  the  mesentery, 
those  of  the  lesser  omentum  and  the  glands  contiguous 
to  the  aorta.  With  this  group  the  pelvic  glands  are 
sometimes,  though  infrequently,  involved  in  tuber- 
culosis. 

The  appearance  and  clinical  history  of  tubercular 
adenitis  oi  the  glands  of  the  neck  are  so  familiar  to 
every  practitioner  that  a  short  reference  will  suffice. 
There  is  reason  to  believe  that  they  become  infected 
from  without  by  the  entrance  of  bacilli  through  the 
mucous  surfaces  of  the  throat,  especially  when  diseased 
through  the  alveoli,  or  from  extension  from  tubercular 
disease.  I  have  seen  them  consecutive  to  caries  of  the 
cervical  vertebrse.  With  reference  to  the  first  method 
of  contamination,  the  experiments  of  Comet  upon  the 
presence  of  bacilli  in  the  dusts  of  cities  and  of  rooms 
show  how  widely  the  virus  is  spread,  and  how  likely 
it  is  that  in  crowded  centres  bacilli  are  inhaled  and 
even  swallowed,  and  thus  that  the  lymphatics  are 
infected. 

It  has  been  suggested  that,  as  the  course  of  this 
adenitis  is  slower  than  the  acute  forms  of  disseminated 
tuberculosis,  it  is  due  to  an  attenuated  virus,  or  it 
becomes  modified  in  its  transmission. 

Regarding  the  implication  of  the  bronchial  and 
mesenteric  groups  of  lymphatics,  we  believe  that  the 
respiratory  and  digestive  tracts  admit  the  bacilli.  But 
in  most  cases  there  is  no  definite  lesion  ac  the  point  of 
entrance.  In  the  experiments  of  Elebs,  who  fed 
animals  on  tubercular  material,  he  found  that  the 
presence  or  absence  of  tubercular  ulcers  in  the  intes- 
tine depended  on  the  size  of  the  particles.  When  pre- 
eented  in  large  masses,  such  as  cheesy  glands  or 
portions  of  lung,  ulcers  resulted,  but  when  given  in 
minute  subdivision  no  such  lesions  were  found. 
Tubercular  deposit  in  thebronchial  or  mesenteric  glands 
are,  therefore,  seen  in  children  without  any  mucous 
lesions.  When  we  remember  that  the  most  probable 
cause  of  infection  is  milk  from  tubercular  cows,  an 
easy  solution  of  the  question  of  the  introduction  of  the 
bacillus  into  the  lymph  channels  and  thence  into  the 
blood  is  given  us.  A  more  difficult  problem  is  to  deter- 
mine the  reason  of  the  selection  of  a  special  bone  or 
joint  for  the  retention  and  development  of  such  ele- 
ments. 

In  addition  to  the  well-known  fact  that  when  non- 
pathogenic elements  are  injected  into  the  blood  they 
are  rapidly  deposited  in  the  medulla  of  bone,  especially 
near  an  epiphysis,  the  developmental  changes  which 
are  in  continual  operation  in  such  a  position  i?  the 
Toung  may  favour  the  deposit  and  growth  of  the 
bacillus. 

But  there  is,  in  addition,  that  exciting  cause,  in 
which  everv  surgeon  seems  to  have  an  instinctive 
belief,  namely,  injury,  a  history  of  which  he  strives  to 
elicit.  That  this  is  a  potent  factor  in  determining  the 
production  of  tubercular  disease  was  proved  by 
experiments  on  animals  by  Professor  Erause,  and  also 
by  Schiiller.  It  was  found  that  severe  injuries,  such 
as  dislocations  or  fractures,  were  repaired  readily  and 


not  followed  by  tuberbular  disease,  but  that  triyial 

Xies,  such  as  strains  or  slight  bruises,  became  taber- 
.  Cases  are  on  record  where  fractures  oocarring 
in  the  shafts  of  bones  whose  extremities  were  tubercu- 
lous, united  easily.  The  preceding  assertions  are  borne 
out  by  our  usual  experience  in  hearing  the  history  of 
hip  joint  disease,  as  we  find  that,  although  there  has 
been  often  some  recollection  of  a  fall  or  bruise,  it  has 
quite  as  frequently  been  forgotten.  It  has  beea  sap- 
posed  that  the  disturbance  of  the  circulation  in  toe 
part,  similar  to  that  of  the  early  stages  of  inflammatioa 
and  necessary  to  repair,  may  favour  the  growth  of  the 
bacillus,  especially  if  there  has  been  extravasation  of 
blood  laden  with  these  organisms. 

We  cannot  overlook  that  condition  vaguely  under- 
stood as  '*  receptivity  of  the  tissues."  Many  inflnenoea 
may  contribute  to  this.  While  it  has  not  yet  been 
proved  that  the  tubercle  bacillus  has  been  directly 
inherited  from  tiie  progenitor  (up  to  this,  experiment 
is  altogether  against  it),  we  all  recognise  tne  fact  that 
the  delicate  offspring  of  delicate  parents  will  not  be 
likely  to  lead  an  outdoor,  athletic,  or  healthful  life, 
but  will  diminish  vitality  of  tissue  by  a  sedentary 
method  of  existence.  That  the  mother  may  trananut 
the  tubercular  diathesis  to  her  offspring  is.  however^ 
generally  admitted.  The  investigations  of  Watkina 
(Pan-American  Medical  Congress  '*  Transactiona," 
September,  1893)  draw  attention  to  certain  granular 
masses  in  the  blood  termed  third  blood  corpuaclesy 
which  occur  in  groups  or  singly,  and  whose  function 
has  been  for  long  a  subject  of  theory  or  conjecture. 
These  structures  are  believed  to  be  a  pathological 
element  and  to  declare  the  presence  of  a  tubercalar 
diathesis.  This  third  blood  corpuscle  is  found  m  pul- 
monary consumption  ;  Pott's  disease,  hip-joint  disease, 
chronic  abscess  and  lupus,  and  tuberculosis  in  any 
form  is  impossible  without  its  presence  in  the  blood. 

The  statement  has  been  made  by  many  that  certain 
slowly-acting  blood  changes,  called  dyscrasia,  precede 
tuberculosis.  Dr.  Watkins  believes  the  third  blood 
corpuscle  to  be  the  »ine  quA  non  of  the  tubercular 
bacillus,  and  as  such  is  one  of  the  chief  means  of  dia- 
gnosing this  dyscrasia  which  it  produces.  In  a  series 
of  experiments  he  claims  to  have  demonstrated  that 
the  tubercle  bacillus  will  live  in  acute  tubercular  blood, 
but  will  not  live  in  blood  which  does  not  contain  the 
third  blood  corpuscle. 

He  states  that  the  third  blood  corpuscle  is  very  often 
discovered  in  the  blood  of  infants  bom  of  tubercular 
mothers,  while  he  has  never  discovered  it  in  the  blood 
of  infants  bom  of  non -tubercular  women,  when  from 
the  very  begUining  they  have  been  nourished  by  their 
mother's  breast. 

The  quality  of  the  food  has  long  been  recognised  as 
a  factor  in  the  production  of  strumous  diseases. 
Watkins  found  that  a  baby  in  unhygienic  circum- 
stances will  have  the  third  blood  corpuscles  produced 
in  its  blood  in  from  three  to  ten  days  by  uainff 
sweetened  milk  and  water,  or  by  over  sweet  condenaea 
milk. 

We  know  that  the  caraivora  are  practically  exempt 
from  tuberculosis,  while  the  herbivora  are  extremely 
susceptible  of  its  ravaffes.  Man  occupies  an  inter- 
mediate position.  Bidder,  in  speaking  of  the  treat- 
ment of  strumous  diseases,  lays  stress  on  the  avoidance 
of  substances  rich  in  potash,  and  also  of  starchy 
materials,  and  advises  the  employment  of  albuminous 
foods  rich  in  soda  and  fat  It  is  certainly  true  that  an 
easy  assimilation  of  fat  appears  to  be  unfavourable  to 
the  development  of  tuberculosis,  and  persons  with 
such  a  diathesis  are  usually  averse  to  its  consumption, 
and  prefer  the  saccharine  and  starchy  elements  at 
food. 

There  is  a  fact  which  cannot  fail  to  attract  the  atten- 
tion of  every  observer,  namely,  the  development  of 
tubercular  disease  in  joints  after  debilitating  diaeasea 
How  often  do  we  see  the  following  :  **  A  healthy  child 


Feb   12,  ]a96. 


ORIGINAL  COMMUNICATIONS. 


The  Mbdicat.  Press.      159 


Kts  whooping-congh,  vomits  constantly  for  weeks, 
mc(Hnea  einaciated»  partly  convalesces,  gets  measles 
with  some  chest  complaint,  begins  to  go  about,  and  is 
then  foand  to  be  lame,  and  soon  exhibits  |kll  the  sym- 
ptoiDB  of  tubercular  morbus  cox»." 

U  we  analyse  the  statistics  of  tubercular  joint 
diaeaaes  in  the  early  years  of  life,  it  will  be  found  that 
a  piaeticai  uniformity  has  been  arrived  at  by  most 
observers  as  to  their  relative  frequency.  Tubercular 
spiae  disease  is  admittedly  the  most  frequent,  and  if 
the  aggregate  of  outdoor  aud  indoor  cases  in  hospital 
be  taken,  will  far  outnumber  disease  of  any  other 
nngle  articulation,  according  to  some  observers,  fur- 
nisEing  almoet  50  per  cent  of  the  whole.  But  if  we 
examine  tbe  proportion  of  indoor  cases  among  children, 
V8  perceive  that  the  hip  cases  are  fully  as  numerous, 
and  I  cannot  avoid  the  conclusion  that  they  would  far 
exceed  other  joint  affections  in  number,  as  hospital 
inmates,  were  it  not  that  there  is  a  feeling  (be  it  correct 
or  otherwise,  I  will  not  hazard  an  opinion)  that  the 
oceapation  of  a  large  number  of  beds  by  cashes  of  a 
necessarily  slow  and  often  uneventful  progress  would 
CQrtail  the  general  usefulness  of  an  hospital,  whether 
i^gftided  from  the  standpoint  of  education  or  philan- 
tmopy. 

That  diseases  of  the  hip-joint  are  more  frequently 
foand  in  occupation  of  hospital  beds  than  spine  dis- 
man  may  be  explained  by  their  greater  exigencies. 
Tbe  difficulty  of  dealing  with  them  efficiently  in 
tlie  homes  of  the  poor.  The  greater  suffering  they 
oocasion,  and  their  greater  liabUity  in  early  life  to 
nppoiation,  and  its  many  consec^uences.  It  is  remark- 
ftUe  how  many  cases  of  extensive  involvement  of  the 
vntebral  bodies  ma^  undergo  retrogressive  changes,  or 
evvDff)  on  to  caseation,  as  may  be  seen  in  dissections 
after  death  from  intercurrence  of  some  other  disease, 
and  yet  no  abscess  will  happen.  An  explanation  of 
thii  must  be  looked  for  in  the  mechanical  conditions 
whidi  inhibit  movement.  The  extravasation  of  lymph 
innnd  the  laadnsB,  which  becomes  semi-orsanised  and 
aerm  as  a  i>oeterior  protective  splint,  and  the  persis- 
tat  contraction  of  tne  spinal  muscles  in  front,  also 
to  the  fact  that  the  tubercular  deposit  in  children  is 
onally  intra-osseous,  and  is  not  so  liable  to  suppura- 
tion, as  in  the  case  of  adults  where  the  seat  of  disease 
is  most  often  the  periphery,  with  involvement  of  the 
intervertebral  fibro-cartilages.  Suppuration  will  no 
dcmbt  sometimes  occur  in  children,  and  more  especially 
if  the  coeto- vertebral  articulations  be  involved,  and 
movement  results  as  a  consequence.  But  in  hip 
disease  the  muscles  not  alone  cause  fixation,  but  inter- 
mittent pressure  of  great  force  from  spasmodic  con- 
tiactbn,  which  rapidly  provokes  morbid  changes, 
llus  with  the  neglect  or  want  of  recognition  of  the 
esse  in  the  early  stages,  the  child  being  often  allowed 
or  even  encouraged  to  run  about,  hastens  the  occur- 
rence of  that  most  disastrous  of  all  complications, 
namdy,  suppuration. 

From  thoroughly  reliable  extracts  from  the  printed 
reports  for  the  past  five  years  at  the  Orthopeedic  Uos- 
pital  I  have  collected  the  following  statistics. 

There  were  in  all  229  indoor  cases  of  joint  disease. 
Of  these  88  were  spinal,  85  hip-joint,  74  knees,  15 
uikles,  7  elbows,  but  I  anticipate  as  it  has  been  deter- 
mined to  reserve  special  accommodation  for  the  future 
for  80  hip-joint  cases  the  results  in  another  five  years 
wiQ  be  very  different,  and  affections  of  the  hip  will 
head  the  list  of  indoor  cases  of  joint  disease. 

There  are  different  opinions  as  to  the  relative  fre- 
qnency  of  the  position  where  disease  may  commence. 
I  think  it  may  be  admitted,  considering  the  varied 

T'oions  of  different  surgeons  of  great  experience,  that 
Bitnations,  whether  acetabular,  svnovial,  or  femoral, 
fnmiah  a  possible  bed  for  a  tubercular  deposit 

Jndglne  from  my  own  experience  in  tubercular 
diaeaee  of  other  joints,  more  especiaUv  the  knee  and 
ftoUe,  I  am  strongly  of  opinion  that  the  primary  dis- 


ease is  most  often  in  the  bone.  Let  any  surgeon  of 
extensive  experience  in  dealing  with  disease  of  those 
joints,  reflect  how  frequently  men  he  considered  the 
synovial  structures  alone  engaged,  and  that  the  case 
was  a  t^^pical  one  for  erasion,  did  he  find  that  there 
were  indications  present  which  made  him  suspect  bone 
implication,  and  that  even  when  the  articular  cartilage 
appeared  healthy  it  was  found  that  on  making  a 
section  a  caseating  tuberculous  mass  or  a  sequestrum 
was  present.  I  instance  the  knee  and  ankle  not  as 
furnishing  any  exception  to  a  general  rule,  but 
that  in  those  joints  we  have  exposed  to  view  during 
a  formal  operation  those  conditions  which  are 
I   believe  common  to  all  articulations   so  s^ected« 

(To  be  continited,) 


ON 

THE    DIAGNOSIS   OF   INSANITY. 
By  THEO.  B.  HYSLOP,  M.D., 

Leoturer  on  Mental  Diseases  to  St.  Mary's  Hospital  Medical  School, 
Assistant  Pliyslcian  to  Bethlem  Boyal  Hospital. 

Lecture  VII. 

The  relationship  of  syphilis  and  insanity  is  a  subject 
fraught  with  much  dimculty,  and  hitherto  it  has  pro- 
vided much  matter  for  contention.  The  literature  of 
the  subject  is  so  extensive,  and  the  conclusions  of 
various  observers  so  contradictory,  that  one  may  well 
be  excused  from  giving  vent  to  definite  statements  as 
to  questions  of  diagnosis. 

Certain  periods  in  the  specific  histories  are  associated 
with  somewhat  definite  types  of  mental  disorder. 
Thus,  during  the  earliest  periods  of  infection,  there 
may  be  emotional  depression  which  sometimes  passea  - 
the  borderland  of  sanity.  So-called  cases  of  '^  syphilo- 
phobia''  are  usually  characterised  by  states  of  mental 
depression  and  fear,  or  actual  hypochondriasis.  The 
patient  is  usually  qf  a  neurotic  type,  and  majr  or  may 
not  have  exposed  himself  to  the  risk  of  infection.  The 
term  *'  syphilophobia,"  when  used  from  a  symptomato- 
logical  point  of  view,  is  unobjectionable,  but  it  in  no 
way  implies  thai'  syphilis  has  been  a  factor  of  causation 
in  the  case. 

In  cases  of  insanity  associated  with  actual  infection 
by  the  specific  virus  of  syphilis,  there  may  be  merely  a 
temporary  or  functional  derangement  of  the  cerebral 
activity,  exhibiting  itself  commonly  during  the 
secondary  stages,  and  passing  off  without  observable 
damage  to  the  brain  structures  or  there  may  be  a  suc- 
cession of  mental  and  somatic  symptoms  associated 
with  the  tertiarv  stages,  having  for  its  cause  certain 
definite  vascular  and  connective  tissue  changea 
which  are,  in  a  great  measure,  distinctive  in  their 
pathology.  Sometimes  the  history  of  syphUitic  infec- 
tion is  so  definite,  and  the  symptoms  of  syphilitic 
lesions  are  so  distinct  that  we  feel  warranted  in  describ- 
ing the  cases  as  of  syphilitic  insanity.  The  term  is  con- 
venient, and  if  not  scientifically  accurate,  at  least  con- 
veys to  our  minds  a  type  of  disease  or  fp^up  of  sym- 
ptoms which  require  diagnosis  and  special  treatment. 
In  attempting  to  classify  the  various  forms  of  mental 
derangement  associated  with  syphilis,  we  have  two 
courses  open  to  us.  We  mav  classify  from  the  patibo- 
logical  or  from  the  mental  standpoint.  Were  the 
ultimate  relations  between  the  brain  and  mind  demon- 
strable, doubtless  a  pathological  classification  would 
suffice,  but  ignorance  of  these  relations,  at  present, 
hinders  any  such  classification.  It  is  difficult 
to  prove  that  syphilis  is  the  actual  and  immediate 
cause  of  insanity.  The  most  we  can  say  is, 
the  svphilitic  virus  does  induce  pathological  changes 
in    the  vascular    and    connective    tissues    of    tiie 


160    Tmt  Mbdioal  Prtos j 


ORIGINAL  COMMUNICATIONS. 


FsB.  12,  1896. 


cerebro-spinal  system,  and  these  changes  act  mechani- 
cally hf  pressure  or  otherwise  and  so  modify  the  nutri- 
tion of  the  nervous  structures  as  to  impair  their 
functions.  As  we  advance  in  our  knowledge  of  cerebral 
patholo^  we  may  be  able  to  demonstrate  more  definite 
associations  between  mental  and  cerebral  events,  in  the 
naeantime  we  must  rest  content  with  separate  descrip- 
tions of  the  two  series  of  phenomena. 

Before  taking  account  of  the  forms  of  insanity 
associated  with  demonstrable  pathological  changes  in 
the  cerebral  tissues,  I  must  refer  to  some  mental  states 
which  have  been  included  under  the  term  '*  syphilitic 
insanity.*'  I  mean  those  forms  occurring  more  especi- 
ally soon  after  specific  infection,  but  more  generally 
just  preceding  or  concomitant  with  the  secondaries. 
In  such  cases  we  may  have  an  ordinary  idiopathic  type 
of  insanity,  but  more  commonlv  the  mental  symptoms 
assume  such  forms  as  mania,  melancholia,  or  alternation 
of  these.  Pare  hypochondriasis  is,  in  my  experience, 
rare.  The  liability  seems  to  depend  chiefly  upon  (a) 
pre-existing  disease  of  the  brain,  (b)  narcotic  inheri- 
tance, (c)  previous  attacks  of  insanity,  &c.  In  most 
cases  there  is  actual  corporeal  disease.  The  mere 
presence  of  a  chancre,  bubo,  eruption,  loss  of  hair,  loss 
of  appetite,  defective  nutrition,  or  ill-health  and  its 
sequelae  suffice  to  account  for  the  melancholia,  restless- 
ness, or  even  excitement  almest  amounting  to  delirium. 
Many  cases  recover  upon  the  disappearance  of  the 
bodily  symptoms.  In  these  cases  the  insanity  would 
therefore  appear  to  be  dependent  mainly  upon  consti- 
tutional effects  without  demonstrable  pathological 
changes  in  the  cerebrum. 

The  period  at  which  these  symptoms  appear  may 
vary  from  as  soon  as  two  weeks  after  infection  to 
several  months.  As  before  mentioned  they  are  most 
commonly  met  with  on  the  appearance  of  the  second- 
ary symptoms,  and  not  infrequently  also  disappear 
with  them.  In  one  case,  reported  by  Dr.  Cadell,  there 
was  great  mental  excitement,  and  restlessness  almost 
to  delirium,  during  the  eruptive  stage,  and  lasting 
nearly  five  months  till  the  eruption  disappeared.  A  year 
after  this  the  hair  of  the  head  and  beard  fell  out  and 
the  patient  became  melancholic,  despondent,  and 
suicidal  for  two  years  till  the  hair  grew  again  which 
was  followed  by  recovery.  In  a  few  cases  the  mental 
symptoms  never  return  ;  more  commonly,  however, 
they  reappear  in  a  more  unfavourable  form  with  the  ter- 
tiaries.  The  patholo^  of  the  derangement  associated 
with  the  secondaries  is  at  present  hypothetical.  It  has 
been  described  as  an  irritative  form  of  insanity  due  to 
cerebral  anaemia  or  to  the  irritating  effects  of  the 
syphilitic  virus.  In  some  cases  gummatous  products 
have  been  found  in  other  organs  while  the  brain  was 
apparently  healthy.  For  convenience  I  have  preferred 
to  style  the  mental  symptoms  associated  with  second- 
aries as  *'  functional/*  and  those  demonstrably  due  to 
organic  cerebral  change  as  ^*orgcmic,"  The  organic 
types  are  divided  into  congenital  and  acquired,  and  the 
latter  group  is  further  subdivided  into  vascular  and 
syphilomatous,  according  to  the  nature  of  the  tissue 
aSected. 

(1)  Functional. 

(2)  Organic  (a)  Congenital. 

(b)  Acquired  (  Vascular. 

{  Connective  tissue. 
It  is  almost  impossible  to  define  the  organic  types 
from  the  clinical  symptoms  alone  for  any  one  symptom 
may  besimulated  by  many  other  morbid  factors.  A  syphi- 
litic tumour  may  be  simulated  hj  an  abscess,  hydatid 
cyst,  or  glioma  ;  or  the  hemiplegia  due  to  thrombosis 
of  an  atheromatous  cerebral  artery  may  not  differ  from 
thrombosis  due  to  syphilitic  arteritis.  We  can  in  some 
cases  only  rely  upon  the  history  of  syphilis  with  its 
succession  of  symptoms.  By  some  authors,  syphilis  of 
the  nervous  system  is  said  not  to  exist  They  main- 
tain that  it  does  not  attack  the  nervous  substance,  but 
t  it  affects  the  neuroglia,  fibrous  tissue,  blood- 


vessels, lymphatics,  membranes,  or  bony  coverings, 
involving  the  nerve  tissue  only  secondarily  by  pressure, 
and  so  causing  irritation,inflammation,  and  rammollisae- 
ment,  or  by  starvation  from  deficient  blood  supply,  so 
causing  degeneration  and  atrophy. 

Congenital  S.vpAiiM.— Clifford  Allbutt,  writing  upon 
mental  affections  in  children,  says,  '^  Apart  from  trau- 
matism, sunstroke,  poisons,  malformation,  and  the 
sequelae  of  typhoid  and  other  fevers,  &c.,  insanity  in 
children  is  practically  always  hereditary  ;  though  bad 
bringing  up  and  excessive  study  may  largely  conspire 
with  original  tendency  to  produce  it.  If,  in  sucn  a 
case^  the  parents  are  not  actually  insane,  eccentric,  or 
dissipated,  we  shall  find  that  syphilitic  antecedents 
may  have  been  the  cause  of  insanity  in  the  offspring, 
or  the  father  may  have  been  well  advanced  in  yean,  if 
not  himself  also  of  failing  vigour,  at  the  time  of  pro- 
creation." Drs  Langdon  Down,  Shuttleworth,  Fletcher 
Beach,  and  others,  have  described  evidences  of  con- 
genital syphilis  in  idiots  and  imbeciles.  Savftge 
believes  that  congenital  syphilis  causes  death  from 
convulsions  and  from  other  diseases  in  children,  who 
would  probably  have  been  mentally  defective  had  they 
lived,  and  that  many  minor  nervous  disorders  occur  in 
such  children  who  are  managed  at  home  because  they 
are  physically  weak,  and  that  these  lesser  neuroses  are 
seen  by  out- patient  physicians  in  many  patients  who 
die  before  maturity. 

The  cases  of  mental  defect  or  disorder  in  connection 
with  congenital  syphilis  have  been  ably  described  by 
Savage  under  three  heads,  viz. :— (1)  Those  withgenend 
defect  of  development,  with  moral  and  intellectaal 
want,  the  only  feature  being  a  distinct  history  of 
parental  syphilis  with  evidences  of  the  disease  in  the 

Eatient.  Such  children  may  have  fairly  well-formed 
eads,  but.  after  early  infancy  they  have  not  developed, 
they  have  learned  to  walk,  but  not  to  talk,  they  are  rest- 
less and  mischievous,  and  only  to  a  very  small  degree 
educable.  They  require  to  be  removed  from  home  for 
the  sake  of  the  other  children  and  for  special  training. 
(2)  Those  with  sensory  defect  and  consequent  mental 
want.  This  group  contains  cases  in  which  specific 
inflammation  has  caused  deafness  or  blindness,  or  both, 
in  early  infancy  ;  these  defects  leading  to  idiocy  by 
deprivation  of  sensory  stimulation.  In  some  of  these 
cases  special  education  for  deaf  and  dumb  and  blind 
fails  to  develop  any  really  useful  mind,  and  with  the 
!  growth  of  sexual  desire  much  serious  trouble  may 
j  arise,  and  the  small  mental  gain  effected  may  be  ruined 
,  very  rapidly.  The  probable  end  of  these  cases  is  the 
I  early  death  from  some  physical  disease,  such  as 
phthisis.  (3)  Those  with  epilepsy  or  paralysis,  and 
consequent  epileptic  or  paralytic  idiocy,  (a)  The 
epileptic  varieties  frequently  begin  with  convulsive 
seizures  in  earlv  infancy,  and  these  fits  recurring, 
I  become  habitual  and  prevent  mental  development.  In 
I  some  cases  the  fits  cease  at  some  period  of  life,  say  about 
I  seven  or  fourteen  years  of  age,  but,  as  a  rule,  the  mind 
has  been  too  seriously  damaged  to  recover,  and  the 
patient  remains  a  quiet  non-epileptic  idiot,  (b)  In 
the  paralytic  cases,  as  also  in  some  epileptic  ones,  local 
lesions  about  the  cranium,  the  membranes,  and  the 
brain  itself  are  the  cause  of  the  convulsive  or  paralytic 
symptoms.  As  a  rule,  these  paralytic  idiots  are  hope- 
lessly weak,  and  need  asylum  care,  and  they  usually 
live  but  a  short  time.  In  a  few  cases,  the  general 
symptoms  of  congenital  syphilis  only  affect  the  mind 
later.  Thus,  defect  of  sight  and  hearing  may  act  in 
the  same  way  that  disfigurement  did  in  making  the 
patient  morbidly  solitary,  self-conscious,  and  suspi- 
cious; and  in  the  end  deluded  and  insane. 
These  cases  generally  are  met  with  in  young  women, 
and  the  prospect  of  cure  is  very  slight,  most  of  the 
patients  pass  into  chronic  weakmindedness  or  delu- 
sional insanity. 

There  is  also  a  fourth  group,  of  which  the  symptoms 
may  be  due  to  inherited  syphilis,    These  cases  present 


Fib.  12.  18M 


OllIGmAL  COMMUNICATIONS. 


Ths  Medical  PRB^s.     161 


i  remarkable  rasemblance  to  general  paralysis.  The 
nfient  featares  of  some  of  them  are  slow  but  progres- 
nTo  dementia,  with  ooncomitant  steady  development  of 
geoeimliaed  paralysis  and  great  emaciation.  I  have 
seen  several  casec»  of  this  type,  but  I  am  unable  to  say 
whether  they  are  or  are  not  true  cases  of  early  general 
parslysia  In  adtilts,  the  syphilitic  process  may  attack 
the  cerebral  vessels,  and  caase  thrombosis,  with  the 
formation  of  a  cyst  and  snbseqaent  atrophy,  or  the 
^mmatoos  matmal  may  affect  Uie  surface  of  the  con- 
volotions  or  internal  nerve  tracts,  Possibly  the  same 
oecnrs  in  children  who  are  congenitally  affected  by 
siyphilitic  disease. 

The  syphilitic  disease  may  manifest  itself  in  lesions 
of  the  bones  of  the  cranium,  the  membranes,  blood- 
vessels, brain  substance,  cerebral  nerves,  or  of  the 
<irgBDs  of  special  sense.  The  skull  bones  may  be 
absorbed  owing  to  gummatous  infiltrations,  or  small 
vess  of  caries  with  exfoliation  may  occur.  The  dura- 
anter  and  the  pia  arachnoid  may  be  thickened  and 
iffected  by  various  inflammatory  deposits,  or  there 
Dflj  be  gummata.  The  middle  and  inner  coats  of  the 
arteries  may  show  the  characteristic  endarteritis.  Peri- 
arteritis and  inflammatory  deposits  round  the  smaller 
arteries  also  occur.  The  brain-substance  maj  be 
afBcted  by  means  of  an  extension  of  the  disease 
from  the  membranes,  or  as  the  result  of  deficiency  of 
Uoodaupply.  The  nerve-structures  of  the  cortex  are 
apt  to  degenerate  in  proportion  to  the  amount  of  over- 
growth of  the  neuroglia  substance.  The  cerebral 
urves  and  the  organs  of  special  sense  may  be  impU- 
cited  symmetrically  or  otherwise.  The  nerve  fibres 
maj  become  atrophied,  and  fail  to  perform  their  func- 

tiOUL 

^ace  will  not  permit  a  full  account  of  all  the  patho- 
logical data  derived  from  innumerable  investigations. 
Iikil,  therefore,  merely  present  to  you  some  of  the 
more  important  of  the  clinical  features  for  diagnostic 
ees.  Mr.  Hutchinson  believes  that  tertiary 
litic  symptoms  are  usually  unsymmetrical.  The 
^  Gsis  is  aided  by  such  symptoms  as^  palsies  of 
oamal  nerves,  convulsive  seizures,  and  hemiplegia  (not 
^  result  of  convulsions).  Paralysis  of  the  third 
oerfe  necessarily  points  to  disease  of  the  nerve  trunk 
or  of  the  eras  close  to  the  implantation  of  the  nerve  ; 
aeoDvnlsion  is  due  to  discharge  of  some  nerve  centre. 
Too  persistent  hemiplegia  does  not  follow  a  convulsion ; 
raeh  a  condition  is  far  more  probably  due  to  throm- 
bosis of  a  syphilitic  artery.  A  convulsion  without 
details  is  of  little  use  in  diagnosis.  The  diagnosis  of 
sypiiiliB  is  not  necessarily  rendered  invalid  when  anti- 
^ilitic  treatment  is  unsuccessful.  It  must  also  be 
remembered  that  general  convulsions  do  not  point  to 
the  affection  of  any  particular  locality.  The  presence 
of  headache,  double  optic  neuritis,  and  hemiplegia 
woold  point  to  a  lesion  of  one  side  of  the  brain,  but, 
as  pointed  out  by  Hughlings- Jackson,  optic  neuritis 
aloDe,  or  convulsions  alone,  have  little  or  no  diagnostic 
Talae ;  associated,  however,  they  are  of  considerable 
importance.  Intense  pain  with  double  optic  neuritis 
voald  apparently  warrant  the  diagnosis  of  some  foreign 
growth  in  the  encephalon.  This  foreign  growth,  how- 
erer,  may  be  a  glioma,  syphiloma,  abscess,  hydatid 
^  kc^  all  of  which  produce  similar  symptoms, 
ojmptoms  of  a  gradual  onset  would  appear  to  indicate 
a  growth  ;  whereas,  a  sudden  onse^  would  indicate  the 
effects  of  thrombosis.  Hughlings  Jackson  has  also 
pointed  out  that  double  optic  neuritis  frequently  exists 
when  there  is  no  evidence  to  show  that  signt  is  affected, 
sod,  indeed,  when  there  is  clear  evidence  that  sight  is 
good.  Optic  neuritis  from  syphilitic  disease 
of  the  brain  is  regarded  as  in  no  way  differ- 
ise  from  optic  neuritis  the  result  of  glioma  or 
other  foreign  body.  It  tells  us  nothing  more  than  that 
there  is  ooarae  organic  disease  of  some Idnd  within  the 
oaniam.  Its  diagnostic  value  is  the  same  whqther 
sight  be  affected  or  not,  and  there  is  no  difference  in 


the  optic  neuritis  whether  the  tumour  or  other  foreign 
body  causine  it  be  in  the  cerebrum  or  cerebellum.  It 
is  of  no  value  in  localising  beyond  that  it  points  to 
disease  within  the  cranium. 

There  is  much  difference  of  opinion  as  to  the  part 
played  by  syphilis  in  the  production  of  general 
paralysis.  My  experience  in  Bethlem  leads  me  to 
believe  that  more  than  half  the  ^neral  paralytics 
admitted  to  the  hospital  owe  their  disease  to  syphilitic 
factors.  Savage  believes  that  at  least  70  per  cent  of 
hb  private  cases  of  general  i)aralysis  have  clear 
histories  of  constitutional  syphilis.  Clinically,  we 
have  to  note  that  syphilis  sometimes  gives  rise  to  a 
pseudo-general  paralysis  in  which,  during  the  early 
stages,  tne  symptoms  may  be  identical  with  those  of 
general  paralysis ;  but  subsequently  there  is  an  arrest 
or  protraction  of  the  disease  in  the  pseudo-form,  so  that 
the  patient  mav  live  for  many  years.  It  must  also  be 
remembered  that  sometimes  patients  recover  from 
syphilitic  affections  of  the  nervous  system,  but  sub- 
sequently relapse  and  suffer  from  cerebral  symptoms 
which  are  totally  different  from  those  of  their  former 
attack. 

The  epileptiform  symptoms  are  usually  suggestive  of 
the  presence  of  nodes  formed  on  the  internal  surfaces 
of  the  skull  pressing  on  and  setting  up  irritation  of  the 
brain  substance,  or  of  gummatous  tumours  of  the 
brain  and  its  meninges.  Typical  syphilitic  insanity, 
with  its  initiatory  stages  of  cephalalgia  and  hypochon- 
driasis, disturbance  of  the  cerebral  nerves,  gradual  loss 
of  mental  power,  and  of  terminal  dementia  and  para- 
lysis, is  usually  indicative  of  meningitis  affecting  the 
cortical  substance  of  the  brain  secondarily,  the  general 
result  being  a  sort  of  matting  together  of  the  mem- 
branes and  their  adhesion  to  the  convolutions  and  to 
the  skull.  The  cerebral  vessels  become  diminished  in 
calibre,  their  walls  are  thickened  by  the  deposition  of 
concentric  rin^  of  plasma ;  as  a  consequence,  the  blood 
supply  is  diminished,  and  subsequently  softening  and 
apoplexy  supervene. 

The  following  considerations  are  compiled  with  the 
object  of  aiding  a  differential  diagnosis  between  general 
paralysis  and  syphilitic  insanity.  General  paralysis  is 
comparatively  rare  under  the  age  of  twenty-five.  Other 
manifestations  of  syphilis  may  render  the  diagnosis 
easy.  £arly  paralyses  of  the  cranial  nerves,  optic 
neuritis,  ptosis,  local  anassthesias,  headaches— noc- 
turnal, deeply-seated,  and  increased  by  pressure  and 
warmth  -  convulsions  and  local  spasms,  early  insomnia, 
rheumatoid  pains  in  extremities  at  night,  neuralgia, 
local  muscular  spasms,  vertigo,  and  affections  of  the 
special  senses  ;  all  these  may  point  to  syphilis. 

Dnring  the  later  stages  of  the  disease  the  following 
symptoms  aid  in  the  formation  of  a  diagnosis.  There 
is  usually  more  marked  insomnia  than  in  general  para- 
lysis, and  the  mental  symptoms  are  not  so  commonly 
indicative  of  progressive  degeneration.  Physically,  in 
syphilis  there  is  little  facial  or  labial  tremor,  although 
there  may  be  hesitation  of  speech.  The  affections  of 
speech  are  more  paralytic  than  a  mingled  weakness 
and  inco-ordination.  Dysphagia  is  sudden  in  syphilis, 
gradual  in  general  paralysis.  Amaurosis,  atrophy, 
neuritis,  disseminated  choroiditis,  mydriasis  with  para- 
lysis of  muscles  of  accommodation  more  common  in 
syphilis.  Local  palsies  are  usually  independent  of 
convulsive  action.  Paralyses  are  local,  unilateral,  and 
affections  of  one  or  more  of  the  cranial  nerves,  with 
hemispasm,  convulsions,  or  anaesthesia  often  co-exist. 
In  syfmilis  apoplectiform  seizures  leave  greater  effects 
than  in  general  paralysis.  Simultaneous  and  unilateral 
paralysis  of  the  fifth  and  sixth  cranial  nerves  is  sugges; 
tive  of  syphilis,  (a) 

In  conclusion,  I  may  quote  the  following  relation- 
ships between  syphilis  and  morbid  mental  states,  as 
given  by  Savage :— (1)  Insane  dread  of  syphilis  ;  (2) 

(a)  See  Mlckle  on  "General  Paralysis." 


1^2     The  Mxdtoal  Press. 


ORTOINAL  COMMUNICATIONS. 


Feb.  12,  1896. 


insane  dread  of  results  of  sjrphilis  ;  (3)  sirphilitic  fever, 
delirium,  mania  ;  (4)  acnte  syphilis  leading  to  mental 
decay:  (5)  syphilitic  cachexia  and  dyscrasia,  and 
mental  oisorder ;  (6)  syphilitic  neuritis  (optic),  with 
suspcion  or  mania  ;  (7)  syphilitic  ulceration,  disfigure- 
ment, and  morbid  self-consciousness ;  (8)  congenital 
sjrphilis,  cranial,  sensory,  or  nerve  tissue  defects  ;  (9) 
congenital  svphilis,  with  e|>ilepey  or  idiocy;  (10) 
infantile  syphilis  may  be  acquired ;  (11)  constitutional 
svphilis  (a)  vascular  or  fibrous,  (6)  epilepsy,  (c)  hemi- 
plegia, {d)  local  palsies,  (e)  general  paralysis,  cerebral, 
spinal  (spastic  and  tabetic),  peripheral ;  (12)  locomotor 
ataxy  (a)  with  insane  crisis,  (6)  with  insane  interpreta- 
tion of  the  ordinary  symptoms. 


{am  (Slinical  %ttkttxta. 


THE    USE   OF   HOT  WATER  IN 
SURGERY. 

Delivered  at  the  Pitie  Hospital, 
By  Dr.  PAUL  RECLUS, 

Profenor  Agr6g6  at  the  Medical  Facalty  of  Paria ;  Surgeon  to  the 
Parte  Hospltab. 

It  would  take  too  long  to  deal  exhaustively  with  the 
various  applications  of  hot  water  in  the  alleviation  of 
pain,  in  inflammation,  &c  I  shall,  therefore,  confine 
myself  in  this  lecture  to  the  use  of  hot  water  in  sprains, 
prostatitip,  and  inflammation  of  the  internal  female 
genital  organs,  that  is  to  say.  perimetro-salpingitis. 

I  have,  on  previous  occasions,  described  my  treat- 
ment of  sprains,  which,  however,  still  appears  not  to  be 
generally  known,  although  more  rapid  and  complete 
recovery  is  obtained  by  my  method  than  by  the  usual 
treatmeut,  which,  as  is  well  known,  consists  of  massage, 
wrappins;  the  affected  joint  in  a  rubber  band,  or  pro- 
longed bathing  with  cold  water.  I  have  combined 
these  three  measures,  with  decided  benefit  to  the 
patient,  which  is  evidenced  by  the  fact  that  I  have  had 
upwards  of  thirty  serious  cases  of  sprain,  where 
recovery  was  obtained  by  this  means  within  from  four 
days  to  a  fortnight. 

it  is  unnecessary  to  describe  the  manner  of  api)lyiag 
the  massage  or  the  elastic  band,  as  this  is  a  very  simple 
matter  ;  as,  however,  this  band  is  the  principal  thing  in 
the  treatment,  it  is  kept  on  until  recovery  is  obtained. 
Morning  and  evening,  however,  it  is  removed  and  the 
hot- water  treatment  resorted  to.  For  this  purpose,  the 
sprained  joint  is  plunged  in  a  bath,  the  temperature  of 
which  is  gradually  raised  from  A8^  to  60"  or  62<', 
and  even  55"  C.^  which  I  consider  high  enough.  Under 
the  influence  of  this  heat,  the  pain  ceases  immediately 
in  a  most  remarkable  manner.  The  circulation,  and 
perhaps  also  the  nutritive  faculty,  becomes  more  active, 
and  to  this  fact  doubtless  a  large  share  of  the  more 
rapid  absorption  of  the  peri-articular  effusion  must 
be  attributed. 

In  addition  to  hot  water  I  also  use  massage,  which, 
like  the  elastic  bandage,  favours  absorption  of  the 
effusion.  The  bandage  has  the  advantage  over  massage 
in  that  its  action  b  continuous,  but  it  cannot  dislodge 
clots.  This  is  accomi>lished  by  energetic  "kneading" 
with  the  fingers,  which  dissipates  the  peri-articular 
infiltration,  tnus  preparing  the  wav  for  the  elastic 
bandage.  My  treatment  of  sprain,  therefore,  consistB 
in  the  use  of  water  at  a  temperature  of  55"  C  ,  massage, 
and  the  application  of  an  elastic  bandage.  Unless  the 
lesion  is  exceptionally  severe,  recovery  will  be  obtained 
"y  this  means  within  a  fortnight. 


The  manner  in  which  I  treat  extensive  tranmatisma 
of  limbs  by  conservative  methoda  I  have  recently 
described  before  the  French  Congress  of  Surgery. 
Whatever  the  extent  or  gravity  of  the  lesions,  I  never, 
under  any  circumstances,  amputate  the  Injured  limb, 
but  merely  wrap  it  in  antiseptic  substances  by  a  veri- 
table "embalming''  process,  leaving  Nature  to  separate 
the  dead  from  the  living  tissues.  This  method  of  treat- 
ment possesses  the  double  advantage  of  being  much 
less  fatal  than  surgical  procedure,  and  of  preserving 
for  the  use  of  the  patient,  if  not  the  entire  limb,  at  any 
rate,  a  much  larger  part  than  would  be  left  after  ampu- 
tation. 

I  should  not  have  the  courage,  however,  to  advocate 
this  uncompromisingly  conservative  treatment,  were  it 
not  for  the  excellent  effects  of  hot  water,  which  I  use 
freely  in  the  following  manner :— The  patient,  who  is 
almost  invariably  in  a  state  of  collapse  from  the  shocks 
is  placed  on  the  operating  table,  wnere  he  is  wrapped 
in  hot  blankets,  only  the  crushed  limb  being  left 
exposed.  The  skin  of  the  latter  is  shaved,  all  fatty 
substances  are  removed  by  the  aid  of  ether,  alcohol,  or 
potassium  permanganate,  and  when  this  preliminary 
disinfection  has  been  thoroughly  done,  the  injured 
parts  are  carefully  cleansed. 

The  principal  agent  employed  for  this  purpose  is  hot 
water  from  a  cistern,  placed  at  a  sufficient  height  above 
the  bed  to  insure  a  forcible  jet.  The  temperature  of  the 
water  should  be  between  60^  and  62*^  C,  but  not 
higher,  for,  if  it  should  reach  64^  C,  the  heat  would  be 
sufficient  to  alter  the  albuminoid  constituents  of  the 
tissues.  This  jet  of  hot  water  is  made  to  irrigate  all 
the  injured  surfaces,  and  to  penetrate  into  ail  the 
hollows  of  the  wound.  This  is  the  only  way  of 
removing  all  clots,  and  washing  away  foreign  bodies, 
together  with  the  microorganisms  they  may  contain. 

The  advantages  of  this  application  of  hot  water  are 
threefold.  In  the  first  place,  at  this  high  temperatare 
it  is  antiseptic.  Not  only  it  removes  such  germs  as 
may  have  entered  the  wound  from  contact  with  the 
clothing  or  ground,  but  it  also  neutralises  their  effect. 
At  62°  C.  the  development  of  microbes  is  checked. 
Miquel  has  shown  that,  when  one  cubic  centimetre  of 
liquid  was  maintained  for  fifteen  minutes  at  a  tem- 
perature of  55°  C,  the  number  of  bacilli  contained 
therein  fell  from  3,500  to  33.  Moreover,  I  mix  with 
the  water  a  small  quantity  of  an  antiseptic,  the  potency 
of  which  is  greatly  increased  by  heat  Further  hot 
water  is  hsemostatic,  oozing  is  arrested,  and  the 
smaller  veins  and  arterioles  contract.  But  water  of  a 
higher  temperature  than  60*  C.  helps  to  compensate 
for  the  loss  of  heat,  resulting  from  the  bleeding  and 
especially  from  the  traumatic  shock.  The  dangerous 
hypothermia  gradually  gives  way,  and  in  the  majority 
of  cases  under  my  observation  I  have  found  that,  when 
the  patient  left  the  operating  table,  his  temperature 
had  already  risen  to  normal,  instead  of  being  sub- 
normal, as  is  the  rule  after  an  amputation  has  been 
performed  for  the  purpose  of  remedying  the  effects  of 
a  traumatism.  I  need  hardly  insist  upon  the  improve- 
ment in  the  prognosis  under  such  conditions.  When 
this  irrigation  has  been  accomplished,  ic  only  remains 
to  have  recourse  to  the  process  of  embalming  before 
referred  to. 

For  many  years  I  have  observed  the  effect  of  ini- 
^tions  with  hot  water  in  hemorrhoids,  and  have 
invariably  found  it  excellent.  I  have  publiahed 
numerous  cases  of  timid  patients  who  could  not  make 
up  their  minds  to  submit  to  an  operation,  but  con- 
tented themselves  at  each  fresh  attack  with  the  appli- 
cation to  the  anal  region  of  gauze  compresses  dipped 
in  water  at  55°  C.  As,  however,  the  water  rapidly 
loses  its  heat,  it  is  necessary  to  dip  the  compresses 
in  hot  water  at  mtervals  of  a  minute  and  apply  Uiem 
immediately  to  the  cleft  of  the  nates. 

In  addition  to  tlus  treatment,  the  patient  must  every 
morning  have  an  injection  at  the  same  temperature, 


Fkb.  12.  I«l6. 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Mkdiual  Puss.     163 


observing  theroles  which  Ishall  lay  down  later  on,  in  de- 
scrihiDg  my  treatment  of  perimetro-salpbgitiB.  Better 
molts  are  obtained  from  these  measnres  in  small 
hemorrhoids  of  recent  formation,  withoat  marked 
cootraction  of  the  sphincter  or  a  perceptible  varicose 
edge.  Under  such  conditions,  the  not  water  treatment 
has  invariably,  in  my  experience,  resulted  in  lengthen- 
ing the  intervals  between  the  attacks  to  snch  an 
extent  as  to  render  the  improvement  equivalent  to  a 
core.  In  severe  cases,  however,  with  large,  prolapsed 
hemorrhoids,  and  contraction  and  pain  of  the  sphincter, 
the  treatment  must  be  dilatation  and  extirpation  with 
the  knife,  followed  by  the  application  of  catgut  sutures 
to  the  mucous  membrane  ana  skin. 

Hot  water  is  particularly  efficacious  in  acute  prostat- 
itis.   I  have  already  published  several  articles,  and 
have  furnished  the  data  for  several  theses,  on  this 
Babject,  although  cases  of  this  affection  are  compara- 
tively rare.    The  method  of  treatment  is  very  simple. 
The  cannula  of  an  irrigator,  filled  with  water  at  a 
temperature  of  from  66*  to  60**  C.  is  introduced  into 
the  anas  slowly  and  carefully,  in  order  not  to  injure 
the  enlarged  prostate  which  projects  into  the  rectum. 
Thereafwu  the  tap  is  opened  very  little,  so  as  to  permit 
the  liquid  to  gradually  escape  and  bathe  the  prostate. 
This  treatment  is  repeated  twice  a  day  until  complete 
recovery  is  obtained.    There  is  almost  immediate  im- 
provement, and  in  none  of  the  nine  cases  under  my 
observation  has  suppuration  supervened,  whatever  the 
canae  of  the  prostatitis  and  the  size  of  the  inflamed 
organ  may  have  been.    I  have  extended  it  to  cases  of 
congestion,    which  is  of  such  frequent  occurrence  in 
hypertrophy  of  the  prostate,  and  I  have  often  success- 
folly  combated  witn  a  hot  enema  the  paroxysms  of 
retention  of  urine  which,  in  prostatic  patients,  fol- 
hw  the  slightest  excess,  fatigue,  or  chill.   It  is  possible 
^  the  rejgular  use    of  such  enemata'might  render 
castration  unnecessary  in  some  cases,  in  which  sur- 
geons nowadays  somewhat  too  readily  resort 

The  time  is  now  past  when  apparently  well-informed 
mgeons  proposed  and  practised  extirpation  of  the 
tdsexa  for  the  relief  of  pain  on  pressure  in  the  vaginal 
cok-de-sac,  ill-defined  infiltration  of  the  region,  men- 
itrnal  troubles,  and  a  sensation  of  weight  in  the  lumbar 
region.  More  than  this  is  now  required  to  justify 
laparotomy.  Forin^  own  part,  I  never  operate  in  the 
peeence  of  these  anections  of  the  true  pelvis,  before  I 
iiave  had  recourse  to  medical  treatment  in  which  hot 
mter  enemata  constitute  the  princi^l  factor.  The 
Rsnlts  obtained  in  this  way  are  so  satisfactory  that,  in 
my  wards  at  the  Pitie  Hospital,  we  only  operate  on  the 
average  on  one  out  of  three  patients  admitted  for 
mdoubted  oophorosalpingitis. 

FoUowing  the  example  of  many  of  my  colleagues, 
I  be^n  by  disinfecting  the  vagina  and  uterus,  followed 
hy  dilatation  of  the  cervix  and  prolonged  drainage  of 
the  uterus,  packing,  and,  if  necessary,  curetting  the 
uterine  cavity,  the  walls  of  which  I  treat  repeatedly 
vith  topical  applications,  such  as  tincture  of  iodine, 
creosote,  and  graduated  solutions  of  zinc  chloride. 
These  manoeuvres  have  been  so  often  described,  that 
there  is  no  necessity  for  repeating  the  description, 
«Keept  in  so  far  as  my  method  differs  from  that  of 
ether  surgeons.  Though  it  is  not  unusual  to  employ 
hot  water,  this  water  is  not,  as  a  rule,  hot  enough,  the 
temperature  ordinarily  being  from  40°  to  46°  C. 
ivhereas  I  nse  water  of  at  least  60°,  and  still  more  fre- 
anently  66°  C.  The  principal  difference,  however,  is 
that,  while  other  surgeons  have  recourse  to  vaginal 
iiriftations,  I  emfdoy  enemata  for  this  purpose. 

Not  that  I  entirely  disapprove  vaginal  injections,  their 
ntility  in  cleansing  the  vagina  cannot  be  despised ;  but  it 
most  be  remembered  that  this  \b  about  all  the  benefit 
to  be  derived  therefrom,  and  these  have  little,  if  any, 
inodifying  effect  on  congestion  of  the  uterus  and  its 
appendages.  Their  use  rests  on  an  anatomical  error, 
for,  if  it  is  desired  to  reach  the  uterus,  ovaries,  and 


oviducts,  the  operation  must  be  carried  out  throiigL 
the  rectum.  An  enema  results  in  the  accumulation 
of  hot  water  in  the  ampulla  of  the  rectum,  into  which 
the  internal  genital  organs  project  Enemata  must, 
therefore,  be  resorted  to  under  these  conditions,  when 
thev  are  best  administered  in  the  morning,  about  half- 
an-hour  before  rising.  The  irrigator,  filled  with  water 
at  a  minimum  temperature  of  66°  C,  is  placed  on  the 
night-table,  the  cannula  is  introduced  above  the 
sphincter,  and  the  tap  is  slowly  opened,  so  that  only  a 
small  quantity  of  liquid  passes  into  the  intestine  the 
slowness  of  the  process  preventing  contraction  ot  the 
muscular  coat.  In  this  manner,  therefore,  a  much 
larger  quantity  of  water  can  be  introduced  than  if  a 
strong  jet  be  turned  on  at  once.  Should,  nevertheless, 
a  desire  to  defsecate  manifest  itself,  the- water  is  shut 
off  until  this  desire  has  passed,  after  which  the  tap  ia 
again  slowly  opened.  The  patient  should  retain  the 
enema  for  half-an-hour  if  possible.  Then  she  is  allowed 
to  evacuate  the  liquid,  repeating  the  operation  the 
next  morning. 

By  this  antiseptic  treatment,  drainage  of  the  uteru& 
and  hot  enemata,  I  have  succeeded  in  relieving,  and 
even  curing,  a  large  number  of  cases  of  perimetro- 
salpingitis. The  infiltration  of  the  culs-de-sac  disap- 
pears, the  peristaltic  movements  of  the  intestine  break 
down  the  adhesions,  and,  instead  of  large  masses  filling 
up  the  true  pelvis,  the  exudations  and  purulent  coUec- 
tionsare  absorbed,  the  vaginal  culsde-sac  become  supple, 
the  uterus  movable,  and  the  region  in  question  resumes 
almost  its  normid  condition,  especially  after  judicious 
and  moderate  application  of  massage.  I  have  on  man^ 
occasions  seen  the  tumour  entirely  disappear,  and  this 
result  was  in  a  large  measure  attributable  to  the  use 
of  hot  water,  which,  as  I  have  shown,  is  of  the  greatest 
value  in  surgery. 


^rsTtBartionB  of  S^odetteft. 

OBSTETRICAL  SOCIETY  OF  LONDON. 
Mebtino  hsld  Wbdnbsdat,  Feb.  Ith. 


The  President,  Dr.  Champnets,  in  the  Chair. 


CASS  OV  aUFTTTRID  TUBAL  GBSTATION. 

Db.  Platfaib  exhibited  a  case  of  ruptured  tubular 
fcBtatiOD  of  unusual  interest.  The  lady  from  whom  it  was 
taken,  nt.  31,  had  had  a  child  five  years  ago.  She  menstru- 
ated when  travelling;  in  Italy  from  October  12th  to  16th. 
She  missed  her  November  period  altogether,  and  believed 
herself  to  be  pregnant.  Early  in  Bomber  ehe  started 
from  Naples  to  travel  to  England.  On  reaching  Milan 
she  was  laid  up  with  very  alarming  uterine  hsBmorrha^, 
and  ^hought  she  had  miscarried.  Two  days  afterwards  the 
haemorrhage  had  ceased,  but  there  was  an  intensely  offensive 
vaginal  discharge,  so  marked  that  the  odourwasapparentto 
everyone  who  came  into  the  room  in  which  she  was.  In  this 
condition  she  travelled  home,  not  feeling  particularly  ill. 
This  was  apparent  from  the  fact  that  on  the  day  after  she 
reached  London  she  went  to  Brighton  and  returned  the 
same  day.  Next  morning,  December  22nd,  she  felt  feverish 
and  ill,  and  was  seen  by  Dr.  Hollings,  and  the  same  after- 
noon by  I^.  Playfair.  The  temperature  was  then  103°, 
5ulse  120%  but  there  was  no  marked  pain.  Per  vaainam— 
'he  uterus  was  fixed,  there  was  some  deposit  in  Douglas 
pouch  and  in  the  right  broad  ligament,  but  no  definite 
tumour.  These  symptoms  did  not  suggest  extra-uterine 
fcBtation,  the  existence  of  which  was  not  suspected,  and 
the  case  was  believed  to  be  one  of  pelvic-peritonitis,  follow- 
ing the  long  journey  immediately  after  miscarriage.  Next 
morning  at  10  a.m.  when  in  bed  the  patient  was  seized 
with  sudden  severe  abdominalpain  and  collapse,  and  was 
believed  to  be  moribund.  The  existence  of  ruptured 
tubular  foetation  was  now  diagnosed,  and  laparotomy  was 
performed  at  2  pm.  On  opening  the  peritoneal  cavity, 
the  right  tube  was  found  to  be  dilared  and  ruptured,  the 
whole  outer  portion  having  been  torn  off,  and  the  posterior 
half,  about  the  size  of  half  a  goose's  egg,  alone  being  left. 


164      TbM  MBDIOAL  PRBbfi. 


TRANSACTIONS  OF  SOCIETIES, 


FsB.  12,  1896L 


The  remainder,  and  the  ovum,  were  not  found.  Thw 
then  was  doubtlese  the  cause  of  her  collapee,  which  was  so 
severe,  that  it  was  doubtful  if  the  patient  would  be  ifot 
alive  o£F  the  table.  The  peculiarity  of  the  case,  however, 
lay  in  the  fact  of  the  blood  extravasated  into  her  peri- 
toneal cavity,  which  was  black  and  evidentlv  old,  being 
intensely  f CBtid.  How  had  the  blood  become  th  us  infected, 
surely  a  very  unusual  occurrence  ?  It  was  found  that  the 
distal  extremity  of  the  tube  was  patulous.  Through  this 
blood  had  probably  escaped  before  rupture  had  occurred, 
and  this  probably  caused  the  deposit  felt  on  examination, 
and  this  must  have  been  infected  through  the  agencv  of  a 
decomposing  dot  retained  in  utero,  which  caused  the 
offensive  discharge  previously  noted.  The  amount  of 
extravasated  blo^,  however,  could  not  have  been  very 
excessive,  since  the  patient  had  been  able  to  travel  from 
Italy.  The  temperature  noted  on  the  day  before  the 
operation  was  not  due  to  pelvic- peritonitis  as  at  first 
supposed,  but  to  septicaemia,  as  was  evidenced  bv  a  severe 
attack  of  pleuro  pneumonia  which  occurred  two  days  after 
the  operation.  The  convalescence  was  protracted,  and 
three  weeks  after  the  operation  the  wound,  which  had 
united  after  the  removal  of  the  drainage  tube  on  the  third 
day,  re- opened  spontaneously,  and  there  was  a  consider- 
able discharge  of  intensely  fcetid  sanious  fluid  and  blood- 
dot.  The  temperature  immediately  fell  to  normal.  A 
drainage  tube  was  now  re-inbroduced,  and  in  a  week  all 
discharge  had  ceased,  and  the  patient  rapidly  convalesced. 
This  combination  of  rupture  of  a  tubular  foetation,  with 
septic  infection  of  previously  extravasated  blood  lying  free 
in  the  peritoneal  cavity,  is  apparently  unique.  The 
symptoms  clearly  pointea  in  the  first  instance  to  abortion, 
and  were  not  at  all  those  characteristic  of  extra- uterine 
fcetation.  It  seems  possible,  althoDgh,  of  course,  this  is 
only  an  hypothesis,  that  the  haemorrhage  in  Milan  was 
due  to  a  co-ez  intent  uterine  gestation,  which  had  aborted, 
and  from  which  came  the  retained  blood-clot  which  caused 
septic  infection. 

IXTRA- UTERINE  OBSTATION. 

Db.  DimoAN  showed  a  specimen  removed  before  rupture 
from  a  woman,  «et.  30.  She  had  twins  in  1892,  »nd  from 
that  time  ehe  was  regular  until  October  10th,  last. 
Between  the  latter  date  and  the  first  of  December  she  had 
no  loss  of  blood  but  complained  of  pelvic  pain.  On 
December  let,  she  was  seized  with  acute  abdominal  pain 
though  she  did  not  faint.  Four  days  later  she  had  a  loss. 
A  tumour  could  be  felt  to  the  risht  of  the  pelvis  per 
v<iginam  paphing  the  uterus  to  the  left.  The  tumour  was 
elastic  and  in  view  of  the  history  one  had  no  difficulty  in 
arriving  at  the  diagnosis  of  extra-uterine  gestation.  He 
operated  and  came  down  upon  a  swelling  the  size  of  an 
orange  in  the  outer  part  of  the  left  right  Fallopian  tube, 
apparently  just  on  the  point  of  rupture.  The  left  tube 
was  distended  by  a  hydrosalpinx,  so  tbis  also  was  removed. 

DOUBLE  TUBO-OVAMAN   CYST. 

Dr.  DuNGAN  also  showed  two  tumours,  removed  from  a 
woman,  aet.  25,  who,  though  married,  had  never  been 
pregnant.  She  was  well  until  two  years  ago,  when  the 
abdomen  began  to  become  prominent,  especially  on  the 
left  side.  At  about  that  time  she  began  to  complain  of 
pain  in  the  abdomen  and  back.  She  consulted  a  doctor, 
who  told  her  it  was  an  ovarian  tumour,  but  as  she  experi- 
enced no  particular  inconvenience  matters  were  allowed 
to  run  on  until  January  6th  of  this  year,  when  she  applied 
at  the  Middlesex  Hospital  for  the  pain  and  swelling  of  the 
abdomen.  He  found  a  cystic  swelling  reaching  up  to 
within  two  fingers'  breadth  of  the  umbilicas.  Per  vaginam 
Douglas's  pouch  was  found  to  be  filled  by  a  cyst  which 
pushed  the  uterus  forwards  and  upwards.  He  diagnosed 
ovarian  tumour,  and  on  opening  the  abdomen  he  came 
down  upon  a  tamour  with  very  large  vessels  resembling 
the  gravid  uterus  at  about  the  fifth  month  of  pregnancy. 
This  he  removed  along  with  a  smaller  tumour  from  the 
otiber  eide.  The  patient  made  a  good  recovery.  The 
interest  of  the  case  lay  in  the  co-existence  of  the  two  cysts, 
a  somewhat  rare  occurrence. 

TflBEB  CASES  OF  BXTBA- UTERINE  0K8TATI0N. 

Dr.  Galabin  showed  specimens  from  three  cases  of 
ectopic  gestation.  The  first  was  one  of  intra-ligamentous 
gestation  removing  after  retention  within  the  abdomen 
for  21  years.    The  patient  was  seen  at  Guy's  Hospital  in 


lg72  by  Drs.  Braxton  Hicks  and  fillips,  giving  a  histOTy 
of  pregnancy  going  on  to  full  term,  but  not  terminating^ 
in  delivery.  The  condition  was  diagnoeed,  but  it  was  no* 
thought  desirable  to  interfere,  and  operative  interferenoe 
was  subsequently  also  dieadvised  at  the  Soho  Hospital. 
She  did  not  experience  much  inoonvenienoe  until  2Q  years 
later,  when  the  abdomen  began  to  enlarge  very  much  witb 
signs  pointing  to  an  ovarian  cyst.  He  operated  and  found 
an  ovarian  cyst  on  the  right  side,  which  he  removed,  and 
then  he  turned  his  attention  to  the  other  tumour.  This 
was  so  calcified  that  it  turned  the  edge  of  the  knife.  He 
thought  it  might  be  a  calcified  fibroma,  and  removed  it  eie 
hU>c,  The  patient  made  an  uninterrupted  recovery.  The 
second  specimen  was  one  of  early  tubal  pregnancy  whicb 
had  ruptured  at  about  six  weeks.  There  was  no  history 
of  prolonged  sterility  in  this  case.  She  had  only  beep 
married  a  year,  and  had  miscarried  five  months  after  with 
a  two  months'  foetus.  Her  last  period  was  on  October 
29th.  On  September  3rd,  she  bemg  then  only  five  days 
over  her  time,  she  had  a  slight  show,  and  was  treated 
for  threatened  abortion.  The  symptoms  subsided 
for  a  time,  but  on  December  13th  she  was  seized 
with  violent  abdominal  pain,  and  the  attack  recurred 
with  violence  when  she  got  out  of  bed  on  the  15th.  She 
then  became  collapsed.  She  was  diagnosed  to  be  suffering 
from  rupture  of  an  extra-uterine  pregnancy,  and  he  saw 
her  in  the  evening.  The  uterus  seemed  small,  and  nothing 
could  be  felt.  There  was  nothing  in  Douglas's  pouch, 
although  the  abdomen  was  slightly  distended.  Under  an 
ansdsthetic  a  small  lump  could  be  made  out  on  the  left 
side.  He  operated,  and  found  a  large  quantity  of  dark 
blood  in  the  peritoneal  cavity  without  any  dots,  and  in 
washing  this  away  a  small  foetus  escaped.  She  made  a 
good  recovery.  The  last  specimen  appeared  to  be  a  case 
of  extra-uterine  foetation,  not  primarily  tubal,  and  pro- 
bably ovarian.  The  patient,  »t.  27,  had  had  three 
children,  the  last  eleven  months  previously,  and  she  had 
been  nursing  this  infant  up  to  the  date  of  the  rupture. 
Menstruation  had  been  absent  during  lactation  up  to  laet 
November,  but  in  that  and  the  following  months  she  had 
normal  periods.  On  January  14th  she  experienced  sudden 
violent  pain  in  the  abdomen  and  fainted.  She  was 
admitted  to  Guy's  Hospital  on  the  16th,  and  was  operated 
upon  at  once.  The  abdomen  was  full  of  clots  and  fluid 
blood,  and  the  gestation  sac  was  found  on  the  right  eide. 
This  was  ligatured  and  removed  with  the  right  tube  and 
the  upper  part  of  the  right  broad  ligament.  There  was  left 
a  large  bleeding  surface  running  across  the  broad  liga- 
ment, which  proved  to  be  a  hsematoma  which  had 
ruptured  into  the  peritoneal  cavity.  During  the  operation 
the  patient  became  so  collapsed  that  saline  fluid  was 
inject^ed,  and  the  whole  pelvis  was  packed  with  iodoform 
gauze.  She  came  round  for  a  time,  but  died  of  collapse 
twelve  hours  later,  in  spite  of  a  further  intra- venous  injec- 
tion. PosUmofrtem, — Douglas's  pouch  was  seen  to  be 
obliterated.  Both  Fallopian  tubes  appeared  to  be  intact. 
A  ten  weeks'  embryo  was  washed  out  of  the  cavity,  this 
being  extra-peritoneal. 

Dr.  A.  Route  pointed  out  that  the  last  spedmen  was 
of  peculiar  interest,  and  he  sug^ted  that  it  should  be 
referred  to  a  committee  for  examination.  It  looked  as  if 
the  extravasation  of  blood  and  the  adventitious  cyst  were 
in  Douglas's  pouch. 

Mr.  Alban  Dorav  observed  that  until  they  could  meet 
with  an  ovary  containing  in  its  interior  a  very  small  and 
very  early  ovum,  the  existence  of  primary  ovarian  preg- 
nancy must  remain  somewhat  uncertain. 

Mr.  Habbison  Cbipps  on  a  case  of 

ABDOmNAL  HY8TEBECT0MY  WITH  INTBA-PBBITONBAL  TBBAT- 
MENT  OF  TUB  STUMP,   WITH  NOTES  OF   BIGHT  OASES. 

The  author  opined  that  the  surgical  removal  of  fibroid 
tumours  of  the  uterus  was  called  fur  in  the  following  class 
of  casoii: — 1-  Excessive  hsemorrhage,  uncontrolled  by  the 
ordinary  methods  of  treatment,  and  in  which  oophorectomy 
was  imfXMsible.  2.  Serious  pressure-efifects  on  the  bladder 
or  rectum.  3.  When  the  pain  or  the  size  of  the  tumour 
rendered  the  patient  unable  to  earn  her  living.  He  con- 
trasted the  extra-peritoneal  with  the  intra-peritoneal 
method  of  treatment  of  the  pedicle,  stating  that  the  latter 
had  given  him  the  best  results  Whilst  in  the  extra-peri- 
toneal method  the  danger  from  sepsis  was  slighter,  that 
from  obstruction  of  the  intestine  and  ureters  seemed 
greater  than  in  the  intra-peritoneal  method.    This  greater 


Fd.  12,  1896 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Msdigal  Pbbss.     165 


riak  of  peritonitis  in  the  intra*peritoneal  method  was  from 
infection  through  the  vai^na.  To  minimise  this  riak  the 
Mithor  laid  stress  on  two  points  :  1.  Thorough  and  repeated 
doncdiing  of  the  vagina  with  perchloride  3  mercnrv.  2. 
The  acoarate  closure  of  the  peritoneum  over  the  surface  of 
the  stump.  He  describea  the  method  of  operation 
employed,  stress  being  laid  on  two  points :  (a)  The  im- 
portance of  having  sufficient  room,  supplied  if  necessary 
by  making  a  long  abdominal  incision,  {b)  The  method  of 
securing  the  vessels  in  the  broad  ligaments.  This 
depended  on  whether  the  layers  of  this  ligament  had  been 
separated  by  lateral  burrowing  of  the  tumour  or  not.  He 
reed  notes  of  eight  cases  operated  on  by  the  intra- 
peritoneal method  up  to  September,  1895.  Seven  case? 
ended  in  recovery,  and  there  was  one  death  from  sepsis, 
doe  to  infection  from  the  vagina. 

ANNUAL  MBETIKO.— PRESEDBNTIAL   ADD&BSS. 

The  Presidkht  then  delivered  the  usual  address.  He 
reviewed  the  neeociations  which  had  taken  place  between 
the  Society  and  the  General  Medic€d  Council,  and  dis- 
cussed the  modifications  that  had  been  conceded  in  the 
certificate  awarded; !io  candidate  midwives  who  had  been 
successful  in  the  examination  held  by  the  Society.  He 
said  that  while  the  representatives  of  the  Society  had 
shown  themeelves  perfectly  ready  to  agree  to  every 
suggestion  affecting  matters  of  detail  they  had  stead- 
fsatly  declined  to  sacrifice  any  questions  of  prin- 
ciple. He  alluded  in  sarcastic  terms  to  the  action  of  cer- 
tain persons  who  had  "  twisted  the  tail  of  the  Council,"  and 
remarked  with  some  complacency  that  the  result  had  pos- 
sibly been  quite  different  to  that  anticipated  by  those  who 
had  fostered  the  outcry,  in  that  the  modified  certificate  had 
now  received  the  formal  imprimatwr  of  the  General  Medi- 
cal Council,  which  was  not  previously  the  case,  so  that 
the  examination  was  at  present  on  a  firmer  footing  than  it 
had  ever  before  been.  He  protested  en  pasaarU  a^inet  the 
spirit  of  trade  unionism  in  such  a  matter,  adding  that 
such  a  spirit  could  not  possibly  be  endorsed  by  Parliament, 
and  if  persisted  in,  must  infallibly  bring  an  honourable 
profession  into  discredit.  He  mentioned  incidentally  that 
the  number  of  successful  candidates  for  the  certificate  of 
proficiency  in  midwifery  had  steadily  gone  on  increasing, 
that  for  laBt  year  being  467,  as  compared  with  432  in  1894, 
a  total  far  in  excess  of  any  previous  record. 

The  meeting  terminated  with  the  usual  vote  of  thanks 
to  the  retiring  officers* 

♦ 

ROrAL  ACADEMY  OF    MEDICINE  IN  IRELAND. 

SSOnON   OF  MSDICINK. 

MsxTiNG  HiLD  Fbiday,  Jak.  17th,  1896. 


The    President,  Db.    T.  W.  Gbihshaw,  in   the  Chair. 


AN  SMTBKIO  BASH. 

Db.  J.  M.  Dat  read  a  paper  on  a  case  of  enteric  fever  in 
which  a  peculiar  rash,  resembling  that  of  typhus  fever,  was 
present. 

Dr.  J .  W.  MooBB  said  the  case  showed  the  necessity  for 
a  fever  wing  being  attached  to  every  hospital,  as  the 
patient)  in  the  first  instance  was  admitted  to  a  general 
ward  in  the  Meath  Hospital.  When  he  first  saw  the  case, 
be  had  no  hesitation  in  pronouncing  it  one  of  typhus  fever, 
bat  that  it  was  not  so,  but  enteric  fever,  the  temperature 
chart  now  shown  proved  absolutely.  He  never  saw  a  case 
mcne  like  typhus  in  the  early  stage.  The  case  could  not 
be  left  in  the  general  ward,  and  had  to  be  sent  to  Cork 
Street  Fever  Hospital.  With  regard  to  the  case,  he 
thought  from  the  number  of  the  spots,  their  unusually  dark 
colour,  and  their  irregular  size,  that  tbey  were  those  of 
ty^^us  fever  rather  than  an  enteric  rash. 

Dr.  Pollock  said  he  had  seen  several  cases  in  which  there 
was  the  rose-coloured  rash  all  over  the  body,  together  with 
all  the  other  symptoms  of  typhoid,  yet  they  were  cases  of 
typhus.  The  brain  became  rapidly  involved,  and  all  the 
cerebral  symptoms  manifested  themselves. 

The  Pbxsidbnt  gave  some  details  of  a  case,  apparently 
d  typhus  fever,  but  a  fatal  result  produced  by  penoration 
moved  that  the  case  was  one  of  typhoid.  The  late  Dr. 
Kennedy  believed  there  were  some  cases  of  mixed  typhoid 
and  typhus,  fever.  The  President  mentioned  a  number  of 
casesthat  occurred  in  Bishop  Street,  in  which  both  rashes 


co-existed  simultaneously  in  the  same  patient.  He  said 
that  enteric  fever  was  not  so  fatal  25  years  a^  as  it  is  at 
present.  He  had  never  lost  a  typhoid  patient  in  Cork 
Street  Hospital,  but  this  he  did  not  attribute  to  his 
superior  skill,  but  to  the  mild  form  the  disease  assumed 
at  the  time  he  was  connected  with  that  Institution  ;  on  the 
other  hand,  cases  of  typhus  fever  were  then  far  more 
numerous. 
Dr.  Dat  briefly  replied. 

FATAL  OASE  OF  OHOBBA. 

Dr.  Jambs  Littlb  related  the  particulars  of  a  case  of 
chorea  which  proved  fatal.  The  patient  was  a  young 
woman,  aged  about  twenty  years. 

Dr.  Alfbbd  Scott  found  at  the  po«^mor^em  examination 
some  very  small  vegetations  on  the  mitral  valve  ;  otherwise 
the  heart  and  viscera  were  normaL  The  brain  was 
removed  and  sections  from  various  parts  examined.  In 
the  large  ganglionic  cells  in  the  motor  area  of  the  cortex,  a 
yellowish  degenerated  patch  could  be  seen,  which  was 
blackened  by  osmic  acid.  Dr.  Scott  thought  that  this 
degeneration  was  probably  caused  by  fatigue,  resulting 
from  the  excessive  choreic  movements  and  not  the  cause 
of  the  disease 

Dr.  Pollock  mentioned  the  case  of  a  young  woman,  c^god 
eighteen,  attacked  by  chorea.  This  case  recovered.  The 
spasms  were  very  marked.  Bromide  of  potassium,  20  grs. 
twice  dnly,  And30  ers.  at  bed-time,  gave  some  hours'  rest, 
but  the  moment  the  drug  was  discontinued  the  spasms 
returned  as  bad  as  ever.  He  administered  arsenic  in 
minute  quantities  There  was  endocarditis  and  a  murmur. 
Joints  were  also  afiected. 

Dr.  Dawson  said  be  would  like  to  ask  Dr.  Scott  at  what 
stage  in  the  hardening  process  he  made  the  section.  He 
considered  the  degeneration  like  that  which  commonly 
accompanied  insani^.  He  believed  it  was  due  to  over- 
action  of  the  cells.  He  would  like  to  know  the  nature  of 
the  staining  substance  used  ? 

Dr.  Boyd  wanted  to  know  if  an  examination  of  any 
other  portion  of  the  nervous  system,  except  the  cortex, 
was  made  ;  whether  the  ganglia  at  the  base  of  the  spinal 
cord  were  examined ;  and  whether  attention  was  paid  to 
the  condition  of  the  capillaries. 

Dr.  Cox  gave  the  details  of  a  case  of  chorea.  It  was  a 
child.  The  faculty  of  speech  was  lost  completely ;  tempe- 
rature high— 104^;  great  wasting,  both  of  muscles  of 
arms  and  body ;  unable  to  support  head  ;  food  adminis- 
tered with  ^reat  difficulty.  Things  looked  as  if  the  case 
would  termmate  fatally.  He  tried  bromide  of  potassium, 
but  found  it  of  little  use.  What  had  a  decidedly  good 
efiect  was  Easton's  syrup  with  arsenic.  The  s«rychnine 
he  gave,  after  some  hesitation,  in  the  hope  of  stimulating 
the  respiratory  centre,  for  he  was  idarmed  lest  the  respira- 
tion would  stop  at  any  moment.  She  recovered.  He 
believed  that  the  spinal  cord  played  as  important  a  part 
as  the  brain  in  the  production  of  chorea. 

Dr.  Pollock  said  he  had  given  strychnia  in  chorea,  but 
never  found  it  of  use. 

Dr.  Knott  gave  the  details  of  a  case,  and  pointed  out 
what  he  considered  the  important  circumstance  about  it 
was  that  the  rheumatic  symptoms  followed  the  choreic 
symptoms. 

Dr.  Habley  stated  the  details  of  some  cases  of  chorea  in 
a  children's  school  that  came  under  his  notice. 

Dr.  Pabscns  said  chorea  in  persons  over  twenty  years  of 
a^e  is  a  rare  affection.  The  absence  of  pregnancy  in  Dr. 
Little's  case  added  to  its  interest.  He  thought  the  vast 
majority  of  cases  would  recover  if  left  alone.  Only  three 
per  cent,  of  ordinary  cases  die,  whereas  when  the  disease 
occurs  in  people  over  twenty,  according  to  Dr.  Gowers, 
who  had  collected  a  large  number  of  cases,  the  mortality 
was  20  per  cent.  Death,  he  (Dr.  Parsons)  thought,  was 
due  to  exhaustion.  He  did  not  believe  in  the  embolic 
theory.  The  injection  of  minute  particles  was  a  recoe- 
nised  fact ;  but  it  was  difficult  to  see  why  they  should 
select  one  carotid  and  go  to  one  side  of  the  brain. 

Dr.  Cbaio  gave  the  details  of  cases  to  show  that  chorea 
was  often  due  to  fright.  In  Dr.  Cox's  case  he  believed  it 
was  the  arsenic  did  good  ^  5-10  minims  of  liq.  arsenicalis 
thrice  daily  might  be  given  to  children. 

Dr.  Boylb  dwelt  on  the  presence  of  uric  acid  in  the 
blood  as  a  possible  cause  of  chorea. 

Dr.  Bewlby  said  that  by  graduaUy  increasing  the  doses 


^^6     The  Mbdical  i^Riss 


TRANSACnONB  OF  SOCIETIES. 


Fbb.  12,  18M. 


aracnio  mifrhb  be  given  with  no  harm,  but  with  much 
good.  As  regards  the  pathology,  be  said  they  knew 
nothing  at  all  about  it,  nor  were  they  likely  to  do  so. 
They  were  completely  ignorant  of  changes  that  took  place 
m  the  oells  of  the  brain  ;  yet  something  did  take  place  to 
acooQDt  for  the  impulse  that  travelled  down  to  the  muscles 
when  thrown  into  action.  The  cells  of  the  cortex  appeared 
to  him  to  be  the  seat  of  these  changes. 

Dr.  S.  M.  Thompson  advocated  the  use  of  chloral 
hydrate. 

Dr.  Little,  in  reply,  said,  to  answer  the  last  speaker 
first,  he  might  say  that  the  first  drug  employed  in  his  case 
was  chloral  hydrate,  but  without  any  good  effects.  After 
its  failure  he  tried  other  remedies.  Of  course  they  all 
knew  that  the  majority  of  cases  that  come  into  hospital 
suffering  from  chorea  will  get  well  without  treatment, 
with  treatment,  or  even  in  spite  of  treatment.  Other 
cases  there  are  that  will  tax  the  resources  of  the  phvsician, 
and  sometimes  we  come  face  to  face  with  people  with 
whom  relief  of  symptoms  for  even  a  short  time  can  be 
given,  and  thereby,  as  Dr.  Thompson  said,  turn  the 
balance  between  life  and  death.  He  mentioned  a  case, 
the  child  of  a  friend  of  his.  that  came  under  his  care  18 
years  ago,  and  in  her  case  nothing  did  so  well  as,  bromide 
of  sodium  at  night  and  arsenic  thrice  daily.  He  believed 
that  small  doees  of  strychnia  might  do  good  in  some  cases 
of  chorea.  In  answer  to  Dr.  Boyd,  he  said  the  embolic 
theory  was  not  originated  by  Dr.  Hughlings- Jackson.  He 
believed  the  embolic  theory  was  now  almost  universally 
abandoned. 

Dr.  SooTT,  in  reply  to  Dr.  Bovd,  said  be  had  notexamined 
the  basic  ganglion.  He  found  no  change  in  the  capillary 
vessels,  nor  any  changes  in  the  medulla.  In  reply  to  Dr. 
Dawson,  he  said  that  at  the  time  of  section  the  brain  was 
half  hardened.  He  used  blue-black,  and  also  another 
form  of  blue  stain. 

The  Section  then  adjourned. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Mbbtino  hsld  Wbdnksdat,  Fbbbuabt  5th. 


The  President,  Dr.  Argyll  Robbbtson,  in  the  Chair. 

8PB0IMENS. 

Db.  Cotibbill  showed  a  man  with  leukoplakia  of  the 
tongue  in  an  advanced  form.  There  was  no  history  of 
syphilis,  but  the  man  was  a  smoker.  This  condition,  he 
said,  was  very  easily  recognised  in  its  later  stages,  but  it 
was  important  to  be  able  to  diagnose  it  during  the  earlier 
period  of  the  disease.  This  was  especially  the  cape  in 
applicants  for  life  assurance.  For  his  part,  be  would  not 
pass  anyone  euffering  from  this  complaint.  Dr.  Cotterill 
also  showed  an  epithelioma  of  the  larynx,  which  he  had 
removed  that  morning.  The  growth  was  situated  above 
the  cords,  and  necessitated  a  large  removal  of  tissue 
before  it  could  be  extirpated. 

bxhibit. 

Dr.  Dawson  Turmbb  showed  by  means  of  a  lime-light 
lantern,  numerous  photographs,  which  he  had  taken  by 
the  Rontgen  process.  They  comprised  the  usual  views  of 
the  hand,  foot,  wrist,  and  metallic  objects  in  purses,  &c. 
Dr.  Turner  stated  that  he  had  been  unable  to  obtain 
eatisfactory  negatives  with  exposures  of  lees  than  hidf  an 
hour. 

Dr.  Btbom  Bbamwbll  read  a  paper  on  a 

OASE  OF  GALOAREOUS   DEOEKEBATION  OF  THE  HEAKT  AlH) 
ABTBBIBS, 

with  rapidly  developed  subcutaneous  tumours  in  tbe 
axill»,  elbows,  groins,  natal  folds  and  popUteal  spaces,  and 
symptoms  suggestive  of  Addison's  disMse,  in  a  young  man, 
set.  25,  affected  with  advanced  cirrhosis  of  the  left  kidney  ; 
the  right  kidney  having  been  completely  destroyed  four- 
teen years  ago  by  a  pyelo-nephritis ;  with  i>athological 
repor  i  by  Dr.  Lovell  Gulland.  The  case,  which  was  one 
of  great  rarity  and  interest,  was  reported  at  considerable 
length,  and  with  Dr.  Bramwell's  usual  wealth  of  detail. 
We  notice  the  prominent  features  of  the  case  in  another 
column. 

In  the  following  discussion  Dr.  W.  Russell  remarked  on 
^th     age  of  the  patient,  and   said  that  such  calcareous 


changes  in  the  arterial  coats  was,  in  his  experienoe,  anpre- 
cedented  in  so  young  a  man.  He  had  seen  verv  consider- 
able calcareous  degeneration  in  a  man  of  33,  But  not  to 
nearly  the  same  extent.  The  tumours  of  the  skin  which 
had  been  handed  round  seemed  to  him  to  be  of  the  natue 
of  fibrous  hyperplasia,  with  deposition  of  caloareoos 
material. 

Dr.  P.  A.  Youvo  related  a  case  of  myositis  oesifioans  ho 
had  seen  some  years  ago,  in  a  child  of  6. 

Dr.  FouLis  thought  one  of  the  most  important  features 
in  the  case  was  the  connection  between  kidney  dieeaee 
and  the  deposition  of  lime  salts  in  the  body. 

Dr.  Abmoub  asked  if  there  had  been  no  symptoms  of 
nr»mia  before  death. 

Dr.  Bkahwbll,  in  reply,  stated  that  no  such  symptoms 
were  observed. 

Dr.  A  Lookhabt-Gillespie  read  a  short  abstract  of  a 
paper  on 

THE  WBATHBB,   IKFLUXNZA,  AND  DISEASE. 

This  paper  was  read  more  fully  at  the  Edinburgh  Royal 
Society  a  fortnight  ago,  and  an  abstract  of  it  printed  in 
our  columns. 

In  the  discuMion  Dr.  Cbaio  asked  if  the  epidemio  of 
1848  was  similar  in  type  to  those  of  the  past  six  years. 

Dr.  Black  thought  that  the  type  of  weather  bad  little 
to  do  with  tne  incidence  of  any  disease. 

In  reply,  Dr.  Gillespie  stated  that  judging  by  the 
records  of  the  Infirmary,  the  epidemics  of  past  years 
identical  in  their  results  with  those  lately  observed. 


WESTLONDON  MEDICO-CHIRURGICAL SOCEBTY. 
Mbbtino  held  Fbidat,  Febbuaby  7th,  1896. 

A.  Symons  Eoolbs,  M.B.,  President,  in  the  Chair. 


THE  BATIONALE  OF  THE  AOOEPTED  TBEATMENT  OF  OOUT. 

Db.  Abghibald  Gabbod  read  this  paper.  He  pointed 
out  at  the  outset  that  very  little  is  as  yet  known  reg^ard- 
ing  the  patholo^  of  gout,  and  drew  attention  to  several 
fundamental  pomts  upon  which  there  is  wide  diversity  of 
views,  such  as  the  importance  of  the  part  played  by  uric 
acid  in  the  phenomena  of  eout,  the  causation  of  the  acoa- 
mulation  of  urate  in  the  blood  by  excessive  production  or 
diminished  elimination,  the  place,  of  origin  of  uric  acid  in 
the  body,  and  the  substance  or  substances  from  whioh  it 
is  formed.  The  aims  of  treatment  as  far  as  the  uric  aoid 
is  concerned  were  next  pointed  out,  and  the  therapeutio 
methods  generally  resorted  to  were  mentioned.  The  bear- 
ings of  such  experimental  researches  as  are  fortbcominff 
upon  the  diet  of  gouty  persons,  the  exercise  they  should 
take,  the  drugs  usually  employed  in  their  treatment,  and 
the  effects  of  mineral  waters  and  baths  were  next  con- 
sidered, and  the  conclusion  was  drawn  that  we  are  not  at 
present  in  possession  of  such  knowledge  of  the  pathology 
of  the  disease  as  would  be  required  to  enable  us  to  formu- 
late a  scientific  course  of  treatment.  On  the  other  hand, 
the  belief  was  expressed  that  the  course  of  treatment 
usually  adopted,  although  largely  empirical  in  its  origin, 
is  capable  of  giving  great  relief,  and  that  the  results 
obtained  in  the  treatment  of  gout  are  decidedly  satisfac- 
tory. 

Dr.  Thudichum  referred  to  the  conflicting  reports  of 
the  results  obtained  in  the  various  plans,  dietetic  and 
medicinad,  which  had  been  used  for  gout,  it  having  been 
afi&rmed  of  many  of  them  that  in  different  hands  they  had 
done  distinct  fi^od,  distinct  harm,  or  had  produced  no 
T^fult  at  all.  He  dwelt  at  length  on  the  work  of  Drs. 
Bence  Jones  and  Roberts,  and  on  recent  researches  in 
foreign  laboratories,  but  he  inclined  to  the  view  that  clini- 
cal experience  was  a  surer  guide  in  the  treatment  of  so 
complex  a  miJady  as  gout. 

After  remarks  from  Dr.  Alderson,  Dr.  Clemow,  Dr. 
Masters  and  Mr.  Atkinson, 

Dr.  Campbell  Pope  expressed  the  opinion  that  in  the 
treatment  of  gout  the  personal  factor  was  of  chief 
importance,  for  on  careful  investigation  some  obvious 
hyeienic  or  dietetic  fault  was  usually  discoverable. 
With  regard  to  diet  he  thousht  this  should  not  be  mixed 
more  than  could  be  avoided,  and  each  particular  meal 
should  present  as  far  as  possible  its  distinctlv  nitrogenous 
or  non-nitrogenous  character  as  the  case  might  be. 


Tbk  12.  1896 


FRANCE. 


Thb  Mbdical  Pebss.     1^7 


Tbe  PktESimNT  aaid  tbat  in  watching  the  effects  of  phy- 
flcal  exercise,  whether  taken  by  the  gouty  patients  them- 
sdves  or  admirietered  to  them  in  the  form  of  massage  by 
others,  he  had  found  the  plus  excretion  of  uric  acid  not  to 
]g8t  many  days,  save  when  the  exercise  taken  is  excessive, 
and  then  not  only  is  the  quantity  of  uric  acid  increased, 
but  that  of  urea  alsa  He  then  drew  attention  to  the 
eddenoe  of  deficient  oxidation  in  the  tissues  of  gouty 
penons  afforded  by  the  presence  of  leucomaines  in  the 
urine  with  no  increase  in  the  amount  of  nitrogen  excreted, 
and  pointed  out  the  bearings  of  this  fact  oh  the  wider 
view  of  the  pathology  of  gout  which  we  may  shortly  be 
driven  to  adopt. 

Dr.  Oabsod,  in  reply,  referred  to  the  importance  of  the 
Praeident's  rei*earches  on  leucomaines,  and  said  that 
posnbly  it  might  be  found  that  while  uric  acid,  so  to  speak, 
the  indicator,  leucomaines  were  the  real  cause  of  gout. 

Specimens  of  renal  calculi  removed  by  nephro-lithotomy 
wen  shown  by  Messrs.  Keetley,  Edwards,  and  Bidwell. 


LIVERPOOL    MEDICAL    SOCIETY. 

MXETINO  HBLD  JANUARY  30TH,    1896. 


The  President,  Db.  Caton,  in  the  Chair. 


Cases. 

Mr.  Robkbt  Jonbs  exhibited  a  case  of  "  Recrudescent 
Kieket^  '*  in  a  girl,  set  16,  who  could  walk  perfectly  until 
two  years  8|!:o,  when  considerable  epiphysial  disturbance 
ocearred.  Changes  were  apparent  in  the  akuU,  jaw,  upper 
limbs,  sacrum,  and  lower  extremities.  The  forearms  pre- 
iented  the  deformities  usually  ascribed  to  crawling, 
al^Kmgh  during  infancy  and  childhood  they  were  per- 
fectly straight.  The  family  history  was  good,  and  no 
distotic  cause  could  be  found  for  the  deformities,  which 
were  very  extreme.  Mr.  Jones  did  not  consider  such  ca^es 
as  rare  as  ascribed,  having  seen  between  twenty  and  thirty 
of  them. 

Dr.  Whitfobd  described  two  cases  of  "Pernicious 
Anemia  "  which  had  recently  been  under  his  care,  one  in 
the  Stanley  Hospital,  and  the  other  in  private.  Both 
caaes  were  beyond  hopes  of  recovery  when  first  seen,  the 
paroentage  of  led  blood  corpuscles  being  about 
one  quarter  of  the  normal.  The  characteristic  lemon - 
yellow  tint  was  a  marked  feature  in  both  cases. 
In  one  of  the  two  cases  there  was  extensive  and 
almost  uncontrollable  haemorrhage  from  mucous  mem- 
hnoes  of  month  and  nose  ;  in  the  other  no  haemorrhage  of 
any  kind  whatever.  In  neither  case  was  there  any  retinal 
hemorrhage.  In  the  hospital  case  a  post-mortem  was 
made.  All  the  organs  of  the  body  were  hiehly  anaemic, 
and  a  serous  fluid  in  all  the  cavities,  including  the  ven- 
tricles of  the  brain.  The  heart  was  fatty,  dilated,  and 
walls  slightly  atrophied  ;  spleen  and  other  organs  normal, 
except  for  the  anaemia  already  mentioned.  No  atrophy  of 
stomach     Death  in  both  cases  was  due  to  asthenia. 

Mr.  Thixwall  Thomas  read  a  short  paper  on 

twbntt-fivx  ooNsxounvx  gasbs  of  stbanoulatbd 
hbbnia. 

These  included  14  inguinal,  7  femoral,  and  4  umbilical. 
There  were  two  cases  in  which  omentum  only  was  found, 
although  acute  intestinal  symptoms  were  pref«ent.  In  one 
•caae  omentum  and  sac  were  sloughy  with  cellulitis  of  the 
abdominal  wall,  and  in  one  gangrene  of  omentum,  bowel 
being  normaL  Amongst  them  was  a  case  of  vesical  hernia 
in  the  right  groin  and  scrotum,  complicating  a  strangu- 
lated inguinal  hernia.  He  advocates  rapidity  of  operation, 
thorough  carbolising  with  1  in  40  carbolic  lotion  the  con- 
tents m  the  sac  before  any  attempt  is  made  at  reduction, 
and  in  the  after-treatment  does  not  permit  opium  or  ice. 

Dr.  Bbigos  read  a  paper  on 

BOTOPIO  PBBOyAHOT   AKD  HAMATOOBLB. 

He  founded  bis  paper  mainly  on  the  cases  he  bad  treated 
by  operation.  There  were  4  undonbtiod  cases  of  ectopic 
gestation : — (1)  Sub-peritoneo  abdominal,  intra-peritoneal 
mptnre  at  the  sixth  month,  sac  drained,  placenta  undis- 
turbed because  of  the  state  of  collapse  of  the  patient,  16^ 
hours  afterwards,  when  the  operation  was  performed. 
i%  (3)>  *Dd  (4)  tubal  pregnancies ;  intra-peritoneal 
rupture  at  the  tenth,  seventh,  and  ninth  weeks.   Fatality 


eighth  day  in  (2)  attributed  to  the  extra  manipulations  in 
tiding  to  arrest  the  bleeding  before  the  final  pluffging 
with  cyanide  gauze  (the  broad  ligament  had  been  tied).  In 
(3)  and  (4)  an  afebrile  recovery  followed  ;  in  (3)  the  tube 
and  ovary  were  not  recogniped  on  the  affected  side,  no 
ligature  was  used,  only  the  plugs  of  cyanide  gauze.  There 
was  also  one  instance  of  pregnancy  in  a  rudimentary  horn 
of  the  uterus  ;  rupture  occurred  at  the  ninth  week  ;  reco- 
very followed  the  operation  which  included  the  removal 
of  the  rudimentary  uterine  comu.  Four  specimens  of 
haemato- salpinx  were  next  considered,  as  the  clinical 
histories  and  pathological  appearances  were  (not  consis- 
tent with  tuoal  pregnancies ;  in  one  the  tube  had  . 
ruptured  at  a  thinned  portion  ;  in  one  the  tube  bad  nearly 
completely  aborted  through  the  patent  abdominal  ostium, 
in  two  the  affected  tube  was  dilated  and  laden  with  blood. 
No  ovuline  structures  were  recognised  in  any  of  them. 
He  described  cases  of  haematocele,  4  due  to  salpingo 
oophoritis,  1  due  to  cystic  ovaries  (tubes  healthy),  and  1 
of  unrecognised  origin.  He  also  showed  the  apoplectic 
ovaries,  one  from  each  of  two  patients.  All  the  cases 
recovered,  except  the  one  of  ectopic  gestation  already 
noted.  This  was  not  a  large  operation  experience  of  has- 
morrhagic  lesions  associated  with  diseased  ovaries  and 
tubes  ;  it  showed  that  operation  was  not  often  necessary. 
The  period  covered  9  years'  hospital  work. 

Drs.  Imlach,  Alexander,  Da  vies,  and  Macfie  Campbell 
took  part  in  the  discussion  which  followed. 


Jfeatttt. 


[PBOM  OUB  OWN  GOBBBSFONPBXT.] 

PARIS,  Feb.  8th,  1896. 
TUBBBOULOSIS. 

At  the  last  meeting  of  the  Academic  de  M^icine,  M. 
Terrier  spoke  on  the  contagion  of  tuberculosis,  a  disease 
which  he  considered  to  be  essentially  and  extremely  con- 
tagious. He  had  known  of  several  cases  where  the  patients 
contracted  the  malady  in  the  hospital  wards,  where  they 
were  in  more  or  less  contact  with  phthisical  patients,  and 
it  was  a  well  known  fact  that  a  considerable  proportion  of 
the  hospital  nurses  become  tuberculous.  As  much  might 
be  said,  almost,  of  the  students,  and  especially  those  who 
work  hard,  remaining  in  the  hospital  several  hours  a  day. 
The  speaker  considered  that  the  hospital  directors 
neglected  disinfecting  the  contaminated  wards,  on  the  one 
hand,  and  overcrowded  them  on  the  other. 

M.  Debore  suggested  isolating  all  phthisical  patients  ; 
the  contagion  of  tuberculosis  was  an  established  fact,  and 
he  did  not  understand  why  persons  affected  with  that 
malady  should  be  allowed  to  mix  so  readily  with  other 

patients. 

Scarlatina. 
Dr.  Valli  calls  attention  to  the  symptoms  of  vomiting 
occurring  at  the  d^hut  of  scarlatina  which  he  considered  of 
considerable  importance  in  diagnosing  at  an  early  hour 
the  affection.  It  permits  also  to  recognise  the  malady 
where  the  usual  symptoms  are  wanting,  or  where  its  evolu- 
tion is  abnormal.  The  vomiting  occurs  without  any 
apparent  cause  and  bruequement.  The  parents  will  tell 
how  the  child,  up  to  then  quite  well,  was  seized  suddenly, 
at  play,  during  repasts,  or  in  their  sleep,  with  vomiting, 
and  from  that  time  the  little  patient  became  feverish.  On 
examination,  the  pulse  will  be  found  rapid,  the  tempera- 
ture high,  and  the  following  day  the  eruption  and  the  sore 
throat  will  appear,  if  the  affection  follow  the  normal  course. 
But,  as  remarks  M.  Valli,  the  importance  of  this  vomiting 
for  the  diagnosis  of  scarlatina  is  the  more  enhanced  in  that 
it  is  particularly  in  that  form  of  the  malady  where  the  ton- 
silitis  and  eruption  are  absent,  that  it  is  met  with,  con- 
sequently the  attendant  should  bear  in  mind,  when  called 


168     Ths  Mkdical  Press. 


GERM  ANY. 


Feb.  12,  i«f6. 


to  such  caaee,  the  possibility  of  scarlartina,  and  make  a 
oareful  examination  of  the  mrine  after  the  fever  has  sub- 
sided, before  allowing  the  patient  to  leave  the  bed,  and, 
more  especiallyy  to  go  out. 

Ebtsipslas. 

Dr.  Chantemesse  has  just  published  a  report  on  the 
treatment  of  501  cases  of  erysipelas  by  serum  prepared  by 
the  Pasteur  Institute,  with  a  mortality  of  only  2  59  per 
oent.  The  effects  of  the  serum  are  both  local  and  general. 
Locally,  at  the  end  of  24  hours,  a  marked  decrease  of  the 
redness,  swelling  and  pain,  is  observed.  Desquamation 
sets  in  at  an  early  hour  consisting  of  thick  epidermic  scales. 
Sometimes  the  lesion  continues  to  spread  but  is  arrested 
by  repeated  injections.  Suppuration  is  very  rare  and 
where  it  existed  before  the  treatment  it  is  considerably 
diminished  by  the  injections. 

The  general  condition  of  the  patient  improves  rapidly 
a  few  hours  after  the  injection  ;  if  the  dose  is  sufiScient  the 
patient  experiences  a  hien  itrS  well  marked  ;  the  nervous 
disturbance  and  particularly  the  delirium  are  favourably 
influenced.  The  fever  abates  rapidly  to  disappear  alto- 
gether at  the  end  of  the  second  day,  while  the  pulse 
dimini»>bes  in  frequency  and  increases  in  strength.  Where 
albuminuria  has  already  set  in,  the  injections  cause  it  to 
disappear  within  48  hours.  The  gravity  and  the  duration 
of  the  affection  are  diminished  by  the  serum  treatment. 
The  ordinary  doses  of  serum  varies  between  six  and  ten 
drachms. 

Trkathbnt  of  Slow  Pulsb. 

Dr.  Debore  recommends  in  the  treatment  of  slow  pulse, 
wheie  the  phenomenon  provokes  different  grave  manifes- 
tations, such  as  vertigo,  syncope,  epileptiform  seizures, 
nrasmia,  &c.,  subcutaneous  injections  of  a  one  per  cent, 
solution  of  nitroglycerine  as  follows : — solution  30  to  40 
drops,  distilled  water  two  drachms  and  a  half.  Three 
fourths  of  the  syringe  are  injected  daily  until  all  danger 
disappears.  The  treatment  is  followed  up  by  the  internal 
administration  of  caffeine,  sulphate  of  sparteine,  or  other 
cardiac  tonics. 


(Su'Uidiiy. 

[FBOM  our  own  00BKK8P05DENT.] 

Bbrun,  Feb.  7th. 
A  Medico- Lkoal  Case. 
A  Mbdigo-legal  case  that  took  a  somewhat  curious 
turn  was  heard  in  one  of  the  local  courts  lately,  in  which 
a  young  medical  practitioner  of  Spandau,  who  became 
qualified  in  1893,  was  accused  of  causing  bodily  injury 
through  negligence.  In  April  of  last  year  a  young  woman 
recently  married  presented  symptoms  of  threatened  abor- 
tion. She  consulted  two  medical  men  who  agreed  as  to 
her  condition.  She  then  placed  herself  under  the  care  of 
the  accused,  who  declared  that  a  harmless  operation  was 
necessary.  This  she  consented  to,  and  the  operation  was 
performed,  with  the  result  that  the  patient  died  of  hasmor- 
rhage  two  and  a  half  hours  afterwards.  What  the  opera- 
tion was  is  not  clear,  but  it  appears  to  have  been  a  curette- 
ment  of  the  uterus,  in  the  course  of  which  perforation  of 
the  walls  of  the  uterus  took  place.  As  a  result  of  the 
post-mortem  examination  Dr.  von  V —  was  accused  of 
culpable  negligence.  The  two  principal  medical  wit- 
nesses were  the  Kreisphysikus  Dr.  Seinicke  and 
Prof.  Landau.  Whilst  Dr.  Reinicke  laid  the  whole 
of  the  blame  on  the  accused.    Prof  Landau  laid  it  on 


the  present  state  of  scientific  knowledge  and  the  defective 
clinical  training  of  students.  Operations  such  as  the  one  in 
question  were  not  taught  practically  to  young  pnofei- 
tioners,  and  they  had  to  gain  their  experienoe  from  their 
patients.  Moreover,  science  followed  the  fashions,  and 
there  was  a  widely  spread  school  that  had  given  up  the 
plan  of  observation  and  waiting,  and  taught  a  method  of 
treatment  that  the  witness  must  characterise  as  brutal, 
and  must,  therefore,  lead  to  brutal  consequenoea.  The 
accused  appeared  to  belong  to  this  modem  school ;  the 
woman  was,  therefore,  not  the  victim  of  his  negligence^ 
but  the  victim  of  the  modem  tendency  of  medicine.  The 
CSourt  then  requested  a  written  opinion  on  the  matter 
from  Dr.  Landau,  and  at  the  same  time  a  control  opinioOy 
or  Obergutachten,  from  the  Royal  Medizinal  Collegium. 
It  is  well  to  bear  in  mind  that  Prof.  Landau  is  not  an  ordi- 
nary professor  of  gynooology  in  charge  in  either  of  the 
teaching  clinics,  but  a  professor  extraordinary  with  a 
privilege  of  private  teaching. 

At  the  meeting  of    the  Medical  Society  Hr.   Stabel 
related  the  results  of  the 

Tbeatmbnt  of  Goitbb  by  Thyboid  Eztbact. 

These  cases,  83  in  number,  were  treated  partly  by  fresh 
glands  and  partly  by  tablets  from  the  Dresden  Hofapo- 
theke.  Of  the  cases  treated  by  the  fresh  glands,  only  25 
were  brought  forward,  as  only  those  cases  that  remained 
four  weeks  under  treatment  were  made  use  of  in  the  paper. 
For  determining  the  size  of  the  goitre  a  measurement  was 
made  at  the  level  of  the  vertebra  prominens.  The  dan- 
gerous symptoms  attributable  to  thyroid  feeding  were  due 
to  decomposition  of  the  gland.  Although  the  glands  weie 
employed  fresh,  in  the  warm  weather  changes  set  in  vety 
rapidly,  and  sometimes  gastric  disturbances  were  pro- 
duced ;  these  symptoms  did  not  come  on  when  a  better 
means  of  preservation  was  adopted.  Baumann  had  sue- 
oeeded  in  isolating  the  active  part  of  the  thyroid  sub- 
stance, had  found  it  associated  with  iodine,  and  given  it 
the  name  of  thyreoiodine.  In  all  the  25  cases  of  feeding 
with  fresh  substance  a  positive  result  was  obtained,  but 
in  almost  all  of  them  it  was  to  the  extent  of  considerable 
improvement.  A  cure  or  total  disappearance  of 
the  goitre  was  only  obtained  in  four  cases.  Two 
cases  only  could  be  considered  as  permanently  cured  f 
8  per  cent,  of  the  cases,  therefore,  were  cured, 
and  92  per  cent,  improved.  The  cases  considered 
to  be  cured  had  remained  well  nine  months.  The  amount 
of  diminution  in  size  brought  about  by  treatment  was  not 
kept  up  after  the  treatment  was  stopped,  but  a  gradual 
enlargement  again  took  place.  A  slight  acceleration  of 
the  pulse  was  almost  constant.  In  simple  stroma  it  was 
never  necessary  to  stop  the  treatment  on  account  of  the 
increased  pulse  rate.  Dangerous  symptoms  were  never 
observed.  In  slighter  cases,  especially  in  young  girls,  a  slight 
loss  of  weight  was  observed.  A  large  number  of  cases  were 
treated  by  tabloids  when  feeding  with  fresh  substance 
was  stopped,  and  in  these  the  struma  never  increased  in 
size  in  consequence  of  the  change.  In  many  a  slow  diminu- 
tion took  place.  The  reeults  of  the  treatment  by  the 
Dresden  tabloids  were  not  so  good  as  when  the  fresh 
extract  was  employed,  the  reason  being  that  so  large  an 
amount  could  be  given  without  threatening  symptoms 
supervening.  Tliree  tabloids  was  the  maximum  dose 
given,  in  seven  days,  therefore,  only  three  grammes  of 
the  active  substance  could  be  given,  whilst  with  the  fresh 
substance  five  times  as  much  could  be  given.  The  tabloids, 
in  addition  to  being  less  active,  had  a  much  more  unf avour- 


Fn.  12,  1896 


AUSTRIA. 


The  Mbdioal  Pbks.     169 


Mb  inflaenoe  on  the  heart.  The  medicine  had  to  be 
jnterrapted  on  acoonnt  of  the  increased  cardiac  activity 
OMieed  by  them.  Especially  in  chlorotio  and  neurasthenic 
giris  threatening  symptoms  supervened  ;  acute  dilatation 
of  the  heart  was  never  observed  under  these  circumstances. 
If  the  heart's  action  was  once  accelerated,  this  effect  was 
kspt  ap  for  weeks  together.  The  tablets  ought  not  to  be 
uMof  of  trade ;  cases  were  increasing  in  which  they  had 
a  diiaatrous  effect.  A  man,  »t.  50,  who  was  taking  them 
for  obesity,  wap  suddenly  attacked  with  a  psychosis  with  a 
delofion  of  persecution,  and  died  in  a  few  days  with 
oerebnl  cedema. 

The  assumption  appeared  justified  in  this  case  that 
intoncation  had  been  produced  by  the  tablets,  and  the 
more  eo,  as  the  speaker  had  observed  three  similar  cases 
where  delusions  of  persecution  had  also  occurred.  He 
added  also  three  cases  of  morbus  basedowii  treated  as 
out-patients.  Two  soon  ceased  attending,  as  the  nervous 
symptoms  grew  rapidly  worse.  In  one  patient  vomicing 
came  on  and  lasted  a  week,  with  great  prostration,  and 
the  eymptoms  returned  three  months  later,  when  the 
trealment  was  recommenced.  The  second  patient  attended 
Mikulicz's  klinik,  where  she  was  given  thymus  extract  to 
loBS  of  consciousness  and  maniacal  attacks,  and  in  this 
condition  was  brought  back  to  Berlin.  The  third  patient 
wsB  treated  with  large  doses  for  three  months -three  to 
four  grammes  daily.  No  change  had  been  observed,  how- 
erer,  although  a  subjective  improvement  took  place.  Seven 
eases  of  morbus  basedowii  had  been  treated  with  tablets, 
but  even  with  large  doses  no  other  result  had  been  ob- 
tained than  an  accelerated  pulse  up  to  116  and  upwards. 
In  the  older  cases  with  exophthalmns  the  nervous  symptoms 
got  rather  worse  than  better,  and  the  ocular  symptom  was 
not  affected.  The  treatment  was  directly  contraindicated 
in  Basedow's  disease  on  account  of  the  effect  on  the  heart. 
In  one  case  of  vascular  gottre  with  oedema,  swollen  pen- 
dnkms  lips,  &c.,  considerable  improvement  took  place. 
The  goitre  became  smaller,  and  no  souffle  could  any 
kmger  be  heard.  In  fourteen  days  she  looked  quite  differ- 
ent, the  face  had  become  more  youthful,  she  felt  quite 
well  and  could  work  hard.  Subjectively  she  was  quite 
coptented  and  the  struma  had  quite  disappeared.  One 
hmdred  and  forty  days  after  the  treatment  was  stopped 
flbe  returned  on  increasing  size  of  the  neck.  Rapid  effect 
waB  produced  by  thirty  tablets  daily,  but  the  symptoms 
returned  when  the  medicine  was  left  off. 


Jlu0tria. 


(#JlOM  OUB  OWK    OOBBBSPOHDBNV.] 

Vienna,  Feb.  7th,  1896. 
Test  fob  Albumen  in  Ubine. 

At  the  Doktoren  Collegium,  Adolf  Jolles  read  a  few  notes 
on  the  Various  Tests  for  Albumen,  after  which  he  brought 
forward  one  composed  of  mercury,  succinic  acid,  and 
hypochlorite  of  soda.  He  remarked  that  the  test  whi6h 
has  recently  met  with  approbation,  and  is  still  esteemed 
the  most  sensitive,  viz.,  the  acetic  acid  and  ferro-cyanide 
of  potassium,  had  its  own  peculiar  defects.  In  the  first 
place,  the  intense  yellow  colouring  which  the  cyanide  of 
potassium  produces  in  the  urine  erroneously  betrays  a 
)a^ia[  or  lower  amount  of  albumen  than  is  absolutely  the 
case.  In  other  cases  it  fails  to  indicate  the  presence  of 
aUiiimen,  even  where  an  undoubted  pathological  condition 
is  present    Spiegler's  is  also  untrustworthy  and  cannot  be 


utilised  as  a  quantitative  test  where  the  total  amount  is 
small.  It  is  very  defective  when  the  urine  contains  few 
chlorides  and  may  be  said  to  depend  largely  upon  the 
presence  of  this  constituent  in  the  urine.  Prof.  Jolles  con- 
sidered that  a  good  test  for  albumen  should  be  free  from 
colour  and  sensitive  in  reaction,  and  thought  the  following: 
fulfilled  these  requirements  :— 

Hydrarg.  bichlor.,  3iJ8B ; 
Acid  succinic,  3v  ; 
Hypochlorite  of  soda,  3iJ88  ; 
Aqua  distill.,  5zv. 

After  filtering  4  or  5  com.  of  the  urine  to  be  tested,  I 
com.  of  a  30  per  cent,  acetic  acid  solution  is  added,  with  4 
com.  of  the  above  reagent.  The  whole  is  well  shaken  and  set 
aside  to  settle.  In  a  second  test  tube,  4  or  5  com.  of  the  urine 
after  filtration  is  treated  with  1  ccm.  of  the  acetic  acid  as 
above  and  then  set  aside  to  settle  in  order  to  estimate  the 
mucine  present.  This  eliminates  any  error  from  the  abso-- 
lute  albumen  present.  The  potassium  ferro-cyanide  test  is 
defective  in  this  respect.  The  reaction  is  very  sensitive 
and  can  detect  one  of  albumen  in  120,000  parts  of  urine.  The 
reagent  is  free  from  colour  throughout,  which  is  another 
advantage  over  the  potassium  ferro-cyanide  test.  It  is  also- 
superior  to  Spiegler's  in  defioing  accurately  the  amount  of 
albumen  present  in  the  absence  of  chlorides. 

Spiegler,  in  criticising  the  foregoing,  said  that  he  had' 
observed  a  communication  in  the  Chemical  Journal,  a  few 
days  ago,  by  Jolles,  entitled  a  ''Sensitive  Test  in  the 
Detection  of  Albumen  in  Urine,"  but  on  examination, 
could  find  nothing  novel  in  it.  He  might  term  it  a  modi- 
fication of  his  own,  but  certainly  there  was  no  new  dis- 
covery made.  As  to  the  defect  caused  by  the  absence  of 
chlorides,  a  small  addition  of  common  salt  will  always- 
overcome  the  difficulty  in  such  rare  cases,  but  the  excep- 
tions are  so  seldom  met  with  that  addition  is  unnecessary. 
As  to  the  objection  taken  by  Jolles  concerning  the  acid*- 
Spiegler  said  that  he  had  always  endeavoured  to  use  an* 
organic  acid,  finding  the  mineral  acids  unsuitable,  and  hOr 
therefore,  adopted  vinous  acid.  For  this  Jolles  substi' 
tuted  succinic  acid,  but  as  far  as  this  novelty  is  concerned 
he  might  have  substituted  hundreds  of  others.  He  con- 
sidered Jollee's  test  only  a  modification  and  founded  on 
the  principle  of  corrosive  sublimate.  Jolles,  he  affirmed, 
tells  us  that  his  modification  detects  1  in  100,000,  but  he 
(Spiegler)  affirmed  that  he  could  detect  1  in  350,000. 

Jolles,  in  responding,  did  not  deny  that  his  test  was  a 
modification  of  Spiegler's,  placing  great  importance  in  the- 
use  of  succinic  acid  in  obtaioinGr  accurate  results. 
Tbopsio  Nkubitis. 

Topolaoski  showed  a  patient  at  the  Gesellschaft  who  had' 
been  bitten  on  the  left  cheek  under  the  eye.  On  the  third 
day  after  the  lesion  high  fever  set  in  which  continued 
three  days.  The  fever  was  accompanied  with  profuse  swell- 
ing over  the  zygoma,  and  the  skin  became  covered  with 
large  and  small  vesicles.  For  fourteen  days  this  increased, 
extending  over  the  sternum,  forehead,  and  neck.  Topo- 
laoski was  unable  to  account  for  the  irregularity  of  this 
morbid  process.  The  fever  was  certainly  in  favour  of 
erysipelas,  while  the  continued  morbid  change  was  against 
this  view.  Erysipelas  and  consecutive  phlegmon  were 
negatived  by  the  rapid  disappearance  of  the  fever  on  the- 
third  day,  which  should  have  continued  had  it  beeo 
phlegmonous  inflammation. 

Weinlechner  remarked  that  the  vesicles  around  the  seal^ 
of  lesion  would  depend  upon  a  trophic  condition  of  the 
nerves,  as  such  a  state  often  occurred  on  the  fingers  when 
the  nerves  had  been  lacerated. 


170    Ths  Mboioal  Pbxbs. 


THE  OPERATING  THEATRES. 


Fbb.  12,  1868. 


^ke  ©perating  ^kratrcB. 

LONDON  HOSPITAL. 
Amputation  of  the  Humerus  Midway  Betwikh  the 
SuBGiCAL  Neck  aud  the  Insertiok  oe  the  Deltoid- 
Elliptical  Operation  —Mr.  H.  P.  Dean  operated  on  a 
man,  wt.  64,  who  was  found  on  the  railway  after  haying 
been  run  over  by  a  train.    The  left  arm  waa  almost  com- 
pletely separated  from  the  body  opposite  the  middle  of 
the  humerus,  simply  hanging  on  by  a  lacerated  portion  of 
the  triceps.    The  middle  third  of  the  humerus  was  com- 
pletely ground  into  small  pieces.    On  admission,  the  man 
was  found  to  have  lost  a  moderate  quantity  of  blood,  but  he 
was  suffering  considerably  from  shock.    By  the  help  of 
stimulants  and  warmth,  he  began  to  improve,  and  ampu- 
tation  was   performed    through   the   humerus   midway 
between  the  surgical  neck  and  the  insertion  of  the  deltoid. 
Owing  to  the  limited  amount  of  skin  left  uninjured,  it  was 
found  that  an  obliquely  circular  operation  would  be  the  best. 
As  the  patient's  neck  was  too  short  and  thick  to  allow  of 
pressure  being  brought  to  bear  on  the  third  part  of  the 
subclavian,  the  axillary  artery  was  controlled  by  rolls  of 
bandage  held  in  position  by  a  tourniquet,  so  that  the 
vessel  was  compressed  at  the  summit  of  the  axilla.    An 
elliptical  skin  incision  was  made  extending  lower  on  the 
outer  than  on  the  inner  side  ;  the  skin,  with  the  fat  And 
the  deep  fascia,  was  turned  down  to  about  the  insertion 
of  the  deltoid,  and  the  muscles  were  next  divided  circu- 
larly at  this  spot ;  the  axillary  artery  and  vein  were  tied 
with  silk,  and,  on  removing  the  tourniquet,    no   other 
vesseU  required  ligature ;  the  wound  was  stitched   up 
with  silkworm  gut,  and  a  drainage-tube,  which  would  be 
removed  in  twenty-four  hours,  inserted  in  the  outer  angle 
of  the  incision.    Mr,  Dean  said  that  the  only  question  to 
decide  in  this  case  was  whether  the  amputation  should  be 
performed  through  the  shoulder-joint,  or  whether  the  sur- 
geon   should    attempt   to   lemove   the   limb  below  the 
surgical  neck  ;   the   latter  procedure,    he   pointed    out, 
necessitated  taking  some  of  the  skin  which  had  been 
rather  bruised  by  the  injury,  but  in  this  case  it  was  found 
that  the  third  part  of  the  subclavian  could  not  be  efficiently 
compressed,  and  it  is  known  by  experience  that   under 
«uch  circumstances  amputation  at  the  shoulder- joint  is 
frequently  accompanied  by  an  amount   of   haemorrhage 
which,  before  it  can  be  controlled,  is  often  considerable. 
Taking  all  this  into  consideration,  he  thought  it  better  to 
amputate  through  the  humerus  in  the  hope  that  the  skin 
would  possess  sufficient  vitality.    Another  advantage,  he 
eaid,  was  that  by  this  plan  a  roundness  of  the  shoulder 
would  be  left,  together  with  a  considerable  amount  of 
strength  in  the  movements  connected  with  the  scapula, 
as  none  of  the  scapular  muscles  were  divided. 

It  IB  satisfactory  to  record  that,  three  days  after  the 
operation,  the  patient  is  doing  well ;  temperature  normal, 
flaps  perfectly  healthy,  and  no  sign  of  inflammation  at 
the  bruised  part 

ROYAL  FREE  HOSPITAL. 
Operation  jor  Pyo-Salpinx.— Mr.  Battle  operated  on 
•  a  woman,  at.  about  40,  who  was  admitted  in  to  the  hospiUl 
a  short  time  before  Christmas  1895.  She  applied  on 
account  of  a  swelling  in  the  abdomen  which  had  shown 
itself  a  short  time  before;  this  swelling  was  most 
prominent  on  the  left  side  above  Poupart's  ligament  where 
the  skin  was  adherent  to  it,  cedematous  and  red.  The 
outline  of  the   swelling  could  be  felt  extending  some 


distance  towards  the    umbilicus  (about  halfway)  and 
gradually  shading  off  on  each  side  towards  the  pelvis ;  it 
was  very  tender,  fluctuated  freely,  and  the  patient  coni- 
plained  of  much  pain  in  it.    Examination  per  vaginam 
showed  a  considerable  inflammatory  exudation  round  tba 
uterus  which  completely  fixed  that  organ.  The  temperatore 
was  raised  and  there  were  other  signs  of  fever.  It  appeared 
as  if  the  abscess  was  going  to  perforate  at  the  point  which 
was  most  prominent  and  red,  and  it  was  decided  to  indse  this 
if  the  condition  had  not  improved  by  the  next  visit ;  how- 
ever, it  was  then  thought  that  there  was  considerable 
improvement,  the  swelling  being  smaller  and  the  signs  of 
inflammation  less  marked.    As  Mr.  Battle  considered  the 
case  was  probably  one  of  pyo-salpinx  on  the  left  side,  means 
were  taken  to  diminish  the  inflammatory  symptoms  in 
hopes  that  the  swelling  would  subside  and  become  less 
adherent  to  the  abdominal  wall.    Progress  of  the  case 
justified  this  expectation,  for  it  considerably  diminished 
in  size,  became  free  from  attachment  to  the  abdominal 
wall,  and  the  exudation  into  the  pelvis  subsided.     At  the 
operation,  more  than  a  month  after  admission,  a  central 
incision  exposed  a  rounded  tumour  a  little  to  the  left  of 
the  middle  line,  crossing  which  obliquely,  so  as  to  reach 
its  anterior  aspect,  was   a  greatly  enlarged  Fallopian 
tube  (the  size  of  a  forefinger).    The  uterus  could   not  be 
defined  until  a  sound  had  been  passed  :  it  was  then  dis- 
covered below,  and  to  the  right  of  the  swelling  completely 
hidden  by  it.    The  intestines  were  placed  out  of  the  way 
and  protected  by  large  flat  sponges,   and  the  tumour 
separated  from  vaiious  adhesions.     One  part  behind  and 
below  was  very  soft,  and  gave  way  under  pressure  of  the 
finger,  permitting  a  large  quantity  of  thick,  offensive  pus 
to  escape  into  the  pelvis.     The  abscess  wall  and  dilated 
tube  were  then  separated  from  their  attachments  to  the 
uterus  and  to  the  left  side  of  the  pelvis,  the  cavity  left 
being  washed  out  with  boracic  lotion  and  thoroughly  dried 
with  sponges,  a  glass  drainage  tube  being  placed  at  the 
bottom  of  the  pelvis  through  the  lower  part  of  the  wound. 
The     right     half     of    the    omentum     was     adherent 
in     the     pelvis    on    the    right     side,     and     to     the 
anterior  abdominal  wall  to  the  right  of  the  middle  line  ; 
the  left  half  which  was  normal  was  drawn  across  the  left 
side  of  the  abdomen  so  as  to  cover  the  bowel  on  that  side. 
The  wound  was  closed  with  interrupted  sutures  in  two 
layers,  the  first  including  only  the  peritoneum,  the  second 
the  structures  aboveit.  Mr.  Battle  considered  that  the  ope- 
ration had  not  only  confirmed  the  diagnosis,  but  the  condi- 
tion of  things  revealed  by  it  proved  that  nothing  short  of 
a  radical  procedure  could  have  saved  the  patient's  life. 
He  thought  tbat  great  advantage  had  resulted  from  the 
delay,  as  the  tumour  was  much  smaller  and  surrounded 
by  less  inflammatory  exudation.   The  fresh  adhesions  were 
still  soft  enough  to  give  under  pressure  of  the  finger,  and 
the  limiting  wall  of  the  abscess  was  firmer  and  better  able 
to  resist  manipulation.    The  right  ovary  and  tube 
healthy. 


A  MiDWiJfJE  was  last  week  committed  for  man- 
alaughter  at  the  Coroner's  Court,  Sheffield,  for  attend- 
ing a  case  of  labour  after  having  been  warned  against 
doing  so.  She  had  previously  attended  a  case  where 
death  took  place  from  puerperal  fever,  and  four  days 
after  this  she  attended  the  woman  whose  death,  also 
from  puerperal  fever,  became  the  subject  of  the 
inquest. 


Fib.  12.  1896. 


LEADING  ARTICLES. 


Tbb  Medical  Pbbbs.    ITl 


^hc  ^tbical  ^xzbb  anb  CirtnUr. 


•TOTT  WadBMdaj  monlDC,  Prloe  fid.   Poit  tt—,  fi^d. 
ADVBBTIBBKBBTt. 

mODlnSBnoB  :~W1iol«  Page,  £6  te.  Od.;  BaU Pag*,  M 10*.  Od. 
QnrtwPftf*,  Afit.:  OiM-«lgiitb,  Iti.  dd. 

fW  A  Bmaa  ov  UransiOMB:— Wboto  Page,  thirteen  InsertloDi 
(vedd7>ft»tn|^tlj,or  mootli]y)at£8  lOkOd.;  twentj-ilz  Inier- 
ttoei  (weeUj  or  f ortnlgfatly)  at  £S  li.  Od. ;  Uttj-two  InierUona 
(vmUj)  at  £S  eadh.  Half -page,  thirteen  Inaertloiia  at  86c. ; 
tvM^-aizat  821^ ;  llfty-two  iDaerttoiii  at  aoa.  eaoh.  Qnaztar-page, 
thirtaeii  iDeertloiw  at  Ui. ;  twanty-elz  Inaertloni  at  16a. ;  flftj-ali 
laiwtloaa  at  Ifta.  each 

BHeO  ABBoiiikoeiD«Dt»  off  Praoticee,  Aaalatanelei,  TacaDdet,  Book 
*e.— 8eT«ii  llnea  or  under,  ia  per  Inaertlon ;  0d.  per  line  beyond. 

MtMBta  this  depArtment  ahoold  be  addreaaed  to  the  Pnbllahert 

BUBsoBipnoim. 

PQ0  IBBB  TO  AnrVAL  SUBSGUBSBS  M    1    0 

ABKOAD.wiTHnr  CHS  PosiALUnoa      M   8  6 

In>IA,  CHIBA.  An>  JAPAa  .  .      M    fi    6 

PortflMee  Ordeia  and  Cheqnea  to  be  drawn  In  faTonr  of— 

A.  A.  TITOAIA,  iO-il  King  William  Street,  Btrand,  London. 
A.  H.  JAOOB,  SO  Moleaworth  Street,  Dublin. 

BVMBlPnovs  VOR  PBAVOi  are  reoelTed  by  Meaan.  BAniJiBB,  Kne 
HaaSefeanie,  Parte— poet  free  in  advanoe,  41  8i.  6d.  per  annun. 


SraKUFiioaB  FOB  CHB  UvRBD  SZATBB,    poat  free 
,«^  -.   .         ^  dfreot  *      ■ 

I  Order. 


In  adTanoe 


(a  Ik  dd.  per  annnmX  ahonld  be  aent  dfreot  to  the  OflleM 
ttb  eonntiy  by  International  Poet  Oflloe  ~ 


SDif  Aimis  /br  Oermtm^  and  Atuiro-BMngaru— 
W.  *&L0WBBTHAL  (Oflloe  of  the  BmrUmerAdrnnuckh 


8/jfe  UjeMral  ^xm  Sc  ^irmlar. 


'8ALUB  POFULI  8UPREMA  LBX.' 


WEDNESDAY,  FEBRUARY  12,  1896. 


MEDICAL  Poor-law  pensions. 

The  Bill  providing  for  Poor-law  pensions— medical 
and  noD-medical—which  was  introduced  in  the  last 
aeaaion  by  Mr.  Walter  Long,  at  the  instance  of  the 
Engdah  Union  Officers'  Association,  will  make  its 
appearance  again  within  the  present  week.  It  is  being 
ickiyely  promoted  by  the  President  of  that  Association, 
Mr.  Bntherglen,  Clerk  to  the  J^ensington  Goardians, 
sod  l^  its  Coancil,  and  so  much  energy  and  fore- 
thought has  been  devoted  by  them  to  the  matter 
that  the  prospect  of  passing  the  Bill  would  appear 
to  be  as  favourable  as  those  of  any  private 
Bill  can  be.  The  English  Poor-law  Medical 
OflleeiB'  Association,  represented  by  Mr,  Wickham 
Banes  is  co-operating,  and  the  Local  Government 
Board  Authorities  of  both  the  Liberal  and  the  Unionist 
Governments  have  expressed  themselves  favourable 
to  the  principle  of  the  measure,  as  are  also  Sir  Walter 
I  Foiter,  Mr.  Walter  Long,  and  other  influential  Mem- 
1  ben  of  the  House.  The  chief  difficulty  which  confronts 
I  the  promoters  is  to  get  it  placed  upon  the  Notice 
Piper  in  such  a  position  that  it  will  be  discussed  as 
an  early  Order  on  a  Private  Member's  day,  and,  inas- 
much as  such  privilege  is  conceded  in  turn  to  Private 
Membera'  Bills,  by  ballot,  it  is  necessary  to  accumu- 
late as  many  votes  as  possible  at  this  preliminary  ballot 
in  favour  of  the  Bill  In  the  attempt  to  do  this  the 
promoters  have,  we  believe,  been  quite  successful,  and 


it  is,  therefore,  likely  that  the  Bill  will  secure  a  '*  place  ^ 
which  will  ensure  for  it  consideration  which  no  private 
bill  can,  under  other  circumstances,  obtain. 

This  Superannuation  Bill,  it  may  be  recollected, 
proposes  to  secure  to  every  Poor-law  Officer,  on  becom- 
ing incapacitated  for  duty,  a  pension,  as  a  matter  of 
right,  on  a  scale  analagous   to    the    Civil   Service 
scale.     The     pension     is    to    be     paid     by     the 
guardians  and  secured  by  them,  but  it  is  to  be  paid 
out  of  a  fund  made  up  of  small  deductions  from  the 
officer's  salary,  somewhat  in  the  nature  of  an  endow- 
ment insurance.    The  amount  of  such  deduction  is 
fixed  by  the  Bill  at  two  per  cent,  of  the  salary  for  an 
officer  of  less  than  five  years  service,  rising  to  three  per 
cent,  for  an  officer  of  over  fifteen  years  service.    For 
example,  a  medical  officer  entering  upon  his  appoint- 
ment at  £100  a  year  will  have  to  submit  to  a  deduc- 
tion of  lOs.  per  quarter.    This  deduction  will  continue 
until  he  has  served  thirty  years  (or  for  a  less  term  if 
previously  ic  capacitated  by  ill-health).    When  he  has 
served  thirty  years  he  will,  if  a  professional  officer  like 
a  doctor,  be  entitled  to  have  ten  years  added  to  his 
actual  service  for  the  purpose  of  computing  his  pension 
and  will  thus  have  credit  for  forty  years.    His  pension- 
will  thus  be  forty-sixtieths,  or  two-thirds  of  his  salary, 
equal  to  £60  138.  4d.  a  year  for  life.     He  cannot,, 
however,  claim  tbis  pension  (except  in  case  of  perman- 
ent incapacity  from  illness)  until  he  reaches  the  age  of 
sixty,  so  that  if  he  commences  at,  say,  twenty-five 
years  of  age,  he  will  have  to  work  on  for  five  years 
after  the   lapse   of   his  thirtieth    year    of   service,, 
while  if  he  is  not  appointed  until  he  is  thirty  years 
of  age  he  will  become  entitled  to  pension  the  moment 
his  thirtieth  year  has  lapsed.     Daring  that  thirty 
years  he  will  have  contributed  £60  from  his  salary 
and  will  have  acquired    an   eventual    provision   of 
£66  138.  4d.  for  life,  but  upon  his  death  at  any  time 
his  contribution  would  disappear.     It  will  thus  be 
seen  that  the  pension  is  to  be  provided  on  the  Tontine 
principle  under  which  the  contributions  of  those  who 
die  go  to  increase  the  pensions  of  the  survivors  or— in 
other  words — to  decrease  their  annual  deductions  from 
salary.     It  would,  of  course,  be  impossible,  by  any 
other  means  to  give  a  pension  of  £66 13s.  4d.,  in  return 
for  a  payment  of  £60.    It  would  be  quite  easy  to  frame 
a  scheme  under  which  the   representatives   of   the 
deceased  officer  would  get  back  a  part  of  what  he  had 
paid  in,  but,  in  such  case,  it  would  be  necessary  to 
increase  the  deductions  from  the  two  or  three  per  cent 
set  down  in  this  Bill  to  some  larger  percentage.      The 
Poor-law  Medical  Officers  of  Ireland  occupy  a  peculiar 
position  with  reference  to  this  question.    At  present 
an   incapacitated    officer    may    receive    the    Civil 
Service  rate    of    pension  above   referred  to  if  the 
guardians  please  to  give   it  to  them  but  not  other- 
wise.   A  few  of  the  richer  Boards  of  Guardians  have 
granted  these  pensions  on  principle  to  all  their  officers. 
Many  others  have  granted  them  to  officers  who  were 
personally  or  politicaUy  popular,  but  have  refused  them 
to  others  more  necessitous.    Many  others  have — on 
principle  also— refused  to  grant  a  pension  under  any 
circumstances,  and  some  others,  of  the  poorest  and 
most  sparsely  populated  districts,  though  willing  to 


172     Thw  Mrdicat.  Pbes«. 


LEATONG  ARTICLES. 


Fkb    12.  1896. 


do  justice  to  their  officers,  have  been  prevented  doing 
so  by  their  poverty.  Thus  it  happens  that  the  grossest 
ii^'astice  and  crud  hardship  has  been  inflicted  upon  the 
Don-Poor-law  Medical  Officers  in  years  past,  insomac  h 
that  for  twenty-fiveyears  they  have  not  ceased  to  clamour 
for  the  grant  of  pensions  not  as  a  matter  of  discretion 
.  but  of  right.  Their  efforts  have,  we  regret  to  say, 
resulted  in  failure,  and,  as  far  as  we  can  look  forward, 
must  so  result  as  long  as  the  object  is  pursued  in  the 
same  way.  ^y  ?  Because  these  Irish  pensions  are 
payable  entirely  out  of  the  poor  rates,  and  the  p^rlia- 
mentary  representatives  of  the  money  saving  Boards  of 
Guardians  have  always  resisted  the  imposition  of  a 
compulsory  pension  upon  the  taxpayer.  An  effort  was 
made  by  Mr.  Gladstone's  government  many  years  ago 
at  the  instance  of  the  Irish  Local  Government  Board, 
instigated  by  the  Irish  Medical  Association,  to  meet 
this  objection  by  paying  the  pensions  out  of  a  general 
national  rate  and  not  out  of  a  local  rate,  but  the  oppo- 
sition of  certain  Irish  members  was  still  too  strong,  and 
the  bill  was  then  and  subsequently  defeated.  Under 
these  circumstances  the  Irish  Medical  Association 
thought  it  right  to  ascertain  by  plebiscite  the  wishes  of 
lihe  Poor-law  Medical  Officers,  and  they  answered  by  a 
large  majority  that  they  would  prefer  to  stand 
in  with  the  principle  of  the  English  Bill  than  to 
submit  to  further  indefinite  postponement.  Many 
of  them  were,  no  doubt,  led  to  this  conclusion 
by  consideration  of  the  provision  which  the  English 
Bill  contains  that  no  one  need  come  under  its  opera- 
tion or  submit  to  any  deduction  of  salary  who  prefers 
to  remain  under  the  present  discretionary  system. 

The  Council  of  the  Irish  Medical  Association  has, 
therefore,  taken  active  steps  to  have  Ireland  included 
in  the  Bill  — which  it  was  not  last  year — and, 
if  this  be  done  we  may  perhaps  cherish  the  hope  that 
the  final  settlement  of  this  interminable  question  is 
within  measurable  distance. 


THE  CAMBRIDGE  UNIVERSITY  DEGREES 
AND  WOMEN. 
The  question  of  whether  or  not  the  degrees  of  the 
University  of  Cambridge  should  be  thrown  open  to 
women  is  at  present  claiming  a  large  measure  of  atten- 
tion among  those  interested  in  the  subject.  The 
movement  is  under  the  leadership  of  Miss  Helen 
.  Gladstone,  the  head  of  Newnham  College,  and  the 
present  makes  the  third  attempt  which  has  been  made 
to  bring  about  this  reform  in  favour  of  the  women. 
In  so  highly  a  conservative  and  academic  an  Institu- 
tion as  the  University  of  Cambridge,  it  is  only  to  be 
anticipated  that  opposition  'to  the  new  scheme  would 
be  encountered,  especially  among  those  holding  official 
positions  in  the  University.  Fortunately,  however, 
for  the  friends  of  the  women,  the  residents  having 
votes  in  the  Senate  number  only  550,  while  the  non- 
residents number  5,000.  Thus  if  the  women  are  to 
gain  the  day,  every  effort  should  be  made  to  influence 
the  latter  with  the  view  of  swamping  the  opposition 
of  the  illiberal  -  minded  minority.  It  is  of  some 
interest  to  note  that  almost  the  same  arguments  which  / 


were  urged  against  the  admission  of  women  to  the 
diplomas  of  the  Royal  College  of  Physicians  are  now 
being  placed  prominently  forward  as  reasons  against 
admitting  women  to  the  degrees  of  the  University  of 
Cambridge.    The  statement  has  been  made  that  the 
granting  of  the  B. A.  degree  would  be  harmful  to  the 
women  themselves,  owing  to  the  demands  upon  them  of 
the  higher  education,  but  that  no  harm  would  happen 
to  the  University,  provided  the   concession  went  no 
further.  Just,  however,  as  certain  of  the  Fellows  of  the 
College  of  Physicians  were  appalled  at  the  reflection 
of  a  woman  ultimately  aspiring  to  be  the  President  of 
the  College,  so  certain  members  of  the  Senate  of  the 
University  of  Cambridge  are  horrified  with  the  idea 
that  women,  if  allowed  to  take  the  degree  of  B.A., 
would  insist  upon  proceeding  further  in  theirUniversity 
career.    It  is  stated  that  they  will  demand    to  be 
admitted  to  the  M.A.  degree,  and  claim  to  become 
members  of  the  Senate  ;  that  they  will  not  be  content 
with  perfect  equality  in  the  University  unless,  and 
until,  they  invade  the  colleges.    Such  is  the  substance 
of  the  nonsensical    arguments   advanced  in  certain 
quarters  against  the  admission  of  women  to  the  degrees. 
On  the  face  of  it,  if  this  is  all  that  the  opponents  of  the 
women  can  urge  against  the  reform,  undeniably  their 
cause  is  a  weak  one.    To  argue  upon  these  lines  Ib 
really  too  paltry,  and  unworthy  of  those  members  of 
the  University,  whose  academic  position  entitles  them 
to  be  regarded  as  men  of  common  sense.     Another 
ingenious  person  has  propounded  the  argument  that 
inasmuch    as    there    are   already  nine  Universities 
to    which    admission  is  granted   to    women,     the 
necessity    for    obtaining     the      same      concession 
from    the   University   of    Cambridge    cannot   exist. 
The  advocates,  however,  of  the  women  point  out  that 
the  latter   are   prepared  to  sacrifice   much   for    the 
greater  educational  advantages  to  be  derived  from 
residence  in  an  old  University.     This  is  quite  a  satis- 
factory and  sufficient  reply.    It  must  always  be  so, 
that  where  the  choice  can  be  made,  a  University  career 
at  an  old  University  with,  say,  the  prestige  of  that  of 
Cambridge,  would  prove  of  more  value  than  one  at  a 
University  of  less  note  and  of  comparatively    recent 
origin.    We  have  carefully  perused  the  statements  of 
the   opponents   of    the    women's    question  at   the 
L^niversity  of  Cambridge,  and  we  have  come  to  the 
conclusion  that  not  one  single  objection  urged  against 
the  reform  is  worthy  of  serious  consideration.    The 
position  of  affairs  at  present  is  that  the  women  in  their 
colleges  of  Newnham  and  Girton  are  merely  in  the 
position  of  guests  of  the  University,  an  anomaly  which 
should  no  longer  be  allowed  to  exist    Simply  as  a 
matter  of  justice,  the  degrees  of  the  University  should 
be  thrown  open  to  the  women ;  in  this  connection,  it 
should  be  borne  in  mind  that  even  if  the  issue  be 
against  the  women  on  the  present  occasion,  the  matter 
will  certainly  not  be  allowed  to  rest  A  liberal-minded 
policy  in  regard  to  the  higher  education  of  women 
has  made  great  progress  of  late  years,  and  the  time  is 
certain  to  come  when  all  the  Universities  and  their 
degrees  will  be  thrown  open  to  the  opposite  sex. 
» 


Fkb.  12,  1896. 


ypTES  OK  CURRENT  TOPIPS 
DIAGNOSIS 


OF 


THE   BACTERIOLOGICAL 

DIPHTHERIA. 
It  seems  that  viruleot  diphtheria  bacilli  may  linger 
for  ao  indefinite  period  in  the  mouth-secretions   of 
persons  who  have  recovered  from  an  attack  ;  indeed, 
in  a  ease  mentioned  by  Dr.  Hewlett  at  the  Pathological 
Sodefy,  they  were  detected  twenty-three  weeks  after 
the  onset  of  the  malady.    This  observation  possesses 
a  special  significance,  in  view  of  the  fact  that  the 
latn*  investigations  were  undertaken  at  the  behest  of  a 
scboolmaster  who  feared  lest  the  lad  might,  on  his 
return  to  school,  be  the  means  of  disseminating  the 
diff'Ase ;  a  well-founded  suspicion,  as  events  proved  it 
to  be.    Mr.  Batlin,  the  President,  took  advantage  of 
the  opportunity  to  review  the  situation  in  respect  of 
the  bacteriological  diagnosis  of  diphtheria.    It  seems 
that  medical  practitioners  in  the  district  where  he 
rendeB  are  now  provided  by  the  authorities  with  the 
Deoeflsary   facilities  for  obtaining   expert  opinion  in 
respect  of  the    secretions   in    suspected    cases,    an 
exoeUent  innovation  one  would  think,  but  one  which 
he  oevertheless  seemed  to  think  somewhat  vexatious 
He  also  referred  to  the  practice  in  the  larger  cities 
of  the  United   States,  where  he  assured  them  it  had 
become  the  custom  for  the  medical  officer  of  health  to 
at  onoe  visit  and  inspect  all  reported  cases  of  diphtheria 
without  going  through  the  usual  formality  of  asking 
the  practitioner  in  charge  to  meet  him  in  consultation. 
Mr.  Bntlin  appears  to  dissent  from  the  idea  that  the 
diagooBis  shall  be  determined  solely  on  bacteriological 
data,  and  he  suggested  that  the  society  might  *<  do 
something"  to  clear   up  a   situation  which,  in  his 
opinion,  was  fall  of  danger  to  the  public  as  well  as  to 
the  profession.     Before  anything  can  be  done,  how- 
e?8r,itwill  be  necessary  for  ns  to  know  exactly  what 
the  danger  is,  and  how  it  is  brought  about,  points 
as  to  which,  Mr.  Bntlin  was  silent    He  questioned 
the  importance  attached  by  the  speaker  to  the  pre- 
aeoce  of  these  virulent  bacilli  after  so  long  a  period, 
and  suggested  that  there  were  probably  hundreds  or 
even  thousands  of   persons   similarly   inhabited   by 
virulent  bacilli  wandering  up  and  down  the  country 
apparently  without  detriment  to  the  public  welfare. 
How  he  arrived  at  the  "  without  detriment"  conclusion 
he  did  not  say.    It  occurs  to  us  that  possibly  the  exist- 
ence of  these  ambulatory  foci  of  infection  may  explain 
the  ever-increasing  spr^  of  the  disease  in  spite  of 
all  the  precautions  that  have  been  taken  to  check  its 
ravages.     We  must  confess  that  we  do  not  clearly 
■ee  what  the  society  can  do  to  clear  up  the  situation. 
The  Pathological  Society,  of  aU  others,  could  hardly 
venture  to  throw  cold  water  on  the  value  and  import- 
ant of  bacteriological  investigation,  but  unless  they 
declare  bacteriology  to  be  a  scientific  fad  and  a  delusion, 
it  is  difficult  to  see  how  they  can  enter  a  protest 
against  its  practical  application  to  diagnosis.    If  the 
oiltnre  from  the  saliva  of  a  given  person  is  capable,  as 
in.  Dr.  Hewlett's  case,  of  determining  the  death   of 
«^ea  ijigs  in  a  few  hours,  even  Mr.  Butlin   would 
Mrtly  wish  to  mtroduce  him  to  his  family  circle,  his 
icepticism  to  the  contrary    notwithstanding.     This 
;  so,  his  protest  would  appear  to  be   singularly 
'^ne,  and,  as  coming  from  the  President  of  the 
5ical  Society,  somewhat  regrettable. 


Thb  MFDiGiiL  Pbiss     173 


ci^CB  on  (Etitrcnt  Capita. 


Mescal  Buttons. 
The  mescal  plant,  technically  known  as  AnkoUonium 
Lewmii^  is  found  in  certain  parts  of  Mexico,  and  among 
the  Kiowa  Indians  is  held  to  possess  wonderful  medi- 
cal and  psychological  properties.    The  plant  is  a  small 
cactus  having  the  general  size  and  shape  of  a  radish, 
and  covered  on  the  exposed  surface  with  the  charac- 
teristic cactus  prickles.    So  numerous  and  important 
are  its  medical  applications,  and  so  exhilarating  and 
glorious  its  effects,  according  to  the  statements  of  the 
natives,  that  it  is  regarded  as  the  vegetable  incarnation 
of  a  deity,  in  consequence  of  which  ceremonial  eating 
of  the  plant  takes  place,  and  this  has  become  the 
great  religious  rite  of  all  the  tribes  of  the  Southern 
plains.    Despite  the  fact,  however,  that  the  use  of  the 
plant  for  medical  and  religious  purposes  is  probably  as 
i  ancient  as  the  Indian  occupancy  of  the  region  over 
which  it  grows,  it   is  only  quite  recently  that  any 
scientific  investigation  has  been  made  into  its  physio- 
logical  effects.     Mr.    James    Mooney,    who    a  few 
years  ago  paid  a  long  visit  to  the  Kiowa  Indians 
states  in  an  interesting  paper  upon  the  subject  in 
the  current  number  of  the  Therapeutic  Gazette  that 
the  mescal  plant  is  a  powerful  stimulant,  and  enables 
those  who  partake  of  it  to  endure  great  physical  efforts 
without  injurious  reaction.    From  the  fact  that  this 
plant  occupies  so  exalted  a  position  among  the  natives 
as  to  have  a  religious  ceremony  associated  with  it,  the 
inference  is  only  a  natural  one  that  we  should  find  it  to 
possess  properties  which  would  entitle  it  to  such  an 
honour.      But  investigations   into  its   physiological 
action  by  Drs.  Prentice  and  Morgan  are,  to  say  the 
least   of   it,   disappointing    in   this   regard.     These 
observers  have  in  reality  nothing  very  remarkable  to 
say  respecting  its  effects.    Perhaps  the  most  noticeable 
result  of  their  inquiry  was  evidence  to  the  effect  that 
mescal  buttons  possessed  the  power  of  production  of 
visions  of  colour,  and  hence  it  is  suggested  that  the 
plant  should  be  given  a  trial  in  cases  of  colour-blind- 
ness.   Beyond  that,  however,  mescal  buttons  might* 
it  is  stated,  be  useful  in  general  nervousness,  nervous 
headache,   nervous     irritable     cough,     colic,     hys- 
terical   manifestations,  and   \b    a    cerebral    stimu- 
lant    in     depressed     conditions     of      the     mind, 
such  as  in  hypochondriasis,  melancholia;   moreover, 
as  a  substitute  for  chloral  and  opium  in  conditions 
of   great   nervous  irritability  or  restlessness,  active 
delirium  and  mania,  and  in  insomnia  caused  by  pain. 
It  will  be  conceded,  therefore,  that  there  is  nothing 
transcendentally  remarkable  in  the  plant  if  nothing 
more  than  this  can  be  said  in  its  favour.    But  perhaps 
it  may  be  necessary  to  be  a  Kiowa  Indian  in  order  to 
thoroughly  appreciate  the  virtues  of  this  new  thera- 
peutical discovery. 


Bcch3mioses  ftom  Natural  Causes. 
It  is  now  a  well-recognised  fact  that  more  or  less 
considerable  extravasations  of  blood  may  take  place 
beneath  the  skin  or  of  the  mucosse  or  on  to  the  sur- 
face of  the  internal  viscera  from  purely  physiological 


174     Thi  Msdioal  Pbbss. 


NOTES  ON  CURRENT  TOPICS. 


Feb   12    1896. 


causes,  giving  rise,  however,  to  appearances  which 
might  easily  be  mistaken  for  the  results  of  violence  in 
some  form  or  another.  The  possibly  natural  origin  of 
such  ecchymoses  seems  only  to  have  been  recognised 
within  the  last  decade  or  two,  and  this  fact  suggests 
some  uncomfortable  thoughts  concerning  probable 
injustice  to  accused  persons  in  the  past.  When  a  cer- 
tain French  medico-legal  authority  first  called  atten- 
tion to  petechial  eccbymosis  on  the  surfaces  of  the 
lungs  it  was  for  the  purpose  of  promulgating  the  view 
that  they  afforded  evidence  of  death  from  suffocation 
in  one  or  other  of  its  forms.  This  has  since  been 
proved  not  to  be  the  case,  for  they  have  been  met  with 
in  connection  with  the  action  of  particular  poisons, 
particularly  those  belonging  to  the  benzine  series,  as 
well  as  after  death  from  burns,  (Sec.  Although  these 
extravasations  thus  lose  the  diagnostic  value  which 
had  been  attributed  to  them,  the  subject  is  one  well 
worthy  of  attention  in  order  that  full  light  may  be 
thrown  upon  the  mechanism  of  their  production. 
For  instance,  they  are  not  unlikely  to  occur  in 
the  insane,  and  in  this  event  their  presence  on 
the  skin  would  not  unnaturally  give  rise  to 
unfounded  suspicions  of  violence  at  the  hands  of 
the  attendants.  In  a  paper  dealing  with  this  subject  at 
a  recent  meeting  of  the  Royal  Medical  and  Chirurgical 
Society,  Dr.  Lediard  laid  particular  stress  upon  the 
possibility  of  such  ecchymoses  on  the  mucous  mem- 
brane of  the  vulva  and  vagina  leading  to  the  presump^ 
tion  of  rape.  Their  position  in  the  body,  their  delicacy 
of  structure,  and  their  vascularity  render  this  portion 
of  the  female  anatomy  peculiarly  liable  io  exhibit 
punctiform  ecchymoses  in  virtue  of  the  same  causes 
that  determine  their  appearance  elsewhere.  Mr. 
Hutchinson  quoted  a  striking  instance  of  the  produc- 
tion of  extensive  ecchymoses  in  an  elderly  gentleman 
as  the  result  of  an  attack  of  whooping-cough  contracted 
from  his  grandchild.  As  any  medical  man  is  liable  to 
be  called  upon  to  discharge  the  delicate  and  responsible 
functions  of  medical  assessor  in  criminal  cases,  it  is 
highly  desirable  that  a  knowledge  of  this  curious 
phenomenon  should  be  widely  disseminated,  for  it  is 
not  difficult  to  imagine  various  circumstances  in  which 
these  ecchymoses  would  probably  be  ascribed  to 
violence  or  asphyxia,  instead  of  to  their  real  cause 
whatever  that  might  be  in  the  particular  case. 


The  Obstetrical  Society  and  its  Certificate. 
At  the  annual  meeting  of  the  Obstetrical  Society 
last  week  Dr.  Champneys  had  an  opportunity  of 
discussing  the  negotiations  between  the  representa- 
tives of  the  society  and  the  General  Medical  Council  in 
reference  to  the  so-called  diplomas  of  proficiency 
awarded  by  the  society  to  women  desirous  of  practic- 
ing as  midwives.  The  comminatory  resolutions  of  the 
Council  seem  to  have  ruffled  the  temper  of  the  leading 
spirits  of  the  society,  and  this  may  explain  the  some- 
what acrimonious  sarcasm  which  characterised  the 
Presidents  utterances  in  respect  of  the  conduct  of  those 
who  had  moved  the  General  Medical  Council  to  take 
action  in  the  matter.  The  society  very  prudently  con- 
ceded all  the  really  important  points  insisted  upon  by 


the  Council,  the  term  certificate  has  been  substitated 
for  diploma,  the  size  of  the  document  has  been  reduced, 
the  seal  and  the  allegorical  figure  have  been  auppress^dr 
and  the  wording  has  been  carefully  revised  so  as  no 
longer  to  convey  the  impression  of  conferring  rights 
which  it  is  beyond  the  power  of  the  examiners  to  accord. 
We  may  congratulate  the  society  on  the  graceful  way 
in  which  they  have  elected  to  "  climb  down  "  from  an 
untenable  position.  While  we  fully  recognise  that 
they  had  at  heart  only  the  better  education  of  midwives 
and  monthly  nurses  and  the  welfare  of  the  partarient 
population,  it  cannot  be  denied  that  their  certificate,  io 
appearance  and  wording,  perilously  resembleda  medical 
diploma.  The  President  is  probacy  entitled  to  con- 
gratulate the  society  on  the  fact  that  the  result  of  the 
fray  has  been  to  place  their  examinations  on  a  firmer 
footing  than  before,  in  that  the  certificate,  as  at  present 
issued,  has  received  the  imprimattir  of  the  General 
Medical  Council,  and  has  thus  been  accorded  an  ofiScial 
recognition  previously  wanting.  The  need  for  some 
such  proof  of  training  is  amply  demonstrated  by  the 
ever-increasing  number  of  candidates,  and  antil 
Government  decides,  if  ever  this  come  to  pass,  to  give 
legislative  sanction  to  a  more  elaborate  scheme  for  the 
training  and  examination  of  midwives  it  cannot  be 
denied  that  the  examination  instituted  by  the  society 
is  a  benefit  to  the  public  by  enabling  members  to  dis- 
tinguish between  women  who  possess  even  a  minimum 
of  knowledge,  and  those  who  only  know  what  th^ 
have  picked  up,  so  to  speak,  by  the  road  side. 


Curious  Death  fix>m  Blood  Poisonin^r- 
The  death  of  a  man  from  blood  poisoning  occurred 
in  a  somewhat  curious  manner  last  week.  According 
to  the  evidence  at  the  inquest  held  before  the  coroner 
for  Central  Middlesex,  the  man  was  engaged  in  exam- 
ining a  drain  which  had  become  blocked.  In  doing 
so,  he  took  a  large  bar  and  broke  the  drain  pipe  near 
to  the  spot  where  he  considered  the  blockage  to  be. 
No  sooner  had  this  been  done  than  the  retained  sewage 
was  suddenly,  and  with  force,  discharged  into  his  face 
aud  over  his  clothing,  some  even  entering  his  mouth. 
For  some  days  afterwards,  he  continued  to  do  his  work 
without  complaint.  Ultimately,  however,  throat 
symptoms  began  to  develop,  and  he  was  admitted  into 
University  College  Hospital,  where  he  soon  died.  The 
evidence  of  the  house  surgeon  was  to  the  effect  that 
death  took  place  from  acute  blood-poisoning,  the  result 
of  inhaling  the  products  of  highly  decomposed  sewage. 
While  in  the  hospital  the  man  asserted  that  he  could 
still  taste  the  sewage  matter  which  had  gone  into  his 
mouth.  A  more  revolting  catastrophe  than  this  could 
scarcely  be  conceived.  Nevertheless,  under  the  circum- 
stances, it  is  difficult  to  see  how  septic  infection  could 
have  been  avoided. 


The  Phrenologfists  on  Cromwell's  Head. 

Last  week  a  leader  of  that  curious  pseudo-scientific 
sect,  the  phrenologists,  delivered  a  learned  dissertation 
upon  the  reputed  skull  of  Oliver  Cromwell.  After 
giving  a  full  history  of  the  relic  he  proceeded  to  the 
measurements  of  the  skull,  and  then  discussed  what 


JPd.  is.  1898. 


NOTES  ON  CURRENT  TOPICS. 


Thb  Mbdioal  Prssb.     175 


flifty  be  termed  hia  "  brncp  "  aspects.  The  cerebellum, 
ho  remarked,  was  small ;  a  fact  which  showed  that  the 
inteUectnal  powers  were  stronger  than  the  animal  pro- 
peoflitieB.  As  to  this  pbintwe  very  mnchquestion  whether 
there  is  any  bat  tiie  smallest  variation  in  the  actual  size 
of  theaverage  human  cerebellum.  The  lecturer  concluded 
that  Cromwell  was  well-fitted  to  live  a  life  of  celibacy, 
but  that  hardly  tallies  with  the  further  assertion  that 
philoprogenitiveness  was  extremely  large.  The  organs 
of  caution,  secretiveness,  acquisitiveness,  comtative- 
liess,  inhabitiveness,  approbativeness,  and  wonder  were 
very  well  developed,  but  the  largest  of  all  was  destruc- 
tfveness.  All  this  jargon  is  highly  entertaining, 
although  it  must  be  confessed  that  such  qualities  as 
mhabitiveness  and  approbativeness  ate  somewhat 
misty  and  nebulous  terms  to  the  non-phrenological 
mind.  It  is  certainly  a  grim  satire  on  the  latterday 
nineteenth  century  intelligence  that  a  number  of  people 
cao  be  found  to  believe  that  the  outside  form  of  the 
skull  corresponds  with  internal  brain  contours  and  local 
developments.  The  conclusion  of  the  phrenologist 
that  the  skull  was  really  CromwelPs  is  unfortunate,  as 
coming  from  such  a  source  it  is  calculated  to  rouse 
considerable  suspicion  in  the  minds  of  scientific 
people.  

Pharmacology  as  an  Examiiiation  Subject. 

From  a  perusal  of  the  regulations  of  the  Conjoin c 
Board,  dated  November  22nd,  1895,  we  gather  that  it 
has  been  decided  that  the  examination  in  phar- 
macology may  be  passed  at  any  time  after  the  com- 
pletion of  the  fourth  year  of  professional  study, 
provided  that  the  student  has  succeeded  in  getting 
through  his  Anatomy  and  Pbypiology.  We  trust  that 
this  arrangement  may  be  regarded  as  final ;  although 
we  are  informed  that  there  is  a  desire  in  some  quarters 
to  tack  on  '*  Medicinal  Actions  "  to  the  examination  in 
pharmacy,  and  to  include  in  the  final  examination 
questionB  on  the  *' Action  of  Medicinal  Agents  on  the 
Body  in  Health  and  Disease."  If  the  modification 
were  adopted,  the  unfortunate  student  would  have  to 
pass  in  pharmacology  twice  over — once  at  the  end  of 
the  first  summer  session  ;  and  again,  this  time  in  con- 
junction with  therapeutics,  in  the  final.  We  trust  that 
there  will  be  no  further  change  in  the  regulations 
which  have  been  officially  adopted,  for  this  constant 
chopping  and  changing  about  leads  to  endless  con- 
iosion,  and  is  a  source  of  worry  and  annoyance  both 
to  students  and  lecturers.  Pharmacology  is  a  subject 
of  the  greatest  importance  as  a  branch  of  medical 
etody,  being  the  foundation  on  which  all  treatment  is 
based  ;  and  any  attempt  to  run  it  in  conjunction,  either 
with  pharmacy  or  with  medicine  and  pathology,  must 
of  neeessity  prove  unsatisfactory. 


The  Lee^Metford  Bullet  and  Its  Effects. 

It  will  be  remembered  that  during  the  Chitral 
Expedition  the  medical  officers  of  the  British  forces 
had  frequent  opportunities  of  judging  of  the  effects  of 
the  Lee-Metford  bullet  This  was  the  first  occasion  in 
which  this  new  magazine  rifle  had  been  tried  on  active 
aervice,  and  consequently  some  report  thereon  was 
looked  forward  to  with  interest  by  those  who  had  paid 


attention  to  the  subject  One  of  the  most  significant 
remarks  made  by  a  medical  officer  attached  to  the 
forces  was  that  his  experience  of  the  wounds  inflicted 
by  the  Lee-Metford  buUet  had  led  him  to  the  conclusion 
that  this  new  rifle  would  be  probably  useless  in  stop- 
ping a  '*  rush."  Curiously  enough,  this  conviction  has 
proved  to  be  nearer  the  truth  than  was  believed  at  the 
time  to  be  likely— if  the  evidence  of  a  witness  of  the 
fight  at  Erugersdorp  is  to  be  accepted.  In  the  course 
of  his  description  of  the  scene  of  battle  he  says,  "'  The 
action  has  proved  one  thing—the  *303  is  a  failure. 
One  man  shot  through  the  chest  and  out  at  the  back 
walked  to  church  on  Sunday ;  another  is  still  alive 
with  a  bullet- wound  clean  through  his  brain,  going  in 
at  one  temple  and  out  at  the  other.  In  all  cases,  men 
wounded  by  Martinis  are  having  the  deuce  to  pay,  while 
the  Boers  plugged  by  the  high  velocity  of  the  Lee-Met- 
fords  make  little  of  their  wounds.  The  rifle  is  not  going 
to  pay,  for  it  will  never  stop  a  rush.  Of  course,  if  they 
could  use  expanding,  soft-nosed  bullets,  well  and  good ; 
but  we  have  still  some  obsolete  notions  about 
humanity.*'  The  evidence,  then,  seems  to  be  accumu- 
lating that  while  the  Lee-Metford  rifle  is  all  that  can 
be  desired  as  a  humane  weapon,  it  does  not  fulfil  so 
very  satisfactorily  that  special  purpose  for  which  it  has 
been  designed.  Practically  it  would  seem  that  its  per- 
fection as  a  shooting  machine  has  considerably 
reduced  its  power  of  killing,  and  that  the  majority  of 
the  wounds  inflicted  by  its  bullet  will  be  such  as  to 
place  the  wounded  person  in  but  little  peril  of  his  life. 
The  matter  is  worthy  of  the  attention  of  the  War 

Office.  

Mr.  Demetrius  Boulger. 
The  silly,  hysterical,  contribution  from  Mr.  Demet- 
rius Boulger,  which  appears  in  the  current  number  of 
one  of  the  monthly  magazines,  purporting  to  be  a  de- 
scription of  his  treatment  by  antitoxin,  when  he  was 
suffering  from  an  attack  of  diphtheria,  does  not  call  for 
any  special  notice.  The  character  of  his  indictment 
against  the  treatment  may  be  judged  by  the  fact  that 
he  attributes  the  post-diphtheritic  paralyses,  of  which 
he  became  the  subject,  to  the  antitoxin.  Of  course,  he 
makes  the  most  of  this  grand  *'  discovery,'*  and  says 
some  startling  things.  But  '*  playing  to  the  gallery  " 
does  not  always  succeed ;  in  this  instance  it  is,  we 
should  imagine,  destined  to  be  a  miserable  failure. 
At  all  events,  Mr.  Boulger  has  not  gone  the  right  way 
to  work  to  try  and  induce  the  public  to  imbibe  his 
opinions. 

An  Extraordinary  Case. 
Db.  Btbom  Bramwell  read  an  account  of  a  most 
extraordinary  case  at  the  Edinburgh  Medico  Chirur- 
gical  Society's  meeting  last  Wednesday.  A  young 
man  of  25,  unmarried,  with  no  history  or  symptoms  of 
syphilis,  and  with  a  good  family  record,  had  led  a  life 
of  considerable  hardship.  The  only  severe  illness  he 
had  had  previously  was  of  an  unknown  nature  and 
occurred  in  youth.  The  supposed  starting  point  of  his 
fatal  malady  was  a  strain  of  the  back  on  lifting  a  heavy 
weight.  This  pain  in  the  back  did  not  go  away  with 
rest  in  bed,  while  similar  pains  occurred  in  other  parts 


176     The  Msdioal  Pbbss. 


NOTES  ON  CURRENT  TOPICS. 


FxB.  12,  189(L 


of  the  body.  When  Dr.  Bramwell  saw  him  there  were 
gymmetriosd  hard  brawny  Bwellings  in  the  axiUae, 
elbows,  groins,  and  other  places.  The  skin  was  yellow 
brown,  simulating  Addison's  disease,  the  pulse  was 
always  above  100,  and  there  was  a  slight  trace  of 
albumen  in  the  urine,  with  a  few  pus  cells,  but  no 
tube  casts.  A  soft  blowing  murmur  could  be  heard 
over  the  mitral  area,  and  the  red  blood  corpuscles  were 
much  diminished  in  number.  The  white  corpuscles 
were  more  numerous  than  usual.  A  few  days  later 
the  swellings  had  increased  in  size  and  hardness,  the 
margins  being  surrounded  with  some  nodules  which 
in  places  ran  together.  The  asthenia  increased  rapidly, 
the  skin  grew  darker,  the  temperature  was  100*2%  and 
the  heart's  action  exceedingly  feeble.  The  peripheral 
arteries  were  now  found  to  have  become  in  a  very  short 
time,  rigid,  and  pulseless.  Some  pericarditic  friction  pre- 
ceded death.  At  the  autopsy,  the  swellings  in  the  skin 
werefound  to  be  simple  inflammatory  over-growths  with 
much  deposition  of  limesalts  in  them.  All  the  peripheral 
arteries  were  converted  into  rigid  tubes,  except  those 
of  the  brain,  while  the  heart  was  enlarged,  calcareous, 
and  did  not  collapse  od  being  opened.  The  papillary 
muscles  were  so  covered  with  salts  as  to  simulate  stal- 
actites. One  of  the  kidneys  was  represented  by  a 
small  portion  of  fibrous  tissue,  the  other  was  in  an 
advanced  stage  of  cirrhosis  with  an  unusual 
amount  of  fibrous  tissue.  The  attack  of  illness 
in  youth  had  evidently  been  of  the  nature  of  a  pyelone- 
phritis which  had  destroyed  one  of  the  kidneys.  The 
remarkable  features  of  this  case  are  the  rapid  deposi- 
tion of  lime  salts  throughout  the  body— this  must  have 
occurred  in  the  courseof  a  few  weeks— the  symmetrical 
calcareous  tumours  of  the  skin,  and  the  fact  that  the 
patient  lived  so  loog,  with  such  imperfect  kidneys, 
without  showing  any  signs  of  uriemia.  The  case  will 
have  to  be  taken  into  account  in  the  future  in  any 
argument  about  the  nature  and  cause  of  ursemic 
poisoning.  

Mistaken  Sex. 

It  is  not  often  that  Nature  leaves  the  sex  of  a  child 
a  matter  of  uncertainty.  Numerous  instances,  how- 
ever, are  on  record  of  this  elementary,  yet  all  important 
detail,  having  been  misinterpreted,  and  the  error  has, 
in  several,  been  perpetuated  until  well  on  in  adult  life. 
Obviously,  once  an  infant  has  been  legally  recognised 
to  belong  to  **  the  female  persuation,''  or  the  contrary,  it 
must  be  a  delicate  and  even  difficult  matter  to  estab- 
lish another  kind  of  civil  status.  The  worst  fate  that 
can  befall  a  young  gentleman  bom  under  a  nebulous 
star,  is  to  be  constrained  to  wear  petticoats,  and  to 
imbibe  his  intellectual  and  other  acquirements  in  a 
feminine  milieu.  It  is  but  a  year  or  two  since  Dr. 
Fancourt  Barnes,  if  we  mistake  not,  showed  at  one  of 
the  medical  societies,  a  young  person,  eighteen  years 
of  age,  who  had  so  far  been  accorded  the  defer- 
ence due  to  supposed  femininity,  and  it  was 
not  until  certain  manifestations,  at  variance  with  the 
code  laid  down  for  the  conduct  of  young  ladies'  semin- 
aries, had  been  noted,  and  presumably  complained  of, 
that  a  medical  opinion  was  sought.  This  proved  to  be 
the   turning  point   of   that   pseudo-young  woman's 


destiny,  for  in  the  result,  she  had  to  cast  aside  the 
appurtenances  and  bearing  of  the  self-respecting 
maiden  for  attire  and  manners  more  in  harmony  with 
the  dictum  of  the  medical  expert.  The  psychology  of 
this  volte  faoe  has  yet  to  be  elucidated.  We  have  been 
favoured  with  a  description  of  the  young  man  who  was 
made  to  see  at  nineteen  yean  of  age,  having  previ- 
ously been  perfectly  blind,  but  his  sensations^ 
curious  though  they  appear  to  have  been,  were 
probably  small  talk,  compared  with  the  mental  and 
moral  bauleversemeni  of  an  abrupt  change  of  aex^ 
"  by  order."  Only  last  week  a  similar  error  was  brought 
to  light  in  France,  where  a  young  woman  wassummoned 
to  military  service  on  the  ground  that,  having  been 
registered  as  a  male,  she  must  contribute,  allegorically 
speaking,  her  pound  of  flesh.  Doubtless,  when  it 
comes  to  the  m^ical  inspection,  she  (the  pseudo-he) 
will  be  exempted  on  the  ground  of  "palpable 
deformity,"  but  red  tape  insists  that  she  shall,  in  the 
meantime,  "  hold  herself  at  the  disposal  of  the  military 
authorities,"  a  rather  dreadful  fate  for  a  right-minded 
young  person  who  has  been  declared  by  competent 
medical  authority  to  be  a  female.  There  are  few  topics 
that  have  not  been  turned  to  account  by  the  industriou^ 
novel-writer,  but  here  is  a  brand-new  plot  hatched 
ready  to  hand,  "  to  be  served  hot"  Even  the  title 
suggests  itself,  to  wit,  "  The  Discarded  Petticoat,  or 
Jilting  made  Easy. " 

The  Begfistration  of  Midwivea 
The  supporters  of  the  Midwives  Registration  ques- 
tion are  determined,  evidently  at  all  costs,  to  gain 
adherents  to  their  views.  They  have  now  appealed  to 
the  Primrose  League,  the  local  secretaries  of  the 
branches  of  which  have  been  asked  to  bring  the 
*'  benefits  "  of  the  registration  scheme  under  the  notice 
of  the  members.  Among  the  papers  sent  to  the  local 
secretaries  are  communications  from  Sir  John  Williams 
and  Dr.  Cullingworth,  of  course  advocating  the  scheme. 
What  an  excellent  advertisement  for  the  two  gentle- 
men named,  and  how  much  they  are  to  be  congratulated 
upon  having  taken  such  a  public  step  in  view  of  the 
fact  that  quite  three-fifths  of  their  own  profession  are 
against  them. 

Lecture  Arrangements  for  1896  at  the  Royal 
College  of  Surgeons,  England. 
The  course  of  lectures  for  1896  at  the  Royal  College 
of  Surgeons,  England,  is  the  following  :~-0n  February 
17th,  19th,  and  21st,  the  Arris  and  Qale  Lecturer,  Dr. 
Ernest  H.  Starling,  will  lecture  on  ''The  Physiological 
Factors  involved  in  the  Causation  of  Dropsy."  On  the 
24th,  26th,  and  28th  Professor  Leonard  K  Hill  will 
lecture  on  "  Cerebral  Pressure  and  the  Cerebral  Circu- 
lation." On  March  2nd.  4th,  6th,  9th,  11th,  and  13th, 
Professor  Charles  Stewart  will  lecture  on  *'  The  Integu- 
mentary System ;  its  structure  and  functions."  On 
the  16th,  18th,  and  20th,  Mr.  W.  G.  Spencer,  F.RC.S., 
the  Erasmus  Wilson  Lecturer,  will  lecture  on  '*  The 
General  Pathology  of  Bone."  And  lastly,  on  the  18th, 
20tb,  23rd,  26th,  and  27th,  Professor  J.  A.  Coutts  will 
lecture  on  "  Infantile  Syphilis."  The  lecture  hour  i» 
5  o'clock  p.m.,  and  all  Fellows  and  Members  of  the 


fiB.  12,  1896. 


SCOTLAND. 


Thk  Mbdical  Prus.     177 


OoU^ge  who  desire  to  attend  will  be  admitted  on  pre- 
sentation of  tbeir  private  visiting  card. 

The  New  Photography  in  Surgery. 
A  LATS  telegram  which  arrived  as  we  are  at  press 
informs  that  the  first  surgical  operation  in 
which  the  first  diagnosis  has  been  made  by  means 
of  the  Rontgen  rays  was  performed  in  Berlin  on 
Monday  last.  The  patient  was  a  woman,  who  had 
broken  the  half  of  a  needle  into  her  hand  two  months 
ago,  and  who  suffered  very  severe  pain.  With  the  help 
of  a  K5ntgen  photograph,  the  exact  position  of  the 
fragment  was  ascertained,  and  its  extraction  made 
withont  difficulty. 

Bone  Grafting  Extraordinary. 
Nothing  is  wasted  in  Nature,  according  to  the 
proverb,  and  Mr.  Waterhouse  emphasised  this  fact  in 
a  case  which  he  brought  before  last  Monday's  meeting 
of  the  Medical  Society  of  London.  Having  found  it 
Deceaaary  to  scoop  out  the  body  of  the  os  calcis  for  the 
removal  of  tuberculous  disease,  a  foot  was  left,  in 
which  this  important  bone  was  represented  only  by  a 
yavming  cavity,  bounded  by  a  thin  shell  of  compact 
bone.  The  outer  wall  of  the  cavity  was  wanting  and 
the  floor  was  badly  damaged.  This  resourceful  Rurgeon 
thereupon  requisitioned  the  collarbone  of  a  lamb  (part 
of  a  shoulder  of  lamb  which  had  been  served  for  the 
dinner  of  the  resident  medical  officers  of  the  hospital). 
He  decalcified  the  bone  by  steeping  it  in  hydro- 
chloric acid,  freed  it  from  fat  by  washing  it  in 
ether  and  then  sterilised  it  by  immersion  in  a 
solution  of  carbolic  acid  of  suitable  strength.  The 
bone  having  been  converted  into  chips  was  made  into 
a  paste  with  iodoform  and  packed  carefully  and  tightly 
into  the  gaping  cavity,  over  which  the  skin  was  securely 
sutured  and  the  foot  was  then  put  up  in  an  antiseptic 
dressing.  It  was  not  dressed  again  for  a  fortnight  or 
so,  and  by  that  time  healing  was  complete  and  has 
remained  so  ever  since.  We  gather  that  this  is  the 
seventh  or  eighth  case  in  which  Mr.  Waterhouse  has 
employed  this  procedure  with  the  same  measure  of 
success,  and  on  this  ground  the  method  commendt* 
itself  for  general  adoption  in  this  class  of  cases.  We 
have  seen  a  finger  grafted  on  to  or  into  a  nose,  and  a 
chicken  bone  used  to  patch  up  this  or  that  small  bone, 
but  the  utilisation  of  a  lamb's  collar  bone  to  build  up 
an  absent  heel  is  as  interesting,  and  even  as  extraordin- 
ary, as  either.  

Anthrax  in  London. 
These  are  no  less  than  five  cases  of  anthrax  under 
treatment  at  the  present  time  at  Guy's  Hospital.  The 
patients  have  all  contracted  the  diisease  at  the  same 
factory  from  the  handling  of  goat  skins.  The  main 
feature  of  treatment  has  consisted  in  the  excision  of 
the  primary  lesion.  Fortunately  anthrax  is  now  almost 
unknown  in  this  country  as  an  endemic  disease,  and 
cases  of  this  kind  where  the  infection  has  been  im- 
ported, are  the  only  ones  likely  to  come  under  the 
notice  of  the  surgeon. 

Ihfluenza    is  once  more  raging  in  the  south  of 
BoBsia. 


It  is  proposed  that  in  future  every  officer  promoted 
to  Surgeon-Major-General's  rank  on  the  Army  Medical 
Staff  shall  spend  three  years  in  that  rank  before  retire* 
ment  This  will  obviate  the  difficulty  occasioned  by 
the  constant  change  of  medical  officers  of  districts,, 
which  has  been  a  fruitful  source  of  complaint  for  some 
time  past  among  general  officers  in  command. 


At  a  recent  dairy  show  in  New  York  cows' 
were  milked  by  machinery.  The  device  obtains  its 
power  from  a  pulsating  vacuum,  imitating  the  suckingr 
of  a  calf,  which  is  created  by  an  air  pump  in  a  series  of 
pipes  connected  by  rubber  rays  to  the  cov^s  teats.  Ten 
cows  were  milked  at  once,  the  time  consumed  in  milk- 
ing being  from  three  to  five  minutes.    What  next  t 


A  CASE  of  small-pox  recently  occurred  in  the  West- 
End  district,  and  every  effort  was  made  to  discover 
how  the  disease  was  contracted.  At  last  it  was  found 
out  that  a  number  of  circulars  had  been  entrusted  to 
a  messenger  to  deliver  at  all  the  houses  in  the  district. 
The  bundle  had  been  kept  over  night  at  his  lodgings 
where  small- pox  had  broken  out 

The  "  potted  meat''  case  before  the  Central  Crimina) 
Court,  which  atracted  so  much  attention  on  account  of 
its  abominable  nature,  was  finished  on  Saturday  last  by 
the  conviction  of  two  manufacturers,  John  and  Alex. 
Munro,  on  whom  a  sentence  of  six  months  hard 
labour  was  passed,  with  the  option  of  a  fine. 


Anotheb  ^  new  cure  for  consumption  "  is  reported  by 
telegraph,  this  time  from  America  instead  of  Germany. 
The  discovery  is  accredited  to  Dr.  Cyrus  Edson,  of  New 
York,  and  the  treatment  is  said  to  consist  of  hypo- 
dermic injections  of  phenol,  pilocarpine,  and  water. 

A  BUTCHEB,  of  Salisbury,  named  Hart,  was  sum^ 
moned  last  week  by  the  Commissioners  of  Sewers,  and 
fined  £50  at  the  Guildhall  Police  Court,  for  sending 
for  sale  a  carcase  of  a  lamb  which  was  diseased  and 
unwholesome  to  the  Central  London  Market 


Dr.  W.B.  GowERS  has  been  appointed  Bradshaw  Lec- 
turer for  the  current  year  at  the  Royal  College  of  Phy- 
sicians of  London. 


Sitotlatd). 


[from   our  own  OORRISFONDINT.] 


University  of  Glasgow  and  Queen  Margaret 
GoLLXGE.— At  the  time  when  Qaeen  Margaret  GoUeffo  was 
offered  as  a  gift  to  the  University  of  Glasgow  a  socd  deal> 
of  controversy  took  place,  which,  however,  ended  with  the 
impreseion  tmit  the  future  University  education  of  women* 
had  been  solved  by  the  Commissioners  in  a  most  progres- 
Mve  and  liberal  spirit,  when  by  their  ordinance  on  gradua- 
tion of  women  the  doors  of  the  Universities  were  thrown 
open  on  equal  terms  both  to  men  and  women  alike.  It 
appears,  however,  that  this  impreseion  was  a  mistake,  and 
it  is  not  unlikely  that  the  incorporation  of  Queen  Margaret 
College  with  the  University  will  become  a  bone  of  conten- 
tion. When  the  gift  was  made  to  the  University,  it 
carried  no  conditions  other  than  it  was  to  be  used  for  the> 
benefit  of  women  only,  and  was  thought  at  the  time  that 


178       ThI  MBDir'AL  PBX"8. 


MEDirAL  SOOTRTY  OF  LONDON. 


rsB.  12.  1896 


in  medioiDe  at  least  separate  teaching  wonid  have  to  be 
oondaoted  in  Queen  Margaret  College,  but  that  combined 
•or  separate  teaching  in  the  Arte  Classes  could  be  con- 
ductea  either  by  mixed  classes  or  otherwise  as  experience 
proved  to  be  beet.  This  understanding  has.  However,  been 
called  in  question.  In  medicine,  separate  education  in 
Queen  Margaret  College  has  firmly  established  itself,  in 
consequence  of  which  quite  a  considerable  number  of 
female  students  are  attending  the  school.  On  the  other 
hand,  a  request  has  been  made  by  the  female  students 
themselves,  that  they  may  be  admitted  to  the  Arts  Classes 
in  the  University,  and  the  University  Council,  in  April 
last,  unanimously  resolved  that  all  the  Arts  Classes  should 
be  thrown  open  to  female  students,  more  especially  as  the 
number  of  such  students  attending  College  is  so  small  it 
was  considered  incompetent  to  carry  on  separate  classes 
for  their  benefit.  This  action  hks  again  been  called  in 
question  as  to  the  Courts  legality.  It  may,  however,  be 
stated  that  at  a  meeting  of  the  General  Council  on  4th 
May,  1893,  a  distinct  and  definite  statement  was  made 
that  '*  under  the  agreement  the  Court  could  at  any  time 
dissolve  any  class  or  classes  specially  at  present  created 
for  teaching  women,  and  provide  thatteachingin an^  way 
that  was  fit."  There  are  restless  spirits  in  theTk>uncil  who 
are  ever  on  the  alert  for  points  of  contention  and  throwing 
obstacles  in  the  way.  When  Queen  Margaret  College 
was  gifted  to  the  University,  no  endowment  came  with 
it,  but  it  was  collected  and  presented  by  the  Council  of  the 
College.  By  itself,  the  building  would  be  a  burden  on  the 
revenue  ana  resources  of  the  University,  as  the  cost  of 
supporting  it  swallows  up  the  greater  part  of  the  endow- 
ment, leaving  annually  only  a  balance  of  about  £900.  At 
the  time  when  the  gin  was  made,  a  certain  section  of  the 
members  of  the  Council  preferred  affiliation  instead  of 
xncarporation  for  the  simple  reason  that  it  would  have 
opened  the  way  for  St  Mungo's  College,  but  in  this  they 
were  foiled,  in  consequence  of  which,  it  may  reasonably 
be  expected  that  every  obstacle  will  be  placed  in  the  way, 
so  as  to  prevent  the  smooth  working  of  the  teaching 
machinery  between  the  incorporated  School  and  the 
University.  It  is  to  be  hoped  that  matters  will  be  amic- 
ably settled,  otherwise  there  will  be  but  one  course  open 
to  the  University,  t.s.,  politely  return  the  "gift,"  which 
^ould  be  unfortunate.  Great  discretion  and  caution  is 
therefore  necessary  in  bringing  about  a  satisfactory 
understanding  in  face  of  those  who  are  apparently  deter- 
mined to  separate,  if  possible.  Queen  Margaret  College 
from  the  University. 
Lord  Ejblvim*s  Jubilkb. — A  joint  meeting  of  the  re- 

Sresentatives  of  the  Corporation  and  of  the  Court  and 
enate  of  the  University  was  held  on  the  5th  inst.,  under 
the  presidency  of  the  iJord  Provost,  who  said  that  he  had 
been  asked  if  the  Corporation  were  disposed  to  take  part 
in  the  celebration  of  the  jubilee  of  Lord  Kelvin,  as  a  pro- 
fessor in  the  University.  He  had  laid  the  matter  before 
the  Corporation,  and  that  body  having  unanimously  de- 
cided to  assist  in  the  celebration,  had  appointed  a  commit- 
tee, consistimg  of  five  senior  magistrates  and  himself.  He 
wished  to  express  the  great  gratification  he  felt  that  the 
University  and  the  City  were  working  together  with  an 
object  which  was  so  deeply  interesting  to  them.  The  Lord 
Provost  suggested  that  the  celebration  should  take  the 
form  of  a  banquet,  to  be  held  in  the  Municipal  Chambers, 
to  be  followed  the  next  evenins  by  a  conversazione  at  the 
Universitv.  It  is  likely  the  celebration  will  take  place  in 
the  end  of  June. 

Thb  Pbbth  Infirmaky. — A  verv  satisfactory  feature  of 
the  annual  report  of  the  Perth  Innrmary  is  the  low  mor- 
tality among  the  patients  treated  in  1895  in  the  institution, 
only  5*2  per  cent.,  if  4  deaths  which  occurred  within  48 
hours  of  admission  be  deducted  from  the  total.  Owing  to 
all  the  local  authorities  having  adopted  the  Notification 
Act  the  number  of  infectious  diseases  treated  has  become 
very  much  greater.  By  an  arrangement  with  the  managers 
the  authorities  could  occupy  40  beds  free  of  charge  for  five 
years  dating  from  1891  on  paying  £1.500  towards  the  ex- 
pense of  erecting  new  buildings.  The  total  number  of 
such  cases  was  52  in  1891  and  had  risen  to  233  in  1895.  A 
further  arrangement  with  the  authorities  is,  therefore, 
absolutely  necessary,  especially  as  the  hospital  exceeded 
its  income  by  £708  during  the  course  of  the  year.  In  the 
medical  officer's  report  reference  is  made  to  the  prevalence 
of  diphtheria  in  the  city  and  county  during  the  past  year. 


No  fewer  than  74  cases  were  treated  in  the  iDstitutiao, 
but  owing  to  the  use  of  antitoxin  the  death-rate  bad  only 
been  5  per  c«it.  compared  with  an  average  of  nearly  40 
per  cent,  for  the  last  18  yoArs. 

Insanitabt  Houses.— The  old  time-honoured  ansavoury 
rookeries  in  the  cities  of  Scotland,  once  the  abode  of  thle 
nobility,  have  fallen  on  evil  times.  On  every  side  attempts 
are  being  made  to  induce  the  working  classes  to  migrate 
to  more  healthy  quarters.  During  the  past  score  of  years 
Edinburgh  has  done  much  in  this  direction,  bat  a  great 
deal  remains  to  be  attempted.  The  chief  difficulty  in  the 
way  is  the  high  rent  charged  for  more  modem  and  more 
sanitary  flats,  not  that  the  rents  for  the  older  hoasee  are 
by  any  means  low ;  many  are  as  much  as  £6  for  one  room 
only  fit  for  kennels.  The  same  difficulty  is  bein|if  experi- 
enced in  Inverness.  Many  of  the  houses  in  the  lower  part 
of  the  town  are  uninhabitable,  but  to  evict  the  tenants 
would  only  aggravate  the  evil  and  cause  more  overcrowd- 
ing, owing  to  workinff-men's  dwellings  being  so  scarce. 
It  was  mentioned  in  the  Town  Council  last  week  that  one 
family  paid  £10  a  year  for  one  small  room  in  which  there 
was  not  a  fireplace.  The  possibility  of  the  occurrence  of 
such  a  thing  is  a  public  scandal;  the  owner  of  the  one 
apartment  deserves  the  gravest  censure.  We  are  glad  to 
see  that  the  Town  Council  propose  to  take  steps  with  the 
view  of  providing  new  houses  for  workmen  at  rente  from 
£8  to  £12.  It  is  to  be  hoped  that  they  will  not  fall  into 
the  error,  which  is  so  common,  of  building  expensive  bonsss 
necessitating  high  rents,  which  working  men  would  rather 
not  pay,  when  simple  airy  and  well  drained  baildinKS 
would  be  much  more  suitable  and  cost  much  lees.  l%e 
erection  of  high  priced  houses  of  this  deecription  will  not 
get  them  out  of  their  difficulty,  for  many  are  unable  to  nay 
for  them,  and  the  lower  class  houses  are  as  crowdea  as 
before,  unless  indeed  they  are  pulled  down,  which  is  the 
only  thing  they  are  really  good  for. 

♦- 

MEDICAL  SOCIETY  OF  LONDON. 

Ths  meeting  on  Monday  last  (Feby.  10th)  was  a  clinicsl 
evening.  A  variety  of  interesting  cases  were  shown 
among. others  one  by  Mr.  Johnson  Smith,  of  Greenwich, 
of  a  case  of  old  standing  obturator  dislocation  of  the  hip 
in  a  sailor,  relieved  by  resection  of  the  head  of  the  bone. 
This  cam  was  followed  by  a  similar  one,  abo  in  a  sailor, 
by  Mr.  W.  R.  Turnss,  but  the  symptoms  rendered  it 
possible  that  there  wa)  a  fracture  as  well  as  an  obturator 
dislocation.  The  »ame  treatmen  t-  will  probably  be  adopted 
in  this  case.  Mr.  Mabmadukb  Sheild  availed  himself  of 
the  opportunity  to  proclaim  that  the  time  was  now  quite 
past  wnen  a  surgeon  could  with  propriety  endeavour  to 
reduce  old  standing  dislocations  by  the  application  of 
direct  violence,  the  only  scientific  method  being  exdsim 
of  the  head  of  the  bone. 

Mr.  CoTTSRKLL  showod  a  lad  upon  whom  he  had  operated 
successfully  for  a  large  exostosis  of  the  orbit  without  im- 
pairment of  vision  or  ocular  movements.  He  also  showed 
a  girl  upon  whom  he  had  performed  laminectomy  of  the 
cervical  vertebrsB  for  paralysis  and  disturbances  of  sensa- 
tion consequent  on  caries  of  these  vetebrse.  Though  he 
did  not  discover  any  particular  disease  the  operation  wss 
followed  by  immediate  return  of  motion  and  sensation. 

Mr.  GooDHALL  showed  two  cases  of  sinuses  over  the 
sacrum  and  coccyx  which  he  had  treated  by  laying  them 
freely  open  and  packing  them  with  dry  cotton.  The 
interest  of  these  cases,  of  which  he  has  operated  on  13, 
lies  in  the  fact  that  the  sinuses  are  not  connected  with 
the  rectum  nor  with  disease  of  the  bones.  Mr.  Swinfovd 
Edwabds  concurred  in  this  view,  adding  that  the  three 
cases  he  had  operated  upon  on  the  author^s  plan  bad  all  I 
proved  rapidly  successful.  Mr.  H.  Allingham  thought 
sinuses  in  this  situation  mieht  sometimes  be  due  to  infiam-  i 
mation  of  cvsts  congenitally  present,  and  he  recalled  a 
case  in  whicn  he  opened  the  abscess  and  dissected  out  the 
cystic  lining  membrane  with  perfect  success. 

Mr.  J.  Maorsadt  showed  a  woman  who  sufiiered  from 
intestinal  obstruction  consequent  on  cancer  at  the  junction 
of  the  sigmoid  flexure  with  the  rectuuL  As  the  obstruc- 
tive symptoms  were  acute,  after  ascertaining  the  situation 
of  the  disease  by  a  median  laparotomy,  he  dmed  the  wound 
and  did  colotomy  instead.  Then,  when  the  obstruction 
had  passed  off,  he  performed  resection  of  the  diseased  por- 
tion of  gut,  and  jomed  the  divided  ends.  The  woman  has 
since  bwn  in  good  health,  and  has  had  no  trouble  at  all 


Fib.  12,  )895. 


MEDICAL  NEWS. 


The  Mkoical  Pusa.     179 


vith  the  boweby  the  motsoiiB  paeeine  per  tnas  nahirales 
onee  the  arttfidal  enoB  was  closed.  This  case  oorroborates 
the  coDcliiBioD  arrived  at  by  Mr.  Allingbam,  that  when 
then  is  iDtestinal  dietension  it  is  necessary  to  perform  a 
nnfiminary  oolotomy,  leaving  the  entereotomy  to  be  per- 
fynaoA  M  a  secondary  operation. 

Dr.  OuTCBBSOH  Wood  showed  a  rare  coincidence  in 
thrae  esses  of  congenital  nystagmos  in  the  same  family. 
Ad  older  brother  appeared  to  be  free  from  the  defect. 

Mr.  KoBUE  SiOTH  described  the  treatment  of  fracture 
of  the  tibia  and  fibula  in  his  own  person  by  the  application 
of  strapping,  early  movement  and  early  massage.  The 
nsalt  proTW  most  satisfactory,  but  how  much  of  it  was 
doe  to  his  excellent  phyaique^  and  how  much  to  this  some- 
what novel  treatment  is  a  matter  for  discussion. 

Mr.  Watbbhousb  showed  a  little  girl  in  whom  it  was 
foimd  neoeesary  to  remove  the  whole  of  the  interior  of  the 
OB  oslds  for  tuberculous  disease,  leaving  only  a  thin  shell 
of  bone,  the  outer  surface  of  the  bone  being  also  com- 
pletely wanting.  He  filled  the  big  cavity  thus  left  with 
ditoe  of  decalcified  bone  made  into  a  paste  with  iodoform, 
andoomplete  and  permanent  healing  took  place  without  a 
hitch.  This  makee  the  seventh  or  eighth  case  dealt  with  in 
this  vty,  all  having  been  attended  with  a  like  measure  of 


CorrtBponbtnxe. 


(We  do  not  bold  oonelTae  respcnuible  for  the  opiniona  of 


ILBCnON   OP   DIKECT    REPRESENTATIVE  FOR 
IRELAND. 

To  iht  Editor  <tf  Thb  MsdioaIi  Pkiss  akd  OraonLAB. 

Sn,— The  statement  circulated  last  week  in  the  Msdioal 
FussAiTD  GiBcniiAB,  and  signed  by  the  Poor-law  Medical 
Offiosrs,  shows  at  least  that  gratitude  is  not  dead  in  the 
hflsrts  of  those  who  have  benefited  by  Dr.  Jacob's  hard 
hbonrs.  It  is  usual  to  taunt  general  practitioners  by 
■yisg  that  they  use  up  a  man  who  works  on  their  behalf, 
and  kick  him  afterwards.  I  regret  to  say  that  this  taunt 
is  sometimes  true.  It  is  now  in  the  power  of  every  general 
pnetitioner  to  show  that  he  appreciates  the  long  and 
wssry  labours  of  Dr.  Jacob.  The  practitioner  who  can 
abow  that  by  his  efibrts,  and  thoee  who  helped  him,  about 
£90^000  a  year  has  been  added  to  their  income,  is  surely, 
Cfveo  from  the  ncieanest  motives,  deserving  of  the  vote  of 
ev«7  general  practitioner. 

This  election  of  Direct  Representative  to  the  Medical 
Council  is  entirely  one  to  give  medical  practitioners— in 
OQDtaadistinctioii  u>  the  Universities  and  Colleges — the 
poww  and  right  to  return  one  who  will  honestly  represent 
them  and  their  aspirations. 

1  hope  that  the  two  candidates  who  are  included  by  the 
teet  vote  of  last  week,  will  at  once  ask  all  those  who  pro- 
mised their  votes  to  cast  them  in  favour  of  Dr.  Jacob. 

Dr.  Jacob  is  a  tried  and  well- proven  candidate.  He  can 
poiiit  to  actual  work  done,  and  to  good  efforts  gained. 
Witboat  dispturaging  the  other  candidates,  I  would  honesUv 
aak— What  real  and  actual  work  have  they  accomplished, 
as  compared  with  that  of  Dr.  Jaoob  ? 

I  am.  Sir,  yours,  A»., 

A  SnPfOBXEB  OF  RkAL  WoBK,  AKD  KOT  PBOBOSaB  ONLT. 

February  9th,  1890. 


THERMO-INHALER  FOR  ETHER. 

To  OU  Editor  of  Tbm  Mxdioal  Pbbss  and  Ciboulab. 

Sib,— As  Dr.  Dudley  Buxton  has  not  given  the  ezplana- 
tioD  asked  for  as  promptly  as  he  made  his  corrections,  will 
yoa  permit  ua  to  call  his  attention  to  our  letter  in  your 
iMoe  of  January  22nd,  which  has  probably  escaped  his 
DOfeios?  We  do  not  wish  to  be  troublesome  in  any  way  ; 
oar  only  desure  is  to  have  the  benefit  of  Dr.  Dudley 
Buxton's  much-vidued  experience,  and,  therefore,  of  his 
BogKestiflns  which,  we  hope,  may  enable  us  to 
ronove  or  to  make  good  at  least  some  of  the  many 
SnH  defeeU  ta  ike  MdUr  which  he  ^found  in  practice 


taAeren^  tn  its  eonstnieUon,  The  particulars  of  some  of 
the  results  Dr.  Dudley  Buxton  has  obtained  with  the 
inhaler  would  also  be  much  esteemed,  as  these  would  help- 
us  greatly  in  carrying  out  his  suggestions,  by  comparing 
them  with  those  obtained  by  Dr.  Garter  with  the  8am» 
apparatus. 

We  are.  Sir,  yours,  &c., 


London,  Feb.  5th,  1890. 


EjtOHNB  &  Sksmakk. 


PROSPECTS  OP  THE  WEATHER  FOR  FEBRUARY. 
To  the  Editor  ofTEM  Mbdioal  Press  Ain>  Ciboui.ab. 

Sib, — As  another  period  of  anticyelonie  weather  ha» 
evidently  eet  in  over  the  British  Isles,  as  in  last  month,  it 
may  interest  your  readers  if  I  draw  attention  to  the  likeli- 
hood of  the  weather  being  coincident  with  a  dimuuehed' 
rainfall  for  Fehruarv, 

That  in  last  month  turned  out  to  have  been  under  the 
average  for  January,  as  there  were  only  ten  days  in  which 
rain  fell,  more  or  less,  with  an  amount  of  fall  of  only  0610 
inch  or  less  than  half  what  it  ought  to  have  been  here. 

Now  it  would  appear  from  experience  that  we  are  likely 
to  have  another  month  of  dry  toeatherf  as  statistics  show 
the  general  occurrence  of  a  dry  February  after  a  dry 
January. 

In  1867  there  were  10  days  of  rain  in  January,  followed' 
by  only  7  days  in  February. 

In  1869  there  were  11  days  of  rain  in  January,  fdlowed 
by  only  8  dm  of  rain  in  iebruary. 

In  1870  January  had  lO  rainy  days,  and  only  7  in 
February. 

In  1871  there  were  only  5  days  of  rain  in  January,  and  4 
in  February. 

In  1873  there  were  only  9  days  of  rain  in  January,  and 
8  days  in  February. 

In  1874  there  were  only  5  days  rain  in  January,  and  2 
days  in  February. 

In  1878  there  were  only  9  days  in  January,  and  7  in 
February. 

In  1886  there  were  10  days  rain  in  January,  and  11  days 
in  February. 

All  the  years  since  1886  seem  to  have  had  here  fairly 
satisfactory  rates  of  rainfall,  and  constitute  a  cycle  of  wet 
winter  seasons  in  this  country. 

On  the  other  hand,  we  seem  to  have  had  a  course  of  dry 
years  in  the  '70's  constituting  a  dry  cycle  ot  winter  seasons, 
most  of  Great  Britain. 

With  the  prevalence  of  this  anti-cyclonic  weather  we 
mav  be  comforted  by  the  assurance  conveyed  in  Dr. 
Gillespie's  address  on  Weather  and  Disease  at  the  Royal 
Society,  that  it  may  turn  out  to  be  a  normal  healthy 
month. 

I  am.  Sir,  yours,  Ac., 

W.  G.  Blaok,  F.R.C.S.,  F.R.MS. 

United  Service  Club,  Edinburgh,  Feb.  7th. 


i^ieUPCAl    <^tD& 


Vital  Statistics. 

Thb  deaths  registered  last  week  in  thirtv-three  great 
towns  of  England  and  Wales  corresponded  to  an  annual^ 
rate  of  19*1  per  1,000  of  their  aggregate  population,  which 
is  estimated  at  10,591,530  persons  in  the  middle  of  this 
year.  The  deaths  r^^tered  in  each  of  the  last  four  weeks 
m  the  several  towns,  alphabetically  arranged,  corres- 
ponded to  the  following  annual  rates  per  1,0W : — 

Birkenhead  17,  Birmingham  22,  Blackburn  18,  Bolton  • 
22,  Bradford  14,  Brighton  16,  Bristol  15,  Burnley  20, 
Cardiff  16,  Croydon  14,  Derhy  14,  Dublin  — ,  Edinburgh 
— ,  GUisgow  — ,  Gateshead  15,  Halifax  17,  Hudderafield 
15,  Hull  17,  Leeds  20,  Leioeeter  21,  Liverpool  19,  London 
17,  Manchester  21,  Kewcastle-on-Tjrne  19,  Norwich  19,. 
Nottingham  18,  Oldham  22,  Plymouth  17,  Portsmouth  18, 
Preston  20,  Salford  20,  Sheffield  21,  Sunderland  16,. 
Swansea  15,  West  Ham  16,  Wolverhampton  15. 


180     Ths  Mmdigal  Pr««8 


NOTICES  TO  CORHE8P0NDENTS. 


Fbb.  12,   1896. 


c^diaB  to 
CxnrrtBponktttB,  ^hgrt  %tttttB,  ice 

§^  COBBHFOVDmnEB  nqatrlng  a  raply  In  thli  oolnmn  »ro  p«r- 
ttcnlarly  nqneitod  to  make  ma  of  a  dittineU^e  HgruOwre  or  iniefab, 
and  avoid  the  pnustlce  of  ilgnliig  themielTee  "  Aeader,"  "  Snbferiber," 
«*  OldSnbaorlber,**  Ac.  Mnoh  oonfuton  wUl  be  ipand  by  attention 
fothiarole. 

QuonrAL  AvaoLEB  or  Lwombb  Intended  for  pnblioatlon  shoald  be 
jrritten  on  one  ilde  of  the  paper  only,  and  mut  be  aathentlcated  with 
the  name  and  addreH  of  the  writer,  not  neceeearily  for  pnblioatlon, 
^t  aa  eiridenoe  of  identity. 

LoOAli  Sbfobtb  AMD  NiWB— CoTTeq^ondenti  deatrooa  of  drawing 
attention  to  theie  are  reqneited  kindly  to  mark  the  newipapen  whan 
jiendlng  them  to  the  Sditor. 

BnpRiNTB-^Aatbon  of  papen  requiring  repriuti  in  pamphlet  form 
jrfter  they  have  appeared  in  theee  colnmnB  can  have  them  at  half  the 
.  juual  cost,  on  application  to  the  printerB  before  type  i«  broken  np. 

BiADma  CASi8,-Gloth  board  caeee,  gilt-lettered,  ooataining  twenty- 
jAx.  strings  for  holding  the  numbers  of  Tbm  Mxdioal  Psiss  axd 
JCniOULAB,  may  now  be  had  at  either  office  of  this  Joomal,  price  ts.  tfd. 
Theee  cases  will  be  found  very  useful  to  keep  each  weekly  number 
intact,  clean,  and  flat  after  it  has  passed  through  the  post. 

Mb.  Biohard  Labb.— We  hope  to  have  space  for  your  paper  on 
^'Bxcision  of  Ossicles  and  Membrane  In  Chronic  Suppuration  of  the 
Middle  Ear"  In  our  next. 

Dbah  Fabbab  is  thanked  for  his  courteous  note. 

Mb.  Clbmxnt  SBkH.— We  do  not  care  to  prolong  the  discussion,  ss 
the  subject  is  somewhat  ultra  vires,  and  the  point  ts  indlnded  in  pre- 
vious correspondence. 

Mb.  B.  B.  Pabkihsob  (ClitheroX~The  case  is  of  almost  daily  oocur- 
jrence,  and  there  is  no  feature  connected  with  that  to  which  yon  draw 

attention  descrying  of  exceptional  reference.    Dr.  M did  what 

every  right-minded  medical  man  would  do  under  similar  circum- 


THE  NOTIPIGATION  CASB-MASON  V,  HADDSN. 
To  the  Editor  of  Tex  Mbdioal  Pbkb  abd  Cxboulab. 
Sib,— With  reference  to  my  letter  in  your  Issae  of  Jan.  22nd,  I  fear 
that  a  portion  of  it  may  be  open  to  misconstruction. 

After  the  recent  decision  of  the  full  court  in  Dr.  Hadden's  favour, 
|)e  was  appealed  to  by  the  plaintiff  not  to  press  for  his  costs,  and  he, 
accordingly,  instructed  his  solidtors  not  to  ask  payment  of  the  same 
from  the  plaintiff. 

I  am.  Sir,  yours,  &c, 

Juaa  GBAio,  Hon.  Sec  and  Treas. 
86  York  St.,  DubUn.  Feb.  8th,  1896. 

Mb.  a.  YoUBa.— We  should  advise  our  oorrespondent  to  refer  the 
matter  to  his  solicitor,  and  be  guided  by  him  before  taking  any  active 
Mops.    The  Itfgal  position  does  not  appear  to  be  plain. 

QENBBAL  PBAOTinonBB.— It  is  not  Clear  that  any  impression  has 
been  made  on  the  mortality  from  phthisis  by  the  gnaicol  or  creosote 
treatment. 


JOeetmsB  of  tht  ^ooettea 

Wkdbbsdat,  Fbb.  12th. 

Labtbqolooioal  Sooibit  of  Londob  (20  Hanover  Square,  W.)..- 
5  p.m.  Discussion  on  the  Nature  of  Laryngeal  Ulcerations  during  the 
oourse  of  Typhoid  Fever,  to  be  introduced  by  Drs.  A.  A.  EaDtiiack 
and  J.  A.  Drysdale.— Discussion  on  Foreisn  Bodies  in  the  Upper  Air 
and  Food  Passages,  to  be  introduced  by  ]£r.  Charters  Symonds. 

Thb  Samitabt  iNsnTUTB  (Parkes'  Museam,  Margaret  Street,  W.)— 
3  p.m.  Dr.  S.  Monckton  Copeman  will  open  a  discussion  on  The  Influ- 
ence of  Subsoil  Wattr  on  Health. 

HUBTBRIAB  SOGIBTT  (London  Institution^— 8.80  p.m.  Hie  Hunterian 
Oration  on  John  Hunter  and  Some  of  his  Contemporaries,  by  Dr.  G. 
ItewtonPltt. 

Thubsbat,  fbb.  18IH. 

BBinsB  Otbjboolooioal  Soohty  (20  Hanover  Square,  W.l-Speei. 
mens  by  Mr.  bowreman  Jessett,  Dr.  Alfred  Smith,  and  Dr.  B.  T 
Smith.  Dr:  Elder :  JNotes  on  a  Supra- vaginal  Hysterectomy  during' 
I'regnancy,  performed  because  of  threatened  intestinal  obstruction 
(with  Specimen).  Dr.  George  Keith :  The  Perman  ent  Cure  of  Anti- 
flexion  by  Operation.  Dr.  E.  r,  Eliot :  Notes  on  Gynaeoological  Cases 
from  a  Provincial  HospitaL 

NoBTH  Londob  mbdioal  abd  CmBUBQiCAL  Sooibtt  (Great 
Northern  Central  Hospital,  UoUowayl— 9  p.m.  Dr.  A.  Moriton :  Car- 
diac Dyspocea.  Dra.  Harry  Campbell,  Burnet,  Christie,  Ostlere,  Alex. 
Beid,  and  others  are  expected  to  take  part  in  the  discussion  on  this 
paper. 

Fkidat,  Fbb.  14th. 
^  Clibioal  Soonrr  of  Lobdon.— 8.S0  p.m.  Mr.  T.  W.  Nunn :  A 
Case  of  Chronic  Cancer.  Mr.  Pitts  amd  Mr.  BaUauce :  On  Splenec- 
tomy for  Bupture,  with  three  suooessful  cases.  Dr.  Hale  White  : 
Two  cases  of  Pneumothorax  in  the  course  of  I^phoid  Fever,  and  both 
due  to  straining  at  stool^  Mr.  Goldlng  Bird :  A  case  of  Lymph  Scrotum 
jand  Lymphatic  Varix. 

Bristol  Qeneral.Hospital,~A  Surgeon  on  the  Hon.  Stait.    Applications 


to  the  Secretary  before  Feb.  19th.  Bnles  relating  to  the  offloe  may 

be  obtained. 
Cardiff  Union.  -Assistant  Medical  Officer  for  the  Workhonae,  under 

the  direction  of  the  Medical  Officer.    Salary.  JtlQO  per  anonm, 

with  rations,  apartments,  attendance,  and  washing.    Applicmtioos 

to  Arthur  J.  Harris,  Clerk,  Queen's  Cnambets,  Cardiff. 
Cumberland  Infirmary,  Carlisle.— An  Assistant  House  Surgeon.  Salary 

£40  per  annum,  with  board,  lodging,  and  washing.    AppUcattomi 

to  the  Secretary  bdfore  Feb.  26th. 
East  London  Hospital  for  Children,  ShadwelL— House  Physician. 

Board,  lodging,  Ac,  are  provided,  but  no  salary.    Further  parti- 

culars  from  Thomas  Hayes,  Secretary. 
Liverpool  Boyal  Infirmary. —Assistant  Honorary  Physician.      AppUea^ 

tfons  to  the  Chairman  of  the  Committee  of  the  Boyal  Inflrmarf, 

liverpooL 
Nass  Union.~Medlcal  Officer.    Sslary  £1S0  per  annum,  and  £15  per 

annum  as  Medical  Officer  of  Health,  with  fees.  Election  Feb.  IMh. 

(See  advert.) 
Salford  Boyal  Hcepital.— House  Surgeon.    Salary  £100  per  annum, 

with  board  and  residence.    Appllcatloas  to   the  Secrecstfy  by 

Feb.  22nd. 
SteeveDs'    Hospital,   Dublin. -Gynaecologist     AppUcatlona    to   the 

Governors  and  Guardians  by  Feb.  20th. 
Western  General   Dispenssry,  Marylebone.— Two  House  Soiigeaoa. 

Salary  £70,  or  £50  with  board  and  residence.    AppUcatlona  to  the 

Hon.  Sec.  by  Feb.  17th. 
Westminster  HospitaL— Surgeon  on  the  Hon.  Staff ;  must  hold  the 

F.B.a3  Bng.    Full  particulars  of  Sidney  M.  Quennt  11,  Secretary. 


Jlptrointmtnts 

ALLBB,  W.  T.  D.,  M.B.,  B.Ch.,  B.A.O.I.,  Assistant  Medical  Officer  to 

the  Parish  Infirmary,  Brownlovr  UlU,  Liverpool. 
ATSiB,  C,  F.B.C.S.En«.,  Surgeon  to  the  Sheffield  General  Inflrmaiy. 
Bbidoib,  8.,  M.B.C.S.,  L.B.C.P.,  Assistant  House  Surgeon  to  the 

Devonshire  Hospital,  Buxton. 
COOBB,  W.  C,  L  B.C.P.,  L.M.Ediu.,  M.B.aS.,  Medical  Officer  of  Health 

to  the  fiognor  Urban  Connd'. 
COLVILLB,  J.,  B.A.,  M.D.,  B.U.I.,  Anassthetist  to  the  Ulster  Hospital 

for  Children  and  Women,  Belfast. 
DixoB,  F.  J.,  M.A.,  M.B.,  B.G.,  Camb.,  Assistant  Begistrar  tothe  (3eD- 

tral  London  Throat  and  Bar  HospitaL 
EvAHS.  W.  H.,  M.D.Lond.,  F.B.C.8.  B.,  Assistant  Surgeon,  with  chaige 

of  Skin  Department,  to  the  Boyal  Free  Ho«pltaL 
Flbmino,  Mrs.,  M.D.Lond.,  Medical  Begistrar  to  the  Boyal  Free  Hea* 

pitaL 
Fobbbs,  T.  D.,  ALBw,  Ch.Ed.,  Assistant  House  Suigeon  to  the  Boyal 

Albert  Hospital  and  Eye  Infirmary,  Devonpbrt. 
Habbubt,  W.  B.,  L.B.C.P..  MJt.C.4..  Second  Assistant  Medical  CMBosi 

to  the  County  Asylum,  Dorchestar. 
Habdman,  F.  H.,  M.B.,  O.M.Kdin.,  Medical  Officer  for  the  Knighton 

Sanitary  District  of  the  Knighton  Union. 
Habdtmab,  G.,  M  B.,  CMLEdin.,  Honorary  Surgeon    to  the  Boyal 

Mineral  Waier  Hospital,  Bath. 
HABBiaoB,  E..  M.B,  Ch.B.  Ylct.,  Medical  Officer  to  the  Birmingham 

General  Dispensary. 
Hbath,  C.  J.,  F.B.C.S.,  Assistant  Begistrar  to  the  Central  London 

Throat  and  Ear  HospitaL 
MOOBB,  T.,  M.B.C.S.,  L.M.,  Medical  Officer  of  Health  for  the  Stock- 
port Bural  Sanitary  District. 
N0UK8B,  W.  J.  C,  F.ll.C.S.Edin.,  Assistant  Begistrar  to  the  Central 

London.Ihroat  and  Ear  HospitaL 
Bbid.  St.  G.  C,  M.B.C.S.,  Surgeon  in  charge  of  the  Bacteriologloal 

Department  of  the  Central  u>ndon  Throat  Hospital. 
Shabpin,  W.  a.,  L.B.C.P.Lond.,  M.BC.8.,  Besident  Medical  Officer 

to  the  Boyal  Hanta  County  Hospital,  Winchestar. 
SIHOLAIK,  W.  W.,  M.B.Aberd..  Honorary  Ophthalmic  Surgeon  to  the 

Kast  Suffolk  and  Ipswich  HospitaL 
Thomas,  J.  T.,  L.B.O.  e.Lond.,  M.B.C.S.,  Medical  Officer  of  Health  bj 

the  Camborne  District  CoundL 


LLBWBLLTB.-Feb.  6th,  at  87  BarUfleld  Boad,  Wandswortti,  the  wife 

of  John  Llewellyn,  M.B.C.S.Eng.,  of  a  daughter. 
Majob.— Feb.  6th,  at  Clulow  Housf ,  London  Boad,  Beading,  the  wife 

of  Arthur  C.  Major,  M.B.C.S.,  L.B.a.P.,  of  a  son. 
Matthbt.  -  Jan.  28rd,  at  Georgetown,  Demerara.  the  wife  of  Arthor 

Matthey,  M  B.C.8.,  of  a  son. 
BOBBBTeoN.-Feb.  4th,  at  Christ  Church  Boad,Tulse  Hill,  S.W.,  the 

wife  of  Johu  B  bertson,  M.A.,  M.D.,  of  a  daughter. 
WiGQLBSWOBTH.— Feb.  6th,  at  Weaham,  Kirkham,  Lanes.,  the  wife  oC 

Sidney  Wlgglesworth,  L.B.C.P.,  M.B.C.S.,  of  a  son. 


FI8HBB-MBDLABD -Feb.  4th,  at  St.  Fetor's,  West  Lei^  Devon, 
William  ireUowes  Fisher,  M.B.,  of  Dudley,  to  Mary  Edith,  third 
daughter  of  the  late  Bev.  WilUam  Medland,  M.  A. 

Ubtom-Coopbb.— Feb.  1st,  at  the  St.  Marylebone  Parish  Church, 
London,  Walter  Lawrence  Listoa,  M  D.,  of  Tewkesbury,  to 
Kathleen  Nora  Cooper. 

TH0]f?S0B— SiDBBT.— Feb.  8th,  at  Washingboro*  Church,  Psccy 
Walker  Tnompeon,  M.B.,  third  son  of  T.  Thompson,  iSsq.,  J.  P.,  of 
Boaedale,  loronto,  to  Fanny,  eldest  daughter  of  the  late  Geoige 
Sidney,  Esq.,  Helghlngton. 


StathB. 


Hbwbt.— Feb.  1st,  at  Cambridge  Gardens,  London,  W.,  John  Patch 

Uewby,  B  A.Oxon.  M.JLa^i.,  aged  61. 
WALL.-Jan.  11th,  at  Carrick-on-SuL-, G.  A.Wall,  L.B.C.PJ.,L.B.C.SX, 

aged4L 


Wht  ^diai  ^vt$$  mA  ^tmhv. 


'SALUS    POPnU    SUPREMA    LEX." 


YouCXJL 


WEDNESDAY,    FEBRUARY    19,     1896. 


Ko.  8. 


Criminal  Communitattotuiw 

TUBEECULAR     DISEASES    OF    THE 

HIP-JOINT. 

By  R.   L.   SWAN,   F-RCSJ., 

Soseon  to  StoevMu'  and  The  Oithop«dlc  HotpiUls,  Dablio. 
(Gonduded  from  page  159.) 

It  wUl  be  oonvenieat  to  review  thoee  circumstances 
which  will  enable  as  to  form  an  opinion  as  to  the  pro- 
bable position  of  the  deposit.  Acetabolar  disease  may, 
I  believe,  occur  in  three  ways.  1st,  As  an  extension  to 
the  joint  of  a  tabercalar  mass  in  the  cancellous  struc- 
ture of  the  pelvis,  having  a  beginning  quite  uncon- 
nected with  the  articulation.  2nd.  From  an  injury 
caused  from  transmission  of  force  by  impact  of  the 
head  of  the  femur,  and  producing  a  sught  traumatism 
which  sets  up  acetabular  disease  ;  and  3rd.  By  exten- 
sion of  disease  primarily  commencing  in  the  synovial 
membrane  or  transmitted  thereto  by  the  caseation  and 
rapture  of  a  femoral  deposit  into  the  joint.  The 
symptomatology  in  such  a  case  will  be  positive  and 
negative.  The  positive  signs  will  be  the  situation  of 
the  pain  which  as  observed  by  Erichsen  will  be  in  the 
iliac  region,  or  back  of  the  thigh,  and  pain  on  digital 
examination  per  rectum  of  the  inner  pelvic  surface 
corresponding  to  the  acetabulum.  This  valuable  sym- 
ptom was  first  pointed  out  by  a  French  surgeon,  M. 
Cadn.  At  a  period  when  the  disease  has  somewhat 
progressed  this  surface  may  be  found  thickened  in 
comparison  with  that  of  the  opposite  side,  and  may 
impart  a  doughy  or  softened  sensation  to  the  finger, 
from  the  presence  of  extravasated  lymph  or  pus.  As 
r^iaids  the  reflex  muscular  starting,  it  appears  to  be 
common  to  every  incidence  of  disease,  and  is,  I  believe, 
due  to  irregular  interarticular  pressure.  At  a  later 
period  the  position  of  abscess,  wnether  intra- pel  vie  or 
gluteal,  or  outside  the  thigh,  will  aid  in  establishing 
the  situation  of  disease.  The  negative  signs  will  be  : 
The  absence  of  thickening  in  the  neck  of  the  femur  or 
trochanter,  unless  the  disease  had  primarilv  begun  in 
those  tissues,  and  a  comparative  absence  of  deformity 
in  the  early  stages. 

That  the  tubercular  deposit  ma^  sometimes  originate 
in  the  ligaments  of  the  joint  there  is  no  reason  to  doubt 
Some  recent  writers,  among  them  Mr.  Edmund  Owen, 
consider  that  the  ligamentum  teres  is  most  frequently 
the  starting  point.  It  was  demonstrated  by  watching 
the  movements  of  the  joint  structures  through  a  hole 
made  in  the  acetabulum  from  the  pelvic  side  that  this 
li^ment  checks  adduction  of  the  partially  flexed 
thigh.  If  a  child  fall,  therefore,  on  the  outer  side  of 
the  partially  flexed  tmgh,  he  may  strain  this  ligament. 
If  healthy,  a  simple  synovitis,  which  a  short  rest  will 
cure,  is  the  result ;  but  if  otherwise,  the  ligament 
becomes  thickened  with  inflammatory  exudation,  and 
after  a  time  incorporated  with  the  contiguous  synovial 
membrane  in  tubercular  infiltration.  In  such  a  case 
there  will  be  deformity,  flexion,  and  abduction,  pain 
at  the  inner  side  of  the  knee.  There  is  an  elastic  resis- 
tuoe  to  the  rectification  of  flexion  due  to  the  bag  of  fluid 
eziBting  within  the  joint  There  may  not  be  any 
marked  pyrexia.    If  the  trochanter  and  neck  of  the 


femur  be  thickened,  and  only  a  moderate  amount  of 
pain  be  present  with  some  lameness,  it  is  probable 
that  the  deposit  is  in  the  neck  of  the  femur,  or  at  or 
outside  the  line  of  the  epiphysis.  If ,  as  a  sequence  to 
a  condition  such  as  this,  there  be  a  sudden  accession  of 
acute  symptoms,  with  fulness  in  the  groin,  and  fixation 
in  the  joint,  it  is  to  be  inferred  that  the  articulation 
has  been  invaded.  That  the  cartilage  thinned  bv 
pressure  has  given  way,  and  that  the  joint  is  fiUed  with 
sero-pus.  In  such  a  case  there  is  prominence  of  the 
structures  in  front  of  the  joint  If  a  calliper  be 
taken  it  will  be  found  on  measurement  that  the  region 
of  the  femoral  artery  at  the  base  of  Scarpa's  triangle 
is  more  advanced  than  the  corresponding  portion  at 
the  healthy  side.  There  is  generally  abduction  of  the 
limb.  There  are  usually  blue  venous  radicles  ramify- 
iufi;  over  the  region  of  and  below  Fouparf  s  ligament ; 
indicating  pressure.  There  is  pain  ;  starting ;  and 
pyrexia.  It  is  convenient  at  this  point,  as  we  are  of  ten 
consulted  when  the  conditions  just  related  exist,  to 
consider  the  line  of  treatment  to  be  adopted,  and  the 
most  important  questions  to  decide  are :  Should  we 
choose  an  expectant  treatment,  or  should  operative 
measures  be  preferred  !  When  the  condition  of  suppu- 
rative arthritis  is  recognised.  When  there  is  fixation, 
flexion,  pain,  and  pyrexia,  I  do  not  hesitate  to  open 
the  joint  This  may  be  done  under  anaesthesia  from 
behmd  through  the  gluteal  fibres,  or  through  the  fascia 
in  front  of  the  tensor  vagines  femoris.  A  long  narrow 
knife  by  which  a  free  opening  may  be  made  into  the 
capsule  is  best  It  is  often  remarkable  what  relief  will 
be  at  once  given  by  this  expedient.  Not  only  is  the 
pain  relieved,  but  the  general  symptoms  subside  and 
extension  of  the  limb  may,  if  thought  desirable,  be  at 
once  adopted,  but  for  reasons  to  be  hereafter  given  this 
is  not  always  expedient  I  have  in  many  instances 
repeated  this  measure  in  the  same  case,  when  signs 
showed  a  re-accumulation  of  the  fluid,  with  benefit 
Mr.  Edmund  Owen  has  advised  the  tapping  of  the 
joint  by  a  trocar  and  cannula  from  behind  through  the 
gluteal  fibres,  or  from  beneath  the  anterior  superior 
spine  of  the  ilium,  working  inwards,  and  Mr.  T.  N. 
Fitzgerald,  of  Melbourne,  passes  a  tenotomy  knife  into 
the  articulation,  allowing  the  fluid  to  escape  into  the 
surrounding  tissues  and  so  to  be  absorbed.  If  on 
opening  the  capsule  with  a  knife,  pus  appears  along  its 
side,  I  make  a  practice  of  passing  in  a  long  sinus  for- 
ceps into  the  cavity,  and  enlarging  the  canal  by  divari- 
cating its  blades,  washing  it  thoroughly  with  boric 
solution,  and  plug^ng  it  with  iodoform  gauze.  At  the 
same  time  the  patient  must  be  kept  at  rest,  and  exten- 
sion should  be  maintained.  I  here  venture  to  make  a 
few  observations  on  this  well-known  subject.  The 
theory  that  I  have  long  held  myself  is— That  it  does 
good  b^  the  diminution  of  intra-articular  pressure  it 
affords  if  properly  applied. 

It  is  that  pressure  which  produces  muscular  spasm, 
and  by  its  removal  the  spasm  is  averted.  This  is 
proved  by  the  fact  that  extension,  if  not  applied  in  the 
axis  of  deformity,  will  increase  spasm  ;  in  other  words, 
although  extending  the  muscular  element,  it  increases 
intra-articular  pressure,  and  is,  therefore,  useless.  That 
this  theory  is  practically  correct  may  be  deduced  from 
the  observations  of  R  H.  Bradford,  and  R.  W.  Lovett, 
in  a  paper  entitled  '*A  Study  of  Traction  in  Hip- 


182    Thb  Msdioal  Pans. 


ORIGINAL  COMMUNICATIONS. 


Fra.  19,  1896. 


Disease."  The  evidence  presented  by  them  was, 
experimental,  pathological,  and  clinical. 

In  a  number  of  dissecting  room  adult  cadavera  the 
legs  were  slightly  flexed  and  abducted,  and  a  weight 
varying  from  60  to  60  lbs.  was  attached  to  the  legs. 
It  was  found  that  the  limbs  could  be  lengthened  three- 
quarters  of  an  inch.  It  was  found  that  no  amount  of 
force  produced  separation  of  the  joint  surfaces  in 
adults  if  the  legs  were  kept  quite  straight. 

The  hip  of  a  foetus  at  full  term  was  prepared  in  such 
a  way  that  the  skin  was  removed  so  as  to  expose  the 
musdes  round  the  hip.  It  was  found  that  under  a 
slight  amount  of  traction  separation  was  possible.  A 
needle  was  inserted  into  the  head  of  the  femur,  another 
into  the  ilium  a  little  above  the  acetabulum— a  slight 
traction  caused  a  separation  of  the  needles. 

Traction  separated  the  joint  surfaces  in  all  cases  in 
children,  dissected  or  otherwise,  and  the  checks  to 
separation  in  adults  lay  in  the  resistance  -  Ist,  of  the 
capsular  ligament,  and  especially  of  the  anterior  bands 
of  the  ilio-femoral  ligament ;  2nd,  in  the  resistance  of 
the  cotyloid  ligament,  and  to  a  slight  degree  to  atmos- 
pheric pressure. 

In  chUdren  the  lower  edge  of  the  acetabulum  pre- 
sents no  resistance  to  traction  in  the  axis  of  the  body. 
In  adults  this  presents  a  resistance  which  is  avoided 
by  abduction  ot  the  limb. 

B3th  in  children  and  adults,  if  the  femur  be  extended 
to  its  utmost  limits,  the  anterior  bands  of  the  ilio- 
femoral ligament  prevent  distraction  by  any  force 
which  can  be  applied  with  safety.  In  a  diseased  joint, 
where  the  capsule  and  cotyloid  ligament  are  disorgan- 
ised, distraction  is  easy. 

Experiments  were  also  made  on  healthy  joints  in 
living  persons,  and  it  was  found  that  20  lbs.  weight 

I>roduced  in  a  girl,  aet.  7,  one  quarter  of  an  inch  in 
engthening,  due  to  separation  ot  joint  surfaces. 

In  diseased  joints  10  lbs.  produces  lengthening 
invariably  by  separation  of  joint  surfaces  before 
puberty,  but  the  extent  varies  in  different  individuals, 
and  is,  as  a  rule,  less  in  older  children  than  in  young 
ones. 

The  pathological  evidence  embraced  cases  where 
traction  had  been  employed,  and  where  it  had  not, 
and  showed  the  different  results  ;  in  the  one  case  a 
preservation  to  a  great  extent  of  the  head  and  neck  of 
the  bone,  without  displacement ;  in  the  other,  the 
wandering  acetabulum,  with  displacement  upwards 
and  backwards  of  the  head  of  the  femur,  which  had 
itself  undergone  destructive  changes.  The  results 
arrived  at  by  those  investigators  seem  to  prove : — 

Ist.  That  traction  properly  applied  draws  apart  the 
articular  surfaces  both  in  the  dead  and  living. 

2nd.  A  greater  force  has  to  be  applied  than  has  com- 
monly been  used  in  hip-joint  disease.  Separation  is 
less  likely  to  occur  in  the  adult  than  in  the  child  and 
more  likely  in  diseased  joints  than  in  healthy  ones. 
Separation  is  more  easy  m  a  flexed  and  abducted  posi- 
tion of  the  limb  than  in  full  extension. 

3rd.  Pathological  evidence  demonstrates  that  the 
upper  edge  of  the  acetabulum  and  the  head  of  the 
femur  are  eroded  in  hip  disease  where  traction  is  not 
used. 

Clinical  evidence  shows  in  routine  hospital  practice 
the  absence  of  subluxation  after  the  use  of  traction. 
In  my  experience  I  find  that  the  weight  used  must,  to 
a  great  extent,  be  regulated  by  the  comfort  afforded. 
For  a  child  undeir  ten  years  of  age  from  three  to  nine 
pounds  may  be  defined  as  the  limit  I  have  adopted 
the  plan  of  making  the  extension  altogether  above  the 
condyles  by  placing  a  plaster-of-paris  case  outside 
padding  applied  to  those  processes  and  attaching 
webbing  bands  thereto.  By  leaving  this  webbing  free 
below  the  knee  two  advantages  are  acquired.  1st. 
The  knee-joint  itself  is  not  weakened,  I  have  known 
it  converted  by  extension  of  the  ligaments  into  almost 
a  diarthrosis ;  and  2Dd,  the  knee  may  rest  on  a  pillow 


and  remain  semiflexed,  such  a  position  not  interfering 
with  the  line  of  traction  in  axis  of  the  deformity  and 
affording  great   comfort  to  the  patient    In   many 


1.— A  small  devioe  for  attaching  stirmp  for  traction. 


2.-~Board  for  gradaating  pulley.    To  be  slipped  andsr 
mattress. 


3.— Extension   applied 
bandages. 


by    means  of   plaster-of-paria 


^^ -l?i'Xrw^^'''''^^''''''  s^sssassssa 


4.— Pelvimeter  for  estimating  alteration  in  position  of 
trochanters. 

instances  when  extension  has  overcome  deformity  and 
starting  has  ceased,  pain  will  return.  This  is  caused 
by  the  overstretching  of  the  inflamed  ligaments,  and 
in  such  a  case  the  lessening  of  weight  or  its  complete 
removal  will  afford  relief.  In  such  a  case  it  will  be 
prudent  to  secure  fixation  of  the  joint  by  a  splint 

In  cases  where  rarefving  osteitis  is  present  and 
where  an  arrest  of  development  of  the  femur  ma^  be 
anticipated  and  consequent  shortening  of  the  limb,  it  is 
better  to  encourage  a  slight  adduction.    As  a  result 


Fbb.  19,  1896. 


ORIGINAL  COMMUlSnCATIONS. 


Thi  Mbdigax  Pb»8.     183 


the  ahorteoing  is  of  less  importance  than  it  would  have 
been  had  anJQrlosifl  taken  place  in  an  abducted  posi- 
tion. Sometimes,  however,  it  is  not  possible  to  prevent 
abduction  by  traction  in  the  axis  of  tibe  limb  or  to- 
wards the  other  side,  as  it  is  almost  impossible  to 
prevent  bv  any  appliance  the  spinal  accommoda- 
tion which  ensues.  It  is  remarkable  how  even  a 
very  young  child  will  extricate  himself  from  the 
lestramt  of  an  irksome  position.  To  obviate  this 
I  have  found  that  a  combination  of  lateral  trac- 
tion, by  fixing  the  upper  portion  of  the  femur  will 
allow  of  the  downward  traction  being  applied  in  the 
direction  of  adduction.  If  extreme  adduction  occur,  as 
may  be  seen  in  cases  of  absorption  of  the  head  of  the 
bone,  or  subluxation,  or  in  cases  of  double  hip-joint 
disease,  of  which  a  good  example  was  in  the  Orthopaedic 
Hospital  a  short  time  ago,  a  crossed-legged  progression 
may  result.  In  such  cases  much  improvement  may  be 
made  by  the  careful  use  of  Thomas's  double  splint  or 
of  Phelp's  box.  It  is  important,  however,  in  the 
application  of  traction  for  the  rectification  of  deformity 
the  result  of  tubercular  trouble,  to  remember  that  we 
are  dealing  with  diseased  tissues  in  which  lives  a  latent 
enemy  easily  aroused,  and  to  proceed  with  the  utmost 
gentleness. 

Rotation,  either  inward  or  outward  may  be  controlled 
in  a  variety  of  ways.  Sandbags  will  ususlly  suffice  if 
thwe  be  a  careful  nurse  in  attendance.  A  piece  of 
splint  wood  fixed  by  the  plaster  bandage  behind  the 
thig^  and  adjusted  so  that  the  patella  must  look 
stnught  in  front,  or  a  zinc  trough  moulded  to  the  limb 
with  two  cross  bars  to  prevent  rotation,  will  effect  the 
same  purpose. 

A  question  will  arise.  At  what  period  may  fixation 
alone  be  substituted  for  fixation  and  extension  7  We 
must  be  guided  by  the  progress  of  the  case,  but  my 
personal  feeling  is,  that  while  I  have  never  regretted 
maintaining  extension  for  a  lengthened  period,  even 
when  it  appeared  unnecessary  to  the  parents  and  even 
to  the  patient  himself,  I  have  often  had  cause  to  regret 
leaving  it  off  too  soon.  Even  when  progressive  disease 
has  been  arrested,  the  weakened  elements  of  the 
damaged  joint  are  easily  influenced  by  muscular  con- 
tractions or  by  extraneous  causes,  more  especially  if 
what  is  termed  the  ambulatory  method  of  treatment  be 
permitted.  The  temperature  which  perhaps  for  months 
has  been  normal  will  rise  a  little  at  night.  Flexion  at 
the  Joint  will  recur,  and  extension  has  again  to  be 
applied  :~if  pain  be  entirely  absent ;  if  muscular 
starting  has  altogether  ceased  and  the  limb  be  in  a  good 
position  ;  if  the  seneral  appearance  and  condition  of 
health  indicate  that  the  (usease  is  at  a  standstill ;  if 
there  be  no  evidence  of  suppuration  ;  if  the  digestion 
be  good,  the  sleep  sound,  and  the  temperature  normal, 
we  may  then  direct  our  attention  to  the  question. 

Incomparably  the  best  as  a  fixation  apparatus  in  my 
opinion  ia  a  Thomas's  splint ;  I  need  only  allude  to  this 
well-known  and  useful  apparatus,  which  is  unfortu- 
nately often  seen  applied  m  a  careless  and  inefficient 
manner. 

A  few  words  regarding  the  deformities  met  with 
during  the  existence  of  hip-joint  disease.  Flexion  is  a 
constant  occurrence,  and  wUl  be  met  witL  in  all  cases 
irrespective  of  the  position  of  the  diseased  focus,  but  it 
will  occur  with  greater  rapidity  when  the  synovial 
membrane  is  engaged  and  intra-articular  effusion  sets 
in.  It  seems  to  be  a  position  instinctively  assumed  to 
lessen  joint  pressure.  The  deformity  can  be  induced 
in  the  cadaver  by  injecting  the  joint  through  a  hole  in 
the  acetabulum,  and  the  mechanics  of  the  phenomenon 
observed.  It  will  be  seen  that  the  anterior  part  of  the 
capsule,  owing  to  the  identification  with  it  of  the 
strong  fibres  oi  the  ileo-femoral  ligament,  is  dense  and 
unyielding,  but  the  posterior  part  is  comparatively  thin. 
On  injecting  a  moaerate  quantity  of  fluid  into  the 
joint  flexion  occurs,  and  by  increasing  the  amount  a 
slight  degree  of  abduction.    I  used  glycerine  myself  in 


making  the  experiment,  beins  a  fluid  probabl^r  of 
consiBteuce  approaching  that  of  the  majority  of  intra- 
articular  effusions.  By  tightly  plugging  the  opening 
with  a  piece  of  indiarubber  it  was  easy  to  observe  the 
elaptic  feel  which  fluid  in  the  joint  imparted  on  attempt- 
ing to  extend  the  limb,  and  the  intra-articular  pressure 
produced  thereby  indicated  by  the  difficulty  in  retain- 
ing the  plug  of  indiarubber  in  position  from  pressure 
on  its  articular  aspect 

At  a  later  period,  owing  either  to  changes  in  all  the 
structures  of  the  joint,  or  to  changes  in  the  acetabulumr 
or  to  an  alteration  in  the  normal  position  of  the  head 
of  the  femur,  adduction  and  rotation  inward  may 
happen.  To  the  deformities  of  abduction  and  adduc- 
tion is  due  the  apparent  shortening  which  is  produced 
by  the  tiltinff  of  the  pelvis.  This  may  be  estimated  by 
comparing  the  measurements  from  the  umbilicus  to- 
the  internal  malleolus  on  either  side.  Real  shortening 
may  occur ;  1st,  In  acetabular  disease  from  recession  of 
the  head  of  the  femur ;  2nd,  From  the  displacement  of 
the  upper  extremity  of  the  femur  consequent  on 
so-called  wandering  acetabulum,  or  from  a  partial  or 
complete  dislocation  of  the  head  of  the  bone,  which 
last  is  a  rare  occurrence.  It  may  also  happen  from  a 
shifting  upwards  of  the  acetabulum  en  masset  from  a 
softening  of  its  base,  as  I  saw  in  the  case  of  a  boy,  let 
9,  in  Steevens'  Hospital  a  few  weeks  ago,  where  it  was 
necessary  to  amputate  through  the  joint 

To  causes  referable  to  the  femur.  1st,  To  absorption 
of  the  head  or  its  removal  as  a  sequestrum.  To 
absorption  of  the  neck,  and  lastly  to  an  arrest  of 
development  of  the  femur,  which  may  continue  when 
the  disease  has  ceased.  To  so  great  an  extent  may 
this  arrest  of  development  proceed,  that  in  the  case  of 
a  girl,  flet  18,  of  otherwise  large  proportions,  who  was 
bedridden  for  thirteen  years,  from  extensive  disease  of 
the  head  and  neck,  and  the  femur  and  the  acetabulum,, 
and  whose  limb  was  removed  from  the  pelvis.  I  found 
the  femur,  about  the  size  of  a  radius,  to  whicn  bone  it 
bore  a  considerable  resemblance.  To  estimate  real 
shortening  a  line  must  be  taken  from  the  anterior 
superior  spine  to  the  inner  malleolus,  but  it  is  impor- 
tant in  making  such  a  measurement,  to  place  both  legs 
in  exactly  the  same  position  as  regards  flexion,  abduc- 
tion, or  adduction,  otherwise  the  measurement  will  be 
inaccurate.  The  upper  margin  of  the  trochanters 
normally  touches  N^laton's  line.  The  vertical  measure- 
ment of  any  part  of  the  trochanter  which  reaches  above^ 
this  line  will  indicate  the  shortening  due  to  alterations 
in  the  head  or  neck  of  the  bone.  If  the  real  shortening 
exceed  this,  the  excess  will  be  due  to  arrest  of  develop- 
ment in  the  length  of  the  femur. 

The  position  of  the  trochanter  as  regards  the  median 
line  is  signiflcant.  This  may  be  measured  by  the  small 
pelvimeter  of  which  an  illustration  is  annexed.  No  &. 
The  trochanter  on  the  dbeasedside  may  be  pushed  out 
further  than  the  other.  This  may  be  due  to  articular 
effusion,  to  serum  or  pus  in  the  joint,  or  to  an 
obliteration  of  the  cavity  of  the  acetabulum  by  a  cell 
proliferation  in  the  ligamentum  teres.  In  dislocation 
on  the  dorsum  ilii  whether  from  acetabulum  alteration 
or  otherwise,  the  same  thing  may  happen,  but  in  such 
a  case,  the  trochanter  will  be  on  a  higher  level  than 
normal. 

The  trochanter  mil  be  nearer  to  the  median  lines 
either  from  absorption  of  the  head  or  neck  of  the  bone, 
or  from  disease  of  the  acetabulum  which  has  allowed  a 
recession  of  the  head  into  that  cavity.  This  may  be 
diagnosed  by  an  examination  through  the  rectum.  At 
a  later  stage  of  the  disease,  and  when  acute  symptoms 
have  ceased,  the  trochanter  at  the  diseased  side  may 
be  found  to  approximate  the  median  line  more  than  its 
fellow.  Vhis  will  be  due  to  arrest  of  development  of 
the  upper  extremities  of  the  femur,  and  may  not  have 
been  observable  during  the  existence  of  the  disease  ixk 
an  acute  form. 


184    Thb  Mbdioal  Prbsb- 


ORIGINAL  COMMUNICATIONS. 


Fbb.  19,  1896. 


THE  DIAGNOSIS   OF   INSANITY. 

By  THEO.  B.  HYSLOP,  M.D., 

Leotnrer  on  If enUl  DImmm  to  St.  Mary'i  Hotpftal  Medical  8cho«l, 
AuUtant  Phjilclan  to  B«thlem  Rojal  HoapitaL 

LlCTUBB  VIII. 

Iir  this  lecture  I  propose  to  deal  with  the  subject  of 
insolation  as  a  factor  in  the  causation  of  insanity,  and 
it  will  be  seen  that  the  effects  of  a  continued  high 
degree  of  temperature  upon  the  vital  processes  of 
man  are  very  important  and  far-reaching.  I  do  not 
propose  to  discuss  the  symi>tomatological  aspects  of 
insolation  ;  but  deem  it  advisable  to  consider  some- 
what in  detail  its  etiology  and  sequelae,  and  of  the 
sequelaB  I  shall  confine  my  attention  more  particularly 
to  the  mental  defects  and  aberrations  commonly  met 
with  in  the  insane. 

The  multiplicity  of  terms  derived  from  the  etiologv, 
symptomatology^  and  pathology  of  insolation  is  liable 
to  cause  confusion,  but  the  recofpaition  that  some  of 
the  numerous  terms  apply  mainly  to  the  several 
degrees  of  the  same  affection  will  serve  to  simplify 
matters.  We  have  the  terms  sun  fever,  thermic  fever, 
ardent  fever,  cerebral  fever,  cephalitis  ifigjrptica,  coup 
de  soleil,  heat  asphyxia,  heat  apoplexy,  ictus  solio, 
erythismus  tropicus,  causus  ab  insolatione,  phrenitis 
indica,  typhomania,  calenture,  &c.,  and  also  various 
combinations,  varying  according  to  the  modes  of 
causation. 

Morache  has  conveniently  divided  the  forms  of  inso- 
lation into  two  classes,  (1)  Coup  de  soleil^  or  sunstroke 
due  to  direct  rays  of  the  sun,  and  (2)  Caujp  de  chaleur. 
or  indirect  form,  due  to  heat  and  other  innuences.  Ol 
the  two  forms,  the  latter  appears  to  be  the  more 
common.  In  fact,  the  former,  without  the  aid  of  a 
greatlv  heated  atmosphere  and  other  causes,  such  as 
humidity,  &c.f  is  seldom  met  with.  A  lengthy  account 
of  the  atmospheric  influences,  together  with  the  rela- 
tive value  of  neat,  humidity,  and  the  influence  of  the 
various  winds,  as  a  cause  would  be  out  of  place  here  ; 
for  although  high  temperature,  rarefication  of  the  air 
with  its  direct  sedative  effects,  quick  evaporation  from 
and  inspissation  of  the  blood,  result  in  venalisation  of 
the  blood  from  diminution  of  the  supply  of  oxygen  at 
each  inspiration,  yet  fatigue,  faultv  bodily  habits, 
excesses  (alcoholic,  dietetic,  or  sexual)  form  the  most 
important  etiological  factors.  Wallther's  experiments 
show  that  the  heat  from  the  streaming  rays  of  the  sun 
can  be  actually  absorbed  by  the  skin.  Most  authors, 
however,  agree  that  it  is  by  the  combination  of  the 
sun's  rays,  a  heated  atmosphere,  and  a  relative  amount 
of  humidity,  acting  together,  that  heat  is  retained  in 
the  body.  As  a  true  exciting  cause,  heat  both  direct 
and  indirect  may  be  an  effective  cause,  but  hygrome- 
tric  and  barometric  states  of  the  atmosphere  have  a 
special  influence  upon  the  general  vigour  of  the  consti- 
tution, and  not  only  render  a  person  more  or  less  sus- 
ceptible to  heat,  but  also  predispose  him  to  suffer 
from  it.  ... 

The  difficulty  in  estimating  the  exact  effects  of  the 
solar  rays  is  not  only  due  to  the  absence  of  a  sufficient 
number  of  experiments,  but  also  bj  the  presence  of 
other  conditions,  such  as  hot,  rarened,  and  perhaps, 
impure  air,  and  heat  of  the  body  produced  by  exercise, 
and  not  attended  by  perspiration.  Eckhard  found 
that  when  a  temperature  much  over  the  natural 
amount  was  applied  to  the  nerves  of  frogs,  the  elec- 
trical currents  through  them  were  ultimately  stopped. 
Weber  also  found  that  the  same  rule  held  good  for  men. 
Solar  heat  as  an  immediate  or  exciting  cause  may  act 
in  two  ways,  causing  (1)  prostration  of  nervous  powers 
and  syncope,  with  symptoms  of  debility,  vertigo,  weari- 
ness, nausea  and  incontinence  of  urine ;  or  (2)  venali- 


sation of  blood,  with  absence  of  perspiration,  suppres- 
sion of  urine,  and  constipation.  The  latter  group  is 
aided  chiefly  by  fatigue,  impure  air,  alcohol,  visceral 
disorders,  and  retained  secretions. 

Bespirations  are  said  to  be  lessened  during  hot 
seasons,  and  the  higher  the  temperature,  the  lesa 
oxygen  there  is  going  into  the  system  and  the  less 
carbonic  acid  exhaled.  When  isolation  is  established, 
the  other  organs  are  hindered  in  their  action  as  com- 
pensatory excretors.  Moore  (a)  has  pointed  out  that 
formerly  many  cases  were  not  returned  in  India,  but 
were  overlooked  owing  to  the  fact  that  only  those  cases 
occurring  after  direct  exposure  to  the  sun  were  recorded. 
Dr.  Tripe,  at  the  Conference  of  the  Boyal  Meteorologi- 
cal Society,  in  July,  1884,  in  discussing  some  of  the 
relations  of  meteorological  phenomena  to  health, 
pointed  out  that  the  effects  of  high  temperature  vary 
much  according  to  the  amount  of  moisture  in  the  air,  as 
when  the  air  is  nearly  saturated  in  hot  climates,  or 
even  in  summer  in  our  own,  more  or  less  langour  and 
malaise  are  felt,  with  great  indisposition  to  fatigue. 
With  a  dry  air  these  are  not  so  noticeable.  In  the 
former  case,  but  little  evaporation  from  the  skin  occurs* 
and  the  normal  amount  of  moisture  is  not  given  off 
from  the  lungs,  so  that  the  body  is  not  cooled  down  to 
such  an  extent  as  by  dry  air,  sunstroke  probably  being 
the  result,  not  onlv  of  the  direct  action  of  the  sun's 
rays,  but  partly  also  from  diminished  cooling  of  the 
blood  by  want  of  evaporation  from  the  lungs  and  skin. 

Undoubtedly,  hot  climates  eventually  sap  the  foun- 
dations of  life  amongst  Europeans,  and  although  the 
hypothesis  of  acclimatisation,  ue.y  that  an  injurious 
effect  ia  first  produced,  and  then  accommodation  of  the 
body  to  the  new  condition  within  a  limited  time,  is  to 
a  certain  extent  true,  yet  the  rule  does  not  extend  to 
the  progeny.  In  fact,  it  appears  that  acclimatisation 
of  Europeans  in  India  depends  to  a  great  extent  upon 
the  intermixing  by  marriage  with  the  natives  ;  other- 
wise, thev  do  not  reach  beyond  the  third  generation. 

The  effects  of  a  tropical  climate  are,  so  to  speak, 
relative,  and  beyond  the  conditions  of  temperature  and 
humidity,  we  have  to  take  into  consideration  the 
malarial  influences  arising  from  the  putrescence  of 
organic  matter,  and  the  effluvia  from  impure  soU, 
which  in  their  turn  cause  malarial  fevers  and  other 
conditions  equally  fatal  to  human  life. 

Various  winds  prove  dangerous  to  human  life  and 
tend  to  produce  deleterious  effects  upon  our  nervous 
systems.  TheScirocco  of  the  North  African  Coast, 
Sicily,  and  Southern  Italy,  is  a  hot,  dry,  south-east 
wind,  and  blows  from  the  heated  Sahara  passing  over 
the  Mediterranean  where  it  absorbs  a  large  amount  of 
moisture  becoming  a  hot  moist  wind  on  reaching 
the  South  of  Europe,  which  causes  languor,  listlessness, 
and  heat-stroke.  The  Leveche  or  Scirocco  of  Spain, 
and  the  Solano,  are  both  productive  of  much  nervous 
prostration.  The  Harmattan  of  the  West  Coast  of 
Africa  from  the  Desert,  the  Khamsin  of  Egypt,  and 
the  Simoon  of  Kutchee  and  Upper  Scinde,  are  all 
particularly  fatal  to  human  life  ;  tne  latter  especially 
causing  sensations  of  suffocation  and  the  asphyxia! 
form  of  insolation.  The  Mistral,  Bora,  Tramontana, 
Northers,  and  Pampero,  all  cause  diy  pleurisy,  pneu- 
monia, rheumatism,  and  muscular  pains,  but  they  have 
little  or  no  effect  upon  the  nervous  system. 

The  hot  winds  of  Australia  are  dry  and  even  afford 
pleasure  to  some  constitutions.  The  Fohn  of  the 
North  Eastern  Valleys  of  Switzerland  is  also  fairly 
healthy.  In  India  the  hot  winds  are  rather  more  con- 
ducive to  good  health  than  bad,  and  unless  the 
exposure  to  sun  and  the  heat  of  the  wind  are  very 
severe  insolation  is  not  likely  to  occur.  The  Loomama, 
however,  is  said  to  cause  *'  hot  wind  stroke.''  In  New 
York  and  other  parts  of  America  insolation  according 
to  some  observers,  generally  develops  in  the  night  and 

(a)  "Diseaieiof  ladia,"  P.  987. 


Feb    19,]  896. 


ORIGINAL  COMMUNICATIONS. 


Tbb  Mbdical  Press.      185 


Dot  when  the  person  is  exposed  to  the  direct  rays  of 
the  san. 

Warm  days  in  the  cool  seasons  of  the  year  are  especi- 
ally dangerous.  Moist  air,  absence  of  wind,  hot  winds, 
all  favour  the  develo{)meDt.  Id  his  account  of  diseases 
prevalent  in  the  Persian  Gulf,  Evatt  draws  attention 
to  the  terrific  heat  of  a  moist  character  there  prevalent. 
Even  the  natives  cannot  endure  it,  and  heat  apoplexy 
assumes  a  deadly  form.  The  fatal  character  or  the 
heat  is  derived  from  moisture.  Further  inland  the 
intense  heat  a^n  assumes  a  terrible  aspect  from  the 
hot  winds  drying  the  skin  and  abolishing  the  salutary 
effects  of  perspiration.  Gordon  (a)  believes  that  in  calm 
sultry  days  when  the  sun  is  obscured  by  a  film  of  clouds 
or  impalpable  dust  insolation  is  most  common,  since 
varying  amounts  of  moisture  in  the  air  materia ly  affect 
the  comfort  and  health  of  man.  In  this  country,  how- 
ever, it  is  not  only  the  absolute,  but  the  relative  pro- 
portions of  aerial  moisture  which  influence  mankind. 
The  bodily  causes  arising  in  connection  with  habits  or 
diseases  of  the  individual  are  of  special  importance, 
and  among  these  may  be  mentioned  fatigue,  over- 
exertion, overcrowding,  bad  ventilation,  unsuitable 
dress,  retained  excretions,  defective  secretions,  in  fact, 
anything  tending  to  debilitate  or  contaminate  the 
system.  Injuries  to  the  head,  malaria,  scorbutic  taint, 
venereal  disease,  former  attacks  of  insolation,  and 
alcoholism  all  predispose  to  its  occurrence.  Malaria, 
syphilis,  and  alcoholism  not  only  play  an  important 
part  in  the  etiology  of  insolation,  but  tney  also  tend  to 
modify  and  influence  the  subsequent  history  of  the 
iodividua],  and  give  rise  to  many  symptoms  which  are 
of  the  utmost  importance  for  diagnostic  purposes,  but 
of  55  cases  of  insanity  following  insolation,  I  found 
that  8  had  had  malaria,  5  syphilis,  and  7  had  been 
alcoholic.  The  latter  affection  especially  predisposes 
to  the  indirect  form  of  sunstroke.  Sir  Cbanes  Napier, 
in  Scinde,  was  fully  alive  to  the  powerful  co-operative 
aid  of  alcohol  in  producing  heat  *stroke  when  he  declared 
that  the  sun  should  have  in  Ms  case  no  ally  in  drink. 
In  ppite  of  what  may  be  thought  to  the  /contrary,  I 
believe  that  the  authorities  who  organised  our  recent 
expedition  to  Coomassie  exercised  a  very  wise  discre- 
tion in  the  matter  of  the  distribution  of  alcohol  to  the 
troops,  and  those  who  have  not  studied  the  subject 
have  yet  to  learn  that,  in  malarial  districts  there  are 
worse  things  to  guard  against  than  conditions  of  tem- 
porary exhaustion.  The  coloured  races  seem  to  enjoy  a 
comparative  immunity,  but  when  the  negro  removes  to 
cities  and  becomes  loose  and  irregular  in  his  habits, 
and  eats  and  drinks  to  excess,  he  becomes  equally  liable 
to  sunstroke  with  the  white  race.  Spirit  drinking,  even 
in  moderation,  powerfully  aids  the  external  causes  of 
insolation.  Even  wine  and  beer  have  this  effect.  A 
full  habit  of  body  and  too  much  animal  diet  favour  a 
plethoric  condition  and  the  development  of  heat- 
stroke. Especially  is  this  apt  to  occur  if,  after  a  heavy 
meal  there  is  also  bad  ventilation. 

Plethoric  intem^rate  men  suffering  from  fatty  heart 
are  especially  predisposed. 

What  the  relationship  of  syphilis  to  sunstroke  is  I 
am  not  prepared  to  say.  Undoubtedly,  syphilis  (as 
pointed  out  by  Hutchinson)  precedes  attacks  of  sun- 
stroke, but  the  part  it  plays  in  the  etiology  of  the 
affection  is  doubtful,  and  much  information  is  yet 
wanted. 

The  special  and  primary  syphilitic  brain-lesions 
affecting  the  meninges,  or  vessels,  or  encephalic 
nervous  substance ;  and  spoken  of  as  cellular  hyper- 
plasiae  ending  in  scleroses  or  in  gummata ;  may 
undoubtedly  predispose  to  insolation,  by  weakening 
the  resistive  power  of  the  organism,  and  brain  par- 
ticularly, to  the  effects  of  heat. 

The  effect  of  the  sun  is  more  to  be  feared  in  the  case 
of  new  arrivals  in  India,  and  the  liability  to  sunstroke— 

(a)  Medical  Timet  and  Gazette,  1857. 


according  to  Bryden — i&  quadrupled,  (a)  He  pointed 
out  that,  taking  tho  standard  of  ten  years,  1860-69  the 
admission  rate  tor  heat  apoplexy  was  4*3  per  1,000,  whilst 
that  of  newly-arrived  regiments,  for. the  years  1864-69, 
was  16*8  per  1,000.  Still  more  did  the  rate  rise  if  a 
newly-arrived  regiment  was  sent  into  the  field  at  once. 
Thus  the  ratio  for  the  new  army  in  the  field  in  1858  was 
55*8  per  1,000.  The  diminution  of  heat  apoplexy  with 
length  of  service  in  India  was  shown  in  the  case  of  the 
newly-arrived  army  in  1858. 

There  were,  in  1858,  42*9  per  1,000  affected. 
„  1859,    87      „  „ 

„  1860,     6-2      „  „ 

1861,  2-2   „ 

1862,  119   „ 

1863,  109   „       „ 

Dr.  Paynten  has  stated  that  sunstroke  is  never  met 
with  in  the  French  Army  in  Algiers,  but  Duncan  (b) 
states  that  this  is  not  correct,  for  sunstroke  does  occur 
in  Algiers.  Two  points  are  remarkable  in  the  history 
of  sunstroke,  viz.,  the  extreme  rarity  of  sunstroke  in 
mid-ocean  and  at  great  elevations.  In  only  one  of  the  55 
casesdid  the  attackoccur  at  sea^^  and  that  was  in  the  Red 
Sea  where,  as  Parkes  (c)  has  pointed  out,  the  proximity 
to  land  does  not  invalidate  the  rule. 

At  great  elevations  the  effect  of  the  sun's  rays  per  se 
is  not  less,  but  even  greater,  than  on  land  or  at  sea 
level,  yet  in  both  sunstroke  is  uncommon. 

The  description  of  the  forms  of  sunstroke,  as  given 
by  Sir  Joseph  Fayrer  {d\  is  particularly  graphic,  and 
with  the  recognition  that  the  affection  may  occur  in 
the  form  of  thermal,  ephemeral,  or  ardent  fever,  heat 
syncope,  heat  apoplexy,  and  heat  asphyxia,  or  spinal 
congestion,  or  in  various  degrees  of  intensity  of  these 
forms,  with  a  great  variety  of  symptoms,  I  will  pass  to 
the  consideration  of  some  of  the  most  important  of  the 
nervous  sequelae. 

Dr.  Handfield  Jones  has  remarked  that "  any  man 
of  experience  in  the  manifold  disorders  of  jaded  and 
exhausted  nervous  systems  will  recognise  at  once  how 
close  is  the  resemblance  between  the  results  of  tropical 
heat  and  those  produced  by  the  ordinary  causes  in 
operation  among  the  struggling  multitudes  in  our  large 
towns." 

The  acute  sequels  to  sunstroke,  as  ardent  fever  with 
acute  delirium,  remittent  and  intermittent  fever  com- 
plicated with  dysenteries,  hepatic  inflammations  and 
congestions  are  all  commonly  seen  in  India,  but  they 
have  not  fallen  within  my  experience.  It  has  been  my 
lot,  however,  during  the  last  ten  years  to  meet  with  a 
notable  number  of  cases  in  which  the  after-symptoms 
of  heat  stroke  have  been  evidenced  by  some  nervous 
defect  or  perversion  essentially  consisting  in  a  func- 
tional paralysis  of  one  or  more  great  nerve  centres. 

It  may  be  obderved  that  the  most  abiding  results  of 
insolation  are  almost  all  referable  to  impaired  func- 
tional energy  of  the  cerebro-spinal  system,  and  this 
impairment  shows  itself  either  in  motor  paralysis,  sen- 
sory paralysis  either  of  common  or  special  sensation, 
hyper-  and  dyssesthesise  of  the  nerves  of  common  ana 
special  sense,  in  debility,  and  undue  excitability  of  the 
emotional  centres,  and  in  similar  states  of  the  cerebral 
hemispheres  and  spinal  cord. 

In  addition  to  tnese  the  extreme  sensitiveness  of  a 
patient  to  the  rays  of  the  sun  or  to  excessive  heat  ever 
afterwards,  and  the  effect  exercised  on  them  by  alcohol 
point  to  an  unstable  condition  of  the  great  vaso-motor 
centre  in  the  medulla  oblongata.  The  mental  sequelae 
are  of  extreme  interest  and  undoubtedly  an  attack  of 
insolation  is  often  attended  with  meningitis  or  cerebral 
changes,  which  may  destroy  the  life  or  intellect  sooner 
or  later,  or  permanently  compromise  the  whole  health 
or  that  of  some  important  function. 


(o)  "Vital  StatUtlcB." 

(b)  "  DlMues  of  Tropical  Canipaignt.*' 

(c)  "  Hvgiene,"  p.  885. 
(d)"Siiiiitroke,''Qoain'BDict  of  Medicine. 


186    Thb  Mxdioal  Pkbbs. 


OEIGINAL  COMMUNICATIONS. 


Feb.  19,  1896. 


In  many  cases  the  sequelsB  may  be  attributed  to  the 
injary  the  brain  suffers  dnrinj^  the  primary  attack 
probably  from  the  loss  of  nutrition  in  the  case  of  the 
syncopal,  and  from  congestion  in  the  apoplectic  forms, 
injuries  by  which  it  may  be  weakened  for  life. 

The  direct  effects  of  actual  attacks  of  insolation  are, 
however,  by  no  means  the  most  appalling,  for  there  are 
many  who  escape  such  attacks  whose  constitution  is 
nevertheless  thoroughly  ruined  by  sun-heat,  who  are 
rendered  liable  to  every  form  of  tropical  malady,  and 
who  are  unable  to  survive  even  slight  wounds  or 
operations. 

Of  the  syncopal,  asphyxial,  and  hvperpyrexial  forms 
of  insolation,  the  two  later  seem  to  be  the  most  impor- 
tant and  dangerous,  and  are  more  liable  to  be  attended 
with  sequelsB  of  a  degenerative  type,  although  even  in 
these  forms,  recovery  may  be  complete. 

It  Is  not  my  intention  here  to  refer  in  detail  to 
special  sensory  or  motor  affections  met  with  apart  from 
mental  aberrations,  but  rather,  by  a  more  general  con- 
sideration of  the  mental  functions  affected,  to  endea- 
vour to  embrace  and  establish  a  connection  between 
them.  In  infancy,  insolation  b  certainly  a  cause  of  acci- 
dental idiocy. 

Langdon  Down  (a)  states  that  he  has  seen  a  notable 
number  of  feeble-minded  children  who  owe  their  dis- 
aster to  sunstroke  while  making  the  passage  of  the 
Red  Sea  and  Suez  Canal  en  route  from  India,  or  from 
exposure  in  that  country,  and  he  attributes  the  mental 
decadence  as  originating  without  doubt  from  the 
actual  exposure  to  heat  At  the  Royal  Albert  Asylum, 
Lancaster,  I  met  with  six  cases  of  mental  defect 
in  children,  in  all  of  which  the  damage  to  the 
mental  powers  was  undoubtedly  dependent  upon 
sunstroke,  and  probablv  the  degree  and  nature  of  the 
defect  coincided  with  the  amount  of  destruction  of  the 
nerve  tissue.  Parents  are  extremely  ready  to  attribute 
the  idiocy  of  their  children  to  an  accidental  fall  or 
blow,  and  even  in  adults  such  causes  are  apt  to  be 
assifpaed.  In  any  case  of  idiocy  or  imbecility  which  is 
attributed  to  the  effects  of  sunstroke  the  existence  of 
hereditary  neurosis,  the  occurrence  of  fits,  or  other 
diseases  likely  to  be  the  cause  of  idiocy,  as  well  as  the 
nature,  extent,  and  immediate  consequences  of  the 
attack,  ought  in  great  measure  to  aid  in  the  formation 
of  a  diagnosis.  The  amount  of  injury  to  the  mental 
powers  is  variable,  but  in  all  the  examples  I  have  seen 
the  patients  have  been  simple-minded  or  imbecile, 
rather  than  belonging  to  the  lower  grades  of  idiocy. 

Sometimes  the  mental  symptoms  are  found  inter- 
current with  the  sopor  and  coma  following  the  shock, 
and  they  may  then  take  the  form  of  delirium,  or  excite- 
ment with  hallucinations,  passing  into  a  condition  very 
similar  to  that  of  primary  dementia.  As  a  general  rule, 
however,  although  therre  may  be  some  trace  left  of  the 
primary  injury  to  the  brain  the  prognosis  is  more 
favourable  in  such  cases  than  when  the  psychosis 
develops  some  months,  or  even  years,  after  the  injury. 


SOME  RECENT  RESULTS    OF 
ORCHOTOMY       (CASTRATION) 

IN  CASBS  OF 

ENLARGED  PROSTATE,  ib) 

By   C.    W.    MANSELL   MOULLIN.   M.D.Oxok., 

F.R.C.S.ENG., 

Surgeon   to  the  London   Hospital:    Evaminer  in   Surgery  at  the 
Uniyersity  of  Oxford. 

Thx  author  stated  that,  while  it  was  quite  true  that 
a  large  number,  the  majority,  in  fact,  of  old  men  who 


I  buffered  f r6m  this  complaint  were  enabled  to   lead 
fairly  comfortable  lives  b^  passing  catheters  from  time 
to   time,  and  when  cystitis  set  in  washing  out  the 
bladder;    it  was  equally  true  that  many  went   on 
steadily  from  bad  to  worse,  and  died  at  last  after  pro- 
longed suffering  from  septic  absorption  and  inflamma- 
tion of  the  kidneys.    Drainage  of  the  bladder  in  such 
cases  is  only  a  palliative.    The  formation  of  an  artifi- 
cial urethra,  either  supra-pubic  or  in  the  perineum,  is 
very  little  better,  as  the  patient  has  to  wear  a  portable 
urinal ;  and  prostatectomy  is  a  very  serious  operation, 
not  so  much  from  the  operation  itself  as  from  its  being 
done  when  it  is  too  late,  in  a  foul  and  septic  bladder. 
Orchotomy,  on  the  other  hand,  offers  a  chance  of  com- 
plete and  permanent  relief  with  but  little  risk  to  life, 
in  supT>ort  of  this,  Mr.  Mansell  Moullin  mentioned  the 
conclusions  at  which  he  had  arrived  from  the  twelve 
cases  in  which  he  had  been  consulted,  or  on  which  he 
had  operated  himself.    Two,  both  under  his  own  care, 
had   died ;    one,   nine    days    after    the    operation, 
from   fatty   d^eneration   of  the   heart,   the    other, 
five   days  after,  from   rupture   of   the   left  middle 
cerebral   artery.      Two   others   had   also   died    bat 
not  for  six  months.    One  of  these  was  82  years  of  age. 
the  other  was  80 ;  and  they  both   had  experienced 
great  relief.    Two  more  had  suffered  from  a  very  severe 
attack  of  traumatic  delirium,  coming  on  shortly  after 
the  operation  and  causing  the  greatest  anxiety.    They 
both  recovered  and  were  well  at  the  present   time. 
There  was  no  evidence  either  that  this  delirium,  or 
that  the  mania  which  had  been  recorded  as  having 
followed  this  operation,  was  in  any  way  different  from 
the  traumatic  delirium  that  not  unfrequently  occurs 
in  old  people  after  severe  injuries,   and  may  even 
follow  the  administration  of  an  anaesthetic.    A3  it  had 
occurred  twice  after  the  removal  of  only  one  testicle* 
it  could  not  be  due  to  the  loss  of  any  specific  power 
exerted  by  the  testicles,  or  if  any  substance  formed  by 
them  and  excreted  into  the  circulation.    Therefore,  it 
was  not  to  be  treated  by  the  injection  of  testiculin  or 
orchitic  extract.    In  all  the  twelve  cases,  including 
that  of  the  patient  who  died  upon  the  fifth  day,  there 
was  a  distinct  diminution  in  the  obstruction  ;  and 
although  this  might,  so  far  as  the  early  days  were  con- 
cerned, be  explained  by  vascular  changes,  the  reduc- 
tion in  the  size  of  the  prostate,  as  measured  both  by 
rectal  and  urethral  examination,  was  far  too  complete 
to  be  accounted  for  in  this  way.    In  some,  the  prostate 
completely  disappeared.  Nor  wast  his  the  result  of  the 
palliative  measures  that  were  adopted  at  the  same 
time;  for,  wherever  it   was   practicable   these   had 
had  a  thorough  trial  by  themselves  first.    In  one  case, 
that  of  a  patient,  eighty  years  of  a^,  the  diminution 
in  size  when  measured  by  the  finger  in  the  rectum  was 
not  very  great,  and  voluntary  control  was  not  retrained. 
But  as  a  soft  catheter  passed  easily,  whereas  oefore 
onlv  a  metal  one  or  a  bicoud^  could  be  used,  and  that 
with  difficulty,  and  as  the  strangury,  which  had  resisted 
all  previous  treatment,  entirely  disappeared,  Mr.  Man- 
sell  Moullin  thought  the  case  could  not  be  considered 
a  failure.    It  was  never  suggested  that  removing  an 
obstruction  at  the  neck  of  the  bladder  would  be  able  to 
regenerate  the  muscular  coat,  if  this  had  been  destroyed 
by  catheterism  and  previous  cystitis.     In  another  case 
the  inflammation  of  the  bladder  persisted,  but  this 
again  was  not  the  fault  of  the  operation,  for  the  walls 
contained  numerous  sacculi^  which  could  not  be  kept 
empty.    Mr.  Mansell  Moullin  also  mentioned  one  case, 
under  the  care  of  Mr.  Manning,  of  Salisbury,  in  which 
unilateral  orchotomy  had  proved  a  very  great  success  ; 
and  discussed  the  question  as  to  the  probability  of  sec- 
tion of  the  vasa  deferentia  being  followed  by  as  good  a 
result  as  removal  of  the  testes. 


(a)  *'  Mental  Affections  of  Childhood  and  Youth,"  p.  46. 
(2>)  Abstract  of  Paper  read  before  the  Haryeian  Society,  Feb.  6th, 
1800. 


Fbb.  19,  1896 


TRANSACTIONS  OF  SOCIETIES. 


Thk  Mbdical  Pbbss.     187 


HOSPITAL   TUBERCULOSIS. 
By  M.  TERRIER, 

FbyddMi  to  the  H6pltal  Bleb«t,  Farii. 
[FBOM  OXrR  FSENCH  COBBESPONDENT.] 

The  contagiousness  of  tuberculosis  is  a  question  of 
capital  importance  in  hospital  practice.  In  many 
hospitals  tne  phthisical  are  freely  mixed  with  other 
patients.  I  consider  tuberculosis  extremely  contagious. 
Mathematical  proof  of  this  fact  cannot  be  {^ven  from 
observation  of  nospital  patients  since  the  disease  does 
not  declare  itself  until  after  di^harge  from  the  hospital, 
bat  ample  proof  is  afforded  among  hospital  nurses  and 
attendants  at  consumption  hospitals. 

Out  of  25  male  ana  female  nurses  of  the  Hdpital 
Bicbat  who  died  in  the  service,  no  less  than  20  perished 
of  tuberculosis.  The  contagiousness  is  further  proved 
by  the  number  of  pupils  and  house  surgeons  who 
develop  the  disease ;  and  it  always  manifests  itself 
most  among  those  who  work  hardest  and  remain 
longest  in  hospital.  The  laboratories  have  afforded 
striking  evidence ;  and  M.  Francois-Franck  records  the 
•cases  of  two  pupils  affected  after  experimenting 
with  desiccated  tuberculous  products.  There  can  be  no 
doubt  that  the  dust  of  apartments  where  tuberculous 
patients  remain  becomes  charged  with  bacilli.  Sus- 
pected cases  should  be  isolated,  and  in  order  to  deter- 
mine the  (juestion,  an  injection  of  tuberculine  ought 
to  be  administerea.  It  is  only  in  this  way  that  the 
dangers  of  contagion  in  hospital  can  be  guarded 
against 

^ 

^ratiBacttoitB  of  ^odetted. 

CLINICAL  SOCIETY  OF  LONDON. 
Mnnifd  HBLD  Friday,  Fxbbuabt  14th,  1806. 

The  Preaident,  Dr.  Buzzard,  in  the  Chair. 


Mb.  T.  W.  Nunn  on  a  case  of 
•chbonlo  cakcsb  op  thb  biubast  of  more  than  thirty 
years'  duration. 

The  paper  was  in  continnatioD  of  two  former  papers 
read  before  the  Society  in  1872  and  1878  respectively,  and 
recorded  in  the  sixth  and  eleventh  volume  of  the  Transac- 
tions. The  patient,  S.  C,  residing  in  Camden  Town,  was 
first  an  ont-patient  at  the  Middlesez  Hospital  in  June, 
1862,  being  then  37  years  of  ago,  mother  of  one  child. 
Menstruation  had  ceased  at  set.  ^.  There  was  a  scirrhus 
tumour  of  the  ri^ht  breast  and  a  chain  of  enlarged  glands 
in  the  axilla.  The  breast  was  removed  by  Mr.  Nunn  in 
September  following.  Four  years  later,  1866,  pain  in  the 
muscles  of  the  arms  and  in  the  fingers  was  complained  of, 
but  the  pain  after  a  short  while  pueed  off.  Patient  exa- 
mined in  1868;  no  alteration  for  the  worse.  In  1878, 
patient  examined  in  the  presence  of  the  clinical  class, 
a  very  limited  return  of  the  disease  at  the 
upper  border  of  the  cicatrix.  In  1893,  over 
more  than  thirty  years  from  the  commencement  of  the 
tumour,  Mr.  Nunn  saw  the  patient  again,  having  in  the 
mean  time  lost  sight  of  her.  There  was  an  increase  in  the 
'Cancer  deposits  which  were  in  the  form  of  flat  vein-marked 
plaques,  and  the  arm  was  swollen.  Mr.  Andrew  Clark 
took  charge  of  the  case  in  the  out-patient  cancer  depart- 
ment of  the  Middlesex  HospitaL  The  swelling  of  the  arm 
having  subsided,  the  patient  ceased  her  visits  to  the  Hos- 
pitaL In  October  of  the  just  past  year,  1895,  Mr.  Nunn 
found  the  patient  still  living  and  energetic,  and  doing 
work  as  a  charwoman.  In  December  it  was  found  that  the 
tissues  of  the  axilla  were  puckered  and  shrunken,  the  arm 
somewhat  swollen  below  the  elbow,  the  patient  having, 
however,  continued  her  occupation.  Appended  to  this 
•case  is  the  sequel  of  Case  2,  recorded  in  1878,  above  alluded 
to.  The  patient  died  a  year  after  the  date  of  Mr.  Nunn's 
paper.  The  post-mortem  revealed  secondary  deposits  on 
the  lungs  and  liver.  Drawings  of  the  microscopical  seo-  ' 
tion  of  the  breast  and  secondary  deposits  made  by  the 


late  Dr.  Lyell,  were  now  submitted  to  the  Society.  As  a 
further  illustration  of  chronic  cancer,  Mr.  Nunn  referred 
to  a  case  of  which  miorosoopical  sections  of  the  recurrent 
tumour  removed  by  him  were  exhibited  at  the  Pathological 
Society  iii  1880,  the  origiual  tumour  having  been  removed 
9even  years  previously  by  Mr.  Curling  ;  Dr.  Goodhart,  the 
late  Mr.  Marcus  Beck  and  Dr.  Rickman  Oodlee  all  having 
determined  that  the  case  was  one  of  cancer,  and  Mr. 
Lawson  operated  on  a  second  recurrence  in  1882,  and  the 
patient  ip,  or  was  until  lately,  still  living. 

Mr.  HowABD  Marsh  recalled  the  case  of  a  lady,  now  71 
years  of  age,  who  had  had  a  carcinoma  of  the  breast  almost 
continuously  for  18  years.  A  few  weeks  ago  he  had  per- 
formed the  tenth  operation  which  she  had  undergone. 
When  first  operated  upon  there  was  nothing  to  indicate 
that  the  case  would  not  run  the  ordinary  course,  the 
operation  beingfollowed  by  rapid  recurrence.  Heobeerved 
that  these  cases  served  a  useful  purpose  in  view  of  the 
statement  that  patients  in  whom  recurrence  did  npt  take 
place  within  three  years  might  be  regarded  as  cured,  for 
they  showed  that  such  was  not  always  the  cape. 

SPLENBCrOMT  FOR  RUFTURI. 

Messrs.  Bernard  Pitts  and  C.  Ballance,  brought 
forward  two  cases  of  splenectomy  for  rupture.  (7t»e  1,  was 
that  of  a  labourer,  »t  36,  who,  on  October  12th,  fell  from 
a  scaffold  on  to  an  iron  bar  which  struck  him  across  the 
left  lower  ribs.  He  was  able  to  stand  and  walk,  but  was 
very  pale.  Four  hours  later  he  became  profoundly 
coliapMd,  the  flanks  being  somewhat  bulged  and  dull, 
especially  on  the  left  side.  The  area  of  splenic  dulness 
was  greatly  increased,  not,  however,  extending  to  the 
spine.  The  same  afternoon  an  incision  was  made  in  the 
middle  line  below  the  umbilicu^i  and  on  reaching  the 
peritoneum  dark  blood  escaped.  The  wound  was  dosed 
with  a  pad,  and  another  made  four  inches  long  from  the 
left  costal  margin  two  inches  from  the  middle  line  and 
parallel  with  it.  The  spleen  was  then  found  to  be  ruptured. 
It  was  withdrawn,  ligatured  and  removed.  No  irrigation 
was  used  and  the  wounds  were  closed.  He  went  on  well 
until  mid-day  on  the  14th,  when  the  abdomen  became 
distended  and  vomiting  set  in.  On  the  16th,  in  spite  of 
enemata  and  purgatives,  nothing  had  passed  by  the  bowels, 
the  patient  was  very  thirsty  but  complained  of  no  pain, 
^e  liver  dulness,  previously  absent,  had  returned.  He 
passed  a  copious  motion  on  the  17th  with  great  relief  to 
his  symptoms.  By  November  the  patient  was  able  to  get 
up.  On  October  19th,  he  passed  72  fluid  ozs.  of  urine. 
This  decreased  during  the  next  few  days.  Between 
October  26th  and  November  Ist  large  quantities  were 
passed  (70  to  101  oz.).  During  the  increased  flow  there 
was  a  distinct  increase  in  the  urea.  On  November  9th 
the  hasmoglobin  showed  43  per  cent  of  normal.  On 
October  14th  the  temperature  gradually  rose  to  100*8'  F. 
During  the  15th  and  16th  it  fell  to  subnormal,  rising 
aeain  on  the  26th  to  100 '8^.  It  continued  to  oscillate 
above  and  below  100**  until  November  5th,  then  it  fell  to 
97^  F.  For  the  next  three  days  it  was  normal  in  the 
morning,  rising  in  the  evening  to  about  100°.  On  November 
9th,  it  was  101%  and  on  the  10th  101 -4%  The  changes  in 
the  blood  were  well-marked,  the  decrease  in  the  red  cells 
and  the  increase  in  the  white  being  constant.  There  was 
loss  of  weight  during  November  and  the  early  part  of 
December.  One  month  after  the  accident  he  had  lost 
421b8.  in  weight.  A  gradual  gain  in  weight  and  an  im- 
provement in  his  appearance  were  coincident  with  the 
improvement  in  the  relative  proportion  of  red  and  white 
corpuscles.  The  treatment  was  at  first  cod-liver  oil  and 
iron,  the  quantity  of  fat  in  his  food  being  simultaneously 
increased.  On  November  29th,  treatment  by  arsenic  was 
commenced  and  progress  towards  convalescence  at  once 
became  satisfactory,  the  daily  rise  of  temperature  ceasing. 
He  left  the  hospital  on  December  18th,  and  reported 
himself  on  January  17th,  looking  remarkably  well.  His 
weight  then  was  128t.  61b.,  the  same  as  before  the  accident. 
He  was  examined  in  February  for  enlarged  glands.  The 
axillary  glands  were  found  to  be  enlarged,  and  the  cervi- 
cal  and  groin  glands  could  also  be  felt.  No  enlargement 
of  the  mesenteric  glands  could  be  made  out. 

Cast  2. — A  lad,  »t.  10,  was  admitted  on  September  11th, 
at  4,30  p.m.,  collapsed  and  evidently  suffering  from  severe 
shock.  He  was  pale  and  the  skin  was  clammy,  respiration 
hurried  and  diaphragmatic.  The  abdomen  was  held 
rigidly  during  respiration  and    was  acutely  tender  to 


188 


Tus  Medical  Pkels. 


TRANSACTIONS  OF  SOCIETIES. 


Feb.  19,  1806. 


palpation,  especially  in  the  pplenic  and  iliac  region?. 
Dulneea  in  both  flanks,  that  in  the  left  flank  varying  with 
position.  After  oscillating  a  good  deal,  operative  interfer- 
ence became  imperative,  so  the  abdomen  was  opened  below 
the  umbilicus.  On  opening  the  peritoneum,  much  liquid 
blood  poured  out  and  an  incision  was  made  in  the  upper 
part  of  the  iinea  semilunaris.  Blood  and  clots  wellea  up 
and  on  examining  the  spleen  it  was  found  to  be  ruptured. 
A  ligature  was  therefore  applied  and  the  organ  removed, 
a  spleniculon  foeine  found  and  left  in.  The  lad  made  a 
|;ood  recovery  and  left  the  hospital  on.October  4th.  The 
mjury  was  caused  by  a  blow  with  a  cricket  ball  flve  days 
before  admission,  so  that  his  condition  on  admission  was 
due  to  secondary  htemorrhage  from  the  spleen. 

Ccue  3.  —A  woman,  st.  45,  was  admitted  on  September 
15th,  having  been  run  over  by  a  cab.  She  was  extremely 
collapsed,  and  complained  of  intense  pain  in  the  left  side. 
A  catheter  was  passed  and  a  little  blood  and  urine  was 
withdrawn.  The  abdomen  was  opened  in  the  middle  line 
when  much  bloody  fluid  escaped.  Another  incision  was 
then  made  in  the  upper  part  of  the  left  Iinea  semilunaris, 
and  the  spleen  was  found  to  be  transversely  ruptured.  It 
was  removed,  the  pedicle  being  tied  with  silk.  About  a 
fortnight  after-  the  operation  her  condition  grew  worse, 
the  temperature  rose  to  102**  every  day,  the  pulse  was  rapid, 
and  her  general  condition  was  one  of  extreme  feebleness. 
There  was  a  diminution  of  red  cells  in  the  blood  and  an 
increase  of  leucocytes.  This  state  continued  for  about  a 
fortnight,  when  she  was  put  on  extract  of  spleen  and  raw 
marrow.  From  this  date  she  gradually  improved,  and 
by  November  19th,  she  was  able  to  walk  down  stairs  with- 
out assistance. 

Mr.  SiLoocK  asked  whether  the  spleen  was  actually 
bleeding  at  the  time  of  removal.  In  the  second  case, 
judging  from  the  specimen,  the  actual  wound  in  the 
spleen  seemed  to  have  been  small,  and  removal  struck  one 
as  possibly  a  rather  heroic  proceeding.  It  occurred  to 
him  that  possibly  hamorrhage  might,  in  some  cases,  be 
checked  by  means  of  the  actual  cautery.  Cases  of  ruptured 
spleen  often  get  well  by  themselves,  for  in  his  post-mortem 
experience  he  had  met  with  deep  cicatrices  pointing  to 
spontaneous  repair  of  ruptures  of  the  spleen. 

Sir  Dtce  Duckworth  observed  that  they  had  not  much 
experience  of  the  efiects  of  removal  of  the  healthy  spleen 
in  the  human  being,  though  it  was  sometimes  removed  in 
splenic  leukaemia,  Hodgkin's  disease,  but  with  an  almost 
uniformly  fatal  result.  It  would  be  a  valuable  appendix 
to  these  notes  if  the  authors  would  give  the  subsequent 
history  of  the  patients. 

Mr.  Wallis  had  also  failed  to  gather  from  the  papers 
whether  there  was  actual  haemorrhage  at  the  time  of 
operation.  It  was  undoubtedly  a  valuable  proceeding  to 
open  the  abdomen  to  let  out  the  blood  and  clots,  but  he 
wished  to  know  exactly  why  it  was  deemed  necessary  to 
remove  the  organ.  At  post-mortems  on  patients  who 
had  succumbed  after  injuries  of  this  kind,  he  had  often 
seen  considerable  attempts  at  repair. 

Dr.  MoTT  pointed  out  that  the  spleen  was  subject  to 
rhythmical  movements  which  would  render  it  more  liable 
to  secondary  hsemorrhaee  than  certain  other  orsrans. 

Mr.  Ballangb,  in  leply,  said  the  patient  in  Case  2  was 
still  bleeding,  the  rupture  involving  the  vessels  of  the 
hilnm,  so  that  he  did  not  see  what  else  there  was  to  do.  He 
operated  in  Case  2  for  secondary  haemorrhage  from  the 
spleen. 

Mr.  Pitt,  in  reply,  said  the  number  of  cases  of  ruptured 
spleen  he  had  seen  post-mortem  after  removal  was  very 
small  compared  with  the  fatal  cases  in  which  death  had 
taken  place  as  a  consequence  of  the  haemorrhage.  They  had 
laid  stress  upon  the  fact  that  the  spleen  ought  not  to  be 
lightly  removed.  Their  experience  of  the  removid  of 
wanderiDf?  spleen  has  been  that  no  special  symptoms 
followed  the  operation.  In  Case  3  the  patient  was  practi- 
cally moribund,  and  the  abdomen  was  as  full  of  blood  as  it 
could  be.  When  practicable,  he  would  prefer  suture  of 
the  tear  to  the  actual  cautery.  The  latter,  morever. 
necessitated  pulling  the  spleen  out  of  the  abdomen,  ana 
he  did  not  think  it  would  oe  a  scientific  or  a  satisfactory 
procedure.  He  promised  that  they  would  do  their  best  to 
obtain  the  subsequent  histories  of  these  patients. 

TWO  CASES  OF  PNEOMOTHOBAX  IN  THE    00X7BSB  OF  TYPHOID 
FEVEB,    BOTH   DUB  TO  STRAINING  AT  STOOL. 

Dr.  Hale  White  read  notes  of  these  two  cases.    The 


first  patient,  a  young  man,  set.  19,  had  an  ordinary  attack 
of  typhoid  fever  followed  by  a  very  severe  relapse-  He 
was  convalescing  from  this  when  on  the  41st  day  while 
the  bowels  were  being  open  after  an  enema  he  suddenly 
became  collapsed,  livid,  bathed  in  perspiration,  and  almost 
pulseless.  For  some  time  previous  to  this  he  had  all  the 
physical  signs  of  a  little  fluid  at  the  left  base,  and  ae 
immediately  after  the  attack  of  collapse  it  was  found  that 
he  had  all  the  si^ns  of  left  pneumo-thorax  it  was  con- 
cluded that,  whilst  straining,  the  pleura  weakened 
by  inflammation  had  ruptured.  The  chest  was 
aspirated.  Seven  ounces  of  non-purulent  fluid  with 
flakes  of  lymph  floating  about  in  it  were  withdrawn. 
The  patient  improved  somewhat,  but  died  three  days 
later.  The  second  case  was  that  of  a  boy,  aet.  12, 
who,  in  the  fifth  week  of  his  illness,  after  a  severe 
attack  of  typhoid  fever  developed  the  general  and  local 
signs  of  a  localised  empyaema  at  the  right  base.  An 
explorinfr  needle  failed  to  withdraw  pus,  but  the  next  dav 
he  coughed  some  up;  as  the  temperature  did  not  fall, 
arrangements  were  made  for  the  empyaema  to  be  opened 
externally,  but  two  hours  before  the  time  fixed  for  this, 
while  his  bowels  were  being  opened,  the  boy  suddenly 
became  extremely  collapsed  and  livid,  and  developed  aU 
the  signs  of  right  pneumothorax.  He  appeued  almost 
dead,  and  was  quite  insensible,  but  oxygen  inhalations 
seemed  to  keep  him  just  going.  The  right  chest  was 
opened,  where  from  the  physical  signs  it  appeared  pro- 
bable that  fluid  was  present,  and  twelve  ounces  of  foul 
pus  escaped.  It  was  done  without  an  anaesthetic,  and 
the  boy  was  so  far  gone  that  he  never  flinched.  After  the 
operation  he  gradually  regained  consciousness,  and  was 
ultimately  discharged  from  the  hospital  quite  well.  Here 
probably  the  localised  empyaema  which  had  burst  into  the 
long  ruptured  into  the  general  pleural  cavity  during 
straining,  and  hence  the  pneumothorax. 

Dr.  GooDHABT  read  notes  of  the  case  of  a  man,  aet.  24, 
who  was  sent  to  him  by  Dr.  Qualtrough,  of  HoUoway,  on 
May  7,  1891.  He  had  had  a  slight  attack  of  pleurisy  in 
1891,  and  returned  to  work  after  a  stay  at  the  seaside. 
He  said  he  had  had  flying  pains  about  his  chest  for  some 
time,  and  for  a  week  previously  had  felt  puffy  in  his  breath- 
ing on  running  upstairs.  When  he  saw  him  he  was  pallid 
and  short  of  breath,  with  well-marked  pneumothorax  on 
the  right  side,  the  heart  being  displaced  to  the  left.  He 
went  into  the  country  for  a  couple  of  months,  and  returned 
having  gained  16  lbs.  in  weight,  and  being  in  all  respects 
quite  well.  On  July  5th,  18^,  he  came  again  with  a 
I  pneumothorax  on  the  left  side,  which  had  come  on  sud- 
denly. He  said  he  had  had  as  before,  flying  pains  about  his 
shoulders  and  chest.  The  heart's  beat  was  displaced  to  the 
epigastrium  and  the  dulness  reached  to  the  right  of  the 
sternum.  As  on  the  former  occasion  there  was  no  real  dis- 
tress, and  he  considered  himself  quite  well.  He  remained 
well  during  the  autumn  and  winter,  and  when  he  saw  him 
again  there  was  no  diff^erence  between  the  two  sides  of 
the  chest.  The  interest  of  this  case  lay  in  the  pneumo- 
thorax occurring  first  on  one  side  and  then  on  the  other, 
in  both  instances  apparently  without  adequate  cause,  also 
that  the  air  was  rapidly  absorbed  on  both  sides  without 
giving  rise  to  any  evidence  of  pleuritic  disturbance.  The 
rupture  of  an  emphysematous  oleb  was,  he  thought,  the 
most  plausible  explanation  of  the  occurrence. 

Dr.  Habebshon  remarked  that  of  the  cases  of  pneumo- 
thorax at  Brompton  at  least  90  per  cent,  were  due  to  tuber- 
culous disease,  but  a  large  majority  of  the  remainder  were 
due  to  rupture  of  an  emphysematous  bleb.  Not  long  since 
he  had  performed  a  post-mortem  examination  in  such  a  case. 
He  remembered  a  case  of  recnirent  pneumothorax  which 
returned  to  the  hospital  several  timep,  and  he  thought  that 
probablv  in  this  case  the  condition  was  also  due  to  rupture 
of  such  blebs. 

Sir  Dyoe  Duckworth  pointed  out  that  the  last  stagee 
of  very  bad  cases  of  enteric  fever  were  accompanied  by 
pvaemic  symptoms  associated  with  the  presence  of  scattered 
abscesses  in  the  lungs.  Possibly  the  rupture  of  these 
abscesses  into  the  pleura  might  account  for  pneumothorax 
in  such  cases.  He  pointed  out  also  that  the  presence  of 
emphysema  in  young  people  was  quite  exceptional,  and 
though  emphysema  in  older  people  was  common,  rupture 
was  rare. 

Dr.  Hale  WmTS,  in  reply,  said  that  he  had  met  with 
cases  in  which  the  rupture  of  emphysematous  blebs  bad 


FsB.  19,  1896. 


TEANSACTIONS  OF  SOCIETIES. 


Thk  Mbdioal  Pbess.     189 


given  rise  to  pneumothorax.  He  doubted,  however, 
whether  this  was  no  in  the  first  case,  for  there  bad  been 
actual  pleurisy,  and  the  thickness  of  the  lymph  deposit 
would  presumably  tend  to  strenf^then  the  pleura  and  so 
check  any  tendency  to  rupture.  In  the  second  case  it 
was  possible  that  Sir  Dyce  Duckworth's  explanation 
might  hold  good,  especially  as  there  was  empyema.  He 
remembered  a  fellow  student  who  got  pneumothorax 
while  suffering  from  pleuro-pneumonia.  He  recovered 
and  had  been  quite  well  ever  since. 


LIVERPOOL    MEDICAL    SOCIETY. 
MxBTiNG  HSLD  Thubsday,  Febsuaby  13th,  1896. 


The  President,  Db.  Caton,  in  the  Chair. 


AN  INQUIBY  INTO  CANCEB. 

Db.  E.  T.  Davies  proposed  the  following  resolution  : — 

1.  That  in  view  of  the  inadequate  information  possessed 
by  the  medical  profession  as  to  the  value  of  operative 
procedure  in  cancer,  it  is  desirable  that  relevant  statis- 
tics should  be  requested  from  the  various  hospital  autbor- 
itiea  of  this  city,  submitted  to  a  committee  of  this  insti- 
tution,  and   reported  upon   at   a  subsequent    meeting. 

2.  That  a  copy  of  this  resolution  be  forwarded  to  the 
eecretary  of  eacn  hospital  and  infirmary. 

Dr.  Cabteb  seconded  the  resolution — he  never  advised 
operation  in  pyloric  cancer,  and  pointed  out  discrepancies. 

After  a  discussion,  in  which  Drs.  Barr  and  Imlach  and 
Mr.  Paul  took  part,  the  motion  was  put  to  the  meeting 
and  lost  by  a  large  majority. 

THE  NEW  FHOTOGBAPHY. 

Mr.  RoBEBT  Jones  showed  a  photograph  taken  for  him 
by  Professor  Oliver  Lodge,  in  the  case  of  a  boy  shot  in  the 
hand.    The  photograph  very  accurately  demonstrated  the 

Ewition  of  the  bullet.    It  was  situated  opposite  the  articu- 
tion  of  the  os  magnum  with  the  metacarpal  bone. 

Mr.  Paul  read  a  paper  on 

the  suboical  tbeatment  of  oall  stones. 

Nine  cases  were  recorded,  all  of  which  recovered.  The^p 
all  occurred  in  women,  and  the  average  duration  of  sym- 
ptoms of  gall  stone  before  operation  was  nine  jears.  In 
four,  the  gall  bladder  was  in  a  fairly  healthy  condition. 
In  two,  it  was  distended  to  form  a  large  tumour.  In  one, 
distended  and  inflamed.  In  one,  absent,  the  stones 
being  in  the  common  duct ;  and  in  one,  the  ducts  were 
dilated  up  into  the  liver,  where  the  stone  receded,  and  it 
was  necoFsary  to  do  cholecystotomy,  for  which  a 
Murphy's  button  was  used.  Mr.  Paul  thought  cholecy- 
stotomy for  gall  scone  the  best  operation  that  had  been 
introduced  into  surg^rv  during  recent  times. 

Dr.  Maoalistbb  read  a  paper  on 

the  physical  btfbots  of  thobacio  effusions, 
in  vhich  he  related  the  results  of  clinical  and  experimen- 
tal observations  having  reference  to  the  explanations  of 
some  of  the  physical  signs  of  the  visceral  displacements. 
He  indicated  that  in  acute  cases  the  dyspnoea,  immobility 
of  the  side,  and  diminished  conduction  of  the  breath 
sonnds  are  mainly  the  result  of  the  incapacitation  of  the 
diaphragm  by  the  pressure  of  the  fluid  upon  ir.  The 
cardiac  displacements  were  shown  to  be  due  to  the 
prassnre  of  the  accumulated  liquids  and  the  lowering  of 
the  heart  to  be  probably  related  to  the  way  in  which 
the  pleura  distends,  superiorly  where  it  crosses 
the  middle  line-  and  overlays  the  heart.  The  ana- 
tomy of  the  displaced  organ  was  referred  to 
and  its  relation  to  the  lung  on  the  healthy  side. 
The  infrequency  of  any  palpable  depression  of  the  spleen 
in  cases  of  left-sided  efi^usions  was  explained  by  the 
manner  in  which  the  diaphragm  becomes  depressed.  A 
marginal  cul-de-sac,  near  its  attachment  to  the  ribs, 
remains,  in  which '  the  head  of  the  spleen  lies,  and  it  so 
remains  uninfluenced  by  the  super-incumbent  pressure. 

Dr.  Abbam  said  he  had  listened  to  the  paper  with  great 
interest.  He  could  not  agree  with  Dr.  Macalister's  con- 
clusions. He  agreed  with  Traube,  Vurordt,  Douglas 
Powell,  and  others,  that  there  is  a  certain  amount  of  trac- 
tion by  the  lungs  upon  the  mediastinum,  due  to  the  fact 
that  they  are  kept  in  a  slight  amount  of  dis- 
tention    by     the     pull     of     the     chest     wall.      This 


slight  distension  is  an  indubitable  fact.  It  fol- 
lowed, he  thought,  that  the  first  result  of  an  efl'usion 
into  the  pleura  was  to  neutralise  the  traction  of  the  cor- 
responding lung  upon  the  mediastinum,  and  to'allow  that 
exerted  by  the  lung  of  the  opposite  side  to  pull  the  heart 
te  the  sound  side.  Later,  actual  pressure  was  exerted  by 
the  efl'usion,  and  the  heart  was  now  pushed  over,  and  the 
diaphragm  depressed.  He  considered  diminution  of 
Traube's  space  to  be  significant  of  a  considerable  effusion. 

Dr.  Buchanan  recognised  the  importance  of  Dr.  Mac- 
alister's  investigations,  but  took  exception  te  the  method 
of  experiment,  m  that  the  introduction  of  fluid  into  an 
indiarubber  bag  placed  in  the  pleural  cavity  could  not 
perfectly  represent  what  would  take  place  were  fluid 
injected  into  the  pleural  cavity  itself.  As  the  pressure 
under  which  pleural  exudations  accumulate  is  not  always  the 
Fame,  and  undeterminable,  alteration  in  respiration  must 
also  vary  in  different  cases  ;  the  inflammatory  nature  of 
pleuritis  with  exudation  would  certainly  produce  dyspnoea, 
in  proportion  to  its  weakness.  Pleural  exudation  must  be 
much  slower  even  in  what  are  called  "  rapid  "  cases,  and 
in  Dr.  Macalistor's  method  of  injecting  fluid  in  a  compara- 
tively sudden  manner,  however  small,  one  would  expect 
a  sudden  dyspnoea.  Cases  of  extensive  pleuritic  exudation 
are  not  uncommon,  in  which  dyspnoea  is  not  at  all  a 
marked  symptom.  Dr.  Macalister's  stetement  that  the 
extent  of  the  alteration  of  percussion  note  was  due  to  the 
area  of  lung  covered  by  fluid,  and  not  proportionate  to 
the  amount  of  fluid,  being  very  considerable  In  small 
exudations  could  hardly  be  accepted  unless  the  lungs 
were  prevented  from  contracting  by  the  pressure  of  ad- 
hesions. The  loss  of  breath  sounds  on  auscultation  could 
not  be  principally  due  to  the  diminished  action  of  the  dia- 
phragm irrespective  of  the  amount  of  fluid,  for  by  sur- 
rounding a  normal  thorax  with  a  water  cushion,  the  dia- 
phragm working,  all  sounds  are  greatly  diminished. 

Mr.  Thelwall  Thomas  related  an  instance  of  displace- 
ment of  the  spleen  into  the  iliac  fossa,  by  a  large  thoracic 
effusion,  empysema.  It  was  a  case  that  had  been  sent  to 
the  Womeii'd  Hospital  for  **  tumour,"  from  whence  she 
was  transft  rred  to  the  Royal  Infirmary,  under  Dr.  Glynn> 
at  whose  request  the  empysema  v^as  opened. 

Drs.  Glynn,  Barr,  and  Carter,  and  Mr.  Damer  IHarrison 
also  took  part  in  the  discussion. 


SHEFFIELD   MEDICO-CHIRURGICAL   SOCIETY. 
Meeting  held  Thursday,  Januaby  16th,  1896. 

The  President,  Dr.  Pobteb,  in  the  Chair. 

cases. 

Mb.  Simeon  Snjill  introduced  a  middle-aged  man  with 
Extreme  Myosis  on  one  side,  and  Argyll  Robertson  and 
Ophthalmoplegia  Interne  on  the  other.  There  was  an 
absence  of  knee-jerks  and  other  symptoms  suggestive  of 
locomotor  ataxy.  A  recent  blow  on  the  forehead  had 
caused  attention  to  be  directed  to  the  eyes,  but  the  con- 
ditions mentioned  were  of  old  standing. 

Dr.  Keeling  showed  a  Drrmoid  Ovarian  Cyst  recently 
removed  from  a  young  woman,  »t.  20,  at  the  Jessop 
Hospitol.  The  right  ovary  was  found  also  diseased  and 
removed  at  the  same  time  ;  on  section  it  shows  commenc- 
ing dermoid  change. 

Mr.  Sandham  Symes  introduced  a  case  of 
bbtbntion  op  ubixb. 

H.  L.,  set.  about  50,  was  admitted  to  Chesterfield 
Hospital  suffering  from  retention,  the  urine  being  only 
passed  by  drops.  About  four  years  ago  he  was  a  patient 
suffering  from  an  injury  of  perinseum  and  laceration  of 
urethra.  I  was  then  able  to  pass  a  catheter  and  kept  one 
in  until  the  swelling,  &a,  had  passed  away,  two  small 
incisions  were  then  made  in  perinseum.  The  man  left  the 
hospitol  quite  recovered.  No.  i2  sound  introduced  with- 
out difficulty.  He  was  told  to  come  to  hospitol  once  a 
week  to  have  an  instrument  passed.  I  believe  he  only 
came  twice.  On  re-admission,  the  bladder  was  distended 
almost  to  umbilicus,  the  urine  coming  drop  by  drop.  The 
case  had  been  considered  as  one  of  incontinence  for  many 
months.  After  many  efforts  a  soft  No.  2  catheter  was  passed 
through  a  very  tight  stricture  and  into  the  bladder,  pass- 
ing over  some  rough  surface.    A  quantity  of  wator  was 


190     Thb  Mbdioal  Pbsss. 


GERMANY. 


FxB.  19,  1896. 


drawn  off,  then  the  inetnimAnt  became  blocked.  A  soand 
passed  tbroaeh  the  strictare  at  onoe  proved  the  presence 
of  calculus.  I^ext  day  the  patient  was  placed  in  lithotomy 
position,  a  staff  passed  to  stricture  and  an  incision  made 
down  to  stricture,  after  cutting  some  bands  of  stricture 
the  stone  slipped  back  into  blMlder  and  it  was  necessary 
to  do  a  median  lithotomy. 

Mr.  FuETOHBB  gave  particulars  of  a  case  of  Obstruction 
of  the  Left  Bronchus  due  to  a  Foreign  Body.  The  patient, 
a  man,  set.  59,  while  at  dinner  was  attacked  by  sudden 
dyspnoBa.  The  foreign  body,  which  proved  to  bNe  a  frag- 
•ment  of  bone,  completely  obstructed  the  left  bronchus,  no 
air  entering  the  left  lung.  The  symptoms  not  being 
urgent,  tracheotomy  was  not  performed.  Physical  signs 
of  consolidation  appeared  at  the  left  base  behind  in  two 
•days,  the  temperature  rising  to  103**.  On  the  7th  day,  the 
patient  coughed  up  the  foreign  body.  After  the  relief  of 
the  obstruction,  recovery  was  speedy  and  complete,  and 
the  patient  was  discharged  well  on  the  10th  day. 
Mebtino  ubld  Thubsdat,  Jan.  30th. 

1.  Dr.  PoBTBB  showed  a  case  of  (?)  Raynaud's  disease. 
Symmetrical  gangrene  had  been  threatened  in  both  hands 
and  feet.  The  feet,  however,  had  recovered,  and  only  the 
tips  of  some  three  fingers  on  each  hand  now  seemed  likely 
to  be  lost.  There  was  no  history  of  crises,  or  h»moglo- 
binuria. 

2.  Dr.  Arthur  Hall  showed  a  case  of  Xanthoma.  Mr, 
-Snkll  made  remarks. 

Mr.  Barker  Bauber  showed  a  case  of  out-growing 
tenth  costal  cartilage — probable  cause,  rickets.  iRie  Pre- 
sident and  Dr.  Littlejohn  made  remarks. 

3.  Dr.  Alfred  Robinson  re^d  short  notes  on  a  fatal 
case  of  Chorea  Gravidarum."  Remarks  by  the  President, 
Dr.  R.  Favell,  Dr.  Burgess,  and  Dr.  Martin. 

4.  Dr.  Harvey  Littlejohn  read  a  paper  entitled  "  Six 
Years  Notification  of  Infectious  Diseases  in  Sheffield." 
Remarks  were  made  by  the  President,  Mr.  Edward 
Barber,  Drs.  Samuel  Mathews,  Alfred  Robinson,  Mr. 
West  Jones,  Dr.  Martin,  Dr.  Stokes,  Mr.  Harvey,  Dr. 
Hargreaves,  and  Dr.  Burman. 


Jlranct. 


[from  our  own  oorrespovdbnt.] 

Paris,  Feb.  18th,  1896. 
Artificial  Serum. 
M.  Lejars  has  published  an  interesting  article  which 
•merits  the  attention  of  practitioners.  He  relates  a  case  of 
difi'used  peritonitis  from  rupture  of  the  intestine,  followed 
by  a  flow  of  stercoral  and  purulent  matter  into  the  cavity. 
The  condition  of  the  patient  was  despaired  of  by  the  sur- 
geons in  attendance,  in  spite  of  laparotomy,  which  bad  been 
performed  as  soon  after  the  accident  as  it  was  possible. 
As  a  last  resource,  and  for  conscience  sake,  a  pint  of  arti- 
-ficial  serum  was  injected  into  the  subcutaneous  tissue.  The 
following  day  the  patient  was  somewhat  worse, .  the  pulse 
was  frequent  (l30)  and  irregular,  the  temperature  below 
the  normal,  and  black  vomiting  set  in  towards  evening. 
The  subcutaneous  injections  were  renewed  morning  and 
evening.  Twenty-four  hours  afterwards,  the  temperature 
rose  to  102^,  while  the  urine  was  rare.  M.  Lejars,  at  this 
stage,  injected  two  pints  of  the  serum  into  the  vein  of  the 
arm.  The  pulse  became  a  little  stronger,  and  the  patient 
expressed  himself  as  feeling  better.  Two  other  intra- 
venous injections  were  made  that  same  day,  and  continued 
at  the  rate  of  three  daily  for  four  subsequent 
days.  The  general  condition  constantly  improved 
nnder  this  treatment.  After  an  interruption  of 
two  or  three  dajs  the  injections  were  renewed  as 
the  condition  of  the  patient  became  less  satisfactory, 
4)ut  on  the  ninth  day,  they  were  suppressed  altogether. 
Consequently,  in  the  lapse  of  nine  days,  the  patient  re- 
ceived forty-five  pints  of  artificial  serum  !    The  patient  was 


saved  in  spite  of  an  accident  which  might  have  seriously 
complicated  the  situation.  On  the  tenth  day,  through  an 
effort  at  coughing,  the  line  of  sutures  burst,  and  the  maas 
of  intestines  bulged  forward  through  the  wound,  covered 
only  by  the  peritoneum. 

Two  other  cases  were  related  by  M.  Lejars  witnessing  in 
favour  of  intravenous  injections  of  artificial  serum,  and 
from  which  he  drew  the  following  conclusions  : — ^Intra- 
venous injections  of  aseptic  serum  at  blood  temperature 
and  in  massive  doses  (two  pints  three  times  daily)  are  in- 
offensive ;  these  injections  are  capable  of  bringing  about 
most  unhoped  for  cures  in  certain  affections,  especially 
those  interesting  the  peritoneum ;  the  injections  seem  to 
act  by  provoking  large  evacuations  of  the  toxines  of  the 
blood,  through  the  kidneys. 

The  author  terminates  his  article  by  giving  a  description 
of  the  modutfaciendi,  "  Our  method  of  operating  is  very 
simple.  We  use  a  glass  recipient  properly  sterilised,  and 
a  glass  cannula  with  a  fine  point ;  the  vein  is  dissected 
through  a  small  incision  tied  and  opened  with  every  anti- 
septic precaution  above  the  ligature,  and  the  cannula 
introduced,  care  being  taken  not  to  let  in  a  bubble  of  air. 
By  raising  the  recipient  the  liquid  enters  by  its  own 
weight ;  a  certain  thrill  felt  by  the  finger  indicates  that 
the  solution  is  penetrating.  At  the  end  of  the  operation 
the  vein  is  tied  above  the  wound  and  the  skin  brought 
together  by  two  sutures.  At  the  second  injection  a  seg- 
ment immediately  superior  of  the  same  vein  is  opened  or 
one  of  the  neighbouring  veins.  In  proceeding  thus  by 
segments  from  below  upwards  from  the  bend  of  the  elbow 
to  the  shoulder,  on  the  superficial  veins,  quite  a  series  of 
injections  can  be  made,  clots  being  entirely  exceptional. 
In  the  case  above  related  in  detail  more  than  twenty  injec- 
tions had  been  made  in  both  arms. 
'*It  might  be  possible  to  pierce  the  vessel  directly  with  the 
point  of  the  canula,  if  it  were  standing  out  in  bold  relief, 
but  it  must  be  remembered  that  the  oases  where  theee 
injections  are  useful  the  veins  are  frequently  fiaccid.  Out 
of  fifty  intravenous  injections  we  never  observed  the  slight- 
est accident,  nor  have  we  remarked  that  the  operation 
was  painful.  Sometimes,  however,  we  observed  a  little 
dyspncBa  at  the  end  of  the  injection.  The  patients  feel  the 
liquid  penetrating  they  experience,  at  first,  an  irritation 
of  the  tongue  and  mouth,  then  a  difficulty  in  breathing 
and  finally  a  sharp  abdominal  pain  of  short  duration,  all 
theee  sensations  proving  that  the  liquid  was  being  rapidly 
diffused.  As  to  the  liquid,  the  useful  formula  of  Prof. 
Hayem  : — 

Chloride  of  sodium  (pure),  5j ; 
Sulphate  of  soda,  5ij ; 
Distilled  water,  IJ  pints. 

'*  The  question  of  intravenous  injections  as  applied  to 
certain  diseases  is  still  on  its  trial,  but  in  my  opinion  we 
have  here  a  therapeutic  method  of  considerable  value  in 
the  great  struggle  with  death." 


[from  our  own  oorrbspondknt.] 

fisauN.  Feb.  Utb. 
At  the  last  meeting  of  the  Medical  Society  Hr.  Laevin- 
showed  a  case  of 

Congenital  Synophthalmia. 
The  child  was  the  sixth  from  a  woman  who  had  given 
birth  to  five  healthy  children.    It  was  bom  alive  at  the 


Fn.  19,  1896. 


AUSTRIA. 


Thb  Medical  Pbbss.     191 


•eighth  month,  the  laboar  being  completed  naturally,  bat 
eolj  lived  a  minute.  There  was  an  abnormality  of  the 
anterior  oerebmm.  In  the  median  line  of  the  frontal  bone, 
where  the  bridge  of  the  nose  oomes,  was  a  cavity  in  which 
the  two  eyes  the  development  of  which  was  arrested,  could 
be  distinguished.  They  presented  the  appearance  of  the 
so-called  cydops  or  [synophthalmia.  The  two  eyes  were 
separated  from  each  other  about  half  a  centimetre.  The 
cavity  was  surrounded  by  two  folds  that  could  be  recog- 
nised as  the  later  eyelids.  There  was  also  hydrocephalus 
and  also  dropsy  of  the  amnion  on  the  part  of  the  mother. 

Hr.  Rothmann  showed  a  preparation  of 
Twisting  of  thx  Colon, 
taken  from  a  young  woman  of  22.  The  father  had 
soflfersd  from  obstinate  constipation.  The  patient  also 
saffered  from  eonntipation  that  gradually  became  worse. 
In  the  summer  of  1894  she  had  an  attack  that  lasted  six 
days,  with  great  sacral  pain.  Relief  was  obtained  by 
means  of  repeated  enemata  of  oil  and  water.  In  December 
of  the  same  year  she  had  a  similar  attack.  The  speaker 
eonduded  that  the  case  was  one  of  ooprostasis  from  stenosis 
of  the  Urge  intestine.  With  careful  dieting  the  patient 
got  through  another  year  fairly  well,  but  with  occasional 
attacks.  The  last  attack  was  in  December,  1895.  On 
Janaary  20:h  the  speaker  was  called  to  her,  as  the  bowels 
had  not  been  opened  for  eight  days,  and  all  attempts  to 
effect  an  evacuation  failed.  Vomiting  came  on,  and  on 
the  third  day  Dr.  Korte  was  called  in.  As  the  patient  had 
then  to  be  removed  to  Hr.  Korte's  klinik,  opium  was 
given,  and  the  operation  was  performed  the  same  day. 
First  of  all  the  c»cum  was  opened,  to  give  exit  to  the  col- 
lected feces.  The  narrowed  part  was  next  sought  for. 
Doring  the  night  the  patient  became  collapsed,  and  died 
the  following  day.  Even  at  the  operation  a  much  dis- 
tended blue-red  coloured  piece  of  large,  intestine  appeared 
at  the  wound  opening.  At  the  autopsy  the  left  half  of  the 
abdomen  was  found  to  be  filled  with  blueish-red  folds  of 
large  intestine,  whilst  the  right  half  was  occupied  by  small 
intestine.  The  narrowing  was  not  at  the  cacum,  but  at 
the  right  flexure  of  the  colon,  and  was  caused 
by  twisting  of  the  bowel  From  this  point 
was  a  part  distended  to  the  size  of  a  distended  stomach, 
and  below  this  another  point,  the  axis  of  which  was  also 
twisted,  and  below  this  normal  rectum.  It  was  concluded 
that  there  was  congenital  lengthening  of  the  meso-colon 
that  allowed  of  rotation,  and  that  a  subsequent  attack  of 
peritonitis  had  permitted  adhesions  to  be  formed  in  such 
a  way  that  the  bowel  could  not  return  to  the  normal 
direction. 

Hr.  Aronsohn  showed 

Phthisical  Lungs  from  a  Gk>AT. 

This  was  the  first  time  successful  inoculation  of  a  goat 
with  tubercle  bacilli  bad  ever  been  performed.  The 
animal  had  been  under  observation  a  long  time,  and  had 
already  been  the  object  of  experiment.  In  May,  1893,  it 
had  injected  2  ccm.  of  tubercnline,  and  these  doses  were 
gradually  increased.  In  October  of  the  same  year,  30  ccm. 
<A  a  pore  preparation  of  tubercle  bacilli  were  injected  into 
the  teat,  and  in  the  following  month,  other  injections  were 
made  in  quantities  of  45  to  150  ccm.  In  May,  1885,  200 
«cm.  were  given.  The  animal  lost  weight,  but  otherwise 
It  leemed  well,  with  the  exception  of  an  evening 
n«  of  temperature.  In  July,  1895,  a  large  quan- 
tity of  blood  was  withdrawn,  and  this  was 
followed  by  rapid  changes  ;  a  sort  of  hectic 
^  in.    The  animal  emaciated,  and  in  six  weeks  after  the 


venesection  it  died.  The  rapid  course  was  a  proof  of  the 
influence  of  debilitating  influences  in  the  origination  of 
phthisis.  Hr.  Virchow  remarked  that  no  doubt  had  ever 
been  thrown  as  to  the  tubercular  nature  of  phthisis,  but 
only  the  observation  had  been  made  that  there  were  other 
forms  of  the  disease  which  might  be  bacillary  without 
being  tuberculous. 

Hr.  Aronsohn  said  that  he  only  had  an  earlier  expression 
of  Liebreich's  in  his  mind  to  the  effect  that  the  essence  of 
phthisis  should  not  be  sought  in  the  tuberculosis,  but  in 
other  accidents.  He  did  not  doubt  that  phthisis  arose  in 
other  ways,  he  had  only  attempted  to  prove  that  typical 
phthisis  might  be  set  up  by  subcutaneous  injection  of 
tubercle  bacilli. 

A  Case  of  Morbus  BASBD0^vII  Cured. 

Hr.  Liley,  in  connection  with  the  opinions  of  Herren 
Senator,  Ewald,  and  Mendel,  expressed  at  the  last  meeting 
as  to  the  uselessnesf*  of  thyroidine  treatment  in  Basedow's 
disease,  brought  forward  a  case  that  showed  the  contrary. 
The  patient  was  first  treated  in  Senator's  Klinik  with 
arsenic,  but  without  result.  The  patient  got  worse  from 
woek  to  week  although  she  was  sent  away  into  the  country 
On  coming  home  again  she  showed  all  the  symptoms  of 
the  disease,  Graefe's  sign,  exophthalmus,  trembling  of  the 
hands,  &c.,  and  she  could  only  drag  herself  up  the  steps 
with  difficulty.  A  lady  made  her  a  present  of  three  boxes 
of  German  thyreoidine  tablets,  of  which  she  took  six 
tablets  a  day.  Although  attending  the  poliklinik  occa- 
sionally, she  continued  taking  the  tablets  on  her  own 
responsibility,  and  at  the  present  time,  after  about  four 
months  of  the  treatment,  she  could  be  pronounced  nearly 
well.  The  circumference  of  the  neck  was  reduced  from 
35  to  33  ctm„  the  cardiac  murmur  had  disappeared,  and 
scarcely  any  trembling  remained.  It  had  to  be  looked 
for  carefully  before  it  could  be  noticed.  The  subjective 
condition  was  good. 

Hr.  Senator  said  his  observations  had  been  made  with 
the  English  tablets. 

Hr.  Ewald  remarked  that  Hr.  Silex's  experience  did  not 
stand  alone.  A  number  of  such  cases  had  been  described, 
especially  in  Eoglish  literature.  The  majority  of  the 
observations  were,  however,  unfavourable.  He  himself 
had  seen  no  good  result.  In  his  case  related  at  the  last 
meeting  the  symptoms  returned  in  an  exaggerated  form, 
and  the  thyreodine  was  no  longer  of  any  use. 


JlUBtlijl 


[jriUill  OUB  0W9   oo&bssfondbnt] 

Vienna,  Feb.  iith,  1896. 
Bloodless  Treatment  of  Congenital  Luxation. 

Adolf  Lobbns  brought  forward  a  few  of  his  cases  for  exhi- 
bition in  the  Gesellschaft  this  week.  From  his  experience 
of  more  than  200  cases,  upon  which  he  has  operated  in 
recent  years,  we  may  conclude  that  congenital  dislocation 
of  the  hip-joint  is  not  a  rare  affection. 

The  deformity  in  all  cases  has  been  corrected  and 
replaced  by  making  an  opening  over  the  joint,  clearing 
away  obstructions,  and  re-establishing  natural  movement 
in  the  acetabulum. 

After  much  thought  and  careful  observation  of  the 
cases  operated  on  he  resolved  to  alter  this  treatment  in 
1895,  and  since  that  time  has  operated  on  13  cases  with 
perfect  success  and  without  any  cutting.  He  qualifies 
the  new  treatment  by  affirmingi  that  it  is  unsuitable  in 


192     The  Medical  Pbbps. 


THE  OPERATING  THEATRES. 


Feb.  19,  1896. 


cacea  where  the  child  has  been  allowed  to  grow  ap  with  it 
to  the  seventh  or  eighth  year,  as  the  radimeDtary  aceta- 
bulum has  by  this  time  become  almost  obliterated.  In 
young  children,  by  careful  manipulation  the  head  of  the 
femur  can  be  readily  made  to  return  to  the  fossa,  with  a 
sharp  sound,  and  will  remain  without  any  external  pressure. 
The  order  of  his  treatment  may  be  concisely  arranged 
in  four  phases  or  stages :  (a)  deduction, — The  returning 
of  the  head  of  the  femur,  which  is  usually  fixed  above  the 
fossa  or  acetabular  depression,  (b)  Reposition. — The  exact 
planting  of  the  head  in  the  rudimentary  acet-abulum. 
(c)  Formation, — The  developing  by  absorption  of  the 
acetabulum,  {d)  and  lastly,  Re8tit\dion,—Th%  movement 
in  the  joint  by  the  muscular  apparatus. 

In  the  operation  of  opening  the  joint  by  incision  the 
order  is  slightly  different,  viz.,  reduction,  formation  of 
cotyloid  cavity,  reposition  and  restitution  ;  but  the  object 
in  view  is  exactly  the  same  in  both.     In  the  bloodless 
operation    the   reduction  and  reposition  may  be  taken 
together.    The  limb  is  extended,  by  hand  or  screw,  slowly 
increasing  the  force,  while  the  head  of  the  bone  is  manipu- 
lated by  the  operator  till  he  is  satisfied  that  the  position 
of  the  trochanter  and  head  of  the  femur  are  in  the  normal 
relative  situation  to  the  spina  superior   anterior,  when 
pressure  is  applied  inwards,  driving  the  head  of  the  bone 
into  the  socket.    To  secure  the  latter  result,  ad  maximum, 
the  limb  must  be  moved  to  a  right  angle  by  abducting  the 
leg,  which  is  a  very  essential  part  of  the  proceeding.    If 
the  operation  be  conducted  slowly  with  the  rolling  out- 
wards and  bending  the  leg  back  an  acoustic  phenomena 
will  occur  that  cannot  be  mistaken  when  the  head  of  the 
bone  slips  over  the  lip  of  the  acetabulum,  which  will 
signalise  the  reduction.    After  this  the  limb  must  be  kept 
in  the  abducted  position  with  flexion  at  the  knee-joint,  or 
the  automatic  action  of  the  surrounding  muscle  will  tend 
to  re-dislocate  the  bone.    This  is  also  necessary  in  the 
incised  operation,  but  is  easier  managed  in  the  bloodless 
treatment.    After  accomplishing  the  reposition  we  must 
wait  patiently,  often  for  years,  before  the  absorption  is 
complete  or  the  cotyloid   cavity  deep  enough  to  safely 
retain    the  head  of    the  bone,  but  during  this   period 
much  may  be  done  to  hasten  the  operation  when  the 
patient  is  healthy,  by  arranging  it  in  such  a  manner  that 
the  weight  of  the  body  may  press  the  head  well  into  the 
aoecabulum. 

After  three  or  four  months  it  will  be  found  that  the  leg 
has  lengthened  three  or  four  centimetres,  and  that  an 
instrument  is  almost  unnecessary,  as  the  gluteal  muscles 
are  the  principal  sentinels  in  these  cases. 

The  first  case  that  he  exhibited  was  four  years  old  ;  she 
was  antesthetised  on  September  28th,  1895,  the  hip  reduced, 
abducted  and  fixed.  On  December  11th,  18^,  the  abduc- 
tion was  reduced  three  centimetres,  i.e.,  the  healthy  lei;: 
required  a  sole  of  three  centimetres  to  equalise  the  lengths. 
This  was  fixed  a  second  time,  and  not  released  till  January, 
1896.  During  the  whole  period  the  weight  of  the  child 
was  allowed  to  fall  on  the  joint,  and  only  during  the  first 
fourteen  days  was  the  child  prevented  from  walking. 
After  the  removal  of  the  apparatus,  the  child  still  wore 
the  sole  below  the  sound  foot,  but  after  a  course  of  massage 
and  gymnastics,  the  child  now  walks  without  anything, 
and  without  any  trace  of  the  former  defect. 

The  second  case  was  a  child  of  three  years  ;  was  anses- 
thetised,  and  first  fixed  on  July  5th,  1895.    This  treatment 
was  continued  with  one  change  till  January  20th,  1896, 
lasting  six  months, 
walk  without  any  apparatus  excepting  a  sole  of  three 


The  history  is  mucb 


centimetres  below  the  sound  foot, 
the  same  as  in  the  preceding  case. 

The  third  case  was  a  boy  of  three  years,  who  was  simi- 
larly treated  on  April  30th,  1895,  but  was  kept  stationary 
for  eight  weeks.  Three  months  after,  the  apparatus  wa» 
removed;  massage,  &c,,  applied,  and  perfect  recovery 
ensued. 

Another  case  of  a  girl,  four  years  of  age,  who,  after 
seven  months'  treatment,  was  similarly  restored. 

Twenty-five  other  cases  were  shown,  seriaHm,  ranging 
from  one  to  three  years  of  age,  in  whom  no  one  could  telV 
from  their  gait  that  there  had  been  anything  wrong. 
Bekei>ik*8  Jubilee. 

During  the  past  week  Prof.  Benedik  has  been  the  object 
of  admiration  and  homage  by  all  the  learned  bodies  in 
Vienna.  It  is  now  forty  years  since  he  appeared  in  the 
literary  world  as  a  writer. 


ST.  THOMAS'S  HOSPITAL. 
Abdominal     Section     foe     Intussusception.  —  Mr. 
Andebson  operated  on  a  case  of  intussusception  by  abdo' 
minal   section.     The  patient,  a  little  boy,   »t.   3,  was 
admitted  with  symptoms  of  obstruction  of  twelve  hours^ 
duration.    The  usual  symptoms  of  intussusception  were 
present.    An  elongated  tumour  could  be  felt  in  the  posi- 
tion of  the  ascending  colon,  extending  into  the  adjacent 
portion  of  the  transverse  colon.     The  child  was  in  consi- 
derable distress,  and  vomited  after  admission.  An  attempt 
was  made  to  reduce  the  intussusception  by  rectal  injec- 
tion, but  without  success ;  the  tumour  was  considerably 
reduced  in  size,  but  could  etill  be  felt,  and  the^syoiptoms 
of  obstruction  remained  unchanged.  Mr.  Anderson  opened 
the  abdomen  by  an  incision  in  the  right  linea  semilunaris. 
The  large  intestine  was  exposed,  and  in  drawing  it  into- 
the  wound  the  intussusception,  which  was  about  three 
inches  in  length,  was  reduced  without  further  manipula- 
tion.     There    was     considerable    thickening     of     the 
coats    of    the    intussuscepted   portion    of    the    ileum, 
but   the   condition  of  the    gut  was  otherwise  favour- 
able.   The   wound   was    then    closed.    Mr.     Anderson 
remarked    that   abdominal   section   for  intussusception 
had  rarely  been  successful,  but  this  depended  upon  the 
unfavourable  conditions  antecedent  to  operation,  and  there 
was  little  doubt  that  if  the  cases  were  brought  before  the 
surgeon  at  an  early  period  the  result  would  be  in  the 
majority  of  instances  good.    He  drew  attention  to  the 
readiness  with  which  the  invagination  was  righted  in  the 
present  case  because  no  adhesions  had  taken  place.    He 
disapproved  of  the  preliminary  use  of  injections,  because 
although  occasionally  successful  they  placed  the  surgeon 
at  a  disadvantage  when,  as  was  usually  the  case,  they 
failed ;  they  not  only  caused  loss  of  valuable  time  but  the 
severe  distension  of  the  large  intestine  was  liable  to  leave 
it  in  a  paralytic  condition  thao  was  in  itself  prejudicial  to 
the  patient's  recovery.    The  abdominal  section  itself  in  a 
recent  case  was  probably  attended  with  a  minimum  of 
danger  ;  less  danger  than  the  blind  use  of  injections.    He 
had,  a  few  weeks  previously,  performed  the  operation|upott 
a  child  of  a  few  weeks  old,  and  although  the  necessary 
manipulation  was  somewhat  tedious  owing  to  the  long^ 

^^^ ^ period  that  had  elapsed  before  the  child  was  brought  to 

Ab  ^e  present  time,  the  child  can  I  the  hospital,  a  considerable  improvement  took  plaoe  after 

the  reduction,  all  signs  of  obstruction  disappeared  and  the 


Fbb.  19,  1896 


LEADING  ARTICLES. 


Thk  Medical  Press.     193 


patient  lived  until  the  fourth  day  when  he  sank  from 
asthenia. 

It  is  satisfactory  to  state  that  a  week  after  the  opera- 
tion JQst  described  the  child  was  doin^  well,  the  intestinal 
functions  being  restored. 

MIDDLESEX  HOSPITAL. 

Utbbinb  Myoma  Complicated  by  an  Ovarian  Tumour. 
— Dr.  William  Duncan  operated  on  a  woman,  set.  35, 
who  was  admitted  with  a  solid  central  tnmonr  reaching 
nearly  up  to  the  umbilicus,  and  which  she  had  noticed  for 
some  years.  In  addition,  there  was  a  cystic  swelling 
occupying  the  left  side  and  extending  up  under  the  ribs. 
This  was  diagnosed  to  be  an  ovarian  tumour.  Per 
▼aginam,  the  solid  growth  was  found  to  be  connected  with 
the  uterus,  and  filling  up  the  right  side  of  the  pelvis.  On 
opening  the  abdomen  in  order  to  reach  the  cyst,  the 
incision  had  to  be  extended  half  an  inch  above  the  um- 
bilicus. The  swelling  was  found  to  be  ovarian,  pushed  up 
by  a  large  fibroid  occopying  the  lower  abdomen.  The 
eyat  was  tapped,  drawn  out  of  the  abdominal  cavity,  the 
pedicle  transfixed,  and  the  tumour  removed  in  the  usual 
way.  Dr.  Duncan  then  proceeded  to  remove  the 
uterine  growth.  The  uterine  artery  on  the  left  side 
could  be  felt  pulsating,  but  owing  to  the  myoma  burrow- 
ing in  between  the  layers  of  the  right  broad  ligament, 
the  artery  on  that  side  could  not  be  felt.  He  next  passed 
an  elastic  lif^ature  tightly  round  the  lower  end  of  the 
tumour,  fixing  it  by  means  of  a  clamp  forceps.  The  large 
myoma  which  was  seen  to  spring  from  the  right  side  of 
the  uterus  was  then  cut  across,  the  peritoneum  dissected 
off  ics  surface,  and  it  was  finally  enucleated  from  its 
attachments  both  to  the  uterus  and  in  the  broad  ligament. 
In  separating  it  from  the  uterus  the  uterine  cavity  was 
fortunately  not  opened.  The  elastic  ligature  was  next 
removed,  upon  which  very  severe  hemorrhage  took  place 
from  numerous  vessels,  both  arterial  and  venous,  which 
were  seen  to  be  spouting  from  the  wall  of  the  cavity  left 
in  the  broad  ligament  after  the  removal  of  the  tumour ; 
this  cavity  was  about  the  size  of  a  small  foetal  head.  The 
vessels  were  clamped  with  forceps  and  each  one  tied 
separately  until  all  bleeding  was  arrested.  The  edges  of 
the  raw  suiface  on  the  right  side  of  the  uterus  were  care- 
fully brought  together  with  silk,  as  were  also  the  edges  of 
the  layers  of  the  broad  ligament,  with  the  exception  of  a 
small  opening  into  which  a  glass  drainage  tube  was  passed 
to  the  bottom  of  the  cavity.  The  abdominal  incision  was  then 
brought  together  in  the  usual  manner.  The  operation 
lasted  nearly  three  hours,  but  the  patient's  condition  was 
very  good  at  its  completion.  Dr.  Duncan  remarked  before 
operating  that  the  cystic  tumour  was  most  probably 
ovarian,  although  the  whole  oondition  felt  on  abdominal 
palpation  might  be  accounted  for  by  a  uterine  fibroid 
undergoing  cystic  des^eneration.  After  the  operation,  he 
pointed  out  the  great  difficulties  attaching  to  the  removal 
of  a  uterine  myoma  which  burrows  between  the  layers  of 
the  broad  ligament,  and  he  said  that  the  operation  would 
have  lasted  even  longer  than  three  hours  had  he  not  been 
able  to  have  the  valuable  and  kind  help  of  his  colleague, 
Mr.  Henry  Morris.  The  elastic  ligature  completely  con- 
trolled all  bleeding  until  it  was  removed.  He  thought 
that  in  another  similar  case,  instead  of  draining  through 
^be  abdominal  wound,  he  would  carefully  and  completely 
ahut  off  the  cavity  in  the  broad  ligament  from  the  general 
peritoneal  canty  and  make  an  opening  into  the  vagina, 
through  which  he  could  pass  a  drainage  tube,  and  thus  get 
more  complete  drainage. 


At  the  end  of  eleven  days,  the  patient's  condition  is 
satisfactory,  but  as  she  is  a  very  stout  woman,  there  is 
suppuration  in  the  abdominal  wall,  especially  where  the 
drainage  tube  was  kept  in  for  thirty-aix  hours. 

RMisnan)  fob  Tban8mi88ion  abroad. 

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^t  ^thml  §W8S  &  Circular. 


'SALUS  POPULI  SOPRBMA  LBX.' 


WEDNESDAY,  FEBRUARY  19,  1896. 


PHARMACOLOGY  AT  THE  LONDON 
CONJOINT  BOARD. 
The  recent  action  of  the  London  Conjoint  Ezamin' 
ing  Board  in  discarding  pharmacology  from  the  sub- 
jects of  examination  calls  for  some  explanation  in  view 
of  the  importance  of  the  subject  thus  summarily  dis- 
missed. In  January,  1882,  the  Board  issued  a  synopsis 
of  pharmacology,  setting  forth  the  scope  of  the  exami- 
nation in  that  subject,  and  this  synopsis  was  reissued 
in  November  last,  without  alteration  or  modification. 
In  conformity  with  the  policy  enunciated  in  this  synop- 
sis, the  lecturers  at  the  various  London  and  Provincial 
schools  abandoned  the  teaching  of  materia  medica, 
pharmacy  being  in  most  instances  relegated  to  the 
hospital  dispenser,  confining  their  attention  to  pharma- 
cology and  therapeutics.  So  far,  all  was  plain  sailing, 
and  we  do  not  remember  to  have  heard  any  objections 
to  this  arrangement  for  conveying  to  the  students  an 
elementary  knowledge  of  a  highly  important  branch  of 
medical  education.  A  short  time  ago,  however,  just 
when  an  examination  was  imminent,  an  agitation  was 


194    Thk  Medical  Pbibs. 


LEADING  ARTICLES. 


Feb.  19, 1896. 


«et  on  foot,  in  whichi  as  far  as  we  can  gather,  Drs. 
West,   Norman  Moore,  Fowler,  and  Thome-Thome, 
took  a  principal  part,  against  the  subject  of  pharmaco- 
logy, and  at  the  meeting  of  the  College  which  took 
place  on  the  13th  inst.,  a  resolution  was  passed  abol- 
ishing pharmacology  as  a  subject  to  be  taught  and 
examined  in.    Materia  medica  is  already  done  away 
with,  so  that  the  student  of  the  future  will  only  be 
called  upon  to  occupy  himself  with  pharmacy.    Now, 
pharmacy  is  undoubtedly  a  subsidiary  branch  of  medi- 
cal knowledge  of  great  practical  importance,  indeed,  we 
should  welcome  more  stringent  requirements  in  this 
direction    in    order    to     prevent    the    writers    of 
prescriptions    from   making   themselves,    as    is    at 
present  so  frequently  the  case,  the  laughing  stock  of 
dispensers.    But  surely  a  knowledge  of  pharmacology, 
which  is  the  science  of  the  physiological  action   of 
drugs,  is  a  subject  in  which  the  medical  man  ought  to 
be   peculiarly    proficient.     Without  it  he  can   only 
follow    the    beaten    track,    without    it    prescribing 
becomes  a  matter  of  routine,  and  further  progress  of 
knowledge  in  the  direction  of  the  application  of  drugs 
for  the  relief  of  disease  becomes  impossible.    Pharma- 
cology constitutes  the  chief  basis  for  the  application  of 
remedies  in  disease,  and  may,  indeed,  be  regarded  as 
the  connecting  link  between  materia  medica  and  the 
art  of  pharmacy.    The  rationale  of  the  employment 
of  such  drags  as  it  is  customary  to  exhibit  in  parti- 
cular conditions  or  to  meet  special  indications  must 
necessarily  escape  the  practitioner  who  has  never  been 
taught  the  action  on  the  healthy   organism   of  the 
drags  he  employs,  and  further  developments  in  this 
direction  become  impossible.    Are  we  to   take   this 
retrograde  step,  for  such  it  appears  to  us  to  be,  as  a 
manifestation  of  the  prevailing  spirit  of  therapeutical 
scepticism  which  has  come  over  the  authorities  who  con- 
trol medical  education  1     Or  is  it  that  those  who  are 
responsible  for  the  change  think  that  the  advent  of 
what  has  been  styled  organic  therapeusis,  by  the  aid 
of   serams   and  juices,  renders  a  knowledge  of   the 
properties  of  the  old-fashioned  remedies   completely 
unnecessary.    We  are,  of  course,  not  in  possession  of 
the  arguments  on  the  strength  of  which  this  sweep- 
ing alteration  has  been   brought  about.    The  curri- 
culum may  be  unduly  crammed,  and  it  may  be  that 
it  exacts  more  than  the  most  diligent  student  can  com- 
pass within  the  allotted  time.    But  even  so  one  would 
have  thought  that  pharmacology,  which  is  to  thera- 
peusis  what  a  knowledge  of  anatomy  is  to  surgery, 
would  at  any  rate  have  retained  the  honoured  place 
which  it  has  occupied  up  to  the  present  time.    We  are 
strongly  of  opinion  that  the  subject  ought  to  find  a 
place  somewhere  in  any  and  every  scheme  of  medical 
education,  and  we  are  fain  to  hope  that  it  may  be 
reinstated  somewhere  in  the  curriculum  without  wait- 
ing for  generations  of  students  to  be  foisted  on  the 
public  ignorant  of  the  very  elements  of  their  art  as 
practitioners  of  medicine.    Possibly,  the  Education 
Committee  of  the  General  Medical  Council  may  hold 
that  the  matter  is  one  calling  for  their  consideration, 
indeed,  we  are  unable  to  reconcile  the  action  of  the 
College  with  the  requiiements  of  the  Council  in  this 
respect. 


MAGISTRATES  AND  THE  MEDICAL  ACTS. 

Since  the   successful  prosecution  by  the  Medical 
Defence  Union  of  the  quack  named  Ferdinand  who 
sought  to  pose  as  a  qualified  medical  man  by  the  use 
of  the  titles  M.D.,  U.S.A.,  one  would  have  thought 
that  the  precedent  then  established  would  have  been 
sufficient  to  enable  any  magistrate  to  arrive  at  a  right 
judgment  upon  a  similar  case  which  happened  to  come 
before  him.    Apparently,  however,  this  is  not  the  fact. 
Either  certam  magistrates  do  not  read  the  newspapers 
or  they  do  not  profit  by  the  information  which  the 
latter  contains.    The  following  is  a  case  in  point : — 
At  the  Cardiff  Police  Court,  last  week,  a  person  styling 
himself     **Dr.    Bridgwater,    M.D.,     U.S.A.,"     was 
summoned  under  the  Medical  Acts  for  having  wilfully 
and  falsely   represented  himself   to  be  a  doctor  of 
medicine.     The  chief  witness  against  the  defendant 
was  Dr.  Morris  Evans,  a  retired  medical  practitioner 
who  had  received  a  circular  of  a  nature  which  clearly 
showed  that  Bridgwater  intended  the  public  to  believe 
that  he  was  a  medical  man.     The  solicitor  for  the 
prosecution  rightly  contended  that  the  letters  "U.S.A.*' 
did  not  exonerate  the  defendant  from  liability  under 
the  Acts.    Despite,  however,  the  clear  exposition  of 
the  law  of  the  case  by  Mr.  Shell  in  the  Ferdinand 
prosecution,  the  magistrate  held  that  the  defendant 
had  not  used  a  description  implying  that  he  was  a 
registered  practitioner  of  the  United  Kingdom.    He 
therefore  dismissed  the  summons.     In    the   meagre 
report  which  has  reached  us  of  this  case  it  does  not 
appear  that  the  successful  prosecuUon  of  Ferdinand 
for  the  same  offence  was  ever  referred  to.   If,  however, 
no  reference  was  made  to  it,  there  is  no  denying  the 
fact  that  the  prosecution  in  Uie  present  instance  was 
sadly  mismanaged.    But  in  the  absence  of  evidence 
upon  this  material  point  it  is  impossible  to  discuas 
this  matter  further.    With  regard  to  the  magistrate's 
decision  it  will  be  observed  that  he  seemed  to  think 
that  any  medical  title   could  be   assumed,  without 
offence  against  the  law,  provided  that  the  person  so 
doing  did  nothing  to   imply  that  he  was  registered 
under  the   Medical   Acts.     Clearly  this   is  a  most 
dangerous  and  erroneous  interpretation  to  have  con- 
ceived of  the  clause  in  the  Act  of  1858,  which  deals 
with  the  assumption  of  medical  titles.    The  clause  in 
question  may  here  be  quoted :  **  Any  person  who  shall 
wilfully  and  falsely  pretend  to  be  or  take  or  use  the 
Name  or  Title  of  a  Physician,  Doctor  of  Medicine, 
Licentiate  in  Medicine  and  Surgery,  Bachelor  of  Medi- 
cine, Surgeon,  General  Practitioner  or  Apothecary,  or 
any   Name,   Title,  addition  or  description  implying 
that  he  is  registered  under  this  Act,  or  that  he  is 
recognised  by  law  as  a  Physician,    or   Surgeon,  or 
Licentiate  in  Medicine  and  Surgery,  or  a  Practitioner 
in  Medicine,  or  an  Apothecary,  shall  upon  a  summary 
conviction    for   any  such   offence,    pay  a  sum    not 
exceeding    twenty    pounds."      Could    anything    be 
clearer  than  this  clause  ?    It  specifically  lays  down  that 
any  person  who  falsely  pretends  that  he  is  recognised 
by  law  as  a  physician  or  surgeon  is  liable  under  the 
Act,  and  this  is  precisely  the  offence  which  a  quack 
commits  when  he  assumes  the  title  M.D.,  U.S. A.    He 


Fib.  12.  1896. 


NOTES  ON  CXJKRENE  TOPICS. 


TBI  MxDiOAL  Pubs.    195 


poses,  in  other  words,  before  the  public  as  a  medical 
man.  By  virtue  of  his  titles  he  is  belieyed  to  be  a 
medical  man  "  recognised  by  the  law."  It  is  not  neces- 
sary in  these  cases  for  evidence  to  be  produced  showing 
that  the  quack  did  anything  to  imply  that  he  was 
registered  under  the  Act  The  public  knows  little  or 
nothing  about  the  Medical  Register.  The  only  thing 
to  which  they  pay  any  heed  is  whether  a  person  claim- 
ing to  be  a  doctor  is  one  or  not,  and  when  they  find 
that  he  calls  himself  a  doctor,  and  attaches  to  his  name 
'*M.D.,  U.S. A."  they  naturally  arrive  at  the  conclusion 
that  he  is  a  medical  man.  At  this  point  it  will  be  seen 
how  important  it  is  for  the  law  to  step  in  and  protect 
the  public  in  such  a  matter.  But,  obviously,  if  the 
magistrates  who  are  paid  to  administer  the  law  will 
not  take  the  trouble  to  inform  themselves  in  respect  to 
the  proper  legal  aspect  of  these  cases,  the  sooner  that 
something  is  done  to  remind  them  of  their  duty  the 
better.  It  is  to  be  trusted  that  ''  Dr.  Bridgwater,  M.D., 
U.SjL,"  will  not  be  left  for  long  in  undisturbed  posses- 
sion of  his  titles,  but  that  the  case  will  be  taken  up  by 
the  Medical  Defence  Union,  whose  officers  have  proved 
themselves  in  many  instances  to  be  quite  cm  fait  in 
demonstrating  to  magistrates  the  true  meaning  of  cer- 
tain clauses  in  the  Medical  Acts. 


SHEFFIELD,  AND  ITS  MEDICAL  OFFICER 

OF  HEALTH. 
Public  health  work  does  not  seem  to  be  very  highly 
esteemed  in  Sheffield.     The  majority  in   die  City 
Council  do  not  show  any  very  marked  desire  to  retain 
the  services  of  a  man  with  ripening  experience  in  the 
work  of  his  department.    In  Dr.  Harvey  Littlejohn, 
they  have  an  excellent  public  servant ;  a  man  who  has 
discharged  the  onerous  duties  of  his  position  with  a 
fearless  honesty  of  purpose,  tact,  and  energy,  and  has 
given  complete  satisfaction  to  the  Members  of  the 
Health  Committee,  under  whoce  oversight  his  work 
more  immediately  lies.    He  has  won  the  confidence 
and  cordial  co-operation  of  the  medical  profession  in 
the  city,  and  the  clauses  of  the  Notification  Act  have 
been  carried  out  without  the  slightest  friction.    More- 
over, he  has  given  the  town  five  years  good  hard 
work.    What  has  been  his  reward  1    On  Wednesday, 
February  12th,  at  a  meeting  of  the  City  Council,  a 
proposition    was    brought   forward   by   the   Health 
Gommittee     unanimously,     that     Dr.     Littlejohn's 
aahiry  should  increase  each  year  by  the  sum  of  £50, 
until  it  attained  a  maximum  of  £750  a  year.    From 
the  members  of  his  Committee  he  received  the  highest 
enconiums  upon  his  work.    It  was  pointed  out  that 
places  which  are  certainly  not  of  greater  importance 
(though  it  cannot  be  denied  that  they  are  possessed  of 
amore  enlightened  appreciation  of  their  responsibilities, 
and  of  good  work)  than  Sheffield,  pay  their  Medical 
Officers  of  Health  much  better.    Brighton  gives  £800, 
Hull   £700,  Bristol  £800,   Newcastle-on-Tyne  £750, 
Nottingham  £600,  and  so  forth.    It  was  pointed  out 
also  that  during  the  five  years  Dr.  Littlejohn  has  been 
in  Sheffield,  the  work  of  his  department  has  greatly 
increased.    But  all  to  no  purpose.    There  was  no  grand 
adieme  before  the  Council  dealing  with  the  expenditure  ' 


of  thousands,  and  with  a  possible  flavour  of  party  spirit 
about  it.     Instead  there  was  a  mean  pettifogging 
spirit  of  economy  in  the  air,  which  evidently  affected 
the  minds  of  men  who  ought  to  have  been  above  it 
They  were  bent  on  proving  to  the  ratepayers  that  they 
had   their   interests   at  heart,  and  meant  to  guard 
their   pockets.     They  set  no  store  upon   the   pos' 
session     of     a     good     man,     with     an     excellent 
record  of  service,  and  a  ripening  experience  of  the  work 
with  a  thorough    knowledge  of  the  details  of  the 
requirements  of  his  department.    No  !  an  infinitesmal 
saving  of  a  fraction  of  a  farthing  was  of  far  greater 
importance  than  such  considerations.     A  Mr.  Muir 
Wilson  proposed,  and  a  Mr.  Wardley  seconded  an 
amendment  that  the  advance  sought  for  should  be 
refused,  and  this,  to  the  disgrace  of  the  Council,  was 
carried  by  a  vote  of  29  to  21.    Of  the  aldermen  only 
3  voted  against,  as  compared  with  12  who  voted  for 
the  advance.    Dr.  Littlejohn  may  congratulate  himself 
upon  the  support  he  received  from  the  men  of  enlighten- 
ment and  position  on  the  Council.    The  majority  have 
very  little  to  congratulate  themselves  upon ;  they  cer- 
tainly will  not  be  regarded  with  any  feelings  of  admira- 
tion by  those  who  know  that  good  work  is  worth 
paying  for,   and  not  to  be  dealt  with  in  a  spirit 
of  mean  economy.    Men  of  ability  must,  in  future, 
not  regard  Sheffield  as  a  place  where  talent  is  likely  to 
be  appreciated  and  rewarded  ;  they  must  look  upon  it 
as  a  place  in  which  experience  may  be  acquired,  but, 
when  acquired,  they  must   go  elsewhere  to  have  it 
appreciated  at  its  proper  value.    The  minds  of  the 
majority  of  the  City  Council  of  Sheffield  are  too  small 
to  allow  of  their  doing  so.    They  think  that  a  hard  and 
fast  income  of  £500  a  year  is  all  that  a  first-class  man 
should  receive  for  watching  over  the  health  interests  of 
a  population  which,  at  the  last  census,   numbered 
330,000,  and  which,  during  the  past  five  years,  has 
increased  by  another  25,000  people ;  truly  they  rate  the 
position  and  importance  of  their  city  and  its  dignity  at 
a  low  figure,  and  cause  it  to  take  a  back  place  among 
the  towns  which  do  appreciate  public  health  work  at 
its  proper  value.    We  trust  that  the  members  of  the 
profession  in  Sheffield  will  take  an  early  opportunity 
of  expressing  their  disapproval  of  Dr.  LitUejohn's 
treatment  by  the  Council,  and  their  appreciation  of  the 
work  that  he  has  done  for  Sheffield. 


^ottB  on  (JTutrent  ^oficB. 

Pharmaceutical  Controversies. 
A  QUESTION  has  recently  been  raised  by  an  appren- 
tice serving  in  the  establishment  of  Grattan  and  Co., 
of  Belfast,  who  asked  that  his  certificate  of  such 
service  should  be  accepted  by  the  Pharmaceutical 
Society  as  qualification  for  its  examination.  The 
Society  refused  on  the  ground  that  Grattan  and  Co. 
were  not  registered  pharmaceutists,  but  only  a  general 
trading  firm  with  a  pharmaceutical  department.  The 
apprentice  applied  to  the  Queen's  Bench  for  a  manda- 
mus  to  compel  the  Society  to  admit  him  to  examina- 
tion, but  he  was  defeated  because  the  Court  held  that 
a  limited  company  is  not  a  "pharmaceutical  chemist,*' 


196     Tot  Medical  Pbkss. 


NOTES  ON  CURRENT  TOPICS. 


Fbb.  19,  1896. 


and,  therefore,  cannot  give  valid  certificates.  But  the 
Court  thought  that  the  apprentice  had  a  legitimate 
grievance,  and  "  recommended  him  to  mercy "  of  the 
Society.  Forthwith  nine  other  apprentices,  similarly 
placed,  applied  for  recognition,  and  after  grave  debate 
the  Council  of  the  Society  decided  that  it  is  question- 
able whether  they  have  any  legal  power  to 
admit  even  one  apprentice  under  such  circum- 
stances, and  they  adjourned  the  question  to 
allow  of  a  law  opinion  being  taken.  The 
decision  thus  given  that  a  company  is  not  a 
**  person  "  has,  however,  resulted  in  the  defeat  of  the 
Society  upon  a  much  more  important  dispute.  The 
Society  sued  a  limited  company  at  Lisburn  for  com- 
pounding prescriptions  through  the  agency  of  a  duly 
qualified  pharmaceutist.  The  facts  were  admitted  and 
it  was  also  admitted  that  an  unqualified  person  would 
be  liable  to  penalty  for  compounding,  but  here  again 
the  Court  held  that  a  company  is  not  a  *'  person  "  and 
is,  therefore,  not  touched  by  the  law  at  all,  and  is  not 
liable  to  either  prosecution  or  penalty.  The  effect  of 
this  decision,  if  it  is  upheld  in  the  Court  of  Appeal 
and  in  the  House  of  Lords  (where,  we  believe,  the 
Society  intends  to  take  it)  will  be  to  throw  open  the 
practice  of  pharmacy  to  any  or  every  person  who 
chooses  to  call  himself  a  company  and  to  register  him- 
self as  such.  This  ruse  has  already  been  adopted  to  a 
considerable  extent  in  England,  and  if  the  appeal  fails, 
there  will  be  no  remedy  for  the  abuse  save  an  altera- 
tion in  the  Act  of  Parliament 

The  Direct  Representation  Contest  in  Ireland 
on  the  General  Medical  Council. 
The  result  of  the  preliminary  vote  instituted  by  the 
Cork  Society  for  the  purpose  of  selecting  a  candidate 
to  carry  the  flag  of  the  provincial  lists  was  announced 
on  the  11th  inst.,  showing  that  Dr.  Cuming,  of  Belfast, 
had  polled  376  votes ;  Dr.  MacDonnell,  of  Dundalk, 
232  ;  and  Dr.  Greene,  of  Ferns,  77.  The  result  of  this 
vote  has  been  the  retirement  of  Drs.  MacDonnell  and 
Greene,  and  the  contest  now  lies  between  Drs.  Jacob,  of 
Dublin,  Cuming,  of  Belfast,  and  Thomson,  of  Dublin. 
It  is  impossible  to  draw  any  just  conclusion  from  this 
vote  considering  that,  out  of  a  total  constituency  of 
about  2,700,  only  685  voted  on  this  occasion.  The 
only  fact  calling  for  observation  is  that  Dr.  Cumings' 
total  vote  exceeds  in  number  his  first  published  list  of 
supporters  by  only  33  votes,  these  representing 
apparently  all  the  additional  supporters  whom  he  has 
been  able  to  gather  together  since  the  issue  of  that 
list.  The  nomination  papers  of  the  three  candidates 
were  lodged  at  the  Branch  Council  s  Office  on  the  15th 
inst.,  and  the  voting  papers  will  go  out  on  or  about  the 
20th.  The  poll  will  continue  until  the  27th,  and  the 
result  will  be  declared  about  the  3rd  of  March.  The 
trial  of  strength  lies  practically  between  Dublin,  repre- 
sented by  Mr.  Thomson,  with  some  country  following  ; 
Belfast,  represented  by  Dr.  Cuming,  with  a  strong 
support  from  the  two  adjoining  counties ;  and  Dr. 
Jacob,  who  depends  upon  the  Poor-law  men  and  other 
country  practitioners,  but  has  also  a  fair  share  of 
Dublin  support 


The  Medical  Staft  Corps  and  Drilling. 
The  Broad  Arrow  never  loses  the  opportunity  of 
finding  fault  with  or  deprecating  the  Medical  Depart- 
ment of  the  Army.  The  latest  *'  grievances  '^  are  that 
there  is  far  too  much  ''  soldiering  "  in  the  Medical  Staff 
Corps,  that  string  bands  are  by  no  means  necessary 
luxuries,  and  that  the  hospital  staff  at  Aldershot  might 
easily  exist  without  a  hand.  Our  kindly  disposed 
contemporary  also  adds,  **  that  any  day  at  Aldershot 
men  of  the  Army  Medical  Staff  Corps  may  be  seen 
learning  manual  exercise,  or  sometimes  amusing  them- 
selves and  the  doctors  who  command  them,  by  acquir- 
ing proficiency  at  battalion  drill.  All  this  is  utter 
nonsense.  In  savage  countries  it  is  no  doubt  desirable 
that  the  hospital  orderlies,  &c.,  should  be  armed  in 
order  to  give  them  the  means  of  protecting  their  lives 
in  cases  of  emergency.  But  if  our  medical  people  take 
rifles  into  the  field  in  a  European  War,  how  can  they 
claim  to  be  non-combatants  ?  AH  the  ordinary  drill 
that  the  Medical  Staff  Corps  requires  is  the  power  of 
forming  fours  in  order  to  march  to  church.  Eifles  are 
useless  to  them  and  so  is  everything  of  a  military  char- 
acter which  is  not  strictly  connected  with  the  discharge 
of  hospital  or  ambulance  duties."  What  petty  jealousy 
the  above  remarks  display.  We  wonder  how  long  it 
will  continue  to  be  fashionable  among  army  officers  to 
follow  the  lead  of  the  late  Commander-in-Chief,  and 
sneer  at  everything  that  the  Army  Medical  Depart - 
mentdoes  which  tends  to  add  to  its  efficiency. 

Influenza  in  India. 
Influenza,  according  to  a  recent  issue  of  the  Indian 
Daily  News,  is  raging  throughout  the  Upper  Punjab. 
Rawalpindi,  Abbottabad,  Nowsheraand  Peshawurhave 
had  their  full  tale  of  sufferers  In  Peshawur  especially 
there  have  been  few  houses  in  the  cantonment  exempt 
from  the  scourge,  in  either  a  mild  or  severe  form.  The 
great  want  of  rain  and  the  consequent  prevalence  of 
dust  may  have  increased  the  virulence,  but  there  is  no 
doubt,  that  the  residents  have  been  visited  by  an 
epidemic  of  the  severest  type  affecting  all  classes. 
Chest  diseases  also  are  very  much  to  the  fore,  and  the 
medical  staff  is  having  a  hard  time  of  it.  The  year 
has  certainly  not  begun  well  from  a  health  point  of 
view,  for  all  the  hospitals  are  pretty  full. 


"No  English  Wanted." 
The  official  announcement  to  the  effect  that  the 
English  language  will  be  excluded  from  the  proceed- 
ings of  the  Twelfth  International  Medical  Congress 
to  be  held  in  Moscow  in  August,  1897,  has  naturally 
excited  a  good  deal  of  irritation  both  in  this  country 
and  America.  The  announcement,  quoted  in  f uU,  is  as 
follows :  "  French  is  recognised  as  the  official  language 
of  the  Congress  in  all  its  international  relations.  At 
the  general  meetings  the  addresses  may  be  delivered  in 
other  European  languages.  Papers  may  be  read 
and  discussed  in  the  meetings  of  the  section  in  French, 
German,  or  Russian."  It  is  of  course  true  that  most 
men  of  any  scientific  note  are  quite  au  fail  in  the 
French  and  German  languages.  But  it  is  not  only  for 
scientific  men  that  these  congresses  are  held.    These 


Tib.  19.  1896. 


NOTES  ON  CURRENT  TOPICS. 


Th«  Medigal  Prkss.     197 


•nunums  take  place  just  as  much  for  one  section  of  the 
medical  commanity  as  for  the  other,  jnst  as  mnch  for 
the  general  practitioner  as  for  the  scientific  consultant. 
To  exclude,  therefore,  the  most  important  language  in 
the  world  from  the  Congress,  simply  means  that  those 
who  speak  it,  and  are  not  sufficiently  acquainted  with 
the'official  languages,  will  not  attend.  Perhaps,  how- 
ever, there  may  be  many  reasons  for  the  decision  which 
has  been  arrived  at  in  this  regard.  The  Roman  Con- 
gress, as  is  well  remembered,  was  a  complete  fiasco  in 
many  respects  owing  to  the  unwieldly  attendance  ;  it 
may  be,  therefore,  that  the  Russian  authorities  have 
seen  that  one  of  the  sources  of  overcrowding  will  be 
eliminated  if  ,no  facilities  are  provided  for  the  attend- 
ance of  English-speaking  practitioners. 


Medical  Joumaliam  in  Australia. 
At  a  special  meeting  of  the  Medical  Society  of 
Victoria,  held  in  December  last,  it  was  decided  to  amal- 
gamate the  Australian  Medical  Journal  with  the  Inter- 
colonial Quarterly  Journal  of  Medicine  and  Surgery 
under  a  new  title.  Thus  our  old  and  well  conducted 
contemporary,  the  Australian  Medical  Journal^  will,  as 
such,  cease  to  appear.  However,  regretful  as  this  act 
may  be,  there  is  nevertheless  this  to  be  said  greatly  in 
its  favour,  namely,  that  it  has  done  a  good  work  in  its 
time.  Founded  as  long  ago  as  the  year  1856,  the 
journal  had  become  one  of  the  oldest  of  the  monthly 
medical  periodicals  in  existence.  It  was  started  by  and 
has  always  been  the  organ  of  the  Medical  Society  of 
Yictoria.  In  an  editorial  in  the  issue  for  December 
last  the  circumstances  are  explained  under  which  the 
change  to  be  carried  out  has  been  brought  about.  One 
important  factor  was  the  commercial  depression  through 
which  the  colonies  have  been  passing.  Another  was 
the  decision  of  the  Australian  branches  of  the  British 
Medical  Association  to  supply  their  members  with  the 
Ausiralian  Medical  Gazette  as  well  as  with  the  organ 
of  the  Association.  Thus  the  competition  became  too 
great  for  the  existence  of  an  independent  journal,  and 
%hw  has  led  to  the  amalgamation  scheme  to  which 
reference  has  been  made. 


Alcoholism  in  Children. 
It  is  well  known  that  cases  of  alcoholism  and  dipso- 
mania are  met  with  in  children.  The  tendency,  in 
some  eases,  is  hereditary ;  often  it  is  the  result  of  some 
psychical  disturbance.  Many  cases  are  due  to  the 
ignorance  of  mothers  who  quiet  their  infants,  even 
while  at  the  breast,  with  wine  or  spirits.  The  per- 
nicious habit  of  parents  taking  their  children  into 
public  houses,  and  there  allowing  them  to  share  the 
drinks,  is  self  evident.  Another  matter  is  that  there 
is  always  a  risk  in  ordering  alcohol  for  children. 
Moreover,  where  there  is  a  history  of  alcoholism  in  a 
child's  parentage,  the  safer  plan  would  be  to  avoid  the 
stimulant  entirely.  Dipsomania,  generally  hereditary, 
occurs  both  in  boys  and  in  girls,  in  the  latter  about  the 
time  of  the  first  menstruation.  Delirium  tremens  has 
been  seen  at  five  years  of  age ;  and  cirrhosis  of  the 
liver,  with  a  definite  history  of  abuse  of  alcohol,  at  three 
years  and  a  half.   Again,  children  who  have  suffered 


from  the  effects  of  alcohol,  are  especially  liable  to 
epilepsy,  hysteria,  insanity,  and  so  forth.  Of  course, 
the  prognosis  in  such  cases  is  bad.  All  these  facts  are 
worthy  of  careful  consideration  when  the  question  of 
administering  alcohol  to  children  comes  before  the 
medical  practitioner.  The  probability  is  that  the  con- 
firmed drunkenness  in  many  women  has  taken  its  origin 
from  the  alcohol  which  has  been  given  them  in  the 
early  days  of  their  childhood,  when  they  were  regarded 
as  *'  delicate,"  and  unable,  without  some  stimulant,  to 
*'  keep  up  their  strength.*' 

An  Opening  Ceremony. 
The  Cardiff  Medical  Society  held  its  annual  meeting 
last  week,  and  at  the  invitation  of  the  Society,  many 
members  of  the  South  Wales  Branch  of  the  British 
Medical  Association  attended  the  proceedings.  Mr. 
Frederick  Treves  was  present  and  read  a  paper  on 
"  The  Present  Position  of  Abdominal  Surgery."  Sub- 
sequently, the  members  of  the  Society  and  their  guests 
adjourned  to  the  newly  acquired  meeting  rooms. 
Whereupon,  quoting  from  the  Western  Mail,  **Dr. 
Treves  was  called  upon  to  perform  the  opening  cere- 
mony, which  he  did  in  a  few  words,  remarking  that  he 
was  familiar  in  some  degree  with  the  opening  of  cham- 
bers, but  he  found  the  opening  of  the  abdomen  not 
nearly  so  difficult  a  feat  as  the  opening  of  a  Medical 
Society's  rooms." 


The  Army  Mediced  Report. 
Last  week  the  report  of  the  Army  Medical  Depart- 
ment for  1894  was  issued  from  the  War  Office.  The 
report  deals  exhaustively  with  the  health  of  the  forces 
in  all  parts  of  the  Empire,  and  the  Director-General 
(Surgeon  Major-GenerflJ  Sir  W.  A,  Mackinnon)  states 
that  the  statistics  from  the  United  Kingdom  compare 
favourably  with  those  of  1893.  In  the  Colonies  the 
general  health  shows  improvement,  and  in  Egypt  the 
improvement  was  marked.  In  Bengal  there  was  an 
increased  rate  of  sickness,  a  severe  outbreak  of  cholera 
occurring,  with  a  very  high  percentage  of  mortality. 
At  Lucknow  144  cases  occurred,  ninety-seven  of  which 
proved  fatal ;  and  on  investigation  the  opinion  was 
formed  that  the  sand  in  filter-beds  attached  to  wells 
was  contaminated  with  the  cholera  microbe.  The 
Madras  statistics  showed  increased  sickness  as  com- 
pared with  1893,  and  in  Bombay  also  the  comparison 
of  1894  with  the  preceding  year  and  the  previous  ten 
years  was  somewhat  unfavourable.  At  home  there 
were  eleven  cases  of  small-pox,  the  highest  recorded 
number  since  1888 ;  the  other  eruptive  fevers  had 
decreased,  also  enteric  fever  and  influenza.  But  how 
is  it  that  the  Report  for  1894  appears  two  years  late  ? 


At  the  Queen's  Hospital,  Birmingham,  last  week,  a 
successful  operation  was  performed  with  the  aid  of  the 
Eontgen  photograph.  A  fortnight  ago  a  woman  ran  a 
needle  into  her  hand,  and  the  hand  became  much 
swollen.  Dr.  Hall  Edwards  took  a  photograph  of  the 
hand,  and  the  needle  was  clearly  seen.  With  the  aid 
of  the  print,  the  foreign  body  having  been  localised, 
extraction  was  successfully  carried  out. 


198     The  Msdioal  Pbxss. 


NOTES  ON  CTTKRENT  TOPICS. 


Feb.  19,  1896 


Vegetarians  as  Cancer  Ourers. 
Cancer  is  a  terrible  malady,  which  has  hitherto 
baffled  the  skill  of  the  surgeon  in  its  cure  no  less  than 
of  the  pathologist  as  to  its  origin.  Its  treatment 
appears  to  exercise  a  perfect  fascination  apon  a  host 
of  trespassers  in  fields  medical.  The  vegetarians  have 
now  entered  the  happy  hunting  ground,  and  one  of 
their  leaders,  Mr.  A.  F.  Hills,  has  started  a  cottage 
hospital  at  Loughton,  in  Essex,  for  the  reception  of 
cancer  patients  for  three,  six,  or  twelve  months, 
''according  to  the  circumstances  of  the  case.''  The 
main  part  of  the  programme  is  to  be  "  a  vegetable 
regimen,  coupled  with  a  plentiful  use  of  distilled  water." 
Our  authority  for  this  statement  is  the  Vegetaricmf 
which  journal  also  states  that  this  system  was  formerly 
carried  out  by  the  famous  Mr.  Abernethy,  who  gained 
some  small  success  in  suspending  the  progress  of  the 
malady.  We  cannot  agree  with  the  conclusion  of  the 
writer  that  if  the  progress  of  a  disease  be  stayed  for  a 
time  something  has  been  done  towards  mastering  that 
disease.  It  is  often  possible  to  check  somewhat  where 
one  cannot  altogether  stop  a  runaway  horse.  For  our 
own  part,  we  believe  that  it  would  be  just  as  feasible 
to  arrest  an  avalanche  with  a  row  of  market  carts  as  to 
cure  cancer  with  a  diet  of  vegetables  and  distilled 
water.  Few  things  are  now  impossible  to  the  human 
intellect,  and  the  bringing  of  this  terrible  malady, 
cancer,  within  the  control  of  legitimate  medical  treat- 
ment will,  in  all  probability,  be  a  mere  question  of 
time. 


The   Scientific    Treatment  of    Crime  and 

Criminals. 
Dr.  Austin  Flint  believes  that  the  treatment  of 
crime  and  criminals  under  the  existing  laws  and  their 
methods  of  execution  is  a  serious  failure,  inasmuch  as 
these  are  based  upon  the  ancient  idea  of  vengeance  and 
retaliation  in  the  form  of  punishment.  He  holds  that 
the  medical  profession  should  at  least  endeavour  to 
induce  the  judges,  lawyers,  and  law- makers  to  study 
law  in  the  light  of  modern  scientific  knowledge.  As 
an  abstract  proposition,  this  is  undoubtedly  excellent, 
but  experience  has  often  shown  that  the  legal  mind  is 
very  difiicult  to  influence  in  the  direction  indicated. 
Criminals  may  be  divided  into  two  classes — the 
curable  and  the  incurable,  and  in  the  scientific  study 
of  crime  the  medical  man  has  to  do  mainly  with  the 
occasional,  the  habitual,  and  the  born  criminal.  Each 
obviously  demands  a  different  mode  of  treatment,  if 
any  satisfactory  progress  is  to  be  made  towards  refor- 
mation. This  matter  is  one  which  is  well  worthy  of 
close  attention,  and  might  be  made  the  subject  of  a 
useful  and  interesting  inquiry  by  some  competent 
prison  medical  officer. 


Industries  in  Prisons. 
Thb  decision  to  substitute  productive  for  the  pre- 
sent unproductive  labour  in  prisons  will  generally 
meet  with  approval.  The  Prisons'  Board  will  now 
provide  work  that  will  interest,  and  the  knowledge  of 
which  will  probably  prove  useful  to  prisoners  on 
release ;  and  a  commencement  of  this  new  arrange- 


ment has  been  made  at  Wormwood  Scrubbs  Prison. 
For  male  convicted  prisoners,  handmills  for  grinding 
wheat  wUl  supersede  the  crank  machines ;  while  wash- 
ing and  needlework  for  Gk)vemment  departments 
will  replace,  to  a  large  extent,  the  oakum-picking  by 
female  prisoners.  No  doubt,  in  time,  other  methods 
of  labour  will  be  introduced  which  will  be  benefidal 
alike  to  the  Gk)vernment  and  the  prisoners.  Presum- 
ably, the  treadmill  is  now  doomed,  and  all  such  devices 
which  did  the  prisoners  no  good,  and  were  otherwise 
quite  useless. 

Leicester  and  its  Refdse  Removal. 
The  "  pail  system  "  of  closet  clearance  presents  so 
many  difficulties  and  drawbacks,  that  its  speedy  com- 
plete disappearance  from  all  modem  cities  maybe  pre- 
dicted with  confidence.  Leicester  is  well  known  for  its 
peculiar  views  on  many  sanitary  matters,  but  its 
citizens  seem  to  have  awakened,  at  any  rate,  to  the 
advisability  of  adopting  an  improved  method  of  sewage 
removal.  The  town  authorities  lately  presented  a 
petition  to  the  Local  Government  Board  for  a  pro- 
visional order  which  should  empower  a  clean  sweep  of 
the  present  order  of  things.  In  consequence  of  thia 
request,  a  special  board  of  inquiry  will  shortly  be  seat 
to  Leicester,  when  the  whole  circumstances  of  the  case 
will  be  carefully  investigated.  One  of  the  chief  obstacles- 
in  effecting  a  reform  of  this  kind  is  the  cost  that 
would  be  necessarily  entailed.  The  Leicester  Council 
has  determined  that  in  exceptionally  bad  cases,  the 
cottage  owner  should  be  compelled  to  carry  out  the 
conversion  at  his  own  expense.  In  all  other  cases, 
however,  they  propose  to  defray  the  cost  out  of  the 
public  funds,  and  for  that  purpose  to  obtain  the  money 
by  additional  borrowing  powers.  As  to  this  part  of 
the  project,  no  doubt,  much  may  be  said  on  both  sides. 
Few  persons  would  object  to  the  relief  of  the  small 
property  owner  by  such  a  payment.  On  the  other  hand, 
however,  many  economists  would  at  once  condemn  the 
proposal  to  make  a  huge  addition  to  the  value  of  the 
property  of  the  wealthier  owners.  In  other  compulsory 
sanitary  alterations,  the  fact  that  the  house  landlord 
has  obtained  a  substantial  additon  to  the  value  of  hia 
property  is  usually  regarded  as  a  sufficient  counterpoise 
to  the  enforced  drain  on  his  pocket. 


The  Importation  of  Wines  into  America. 

Some  remarkable  figures  with  respect  to  the  importa- 
tion of  champagne  and  other  sparkling  wines  into  the 
United  States  have  been  recorded.  During  the  year 
1875  the  number  of  bottles  of  these  wines  amounted  to 
1,857,840  ;  in  1885  the  number  increased  to  2,608,162  ; 
and  in  1895,  just  closed,  2,878,140.  Enormous  as  these 
totals  are,  they  are  quite  surpassed  by  the  total  for  the 
year  1890,  which  was  4;753,836.  Perhaps  the  latter 
year  was  one  of  great  prosperity  to  American  citizens, 
who  very  properly  made  the  most  of  the  time. 


The  Duchess  of  York  has  appointed  Sir  John 
Williams,  Bart.,  M.D.,  to  be  her  Physician-Accoucheur ; 
and  the  Duke  of  York  has  appointed  Dr.  Robert  W. 
Burnet  to  be  his  Physician  in  Ordinary. 


Feb.  19,  1896. 


NOTES  ON  CUEKENT  TOFICS. 


Thk  Msdigal  Pbxss.     199 


The  Parasites  of  Malaria. 
Ths  discussion  on  the  parasites  of  malaria  which 
took  place  at  the  last  meeting  of  the  Boyal  Medical 
and  Chimrgical  Society  comes  in  curious  juxtaposition 
with  Dr.  Lawrie's  affirmation  that  Laveran's  so-called 
Plasmodium  is  a  delusion  and  a  snare.  While  this 
eminent  observer  declares  his  disbelief  in  the  validity 
of  Laveran's  discovery,  we  over  here  are  engaged  in 
discussing  whether  particular  parasites  can  be  identi- 
fied as  the  cause  of  particular  varieties  of  malarial 
disease.  Certainly  the  scepticism  telegraphed  from 
the  far  East  found  no  echo  among  those  who  took  part 
in  this  discussion,  and  untU  we  are  in  possession  of  the 
data,  on  the  strength  of  which  Dr.  Lawrie  bases  his 
repudiation  of  the  association  between  the  Plasmodium 
and  the  genesis  of  malaria,  we  are  entitled  to  continue 
to  hold  that  the  presence  of  this  parasite  is  really  the 
cause  of  the  disease.  It  must  be  admitted  that  the 
parasites  found  in  this  association  are  numerous  and 
present  a  picturesque  variety  in  the  matter  of  shape. 
It  is,  however,  quite  possible  that  many  of  the  forms 
described  and  figured  are  really  different  stages  in  the 
evolution  of  the  self -same  parasite,  but  this  is  a  con- 
clusion which  only  long  and  painstaking  observation 
can  decide.  An  interesting  collateral  question  was 
raised  by  X>r.  Cumow,  who  challenged  the  conclusion 
arrived  at  by  the  authors  of  the  paper,  that  malaria  is 
not  a  water-borne  disease.  Their  conclusion  in  this 
respect  was  based  on  researches  carried  out  principally 
n  a  province  in  Spain,  and  it  must  strike  everyone 
that  in  view  of  the  extreme  variety  which  obtains  in 
the  manifestations  of  diseases  grouped  as  malarial,  it 
must  be  unsafe  to  generalise  on  the  strength  of  obser- 
vations carried  out  in  such  a  limited  area.  Certainly 
the  instances  alleged  by  Dr.  Cumow  of  apparent  infec- 
tion through  drinking  contaminated  water  render  it 
difficult  to  believe  that  malaria  Ls  never  water-borne. 
In  several  recorded  instances  the  disease  attacked  only 
those  who  partook  of  the  contaminated  water,  the 
others  escaping.  Then,  too,  sailors  are  generally  of 
opinion  that  they  can  trace  the  onset  of  the  disease  to 
their  having  made  use  of  river  water  from  malarial 
districts,  and  their  opinion  is  supported  by  the  fact 
that  in  many  no  other  source  of  infection  can  be 
alleged.  This  is  obviously  a  point  of  exceeding  practi- 
cal importance,  and  its  significance  is  enhanced  by  the 
&ct  tlutt  sailors  on  vessels  where  condensed  water  is 
used  suffer  in  vastly  smaller  proportion  than  their 
fellows  on  less-favoured  ships. 

Salvioni  on  Bontgen. 
Thi  new  rays  of  Professor  Kontgen  seem  destined 
to  have  some  day  a  wide  field  of  application  in  many 
arts  and  sciences.  In  the  meantime,  one  of  the  most 
extraordinary  developments  hitherto  announced  in 
connection  with  the  new  photography  comes  from 
Eome.  According  to  the  special  correspondent  of  the 
Daily  Chronicle,  Professor  Salvioni,  of  Perugia,  has 
achieved  no  less  a  feat  than  the  vbual  penetration  of 
opaque  bodies.  The  scientist  mentioned  has  con- 
structed an  instrument  called  a  cryptoscope,  which, 
vhen  fitted  to  the  eye,  enables  the  wearer,  by  means  of 
the  Bontgen  rays,  to  see  through  opaque  bodies.    It 


is  added  that  the  retina  is  impressed  through  the 
agency  of  the  cryptoscope  exactly  in  the  same  way  as 
a  photographic  plate.  If  this  news  be  true,  it  points 
to  possibilities  of  an  extraordinary  nature.  With  such 
a  marvellous  extension  of  the  human  faculties  as  that 
foreshadowed  by  Salvioni,  science  may  hope  at  an 
early  date  to  acquire  an  enormous  mass  of  hitherto 
unascertained  physical  phenomena.  It  seems  not  im- 
possible that  some  of  the  more  remarkable  and  im- 
portant developments  will  profoundly  affect  the  media 
of  communication  between  the  earth  and  the  heavenly 
bodies. 


Women  as  Prison  Medical  Officers. 
The  question^as  to  whether  or  not  a  woman  doctor  is 
fitted  to  fill  the  post  of  Prison  Medical  Officer  is  now 
causing  much  diversity  of  opinion  in  the  town  of  Car- 
diff. Many  medical  men,  who  do  not  disapprove  of 
the  admission  of  women  to  their  profession,  neverthe- 
less, object  strongly  to  this  particular  proposal.  The 
chief  argument  advanced  in  favour  of  such  an  appoint- 
ment is  the  familiar  one  that  the  female  prisoners  under 
certain  circumstances  would  often  prefer  a  female 
surgeon.  With  regard  to  this  point  it  may  be  honestly 
doubted  whether  999  out  of  every  1,000  of  the  women 
inmates  would  trouble  their  heads  about  the  matter. 
Indeed,  an  air  of  unreality  hangs  about  the  whole 
affair,  which  has  little  immediate  interest  or  value 
beyond  the  advancement  of  a  principle.  Under  these 
circumstances  we  should  advise  the  lady  doctors  to 
leave  the  prison  appointments  severely  alone.  Women 
are  now  admitted  to  the  staffs  of  many  medical  charit- 
able institutions,  and  have  by  strenuous  perseverance 
opened  up  many  fresh  fields  of  medical  enterprise.  It 
would  be  a  pity  if  by  coveting  too  much  they  should 
run  some  risk  of  injuring  their  cause.  There  is  no 
blinking  the  fact  that  their  clientele  is  for  the  most  part 
drawn  from  the  wealthier  classes  of  the  community, 
and  that,  so  far,  the  poor  do  not  flock  to  their  ministra- 
tion in  any  ponderable  numbers. 

The  Dublin  Branch  of  the  British  Medical 
Association. 
The  Annual  Meeting  of  this  Branch  is  announced 
as  having  been  held  a  few  days  ago.  As  a  medical 
organisation  it  does  not  seem  to  be  an  unequivocal 
success.  It  has  existed  for  nineteen  years  and  has  had 
about  a  dozen  honorary  secretaries,  and  yet  the  out- 
going president  plaintively  appealed  to  his  audience 
to  save  the  Branch  from  being  shut  up  althogether  for 
want  of  members  and  funds.  The  fact  is  that  there  is 
nothing  for  the  Branch  to  do  which  is  not  much  better 
done  elsewhere,  and  it  has,  therefore,  reaUy  no  rataon 
d'etre. 


The  Local  Government  Board  have  intimated  to  the 
Chelsea  Board  of  Guardians  that  no  objection  would 
be  taken  to  the  appointment  of  a  female  practitioner 
as  assistant  medical  officer  for  the  Chelsea  Infirmary, 
provided  the  Guardians  were  satisfied  that  suitable 
accommodation  could  be  found  for  such  an  officer. 


Thb  recent  results  of  the  Netley  and  London  exa- 


200     Thx  Mbdioal  FRsas 


SCOTLAND. 


FxB.  19,  1895. 


minations  for  the  Indian  Medical  Service  (eighteen 
Burgeons)  and  Army  Medical  Staff  (nine  saigeons) 
show  that  Mr.  Bokhla,  who  \b  a  Hindoo,  won  four 
prizes.  There  was  one  failure  in  the  Army  Medical 
Service. 


The  New  Electrograpby ;  Bontg^en's  Bays. 

At  the  meeting  of  the  Sheffield  Medico-Chirurgical 
Society,  held  on  Thursday  last,  Dr.  Hicks,  President 
of  Firth  College,  very  kindly  gave  the  members  a  suc- 
cinct risumi  of  all  that  was  known  as  to  the  new  pro- 
cess of  electrographiog,  and  placed  before  them  very 
numerous  examples,  the  result  of  his  own  experiments. 
For  these  experiments,  he  was  very  fortunate  in 
securing  a  Crookes's  tube,  which  appeared  to  be 
specially  adapted  for  the  work.  It  seems  that  all 
tubes  are  not  alike,  and  that  it  is  a  matter  of 
some  difficulty  to  secure  one  that  will  answer 
the  purpose  properly,  as  the  rays  do  not 
proceed  from  all  parts  of  the  tube  alike.  At 
Dr.  Addison's  saggestion,  and  in  conjunction  with 
him.  Prof.  Hicks  made  some  beautiful  electrographs  of 
the  hand,  showing  the  bones  and  the  bloodvessels 
injected  with  a  preparation  of  lead,  and  also  of  the 
kidneys  prepared  in  the  same  way.  The  result  was  in 
the  highest  degree  interesting,  as  the  circulation  in 
both  cases  was  beautifully  illustrated,  as  far  as  the 
distribution  of  the  vessels  was  concerned ;  nothing 
better  could  be  desired.  This  appears  to  open  out  an 
important  field  for  further  results  in  the  use  of  this 
wonderful  discovery.  Two  electrographs  were  shown, 
in  which  the  previously  undiscoverable  position  of  a 
needle  in  a  foot,  and  in  a  hand,  were  at  once  demon- 
strated, and  the  foreign  bodies  easily  removed.  In 
one  case,  that  of  the  foot,  the  needle  was  end  up,  and 
only  showed  as  a  small  black  spot. 


Db.  Knowsley  Thorxton  will  deliver  the  second 
Hunterian  Society's  lecture  on  Wednesday,  February 
26th,  at  8.30  p.m.,  in  the  theatre  of  the  London  Insti- 
tution, Finsbury  Circus.  The  subject  will  be,  *'  The 
Lines  of  Advance  in  Abdominal  Surgery."  Members 
of  the  profession  are  cordially  invited. 


The  latest  returns  of  the  Metropolitan  Asylams 
Board  show  that  scarlet  fever  is  still  prevalent  in 
London.  The  total  number  of  patients  in  the  several 
fever  hospitals  of  tbe  Board  suffering  from  this  parti- 
cular disease  is  now  3,020. 


The  Daily  News  reports  that  Professor  VirchoVs 
assistant  has  succeeded  in  photographing  a  chloro- 
formed frog  with  Rontgen  rays  in  which  the  lungs  of 
the  frog  in  the  act  of  breathing  are  distinctly  seen. 


The  Pharmaceutical  Society  have  now  turned  their 
attention  to  Belfast,  where  they  have  prosecuted  a  firm 
of  photographic  dealers  for  selling  bichloride  of 
mercury. 


[FmoM  ova  owir  oosbmfohdixt.] 

The  Hokorabt  Deobbb  Fasge.— Each  year  the  Scot- 
tish Universities  do  themeelves  the  honoor  of  cooferring 
honorary  degrees  on  certain  celebrated  and,  no  donbb, 
deeerviDg  gentlemen.  How  far  the  Universities  will  go  in 
this  respect  is  only  a  matter  of  eon  jectare.  If  they  only 
conferred  these  titles  on  well  known  and  pablic  men  not 
much  conld  be  said  against  them,  and  the  honour  woold 
be  regarded  as  being  of  some  value.  We  may  divide  the 
recipients  of  these  empty  titles  into  three  categories  : — 
First,  those  who  have  done  something  to  deserve  them, 
and  whom  it  is  an  honour  to  the  Universities  to  reooffnise 
in  the  only  way  open  to  them  ;  secondly,  those  who  nave 
given  large  same  of  money  for  the  advancement  of  science, 
or  to  some  infirmary,  .and  who  receive  the  honour  as  a 
quid  pro  qno;  thirdly,  and  often  the  most  nnmerous,  local 
nobodies,  especially  if  they  happen  to  be  personal  friends 
of  members  of  the  Senatus  Academicas.  The  Senatns  of 
the  University  of  St.  Andrews  has  resolved  to  confer  the 
honorary  degree  of  LL.D.  on  Dr.  George  W.  Balfoar,  of 
Edinbui]gh,  already  an  LL.D.  of  the  University  of  that 
city,  and  on  Dr.  Andrew  Smart,  also  of  Edinburgh,  and 
one  of  the  ordinary  physicians  of  the  Edinburgh  Boysl 
Infirmary,  among  others.  To  give  Dr.  Balfour  a  second 
degree  of  LL.D.  seems  to  be  a  work  of  supererogation,  but 
we  suppose  that  it  has  been  given  on  the  principle  of 
«  scratch  my  back  and  I'll  scratch  yours,"  as  Dr.  Balfour 
is  one  of  the  University  Court  officials  in  favour  of  the 
enlargement  of  tbe  medical  school  at  St.  Andrews.  The 
other  recipient  of  the  degree  is  an  amiable  member  of  the 
medical  profession  who,  we  have  no  doubt,  will  be  much 
surprisea  to  find  that  be  is  a  Doctor  learned  in  the  Law. 
We  believe  that  at  St.  Andrew's  each  professor,  it  may 
be  in  rotation,  has  tbe  right  of  proposing  a  name  for 
an  honorary  degree.  If  this  is  so  the  degrees  so  obtained 
lose  all  their  si^ificance.  It  is  a  prostitution  of  what 
should  be  a  jealously  guarded  riffht.  The  friendship  of 
a  professor  and,  it  may  ne  suppoeed,  a  little  judicious  adu- 
lation now  and  then,  may,  we  presume,  suffice  to 
ensure  a  friend  tbe  coveted  honour.  Perhaps,  in  addition 
to  the  three  classes  of  recipients  enumerated  above,  a 
fourth  might  be  added,  namely,  professors  in  other  Scottish 
Universities,  who  appear  to  get  the  degree  on  the  mutual 
admiration  principle.  A  university  which  honours  the 
officials  of  another  probably  eirpects  a  like  honour  in 
return  in  the  persons  of  its  own  Senatus. 

The  Soottish  Uniybbsitt  M.D.  undbb  the  New 
Regulations.-  There  is  some  dubiety  in  University 
circles  in  Scotland  how  the  clinical  examination  which  is 
now  necessary  for  the  M.D.  degree,  in  addition  to  the 
time-honoured  thesis,  is  to  be  conducted.  The  prevalent 
feeling  among  the  authorities  seems  to  centre  in  a  glorified 
M.B.,  CM.  clinical  examination,  in  which  the  candidate 
for  the  higher  degree  should  be  asked  to  examine  easel 
and  report  thereon,  though  he  may  be  a  physician  of  some 
standing,  and  to  undergo  an  examination  in  the  out-of-the- 
way  branches  of  medical  science,  such  as  ophthalmology* 
laryngoscopy,  and  the  like.  If  this  be  decided  upon  a 
great  injustice  will  be  done  to  the  profession.  For 
instance,  a  specialist  for  throat  affections  under  the  old 
regulations  might  send  in  a  gold  medal  thesis  on  some 
branch  of  his  specialty.  If  tbe  suggested  conditions  are 
insisted  on  he  may  send  in  as  good  a  thesis,  but  because 
he  does  not  happen  to  know  very  much  about  medical 
electricity  or  the  microscopic  appearances  of  ringworm,  he 
I  loses  all  chance  of  distinction  and  gains  a  mere  pass. 
The  plan  that  should  be  adopted  in  our  opinion  is  as 
,  follows :— Each  candidate,  in  addition  to  sending  in  his 
I  thesis,  should  be  requested  to  send  in  the  branch  of  medi- 
cine in  which  he  would  wish  to  be  examined,  that  is  if 
'  be  has  any  preference,  and  is  not  an  all-round  Admirable 
Crichton.  The  University  professors  are  supposed  to 
know  all  branches  of  medical  science,  but  might  well  be 
supported  by  expert  assessors  if  necessary.  Such  a  plan 
would  be  fair  to  all.  Perhaps,  however,  the  wish  of  tbe 
University  professors  to  proceed  with  the  new  examina- 
tion in  the  old  way  is  due  to  a  laudable  wish  not  to  cxposs 
their  possible  ignorance  of  special  subjects,  a  supposed 


FsB.  19,  1896. 


iffDoraooe   which  cannot  be   regarded  as  repreheneible 
when  the  rapid  atridee  of  modern  medicine  are  considered 
The  Ttfhoid  Oijtbbbak  at  Dunbab.— The  history  of 
thiB  outbreak,  as  amended  up  to  date,  is  a  sad  commentary 
on  the  achievements  possible  under   the  name  of  Local 
Government.   East  Lothian  is  the  only  county  in  SootUnd, 
we  believe,  which  chose  the  second  alternative  allowed  in 
the  Local  Government  Bill  for  the  appointment  of  county 
medical  oflScers.    In    the  others,  the  medical  officer  of 
nealth  is  resident  in  the  county,  and  is  debarred  from 
general  practice.    He  is  given  a  salary  supposed  to  be 
anffieient  for  his  wants.    In  East  Lothian,  a  consulting 
medical  officer  was  appointed,  and  subordinate  mediciS 
men  for  the  different  districts.    The  consultin^^  medical 
offioOT  is  a  practitioner livinginEdinburjfh,  who  has  not  got 
a  Public  Health  Degree,  but  who  happens  to  be  the  surgeon 
to  the  local  corps  of  Yeomanry.     We  have  no  wish  to  dis- 
parage this  official's  attainments,  but  such  appointments 
m  apt  to  render  the  working  of  the  Local  Government 
Bill  nugatory.    No  one  in  the  county  seems  quite  to  know 
who  really  is  in  authority,  or  who  is  reeponeibie  for  reports 
and  the  ordering  of  inquiries.  For  instance,  during  the  epi- 
demic of  typhoid  fever  at  Dunbar,  which  we  are  glad  to  be 
able  to  report  seems  at  last  to  be  declining,  the  district 
committee  of  the  county  council  did  not  meet  for  weeks 
alter  the  commencement  of  the  outbreak,  and  when  they 
did  meet,  under  the  pressure  of  public  opinion,  they  gave 
as  a  reason  for  their  neglect,  that  they  had  delegated  all 
powers  to  a  public  health  sub-committee.     This  sub-com- 
mittee met  once,  and  in  turn,  delegated  all  powers  to  the 
district  medical  officer.     In  fact,  the  members  of  the  sub- 
committee  did  not  know  whether  they  existed  as  an  official 
body  after  the  annual  elections  in  December,  and  no  meet- 
mg  of  the  new  council  was  held  until  January  2l8t.     The 
position  of  affairs  was  rather  involved.    A  serious  outbreak 
of  fever,  a  county  council  which  did  not  meet,  a  sub-com- 
mittee which  did  not  know  if  they  were  defunct  officially 
or  not,  a  consulting  medical  officer  of  whom  no  mention  is 
i^de  m  the  reports  on  the  subject,  and  a  local  medical 
officer  in  practice,  on  whom  the  brunt  of  the  work  and  the 
odium  attaching  to  it  fell.    It  is  to  the  credit  of  the  last 
named  that  at  length  effective  measures  were  taken  fo 
stamp  out  the  fever.     We  will  return  to  the  subject  next 
week. 

TuBERCCLOsis  :  Its  C.\use  AND  PREVENTION.— A  memo- 
rial presented  by  the  Medico- Chirurgical  Society  of  Glai»- 
gow  to  the  Health  Committee  of  Gbsgow  Town  Council 
"calling  attention  to  the  fact  that  tuberculosis  is  now 
foUy  recognised  as  an  infectious  disease,  and  asking  them 
to  take  the  matter  into  their  serious  consideration,  with 
a  view  to  protection  of  the  community  from  infection." 
was  remitted  to  Dr.  Russell,  Medical  Officer  of  Health. 
Dr.  Russell  has  just  issued  in  pamphlet  form  an  exhaus- 
tive report  dealing  with  the  whole  subject,  concluding 
with  a  number  of  practical  suggestions.  The  report  hiS 
been  sent  to  all  the  medical  men  practising  in  Glasgow 
and  to  aU  the  public  institutions.  It  is  pointed  out  in  the 
report  that  the  local  authority  ought  to  resolve  that,  in 
the  interest  of  public  health,  it  is  necessary  that  washing 
and  disinfection  should  be  carried  out  after  every  death 
from  pulmonary  consumption.  Dr.  Russell  insists  on  the 
importance  of  taking  immediate  action  in  the  direction  of 
eliminating  tuberculous  cows  from  dairies,  and  for  this 
purpose  powers  must  be  given  to  an  expert  veterinarv 
surgeon.  '' 

The  Proposed  Maternity  Hospital  for  Dundee  — 
After  the  grant  of  £5,000  by  the  Cobb  Trustees  there  is 
every  prospect  of  the  proposed  Maternity  Hospital  for 
Dundee  soon  becoming  an  accomplished  fact.  So  far  back 
ae  1892  a  scheme  for  the  foundation  of  such  an  institution 
was  partly  sketched  out  by  the  Forfarshire  Medical  Asso- 
ciation,  and  submitted  to  the  Cobb  Trustees,  along  with  a 
request  for  substantial  financial  assistance.  The  sugges- 
tions of  the  Association  consisted  in  substance  of  the  erec- 
tion of  a  hospital  in  a  central*  part  of  the  city,  with  accom- 
modaiaon  for  twenty  beds,  arranged  in  two  series,  to  be 
used  alternately  on  hygienic  grounds,  and  each  series  to 
conaist  of  two  wards  of  four  beds  each,  an  isolation  ward, 
and  pother  ward.  The  cost  of  erecting  and  finishing  such 
a  building  wae  estimated  at  about  £5,000,  and  the  winual 
expenditure  about  £600.  In  order  not  to  depend  for  the 
income  altogether  on  public  subscriptions,  it  was  intended 
that  at  tiie  outset  there  thould  be  an  endowment,  from 
which  about  half  of  the  annual  expenditure   could  be 


>XAMiyATIOy  PAPERS. 


The  Medical  Pbess.     201 


obtained.    It  was  considered  that  before  fanything  could 
be  done  it  would  be  necessary  to  have  at  least  ^10.000  in- 

M«dr^tA.^^^\^^"™."u**^"  ^«"«  prosecuted  bVthe 
Medical  Association,  and,  besides  the  £5,000  given  by  the 
Cobb  Trustees,  donations  of  £1,000  and  £500  have  also  been 
promised.  There  has  not  yet  been  time  to  take  any 
definite  steps  for  secunng  aWlding,  but  large  houses  i£i 
different  parts  of  the  city  have  been  spoken  about.  It  ia- 
expected,  however,  that  next  week  a  forward  step  wiU  be 
taken  m  the  matter.  v^f    *«  m« 

As  in  many  other  parts  of  the  country,  the  unseaeon- 
able  warmth  of  the  past  month  has  had  a  remarkable  effect 
on  the  death-rate  in  Edinburgh.  Notwithstanding  the- 
old  adage  about  a  green  yule,  it  is  many  years  sin^  the 
mean  temperature  has  been  so  high,  and  the  mortaUty  so 
'^"oo'^*""*'^-  '^^^  °*«*°  temperature  for  the  month 
Z^  ?7  **7LS??  ^'^^^^S®*  ^^^  death-rate  14  75  per  1,000, 
or  6  77  per  1.000  below  the  average  for  the  last  five  years. 

♦ 

EXAMINATION  PAPERS  FOR  THE  DIPLOMA  IN 
PUBLIC  HEALTH  AT  THE  UNIVERSITIES- 
OF  OXFORD,  CAMBRIDGE,  DURHAM,  (a)  ANI> 
VICTORIA.  AND  THE  CONJOIN  BOARD  OF' 
ENGLAND. 

{Continued  from  page  124.) 
Oxford,  Novembbb  27th,  1895.— Part  II. 
10  a.m.  No.  IIL-^Preventive  Medicine, 

1.  How  may  the  nature  of  the  soil  on  which  a  dwelling- 
house  is  constructed  produce  conditions  injurious  to 
health?  Discuss  the  relative  advantages  and  disadvan- 
tages of  gravel  and  clay  soils. 

2.  What  are  the  practical  difficulties  usually  met  with- 
in the  case  of  the  '*  Common  Lodging  Houses"  and 
"Tenement  Houses"  of  the  poor  quarters  of  large  towns 
in  maintaining  the  water-carriage  system  of  excrement 
removal  in  a  wholesome  condition  ?  Describe  the  kind  of 
water-closet  which  is  in  your  opinion  best  suited  to  the 
circumstances.    Illustrate  your  description  by  diagrams. 

3.  State  what  you  know  about  the  occasional  unwhole- 
someness  of  the  following  kinds  of  preserved  food  ;  how 
this  occasional  unwholesomeness  is  manifested ;  and  to 
what  you  believe  it  is  due:  viz.,  ham  or  bacon,  tinned 
lobster,  and  tinned  fruits. 

4.  Describe  the  leading  characters  of  Rickets.  To  what 
extent  do  you  consider  it  is  influenced  by  insanitary 
conditions  ? 

5.  Enumerate  and  describe  the  rashes  that  may  resemble 
the  eruption  of  Scarlatina,  giving  the  diflferential  diagnosis^ 
in  each  case. 

6.  What  is  the  essential  difference  between  an  antiseptic 
and  a  disinfectant?  Give  examples  of  each,  and  state- 
shortly  in  what  circumstances  they,  severally,  are  useful. 

2  p.m.  Part  IL— No.  lY .—Preventive  Medicine. 

1.  You  are  consulted  as  to  the  hygienic  regulation  and 
management    of  an    Industrial  School.     What    diseases 
would  you  expect  to  occur  in  such  an  institution,  and  what- 
measures  would  you  advise  lor  preventing  their  occurrence 
and  spread  ? 

2.  A  village  consisting  of  one  hundred  and  fifty  houses, 
chiefly  labourers'  cottages,  is  situate  on  the  banks  of  a 
rapid  stream  flowing  to  a  river  from  which  a  large  town 
takes  its  water-supply  at  a  point  twelve  miles  below  the 
village.  The  "dry-earth"  system  has  been  adopted  in 
the  village,  and  it  is  contended  that  its  drainage  cannot 
therefore  seriously  pollute  the  stream.  What  are  your 
views  on  this  question  ? 

3.  Enumerate  the  provisions  of  the  Public  Health  Act, 
1875,  against  the  spread  of  infection  from  infected  persons 
8U)d  things. 

4.  In  what  respects  and  to  what  extent  may  the  general 
death-rate  of  an  "Unhealthy  Area"  be  influenced  by 
causes  independent  of  sanitary  administration  or  local 
sanitary  conditions. 

5.  Enumerate,  in  the  order  of  their  importance,  the 
matters  in  which  sanitary  authorities  have  power  to  make 
bye-laws  for  the  safeguarding  of  the  Public  Health. 

6.  The  District  Council  of  a  well-to-do  suburban  district, 

(a)  Examination  for  the  Degree  of  Bachelor  In  Hygiene,  and  for  the^ 
mploma  in  Pnblic  Health  (D.P.H.)  Durham^ 


202     Thb  Mbdioal  Pbsss. 


MEDICAL  NEWS. 


Fib.  19.  18M. 


with  a  population  of  aboat  twelve  tboasand,  is  about  to 
reorganise  ita  staff  for  sanitary  purposes.  The  question 
arises  whether  it  is  desirable  for  the  offices  of  Building 
Surveyor  and  Inspector  of  Nuisances  to  be  held  by  the 
same  person.    Qive  your  own  views  on  this  subject. 

>€ambbidob»  Thubsdat,  Octobbb  dBD,  1895.— Pabt  II., 
Papbb  I. 

1.  What  advice  would  you  give  by  way  of  securing 
such  care  and  control  of  milch-cows  as  would  tend  to 
prevent  the  spread  of  bovine  tuberculosis  on  a  dairy  farm  ? 
Differentiate  between  such  recommendations  as  can  be 
enforced  by  any  local  authority  and  those  which  must  be 
left  to  the  discretion  of  the  dairy  farmer.  Explain  your 
grounds  for  each  recommendation. 

2.  The  council  of  an  urban  district  of  20,000  inhabit- 
ants have  requested  from  you,  as  their  Medical  Officer  of 
Health,  a  report  on  the  subject  of  the  provision  by  them 
of  a  hospital  for  the  isolation  of  small-pox,  together  with 
an  explanation  of  the  grounds  on  which  each  point  yon 
Tefer  to  is  based,  especially  in  regard  to  the  position  and 
■construction  of  such  hospital.     Write  out  such  a  report. 

3.  It  is  sought  to  provide  a  wholesome  water-supply  for 
■A  village  which  has  at  present  no  available  water  except 
from  ponds  and  ditches,  and  which  lies  on  a  deep  layer  of 
subsoil  clay.  Explain  the  various  ways  in  which  such  a 
supply  may,  under  differing  local  circumstances,  be 
{>rocurable. 

4.  Give  an  account  of  the  history  of  small-pox  in  this 
country  during  the  last  fifty  years.  Specify  the  various 
legislative  and  other  administrative  measures  which  have 
been  taken  during  that  period  to  control  this  disease. 
Explain,  as  regards  each  such  measure,  how  far  it  has 
succeeded  or  failed. 

5.  Explain  the  law  as  to  Naisances  under  the  Public 
Health  Act,  1875.  Give  an  account  of  the  several  steps  to 
be  taken  by  the  local  sanitary  authority  and  their  various 
officers  to  secure  the  abatement  of  an  ordinary  nuisance 
and  of  one  that  is  likely  to  recur. 

Fkiday,  Ootobbb  4th,  1895.— Pabt  II.,  Papbb  II. 

1.  To  what  extent  does  local  injury  from  previous 
d  isease  affect  the  susceptibility  of  the  body  to  microbic 
diseases?  Illustrate  your  remarks  by  reference  to  facts 
relating  to  the  prevalence  of  such  diseases. 

2.  Give  the  relative  rates  of  mortality  at  the  different 
ten-years  age  periods,  from  fifteen  years  and  upwards, 
from  the  following  classes  of  disease ;  cancer,  phthisis, 
diseases  of  the  nervous  system,  of  the  circulatory  system, 
of  the  respiratory  system  (not  phthisis),  and  of  the  digestive 
fystem.  State  the  influence  to  which  each  such  inci- 
dence of  disease  is  probably  due. 

3.  Give  some  account  of  researches  upon  the  preva- 
lence of  disease  in  **  back-to- back  "  houses,  and  draw  out 
^lans  for  their  conversion  into  more  healthy  habitations. 

4.  Describe  any  efficient  measures  for  the  disinfection 
of  houses,  clothing,  &c.,  after  the  occurrence  in  them  of 
infectious  diseases.  Give  your  reasons  for  employing  the 
means  of  disinfection  that  you  select. 

5.  Draw  out  a  list  of  the  diseases  that  may  arise  from 
drinking  impure  water,  and,  with  reference  to  cholera 
and  enteric  fever,  describe  the  conditions  under  which 
infection  from  this  source  is  h'kely  to  occur. 

6.  Describe  in  detail  the  measures  necessary  for  the 
prevention  of  diphtheria. 

(^To  he  continued,) 


Corr^Bponbtnxe. 

fWe  do  not  hold  odnelves  responsible  for  ths  opinions  of  our 
^^oirespondentcj  

THE  EDINBURGH  M.D. 

To  the  Editor  ofTu^  Mbdioal  Pbbss  and  Giboulab. 

Sib. — Your  Journal  of  January  29th  ulto.,  states  that 

'*  under  the  new  regulations,  the  candidate  for  the  M.D. 

may  pass  a  further  examination  in  Clinical  Medicine,  and 

thus  escape  the  ordeal  of  furbishing  up  Greek  or  Moral 

"Philosophy."    You  remark,  on  this, — "  The  University  of 

Edinburgh  appears  to  be  acting  wisely  in  making  the  path 


of  its  alumni  as  smooth  as  may  be  from  starting  poin 
togoaL" 

lam  aware  that  the  '*  further  examination  in  Clinical 
Medicine,"  for  the  final  M.D.,  may  be  made  a  very 
wide  and  searching  test;  indeed,  such  a  kind  and 
degree  of  clinical  teet^  should  be,  of  neoeeeity, 
a  strict  part  of  the  M.D.  examination,  but  I 
venture  to  differ  from  you,  it  you  think  that 
any  feasibly  severe  or  strict  test  in  clinical  medicine  can 
justify  the  omission  of  logic  or  psychology  or  philosophy. 
Ic  is  precisely  in  that  kind  of  culture  which  the  study  of 
these  subjects  gives,  which  is  so  lamentably  absent  from 
the  medical  mind.  It  is  not  that  the  study  of  logic  or 
psychology  gives  any  new  facts  of  "  practical  medicine" 
to  the  student,  but  it  opens  his  eves  to  the  method  and 
relativity  of  all  knowledge  and  of  all  facts.  The  mind 
which  has  studied  logic  or  the  history  of  the  growth  and 
evolution  of  human  knowledge,  or  the  great  principlee 
which  lie  at  the  root  of  what  philosophers  call  "  ednoa- 
tion,"  will  be,  throughout  the  life  of  the  individual,  vastly 
aided  in  correct  generalisation  in  his  profession  and  prac- 
tice ;  he  will  be  able  to  form  jnster  conceptions  of  new 
theories  and  new  methods  of  practice ;  he  will  be,  in  the 
best  sense  of  the  word,  a  far  more  "  educated  **  man  than 
if  his  culture  be  confined  to  the  technicalities  of  his  pro- 
fession. 

Unless  this  basis  of  philosophic  method  and  caltnrs 
come  to  the  medical  man  early  it  will  very  rarely,  if  atall,  bo 
attained  afterwards.  Such  culture  lays  the  foundation  for 
a  just  modesty  of  mind  ;  it  shows  the  young  man  in  how 
great  a  world  his  field  of  work  lies  ;  he  is  enabled  to  see, 
in  his  own  work  and  studies,  that  the  higher  method  of  all 
philosophy  exists.  The  young  man  will  often,  by  a  etady 
of  logic  and  philosophy,  be  saved  from  the  narrow  arro- 
gance, which  the  knowledge  and  practice  of  technical  pro- 
fessional work  onlv,  is  apt  to  induce.  This  higher  kind  of 
culture,  this  breadth  of  view,  this  conception  of  the  rela- 
tivity of  all  knowledge,  of  the  unity  of  method  of  all 
knowledge,  this  culture  for  the  sake  of  *'  sweetness  and 
light,"  this  method  for  the  fuller  use  and  understanding  of 
bare  facts,  is  all  the  more  important  now  for  the  higher 
degrees  in  medicine,  seeing  that  the  varied  licensing  bodies 
are  pouring  forth  such  a  vast  number  of  *'  qualified  " 
<< physicians  and  surgeons"  (M.R.C.S.,  L.R.C.P.,  &a), 
men  who,  in  the  main,  have  little  preliminary  education, 
and  who  have  no  time,  in  their  five  years'  curriculum,  to 
look  at  anything  hot  the  bare  facts  needed  for  their  search- 
ing examinations.  These  men  are  usually  at  once  absorbed 
into  the  *'  business "  of  practice,  and  culture  never  or 
rarely  comes  to  them  afterwards. 

Uniformity  of  curriculum  in  medical  education  would 
be  a  great  c^damity ;  nor  le^s  a  calamity  would  be  the* 
« one-portal"  system,  or  the  domination  of  any  ^peat 
society  having  very  much  the  spirit  of  a  *'  trades-union." 
Medicine  is  not  a  mere  technical  art,  but  it  is  part,  and  a 
very  great  part,  of  all  science  and  all  philosophy.  It  is, 
therefore,  reasonable  and  ri^ht,  that  those  who  aspire  to 
the  higher — or  what  should  ne  the  higher — degree  of  M.D. 
should  give  proof  that  thev  have  seen  into  the  Method  of 
the  human  mind  in  knowledge ;  should  give  proof  that 
they  can  arrange  their  ideas  in  an  orderly  teshion,  and  can 
draw  inferences  with  a  logical  severity  of  truth. 

Holding  these  views,  I  cannot  but  feel  that  the  Univer- 
sity of  Edinbargh  has  made  a  very  retrograde  movement. 
Just  when  the  philosophies  of  Hume,  Kant,  &c.,  are  begin- 
ning to  be  understood  in  England,  and  at  a  time  when 
men's  minds  need  steadying  under  the  great  waves  of  pro- 
gress which  have  followed  Darwin,  F.  Schiegel,  ^.,  the 
University  of  Edinburgh  has  deprived  its  alunmi  of  a  very 
ancient  light  of  true  method. 

I  am.  Sir,  yours,  &c., 

Sausbubt  Cbaios. 

Edinburgh,  February  12th,  1896. 


National  Hospital  for  Consumption,  Ventnor. 

The  Report  of  the  27th  year  of  the  operations  of  this 

well-known  hospital  for  chest  diseases,  adopted  at  the 

annual  meeting  of  governors  held  on  Thursday  last,  shows 

that  the  work  has  gone  forward  steadily  and  satisfactorily 


FsB.  19,  1S96. 


MEDICAL  NEWS. 


Thk  Mbdigal  Pbiss.    203 


The  Board  of  MaDa^ment  have  aoeommodation  for  1S4 
patients,  in  ten  blocks  of  bouses  situated  in  the  Undercliff, 
Isle  of  Wight,  each  patient  being  provided  with  a  separate 
bedroom  facing  soutn  and  overlooking  the  sea ;  and  while 
every  bed  continues  to  be  occupied,  there  are  a  large 
number  of  cases  for  which  there  is  at  present  no  accommo- 
dation. The  total  receipts  in  1895  amounted  to  £15,133 
(including  legacies  £4,623),  and  the  expenditure  to 
£11,160.  The  number  of  patients  treated  was  778,  some 
of  whom  wero  resident  as  long  as  30  weeks,  thoufirh  the 
average  stay  was  nine  weeks ;  34  died,  and  509  were 
improved  in  health  by  treatment.  As  the  annual  subscrip- 
ticns  are  only  £2,361,  an  effort  will  be  made  this  year  to 
obtain  the  ncxsessary  funds  for  maintenance  by  a  festivid 
dinner  in  London  on  April  29Ui,  at  which  the  Attorney • 
General  (Sir  Richard  £.  Webster,  G.C.M.G.,  QC,  M.P.) 
will  preside.  Mr.  George  J.  Drummond  was  unanimously 
elected  treasurer  of  the  hospital.  The  re-election  of  the 
retiring  members  of  the  board  and  auditors,  and  a  vote  of 
thanks  to  the  chairman,  brought  the  proceedings  to  a 
cloee. 

Hospital  Finance. 

A  CRISIS  has  developed  in  the  affairs  of  the  North- West 
London  Hospital,  in  the  Kentish  Town  Road,  N.  W.  Lord 
Bathmore,  the  Chairman  of  its  Committee  of  Management, 
reports  that  the  Treasurer,  (Mr.  George  Herring)  says 
that,  in  his  opinion,  the  hospital  must  m  closed  at  once, 
Dslees  it  can  attract  more  support.  He  has  in  hand 
£300.  whereas  the  institution  owes  a  debt  of  £2,000,  and 
entails  an  expenditure  of  £80  a  week  against  an  income  of 
only  £16  per  week  from  annual  subscriptionp.  Mr.  Herring 
ofiSBTB  to  subscribe  a  sum  equal  to  one-third  of  the  result  of  a 
epeoial  appeal. 

The  Honterian  Society. 

Tin  annual  General  Meeting  was  held  on  Wednesday, 
Feb,  12,  in  the  London  Institution,  Mr.  C.  J.  Symonds, 
Pkeddent,  in  the  chair.  A  cordial  vote  of  thanks  to  the 
retiring  President  was  passed  by  acclamation,  and  after 
the  usual  compliments  to  the  officers  of  the  past  year,  the 
following  list  was  unanimoushr  elected  for  the  coming 
year :— President :  Dr.  G.  E.  Herman.  Vice-Presidents  : 
Brs.  R.  H..  Fox  and  A.  T.  Davies,  Messrs.  T.  Mark  Trovell 
and  T.  H.  Openshaw.  Treasurer:  Dr.  F.  C.  Turner. 
Trustees :  Dr.  H.  P.  Fotherby  and  Mr.  F.  M.  Comer. 
Librarian :  Dr.  A.  T.  Davies.  Orator,  1897  :  Dr.  Hingston 
Fox.  Secretaries:  Dr.  Fred  J.  Smith  and  Mr.  A.  F. 
Tnbby.  Council :  Dra  T.  H.  A.  Chaplin,  J.  M.  Ettles,  B. 
Dawson,  T.  G.  Lyon,  J.  W.  Oliver,  W.  Rawes,  Henry  J. 
Sequeira,  St.  Clair,  B.  Shadwell,  J.  T.  Woods,  Messrs. 
Hope  Grant,  C  J.  Symonds,  J.  H.  Targett.  Auditors: 
Dr.  T.  G.  Lyon,  and  Messrs.  F.  G.  Brown,  Hope  Grant, 
T.  R.  Humphreys.  The  Fellows  then  adjourned  to  the 
Theatre  of  the  London  Listitution  to  listen  to  the  Annual 
Oration,  delivered  by  Dr.  G.  Xewton-Pitt,  on  '<  Hunter 
and  His  Cont«nporaries,  with  Special  Reference  to  Hunter 
as  a  Clinician,  and  his  Lifluence  on  the  Medical  Societies 
of  his  Time,"  a  full  report  of  which  will  appear  in  the 
Transaotions,  and  a  large  portion,  we  hope,  in  the  journals, 
as  of  much  wider  interest.  After  a  warm  vote  of  thanks 
to  the  orator,  proposed  by  Dr.  Davies,  and  seconded  by 
Dr.  James  H.  Sequeira,  the  meeting  dissolved.  The 
Annual  Dinner  was  held  at  the  First  Avenue  Hotel,  on 
Friday,  Feb.  14th.  Sir  Joseph  Lister  honoured  the  Society 
as  a  guest  at  this  function. 

Vital  Statistics. 

Ths  deaths  registered  last  week  in  thirtv-three  great 
towns  of  England  and  Wales  corresponded  to  an  annual 
rate  of  20*5  per  1,000  of  their  aggregate  population,  which 
is  estimated  at  10,860,971  persons  in  the  middle  of  this 
^ear.  The  deaths  registerea  in  each  of  the  last  four  weeks 
m  the  several  towns,  alphabetically  arranged,  corres- 
ponded to  the  following  annual  rates  per  1,0(% :-- 

Birkenhead  16,  Birmingham  20,  Blackbum  15,  Bolton 
26,  Bradford  17,  Brighton  20,  Bristol  18,  Burnley  18, 
Cardiff  17,  Croydon  15,  Derby  17,  DubUn  24,  Edinburgh 
17,  Glasgow  19,  Gateshead  21,  Halifax  24,  Huddersfield 
15,  Hull  18,  Leeds  20,  Leicester  22,  Liverpool  25,  London 
20,  Manchester  21,  Xewcastle-on-Tyne  16,  Norwich  25, 
Nottmgham  16,  Oldham  21,  Plymouth  19,  Portsmouth  19, 
Pnston  22,  Salford  22,  Sheffield  20,  SunderUind  24, 
Swansea  15,  West  Ham  16,  Wolverhampton  24.  The 
highest  annual  death-rates  per  1,000  living,  as  measured 


by  last  week's  mortality  were: — From  measles,  1*6  in 
Leicester,  and  4*8  in  Norwich  ;  from  whooping-cough,  l.T 
in  Salford,  and  3*9  in  Bolton  ;  from  fever,  13  in  Bolton  ;• 
and  from  diarrhosa,  1*0  in  Burnley.  The  death-rate  from- 
scarlet  fever  did  not  reach  1*0  per  1,000  in  anv  of  the 
large  towns.  The  102  deaths  from  diphtheriainduded  63  in 
London,  5  in  West  Ham,  5  in  Birmingham,  and  3  in  Edin- 
burgh. One  death  from  pmall-pox  was  registered  in 
Swansea  hot  not  one  in  any  other  town. 

The  Mori^ty  of  Foreign  Cities. 
Thk  annual  death-rate  per  1,000  in  the  principal  foreign 
cities  according  to  the  weeklv  returns  communicated  to 
the  Registrar-General,  is  as  follows :— Calcutta  39,  Bombay 
31,  Paris  22,  Bruspels  17,  Amsterdam  17,  Rotterdam  17,. 
The  Hague  13.  Copenhagen  15,  Stockholm  16.  Christiania 
18,  St  Petenburar  34,  Moscow  36,  Berlin  17,  Hamburg  16, 
Dresden  18,  BresUu  19,  Munich  21,  Vienna  23,  Prague  23, 
Buda-Pesth  21,  Trieste  23,  Rome  23,  Turin  20,  Venice  38r 
Cairo  51,  Alexandria  3%,  New  York  23,  Brooklyn  21, 
Philadelphia  23,  New  Orleans  30. 

Royal  College  of  Physicians  of  Edinburgh,  Royal  Col- 
lege of  Surgeons  of  Edinburgh,  and  Faculty  of  Phy- 
sicians and  Surgeons  of  Glasgow. 
At  the  quarterly  Examinations  for  the  Triple  Qualifica- 
tion held  in  Edinburgh  during  January  the  following  were- 
the  results : — 

First  Examination,  Four  Years'  Course. 

Of  24 candidates,  11  passed,  viz.:— 
Alfred  John   WilUjun  Noble,  William  OSalttTan,  Joeeph  Horgan, 
FraDoie  Gerter.   Alfred    SiffUmond    Powell.   Eldred    LtAjnutn, 
William  MacKlrdy,  Edward  Bennett,  James  MaoBae,  George 
Robert  Harland,  and  Timothy  Murphy. 
And  three  passed  in  one  division  of  the  Examination. 
First  Examination,  Five  Years'  Course. 

Of  28  candidates,  11  passed,  viz.: — 
Bdith  Keild.  Robert  Jackaon  Mackay,  Charles  Rlofaardion  White,- 
Oeorire  Henry  Fallartoa  OraTee,  Edward  Parker  Haythomthwalte, 
Dayld  Coffey,  John  Blaot  Swlnden,  William   Arthor   Dawson, 
Agnes  McLean  Blaok,  James  Patrick  Lavery,  and  Lizzie  Beatty. 

And  6  passed  in  one  or  two  divisions  of  the  examinations. 

Second  Examination,  Two  Years'  Course. 

Of  52  candidates,  21  passed,  viz.  :— 
Manrloe  MoSherry,  Thomas  KUllps  Greenfield,  George  Crofts  Beamish, 
Robert  Hamilton   Flemins,    Robert  Philip  Graham.  BertlTine* 
Goldsmith  Rosooe,  John  Robert  Askew,  Eldred  Ladyman,  John 
Kirkpatrlck,  Anthony  Joseph  Rencontre,  Samuel  DaTld  dements, 
Denis  Nyhan,  Edward  Rambant  KeUett,  John  Henry  O'SnUivan, 
Thomas  Harold  Waddlngton,  John  Titos  Newton,  Charles  Herbert 
ihackrah,  Robert  Stenbonse  Williams.  James  Charles  Boaohier- 
Hayes,  Percy  Ashwoi th  Wedgwood,  and  Clayton  Simpson. 
And  13  passed  in  one  or  two  divisions  of  the  examina- 
tion. 

Second  Examination,  Five  Years'  Course. 

Of  12  candidates  the  following  8  passed : — 
Abraham  Johannes  Benjamin  Albertyn,  Joon  Tobin  (with  dlstlnotloD),'- 
Henry  Fowler,  Thomas  Kevllle.  James  Roes,  Charles  John  Grig,- 
Vaufl^ian  Bateson,aud  James  Soarp  Hamilton. « 

Thurd  Examination— Five  Years'  Course. 

Of  8  candidates,  7  passed,  viz.  :— 
James  Morray,  John  St.  /ohn  Murphy,  Albert  Fletcher  Jones,  George 
Herbert  Arthur  Taylor,  Joseph  Martin  Donovan,  Richard  Ftancl» 
Flood,  and  Georgina  Collier. 

Final  Examination. 
Of  137  candidates  the  following  66  passed,  and  were 
admitted  L.R.C.P.E.,  L.R.C  S.E.,  and  L.F.P.  &  S.G.  :— 
Elicftbeth  Henderson^  WllUam  Henry  Rowthom,  Arthur  James 
Tronghton,  Charles  Oraves,  Arthor  Bishop  Carey  Orchard,  Bmilla 
Margaret  Gothrie,  Richard  Wolfendale,  Bryce  Johnstone  Macau- 
lay,  v«  alter  Pearson,  Martha  Florence  Armitage,  Selim  Hishmeh,- 
Dayid  Alexander,  Charlotte  Sonannah  Vines,  Samuel  Robb,  Elisa- 
beth Mary  Hooper,  James  Blewltt,  Henry  GreaTes,  Percy 
Bandiland  Vesteven,  Robert  Wllbond,  Walter  Scharensnivel, 
Percy  Ridley  Oange,  Herbert  Arthnr  Lake  Banham,  IMward 
Bailer  Hloks,  Joseph  William  Forey,  Daniel  Urban  Hanley,  Denis 
Hennessy.  John  Collingwood  Thompson,  Arthur  Wellealey  Ball, 
Annie  Gillespie,  Solomon  Harold  Richards,  Joseph  O'Meara, 
Walter  Squibbs,  John  Ewart  Martin,  Thomas  Aspinall,  Andrew 
Morris  Stewart,  Erie  Norham,  John  Edmund  O  Ryan,  Thomas 
Canning  Hunter,  Patrick  Bernard  Molony,  James  Munoe, 
Alexander  Jason  Haasard,  Richard  Lester  Park.  WUUam  Barclay 
Thomas,  James  McAllister  Ramsay,  Timothy  CCallaghan.  Hen- 
drlk  Jan  Van  Brook,  Douglas  Albert  Robinson,  Thomas  Franela 
Elmes,  Henry  Edward  Birmingham,  Thomas  William  Herbert 
Tounir,  Thomas  Matthew  Donovan,  Thomas  McKinlay,  Martin 
Cleary,  George  GiUon  Irving,  William  Hugh  Jones,  Thomas 
Bannerman,  George  Henry  Field,  Maurice  Hlckey  Snright, 
Thomas  Ghraeme  Dickson,  Hugh  Sommenrille  Doble,  Ernest  Bnoe, 
Alexander  McLellan  Wilson,  Benjamin  HlltonLeigh,  William  Johnr 
Nixon  Davies,  Charles  Herbert  Harris,  and  thirteen  candidates 
passed  in  one  or  more  divisions. 


204     Ths  Mvdioal  Vbxm 


NOTICES  TO  CORRESPONDENTS. 


Fbb.  19    1896. 


t9r  COKBMPOHBiiraB  roqniriiig  a  reply  In  Chli  oolumn  an  par- 
«ilcnlarly  requeafead  to  maka  uaa  of  a  dltHnelivt  Hgnatar*  or  UUUU, 
and  aroid  the  piraotlea  of  ilgning  themaalTaa  "  Baader,** "  Snbaorlbar," 
•"  Old  Snbaeribar,"  dko.  Hnoli  oonfuloa  will  ba  ipand  by  attentloii 
tothlirala. 

OBionrAL  ABnous  or  Lnms  Intaodadfor  pablioatloo  ihonld  ba 
written  on  one  ride  of  the  paper  only,  and  mntt  be  aothantloatad  with 
the  name  and  addreai  of  the  writer,  not  neoemrlly  for  onbllcation, 
lint  aa  eridenoe  of  IdentltY. 

Bnpunras.— Anthon  of  papen  requiring  reprints  In  pamphlet  form 
after  they  hare  appeared  In  theae  oolnmna  can  have  them  at  half  the 
nnial  coat,  on  application  to  the  printen  before  type  la  broken  np. 

H.S.a8.  (Mancheater).— The  matter  la  nnfortonately  of  every  day 
^>ccurrenf e,  and  ia  apparently  on  the  Inoreaae.  Although  regrettable. 
It  la  hardly  one  to  bring  before  his  Oo]1c«e,  It  Is  more  a  qnettlon  of 
etiquette  and  gentlsmaniy  feeUng,  of  which  your  neighbour  eridantly 
•poaaaasea  a  very  amall  modicum. 

THK  KI8BY  FUND. 
To  the  Editor  of  Tbm  Mbdioal  Priss  ahd  Cibcular. 
Sib,— I  shall  be  glad  if  you  will  allow  me  to  acknowledge  the  receiot 
■of  the  following  subscriptions  to  this  Fund,  in  addition  to  the  list 
published  in  your  issue  for  January  29th. 

I  am,  Bir,  yours,  Ac, 
Oarrickmaoross.  P.  MoKbhha,  M.B.,  Hon.  Sao. 

Dr.  H.  Stear, (Saffron  Walden)        ..        ..£110 
Dr.  Jss.  O.  Gahill  (BallTnacargy)  10    0 

Dr.  W.  O.  Dun  woody  (Monaghan)    ..  0  10    • 

Dr.  McQuaid  (Cootehlll)         10    0 

Dr.  K.  M.  Target  10    0 

DB.  J.  B.  T.  (Preaton).— We  shall  be  gUd  to  recdre  the  MS.,  and.  If 
-possible,  insert  the  paper  in  an  early  number. 

OiTT's  ToHlo  CoxpANT  -We  received  a  long  communication  from 
the  Manager  of  this  Company  as  we  were  at  press,  anlmadrerting  on 
aome  rsmarka  made  by  us  on  "  quack  medicines."  We  hope  to  deal 
with  this  in  our  next 

Db.  F.  T.  8.— We  have  forwarded  your  letter  to  the  address  of  the 
•gentleman  concerned,  who  is,  we  understand,  abroad  at  present. 

Mb.  Moadax  Boolis's  Lecture  on  *'  Hernia*'  is  marked  for  early 
-Insertion. 

THE  TRIALS  OF  THE  PROFESSION. 
DOCTOB  (to  husband  of  patient) :  Your  wife  ia  In  a  critical  state,  I 
should  advise  yon  to  call  in  a  specialist  to  consult  on  the  case. 

HvsBABD :  Yes,  I  told  my  wife  long  ago  that  she  ought  to  get  proper 
medical  adrice,  but  aha  thought  you  would  be  offended. 

4RtetmgB  of  the  ^odttte^ 

WBDNI8DAT,  FBB.    19TH. 

Nobth-Wbst  LoHDOir  Clinioal  S00IBTT.-8  p.m.  General  Meet- 
ing.—8.80  p.m.    Clinical  Meeting. 

ROTAL  MIOBOSCOPIOAL  SooiBTT,  (20  Hanover  Square,  W.)— 8  p.m. 
Mr.  F.  R.  Dixon  NuttaU :  On  the  Male  of  Stephanoceros  Sichhomii— 
Mesara.  W.  and  G.  S.  West :  New  Freshwater  Algn. 
THUB8DAT,  FBB.  20TH. 

Habyxlan  Sooirt  (Stafford  Rooms,  Titchbome  Street,  W.^— Dr.  J. 
B.  Squire :  Some  Clinical  Aspects  of  Pneumonia. 

SociBTT  OF  An^bsthbtists,  (20  Hanover  Square,  W.).-8.90  p.m. 
Dr.  Prince  8t*llard  (Manchester) :  Pental,  Its  Administration  in  150 


Royal  Ihstitution.-S  p.m.    Prof.  H.  Marshall  Ward :  On  Some 
A  pects  of  Modem  Botany. 

Fbipat,  Fbb.  218I. 

ROTAL  iHflTlTunov.— 0  p.m.    Mr.  E.  Frankland :  The  Past,  Present, 
jmd  Future  Water  Supply  of  London. 


flrmlnidiam  Provident  Dispensary  (Sands  Cox  Trust— Hockley  Branch). 
—Medical  Officer.  Minimum  salary  £260.  with  residence  and 
gaa.  Full  particulars  of  the  Secretary,  A.  Derrington,  20  Weston 
Road,  Hands  worth,  Birmingham. 

Buckinghamshire  General  Infirmary,  Aylesbury.— Resident  Suigeon 
and  Apothecary,  unmarried.  Salary  £80  for  the  first  year,  witn  an 
advance  of  £10  per  annum  until  It  amounts  to  £100,  with  board* 
lodging,  Ac.  Original  teatimonials  to  Mr.  George  Fell,  Solicitor, 
Aylesbunr  before  February  24th. 

Oimberland  Inflrmary,  Carlisle.— An  Assistant  House  Surgeon.  Salary 
£40  per  annum,  with  board,  lodging,  and  washing.  Applications 
to  the  Secretary  bdfore  Feb.  26th. 

East  Suffolk  and  Ipswich  HospltaL— Second  House  Suigeon.  Salary 
£70  per  annum,  with  board,  lodging,  ftc.  Applications,  with 
testimonial!,  to  the  Secretary  on  or  before  Feb.  26th. 

Great  Northern  Central  Bospital.— House  Physician.  Salary  £60  per 
annum,  with  board,  lodging,  6k.  Applications,  with  testimonials, 
to  the  Secretary  on  or  before  Feb.  26th. 

Lincolnshire  County  Hospital— Assistant  House  Surgeon.  An  honor- 
arium of  £10  for  each  period  of  six  months,  with  board  and  resi- 
dence. Applications,  with  testimonials,  to  the  Secretary  on  or 
before  Feb.  22nd. 


Salford  Royal  Hoapltal.— House  Surgeon.  Salary  £100  per  annum, 
with  board  and  rsridanoa.  Applications  to  the  Secreiary  1^ 
Fab.  SSnd. 

Shefllald  General  Infirmary.— Junior  Assistant  Honse  Surgeon.  SalaiT 
£60  per  annum,  with  board,  lodging,  Ac.  Applloations,  with 
testimonials,  to  the  Medical  Staff  of  the  Sheffield  General  Inflrmary, 
to  the  care  of  the  Secretary,  on  or  before  Feb.  29th. 

Sheffield  Royal  Hospital.— House  Surgeon.  Salary  1^0  guineas  per 
annum,  with  board  and  lodging.  Applicatlona,  with  tentlmoniala, 
to  Dr.  Sinclair  Whice,  Secretary  to  the  Hon.  Medical  Staff,  on  or 
before  Feb.  20th. 

Sheffield  Union.— Resident  Assistant  Medical  Officer.  Salsry  £100  per 
annum,  with  apartments,  rations,  and  the  other  usual  allowancea. 
Applications,  with  testimonials,  to  Joseph  Spencer,  Clerk  to  the 
Guirdians,  on  or  before  Feb.  SOth. 

Victoria  Hoapltal,  Folkeatooe.->Hou»e  Surgeon.  Salary  £80,rialnK  £10 
annually,  with  board,  realdence.  maA  wasbing.  Applicatlona, 
with  testimonials,  to  the  Secretary  by  March  20th. 


SipvointmtntM 

COLMAV.  W.  8.,  M.D.T.ond.,  M.V.C.P.,    Assistant  PhyalcUn  to  the 

National  Hospital  for  the  Paralysed  and  Bptleptio,  Bloomsbury. 
Bdmomd,  G.  M  ,  M.i>.,  C.M.Aberd.,  Second  Aaslatant  Physician  to  the 

Rot  al  Infirmary,  Aberdeen. 
EL8W0RTH,  R.  C.  M.B.,  C.M.Edln.,  M.R.C.S..  Visiting  Surgeon  to  the 

Swansea  Hohpital. 
Gabstabo,  F.  WT.  M.R.C.S.,  Medical  Officer  of  Health  to  the  North- 

wlob  Urban  District  Council. 
Haibbs,  Sdwabd,  L  ILC.P.Lond..  M.R.a8.,  Junior  Medical  Officer  for 

the  Infirmary  of  tbe  Wandsworth  and  Clapham  Union. 
J0BB8,  RiCHABD,  M.D.,  CM  Edin.,  D.P.H.Camb.,  Medical  Offloer  of 

Health  for  the  Urban  District  of  Festinlc«. 
Kbhdall,  Hbbbbrt  W.,  M.R.O.S.,  L.RC.P.Cond.,  Assistant  Surgeon 

to  the  Bristol  Hospital  for  Stck  Children  and  Women. 
MOBBIS,  C.  D.,  LR.C.P.Lond.,  M.R  C  S.,  Medical  Officer  of  Health  by 

the  Snnbnry  District  OounelL 
Nitoh-Smxth,  Rbqinald,  L.R.C.P.Lond.,  M.R.C.8..  House  Physician 

to  Westminster  HoaplUl,  S.W. 
Odbll,  R.,  L.R.C.P.Loud.,   M.R.C.S.,   Assistant  Honorary  Medical 

Officer  to  tbe  Hertford  Genersl  Inflrmary. 
PBOK,  K.  G ,  l<.R.C.P.Edin..  M.R.C.S.,  Medical  Officer  for  the  Queena- 

bnry  Sanitary  District  of  the  flallfaK  Union. 
Ward.  Fbabcu,  M.&.  CM.  Edin.,  Senior  Honse  Surgeon  to  the  Bast 

Suffolk  and  Ipswich  Hospital. 
WiLBOB,  S.,  L.R.C.P.,  L  M.Edm.,  Medical  Officer  for  the  Enniskillen 

Workhouse  Inflrmary. 


I^ittha. 


Chapxab.-  Feb.  12th,  at  1  St.  John's  Street,  Hereford,  the  wife  of 
Paul  M.  Chapman,  M.D  Lond.,  F.RCP.,  of  a  son. 

DBAOOB.^Feb.  nth,  at  Warlingham  House,  West  Graydon,  the  wife  of 
J.  G.  Deacon,  M.D.Irel.,  of  a  daughter. 

Williams  ->Feb.  8ih,  at  Fairfield,  Pontypridd,  Glam.,  the  wife  of  T. 
R.  Hamlen  Williama,  M.R.CS.,  L.R.aP..  of  a  daughter. 


CuBBii— GvBBiBS.— Feb.  8th,  at  Harrismith,  Orange  Free  State, 
Oswald  Jamea  Cnrrie,  M.B.Lond.,  M.R.CS.B.,  of  Maritzburg. 
Natal,  eldest  son  of  Alexander  Currie^  of  Blaokheath,  Kent,  to 
Sara,  second  daughter  of  the  late  George  Goagh  GnbUna,  of 
Summerville,  Co.  Umerick. 

HoSKiBS-  PA80SAL.-Feb.  12th,  at  SI  Nicholas  Parish  Church,  Chis. 
wick,  William  Hosklns,  M.B.Aberd.,  of  Laoadowne  House,  Broz- 
bourne,  to  Geoigina  Augusta,  only  daughter  of  the  late  CoL 
Paschal.  70th  Regt.,  of  Morton  House.  C  hlswick. 

HoWABD-CUMBiBaHAX.— Feb.  8th,  at  St  Sariour  s,  Aberdeen  Park, 
John  Alexander  Howard,  M.D. Loud.,  only  son  of  John  Howard, 
of  Ashby  Road,  Canonbnry,  to  Emily  Gertrude  eldest  daughter  of 
the  Ute  Chas.  Cunningham,  of  Balfour  Road,  Highbury  New  Park. 

PATOH-PBBSHOBB.— Keb.  12th,  at  St.  Mary  Magdalene,  Upon,  Tor- 
quay,  Henry  H.  L.  Patoh,  M.R.CS.,  L.R.C.P.Lond.,  of  Chadleigh, 
to  Blicabeth,  eldest  daughter  of  Francis  Pershore,  of  Chelaton 
Towers,  Torquay. 

COLLUX.-Feb.  12th,  Archie  Tillyer  Collum,  M.B..  F.R.C8.,  of  7  Groa- 
▼enor  Street,  London,  W.,  aged  (^8,  fltth  son  of  Surgeon-Major 
Robert  Collum,  M.D  ,  M.R.C.P.,  of  Bnniakillen,  Co.  i^ermanagh. 

EDIB.-Feb.  8th,  at  Barton  Street,  Glouceetor,  Thoa.  Edis,  M.R.CS., 
L.S.A. 

EKiB.^Feb.  14th,  at  his  residence  in  Loudon,  Surgeon-General  Jaa. 
Rkin,  C.B.,  M.B.Lond.,  aged 87. 

Habdoastlb.-  Feb  llth,  at  18  Cheater  Crescent,  London,  late  of  New- 
castle-upon-Tyne, Hugo  Macaaley  Hardcastle,  M.D.,  aged  88. 

HooPBB.-Feb.   14th,    at  Allandale,   Southampton,  Chas.   Hooper, 

r;::M.R.CS.,aged75. 

SAUBDBB9.~Feb.  16th,  at  Hartham  Road,  Camden  Town,  Thoa.  J. 
Saunders,  M.R.G.S.,  L.R.C.P.,  aged  82. 

Swm.— Feb.  6th,  at  14  Leybnm  Terrace,  Dover,  Benjamin  Pratt 
Swift.  M.D..  Deputy-Inapector-Generaf  of  Hoapitals,  late  14th  and 
96th  Regimenta,  aged  79. 

TUXFOBD.-Feb.  18th,  at  his  residence.  The  Sqnare,  Boston,  Lincoln- 
shire, James  Ed.  Tuxford,  M.R.C.S.,  J.P.,aged  92. 

WALKBB.-Feb.  9th,  at  54  Fulham  Park  Gardens,  8.W.,  the  Ktir,  Hyde 
•  Edwards  Walker,  M.  A.Oxon.,  L.R.C.P.Lond. 

WILSON.— Feb.  16th,  at  7  Warrior  Square,  St  Leonards-on-Sea,  of 
pneumonia,  Robt.  J.  Wilson,  F.R.(;.P.Sd.,  J.P.,  aged  68. 

NOTICE — Announe-tnenti  or  liinhM,  Marriages^  and  Deatht  in  iM 
faimUxM  of  Subseribers  tu  thus  Journal  art  ingerUd  free,  and  mutt 
I     recfih  the  puldinhtrt  not  later  than  the  Monday  preeeding  publicatiou. 


Mh  ^diai  §m&  mA  €imht 


"SALUS  POPULI  SUPREMA  LEX." 


Vou  CXIL 


WEDNESDAY,    FEBEUARY    26,     1896. 


No.  9. 


<8)rijginai  ComnmniJcatxonjBw 

NOTES  ON  A  CASE  OF 

SUPRA-VAGINAL    HYSTEEECTOMY. 
PERFORMED  DURING  PREGNANCY 

THREATENED  INTESTINAL  OBSTRUCTION,  (o) 
By  G.  ELDER,  M.D., 

Bargeon  to  the  Samaritan  Hospital  lor  Women,  Nottingham. 

The  patient  from  whom  the  specimen  was  taken 
which  I  exhibit  this  evening,  is  37  years  of  age,  and 
was  married  three  years  ago.  She  comes  of  a  very 
hardy  stock  and  had  herself  always  had  exceedingly 
f^od  health  prior  to  marriage  and  since,  excepting 
increasing  difficulty  in  having  her  bowels  relieved, 
until  a  few  weeks  before  consulting  me.  Although 
menstruation  had  always  been  very  free,  it  was  regular 
and  remained  so  until  three  or  four  months  before 
her  illness,  when  it  ceased.  Marriage  had  not  affected 
the  amount  or  the  regularity  of  the  flow,  and  up  to 
her  illness  she  had  not  the  faintest  suspicion  of  being 
afflicted  with  pelvic  mischief.  As  above  mentioned, 
constipation  had  been  suffered  from  for  a  lonj;  time 
past,  but  this  had  become  very  much  worse  dunng  the 
past  ^ye  or  six  montha,  and  during  the  latter  five  or 
six  weeks  of  this  period,  relief  could  only  be  had  by 
the  use  of  increasmgly  large  doses  of  aperients.  In 
addition  to  this  symptom  there  had  troubled  the 
patient  onlj  since  her  marriage  frequency  recurring 
attacks  of  sickness.  The  cessation  of  the  menses  for  four 
months  coupled  with  enlargement  of  the  breasts,  made 
the  patient  suspect  herself  pregnant  The  illness  which 
cQlminated  in  the  operation  shortly  to  be  described, 
began  suddenly  on  the  12th  of  last  December  with 
violent  sickness  which  continued  almost  continuously 
day  and  night  for  three  days  ;  and  for  four  days  there- 
after, it  was  excited  by  any  attempt  to  take  food.  The 
▼omit  was  bilious  in  character,  and  although  towards 
the  latter  part,  it  is  described  by  the  patient  as  being 
"  thick,  dirty-looking  stuff/'  it  does  not  seem  to  have 
been  feculent.  Repeated  enemata  failed  to  relieve  the 
bowels  until  the  seventh  day,  when  a  small  motion  was 
passed,  and  from  this  time  onwards,  until  January  Ist, 
when  she  saw  me,  despite  the  use  of  the  same  mean?, 
assisted  by  aperients,  there  had  only  been  two  good 
stools,  these  being  on  December  3lBt  and  the  morning 
of  January  1st  respectively.  During  her  illnesp,  she 
had  become  very  sallow,  and  lost  considerably  in  flesh, 
and  it  was  felt  by  her  medical  attendant,  Dr.  Rafferty, 
of  Waltham,  who,  throughout  had  recognised  the 
gravity  of  her  condition,  that  an  operation  offered  the 

Eatient  the  best  chance  of  recovery.  On  examining 
er  abdomen,  there  could  be  seen  and  felt  a  somewhat 
prominent  tumour,  rising  up  from  the  pelvis  to  within 
an  inch  of  the  umbilicus,  consisting  of  a  mcgor  central 
portion,  of  which  the  upper  part  felt  like  the  pregnant 
uterus.  Two  offshoots  could  very  distinctly  be  felt 
running  up  from  the  uterine  mass,  the  left  and  larger 
was  very  irregular  in  shape,  whilst  that  on  the  right 
seemed  to  have  a  closer  connection  with  the  parent 

(a)  Read  before  the  Britiih  Gynacological  Society,  Feb.  13th,  1S96. 


tumour  and  consisted  of  two  or  three  somewhat  large 
nodules. 

Per  vaginam  the  os  could  be  felt  with  difficulty,  as 
it  was  pressed  to  the  left  by  a  large  solid,  evidently 
fibroid,  growth,  which  completely  blocked  up  tiie 
pelvic  outlet 

On  January  4th  supra-vaginal  hysterectomy  was 
performed  in  the  following  manner  -.—First  of  all,  both 
broad  ligaments  were  tied  off,  so  as  to  minimise  the 
risk  of  tension,  then  the  uterine  appendages  were 
removed,  and,  now,  on  lifting  up  the  growth  prepara- 
toij  to  its  removal,  a  coil  of  small  bowel,  from  three 
to  four  inches  long,  was  found  firmly  attached  to  its 
upper  surface.  Fortunately,  without  interfering  with 
the  integrity  of  the  bowel,  the  adhesions  were  freed 
and  ligatured.  A  provisional  elastic  ligature  being 
passed  round  the  uterine  neck,  a  circular  incision 
through  the  peritoneal  investment  was  m^de  a  few 
inches  above,  and  the  whole  mass  shelled  out.  Nothing 
now  was  left  but  part  of  the  cervix,  and  when  the 
uterine  arteries  were  ligatured,  the  elastic  lif^ture  was 
removed,  and  bleeding  points  controlled  by  li^jature  or 
pressure  from  the  several  layers  of  sutures  which  were 
put  in  to  bring  together  the  raw  edges  of  the  stump. 
This  having  been  fixed  at  the  lowest  angle  of  the  wound, 
the  abdominal  parietes  were  brought  together  in  the 
usual  manner,  provision  being  made  for  drainage  by  a 
glass  tube  pacsed  down  to  Douglas's  pouch. 
The  patient  bore  the  operation  well,  but  some 
eight  hours  afterwards,  probably  as  the  result 
of  sickness,  the  surface  of  the  stump  bled  freely,  to 
check  which  it  had  to  be  somewhat  opened  up  and  its 
surface  desiccated  by  the  solid  perchloride  of  iron  and 
pressure  applied.  Althongh  this  incident  has  some- 
what prolonged  the  convcJescence  of  the  patient,  in 
other  respects  recovery  has  been  uneventful,  and  she  is 
returning  home  this  week  with  her  wound  perfectly 
healed. 

The  patient  had  the  first  week  considerably  more 
pain  than  is  usually  found  accompany icg  this  treat- 
ment of  the  stamp,  and  it  was  not  until  the  fifth  day 
that  the  fluid  drained  off  became  clear  and  allowed  of 
the  removal  of  the  glass  tubes.  As  will  be  seen  from 
the  charts  which  I  hand  round,  the  temperature  only 
once  ran  above  100'',  viz.,  on  the  evening  of  the  8th 
day,  and  the  pulse,  except  on  the  1st,  2nd,  3rd,  4th,  5th, 
6th,  and  7th  days,  never  went  above  100. 

I)e8crij)tion  of  ilie  Tumour:— Die  specimen,  as  will 
be  seen,  consists  of  the  uterus  cut  through  the  cervix, 
and  containing  a  foetus  eight  inches  in  length  together 
with  the  amniotic  fluid.  In  the  region  of  the  left 
broad  ligament  there  is  a  series  of  pediculated  myo- 
matous nodules  of  irregular  shape,  in  all  about  the  size 
of  a  foetal  head  at  term.  Anterior  and  posterior  to 
this  there  are  two  separate  nodules  of  the  size  of  a 
STuinea  fowl's  and  hen's  egg  respectively.  Occupying 
the  uterine  wall  on  the  right  side  there  is  a  more  flat- 
tened myomatous  mass,  and  at  the  fundus  and  behind 
the  cervix  there  are  also  other  nodulee.  (The  whole 
tumour  has  shrunk  very  much  since  its  removal  six 
weeks  ago,  more  especially  the  uterine  cavity,  although 
the  foetus  was  not  removed  until  after  the  finish  of  the 
operation.) 

Comments: — ^Although  there  are  many  points  of 
interest  in  this  case  the  one  to  which  I  wish  to  specially 


206     Thx  Medical  Pbbbs. 


ORIGINAL  COMMUNICATIONS. 


Feb.  26,  1896. 


invite  yoar  atteotion  \b  the  evident  connection  which 
marriage  bore  to  the  periloos  illness  of  the  patient. 
Some  eighteen  years  of  menstrual  life  had  been  passed 
without  the  patient  ever  suspecting  herself  to  be 
suffering  from  any  uterine  trouble.  Almost  a  parallel 
condition  of  matters  was  experienced  in  the  case  of  the 
Porro  operation  which  I  described  at  this  Society  last 
November,  where  the  woman  up  till  the  moment  of 
labour  believed  herself  to  be  absolutely  healthy. 


%tttnxtfB 

ON 

THE   DIAGNOSIS  OF  INSANITY. 

By  THEO.  B.  HYSLOP,  M.D., 

Ltoinrer  on  If  enUl  Diieavei  to  St.  Mazr's  Hotpltal  Medical  Sohool, 
ABsi»t«nt  Phyilclan  to  BethlMo  Royu  Uospltal. 

Lectubb  IX.— (C/onc/tmon.) 

The  possession  of  an  unstable  nervous  system  is 
attended  with  a  peculiar  liability  to  easily  succumb 
to  the  effects  of  heat.  This  is  seen  in  a  marked  degree 
in  the  MoDf^lian  and  Kalmuc  type  of  idiocy.  Their 
circulation  is  usually  feeble.  They  advance  in  summer 
and  undergo  retrogression  in  winter.  They  undergo, 
in  fact,  a  species  of  hibernation.  Not  only  are  they 
prone  to  chilblains  and  frostbites,  but  they  are  little 
tolerant  of  excessive  heat  and  prozimitv  to  a  fire,  which 
to  many  would  be  only  agreeable,  would  to  ipatie.ts  of 
this  class  be  attended  by  a  serious  blistering  of  the 
legs  even  when  protected  by  stockings  or  other  articles 
of  clothing,  (a)  I  have  seen  several  cases  of  syncopal 
attacks,  and  one  of  an  asphyxial  character  occurring  in 
imbeciles  after  exposure  for  a  few  hours  to  a  hot  nun, 
and  their  exceeding  proneness  to  be  affected  in  this 
manner  by  heat  renders  it  necessary  to  exercise  care 
during  the  hot  months  that  they  are  not  exposed  un- 
duly. 

EpUepsy  is  one  of  the  most  common  of  the  sequelae 
and  occurs  in  various  degrees  of  severity  from  slight 
epileptiform  convulsions  to  the  severest  forms  of  the 
disease.  Mickle  (&)  is  of  opinion  that  the  apoplecti- 
form seizure  or  epileptiform  petit  mod  of  general  para- 
lysis has  been  mistaken  for  sunstroke,  and  in  support 
of  his  views  he  states  that  he  has  seen  some  cases  with 
severe  extensive  brain-lesions  of  general  paralysis. 
Maclean  (a)  observed  that  immense  numbers  of  soldiers 
were  invalided  home  from  India  for  this  affection 
following  sunstroke,  but  in  a  large  proportion  of  the 
cases  the  attacks  disappeared  before  arrival  at  Netley, 
particularly  in  the  lonff  voyage  round  the  Cape  of 
Good  Hope.  As  a  rule,  the  disease  seemed  to  be 
amenable  to  treatment  The  same  author  also  noted 
a  few  examples  of  chorea  like  movements  of  the 
muscles  of  the  forearm  and  hands,  probably  due  to 
nerve  irritation.  The  frequent  occurrence  of  epilepsy 
is  suggestive,  and,  as  in  the  cases  of  the  periodica 
psychoses,  of  which  I  have  given  several  examples  (6), 
the  disorder  seems  to  be  a  manifestation  of  an  unstable 
vaso-motor  state. 

Both  idiocy  and  imbecility  may  be  dependent  upon 
early  epilepsy,  but  the  absence  of  spastic  symptoms, 
contractures,  strabismus,  and  other  deformities,  to- 
gether with  the  absence  of  progressive  deterioration 
associated  with  the  occurrence  of  the  convulsions,  are  in 
my  opinion  characteristic  of  the  acquired  type  rather 
than  the  hereditary,  and  in  cases  of  epilepsy  following 
upon  sunstroke,  the  mental  defect  ana  convulsions  are 
collateral  phenomena,  both  depending  upon  the  same 
cause,  whilst  the  positive  signs  of  alienism,  such  as 
anomalies  of  character  and  moral  perversions,  with 

fLingdoD  DowD,  op.  cit..  p.  12. 
"  GttDeral  Panlyun  of  the  iDtane/'  p.  272. 
"  DisMSM  of  Tropical  CUmatM."  p.  IfiO. 
Soe  Tables. 


defective  or  one-sided  development  of  special  faculties, 
all  point  to  an  acquired  psychosis,  in  a  large  measure 
differing  from  the  progressive  deterioration  of  ordinary 
idiopathic  or  hereditary  epilepsy. 

In  adults  I  have  seen  the  occurrence  of  episodical 
attacks  somewhat  analogous  to  epilepsy  in  which  there 
was  a  periodical  attack  of  depression,  or  maniacal  delir- 
ium, or  even  conditions  doseljr  resembling  the  man- 
iacal, epileptiform  and  apoplectiform  attack  of  paretic 
dementia. 

Insanity  arising  from  insolation  is  much  like  that 
due  to  traumatism,  but  as  a  rule,  progressive  deteriora- 
tion terminating  in  paretic  dementia  is  far  more  com- 
mon in  the  latter  than  in  the  former.  Insolation  forms 
an  acquired  predisposition  to  insanity,  and  as  in  the 
cases  of  traumatism,  the  most  serious  psychoses  are 
developed  months,  or  even  years,  after  the  injury. 

Earle's  tables  of  107  admissions  to  the  Northampton 
Lunatic  HoRoital  show  that  four  were  due  to  sunstroke, 
(a).  In  the  York  Asylum  7  out  of  864  admissions  were 
rejferred  to  the  same  cause.  In  Bethlem  Hospital,  oat 
of  1,947  cases  admitted,  no  less  than  49  were  attributed 
to  sunstroke.  Cloui^ton  believes  that  few  Englishmen 
become  insane  in  hot  climates,  in  whom  that  cause  ia 
not  assigned,  and  that  sunstroke  gets  the  credit  of  far 
more  insanit^f  than  it  produces,  {h)  He  only  admitted 
twelve  cases  in  nine  years  which  could  be  said  to  have 
been  due  to  traumatism  or  sunstroke,  being  only  one- 
third  per  cent  of  the  admissions.  This,  I  believe,  to 
be  unusually  low,  but  possibly  the  high  percentage 
(2*4)  in  the  case  of  Bethlem  may  be  accounted  for  by 
the  large  numbers  of  officers  and  others  admitted  who 
have  seen  foreign  service. 

Mickle  (c)  is  of  opinion  that  sunstroke  is  not  un- 
commonly a  cause  of  general  paralysis  among  British 
soldiers  in  India. 

In  the  returns  of  the  Commissioners  of  Lunacy  (d) 
94  (or  2'8  per  cent)  of  3,374  male,  and  3  (or  3  per  cent.) 
of  910  female  cases  of  general  paralysis  were  attributed, 
or  partly  so,  to  sunstroke. 

In  60  cases  of  general  paralysis  Meyer  U)  found 
three  from  sunstroke,  and  he  endeavoured  to  dis- 
tinguish clinically  the  cases  following  insolation  from 
thone  following  exposure  to  other  great  heat. 

Victor  if)  has  described  several  cases  apparently  of 
general  paralysis  due  to  exposure  to  excessive  heat  in 
a  gun  foundry.  Berstens  {g)  has  published  similar 
cases.  (Jalmeil  declared  that  exposure  to  great  furnace 
heat  was  a  cause  of  "  polyphar^ie "  and  was  fre- 
quently seen  in  labourers  in  iron-works,  rolling 
mills,  dbc. 

Oeneral  paralysis  is  said  to  be  rare  in  hot  climates 
but  it  is  an  old  observation  that  this  comparative 
exemption  does  not  extend  to  new  comers.  (A)  I  have 
only  seen  one  case  of  general  paralysis  with  a  history 
of  sunstroke,  and  in  this  case  the  symptoms  and  patho- 
logical appearances  were  by  no  means  conclusive  as  to 
the  nature  of  the  disease,  whereas  the  number  of  cases 
simulating  general  paralysis  has  been  remarkable.  In 
no  less  than  twenty  two  of  the  cases  tabulated  the 
symptoms  consisted  in  associated  mental  and  motor 
defects,  which  rendered  the  differential  diagnosis  one 
of  extreme  difficulty.  They  mostly  had  pbydical  sjrm- 
ptoms,  such  as  tongue  tremors,  thickness  or  slurring 
of  speech,  inequality  of  the  pupils,  altered  reflexes 
(chiefly  exsg^rated),  shsky  and  interrupted  hand- 
writing, tottering  or  weak  gait,  loss  of  control  over 
bladder  and  rectum,  hallucinations  or  perversions  of 
all  or  some  of  the  senses  (most  frequently  of  sight, 
hearing,  and  taste),  and  mental  conditions,  such  as 


a)  "  Huual  of  Ptycholoalcal  Ifedi  ino.' 

b)  " MentolDtMuea.'  p.  414. 


BackniU  A  Take,  p.  97. 


"  Geoenl  Panljsls  of  the  Inutne/'  p.  S72. 
I  Seiiorts  of  CominiMloii'n  of  Lnnacy,  No*.  85-6-7-8. 
<«)  ArchlT.  flir  Ptych.,  ill  bd.,  p.  280. 
(/)  Allgem  ZettKhr.,  fttr  P»7ch.,  zl  bd. 
ig)  Jour.  Ment.  Scienoe,  Oct.  1884.  p.  442. 
ih)  Mickle,  op,  cit,  p.  160. 


Fib.  26,  1896. 


OKIGINAL  COMMUNICATIONS. 


Tbk  Midical  Prj&s.     207 


melancholia,  hypochondriasis,  but  more  commonly 
exaltation,  extravagance,  excitement,  and  even  acute 
mania.  With  such  a  combination  of  symptoms  the 
diagnofiis  was  apparently  simple,  but  most  of  the  cases 
proved  deceptive,  for  after  a  time  the  physical  signs 
disappeared,  leaving,  however,  the  mental  health  in  a 
weak  and  permanently  impaired  condition,  as  shown 
by  some  cnildishness  or  simplicity,  or  perhaps  irre- 
velancy  or  inattentiveness,  or  more  commonly  by 
smiling,  pleased,  self-satisfaction,  and  a  trace  of  fixed 
expansive  ideas. 

Such  patients  are  tractable,  docile,  useful,  and  indus- 
trious, and  are  perhaps  able  to  resume  work,  and  so 
they  may  go  on  for  many  years  with  no  return  of  the 
motor  symptoms,  no  special  sensory  disturbances,  and 
no  marked  change  in  the  mental  state  from  year  to 

A  very  common  svmptom  is  cephalalgia  (a),  which 
may  occur  periodical]^  or  i)ersistent]y,  and  probably 
depending  upon  chronic  meningitis,  with  some  thicken- 
ing or  opacity  of  the  membranes,  these  patients  cannot 
tolerate  heat,  and  a  close  or  heated  atmosphere  will 
cause  an  exacerbation  of  the  sensory  symptoms,  or 
even  a  recurrence  of  the  mental  disturbance.  Alcohol 
is  also  apt  to  aggravate  the  symptoms,  just  as  in  cases 
of  traumatism.  In  several  cases  perhaps  alcohol  played 
a  considerable  part  in  the  production  of  the  insanity  ; 
but  this  was  possibly  owing  to  the  readiness  with 
which  alcohol  diisturbsa  brain  previously  weakened  by 
sunstroke.  Where  this  happens  the  primary  affection 
usually  leaves  no  immediate  mental  or  physical  defect ; 
but,  nevertheless,  it  forms  a  predisposition  to  the  dis- 
astrous effects  of  other  exciting  causes,  such  as 
alcohol,  &c. 

The  symptoms  of  bromide  poisoning,  plumbism, 
locomotor  ataxy,  and  tabes  dorsalis,  acute  ascending 
paralysis,  acute,  chronic,  or  more  or  less  generalised 
palsy,  generalised  or  diffuse  paralysis  or  ataxy  follow- 
ing acute  affections,  epilepsy,  senile  dementia,  dis- 
seminated sclerosis,  ana  brain  tumours,  all  may  tend 
to  complicate  the  task  of  differentiation.  The 
greatest  difficulty,  however,  is  experienced  with  such 
affections  as  general  paralysis  of  the  insane,  syphilitic 
disease  of  the  brain  and  membranes,  alcoholic  insanity, 
dementia,  with  paralysis  from  local  lesions,  or  circum- 
scribed cerebral  lesions  with  dementia,  and  paralysis 
due  to  softening,  haemorrhage,  embolism,  or  thrombosis. 
There  are  few  motor,  sensory,  or  mental  features  which 
can  be  regarded  as  characteristic  of  sunstroke ;  it  is 
rather  by  the  history  of  the  case^  and  the  consideration 
of  all  the  details,  that  a  diagnosis  can  be  made. 

The  pathology  of  the  affection  Ib  somewhat  indefi- 
nite. Many  writers  uphold  the  view  that  exposure  of 
the  uncovered  head  to  the  scorching  rays  of  the  sun 
may  give  rise  to  purulent  meningitis  ;  but  the  question 
may  be  asked,  why.  when  so  many  people  are  exposed 
to  the  injurious  iDUuence.  so  few  suffer  from  it  ?  The 
difficulty  in  answering  this  question  is  increased  by 
^e  want  of  a  satisfactory  physical  explanation  of  the 
fact  Obemier  (h)  has  endeavoured  to  show  by  both 
dinical  and  experimental  observations  that  the  cause 
and  nature  of  sunstroke  are  to  be  sought  in  the  abnor- 
mal increase  of  temperature  in  the  body,  and  Lieber- 
meister  (c)  has  further  shown  that  the  cerebral 
symptoms  associated  with  high  temperatures  are  only 
to  a  limited  decree,  if  at  all,  dependent  upon  cerebral 
bypersemia.  With  due  regard  to  the  observations  of 
these  writers,  there  is  some  probability  that  at  the 
onset  of  the  symptoms  there  is  some  hypersemia  of  the 
pia  and  brain,  or,  more  accuratel;^  speaking,  a  disten- 
sion of  the  whole  venous  system  with,  may  be,  (Edema- 
tous infiltration  of  the  brain  substance,  and  the 
changes  found  after  death  may  further  assume  the 


(a)  CloiutOD,  op.  cit.^  p.  41fi. 
(6)  Obernier.    '-DerHftzschlag."    Bonn:  1S67. 
(c)  Liebermefster.    "  Ueb  die  vv  viklogen  der  Febrifen  Teir perateor- 
itelgernog."    '  Dentscb.  Arcb.  f.  K.  T.  Med.  1.  Bd.' 


existence  of  a  cerebral  congestion  similar  to  the  con- 
gestion found  in  other  organs.  Enough  facts  are  not 
yet  established  to  justify  any  decided  opinion  as  to  the 
pathology,  and  accurate  anatomical  investigations  in 
the  various  stages  are  much  required. 

Experiments  have  shown  that  moderate  heat,  directed 
upon  the  cranium,  causes  dilatation  of  the  vessels,  and 
we  must  conclude  that  the  initial  congestion  of  sun- 
stroke is  due  in  part  to  heat.  Buck  (a)  is  of  opinion 
that  a  tendency  to  capillary  stasis  is  induced,  the 
heart  labours  to  overcome  the  obscruction,  and  failing, 
gives  us  the  sjrncopal  or  cardiac  variety ;  or  the  nervous 
system,  resenting  the  increased  abnormity  of  the  circu- 
lation, develops  convulsions  and  coma  as  the  cerebro- 
spinal variety  of  the  disease. 

The  post-mortem  appearances  vary  according  to  the 
form  of  the  disease.  In  ardent  fever,  serous  effusions 
in  the  ventricles  and  between  the  membranes  of  the 
brain  have  been  noted  {b)  with  turgescence  of  vessels 
and  congestion  of  the  pulmonary  system. 

The  cause  of  death  is  said  to  be  most  commonly  due 
to  asphyxia  and  not  to  apoplexy,  and  the  most  impor- 
tant changes  are  found  in  connection  with  the  thoracic 
viscera,  (c)  When  the  medulla  is  affected,  accumula- 
tion of  blood  takes  place  in  the  right  side  of  the  heart 
and  lungs,  with,  secondarily,  as  a  consequence,  a  want 
of  that  fluid  duly  arterialised  in  the  brain.  Roth  and 
Lex  (d)  state  that  death  in  the  majority  of  cases  occurs 
from  cardiac  paralysis  and  only  occasionally  from 
cerebral  disturoance.  Arudt(<;)  speaks  vagueiv  of  a 
''diffuse  encephalitis''  as  explaining  the  cerebral  sym- 
ptoms which  often  remain  after  the  acute  attack.  The 
same  author  points  out  that  the  blood  is  acid  during  an 
attack  of  insolation,  ia  very  rich  in  urea  and  white 
globules,  and  shows  very  little  tendency  to  coagulation. 
Koster  (/)  and  Fox((jr)  have  called  attention  to  the 
occurrences  of  haemorrhages  in  the  superior  cervical 
ganglion,  and  the  former  found  hsemorrhaj^es,  separa^ 
tion  of  the  nerve  fibres  and  extravasations  m  both  vagi 
and  phrenic  nerves.  In  one  case  (Dr.  Shuttleworth), 
t^ere  was  found  after  death,  meningitis  with  effusion 
and  traces  of  old  standing  disease  of  the  membranes. 
In  another  case  (6),  there  were  no  effusions,  but 
the  membranes  were  thickened  and  somewhat 
opaque  more  especially  at  the  vertex. 

In  one  case  I  found  marked  opacity  of  the  arachnoid 
with  an  excess  of  serous  fluid  between  the  convolutions 
and  in  the  ventricles.  The  dura  mater  was  apparently 
healthy  and  nonadherent  to  the  skull  cap.  The  inner 
membranes  stripped  readily,  and  in  one  coherent  film, 
leaving  the  surface  of  the  convolutions  intact.  The 
vessels  at  the  base  were  healthy  and  normal  in  arrange- 
ment There  was  no  marked  congestion  of  the  nervous 
system.  The  convolutions  themselves  were  well 
formed  and  the  cortex  was  of  good  depth  and  colour. 
Striation.  however,  was  ill-defined  and  throughout  the 
white  suDstance  of  the  brain  there  was  a  *' water- 
logged "  condition.  On  microscopic  examination  of  the 
cortex  cerebri,  I  found  a  considerable  number  of  spider 
cells  in  the  interstitial  substance  and  these  were  by  no 
means  confined  to  any  particular  layer  of  cells.  The 
presence  of  these  spider  cells  is  common  in  general 
paralysis  of  the  insane.  Although  by  no  means  special 
to  it  Mickle  (h)  has  observed  them  in  chronic  local 
syphilitic  cortical  cerebritis ;  and  in  connection  with 
local  destructive,  and  in  parts,  slightly  indurative, 
changes  following  traumatic  (i)  cranial  and  cerebral 
damage. 

The  absence  of  adhesion  of  the  pia  to  the  cortex,  and 

Back.    ' '  Hygiene  and  Public  Health,"  to),  iii,  p.  157. 
Moore,  "Dlaeaseeof  India,"  p.  268. 
Vajrer,  "  Qnain'e  Diet  Med"  Sunatroke.  - 
Duncan,  Op.dt.,  p.  253. 
Zlemi.  "  Cyc.  of  Med."  vol.  lil.,  p.  439. 
Berlin  Kim.  Wocbenecbr,  1875,  No.  84. 
Fox,  "  Influence  of  Sympathetic  on  Dfieaie,"  p.  279. 
Mickle  "  General  Paralysis  of  the  Irsane,'*  p.  807. 
Popoff  "  Virchow's  Arch.,"  xill,  421,  and"  ^entralblatt,"  No.  83 


(«) 
(b) 
(c) 


(i) 
1876. 


c 


208     The  Mbdioal  Pbbss. 


OKIGINAL  COMMUNICATIONS. 


Feb.  26,  1896. 


the  preseooe  of  the  spider  cells  is  not  at  variance  with 
the  view  of  Mendel  (a)  that  by  the  pathological  swelling 
of  the  spider  cells,  increase  of  nuclei  and  of  formed 
intercellular  substance,  the  outermost  layer  of  brain- 
cortex  is  swollen.  Simultaneously,  dilatation  of  vessels 
exist  in  the  pia,  and  hindered  circulation,  and  from  this 
condition  of  pia  and  cortex  the  space  normally  existing 
between  them  is  obliterated,  and  the  friction  between 
pia  and  cortex  leads  to  exudation,  and  nuclear  prolife- 
ration in  the  pia,  which  last  passes  into  and  incorporates 
itself  with  the  cortex  ;  a  condition  favoured  dv  the 
belt  work  resulting  from  increase  of  the  intercellular 
substance. 

Undoubtedly,  the  densely  matted  network  of 
scavenger  cells  {h)  which  pervades  the  upper  or  outer- 
most region  of  the  cortex  immediately  under  the  pia 
may  remind  one  of  the  increase  of  connective  tissue 
passing  along  Glisson's  capsule  in  a  sclerosed  state  of 
the  liver,  but  the  presence  of  spider  cells  in  the  cortex 
does  not  invariably  imply  obliteration  of  the  epicerebral 
space  or  adhesion  of  the  outermost  layer  with  the  pia. 

In  another  case  which  was  diagnosed  as  general 
paralysis,  the  dura  mater  was  found  normal,  no  pachy- 
meningitis, great  excess  of  subarachnoid  fluid  ail  over 
the  surface  of  the  brain,  especially  marked  over  the 
upper  ends  of  the  ascenaing  frontal  and  parietal  con- 
volutions. Pia  mater,  sodden  and  thick^  but  peeling 
readily  from  the  upper  surface  of  the  brain  leavmg  the 
convolutions  intact.  The  convolutions  were  somewhat 
thin,  arteries  at  base  slightly  atheromatous,  pia  mater 
at  base  peeled  readily  and  did  not  tear  the  surface  of 
the  convolutions.  On  section  the  grey  matter  was 
pale  and  ill  defined,  especially  over  the  whole  of  the 
trontal  region.  Left  lateral  ventricle  somewhat  dilated, 
right  apparently  normal,  no  sign  of  disease  in  ganglia 
at  base,  pons  and  medulla  apparently  normal,  white 
substance  of  brain  soft  and  pale,  the  spinal  cord  was 
interesting,  the  dura  mater  was  distended  by  fluid  in 
its  lower  parts,  whilst  along  the  cervical  and  chiefly 
dorsal  regions  there  were  numerous  hsemorrhagic 
patches  on  its  outer  surface  consisting  i)rincipally  of 
clotted  blood  lying  in  the  meshes  of  thin  gelatinous 
material,  no  lymph  or  actual  inflammation  of  the  mem- 
branes. In  the  lower  cervical  region  the  anterior 
surface  of  the  dura  mater  was  adherent  to  the  posterior 
surfaces  of  the  bodies  of  three  cervical  vertebrae  by  old 
firm  adhesions.  No  compression  of  cord  and  no  caries 
of  bone  could  be  detected.  The  cord  itself  was 
firm  and  healthy  and  did  not  show  any  signs  of 
degeneration.  Koster  (c)  has  described  a  nypersemic 
condition  of  the  brain,  the  occurrence  of  several  small 
ecchymoses  under  the  ependyma  of  the  left  ventricle, 
infiltration  of  the  lower  lobe  of  the  right  lung  and 
also  ecchymoses  nnder  the  peri  and  subcardium  of  the 
left  ventricle."  The  same  author,  however,  has  seen 
similar  results  in  the  case  of  a  syphilitic  woman  where 
excessive  increase  of  temperature  could  not  have  been 
the  cause  of  death,  and  ne  further  calls  attention  to 
the  possible  occurrence  of  disturbances  of  the  vaso- 
motor and  respiratory  nerve  centres  which  must  take 
place  in  a  pronounced  form  in  patients  suffering  from 
sunstroke.  The  inner  membranes  were  easily  stripped 
from  the  convolutions.  There  was  a  slight  excess  of 
cerebro-spinal  fl.uid  ;  the  white  substance  of  the  brain 
was  (Edematous  and  gaped  on  section ;  otherwise, 
beyond  considerable  injection  of  the  choroid  plexus,  the 
brain  was  fairly  healthy. 

Hitherto,  I  have  endeavoured  to  bring  before  jrou 
some  of  the  more  difficult  problems  of  diagnosis  arising 
in  connection  with  heredity  and  bodily  illnesses. 
Although  I  have  made  use  of  some  material  which  may 
be  considered  old,  I  feel  that  the  importance  of  the 
subjects  renders  occasional  repetition  desirable. 


MeadeL  lied.  Soc.  of  Berlin.  Feb.  14, 1888. 

BeTu  Lewis,  "  Maniud  of  Mental  DUeasee,"  p.  52S. 

Ktfcter,  op.  cit. 


EXCISION  OF  OSSICLES  AND 
MEMBRANE  IN  CHRONIC  SUPPURA- 
TION OF  THE  MIDDLE  EAR. 
By  RICHARD  LAKE,  F.RCa 

Operative  treatment  on  the  mastoid,  in  otitis 
media  suppurativachronica;  has  come  very  prominently 
forward  of  recent  years,  and  it  is  with  a  view  of  point- 
ing out  the  mean,  which  exists  between  the  antiseptic 
local  treatment  of  the  ear,  and  the  operation  of  open- 
ing the  mastoid  antrum  (letting  alone  those  far  more 
serious  operations  on  the  lateral  sinus,  or  for  otitic 
brain  abcesses  which  do  not  come  within  the  list  of 
methods  of  treatment  of  the  above  diseases),  that  this 
paper  is  written. 

The  occasions  for  removal  of  the  diseased  structures 
in  this  complaint  are :  (1^  The  cure  of  otherwise 
intractable  suppuration.  (2)  Improvement  of  the  hear- 
ing power.  (3)  A  minimising  of  the  risk  of  intra- 
cranial complication.  (4)  As  a  substitute  for  mastoid 
operation.  From  a  consideration  of  these  points,  es- 
pecicJly  the  first  two  and  last,  the  exact  indications 
tor  operative,  and  successful  operative  procedures 
should  result. 

I  would  like  to  remark  at  once,  that  save  in  the  ex- 
ceptional circumstances  which  will  be  pointed  out  as 
we  proceed,  no  operation  should  be  attempted  unless 
the  suppuration  is  of  over  three  months'  standing,  and 
has  resisted  antiseptic  treatment  carefully  carried  out 
for  that  time,  or  unless  the  discharge  is  for  ever 
recurring. 

For  the  cure  of  this  disease,  it  is  necessary  not  only 
to  remove  polypi,  granulations,  and  sequestra,  but,  and 
in  this  lies  the  key  to  the  value  of  the  operative  treat- 
ment, also  to  supply  efficient  and  free  drainage  ;  it  is 
precisely  in  cases  m  which  the  perforation  is  high  up 
in  the  membrane  that  the  operation  is  most  useful,  for 
instance,  in  Shrapnell's  membrane,  in  the  posterior 
superior  quadrant.  For  although  these  two  points  are 
both  at  the  lower  part  of  the  attic,  yet  we  know  unfor- 
tunately that  true  basal  drainage  rarely  obtains  here, 
and  that  the  irregularities  and  divisions  of  the  attic, 
its  inaccessibility  to  antiseptic  irrigation,  cause  the 
contrary  really  to  be  the  case.  Neither  in  the  remain- 
ing cases,  those  in  which  the  two  large  ossicles  are 
partly  destroyed,  and  their  bodies  alone,  with  more  or 
less  of  the  membrane  remaining,  is  drainage  free  for 
the  semi-necrotic  ossicles  are  partly  shut  off  from  the 
exposed  cavum  by  cicatricial  tissue,  pus  percolation^ 
through  its  meshes. 

With  respect  to  necrosis  of  the  ossicles,  it  has  been 
said,  and  I  think  rightly,  that  the  malleus  idone  is 
rarely  affected  ;  but  when  one  ossicle  only  is  affected 
it  is  usually  the  incus,  naturally,  there  is  no  regular 
rule  for  the  extensive  destructions  of  membrane  which 
are  accompani^  by  destruction  of  the  handle,  and 
sometimes  exfoliation  of  the  incus,  so  that  when  excis- 
ing the  malleus  the  incus  should  be  sought  for. 

But  bv  removing  the  ossicles  and  membrane  we  have 
not  in  all  cases  finished  our  work,  for  a  study  of  speci- 
mens, and  publbhed  results,  will  show  that  a  large  pro- 
portion of  these  cases  are  not  really  cured  by  these 
proceedings  even  in  the  large  perforation  cases  wiUi 
long-standing  suppuration,  since  in  these,  as  previously 
stated,  the  attic  and  antral  orifices  are  not  infrequently 
obstructed  by  a  mass  of  cicatricial  bands  or  webs  wil£ 
caseous  pus  and  detritus  read^  to  take  an  active  septic 
development  from  suitable  stimulation  ;  as  a  result  of 
this  condition  it  behoves  the  operator  to  remove  with 
curettes  all  the  tissue  from  these  regions,  and  to  com- 
bine this  with  a  careful  irrigation  with  an  efficient 


Fkb.  26.  1896 


CLINICAL  RECORDS. 


Tub  Mbdical  Prxss.     209 


antiseptic,  after  luiiig  hydrogen  peroxide.  I  believe 
that  it  tlus  be  done  carefully  in  suitable  cases  it  will 
frequency  obviate  the  necessity  of  the  mastoid  opera- 
tion, though  if  after  this  has  been  done  suppuration 
continues  the  major  operation  is  clearljr  indicated,  and 
should  be  done  without  hesitation.  It  is  also  probable 
that  a  removal  of  the  anterior  attic  wall  would  be 
advisable  in  many  cases. 

Now  with  regard  to  the  improvement  in  hearing ; 
after  this  operation  no  one  who  has  performed  this 
operation  with  a  sensible  appreciation  of  its  obiects, 
can  fail  to  have  been  struck  oy  the  usual  marked  im- 
provement in  the  cases  so  treated  over  those  which 
nave  been  quieted  down  by  a  long  and  often  tedious 
treatment  of  antiseptics,  when  from  one  cause  or 
anoiJier  more  radical  measures  have  not  been  pos- 
sible. 

The  acoustic  functions  of  the  organ  are  always 
adversely  affected  in  the  latter,  often  indeed  to  a  point 
of  absolute  suspension,  with  a  probability  of  ultimate 
destruction,  together  with  the  permanent  risk  of  inter- 
cranial  disease,  or  a  recurrence  of  the  distressin|^  dis- 
charge. By  an  intelligent  appreciation  of  the  aim  of 
this  operation  is  meant  the  recognition  of  all  the 
objects  in  view,  that  is  to  say,  the  wJiole  membrane 
must  be  removed  to  obtain  the  happiest  results  in  the 
improvement  of  hearing.  The  object  being  to  expose 
the  stapes,  and  not  to  have  it  covered  by  a  piece  of 
useless  membranatympanL  which  will  most  probably 
li^r  on  form  adhesions,  tnus  still  further  preventing 
sound  waves  reaching  the  stapes  direct 

Operation.— The  most  efficient  antiseptic  irrigation 
of  the  canal  should  be  performed  with  a  cool  unirritat- 
iDg  lotion  (not  a  hot  one),  in  order  not  to  cause  unneces- 
sary relaxation  to  the  vessels ;  also  irrigate  the  attic, 
if  open,  by  means  of  Hartman's  cannula. 

The  ear  is  then  packed  with  wool  soaked  in  cocaine 
byd.,  20  per  cent,  and  left  for  five  minutes,  even  if 
general  anaesthesia  is  used.  Commence  the  excision 
by  dividing  the  membrane  at  its  attachment  to  the 
meatus,  taking  care  that  this  circumcision  is  complete, 
a  probe  will  demonstrate  this.  The  tendon  of  the 
tensor  ^ympani  and  the  anterior  ligament  next  require 
division ;  the  membrane  is  then  seized  with  forceps, 
snare,  or  extractor,  and  together  with  the  malleus  is 
dragged  down  and  out  H»morrhage  during  the 
operation  is  to  be  checked  by  cocaine  and  pressure. 

It  is  usually  the  extraction  of  the  incus  which  gives 
most  trouble,  but  a  crotchet-shaped  curette  will  usually 
extract  it,  or  an  incus  hook  may  be  used,  but  the  incus 
is  in  difficult  cases  only  a  remnant  Haemorrhage  is 
sometimes  very  troublesome  and  persistent,  but  if  this 
18  so,  patience  will  eventually  conquer  it. 

*  Crotchet-shaped  curettes  should  be  used  to  clear  out 
the  attic  thoroughly. 

General  anaesthesia  is  not  necessary  if  the  patient 
has  sufficient  self-control  to  keep  still ;  moreover,  I 
think  that  it  increases  the  bleeding  on  account  of  the 
posture  of  the  head ;  again,  it  is  certainly  less  easy  to 
operate  with  general  anaesthetics  than  with  cocaine 
alone. 

During  the  operation  there  are  certain  details  which 
should  be  remembered  in  this  operation  ;  and  one  is  not 
to  cut  the  corda.  In  order  to  avoid  this,  fpreat  care  iB 
often  required,  indeed,  it  would  in  certain -instances 
seem  impossible  to  avoid  doing  so,  for  instance,  in 
those  cases  in  which  the  nerve  either  runs  an  abnormal 
eourse  or  is  adherent  to  the  membrane  at  the  usual 
level  As  a  general  rule,  however,  if  when  dividing 
the  membrane  at  its  posterior  attachment  care  is  taken 
Bot  to  have  more  tnan  just  the  point  of  the  koife 
through  the  membrane  no  accident  will  happen.  The 
eoida  lies  about  l-32nd  of  an  inch  beneath  the 
membrane. 

Hie  second  point  is  the  necessity  of  dividing  the 
anterior  ligament  of  the  malleus  as  well  as  the  tendon 


of  the  tensor  tympani,  and  this  is  most  easily  done 
with  a  rectangle  tenotome ;  this  is  passed  upwards 
anterior  to  the  head,  its  division  being  made  by  a 
forward  and  outward  cut 

A.  third  point  is  the  division  of  the  long  process 
of  the  incus  or  the  inco-stapedial  joint  Experience 
shows  that  quite  as  frequently  as  not  this  is  not  neces- 
sary, not  only  because  the  joint  usualljr  gives  way  when 
the  incus  is  pulled  on,  but  because  in  long-standing 
cases  the  long  process  is  frequently  destroyed  wholly  or 
in  part.  If  the  points  above  mentioned  are  adhered  to 
the  whole  strain  of  the  pull  on  the  malleus  is  trans- 
ferred to  the  incus,  and  the  latter  bone  will  often  come 
away  also. 

The  following  unsatisfactory  results  may  ensue  :— 
Continuance  of  the  discharge  in  spite  of  treatment, 
requiring  the  openin(i;  of  the  antrum.  Transient  ver- 
tigo is  of  no  special  importance,  on  account  of  its  tem- 
porary character.  But  a  more  objectionable  seq[uel  is 
the  formation  of  false  cholesteatomatous  masses  m  the 
attic,  as  has  been  reported  bv  numerous  observers, 
though  I  have  not  seen  it  myself  ;  there  would  be  no 
particular  difficulty  in  cleaning  it,  though  it  would  pro- 
oably  recur,  and  is  usually  present  before.  The  mal- 
leus may  break  off  short,  if  it  does  the  effect  of  treat- 
ment may  be  tried  before  further  operation,  as  the 
whole  trouble  may  have  been  in  the  neck  of  the  bone. 
Section  of  the  corda  :  this  causes  paralysis  of  the  sense 
of  taste  on  the  same  side  of  the  tongue,  in  its  anterior 
two-thirds,  with  a  sense  of  numbness  over  the  same 
region.  This  never  lasts  for  more  than  two  months. 
Transient  facial  paby  may  occur  if  energetic  curettage 
of  the  tympanum  is  required. 

As  in  this  paper  other  than  suppurative  conditions 
are  not  under  consideration,  I  shall  not  touch  on  the 
other  diseases,  for  the  relief  of  which  excision  of  the 
ossicles  and  membrane  has  been  brought  forward 
lately. 

The  following  suppurative  conditions  are,  in  my 
opinion,  sufficient  to  justify  operation  ;  if  careful 
treatment  has  failed  to  stop  the  discharge  when  con- 
sistently carried  out  for  a  period  of  from  six  weeks  to 
three  months,  or  if,  the  treatment  being  successful, 
there  is  great  impairment  of  hearing,  with  good  bone 
conduction,  and  tne  stapes  not  visible  :— 

1.  Perforation  in  membrana  Shrapnelli,  with  definite 
evidence  of  caries  and  deafness. 

2.  Perforation  over  foramen  ovale,  i.e.,  in  posterior 
superior  quadrant 

3.  Large  perforation  in  the  inferior  half  of  the  mem- 
brane, or  including  the  whole  membrane. 

4.  Perforation  of  the  M.S.  with  destruction  of  the 
anterior  attic  wall  and  disease  of  the  ossicles. 

5.  ^en  there  is  evidence  of  caries  of  the  inner 
tympanic  wall,  as  evinced  by  lateral  vertigo,  <kc.,  on 
sjrringing  ;  dizziness  alone  being  usually  the  effect  of 
pressure  on  the  stapes. 

19  Hariey  Street.  W. 


(SJ^adalJBitanJiA 


CANCER  HOSPITAL,  BROMPTON. 

Hasmorrhagie  Cy«t  of  the  Ovary  fiUing  Pdvis— Accom- 
panied by  Adeno-Carcinoma  of  the  Utena — Pan- 
Hfiatereciomy  and  Removal  of  Cyst  and  Appendages— 
jReoovery, 

Under  the  care  of  Mb.   Fbsd.  Bowrxman  Jesssit, 
F.R.C.S. 

A.  C,  iET.  43,  married,  was  admitted  under  my  care 
complaining  of  bleeding  from  the  vagina.  Has  always 
had  good  health.    She  Iwd  had  six  pregnancies,  and  three 


210    Thb  Mbdigal  PRft<i. 


TBAN8ACTI0XS  OF  SOCIETIES. 


rxB.  26,  1896. 


The 


cbildreD.   the  laet  heioi;  three  to  four  years  ego. 
yonngett  child  is  ten  years  old. 

History : — Up  to  two  months  %go  patient  had  always 
been  quite  regular  and  natural,  bu  tsince  then  there  had 
been  almost^  eontinnous  bloody  discharge  per  vaginam. 
Has  not  missed  any  period,  nor  was  there  any  increase  in 
the  amount  of  blood  lost  at  the  previous  periods. 

During  the  earlier  part  of  the  time  there  was  some  inter- 
mittent abdominal  pain,  but  lately  has  had  none. 

Present  Condition. — Patient  is  anemic  with  pallid  lipe 
and  pearly  conjunctivas.  By  abdominal  palpation  there  is 
found  a  round,  hard,  fixed  swelling  occnpyinff  the  left 
iliac  and  hypochondriac  regions.  Tbe  limits  oithe  swell- 
ing cannot  be  determined  with  any  degree  of  accuracy. 

Per  Vaginam  the  cervix  is  found  to  be  high  up  and 
pointing  forwards,  but  normal  in  appearance  and  to  the 
touch,  excepting  in  the  posterior  lip  which  is  rather  hard. 
The  OS  is  papular  and  admits  the  nnser  tip.  There  is  a 
larffe  hara  mass,  semi-elastic,  situated  in  Douglas's  pouch 
andprojectinfip  into  tbe  posterior  fornix.  This  swelling  is 
oontmuous  with  the  swelling  felt  in  the  abdomen,  the 
whole  mass  is  very  slightly  mobile  and  attached  to  the 
uterus.    Digital  examination  caused  slight  bleeding. 

On  December  31  st  the  patient  was  examined  under 
ether.  The  fundus  uteri  was  then  found  to  be  firmly 
adherent  to  the  mass.  The  os  was  high  up  behind  tfaie 
pubea.  The  mass  was  found  to  be  fairly  mobile.  The 
uterus  sound  passed  4}  inches.  After  consultation  it 
was  decided  to  perform  an  exploratory  operation,  the 
diagnosis  being  soft  rapidly-growing  myoma  of  uterus. 

On  January  7th,  the  vagina  having  boon  kept  douched 
with  hyd.perchl  solution,  1-3,000,  and  cotton-wool  tampons 
soaked  in  1 -5,000  hydr.  perchL  solution,  with  the  assist- 
ance of  my  colleague,  Dr.  Puroell,  I  performed  the  follow- 
ing operation. 

On  opening  the  abdomen,  it  was  found  that  the 
tumour  was  firmly  adherent  to  the  sigmoid  flexure 
and  filled  the  pelvis.  With  some  difficulty,  the 
adhesions  were  separated  which  fixed  the  growth  to  tbe 
pelvic  peritoneum.  On  passing  my  hand  down  on  the  left 
side,  I  tore  through  the  cysc  wall,  and  a  large  quan- 
tity of  dark,  almost  black,  blood  clot  escaped.  By 
degrees,  I  separated  all  adhesions,  and  then  peeled  the 
cyst  off  the  posterior  surface  of  the  uterus,  ligatured  the 
ovarian  arteries  on  the  left  side,  and  divided  the  broad 
ligament.  The  right  ovarv  was  then  examined  and  found 
to  be  much  enlarged,  and  containing  a  cyst  the  size  of  a 
large  walnut,  fillea  with  dark  blood  clot.  This  ovary  was 
firmly  adherent  to  the  cyst  on  the  left  side,  and  as  you 
see  by  the  specimen,  this  was  the  point  I  tore  through 
when  separatwg  the  adhesion.  It  became  a  question,  then, 
whether  to  remove  the  cysts  and  appendages  and  leave  the 
uterus,  or  to  remove  that  organ.  Being  guided  by  the 
history  of  the  case,  and  the  enlarged  condition  of  the 
uterus  suggesting  possible  malignant  disease,  and  also 
to  some  extent  by  the  fact  that  the  cyst  which  in  the  first 
instance  suggested  possible  tubal  pregnancy,  had  been  so 
adherent  to  tbe  posterior  surface  and  to  the  whole  of  the 
pelvic  peritoneum,  I  thought  the  patient  would  be  in  a 
betcer  condition  if  tbe  whole  orean  were  removed,  and  free 
drainage  arranged  for  through  the  vagina.  I  therefore 
proceeded  to  perform  pan-hysterectomy  in  the  manner  I 
have  so  recently  advocated  here,  leaving  a  glass  drain- 
age tube  in  the  vagina,  and  packing  wound  with  iodoform 
gauze.  The  patient  made  an  uninterrupted  recovery,  was 
up  in  three  weeks,  and  leaves  the  hospital  on  Saturday. 
The  Pathologist  has  furnished  me  with  a  report  of  the 
specimen  whereby  my  decision  to  remove  the  uterus  is 
thoroughly  justified.  Mr.  Plimmer  says  <*  A  section  from 
the  uterus  presents  the  characteristics  of  malignant  ade- 
noma, the  tissues  being  infiltrated  by  atypical  gland 
formations.  The  wall  of  the  cyst  is  composed  of  fibrous 
tissue,  with  irregular  bands  of  unstriped  muscle  arranged 
without  any  order,  so  that  the  section  shows  these  bands 
cut  obliquely  in  all  ways,  longitudinally  and  transversely. 
The  interior  is  lined  with  epidielium,  which  ib  arranged  in 
papillary  processes.  The  sections  of  the  cyst  show  no  sign 
of  malignant  growth,  being  apparently  formed  of  die- 
organised  ovarian  stroma  tissue. 


^jMXBaaxanB  at  ^oattit^ 

BRITISH  GYNECOLOGICAL  SOCIETY. 
Meeting  bbld  Tudrsdat,  Febbuabt  13th,  1896. 


The  President,  Clbmekt  Godson,  M.D.,  in  the  Chair. 

8PE0IMBN8. 

Mb.  F.  Bowbbman  Jishett  showed  two  specimens  : — 

(1)  Hemorrhagic  cyst  of  the  ovary,  filling  the  pelvis, 
accompanied  by  adeno-carcinoma  of  the  uterus,  pan- 
hysterectomy, with  removal  of  the  appendages,  which  will 
be  found  in  another  column  under  the  heeding  **  Clinical 
Records.'* 

(2)  Case  of  advanced  uterine  carcinoma,  treated  by 
chloride  of  zinc  paste.    Recovery. 

The  author  was  induced  to  show  this  specimen  for  the 
following  reasons :  First,  bacause  the  patient  was  first  seea 
by  the  President,  being  sent  to  him  by  Dr.  Chambers  ;  and 
the  President  had  asked  him  to  see  her  and  perform  the 
operation.  She  was  74  years  of  age,  highly  nervous,  and 
suffered  from  heart  disease  ;  and  it  was  therefore  thought 
that  she  could  not  bear  the  shock  of  vaginal  hysterectomy. 
After  scraping  away  as  much  of  the  disease  as  possible  with 
a  Volkmann'a  spoon,  he  applied  the  dredger,  and  then 
packed  with  chloride  of  zinc  wool.  The  slough  came 
a  way  on  the  tenth  day .  Secondly,  he  showed  the  specimen 
as  illustrating  how  difficult  it  was  in  some  capes  to  avoid 
the  accident  of  a  slough  into  tbe  rectum.  For,  in  this 
case,  a  fsecal  fistula  occurred ;  ten  weeks  sf ter  the  opera- 
tion, however,  this  bad  quite  healed.  Thirdly,  the  speci- 
men supplied  an  answer  to  the  question  whether  the 
periconesi  covering  of  the  uterus  shared  in  the  process  of 
sloughing.  In  this  case  the  peritoneal  refiections,  both  in 
front  ana  behind,  could  be  plainly  seen  on  the  specimen. 

The  Pbxsidbnt  said  he  was  very  gratified  to  see  this 
specimen.  The  patient  was  the  mother  of  a  medical  man  ; 
and  when  she  learned  from  her  own  medical  attendant. 
Dr.  Chambers,  that  she  had  malignant  disease,  she  was 
greatly  distressed.  But,  having  in  view  the  operation 
performed  by  Mr.  Jessett,  he  felt  that  he  could  bold  out 
to  her  hope  of  recovery.  Formerly  such  a  case  would 
have  had  to  go  unrelieved.  It  was  too  soon  io  speak  of 
permanent  results ;  but  meanwhile  the  patient  was  greatly 
relieved,  her  life  was  prolonged,  and  she  had  the  hope  that 
the  disease  was  cored ;  and  this  result  was  a  great  deal  in 
itself. 

Dr.  PuBCSLL  was  still  in  doubt  as  to  the  presence  of  the 
peritoneum  on  the  slough  shown  ;  he  did  not  know 
whether  the  specimen  had  been  submitted  to  the  patho- 
logist. The  principal  accident  to  be  feared  was  sloughing 
into  the  rectum ;  and  the  risk  could  be  minimised  by 
applying  sufficient  bicarbonate  of  soda  to  neutralise  thie 
excess  w  chloride  of  zinc. 

Dr.  Hbtwood  Smith  thought  the  technique  of  the 
caustic  operation  was  most  important.  He  would  ask 
whether  m  this  case  the  chloride  of  zinc  wool  was  used 
too  wet ;  it  should  be  only  damp,  as  advised  originally  by 
Sims.  He  thought  the  bicarbonate  of  soda  should  be 
applied  next  to  the  chloride  of  zinc,  without  the  interven- 
tion of  gutta  percba. 

Mr.  Jbssbtt,  in  reply,  said  that  in  this,  as  in  other 
cases,  he  used  a  gutta  percba  cap,  but  inside  it,  next  to 
tbe  chloride  of  zinc  wool  he  inserted  some  dry  wool,  which 
absorbed  excess  of  chloride  of  zinc  sufficiently  to  act  on 
the  lower  part  of  the  uterus.  As  an  additional  precaution 
he  had  lately  adopted  the  further  procedure  of  pecking 
the  vaginal  walls  round  with  lint  covered  with  iodoform 
ointment.  He  had  found  that  if  the  wool  was  too  dry  it 
had  little  or  no  effect,  as  it  could  not  then  be  got  strone 
enough.  He  used  tbe  paste  in  pellets  which  he  packed 
in  one  at  a  time  into  the  uterine  cavity,  and  by  this 
means  the  caustic  was  applied  as  dry  as  was  consistent 
with  efficacy. 

i  Dr.  Geobgb  Eldeb,  of  Nottingham,  showed  two  speci- 
I  mens :  1.  From  a  case  of  supra- vaginal  hysterectomy 
j  during  pregnancy  for  threatened  intestinal  obstruction, 
I  full  notes  of  which  will  be  found  on  page  205. 
I  2.  A  large  fibroid,  increased  rapidly  after  marriage.  In 
I  the  discussion  that  followed. 

i      The  Pbesident  thanked  Dr.  Elder  for  his  interesting 
I  specimen,  and  asked  him  whether  the  symptoms  were 


26,  1896. 


TEAKSACTIONS  OF  SOCIETIES. 


TiiE  Mbdiual  I'BISS.      211 


•Qch  as  to  reqaire  immediate  interference,  or  whether  it 
would  have  been  possible  to  allow  the  patient  to  go  on  to 
a  later  stage  of  pr^^ncy,  a  Porro's  operation- being  then 
performed.  For,  tboogh  there  bad  been  obstruction,  it 
was  apparently  relieved  the  day  before  the  operation. 

Dr.  Bantogk  joined  the  President  in  coogratnlating  Dr. 
Elder  on  the  sncoess  of  his  case.  He  thought  it  was  a 
serioos  step  to  question  the  judgment  of  a  man  who  had  a 
case  like  this  to  deal  with,  as  he  alone  could  have  the 
knowledge  necessary  to  guide  him  to  a  correct  decision. 
For  this  reason  he  upheld  Dr.  Elder's  action.  The  speci- 
mens illaetrated  very  well  the  arguments  be  had  repeatedly 
nrged  against  intra-peritoneal  treatment  of  the  stump. 
Tlie  chief  diflGieolty  was  hemorrhage.  For,  at  the  time 
when  hsBmorrhage  was  likely  to  occur,  they  found  that  it 
did  occur  from  the  stump,  in  the  extra-peritoneal  method, 
however  well  controlled  at  the  time  of  operation  ;  and  if 
the  stump  was  inside  the  peritoneum,  they  had  no 
command  over  the  haemorrhage.  As  a  matter  of  fact,  the 
intra-peritoneal  method  was  now  no  longer  performed  by 
any  operator  of  repute.  It  was  largely  replaced  by  the 
method  of  total  extirpation,  which  was  a  form  of  extra- 
poritoneal  procedure.  His  experience  led  him  to  regard 
this  operation  with  favour;  nevertheless,  in  view  of  the 
importance,  in  his  opinion,  of  keeping  the  vaginal  roof 
intact,  he  contended  that  the  cervix  should  be  left,  when 
this  was  possible. 

Dr.  PoscBLL  did  not  gather  whether  Dr.  Elder  used  a 
Koeberl^'a  serre-noeud ;  if  so,  could  the  hemorrhage  not 
have  been  controlled  by  it?  He  was  glad  to  hear  that 
Dr.  Bantock  had  come  round  to  the  view  that  pan- 
hyHterectomy  was  an  extra-peritoneal  procedure. 

Dr.  Baktcck  observed  that  he  had  always  held  this  view. 

Mr.  BowRBMAN  JB8SITT  Congratulated  Dr.  Elder  on  his 
case,  and  remarked  that  statistics  showed  that,  under  such 
circumstances,  removal  of  the  uterus  and  tumour  was  the 
proper  procedure.  The  only  point  in  which  hedifiFered 
was  thab  he  tboug^ht  it  would  have  been  better  to  remove 
the  whole  cervix,  m  which  case  there  would  have  been  no 
after-hemorrhage.  When  the  cervix  was  left,  and  the 
peritoneum  lacM  over  it,  then,  if  hemorrhage  occurred, 
it  formed  a  hematocele  between  the  etump  and  the  peri- 
toneum, which  would  require  interference.  He  contended 
that  pan-hysterectomy  did  not  weaken  the  vaginal  roof  ; 
be  bad  seen  now  many  instances  where  the  after-results 
showed  the  contrary.  Moreover,  the  possible  weakening 
was  not  to  be  compared  in  gravity  with  the  weakening  m 
the  abdominal  wall,  with  the  tardy  convalescence,  and 
with  the  risk  of  abdominal  hernia  and  fistula,  which  re- 
sulted from  treatment  by  the  serre-noeud. 

Dr.  Eldbb,  in  answer  to  the  President's  question,  said 
that  the  foetus  in  this  case  was  dead ;  but  had  it  been 
firing,  the  patient's  condition  was  so  grave  as  to  place  her 
interests  paramount,  and.  further,  the  nearest  doctor 
lived  seven  miles  away.  His  only  regret  was  that  he  left 
the  cervix,  as  otherwise  the  patient  might  have  been  spared 
both  pain  and  risk  from  hemorrhage.  He  did  not  use  a 
terre-ncend,  but  brought  the  peritoneum  round  the  stump. 

Dr.  Gborgb  Ksith  read  a  paper  on  "The  Permanent 
Cure  of  Anteflexion,"  and  Dr.  Eliot  read  some  *'  Notes  of 
Gynecological  Cases,"  both  of  which  we  hope  to  publish  in 
our  next. 


ROYAL  ACADEMY  OF   MEDICINE  IN  IRELAND 

Section  of  Anatomy  and  Phtsiologt. 

MsiTiNO  HKLD  Fridat,  Januart  24th,  1896. 

The  Presideiit,  Dr.  Johnson  Symington,  in  the  Chair. 

Thb  President,  after  expressing  his  thanks  for  the 
honour  accorded  to  him  by  bis  election  to  the  chair, 
formally  declared  the  business  of  the  evening  opened.  He 
then  exhibited  a  pulmonary  artery  with  four  valves,  all  of 
which  were  well-developed,  and  of  nearly  equal  size ;  two 
of  them  were  somewhat  more  closely  connected  than  the 
others.  The  President  also  exhibited,  for  Professor  Cun- 
ningham (who  was  unavoidably  absent^,  three  puppies  of 
the  Cape  Huntinu:  Dog  {ljyca<m  Piclua),  which  were  bom 
in  the  Dublin  Zoological  Gardens,  and  explained  their 
peculiarities. 

stimulation  of  the  pkeumogastric  nerve. 
Prof.  Purser  made  a  communication  on  the  stoppage  of  ' 


respiration,  which  sometimes  follows  stimulation  of  the 
peripheral  end  of  the  pneumo^astric  nerve,  and  pointed 
out  that  this  event  may  explain  certain  cases  of  sudden 
death,  which  are  often  attributed  to  primary  stoppaffe  of 
the  heart :  as  in  death  reeultiog  from  a  blow  on  tne  abdo- 
men, or  death  from  inhalation  of  chloroform. 

Dr.  FfiAztR  said  he  was  the  first  person  who  administered 
chloroform  in  Dublin,  and  he  never  had  a  fatal  case.  He 
attributed  his  success  to  watching  the  respiration.  He 
did  not  believe  a  right  explanation  had  been  given  of  the 
cause  of  death  in  fatal  cases.  The  symptoms  in  those 
fatal  cases  mentioned  were  undoubtedly  respiratory,  not 
cardiac.  He  made  it  a  point  in  the  administration  of 
chloroform  to  watch  the  respiration,  and  when  the  breath- 
ing became  embarrassed,  to  stop  the  inhalation. 

Dr.  Parsons  gave  the  history  of  three  cases  which  he 
said  pointed  to  the  conclusion  that  death  from  inhalation 
of  chloroform  was  to  be  attributed  to  cessation  of  respira- 
tion rather  than  to  stoppage  of  the  heart's  action.  The 
heart,  he  said,  may  beat  for  a  few  minutes  after  the  respira- 
tory functions  had  ceased.  He  would  like  to  know  Pro- 
fessor Purser's  opinion  as  to  the  effect  of  nitrite  of  amyl. 

Dr.  D.  J.  Coffey,  in  discussing  Professor  Purser's  paper, 
suggested  that  the  fact  that  the  inhibition  of  the  heart, 
brought  about  by  peripheral  stimulation  of  the  vsgus,  is 
not  permanent,  does  not  warrant  the  conclusion  uiat  a 
permanent  inhibition  cannot  be  determined  by  reflex 
excitation.  In  the  latter  case,  powerful  impulses  roused 
in  afferent  nerves  fall  on  the  cardio-inhibitof^  centre,  and 
the  conditions  are  very  different  from  those  in  peripheral 
excitation. 

Prof.  Birmingham  asked  if  the  author  had  in  any  of  his 
experiments  on  animals,  or  in  other  cases,  seen  death  due 
primarily  to  stoppsge  of  the  heart  while  respiration  was 
unaffected  ? 

Prof.  Purser,  in  replying,  said  it  would  be  a  dangerous 
condition  of  things  if  reflex  impulses  travelling  along  the 
pneumogastric  could  cause  death  by  inhibition  of  the 
heart.  He  agreed  with  Dr.  Coffey  that  a  message  sent 
down  the  vagi,  from  a  reflex  centre  in  the  brain,  might 
produce  results  very  different  from  excitation  of  the  peri- 
pheral portion  of  the  cut  nerve.  He  had  never  seen  a 
numan  being  die  of  chloroform.  In  a  series  of  experi- 
ments on  animals,  where  death  took  place  from  chloro- 
form, he  never  found  the  heart  stop  before  the  respirations. 
He  could  not  give  Dr.  Parsons  any  information  on  the 
subject  of  nitrite  of  amyl ;  he  had  never  experimented  on 
animals  wi'h  the  drug  ;  he  had,  however,  prescribed  it  in 
practice  with  satisfactory  results.  In  reply  to  Dr.  Bir- 
mingham, he  said  he  had  never  seen  such  a  case. 

THE  homology  OF  THE  DUMB  BELL-SHAPED  BONE  IX  THE 
ORNITHORHYNCHUS. 

Prof.  Symington  described  the  form  and  relations  of  the 
dumb-bell-shaped  bone  in  the  omithorhynchus,  based  upon 
the  microscopic  examination  of  serial  sections  of  the  beak 
of  this  animal.  He  discussed  the  theory  as  to  its  homo- 
logy, and  considered  that  it  corresponded  to  the  mesial 
puatine  process  of  the  premaxilla  of  ordinary  mammals. 

THE    topographical    ANATOMY     OF    THB    PANCREAS,     DUO- 
DENUM, SPLEEN,   AND  KIDNEYS. 

Prof.  Birmingham  made  a  communication  on  the  topo- 
graphical anatomy  of  some  of  the  abdominal  viscera, 
which  he  illustrated  by  a  plaster  cast.  The  cast  was 
prepared  from  a  body  in  which  the  viscera  had  been 
previously  hardened  in  situ,  by  the  injection  of  a  solution 
of  chromic  acid.  The  cast  gave  a  very  clear  idea  of  the 
condition  of  the  pancreas,  spleen,  duodenum,  kidneys  and 
supra-renals ;  it  also  showed  ps^icularly  well  what  the 
exhibitor  called  the  *'  stomach  bed."  The  author  remarked 
that  in  probably  the  majority  of  cases  the  stomach 
assumed,  when  empty,  an  attenuated  pear  shape,  and 
rarely  if  ever  became  flattened,  as  often  represented. 
The  greater  part  of  the  stomach  in  this  conciition  li^ 
nearly  horizontally  with  its  long  axis  from  behind  forward, 
the  narrow  end  bending  to  the  right.  He  believed  that 
during  distension  the  enlargement  was  more  in  a  direction 
forwaras  and  to  the  right  than  downward*.  The  duo- 
denum did  not  lie  in  a  coronal  place  as  usually  repre- 
sented, on  the  contrary  it  is  strongly  flexed  (moulded) 
round  the  right  side  of  the  vertebral  column.  He  also 
pointed  out  that  the  descending  duodenum  lies  not  in 
front  of  the  inferior  cava,  but  to  its  outer  side.^ 


212     Thk  Mbdioal  Fbkss. 


FRANCE, 


Fib  26,  1816. 


The  President  said  they  bad  reason  to  feel  oblij^ed  to 
Prof.  Birmingham  for  the  ^reab  trouble  he  bad  taken  in 
the  preparation  of  his  cast.  He  had  spent,  he  said,  some 
time  in  considering  the  positions  and  relations  of  the 
abdominal  organs,  and  to  acquire  accurate  knowledge  in 
this  respect  was  a  matter  of  great  difficulty.  On  these 
questions  there  could  be  no  doubt  but  that  the  opinions 
of  the  older  anatomists  are  extremely  fallacious.  He  felt 
bound  to  protest  against  many  statements  in  reference  to 
the  relations  of  the  abdominal  viscera,  contained  in  text 
books.  It  was  the  duty  of  the  anatomists,  so  far  as  lay  in 
their  power,  to  supply  physicians  with  accurate  descrip- 
tions of  those  viscera. 


Jlrance. 


[fbom  our  own  corrssponpsxt.] 


PARIS,  Feb.  22Dd,  1896. 

Treatment  op  Hydatid  Cysts. 

M.  DupLAT  read  a  paper  at  the  meeting  of  the 
Academic  de  Medecine  on  the  treatment  of  hydatid  cysts 
of  the  abdpmen,  in  which  he  recommended  a  free  opening 
of  the  tumour  and  the  complete  removal  of  all  the  vesicles. 
Thus  emptied  of  its  contents  and  cleaned  out,  the  walls  of 
the  cy»t9  are  sutured  and  returned  into  the  abdomen  ;  the 
operation  being  terminated  by  suture  of  the  primitive 
incision.  In  one  case  a  hydatid  cyst  of  the  liver,  in  which 
the  author  had  put  into  practice  this  method,  the 
patient  was  well  in  fifteen  days. 

Aneurism  op  the  Bone. 

M.  P4au  called  attention  to  two  cases  of  tumours,  styled 
aneurisms  of  the  bone,  which  presented  a  certain  interest. 
The  first  case  was  that  of  a  man  of  50,  who  for  two  years 
had  been  taken  with  recurrent  hsemorrhage  from  a  small 
pulsatile  tumour  situated  in  the  centre  of  the  palate. 
The  loss  of  blood  placing  the  man's  life  in  danger,  the 
speaker  decided  to  operate.  An  incision  was  made  from 
before  backwards  through  the  soft  parts  of  the  palate,  and 
through  the  centre  of  the  tumour.  Immediately  an 
enormous  jet  of  blood  followed,  which  the  operator  arrested 
with  his  finger.  With  the  gouge  he  attacked  the  alveolar 
edge,  and  removed  a  large  piece  of  the  bone  up  to  and 
including  the  central  portion.  The  wouqd  was  treated  in 
the  same  way  as  in  resection  of  the  maxilla,  and  the 
patient  recovered  without  further  difficulty.  An  histo- 
logical examination  proved  the  tumour  to  be  an  angioma. 

The  second  case  was  that  of  a  young  American  girl, 
8Bt.  14,  who  was  sufifering  from  an  erectile  tumour  below 
the  orbit.  Dr.  P^au  circumscribed  the  tumour  by  a  circular 
incision,  and  removed  it  piecemeal  down  to  the  perios- 
teum, cutting  across  the  large  vessels,  which  ran  in  every 
sense  over  it.  As  the  bone  was  not  in  any  way  implicated, 
it  was  respected.  This  was  also  a  case  of  vascular  tissue 
resembling  in  every  way  an  erectile  tumour.  These  two 
examples  were  interesting  by  the  fact  that  they  establish 
in  an  indisputable  manner  that  aneurisms  of  the  bone, 
though  rare,  have  a  real  existence,  and  should  not  be 
confounded,  as  is  frequently  the  case,  with  other  vascular 
tumours  such  as  sarcoma. 

Cystotomy. 

At  the  Socidt^  de  Chirurgie,  M.  Bazy  read  a  report  on  a 
case  of  supra-pubic  cystotomy  performed  on  a  man  who 
had  an  enlarged  prostate.  It  was  that  of  a  man,  set.  70, 
who  bad  been  suffering  for  six  months  previously  from 
retention  of  urine,  which  catheterism  relieved  with  the 
utmost  difficulty.  Finally,  no  catheter  would  pass,  and 
cystotomy  was  performed,  local  ansesthesia  being  obtained 


by  cocaine.  The  bladder  was  found  to  be  seriously  diseaf  iod* 
and  the  patient  only  survived  a  short  time. 

In  commenting  on  the  case  M.  Bazy  said  that  he  would 
mention  briefly  the  indications  and  counter  indications  of 
cystotomy. .  He  applied  generally  to  those  afl'ections  of 
the  bladder  in  which  the  element  "pain'*  predominated 
and  in  those  large  prostates  which  bled  a  great  deal.  Bub 
even  here  the  sound  a  demeure  frequently  arrests  the  hsemor* 
rhage  and  should  generally  be  tried  first. 

Hernia  of  the  Obturator  Foramen. 

In  an  interesting  these,  Dr.  Berger  treated  with  much 
details  a  variety  of  hernia  which  is  considered  rare  bat 
which  in  reality  is  frequent  enough  when  it  is  properly 
diagnosed.  Hernia  of  the  obturator  foramen  is  met  with 
more  frequently  in  women  than  men  and  can  be  seen  at  all 
ages,  but  is  more  frequent  after  sixty  years.  There  is  no 
strangulated  hernia  so  easily  overlooked  as  the  kind  in 
question  because  the  tumour  is  not  always  to  be  seen  or 
felt,  and  also  the  symptoms  are  in  general  far  less  accentu- 
ated than  those  occurring  in  other  portions  of  the  body. 

Hernia  of  the  obdurator  bole  has  been  confounded  very 
frequently  with  crural  or  perineal  hernia ;  however,  the 
former  was  a  pedicle,  and  its  tract  is  above  the  horizontsd 
branch  of  the  pubis  and  internal  to  the  vessels,  while  the 
latter  is  felt  in  the  lower  outlet  and  can  be  traced  throug^h 
the  vagina.  The  situation  of  the  obturator  hernia  is  in 
the  angle  formed  by  the  two  branches  of  the  pubie. 
Frequently  symptoms  of  occlusion  of  the  intestine  ezista, 
and  it  is  a  difficult  point  to  distinguish  between  internal 
or  hernial  strangulation.  The  situation  can  be  cleared  np 
with  care,  a  certain  amount  of  swelling  will  be  noticed  on 
the  inside  of  the  thigh,  vaginal  examination  will  revesJ 
sensitiveness  of  the  oorrespoQding  region,  and  the  sign  ol 
Romberg  (neuralgia)  may  be  considered  as  almoet 
pathognomonic. 

All  hernia  of  the  sub-pubic  aperture  should  be  treated 
by  operation  as  soon  as  possible,  either  as  a  preventive 
measure  or  to  relieve  strangulation.  The  operation  oon- 
sists  in  an  incision  over  the  tumour  at  the  origin  of  the 
thigh,  care  being  taken  not  to  wound  the  obturator  artery. 
Laparotomy  should  be  reserved  until  the  surgeon  was  able 
to  satisfy  himself  by  minute  researcii,  that  no  bemia 
existed. 

Managxmbnt  of  the  Umbilicus  in  Infants. 

In  an  address  recently  delivered  on  the  subject.  Dr. 
Cassel  made  the  complaint  that  the  principles  first  made 
known  by  the  pioneer  labours  of  Semmelweiss  in  the  region 
of  obstetrics  had  received  a  suitable  application  in 
regard  to  the  umbilicus  of  the  newly  bom  infant.  This 
was,  therefore,  the  starting  point  of  most  of  the  infectiire 
diseases  of  the  newly -bom.  He  then  pleaded  for  a  method 
of  management  more  in  accord  with  the  science  of  the 
day,  and  in  support  of  his  claims  gave  a  resume  of  the  work 
of  Erofs  (Beobachtungen  uber  Nabel  Krankheiten  nnd 
die  von  ihnen  aus  gehende  Inction  des  Organismus),  and 
also  those  of  Ehrendorfer,  of  Innsbruck  ;  also  Doctor, 
Buda-Pesth,  Roeeing,  of  the  University  Women's  Kinik» 
Halle,  Schrader,  Franz  Soberer,  Hermer,  and  Almander 
Keilmann.  The  daily  bath  of  the  infant  was  looked  upon 
as  injurious,  as  by  means  of  it  proper  mummification  and 
desiccation  of  the  cord  was  retarded  or  prevented.  Out  of 
400  children  who  were  not  bathed,  not  one  had  a  height- 
ened temperature,  whilst  nearly  5  per  cent,  of  those  that 
were  bathed  suffered  more  or  less  from  fever. 


Fkb.  26,  1896. 


GERMANY. 


Tub  Medical  Paiss      213 


(SermatiQ. 


[from  OUB  own  C0BRI8P0SDBNT.] 


BlBLIir,  Feb.  218(. 

Thk  Spkbma  aiid  Ssxual  Glands  of  Tubibculous 
Individuals  and  Bacilli. 

In  Yirchow'fl  Archiv.  142-1 »  Dr  Jaeckh  has  an  article 
on  this  subject,  giving  the  results  of  an  experimental 
inquiry.  In  five  cases  guinea-pigs  and  rabbits  were  inocu- 
lated with  seminal  fluid  and  testicular  substance  of  tuber- 
culous individuals.  The  experiments  with  seminal  fluid 
succeeded  three  times,  and  those  with  the  seminal  sub- 
stance once.  When  ovarian  substance  was  treated  in  a 
similar  way  it  succeeded  three  times  iu  four  experiments. 
The  ob;ection  often  made  that  the  bacilli  came  from  the 
blood,  and  not  from  the  substances  experimetted  with 
themselves,  could  not  hold  good,  as  in  those  caees  in  which 
admixture  of  blood  was  unavoidable  the  inoculation  almost 
always  failed.  The  young  of  tuberculous  guinea* pigs 
were  tuberculous  in  only  one  instance,  and  even  in  this 
case  a  positive  result  could  only  have  been  attained  by 
inoculation  of  the  membranes,  and  not  of  the  fcetus  itself. 
In  any  case,  the  author  claims  to  have  succeeded  in  proving 
the  presence  of  tubercle  bacilli  capable  of  development  in 
the  seminal  fluid  of  tuberculous  men. 

TUBBBCOLOSIS  IN   GeBMANV. 

From  a  recent  publication  of  Dr.  Brumerfilds,  we  have 
some  statistics  as  to  the  doings  of  tuberculosis  in  Ger- 
many. There  die  every  year  in  Germany  from  170  to  180 
thousand  people  (according  tc  Bollinger,  250,000)  of  pul- 
monary phthisis.  Of  every  1,000  deaths,  from  105  to  107 
are  due  to  tubercle.  Of  1,000  deaths  in  the  firfet  year  of 
life,  10*8  are  due  to  the  same  cause ;  from  the  1st  to  the 
15th  year,  62  per  1,000  ;  and  from  the  15th  to  the  60th, 
322  2  per  1,000 ;  in  other  words,  of  those  who  are  most 
capable  of  earning  a  living,  one-third  die  of  consumption. 

As  regards  Berlin  itself,  the  picture  is  darker  still.  Of 
the  deaths  between  the  ages  named,  15  and  60,  332  3  per 
1,000  are  due  to  tuberculosis.  Amongst  masons  the  rate 
yi  382,  whilst  amongst  stone-preesers  and  lithographers 
it  is  446,  amongst  tailors  and  ehoemakers  it  is  563, 
amongst  bookbinders  574,  amongst  cigar-makers  598, 
amongst  turners  610,  amongst  hat-makers  664,  amongst  | 
furriers  678.  Amongst  the  grinders  of  Solingen  the  rate  is  ' 
higher  still,  and  reaches  783  per  1,000.  The  highest  mor- 
tality from  consumption  is,  however,  reached  by  the 
stonemasons  amongst  whom,  out  of  1,000  deaths,  893  are 
due  to  pulmonary  phthisis. 

At  the  Society  for  Innere  Medizin,  Hr.  Litten  gave  an 
address  on 

Tub  Micboscofig  Examination  of  Fbesh  Blood. 

He  said  that  from  the  time  be  commenced  practice  he 
had  examined  the  fresh  blood  of  all  his  patients  and  had 
become  convinced  that  these  preparations  afl*orded  a  truer 
and  more  correct  indication  than  the  stained  preparations. 
He  had  shown  such  preparations  in  1892  at  the  Congress 
for  Medicine,  and  was  astonished  that  thoee  most  in  the 
habit  of  examining  blood  were  ignorant  of  them.  He  had 
found  two  peculiar  structures  in  the  blood  of  many 
healthy  and  sick  individuals  there  were  peculiar  cylinder- 
shaped  masses,  of  a  white  colour,  granular,  and  highly 
refracting,  about  four  to  six  times  the  size  of  the  red  blood 
corpuscles.  Their  size  seemed  to  pieclude  the  possibility 
of  their  circulation  m  the  blood  as  they  could  not  pass 
through  the  capillaries.    Investigation  led  to  the  ccnvic- 


tion  that  these  bodies  were  formed  from  the  eo-called 
blood  platee,  and  staining  showed  that  the  conviction  was 
correct.  These  plates  were  present  in  the  blood  of  every 
one  either  singly  or  in  groups.  They  were  present  in 
many  diseases,  as  in  leuosomia,  pernicious  ansdmia,  in 
increased  numbers.  Such  cylinders  were  not  present  in 
living  blood  but  formed  when  the  blood  was  placed  on 
the  object  glass  and  covered,  they  might  be  looked  upon 
as  collections  of  blood  plates. 

He  had  also  determined  the  existence  oi  a  second  group 
of  cylinders  in  fresh  blood  which  were  present  in  all  cases 
without  exception.  These  cylinders  were  not  quite  so 
highly  refracting  as  the  former  group,  they  were  not  white, 
but  bluish  and  not  granular.  The  edges  were  partially 
indented.  He  bad  paid  special  attention  to  the  No.  2  form 
of  cylinder  lately.  A  patient  came  under  nis  care  with 
numerous  well-marked  forms.  He  was  intending  to  demon- 
strate them  to  his  hearers  the  next  day,  and  instructed  his 
demonstrator  to  prepare  specimens,  but  was  not  a  little 
astonished  to  find  no  cylinders  in  them.  When  he  prepared 
them  himself  later  they  were  numerous,  but  they  were  as 
regularly  absent  when  his  assistants  prepared  theslides.  The 
different  results  mast  be  in  the  different  methods  of  pre- 
paring the  slides.  The  usual  methods  employed  by  the 
assistants  was  to  place  the  cover  glass  perfectly  horizon- 
tally on  the  object,  whilst  he  himself  gave  a  gentle  pull 
on  the  object  carrier,  so  as  to  have  an  exceedingly  thin 
layer  of  the  object  on  the  slide.  It  was  shown  later  that 
the  cylinders  were  really  produced  by  the  physical  action 
on  the  blood,  He  later  on  sought  to  detect  the  cylinder 
in  the  process  of  formation,  and  saw  that  on  the  first 
movement  of  the  cover-glass  the  red  blood  corpuscles 
formed  themselves  in  rows,  the  haemoglobin  was  pressed 
out  of  them  by  the  movement  so  that  they  became  quite 
colourless,  whilst  the  blood-serum  had  become  coloured. 
There  could  be  no  doubt;,  therefore,  that  the  cylinders 
were  formed  out  of  the  red  blood  corpuscles.  In  the 
inquiry,  however,  a  second  query  was  answered,  viz.,  the 
origin  of  the  blood  plates.  A  colouring  matter  was  added 
that  stained  the  stroma  of  the  nuclei  of  the  corpuscles, 
when  the  stroma  of  the  pressed-out  nuclei  was  seen  in  the 
form  of  blood  plates.  From  the  experiments,  it  was 
shown  that  the  blood  plates  were  not,  as  was  assumed, 
decomposition  products  of  white  blood  corpuscles,  nor 
prf  paratory  stages  of  red  blood  corpuscles,  but  decomposi- 
tion products  of  the  latter— stroma  minus  haemoglobin. 

At  the  Medical  Society  Hr.  Gluck  showed 
A  Sebiis  of  Cases  of  Successful  Risiction  of  the 
Hip-Joint. 

The  operations  were  performed  at  the  EL  K.  Friedrich- 
Kinderkrankenhause.  The  first  case  was  that  of  a  girl  of 
9,  who  had  congenital  dislocation  of  the  hip.  After  some 
trouble,  a  fairly  good  result  was  obtained,  the  shortening 
being  reduced  2i  ctm.  in  a  total  of  9  ctm.  The  second 
case  had  been  in  hospital  15  months,  and  was  a  very  serious 
one.  Tuberculous  disease  was  so  extensive  that  the  whole 
of  the  ileum  was  removed,  the  hip-joint  resected,  the 
marrow  scraped  out,  and  the  way  prepared  for  recovery  in 
such  a  way  that  the  femur  found  its  support  on  the 
horizontal  ramus  of  the  pubes.  The  child  could  now  not 
only  walk,  but  hop  about  on  the  lame  leg.  In  the  third 
and  fourth  cases  the  results  were  also  satisfactory.  In  the 
fifth  case  there  was  knee-joint  affection  that  had  been 
first  treated  on  the  conservative  method,  ^ynorrectomy 
was  performed  later,  the  joint  cleared  out ;  it  was  then 
tamponnaded  with  iodoform  gauze,  and  with  the  exception 


214     Th«  Medical  Prrsp. 


AUSTRIA. 


Feb.  26,  1896. 


of  a  little  thickening  of  the  capsule,  the  child  was  quite 
well. 

Treatment  of  Hypebtbophy  of  the  Prostate. 
The  question  of  the  treatment  of  hypertrophy  of  the 
prostate  by  castration  and  by  resection  of  the  deferens  is 
the  order  of  the  day.  Numerous  works  have  been  pub- 
lished on  th9  influence  exercised  by  ablation  of  the  testicles 
on  the  volume  of  the  prostabe,  the  majority  of  which  pro- 
nounce in  favour  of  the  operation.  But  patients  are  not 
always  ready  to  accept  the  mutilation,  even  though  they 
may  be  advanced  in  age.  In  face,  consequently  of  this  mani- 
festation of  amour  propre  surgeons  are  willing  to  resort  to 
any  other  means  which  may  tend  to  the  same  end.  It 
is  thu9  that  the  method  practised  by  Prof.  Helferich  will 
probably  be  well  received  by  both  surgeon  and  patient. 
The  operation  consists  in  resecting  on  both  sides  the  vas 
deferens.  In  ten  cases  in  which  he  tried  this  method  he 
witnessed  a  satisfactory  result  at  the  end  of  two  months. 
Only  two  of  the  patients  were  put  under  chloroform,  the 
remainder  supported  the  pain  without  any  effort.  The 
modus  operandi  was  as  follows:  the  vas  deferens  was 
pinched  up  with  the  left  hand,  and  the  skin  iucised  for  an 
inch ;  with  a  blunt  iostrument  the  canal  was  isolated, 
drawn  out  the  length  of  six  or  eight  inches,  torn  off  the 
epididymis,  and  excised.  With  a  little  dexterity  the 
double  operation  lasts  only  a  few  minutes.  The  wound, 
treated  antiseptically,  is  closed  and  covered  with  collodion. 
A  suspensory  bandage  is  applied,  and  the  patient  returns 
to  his  occupation.  The  effect  was  almost  constant  in  all 
the  cases,  micturition  was  greatly  improved,  but  only  in 
a  few  instances  was  the  prostate  diminished  in  volume. 
Hr.  Helferich  does  not  pretend  that  resection  of  the  vas 
deferens  equals  in  efficacy  double  castration,  but  it  fre- 
quently succeeds  in  improving  sufficienMy  the  condition 
of  the  patient,  and  as  it  is  a  benign  operation  it  ought  to 
be  tried. 


.auBlria. 


[fUUM  OUB  own    0OBBE8POKDBNT.] 

Vienns,  Feb.  2lat,  1806. 
Investigations  on  Facial  Paralysis. 
Dbxler  described  to  the  K.  K.  Gesellschaf  b  his  experi- 
ments on  a  horse  suffering  from  bilateral  facial  paralysis. 
The  object  of  his  investigations  was  to  test  the  theory  of 
ptosis ;  whether  it  was  due  to  the  firm  covering  of  the 
bnlbus,  or  downward  pressure  of  the  lid  after  paralysis  of 
the  face  had  been  established,  as  many  authors  affirm  ;  or 
whether  the  ptosis  was  due  to  other  causes  such  as  lag- 
ophthalmus.  Dexler  has  always  held  to  the  later  opinion 
and  thinks  he  has  demonstrated  it  to  the  satisfaction 
of  others  in  his  experiments,  combined  with  the  histo- 
logical results.  He  opened  the  cranium  of  the  para- 
lysed horse,  and  reaching  the  foramen  opticum,  applied 
Uie  electrode  of  a  battery  with  a  feeble  current  which 
caused  all  the  oculo- motors  to  act  promptly  as  well  as  the 
musculus  levator  palpebrte  superioris,  whose  function  was 
also  intact.  If  ptosis  were  simply  understood  to  be  a  sus- 
pension of  the  function  of  the  muscles,  and  thus  cause  a 
drooping  of  the  eyelid,  the  present  facts  must  be  aban- 
doned to  sustain  such  an  argument.  It  is  more  likely  that 
the  action  resembles  lagophthalmus,  where  another  set  of 
muscles  are  more  actively  engaged,  such  as  the  retractor 
bulbi  in         case,  and  thus  produce  the  deformity.  Where 


any  improvemenc  takes  place  in  the  facial  paralysis  it 
begins  in  the  upper  branches  of  the  nerve  of  the  horse,  as 
in  man. 

The  histological  examination  is  in  harmony  with  the 
above  experiment.  The  oculo-motor  nerve  in  all  its 
branches  and  central  ganglia  were  found  perfectly  healthy, 
while  the  trunk  and  branches  of  the  facial  nerve  were 
seriously  degenerated  by  an  inflammatory  lesion  in  the 
ganglion  geniculi.  The  blood  vessels  were  greatly  dilated 
and  infiltrated  with  leucocytes  while  the  ganglionic  cells 
had  lost  their  processes  and  were  difficult  to  colour.  There 
was  also  an  infl«mmatory  lesion  in  the  Gasserian  ganglion. 
There  was  no  injury  or  ear  affection  to  account  for  the 
morbid  lesion,  and  Dexler  concluded  that  the  ganglion 
geniculi  had  been  originally  attacked  by  some  unknown 

affection. 

Antitoxin. 

Palbauf  related  the  history  of  a  horse  in  the  Serum 
Institute  that  produces  a  finid  of  500  units  per  cam. 

At  the  last  meeting  of  the  German  Congress,  Behring 
proudly  affirmed  that  a  serum  could  be  obtained  by  newer 
methods  that  could  be  relied  on  containing  1,000  unite  in 
2  cm.  Palbauf  affirms  that  the  method  has  nothing  to  do 
with  the  strength  of  the  serum,  but,  that  it  depends  upon 
the  individual  animal.  The  animal  in  point  is  a  six-year 
gilding  which  was  received  into  the  instittue  in  December 
1894.  In  March  1895,  the  strength  of  the  serum  was  125 
to  130  units  ;  in  September,  140 ;  in  December,  170 ;  and 
at  the  present  time  is  500,  or  in  other  words  0'0002  cubic 
centimetres  of  this  serum  is  ten  times  the  lethal  dose.  This 
animal  has  now  produced  six  litres  of  toxin  since  its 
reception.  He  has  other  animals  in  the  institute  about 
the  same  age  and  under  similar  circumstances  which  seem 
to  vary  very  little  in  strength,  andhe  concludes  that  it  is  the 
animal  and  not  the  method  that  must  be  observed  in  order 
to  regulate  the  strength  of  the  serum. 

Gymnastic  Treatment  for  the  Gircitlation. 

Bum  brought  this  subject  before  the  Medical  Club  for 
discussion  in  the  form  of  a  long  review  of  the  different 
opinions  held  on  the  treatment  of  cardiac  diseases.  Mas- 
sage, diet,  drugs,  and  mechanical  applications  of  different 
sorts  had  been  tried  and  lauded  in  turn,  but  with  almost 
hopeless  success.  There  were  three  indications  to  be  ful- 
filled in  every  method  of  treatment  of  the  circulation 
which  would  make  or  mar  the  success  of  any  plan  adopted. 
These  were :  (a)  To  prevent  the  congestion  of  the  venous 
system ;  (6)  Reduce  the  resistance  in  the  peripheral 
vessels  in  order  to  relieve  the  pressure  in  the  left  ventricle ; 
(c)  To  strengthen  the  cardiac  muscle. 

To  prove  the  necessity  of  mechanical  gymnastics,  Sad- 
ler's experiments  were  brought  forward  to  show  how  the 
nutrition  can  be  sustained.  Sadler  found  that  dogs  kept 
at  perfect  rest  had  a  nutritive  power  of  36*6  per  cent., 
while  those  with  more  activity  had  66  per  cent.  Conges- 
tion in  the  muscle  is  prevented  by  its  own  activity,  a  form 
of  inspiration  and  expiration  by  its  own  contraction. 
More  C  Oj  is  produced,  showing  that  oxidation  is  greater 
and  more  heat  evolved,  as  shown  by  Helmboltz.  The 
C  Oj  next  excites  the  lungs,  increases  the  respiration,  and 
acts  vigorously  on  the  other  parts  of  the  organism. 

Sommerbrodt  has  shown  that  the  intra- bronchial  pres- 
sure is  reduced  by  exercise,  hastens  the  activity  of  the 
\  heart,    and    expands     the     arterial     blood     channels, 
I  without  raising  the  pressure,  as  shown  by  his  sphygmo- 
graphic  experiments.    Bum,  therefore,  recommended  deep 
respirations,    which    aided    the    venous    system,    with 


Fib.  26,  1S96. 


THE  OPERATIKG  THEATRES. 


The  Medical  Pbvss.    215 


«aeibodical  muecnlar  movements  to  relieve  the  re^ietance 
in  the  »yetemio  circnlation.  To  supply  the  purely  gym- 
OMtio  movementi,  the  depletory  foim  of  maetsge,  with 
ftriping,  and  muscular  kueadiuf;  of  the  eztrcmitiee  and 
seek,  with  firm  tapping  on  the  thorax  and  back,  to  pro- 
duce vibrationa  in  Uie  cardiac  legiona  are  potent  agents  in 
eecnriiig  a  restorative  action. 

Phosphobus. 
The  "Obersten  Sanit&tsrathes "  had  under  their  con- 
sideration this  week  the  propriety  of  allowing  matches  to 
be  made  with  yellow  phosphorus.    It  is  now  proposed  to 
make  this  practice  illegal  and  to  substitute  the  Swedish  or 
red  phosphorus  in  the  manufacture  of   this  commodity, 
although  many  industrial  di£Sculties  stand  in  the  way  ; 
yet  the  number  of  deaths  annually  occurring  from  tbe 
Abuse  of  this  household  article  has  excited  alarm,    and 
compels  the  enforcement  of  the  use  of  a  less  dangerous 
substance  in  the  manufacture  of  these  matches.    It  was 
also  ooDsidered  that  the  red  phosphorus  would  reduce  the 
•death-rate  among  the  workers  of  the  match  works. 

DXVSITT  07  POPCTLATIOK. 

At  the  last  sanitary  meeting,  the  health  of  Vienna  was 
discosced,  and  the  death-rate  of  other  large  towns  of 
Europe  compared  with  it.  The  investigation  only  con- 
firmed the  preceding  experience  that  density  of  population 
ia  an  active  factor  in  the  death-rate,  although  the  condi- 
tion of  the  houses  was  much  to  blame.  In  districts  where 
-2  per  cent,  of  the  population  was  located,  1*14  of  the  deaths 
•oocnrred ;  in  others,  where  28 '3  of  the  population  resided, 
the  contribution  to  the  death-rate  was  3*5  per  cent,  It 
was  resolved  to  formulate  a  recommendation  to  the  Govern- 
ment to  reduce  the  overcrowded  parts  considerably. 
Tbachoma. 
According  to  the  oflSdal  report  trachoma  is  on  the 
increase,  more  especiaUy  in  the  northern  counties  of  the 
kingdom.  The  incidence  is  particularly  high  among  the 
peasantry.    The  Ck>unty  of  Trenesiner  alone  records  3,860 


The  usual  causes  of  filth  and  over-crowding  are  assigned 
as  the  source  of  the  increase. 

Thtboid  Gland  and  Mobbus  Basedowi. 

Beholz  in  his  experiments  with  thyroid  tabloids  in  the 
healthy  and  morbid  state  measured  the  amount  of  elimina- 
tion both  before  and  after  administration. 

Before  administration,  the  elimination  was  equal  to  the 
ingestion.  On  the  use  of  the  tabloids  no  change  in  the 
-elimination  of  nitrogen  took  place,  while  in  the  healthy 
it  was  reduced,  but  did  not  disturb  the  balance  as  no 
reduction  of  weight  took  place  in  either  case. 

The  phosphoric  acid  elimination  was  tenfold  increased  in 
awrbus  Basedowi,  while  it  was  only  four  times  in  the 
healthy.  In  both  cases,  during  the  administration  of  thy- 
fftrid,  more  phosphoric  acid  was  eliminated  than  taken  in. 
This  agrees  with  Roos*  results,  and  bears  out  Kocher  in  his 
opbiion  that  phosphate  of  soda  is  the  rational  treatment 
te  morbus  Basedowi. 


Jtalg. 

[IBOM  AN  000A8IONAL  00BBI8PONDENT.] 

BoXX^Feb.  21lt 

MoNOFOLY  OP  Quinine. 
Pabuambnt  has  decided  from  a  humanitarian  point  of 
iew  to  take  over  the  sale  of  sulphate  of  quinine,  which 


henceforth  will  be  sold  in  the  tobacco  and  tsM  ehops,  put 
up  in  small  packets  containing  3  grammes  of  the  sulphate 
of  quinine,  or  2  grammes  of  the  hydrochlorate  of  quinine ; 
each  packet  will  cost  50  centimes,  which  is  at  the  rate  of 
2  soldi  per  gramme.  The  monopoly  is  undertaken  for  five 
years,  after  which  it  may  be  removed.  The  action  of  the 
Government  is  a  benevolent  one.  It  is  calculated  that 
16,000  Italians  die  annually  from  malaria,  and  that  3,000 
parishes  at  present  exist  where  no  apothecary  can  be 
found. 

It  is  thought  that  if  quinine  can  be  timely  administered 
many  of  these  lives  msy  be  saved  and  the  death-rate 
reduced. 

The  Blastomtoetes  of  Sabcoma. 

Roncali,  who  is  acting  under  Prof.  Durante,  in  Rome, 
afiBims  that  he  has  found  the  (ame  miciobe  as  Sanfelice  in 
sarccma  and  adenoid  carcinoma  of  the  ovaries.  It  requires 
a  specific  colouring  sgent  as  it  resists  both  acids  and 
alkalies.  The  parasite  is  found  both  within  and  without 
the  cell.  When  young,  and  without  covering  membrane, 
the  protoplaf  m  is  chromatic ;  as  it  increases  in  sge  the 
membrane  thickens  and  the  colour  recedes.  This  **  Blaeto- 
mycetes  *'  in  the  cancerous  tumour  is  still  awaiting  con- 
fiimation,  as  many  efforts  by  other  investigators  have 
failed  to  obtain  this  parasite. 


UNIVERSITY  COLLEGE  HOSPITAL. 
Abthbsctoht  or  the  Elbow — Mr.  Babkeb  operated 
on  a  middle-aged  woman  suffering  fiom  what  appeared  to 
be  tubercular  disease  of  the  left  elbew- joint,  which  had 
lasted  for  four  years ;  there  was  tenderness  and  limited 
mobility  ;  a  year  and  a  half  ago  an  abicees  had  formed, 
which  had  been  opened.  At  present  the  part  presented  a 
pulpy  swelling  more  marked  than  ueual,  especially  over 
the  head  of  the  radius.  Mr.  Barker  said  he  thought 
nothing  better  could  be  done  than  to  excise  freely.  He 
made  a  curved  incision  under  the  olecranon,  the  convexity 
of  the  cut  being  downwards  so  as  to  turn  up  an  oval  flap ; 
the  olecranon  was  divided  by  means  of  a  chisel  and 
hammer,  a^d  turned  upwards ;  a  little  patch  of  granula- 
tion was  found  on  the  cartilage  with  a  small  hole  leading 
into  the  bone  for  about  an  eighth  of  an  inch.  Finding, 
however,  that  the  disease  was  mostly  confined  to  the 
synovial  membrane  Mr.  Barker  decided  to  do  an 
arthrectomy  as  for  the  knee,  considering  it  better  to  try 
and  save  the  bone,  even  in  the  event  of  having  to  perfoim 
a  subsequent  operation.  He  dissected  off  the  synovial 
membrane  very  carefully  and  with  a  certain  amount  of 
di£Sculty,  as  it  bulged  down  in  some  parts  almost  like  a 
fatty  tumour ;  he  took  it  away  in  one  piece,  which,  he 
remarked,  was  the  best  method,  as  then  the  surgeon  could 
make  sure  of  having  removed  it  all.  He  said  that  if  the  joint 
healed  up  without  the  removal  of  any  bone  the  result 
would  be  not  only  very  rare,  but  also  one  very  difBcult  to 
obtain,  and  one  it  was  not  often  justifiable  to  attempt. 
He  had  never  operated  on  a  case  exactly  at  the  same  stage 
as  the  present  one,  in  which  it  eeemed  a  pity  to  sacrifice 
any  bone ;  there  was  only  one  spot  round  the  head  of  the 
radius  where  the  bone  was  at  all  affected,  and  this  was  at 
a  point  where  the  osseous  surface  had  been  in  con- 
tact with  the  diseased  synovial  membrane ;  this 
spot  he  carefuUy  scraped.  The  separated  portions 
of  the  olecranon  were  then  drilled  and  brought  into  appo- 


210     Ths  Mkdical  Pbiesp. 


LEADING  ARTICLES. 


Fib.  26,  1896. 


Bition  with  a  eilver  wire,  the  knot  of  which  was  made  on 
the  outside,  in  order  to  be  out  of  the  way  of  the  ulnar 
nerve  ;  the  nerve  had  been  reco^ised  at  an  early  stage  of 
the  operation  and  carefully  held  out  of  the  way.    There 
was  very  little  bleeding,  although  no  Esmarch  was  used ; 
the  bandage,  as  Mr.  Barker  pointed  out,  being  very  con- 
venient for  the  surgeon  during  the  operation,  but  giving 
rise  to  interminable  oozing  when  taken  off.    He  said  that 
the  elbow  was  admitted  by  all  to  be  a  joint  lending  itself 
but  very  little  to  arthrectomy,  but  as  the  cartilaginous 
surfaces  were  left  fairly  sound  in  the  case  be  had  just  done, 
thereoughttobeagood  chance  of  recovery  with  movement; 
a  new  synovial  membrane  would  form,  or  at  least,  some- 
thing which  took  its  place.     Of  course,  for  a  successful 
result  it  was  necessary  to  have  union  by  first  intention. 
He  considered  that  surgeons  do  not  really  yet  know  how 
far  they  can  go  in  resections,  as  it  is  only  of  late  years 
that  it  has  been  possible  to  carry  out  arthrectomies ;  it 
was  wrong,  he  thought,  to  dogmatise.     After  the  original 
incision  had  been  closed  the  limb  was  dressed,  but  no 
splint  was  put  on,  for  the  arm  was  to  be  moved  as  soon  as 
the  patient  liked  ;  no  passive  movement  causing  pain  was 
to  be  employed  as  it  is  apt  to  excite  reaction  leading  to 
consolidation  of  the  tissues  and  ankylosie. 
ROYAL  TREE  HOSPITAL. 
Removal  of  a  Portion  of  a  Needle  afteb  its  Lo- 
calisation BY    MEANS    OF   THE  NeW  MeTHOD  OF  PHOTO- 
GRAPHY.— Mr.    Battle  has  recently  had  an  interesting 
case  under  his  care  in  which  the  advantages  of  the  new 
method  of  photography  were  strikingly  illustrated.    The 
patient  was  a  young  woman,   »t.  30,  who,  nine  months 
ago,  ran  a  needle  into  her  thumb,  and  had  broken  it  off, 
leaving  a  portion  in  the  thumb.    She  had  suffered  pain  in 
the  part  at  the  metacarpo-phalangeal  joint,  and  had  been 
unable  to  use  it  properly  since.    Examination  showed  a 
small  scar  over  the  outer  side  of  the  joint  named,  and  this 
was  stated  to  be  the  spot  at  which  the  needle  had  entered, 
and  at  which  an  attempt  had  been  made  to  remove  it  some 
months  ago,  but  unsuccessfully.    There  was  no  abnor- 
mality to  be  felt,  but  the  patient  said  that  this  spot  was 
tender  to  pressure,  and  movements  of  the  joint,  especially 
.  those  of  flexion,  caused  pain.      It  was  not  possible  to 
localise  the  needle,  so  Mr.  Battle  suggested  that  a  photo- 
graph should  be  taken  by  the  new  method  in  order  that 
if  possible  exploration  might  be  undertaken  with  some 
prospect  of  success.     Mr.  Rowland  kindly  did  this,  and 
the  result  of  the  photograph  showed  the  presence  of  a 
piece  of  needle  lying  across  the  joint  at  right  angles  to  the 
long  axis  of  the  thumb,  but  it  could  not  be  told  from  the 
photograph  whether  the  needle  was  in  front  of  or  behind 
the  joint.    From  the  position  of  the  scar  and  the  character 
of  the  pain  Mr.  Battle  concluded  that  the  foreign  body 
was  in  front  of  the  articulation,  and  so  he  made  an  incision 
in  this  situation,  the  incision  being  placed  between  the 
points  of  insertion  of  the  abductor  pollicis  and  the  oppo- 
nens  pollicis ;  this  incision  immediately  came  upon  a  small 
bead  of  granulations  in  the  middle  of  which  could  be  seen 
a  black  speck,  evidently  one  end  of  the  broken  portion 
of  the  needle.     It  was  readily  withdrawn  with  dissecting 
forceps.    It  was,  as  had  been  indicated  by  the  photo- 
graph, probably  just  on  the  edge  of  the  joint ;  it  pre- 
sented   the    usual     black    discoloured    appearance    of 
such  bodies  after  they   have  remained  for   some   con- 
siderable time  in  the  tissues.    The   needle  was  about 
half-an-inch  long  and  consisted  of  the  half  portion  con- 
taining  the   eye.     As    a   rule,    Mr.    Battle   remarked. 


when  a  needle  is  buried  in  the  hand  it  is  possible 
to  find  some  indication  of  its  presence,  such  as  a  hard 
localised  point  of  resistance  under  the  skin,  but  some 
times  its  position  is  by  the  side  of  a  tendon  or  under 
some  procees  of  fascia  so  that  it  cannot  be  felt  in  the 
way  mentioned  ;  it  appears,  he  said,  that  the  new  method 
affords  a  me^ns  of  diagnosing  such  hidden  bodies, 
whereas  previously  suigeons  had  to  fall  back  on  an  elec- 
trical apparatus  to  indicate  the  actual  presence  of  the 
foreign  body.  By  this  new  process  not  only  is  the  presence 
ot  the  foreign  body  proved,  but  its  relationship  to  the 
bones  and  the  direction  in  which  it  is  lying  are  fully 
shown.  The  body  in  the  present  case  would  have  been 
very  difficult  to  localise  without  this  process  for  it  wae 
placed  between  the  two  bones  and  covered  over  by  the 
tendons  going  to  their  insertion  in  the  phalanx  beyond. 


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EJfje  ^tisml  §ress  ^  ^ircittlHr. 


'  SALUS  POPULI  BUPREMA  LEX. 


WEDNESDAY,  FEBRUARY  26,  1896. 


IS  SURGERY  A  CURE  FOR  CANCER? 
Ix  discasslDg  the  question  of  the  results  of  the  sur- 
gical treatment  of  cancer,  probably  most  surgeons  wUl 
be  prepared  to  admit  that  it  is  inexpedient  to  place  too 
much  reliance  upon  the  statistics  belonging  thereto^ 
for  a  little  reflection  must  show  that  a  collection  of 
figures  alone  cannot,  in  this  instance,  afford  any  trust* 
worthy  indication  of  the  true  value  of  the  treatment. 
In  the  first  place,  it  is  obvious  that  several  causes 
must  be  concerned  in  rendering  these  results  either 


Fib.  26. 


LEADING  ARTICLES. 


Tub  Medical  Pbbss.     217 


favoorable  or  the  reverse.  For  example,  the  Btatistics 
may  only  apply  to  a  series  of  selected  cases,  and  do 
demonstration  is  needed  to  point  ont  that  when  this  is 
the  fact  the  results  mnst  show  a  better  record  than  in 
the  cases  in  which  selection  has  not  been  made.  Again, 
it  is  essential  to  bear  in  mind  that  surgeons  are  some- 
times called  npon  to  operate  upon  patients  who  are 
practically  far  beyond  the  aid  of  surgery.  Such 
patients,  knowing  full  well  the  fate  which  is  in  store 
for  them,  and  overwhelmed  with  despair  for  the  hap- 
lessness  of  their  condition,  will,  nevertheless,  sometimes 
earnestly  entreat  the  surgeon  to  make  some  attempt 
to  afford  them  relief,  Thus,  if  out  of  common  humanity 
the  surgeon  consents  to  operate,  he  is  bound  to  include 
the  results,  whatever  they  may  be,  among  his  statistic?. 
Perhaps,  then,  a  sense  of  duty  and  a  feeling  of  com- 
passion for  his  hapless  patient,  impels  him  to  do  that 
which  is  certain  to  affect  his  statistics  unfavourably. 
A  further  point,  however,  may  be  mentioned  in  connec- 
tion with  this  aspect  of  the  subject,  and,  that  is,  that 
it  is  not  fair  to  pass  an  adverse  judgment  upon  the 
results  of  the  operative  treatment  of  cancer  based  upon 
a  generalisation  of  those  results.  Let  any  one  who  is 
disposed  to  do  this  reflect  for  a  moment,  how  cases  of 
cancer  vary,  not  only  in  regard  to  their  accessibility 
and  fitness  for  surgical  interference,  but  also  in  respect 
to  the  period  during  which  the  disease  has  persisted 
before  the  patients  come  under  the  notice  of  the  sur- 
geon. Regarding  the  modem  theory  as  the  correct  one, 
that  cancer  is  a  local  disease,  it  is  indisputable  that  the 
earlier  a  malignant  growth  is  diagnosed  and  removed 
the  better  are  the  prospects  of  a  good  result  following. 
In  order,  therefore,  to  make  the  statistics  of  the  surgi- 
cal treatment  of  the  disease  even  trustworthy  in  this 
respect,  it  would  be  essential  for  the  cases  operated  on 
to  be  limited  to  those  in  which  the  growths  had  only 
been  noticed,  say,  for  a  period  of  three  months^  But 
even  then  some  element  of  uncertainty  would  exist, 
for  experience  commonly  teaches  how  the  degree  of 
malignancy  of  cancerous  growths  varies.  In  some 
patients  the  neoplasms  progress  at  a  slow  rate,  even  at 
the  time  of  life  when  the  reverse  might  reasonably  be 
anticipated ;  in  others,  on  the  contrary,  the  growths 
develop  with  a  rapidity  which  presages  a  speedy  ter- 
mination of  life  despite  the  interference  of  surgery 
or  the  resort  to  any  other  procedures  which  the 
science  of  the  day  could  suggest.  Thus  it  must  be 
conceded,  that  the  statistics  of  the  results  of  operations 
for  cancer  are  to  a  large  extent  not  adapted  for  the 
purpose  of  generalisation.  It  might,  however,  be 
urged  that  this  argument  could  be  applied  with  the 
same  force  to  all  operations  in  surgery,  and  that  in 
any  given  series  of  cases  requiring  the  same  operative 
treatment  the  conditions  will  vary  just  as  they  are 
found  to  vary  in  cases  of  malignant  disease.  For 
example,  the  varying  conditions  present  in  cases  of 
ovariotomy  might  be  quoted  in  support  of  this  state- 
ment. But  we  submit  that  a  little  reflection  will  show 
that  cases  of  malignant  disease  stand  in  a  category  by 
themselves,  inasmuch  as  one  element  is  common  to 
them  all,  namely,  the  assemblage  of  those  features  by 
which  each  case  is  endowed  with  a  gravity  not  present 


in  any  other  pathological  condition.  But  to  take  a 
gloomy,  pessimistic  view  of  the  surgical  treatment  of 
cancer,  as  has  been  done  by  some  surgeons,  and  to 
question  whether  the  advanced  surgery  of  the  day  is 
justifiable  in  this  connection,  is  by  no  means  warranted 
by  the  facts.  At  no  time  have  the  results  of  surgical 
interference  in  these  cases  shown  so  good  a  record  as 
in  the  present  day.  It  should  be  borne  in  mind^ 
moreover,  that  many  operations  are  now  prac- 
tised, under  the  aegis  of  antisepticism,  and  much 
relief  for  the  patients  gained,  which  in  earlier  days 
would  have  been  impossible.  To  compare,  therefore, 
the  results  of  Brodie  and  the  surgeons  of  former  times 
with  those  obtained  by  modern  surgeons,  is  practically 
useless.  Nor  has  the  Hippocratic  saying  that  **  It  is 
better  not  to  treat  those  in  whom  occult  cancers  have 
been  formed,  for  when  treated,  they  soon  die,  but  if  not 
treated,  they  live  a  longer  time,"— much  value  in  the 
present  day.  Contrast,  for  a  moment,  how  a  contem- 
porary of  Hippocrates  would  have  proceeded  to  deal 
with  an  *'  occult  cancer."  What  other  result  could  be 
expected  to  follow  than  the  speedy  death  of  the  patient? 
But  as  Hippocrates  has  been  appealed  to  in  the  matter, 
it  may  be  observed  that  his  are  not  the  only  aphorisms 
which  should  be  pressed  into  service  when  debated 
points  in  medical  or  surgical  treatment  are  under  dis- 
cussion, and  especially  so  far  as  the  present  subject  is 
concerned,  we  would  suggest  that  the  foUowing  state- 
ment more  truly  represents  the  position  of  affairs,  namely 
that  '*  it  is  the  duty  of  the  surgeon  always  to  remove  a 
cancerous  growth  whenever  he  has  grounds  for  the  belief 
that  the  operation  can  be  completely  carried  out." 


THE  CHRONIC  POLICECELL  INEBRIATE. 
DimiNG  the  past  month  one  of  the  London  magis- 
trates has  adopted  a  course  which,  it  may  be  confi- 
dently hoped,  will  mark  a  new  era  in  our  social 
treatment  of  the  chronic  inebriates  of  the  police-courts 
We  allude  to  the  case  of  the  notorious  Jane  Cakebread, 
whose  name  has  been  familiar  to  newspaper  readers 
for  many  years  past.  This  unfortunate  woman  had 
been  convicted  280  times,  or  thereabouts,  for  the 
offence  of  being  drunk  and  disorderly,  when  she  was 
taken  in  hand  by  Ijady  Henry  Somerset,  who  re- 
moved her  to  a  charitable  home  founded  for 
women  of  her  class  somewhere  in  the  country. 
After  a  stay  of  some  months,  during  which  she 
failed  to  manifest  the  slightest  desire  for  alcohol, 
the  deliberate  opinion  arrived  at  by  those  responsible 
for  her  medical  care  was  that  she  was  mentally  irre- 
sponsible. She  soon  after  left  the  "home,"  and 
promptly  went  through  the  old  familiar  programme^ 
with  theresultthat  she  was  withlitUe  delay  haled  before 
a  justice  of  the  peace.  On  this  occasion,  however,  the 
criminal  career  of  Jane  Cakebread  was  suspended 
indefinitely  by  the  decision  of  the  magistrate  that  on 
account  of  her  mental  condition  she  was  to  be  handed 
over  to  the  safe  keeping  of  the  Poor-law  i^uthorities^ 
To  the  general  public  this  decision  of  the  bench  may 
not  possess  a  great  deal  of  significance,  but  there  can 
nevertheless  be  little  doubt  that  it  marks  a  new  depar' 
ture  of  great  importance  in   the  administration  of 


218     The  Mbdi'^al  Pbros*. 


NOTFS  ON  CURRKNT  TOPICS. 


FsB  26.  1896. 


minor  justice.  .  The  chief  wonder  appears  to  be 
that  such  a  conrse  was  not  adopted  with  regard 
to  this  nnhappy  woman  long  before  her  280th  appear- 
ance in  the  dock.  Her  marked  eccentricities  of  lan- 
guage, the  ease  with  which  she  became  intoxicated, 
the  apparent  absence  of  any  moral  sense,  and  her 
repeated  convictions,  were  bo  many  sign  posts  that 
have  for  many  a  year  pointed  with  unerring  finger  in 
the  direction  of  mental  aberration.  Yet  this  poor, 
half-witted  Bedlamite  has  spent  a  large  proportion  of 
her  adult  life  in  gaol  as  a  responsible  criminal.  Like 
many  other  chronic  inebriates  affected  with  a  similar 
weakness  of  mind  and  infirmity  of  will,  she  has  become 
^*  known  to  the  police/'  and  has  long  since  drifted  into 
the  ranks  of  those  outcasts  whose  lives  are  mainly 
passed  in  gaols  and  in  workhouses.  Now  that 
at  last  her  irresponsible  condition  has  been  re- 
•cognised  from  the  bench,  it  is  to  be  hoped  that 
similar  cases  will  in  future  receive  careful  inves- 
tigation, and  that  these  repeated  convictions  of  chronic 
inebriates  will  become  a  thing  of  the  past.  It  is  clearly 
a  matter  of  extreme  difficulty  and  delicacy  to  interfere 
with  the  liberty  of  the  subject  in  cases  of  chronic 
drunkenness.  Few  people,  however,  would  raise  any 
objection  to  regulations  if  carefully  safe  guarded  from 
the  point  of  view  both  of  the  public  generally  and  of 
the  afflicted  individuals  in  particular.  After  a  certain 
number  of  convictions  for  drunk  and  disorderly  conduct, 
for  instance,  it  would  be  safe  enough  to  direct  that  the 
mental  condition  of  the  offender  should  be  examined  by 
an  independent  body  of  medical  experts.  If  found 
to  be  irresponsible  the  next  step  would  obviously 
•be  to  treat  the  inebriate  as  an  ordinary  lunatic,  and 
put  him  under  appropriate  curative  or  palliatory  treat- 
ment. In  this  way  modern  society  would  be  saved 
from  the  standing  scandal  of  the  repeated  and  savage 
punishment  of  weak-witted  chronic  inebriates.  The 
general  question  may  be  stated  in  somewhat  the  follow- 
ing way :— How  is  a  civilised  community  to  deal  with 
the  special  form  of  moral  insanity  which  manifests 
itself  in  the  shape  of  chronic  inebriety  ?  There  can  be 
no  doubt  whatever  that  the  system  which  punishes  this 
manifestation  as  a  crime  is  a  relic  of  pre-scientific  and 
barbarous  ages.  Any  punitive  step  whatever,  if 
undertaken  against  a  morally  irresponsible  individual, 
appears  to  us  to  be  simply  indefensible.  We  should  be 
giad  to  see  every  magistrate  grounded  in  the  principles 
of  mental  pathology.  Such  a  training  would,  at  any  rate, 
to  some  extent  render  him  alive  to  the  necessities  of 
the  case.  It  is  obvious  that  persons  of  ill-balanced 
intellect  are  of  all  others  the  most  likely  to  be  put  on 
their  trial  on  criminal  charges.  Some  authorities, 
indeed,  assume  the  extreme  general  position  that  all 
crime  is  the  outcome  of  diseased  brain  action.  It  is 
not  for  a  moment  to  be  supposed  that  the  better  edu- 
cation of  the  judges  in  the  workings  of  normal  and 
abnormal  minds  would  prevent  many  grave  miscarri- 
ages of  justice  in  the  sentencing  of  mentally  irrespon- 
sible persons.  At  the  same  time,  however,  it  would 
serve  to  some  extent  to  keep  their  minds  open  as  to  the 
bearings  and  possibilities  of  criminal  mental  pathology, 
'^hat  we  have  always  advocated  ib  an  independent 


board  of  medical  men  skilled  in  the  study  of  insanity 
to  be  available  in  our  law  courts  from  the  highest  to 
the  lowest  in  the  land. 


^oitB  on  Current  %opks. 

The  Army  Medioal  Department  and  the 
Ashanti  Expedition 
It  was  felt  from  the  beginning,  when  the  Ashanti 
expedition  was  decided  on,  that  the  medical  officers 
attached  to  the  forces  would  be  called  upon  to  play  a 
prominent  part  in  the  operations.  The  extent,  how- 
ever, to  which  this  assumption  was  correct  is  now 
becoming  apparent  in  the  accounts  of  the  work  carried 
out  by  the  expedition  which  have  been  appearing  in 
the  public  press.  But  among  all  the  references  to  the 
duties  discharged  by  the  medical  officers,  we  feel 
that  the  Army  Medical  Department  generally 
will  appreciate  most  that  which  has  appeared  in 
our  contemporary  the  Army  and  Navy  Gazette. 
We  read  as  follows  in  its  issue  for  last  week  :— *'  As 
the  Medical  Department  of  the  Army  has  recently 
been  subjected  to  severe  criticism  it  is  only 
fair  to  notice  that  when  submitted  to  a  severe 
ordeal,  as  undoubtedly  was  the  late  Ashanti  expedi- 
tion, the  authorities  responsible  during  a  very  anxious 
period  acquitted  themselves  most  admirably— results 
proving  how  perfect  the  arrangements  weie,  both 
at  home  and  on  the  theatre  of  action,  how  wise  and 
comprehensive  the  forethought,  how  energetic  the 
execution  of  trying  duties.  In  this  connection  a  corre- 
spondent, a  combatant  officer,  writes  :  '  I  am  bound 
to  say  that  I  never  saw  anything  to  equal  the  unwaver- 
ing devotion  of  all  ranks  of  the  medical  staff.  Day 
and  night  have  I  seen  the  doctors  here  labouring  to 
save  life.  They  were  simply  a  band  of  heroes,  and  I 
only  wish  that  some  of  their  detractors  and  blackballers 
in  Service  clubland  could  have  been  here  to  have  seen 
for  themselves  what  England's  soldier-doctors  can  do 
when  put  to  the  test-of  service.  On  the  principle  of 
honour  to  whom  honour  is  due,  I  trust  you  will  allow 
me  to  say  that  Surgeon-Colonel  Taylor  and  his  staff 
are  entitled  to  every  credit,  and  this,  I  trust,  will 
be  accorded  them  officially,  as  I  can  answer  for  it, 
it  is,  unofficially,  throughout  this  force.' "  This  kindly 
paragraph  of  our  valued  contemporaiy,  and  its  corre- 
spondent's communication,  will,  we  are  convinced, 
have  a  beneficial  effect  upon  those  who  are  accustomed 
to  traduce  the  officers  of  the  Army  Medical  Depart- 
ment 


An  English  Judge  on  the  Anti- Vaccination 
Question. 
A  REMARKABLE  State  of  things  is  at  present  disturb- 
ing the  minds  of  the  people  of  Gloucester.  The  town 
in  question,  as  is  commonly  known,  is  one  of  the  few 
centres  in  England  in  which  the  will  of  the  anti- 
vaccinationist  has  been  allowed  to  obtain  a  sway.  In 
the  course  of  last  week  Mr.  Justice  Grantham  attended 
at  the  town  for  the  purpose  of  opening  the  Winter 
Assizes  there,  and  in  his  charge  to  the  Grand  Jury  he 


Feb.  26,  1896. 


NOTES  ON  CURRENT  TOPICS. 


Thb  Medical  Pbxss.     219 


stated  that  he  had  received  a  oommunication  from  the 
authoritieB  in  Gloucester  to  the  effect  that  small-poz 
was  prevalent  in  the  city  and  had  been  so  for  some 
little  time  past.  Although  every  step  had  been  taken 
to  prevent  any  spread  of  the  disease  he  had  been  asked 
to  anthorise  an  order  to  be  issued  closing  all  the  public 
galleries  in  the  court,  so  that  no  one  should  be  allowed 
to  attend  the  assizes  save  those  on  business.  This  he 
deemed  was  a  very  serious  thing  to  do»  and  the  ques- 
tion occurred  to  him  if  the  outbreak  was  such  that, 
for  precautionary  reasons,  the  public  should  not  be 
perndtted  in  the  court,  whether  he  was  justified  in 
bringing  together  into  a  town,  where  disease  was  pre- 
valent, persons  from  all  parts  of  the  country,  of  all  ages 
and  both  sexes,  and  in  all  states  of  health.  The  judge, 
therefore,  held  that  his  proper  course  was  to  communi- 
cate with  the  Lord  Chancellor,  with  the  result  that  the 
assizes  were  ordered  to  be  removed  to  Cheltenham. 
Since,  however,  this  decision  had  been  arrived  at  the 
Judge  observed  that  another  reason  for  the  removal  had 
come  under  his  notice.  He  understood  that  in 
Gloucester  there  were  many  people  who,  for  the  sake 
of  a  better  name,  called  themselves  anti-vaccina- 
tionists—that  was,  they  resented  the  opinion  that  was 
generally  expressed  in  the  country,  and  by  persons  in 
authority,  that  all  children  should  be  vaccinated. 
When,  therefore,  he  heard  that  the  local  authorities 
refused  to  compel  persons  to  have  their  children  vaccin- 
ated he  thought  it  was  more  desirable  than  ever  to 
take  the  step  which  had  been  taken  because  there  were 
in  the  town  many  people — children  and  adults — who 
had  not  been  vaccinated.  It  may  be  after  this  that 
the  ** authorities  in  Gloucester''  will  take  these 
weighty  remarks  of  Mr.  Justice  Grantham  into  serious 
consideration.  It  could  not  have  been  very  satisfactory 
for  them  to  have  heard  the  Judge's  reasons  for  the 
removal  of  the  assizes  to  Cheltenham. 


The  Apostle  of  Degeneration  and  the 

English  Race. 
Most  of  us,  we  presume,  who  have  read  Max 
Nordau's  ''Degeneration,*'  arrived  at  the  conclusion 
that  the  sweeping  remarks  of  the  author  as  to  the 
advancing  degeneracy  of  mankind  were  intended  to 
have  a  general  application.  But  judging  by  some 
recent  observations  respecting  the  English  race,  pub- 
lished by  Max  Nordau  in  the  Nem  Freie  Presse,  no 
such  interpretation  could  have  been  meant.  Ap- 
parently, it  is  the  case  that  too  much  cannot  be  said 
in  favour  of  the  race  of  Englishmen.  But  Max  Nordau 
shall  give  his  own  convictions  upon  this  subject,  and 
they  are  as  follows:—'' The  British  a  nation  of  shop- 
keepers ?  Shopkeepers,  indeed  !  Those  who  fought  at 
Hastings  like  giants  and  Titans,  who  subdued  two 
continents,  are  ruling  two  hundred  million  Asiatics  by 
the  will  and  nerve  of  a  couple  of  thousand  of  their  race, 
who  brought  to  their  knees  such  men  as  Napoleon  I 
and  Nicholas  I,  and  who  still  have  their  Jamesons  to 
demonstrate  that  their  old  strength  of  will  and  power 
of  ruling  over  others  have  not  yet  died  out !  If  these 
are  the  characteristics  of  shopkeepers,  what  is  tbe  essen- 
tial difference  between  shopkeepers  and  the  heroes  of 


the  Greek  myth  ?  The  ruling  classes  of  England  are 
the  most  powerful  race  of  masters  the  world  has  seen 
since  the  Republic  of  Rome  and  the  early  Roman 
Empire.  To  please  an  Englishman  one  must  be  strong 
and  daring.  The  English  are  a  bluff  race,  incomparable 
friends,  and  terrible  enemies,  rather  proud  of  being 
more  feared  than  loved."  These  are  pleasant  things  to 
have  had  said  about  us  by  one  who  has  shown  himself 
to  be  so  shrewd  an  observer  of  human  nature.  But, 
perhaps,  Max  Nordau's  convictions  in  this  regard  were 
strengthened  by  his  recent  visit  to  England— after  his 
book  on  "  Degeneration  "  had  been  published. 


Board  School  Children  and  Spectacles. 
If  the  Education  Department  has  done  anything,  it 
has  certainly  played  an  important  part  in  adding  ta 
the  number  of  children  wearing  spectacles.  By  some,  the 
increased  use  of  spectacles  is  attributed  to  the  want 
of  wisdom  of  the  Department  in  taxing  the  eyes  of  chil- 
dren.   But  to  this  assumption  we  cannot  agree.    The 
real  explanation  of  the  increase  in  spectacled  children 
lies,  we  believe,  in  the  fact  that  the  Board   School 
teachers  wisely  complain  to  the  parents  of  the  children 
when  the  latter  are  found  to  have  faulty  vision,  as  the 
result  of  which,  advice  is  sought  at  the  nearest  hospital 
in  which  the  diseases  of  the  eye  are  attended  to.    In 
the  majority  of  cases,  the  inability  to  see  properly  is- 
found  to  be  due  to  some  error  of  refraction ;  and  after 
this  has  been  properly  estimated,  a  pair  of  spectacles- 
is  ordered  for  its  correction.    Thus  it  is  that  the  child* 
returns  to  school  with  the  appliance  in  question.    In< 
former  days,  no  trouble  was  taken  to  relieve  the  child 
of  the  ocular  discomforts  associated  with  refractive  error 
of  which  it  complained.   But  the  reverse  isthecaseunder 
present  circumstances,  a  fact  which  needs  no  further 
demonstration.    Apropos  of  this  subject  at  the  annual 
meeting  of  the  Bradford  Eye  and  Ear  Hospital  last 
week  it  was  stated  that  during  the  past  twelve  months 
two  thousand  pairs  of  spectacles  were  ordered  for 
patients,  whereas  ten  years  ago  the  number  required' 
was  only  three  hundred. 

The  Football  Season. 
In  a  recent  editorial  the  New  Yai-k  Medical  Record' 
amusingly  remarks,  "  The  football  season  is  over,  and 
the  football  player  has  retired  to  the  classic  shades  of 
his  'Varsity,  there  to  give  the  lumbar  enlargement  of 
his  spinal  cord  its  necessary  rest,  and  to  cause  the  fallow 
grey  matter  of  his  cerebral  convolutions  to  indulge  in 
needful  and  healthful  exercise."  In  this  country,  it 
may  be  observed  the  football  season  is  just  at  its 
zenith,  the  contests  becoming  keener  every  day  as  the 
matches  for  the  League  Championships  are  being  played 
off.  It  is  satisfactory  to  note  that  so  far  during  the 
current  season  fewer  accidents  have  been  recorded,  and 
less  injury  to  life  and  limb  has  occurred,  than  has  been 
the  case  for  some  years.  Presumably,  however,  it 
cannot  be  argued  from  this  that  the  contests  have  been 
less  vigorously  fought,  or  that  any  diminution  has 
taken  place  in  the  enthusiasm  with  which  the  results 
have  been  striven  for.  On  the  contrary,  the  evidence 
upon  this  matter  would  seem  altogether  to  point  in  the 


220    The  Ukdical  Pxbs. 


NOTES  ON  CURRENT  TOPICS. 


FXB  26.  ISM. 


other  direction.  It  is  now  commonly  admitted  that 
the  fierce  rivalry  induced  among  the  dabs  throughout 
the  country  owing  to  the  introduction  of  the  League 
matches  has  led  so  largely  to  the  development  of  what 
18  known  as  "  professionalism  "  that  football  is  fast 
losing  its  characteristics  as  a  national  game.  For  this 
the  Association  game  is  greatly  responsible.  In  the 
good  old  days,  when  every  football  match  was  played 
under  Rugby  rules,  the  pastime  could  be  followed  for 
its  own  sake,  and  the  professional  element  was  not 
required.  But  the  progress  of  the  game  under  the 
Association  rules  has  worked  during  recent  years  a 
wondrous  change  for  the  worse  in  this  respect.  How- 
ever, the  evil  is  now  admitted,  and  some  steps  will  soon 
be  taken  to  remedy  it.  The  most  notable  incident  in 
this  connection  which  has  just  occurred  is  the  announce- 
ment that  the  authorities  of  Eton  College  have  decided 
to  adopt  the  Rugby  game,  and  to  banit>h  the  Associa- 
tion game  from  the  school.  This  step,  it  is  believed, 
will  be  generally  followed  by  the  other  public  schools, 
and,  thus,  with  this  movement  beginning  and  spreading 
throughout  the  country,  it  may  be  that  the  Rugby 
game  will  ultimately  regain  ail  its  lost  popularity. 


The  Physical  Examination  of  Competitive 
Candidates  for  the  Army  Medical  Service. 
SsvERAL  of  our  non-medical  contemporaries  have 
recently  reverted  to  a  subject  to  which  we  have,  more 
than  once,  called  attention  as  requiring  reform.  They 
point  out  that  in  connection  with  the  competitive 
^examinations  for  the  Army  and  other  public  services, 
the  examination  of  the  candidate  as  to  his  health  and 
physical  fitness,  cannot  take  place  until  he  has  passed 
his  educational  test,  and  that  it  is  thus  possible,  and 
not  uncommon,  for  candidates  to  expend  years  of 
labour  and  much  money  in  qualifying  themselves  for 
appointments,  from  which,  after  they  have  been 
proved  to  be  educationally  fit,  they  are  excluded  be- 
cBXLBe  they  suffer  from  some  physical  defect.  We  have 
never  heard  any  tenable  cause  why  this  injustice  should 
continue.  In  fact,  the  only  reason  which  has  been 
suggested  is  that  it  would  be  too  much  trouble  for  the 
medical  board  which  is  entrusted  with  the  physical 
examination  to  have  to  test  the  unsuccessful  as  well 
as  the  successful  competitors.  An  argument  of  this 
sort  is  scarcely  abmissible  under  any  circumstances, 
but,  if  the  previous  physical  examination  imposed 
upon  the  Medical  Board  any  unreasonable  labour,  we 
apprehend  that  the  candidates  would  be  well  content 
to  pay  a  special  fee  for  such  special  examination.  We 
do  not  suggest  that  the  physical  examination  after  the 
passing  of  the  educational  examination  should  be  dis- 
pensed with,  for  it  is  obviously  necessary  that  the  fit- 
ness of  the  candidate  at  the  last  moment  of  his  entry 
into  the  service  should  be  guaranteed,  but  there  seems 
to  be  no  good  reason  why  an  additional  previous  test 
should  not  be  taken  at  an  earlier  stage  if  the  candidate* 
wishes,  and  that  he  should  thus  be  afforded  the  oppor- 
tunity of  deciding  whether  any  absolute  and  incurable 
disability,  such,  for  instance,  as  a  high  degree  of 
myopiai  exists.  The  private  opinion  of  an  unoflScial 
practitioner  must  always  be,  in  such  case,  imperfect 


and  unsatisfying,  and  we  do  not  see  why  the  reason- 
able wishes  of  the  competing  public  should  not  be  met 
by  an  alteration  of  the  system  which  could  be  so 
readily  effected. 

Dublin  Hospital  Sunday. 
The  annual  meetings  of  the  supporters  of  tie  Fund 
and  that  of  its  Council  were  held  last  week  and  passed 
with  a  quietude  almost  somnolent  The  income  of 
the  Fund  for  the  past  year  fell  short  of  that  of  the 
previous  year  by  about  £200,  but  this  was  sufficiently 
accounted  for  by  the  terrible  weather  which  marked 
the  occasion  of  the  annual  collection.  The  deficit 
would  have  been  £100  more  but  for  a  donation  of  that 
sum  from  an  individual  benefactor.  The  total  amount 
for  distribution  was  £4,264.  The  amounts  granted 
varied  from  £560  to  the  Meath  Hospital,  and  £536  to 
the  Adelaide,  down  to  £95  given  to  Mercer's.  It  is 
just  to  the  Committee  of  Council  to  say  that  the 
expenses  of  administration  compare  very  favourably 
with  those  current  in  other  hospital  funds,  being  only 
6  18  per  cent,  of  the  income.  The  system  of  distribu- 
tion is,  however,  and  has  always  been  at  variance  with 
the  interest  of  the  sick  poor,  being  framed  upon  the 
extraordinary  principle  that  the  bulk  of  the  Fund 
should  be  given  to  .the  hospitals  which  do  least  work 
for  the  sick  poor  and  have  least  need  for  money,  while 
those  which  are  most  useful  to  the  community  are 
starved.  However,  if  it  is  not  worth  the  while  of  the 
hospitals  which  suffer  this  injustice  to  raise  an  agita- 
tion against  the  existing  system  of  distribution,  it  is 
certainly  not  for  us  to  force  the  consideration  of  the 
matter  upon  them.  At  present  the  representation  of 
hospitals  on  the  Fund  Council  is  a  perfect  farce. 
Deadheads,  whose  very  existence  it  is  difilcult  to  dis- 
cover, are  appointed  from  year  to  year,  and  when 
appointed  they  rarely  attend  the  meetings  of  the 
Council,  bnd  still  more  rarely  understand  anything 
about  the  subject,  nor  can  they,  as  a  rule,  tell  why  this 
or  that  hospital  is  mulcted  of  income  which  is  enjoyed 
by  other  more  favoured  institutions. 

Dental  Surgeons  for  the  Army. 
A  DENTIST  writing  to  a  Liverpool  contemporary 
suggests  that  dental  officers  should  be  appointed  to  the 
Medical  Staff  of  the  Army.  He  states  that  when- 
ever Army  recruits  have  faulty  teeth  requiring  atten- 
tion they  are  despatched  to  a  dental  hospital  in  order 
to  have  their  teeth  put  in  order  before  the  men  can  be 
passed  for  the  Service.  Arguing  from  these  facts,  he 
claims  that  were  dentists  to  be  attached  to  the  Medical 
Staff  of  the  Army  it  would  be  better  for  the  men. 
Perhaps  in  rare  instances  this  would  be  the  case,  but 
we  cannot  admit  that  the  dental  troubles  of  Thomas 
Atkins  would  be  sufficiently  grave  or  numerous  as  to 
require  a  special  department  for  their  special  treatment 
Probably  when  Thomas  Atkins  has  a  tooth  which  gives 
him  exceptional  trouble  he  is  always  quite  willing  to 
part  with  it,  and  the  extraction  pro<^ure  is  one  which 
most  medical  officers  in  the  Army  would  be  able  suc- 
cessfully to  accomplish.  But  when  the  question  of 
stopping  teeth,  and  the  more  refined  proceaaeB  of  the 


FxB.  26,  1896. 


NOTES  ON  CDRRENE  TOPICS. 


Tpb  Mbdtoal  Pbbss.    221 


dental  art  are  concerned,  it  is  trae  that  only  a  dentist 
wonld  be  able  to  satisfy  Thomas  Atkins*  demands.  In 
the  meantime,  however,  it  will  have  to  be  proved 
whether  snch  demands  exist,  and,  if  they  exist, 
whether  the  country  would  be  justified  in  providing 
for  them  out  of  the  public  purse. 

AsbeetoB  for  Boots  and  Shoes. 
All  who  enjoy  walking  exercise  and  desire  warm 
dry  feet  wUl  be  glad  to  hear  that  a  company  has  been 
formed  to  utilise  asbestos  in  the  manufacture  of  boots. 
Asbestos  possesses  the  essential  properties  for  a  com- 
fortable boot ;  it  is  light,  and  is  a  non-conductor  ;  with 
the  mineral  replacing  leather  or  felt,  as  an  inner  sole, 
the  boot  may  be  worn  on  the  hot  flags  of  a  city  street 
on  a  summer  day,  or  on  slush  of  snow  in  winter, 
without  the  wearer  being  made  uncomfortable 
by  either.  During  the  Eighteenth  Century  as- 
bestos was  much  more  used  for  wearing  apparel 
than  at  present,  even  two  centuries  earlier  the 
spinning  of  asbestos  was  a  recognised  industry 
in  Venice.  Signor  Castaquatta  carried  the  art  to  such 
perfection  that  his  woven  asbestos  was  soft  and  tract- 
able, resembling  dressed  lambskin.  He  could  thicken 
or  thin  the  product  at  pleasure,  and  thus  either  make 
it  a  very  white  skin  or  a  very  white  paper.  Signor 
Oiampini  describes  the  method  of  weaving  asbestos 
thus  : — The  stone  is  laid  to  soak  in  warm  water,  then 
opened  and  divided  by  the  hands,  that  the  earthy 
matter  may  be  washed  out  The  washing  being  several 
times  repeated,  the  flax  like  filaments  are  collected  and 
dried  ;  and  they  are  most  conveniently  spun  with  an 
addition  of  flax.  Two  or  three  filaments  of  the  asbestos 
are  easily  twisted  along  with  the  flaxen  thread,  if  the 
operator's  fingers  are  kept  oiled.  The  cloth  also  when 
woven  is  best  preserved  by  oil  from  breaking  or  wast- 
ing. On  exposure  to  the  fire  the  flax  and  oil  bum  out. 
And  the  clotii  remains  pure  and  white,  a  light,  dur- 
able, non-conducting  fabric.  It  will  thus  be  seen  that 
woven  asbestos  is  admirably  suited  for  the  inner  soles 
of  boots 


An  Interesting  Discovery  in  Comparative 
Pathology. 

The  prevalence  of  sheep  fluke  in  the  Australian 
sheep  farms  has  often-  proved  a  very  serious  matter 
to  the  stock  owners,  and  for  a  long  time  efforts  have 
been  made  to  discover  the  "  intermediate  host "  through 
which  the  animals  became  infected.  This  discovery 
has  now  been  accomplished.  Dr.  Cobb,  of  Sydney, 
working  on  behalf  of  the  Agricultural  Department  of 
the  colony,  has  just  clearly  shown  that  the  '*  interme- 
diate host"  is  the  common  land  snail  {Btdimus  hrazieri). 
The  importance  of  this  fact  is  such  that  it  will  lead  to 
the  enforcement  of  several  recommendations  having  for 
their  object  the  suppression  of  the  fluke.  Observation 
has  shown  that  the  greatest  enemy  the  snail  has  is  the 
peewee.  Dr.  Cobb  is  of  the  opinion  that  the  peewee 
is  the  best  friend  that  the  sheep  owner  has  in  the 
Australian  colonies.  Other  birds,  such  as  the  blue 
crane,  wild  duck,  and  the  domestic  duck,  also  feed  on 
ihe  snail. 


Hydrogen  Sulphide  in  the  Urine. 
The  rare  instances  in  which  hydrogen  sulphide  is 
met  with  in  the  urine  renders  each  case  that  occurs 
worthy  of  being  recorded.  A  correspondent  to  a  con- 
temporary gives  the  notes  of  the  following  case  which 
recently  occurred  in  his  practice.  A  negress,  aged 
seventeen,  a  primipara,  developed  eclampsia,  both 
ante-partal  and  post-partal.  The  labour  was  normal 
otherwise,  and  the  child  was  bom  alive.  The  urine 
contained  10  per  cent,  by  weight  of  albumen.  On  the 
fifth  day  after  the  delivery,  hydrogen  sulphide  was 
detected  in  the  urine.  The  absorption  of  this  poisonous 
gas  into  her  blood  caused  the  development  of  toxsemic 
symptoms  such  as  restlessness,  vomiting,  delirium, 
delusions,  and  intermittent  pulse,  and  complaints  of 
smelling  bad  odours.  The  bladder  was  washed  out 
with  a  weak  solution  of  permanganate  of  potassium, 
and  the  symptoms  soon  subsided. 


The  Direct  Bepresentation  for  Ireland. 
The  poll  for  this  position  of  honour  will  have  been 
almost  completed  when  this  journal  reaches  our  readers. 
It  closes  on  the  evening  of  the  27th,  and  when  our 
readers  in  Ireland  receive  this  issue,  there  will  be  just 
time  for  those  who  have  not  yet  sent  in  their  voting 
papers  to  be  in  time  for  the  count  which  commences  on 
Friday  morning,  by  sending  them  forward  in  all  haste. 
Until  the  votes  are  counted,  a  process  which  will  be 
completed  on  Saturday  evening,  there  can  be  nothing 
more  trustworthy  than  speculation  to  decide  the  issue. 
The  competitors,  Drs.  Jacob,  Cuming,  and  Thomson, 
are  generally  considered  to  be  very  closely  matched. 
If  a  Dublin  man  is  asked,  he  predicts  the  return  of  Dr. 
Thomson ;  if  an  Ulster  man,  the  return  of  Dr. 
Cuming ;  and,  if  a  provincial,  the  triumph  of  Dr.  Jacob. 


Mr.  B.  B.  Anderson  and  the  Queen. 
We  learn  that  Mr.  R  B.  Anderson  has  decided,  since 
the  Court  of  Appeal  has  refused  to  listen  to  any  further 
application  from  him,  to  petition  Her  Majesty  the 
Queen  in  respect  to  his  case.  The  petition  sets  forth 
the  many  grievous  wrongs  and  oppressions  wilfully 
and  illegally  done  to  him  and  suffered  by  him  at  the 
hands  of  the  judges,  Her  Majesty's  servants  and 
representatives,  in  tiie  infringement  of  his  rights  and 
liberties  as  a  British  subject.  Mr.  Anderson  deserves 
the  sympathy  and  assistance  of  the  public  generally  in 
the  plucky  fight  which  he  is  making  for  the  redress  of 
his  wrongs.  All  of  those  who  have  taken  the  trouble 
to  read  the  published  reports  of  his  case  must  admit 
that  a  more  extraordinary  revelation  of  judicial  perse- 
cution could  scarcely  have  been  brought  under  their 
notice.  Indeed,  no  one  can  help  feeling  that  there  is 
more  of  that  which  belongs  to  fiction  than  reality  in 
the  injustice  which  has  been  meted  out  to  Imn. 


The  son  of  a  solicitor  in  Dudley,  Worcestershire, 
died  last  week  under  chloroform,  which  had  been 
administered  for  the  purpose  of  the  extraction  of  some 
teeth.  The  anaesthetic  was  given  {in  the  house  of  a 
local  dentist  by  a  medical  practitioner. 


222     The  Medical  Presf. 


SCOTLAND. 


Feb.  26.  Ig96 


The  M.D.,  U.S.A.  Question 
In  the  leading  article  in  onr  ispue  of  last  week  with 
reference  to  the  prosecution  of  **Dr."  Bridgwater  in 
the  Cardiff  Police-conrt,  we  commented  upon  the 
apparent  abdence  of  any  reference  to  the  recent  im- 
portant decision  by  Mr.  Shiel  (confirmed  on  appeal  in 
the  Ferdinand  case).  We  are,  however,  informed  by 
Mr.  Hempson,  solicitor  to  the  Medical  Defence  Union, 
that,  not  only  was  the  case  of  Ferdinand  quoted  for 
the  prosecution,  but  other  cases  also  in  which  the 
Union  had  been  successful  in  obtaining  convictions  for 
similar  offences.  We  learn,  moreover,  from  the  same 
authority  that  the  stipendiary  magistrate  at  Cardiff 
has  been  asked  to  state  a  case  by  way  of  appeal  for 
the  opinion  of  the  High  Court.  It  is  to  be  trusted  that 
the  magistrate  will  raise  no  difficulty  towards  enabling 
a  higher  tribunal  to  consider  his  decision. 

A  Phenomenal  Prospective  Legacy  for  a 
Medical  Man. 

Indian  potentates  have  commonly  taken  some 
practical  step  to  show  their  appreciation  of  the  value 
of  the  services  of  their  European  medical  attendants. 
Several  cases  ore,  indeed,  on  record  where  large  sums 
in  the  form  of  fees  have  thus  been  paid  to  the  latter. 
But  the  most  phenomenal  instance  of  the  kind  which 
has  come  under  our  notice  is  that  which  is  reported  in 
the  Deccan  Btidget.  The  NawabFakr-uI-mulk  has,  we 
are  told,  made  a  will  leaving  £600,000,  or  2,000,000 
rupees,  tp  his  medical  man.  This  immense  sum  will 
come  to  the  latter  on  the  death  of  his  patient. 


The  Question  of  Private  Lunatic  Asylums. 
The  question  of  private  lunatic  asylums  came  before 
the  House  of  Commons  last  week  in  relation  to  the 
case  of  the  young  lady  who  some  months  ago  was 
confined  in  an  asylum,  for  holding  certain  ultra  views 
in  regard  to  the  marriage  laws.  The  Home  Secretary 
intimated  that  the  Lord  Chancellor  had  a  Bill  in  pre- 
paration which,  among  other  things,  will  aim  at  im- 
proving and  extending  the  precautions  against  any 
abuse  of  the  lunacy  laws.  It  is,  doubtless,  generally 
known  that  the  last  Lunacy  Act  precluded  the  estab- 
lishment of  any  private  asylum  in  the  future. 


The  New  Photography. 
At  the  Medical  Society,  London,  on  the  24th  instant, 
Mr.  Sydney  Rowland  gave  a  demonstration  of  the  new 
photography.  Starting  from  a  single  electric  spark, 
the  lecturer  demonstrated  the  effect  of  gradually  re- 
ducing the  pressure  of  the  gas  through  which  the  spark 
passed,  until  gradually,  when  the  air  was  almost  com- 
pletely exhausted,  the  character  of  the  discharge 
completely  changed.  From  this  point  the  practical 
application  of  the  discharge  in  vacuo  might  be  said  to 
begin.  Some  very  beautiful  Greissler  and  Crooke's 
tubes  were  shown,  one  in  particular,  showing  the 
mechanical  energy  developed  from  the  cathode 
rays  by  the  revolution  of  a  mica  vane  illus- 
trating very  well  the  theory  already  established 
by  Professor  J.  J.  Thomson,  of  Cambridge,  that  the 
X  rays  were  generated  at  the  point  of  impact  of  these 


rays  with  the  glass.  The  relative  advantages  of  Teala 
and  Rumkorff*s  coils  in  illuminating  the  vacuum  tubes 
were  discussed,  with  the  conclusion  that  the  Teala 
currents  were  in  every  way  preferable  if  only  the  tubes 
could  be  got  to  stand  the  strain.  A  new  method  of 
sensitising  the  plates  was  mentioned.  Using  this- 
method,  the  lecturer  had  succeeded  in  producing  a 
negative  of  the  bones  of  the  hand  in  twenty  secoods. 
Some  of  its  applications  to  surgery  and  medicine  were 
then  entered  into. 

The  ''Medical  Press  and  Circular"  and  the* 
"Times." 
In  our  issue  last  week  we  drew  attention  to  the 
feeling  which  has  been  caused  in  this  country  and 
America  in  consequence  of  a  certain  decision  of  the 
authorities  responsible  for  the  arrangements  of  the 
International  Medical  Congress  at  Moscow  next  year.. 
The  paragraph  in  which  our  remarks  appeared  was 
largely  quoted  by  our  lay  contemporaries,  by  whom 
the  source  was  duly  acknowledged.  There  was,  how- 
however,  one  exception,  and  that  was  the  Times.  We 
have  simply  to  state  that  we  cannot  congratulate  the 
Times  upon  the  courtesy  which  it  displayed  upon  this- 
occasion,  nor  can  we  understand  why  the  editor  should 
have  appropriated  a  paragraph  emanating  from  this 
journal,  while  his  contemporaries  had,  without  excep'^ 
tion,  courteously  acknowledged  its  source. 


[rBtH^OUB  OWN  COBBBBFOVDBn.] 

Edinburgh  Medigo-Chiruboioal  Sooiity. — ^The  meet-- 
iDg  of  this  Society  on  Wednesday  last  was  entirely  given 
over  to  the  exhibitioD  of  patients  and  specimens.  Dr. 
James  showed  patients  suffering  from  Pfleudo-Hypertrophur 
Paralysis  and  Hydronephrosis.  Mr.  Cotterill  showed  « 
remarkable  case  of  Vascular  Tumour  of  the  Face  which  had 
lasted  for  twenty  years  and  bad  been  treated  without/ 
avail  in  many  ways.  The  tumour  involved  the  right  side 
of  tbe  face,  and  was  of  large  size.  Electrolysis  bad  done 
no  good,  but  he  thought  that  be  would  try  the  effect  of 
tying  tbe  internal  carotid  on  the  affected  side.  Among 
tne  specimens  »hown  were :  A  Skull  and  Brain  illustrating^ 
old-standing  depre^fed  fractures  without  symptoms. 
Elephantiasis  of  tbe  Labium  Majus,  weighing  several 
pounds,  from  Mombasa,  by  Mr.  Gathcart ;  Sections  of  a 
Glio-sarcoma  of  tbe  Pons  involving  all  tbe  Cranial  Nerye* 
Origins  on  one  eide  eave  those  of  the  first  three,  by  Dr. 
Bramwell ;  Albumosefl  from  a  Urine  in  a  ease  of  ChroDic 
Nephiitis,  by  Dr.  Gillespie  ;  and  specimens  from  a  case  of 
Hsemorrbagic  Pancreatitis,  by  Dr.  Leith. 

The  Typhoid  Outbreak  at  Dunbar. — Since  calling- 
attention  to  the  anomalous  state  of  the  Public  Health 
Service  of  Haddingtonshire  in  our  last  number,  we  find 
that  the  Dii>tricc  Committee  have  a  notice  of  motion  before 
them  to  the  following  effect : — That  this  Committee 
memorialise  the  County  Council  to  take  into  serious  con-- 
sideration  tbe  present  unsatisfactory  arrangements  as  to 
the  county  ana  district  medical  officers,  and  in  doing  so, 
suggest  the  propriety  of  terminating  these  arrangements,, 
and  in  lieu  thereof  appoint  a  county  medical  officer,  free 
from  private  practice,  resident  in  the  county,  to  devote 
his  whole  time  to  the  duties  of  his  office,  with  permission 
to  the  diRtrict  committees  of  the  county  to  appoint  him- 
also  district  medical  officer.  A  copy  of  this  to  be  sent  to- 
tne  Local  Government  Board.  Such  a  course  is  in  exact' 
accordance  with  what  we  said  last  week,  and  we  can  only 
hope   that    the    County    Council  will   be  large-minded^ 


Fbb.  26,18m. 


EXAMINATION  PAPERS. 


The  Mbdigjll  Press.      223 


<«noagh  to  pat  an  end  to  the  present  position  of  sanitary 
administration  in  East  Lothian. 

MxDiGAL  Education  of  Wobibn.— The  sixth  annual 
ceport  of  the  Scottisb  Association  for  the  Medical  Edn- 
cation  of  Women  and  the  Medical  College  for  Women, 
Chambers  Street,  Edinbureh.  states  that  the  past  year 
has  again  shown  a  very  manced  increase  in  the  attendance 
at  the  college  of  the  Association,  and  also  steady  work 
and  creditable  progress  on  the  part  of  the  stndents.  As 
the  growth  of  the  college  demanded  increased  accommo- 
dation, especially  in  theanatomicaldepartment,  an  arrange- 
ment has  been  made  which  has  given  the  students  excellent 
practical  anatomy  rooms  and  class  rooms  in  a  most  con- 
venient locality,  and  has  added  greatlv  to  their  comfort. 
The  Court  is  strongly  of  opinion  that  the  only  satisfactory 
WAV  to  make  the  College  for  Women  what  it  should  be, 
4uia  a  fit  companion  to  the  other  educational  establish- 
ments in  Edinburgh,  is  to  have  a  building  belonging  more 
or  lese  to  the  Association. 

Lbith  Hospital.— The  authoririeeof  this  hospital  have 
been  engaged  for  some  time  back  in  setting  their  house  in 
order.  The  staff  has  been  almost  entirely  changed  within 
the  last  year,  and  a  new  batch  of  appointmente  was  made 
last  week.  It  will  be  noticed  that  most  of  tbe  new 
•officers  hail  from  Edinbargh.  The  following  are  the 
appointments  :—H.  C.  Langwill,  M.KC.PE.  (from  the 
clispensary  department),  to  be  oua  of  the  physicians ; 
Alexander  Miles,  M  D.,  F.R.C.S.E  .  ro  be  one  of  the 
Burgeons  ;  David  Berry  Hart,  F  R.C  P  E  ,  to  bephypician 
-for  diseases  peculiar  to  women  ;  Dr.  W.  G.  Sim,  F.R.C.S.E., 
*to  be  ophthalmic  »>urgeon  ;  Dr.  Theodore  Sbennan  to  be 
pathologist,  and  Dr.  George  Elder,  Dr  J.  S  Fowler,  and 
Dr.  A.  bcot-Skirviog  to  be  medical  officer  s  "^  he  di^pen  • 
aary  department. 

MEDICAL  SOCIETY  OF  LONDON. 
Thb  meeting  on  Monday  evening  last  (February  24th) 
•opened  with  a  very  interesting  paper  by  Mr.  Hurry  Fen- 
wick  on  the  assistance  to  be  derived  from  the  painful  mani- 
festations associated  with  the  presence  of  stone  in  the 
kidney  in  respect  of  its  exact  situation.  He  pointed  out 
that,  whereas  with  the  stone  in  the  pelvis  there  are  fre 
•quent  attacks  of  colic,  with  radiation  of  the  pain  and 
bladder  irritability,  these  svmptoms  were  usually  absent 
when  the  stone  is  embedded  in  the  cortex.  When  the 
stone  is  situated  in  the  parenchyma  of  the  kidney,  t «.,  in 
the  pyramids,  the  patient  is  usually  unable  to  sleep  except 
on  the  side  of  the  affected  organ,  lying  on  the  other  side 
ffiviog  rise  to  pain.  With  pelvic  stones  the  patient  could 
lie  on  theaffiscted  side. 

Dr.  Rolfe  (by  proxy)  followed  with  a  paper  on  the  cases 
of  renal  pain  calling  for  medical,  as  distinguished  from 
aa^cal,  treatment.  He  divided  the  cases  into  thof>e  in 
which  the  pain  was  dependent  on  reflex  nervous  disturb- 
ance, and  the  so-called  *' aching"  kidney.  The  former  is 
«Det  with  in  association  with  valvular  disease  of  the  heart, 
more  particularly  aortic,  and  thoracic,  and  especially 
abdominal,  aneurism.  The  aching  kidney,  he  suggested, 
was  usually  due  to  movable  kidnev,  but  was  also  met  with 
.ae  the  result)  of  tight-lacing,  and  from  undue  acidity  of 
the  urine  or  other  excess  of  some  normal  constituent  of  the 
orine. 

Mr.  Sydney  Rowland  gave  a  demonstration  of  the  new 
photography,  to  which  reference  is  made  on  page  222. 


I. — Specific^  FehrilCt  or   Zymotic  Dideast»^  viz. : — 
(1)  Miasmatic,  (2)  Diarrhoea!,    (3)  Venerea^ 
(4)  Septic        ' 
11. — Parasitic  Diteates. 
Ill  — Dietic  Diseases, 
IV. — ConstUutional  Diseases. 
V. — Developmental  Diseases, 

VI.  -  Local  Diseases  in  the  following  svstems,  viz. : — 
(1)  Nervous,  (2)  Circulatory,  (3)  Respiratory, 
(4)  Digestive,  (5)  Urinary,  (6)  Reproductive. 
Iodic -ice  other  causes  of  death  not  provided  for  in 
the  above  table. 

3.  Name  the  diseases  with  which  Small-pox  and  Typhus 
respectively  may  be  confused,  indicating  the  signs  IcMtding 
to  error,  and  those  by  which  a  correct  diagnosis  is  to  be 
made  in  each  casa 

4.  Describe  the  origin  and  mode  of  Spread  of  Wool- 
sorters'  Disease,  and  the  measures  to  be  taken  for  its  pre- 
vention.] 

[5  What  is  the  meaning  of  the  term '  <  S pecific  Infectious 
Diseases  "  ?    How  are  these  diseases  characterised  ? 

6.  Enumerate  the  diseases  with  which  Enteric  Fever 
may  be  confounded,  and  give  the  differential  diagnosis  of 
the  conditions  mentioned.] 

Directions  : — The  answers  are  to  be  made  up  into  two 
sets,  indicated  by  the  brackets  on  the  questions.  Each 
set  is  to  bear  the  Candidate's  number. 


EXAMINATION  PAPERS  FOR  THE  DIPLOMA  IN 
PUBLIC  HEALTH  AT  THE  UNIVERSITIES 
OF  OXFORD,  CAMBRIDGE  DURHAM,  (a)  AND 
VICTORIA,  AND  THE  CONJOINT  BOARD  OF 
ENGLAND. 

{Continued  frbm  page  202  ) 

DuEHAM,  April  16th,  1895.-  No.  I. 

[1.  Give  an  outline  of  the  Sanitary  Provisions  of  the 
Pablie  Health  Acts  Amendment  Act,  1890. 

2.  Fill  in  the  diseasee  and  other  causes  of  death 
Oreat  Britain  in  the  following  Nosological  Table  ;— 

(at  EzaiDiirotton  for  the  Jhtgrw  of  Bschelor  In  Bygiei  e,  and  for  ihe 
D4»loni«  iu  Pabilc  bealta  (u.r.H.)  Durham 


Thursday,  April  18th,  1895. 
No.  IV. — Practical  Hygiene,  CUmatology,  Meteorology ,  dkc., 
atid  Vital  Statistics, 
[I.  Show  the  different  liabilities  at  various  age- periods 
to  sickness  and  death  from  the  several  Zymotic  and 
Respiratory  Diseases,  also  from  Diseases  of  the  Circulatory 
and  Nervous  systems. 

2.  Desc^ibe  two  systems  of  Ventilation  and  Warming 
applicable  for  Board  Schools  and  other  public  institu- 
tions, 

3.  Describe  the  <<  Old  Dutch  "  Process  of  White  Lead 
Making,  showing  the  dangers  to  the  health  of  the  workers, 
the  protective  regulations  in  force,  and  any  other  measures 
you  would  adopt  for  preventing  lead  poisoning  in  this 
manufacture. 

4.  Name  the  different  sources  and  causes  of  Plumbism 
other  than  the  Manufacture  of  White  Lead,  as  affecting 
(a)  workpeople,  and  (b)  other  persons.] 

[5.  Discuss  the  question  of  the  aerial  convection  of 
Small-pox  from  Hospitals. 

6.  Give  the  Regi^^trar-Generars  classification  of  com- 
municable diseases  ] 

Directions : — The  answers  are  to  be  made  up  into  two 
sets,  indiciftted  by  the  brackets  on  the  questions.  Each 
set  is  to  bear  the  Candidate's  number. 


m 


Victoria  University,  July  17th,  1895.— Part  II. 

Medicine, 

(Four  questions  only  to  be  answered.) 

1.  enumerate  the  diseases  which  may  arise  from  meat  of 
bad  quality.  Describe  briefly  in  each  case  the  chief 
features  by  which  you  can  recognise  that  the  flesh  is 
diseased. 

2.  How  does  soil  influence  the  causation  of  disease? 
Discuss  this  factor  more  especially  in  regard  to  the 
Etiology  and  prevalence  of  (a)  acute  rheumatism,  {h) 
diarrhoea. 

3  What  diseases  are  more  particularly  associated  with 
coal  and  copper  mining,  button -making,  and  the  manu- 
facture of  artificial  flowers  ?  Explain  upon  what  causes 
the  prevalence  of  any  special  disease  in  these  particular 
callings  depends,  snd  indicate  the  precautions  necessary 
to  minimise  or  obviate  their  action. 

4.  What  are  the  lesions  most  usually  observed  after 
phosphorus  poisoning?  Give  an  account  of  the  circum- 
stances under  which  this  mode  of  poisoning  may  occur  in 
practice. 

5.  Give  an  account  of  the  etiology  of  Tuberculosis.  What 
are  the  modes  of  tubercular  infection  that  are  of  practical 
importance  ? 


i224    Ths  Medical  Fbbbs. 


COBRESPONDENCK 


Fkb.  26.  19», 


Wbdvudat,  July  17th,  1805b— Past  IL 
Sanitary  Adtninuiratiant  d^c, 

1.  Under  what  circnmstanoes  is  a  Medical  OflSoer  M 
Health  juatified  in  deacribiDg  a  dwelling  aa  "  unfit  for 
human  habitation,"  and  how  may  a  ckMing  order  be 
obtained? 

2.  Giv^e  the  snbstanoe  of  the  several  legal  enactments 
intended  to  provide  against  the  sale  of  nnsoand  or  unwhole- 
some foods. 

3.  Define  a  bye -law,  and  explain  the  diflerenoe  between 
a  bye  law  and  a  regulation.  What  is  meant  by  the  terms 
Power  of  Entry  ;  &»rvioe  of  Notice ;  Contributory  Place  ; 
Provisional  Oraer ;  Court  of  Summary  Jurisdiction  ? 

4.  What  statutory  measures  can  be  taken  for  the  dis- 
infection of  infected  articles  and  premises  ?  Distinguish 
between  those  which  are  applicable  nnder  the  general 
9anitary  law  and  those  under  acloptive  legislation, 

5.  Compare  the  system  of  Quarantme  as  employed 
abroad  with  that  adopted  in  England  for  the  prevention 
of  cholera,  and  give  instances  of  the  operation  of  these 
two  systems  in  recent  epidemics  of  the  disease. 

Conjoint  Boa&d  of  England,  Monday,  July  8th,  1805. 
No.  1. 

1.  Give  an  account  of  the  Ray-fungus  disease  of  animals, 
describing  both  naked-eye  and  microscopic  appearances. 
State  also  what  you  know  of  the  etiology  of  the  disease, 
and  give  your  views  as  to  its  communicability  from  animals 
to  man. 

2.  To  what  extent  do  you  consider  Climate  and 
conditions  of  the  soil  to  be  factors  in  the  Causation  of 
Acute  Rheumatism  ? 

«3.  In  what  ways  does  the  health  of  children  deteriorate 
from  insufficiency  of  air  and  light  ? 

Show  in  what  respects  the  regulations  relating  to  the 
erection  of  dwellings  in  larg^  cities  fail  to  protect  the 
public  health  in  this  direction. 

4.  Give  a  short  description  of  the  trade-processes  in 
which  Sulphur  compounds  are  produced  or  employed,  and 
the  way  in  which  the  health  of  the  workers  in  such  trade 
processes  may  be  injuriously  aflfected. 

What  practical  suggestions  would  you  make  for  the 
general  improvement  of  the  health  conditions  of  the 
workers  ? 

5.  Enumerate  and  describe  the  rashes  that  may  resemble 
the  eruption  of  Scarlatina,  giving  the  differential  diagnosis 
in  each  ease. 

Monday,  July  8th,  1895.— No.  II. 

1.  In  an  urban  district  (population  28,000)  it  is  proposed 
to  utilise,  for  the  purposes  of  an  isolation  hospital,  an 
old-fashioned  detached  bouee  capable  of  accommodatinfl:  15 
beds.  The  house  has  a  fair-sized  garden  attached.  What 
are  the  chief  practical  objections  to  the  proposal  ? 

2.  Burial  gtoundit.  predispose  to  disease  and  are  the  source 
of  actual  disease.  Review  critically  the  eviclenceon  which 
the  above  statement  is  based. 

Give  the  substance  of  the  Memorandum  of  the  Local 
Government  Board  "On  the  Sanitary  requirements  of 
CemetiCries.'' 

3.  Describe  the  form  of  Table  of  Deaths  classified 
according  to  Diseases,  Ages,  and  Localities,  K-3(A).  which 
is  required  by  the  Local  Government  Board  to  accompany 
the  Annual  Report  of  every  Medical  Officer  of  Health 
under  its  regulations.  State  clearly  the  rules  to  be 
observed  in  order  that  this  Table  may  furnish  the  basis  of 
a  true  record  of  mortality  for  the  district  to  which  it 
relates. 

4.  What  are  the  provisions  of  Parts  II.  and  III.  <  f  the 
Housing  of  the  Working  Classes  Act,  as  they  affect  the 
condition  of  Rural  Sanitary  Districts?  What  have 
hitherto  been  the  chief  sources  of  hindrance  in  their 
practical  operation  ? 

5.  What  are  the  Powers  and  Duties  of  Sanitary 
Authorities  and  their  Officers  in  respect  of  the  pollution  of 
Rivers  by  Trade  Refuse? 

Mb.  Gsokgb  Richmond  has  contributsd  jffl,000  to  endow 
a  surgical  bed  in  St.  Thomas's  Hospital  in  memory  of  the 
late  tJames  Richmond. 

We  regret  to  learn  that  Dr.  H.  Rigby  Matheson  was 
drowned  at  Strahan  by  the  capsizing  ot  a  yacht. 


€orr»)ronbtnct. 


(We  do  not  bold  oanthrei  nspoufbls  far  the  opInioiH  of  our 

THE  EDINBURGH  M.D. 
To  ihs  SdUor  of  Tbm  Mkdioal  Pbsbs  and  CiBCUi«am. 
Sm,— I  cannot  help  feeluig  some  degree  of  amusemeofe 
at  the  simplicity  of  your  correspondent  '*8alisba^ 
Craigs.'*  Is  he  really  of  opinion  that  the  amount  of  logie 
whidi  it  was  neoesMiry  to  know  to  pass  the  preUminary 
examination  of  the  Edinburgh  University  could  have  had 
the  very  slightest  effect  on  the  brains  of  the  candidates  T 
The  mere  knowledge  of  the  outward  signs  and  qrmbols  d 
the  science  of  logic,  a  knowledge  of  '*  Barbara  ^  and  her 
sisters,  which  was  chiefly  parrot-like,  could  never  increase 
the  logical  faculty  in  the  studenrs'  mind.  Logic  in  Edin- 
burgh  has  always  been  something  of  a  farce,  and  with  eo 
mu&  cJse  to  learn  the  student  is  better  without  it.  Tour 
oorrespondenc  takes  a  very  low  view  of  medical  teaching. 
As  far  as  I  am  able  to  judge,  proper  teaching  of  the  naeee 
sary  subjects  in  the  medical  curriculum  is,  throughoot,  a 
very  valuable  lesson  in  logic,  inductive  and  deductive.  To 
use  a  common  phrase  a  medical  man  is.  as  a  rule,  as  aUe 
to  put  two  and  two  together,  perhaps  I  should  say  more 
able,  than  the  average  logician  of  {Oxford  or  Cambridge, 
who  are  more  concerned  with  the  form  than  the  subetanoe. 
He  must  be  the  veriest  duUard  who  does  not  pick  up  from 
his  courses  on  chemistry,  physiology,  or  medicine  iteelf,  a 
loffical  instinct.  Why,  every  ciiemical  equation  is  a 
syllogism,  everv  physiological  experiment  or  medical  dia- 
gnosis must  eibibit  a  process  of  logical  reasoning.  Unless 
your  correspondent  would  go  the  tongth  of  advising  that 
each  aspirant  for  the  deg^ree  of  M.D.  should  take  a  degree 
in  Arts  before  commencing  his  medical  studies,  so  that  he 
should  receive  something  worth  the  learning,  I  am  afraid 
that  his  suggestion  would  be  of  little  avail. 

In  vonr  number  of  last  week  you  published  a  communica- 
tion from  your  Scottish  correspondent  which  refers  to  the 
manner  in  which  the  clinical  part  of  the  new  examination 
for  the  M.D.  degree  is  to  be  carried  out.  It  seems  to  me 
that  the  proposal  to  make  the  examination  simply  a  reflex 
of  the  M.B.,  CM.  examination  is  very  weak.  Yon  justly 
say  that  a  specialist  may  be  well  worthy  of  the  higher 
honours  without  having  to  display  an  extensive  knowledge 
of  everything  that  appertains  to  general  medicine.  I 
admit  that  a  narrow-minded  specialist  is  not  a  satisfactory 
ornament  to  the  profession,  but  it  must  be  remembered 
that  he  has  already  had  to  go  through  the  lower  examina- 
tions in  common  with  the  future  general  practitioneis. 
Specialism,  owing  to  the  great  increase  of  scientific  know- 
ledge and  acquirements,  has  expanded  much  of  late,  and, 
however  mnd\  we  may  deplore  the  fact,  must  expand  still 
more  in  the  future.  Would  it  be  fair  to  ask  a  professed 
pathologist  of  some  years  standing,  or  a  physiologist,  who 
intends  devoting  his  life  to  the  teaching  of  his  subject,  to 
undergo  a  dini^  examination  ? 

The  University  of  Edinburgh  may  have  smoothed  the 
path  for  its  aJumnl  at  the  beginning  of  their  work ;  it 
would  be  a  pity  if  it  determined  to  place  obstacles  in  their 
way  at  the  end. 

I  am.  Sir,  yours,  ^c 

M.P.EDIN. 

Edinburgh,  February  22nd,  1896. 


MEDICAL  TITLES. 


To  the  Editor  of  Turn  Medical  Pkbss  and  Ciboulab. 

'  Sir, — Quite  recently  Idirected  attention  in  your  colamnt 
to  the  extraordinary  anomalies  of  the  law  on  this  question, 
and  the  subject  is  again  revived  by  your  "  leader  "  in  last 
week's  impression.  According  to  the  judgment  in  the 
caso  of  Ferdinand,  a  man  cannot  append  the  title  "M.D." 
with  the  qualifying  letters  ".US. A."  to  his  name,  with- 
out the  risk  of  being  mulcted  in  a  substantial  fine.  Ac- 
,  cording  to  the  judgment  at  Cardiff,  in  the  case  of 
I  Bridgwater,  M.D.,  U.S.A.,  he  can,  as  there  is  no  impli^ 
tion  that  the  man  who  so  stylos  himself  is  "a registered 
practitioner  of  the  United  Kingdom."  Now,  I  should  like 
to  ask  pundits  in  the  quibbles  of  the  law  whether  wi 
"M.D.,  U.S. A."  can  legally  prefix  the  title  "  Dr."  to  bis 
name,  and  practise  medicine.    It  is  not  the  practice  of 


Vmn.  28»  18061 


CORRESPONDENCE. 


Thv  Medioal  Pbxss.     225 


medicine  which  is  illegal^  it  is  the  assumption  of  a 
medical  title.  If  he  cannot  do  so,  has  be  not 
ae  mach  right  to  prefix  the  title  ''Dr."  as  the  possessors 
of  the  woruiless  and  non-registrable  title  of  M.D.,  or 
LL  D.  from  some  sham  Universitv of  Germany  or  America? 
There  are  scores  of  men  in  this  city,  and  doubtless  in 
other  cities  also,  who  practise  medicine  and  chemistry, 
who  prefix  the  title  "  Dr."  to  their  name  and  who  are 
not  in  possession  of  the  registrable  degree  of  *'  M.D."  from 
any  University  whatsoever.  What  better  right  have  they 
to  do  so  than  the  '*  M.D.,U.S.  A."  ?  I  recently  communi- 
cated with  Dr.  Bateman,  of  the  Medical  Defence  Union, 
on  this  question,  and  in  his  reply  he  states:  '*With 
regard  to  the  title  'Dr.*  used  by  persons  duly  qualified 
but  not  holding  the  M.D.  degree,  we  have  no  intention  of 
prosecuting.  It  must  be  remembered  that  the  M.D. 
means  'Doctor  of  Medicine,'  whereas  the  word  <Dr." 
simply  means  any  person  practising  medicine,  and 
ia  used  commonly  by  the  public  generally  as  meaning 
a  practitioner  whatever  his  quanfications  may  be. 
This  contention  I  hold  to  be  eminently  unsatisfactory  and 
fallacious.  It  is  not  the  title  which  the  public  give  that 
any  gentleman  assumes.  It  is  his  academic  distinction,  or 
lejgal  qualification,  that  a  man  ought  in  honour  to  use  in 
bis  professional  or  other  capacity ;  and  I  humbly  submic 
that  if  what  the  public  call  a  man  who  practises  medicine 
€>r  surgery  is  the  title  which  be  ought  to  assume  then  the 
"M.D.,U.S.A.,"  or  the  "Ph-D."  or  the  "LL-D."  of 
tbe  diploma  shops  has  just  as  valid  a  right  to  the  title  of 
'*  Dr."  as  the  man  who  assumes  ic  while  posseesing  no 
regiairabU  degree  of  "  M.D."  Many  medical  practitioners 
possessing  only  the  licence  of  the  Glasgow  Faculty— « 
aiiigle    qualification    siiiiply    to  practise  surgery — style 

themselves  ''Dr. ,  Surgeon."    This  I  hold  to  be 

fraudulent  representation,  as  wese  men  certainly  intend 
to  convey  to  the  public  that  they  are  in  possession  of  the 
**  M.D."  degree,  in  addition  to  a  surgical  qualification, and 
I  need  hardly  add  that  it  is  in  the  intention  to  deceive  that 
tbe  law  is  violated.  The  Medical  Defence  Union  would  be 
better  employed,  in  my  opinion,  in  endeavouring  to  settle 
this  important  professional  question,  than  in  those  minor 
points  with  which  they  are  often  connected  throughout 
the  kingdom. 

I  am.  Sir,  yours,  &o., 

D.  Camfbsll  Blaok. 
Glasgow,  19th  Feb.,  1896. 


ST.  JOHN'S  HOSPITAL  FOR  SKIN  DISEASES. 
To  the  Editor  of  the  Medical  Pkbss  and  CmoiniAR. 

Sib,— Under  the  heading  '<  Opening  of  a  New  Hospital " 
The  Times  newspaper  publishes  a  glowing  description  of 
the  ceremony  of  inauguration  of  a  new  branch  of  St. 
John's  Hospital  for  Diseases  of  the  Skin  (Leicester  Square, 
London,  W.)  The  new  branch  is  installed  in  an  isolated 
mansion  in  the  Uxbridge  Road,  Suburban  London,  and 
converted  at  great  cost  to  its  new  purpose.  We  are  told 
that  a  distinguished  company  was  prei>ent,  including  the 
Ck>unte8s  of  Chesterfield  (who"  opened  "  the  hospital),  her 
eon  the  Earl,  the  Bishop  of  Marlborough,  Cardinal 
Taughan,  and  Lieut.-C>>L  Merder.  The  Earl  of  Chester- 
field delivered  an  address,  tracing  the  development  of  the 
institution,  and  ending  with  the  statement  that  an 
annual  addition  of  £2,000  a  year  would  be  needed 
to  their  income.  The  Countess,  in  declaring  the 
bospital  open  expressed  her  great  pleasure  in  being 
associated  with  her  son  "  in  so  great  and  noble  a  work." 

Cardinal  Yaughan  made  a  speech,  in  which  he  remarked 
that  the  aristocracv  and  gentiV  of  this  country  knew  well 
tbe  times  in  which  they  lived  and  the  duties  incumbent 
upon  them.  They  were  to  be  found  taking  their  part  in 
tbe  public  life  of  the  land,  in  political  and  civil  Ufe,  in 
aoience  and  literature,  in  the  defences  of  the  country  ;  but 
be  ventured  to  think  they  could  be  engaged  in  no  work 
which  would  commend  them  more  generally  or  more 
heartily  to  the  English  people  than  in  works  of  mercy  such 
as  that  hospital  represented. 

Now,  Sir,  I  venture  to  say  that  everyone  of  your 
readers  who  has  adequate  knowledge  of  the  question  of 
medical  charily,  of  hospital  accommodation,  and  of  the 
£[igantic  abuses  associated  at  present  with  the  administra- 
tion of  medical  relief  will  read  this  report  with  regret  and 


with  indignation.  Every  member  of  the  profession  knows 
that  there  is  no  real  reason  for  the  existence  of  any  hospi' 
tal  for  diseases  of  the  skin.  Diseases  of  the  skin  are 
received  and  treated  at  every  general  hospital  in  both  the 
out  and  in-patient  departmenti^.  The  great  hospitals  are 
all  languishing  for  lack  of  funds,  and  most  of  them  have 
many  empty  beds  if  not  many  empty  wards.  Every- 
one knows  how  deplorable  is  the  waste  of  money 
inevitable  in  the  administration  of  the  best  managed 
special  hospitals ;  the  salaries  of  the  secretaries,  the 
commissions  to  colleetors,  the  cost  of  public  advertisements 
appealing  for  funds,  so  that  the  expense  of  maintaining 
each  bed  in  these  institutions  usually  exceeds  by  two  or 
three  times  the  cost  of  that  found  necessary  in  well- 
managed  general  hospitals.  There  exist  in  London  alone 
some  forty  or  fifty  useless  or  unnecessary  special  hospitals, 
whose  total  income  would,  if  distributed  among  necessair 
and  deserving  institutions,  probably  snfiice  to  provide  all 
their  pressing  needs. 

Among  special  hospitals  there  are  many  which  must  be 
styled  not  only  unnecessary,  but  shams  and  frauds- 
establishments  kept  up  for  the  personal  purposes  of  their 
promoters,  and  the  staff  who  work  them. 

The  unnecessary  special  hospital  abuse  is  one  of  the 
greatest  affecting  the  true  welfare  of  charity,  and  ae 
every  one  who  has  examined  the  subject  ia  aware,  is 
attended  with  many  other  evils.  It  forms  a  prime  factor 
in  pauperising  the  people  in  the  matter  of  meidical  relief, 
and  inflicts  harm  in  many  ways  upon  the  whole  medical 
profession. 

Except  what  I  have  gathered  from  an  occasional  para- 
graph in  newspapers,  I  know  nothing  about  St.  John's 
Hospital,  its  promoters,  or  its  staff,  and  I  have  not 
the  least  doubt  they  are  all  animated  by  tbe  best  motivesr 
and  acting  in  perfect  good  faith. 

Nor  can  we  find  fault  with  members  of  tbe  aristocracy 
and  wealthy  members  of  society,  full  of  fine  feelings  (and 
perhaps  not  overburdened  with  brains)  who  lend  a  ready 
ear  to  any  plausible  plea  on  behalf  of  charity ;  but  one 
looks  for  something  better  on  the  part  of  dignatories  of 
the  Enghsh  and  Komao  Churches  like  the  Bishop  of 
Marlborough  and  Cardinal  Yaughan.  It  is,  indeed, 
astonishing  to  find  Cardinal  Yaughan  taking  part  in  pro- 
motion of  thia  enterprise  and  diecussing  it  in  Uie  terms  he 
employed. 

Judging  from  his  published  utterances  the  Cardinal  is 
distinguished  by  the  strongest  common  sense ;  and  he  has 
shown  himself  a  deep  and  earnest  student  of  social 
problems.  It  is  evident  he  has  not  made  himself  properly 
familiar  with  these  problems,  in  so  far  as  they  are  mvolved 
with  questions  of  medical  succour  of  the  suffering  poor, 
and  in  giving  his  countenance  and  eloquent  support  to  the 
undertaking  which  I  criticise  he  has  done  more  to  damage 
the  cause  he  doubtless  has  at  heart  than  can  be  retrieved 
by  any  effort  he  may  put  forth  for  many  a  long  day. 
I  am,  Sir,  yours,  &c., 

Hospital  Rbfobbiib« 


"  THE  POOR  MOTHERS  OF  ENGLAND." 
To  the  Editor  of  The  Mxdigal  Pi&iss  and  Cibcular. 
Sib,— The  pathetic  cry  on  their  behalf  bv  a  number  of 
ladies,  wives  of  Members  of  Parliament,  ana  others,  in  the 
London  newspapers  some  months  ago,  seems  to  be  lost  sight 
of  just  now  in  tbe  discussion  on  Mid  wives'  Registration. 
This  *'cry''  was  considered  useful  at  that  period,  and 
served  well  for  the  insertion  of  the  thin  edge  of  the  wedge, 
namely,  asking  for  registration  for  the  benefit  and  the  pro- 
tection of  these  poor  mothers.  But  now  **  the  cry  "  has 
been  dropped,  and  if  midwives  are  roistered,  they  wiU  be 
empowmd  to  attend  any  of  the  mothers  of  England,  rich 
or  poor,  for  they  will  be  reoognised  by  law,  and  the  con- 
fidence of  the  public  will  be  increased  as  to  their  capabili- 
ties, and  simply  because  of  this  legal  stamp. 

If  the  above  "  crv  "  was  to  obtain  for  these  poor  people 
more  reliable  and  skilled  attendance  in  their  hour  of  need, 
why  stop  at  registering  women  '*  midwives  '*  only  ?  What 
about  toe  Isrge  army  of  men  who  have  taken  out  their 
full  medical  curriculum,  and  have  not  been  able  to  full^ 
qualify  and  register  according  to  law  as  medical  practi- 
tioners? Why  are  they  not  considered?  Because  they 
have  not  bad  the  Obstetrical  Society  of  London  to  ''  nego- 


22B     Thx  Medical  Pbkss. 


MEDICAL  NEWS. 


FsB.  26,  imL 


tiata  "  for  tbem  with  the  General  Medical  CooDcil,  ae  Dr. 
ObampneyB  has  told  ub  was  done  for  tbeae  women,  in  his 
presidential  address  delivered  a  fortnight  ago. 

In  reply  to  registering  men,  they  will  say  :— **  No,  that 
would  be  a  retrograde  step.  Would  be  opening  a  door 
for  unqualified  practice  "  We  retort,  "  Is  not  registering 
uneducated  women  to  practise  midwifery  a  much  greater 
retrograde  step  than  it  would  be  to  register  as  ''mid- 
wives  '  tho^e  men  who  are  all  but  qualified  as  medical 
men?  If  registration  is  for  the  benefit  of  **the  poor 
mothers  of  England,"  would  this  latter  plan  not  give  them 
more  skilled  aid  than  women  can  offer  them  ?  I  shall  be 
glad  if  **  Registratiooist '  will  answer  these  questions. 

I  fear  these  poor  unqualified  men  of  England  have  not 
gone  the  right  way  about  it.  If  they  could  have  **  nego- 
tiated "  wiui  Dr.  Champneys  and  the  Obstetrical  Society 
(d  London  and  obtained  their  "  diploma,"  then  they  would 
have  had  powerful  diplomatists  at  their  back,  who  would 
have  ioteroeded  for  them  with  the  General  Medical  Council, 
and  they  would  now  have  been  in  possession  of  a  docu-. 
ment  recognised  by  that  august  body  !  And  yet,  on  the 
other  hand,  the  executive  committee  of  the  General  Medi- 
cal Council  resolved  on  Monday,  February  24rh,  1895,  that 
**  the  Council  cannot  approve  of  any  document  professing 
to  qualify  persons  for  any  practice  in  medicine,  surgeiy,  or 
midwifery,  issued  by  any  body  or  institution  which  is  not 
a  medical  authority  nnoer  the  Medical  Acts  '* !  Surely, 
this  looks  very  like  a  *'  solution  of  continuity,'*  when  they 
approved  of  the  certificate,  that  Dr.  Champneys  refers  to, 
of  the  Obstetrical  Society,  in  May  last ! 

I  wonder  what  they  who  have  been  punished  at  various 
times  by  the  Council  by  being  struck  off  the  Register  will 
think  of  those  who  had  been  ** warned"  ''negotiating" 
with  their  judges?  Does  this  not  look  as  if  there  is  one 
law  for  the  high  and  another  for  the  lo«]y,  who  have  no 
influential  "  negotiators" ? 

I  am,  Sir,  yours,  Ac., 

G.  H.  Bboadbbnt. 

8  Ardwick  Green,  Manchester, 
Feb.  22od,  1896. 


HAAB  S  ATLAS  OF  OPHTHALMOSCOPY,  (a) 
So  far  as  ophthalmological  literature  is  concerned,  this 
volume,  which  the  enterprise  of  the  publishers  has 
placed  within  the  reach  of  English  readers,  marks  an 
epoch  worthy  of  special  notice.  Within  the  compass  of 
an  ordinary- si  zed  text-book  **Haab's  Atlas  of  Ophthal- 
moscopy "  contains  aoompleteperies  of  admirable  coloured 
•drawings  of  the  normal  and  pathological  appearances  of 
the  fundus.  The  full  significance  of  this  fact  stands 
•out  in  bold  relief,  when  it  is  remembered  that 
hitherto  all  atlases  of  the  kind  have  been  large, 
4>ulky  tomes,  suitable  only  for  works  of  reference  in  the 
public  medical  libraries.  Such  works,  monumental 
as  they  may  be  of  the  industry,  skill,  and  originality  of 
their  authors,  have  nevertheless,  it  may  well  be  under- 
stood, fulfilled  but  a  limited  usefulness  to  both  students 
and  practitioners  alike.  They  were  almost  inaccessible,  and 
their  sisse  and  price  for  the  most  part  have  baniahed  them 
from  the  libraries  of  ophthalmic  surgeons  Wo  have,  there- 
fore, no  hesitation  in  saying  that  the  volume  before  us  is 
a  most  valuable  addition  to  the  literature  of  this  special 
subject,  and  will  find  favour  where  previous  ventures  in 
this  department  have  failed.  The  drawings  are  excellent 
in  every  way,  accurate  as  to  detail,  artistic  as  to  colour, 
jmd  beautifully  reproduced.  Each  drawing  is  furnished 
with  letter- press  description,  concisely  pointing  out  the 
various  details  depicted.  In  all  the  drawings  number  no 
less  than  siity-four.  The  first  fifty  pages  or  so  of  the 
volume  are  taken  up  with  some  practical  remarks  on  the 
■ophthalmoscope,  retinoscopy,  errors  of  refraction,  &c. 
These  in  part,  owing  to  their  conciseness,  will  be  found 
specially  useful  by  students  and  practitioners  who  have 
neither  the  time  nor  the  opportunity  to  consult  larger 
works  on  the  subject.      It  only  remains  for  us  to  add  that 

(«i)  "An  Atlai  of  Ophthalmoscopy  ;  with  an  IntrodaetioD  to  the 
Um  of  thA  OpbthaimoMsope."  By  Dr.  O.  Haab,  Frofeaaor  of  Opbthal- 
molog?,  Uniyenlty  of  Zurich.  With  64  coloared  pUt«a.  Translated 
and  Kdited  by  EroeU  (l^rke,  M.D.,  B  S.  (Lond.),  F.B.C.S.  London: 
Ballllere,  TinJa  1  and  Cox.    1896.    nice  lOa.  6d. 


the  translator  and  editor.  Dr.  Ernest  Clarke,  has  done  bit 
work  well,  and  that  the  book,  for  the  reasons  above  men- 
tioned, is  worthy  of  the  highest  commendation. 

THE  YEAR-BOOK  OF  TREATMENT  FOR  18»6.  (o) 
Fbom  the  preface  we  learn  that  this  is  the  twelfth  iaaae 
of  this  popular  yearbook,  and  a  line  of  familiar  red>backed 
books  on  the  f^helf  tells  that  for  more  than  a  decade  we 
have  not  unfrequently  consulted  Cassell's  Year-Book.  The 
great  msjority  of  the  issues  are  much  alike,  the  editor 
wisely  adhering  to  an  arrangement  which  the  medical 
profession  approved  of,  but  progress  and  time  works  some 
changes,  and  we  are  glad  to  find  a  section  on  Tropical 
Diseases  in  this  iseue. 

Where  all  the  sectiona  are  well  edited  it  may  look  invi- 
dious to  select  pnme  for  special  notice  ;  we,  however, 
think  that  Dr.  Reynold's  section  on  the  treatment  of 
nervous  and  mental  diseases  ;  Dr.  Hale  White's  eeotion  on 
diseases  of  the  stomach,  intestines  and  liver  ;  Dr.  Dawson 
Williams'  on  the  medical  diseases  of  children  ;  and  Mr. 
William  Rose's  section  on  general  surgeiy  are  of  such 
excellence  that  we  draw  our  readers'  attention  specially  to 
them. 

The  section  on  ansBSthetics  has  the  great  value  of 
emphasising  everything  which  appeared  in  the  medical 
journals  during  the  firsD  year  which  was  unfavourable  to 
chloroform,  and  displaying  much  ingenuity  in  minimising 
the  evils  of  etherisation.  Bronchitis  follows  etherisation 
in  the  practice  of  Muret  "  was  this  due,"  he  inquires,  *<to 
etherisation  or  to  exposure,  &c.."  page  173.  Oa  page  172 
we  resd  Nauwerck's  theory  that  pneumonia  foUowiDg 
etherisation  is  caused  by  the  pathogenic  bacteria  wbicE 
eiist  so  abundantly  in  the  buccal  cavity.  Yet  we  get  no 
hint  to  ei  plain  why  etherisation  sends  them  down  to  the 
lung  and  chloroformisation  does  not. 


(Dbitnitrp. 


DR.  JAMES  FITZGERALD,  OF  NEWTOWNBUTLER 
Wb  regret  to  record  the  death  last  week  of  this  estim- 
able gentleman,  one  of  the  veterans  of  the  profession  in 
Ireland.  He  was  stricken  with  hemiplegia  at  the  ripe  age 
of  88.  and  survived  only  five  days.  He  held  the  Member- 
ship of  the  London  College  of  Surgeons,  obtained  as  fsr 
back  as  the  year  1833.  having  been  previously  a  pupil  of 
Sir  Astley  Cooper.  He  retired  from  the  Foor-law  Service 
on  pension  a  great  many  years  ago,  and  occuoied  himself 
in  the  duties  of  a  country  gentleman  ana  an  active 
member  of  the  Church  of  Ireland.  He  was  greatly 
esteemed  in  his  neighbourhood,  and  was  laid  to  his  rest  by 
one  of  his  oldest  friends,  the  Bishop  of  Clogher. 


St.  Thomas's  Hospital,  London. 
The  following  gentlemen  have  been  selected  as  Houie 
Officers  from  Tuesday,  March  3rd,  1896  :— Resident  House 
Physicians:  F.  B.  Thornton,  L.R.C.P.,  M.R.C.S.  (exteo- 
sion);  W.  E.  Dixon,  B  ScLond.,  L  R.CP.,  M.RC.S. 
(extension).  Non-Residenc  House  Physicians:  E.  W. 
Palin,  M.A.,  M.B.,  B.Ch.Oxon.,  LR.C.P.,  M.R.C.S.;  P.8. 
Hichens,  M.A.,  M.B.,  B.Ch.Oxon.,  L.R.C.P.,  M.RCS. 
House  Surgeons :  L.  A  R.  WalUoe,  B.A.,  M  B.,  B.Ch.- 
Oxon., L.R,C.F,  M.R.C.S.;  H.  C.  Crouch,  L.R.C.P., 
M.R.C.S.;  J.  L.  Prain,  L  R.C.P.,  M.RC  S.;  G,  J.  Cooford, 
B.A.,  M.B.,  BCh.Oxon.,  L.R.C.P.,  M  R.C.S.  Aseiitwt 
House  Surgeons  :  B.  Dyball,  L  R.CP  ,  M.R.C.S.;  P.  W. 
Kent.  L.R.C.P.,  M.R.C.S.;  J.  Smith,  B.A,  M.B.  B.a- 
Cantab.,  LR.C.P.,  M  R  C.S.;  W.  D.  F.azer,  LE.C.P., 
M. R.C.S.  Obstetric  House  Physicians:  Senior— 6.  Tt. 
Genge,  L.R.C.P.,  M.R.C.S.  Junior— C.  W.  Grant  Wilaoo. 
L.R.C.P.,  M.R.C.S.  Ophthahnic  House  Surgeons :  Senior 
-  A  H.  P.  Dawnay,  LR  C.P.,  M.RC  S.  Jnmor-E.  A 
Saunders,  M.A.,  M.B.,  B.Ch.Oxon.,  L  R.C.P.,  M.K.C.S. 
Clinical  Assistants  in  the  Special  Departments  for  DiMises 

(a)  "  The  Year-Book  of  Treatment  lor  ISOe."  A  CriUcal  Kwlew «» 
Practitioners  of  Medicine  sud  Surgery.  London :  CsueU  asd  i^t 
Limited. 


Feb.  26,  1S95. 


MEDICAL  NEWS. 


The  Medical  Prk8Ci.     227 


of  th«  Throat :  W.  Thornely,  B.A.Gaateb.,  L  R.C.P., 
H.R.C  S.  texceneioD) ;  P.  L.  Blaber.  L  R.G.P.,  M.R.C  S  ; 
Skin:  W.  D.  Koocker,  LRC.P.,  MECa  (ezteosion); 
G.  R  Haraoort,  L.R  G.P.,  M.R.C.S.  (eztenrion) ;  Ear: 
W  H.J.  PatoiToo,  LRC.P.,  M.R.C.S.;  R.  G.  Strange. 
L.R.G.P.,  M-^G-S.  Glinical  AwiaUntA  in  the  Electrical 
Department:  F.  J.  Brakeoridge,  L.R.G.P.,  M.RG.S. 
(eztenvicm) ;  P.  J.  A.  Seccombe.  M.A.Gantab,  L.R.G.P., 
M.R,C.S. 

British  Medical  Association  —Visit  to  Carlisle. 
Some  progress  has  been  made  with  the  arrangements 
for  the  meeting  of  the  British  Medical  Association  at 
Carlisle  on  July  28ch,  2dth,  30th,  and  31st.  The  President- 
elect, Dr.  Henry  Barnes,  of  Carlisle,  will  deliver  the  presi- 
dential address  ;  the  address  in  medicine  will  be  given  by 
SirDyce  Duckworth,  M.D.,  LL.D.,  and  Dr.  Madaren,  of 
Cifflisle,  will  deliver  the  address  in  surgery.  The  sec- 
tional programme  has  to  some  extent  been  arranged. 
There  will  be  nine  sections.  The  presidents  and  vice- 
presidents  of  the  different  sections  have  been  appointed. 
The  names  of  the  presidents  are  as  follows : — Medicine, 
Dr.  George  F.  Doffey,  physician  to  the  City  of  Dublin 
Hospital,  and  Lecturer  on  Clinical  Medicine ;  surgery,  Dr. 
Alexander  Ogstoo,  Professor  of  Surgery  in  Aberdeen 
University  ;  midwifery,  Dr.  J.  Halliday  Groom,  Obstetric 
Physician,  Royal  Infirmary,  Edinburgh  :  pablic  medicine. 
Sir  Joseph  Ewart,  M  D.,  Brighton  ;  psychology.  Dr.  J.  A. 
Campbell,  Medical  Superintendent,  Cumberland  and 
Westmoreland  Asylum  at  Garlands;  pathology,  and 
bacteriology,  Dr.  Sheridan  Del^pine,  Professor  of 
Pathology,  Owens  College,  Manchester :  ophthalmology. 
Dr.  David  Little,  Lecturer  on  Ophthalmology,  Owens 
College,  Manchester ;  diseases  of  children  Dr.  James 
Finlayson,  Physician  to  the  Western  Infirmary,  Glasgow  ; 
ethics,  Dr.  T.  F.  I'Aoson,  Whitehaven.  The  Bishop  of 
Carlisle  and  the  civic  authorities  have  signified  their 
intention  to  do  all  in  their  power  to  make  the  gathering  a 
successful  one. 

The  Notorious  Hernia  Specialist — Sherman. 
At  the  Manchester  Assizes  last  week,  George 
Greenwood,  lodging  house  keeper,  of  Rochdale,  sued 
Samuel  John  Sherman,  described  as  a  "  specialist " 
in  the  treatment  of  hernia  and  rupture,  for  the  return  of 
money  said  to  have  been  obtained  by  fraud.  The  defen- 
dant neither  put  in  an  appearance  himself  nor  was  repre- 
seoted  by  counseL  Mr.  Langdon  said  the  charge  against 
the  defendant,  who  carried  on  his  business  in  Chancery 
Luia,  London,  and  Kmg  Street,  Manchester,  was  that  by 
means  of  lies  he  had  obtained  from  the  plaintiff  the  sum  of 
eighty  liruineas.  For  some  twelve  or  fifteen  years,  the 
platntiff  had  been  suffering  from  a  double  rupture,  but  by 
wearing  an  ordinary  truss  he  was  able  to  go  about  and 
work  without  any  trouble.  The  son  of  the  plaintiff  in 
June  laat  f>aw  an  advertisement  in  a  Manchester  evening 
paper  stating  that  rupture  was  cured  without  operation 
by  defrndant,  and  that  all  who  wished  to  get  rid 
of  rupture  and  truss  should  send  to  him.  The  plain- 
tiff resolved  to  see  Sherman  and  went  to  the 
offices  in  King  Street,  Manchester.  Before  he  was 
admitted  he  hcul  to  pay  a  fee  of  a  guinea.  Sherman 
examined  tne  plaintiff,  in  reply  to  whom  he  said 
he  could  cure  the  rupture,  and,  in  fact,  make  the  plaintiff 
stronger  than  he  had  ever  been  before.  But  it  was  a  diffi- 
cult case,  and  he  said  he  should  want  100  guineas  for  the 
cure.  Photog^phs  were  shown  to  the  plaintiff  of  men 
who  had  been  cured  or  were  in  process  of  being  cured. 
The  plaintiff  ultimatelv  agreed  to  pay  80  guineas  for  the 
treatment  and  cure.  The  money  was  paid  on  the  follow- 
ing day,  and  Sherman  then  fitted  on  to  the  plaintiff  a  bad 
truss  and  gave  him  a  bottle  of  lotion.  The  truss  not  being 
a  proper  appliance,  the  plaintiff  had  suffered  a  good  deiu 
of  pain  from  it.  In  the  beginning  of  this  year  he  saw  Mr. 
Whitehead,  of  the  Manchester  Royal  Infirmary,  who  told 
him  that  the  truss  and  the  lotion  were  of  no  use,  and  were 
in  fact  rather  bad  than  good.  The  plaintiff  having  given 
evidence,  Mr.  Whitehead  was  oalled  and  stated  that 
rupture  in  an  adult  was  not  curable  without  an  operation. 
The  truss  given  by  the  defendant  to  the  plaintiff  was  an 
improper  truss.  The  "  compound  "  would  soften  the  skin 
rather  than  harden  it,  and  so  it  would  do  rather  more 
harm  than  good.  Tte  jury  gave  a  verdict  for  the  plaintiff 
for  85  guineas. 


PASS    LISTS. 


Army  Medical  Service. 
Tbe  following  is  an  official  list  of  candidates  for  com' 
missions  in  the  Medical  Staff  of  Her  Majesty's  Army  who 
were  successful  at  the  recent  Competitive  Examination  in 
London,  placed  in  the  order  of  merit : — 

Names.  Markg.  I  Xamrs.  Mark*. 

Kirrell,  R.  T.  F 8740  |  MacDoiigall,  A.J «n7 

Morris,  A.  B 2308  I  RMdi<  k.  0.  B 2185 

Archer,  S.  A.  ..    2297  |  Hewet«on,  H 21C7 

Cochrane.  E.  W.  W.  ..    222^  I  Clements,  R.  W 2"0a 

Swably,  M 221U  | 

Indian  Medical  Service. 

Ths  following  is  an  official  list  of  the  candidates  for  Her 
Majesty's  Indian  Medical  Service  who  were  PUCOf»ssful  at 
the  Competitive  Ezauiination  held  in  London  on  February 
7th,  1896,  and  following  days,  arranged  in  order  of 
merit:— 


Names. 


Marks.  I     Name*. 


Rrown,  H.  E  .. 
Fleming.  i».  y. .. 
Jnmes.  A.  P. 


Marks. 
..  2S81 
..  2816 
..    SSOft 


2«es 

225» 


Walton,  H.J S186  I 

Ainsworth^H 3010 

Cornwall,  J.  W 2«8< 

Smith,  F.  A 26M  !  Plnvh,  A.  E.  H. 

SteT*:nsoD,  J.  S 2^10   Dee.  P. 

Dickson,  H.  A.  D.      . .        . .  2004  !  Mel],  K.  O.  N. .. 

Klcharrts,  W.  0 2518  j  Brown,  F  D.  .. 

Dick.  M 2ns  '  Hammond,  K.  A.  L.  . 

Miller,  A.         ..         ..         ..  247tf 

University  of  London. 

Thi  following  are  official  lists  of  candidates  who  passed 
tbe  recent  Intermediate  Examinations  in  Medicine : — 
Entire  Examination. — Second  Division. 


Alexander,  K.  B.,  Ooy's  Hosp. 
Anderson,  W.  M.  Lond'tu  Hoep. 
Balderston,  E.J^tiy's  Hoap. 
Barron,  U.  T.,  wesnninsterllosp. 
Belfrage,  8.  H..  Uuiverkity  ColL 
KriBcoe.  J.  C.  Kind's  College 
Oammidge,  P  J  .  St.  Bat's.  Hcsp. 
Clifford.  H  .  University  OolL 
«'oUens.  E.  H..  Mason  Colle/e 
E«ann.  H.  L.,  Ooy's  Hospital 
Fatrhank,  H.  a.  T..  Charing  Cross 
Hospital 


Forster,  L.  C.  E.,  Sch.  of  Med.  for 

Women 
Olover,  J.  A.,  Ony's  Hospital 
Kelly  C.  K  M.,  Owen*  Coll. 
Kniffht,  C.  v.,  Ht.  B«rc*s.  Bo«p 
Lander,  C.  L.,  B  Se. , London  Hasp.. 
Lew  s,  F.  C,  St.  Mary  s  Ho*>p. 
Meakin,  E.  B.  M.,  Sch.  of  Med.  for- 

Woro«-n 
N^nrman,  n.,  London  Hosp. 
Perdran.  J.  A.,  (Tniverslty  ColL 
Utley,  C.  J.,  Owens  CoUece 
Watson,  J.  v.,  Owens  College 


Excluding  Physiology. 
G  *tes,  Edward  Alfred.  St.  Thomas's  Hospital. 
Second  Division. 


(First  Division.) 


Ra?low,  H.  C,  Westminster  Hosp. 
Bingham.    8.   O.,  St.   Thomas's 

Hosp. 
Che«*iman,  H.  H.,    Westminster 

HOSD. 

Everington,    H.   D.,   St.    Bart.'s 

Hosp. 
F.  X,  H.  K.  C,  Guy's  Hosp. 
Fox.  T.  H..  Yorkshire  ColL 
Hibblnt,  H.  K.,st  Bart,  s  Hosp. 
H«u"on,  U .  B.,  Sch.  of  Med.  for 

Women 
HatfleH.  IL,  St.  B4rt.'sHosp. 
Ibotson,  If.  O.  B..  Ony's  Uo»p. 


H.    S.,  St    Mary's- 


Uddell,  W. 

Uosp. 

Longli^y.  J.  A.  N.,  Mason  ColL 
Owsley,  0.  C,  Gay's  Hosp. 
Farrett,  E.  E..  B.A.,  Gay*s  Hosp. 
Parsons,  A.  C,  St  Toomat's  H  Mp . 
Rhodes.  J.  H..  St  Bart's  H<isp. 
Richards,  G.  M.  O.,  Owens  ColL 
Rtbinsoo,  J.  K,  St.  Bart's  Hosp. 
Rowland,  P.  W.,  St.  Bart.*s  Hosp. 
TsnntOB,  J.  G.  C,  Mason  CoU. 
Tayler,  Q.  P.,  St,  But 's  Hosp. 
Taylor,  I..  Yorkshire  Co*L 
Miller.  Q.  V.,  Ualrerslty  CoU. 


Avelln^,  H. 
SchooL 


Physiology  only. — First  Division. 
T.  S..  Bristol  Med.  I  Wallis,  J.  O.,  London  Hosp. 

Second  Division. 


Boi-,  F.  V.  O.  St  Barts  Bosp. 
Crisp,  G.  B.,  St  Mtry's  Hjsp 
Oiinrher,  H.  A.,  Unlversttv  CoU. 
Haindson,  L.  K.  o.,  i^uy's  Hosp. 
Jones  J.  U.  University  ColL 
Northctce,  P., St  Thomas's  Bosp. 
E I  we,  W.  T.,  St.  Bart's.  Hosp. 


Soott,  ff .  H.,  Bt  Thomu's  Hosp. 
Stock  W.  S.  V.,Univ.  OoU., Bristol, 
btuart   W.  L.,  Gay's  Hosp. 
Ihwaitei    O.  B.,   St.   Thomas's 

Hosp. 
Woodbridge,  K  W.,  St.    Bsrt's. 

Hasp. 


Boyal  College   of  Surgeons   in  Ireland.  — Fellowship 
Examination. 

The  following  gentlemen  have  passed  the  primary  part 
of  the  examination  : — 
Mervyn  Winf red  Falkner  and  Percy  Hope  Falkner. 

The  following  gentlemen  having  passed  the  necessary 

examination  have  been  admitted  Fellows  of  the  College  : — 

Bernard  Robert  Chatterton,  M  D.,  B.Cii.,  Univ.  Dub.;  Edward  Henry 

Ta\lor  M.B.,  B.Ch.,  Univ.  Dab.;  Patrick  Joseph  Pasaa,  L.ltO.p.1. 

RDdL.R.C.S.1. ,  aud  Alfred  Ernest  WUIUm  Ramsbottom,  L.R.C.S.J., 

L.R.CP.I.      . 


228    Thb  Midioal  Pbms 


NOTICES  TO  CORRE-PONr>ENTF. 


Fkb.  26    1896. 


cftottCtB  to 

Corrjegponbttttg,  ghort  l^ttters,  ict. 

69^  O0BBMM>n>nraB  nqairlng  •  nply  tn  tlili  oolumii  in  par. 
(toularly  rsqiiMtod  to  make  om  of  •  dUtktaHm  nonaiun  or  iwMolt, 
and  aTold  the  pnctloo  of  dgning  UiobimItw  "  Baulor,"  **  SttbtetilMr,'' 
'*01d8nbtcrllMr,"  *o.  MqoIi  ooafuloa  wlU  bo  spond  by  attoiitfoii 
to  thia  mle. 

THB  KI8BT  FUND. 
To  the  Editor  of  Thb  1Ch>ioal  Peisb  ahd  Ciboolab. 
Sib,— I  ■hall  be  glad  if  yna  wUl  ackn  wlodge  tbo  receipt  of  the 
following  additional  anbicriptlons  to  above  ftind. 

I  am.  Air  yonn,  Ac  , 


CarriokmaoroM, 

February  20tb,  1396 

£  1.  d. 
Moat  Rot.  Dr.  Owen  ..200 
Mr.  C.  Woodd,(Penge)..  2  2  0 
Dr.  McCarthy ,  (Bridport)  10  0 
Dr.  Moore,  (Sockerry) ..  10  0 
Dr.  Moore,  (Ardee)  ..100 
Dr.  Strahan,  (Onbiin)  ..100 
J.    T.    Msguire,    B«i., 

solicitor  ..100 

Dr.  J.  B.  Storey,  (Dablin)  1  i  o 
Dr.  Black,  (aaTcnidale)  10  0 
Mr.  Clarke,  ("hirock)  ..  i  0  0 
Dr.  CnmiDg,  (Belfaet)  . .  1  0  u 
Dr.  H.  B.  HWttn«y,  (Dub.)  10  0 
Dr.c.J.Clibbom,(ttlf«t.)   I    0   0 


r.  McKkhma,  M.l^,  Hm.  Sec. 


£ 


a.  d. 
0    0 


Dr.  Taylor,  Monagtian) 
Dr.  Moorehead,  (Coote- 

hill) 11 

Dr.8.  Woodhoaae,(Dob)  1  t 
Dr.  Delahoyde,  (Dublin)  0  10 
Dr.    O'Hagar,     (Cafttie- 

biUiogham)  ..    0  10 

Dr.  Keelar,  (Dunbar)  ..10 
Dr.  Flood,  (l>nnda)k)  ..10 
Terence    Clarke,    Ksq., 

(Bray) lie 

P.     J.     Clarke,      Eeq., 

(Uiceeter)     ..       ..110 


Bathtbibs.— A  letter  addreeaed  to  the  Aegfttrar,  Boyal  College  of 
Physicians,  Pall  Mali  Kast.  London,  will  enable  oar  correspondent  to 
obtain  the  information  he  desires. 

Db.  T.  MiLBAk  KB  (Exeter).  We  regret  that  we  have  no  space  at 
present  to  devote  to  the  sabj«ct  to  which  oar  correspondent  refers. 

Thb  letters  of  M.  L.  and  Twice  Rejected,  are  nnavoidably  orowde  d 
out  at  Press. 

Mb.  Swab's  second  leotnre  on  "  Tubercalar  Disease  of  the  Blp- 
Joint."  has  been  received. 

Mb.  Stdmbt  Btbphbbsoxb  paper  on  "Episcleritis  Periodica 
Fogaz  "  is  marked  for  earlv  insertion. 

kXlT  JANB  CAKEBBBAD. 

As  corollary  to  the  leader  in  another  column,  we  roach  regret  to 
learn  that  Dr.  Gordon,  medical  superintendent  of  ihe  Backney 
Inflrmaiy,  is  at  present  incapecitated  from  duty,  suffering  from  two 
broken  ribs  .caused  by  a  kick  from  the  notorious  Jane  Cakebread.  It 
was  his  du^  to  see  the  woman  before  her  removal  to  the  lonatic 
asylum,  she  having  been  certified  to  be  ins«oe,  and  when  Cakebread 
heard  her  fate  she  kicked  him  savagely  in  ihe  chest  Upon  examina- 
tion it  was  foond  tliat  Dr.  Qoriion  was  suffering  from  two  broken 
riba.  and  the  gnardians  have  appointed  another  medical  oAoer  to 
undertake  the  daties  daring  his  Ulness. 

Db.  Cabtbb  (Liverpool)  is  thanked  for  his  note. 

Mr.  Cbaoos  —The  case  i«  not  by  any  means  singular ;  a  *'  swab  "  of 
the  throat  after  six  weeks  and  even  double  that  length  of  time  fre- 
ciuently  reveals  the  presence  of  bacilli,  and  illustfates  toe  fact  of  the 
long  continued  contsgiousnees  of  diphtheria  after  the  child  is  supposed 
to  have  recovered.  We  shall  be  glad  to  receive  full  particulars  when 
ihe  case  is  completed. 

Jleettngs  of  tht  ^otxtHtB. 

THUBSDAT,  FBB.  27TH. 

BOTAL  Institution.- 8  p.m.  Prof.  H.  Marshall  Ward :  On  some 
Aipeots  of  Modem  Botany. 

SooiBTT  or  ABTa  (Imperial  Institute,  South  Kensington).-  4.80  p.m. 
Mr.  C.  Tripp :  The  Tobacco  Indoatry  of  India  and  the  Far  Basft. 

FaiDAT,  FBB.  28TB. 
CTLIBIOAL  SooiXTT  ov  LOBDOB.— 8.30  p.m.    Clinical  Cases. 
BOTAL  Ibstitutiob.—O  p.m.    Mr.  J.  Murray :  Marine  Oiganisms 
/ind  their  Conditioas  of  Bnvirunment. 

SATUBDAT,  FBB.  20TH. 

BOTAL  IB8TITUTZ0B.~8  p.m.    Lord  Baylelgh :  Light 

FBIDAT,  MABCn  OTH. 

Wbst  Kbrt  MBDioo-CHiBUBQioaL  SooiBTT.— 8.15  p.nL  At  Boyal 
Kent  Dispensary,  Greenwich,  clinical  Kveoing.  Cases,  spedmena, 
*c.,  by  the  President    (Mr.    ~  -    -  -     - 

Jocelyne,  and  otbeta. 


Ernest  Claike),   Drs.   ColUe,  Henry, 


Anderson's  CoUege  Medical  Pchool,  Glasgow.— Chair  of  Midwifery. 

Information  regarding  the  duties  and  terms  of  appointment  of 

John  Kldston,  Secretary,  60  West  Begent  Street,  Qlawow 
Birkenhead  Union.— Besideiit  Assistant  Medical  Officer  of  Workhoose 

and  Schoola.    Salary  £60  for  the  Workhouse  and  £20  for  the 

schools,  with  rations,  attendance,  washing  and  residence.    Appli. 

cations  to  John  Carter,  Clerk  to  the  Gaardlans,  46  flamllton 

square,  Birkenhead. 
Bolton  Infirmary.  -  Senior  and  Janior  Houae  Surgeons.    Salair  for  the 

Senior,  £120,  and  for  the  Junior,  £80  per  annum,  with  apait- 

menu,  board,  and  attendance.  AppUcatlona  to  Peter  Kevan,  Esq., 

Bon.  ScOm  is  Acreslleld,  Bolton. 
Fofteetone,  Victoria  HospltaL— House  Soigeon.  Salary  £80,  rlMns  £10 

annually,  with  board,  residence,  and  washino.     AppUcaMona, 

with  teettmonUlB,  to  the  Secretary  by  March  20th. 
Mancheater  Southern  and  Maternity  HospltaL— Besldent  House  Sur* 

geon.    Honorarium,  £60  per  annum  wlih  board.    AppUoations  to 

Gea  Wm.  Fox,  68  Prtncen  Street,  Hon.  See. 


MetropoUtan  Hbaplt^  Kingaland.— Boose  Pkvsleian.  Honne  ^unreon, 
Asststaot  Honse  Phvaieian,  and  Assistant  House  Suraeon.  «alary 
of  House  Physician  and  Ronae  IMifgeon  £«0  a  year,  th^t  of  the 
Assistant  House  Physidan  and  Assi«tant  House  S'i<  geon  £  0  a  yiar. 
ApplicAtlonato  be  sent  by  March  7th  to  Charles  B.  By-rs,  j^«n 

NorthnmYt^rtand  County  Lunatic  Asylum,  Morpefeli.  -  Assist  iit  M>'d{- 
cal  ( )fiicrr.  S-Ua  y  £l2o  per  annum,  increaning  £10  y^Arly  to  £l5*s 
with  furnished  apwrtujents,  board  and  lodging.  Appllcatloni  to 
Dr.  McDowell,  at  the  Asylum. 

Bipon  Dispensary  and  Cottsae  Hospital.— Besll^nt  Rouse  Surgeon 
and  Dispenser.  Biilarv  £70  per  Munum  with  board  and  lodging. 
Appli««tion  to  F.  D.  Wise,  Hon.  See. 

Warrington  Infirmary.-  Junior  B  -sident  Hons^  ^urfte^.    Salary  £100 

rr  annnm  with  famished  residettoe  an  1  board.    Application  t*)  J. 
Tnnsta  L  Hon  Sec. 
Yorkshire  College,  Leeds.— Demon^ator  of  Phyaiology.    Salary  £150. 
Particulars  of  the  CoUege  Secretary. 


S^ppointmtntM 


Habbis.  T  ,  \r.D.Lond.,  .  .B.C.*'..  M.B.C.*.,  Visiting  Physician  to  the 

Mtn'hest«tr  Boyal  Lunatic  Asylnm 
RODOsny,  C.  E.,  L.B.C.P.,  L.B.n  S.Ir«L,  Besld^nt  Clioical  Aaabtut 

to  thit  City  Asvlum.  Birmingham. 
JOBES.    BOWLAND  K.  H  ,  L.R^.P.Lond.,  MB.C.^..  n.p.ff.,  Medical 

Officer  for  the  Workhouse  nf  the  Bangor  mnd  U«anm«r1s  Onion. 
LiBCARBB,  B.  Lb  Cbobibb,  H.R.,    B.oh.Oxon,    Physiciftn   to  the 

Swansea  and  Sooth  ^ales  Institution  for  the  Blind. 
MILB8,  W.  Kbbbst.  F.B.C.8.Knc.,   House  Surgeon  to  St.    Mark's 

Hospital  for  DlseasM  of  the  Rectum. 
Mbwman,    Williax,   M.D.,   M.B.aP.Lond.,    F.B.C.S ,    Consiltlng 

Surgeon  to  the  Stamford  and  Batland  Oener'^l  Inflraurv. 
Pkhmt,  w.  B.,  M.E.C.S.,  L.B.C.P.,  Honse  Surgeon  to  Westminster 

HosplUI. 
Phillips,   Gborgb,   M.R.CS.Enff.,    L.B.C.P.Lond.,    Junior  Houas 

Surgeon  to  the  Bary  DIspenstfy  Hospital.  L«ne«. 
BiCHABDS,  A.  F.   B..  M.B.,    B.CCamb,    L.E.C.P.fx>Bd.,    M.R.G.S., 

Medical  Officer  for  the  Hospital.  Swansea. 
SMITH,  A.  T.,  M.B.,C.M.Aberd.,  Medical  Omcer  for  the  Third  Sanitary 

District  of  the  Bromley  Union. 
Stbbll,  G.,  M.D.Bdin.,  cm  ,  F.B.CP.Lond.,  Visiting  Physician  to  the 

Manchester  Boyal  Lanatlc  Asylum. 
STEVBBBOB,  A.  K.  M.D.,  CALIreL,  Medical  Offiser  for  the  D>agh 

Dispensary  District. 
Tatlob,  Jas,  L.E.C.P.Londy  F  E.C.8.,   L.F.P.S.GIasg.,  Consultiog 

Surgeon  to  the  Wrexham  inflrmarv. 
Vawdbby,  Gbo.,  L.B  C.P.Lond..  L.M.Bdin.,  M.B.C.S.,  Medical  Oacer 

by  the  Famborougb  District  Council. 
Wabd,  T.   H..   MB.,   CM.iEdin.,   Medical  Officer  for  the  Second 

Sanit«ry  District  of  the  Tomes  Union. 
Wattb,  J.  M.A.,   MB.,  B.0h.Oxon.  M.&.C.S.Rng.,  L.R.C.P.Lond., 

Surge  tn  to  Croydon  General  HoepitaL 
WiLUAMS,  Kd.  Cboil,  B.A.,  M.B.,  B.C.Caatab.,  Phvsiclan  to  Out- 
patients to  the  Bristol  Hospital  for  Childnn  and  Women. 

$trth0. 

Abhold.— Feb.  14th,  at  Oxford  Boad,   Manchester,  the  wife  of  Francis 

Sorell  Arnold,  M.B.Oxon.  of  a  daughter. 
Bbll.— Feb.  10th,  at  Umndlsburgh,  woodhridge,  Suffolk,  the  wife  of 

Frank  OUnhant  Bell,  M. a,  CM.,  of  a  daughter. 
CLABKB.— Feb.  10th,  at  Gledatanes  Boad,  Weat  Kensington,  W.,  the 

wife  of  William  mderick  CUrke,  M.D..  B.S.Lond.,  of  a  son. 
COOPBB  —Feb.  12th,  at  Oourtfleld  Boad,  the  wife  of  G.  White  Cooper, 

M.B.,  of  a  daughter. 
1!^>THBB0ILL.-Feb.lftth,  at  Olive  House,  Boeester,  Staffs,  the  wife  of 

George  A.  Fothergill,  M  B.,  of  a  son. 
Gbobob.— Feb.  28rd,  at  1  Burton  Boad,  Brondsabury,  the  wife  of 

Alfred  W.  George.  M.B.,  M.E.C.S.,  of  a  daughter. 
Habbis.— Feb.  14th,  at  Holy  Innoeenfa  Boad,  Homsey,  the  wife  of  B. 

Bernard    Harris,    M.B.C.S.Bng..    L.E.aP.Lond.,   L.S.A.,    of  a 

PlOK.-J'eb*  isth,  at  64  Ck>wer  Street,  the  wife  of  Awdry  Peek,  M.A., 

Oxon.,  M.B.C.3.,  L.B.CP.,  of  a  daoghter.l 
BAWUB80B.-Feb.  16th,  at  Stuart  Hoa2e.  Bognor,  the  wife  of  F. 

Juland  BawUnson,  F.B.C.S.,  of  a  son. 


CBOUOH  -  Smith.— Feb.  ittcn,  at  St.  Toomat's  Portman  Square, 
London,  Charles  Percival  Crouch,  F.B  CS.Eng.,  M.B.Lood.,  of 
^  eston-snper-Mare,  to  Annie  Parbury,  second  daughter  of  Thomas 
Smith,  F.B.C.8.Eng.,  of  Stratford  flaoe,  W.      ^  ^  ^^     _      ,^  ^ 

TAYLOB-STBATTOB.-Feb.  21st,  at  Sehore,  Central  India,  Harold  B. 
Ta>lor,  e*Ute  Baily.  Branch,  P.  W.D.,  to  Margery,  daughter  of  the 
late  Brigade-Surgeon  J.  B.  Stratton,  M.D.,  Indian  Medical  Service 
(By  Telegrapb.)        

FITZOBBALD.— Feb.   10th,    at    Dlewtowaoutler,    James  ntqpgrald, 

M  H^C  8  B    seed  H8 
MALCOLM  .'SMiTH.~Feb.  20th,  at  AmweU  Plaoe,  Hurstpierpoint,  Snasex, 

Geo.  J.  Malcolm-Smith,  M.D.,  aged  46.  .    _.«      «  r^ 

MiLB8.^Feb.  2  2nd,  at  Kandy,  Ceylon,  Jane  Arsoott,  wife  of  Geo. 

MUea,M.B.CS.,formerlyofPlymptoii,  Devon.  ^ 

BOBBBTSOB.— Feb.  21st,  at  16  Great   King  Street,   Bdtaibui]|^  J. 

Hntchinson  Bobertson,  M.D.,  J.P.,  If^  of  Slnaapor^  ffS^?i  * 
Wbbb.— Feb.  22nd,  atGlonoester,  Chaa.  Loals  Webb,  M.B.C.&,  L.8.A., 
formerly  ef  Walton^on-Thamea,  aged  44. 

jixji'ixja, — ^T»fM/tt#M>wt«vMN  ({/  x>4.yii««,  jtmrriageif  and  DetUht  totks 
famOiu  cf  Subteriben  to  tki$  Journal  or»  inaortod  froojjamd jmM 
fwdk  dke  jmMidherv  fief  taeer  (Aon  dke  jr<mdayj»«oe<l»ivjwMta(<iik 


Wht  ^dmi  ^vm  mA  (^tmht 


•'SALUS    POPULI    SUPRBMA    LEX.* 


Voi^cxn. 


WEDNESDAY,    MARCH    4,    1896. 


No.  10. 


igftvpvad  (2i:ommttntJcaU0ii& 

THE  PERMANENT  CURE  OF  ANTE- 
FLEXION  BY  OPERATION,  {a) 
By   GEORGE    R    KEITH,  M.R,   CM 

Without  entering  into  the  question  of  dysmenor- 
rhcea  in  all  its  phases,  I  would  draw  attention  to  the 
Tariety  known  as  obstructiye  dysmenorrhcBa.  It  seems 
stiange  to  me,  and  probably  also  to  others  that  there 
can  be  a  doubt  whether  there  is  such  a  thing  as 
obstructive  dvsmenorrhoea  or  not  Opinions  on  this 
question  are,  no wever,  divided. 

Those  who  believe  in  the  obstructive  theory  consider 
that  the  pain  is  frequently  due  to  an  alteration  in  the 
shape  of  the  uterus  or  in  other  words  to  an  anteflexion 
of  that  oroan.  This  flexion  occurs  either  at  the  junction 
of  the  boay  and  cervix  or  in  the  cervix  itself,  and  may 
vaiy  very  much  in  desree.  The  fundus  of  the  uterus 
appears  always  to  be  oirected  more  towards  the  pubes 
than  is  natural,  and  the  os  looks  more  or  less  forwards : 
in  a  very  well  marked  case  the  position  of  the  os  will 
show  that,  if  the  cervical  canal  were  prolonged  for- 
wards, it  would  be  parallel  to  the  cavity  of  the  body  of 
theaterus. 

For  example,  when  an  examination  is  made  in  an 
extreme  case,  the  finger  strikes  against  the  os,  which 
is  looking  forwards  and  upwards  ;  the  shape  of  the 
cervix  is  not  what  is  usual,  the  distance  between  the 
OS  and  the  vaginal  junction  in  front  being  much  shorter 
than  that  from  the  os  to  the  vaginal  lunctiou  behind. 
Poshing  the  finger  up  in  front  the  body  is  felt  through 
the  anterior  fornix.  It  is  thus  evident,  and  it  is  shown 
on  bi-manual  examination,  that  the  uterine  canal  can- 
not possibly  be  in  a  straight,  or  even  an  approximately 
straight,  line. 

It  IS  unnecessary  to  trouble  you  with  the  svmptoms 
which  may  be  caused  bv  an  anteflexion,  but  it  is 
necessary  to  remember  that  those  tend  to  become 
more  severe  owing  to  alterations  in  the  lining  mem- 
brane of  the  bodv  of  the  uterus  and  in  the  pelvic  cir- 
culation ffeneraUy.  This  must  be  borne  in  mind, 
because  the  full  benefit  of  the  operation  to  be 
described  does  not  always  appear  immediately.  The 
old  operation  of  splitting  the  cervix  has  been  perfected 
by  Dr.  Dudley,  of  Chicago.  His  modification  does  not 
seem  to  have  met  with  the  attention  it  deserves,  and 
it  is  one  of  great  importance,  because  it  does  away  with 
the  healinff  by  granulation  and  its  accompanying 
evils.  I  believe  that  the  object  to  be  aimed  at  is  not 
the  removal  of  any  real  or  supposititious  lessening  of 
the  lumen  of  the  uterine  canal,  but  in  the  rendering  of 
liiis  canal  straight,  or,  at  least,  in  doing  away  with 
any  marked  bend,  and  in  this  way  relieving  the  pelvic 
ciiculation. 

The  old  operation  of  dividing;  the  cervix  either  later- 
ally or  through  the  posterior  hp  has  this  great  fault, 
that,  unless  artificial  means  be  taken  to  keep  the  canal 
dilated,  the  cut  surfaces  adhere  almost  immediately 
and  the  malformation  is  exactly  as  before.  If  the 
canal  is  rendered  permanently  enlarged  by  artificial 


(a)  Pftper  iwd  befon  tha  Britlf h  GTiiaoological  Sodely,  Tet.  18thJ 


means,  a  slight  deformity  may  be  cured,  but  a  marked 
one  WLll  not  be  relieved,  as  a  rule,  because  the  uterine 
canal  has  not  been  made  straight  or  at  least  sufficiently 
straight  to  allow  of  the  easy  exit  of  the  menstrual 


¥ia.  I. 


fluid.  In  addition,  more  or  less  cicatricial  tissue  wil 
be  formed.  The  aim  of  the  operation  ought  to  be  to 
make  the  canal  of  the  body  of  the  uterus  and  the 
cervix  into  a  straight  line  in  such  a  way  that  there 
can  be  no  retuniS  the  deformity. 


230    Thb  MiDicAL  Press. 


ORIGINAL  COMMUNICATIONS. 


The  followiDg  are  the  steps  of  the  operation  :— It  is 
essential  to  use  Sim's  8peom!im,and  as  this  operation 
may  have  to  be  performed  on  unmarried  women  the 
smaller  end  of  the  smallest  sized  specnlum,  three- 
(quarters  of  an  inch  in  width,  must  be  the  one  selected 
in  such  cases.  It  is  thus  unnecessary  to  rupture  the 
hymen  unless  it  be  very  large.  The  yagina  is  to  be 
washed  out,  a  tenaculum  is  to  be  fixed  into  the  centre 
of  the  anterior  lip  of  the  cervix  and  the  uterus  is  drawn 
slightlv  downwards  to  straighten  the  bend  as  far  as 
]M)88ible.  A  sound  is  passed  to  determine  the  exact  direc- 
tion of  the  canal  which  is  then  thoroughly  dilated,  prefer- 
ably with  a  Qoodell's  dilator.  This  is  followed  by  curet- 
ting, a  large  quantity  of  fungoeities  being  usually 
removed.  The  operator  then  takes  the  tenaculum  in 
the  left  hand  and  with  knee>bent  scissors  in  the  right 


cuts  throuf^h  the  whole  thickness  of  the  posterior  lip 
of  the  cervix  almost  to  the  vaginal  mucous  membrane, 
(see  diagram). .  For  convenience  I  propose  to  call  the  end 
of  the  cervix  at  the  oe  the  point  ana  the  part  where  it 
meets  the  vagina  the  base.    There  are  now  ,two  |cut 


Mab.  4,  1898, 

surfaces,  the  upper  or  right,  and  the  lower  or  left,  and 
each  reouires  to  be  sutured  separately.  It  wUl 
be  seen  that  if  the  cut  surface  on  one  side  is  doubled 
on  itself  so  that  the  point  touches  the  base,  and  the 
same  is  done  on  the  other  side,  the  point,  i.e.,  the  oe» 
muift  be  either  drawn  backwards  or  tne  base  must  be 
drawn  forwards.  What  happens  is  that  the  point  is 
drawn  backwards.  It  is  next  fixed  in  this  posmon  by 
sutures.  The  stitches  are  put  in  in  the  following  way, 
the  needle  is  passed  through  the  whole  thickness  of 
the  point  on  one  side  and  from  the  vaginal  surface  to 
the  cervical,  and  in  the  reverse  direction  through  the 
whole  thickness  of  the  base,  (see  diagram).  The  stitch 
is  then  tied^  thus  keeping  the  cut  surface  doubled  on 
Itself.  A  similar  stitch  is  then  put  into  the  lower  side, 
one  stitch  on  each  side  being  usually  sufficient.  In  this 
way  the  incision  which  was  originaUv  longitudinal  has 
become  transverse.  althou|[h  in  two  halves.  It  will  be 
now  noticed  that  the  anterior  lip  has  become  elongated, 
and  on  bi-manual  examination  the  body  of  the  uterus 
and  the  newlv- formed  os  will  be  found  m  a  straight  or . 
almost  straight  line. 

The  after-treatment  consists  in  simply  keeping  the 
patient  in  bed  for  ten  days. 

Case  L—For  Dysmenorrhaa  and  Sterility,  The 
patient,  sat.  29,  married  for  eight  years,  had  never 
menstruated  without  pain.  This  pain  commenced  a 
few  hours  before  the  flow  and  lasted  usually  for  24 
hours,  during  which  time  she  had  always  to  keep  her 
bed.  The  ^neral  health  was  not  very  good,  out  what 
was  most  distressing  to  the  patient  was  that  she  was 
absolutely  sterile.  Before  I  saw  her  she  had  under- 
gone a  large  amount  of  local  treatment  without  benefit 
On  examination,  the  cervix  was  found  to  be  bent  at  a 
right  angle  to  the  body,  which  was  somewhat  ante- 
verted.  After  the  operation  already  described  had 
been  performed,  the  patient  menstruated  without  pain, 
soon  became  pregnant,  and  was  delivered  at  full  time. 

Case  IL— Miss  C— .  sat  32^  suffered  from  dys- 
menorrhoea  and  menorrnagia,  which  had  so  affected  her 
general  health  that  she  had  to  give  up  her  situation  of 
a  governess.  The  pain  lasted  for  two  days,  commenc- 
ing a  few  hours  before  the  flow^  and  although  it  had 
been  always  present  at  these  times  it  was  decidedly 
becoming  worse.  The  menorrhagia  was  of  more  recent 
date  and  the  quantity  of  blood  lost  was  said  to  be  four 
times  as  much  as  it  had  previously  been.  The  usual 
remedies  had  apparently  all  been  tried,  and  as  it  was 
essential  to  Uie  patient  that  time  should  not  be  lost  an 
examination  was  made  at  once  under  an  ansesthetic 
The  cervix  was  found  to  be  long  and  anteflexed,  but 
not  to  such  a  c[reat  degree  as  in  the  previous  case.  A 
similar  operation  was  performed  in  the  summer  of 
1893.  Tnere  was  little  improvement  experienced  at 
the  first  two  periods,  during  the  third  and  fourth  there 
was  decidedly  less  pain  and  hsemorrhage.  The  fifth 
was  almost  natural  in  almost  every  respect  and  since 
then  there  has  been  no  trouble  and  the  patient  is  now 
in  perfect  hefdth. 

Case  IIL— The  patient,  st  27,  had  been  married 
four  years,  and  hsld  never  been  pregnant  She  had 
suffered  from  dysmenorrhoea  since  the  first  period,  the 
pain  coming  with  the  flow.  On  several  occasions  the 
canal  had  been  dilated.  A  year  after  the  operation 
the  patient  was  still  sterile^  but  this  mav  be  accounted 
for  by  the  fact  that  none  of  her  husband  s  four  married 
brothers  have  had  any  family.  The  dysmenorrhoea 
has  been  entirely  relieved.  This  case  was  operated  on 
by  Mr.  Skene  Keith. 

Case  IY.— Miss  B— ,  st  27,  first  menstruated  at  the 
age  of  lU  years,  and  always  had  pain  since  she  could 
remember,  with  excessive  flow  which  lasted  a  full 
week.  When  17,  she  suffered  from  gastric  ulcer,  and 
since  then  the  periods  have  been  accompanied  by 
intense  headache  and  sickness,  coming  on  two  or  three 
days  before  the  flow.    There  was  dysuria  and  f requenpy 


Mab.4,  1896. 


OBlQWAh  COMMUNICATIONS. 


Thb  Mxdioal  Pbjks.     231 


of  miBtnritibn  and  the  patient  had  to  make  water  as 
often  as  thirty  times  in  the  twenty-fonr  honre.  All 
these  qrmptoms  being  worse  daring  the  flow.  Examina- 
tion showing  a  v^  acute  bend.  Operation  on  October 
SOth.  During  the  night  following  the  operation  the 
patient  made  water  only  twice.  I  had  a  letter  from 
her  doctor  last  week  in  which  he  says :  "  Miss  B— ,  is 
▼err  much  better,  there  is  now  no  sickness  nor  pain 
with  the  periods,  only  a  slight  headache,  the  flow  is 
normal  and  lasts  three  days  and  the  patient  does  not 
require  to  get  up  during  the  night  to  pass  water. 
There  have  been  three  periods  since  you  operated." 


TUBERCULAR  DISEASE  OF  THE 

HIP-JOINT. 

By  R.  L.  SWAN,  F.RC.S.L, 

SaigeoD  to  StcercDB*  and  the  Orthopfledio  Hcwpitalfl,  Ihiblin. 

It  will  be  convenient  for  clinical  purposes  to  consider 
the  features  of  hip-joint  disease,  as  they  present  them- 
aeJTes  in  three  stages.  1st.  Where  they  are  of  recent 
origin ;  where  there  is  no  real  shortening,  but  suspicion 
of  disease  is  excited  by  familiar  symptoms  which  shall 
be  briefly  alluded  to.  2nd.  Where  real  shortening 
has  occurred  with  or  without  suppuration.  3rd.  Where 
a  certain  amount  of  consolidation  has  occurred  with 
more  or  leas  shortening  or  deformity. 

There  are  considerable  differences  in  the  early  mani- 
festations of  morbus  coz»  apparently  due  to  the 
position  of  the  deposit.  If  it  be  at  or  outside  the 
epiphysial  line,  the  symptoms  may  not  be  very  acute. 
The  parents  of  the  child  will  notice  a  limping  gait  to 
which  they  may  not  attach  much  importance.  The 
child  may  complain  of  fatigue  rather  than  pain.  If 
the  disease  processes,  pain  at  the  inner  side  ofthe  knee 
wiU  be  a  prominent  symptom,  and  night  cries  will  be 
present  The  appetite  and  digestion  may  be  deranged, 
and  the  child  will  look  badly. 

The  svmptoms  will  differ  when  the  articulation  is 
involved  upon  the  circumstances  of  its  primary  or 
secondary  implication.  In  the  first  instance  there  may 
be  signs  of  an  acute  inflammation  ensuing  on  the 
receipt  of  an  injury,  probably  a  fall  on  the  outer  side 
of  the  thigh  when  the  limb  is  semi-flexed.  There  will 
be  pain,  slight  flexion,  or  abduction.  The  pain  will  be 
referred  to  the  joint  itself,  and  is  increased  by  move- 
ment, concussion  of  the  femur,  or  pressure  over  the 
trochanter.  In  such  a  case  it  will  be  necessaiy  to 
differentiate  between  simple  and  tubercular  inflam- 
mation of  the  joint.  A  few  days'  rest  in  hed  will  settle 
that  question,  if  simple  ;  the  symptoms  will  subside,  but 
if  a  focus  of  tubercular  disease  be  established  vhe  signs, 
if  not  much  aggravated,  will  remain  about  the  same. 
After  a  time,  a  prominent  and  invariable  symi>tom  is 
muscular  wasting.  This  may  be  seen  by  a  comparison  of 
the  twolimbs,  taking  a  similar  point  oneachfor  measure- 
ment This  sign  is  of  great  diagnostic  value,  and  taken 
in  conjunction  with  limitation  of  motion,  both  as 
regards  flexion  and  rotation,  will  almost  fix  the  dia- 
gnosis. The  evidence  that  pain  affords  in  the  case  of 
a  younff  child  is  extremely  misleading,  as  such  patients 
invariably  cry  from  apprehension,  and  the  infliction  of 
pain  in  an  examination  is  undesirable,  and  to  be  avoided. 
In  making  an  examination,  the  child  should,  when  the 
dothes  have  been  removed,  be  made  to  stand,  facing 
the  surgeon.  The  affected  limb  will  be  usually  ad- 
vanced, and  the  foot  will  touch  the  ground  by  the 
anterior  part  of  the  sole.  The  anterior  superior  spine 
will  bs  depressed  below  that  of  the  opposite  side,  and 
the  limb  will  appear  longer  than  its  fellow,  die  length- 
ening, hiowever,  being  only  apparent^  as  will  be  found, 
by  measurement.  From  the  postenor  view,  it  will  be 
learned  that  the  glutei  are  flattened  at  the  affected 
Side ;  that  then  is  an  apparent  widening  of  the  natis 


owinff  to  the  loss  of  the  muscular  prominence^  and 
an  obliteration  of  the  fold  below  the  gluteus  maximus. 
This  muscular  wasting  is  observable  in  all  the  crural 
muscles,  and  is  an  atrophic  process  of  a  rapid  nature, 
superadded  to  what  must  be  viewed  as  a  minor  cause, 
namely,  the  wasting  due  to  functional  disuse.  The 
child  should  now  be  placed  on  a  flat  table  covered  with 
a  blanket,  lying  on  its  back.  If  the  limbs  are  i>laced 
parallel  to  each  oUier  and  flat  on  the  table,  it  will  be 
found  that  the  loins  are  arched  forwards.  This  indi- 
cates flexion,  and  the  amount  of  this  deformity  is 
recognised  wnen  the  back  touches  the  table.  If  the 
anterior  superior  spine  is  lower  than  the  other,  abduc- 
tion is  present.  The  amount  is  manifest  bv  moving 
the  limbs  outward  till  both  spines  are  on  a  level.  If, 
which  is  not  a  common  occurrence,  the  affected  side  be 
higher  than  the  other,  it  shows  adduction,  and  ito 
amount  may  be  ascertained  by  movins  the  limb 
inwards  till  a  horizontal  line  will  pass  through  both 
these  points. 

It  is  necessary  in  the  early  stage  of  hii>-joint  disease 
to  bear  in  mind  the  following  conditions,  with  a  view  to 
their  rejection :— 1.  Infantile  paralysis.  This  may  be 
simulated  by  the  muscular  wasting,  and  imperfect  cir- 
culation of  uie  limb.  The  limitation  of  motion  at  the 
joint,  and  the  history,  will  render  the  diagnosis  clear. 

2.  The  lordosis  of  rachitis,  with  subacute  epiphysitis. 
Here,  however,  the  abundant  evidences  of  a  general 
rachitic    diathesis    will     determine    the    question. 

3.  Spinal  disease  with  psoas  abscess.  Here,  althou^ 
flexion  may  be  present,  the  rotary  movements  of  the 
joint  are  unaffected,  and  positive  evidence  of  spinal 
disease  may  exist.  4.  Gluteal  or  other  extra-articular 
abscess.  Here  we  must  be  guided  by  the  absolute 
condition  of  the  joint,  by  the  concomitant  symptoms^ 
and  by  the  history.  5.  Conffenital  dislocation  of  the 
femur.  In  such  a  case,  the  absence  of  pain,  the 
peculiar  gait,  the  shortening  without  marked  inversion, . 
and  the  history  will  be  sufficient  guides.  6.  Periostitis 
of  upper  extremity  of  femur.  Here  the  symptoms  are  > 
extremely  acute.  The  pain  and  tenderness  are  exces- ' 
sive.  There  is  high  temperature,  and  even  convulsions 
may  occur.  At  a  comparatively  earljr  period  signs  of 
nepticsemia  may  supervene.  7.  Sacro-iliac  disease.  By. 
fixing  the  pelvis,  the  movements  of  the  joint,  whether 
flexion-extension  or  rotation,  are  unimpaired.  The  pro- 
{;res8ion  is  also  distinctive  of  sacro-iliac  disease.  This, 
in  my  experience,  appears  to  be  a  disease  of  .adjalts, 
except  in  very  exceptional  instances,  while  hip-joint 
disease  is  essentiallv  a  disease  of  childhood.  8.  The 
term  usually  namied'*  hysterical  joint,"  and  to  which 
Sir  James  Paget  has  applied  the  term  ^  neuro-mimesis." 
This  condition  will  often  tax  the  diagnostic  skill  of  the 
surgeon,  the  more  so,  as  it  tnay  undoubtedly  co-exist 
with  incipient  disease 'of  the  joint,  and  is' sometimes 
associated  with  ^neral  evidence  of  the  hysterical  habit 
But  there  is  an  inconsistency  of  symptoms.  The  pain 
is  often  referred  to  the  skin,  and  apparently  produced 
by  superficial  manipulatiouj  which  would  nave  no  effect 
in  genuine  disease  of  the  joint.  As  was  pointed  out  by 
Hilton,  the  nervous  relations  to  the  hip-joint  are  those 
which  have  a  direct  relation  to  the  supply  of  the 
uterine  appendages.  The  condition,  however,  is  not 
confined  to  the  female,  but  is  found  in  both 
sexes.  The  postural  symptoms  are  unusual  and 
erratic,  and  there  is  an  exaggeration  of  all  the 
subjective  signs.  At  the  same  time,  there  is  an  absence 
of  pyrexia,  and  of  the  presence  of  those  symptoms 
which  indicate  joint  mischief.  There  are  no  night 
cries,  and  the  immobility  of  the  joint  is  not  constant. 
By  directing  the  attention  of  the  patient  to  some  en- 
grossing^ subjects,  manipulations  are  borne  without 
complaint,  which  would  otherwise  elicit  cries  of  pain. 
There  is  no  muscular  wasting,  or,  at  least,  only  what 
is  due  to  functional  muscular  disuse.  In  a  case  of  this 
Idnd  the  suigeon  must  not  commit  himself  to  a  hasty 


232    Ths  Mbdioal 


ORIGINAL  COMMUNICATIONS. 


Mab.  4,  1896. 


opinion  but.  until  he  has  had  opportonitiee  sufficient 
to  fully  make  up  his  mind  on  the  subject,  he  must 
treat  the  case  as  u  the  joint  were  raally  implicated.  ^ 
.  There  are  some  rare  or  accidental  conditions  which 
may  render  diagnosiB  difficult  One  vs  an  inflammation 
of  the  bursa  under  the  tendon  of  the  psoas  and  iliacus. 
Another,  which  the  foUowing  case  will  exemplifjr  :* 
A..  EL  nt.  10,  was  seized  with  intense  pain  in  the  right 
hip.  I  was  called  to  see  him  the  next  morning.  There 
was  some  pyrexia,  and  the  boy  screamed  if  the  limb 
were  touched.  I  desisted  from  any  examination,  and 
ordered  him  warm  fomentations  to  the  part  The 
following  day  a  well-marked  eruption  of  herpes  zoster, 
following  the  course  of  the  Uio-inguinal  nerve,  was 
evident,  and  explained  the  circumstances. 


THE    OBJECTS    AND    LIMITS    OF 

OPERATIONS   FOR  CANCER.(a) 

By  W.  WATSON  CHEYNE,  F.RS., 

ProfeMor  of  Borg&ty  tt  King's  OoncM ;  Surgeon  to  King's  Collrgo 

Ons  of  the  departments  in  which  there  has  been  snob 
activity  of  late  years  is  in  the  treatment  of  oanceroas  dis- 
eases. The  last  few  years  have  seen  marked  alterations  in 
the  older  methods  of  operating  in  these  cases,  and  also  the 
introdaotiOD  of  operatums  in  rei^ons  and  of  an  extent  for* 
merly  not  tbongnt  of.  OpiDions  differ  very  macb  at  the 
present  time  as  to  the  ntuity  of  many  of  tboM  sargioal 
prooednres,  and  it  is  a  matter  of  macb  interest  and  import- 
ance to  consider  the  results  wblob  have  been  obtained,  and 
to  come  to  some  definite  condnsions  as  to  tbeir  valne. 
And  it  is  with  a  view  of  trying  to  estimate  the  value  of  the 
work  done  in  this  department  that  I  have  dedded  to  discnts 
in  these  lectures  tbe  objects  which  we  should  aim  at,  and 
the  limits  to  wbicb  we  may  go  in  operating  for  cancerous 


Bv  cancer  I  mean  tbe  cardnomata,  the  essential  feature 
of  wnich  is  continuous  and  excessiye  growth  of  epithelium. 
Once  this  growth  bat  commenced,  nothing  that  we  know  of 
has  any  power  to  stop  it.  It  invades  the  surrounding 
tissues,  it  spreads  along  the  lymphatic  vessels,  or  is  carried 
by  tbeee  vessels  to  the  nearest  lympbatic  glands ;  it  passes 
from  one  lymphatic  srland  or  one  cbain  of  lympbatic  glands 
to  another,  till  it  ultimately  reaobes  tbe  mam  lymphatic 
trunks,  through  wbicb  it  enters  tbe  blood  stream,  and  is 
deposited  in  distant  organs  and  parts  of  tbe  body.  De- 
posited in  these  distant  organs  it  again  grows,  and  tbe 
same  cycle  of  events  follows,  or  would  follow,  were  it  not 
that  tbe  patient  soon  succumbs  from  general  poisoning  as 
tbe  result  of  absorption  of  materials  eUborated  at  tbe  seat 
of  tbe  disease,  from  interference  with  tbe  vital  functions 
owinfl;  to  tbe  presence  of  tbe  growth  in  important  organs, 
from  repeated  bsBmorrbages  due  to  erosion  «  blood  veeselB, 
and  so  on.  Once  this  overgrowth  of  epithelium  has  begun 
it  goes  on  inexorably,  unless  we  can  arrest  it,  to  the  one 
fatal  end. 

Let  us  pass  on  now  to  tbe  subject  proper  of  these  lectures 
— namely,  the  ofyeeis  and  limits  of  opercUian  in  cases  of  this 
disease.  The  prmiary  object  of  operation  in  cancer  is,  of 
course,  tbe  prolongation  of  tbe  patient's  life  and  the  alle- 
viation of  bis  local  trouble,  and  what  I  propose  to  apsertin 
these  lectures  is  that  tbeee  results  are  in  most  cases  best 
attained  by  aiming,  where  possible,  at  tbe  cure  of  the 
disease.  Up  till  quire  recently,  and  even  now,  many  sur- 
geons approach  operation  in  these  cases  impresiied  with  tbe 
view  that  real  cure  is  practically  hopeless,  and  that,  with 
a  few  rare  exceptions,  the  most  thai  can  be  expected  is 
prolongation  of  life  for  a  variable  length  of  time.  Thev 
therefore  oppose  elaborate  and  extensive  operations  which 
in  themselves  must  involve  considerable  risk  of  life  and  are 
content  with  fairlv  free  removal  of  noticeable  disease  ;  in 
some  cases,  indeea,  they  do  not  even  go  so  far.  For  ex- 
ample, in  cases  of  mammary  cancer,  even  where  some  en- 
larged elands  are  to  be  felt  in  tbe  axilla,  they  comfort 
themselves  with  the  idea  that  the  glands  may  only  be 
enlarged  from  irritation  and  not  from  cancerous  deposit, 

(a)  Abftracfeof  tbe  First  Lettsomisn  Lecture,  delivered  before  the 
Mescal  Society  of  London,  Teb.  1898. 


and  therefore  leave  them  alone  until  their  true  oanceroas 
nature  is  only  too  evident.  Of  course,  if  operations  are 
performed  in  this  manner  and  with  these  views,  it  is  no 
wonder  that  these  surgeons  are  confirmed  hn  their  views 
and  go  on  operating  on  cancer  with  the  sde  object  d  pro- 
longing life  for  a  comparatively  short  time.  In  discussing 
the  curability  of  the  disease  I  have  already  msntionea, 
evidence  as  regards  cancer  d  the  extremitlee,  lips,  and 
uterus,  which  shows  that  a  real  cure  is  obtainable  in  a  very 
considerable  proportion  d  cases,  and  bn  the  following 
lectures  I  shall  try  to  produce  similar  evidence  as  regards 
other  parts.  I  therdore  hold,  and  would  strongly  nrgjo, 
the  view  that  the  first  question  to  be  kept  before  us  in 
investigating  a  case  d  cancer  is  whether  there  is  any  pos- 
sibility d  curing  the  disease  or  not  Such  a  point  of  view 
makes  a  very  mat  difference  in  the  operation,  for  it  is 
not  then  sufficient  to  remove  only  the  noticeable  disease, 
but  it  is  necessary  to  take  away,  as  far  as  possible,  tbe  parts 
in  which  disease  may  have  become  disseminated,  although 
still  unrecognisable— in  other  words,  possibly  infected 
lymphatic  areas.  Thus,  if  the  skin  is  afiected,  a  consider- 
able portion  around  must  be  taken  away,  and  this  is  the 
more  necessary  where  the  infection  of  the  skin  has  come 
from  beneath,  as,  for  example,  where  cancers  d  the  breast 
reach  the  surface,  for  the  dissemination  in  the  cutaneous 
lymphatic  plexus  is  dten  under  these  circumstances  very 
rapid  and  extensive,  and  this  is  probably  due  in  part  to  the 
larger  size  of  tbe  deep  cutaneous  plexus,  which  will,  in  tbe 
latter  case,  be  first  involved.  Again,  where  muscle  is 
infected,  the  cancer  cdls  are  very  rapidly  and  early  driven 
along  tbe  lymphatic  vessels  of  the  musde,  and  even  though 
there  may  only  be  one  visible  nodule  in  the  muscle^  the 
whole  or  tbe  greater  part  of  it  must  be  looked  on  as  sue- 
picious,  and  must  be  removed  if  there  is  to  be  anything 
like  certainty  in  attaining  the  object  of  the  operation— 
namely,  the  patient's  cure.  Again,  as  regards  the  Ivm- 
phatic  glands,  we  know  that  from  a  very  early  period  they 
oeoome  affected,  and  that,  of  course,  without  any  visible 
enlargement  in  the  first  instance ;  and,  in  addition  to  this 
infection  of  the  glands  without  enlargement^  plQf?s  cl 
cancer  cdls  very  dten  stick  in  the  lympbatic  vessels  on 
their  way  to  the  glands.  Hence  it  is  necessary  in  all  cases 
where  the  disease  has  lasted  any  time  or  extended  at  all 
deeply,  not  only  to  remove  the  primary  mass  freely,  but 
also  to  take  away  the  whole  lymphaUc  area  up  to,  and 
including  the  nearest  lymphatic  glands.  Thus  the  opera- 
tion performed  with  the  object  of  curing  the  disease 
becomes  a  much  more  extensive  one,  and  consequently 
much  more  serious,  than  that  which  simply  aims  at  getting 
rid  of  tbe  main  trouble  for  a  time  ana  prolonging  the 
patient's  life. 

The  primary  object  of  operation  in  these  cases  being, 
therdore,  cure,  tbe  limits  of  the  radical  operation  are 
where  there  is  no  reasonable  prospect  of  removing  the 
whole  disease,  or  where,  along  with  a  very  poor  prospect 
of  success,  there  is  a  very  high  mortality  from  the  attempt. 
In  such  cases  I  do  not  think  that  operatiou  should  ne 
mentioned  at  all,  for  even  where  the  patient  recovers  from 
it  and  has  presuniably  two  or  three  months  added  to  bis 
life  few  would,  I  think,  thank  one  for  it,  seeing  that  these 
two  or  three  months  have  been  spent  in  convalescing  from 
a  serious  and,  in  the  end,  useless  operation.  But  even  in 
cases  where  hopes  of  cure  or  marked  prolongation  d  life 
by  a  radical  operation  are  out  of  the  question  operation 
may  sometimes  be  advisable,  with  thb  object  d  removing 
symptoms  which  are  immediately  threatening  to  life,  such 
operations,  for  example,  as  tracheotomy,  colotomy,  ftc., 
or,  in  the  second  place,  with  tbe  object  of  taking  away  the 
primary  disease  from  a  part,  such  as  tbe  mouth  or  throat, 
where  its  continued  development  means  intense  pain  and 
trouble,  and  thus  of  substituting  for  these  troubles  an 
easier  death  from  exhaustion.  A  sine  qvd  turn  of  such 
operations  must,  however,  be  that  they  are  reasonably  free 
from  immediate  risk,  and  with  rej^ara  to  the  second  class 
that  there  is  a  prospect  of  attaining  the  object  d  the 
operation — namer^,  the  entire  removid  of  the  disease  from 
tne  part  operated  on.  I  do  not  think  that  a  dangerous 
operation  is  allowable  for  simple  relid  of  symptoms,  how- 
ever proper  it  may  be  if  a  cure  may  be  hoped  for. 

There  are  thus  two  different  objects  to  be  held  in  view, 
and  two  different  questions  as  regards  operation  which  we 
must  bear  in  mind  in  treating  a  case  of  cancec^-namdy 
(1)  Oan  we  reasonably  hope  xor  a  cure  ?  for  if  we  can,  a 


Mab.  4»  1806. 


ORIGINAL  COMMUNFCATIONS. 


Thb  Mbdiual  Pbxss.     233 


serious  or  dangerons  operation  is  permissible  ;  or  (2)  Care 
not  being  poesiUe,  can  we  decidedly  ameliorate  the 
patient's  condition  by  operation,  such  operation,  however, 
not  involving  any  great  risk  of  life  ? 

It  IS,  of  coarse,  impossible  for  me  in  the  time  at  my 
disposal  to  discass  the  objects  and  limits  of  operation  for 
cancer  in  all  parts  of  the  body,  and  I  have  therefore 
selected  three  regions  for  examination — namely,  (I)  the 
breast,  (2)  t>he  throat,  and  (3)  the  intestinal  tract,  as  these 
three  regions  illustrate  very  well  all  the  points  bearing  on 
oar  subject. 

Before  going  on  to  discass  the  results  of  operation  for 
cancer  of  the  breast  I  must  very  shortly  indicate  the  sort 
of  procedure  which  I  think  is  necessary,  and  as  I  have 
already  written  on  this  subject  I  need  not  tto  at  all  fully 
into  details.  Knowing  the  very  early  period  at  which  the 
cancer  cells  get  into  the  lymphatic  vessels,  an  operation 
to  be  at  all  complete  must  include  the  primary  disease, 
the  lymph  channels  leading  from  it,  and  the  whole  mass 
of  the  nearest  lymphatic  glands.  It  does  not,  however, 
follow  that  when  these  glands  are  enlarged  it  is  not 
absolutely  necessary  to  go  Mvond  the  first  group  because, 
for  a  time  at  any  rate,  the  disease  seems  to  be  held  back 
at  that  point ;  but,  as  I  say,  the  minimum  operation  for 
cancer  which  will  offer  anything  like  a  real  chance  of 
cure  must  take  away  everything  up  to,  and  including, 
the  first  chain  of  glands.  Hence,  in  the  case  of  the  bieast 
we  most  remove  the  primary  disease,  the  whole  breast  the 
tissue  in  which  the  lymphatics  run  from  the  breast  to  the 
axilla,  and  the  whole  of  the  axillary  glands.  In  this  con- 
nection we  must  remember  that  recent  researches  have 
ahown  that  the  breast  is  a  very  much  more  extensive  organ 
than  was  formerly  supposed,  and  that  by  the  old  method 
of  operating  practically  only  the  central  part  was  taken 
awav.  Lobules  of  the  breast  run  in  the  fat  over  the  pec- 
torsi  muscle  nearly  up  to  the  clavicle,  well  into  the  axillary 
line,  almost  on  to  the  sternum,  and  downwards  on  to  the 
orign  of  the  abdominal  muscles.  In  the  deeper  part,  al^o, 
the  lobules  of  the  breast  are  intimately  connected  with  the 
pectoral  fascia,  and  the  removal  of  the  breast  without 
simultaneous  thorough  removal  of  the  pectoral  fascia 
inevitably  means  that  numerous  lobules  are  left  behind. 
Hence  our  skin  incisions  must  be  very  much  more  free 
than  formerly  was  the  rule,  and  for  my  own  part  I  always 
take  away  the  skin  coexteoeive  with  toe  prominent  part  of 
the  organ.  There  is  another  reason  for  taking  away 
this  large  amount  of  skin — namely,  the  existence  of 
the  suspensory  ligaments  of  the  breasc,  in  which  lymphatic 
vessels  run  from  the  organ  to  the  skin,  and  theue  are 
not  at  all  infrequently  infected  with  cancer  cells.  In 
addition  to  this  portion  absolutely  taken  away,  the  skin 
all  round  must  be  raised,  leaving  fat  and  lobules  of  the 
breast,  as  high  as  the  clavicle,  as  far  inwards  as  the  middle 
of  the  sternum,  downwards  on  to  the  abdominid  mu«cles, 
and  outwards  on  to  the  latissimus  dorsi,  and  one  advan- 
tage of  this  free  undermining  of  the  skin  is  that  in  the 
great  majority  of  cases  one  can  subsequently  bring  the 
edg^  together  by  means  of  stitches.  Where  the  tumour 
is  situated  towards  one  side  of  the  breast  additional  por- 
tioas  of  skin  must  be  taken  away  in  a  V-shapod  manner, 
so  that  all  the  skin  from  the  vicinity  of  the  disease  is  re- 
moved. The  skin  flaps  being  held  up,  the  pectoral 
muscle  must  be  ex(>08ea  at  the  upper  part,  and  then,  in 
order  to  ensure  the  removal  of  the  fascia,  a  layer  of  the 
whole  surface  of  the  muscle  must  be  taken  away,  and 
when  the  lower  and  outer  edge  of  the  pectoral  muscle 
is  reached  the  fascia  over  the  serratus  magnus  and 
the  whole  fatty  tissue  containing  Ivmphatics,  as 
far  back  as  the  edge  of  the  latissimus  dorsi,  must  be 
detached.  In  this  way  the  primary  disease,  the  breast, 
and  the  lymphatic  vessels  running  in  the  fat  and  pectoral 
fascia  towards  the  axilla  are  separated,  and  then  one  pro- 
ceeds to  clear  out  the  whole  contents  of  the  axilla,  finally 
leaving  the  nerves  and  vessels  thoroughly  cleansed,  as  in 
an  anatomical  dissection.  One  first  follows  the  fat  and 
fascia  running  between  the  pectoralis  major  and  minor  on 
to  the  coeta-coracoid  membrane ;  and  then  I  explore  the 
axillary  vein  at  the  lower  part  and  tear  open  its  fheath 
along  its  whole  iMigth.  Then,  raising  the  pectoralis 
minor,  I  begin  at  tbe  very  apex  of  the  axilla  right  up 
ucder  the  clavicle,  and  with  a  curved  blunt  instrument 
(the  one  I  find  most  useful  is  a  periosteum  detacher 
invented  by  Dr.  GreviUe  Macdonald  for  operations  on  the 


nasal  septum),  and  the  finger  detach  the  whole  faf  and 
included  glands  and  lymphatic  vessels  till  everything 
except  the  important  structures  in  the  axilla  has  been  got 
away.  It  is  very  important  also  that  the  whole  tidi«ue 
should  be  removed  in  oce  piece ;  in  the  first  place  it  is  of 
great  advantage  in  clearing  the  axilla  to  have  the  parts 
dragged  down  by  the  weight  of  the  breast,  and  in  the 
second  place  it  is  vei7  important  not  to  cut  through  tissue 
which  may  be  actuaJdv  diseased,  and  which  may  lead  to 
subsequent  infection  tn  the  wound,  as  might  be  the  case, 
were  the  mamma  taken  awav  in  the  first  instance  and  the 
axillary  tissues  removed  subsequently.  And  this  ri^k  of 
soiling  of  the  wound  is  no  imaginary  one ;  had  I  time  I 
could  bring  forward  evidence  to  show  that  recurrence  may 
be  due  to  this  cause,  and  that  if  it  can  possibly  be  avoided 
a  malignant  tumour  should  not  be  cut  into,  and  on  no 
account  should  it  be  removed  piecemeal,  as  is  sometimes 
done  in  other  parte  of  the  body. 

This  operation  is,  in  my  opinion,  the  least  extensive 
which  ought  to  be  done,  even  in  a  simple  case,  if  the  object 
is  to  cure  the  patient,  but  it  must  be  modified  and 
extended  in  most  instances  according  to  circumstances. 
Where  the  skin  is  much  tacked  down  over  the  tumour, 
although  it  may  not  be  actually  involved  in  the  disease, 
the  cutaneous  lymphatic  vessels  and  those  running  in  the 
suspensory  ligaments  are  apt  to  be  affected  over  a  wide 
area,  and  hence  it  is  necessary  in  such  cases  to  cut  excep- 
tionally wide  of  the  disease.  Where  the  tamour  itself 
actnslfy  involves  the  skin,  however,  we  know  that  the 
disease  has  almost  certainly  spread  widely  in  the  cutane- 
ous lymphatic  plexus,  and  in  such  a  case  one  must  not 
hesitate  to  remove  the  skin  extremely  freely  and  to  leave 
a  wound  the  edges  of  which  it  may  not  be  possible  to  biiog 
together.  If  such  a  wound  is  left  it  can  very  readily  to 
closed  by  skin  grafting,  either  at  the  time  of  the  original 
operation,  or  if  the  patient  is  too  exhausted  about  ten  days 
or  a  fortnight  afterwards. 

Where  the  tumour  is  adherent  to  the  pectoral  fascia,  ss 
is  very  commonly  the  case,  I  think  it  is  advisable  to 
uke  away  the  whole  thickness  of  the  muscle  at  that  parr, 
and  as  tbe  lymph  tends  to  be  forced  onwards  in  the 
direction  of  the  muscular  fibres  the  mass  of  muscle  re- 
moved should  be  detached  along  its  whole  length,  from  ite 
origin  to  its  insertion.  In  operating  on  such  cases,  as  I 
approach  the  neighbourhood  of  the  tumoar  I  usually  sink 
my  hand  through  the  muscle,  and  then  rapidly  separate 
the  part  grasped  from  origin  to  insertion,  and  detach  it  an 
both  end3,  and,  as  a  matter  of  fact,  in  many  of  my  cases 
I  bave  done  this,  and  have  thus  removed  a  oonsiderabte 
part  of  tbe  lower  portion  of  the  pectoral  muscle.  Halsted 
and  others  advise  that  the  pectoral  ma8cle»  at  any  rate  it-* 
sternal  origin,  should  be  taken  away  in  every  case,  partly 
in  order  to  get  thoronghly  rid  of  the  pectoral  fascia,  and 
partly  in  order  to  be  able  to  clear  out  the  axilla  more 
effectually.  As  will  be  evident  when  I  come  to  compare 
my  statistics  with  Halsted's,  this  is  really  not  necessary 
unless  there  are  actual  nodules  in  the  substance  of  the 
muscle,  more  especially  where  the  lower  portion  of  tbe 
muscle  is  removed  in  the  manner  I  have  described  there  ie 
no  difficulty  whatever  in  pulling  up  the  remains  of  the 
pectoral  muscle  sufficiently  to  obtain  complete  access  to 
the  upper  part  of  the  axilla. 

Where  the  muscle  iteelf  is  actually  diseased — that  is  to 
sav,  where  there  are  one  or  more  nodules  in  the  muscular 
substance — it  has  been  pointed  out  by  Heidenhain  thati 
the  whole  muscle  must  be  looked  on  as  infected,  for  the 
muscular  contractions  very  quickly  distribute  the  con- 
tents of  the  lymphatic  vessels  over  it.  He  therefore 
advises  complete  removal  of  the  pectoralis  major  under 
these  circumstances.  I  am  inclined  to  think,  however, 
that  even  in  these  cases  it  is  often  sufficient  to  take  away 
the  sternal  origin  of  the  muscle,  and  that  the  clavicular 
portion  may  be  left  unless  there  is  actual  disease  present/ 
in  it.  The  connection  between  the  two  portions  is  not 
very  intimate,  and  from  a  functional  point  of  view  it  is  of 
great  importance  to  leave  the  clavicular  part. 

Where  the  glands  in  the  axilla  are  markedly  enlarged 
the  question  arises  as  to  how  far  one  should  go.  In  the 
first  place,  under  such  circumstances,  it  is  certainly  well 
to  see  what  one  is  doing,  and  while  if  the  pectoral  mo-cle 
is  not  affected  at  all  I  prefer  leaving  it,  I  think  it  is  well  to 
divide  it  transversely  and  after  the  operation  to  stitch  it 
up.    The  chief  question,  however,  which  has  to  be  con- 


234     Tms  Medioal  Pbhs. 


ORIGINAL  COMMUNICAXrONg. 


Mar.  4.  1806. 


tidered  ia  T'hether,  having  found  the  higher  axillary  glands 
enlaived,  one  oagbt  not  to  go  farther  and  remove  the 
&lan(Ui  from  the  poeterior  triangle  of  the  neck.  Some 
have,  indeed*  triea  to  make  it  a  universal  rale  that  if  the 
azillanr  glands  are  at  all  enlarged  those  in  the  posterior 
triangle  mast  also  be  taken  away  ;  bat,  as  I  have  already 
said,  the  first  chain  of  glands  opposes  a  barrier  for  a  con- 
siderable time  against  the  onward  spread  of  the  disease, 
and  if  only  it  is  thoroughly  removed  I  think  one  may  in 
most  oases  be  content.  Where  the  cancer  is  a  slow- 
growing  one  and  only  the  lower  axillary  glands  are  notice- 
ably enlarged  I  do  not,  therefore,  open  up  the  posterior 
triangle  of  the  neck,  and,  so  far  as  I  can  recall,  I  have 
only  twice  had  recurrence  in  the  supra-clavicular  glands. 
If,  however,  the  highest  axillary  glands  are  noticeably 
affected,  it  stands  to  reason  that  the  posterior  triangle  of 
the  neck  should  be  opened.  Unfortunately,  however,  in 
these  oases  the  line  of  infection  does  not  so  much  run  into 
the  posterior  triangle  as  along  the  subclavian  vein  into 
the  thorax  along  a  route  that  is  only  imperfectly  accessible 
even  when  the  posterior  triangle  is  opened,  and  I  have 
not  seen  much  oenefit  in  the  way  of  finding  and  rooting 
out  disease  as  the  result  of  opening  up  the  posterior 
triangle.  Mr.  Arbuthnot  Lane  apparently  advocates 
division  of  the  clavicle  and  clearing  out  tbesupra-clavicular 
glands  in  all  cases,  but  this  is  a  method  which  I  cannot  at 
all  agree  with,  and  I  think  that  my  results  bear  me  out ; 
and  where  the  disease  is  noticeable  in  the  supra-clavicular 
glands  I  believe  that  cure  is  hopeless.  Some  have  also 
advocated  amputation  at  the  shoulder-joint  with  the  view 
of  removing  the  axillary  disease  still  more  thoroughly,  and 
this  was  first  done  by  Sir  Joseph  Lister,  partly  at  my  own 
instigation.  I  do  not,  however,  believe  that  when  the 
disease  has  gone  so  far  as  to  necessitate  such  a  procedure 
there  is  the  slightest  probability  of  curing  the  patient 
The  conditions  under  which  amputation  of  the  arm  would 
be  necessary  aro  the  presence  of  a  large  mass  in  the  axilla 
involving  the  nerves,  for  involvement  of  the  vein  or  the 
artery,  or  even  of  both,  does  not  necessitate  amputation. 
I  have  on  more  than  one  occasion  romoved  portions  of 
the  axillary  vein  to  which  glands  were  firmly  adherent, 
and  in  one  case  I  removed  both  vein  and  arterv  without 
any  loss  of  vitality  or  other  trouble  in  the  limb ;  but  where 
the  disease  is  so  diffuse  as  to  involve  the  nerves  I  think  it 
may  be  taken  as  certain  that  it  has  extended  beyond 
reach. 

As  rmtrds  the  limits  of  operation  for  cure  in  breast 
cancer,  I  would  exclude  from  operation : 

1.  Gases  of  cancer  m  cuircuse, 

2.  Cases  where  there  is  a  large  mass  in  the  axilla  involv- 
ing the  nerves. 

3.  Cases  where  large  glands  can  be  felt  above  the 
clavicle. 

4.  All  cases  where  secondary  cancers  already  exist  else- 
where. 

In  none  of  these  instances  is  there  any  reasonable  pros- 
pect of  cure  ;  and  there  will  be  but  little  to  be  gained  by 
subjecting  the  patient  to  elaborate  operations.  Short  of 
these  conditions,  however,  I  think  a  patient  ought  to  have 
the  chance  of  operation,  and  though,  as  I  have  said  before, 
I  would  not  urge  it  in  bad  cases,  I  tbink  she  should  be 
allowed  to  choose.  Even  when  the  operation  fails  to  cure 
the  prolongation  of  life  is  often  marked,  much  more  so 
after  those  thorough  operations  than  after  the  ordinary 
imperfect  procedure.  In  this  list  I  have  not  included 
cancerous  cachexia,  as  is  usually  done,  because  it  seems  to 
be  due  to  absorption  of  products  from  the  cancerous 
growth,  and  does  not  neoessarily  imply  a  general  internal 
infection.  I  have  repeatedly  seen  patients  with  marked 
cancerous  cachexia  improve  immensely  after  the  opera- 
tion. 

In  considering  the  results  of  former  and  recent  methods 
of  operation  for  cancer  of  the  breast  we  may  look  either  at 
the  question  of  cure  or  at  that  of  local  recurrence^  and 
the  most  satLsfactory  conclusion  is,  I  think,  obtained 
when  we  take  both  together:  indeed,  since  the  most 
recent  views  have  influenced  practice  the  thne  is 
too  short  for  the  accumulation  of  any  large  statistics 
as  regards  cure,  and  one  must  therefore  judge 
of  the  effect  to  some  extent  by  considering  the 
question  of  recurrence.  A  regards  cure,  I  have  adopted 
yolkmann's  three-year  limit,  and  include  under  cures  all 
cases  which  for  a  period  of  three  years  or  longer  after  the 


operation  have  had  no  local  recurrence  and  have  shown  no 
sign  of  internal  cancer.  Although  this  three-year  period 
is,  as  I  have  already  said,  not  absolutely  accurate— for  a 
certain,  though  small,  proportion  of  patients  who  have 
been  alive  and  well  at  ^he  end  of  three  years  have  yet  died 
of  cancer— nevertheless  it  is  near  enough  for  all  practical 
purposes,  and  even  if  we  only  secured  the  patient  three 
years  of  complete  freedom  from  disease  such  a  gain  would 
fully  justify  the  most  radical  operation. 

As  regaras  the  question  of  local  recurrence,  it  will  be 
seen  that  a  very  marked  chanee  has  been  produced  by 
recent  methods  of  operating.  Formerly,  and  even  now, 
local  recurrence  was  extremely  frequent  (Gross  puts  it  at 
68*8  per  cent.),  and  that  is  not  including  the  cases  which 
have  been  lost  sight  of,  probably  many  m  which  have  also 
recurred).  In  considering  this  question  of  local  recurrence, 
it  must  also  be  remembered  that  up  till  recently  half  of 
these  local  recurrences  took  place  during  the  first  three 
months  after  the  operetion,  and  over  80  per  cent,  during 
the  first  year.  Halsted  has  drawn  a  distinction  between 
what  he  terms  local  recurrence  and  regional  recurrence. 
By  local  recurrence  he  means  recurrence  actually  in  the 
track  or  area  of  the  wound ;  by  regional  recurrence  he 
implies  recurrence  in  the  neighbourhood,  or  in  glandular 
areas  which  were  not  included  in  the  first  operation.  Such 
a  distinction  is,  however,  extremely  difficult  to  carry  out, 
and  it  must  often  be  impossible  to  determine  whether  a 
particular  noduie  has  appeared  in  the  track  of  the  former 
operation  or  in  its  immediate  vicinity.  As  a  matter  of 
fact,  Halsted's  regional  recurrences  imply  an  imperfect 
operation  just  as  much  as  his  local  recurrences  do ; 
they  simply  mean  that  the  operation  has  not  been  suffi- 
ciently extensive,  no  doubt  in  many  cases  because  it  wa^ 
impossible  ;  hence  I  prefer  to  group  both  there  so-called 
local  and  regional  recurrences  together  under  the  heading 
of  external  recurrences,  and  in  my  own  statistics  I  speak 
of  two  sets  of  recurrences,  namely  external  recurrences  in 
the  wound,  its  vicinity,  or  the  glands,  and  internal  or 
metastatic  deposits. 

The  study  of  my  cases  fully  justifies,  I  think,  what  I 
have  said  as  to  the  necessity  for  extensive  operation  and 
the  advantages  to  be  derived  from  it.  Contrast  the  older 
results  from  Trendelenburg's  with  4  per  cent,  of  cures  to 
Fischer's  with  15  percent.,  or  taken  altogether  an  average 
of  about  10  per  cent.,  with  the  more  recent  results,  varying 
from  15  per  cent,  in  Kiister's  practice  up  to  57  per  cent,  in 
my  own,  and  we  see  that,  as  the  result  of  greater  care  in 
operating,  the  chances  of  cure  have  been  largely  increased, 
and  the  recent  results  in  this  table  ought  to  be  really 
better,  for  a  little  study  of  the  methods  employed  by  some 
of  the  surgeons  in  the  more  recent  period  shows  that  even 
there  the  operations  were  not  so  complete  as  could  be 
wished.  The  value  of  even  an  imperfect  improvement  is 
well  shown  in  Esmaroh's  results,  for  during  the  first 
period  up  to  1863,  the  old  plan  of  operating  was  employed 
with  only  4  per  cent,  of  cures ;  while  afterwards  the  axilla 
was  clesrod  out  more  or  less  thoroughly,  with  a  jump  at 
once  to  18  per  cent — a  result  more  than  four  times 
better. 

Looking  at  my  own  results  it  will  be  seen  that  the  effect 
of  thorough  removal  of  the  disease  is  very  marked  indeed. 
Taking  toe  oases  which  have  been  operated  on  in  the 
manner  described  up  to  three  yean  ago,  21  in  number,  we 
have  no  deaths — 12,  or  57  per  cent,  of  cures,  and  9,  or  42*7 
per  cent,  of  cases  recurring  either  externally  or  internally. 
And  if  itis  objected  that  21  is  asmallnumber  of  cases  toargue 
about,  I  would  point  out  that  12  cures  are  more  than  can 
be  shown  by  many  of  the  older  surgeons,  although  their 
cases  exceed  100.  Again,  if  we  study  my  results  from  the 
pointof  view  of  the  return  of  the  disease,  taking  in  therecent 
cases,  we  have  a  total  of  61  cases,  with  19  or  31  per  cent.,  of 
recurrence  of  metastatic  deposits,  and  among  those  recur- 
rent cases  were  two  which  were  really  inoperable  (in  one 
case,  indeed,  visible  disease  being  left  behind),  and  which 
only  raise  the  percentage  of  failures  unnecessarily,  and 
also  included  in  these  is  one  case  in  which  I  only  assume 
that  there  was  a  metastatic  deposit,  but  have  nothing 
but  suspicion  to  go  upon.  Excluding  the  two  cases  as 
being  inoperable  cases,  as  is  usually  done  in  the  statistical 
reports  I  nave  quoted,  we  have  59  oases  operated  on  with 
reasonable  hope  of  cure,  with  16  certain  recurrences,  or  27 
per  cent.  Some  of  these,  it  is  true,  have  only  been  ope- 
rated on  quite  recently,  and  they  therefore  are  not  of  much 


Hak.  4.  1896. 


TRAXSACTIOSrS  OF  SOCIETIES. 


Thb  Medical  PUEds.     235 


vftloe,  altbouffh  it  most  be  remembered  that  by  the  older 
methods  local  occnrreooes  in  half  the  caeee  took  place 
within  three  months  of  the  primary  operation.  At  the 
aame  time,  let  us  ezdnde  the  eves  operated  on  daring  the 
last  year  (and,  as  I  have  previonslV  mentioned,  over  80 
per  cent,  of  the  recurrences  take  pUce  during  the  first 
year  after  operation),  I  say  excluding  the  cases  operated 
on  daring  the  last  year  we  are  left  with  40  ca^es,  with,  at 
the  very  worst,  16,  or  40  oer  cent.,  internal  or  external 
recurrences,  and  that  is  inoluding  Nos.  24  and  29.  Taking 
the  external  recurrences  alone,  we  have  in  the  61  cases  only 
11  external  recurrences,  or  possibly  12,  giving  an  average 
percentage  of  external  recurrences  d  18  per  cent,  or  19  per 
cent.  As  regards  the  12  cured  cases,  of  course,  recurrence 
mav  still  take  place  in  some,  but  taking  the  most 
un&vonrable  statements — viz  ,  Konie's — ^that  15  per  cent, 
recur  even  i^ter  three  years,  we  womd  still  be  left  with  9 
cures  (and  that  is  iMving  out  also  Case  9  which  died 
without  recurrence  after  tbree  years),  or  42  per  cent,  of 
definite  caret,  a  result  far  superior,  however  it  is  worked 
out,  to  that  obtained  by  the  ordinarr  operation. 

I  have  already  rderred  to  Halsted's  paper  (which  up  to 
the  present  has  shown  the  most  favourable  results  as 
regards  recurrenceB),  and  he  points  out  thai  in  his  50 
cases  he  has  only  had  3  local  occurrences ;  but  he  has  also 
had  8  refdonal  recurrences,  and.  as  I  have  already  said,  I 
think  it  is  much  fairer  to  combine  his  local  and  regional 
recurrences  under  one  heading,  "  external  recurrences,"  as 
I  have  done  in  my  own  statistics,  and  this  gives  him  a  per- 
centage of  22  per  cent,  extemsl  recurrences.  Contrast  the 
results  as  regards  external  recurrence  obtained  by  Halsted 
(22  per  cent. )  and  myself  (18  per  cent.)  with  those  of  sur- 
geons operating  lees  completely  as  worked  out  by  Halsted ; 
for  example,  Billroth,  85  per  cent. ;  Czemy,  62  per  cent. ; 
Fischer,  75  per  cent. ;  Gussenbautr,  64  per  cent. ;  Volk- 
mann,  59  per  cent.,  kc  ;  and  the  difference  between  the 
old  imperfect  operation  and  the  thorough  one  becomes  most 
striking. 

While  the  results,  as  I  have  pointed  out,  are  steadily 
improving,  the  proportion  of  cases  which  succumb  to 
cancer  is  still  considerable,  and  will  not,  I  think,  be  much 
reduced  till  patients  and  medical  men  understand  that 
there  is  a  g^ood  chance  of  radical  cure  from  early  and  tho- 
rough operation  in  mammary  cancer,  and  that  a  suspicious 
lump  in  the  breast^  especially  in  ^erly  women,  is  not  a 
thins  to  be  watched,  for  I  may  say  that  over  90  per  cent, 
of  Uie  swellings  of  the  breast  in  elderly  women  are 
canceroue. 

Contrary  to  the  usual  dictum,  it  is  now  found  that  the 
most  favoarable  of  all  cases  for  operation  are  those  of 
atrophic  ecirrhus,  and  the  more  nearly  a  cancer  approaches 
the  atrophic  form  the  greater  is  the  chance  of  permanent 
cure ;  indeed,  I  believe  that  the  malignancy  of  the  cancer 
in  the  individual  cases  has  a  great  Seal  to  do  With  the 
favourable  result  of  operation,  indeed,  possibly  mere  than 
the  early  period  of  the  operation  ;  but  that,  expressed  in 
other  terms,  is  only  to  say  that  in  the  less  malignant  forms 
of  cancer  the  disease  does  not  diffuse  itself  as  rapidly  or 
widely,tand  that  bv  an  extensive  operation  we  have  a  better 
chance  of  getting  beyond  it  A  patient  who  comes  with  a 
raiall  tumour  which  nas  been  noticed  for  several  months, 
which  has  not  markedly  increased  in  size,  and  in  connec- 
tion with  which  we  have  only  small  glands  in  the  axilla, 
has  a  mach  better  chance  thim  one  who  has  found  a  tumour 
quite  recently  which  is  noticeably  enlarging,  and  in  which 
tbe  axillary  elands  are  of  considerable  size.  In  the  former 
case  the  proEability  ol  getting  beyond  the  disease  is  great 
on  account  of  its  slow  spread ;  in  the  latter  the  reverse  is 
the  case.  Hence  while  the  sooner  a  cancer  of  tbe  breast 
is  radically  removed  the  better,  one  cannot  say  that  the 
chance  of  cure  is  necessarily  proportionate  to  the  early 
period  of  tbe  operation  ;  in  any  case,  however,  the  chance 
of  care  of  necessity  depends  on  the  thoroughness  of  the 
operation. 

•  ♦ 

Dr.  Henry  Hicks  of  Hendon,  whose  geological 
researches  are  well  known,  has  been  elected  President 
of  the  Geological  Society  of  London.  Dr.  Hicks  is,  we 
believe,  the.8eoondmedioGd  man  who  has  been  elevated  to 
this  post  of  honour.  The  late  Mr.  Hulke  was  presi- 
dent oi  the  Society  at  the  time  of  his  death. 


Clmtcal  |tlf corbs. 


CASE  OF  ACCIDENTAL  HAEMORRHAGE. 

Under    the    Care   of    Michaxl    C.    O'Gorman,    J. P., 

L.R.C.S.I.  and  K.Q.R.C.P.L 

Sbvkue  cases  of  accidental  hsdmorrhage  have  occurred 
in  my  practice  from  time  to  time,  but  a  case  I  attended  on 
the  26th  January,  1896,  seems  to  me  sufficiently  interest- 
ing for  publication.  The  patient,  Mrs.  G.,  »t.  40,  a 
multipara,  and  in  the  seventh  month  of  pregnancy,  was 
taken  suddenly  ill  under  the  following  circumstances : — 

Her  servant  left  her  early  on  the  morning  of  the  25th 
January,  and  conseanently  she  had  to  do  some  additional 
household  work,  and  carried  two  buckets  of  water  a  con- 
siderable distance. 

She  retired  to  rest  at  eleven  o'clock  on  that  evening 
feeling  quite  well,  but  awoke  at  twelve  in  great  pain  with 
an  intense  desire  to  pass  water.  She  eot  out  of  bed  for 
that  purpose,  when  to  her  surprise  she  began  to  bleed 
copiously.  The  ordinary  chamber  soon  became  full  of 
blood  i  she  fainted,  and  was  lifted  into  bed. 

When  I  arrived  (about  5.90  a.m.)  the  hsemorrhage  had 
saturated  the  bed,  and  the  patient  was  completely  col- 
lapsed. I  immediately  administered  restoratives,  and 
Eroceeded  to  make  a  vaginal  examination.  The  os  was 
igh  up,  undilated,  and  frequent  gushes  of  haemorrhage 
occurred.  Ballottement  was  easily  made  out.  The  patient 
moaned  frequently,  and  oomplainied  of  intermittent  pains 
in  the  vagina,  but  nothing  else. 

External  auscultation  revealed  nothing.  I  could  hear 
no  foetal  heart  or  placental  bruit,  and  palpa^on  proved  the 
foetal  head  was  presenting.  Under  these  circumstances,  I 
dismissed  all  thought  of  placenta  prsvia,  and  proceeded  to 
treat  the  case  as  follows.  By  nteans  of  an  irrigator,  I 
injected  (for  about  an  hour)  into  the  vagina  streams  of 
hot  and  cold  water  alternately,  s[ave  a  f  uU  dose  of  ergot, 
and  applied  a  tight  abdominiu  binder. 

The  hmnorrh^  soon  ceased,  the  patient  doseii,  and 
labour  pains  set  in.  I  made  careful  vaginal  examinations 
from  time  to  time,  but  could  not  discover  the  cause  of  the 
hsemorrhage.  Finally,  I  ruptured  the  membranes,  and 
tbe  confinement  terminated  quite  normally,  with  these 
exceptions. 

The  foetus,  with  umbilical  cord  twisted  round  tte  neck, 
and  placenta  were  expelled  simultaneouslv.  The  placenta  • 
was  small  and  bloodless.  On  cutting  the  cord,  it  con- 
tained no  blood,  and  the  foetus,  though  well  developed 
(for  seven  months),  was  dreadfully  anaemic.  Quantities 
of  large  blood  clots  were  also  expelled. 

Here  was  a  case  in  which,  I  should  say,  complete 
separation  of  the  placenta  had  taken  place  some  time 
before  labour  was  induced.  Its  analogy  to  tbe  symptoms 
of  placenta  prsevia  in  the  early  stage  of  that  abnormal 
complication  is  interesting  and  peculiar. 

The  patient  is  making  a  good  recovery,  but  still  weak 
and  ansmic. 


^^bMtmM&mB  at  Sadx&tB. 

CLINICAL  SOCIETY  OF  LONDON. 
Mbetiku  hbld  Fbidat,  Fbbbuary  28th,  1896. 


The  President,  Dr.  Buzzard,  in  the  Chair. 

CUNIOAL  EVBNING. 
A  CASE  OF  IDIOPATHIC  MUSCULAB  ATROPHT. 

Db.  Carr  showed  a  lad,  set.  8,  tbe  youngest  of 
thirteen  children,  none  of  whom  had  suffered  from  any 
similar  manifestation,  who  was  a  typical  case  of  muscular 
atrophy  or  dystrophy  of  the  facio-scapulo-humeral  variety. 
From  the  hardening  of  the  calf  muscles,  there  is  reason  to 
suppose  that  it  may  have  be^n  as  peeudo-hypertropbic 
paralysis.  The  recti -abdominis  were  singularly  atrophied , 
and  he  could  not  raise  himself  forwards  when  on  his  back. 

The  PRXSIDBNT  observed  that  the  interesting  feature  of 
the  case  lay  in  the  fact  of  the  patient,  the  youngest  of 
thirteen  children,  exhibiting  alone  among  them  symptoms 
of  a  disease  which  was  usually  held  to  be  a  family  disease, 


236     The  Medical  Pans. 


TRANSACTIONS  OF  SOCIETIES, 


Mab.  4,  1896. 


He  held  the  view  that  nuuiy  of  these  lo-called  family 
diMAiet  would  tnni  oat  to  be  of  infeotive  origin.  The 
fact  that  only  this  child,  out  of  thirteen,  suffered  from  this 
affection,  did  not,  at  first  sight,  appear  to  favour  that  view, 
but,  on  the  other  hand,  it  would  be  eztracnrdinary,  if  the 
dliease  were  really  hereditary,  that  only  one  child  should 
so  suffer.  The  occurrenoe  of  these  diseases  in  several  mem- 
bers of  a  family  might  be  explained  by  exposure  to  the 
same  influences.  Thef act  that  the  patient  had  had  measles  a 
year  previously,  moreover,  favoured  the  idea  of  an  infective 
origin. 

CASE  OF  ACCIDENTAL  VACCINATION. 

Dr.  Abraham  showed  a  child,  set.  3,  who  presented  two 
ulcers,  one  on  the  eyelid  and  the  other  on  the  chin,  on  a 
hard  base,  with  the  characteristic  appearances  of  aoddental 
vaccination.  She  was  said  to  have  been  vaccinated  as  an 
infant,  but  there  were  no  marks  on  the  arms.  She  had 
been  sleeping  with  a  younger  brother  who  had  been  success- 
fully vaccinated,  and  probably  that  was  bow  she  was 
inoculated. 

GOKTBACTiON  OF  FOBEARM. 

Mr.  Battle  showed  a  boy,  set.  12,  who  laet  year  fell 
down,  and  fractured  both  bones  of  the  forearm.  It  was 
put  up  in  splintp,  but  six  weeks  later,  when  the  splints 
were  removed,  there  was  a  large  slough  of  the  anterior 
surface  of  the  forearm,  with  contraction  of  the  flexors,  so 
that  he  was  at  present  unable  to  extend  the  wrist  or  the 
fingers.  He  has  been  under  treatment  at  St.  Thomas's 
Hospital  for  this  condition  for  about  five  months,  but,  so 
far,  no  improvement  has  been  obtained.  The  contraction 
was  not  influenced  by  antosthesia. 

Mr.  W.  G.  Spencer  pointed  out  that  this  was  the  condi- 
tion to  which  Volkmann  had  given  the  name  of  "  ischsemic 
paralysis,"  under  which  name  he  suggested  this  case 
ought  to  be  described.  Such  cases  were  almost  hopeless 
from  a  treatment  point  of  view,  because  the  contraction 
was  due  to  inflammatory  fibrosis  of  the  muscles.  He  had 
seen  this  condition  in  a  modified  degree  follow  ligature  of 
the  femoral  artery,  tight  bandaging,  &c. 

Mr.  Abbuthnot  Lahe  took  a  more  favourable  view  in 
respect  of  the  prognosis  on  the  strength  of  two  similar 
cases,  in  which,  by  using  the  tenotomy  knife  freely,  he 
had  succeeded  in  obtaining  very  satisfactory  results. 

Mr.  Openssaw  said  he  had  had  two  cases  like  this  one 
and  he  als^  had  divided  the  flexors. 

Dr.  Ormerod  asked  whether  the  author  attached  any 
importance  to  the  fact  that  the  terminal  phalanges 
remained  unflexed  while  the  others  were  flexed. 

Mr.  Battle  replied  in  the  negative. 

CONGENITAL  DISLOCATION  OF    HIP  REPLACED  BT 
OPERATION. 

Mr.  Openshaw  showed  a  girl,  »t.  3,  who  came  to  him 
presenting  the  typical  appearances  of  congenital  disloca- 
tion of  the  hip.  lie  cut  down  into  the  joint,  removed  a 
portion  of  the  iliac  bone  at  the  upper  and  back  part  of  the 
acetabulum  and  eot  the  head  b^k  into  the  cavity.  The 
shortening,  which  was  previously  1}  inches,  was  thereby 
reduced  to  ^  of  an  inch,  and  she  could  walk  with  a  slight 
limp.  The  movements  of  the  joint  were  frse  in  almost 
e'^ery  direction,  it  being  four  months  since  the  opera- 
tion. He  pointed  out  that  unilateral  cases  were  more 
favourable  for  ofieration  than  when  the  dislocation  was 
bilateral.  The  head  could  not  very  well  be  replaced 
in  the  cavity  before  2^  years  of  age  on  account  of  the  con- 
traction of  the  acetabulum. 

CONGENITAL    DliJLOCATION    OF  THE    HIP  WITH     PECULIAR 
FBATCTRXS. 

Dr.  Taylor  showed  a  woman,  set.  23,  who  came  under 
his  care  for  epilepsy.  He  noticed  that  she  was  lame,  and 
on  examining  her  he  found  there  was  (probably)  congeni- 
tal dislocation  of  the  hip.  Mr.  Ballance  concurred  in  this 
view.  It  was  peculiar  in  that  there  was  very  great  mobility 
of  the  joint,  this  being  associated  with  abnormal  mobility 
in  the  corresponding  knee  as  well  as  in  the  opposite  knee. 
The  limb  was  much  shortened  with  corresponding  lateral 
spinal  curvature.  There  was  much  grating  on  moving  the 
femur  and  it  sometimes  seemed  to  slip  into  a  hole  as  if 
there  were  the  remains  of  an  acetabulum. 

Mr.  Wallis  said  that  after  seeing  this  patient  walk 
and  noticing  how  easily  she  did  so,  he  was  disposed  to 
congratulate  her  on  hairmg  escaped  operative  intenerence. 


Mr.  Gordon  Brodib  recalled  the  case  of  a  lad  with  » 
similar  condition  who  oould  walk  several  miles  without 
inconvenience,  and  under  these  circumstances  he  too  was 
inclined  to  doubt  the  desirability  of  operative  interference. 

Mr.  Battle  observed  that  in  this  case  there  seemed  to 
be  very  little  neck  left  and  he  presumed  that,  as  in  cases 
of  injury,  there  has  been  some  atrophy  and  absorption  of 
the  upper  end  of  the  bone. 

The  President  suggested  t.hat  the  condition  might 
possibly  be  the  remains  of  an  attack  of  infantile  paralysis. 

Dr.  Taylor  said  that  idea  had  occurred  to  him  but  he 
had  not  been  able  to  elicit  any  information  pointing  to  any 
such  attack. 

Mr.  Openshaw  recalled  an  interesting  ease  of  genu 
recurvatum,  a  condition  which  was  attributed  to  faulty 
intra- uterine  position,  and  he  pointed  out  that  most  cases 
of  congenital  dislocation  of  the  hip  occurred  in  children 
bom  with  a  breech  presentation,  observing  that  this 
patient  presented  two  of  the  features  attributed  to  faulty 
mtra- uterine  position.  Before  2i  years  of  age,  Lorenzo 
now  preferred  to  apply  extension,  but  between  that  age 
and  10  he  still  advocated  this  operation.  He  did  not 
think  it  was  a  justifiable  operation  after  10  vears  of  age. 

Mr.  Taroett  pointed  out  tnat  the  head  of  the  bone 
having  been  outside  the  cavity  would  explain  an  absence 
of  roundness. 

Dr.  Taylor,  in  reply,  said  that  the  child,  the  eldest^ 
was  bom  after  a  tedious  labour,  but  the  mother  did  not 
know  whether  the  presentation  was  abnormaL 

CASE  OF  ECTOPION  VESICAS. 

Mr.  H.  B.  Robinson  showed  a  child,  let.  4,  with  ectopion 
vesica  in  its  simplest  form.  The  umbilical  cicatrix  was 
very  large,  prominent,  and  was  situated  only  a  short  dis- 
tance above  the  pelvis.  The  upper  margin  was  well 
defined,  and  latendly  its  margins  were  directed  down- 
wards and  outwards  to  the  separated  pubic  crests,  in  rela- 
tion with  widely-diverging  recti  musolse.  The  pelvic 
symphisis  was  absent,  and  the  bones  were  united  by  a  firm 
fllbrous  band.  The  bladder  and  urethra  were  intact,  but 
the  clitoris  was  bifid,  and  the  vaginal  opening  was  a 
vertical  slit  to  the  left  of  the  micDine.  Per  redum^  the 
uteras  appeared  to  be  normal  On  passing  a  catheter,  its 
point  could  be  felt  plainly  under  the  tissue  above  the 
pubes.  As  there  was  so  much  protrusion,  he  cut  down, 
dissected  off  part  of  the  fascia  covering  the  recti,  and 
brought  the  naps  together  in  the  middle,  thus  providing 
much  additional  support  to  the  abdominal  walL 

DOUBLE  FACIAL  PARALYSIS. 

Dr.  H.  E.  TuRNET  showed  a  woman,  set.  25,  with  no 
history  of  rheumatism  or  of  anything  in  particular,  whe 
after  exposure  to  a  draught  three  months  aso  developed 
facial  paralysis  on  the  left  side.  Six  weeks  uiter  the  con- 
dition on  the  left  side  remaining  permanent,  and  without 
conscious  exposure,  paralysis  suddenly  supervened  on  the 
other  side  of  the  face  as  complete  as  in  the  first  instance. 
There  was  actually  complete  loss  of  expressional  and  voli- 
tional movements  on  both  sides,  but  no  aflection  of  taste 
or  hearing. 

The  President  observed  that  such  eases  were  very  rare, 
though  he  had  seen  one  following;  infiuenza.  By  rare  he 
meant  rare  in  this  form,  for  it  might,  of  course,  occur  in 
disease  of  the  pons. 

Dr.  Ormerod  recalled  the  case  of  a  man  whom  he  had 
seen  a  few  years  ago  with  the  double  affection  equally  weU 
marked.  He  was  at  the  time  suffering  from  syphilis,  and 
be  assumed  that  it  was  probably  due  to  syphilitic  disease 
of  the  facial  nerves. 

Dr.|MoTT  remembered  a  similar  case  in  a  boy,  the  paraly> 
sis  coming  on  the  other  side  of  the  face  within  a  day  or  two 
of  Uie  first  attack.  He  recovered  perfectly  in  about  six 
weeks. 

osteitis  deformans. 

Dr.  H.  G.  Mackenzie  showed  a  man,  et.  48,  who  dated 
his  illness  from  a  fall  eight  yt»ars  sgo.  He  presented 
marked  bowing  of  the  tibis  and  femora,  with  much 
thickening  of  the  bones.  There  was  marked  deformity  of 
the  thorax,  and  the  skull  was  very  '*  bossy,"  its  size  being 
incrmised  upwards  as  well  as  antero-posteriorly.  Since 
December  of  Isst  year  he  had  on  three  occasions  experi- 
enced a  snap  followed  by  pain  and  local  swelling,  but  na 
crepitus,  twice  over  the  ribs,  and  on  the  last  occasion  in 


Mab.  4, 1806. 


TRANSACTIONS  OF  f^OCIElIES. 


Tbb  Msdigal  Pkxss.      237 


the  leg.  In  view  of  the  rMembUooe  of  this  affection  to 
octeo-malacia  he  bad  tried  a  coone  of  red-bone  marrow, 
bat  though  the  treatment  teemed  to  have  relieved  the 
painfiil  manifentatione  the  condition  of  the  bones  wa« 
Apparently  unaltered. 

Mr.  W.  6.  SpBNOiiK  TOggeeted  that  the  case  might  be 
<me  of  multiple  rarooma,  the  characteristic  features  of 
which  would  possibly  becomf>  more  manifest  later  on. 

Mr.  Wallis  pointed  out  t  bat  it  was  not  unusual  for  this 
affection  to  date  from  an  injury.  The  patient,  he  said, 
waa  well-known  at  several  London  bospitalf,  and  anless 
the  anther  were  in  a  position  to  confirm  his  story,  he  should 
be  inclined  to  doubt  his  history  in  respect  of  the  injury. 

MULTIPLK  LIFOMATA. 

Mr.  Bid  WELL  showed  a  strongly  built  man,  ae'.  23, 
who  had  a  tumour  in  the  palm  of  one  hand,  and  on  the 
neck,  ever  since  he  could  remember.  Seven  years  ago, 
something  was  done  to  the  tumour  on  the  neck,  and  soon 
after,  several  other  tumours  appemd,  and  he  now  pre- 
tentcKl  numerous  tumours  varying  in  size  from  a  pea  to  a 
walnut,  all  over  the  body.  Thke  skin  over  the  large 
tumou'8  was  freely  movable. 

Dr.  Abraham  said  he  had  made  flections  of  one  tumour 
and  foand  chiefly  very  vascular  fibrous  tissue  with  f>igns 
of  inflammation.  He  did  not  think  it  could  be  deecribed 
as  a  case  of  moUuscum  fibrosum. 

Mr.  Clsmbkt  Lucas  said  some  of  the  larger  tumours 
were  probably  fatty,  but  the  smaller  ones  appear  to  be 
fibrous. 

OOKGXKITAL  ENLABOBMBMT  OF  FOREARM. 

Mr.  Makins  showed  a  young  woman,  set.  23,  who 
presented  marked  enlargement  of  one  forearm.  The 
affection  (nasvoid  ?)  appeared  to  involve  only  the  deeper 
veins.  He  a»ked  whether  it  was  a  simple  venous  nevus, 
or  one  involving  the  lymphatics.  She  complained  of  pain 
and  numbness  in  the  limb,  and  the  swelling  was  entirely 
confined  to  the  forearm,  not  extending  into  the  hand. 

Mr.  Clbmsnt  Lucas  said  he  bad  no  doubt  it  was  a  case 
of  veno- lymphatic  nsBvus,  and  expressed  surprise  that  she 
flhonld  not  have  been  operated  on  before.  He  referred  to  a 
patient,  a  girl  between  12  and  14  years  of  age,  who  pre- 
sented this  condition,  there  being  a  large  spongy  mass 
extending  from  the  thigh  to  tho  ankle.  He  excised  it  in 
part  ^ery  freely,  and  a  year  later  she  returned  in  order 
that  be  might  repeat  the  operation  in  respect  of  the 
Temainder. 

TUMOUB  OF  median  NEBVE. 

Mr.  Walus  showed  a  young  woman,  »t.  23,  who  had 
.austained  an  injury  to  herrightband,  damaging  the  median 
nerve,  on  which  a  tumour  formed,  which  bad  Iwen  operated 
on  several  times.  In  January  she  came  presenting  signs 
of  trophic  disturbance,  due  to  interference  with  the  inner- 
vatioD  of  the  nerve,  in  the  shape  of  an  ulcer  on  the  index 
finger  and  oonuneocing  ankyloeis  of  the  joints.  He  excised 
the  whole  of  the  tumour,  which  measured  2^  inches,  and 
brought  the  divided  ends  of  the  nerve  together.  She  now 
had  a  very  useful  hand,  fully  capable  o?  being  used  for 
sewing,  kc» 

SCTUBE  OF  TENBOKS. 

Mr.  Wallis  also  showed  a  lad,  who  had  met  with  an 
aoddent  resulting  in  the  division  of  the  extensor  tendons 
-of  the  third  and  little  finger,  which,  after  healing  of  the 
wound,  he  was  quite  unable  to  extend.  He  consented  to 
an  operation,  but  as  he  could  not  find  the  upper  ends  of 
the  divided  tendons,  he  split  the  lower  segments  and 
sutured  them  to  the  tendon  of  the  middle  finger,  and  he 
could  now  fully  extend  both  fingers  with  perfect  ease. 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  February  13th,  18 


The  President,  Clemekt  Godson,  M.D.,  in  the  Chair. 
Dr.  George  Kbitij  read  a  paper  on 

THE  PBRMANSHT  CURB  OF  ANTEFLEXION   BY    OPERATION. 

which  will  be  found  with  illustrations,  on  page  229. 

The  President,  in  thanking  Dr.  Keith  for  his  valuable 
paper,  said  that  the  older  meUiods  of  treating  anteversion 
by  the  intrm-nterine  stem,  by  Dr.  Wynn  Williams's  pes- 


sary, and  by  Hewitt's  cradle  pessary  were  so  unsatisfac- 
tory as  to  have  been  abandoned.  The  good  results  of  Dr. 
Keith's  operation  held  out  a  hope  that  it  would  prove  a 
valuable  means  of  treatment. 

Mr.  Skenb  Keith  said  that  when  his  brother  first 
described  the  operation,  he  did  not  think  it  would  ans wet, 
but  once  he  had  seen  it  he  was  so  satisfied  with  it  that  he 
had  performed  it  since  about  twenty  times.  In  four  out 
of  five  cases  cure  followed,  and  in  the  fifth,  relief.  In  the 
latter  class  the  method  was  perhaps  responsible,  he  had 
consequently  slightly  modified  the  procedure  by  makmg 
the  division  more  complete  snd  paring  off  the  comers  left 
after  division,  soasto  sJlow  theuterustoassume  astraighter 
position.  He  thought  bis  brother's  method  was  a  real 
advance  in  their  knowledge. 

Dr.  Hbywood  Smith  said  that  hitherto  the  explanation 
of  the  pain  was  that  it  was  due  to  a  kink  at  the  internal 
OS.  But  m  Dr.  Keith's  operation  only  the  lower  segment 
was  opened  up,  suggesting  that  the  pain  was  probably 
due  to  the  pressure  against  the  posterior  wall  of  tne  cervix 
exerted  by  the  uterus  when  expelling  its  contents.  He 
thought  that,  as  a  rule,  a  single  dilatation  was  upeless. 
owing  to  the  tendency  to  recurrence,  but  if  scAne  kind  of 
incision  were  made,  good  results  were  more  likely  to 
follow.  He  c  uld  see  no  objection  to  a  glass  stem  inserted 
for  a  few  days,  and  he  had  known  this  to  answer  well 
both  for  sterility  and  for  dysmenorrhoea. 

Dr.  Baktock  traced  the  history  of  the  treatment  of 
these  cases.  The  earlier  methods  of  bilateral  division  of 
the  cervix  (Sir  James  Simpson)  and  incision  of  the  pos- 
terior lip  (dims)  were  not  free  from  risk,  and  had  been 
given  up.  The  natural  history  of  the  dysmenorrhoea  was 
that  at  first  the  patient  menstruated  without  pain  ;  later 
there  was  some  hindrance  to  the  flow  of  blood,  causing  a 
little  pain.  By  repetition,  stasis  was  induced  in  the 
uterine  vessels,  and  hvperplasia  occurred,  causing  narrow- 
ing of  the  canal,  so  that  often  it  would  not  admit  a  sur- 
gical probe.  The  pain  often  became  most  severe  at  about 
the  age  of  22.  He  had  found  dilatation,  to  No.  16,  of  the 
greatest  service ;  if  pregnancy  followed,  the  relief  waa 
permanent,  but  otherwise,  and  m  single  women,  dilatation 
most  be  repeated  till  the  patient  was  cured. 

The  President  said  that  his  experience  of  the  value  of 
dilatation  had  been  remarkable,  and  he  hoped  at  soma 
time  to  record  his  results.  The  point  whicn  struck  him 
was  that  there  were  two  kinds  of  anteflexion :  one  in 
which  the  cervis  was  in  a  good  position  and  the  fundus 
was  flexed  forward,  the  other  in  which  the  cervix  was  at 
fault,  the  fundus  being  in  good  position.  He  thought  that 
Dr.  Keith's  operation  would  be  found  to  be  least  satisfac- 
torv  in  the  latter  class.  In  his  experience,  dibtation  up 
to  No.  16  gave  the  best  results. 

Dr.  George  Keith,  in  reply,  claimed  no  merit  for  the 
operation,  which  he  had  learned  from  Dr.  Dudley,  of 
Chicago.  When  he  first  heard  of  it  he  did  not  think  it 
woulddo  any  good,  but  after  seeing  the  results  of  it  in  Dr. 
Dudley's  patients  he  changed  his  mind.  By  this  method 
the  patient  could  be  cured  once  for  all,  instead  of  requir- 
ing the  repeated  dilatations  mentioned  by  Dr.  Bantock, 
and  he  thought  that  in  the  case  of  virgins  especially,  this 
was  a  most  important  advantage. 

Dr.  E.  F.  Euot,  of  Southampton,  read  "Notes  of 
GynsBOologieal  Cases  from  a  Provincial  Hospital,"  for  which 
we  hope  to  have  space  in  our  next. 


HARVEIAN  SOCIETY. 
Meeting  held  February  20th,  1896. 

J.  Knowsley  Thornton,  Esq.,  President,  in  the  Chair. 


Dr.  J.  Edward  Squire  read  a  paper  on 

some  clinical  remarks  on  pneumonia. 

Dr.  Squire  first  remarked  on  the  influence  on  the  pro- 
duction of  pneumonia  and  on  the  course  of  the  disease, 
which  is  due  to  the  condition  of  the  lung  tissue-  modifica- 
tions in  the  *'  tissue-soil "  which  allow  of  the  growth  of 
micro-organisms.  It  is  on  the  character  of  this  change  in 
the  tissues  that  the  "  individuality  "  of  each  case  of  pneu- 
monia depends.  Thou(^h  chill  is  theconunon  determining 
cause  of  pneumonia,  fatigue  or  debility  after  illness  render 
the  risks  from  chill  greater.    In  this  connection  a  case  is 


238    Th«  Medical  PBtn. 


TBAETSACnONB  OF  SCMJIETIKS. 


Mar  4.  1896. 


qnolad  whtn  pooniiooiA  fdlowad  m  efaiU  during  oooTAlat- 
fram  moiilrn  Tha  not-iDlraqiMot  ooctuntvDoe  ol 
k  M  a  oompUoAtioii  of  aDterie  f eror*  inteodoiMd 
rks  on  the  importanoe  ol  deciding  in  an j  CMe 
of  pnoomonU  wlieUMr  the  long  miaoiiief  folly  ocplaint  the 
ooone  of  Uia  illnaw  m  well  m  Ibe  exiting  •rmpfcenia. 
Tbe  oocnmnce  of  pneomonia  bet  aoinefcunet  deU jed  the 
leoognifeion  d  tbediaeMe  of  which  it  wm  merely  a  com- 
plication. The  pecaliaritiet  of  the  pneumonia  of  influenza 
wera  refened  to,  and  the  influence  of  malaria  on  poen- 
monia was diecoaeed.  Whether ornot malaria pfeditpoeee 
to  pneumonia,  there  ■eeme  little  doubt  that  the  caoneria 
left  after  malarial  poieooing  adds  to  the  danger  of  a  nib- 
•eqnent  attack  of  inflammation  of  the  Inng.  Dr.  Sqnire 
then  coneidered  the  qoeetion  whether  acnte  congeetion  of 
the  long  oocon,  or  whether  the  caaec  so  detcribed 
axe  not,  in  fact»  caaee  of  pneamonia.  Pnevmonia  may 
prore  fatal  before  the  lang  consolidation  is  complete, 
and  in  other  cases  resolution  of  the  polmonary 
exudation  may  occur  before  this  has  coagulated.  In  both 
inft^Hicftf  the  signs  and  symptoms  of  pneumonia  are  not 
fully  declared,  and  when  recovery  takes  place  in  the  first 
stage  of  the  pneumonia  process,  the  term  *'  abortive  pneu* 
monia  "  may  be  used.  Passing  on  to  the  course  and  sym- 
ptoms of  pneumonia,  instances  of  divergence  from  the 
usual  course  of  the  disease  were  mentioned,  and  some  of 
the  more  important  complications  and  sequels  were  illus- 
trated by  cases  which  had  come  under  Dr.  Squire's  obser- 
vation. Pneumonia  of  the  apex  sometimes  gives  rise  to 
difficulties  in  diagnosis^  especially  with  reference  to  the 
pretence  or  absence  of  tubwculosis.  In  the  treatment  of 
pneumonia.  Dr.  Squire  strongly  advocated  a  stimulant 
Une  of  treatment  from  the  first.  Tbe  exhaustion,  which 
constitutes  so  great  a  danser,  may  be  more  easily  pre- 
vented than  counteracted.  The  necessity  for  a  plentiful 
supply  of  nourishment,  which  must  be  administered  fre- 
quently in  small  quantities,  makes  good  nursing  oasentiaL 
The  good  results  obtained  by  the  inhalation  of  oxygen  in 
oertun  oases,  and  tbe  relief  following  a  tepid  bath  in 
one  instance,  were  also  referred  to.  In  conclusion.  Dr. 
Squire  remarked  that,  though  we  may  have  some  general 
principles  of  treatment,  which  g^ide  us  in  all  oases  of 
pneumonia,  the  details  must  depend  upon  the  individual 
peculiarities  of  each  case. 

The  PEisiDiiiT  remarked  that  he  hardly  ever  saw  a  case 
of  pneumonia  in  his  practioe,  possibly  because  when 
necessary  he  stimulatea  very  early. 

Dr.  BoxALL  had  met  with  several  oases  of  acute  lobar 
pneumonia  in  connection  with  childbirth,  cases  in  which 
therefwas  not  the  slightest  suspicion  of  septic  complication, 
and  all  of  them  in  hospital  practice,  where  the  septic  ele- 
ment could  be  completely  eliminated.  But  there  are  two 
factors  in  these  cases  which  appear  to  have  an  important 
bearing  on  the  incidence  of  the  disease,  and  serve  to  sup- 
port tbe  opinion  so  ably  put  forward  by  the  author  of  tbe 
Saper.  (1)  The  removal  of  the  patient  to  tbe  hospital 
uring  labour  entails  a  considerable  risk  of  chilL  (2)  The 
labour  itself  entails,  at  any  rate  in  first  cases,  the  hardest 
day's  work  which,  even  in  this  class  of  patient,  a  woulan  is 
called  upon  to  perform,  and  leads  to  fcOigue.  He  had 
noted  the  same  in  connection  with  pleurisy  and  'acute 
rheumatism.  But  these  cases,  if  treated  on  the  now 
generally  accepted  lines,  all  seemed  to  do  well.  He  had 
met  with  acute  lobar  pneumonia  associated  with  child- 
birth aire  in  another  way.  Acute  lobar  pneumonia,  like 
many  other  febrile  diseases,  and  especially  those  known  as 
**  acute  specifics,"  often  led  to  premature  delivery  or  to 
miscarriage.  These  cases  also,  if  septic  contamination  be 
avoided,  seemed  to  do  well.  It  was  a  point  worth  noting, 
that  as  soon  as  delivei^  or  miscarriage  occurred,  not  only 
did  the  general  condition  of  the  patient  become  no  worse, 
on  the  contrary,  it  often  improved,  but  the  local  manifesta- 
tion of  tbe  disease,  the  lung  consolidation,  often  rapidly 
improved  also,  an  effect  probably  due  to  the  inevitable  loss 
of  blood.  As  regards  oxygen  inhalations.  Dr.  Boxall 
considered  them  pre-eminently  of  service  as  a  means  of 
oxygenation  when  the  lung  was  extensively  consolidated, 
but  he  wished  also  to  elicit  an  opinion  as  to  its  general 
stimulating  effect.  In  both  ways  benefit  might  be  de- 
rived. 

Dr.  G.  A.  ScTTKERLAND  referred  to  the  inverted  type  of 
breathing  which  was  fraquentiy  preaent  in  pneumonia,  and 
might  prove  an  aid  in  the  diagnoaia  of  obeoure  caeea. 


The  teapiratocy  cyde^  inalead  d  the  normal  aequeoce  of 
mtpirutianf  expiroHon^  P^^^^  took  the  form  d  expiratitm^ 
in^frinUicnt  ptmte.  The  freah  air  was  thua  retained  in  the 
Innga  aa  long  aa  poaBible»  and  the  deoumd  for  more  oxygen 


Dr.  Cock  mentioned  caeea  whese  oxygen  had  been  of 
the  greeteat.  aarvice,  noticing,  in  particular,  how  ita 
adminiatration  seamed  to  act  not  only  as  a  stimulant 
and  restorative,  but  also  as  an  expectorant  of  great  value. 
He  asked  if  it  had  been  obeerved  that  sometimes,  in  the 
patchy  pneumonia  of  influenza,  the  sputum  was  of  a  bright 
sulphur  yellow  in  colour,  thouf^h  scanty  in  quantity.  He 
remembeied  that  when  living  m  a  malarious  English  dia- 
trict  tbe  type  of  pneumonia  waa  of  a  particularly  fatal 
character,  alao  mentionins  a  case  of  a  soldier  invalided 
home  for  Egyptian  malanons  fever,  who  developed  pnea- 
monia from  a  chill,  with  a  n^dly  fatal  reanlt. 

Mr.   Hazbl  aaid   that  he  had  recentiy  aucceeafully 


treated  a  bad  case  of  pneumonia,  attended  with  great 
debility,  in  a  medical  friend,  »t.  75,  who  took  alcoholic 
stimulants  (whisky  and  brandy)  to  the  extent  of  12  oz.  in 
twenty-four  hours ;  and  that  he  and  the  patient  largely 
attributed  the  recovery  to  their  use.  In  addition,  he 
took  stnqphanthusand  nux  vomica,  which  he  preferred  to 
digitalis  and  strychnine ;  and  to  aid  resolution,  iodide  of 
pcSassiom* 

Dr.  Edward  Gbat  remarked  that  the  paper  under  dia- 
cueaion  reminded  him  of  a  case  he  had  about  two  years 
ago.  His  patient,  a  strong,  robust  man,  et.  90,  had  passed 
through  sll  the  well-known  stara  of  typical  pneumonia 
:,  had  gradually  < 


which,  in  spite  of  treatment,  had  gradually  crept  over  the 
greater  part  of  both  lungs.  There  was  oonsoliaation  of  a 
good  deal  of  the  right  and  apparently  the  whole  of  the 
bit  lung  with  effusion  into  the  ti^ht  pleura.  The  pulse 
was  of  low  tension,  very  rapid  and  irregular.  The  breath- 
ing also  was  very  quick,  shallow  and  irregular — in  fact,  he 
was  breathing  chiefly  by  means  of  the  middle  lobe  of  the 
right  lung.  The  face  was  livid  and  the  lips  blue.  Seeing 
tlMt  tbe  case  was  desperate  he  determined  to  try  oxygen 
as  a  last  resource.  He  drove  to  Krohne  and  Sesemann> 
in  Duke  Street,  and  brought  back  a  cylinder  containing 
from  dO  to  40  feet  of  that  gas.  When  he  re-entersd  the 
sick  room,  the  nurse  met  h&n  with  the  remark  *'  Ita  all 
over,  doctor."  He  looked  at  the  patient :  breathing  had 
ceaaed  and  there  was  no  reflex  action  on  touching  tbe  con- 
junctiva. There  was  no  time  to  examine  the  hei^,  but  no 
pulse  at  wrist  or  temporal  was  perceptible.  He  lost  no 
time  in  putting  the  apparatus  together  and  applying  the 
mouthpiece.  He  then  turned  on  the  gas,  compressed  the 
patient's  cheat  at  regular  intervalf ,  aM  eventuallv  perae- 
verance  waa  reward^l  by  reapiration  being  re-eatabliahed. 
The  patient  gradually  improved  from  that  hour  and  ia  now 
as  well  and  strong  as  ever  he  was.  Dr.  Graj  added  that 
with  regard  to  the  colour  of  the  expectoration  in  pneumonia 
following  influenza,  that  he  waa  at  preaent  attending  a^ 
caae,  and  was  much  surprised  at  the  long  coAtinuance  of 
what  he  took  to  be  tbe  characteristic  rusty-coloured 
sputa.  A  day  or  two  ago,  however,  he  found  on  inquirv 
that  his  patient  had  been  in  the  habit  of  sucking  '*  Spanish 
liquorice"  for  the  relief  of  the  cough.  It  was  quite  poe- 
sible,  therefore,  that  her  expectoration  had  taken  on  the 
yellow  colour  alluded  to  by  Dr.  Cock  from  this  cause.  The 
fact,  he  thought^  was  worth  remembering  as  showing  how 
necessary  it  was  to  make  minute  inquiries  and  accurate* 
otMorvations. 

Mr.  SPKNcm  HiTBLBtrR  agreed  with  Dr.  Squire  that 
pneumonia  following  influenza  differed  in  many  respeete 
from  the  ordmary  loW  variety ;  it  was  especially  in  these 
cases  that  the  early  and  free  use  of  stimulants  were 
required.  He  inquired  in  what  stage  of  pneumonia  was  the 
inhalation  of  oxygen  most  likely  to  be  of  service? 

Dr.OAONiT  spoke  of  the  aavantage  of  administering^ 
oxygen  by  inhalation  in  pneumonia  and  in  cases  of  heart 
failure  from  other  causes,  illustrating  these  points  by  the 
mention  of  cases  within  his  experience. 

Dr.  Squibb  then  replied  to  the  various  questions  and 
points  raised,  and  the  meeting  adjourned. 
e 

Dr.  OsAinriLLE  Bantock.  r.RC.S.Ed.,  Senior 
SargeoQ  to  the  Samaritan  Free  Hoepital,  having^ 
resigned  that  poet,  has  been  elected  on  the  CoDsaltiDC^ 


Mar.  4,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Mboioal  Pjus8.     239 


THE   LAR7NG0L06IGAL  SOdETT  OF   LONDON. 
Mebtiko  bxld  Fkbbuabt  12th. 

Db.  Fxlzz  SiMOKy  President,  in  the  Chair. 

DI80U8SI0N  ON  THB  NATUBB  OW  LABTVOBAL  OOBfFUGATIOVS 
or  TYPHOID  TBYBB. 

Thb  diMmarion  was  opened  by  a  paper  by  Dra.  Kah- 
THAOK  and  T.  A.  Dbtsdalb. 

Dr.  ELanthack,  who  read  the  paper,  hegKa  by  stating 
that  opinions  differed  considerably  with  regard  to  the 
frequency  of  intra-laryngeal  ulcerations  during  typhoid 
fever.  €>ut  of  61  fatal  oases  at  St.  Bartholomew's  ulcera- 
tion was  found  in  26  oases.  The  general  situations  were 
the  tip  and  edges  of  the  epiglottis  and  in  the  neighbour- 
hood of  the  vocal  processes.  With  regard  to  the  patholo- 
gical nature  of  the  lesions,  Are  they  specifically  typho- 
genetic?  The  assumption  that  the  ulcers  are  decubital 
was  ab  once  set  aside  as  erroneous.  That  they  are  pro- 
duced by  repeated  injuries  acting  on  debilitated  tissue 
was  more  commended.  That  they  were  typho-genetic  on 
the  ground  that  the  ulceration  affected  the  adenoid  tissue 
of  the  larynx  is  incorrect,  as  in  the  above  regions  no  such 
tissue  exists.  That  the  evidence  of  the  as8un\ption  from 
analogy  of  other  parts,  such  as  periostitis  and  parotitis, 
than  the  typhoid  bacillus  produces  the  ulcers  is  weak  and 
insufficient.  The  bacteriological  evidence  is  very  incom- 
plete, and  such  as  there  is  points  against  their  specifically 
typho-genetic  nature.  Clinical  evidence  too  does  not 
support  tlie  theory,  as  there  seems  to  be  no  relationship 
between  the  symptoms  of  the  fever  and  the  laryngeal 
lesione.  The  explanation  that  the  mucosa  of  the  larynx 
beinfl^  in  the  so-called  **  typhoid  state  "  is  readily  injured 
and  forms  an  easy  portal  for  pyo-^penetic  cocci,  and  natur- 
ally this  occurs  most  commonly  m  the  most  inefficiently 
vascularised  portions,  however,  does  not  satisfy  all  cases. 
The  lesions  are  undoubtedly  caused  by  micro-organisms, 
and  there  is  the  strongest  evidence  that  these  are  the  pyo- 
cocci, and  with  very  rare  exceptions  the  typhoid  bacillus. 

Dr.  Watsou  Williams  (Bristol)  was  of  opinion  that 
while  acute  and  chronic  laryngeal  lesions  are  sometimes 
undoubtedly  secondary,  the  result  of  septic  infection,  they 
are  in  the  main  specific,  and  due  to  typhoid  toxin,  and 
more  frequently  associated  with  the  presence  of  the 
Eberth  bacillus  than  Dr.  Kanthack's  observation  had  led 
him  to  believe.  Dr.  Williams  submitted  the  following 
reasons  for  arriving  at  this  conclusion :  1.  As  regards 
lymphoid  tissue,  Comil  and  Ranvier  had  found  that,  while 
in  typhoid  cases  dying  from  pulmonary  and  bronchial 
complications  catarrhal  laryngitis  was  generally  present, 
in  a  amaller  portion,  and  in  a  more  acute  form  of  laiTngitis, 
the  Wmph  lollides  were  tumefied  and  formed  nodules, 
in  which  the  multiplication  of  the  nuclei  and  infiltration 
of  the  retiform  tissue  were  entirely  similar  to  what  is 
observed  in  the  closed  follicles  of  the  small  intestine. 
Theee  tumefactions  often  five  place  to  orateriform  ulcers. 

2.  The  frequency  of  initial  lung  symptoms  in  typhoid 
were  susgestive  of  a  specific  origin,  and,  in  fact,  the 
typhoid  bacillus  had  been  found  in  the  lungs  in  numerous 
instances.  Newman  found  the  typhoid  bacillus  in  11  out 
of  48  cases  in  the  kidney,  and  concluded  that  the  bacilli 
appeared  only  in  the  urine  when  the  kidney  is  directly 
involved.  Thus  the  preliminary  and  renal  lesions  should 
be  regarded  as  due  to  the  typhoid  bacilli  and  their  toxins. 

3.  The  frequency  and  the  characteristic  aspect  of  laryngeal 
uloers  in  typhoid,  as  compared  with  the  rarity  in  other 
exanthemata,  pneumonia  was  strong  ^rtm^yooie  evidence 
in  favour  of  their  specific  nature.  In  congenital  typhoid 
the  intestines  do  not  present  ulceration,  due,  Dr. 
Williams  thinks,  to  the  absence  of  saprophytic  micro- 
organisms, especially  the  B.  coli,  which,  abounding  in 
the  intestinal  tracts  in  after-life,  add  to  the  virulence  of 
the  typhoid  bacillus.  So  in  the  larynx,  the  ulcerative  pro- 
sess  may  be  due  to  its  exposure  to  the  combined  action  of 
these  badlli,  under  conditions  which  markedly  favour  the 
development  of  extreme  pathogenic  properties.  4.  It  was 
hardly  possible  to  account  for  the  inoculation  of  certain 
oasss,  except  by  SBrial  infection.  Dr.  Williams  referred  to 
eases  in  which  typhoid  was  apparently  caught  from  the 
expectoration  of  a  case  with  laryngeal  ulceration.  These 
eases  were  virulent  and  fataL  T  wo  had  laiyngeal  ulceration, 
and  in  one  case,  Eberth's  bacilli  had  been  obtained  from 


these  ulcers.  5.  Just  as  more  general  tvpboid  lesions  fell 
into  two  groups — the  acute  and  the  chronic,  secondary 
focal  abscesses,  otorrhosa,  osteomyelitis,  in  which  typhoid 
bacilli  had  been  demonstrated,  so,  likewise,  did  the  laryn- 
geal complications  of  typhoid  fever. 

Mr.  S.  G.  Shattock  exhibited  some  preparations  show- 
ing the  ulcers  so  typical  in  situation,  viz.,  over  the  voinJ 
processes  of  the  arytemoids.  He  could  say  from  having 
examined  especially  into  the  point,  that  there  was  no 
lymphoid  tissue  in  this  situation  in  the  normal  condition. 
Therefore,  the  lesions  in  the  larynx  were  not  strictly  com- 
parable to  the  intestinal  lesions. 

Dr.  J.  HoBNB  said  that  ulceration  of  the  laiynx  in 
typhoid  fever  was  necessarily  of  a  typhoid  origin.  In 
some  oases,  the  ulceration  had  been  found  paae-inoviem  to 
be  tubercular.  In  such  cases,  it  would  be  important  to 
know  the  state  of  the  lungs  and  larynx  before  the  onset  of 
the  fever.  Bearing  in  mind  that  tuberculosis  more  com- 
monly follows  typhoid  tban  any  other  fever,  it  may  be  that 
typhoid  renders  the  laryngeal  tissues  more  vulnerable  to 
the  attacks  of  the  tubercle  bacillus. 

The  FliBSiDKNT  asked  why  the  cricoid  cartilage  was  so 
frequency  the  site  of  the  diseases?  There  were  several 
specimens  showing  this  without  disease  at  the  processus 
vocalis. 

Dr.  Kanthack,  in  reply  to  Dr.  W.  Williams,  did  not 
accept  the  statements  with  regard  to  lymph  follicles  in  the 
larynx.  His  own  and  other  observations  showed  the 
absence,  even  in  disease,  of  adenoid  tissue  on  the  vocal 
processes  and  on  the  tip  of  the  epiglottis.  He  desired  to 
Know  what  authority  Dr.  Williams  had  for  stating  that 
the  typhoid  bacillus  had  been  found  in  the  lungs  in 
numerous  instances.  The  presence  of  Eberth's  bacillus 
in  the  blood  during  typhoid  was  generally  acknowledged 
to  be  extremely  rare.  Its  frequent  occurrence  in  the 
urine  was  indisputable,  but  this  was  no  argnxnent  that  the 
tissues  were  generally  infected.  Toargueirom  congenital 
typhoid  was  to  argue,' in  his  opinion,  from  the  unknown. 
Dr.  Williams  assumed  that  tne  typhoid  bacillus  in  the 
lungs  produced  no  ulcerative  lesions  because  it  did  not 
co-exist  in  the  B.  coli.  Dr.  Kanthack,  on  the  other  hand, 
had  shown  that  it  was  always  there,  and  in  following  Dr. 
Williams'  own  argument,  necrotic  lesions  in  the  lung 
should  be  common  in  typhoid.  Most  authors  had  failed 
to  find  typhoid  bacilli  in  suppurative  and  inflammatory 
complications  of  typhoid.  With  regard  to  the  President's 
question,  he  was  not  prepared  to  answer  without  a  little 
more  thought  and  study,  but  he  had  always  considered 
the  cricoid  perichondritis  to  be  secondary  to  the  ulcera- 
tion on  the  processus  vocalis. 

DISCUSSION  ON  FOBKIGN    BODIBS    llf  THE    UPPSB    AIB  AND 
POOD  PASSAOBS. 

Mr.  C.  SvMONDS.  in  opening  the  discussion,  said  that 
in  the  nose,  when  no  histonr  was  given,  the  most  charac- 
teristic symptom  was  unilateral  purulent,  often  blood- 
stained, discharge,  with  more  or  less  obstruction.  Young 
children  should  be  examined  under  chloroform,  and  the 
foreign  body  removed  with  forceps  or  probe.  In  the 
pharynx  stress  was  laid  upon  the  importance  of  examina- 
tion with  the  mirror,  and  the  dose  resemblance  of  a  string 
of  glazy  mucus  to  a  fish-bone.  Where  nothing  could  be 
seen  the  finger  should  be  used.  The  danger  of  thus 
driving  in  sharp  bodies  was  referred  to.  In  the  larynx 
division  was  made  into  those  that  were  small  and  did 
not  impede  respiration,  and  those  that  were  large 
and  obstructive.  In  the  first  case,  intra-laryngeiu 
methods  of  removal  were  recommended.  In  the  second 
group  great  stress  was  laid  upon  the  importance  of  having 
everything  ready  for  tracheotomy,  in  case  of  spasm  occur- 
ring. If  Uie  body  is  impacted  in  the  glottis,  after  trache- 
otomy, he  ccnsiaered  it  better  to  attempt  at  removal 
through  the  mouth  by  a  skilled  operator  before  dividing 
the  thyroid  cartilage.  He  would  not  retain  the  tuM 
after  all  extraneous  substances  were  removed.  In  the 
trachea  and  bronchi  the  value  of  the  paroxysmal  cough 
was  referred  to,  also  the  importance  of  the  knowledge  of 
the  nature  of  the  foreign  boay«  The  danger  of  mistaking 
the  quiet  period  for  complete  recovery  was  pointed  out. 
The  danger  of  inversion  and  succession,  without  previous 
tracheotomy,  was  thought  to  be  sufficient  to  exclude  the 
method.  Tracheotomy  should  always  be  performed  if  a 
foreign  body  were  in  the  trachea  or  bronchi.    In  the  oeso- 


240     Thi  Mxdigal  Pbx88. 


FRANCE. 


Mab  4,  Ihl'ft. 


p^agas  the  main  pointft  «ere  the  danger  of«over-inanipala- 
tion,  oausiDg  fatal  laceration,  driving  penetrating  bodiee 
into  the  OBSophagns,  and  the  wisdom  or  otherwise  of  pushing 
down  impacted  fooidy  rather  than  waiting  a  few  hours  for 
solution  to  take  pi  ice.  Importance  was  attached  to  the 
Aounding  for  coin^,  and  the  inadvisability  of  using  an 
ordinary  bougie.  For  the  removal  of  tooth-plates  oetopha- 
gotomy  was  recommended,  the  wound  to  be  packed  with 
gauze  after  suturing  the  gullet. 

SHEFFIELD   MEDICOCHIRURGICAL   SOCIETY. 
Mbkting  hxld  Thubsdat,  Ff  beuabt  13tm,  1896. 

The  President,  Dr.  Porter,  in  the  Chair. 


Professor  Hicks,  F.R.S.,  Principal  of  Firth  College, 
gave  a  very  dear  and  interestiDg  account  of  his  experi- 
ments With  RoDtgen's  rays,  of  which  we  gave  a  descrip- 
tion in  our  issue  for  February  19^h.  He  showed  a  large 
number  of  sharply-defined  and  beautifully  ex^cutSd 
shadowgraphs. 

Dr.  Arthur  Hall  showed :  (1)  a  case  of  facial  spasm  ; 
(2)  a  case  of  osteo-arthritis,  with  Rootgen  shadowgraph 
of  one  hand. 

Mr.  Dale  James  showed  (1)  a  case  of '*  Circumscribed 
Scleroma"  in  a  girl,  sDt.  19.  The  patch  existed  as  an  arc 
four  inches  long  upon  the  upper  surface  of  the  left  mamma. 
It  followed  a  severe  blow  upon  the  site  four  years 
before.  Under  massage  and  the  constant  current,  it  was 
rapidly  improving.  (2)  A  severe  case  of  "  Raynaud's 
Disease.*'  The  patient  was  a  woman,  set.  44.  When  first 
seen,  a  fortnight  before,  the  fore  half  of  each  foot  was 
deeply  oyanosed,  and  mottled  patches  extended  above  the 
outer  arch  of  the  left  leg.  Both  arms  were  similarly 
mottled  to  the  shoulder  on  the  extensor  surfaces.  The 
right  hand  was  cold,  purple,  and  oedematous.  The  left 
presented  an  extraordinary  appearance.  The  fingers 
were  greatly  swollen,  of  a  brilliant  scarlet  colour,  spotted 
with  white;  the  index  and  second  fingers  showed  hard 
necrotic  plugs,  destroying  the  entire  pulp.  These  have 
since  broken  down  to  some  extent,  but  are  not  yet  de- 
tached. A  former  attack,  six  years  ago,  was  not  to  severe, 
but  involved  some  of  the  toes  in  superficial  ulceration. 
There  is  no  evidence  of  specific  taint,  although  she  has 
miscarried  twice,  having  four  living  children.  She  had 
rheumatic  fever  eleven  years  ago,  which  has  left  a  slightly 
damaged  aortic  valve.  The  present  attack  commenrnd  in 
September,  after  a  miscarriage. 

Mr.  Charles  Atkins  showed  a  case  of 

SYMMETRICAL  OAKGRENE— 7  BAT1IAUD*S  DISEASE. 

Mr.  C.  B.,  8Bt.  39,  complains  of  the  tips  of  the  fourth 
and  fifth  digit  on  each  hand  being  cold  and  dead :  one 
mcmth.  One  month  ago,  when  employed  at  work  in  a 
cold  and  damp  cellar,  be  became  ill  with  a  severe  cold 
(?  infinenza).  Had  pain  like  rheumatism  in  his  fingers  and 
then  they  became  cold,  and  of  a  purple  colour,  tumiofir  to 
a  deep  dead  black,  down  as  far  as  first  joint,  except  fifth 
digit  on  right  hand,  which  is  only  affected  just  at  the  tip  ; 
the  parts  just  above  the  line  of  demarcation  are  slightly 
swollen,  infiamed,  and  tender.  Both  feet  have  been 
affected  with  discolouration,  extending  from  centre  of 
foot  on  outer  side  round  the  heel  to  a  point  opposite  on  the 
inner  side.  The  toes  have  also  been  «l]ghtly  discoloured 
and  painful  on  the  dorsum.  When  15,  had  rheumatic 
fever.  No  other  severe  illness  of  any  kind.  No  history 
of  syphilis.  Has  had  sliffht  (?)  rheumatic  pains  on  and  off 
last  three  years.  Has  had  very  good  health.  Father 
died,  8Bt.  70,  of  hepatic  cirrhosis.  Mother  alive  and  well, 
et.  56,  Seven  sisters,  all  alive  and  in  good  health.  One 
brother,  ditto.  No  family  history  ol  any  complaint. 
Heart  normaL   CTrtne— Clear,  acid,  1020,  alb.   J.  No  sugar. 

Dr.  Sinclair  White  showed 

(1)  A  woman,  set.  50,  who  had  a  cancerous  stricture  of 
the  rectum  of  six  years'  duration.  Colotomy  had  been 
performed  three  years  after  the  onset  of  symptoms.  The 
patient  was  still  fairly  well  and  might  be  expected  to  live 
several  years  yet. 

(2)  A  man,  et.  69,  whose  rectum  had  been  resected  nine 
months  previously  for  cancerous  stricture  situated  three 
inches  from  the  anus.  The  growth  together  with  five 
inches  of  the  rectum  was  removed  by  the  trans-sacral 


incision.  The  peritoneum  was  freely  opened  and  the 
growth  drawn  out  of  the  wound.  A  Murphy's  button  was 
used  to  unite  the  ends  of  the  rectum.  The  posterior  part 
of  the  rectal  wound  leaked,  and  for  a  time  there  was  a 
faBcal  fistula,  but  this  gradually  contracted.  There  was 
no  evidence  of  reoorrence,  and  he  had  complete  control 
over  his  sphincters.  He  had  gained  two  stones  in  weight 
r>ince  this  operation,  and  was  stronger  than  he  had  been 
for  years. 

♦ 


[FROM  OUR  OWN  CORRKSPONPENT.] 

PARIS,  Feb.  S9th,  1886. 

Anti-Diphtheritio  Sebum. 

At  the  last  meeting  of  the  Socid'^  M^icaledes  Hop- 
pitaux  M.  Hutinel  read  a  paper  on  this  subject.  He  said 
he  considered  Roui's  serum  a  marvellous  remedy,  and 
invariably  employed  it  in  diphtheria  of  any  gravity.  He 
thought  it,  however,  necessary  to  subscribe  to  the  two 
following  propositions  set  forth  by  M.  Sevestre. 

When  a  diphtheritic  angina  of  benign  aspect  develops  in 
a  child,  the  subject  of  enlarged  chronically  infiamed  tonsils 
and  adenoid  vegetations  it  is  better  not  to  commence  injec- 
tion of  serum,  unless  examination  reveal  the  presence  of 
Ldffler*s  bacillus  of  the  long  variety,  and  in  great  namberr, 
or  unless  the  membranous  fossae  be  affected. 

And  again,  in  cases  of  scarlet  fever,  when  the  bacillus  of 
Loffler  is  discovered  in  the  throat,  it  is  best  to  make  sure 
before  injecting  if  the  bacilli  are  long  and  numerous  and 
the  diphtheria  clearly  characterised. 

For  a  long  time  M.  Hutinel  has  held  the  opinion  that 
the  more  serious  of  the  complications  following  injection 
of  serum  ought  not  to  be  ascribed  exclusively  to  the  serum 
nor  to  the  antitoxin  which  it  contains,  but  rather  to 
secondary  infections.  These  infections  are  probably  due 
to  streptococci.  The  presence  of  streptococcus,  even  of 
the  virulent  type,  in  the  throat,  is  not,  however,  reason 
sufficient  to  make  that  organism  responsible  for  the  com- 
plications which  may  follow  injection  of  serum.  In  cases 
of  undoubted  streptococcus  he  has  often  sought  in  vain  for 
that  organism  in  the  blood. 

He  has  considered  whether  chronic  inflammations  of  the 
throat,  before  onset  of  diphtheria,  were  not  in  some  way 
associated  with  complications  following  sero-therapy. 
He  has  observed  that  the  most  serious  manifestations 
were  usually  produced  in  children  with  large  tonsils,  with 
chronic  inflammation,  and  with  adenoids,  and  he  thinks 
that  the  specific  germs  may  develop  in  the  crypts  and 
cavities  of  the  parts. 

A  recent  case  of  death  in  a  girl,  let.  12,  suffering  from 
diphtheria  and  streptococcus  has  confirmed  him  in  bis 
belief  in  the  greater  gravity  of  oases  of  the  above  kind  ; 
and  he  has  records  of  other  cases  in  which,  as  in  this,  after 
injection  there  supervened  albuminuria,  anuria  and  death. 
M.  Chantemesse  thinks  that  no  one  with  any  experience 
can  believe  that  complications  of  any  more  than  slight 
importance  ever  follow  serum  injection ;  and  does  not 
believe  that  albuminuria  is  ever  so  caused.  He  believes, 
on  the  contrary,  that  the  serum  protects  the  kidneys  ;  and 
that  when  albuminuria  occurs,  it  is  almost  always  due 
either  to  the  diphtheritic  infection  itself  or  to  an  infection 
by  streptococci.  He  criticised  capes  in  which  albumin- 
uria had  been  ascribed  to  injection  of  10  cc.  of  serum,  and 
asked  if  so  small  a  dose  were  capable  of  giving  rise  to  this 
complication;  whether  cases  would  not  be  much  more 
commonly  met  with  ;  and  it  was  well  known  that  the  most 


Mab.  4,  1^06. 


GERMANY. 


The  Mbdical  Pb^ss      241 


'minate  ezaminatioii  in  muiy  c^aee  failed  to  show  the 
•lil^hteet  trace  of  albommi.  M.  Variot,  who  has  had  a  vast 
•ezperienoe  in  this  matter,  has  never  seen  a  case  of  alba- 
jninuria  which  he  oonld  ascribe  t-t  seram,  nor  has  he  ever 
-observed  any  effect  on  the  kidneys,  save  an  almost  con- 
stant diminution  of  the  quantity  of  urine  secreted  during 
forty-eight  hours. 

[tbom  oub  owx  oobbxspondknt.] 

fiBRLiN,  Feb.  28th. 
TCTBBRCCJLOUS  PbRITONITIS. 

Pbof.  Isbael,  in  a  contribution  on  the  above-named 
.subject,  reports  4  cases  successfully  treated  by  operation. 
'Three  of  them  were  children  from  4  to  7  years  of  age,  and 
one  was  a  girl  of  20.  In  the  first  3  the  diagnosis  was 
arrived  at  before  operation  and  confirmed  microscopically. 
The  time  that  had  elapsed  after  the  operation  was  17, 16^, 
and  7  months  respectively.  The  only  new  feature  about 
ihese  cases  was  that  before  closure  of  the  abdominal  wound 
aquantity  of  iodoform  oil  emulsion,  10  percent,  in  strength 
and  from  10  to  30  grammes  in  quantity,  was  poured  into 
the  abdominal  cavity.  He  thinks  the  cure  of  tubercular 
peritonitis  cannot  be  explained  by  the  removal  of  the 
ascites  that  goes  along  with  the  laparotomy.  In  spite  of 
the  presence  of  tuberculous  ulcers  of  the  bowel  permanent 
recovery  may  result  from  operation*  Even  within  36  days 
of  the  operation  all  tuberculous  nodules,  even  those  the 
mxe  of  a  cherry,  may  have  disappeared.  Fever  is  not  a 
oontrarindication  of  the  operation. 

In  the  fourth  case  there  was  tumour-like  tuberculosis  of 
the  asoeodiog  colon.  On  account  of  the  extensive  dissemina- 
tion of  taberde  in  the  peritoneum,  no  attempt  was  made 
•on  the  tumour-like  growth,  but  an  anastomosis  was  made 
between  the  colon  and  the  ileum,  10  ctm.  nearer  the  anus 
than  the  tumour.  Recovery  uninterrupted.  The  tumour 
diminished  so  much  in  size  after  the  operation  that  at  the 
time  of  writing  it  was  no  larger  than  a  walnut. 
Rbgulab  Phbnobtbna  in  thb  Spbbad  of  Somb  Endemic 

DiSBASBS. 

At  the  Hnfeland  Society  Hr.  A.  GofliBtein  read  a  paper 
on  this  subject.  After  a  definition  of  infection,  be  said 
that  in  the  case  of  tuberculosis  something  more  than  the 
exciter  was  necessary  to  the  production  of  the  disease — a 
certain  condition  of  the  organism  or  disposition  was  neces- 
sary, and  this  had  nothing  to  do  with  the  pathogenic 
germs.  The  necessary  factor  was  at  first  denied,  but 
later  it  had  to  be  conceded,  and  not  only  for  tuberculous, 
but  also  for  diphtheria  and  cholera.  It  was  especially  due 
to  Liebreich,  by  the  introduction  of  the  idea  of  noso-para- 
sitism,  that  we  had  an  explanation  of  this  question.  In 
order  to  understand  the  processes  in  the  spread  of 
infective  diseases,  we  must  not  only  consider  the 
bacteriological  aspect  of  the  subject^  but  also  the  recep- 
tivity of  the  individual,  for  on  this  factor  alone  depen  ded 
the  mode  of  the  extension  of  the  disease.  If  contagion 
alone  was  all  sufficient,  enormous  numbers  would  sicken 
in  a  short  time,  as  in  the  case  of  small-pox,  measles,  and 
war  typhus.  The  spread  of  an  infective  disease  was  quite 
different  when  the  population  was  not  susceptible.  Here 
the  rise  of  the  curve  would  be  much  slower,  it  would  never 
preach  the  height  of  that  of  the  other  disease,  and  its  fall 
would  be  much  slower.  It  this  were  applied  to  the  spread 
-of  an  epidemic  it  would  follow  the  more  general  the  re- 


ceptivity for  infection,  the  more  rapidly  would  the  epi- 
demic spread  and  die  away,  and  vke  verm.  The  amount 
of  this  receptivity  was  determined  by  reckoning  how  many 
out  of  100  people  coming  into  contact  with  the  infection 
would  later  on  be  attacked  with  the  disease.  This  number 
he  had  named  the  contagion  index,  and  he  had  attempted 
to  fix  ir.  for  measles,  scarlatina,  and  diphtheria. 

As  regarded  measles,  of  100  children  coming  into  con- 
tact with  the  infection,  95  would  take  the  disease,  so  the 
contagion  index  would  be  0*95.  From  numerous  data,  he 
had  determined  that  in  the  case  of  scarlatina,  the  con- 
tagion index  was  0*4,  and  for  diphtheria,  O'l,  t  e.,  of  100 
children  exposed  to  the  infection  of  scarlatina,  40  would 
contract  the  disease,  and  in  the  case  of  diphtheria,  10. 
According  to  this  the  courses  of  the  three  epidemics  must 
be  very  different  from  each  other.  The  curves  of  measles 
epidemics  must  be  very  abrupt,  there  must  be  a  sudden 
rise  and  a  sudden  falL  The  curves  of  scarlatina  epidemics 
must  mount  more  slowly,  they  could  never  reach  the  height 
of  tboee  of  measles  and  the  fall  must  be  more  gentle.  The 
diphtheria  curve  must  be  flatter  still  and  the  time  from 
the  commencement  to  the  highest  point  and  to  the  final 
fall  might  perhaps  cover  decenninms. 

The  importance  of  these  considerations  was  not  seen  in 
the  material  of  the  smaller  towns,  as  epidemics  were  pre- 
maturely extinguished  for  want  of  material.  As  objects  of 
study  only  towns  of  100,000  and  upwards  would  be  taken, 
and  the  curves  could  only  be  constructed  from  the  morta* 
lity  as  no  other  data  were  accessible. 

The  speaker  then  showed  his  curves  relating  to  these 
diseases  in  fourteen  of  the  chief  cities  of  Europe.  They 
were  uncommonly  characteristic  and  showed  that  similar 
conditions  prevailed  in  all  the  towns.  A  peculiarity  of  the 
measles  curve  was  that  all  the  greater  epidemics  began  in 
the  second  quarter  of  the  year.  Another  peculiarity  was 
that  the  outbreak  began  in  many  towns  in  the  same 
quarter  of  the  same  year. 

As  regarded  scarlatina  a  period  of  10  years  was  too  short 
to  allow  more  than  one  epidemic.  It  was  lighted  up  in 
these  towns  about  every  10  or  15  years,  and  the  descend- 
ing curve  was  generally  more  abrupt  than  the  descending 
one.  The  duration  of  a  curve  was  3  years  and  upwards. 
It  was  of  no  use  to  give  a  10  years'  curve  of  diphtheria ; 
those  of  Heubner  and  Hecker  were  only  fractions  of  a 
whole,  anid  were,  indeed,  the  tolerably  steep  ascending 
limb  of  a  curve,  the  summit  of  which  was  reached  in  the 
first  half  of  the  "  Eighties."  iSdava  had  shown  this  fall  for 
Italy,  and  it  was  incomprehensible  how  Behring  had 
brought  him  forward  as  a  witness  for  the  constancy  of 
diphtheria.  To  get  a  characteristic  curve  for  diphtheria 
one  must  take  a  period  of  over  a  quarter  of  a  century.  The 
speaker  then  showed  25-year  curves  for  diphtheria  for 
Berlin,  Leipsic,  and  Dresden.  The  curve  rose  irregu- 
arly,  suddenly  reached  a  high  point,  and  then  fell  with 
terrace-like  gradations.  All  the  large  cities  of  Germany 
were  in  the  terrace  stage  of  decline  long  before  the  intro- 
duction of  Behring's  serum.  London  alone,  where  the 
acme  was  reached  later,  viz.,  at  the  end  of  the  Eighties, 
had  in  1895,  in  spite  of  serum,  a  mortality  almost  equal  to 
that  of  the  worst  period.  The  study  of  diphtheria  epi- 
demics then  required,  not  decenniums,  as  in  the  case  of 
measles  and  scarlatina,  but  centuries. 

From  the  study  of  the  history  of  diphtheria,  we  learned 
the  surprising  fact  that  an  epidemic  of  diphtheria  extend- 
ing over  decenniums  follows  upon  a  period  equally  long,  in 
which  nothing  is  heard  of  the  disease,  that  whole  genera- 


242     Thv  Msdical  Press. 


AUSTRIA. 


Mab.  4,  1890. 


tions  of  physiciaiia  did  not  know  the  new  diBease  that  had 
•pruog  up. 

In  Europe  the  contagion  first  appeared  in  Spain  at  the 
oommenoement  of  the  17th  century ;  it  reached  its  height 
in  1613,  and  played  an  important  part  in  Spain,  England, 
and  Italy  in  the  first  half  of  the  oentory.  Just  100  yeaie 
later  it  again  appeared,  and  deirastated  the  peninsula, 
and  about  the  end  of  the  Forties  attacked  England,France, 
Italy,  Switzerland,  and  Sweden.  It  appeared  first  in 
Germany  in  the  latter  half  of  the  century,  and  in 
1798  was  spread  over  the  whole  of  Europe.  At  the 
commencement  of  this  century  it  appeared  in  Eastern 
Europe,  and  in  East  and  Mid-Oermany.  In  the  second 
and  third  decenninms  it  was  almost  confined  to  France, 
where  Breton  oean  published  his  classical  work.  From 
then  to  the  commencement  d  iJie  Fifties  it  completely  sub- 
sided in  Europe.  This  disappearance  only  lasted  15  years 
in  France,  but  in  Germany  a  whole  generation,  and  for  the 
Netherlands  half  a  oentury.  Just  before  the  middle  of  the 
century  diphtheria  again  began  its  march  through  Europe, 
reached  its  highest  point,  as  already  stated,  about  the 
end  of  the  Eighties,  from  which  date  a  distinctly  recog- 
nisable subsidence  has  taken  place.  In  Berlin  the  disease 
first  appeared  in  a  noteworthy  manner  at  the  commence- 
ment of  the  Sixties,  reached  its  highest  point  in  1883-4» 
and  since  then  has  steadily  subsided.  Whether  the  epi- 
demic will  become  extinguished,  whether  it  will  become 
epidemic  in  the  great  towns,  with  periods  of  exacerbation 
and  retrogression,  the  next  twenty  years  will  teach  us 
with  greater  certainty. 


[VBOM  OVB  OWK   OOBBHPOirDmrT.] 

VmSA,  Feb.  SSth,  ISM. 
BUBNS. 

Kaposi  showed  to  the  Gesellschaf t  at  the  last  meeting 
a  young  man  with  a  deep  bum  on  the  hand  which  he  con- 
sidered of  great  importance,  as  it  exhibited  a  condition  of 
charring  of  the  tissues  unusually  met  with.  The  patient 
was  fifteen  years  of  age,  and  was  engaged  with  a  butcher. 
On  January  15th,  be  met  with  the  accident,  and  on  the 
following  day  was  brought  to  the  clinic,  when  it  was  found 
that  the  skin  and  soft  tissues  of  the  left  arm  were 
charred  to  the  elbow,  while  the  injury  to  the  right 
was  confined  to  the  back  of  the  hand.  In  the  hard  mass 
the  subcutaneous  veins  could  be  distinctly  seen  coursing 
under  the  surface.  There  we^  no  secondary  phenomena 
which  usually  accompanied  deep  injuries  of  this  character. 
No  albumen  in  the  urine,  no  pain,  nor  other  toxic  sym- 
ptoms. A  few  days  later  it  was  discovered  that  the 
skin,  subcutaneous  fat,  and  tendons  had  been  quite 
destroyed  by  the  heat,  since  the  capsules  of  the  joints  soon 
sloughed,  the  ends  of  the  bones  extruding.  In  closely 
examining  the  cause  of  this  lesion  several  difficulties  pre- 
sent themselves,  as  the  history  leaves  us  to  conjecture  the 
cause.  In  the  case  of  females  where  clothing  has 
taken  fire,  and  produced  severe  burning,  we  are  often  able 
to  trace  the  lines  on  the  body  where  the  hard  parts  of  the 
stays  have  been  in  contact  with  the  surface  which,  owing 
to  their  greater  capacity  for  heat,  have  produced  local 
charring.  This  boy's  duty  was  to  attend  to  the  fire  on  which 
large  quantities  of  refuse  were  kept  constantly  burning. 
It  is  presumed  that  at  the  time  of  the  accident,  the  lad's 
hands  and  arms  of  his  coat  were  covered  with  fat,  which 


has  also  a  great  oapacity  for  beat,  and  may  probably 
be  accounted  for  the  severity  of  the  Issions.  It  ie 
also  presumed  that  he  had  taken  a  fit  as  we  learn  hr 
had  three  epileptic  attacks  in  the  preoediiqi:  year.  All 
the  information  we  ean  glean  from  the  lad  is  that  he  had 
fallen  asleep  by  the  fire  and  that  he  was  awakened  by  the 
smarting  sensation  of  the  heat.  It  is  possible  that  this  eo- 
called  sleep  may  have  been  equivalent  to  an  epileptie- 
attack. 

Alloxukivi  Bodixs. 

KoUsoh  followed  Kaposi  with  a  reply  to  Ziilzer,  of* 
Frankfort,  who  has  challeoged  the  correctness  of  the  reeolte 
in  a  paper  which  the  former  read  a  few  months  ago  before* 
tne  Gesellschaft.  In  that  address  on  the  morbid  oooditione 
of  gout  Kolisoh  placed  the  maximum  value  in  per* 
feet  health  of  the  nitrogenous  bases  at  0*06  which  seems 
to  have  been  in  dose  accord  with  Leyden's  result,  which 
was  0*07.  Any  variation  from  this  was  classed  as  a  patho* 
logical  disturbance,  which  might  rise  as  high  as  0*1  or 
0*12,  or  double  the  maximal  normal  result.  Ziilnr  now 
affirms  that  this  nitrogenous  base  is  very  much  lower 
than  what  Kolisch  has  reckoned  it,  and  quotes  six  cases 
where  it  was  absent.  Kolisch  produced  a  letter  from 
Kriiger,  who  first  introduced  this  method  of  inquiry,  and 
affirms  that  Ziilzer  has  erred  in  his  analysis.  In  the  dis^ 
cussion  that  arose.  Freund  related  twelve  cases  of  Morbue 
Brightii  in  which  the  alloxurine  bodies  had  been  carefully 
separated ;  eleven  gave  the  exact  results  recorded  by 
Kolisch.  The  remaining  case  seems  to  have  been  affected* 
by  the  diuresis. 

Mtxobdsma. 

At  the  Medical  Club,  Hock  exhibited  a  child,  21  monthr 
old,  with  typical  myxoedema,  which  he  had  treated  with* 
the  thyroid  extract.  Alongside  with  this  patient  he 
placed  an  idiotic  child  four  years  of  ago,  whom  he  had' 
treated  with  the  same  preparation,  with  satisfactory  results. 
He  thought  it  ought  to  be  more  generally  known  that  tby- 
roidin  was  as  efficaeions  in  the  idiotic  as  in  myxoedema. 

Prof*  Kassowits  related  a  case  of  cretinism  and  myxos*^ 
dema  combined,  which  improved  wondrously  under  the- 
thyroid  treatment. 

He  admitted  that  the  intelligence  remained  unchanged^ 
but  the  other  sjrmptoms  were  greatly  improved.  He  also* 
added  that  erotinism  was  mora  general  in  Vienna  than  at 
pceeent  recognised.  The  differential  diagnosis  from  idiocy 
was  the  vaulted  condition  of  the  month  or  the  thorns  pala- 
tinus.  To  this  Kohn  said  that  he  had  often  seen  oasee  with 
thorns  palatinus  and  not  a  trace  of  erotinism  present. 
Kassowitz  admitted  this  was  possible,  but  he  would  never 
meet  with  a  cased  cretiniBm  without  the thorus  palatinus. 

lODIVB  IN  THB  ThTBOIO. 

Topfer  brought  the  recent  results  of  Baumann  beforo 
the  Gesellschaft  by  stating  that  the  normal  gland  con^ 
tained  iodine,  whidi  was  firmly  bound  up  with  the  organic 
matter,  but  after  boiling  with  sulphuric  acid  could  be 
separated.  Baumann  macerated  the  gland  from  4  to  8* 
hours  in  a  10  per  cent,  solution  of  sulphuric  acid ;  the  solu- 
tion was  then  filtered,  and  treated  with  alcohol,  he  after- 
wards obtained  iodine  by  evaporation,  varying  in- 
amount  from  9*3  per  cent.  Baumann  has  named  this 
'<  Thyroid  Iodine.''  This  he  thinks  accounts  for  the  absence- 
of  iodine  in  the  fiuids  of  crotins  and  strumous  patients. 


The  Duke  and  DncfaeBe  of  York  will  Tiait  Halifax- 
on  July  2lBt,  in  order  to  opeo  a  new  Infirmary  which* 
has  been  built  at  a  cost  of  £80,000. 


Mar.     4.  1S96. 


THE  OPEEATIKG  THEA1RES. 


The  Mkdigal  P&tss.    243 


^be  (Dptrating  ^beatree. 

MIDDLESEX  HOSPITAL. 
Lymphatic  N^svus  of  thb  Tonoub  (Ltuphaiigioma).— 
Mr.  Bland  Surroir  operated  on  a  oonntrymaD,  sab.  40, 
who  was  sent  in  with  an  elongated  raited  patch  upon  the 
left  aide  of  his  tongne  measnring  seven  centimetres  in 
length,  and  two  centimetres  in  breadth,  the  long  axis  of 
the  patch  coinciding  with  the  long  axis  of  the  tongue.  In 
colour  the  tumour  resembled  a  patch  of  xanthelasma,  but 
the  nnifbrmity  of  its  surface  was  broken  by  small  cysts 
the  size  of  millet  seeds.  The  man  sUted  he  had  had  this 
tamoar  for  ten  years,  but  lately  it  had  been  getting  much 
lai^er.  When  touched  roughly  with  a  towel  its  surface 
bled.  There  was  little  doubt  that  the  tumour  was  a  lym- 
phatic  nsBvus.  It  wss  freely  removed  with  the  knife  and 
about  fifteen  ve»els  required  pinching  or  ligature  ;  some 
of  these  were  compressed  and  others  tied  with  fine  silk 
and  the  edges  of  the  wound  brought  together  by  sutures. 
Mr.  Sutton  remarked  that  this  was  a  rare  species  of  tumour, 
the  usual  form  being  known  as  macroglossia ;  of  course, 
he  said,  ib  is  well  known  that  all  n»vi  of  the  tongue  as  of 
the  skin  contain  lymphatics,  but  in  some  of  these  tumours 
the  lymphatics  preponderate  over  the  hsemic  capillaries  and 
then  the  growth  is  called  a  lymphatic  nievus,  but  this 
condition  of  things  is  excessively  rare,  blood  vessels,  how- 
ever, were  nob  absent  in  the  one  just  removed  as  the 
exceedingly  free  bleeding  demonstrated.  The  cut 
surface  of  the  tumour  exhibited  a  structure  exactly 
resembling  that  of  a  corpus  cavemosum  or  spongiosum. 
Mr.  Sutton  further  stated  that  the  clinical  distinction 
between  a  nevus  and  a  lymphatic  naevus  of  the  tongue 
was  simple  as  the  former  was  deep  blue,  like  an  ordinary 
venous  navus  of  the  skin,  but  the  latter  was  colourless 
and  resembled  s  patch  of  xanthelasma. 

CHELSEA  HOSPITAL  FOR  WOMEN. 
Cholecystoioiit,— Mr.  Bland  Sutton  operated  on  a 
woman,  »t.  40,  who  had  been  admitted  with  acute  abdo- 
mmal  pain,  vomiting,  and  jaundice ;  she  was  very  fat, 
and  had  an  umbilical  hernia,  and  for  some  hours  it  was 
conjectured  that  the  bowol  was  strangulated  in  the  sac. 
When  he  saw  the  case  the  sac  was  soft,  and  its  contents 
easily  reducible,  and  this  disposed  of  the  idea  that  the 
hernia   was   strangulated.    The  jaundice  and  the  acute 
pain   which   the   patient  felt  in  the  region  of  the  gall 
bladder  made  him  think  that  gall-stones  were  the  source 
of  trouble.  An  enema  was  prescribed,  and  a  subcutaneous 
injection  to  relieve  the  pain.    The  patient  stated    that 
she  had  had  an  attack  three  months  previously,  and  ever 
since  felt  pain  just  below  the  right  costal  arch  ;  she  was 
watched  for  a  few  days,  and  Mr.  Sutton  came  to  the  con- 
dosion  that  she  had  gall-stones  impacted  in  the  cystic 
duct,  and  occasionally  that  the  stone  interfered  with  the 
passage  of  bile  from  the  hepatic  duct.    The  woman  was 
recommended  to  submit  to  operation.    The  gall  bladder 
wfts  exposed  by  a  longitudinal  indsion  in  the  right  linea 
semilunaris,  and  found  enlarged  and  its  walls  thickened  ; 
the  cystic  duct  contained  a  number  of  small  calculi.    The 
fandns  and  the  gall  bladder  was  incised,  and  the  calculi, 
manipulated  by  the  fingers,  were  conveyed  from  the  cystic 
duct  into  the  gall  bladder,  and  from  thence  extrscted  with 
a  eooop.    The  fundus  of  the  gall  bladder  was  sutured  to 
the  peritoneum,  and  the  incision  closed  in  triple  layers. 
Ur.  Sutton  said  the  interest  of  the  case  was  two-fold  :  In 
the  firBt  place,  the  diagnssis  that  the  calculi  were  lodged 


in  the  cystic  duct  was  confirmed ;  and  secondly,  the  oou' 
oretions  were  of  peculiar  shape  inasmuch  as  th^  were  the 
size  of  green  peas,  but  tuberculated  in  all  their  contour, 
like  mulberry  veshtal  calculi 

Forty^ight  hours  later  the  patient  was  absolutely  free 
from  pain  and  jaundice. 

ST.  THOMAS'S  HOSPITAL. 
Suprapubic  Cystotomy.— Mr.  Battli  operated  on  a 
man,  sBt.  72,  for  stone  in  the  bladder.    The  patient  had 
been  attending  as  out-patient  for  symptoms  of  enlarged 
prostate  with  cystitis  and  a  stone  had  been  discovered  on 
sounding.    The  symptoms  had  commenced  some  months 
before  but  had  recently  become  worse.    On  admission  he 
had  most  of  the  usual  signs  of  stone  but  without  hsemor- 
rhage ;  there  was  a  small  amount  of  pus  in  the  urine  and 
a  little  mucus.    As  there  could  be  no  doubt  of  the  pre* 
sence  of  a  stone  he  was  kept  in  bed  for  a  few  days  and  no 
instrument  passed.     His  symptoms  improved  and   his 
general  health  was  better  by  the  time  of  operation.  After 
the  administration  of  ether  a  lithotrite  was  passed,  the 
presence  of  the  stone  immediately  detected  and  its  size  at 
once  ascertained.  As  it  measured  more  than  an  inch-and-a 
half  it  was  decided  to  remove  it  by  the  high  operation  and  not 
by  lithotrity.  It  was  considered  that  the  crushing  bf  a  stone 
of  this  size  would  take  a  long  time,  and  in  a  patient  of  his 
age  this  would  be  a  serious  consideration,  and  besides  it 
was  not  possible  to  say  what  the  consistence  of  the  calculus 
might  be.    The  bladder  would  nob  hold  more  than  four 
ounces  of  .boracic  lotion,  and  although  the  rectal  bag  was 
introduced  this  did  not  cause  the  bladder  to  rise  more  than 
about  two  inches  above  the  pnbes.    A  median  incision  was 
employed  and  the  bladder  exposed  ;  the  fold  of  peritoneum 
came  low  down,  but  was  easily  pushed  upwards.    The 
surface  of  the  bladder  was  covered  by  a  network  of  vari* 
cose   veins   unusually  numerous.     Two  ligatures   were 
passed  through  the  wall  of  the  bladder  on  either  side  of  the 
middle  line  and  the  viscus  opened  between ;  a  large  stone 
was  immediately  felt  lying  behind  the  prostate,  and  it  was 
necessary  to  enlarge  the  opening  in  the  bladder  consider- 
ably before  it  could  be  extracted.    It  broke  in  two  parts 
during  extraction,  and  was  seen  to  consist  of  a  central 
nucleus  of  oxalate  of  lime  with  a  thick  coating  of  phos- 
phates.   It  measured  two  inches  in  its  longest  diameter, 
and  an  inch  and  a  half  across.    The  walls  of  the  bladder 
were  somewhat  hypertrophied,  and  the  mucous  membrane 
showed  signs  of  chronic  inflammation.    The  prostate  was 
hypertrophied,  but  there  was  no  special  projection  of  any 
one  part.    The  bladder  walls  were  stitohed  on  each  side 
to   the  skin ;    a  special  drainage   tube  (resembling  a 
tracheotomy   tube)  was   passed  to  the   bottom  of   the 
bladder,  and  the  upper  part  of  the  wound  closed  with  silk 
stitches.    A  dressing  of  cyanide  gauze  was  then  appliedr 
and  on  return  to  bed  a  long  tube  was  passed  into  the 
drainage  tube  already  in  position  to  carry  the  urine  into  » 
utensil  by  the  side  of  the  bed.    Mr.  Battle  remarked  thafr 
the  size  of  the  stone  and  the  hard  character  of  the  nucleus 
proved  that  its  removal  by  lithotrity  would  have  been 
somewhat  difficult  and  required  too  much  time ;  whereas  the 
the  operation  performed  took  about  half  an  hour,  the 
lithotrity  would  have  taken  an  hour  or  an  hour  and  a  half, 
and  the  advantage  of  drainage  to  the  bladder  would  have 
been  lost. 


The  deaths  from  diphtheria,  which  had  been  61,  63, 
and  45  in  the  preceding  3  weeks,  rose  again  last  w*^^ 
in  London  to  48,  exceeding  the  corrected  average  by 


244    The  Mbdioal  Pbefs. 


LEADING  ARTICLES. 


Mar.  4.  IW6. 


RMIimUP  ^E  Teaebmbmioe  AEE0A]>. 

^he  JRebird  ^rcBB  atib  (Eirrular. 

Publlaliad  •Toy  W«dnaidaj  morDlng,  Price  M.    Poat  fret,  5^6. 
ADVBSTISBMBXTt. 

VOB  OBB  iBBBEnOE :— Wbole  Paff«i  M  Oi.  Od. ;  Self  P»f  e,  Jt  ]0».  Od. 
Qvsrttr  Pife,  «1  Bf . ;  Ooe-di^tli,  lH.  6d. 

VOE  ▲  SBEIE8  ov  lB8BEnoE8 :— Whole  Paff«i  tblrteen  laseftloni 
(weekly,  forlnighllj,  or  monthly)  at  £8  IOl  Od. ;  twenty-elz  Inier- 
UoDi  (weekly  or  foitiilghtly)  et  £8  Si.  Od. ;  flfty-two  Inieitioiie 
(weekly)  et  £8  eaoh.  Helf-pege,  thirteen  Iniettloni  et  86i. ; 
twenty-ilz  et  Ml  ;  llfty-two  ineertfcmi  et  Mi.  eeoh.  Qotfter-pece, 
thirteen  Iniertlont  et  18i. ;  twenty-etz  InMrtloni  et  lOe. ;  llfty-eSz 
Iniertloni  et  Ifie.  eeoh 

dmsll  ADnovneementi  of  Prsctloet,  AMlitinclrt.  TertDcIf*.  Prrk 
*e.— Beven  Unee  or  under,  4i  per  tmertlon ;  ed.  per  line  beyond. 

Letters  In  thli  department  ihonld  be  addrened  to  the  Pntollaheri 
IVBSOBIPTIOMB. 

POR  PEBB  to  AEBVAL  SVB80EIBBE8  £110 

„  ABBOAD.WITHIB  THE  POflCALUjnOE        £116 

H  IBDIA,  CsniA,  ABD  JAPAB  .  .      £1    ft    6 

Poet-offioe  Orden  and  Cheqiiee  to  be  drawn  In  f  avonr  of— 

A.  A.  TIBDALL,  SO-21  Klnff  William  Street,  Stnmd,  London. 
A.  H.  JAOOB.  to  Molesworth  Street.  Dublin. 

BUBSOEiFnoBS  FOE  Pbabob  are  reoelTed  by  Memn.  BAn.LlBBE,  Bne 
HantefeuUle,  Parle— poet  free  In  advance,  £1  8a.  6d.  per  annum. 

SVBMEZPnoBS  FOE  THB  Uhitbd  STATES,  txMt  free  In  adTanee 
(£1  dM.  6d.  per  annum),  ihould  be  sent  direct  to  the  (MBcea  In 
thia  oountiy  by  International  Poet  Ottoe  Order. 

Sou  AgonU  fbr  €7«mMmy  and  AuHro-Hunffary-^ 
W.  A  S.  LoWBBTHAL(Ofloe  of  the  BorHmr  AdreM^uOi),  Qtunitraiae 
4,  Berlin. 


^t  ^tbml  ^tm  Sc  ^mn\wi. 


*SALUS  POPULI  SDPREXA  LEX." 


WEDNESDAY,  MARCH  4,  1896. 


DEVELOPMENTAL  HEART  DISEASE 
It  is  a  well-known  clinical  fact  that  certain  varieties 
of  heart  disease  are  associated  with  the  growth  of  the 
organism,  bat  the  pathology  of  the  subject  is  still 
characterised  by  a  vagueness  which  is  not  conducive  to 
the  success  of  therapeutical  measures.  It  is  evident 
that  rapid  growth  must  throw  an  extra  strain  on  the 
lieart  as  the  distributor  of  theelements  which  go  to  main- 
tain the  tissues  and  to  provide  the  materials  for  theirde- 
Telopment.  It  is  evidentthat  thepresence  of  congenital 
cardiac  lesions  interfering  with  the  distributive  function 
of  the  heart  necessarily  retards  growth,  and,  on  the 
other  hand,  a  heart  which  has  been  able  to  fulfil 
all  requirements  up  to  a  certain  point  may,  when  a 
sudden  strain  is  thrown  upon  it  by  the  supervention 
of  active  growth,  as  at  puberty,  develop  functional 
disturbances  and  bring  to  light  previously  unsuspected 
sources  of  cardiac  weakness.  During  these  periods 
of  rapid  growth  the  heart  undergoes  a  physiological 
increase  of  size,  which  might  be  called  hypertrophy 
were  it  not  for  the  fact  that  hypertrophy  is  a  term 
indicative  of  something  abnormal.  It  is  under  these 
circumstances  that  the  heart,  which  is  hereditarily 
prone  to  abnormal  or  irregular  development,  first  gives 
evidence  of  its  tendency.  Cardiac  defects  at  these 
periods  of  growth  may  arise  then,  either  from  develop- 


ment along  abnormal  lines  or  to  more  or  less  partial 
arrest  or  imperfection  of  development.  Organic 
murmurs  are  met  with  at  these  periods  with  toler- 
able frequency.  Rare  in  new-bom  and  suckling 
infants,  they  increase  in  frequency  with  the 
advance  of  age  up  to  the  fifteenth  year,  when 
for  a  time  they  undergo  a  diminution,  only  to  resume 
their  sway  at  the  twentieth  year  of  life,  lliey  are  met 
with  more  frequently  in  boys  than  in  girls,  and  seldom 
in  children  of  good  health.  This  liability  of  the  heart 
to  develop  latent  tendencies  at  particular  periods  is 
well  shown  in  the  lesions  associated  with  the  rheumatic 
diathesis.  It  is  essentially  during  the  periods  of  rapid 
growth  that  we  most  frequently  meet  with  evidence 
of  cardiac  mischief  of  the  kind  which  accompanies  or 
follows  rheumatic  manifestations  in  any  form.  One  of 
the  difficulties  of  the  subject  arises  from  the  fact  that 
the  growing  heart  is  peculiarly  liable  to  undergo  dila- 
tation under  comparatively  slight  provocation  and  also 
that  disturbances  of  cardiac  innervation  are  liable  to 
arise  from  reflex  or  other  adventitious  causes.  Prac- 
titioners are  familiar  with  phenomena  of  this  class  due 
to  undue  physical  exertion  during  adolescence  and 
other  disturbing  causes  are  the  early  use  of  tobacco 
and  disturbances  of  the  gastric  functions.  Then,  too, 
the  adolescent  heart  appears  to  be  peculiarly  suscep- 
tible to  the  influence  of  infective  agents,  and  the 
influence  of  these  agents  may  accentuate  and  make 
evident  inherent  weaknesses  of  structure.  The  compara- 
tive abundance  of  lymphoid  tissue  in  the  growing 
heart  renders  it  especiaUy  amenable  to  toxic 
influences  of  this  kind.  Considering  the  large 
number,  not  only  of  infectious  diseases  but  of 
infective  states,  to  which  a  child  is  exposed,  it  is 
evident  that  the  heart  must  be  frequently  attacked. 
Apart  from  rheumatism,  measles,  and  other  common 
febrile  complaints  of  infancy  and  adolescence,  the 
growing  child  is  subject  to  influenza,  acute  dyspepsia, 
febrile  attacks  with  swelling  of  the  lymphatic  and 
febrile  attacks  not  possessing  any  definite  characteris- 
tics. All  these  affections  are  determined  by,  or  at  any 
rate  associated  with,  toxic  or  infective  phenomena, 
capable,  under  particular  conditions,  of  exerting  an 
injurious  effect  on  the  heart  Many  of  these  distur- 
bances being  ephemeral,  often  escape  recognition  and 
when  discovered  may  excite  surprise  by  their  sudden 
disappearance.  The  disappearance  of  the  clinical 
signs,  however,  by  no  means  implies  that  the  heart  has 
resumed  an  absolutely  normal  state,  though  the  process 
of  growth,  as  all  clinical  observers  know,  favours  reco- 
very. Nevertheless,  these  disturbances  may  not  im- 
probably pave  the  way  to  subsequent  disease  of  that 
organ.  This,  as  Dr.  Springer  aptly  observes  in  a  recent 
article  in  La  Semaine  Mediccdey  is  not  merely  a  hypo- 
thesis, for,  as  he  points  out,  the  occurre  cce  of  an  attack 
of  endocarditis  after  an  infectious  disease  renders  the 
heart  more  prone  to  subsequent  infection.  All  children 
contract  infectious  diseases  but  all  do  not  develop 
heart  disease.  This  is  due  to  the  fact  that  the  lesion 
becomes  localised  in  an  organ  predisposed  to  it  by  here- 
ditary infiuence.  Under  these  circumstances  there  is 
a  tendency   to  fibroid  degeneration   which,   rarely 


Mab.  4,  1896. 


LEADING  ARTICLES. 


The  Mxdical  Pttxss.     245 


observed  in  new-born  infants,  becomes  more  frequent 
and  more  marked  as  the  period  of  growth  is  approached 
and  it  is  especially  towards  the  dose  of  the  period  of 
growth  that  they  supervene,  for,  in  proportion  as  the 
strain  of  growtii  loses  its  preponderance,  heredity 
resumes  its  sway. 

DR.  ARMSTRONG  AND  THE  TYNE  PORT 
SANITARY  AUTHORITY. 

At  the  end  of  last  January  the  Tyne  Port  Sanitary 
Authority  received  its  annual  report  under  circum- 
stances  that  demand  something    more   than   mere 
passing  comment    The  document  in   question   was 
drawn  up  by  Dr.  Armstrong,  although  his  resignation 
of  the  post  of  the  medical  ofilcership  had  been  pre- 
viously accepted  by  the  authority.    It  contains  a  sum- 
mary of  the  circumstances  that  led  up  to  his  with- 
drawal, and  is  probably  unique  in  the  history  of  official 
sanitary  reports,  as  it  contains  a  serious  indictment  of 
those  responsible  for  the  local  government  of  the  Tyne 
Port.    Opinions  will  doubtless  differ  as  to  the  entire 
wisdom   of  the   course  adopted   by   its   author  in 
availing    himself    of    the    accident  that  placed  so 
powerful  a  Parthian    weapon    in    his    hand?.     He 
may  be  reminded,  perhaps,  that  his  report   may  not 
only  fall  short  of  an  ultimate  position,  but  may  ev  n 
turn  out  to  be  many  times  removed  from  the  penulti- 
mate.   In  disputes  of  this  kind  the  exact  advent  of 
the  ^last  word"  very  much  depends  on  the  strength 
and  temper  of  the  opponents.    However,  in  this  parti- 
cular case  Dr.  Armstrong  appears  to  have  been  badly 
treated,  and  as  the  whole  affair  involves  principles  of 
importance  in  the  future  of  public  health  administra- 
tion it  may  be  well  to  review  briefly  the  leading  features 
and  bearings  of  this  Northern  casus  belli.    For  many 
years  past  Dr.  Armstrong  has  done  extremely  good  and 
progressive  sanitary  work  as  Medical  Officer  of  the 
town  of  Newcastle-on-Tyne.    To  that  post  he  united, 
Dftturally  enough,  as  it  will  seem  to  most  people,  the 
Medical  Officership  of  the  neigbouring  authority  of  the 
River  Tyne  Port.  The  latter  includes  Gateshead,  Tyne- 
mouth,South  Shields,  Jarrow,  and  an  area  that  may  be 
broadly  defined  as  comprising  the  seaboard,  river,  and 
river  banks,  at  and  about  the  mouth  of  the  Tyne.    It 
will  thus  be  seen  that  the  Tyne  Port  Authority  holds 
the  key  to  the  shipping  traffic  as  it  passes  on  its  way  to 
the  great  commercial  centre  of  Newcastle.    Some  idea 
of  the  extent  and  responsible  nature  of  the  duties  dis- 
charged by  the  down-river  Board  may  be  gathered 
from  the  Report  for  the  year  1895.    During  the  twelve 
months  in  question,  no  less  than  11,757  vessels  were 
inspected,  and  of  these   1,381  were  found  defective. 
The  total  number  on  board  the  11,757  inspected  vessels, 
including  crews,  passengers,  and  emigrants,  amounted 
to    173,782    persons.     520  vessels   were  boarded  on 
account    of    their    coming    either   directly    or   in- 
directly   from   foreign    ports  infected  with   cholera 
or  small -pox ;    while   a    further   239    came    from 
places    suspected    of    similar    infection.     Turning 
next    to    diseases    reported    on    shipboard   during 
voyage,  on  arrival,  or  whilst  in  the  River  Tyne  Port, 
during  the  year  1895,  we  find  9  cases  of  small-pox,  21  of 


cholera  (all  of  them  on  the  voyage) ;  143  of  diarrhoea, 
choleraic  diarrhoea,  and  suspicious  cases ;  12  of  enteric 
fever ;  17  of  malaria ;  38  ofyellow  fever  (all  on  voysge) ; 
and  27  of  fever  and  ague.    It  is  from  these  returns 
that  the  importance  of  the  preventive  work  done  at  the 
mouth  of  the  Tyne  will  be  mainly  apparent.    Tho 
arrest  of  cases  of  cholera  at  the  seaports,  whereby  they 
are  prevented  from  going  inland  to  act  as  centres  of 
infection,  is  now  recognised  to  be  a  preventive  step  of 
nothing  less  than  national  importance.     Indeed,  it 
may  be  asserted  without  fear  of  serious  contradiction 
that  had  no  other  function  than  that  of  cholera  pre- 
vention  been    performed    by   the    Port    Authority 
since    its     foundation,    that     work    alone     would 
have  fully  justified  its  existence.    Now,  the  whole  of 
the  excellent  system  of  inspection  and  control  of  the 
port  shipping  has  been  organised  and  administered  by 
Dr.  Armstrong,  who  some  years  since,  when  cholera 
raged  on  the  Continent,  rendered  important  service  to- 
the  nation  by  the  rigid  and  admirable  sanitary  cordon 
which  he  established  at  the  entrance  of  the  Newcastle 
waterway.  It  is,  therefore,  to  be  regretted  that  anything 
should  have  arisen  to  disturb  the  hitherto  harmonious 
relations  between  so  efficient  an  officer  and  his  board. 
The  circumstances  that  gave  rise  to  the  misunderstand' 
ing  may  be  thus  summarised  from  the  report  presented 
by  Dr.  Armstrong.    In  May  last,  during  his  tempor- 
ary   absence  from     home,    a    ship    arrived    with 
several  small-pox  cases  on  board.    After  inspection 
the   patients   were   removed    to  hospital,   and   the 
ship  disinfected.    Some  infected  bedclothes,  however, 
concealed  in  another  part  of  the  ship,  were  afterwards 
taken  on  shore  by  a  healthy  sailor,  and  were  alleged  to 
have  caused  three  cases  of  small-pox  in  Jarrow.    In 
the  absence  of  their  Medical  Officer,  the  authority  met 
and  passed  a  vote  of  censure  both  upon  him  and  his 
assistant ;  and  although  eventually  they  decided  to  let 
the  matter  drop  they  nevertheless  did  not  rescind  the 
adverse  vote.    Later  on  it  was  proposed  that  the  Port 
Medical  Officer  should  reside  at  the  mouth  of  the  river, 
a  motion  which  would,  if  carried,  practically  dismiss 
Dr.  Armstrong  from  the  post    At  that  point  the 
gentleman  in  question  decided  that  the  most  dignified 
course  would  be  to  send  in  his  resignation,  which  was 
accepted.     There  the  matter  stands.     The  incident 
furnishes  strong  proof  of  the  necessity  of  some  conti- 
nuity and  security  of  tenure  on  the  part  of  Medical 
Officers    of    HesJth.    A    public    board   notoriously 
has  no  conscience,  but  it   may  be  doubted  whether 
a    more    signal   instance   of   treachery    and   ingra- 
titude has  ever  been  laid  before  the  public.    In  most 
cases  of  the  kind  the  injured  medical  officer  has 
not  enjoyed  the  opportunity  which  chance  has  afforded 
Dr.  Armstrong  of  making  his  wrongs  known  to  the 
outside  world    One  other  point  to  which  attention 
may  be  drawn  is  the  feeble  attitude  of   the   Local 
Government  Board  in  the  matter.    As  usual,  the  local 
officer  has  been  left  to  fight  his  own  battles  alone  and 
unaided.    The  traditions  of  the  Department  seem  to 
insist  that  no  active  support  shall  be  given  to  any 
medical  officer,  however  just  his  cause,   in  the   en- 
deavour to  defend  his  position  against  a  hostile  board. 


240     Thb  Medical  Prb8-, 


LEAPIKCi  AKTJCLEP. 


Mar  4,  1896. 


TJDtil  the  Pablic  Sanitary  Service  can  reckon  upon  the 
help  of  the  Local  Oovernment  Board  in  all  joBt  and 
progressive  protests  there  can  be  little  prospect  of  any 
eolid  advances  in  the  local  sanitary  administration  of 
this  country. 


THE  ELECTION  OF  DIRECT    EEPRESENIA- 
TIVE  FOR  IRELAND. 

Thb  counting  of  the  votes  by  the  Branch  Council 
was  completed  on  Saturday  last,  when  it  was  ascer- 
certained  that  Mr.  Thomson  had  been  elected  Direct 
Representative  by  a  considerable  minority.  In  him 
the  profession  in  Dublin,  the  Conjoint  Colleges,  the 
Royal  University,  and  the  Queen's  Colleges  have 
secured  a  representative  to  whom  the  most  captious 
critic  could  not  offer  objection.  As  the  Vice-President 
of  the  College  of  Surgeons  and  a  Senator  of  the  Royal 
University,  Mr.  Thomson  brings  to  his  new  office  the 
dignity  appropriate  to  so  honourable  a  position.  Intel- 
lectually, and  by  his  long  experience  of  teaching  and 
examining,  and  public  professional  work  in  general,  he 
ought  to  take  his  position  as  one  of  the  most  useful 
and  capable  members  of  the  Medical  Council  in  educa- 
tional matters.  Mr.  Thomson  is,  also,  a  man  of  decided 
individuality,  and  unmistakably  vertebrate ;  he  is  a 
lucid  and  deliberate  speaker  and  a  skilled  writer,  and, 
on  the  whole,  it  must  be  said  that  the  Irish  colleges 
and  schools  could  not  have  sent  forward  a  better 
representative. 

The  contest  has  been  a  most  interesting  one,  and  the 
upshot  of  it  teaches  many  useful  lesssons.  The  first  is 
taught  by  the  record  of  the  number  of  voting  papers 
issued— 2,768— and  the  relative  number  of  papers 
returned— 2,078.  It  thus  appears  that  680  voters  did 
not  take  sufficient  interest  in  the  matter  to  induce  them 
to  attach  their  names  to  the  voting  paper  and  put 
it  into  the  post  (for  the  stamp  was  already  attached). 
Considering  that  five  candidates  have,  for  the  last  three 
months,  exhausted  their  energies  in  canvassing  the 
constituency  with  addresses,  circulars,  post-cards, 
telegrams,  and  personal  letters  of  importunity,  the 
existence  of  such  a  cataleptic  condition  in  one-fourth 
of  the  voters  is  amazing.  If  the  rank  and  file  of  the 
profession  in  Ireland  slumber  in  this  condition  of 
lethargy  about  their  other  public  affairs,  it  will  be 
readily  understood  why  they  occupy  the  humiliating 
public  position  which  they  do.  At  the  election  of  1886 
the  same  phenomenon  was  seen,  out  of  2,671  voters 
only  2,040  returned  their  papers.  The  number  of 
missing  votes  would  have  been  much  greater 
at  the  present  election,  but  for  an  agreement 
formally  entered  into  by  the  candidates  that 
they  would  not  raise  any  questions  as  to  the 
validity  of  papers  upon  which  irregularities  (such 
as  the  inaccurate  statement  of  qualifications)  might 
appear.  Such  irregularities  invalidated,  at  the  1886 
election,  160  votes ;  at  this  election  only  three. 

The  final  result  of  the  poll  was  declared  as  follows  :— 

Thomson     866 

Cuming      767 

Jacob         455 

Total     2,078 


In  analysing  these  figures  it  should  be  recollected 
that,  in  addition  to  the  candidates  named,  there  were 
originally  two  others,  Drs.  MacDonnell  and  Greene, 
who  declared  themselves  the  champions  of  the  pro- 
vincial practitioners  and  the  antagonists  of  metropoli- 
tanism.  Dr.  Cuming,  though  strictly  a  metropolitan, 
posed  also  as  the  representative  of  provincialism 
because  he  happened  to  live  in  Belfast.  After  a  time 
it  became  manifest  that,  with  three  so-called  pro- 
vincialists  in  the  field  all  must  inevitably  lose,  and 
some  gentleman  in  the  South  of  Ireland  undertook  to 
reduce  the  number  by  eliminating  two  of  the  three, 
for  which  purpose  they  proposed  a  preliminary  vote 
as  between  them.  Their  enterprise  did  not  succeed 
very  well,  for  out  of  the  2,700  voters  in  Ireland  they 
elicited  answers  from  only  685,  but  the  reply  sufficed 
to  show  that  Dr.  Cuming,  with  his  Queen's  College 
backing,  had  the  best  chance  of  success.  Wherefore, 
Drs.  MacDonnell  and  Qreene  retired,  and  their 
voters,  to  the  number  probably  of  about  500,  were 
ostensibly  set  free,  and  for  them  a  general  scramble 
ensued  amongst  the  three  remaining  candidates.  It 
was  assumed  that  the  great  majority  of  these,  being 
freed  from  their  original  promises,  would  exercise  an  un 
pledged  vote,  but  it  would  appear  from  the  result  that 
the  large  majority  of  them  felt  themselves  bound  to  vote 
for  Dr.  Cuming,  as  a  sort  of  provincialist,  and  they  did 
so  with  the  result  of  running  his  probable  poll  up  from 
500  to  727,  and  proportionately  running  down  to  455 
the  poll  of  Dr.  Jacob,  whose  chief  dependence  was  on 
the  Poor-law  vote.  Mr.  Thomson  being  sustained  by 
his  large  metropolitan  vote,  and  gaining  some  accession 
of  strength  from  this  unpledged  contingent,  beat  all 
candidates  out  of  the  field. 


The  final  lesson  to  be  learned  from  the  contest  is 
that  the  provincial  practitioners  of  Ireland  are  incap- 
able of  returning  a  Direct  Representative,  or,  indeed, 
effecting  any  other  substantial  change  in  their  own 
position*  not  because  they  are  not  strong  enough,  but 
because  they  are  absolutely  indifferent,  and  refuse 
to  exercise  their  strength.  We  confess  that  we  fail  to 
see  any  forcejin  the  cry  for  a  provincial  Direct  Repre- 
sentative, and  it  seems  reasonable  to  suppose  that 
association  with  the  leaders  of  thought  in  a  metropolis 
will  be  likely  to  produce  a  more  experienced  and  com- 
petent representative  than  residence  in  the  obscurity 
of  a  country  town.  Nevertheless,  it  seems  that  there  is  a 
substantial  feeling  in  favour  of  the  subject  on  the  part 
of  Irish  provincials  and  we  do  not  see  why  they  should 
not  gratify  that  sentiment  if  they  have  the  power. 
But,  if  they  have,  and  will  not  take  the  trouble  to 
avail  themselves  of  it  they  may,  without  pity,  remain 
out  in  the  cold.  On  this  occasion,  they  have  acted 
with  complete  want  of  sense.  They  were  warned,  and 
everyone  knew,  that  without  a  unanimity,  which  never 
previously  was  experienced,  they  could  not  place  their 
man  and  that  the  only  effect  of  their '  running  a  pro- 
vincialist would  be  to  secure  the  coveted  position  for 
some  one  with  a  strong  metropolitan  and  School- 
College  backing,  a  consummation  which  they  most 
dreaded. 


Mab-  4,  1896. 


NOTES  ON  CURRENT  TOPICS 


Tbm  Mbdigal  Pbbss.    .247 


One  more  aspect  of  this  contest  we  most  briefly 
•aUude  to,  and  that  is  the  wholesale  abandonment  of 
Dr.  Jacob  by  the  Poor-law  men  for  whom  he  has  spent 
a  quarter  of  a  century  of  his  life.  Mr.  Thomson,  Dr. 
Chiming,  and  every  other  person  who  aspires  to  medico- 
political  life  have,  by  this,  leiurned,  if  they  like  to  avail ! 
themselves  of  the  instruction,  that  the  less  time,  labour, 
and  self-interest  they  expend  upon  the  Poor-law 
Medical  Officers  of  Ireland  the  better  for  themselves. 
Should  they  try  to  deserve  the  approval  of  this  class 
in  a  public  contest  th^  will  find,  as  Dr.  Jacob  has 
^und,  opponents  started  to  keep  them  out  of  all 
positions  of  honour,  and  th^  will  see  many  who  ought 
to  recollect  past  services  quite  willing  to  throw  them 
over  because  they  are  asked  to  do  so  by  some  casual 
ju»)uaintance. 


^0tc0  on  €mxtnt  ^opitB. 

The  Malarial  Parasite. 
Malakial  affections  are  not  comprised  among  the 
diseases  with  which  the  British  practitioner  has  to  deal 
in  daily  practice,  but  we  have  a  sufficient  number  of 
colonies  and  dependencies  in  which  they  are  rampant, 
to  make  the  subject  worthy  of  our  serious  attention. 
This  was  doubtless  the  reason  why  the  subject  was 
selected  asone  of  theset  discussions  at  theRoyal  Medical 
and  Chirurgical  Society,  and  the  interest  taken  therein 
was  testified  to  by  the  fact  that  tlus  discussion  extended 
over  two  full  evenings,  the  second,  indeed,  of  unpre- 
cedented length.  We  are  fain  to  confess,  however, 
that  the  moot  points  appear  as  far  from  settlement  as 
before  this  prolix  discussion.  One's  confidence  in 
Laveran's  parasite  is  somewhat  disturbed  by  the  tele- 
gram announcing  Dr.  Lawrie's  disclidmer,  and  until 
the  validity  of  its  existence  has  been  cleared  up,  it 
seems  a  trifle  superfluous  to  go  into  details.  Before 
it  can  safely  be  affirmed  that  particular  varieties  of 
the  parasite  are  associated  with  particular  forms  of  the 
disease,  it  would  be  well  to  make  sure  that  any  one 
such  parasite  has  really  been  differentiated.  As 
might  be  expected,  a  large  number  of  the  retired  Indian 
Medical  Officers  inhabiting  the  Metropolis  had 
something  to  say  on  the  diagnosis  and  treat- 
ment of  malarial  disease,  but  they  were,  for  the 
most  part,  unnecessarily  reticent  on  the  biological 
questions  under  consideration.  What  we  want,  in 
order  to  decide  the  questions  at  issue,  is  direct  evi- 
dence, the  outcome  of  personal  observation  and 
research.  Instead  of  this,  we  were  treated  to  copious 
quotations  from  the  works  of  others,  some  of  whom 
affirm  one  thing  and  some  the  other.  Each  speaker 
chose  his  supporters  from  among  those  whose  views 
he  had  espoused,  and  we  are  left  in  a  state  of  confusion 
not  unusual  when  expert  evidence  is  pitted  against  itself. 
It  may  be  conceded  that  the  problems  are  of  exceeding 
and  peculiar  complexity,  but  this  dialectic  method  of 
dealing  with  matters  which  are  essentially  of  observa- 
tion only  tends  to  stultify  original  research  and  to 
confuse  the  points  at  issue.  On  the  whole,  assuming 
that  there  is  a  parasite  of  malaria,  and  that  it  has 


been  sufficiently  identified,  the  balance  of  evidence 
seems  to  be  in  favour  of  all  varieties  of  malaria  being 
modifications  of  one  and  the  same  disease,  the  viru- 
lence of  the  affection  in  particular  individuals  and 
places  being  attributable  to  personal  suisceptibility  or 
exceptionally  favourable  conditions  for  the  develop- 
ment of  the  parasite. 

Intra-Uterine  iDjections  of  Glycerine. 
It  is  now  upivards  of  tiiree  years  since  Dr.  Pelzer,  of 
Cologne,  first  called  the  attention  of  the  medical  pro- 
fession to  the  intra-uterine  injection  of  glycerine  for 
the  induction  of  labour  and  to  stimulate  uterine  con- 
tractions. The  publication  of  his  paper  on  this  subject 
with  five  illustrative  cases  in  the  CentrcUblatt  fur 
Gynecologies  was  followed  by  the  adoption  of  this 
alternative  means  of  inducing  labour  by  practitioners 
of  an  experimental  turn  of  mind  all  over  the  world. 
The  last  number  of  the  St  Lotus  Medical  Mirror 
contains  a  critical  review  of  the  recorded  cases  in  which 
this  method  has  been  tried,  and  the  conclusions  arrived 
at  are  sufficiently  clear  to  merit  notice.  It  seems  that 
glycerine  injections  sometimes  produce  very  violent 
uterine  contractions,  with  the  result  of  causing  a  high 
percentage  of  fcetal  mortality.  This  of  itself  is  an 
obvious  drawback  to  a  method  which  was  at  the  start 
hailed  as  a  *^  simple,  safe,  and  efficient  means  for  the 
induction  of  labour  and  the  stimulation  of  uterine 
contractions."  Of  33  cases  subsequently  reported  by 
Pelzer,  13  children  were  bom  dead  or  survived  but  a 
short  time,  and  Pelzer  himself  admits  that  the  injection 
of  quantities  varying  from  50  to  100  cubic  centimetres 
is  likely  to  determine  the  death  of  the  foetus.  On  the 
other  hand,  injections  of  less  than  50  cc.  are  often 
ineffectual,  and  injections  of  glycerine,  like  other  intra- 
uterine injections,  are  liable  to  be  followed  by  shock, 
air-embolism,  thrombosis,  nephritis,  and  sepsis.  More- 
over, they  sometimes  give  rise  to  glycerine  poisoning, 
manifested  by  decomposition  of  the  blood  corpuscles, 
resulting  in  diseases  of  various  organs,  more  especially 
nephritis,  with  hsemiglobinuria.  Our  contemporary 
concludes  that  the  use  of  intra-uterine  glycerine  injec- 
ions  should  be  abandoned,  or  at  any  rate,  that  the 
doses  should  be  reduced,  special  caution  being  indicated 
nthe  subjects  of  chronic  kidney  affections. 


Bacteria  in  Agriculture. 
In  times  gone  by,  as  everyone  knows,  science  has 
afforded  a  vast  deal  of  help  to  the  farmer.  It  may  be 
questioned,  however,  whether  the  fields  of  scientific 
agriculture  have  been  even  yet  fairly  entered  by  scien- 
tific investigation.  For  many  years  past,  the  pressing 
problem  has  been  how  to  obtain  the  nitrogen  from  the 
air  (or  elsewhere),  and  to  convey  it  to  the  soil  in  such 
a  way  as  to  be  available  for  the  growth  of  plants.  Bac- 
teriologists have  been  at  work  lately,  from  this  stand- 
point, in  the  investigation  of  the  nitrifying  organisms 
of  the  soil,  and  there  now  appears  to  be  a  good  prospect 
of  an  immediate  practical  result  from  their  labours.  It 
has  been  announced  in  Berlin,  before  the  German 
Agricultural  Society,  that  Herr  Notbe  has  succeeded 
in  cultivating  the  special  bacteria   mentioned  on  a 


248     The  Medipal  Prices. 


NOTES  ON  CURRENT  TOPICS. 


Mab.  4.  1896. 


large  scale.  He  ia  coovinced  that  the  aowiDg  of  these 
cultures  will  make  soils  which  need  them  more  pro- 
ductive in  a  cheaper  and  more  convenient  way  than 
the  method  of  inoculating  suitable  earth  invented 
some  time  ago.  The  expense  of  treating  a  Prussian 
morc/en,  about  half  an  English  acre,  by  the  bacterial 
method,  will  be  half-a-crown.  If  this  plan  prove  to 
be  of  practical  value,  it  will  offer  an  undoubted  boon 
to  agriculturists.  It  is  not  a  little  interesting  to  note 
the  extraordinary  crop  of  discoveries  and  developments 
that  are  being  daily  opened  up  to  the  various  arts  of 
mankind  by  the  comparatively  youthful  science  of 
bacteriology. 

Anti- Foreign  Medical  Movement  in  Paris. 

Some  months  since  the  strong  anti-foreign  feeling, 
which  has  of  late  years  grown  up  in  Paris  against 
foreign  medical  students  and  doctors  was  commented 
upon  in  these  columns.  That  there  has  been  no  abate- 
ment in  the  crusade  was  shown  by  a  recent  resolution 
of  the  Montpellier  students  to  the  effect  that  the  inva- 
sion of  foreigners  constituted  an  obstacle  to  their 
studies,  and  a  threat  for  the  future.  Dr.  Brouardd, 
Senior  Member  of  the  Medical  Faculty,  has  lately  made 
a  public  statement  of  his  views  upon  the  subject  of 
the  agitation.  The  chief  cause  he  at  once  traced  to 
the  want  of  room  in  the  schools  and  hospitals.  The 
accommodation  of  the  Paris  medical  schools  he  esti- 
mated as  sufficient  for  3,000,  but,  as  a  matter  of  fact, 
there  were  no  less  than  6,000  students,  of  whom  1,000 
were  foreigners.  In  order  to  lessen  the  pressure,  the 
Minister  of  Public  Instruction,  last  November,  issued 
a  decree  prohibiting  the  further  admission  of  strangers 
to  the  Paris  Medical  Faculty.  That  edict  had  the 
effect  of  driving  the  overflow  of  new-comers  to  the 
provincial  medical  faculties.  At  present,  one  doctor 
out  of  every  five  practising  in  France  was  an  alien  by 
birth.  Dr.  Brouardel  suggested  that  the  Minister  of 
Public  Instruction  should  create  a  new  and  special 
medical  diploma,  which  would  not  confer  the  right  to 
practise  in  France.  To  most  Englishmen,  this  attempt 
to  establish  protection  in  intellectual  matters  will  seem 
an  extremely  short-sighted  policy.  The  coming  London 
University  could  not  fail  to  benefit  greatly  from  the 
jealous  exclusion  of  so  many  enterprising  students. 

A  Milkman's  Oversight. 
The  intermittent  or  rather  the  remittent  prosecution 
of  fraudulent  milk  vendors  forms  a  staple  feature  of 
police-court  proceedings  in  most  of  our  large  towop. 
In  no  class  of  cases,  probably,  is  there  a  greater 
assumption  of  injured  innocence  and  a  more  copious 
fertility  of  excuse  than  among  these  humble  but  neces- 
sary tradesmen.  A  good  example  of  both  phases  was 
produced  last  week  before  a  metropolitan  magistrate. 
The  evidence  showed  that  a  Knightsbridge  cowkeeper 
purveyed  milk  from  which  no  less  than  three-fifths  of 
the  cream  had  been  abstracted.  In  defence,  the 
ingenuous  milkman  stated  that  he  sold  the  milk  as  it 
was  taken  from  his  own  cows.  He  was  of  opinion, 
however,  that  he  had  not  stirred  it  up  properly,  so  that 
some  of  the  customers  got  the  top  layer,  which  con- 


tained the  cream,  and  unfortunately  the  inspector  had 
been  supplied  with  thin  milk  from  the  bottom  of  the 
can.  This  explanation  did  not  satisfy  the  bench  as  to* 
the  three-fifths  deficiency  of  cream,  and  defendant  was- 
fined  438.  There  is  a  large  field  for  local  authorities  in 
preserving  the  purity  of  this  important  article  of 
popular  consumption.  To  look  after  the  milk  is  a- 
simple,  straightforward,  and  serviceable  duty,  more  to 
be  desired  than  prosecutions  for  the  coppering  of  peas 
and  suchlike debateable  and  transcendental  proceed- 
ings. 


The  Notifloation  of  Diseases  Act  and  its 

Adoption. 
M  R.  Chaplin,  in  the  House  of  Commons  last  week, 
quoted  some  interesting  figures  in  regard  to  the  adop- 
tion of  the  Notification  of  Diseases  Act  The  Act  it 
appears  is  now  in  force,  in  districts  containing  an 
aggregate .  population  of  27,220,000,  out  of  a  total 
population  of  29,000,000.  The  question  of  making  the 
Act  of  1889  compulsory  has  been  under  the  considera^ 
tion  of  the  Local  (Government  Board,  but  the  conclusion 
arrived  at  by  the  Board  is  that  the  Act  is  more  likely 
to  be  enforced  when  it  is  voluntarily  adopted  by  the 
local  authority  than  if  it  were  made  applicable  to  a 
district  without  the  concurrence  of  the  local  authority. 
Inquiry  shows  that  at  the  end  of  last  year  there  were- 
202  urban  and  94  rural  districts  in  which  the  Act  is 
not  yet  in  operation.  The  Board  therefore  intends  to 
communicate  with  the  local  authorities  in  these 
districts  with  a  view  to  bringing  pressure  to  bear  in 
order  that  the  adoption  of  the  Act  should  be  carried 
out.  Probably  few  of  our  readers  could  have  had  any^ 
knowledge  of  the  remarkable  progress  which  the  Act 
has  made  throughout  the  country  as  a  voluntary 
measure. 

The  Unpopularity  of  the  Army  Medical 
Service. 

If  further  evidence  were  wanted  to  show  the  unpopu- 
larity of  the  Army  Medical  Service,  it  is  to  be  obtained 
from  the  results  of  the  last  competitive  examination  to 
fill  the  vacancies  for  the  same ;  and  in  passing,  we  may 
remark  that  the  War  Office  would  do  well  to  read«  mark, 
and  seriously  reflect  upon  these  results.  Sixteen 
vacancies  were  declared,  for  which  only  seventeen  can- 
didates competed.  But  out  of  these  seventeen,  no  more 
than  nine  were  reported  by  the  examiners  to  have 
obtained  the  requisite  number  of  qualifying  marks.  The 
inference  to  be  drawn  from  these  facts  is  self-evident. 
Clearly,  the  Service  has  ceased  to  have  any  attraction 
for  the  bulk  of  the  higher  class  of  young  practitioners- 
who  might  otherwise  be  induced  to  compete.  What  the 
ending  of  this  dearth  of  candidates  will  be  cui  be  easily 
foreseen.  The  War  Office  will  ere  long  find  themselves  ia 
a  difficulty  which,  unless  some  steps  be  taken  to  remedy 
it,  will  only  increase  with  time,  As  we  have,  however^ 
repeatedly  pointed  out,  the  matter  is  one  which  does 
not  rest  alone  with  the  War  Office  officials.  It  is  one 
in  which  the  British  taxpayer  is  intimately  concerned. 
The  country  pays  for  the  Army,  and  has  a  right  to 
demand  that  that  Army  for  which  it  makes  provision 


Mail  4,  1896. 


NOTES  ON  CUKRENT  TOPICS. 


Tbb  MiDiOAL  Pbub.    249 


tfhall  be  as  efficient  as  poeaible.  Indnded  in  that  Army 
ii  tiie  Medical  Department ;  but  if  those  in  military 
aathority,  by  petty  jealonaee,  or  puerile  regolations, 
fender  the  Medical  Service  nnpopolar  to  those  who 
woidd  otherwise  join  it,  it  is  for  the  public 
to  insist  that  all  such  internecine  absurdities 
shall  cease,  and  steps  be  taken  to  attract  medi- 
cal men  to  the  Service  whose  competency  would 
be  a  guarantee  that  the  efficiency  of  the  Department 
was  being  maintained.  The  dearth  of  officers  and  the 
nmnber  of  unfilled  vacancies  is  becoming  a  serious 
matter.  We  wonder  that  no  member  of  the  House  of 
Oommons  has  not  already  drawn  attention  to  it  We 
should  like  to  see  the  following  suggestions  incorpor- 
ated into  a  question  put  to  the  Secretary  of  State  for 
War :— ^^  Having  regard  to  the  clear  evidence  which 
^eiists  of  the  unpopularity  of  the  Army  Medical  Service 
among  young  medical  men,  it  is  imperative  that  some 
public  inquiry  be  made  respecting  the  causes  of  that 
unpopularity,  and  that  steps  be  taken  immediately  to 
remedy  the  existing  unsatisfactory  state  of  things." 


Multiple  Tnmotirs  of  the  Oerebrum. 
A  SPECIMSN  of  considerable  interest  was  recently 
shown  at  a  meeting  of  the  New  York  FathologiciJ 
^Society.  It  was  that  of  the  brain  of  a  littie  girl  who 
had  previously  to  her  death  suffered  from  some  obscure 
nerve  lesion.  The  history  was  that  after  a  protracted 
attack  of  diarrhoea  the  chUd  passed  into  a  condition  of 
dull  coneeiousness,  and  finally  became  cataleptic.  The 
<miy  symptom  present  of  cranial  paralysis  was  the 
absence  of  pupiUary  reaction  to  light  and  accommoda- 
tion, and  the  diagnosis  arrived  at  was  that  of  a  tumour 
probably  of  the  basal  ganglia.  There  was  no  enlarge 
ment  of  the  head,  no  optic  neuritis,  nor  any  sign  to 
indicate  distension  of  the  ventricles.  Finally  the  child 
^ed,  apparenUy  from  inanition.  At  the  post-mortem 
examination,  on  the  basal  surface  of  the  left  cerebellar 
bbe  a  small,  whitish  tumour  was  found,  apparentiy 
-connected  only  with  the  pia  mater.  It  was  also  found 
that  the  head  of  the  caudate  nucleus  on  the  right  side 
was  the  seat  of  a  similar  new  growth.  A  third  new 
growth,  and  the  one  which  had  prodaced  the  sym* 
ptoms,  was  found  to  involve  the  anterior  and  posterior 
^luadrigeminal  bodies.  No  mention  is  made  in  the 
report  of  the  microscopical  appearances  of  the  growths, 
4xmsequentiy  their  exact  nature  is  a  matter  of  specula- 
tion. A  point  worthy  of  special  note  is  the  absence  of 
jmy  marked  clinical  features  indicative  of  the  serious 
nature  of  the  lesions  which  were  present. 


Syphilis  ftom  an  Insuranoe  Point  of  View. 
The  question  of  syphilis  in  relation  to  life  insurance 
is  an  important  one,  and  it  is  doubtless  the  case  that  not 
41  littie  divergence  of  opinion  prevails  upon  the  subject. 
The  remarks,  therefore,  of  Dr.  MacLaren,  in  the  March 
number  of  the  Edinburgh  Medical  JoumcU,  in  this 
connection  are  opportune.  The  author  classifies,  for 
insurance  purposes,  all  syphilitics  under  the  three  fol- 
lowing groups :— 1.  If  a  man  has  been  properly  treated, 
the  probabiUties  are,  that  provided  he  is  of  good  consti- 
tution  and  habits,  that  no  complications  will  arise,  and 


the  expectation  would  be  that  he  will  go  through  life 
with  scarcely  more  appredable  risk  than  one  who  hays 
never  had  tiie  disease.  2.  If  the  proposer  has  not 
undergone  a  sufficient  course  of  treatment,  and  applies 
for  insurance  before  the  expiration  of  six  years,  and  yet 
is  not  suffering  from  any  tertiary  manifestations, 
and  is  otherwise  satisfactory,  the  chances  are  that  he 
may  escape  the  malignant  form,  but  a  10  per  cent  extra 
should  be  charged  until  the  expiration  of  the  six  years, 
and  then  his  case  should  be  reconsidered.  3.  When 
tertiary  symptoms  have  developed,  the  proposal  should 
be  absolutely  declined,  because,  while  treatment  may 
temporarily  remove  these,  it  cannot  eradicate  the  ten- 
dency to  recurrence ;  and  clinical  observation  has  shown 
that  those  so  affected  rarely  live  beyond  a  term  of  ten 
years,  and  often  much  less  when  palliative  treatment  is 
wanting.  In  view  of  these  pronounced  statements,  we 
should  be  glad  to  hear  the  opinions  of  other  medical 
officers  attached  to  insurance  companies,  and  to  learn 
to  what  extent  their  practice  coincides  with  that  which 
Dr.  MacLarenjadopts. 

The  Latest  Experimental  BesearcheB  with 
fileotrioity  on  Diphtheritio  Bacilli 
Habdlt  has  the  wonderful  discovery  of  Professor 
Bontgen  been  made  known  and  commenced  to  give 
satisfactory  results,  than  another  and  perhaps  still  more 
important  discovery  is  announced  to  the  scientific 
world.  Oar  French  Ck>rrespondent  informs  us  that 
M.  S.  Arsonval,  Professor  at  the  (College  de  France, 
has  iust  presented  to  the  Acad^mie  des  Sciences  the 
results  of  his  experiments  on  the  action  of  electricity 
on  microbes.  Passing  an  electric  current  producing 
two-hundred  and  twenty-five  thousand  oscillations  per 
second,  through  a  glass  tube  containing  the  microbe  of 
diphtheria,  he  found  that,  at  the  end  of  a  very  short 
time,  the  secretion  of  the  microbes,  which  before  the 
operation  had  been  mortal,  had  completely  lost  their 
virulence.  On  the  other  hand,  and  this  is  the  impor- 
tant point,  the  current  had  not  completely  destroyed 
the  toxines,  but  had  transformed  them  into  vaccine.  In 
this  way,  M.  S.  Arsonval  was  able  to  render  immune 
from  diphtheria  about  thirty  guinea  pigs,  inocula- 
ting them  with  the  liquid.  According  to  the  Professor, 
these  electric  currents  contraverse  the  organism 
without  producing  any  morbid  effect,  that  is  to  say, 
while  currents  producing  only  one-hundred  and 
fifty  thousand  oscillations  per  second  kill  instantly, 
those  of  the  velocity  employed  by  M.  S.  Arsonval  are 
abeolutely  harmless.  Consequentiy  it  is  possible  to 
treat  directiy  certain  bacterial  affections  by  this  method, 
and  experiments  are  being  made  in  this  direction  on 
guinea  pigs  which  are  yielding  very  satisfactory 
results. 


A  DBPUTATiON  of  the  Medical  Faculty  of  Wiirzburg 
University,  of  which  Dr.  Bontgen,  the  discoverer  of 
the  new  i^otography,  is  a  Professor,  presented  him 
last  week  with  a  diploma  conferring  on  him  the  titie  of 
Doctor  of  Medicine,  an  honour  granted  unanimousl 
by  the  Faculty. 


250    The  MiDiGi.L  Pbbbs. 


NOTES  ON  CURRENT  TOPICS. 


Mar.  4,  18M. 


Biqyole-Riding  and  Uretliral  Troubles. 
**  BiCYCLB-BiDiNo,''  flajB  an  American  miTgeony  **  with 
the  oommon  saddle,'  such  as  is  sold  with  most  machines, 
causes  disease  of  the  prostate  and  orethnk,  the  severitsr 
of' which  is  in  proportion  to  the  amount  ridden  and 
the  relation  of  tiie  buttocks  and  perineum  of  tiie  rider 
to  the  saddle/'  The  subject  is  one,  the  author  states, 
to  which  he  has  paid  a  large  amount  of  attention, 
having  been  led  to  do  so  by  the  number  of  patients 
presenting  themselves  with  prostatic  and  urethral 
irritability,  who  denied  a  venereal  history.  The  chief 
symptoms  were  fiequency  of  micturition,  with  some 
dysuria,  and  endoscopic  examination  of  the  prostatic 
urethra  showed  a  swollen,  velvety,  and  a  sensitive-to- 
pressure  condition  of  the  mucous  membrane.  In  short 
there  was  present  a  parenchymatous  prostatitis  together 
with  granular  urethritis.  The  cause  of  these  conditions 
was  traced  by  the  author  to  &ulty-made  saddles 
by  which  the  whole  weight  of  the  patients'  bodies 
were  made  to  rest  upon  the  perineum,  instead  of  upon 
their  buttocks.  Hence,  when  the  bicycle-riding  was 
indulged  in  to  excess  the  trouble  resulting  therefrom 
was  not  long  in  developing.  In  all  cases  the  author 
interdicted  the  use  of  the  bicycle,  and  then  the 
symptoms  quickly  began  to  subside.  Inasmuch  a^ 
prostatitis  is  of  very  uncommon  occurrence,  save  when 
caused  by  gonorrhoea,  the  point  raised  by  the  author  is 
of  some  interest.  There  are  reasons,  however,  for 
doubting  whether,  at  all  events  in  this  country,  medical 
men  have  been  called  upon  to  treat  cases  of  prostatitis 
the  origin  of  which  could  be  distinctly  traced  to  riding 
a  bicycle.  •  Manufacturers  have  paid  so  much  detailed 
attention  to  perfecting  the  saddles  of  the  machines 
that  an  iU-fitting  saddle  must  now  be  almost  a  thing 
of  the  past.  Nevertheless,  it  is  well  to  bear  in  mind 
that  harm  of  the  kind  to  which  the  author  draws  atten- 
tion has  been  observed. 

How  to  Sterilise  Cotton. 
A  RATHEB  ingenious  plan  for  sterilising  cotton  is 
referred  to  in  a  French  contemporary.  A  piece  of 
cotton  is  taken,  twisted  on  a  stick  or  a  piece  of  wood, 
and  dipped  into  a  saturated  alcoholic  solution  of 
boracic  acid  for  a  moment  or  so.  It  is  then  withdrawn 
from  the  solution,  and  a  light  is  applied  to  it,  as  the 
result  of  which  the  alcohol  bums  out,  while  the  boracic 
acid  prevents  the  cotton  from  buming.  Five  seconds 
are  enough ;  as  soon  as  the  flame  turns  green  it  is 
extinguished.  The  cotton  remains  white,  dry,  warm, 
but  absolutely  sterilised. 


A  New  Material  for  Skin-Grafting^. 
Thk  di£Bculty  which  is  sometimes  experienced  in 
obtaining  skin  grafts  to  unite  is  apt  to  interfere  to  a 
considerable  extent  with  the  ultimate  success  of  a 
case,  and  this  despite  every  care  and  the  method  which 
may  be  adopted.  It  is,  however,  worthy  of  mention 
that  an  American  surgeon.  Dr.  Z.  J.  Lusk,  has  sug- 
gested a  new  and  original  method  of  obtaining 
material  for  skin-grafting.  Having  recently  to  treat  a 
man  with  an  unusually  extensive  bum,  the  result  of  a 
fall  into  a  vat  of  boiling  brine,  the  plan  suggested 


itself  of  using  some  of  the  exfoliated  epidemus  from  the 
vencles.  A  piece  one  inch  square  was  softened  and 
sterilised  in  warm  boric  acid  solution^  and  divided  into 
twelve  grafts.  Seven  of  these  grew  rapidly.  The 
process  was  continued,  and  at  the  end  of  six  weeks  the 
very  large  surface  had  become  completely  covered  with 
soft,  firm  skin.  The  same  process  was  successfully 
applied  to  the  treatment  of  an  old  varicose  ulcer,  the 
skin  being  obtained  by  raising  a  blister  on  the  patient 
This  method  seems  simple  enough,  and  evidently  pro- 
mises to  be  useful  in  practice. 

The  Nauheim  Treatment  at  Bath. 
Any  enterprise  which  is  destined  to  improve  and 
add  to  the  attractions  of  the  English  spas,  so  that 
English  invalids  may  be  prevailed  upon  to  patronise 
them  instead  of  going  abroad,  is  worthy  of  commenda- 
tion. We  notice  in  this  connection  that  the  Nauheim 
treatment  has  been  introduced  into  the  Queen's  Bath 
at  Bath,  and  despite  the  fact  that  the  appliances  have 
only  been  in  use  for  a  few  months,  already  a  thousand 
baths  have  been  administered.  It  may  be  mentioned 
that  the  Nauheim  treatment,  or  "  Thermalsoolbad,'' 
consists  mainly  in  the  use  of  a  highly  carbonised  hot 
brine  bath,  by  which  sufferers  from  cardiac  aiEsetione 
are  greatly  benefited.  It  is  only  just  to  say  that  for  this 
new  devabpment  in  the  application  of  the  Bath  waters 
the  town  is  indebted  to  Mr.  Alderman  H.  W.  Freeman, 
Surgeon  to  the  Royal  United  Hospital  at  Bath. 


The  Cardiff  Quack  Proseoution. 
Wb  learn  that  the  excellent  "Stipendiary"  who 
adyudicated  in  the  case  of  "  Dr."  Bridgwater,  M.D., 
U.S. A.,  has  refused  to  grant  a  case  for  a  higher  court,  on 
the  ground  that  the  qaestions  involved  were  those  of 
fact,  and  not  of  law.  As  a  corollary  to  this  remarkable 
judgment,  it  is  stated  that  **  Dr.**  Bridgwater,  M.D., 
U.S.A.,  has  threatened  to  take  proceedings  against  the 
medical  man  who  laid  the  information  in  the  case,  with 
a  view  to  recovering  damages  in  respect  of  the  proseca 
tion.  What  has  the  Medical  Defence  Union  to  say  to 
this  new  development  1 

An  Action  for  Libel  against  the  British 
Medical  Journal. 

A  CASB  of  unusual  interest  to  medical  men  generally 
was  tried  at  the  Manchester  Assizes  on  Saturday  last, 
A  medical  practitioner  residing  in  Blackpool  is  con- 
nected, but  without  payment  on  either  side,  with  two 
hydropathic  establishments  in  that  town.  His  name 
appears  on  large  plates  at  the  entrances  and  on  ths 
tariff  bilk.  These  facts  were  submitted  to  the  editor 
of  our  contemporary,  the  British  Medical  Journal^  for 
comment  and  an  expression  of  opinion  with  respect  to 
the  ethical  aspect  of  the  case.  The  view  given  was  that 
the  exhibition  of  the  plates  was  wholly  incom- 
patible with  the  honour  and  dignity  of  the  profession 
This  was  the  libel  complained  of.  For  the  plain- 
tiff, Drs.  Renaud,  Collins,  and  David  Little  gave 
evidence  to  the  effect  that  no  ethical  rule  had  been 
broken.  While  for  the  defendant,  Sir  Dyce  Dude- 
worth— whose  testimony  was  wholly  discounted  by  hie 


Mab.  4,  1896. 


SCOTLAND. 


The  Medical  Pbess.     251 


admission  that  his  name,  tiie  hospital  with  which  he 
was  connected,  and  his  private  address  appeared  in  an 
Insurance  prospectus  widely  circulated,  and  placed  in 
numbers  upon  public  counters— Dr.  Ward  Cousins 
and  Dr.  Bateman  stated  that  Dr.  Einsbury  had  broken 
an  unwritten  law  of  the  profession.  The  judgej  in 
summing  up,  apparently  regarded  the  statement  of 
which  complaint  was  made  as  one  of  fair  comment. 
But  the  jury  were  asked  to  consider  whether  there  had 
been  misstatement  and  comment  which  was  unfair. 
They  arrived  at  the  latter  conclusion,  and  awarded  the 
plaintifT  £150  damages.  In  reviewing  the  evidence 
and  the  facts  of  the  case,  it  appears  to  us  that  the 
matter  resolved  itself  into  one  of  whether  complaint 
had  or  had  not  been  made  by  the  local  practitioner^ 
against  their  confrh'e.  The  British  Medical  Joitmal 
said  that  the  practitioners  had  complained,  and  this  is 
bcNme  out  by  the  fact  that  the  editor  was  asked  to 
express  his  opinion  on  the  case.  But  at  the  trial  it  was 
apparently  impossible  to  obtain  any  evidence  in 
support  of  this  statement  from  the  other  practitioners 
in  Blackpool,  from  which  we  are  led  to  the  conclusion 
that  at  the  last  moment  they  left  the  editor  of  our  con- 
temporary in  the  lurch. 

A  Sensational  Case  in  Vienna. 
Some  of  our  lay  contemporaries  have  been  exercising 
their  minds  with  respect  to  a  supposed  wonderful 
operation  performed  in  one  of  the  Vienna  hospitals. 
The  report  is  to  the  effect  that  a  young  man,  aged  19, 
suffered  from  some  abdominal  enlargement,  for  which 
it  was  deemed  necessary  to  perform  laparotomy.  When 
the  abdomen  was  opened,  **  the  professor  found  between 
the  spine  and  the  intestines  the  undeveloped  form  of 
a  child  without  a  head."  Such  is  the  announcement  of 
which  so  much  has  been  made.  The  tumour  was 
removed  but  the  patient  succumbed.  It  is,  we  sup- 
pose, scarcely  necessary,  to  observe  further  than  to  say 
that  there  is  nothing  remarkable  about  this  case.  The 
tumour,  was  so  far  as  can  be  gathered  from  the  reports, 
flimply  a  dermoid  cyst,  the  contents  of  which  are 
always  various. 


Bbbidemts  in  Johannesburg  are  suffering  from  an 
epidemic  of  typhoid  and  dysentery  of  a  most  serious 
character.  Dr.  Yissor,  the  health  officer,  states  that 
never  in  his  experience  has  there  been  so  much  typhoid 
in  the  town  as  at  the  present  moment  The  hospital  is 
overcrowded  with  zymotic  cases,  and  160  extra  beds 
are  wanted.  The  outbreak,  it  is  alleged,  is  due  to 
impure  water,  owing  to  the  prolonged  drought,  and 
also  to  bad  milk. 


^COtlintll. 


[TBOM  ova  owv  ooaaaapoNDEiiT.] 

Dbaxb  or  A  LvKAOT  OoMMissiGiixR  — The  death  of  Br. 
Robert  LawaoD,  one  of  the  Deputy-CommitsiODers  in 
Lanaoy,  took  place  in  Edinburgh  last  week.  Dr.  Lawson, 
about  a  year  aeo,  obtained  leave  of  abeenoe  from  the  Board 
OD  aoooont  of  01  health,  and  his  decease  was  caused  by  an 


a£feetion  of  the  heart.  A  native  of  Ktrriemnir,  Dr.  Lawson 
went  to  Edinburgh  to  study  medioine,  taking  his  degree 
of  M.B.,G.M.,  in  1871,  and  M.IX,  in.  1888.  In  1874,  he 
was  an  assistant  in  West  Biding  Asylum,  Yorkshire,  and 
before  bis  appointment  ae.aCommisnoner  in  .1878,  he  was 
superintendwit  of  Wonfdrd  House,  a  rmstered  itsylum  in 
Devonshire.  During  bis  long  term  of  service  with  the 
Lunacy  Board,  Dr.  Lawson  had  wide  literary  tastes,  and 
was  the  author  of  numerous  contributions  to  medical 
journals.  He  was  a  warm  supporter  of  the  system  of 
boarding  suitable  patients  in  private  dwellings. 

Glasgow  Obstxtrigal  akd  GvNiEOOLOOioAL  Soonerv. — 
An  address  entitled  *' Historical  Sketch  of  Gvnecolofi^ 
durinff  the  last  50  years  "  was  delivered  by  the  Hon.  Presi- 
dent, Sir  John  Williams,  Bart.,  London,  on  Wednesday, 
to  the  Sodety,  in  the  Faculty  Hall,  St.  Vincent  Street, 
Glasgow.  A  lan^  number  of  the  Fellows  and  Medical 
Practitioners  of  Glasgow  and  surrounding  neighbourhood 
werepreeent.  The  £ldress  was  an  admirabfe  one,  and 
was  thoroughly  appreciated  by  the  audience,  after  which 
a  complimentary  amner  was  eiven  to  the  Hon.  President, 
and  during  the  toasts,  old  reminiBoenoes  were  revived  which 
made  **  the  old  men  "  feel  young  again.  The  chairman 
reminded  the  members  that  the  guest  (Sir  John)  had  onoe 
been  a  student  in  the  "old  Ck>l^^''  in  the  High  Street, 
and  on  the  banks  of  the  classic  Molenduiar,  **8ic  transit 
gloria  mwidi,*' 

Thb  Fifth  Ykab  of  Study.— At  a  meeting  of  the 
Students'  Bepreeentative  Council  held  last  week  a  con- 
siderable amount  of  important  business  was  got  through, 
amongst  which  the  report  of  the  delegates  who  represented 
Glasgow  in  the  Inter-University  Conference  was  considered. 
Thereat  it  was  unanimously  adopted  that  the  Students' 
Representative  Council  should  petition  the  General  Medical 
Council  so  as  to  arrange  that  the  fifth  year  of  medical  study 
<  should  be  exclusively  devoted  to  cdinical  work.  It  is 
'  well  known  that  the  University  Commissioner,  in  inoreas- 
i  ing  the  number  of  years  of  medical  study,  intended  the 
;  additional  year  to  be  devoted  to  practical  work.  It 
appears,  however,  that  their  object  is  likely  to  be  defeated 
in  practice,  unless  effect  is  given  to  the  reforms  which  the 
new  ordinances  were  designed  to  accomplish. 

Bdikbubgh  Univxbsitt  Bioiobship.— We  understand 
that  Lord  Balfour  of  Burleigh,  the  Secretary  of  State  for 
Scotland,  will  be  the  Unionist  nominee  for  the  Rectorship 
in  the  University  of  Edinburgh,  and  Mr.  Haldane,  M.P. 
for  East  Lothian,  the  Liberal  candidate. 

Th*  Mobison  LBcruBXS,  Edinbubgh.— Dr.  Alexander 
Bruoe  has  delivered  the  course  of  six  lectures  for  which 
provision  was  made  by  the  Morison  bequest,  taking  as  his 
subject  the  minute  anatomy  of  the  central  nervous  sys- 
tem. The  lectures  were  lavishly  illustrated  by  lime-l^^bt 
views,  and  proved  a  source  of  instruction  and  enjoyment 
to  the  large  audiences  attracted  by  the  lecturer's  well- 
known  acquaintance  with  this  difficult  subject. 

Eddibubgh  Royal  Ihfibmaby.— At  a  meeting  of  the 
Medical  and  Surgical  Staff  of  the  Edinburgh  Royal 
Infirmary,  held  lait  week,  it  was  unanimously  agreed  to 
hold  two  statutory  meetings  during  the  year  to  discuss 
any  point  arising  which  might  affect  the  staff  of  the  hos- 

S'tal.    The  meetings  are  to  be  held  early  in  May  and 
ovember. 

Thb  Latb  Db.  Andebsok,  of  DuNDBB.--We  are  sorry  to 
have  to  report  the  death  of  Dr.  A.  M.  Anderson,  who  held 
the  post  of  Medical  Offioer  of  Health  for  Dundee  from 
1882  until  last  year,  when  he  resigned  owing  to  failing 
health.  Dr.  Anderson  graduated  in  Glasgow  in  1864,  and 
became  a  Licentiate  of  the  Royal  College  of  Surgeons, 
Edinburgh,  in  the  same  year.  During  the  oourse  of  a 
busy  life  he  filled  the  posts,  in  addition  to  the  one  noted 
above,  of  Superintendent  of  the  Fever  House  in  the  Town's 
Hospital,  Glasgow,  and  Superintendent  of  the  Royal 
Infirmary  and  King's  Cross  Fever  Hospital,  Dundee.  A 
few  years  ago  he  published  wme  remarkably  suooeesful 
results  obtained  in  the  treatment  of  typhoid  fever,  by 
means  of  large  doses  of  saloL 


It  is  understood  that  the  Qovemment  of  New 
Zealand  will  introduce  a  measure  for  the  exclusion  of 
consumptive  persons  on  the  same  lines  as  that  dealing 
with  small-pox,  making  masters  of  ships  liable. 


262    Tmi  Mmiou  Pus. 


COBRESFONDENCE. 


Mas.  4,  18M. 


dtorrtsponbtnxe. 


fWe  do  not  liokl  ounelvw  nqponiible  for  the  opiniom  of  our 

HUl  fip0U<l6l  I  111- 1  __^ 

THE  DEPOSITION  OF  PHARMACOLOGY  BY  THE 

LONDON  CONJOINT  BOARD. 
To  ike  Editor  of  Thi  Msdigal  Pbiss  akd  Cxboular. 

Sib,— It  is  diffieolt  to  nndentADd  the  object  of  the  Con- 
jointBoerd  in  removing  phamui«M)log7  from  their  aohedule. 
The  snbiect  has  for  many  vears  occupied  a  definite  posi- 
tion in  the  medical  carricalnm,  and  has  served  a  purpose 
which  no  other  department  can  fnlfiL  It  has  shown  the 
stodentof  chemistry  and  physiology  how  he  may  ntilise 
the  scientific  knowledge  he  las  aueady  obtained  in  the 
treatment  of  disease,  and  has  laid  a  firm  fonndation  on 
which  his  subseqnent  study  of  therapeutics  may  rest. 
Without  it  treatment  can  only  develop  into  empiricism, 
and  the  science  of  medicine  again  degrade  to  an  art. 

But  it  is  easy  to  find  reasons  why  pharmacology  should 
be  retained,  the  diflSculty  lies  in  finding  reasons  why  it 
should  be  removed.  If  the  promoters  of  the  abolition 
scheme  wish  to  benefit  medical  students  (as  they  would 
have  us  believe)  why  do  they  not  turn  their  attention  to 
the  subject  of  pharmacy,  which  contains  much  that  is 
useless  to  the  practitioner,  and  is  sadly  in  need  of  reform  7 
Why,  for  example,  should  a  medical  student  be  expected 
to  distinguish  between  the  different  kinds  of  aloes  or 
senna  leaves,  or  between  the  ordinary  and  ^annlated 
sulphate  of  iron  ?  Would  it  not  be  snflScient  if  he  were 
able  to  distinguish  the  active  poisons  of  the  materia 
medioa  without  having  to  struggle  through  the  differential 
characteristics  of  comparatively  innocuous  roots  and 
woods? 

There  are  many  wavs  in  which  the  burdens  of  students 
might  be  lightened,  but  one  is  not  by  the  abolition  of  a 
subject  which  helps  to  a  rational  understanding  of  the 
methods  of  healing  and  helps  to  diminish  all  future  study 
in  the  field  of  medicine.  If  the  Board  persist  in  this 
folly  it  must  sooner  or  later  bring  its  own  reward.  The 
Umversitiee,  recognising  the  value  of  pharmacology,  are 
raising  the  standard  of  requirements  in  this  subject,  and 
it  is  very  improbable  that  they  will  follow  the  lead  oi  the 
Conjoint  Board  in  abolishing  it.  The  result  will  be  a 
further  widening  of  the  gap  between  graduates  and  dip- 
lomates,  which  will  assuredly  not  be  to  the  credit  of  the 
latter. 

I  am.  Sir,  yours,  ke., 

C.  R.  Marshall. 

Pharmacoloeical  Laboratory, 
Downing  College,  Cambridge. 
February  28th,  1896. 


CONTRIBUTING  CAUSES  TO  THE  RECENT  ARMY 
MEDICAL  EXAMINATION  FAILURES. 

To  th€  Editor  of  Tbm  Mbdioal  Pbxss  asd  Cibculab. 

Sib,— The  recently  published  Results  of  the  Army 
Medical  Examination  certainly  call  for  some  inquiry.  To 
what  cause  is  the  failure  to  fiU  the  vacancies  to  be  attri- 
buted ?  Different  persons  will  assign  diffsrent  reasons.  But 
if  the  candidates  may  be  consultea  on  the  subject,  the  real 
state  of  affairs  should  become  more  apparent.  Tbe  fact  is, 
that  the  candidates  and  younger  members  of  the  medical 
profession,  rightly  or  wrongW,  still  consider  the  Army, 
w^  its  many  acknowledgedorawbacks,  to  be  a  fair  open- 
ing with  which  to  commence  their  medical  career,  and 
would  gladly  enter  it,  if  they  only  got  a  fair  chance  at  the 
examination. 

No  candidate  can  now  enter  the  Army  Medical  Depart- 
ment unless  he  fulfils  the  following  regulations,  viz.,  "  that 
no  candidate  shall  be  considered  eli^ble  for  the  Medical 
Staff  who  shall  not  have  obtained  at  least  'one- 
third  '  of  the  marks  obtainable  in  each  of  the  compulsory 
subjects,  and  at  least  'one-half'  of  the  aggregate  marks 
for  all  the  compulsory  subjects."  This  regulation  came 
into  force  only  for  the  first  time  during  the  last  two  exa- 
minations, and  resulted  on  both  occasions  in  the  vacancies 
being  unfilled.  If  the  first  part  of  the  regulation  were 
only  put  in  force,  there  would  be  now  remaining  no 
▼acancies  as  well  as  no  grievances.  Several  of  the  men 
disqualified  by  the  second  and  newer  part  of  the  rule 


would  be  eligible  in  acoordaoce  with  the  first  and  older 
part,  and  in  many  cases  would  have  from  four  to  six 
bundred  marks  to  spare.  It  may  seem  an  easy  and 
rational  condition  of  the  regulation  that  the  snocessful 
candidate  be  required  to  obtain  half  the  aggregate  of 
marks,  but  the  candidate  who  has  tried  finds  it  very  differ- 
ent. He  is  in  a  position  to  know  by  comparison  that 
the  Army  Medical  Examiners,  as  a  combination,  are 
the  worst  set  of  markers  to  be  probably  found. 
He  also  considers  each  Examiner  marks  you  according, 
or  in  proportion  to,  his  own  knowledge  of  that 
one  subject,  of  whioJi  alone  he  himself  nas  made  a 
special  study  of  for  perhaps  more  than  a  quarter  of  a 
century,  entirely  forgetting  that  the  candidate  has  to 
reserve  some  of  hip  already  overtaxed  memory  for  every 
subject  and  its  different  branches  required  by  the  Medical 
Council  since  the  first  day  he  became  a  student,  and  now, 
again,  required  en  mtuw  for  the  Army  Medical  Examina- 
tton.  The  second  part  of  the  regulation  is  simply  unique 
in  its  application.  Take  the  case  of  a  candidate  who  has 
fulfilled  the  first  condition  of  the  regulation  Quoted  above, 
that  is,  he  has  obtained  30  per  cent,  or  considerably  more, 
as  happened  in  the  recent  examination  in  each  subject 
It  wUl,  however,  be  found  that  unless  his  excess  of  the 
rsQuired  30  per  cent,  standard  reaches  50  per  cent,  he  will 
fall  short  of  half  the  agmgate  or  two  thousand  marks,  if 
he  cannot  save  himseuby  an  extraordinary  knowledge  of 
some  one  particular  subject,  e.g,,  if  a  candidate  at  any 
time  of  his  life  made  a  special  study  of  chemistry,  so  much 
that,  by  his  knowledge  he  secured  full  marks  at  the  Army 
Examination,  he  could  owing  to  these  marks  afford  only 
to  get  30  per  cent,  in  two  such  important  subjects  as  sur- 
gery and  medicine,  as  the  extra  marks  in  chemistry  would 
bring  him  up  in  the  other  subjects  to  the  two  thousand 
marks  and  thereby  secure  a  place  for  him.  Now 
contrast  this  case  with  the  bandidate  who  has  not  mads  a 
special  study  of  chemistry  or  any  one  particular  subject ;  but 
who  obtains  from  40  to  45  per  cent,  in  each  subject,  but 
as  this  percentage  in  the  aggregate  will  fall  short  of  the 
two  thousand  marks  he  will  miss  a  place,  though  he  may 
have  actually,  in  each  of  the  three  out  of  the  four  com- 
pulsory groups,  beaten  by  10  or  15  per  cent,  the  candidate 
with  the  extra  knowledge  of  chemistry.  Still  he  will  remain 
unplaced,notwithstandmg  that  he  is  as  much  as  15  per  cent, 
in  excess  of  the  standard  required  in  each  of  all  the  sub- 
jects ;  but  it  is  here  the  injustice  of  the  second  part  of  tbe 
regulation  makes  itself  felt  again.  This  is  the  exact  posi- 
tion of  many  of  the  candidates  who  were  in  for  the  recent 
examination,  having  got  10  or  15  per  cent,  more  than  the 
standard  required  m  each  subject,  failed  to  get  a  place 
from  the  insufficiency  of  the  aggregate  of  their  marks,  in 
most  part  due  to  the  customary  Tow  marking  of  several  of 
the  examiners.  Again,  if  at  the  present  day  a  candidate 
is  considered  not  eligible  for  the  Army  Medical  De- 
partment unless  he  obtains  2,000  marks,  it  may  accord- 
ingly be  inferred  that  at  least  nine-tenths  of  the  present 
Army  Medical  Staff  are  not  eligible  for  the  same  reason 
that  they  never  obtained  anything  like  2,000  marks  when 
appointed.  Quite  previously  to  the  enforcement  of  the 
preeent  regulation,  men  received  commissions  with  1,200 
marks,  or  thereabouts,  and  there  are  to-day  men  considered 
not  elij^ble  with  1,500  to  1,800  marks,  and  in  this  way, 
vacancies  renutin  unfilled.  It  is  to  be  hoped  that  it  is  not 
yet  too  late  to  abandon  such  an  absurd  regulation,  which, 
m  the  hands  of  low-marking  examiners,  will  eventually 
render  the  Army  Medical  Department  manless.  There  is 
a  strong  feeling  amongst  the  candidates  that  they  will  yet 
be  called  in,  and  there  are  instances  in  the  past  where  men 
were  called  to  fill  extra  places  which  were  not  even  adver- 
tised at  the  time  of  the  examination.  The  candidates  also 
expect  the  medical  press  will  accord  its  support  in  redress- 
ing their  grievances.  To  many  of  the  cancidates,  as  in  tbe 
case  of  the  subscribed,  it  means  their  last  chance. 
Thanking  you  in  anticipation, 

I  am.  Sir,  yours  truly, 

TwicB  Rejkcted. 


PSEUDO-COXALGIA. 

To  the  Editor  of  Thb  Mbdioal  Pbxss  and  Cibovlab. 

Sib, — ^I  was  very  much  interested  in  the  report  of  Prof. 
Dnplay's  lecture  on  Pseudo-coxalgia,  Mbdigal  Psbs 
&  CiBOULAB.  January   15th,  as  I  had  two  cases  under 


Mab.  4,  1896. 


MEDICAL  NEWS. 


Thx  Medical  Pbiss.     253 


my  eare  which  slightly  reeemble  the  case  of  the  woman, 
mt,  43,  which  he  quotes.  If  yon  would  kindlv  ^veme 
space,  I  will  very  briefly  give  the  principal  pointa  of  the 


Both  were  males,  »t.  36  and  28  respectively.  Their 
histoiy  np  to  a  certain  point  is  similar,  and  is  as  follows  :— 
Th^  noticed  a  hard,  pointed  swelling,  about  the  sise 
of  a  bean,  in  the  ingoinal  region,  jnst  below  Ponpart's 
ligament  and  to  the  inside  of  the  inguinal  vessels,  much 
resembling  an  enlarged  gland.  It  was  not  painful,  but 
gave  a  certain  degree  of  stiflness  when  walking.    No 


ffODorrhcea  existed  at  the  time,  but  some  years  previously 
both  suflered  from  that  disease.  The  sweUing  increased 
in  size  slowly,  and  became  more  painful,  with  increased 


lameness.  At  its  height  the  swelling  was  about  the  sise 
of  « large  egg,  half  of  it  being  above  Pouparf  s  ligament 
and  halfbeing  below.  At  this  time  deep-seated  fluctua- 
tion appeared— both  were  opened,  drained,  and  syringed 
out  with  a  solution  of  carbolic  acid.  The  swelling  almost 
disappeared,  but  when  the  cavity  was  allowed  to  dose  the 
mnptoms  returned.  So  far  both  were  similar — a  slight 
diflerenoe  in  their  history  takes  place  now. 

The  man,  nt.  36,  suddenly  and  without  cause  got  a 
most  severe  attack  of  sciatica  extending  to  and  most 
severe  at  knee.  He  lay  in  bed  with  thigh  flexed  on  abdo- 
men and  leg  on  thigh,  the  thigh  being  rotated  inwards. 
After  ordinary  counter-irritant  treatment  he  was  relieved 
of  the  pain,  so  that  he  could  be  removed  to  hospital  In 
hospital  he  was  kept  at  rest  in  bed  without  any  splint  or 
support,  and  was  put  on  iodide  of  potash  and  mercury 
internally  for  four  weeks.  Then  he  got  about  on  crutches 
for  some  weeks,  when  he  ultimately  recovered  with  a 
slight  halt  and  a  turning  in  of  his  toes. 

My  other  patient  developed  symptoms  of  sciatica  more 
slowly.  When  I  discovered  the  least  symptom  of  it  I  got 
him  to  bed  at  once.  He  complained  of  great  pain  and 
tenderness  at  back  of  hip  over  sciatic  nerve,  but  was  never 
troubled  with  pain  in  his  knee.  I  put  him  up  in  a  weight 
and  pulley  extension  apparatus,  bqg^ning  with  one  ana  a 
half  pounds,  and  gradiuulv  increasing  it  in  ten  diivs  to  nine 
pounds.  He  was  a  month  in  bed  altogether.  Then  I  ^t 
him  up  with  a  patten  on  sound  leg  and  crutches,  sent  him 
to  the  eoMide,  where  he  recoverwi  perieot  use  of  the  leg 
without  any  lameness  or  pointing  in  of  toes.  Twelve 
months  afterwards  the  swelling  and  abscess  returned,  in 
this  case  in  the  same  spot.  It  was  opened  under  chloro- 
form, and  found  to  be  at  least  three  inches  deep.  He  got 
better  quickly. 

The  reason  I  give  this  very  brief  sketch  of  the  cases  is, 
that  th^  are  so  rarely  seen  in  country  practice. 

I  am,  Sir,  yours,  &c., 
M.  L. 
P.S. — I  endoee  my  card,  but  not  for  publication. 

MEDICAL  TITLES. 

To  ike  Editor  of  Turn  Medigal  Piuess  and  CiBonLAS. 

Sib, — Dr.  Campbell  Black  deserves  thanks  for  bringing 
this  question  to  the  front  and  keeping  it  there.  No  one 
who  has  studied  the  case  of  the  meoical  profession  and 
recognised  the  causes  which  retard  its  progress  can  dis- 
sent from  Dr.  Black's  implied  proposition  that  it  is  of 
far  greater  importance  to  put  an  end  to  false  pretence  and 
quackery  within,  than  to  overthrow  quackery  outside  our 
ranks.  Outside  quackery,  including  the  sale  of  quack 
medicines,  does  no  harm  to  the  legitimate  practitioner ; 
on  the  contrary,  it  manufactures  invalids  and  aggra- 
vates disease;  and  as  the  vast  majority  of  cases  uius 
ersated  or  made  worse  gravitate  in  the  end  into  the  hands 
of  qualified  men,  quackery  from  a  sordid  point  of  view,  is 
an  advantage  to  the  whole  profession.  The  only  way 
efliBotually  to  hamper  the  unqualified  quack  would  be  by 
forbiddinff  the  practice  of  medicine  in  any  department  for 
gain  to  au  save  the  legally  qualified.  Thac  such  a  measure 
would  put  a  stop  to  the  mfiiction  of  a  vast  amount  of 
misery  needs  no  proof— proof  is  to  be  found  in  the  frequent 
published  reports,  in  which  are  exposed  the  cynical  villainy 
with  which  the  army  of  medical  impostors,  including 
cancer,  rupture  and  consumption  curers,  pursue  their  aims. 
A  measure  hampering  the  sham-medical  harpy  would  save 
from  maltreatment  Mid  plunder  a  class  of  the  community 


—the  weak  and  suflEering— whose  claim  to  the  protection 
of  the  State  is  surely  paramount ;  but  he  would  be  a  very 
sanguine  individual  who  imagined  such  a  measure  were 
within  the  scope  of  present  day  practical  politics. 

Meanwhile,  the  Medical  Acts  need  amending  to  render 
them  operative  even  to  the  meagre  extent  which  their 
sense  expresses.  Dr.  Bateman  evidently  was  far  too  con- 
fident in  his  belief  in  the  efficiency  of  the  Acts,  as  therecent 
maeisterial  decision  in  the  Cardiff  case  sufficiently  shows. 
If  that  case  be  argued  in  the  High  Court  it  is  probable  the 
magistrate's  judgment  will  be  upheld.  In  the  case  of  Ferdi- 
nani  an  appeal  after  magisterial  conviction  was  heaid  by  a^ 
bench  of  magistrates  and  the  conviction  was  confirmed. 
Had  the  magistrates  refused  to  convict,  and  had  the  case 
been  sent  for  argument  before  the  bench  of  judges,  a  very 
different  result  might  have  been  looked  for.  Meanwhile,, 
in  the  uncertainty  of  the  law  and  in  the  absence  of  any 
public  functionary  charged  with  its  enforcement,  the 
unqualified  quack  flourishes  apace  and  is  enabled  to  amase 
wealth  in  proportion  as  he  possesses  capital  to  puff  him- 
self. This  varies,  and  in  proportion  as  he  is  pervaded 
by  an  anti-human  indifference  to  the  suffering  and  misery 
which  he  deliberately  inflicts  upon  his  victims. 

I  am.  Sir,  yours,  &a, 

Si 

Feb.  28th,  1896. 


Royal  Free  Hospital, .  London. 
At  the  sixty-eighth  annual  Court  of  Covemors,  held  oi> 
Wednesday  last,  under  the  presidency  of  the  Hon.  Mr. 
Justice  Bruce,  chairman  of  the  committee,  the  report  of 
the  past  year  which  was  read  by  the  secretary,  Mr  Conrad 
W.  Thies,  showed  that  the  total  cost  of  the  new  buildings 
which  were  opened  by  the  Prince  and  Princess  of  Wales 
in  July  last,  and  other  necessary  alterations  and  improve- 
ments, had  been  about  £29,300,  towards  which,  the  sum  of 
£27,600  had  been  raised,  leaving  a  deficit  of  about  £1,700. 
The  Chairman  appealed  to  the  public  to  help  the  Commit- 
tee by  providing  the  sum  needed  to  pay  off  the  remaining 
liabilities.  The  Medical  Report  showed  that  the  number  of 
patients  treated  during  the  past  year  was  35,714,  as  com- 
pared with  30,337  in  the  preceding  year.  Lord  Rowton 
and  Sir  Jamee  Stansield  were  elected  vioepresidente  of 
the  Hospital  At  the  conclusion  of  the  meeting,  Mr. 
Justice  Bruce  unveiled  a  marble  memorial  of  the  late  Mr. 
George  Moore,  in  the  Moore  Ward.  He  mentioned  that 
Mr.  Moore  had  been  chairman  of  the  Committee  ol  the 
Hospitid,  and  for  many  years  devoted  much  time  and 
energy  to  the  welfare  of  the  institution.  He  raised  a  laree 
sum  of  money  to  purchase  the  freehold,  and  owing  to  his 
efforts  the  financial  position  of  the  Charity  had  bmn  per- 
manently improved.  Thev,  therefore,  felt  greatly  indebted 
to  him,  and  desired  that  bis  name  should  be  remembered. 
The  memorial  was  a  replica  of  a  similar  tablet  executed  by 
Mr.  John  Adams  Acton  for  Carlisle  Cathedral.  The  cost 
had  been  defrayed  bv  Mr.  W.  Parkin-Moore,  of  WhitehaU,. 
Cumberland.  The  following  is  the  inscription  on  the 
memorial:— "George  Moore,  whose  valuable  services  to 
the  Royal  Free  Hospital  are  gratefully  remembered,  died 
November  21st,  1876." 

The  Cancer  Hospital,  Brompton. 
At  the  forty-fifth  annual  meeting  of  the  Governors  of 
this  charity,  held  on  Wednesdaylast,  Sir  George  Samuel 
Meason,  J. P.,  in  the  chair,  Mr.  W.  H.  Hughes,  the  Secre- 
tary, read  the  report  of  the  Committee,  from  which  it 
appears  that  during  the  past  year  2,233  new  patients  were- 
received,  806  as  in-patients,  and  1,428  as  out-patients, 
in  excess  of  any  previous  vear  since  the  nospital 
iinded  in  1851.  Considerable  expense  has  recently 
been  incurxed  in  connection  with  the  operating-room  by 
fitting  it  up  in  accordance  with  the  aseptic  requirements 
of  the  present  day,  and  providing  anesthetic  and  steri- 
lising rooms,  &c  llie  hospital  has  i&  been  fitted  through- 
out  with  the  electric  light,  and  the  Committee  make  an 
appeal  for  oontmued  support  to  enable  them  to  pay  for 
tnese  necessary  outlays,  and  to  carry  on  the  important 
work  of  aUeviating,  and,  as  far  as  possible,  arreetmar  the 
growth  d  this  terrible  disease. 


254  ,  Ths  Mbdigal  Prim 


NOTICES  TO  CORRESPONDENTS. 


Mab.  4,  1896. 


entices  to 
CorrcfiponbciitB,  ^hort  %tUtVB,  ice 

9^  OoBBaBFonnm  nqnMng  a  replj  In  llito  ootamii  m  par- 
iioularlj  requMtod  to  make  uo  of  a  diaUmltim  •iffiuMtv  or  imitkAt, 
and  nyoM  the  mractJoe  of  ilgnlng  tbiinMlvef  "  SMdor,"  "  BnlMortbtf," 
"  Old  SnlMoriber/'  Ao.  Mnoh  oonfngloii  will  be  qMnd  b7  attantlon 
tothlinle. 

BEQUAH'S    NEW    BOLE. 

THS  rcpToaonttttve  and  proprietor  of  the  onoe  profperooi  qnaek 
noBtram  ^<  Prafrie  Flower  "  can  now  be  leen,  we  are  to1<i,  at  the  «««lety 
Mwic  Ball,  Birmingham,  extracting  molars  "  with  hU  ao<-Qitomed 
dexterity."  Having  now  got  to  tooth-drawing  aa  a  moiic  hall  attrac- 
tion, perhMpa  tome  "  M.D.,  U.S. A."  will  treat  the  public  to  the  alghc 
of  a  few  in  glcal  operations  as  a  further  progresslTe  develapment  of 
etage  attraction. 

Mb.  B.  B.  ABDiBSoa.— It  is  quite  beyond  our  province,  and  would 
be  beyond  oor  space,  to  attempt  to  publish  oommunicatloos  addressed 
to  the  branches  of  the  British  Medical  Aaeociatton. 

Mr.  B.  VaVasssub  will  receive  a  private  ijoie  wlien  a  decision  has 
been  arrived  at. 

Prof  Liich's  commuuioation  is  unavoidably  crowded  out  at  press. 
It  shall  appear  in  our  next. 

Db.  F.  W.  £ii>D.-Your  paper  Is  held  over  for  the  production  of  the 
necessary  illostration. 

A    NEW    VEB8I0N. 

LnTLB  BOT :  "  Please,  want  the  doctor  to  come  and  see  mother." 

Doctor's  Servant :  "  The  doctor's  out ;  where  do  you  come  from  ?  *' 

Little  Boy  :  "  What  I  don't  you  know  me?  Why,  we  deal  with  you. 

We  had  a  baby  from  here  last  week." 

M.B.C.S.,  L.R.C.P.   (Wolverhampton^— One   method   which    has 

proved  very  effectual  in  the  resuscitation  of  the  new  bom  ia  to  dilate 

the  infant's  rectum  with  the  finger.    Ooinddent  with  the  passage  of 

the  finger  through  the  sphincter  respiration  will  be  started. 

M.B.Cartab.  (ChelteDharoX -There  is  no  evidence  at  present  to 

how  that  the  serum  treatment  of  oanoer  ia  of  any  use. 


.^leetmaB  of  tht  ^ooetieft 

WlDRKDAT,   MaBOH.   4TH. 

British  Bauiiolooioal  and  Gumatulogioal  Soonrr  (limmer's 
Hotel,  Oondtilt  Street,  W.).~  8  p.m..  Dr.  H.  McClure  (Cromer j :  S^^me 
Fantors  in  our  Atmospheric  Environment  and  their  Relation  to  Health. 
—Dr.  D.  Kerr  (Bath) :  Modem  Improwments  in  British  Balneological 
Practice.  

OBSTiTRiCALBoonTroFLoHDOH.— 8  p.m.  Specimens  by  Dr.  Amend 
Bonth.  Dr.  Oalabln,  and  others.  Adjourned  Dlscutsion  of  Mr.  Hani- 
son  Cripp's  paper  on  Abdomioal  Hysterectomy  with  Intra-peritoneal 
O^eatment  of  the  Stump,  with  Notes  of  Big^t  (3a«ee— Mr.  Alban  Doran : 
Cases  of  Fibroma  of  the  Ovary  and  Ovarian  L* gament  removed  by 
<hMration.  with  a  Series  of  After-histories  of  Cases  reported  in  the 
"  Transactions  *'»ince  lb79. 

SociRT  OF  ARTS.— 8  p.m.  Mr.  A.  A.  C.  Swlnton  :  Boentgen's 
Photogiaphy  of  the  Invisible. 

TBUBflDAT,  MAEOH  6TH. 

Harybian  Sooott  (Stafford  Booms,  Titohbome  Street,  Bdgware 
Boad,  W.X— 8.80  p.m.    Clinical  Xvening. 

Friday,  Mabch  arn. 

WB0T  KnT  MlDIOO-CHIRVROIOAL  8O0IITT.-8.15  p.m.  At  Boyal 
Xent  Disnensary,  Greeowlch.  clinical  Evening.  Cues,  specimens, 
Ac,  by  the  President  (Mr.  Bmcst  Clarke),  Drs.  Collie,  Henry, 
Josoelyne,  and  others. 

Virs8T-LoNDORMBPioo-(3HiRUROiOAL  SoonTT  (West  London  Hoepi- 
tal.  W.).-8.80  p.m.  (finical  Evening.  Cases  will  be  shown  by  Drs. 
Hanison,  A.  L.  Scott.  C.  (Shapman,  and  Sutherland,  Measrs.  KeeUey, 
Edwards,  and  BidwelL 

SAIURDAT,  MABOH.  7TH. 

Medical  Sooiitt  of  Losdob.—t  p.m.— Anniversary  Dinner  at  the 
WhltehaU  Booms,  HAtel  Metxopole. 

WiDaisDAT,  March  iith. 

Lartbooloqical  SocniT  OF  LoBDOH  (20  HanovcT  Square,  w.).~ 
6  p.m.- Adjourned  Dlsensslon  of  *'  Foreign  Bodies  in  the  Upper  Air 
and  Food  Passages,"  introduced  by  Mr.  Charters  Symonds  at  the 
February  meeting.  Members  who  intend  taking  part  in  the  Discus- 
sion are  requested  to  communicate  at  onoe  with  the  Honorary  Secre- 
taries. The  following  cases  and  specimens  will  be  shown:— Dr. 
Clifford  Beale :— Cyst  between  Tongue  and  Epiglottis ;  Case  of  (?) 
Canoer  or  Tubercle.  Dr.  Bond  :  Maggots  In  the  Nose  (case  and  speci- 
men) ;  Myxoma  of  Vocal  Cord  (oase  and  specimen).  Mr.  E.  C.  Stabb  : 
Lupus  of  Palate  and  Lsrynx ;  Tumour  of  Soft  Palate.  Dr.  St.  Clair 
Thomson :  Myxoma  of  Vocal  Cord  (case  and  microsooidc  section). 
Thvbsdat,  Mabch  istb. 

BBinsH  Gtrjeoological  Soceett  (20  Hanover  Square,  W.).-^peci- 
mens: -Dr.  Puroell :  Three  Uteri  removed  per  vaglnam  for  Malignant 
Disease.  Dr.  Schacht :  Unlntenupted  Tubal  Gestation  containing 
FoBtus.  A  Discussion  on  "  Ventro-fixation,  ventro-suspension,  and 
AlUed  Operations  with  their  Besalto  "  wHl  be  introduced  by  Mr.  Mayo 
Bobson. 


Birmingham  and  Midland  Eye  Hospital.— Assistant  House  Surgeon. 
Sslary  £60  per  annum,  with  apartments  and  board.  Testimonials 
to  the  Chairman  on  or  before  March  12th. 


Boecombe  Hoapital.— House  Surgeon  (nnmarriedX  -  9%lary  £60  with 

board,  lodRJiog,  and  waahinr.    Apuioations  and  testtmoiilals    o 

the  Hon.  See.  on  or  before  Maroh  wh. 
Bristol  General  HoapitaL—Honse  Surgeon.— Salary  £120  per  annum, 

with  board,  residence,  dte.    Applications  to  the  becrstavy  mi  or 

before  March  18th. 
Buxton-on*Trant  Infirmary.- House  Surgeon.  Salary  £180  per  annum, 

with  a  prospect  of  rooms  in  the  Infirmary  tree ;  also  coals  and  gas. 

Applications  and  testimonials  to  the  Hon.  See ,  Mr.  J«mes  C. 

4mnUng.  The  laficmary,  Biirton-on-Trent,  on  or  before  Maroh 

12th. 
Cheiaea  Hospttalfor  Women,  Fulham  Boad,  8.W.-  Besident  Medical 

Officer.    Salary  £00  per  annum ,  with  board,  lodgtog,  and  wadiins. 

Applloations  and  testimonials  to  the  Secretary  on  or  befote  March 

14th. 
Cornwall  County  Lunatic  Asylum,  Bodmin.— Jonior  Assistant  Medical 

Officer.    Saisry  £100  a  year,  liicxeasing  £10  yearly  to  £120,  with 

board,  lodaing,  Ac.    Applications  to  the  Medical  Superintendent 

at  the  Asylum,  on  or  before  March  10th. 
Greenwich    Union   Infirmary.— Second    Assistant    Medical   Offloer 

(unmkXrisdX    Salary  £80  per  snnum,  with  bosrd,  Lidgiog,  wash- 

ing  Ac.    Applications  ana  testimonials  to  the  Clerk  of  the  Guar- 
dians before  March  18th. 
Metropolitan  Asylums  Board.«Assistsnt  Medical  Officer  (unmanled) 

for  the  North-western  Fever  Itospital,  Haverstock  Hill.  N.W. 

Salary  £l6u  first  year,  £180  seoand  year,  and  £200  subsequent 

years.    (See  adtert.). 
National  Hospital  for  (Consumption  for  Ireland. —Physician  as  Real* 

dent  Medical  Officer  and  Begistrar.    Salary  £100  per  annum,  with 

apartments,  Ac.    Applications  and  tesdmonlals  to  the  Hon.  Sec. 

not  later  than  March  14th.   (See  advert.). 
Sunderland  and  North  Durham  Eye   Infirmary. -House  Surgeon. 

Salary  £a0  a  vear,  rising  to  £00  after  six  months.    Applications 

and  testimonials  to  the  (Chairman  of  Committee,  care  of  J.  F. 

Potts,  Secretary,  18  Derby  Street.  Sunderiand 
West  Suisex  Asylum. -Medical  Superintendent.    Saliffy  £450  a  year, 

with  unfumlahed  honse,  Iteht.  washing,  coals,  Ac.    Applications 

and  teatlmoniali  to  the  <21erk  to  the  C'tmmittee  on  or 


March  25tii. 


or  before 


JltrtrotntmtnU 


GRIFFITBP,  P.B  ,  M.i>.,  a:).  Lund.,  M.B.C.S.,  Honorary  Surgeon  to  the 

Cardiff  Infirmary* 
Hall,  J.  • .,  M.a,  Clh.B.yict.,  M.B.C.8.,  L.B.C.P.,  Junior  House  Sur- 
geon to  the  Halford  Boyal  HospitaL 
Paob,  F^  M.D.Bdin.,  M.B.C.S..  an  Examiner  in  ClinicaL  Snrgccy  In 

the  University  of  Edinburgh. 
BAY,  J.  H.,  M.B..  Ch.B.VIot.,  1LB.C.&,  L.B.C.P.,  House  Furgeonto 

the  Salford  Boyal  Uoepltal. 
BBHshaw,J.  a.  K.,  M.B.,  CM.,  M.A.Caatob.,  L.8.A.Lond  ,  House 

Surgeon  to  the  Manchester  Boyal  Infirmary. 
Stobham,  C.,  F.B.C  8.K..  surgeon  to  the  Westminster  Hospital. 
Taylor,  a.  k,  M.B.,  aM.Edin..  L.m.CP.,  L.B.C.8  Ed..  BonorttT 

Assistant  Physldan  to  the  Cardiff  Infirmary. 
TATLOa,  J.,  F.B.C.S.E.t  Honorary  Consulting  Surgeon  to  the  Wrexham 

HospitaL 
Taylor,  W.,  M.D.Edln.,  L  B.C.P.B4in.,  M.B.C.S.,  Honorary  Contnlt- 

ing  Physician  tu  the  Caraiff  Infirmary. 
TURHER,  w.,  M.a,  F.B.C.S.,  L.B.C.P.,  one  of  the  Visitluff  Surgeons  to 

the  Seamen's  Hospital  Boyal  Victoria  and  Albert  D«icks,  (a  Branch 

of  the  Seamen's  Hospital)  at  Greenwich. 
Watkins.  a  v.,  M.B.,  (%.B.Vlct.,  M.B.C.a,  L.aC.P.Lond.,  House 

Surgeon  to  the  Manchester  Boyal  Infirmary. 


$ittk0« 


BoBDu-Feb.  20tii,  at  Leytoa,  Essex,  the  wlfb  of  Mayston    Bond, 

M.B.C.8..  L.aaP..  of  a  daughter. 
BBVBLL.— Feb.  27th,  at  11  Oranrille  Boad,  Sonthflelds,  Wandsworth, 

S.  W. ,  the  wife  of  Hugh  Stanley  BeveU,  of  a  dau«hter. 
Bo«8.— Feb.  28th,  at  0  PavOioa  Parade,  Brighton,  the  wife  of  Douglas 

M.  Boss,  M.D.,  of  a  son. 
SMYTH.- Feb.  84th,  at  Adelaide  Boad  ,  Brockley,  S.a,  the  wife  of  F. 

Sydney  Smyth.  F.ac.8.Bdin.,  of  a  daoghter. 
Taylob.— Feb.  25tti.  at  Thruxton.  near  Andover,  the  wife  of  James 

Taylor,  M.D.,  of  a  daughter. 

WttLBY- PBRRY.-Feb.  27th,  at  Christ  Church.  Sneydpark,  new 
Bristol,  Frederick  J.  IngorWlIley,  M.a,  B.8.,  ILKCS..  CJrouch 
End,  London,  N.,  to  riorenoe  Elisabeth  Perry,  aScLond.,  second 
daughter  of  BenJ.  Perry,  Bmi.,  Avonleigh,  Stoke  Bishop,  near 
BristoL 

BUPD.-Feb.  2eth,  at  BamsUple,  Biohard  Budd,  M.D.,  in  his  87th 

year. 
BYRBB.-Jan.  Utti,  at  Hay,  New  Sontii  Wales,  Dr.  Edward  H.  Byrne, 

of  heat  apoplexy.  . 

Hall. -Feb.  28th,  at  BaOieborough,  WUllam  HaU,  L.aC.8.1.,  and 

L  B.C.P.L,  son  of  John  Hall,  aged  28.  deeply  lamented. 
lLOTT.~Fab.  2lst,  at  Beechfield,  Bromley,  Kent,  James  William  Bott, 

M.E.C  H..  L.R.A.,  aged 80.  _  , 

Lawoon.— Feb.  22ad,  at  Mayfleld  Terrace,  Eiinburgh,  Bobert  Uwson. 

M.D.Edin.,  F  aS.E.,  Deputy-Oommissioner  in  Lunacy. 
Lyboh.— Feb.  10th,  at  Sudbury,  Suffolk,  John  Cox  Lynch,  surgeon, 

MoORB.-Feb.  28th,  at  Bockcornr,  co.  Monaghan.  Bobert  Wm.  Moore, 
aA.,  M.B.,  T.C.D.,  only  and  dearly-beloved  son  of  Dr.  Bobert  B. 
Moore,  Bockcorry. 


Wht  9«ilia(  ^tt$$  mi  (i)\tmht 


"SALUS  POPULI  SUFREMA  LEX." 


Vol.  CXIL 


WEDNESDAY,    MARCH    11,     1896. 


No.  11. 


NOTES  ON  A 

CASE     OF    SO-CALLED    ELEPHAN- 

TIASIS.  (a) 

By  FREDERIC  WM.  KIDD,  BA.,  M.D., 

Miurter  of  the  Coombe  IoriDg-in-Ho«piUI,  Dablin. 

Thb  patient,  set  33,  sent  to  me  by  Dr.  Blake,  of 
Bavenaoale— has  never  been  abroad,  nor  is  there  any 
suspicion  of  a  syphilitic  origin  —  states  that  aboat 
thirteen  years  ago  she  got  a  fall,  to  which  she  attributed 
the  (growth  of  the  tumour.  The  tumour  commenced  in 
and  mvolved  all  the  tissues  of  the  right  labium,  and 
hung  down  more  than  half  way  to  her  knees.  It  did 
not  grow  quickly  at  first,  but  increased  more  rapidly 
for  the  last  eighteen  months.  Patient  had  never 
4M>ught  advic&  and  only  now  came  because  the  growth 
had  assumed  such  proportions  that  it  was  im- 
possible for  her  to  sit  down  with  any  comfort 
There  were  no  disorders  of  menstruation  or  micturition. 
The  operation  for  the  removal  of  this  growth  was  done 
on  December  7th,  18d6.  Before  operation  an  attempt 
was  made  to  pass  the  catheter.  This  at  first  was  unsuc- 
cessful, as  the  catheter  went  up  its  whole  length  into 
a  kind  of  sinus  or  space,  and  the  point  of  it  could  be 
felt  anterior  to  the  symphysis  puois  and  nearlv  on  a 
level  with  its  upper  border.  An  elliptical  incision  naving 
been  made,  the  diseased  tissues  were  dissected  out  from 
the  anterior  surface  of  the  symphysis,  where  they  were 
very  adherent;  bleedinf^  points  were  ligatured  or 
twisted,  the  site  of  the  chtoris  giving  most  trouble.  A 
drainage-tube  having,  been  inserted  the  length  of  the 
wound,  it  was  dosed  with  numerous  silkworm-gut 
eutures.  One  small  nodule  of  this  fibrous  like  tissue 
was  left  immediately  anterior  to  and  above  the  meatus 
nrinarius— owinff  to  the  patient  becoming  rather 
eollapsed,  with  the  intention  of  removing  it  by  asubse- 
•quent  operation  if  the  growth  showed  any  tendency  to 
recur.  The  wound  dia  not  heal  by  first  intention— a 
result  probably  due  to  the  low  vitality  of  the  part  and 
its  oedematous  condition.  The  tissues  became  very 
cedematous,  and  at  one  time  had  an  erysipelatous- 
looking  blush.  Some  suppuration  took  place,  and  it 
was  onlj  by  the  most  absolute  care  that  septic  trouble 
was  avoided.  There  must  have  been  many  lymphatics 
in  a  condition  likely  to  absorb  septic  matter.  The 
temperature  never  went  above  101-2°.  She  made  a 
good  recovery,  though  somewhat  slow.  The  condition 
of  the  patient  two  months  after  the  operation  was  not 
<raite  satisfactory ;  several  small  sinuses  existed  about 
the  middle  of  the  wound  and  when  laid  open  and  joined 
together  it  was  found  that  the  cavity  into  which  they 
omned  was  just  similar  to  the  description  given  by 
Dr.  McWeeney,  where  a  smooth  mucous  membrane 
Uned  the  so-called  cavities  of  sinuses  in  the  onginal 
tumour.  The  skin  above  the  syinphysis  is  hara  and 
liyi>ertrophied  and  could  be  easily  removed,  but  the 
patient  will  not  hear  of  another  operation  at  present 

When  removed,  and  in  the  recent  condition,  the 

(a)RMdaitlie0btteCrical8eQtton<]ftlieRoyalAcadflD7ofMedlcbi6, 
AitJnravy.lSM. 


tumour  weighed  54  lbs.  The  following  was  the  report 
made  by  Dr.  McWeeney  :— "The  tumour  is  whitisn  in 
colour,  covered  close  to  the  pedicle  with  rather  dark- 
coloured  skin,  from  which  grew  a  few  long  hairs,  whilst 
elsewhere  it  b  covered  with  epithelium  which  has  the 
character  of  mucous  membrane.  It  is  lobulated  and 
very  irregular  in  shape,  with  numerous  papilla-like 
excrescences^  so  as  to  resemble  a  gigantic  wart :  the 
consistency  is  rather  soft.  Between  the  larger  lobes 
are  curious  sinuous  cavities,  some  of  which  are  actual 
passages  or  canals  running  right  through  the  mass 
irom  near  the  pedicle  at  one  end  to  the  free  convexity 
on  the  other.  Part  of  the  skin  covering  the  base  of  the 
tumour  is  covered  with  innumerable  small  peduncu- 
lated protuberances  like  fungiform  papillae.  Micro- 
scopically, the  tumour  consists  of  a  somewhat  oedema- 
tous fibrous  tissue  of  loose  texture  containing  so  many 
lymph  clefts  that  in  places  one  might  almost  term  it  a 
lymphangioma.  There  are  also  very  numerous  newly- 
formed  blood  vessels.  Around  the  lymph  clefts  are 
many  collections  of  lymphoid  and  epithelioid  cdls. 
Sections  of  the  papilla-like  protuberances  show  essen- 
tially the  same  appearances.  The  surface  is  covered 
with  stratified  epithelium,  which,  from  its  slightly- 
developed  homy  layer  and  absence  of  hair  follicles, 
may  be  said  to  constitute  a  mucous  membrane.  I 
should  be  inclined  to  class  this  specimen  provisionally 
as  moUuscum  fibrosum." 


The  points  of  interest  in  the  case  are  the  compara* 
ti  ve  rarity  of  this  form  of  growth ;  the  presence  of  these 
cavities  or  sinuses  permeating  it ;  the  size  it  had 
attained  before  relief  was  sought ;  the  absence  of 
serious  trouble,  both  from  haemorrhage  during  the 
operation  and  from  septic  absorption  when  portion  of 
the  wound  suppurated ;  the  question  as  to  whethw 
the  growth  would  be  one  likely  to  recur  if  any  portion 
of  it  were  left  behind. 

It  was  usual  to  refer  cases  of  this  nature  to  repeated 
attacks  of  an  erisepelatous  character,  or  to  obstruction 
of  tiie  lymphatic  channels,  from  the  presence  of  the 


256      TbS  llEDlCAt  FBB&0. 


OBIGINAL  COMMUlflCATIONS. 


Mak.  11,  1880. 


^'filaria  sangmniB  hominia,"  bat  in  this  case  there  was 
no  history  of  pre^kma  infiamroafeorjr  attacks  nor  had 
the  patient  ever  been  abroad,  which  alone  could  account 
for  the  presence  of  "filarial."  In  the  accompanying 
illnstmtion  (from  a  i^otograph  taken  hj  Dr.  Alfred  jT 
Scott),  the  patient  is  on  a  gynsaootogical  chair,  the 
thighs  abducted  and  the  knees  supported  on  the 
cratches  of  the  chair. 


ON  SOME  CASES  OF  HERNIA. 

A  Post^GraducUe  Demonstration  given  at  the  West 
London  Hospital,  on  November  6, 1895. 

By  W.  McADAM  ECCLES,  M.S.,  Lond.,  F.R.C.S., 
Eng., 

AjMtotant'Siitgeoii,  Oi^jr  of  London  TniM  Sodoty,  aod  West  London 
Hospital,  *e. 

I  SHALL,  first  of  alJ,  show  you  a  series  of  cases  iUns- 
trating  some  points  in  connection  with  femoral  hernia. 
This  form  of  rupture  ie  always  one  which  has  especial 
interest  but  more  particularly  so  when  occurring  in 
male  subjects.  Femoral  hernia  is  rare  before  the  age 
of  pubertsr ;  and  before  12  years  of  age,  it  occurs 
nearly  as  trequently  in  boys  as  in  girk.  After  this 
age,  however,  the  proportion  becomes  vastly  greater  in 
the  female  sextham  in  the  male. 

About  eighteen  months  ago,  a  boy,  set  9,  was 
brought  by  his  father  to  the  Truss  Society,  with  the 
complaint  that  he  had  had  a  swelling  in  the  right  groin 
for  about  a  year.  On  examination,  a  well-marked, 
rounded  protrusion,  presenting  all  the  typical  character- 
istics of  a  femoral  hernia  was  found.  It  was  completely 
reducible,  and  seemed  to  give  the  little  fellow  but  a 
small  amount  of  trouble.  There  was  no  family  history 
of  rupture,  though  it  is  by  no  means  uncommon  to 
find  m  these  cases  of  femoral  protrusion  that  some 
near  female  relative  is,  or  has  been,  aJso  the  subject 
of  it 

The  boy  was  fitted  with  an  ordinary  femoral  truss. 
Great  care  is  to  ba  taken  in  dealing  with  these  cases 
that  the  measurement  taken  for  the  truss  is  accurate, 
in  order  that  it  may  be  very  nicely  adjusted.  If  too 
short,  the  instrument  will  be  so  uncomfortable  that  the 
patient,  especially  if  a  child,  will  refuse  to  wear  it ;  if 
too  long,  it  is  certain  to  press  on  the  spine  of  the  os 
pubis,  and  thus  cause  intolerable  pdn. 

This  bov  then  was  sent  away  wearing  a  well-fitting 
truss,  with  instructions  that  it  should  be  kept  applied 
day  and  night. 

I  have  not  examined  him  since  until  now.  The 
patient  is  undressed  before  you,  and  I  would  have  you 
notice  that  the  truss  is  by  no  means  worn  out,  and 
still  lies  comfortably  in  position.  We  will  remove  it, 
and  it  is  obvious  to  all  that  there  is  no  visible  protru- 
sion in  the  riffht  groin,  not  even  when  the  boy  stands 
up  and  oou^.  The  truss,  therefore,  has  not  only 
been  sufficient  in  keeping  the  hernia  rkluced,  but  it  has 
done  more ;  it  has  considerably  lessened  the  tendency 
to  protrusion  ;  it  has,  in  other  words,  brought  about  a 
partial  cure.  If  one  were  to  cut  down  on  the  parts 
now.  the  sac,  owing  to  the  continuous  pressure  and  the 
conaensation  of  tissues  around,  woiud  probably  be 
found  partiy,  if  not  wholly,  obliterated. 

Mav  we  then  allow  thu  patient  to  discard  his  truss 
after  nis  wearing  it  for  eighteen  montiis  ?  No,  I  am  cer- 
tain it  would,  to  say  the  least,  be  unwise  to  do  so,  for 
I  am  sure  that  seeing  a  strong,  healthy,  young  subject 
has  developed  a  hernia,  he  has  still  a  tendency  to  such, 
and  if  no  support  be  given  the  protrusion  is  very  likely 
to  reappear,  and  this  particularly  so  in  the  I emorA 
variety. 

This  patient  presents  the  condition  so  often  found 
after  the  so-called  "^  radical  cure  "  of  hernia,  and  I  ven- 
ture to  assert  that  the  truss  pressure  has  wroni^t  in 


his  case  practically  exactiy  what  an  operation  woold 
have  done,  namelv,  the  nearly  complete  absence  of  acy^ 
impulse  on  ooug^,  Neverlteless,  in  either  case  he 
should  be  still  wearing  a  truas  for  some  time  yet  to* 
come. 

The  next  case  I  bring  before  vou  is  also  a  boy 
(Idndly  shown  to  me  fay  my  colleague  Mr.  L.  A. 
Bidwell)  who  has  a  double  femoral  hernia,  but  with 
this  important  distinction,  that  the  protrusion  on  the 
left  side  is  irreducible. 

It  is  open  to  us  to  treat  this  bov  in  one  of  two  ways  ^ 
firstly,  to  provide  him  with  a  double  femoral  traes^ 
having  the  pad  concave  or  hollow  on  the  left  side^  or 
secondlv,  to  perform  herniotomy  and  attempt  a  radical 
cure,  suDsequentiy  ordering  him  to  wear  an  ordinary 
light  double  femoral  truss. 

The  hoUow-pad  truss  will  probably  bring  about  re- 
duction  before  very  long,  and  that  with  a  minimum  of 
risk,  whereas  an  operation  would  certainly  also  effect 
the  return  of  the  contents  at  once,  but  with  a  certain 
amount  of  risk.  The  patient  remains  in  danger  so  loner 
as  neither  of  these  plans  are  carried  out 

The  third  case,  which  is  now  before  you,  is  a  male 
adult  who  demonstrates  a  vcoy  interesting  disease  in 
addition  to  his  hernia,.  He  is  the  subject  of  diffoae 
molluscum  fibroeum  which  he  has  had  as  long  as  be 
can  remember.  His  femoral  protrusion  is  very  dis- 
tinct. As  he  stands  before  you  and  coughs  you  will 
observe  the  pronounced  manner  in  which  the  abdo- 
minal contents  descend  into  the  hernial  sac.  If  we 
place  him  in  the  horizontal  position  the  swelling  is  not 
altogether  siwntaneously  reducible,  but  very  sUght 
taxis  causes  it  to  disappear  with  the  characteristic 
gurgle  of  gut.  A  resonant  note  on  percussion,  with  the 
usnal  intestinal  sounds  on  auscultation,  conclusiyely 
prove  the  i>resence  of  bowel  in  the  sac.  The  hernia  la 
of  such  a  size,  that  of  a  tangerine  orange,  and  the  force 
with  which  it  is  protruded  ii  so  strong  that  at  first  I 
was  doubtful  whether  an  ordinaiy  femoral  truss  would 
retain  it,  but  when  we  adjust  tUs  33-inch  one  it  holds 
it  up  most  satisfactorily. 

It  is  interesting  to  note  that  although  nearly  the 
whole  surface  of  nil  body  is  studded  with  mollusciim 
swellings,  many  of  which  are  of  quite  recent  develop- 
ment, he  has  not  a  single  nodule  over  the  area  with 
which  the  spring  and  pad  of  the  truss  come  in  contact 
Can  the  use  of  the  truss  for  several  years  have  pre- 
vented the  occurrence  of  the  molluscum  formation  \ 

We  now  pass  on  to  our  fourth  and  last  case  of 
femoral  protrusion.  Ueuanolderman,  beingsix^-tbree 
yevs  of  age.  He  has  had  hernia  in  the  right  femoral 
re^on  for  no  less  than  thirty-seven  years,  but  it  was 
sadly  neglected  when  it  first  appeared,  consequently  he 
had  now  a  large  protrusion,  which  is,  however,  wboUy 
reducible.  If  we  observe  this  rupture  closely  as  it  pro- 
trudes it  will  be  seen  that  it  has  a  tendenqr  to  pass 
upwards  in  front  of  Ponpart's  ligament  as  femoral 
hemiae  so  commonly  do,  as  well  as  passing  somewhat 
downwards. 

In  order  to  efiidentl]^  keep  the  contents  of  the  aac 
within,  the  abdomen  this  patient  must  have  a  spedally 
made  truss. 

Firstiy,  a  femoral  pad  is  necessary  in  order  that  the 
ring  be  covered,  but  this  will  not  be  sufficient  to  retain 
the  hernia. 

Observe  what  happens  when  we  put  an  cffdinaiy 
femoral  truss  on  and  get  the  patient  to  cough— tfae 
rupture  slips  down  and  protrudes  above  and  below  the 
pad  chiefly  passing  out  above  it 

In  order  to  overcome  this  upward  passage,  what  is 
called  an  inguinal  fulness  is  to  be  superadded  to  the 
femoral  pad. 

It  will  be  observed  that  tins  addition  has  a  strap 
which  is  to  be  fastened  to  a  buckle  placed  jnst  within 
the  anterior  superior  spine  of  the  left  uiunL  To- 
further  satisfactorily  deal  with  the  lower  portion  of 


14AS.  n.  18b6 


ORIGINAL  C0MMUN1CATI05S. 


Thb  MiDiOAL  Fbxss.     257 


the  protnision  the  femoral  pad  itself  is  prolonged 
somewhat  downwards,  and  attached  to  its  inner  border 
is  a  ahaned  piece  of  jean  which  passes  round  the  thigh 
and  is  nzed  on  the  outer  side  bv  means  of  straps  and 
buckles.  This  is  called  a  thigh  belt,  and  serves  to 
prevent  the  truss  being  displaced  upwards,  and  with 
the  inguinal  fulness  and  the  ordinary  femoral  pad  will 
effectually  control  the  rupture. 

Our  first  case  showed  well  the  effect  of  a  truss  in 
causing  considerable  improvement  of  a  femoral  pro- 
trusion in  a  young  subiect.  I  should  now  like  to  show 
you  a  case  in  which  a  scrotal  hernia  has  been  in  like 
manner  practically  cured  by  the  adjustment  of  a 
properly  constructed  truss. 

Tnis  young  man  of  nineteen,  came  to  the  Truss 
Society  two  years  ago  with  a  fully  developed,  but  com- 
pletely reducible  scrotal  rupture,  and  he  was  fitted 
with  a  rat-tailed  truss.  The  prolongation  of  the  pad 
in  these  trusses  should  be  made  quite  soft  and  flexible 
without  any  part  of  the  metal  of  the  pad  projecting 
into  them.  Me  wore  this  steadily  day  and  night  till 
he  came  up  again  a  week  or  so  ago,  and  now  if  you 
examine  him  carefully  I  think  you  will  agree  with  me 
that  there  is  little  or  no  impulse  on  cough. 

This  result  occurs  in  hundreds  of  cases,  and  I  claim 
that  it  Ib  quite  as  good  as  many  a  case  of  radical  cure 
by  operation.  He  is,  however,  still  in  danger  of  a 
recurrence  of  the  hernia,  and  therefore  he  now  wears 
an  ordinary  inguinal  truss. 

I  am  convinced  after  some  close  observation  that  a 
lar;^  proportion  of  "radical  cures"  are  in  precisely 
similar  condition  to  this  patient,  and  ought  to  be 
treated  like  him  with  a  light  truss  for  at  least  two 
years  or  so  after  the  operation. 

The  sixth  case  is  a  man  who  presents  the  double 
affection  of  a  hydrocele  with  a  complete  inguinal 
bemiiL  both  on  the  same  side.  These  cases  are  common 
enough,  but  the  diagnosis  of  them  is  not  always  a 
perfectly  straightf or «rard  matter.  This  one  shows  very 
clearly  some  of  the  points  to  be  relied  on  in  coming 
to  a  declEdon  as  to  the  condition.  There  is  a  slight 
constriction  between  the  hydrocele  below  and  the 
hernia  above.  The  impulse  on  cough  in  the  upper 
part  is  expansile  in  nature,  that  in  the  lower  half  is 
merely  one  of  a  forward  character.  The  hernia  is 
reducible  with  the  peculiar  ^rgle  of  intestine  and  the 
feeling  of  a  solid  body  sliming  away  from  the  fingers. 
The  hydrocele  is  irreducible.  Fluctuation  may  be 
obtained  over  the  hydrocele,  and  this  fluid-containing 
sac  is  translucent.  There  is  a  resonant  note  over  the 
hernial  portion,  there  is  dulness  over  the  fluid  part. 
Auscultation  gives  evidence  of  bowel  above,  but  reveals 
nothing  below. 

The  treatment  of  such  a  case  is  to  carefully  tap  the 
hydrocele,  and  apply  a  truss  to  the  hernia. 

We  have  now  in  oi^r  seventh  case  a  very  interesting 
one.  Here  is  a  man  who  is  the  subject  of  a  partially 
descended  rijght  testis,  which  lies  in  fact  in  the  inguinal 
canal  just  within  the  external  abdominal  ring.  You 
will  observe  that  the  right  halt  of  his  scrotum  is 
practicaUy  entirely  unoevelopeid.  Yerjr  frequently 
retention  of  the  testicle  is  associated  with  escape  of 
contents  of  the  abdomen,  and  in  some  of  these  cases  a 
carious  variety  of  inguinal  hernia  is  induced.  I  refer 
to  what  is  termed  the  interstitial  hernia. 

As  the  man  stands  before  you,  vou  will  see  he  has 
some  fulness  in  the  right  inguinal  region  due  in  piurt 
no  doubt  to  the  retained  testis.  On  asking  him  to 
cough  you  will  observe  the  descent  of  the  hernia,  and 
the  typical  direction  which  it  pursues.  Instead  of 
iMkssbg  from  the  canal  into  the  scrotum,  it  turns  up- 
wards on  to  the  abdomen,  mounting  up,  as  it  were,  by 
dissecting  the  layers  of  the  abdominal  parietes. 

In  this  ascension  the  sac  and  its  contents  lie  in  one 
of  three  positions  :^ 

1.  Bebveen  the  partial  peritoneum  and  the  fascia 
transversalis. 


2.  Between  the  internal  and  external  oUique  muscles* 

3.  Between  the  aponeurosis  of  the  external  oblique 
muscle  and  the  skin. 

As  to  the  cause  of  this  peculiar  variety  of  hernia,  it 
has  been  thought  that  the  extension  of  the  sac  upon  the 
abdominal  wall  is  due  to  repeated  attempts  at  reduc- 
tion, especiallv  in  funicular  nemia,  where  the  opening 
of  the  internal  ring  is  small.  A  similar  condition  may, 
of  course,  be  found  in  one  of  the  varieties  of  reduc- 
tion en  masse.  Again,  if  a  truss  is  worn  over  the 
external  ring  alone,  in  other  words,  a  truss  which  is 
manifestly  too  long,  it  has  been  considered  likely  that 
the  sac  within  the  canal  may  pass  upwards,  being  pre* 
vented  by  the  pressure  on  the  external  ring  from 
descecding  into  the  scrotum.  Against  this  theory  it 
may  be  urged  that  interstitial  hemisB  are  very  rare,  but 
a  truss  worn  in  the  above-mentioned  wrong  position  is 
unfortunately  very  common. 

Lastlv,  it  nas  been  held  that  a  partially  descended 
testis  blocks  the  external  ring  when  it  lies  just  within 
it,  and  so  retards  the  formation  of  a  complete  hernia^ 
and  in  some  cases,  prohibits  its  production  altogether. 
But,  on  the  other  hand,  many  patients  with  a  testis  in 
the  canal  are  not  the  subjects  of  interstitial  hernia. 

It  is  true,  however,  that  the  migority  of  cases  of 
interstitial  hernia  in  males  have  a  but  partially 
undated  testis.  When  the  condition  occurs  in  women^ 
their  smaller  and  tighter  external  ring  may  account  in 
some  measure  for  the  abnormal  course  of  the  protrusion. 
It  ma^r  in  all  these  cases  then  be  said  that  the  sac  en- 
larges in  the  direction  of  least  resistance. 

llie  treatment  falls  under  two  heads,  either  opera- 
tive or  mechanical.  I  think  such  cases  of  the  not  far 
advanced  types  of  interstitial  ruptures  may  be  greatly 
benefited  by  operation,  and  I  strongly  advise,  if  there 
be  an  offending  testicle,  that  it  be  either  replaced 
within  the  abdomen,  or,  if  ill-developed,  removed  at 
the  same  time  as  the  sac  is  dealt  with.  If,  on  the 
other  hand,  a  truss  be  applied,  one  with  an  interstitial 
plate  will  be  necessary.  This  testis,  if  present  in  the 
canal,  need  not  be  thought  of,  as  it  will  take  care  of 
itself. 

Our  last  case  of  inguinal  hernia  is  a  very  rare  one^ 
in  fact  so  uncommon  is  it  that  this  is  the  only  typical 
case  I  have  seen.  He  presents  the  condition  known  as 
a  cruro-scrotal  hernia.  By  this  term  is  meant  a  rupture 
which,  instead  of  having  a  sac  passing  into  the  scrotum^ 
has,  as  it  were,  developed  a  sac  which  pushes  down  in 
front  of  it  the  tissues  at  the  upper  part  of  the  fold 
between  the  thigh  and  the  scrotum. 

These  cases  are  usually,  if  not  always,  associated 
with  malposition  of  the  testis  on  the  same  side.  It 
would  seem  that  tlds  organ  having  escaped  from  the 
external  abdominal  ring,  misses  the  way  into  the 
scrotum,  and  turns  or  is  ara^^ed  by  a  process  of  the 
{[ubemaculum  toward  the  pennenm,  but  stops  short  on 
Its  way. 

This  arrest  may  afterwards  have  developed  in  con- 
nection with  it  a  hernia  such  as  we  have  here  before  us. 

If  you  will  notice,  in  this  man  the  right  half  of  his 
scrotum  is  undistended  by  either  a  testis  or  the^  hernia^ 
but  presents  very  clearly  the  corrugated  condition  or 
the  skin  of  a  normal  scrotum.  The  hernial  protrusion 
lies  altogether  external  to  the  scrotum  itself.  The 
treatment  of  such  cases  is  that  of  an  ordinary  scrotal 
hernia. 

'  There  are  now  remaining  two  cases  of  ventral 
hernia  to  be  seen.  One  is  a  man  who  has  a  typical 
protrusion  through  the  linea  alba  some  two  inches 
above  the  umbilicus.  This  is  the  common  position^ 
namely,  between  the  navel  and  the  ensiform  appendix^ 
for  such  hemise. 

They  are  frequently  in  their  earlier  stages  merely  a 
prolapse  of  subperitoneal  fat  through  an  opening  in  the 
fibrous  tissue  of  the  linea  alba.  The  opemng  in  this  is 
commonly  wider  transversely  than  vertically. 

Such  small  ruptures  may  be  retained,   especially 


258    Tax  Mbdigal  PBtt& 


ORIGINJ^L  COMMUl^ICATIONS. 


Mas.  11,  ia96. 


when  the  patient  is  thin,  by  a  Salmon  and  Ody's  afn- 
bilical  triiML  If  th^  caiue  much  pain,  as  they  not  in- 
freguently  do,  I  usually  operate  on  them  hj  a  vertical 
incision  on  to  the  tumour,  freeing  the  sac  if  there  be 
one,  or  the  tag  of  fat  if  this  is  all  that  is  protruded,  and 
then  transfixing  either  and  cutting  the  part  away.  The 
edges  of  the  opening  are  now  refreshed  and  sutured 
transvereely  with  silk. 

The  last  case  I  have  to  bring  before  you  is  a  man 
with  a  well-marked  non-traumatic  protrusion  through 
the  linea  semilunaris. 

These  are  nearly  always  on  the  left  side  and  below 
the  umbilicus,  this  possibly  being  due  to  the  fold  of 
Doiiglas. 

They  occur  usualljr  after  middle  life,  as  in  our  patient, 
a;nd  by  no  means  infrequently  become  strangulated 
when  they  contain  bowel. 

A  smaU  umbilical  pattern  truss  answers  well  in  the 
majority  of  these  cases.  Operative  treatment  is  not 
very  satisfactory  in  producing  a  radical  cure. 


CLINICAL  NOTES  OF 
GYNECOLOGICAL    CASES 

FROM  A  PROVINCIAL  HOSPITAL,    (a) 
By  K  F.  ELIOT.   F.F.P.  AS.  Glags., 

Soxgeon  to  the  Women's  BoepiUd,  Southampton. 

Having  been  to  some  extent  instrumental  in  initia- 
ting the  establishment  of  a  hospital  for  the  treatment 
of  the  special  diseases  of  women  in  Southampton,  I 
think  a  short  account  of  its  foundation  and  work 
may  be  of  some  little  interest  I  feel  acutely  how 
very  difficult  it  is  to  introduce  Jsmy  new  idea  or  any 
information  of  any  real  interest  or  importance,  and  my 
apology  must  be  that,  in  bringing  before  your  notice 
this  evening  some  details  of  the  early  work  of  a  small 
hospital,  and  recording  a  few  notes  of  my  earliest 
cases,  I  may  be  able  to  justify  my  own  practice,  and 
Encourage  renewed  zeal  and  energy  in  some  members 
of  the  profession,  who,  perchance,  may  be  at  the  pre- 
sent time  experiencing  difficulties  similar  to  my  own, 
and  also  show  the  leaders  and  teachers  of  gynaecology 
that  their  seed  is  not  cast  in  vain,  but  that  it  is  finding 
root  in  remote  comers  of  the  land. 

After  I  had  been  in  practice  for  some  years  in  South- 
ampton, a  great  many  cases  requiring  special  treatment 
came  under  inv  observation,  cases  which  appeared  to 
ine  to  be  oi^tside  the  pale  of  ordinary  medi<»i  and  sur- 
gical treatment,  and  as  there  was  no  institution  where 
such  cases  were  treated,  or  treated  in  any  special 
manner  or  department,  a  small  committee  was  formed 
which,  after  consultation  with  Mr.  Lawson  Tait, 
decided  it  would  endeavour  to  establish  an  institution 
where  cases  of  a  special  nature  could  be  dealt  with. 
I  need  not  refer  to  the  uphill  nature  of  the  work, 
except  to  say  we  have  had  a  hard  stru£U^le,  but  now, 
I  am  thankful  to  say,  we  are  established,  and  I  hope 
doing  some  useful  work.  I  am  ouite  satisfied  that  this 
work  should  be  done  at  a  special  institution,  as  redly 
there  is  no  branch  of  surgery  which  requires  more 
special  knowledge,  more  special  care  and  tact,  and  more 
special  forethought  and  judgment  in  weighing  the  im- 
portance of  the  histor]^  of  each  case. 

The  female  pelvis  is,  at  any  rate  to  a  banner,  a 
most  gloomy  and  dark  region,  wherein  one  must 
always  be  prepared  for  the  unexpected ;  as  it  often 
happens  that  the  surgeon  launches  on  a  voyage  of  dis- 
covery, and  does  not  know  what  he  may  have  to  do  or 
deal  with  until  the  patient  is  on  the  operating  table, 
and  the  operation  is  commenced.  Even  my  short  ex- 
perience has  taught  me  that  cases  which  before  opera- 
tion have  promised  to  be  of  a  simple  and  straightfor- 


<a)  Read  before  the  Britiah  GynaBOoiogical  Society,  Feb.  18th,  189S. 


ward  character  are  often  eases  of  extreme  ^Officulty, 
and  tax  the  resources  and  skill  of  anyway  the  young 
operator,  to  the  utmost. 

There  are  such  a  lar^  number  of  cases  of  women 
who  eventually  find  their  way  to  si>ecial  hospitalB  and 
to  the  consulting-rooms  of  abdominal  surgeons,  who 
tell  the  same  tale  of  woe,  and  who  have  oeen  going 
from  doctor  to  doctor  to  find  relief,  cases  in  which 
examination  reveals  nothing,  or  at  the  most,  very  little, 
and  cases  in  which  the  greatest  care  and  judgment  are 
necessary  in  deciding  on  the  right  course  to  pursue. 
Advanced  cases  of  pyoaalpinx  or  myomata,  or  ovarian 
(^st  are  easy  enougn  to  recognise,  but  it  is  the  chronic 
cases,  the  cases  on  the  boraer-land,  that  require  the 
knowledge  gained  only  by  experience  and  practice. 

In  hospital  practice,  when  it  comes  to  a  (question 
of  operation,  I  always  put  the  case  to  the  patient  and 
her  friends  under  certain  heads  :— (1)  the  probable 
result  of  leaving  the  case  alone ;  (2)  the  certain  results 
of  medical  treatment ;  (3)  the  probaole  result  of  surgical 
interference  and  the  exact  methods  proposed ;  (4)  the 
risks  of  surgical  operations.  The  choice  must  be  made 
by  the  patient  after  considering  these  points.  By  this 
means  no  operation  is  forced  on  any  patient,  and  each 
thoroughly  understands,  or  has  the  chance  of  under- 
standing, what  is  going  to  be  done,  and  what  object  is 
hoped  to  be  achieved.  This  is  more  important  in  a 
provincial  town,  as  one  has  to  live,  perhaps,  very  near 
one's  patient  In  all  these  cases,  a  carefully  recorded 
case,  a  carefully  given  opinion,  and  a  carefully  noted 
result  place  one  in  a  position  to  answer  any  criticisms 
which  may  be  passed  in  a  decisive  and  unanswerable 
manner ;  and  it  is  for  this  reason  that  we  have  been 
able  to  treat  many  attacks  which  have  been  made  on 
our  work  with  absolute  contempt  (and  to  leave  them 
unanswered),  knowing  that  our  work  rested  on  a  sound 
basis. 

All  difficulties  can  be  overcome  by  knowing  they 
exist;  being  forewarned  is  being  forearmed  By  keep- 
ing a  high  standard  of  honour  always  before  one,  by 
building  up  a  stock  of  experience,  by  having  a  sound 
reason  for  every  measure  one  adopts,  and  by  adopting 
a  system  of  method  in  dealing  with  one's  cases,  all 
difficulties  will  soon  disappear,  or  can  be  easily  com- 
bated, and  as  a  compensation  for  all  the  troubles  and 
worries  there  is  the  greatest  consolation  in  every  diffi- 
culty that  is  overcome,  and  there  is,  so  my  experience 
teaches  me,  the  hand  of  friendship  and  encouragement, 
and  the  word  of  counsel  and  advice,  always  waiting  for 
^e  beginner  amongst  the  veterans  and  leaders  of  our 
great  profession. 

Apart  from  the  major  cases  and  m^jor  operations, 
there  is  such  a  vast  amount  to  be  done  in  connection 
with  uterine  therapeutics,  and  to  collect  these  cases 
together  must  builol  up  an  experience  which  must  be 
of  use  to  anyway  the  poorer  inhabitants  of  a  town, 
and,  take  it,  tnis  society  welcomes  an  account  of  work 
done  in  the  provinces,  and  that  the  leaders  in  London 
of  this  great  branch  ik  surffeiv  are  always  ^hid  to  lay 
the  little  fra^ents  of  work  done  in  a  provincial  town 
by  a  provincial  man  as  a  proof  that  their  own  work  is 
not  in  vain,  and  that  the  doctrines  they  are  teaching 
are  finding  root  throughout  the  country. 

In  condusion,  I  would  draw  your  attention  to  the 
following  cases,  and  thank  you  for  the  honour  you  have 
done  me  in  listening  to  my  paper  to-night 

Gasb  No.  lOSi— Mrs.  T ,  et  25,  healthy  till  marriage 

four  years  ago  ;  twins  two  years  ago,  and  a  year  later  a 
boy  at  the  seventh  month  ;  regular,  no  dysmenorrhoea  or 
discharge.  Swelling  first  noticed  six  weeks  ago»  has 
increacM  rapidly  since.  Patient  looks  very  ill  and  is 
lossnff  flesh  fast.  When  first  seen  tumour  was  up  to 
ambmciis,  slightly  to  the  left  side,  and  was  diagnosed  as 
a  parovarian  cyst  (while  the  possibility  of  its  being  a 
cystio  sarcoma  or  a  ooUeotion  of  enjoysted  fiuid  was  enter- 
tained). No  large  glands  or  veins.  ,  Been  1^  Mr. 
I  Lawcon  Tait,  of  JBirmingham,  and  he  wrote :  "A  plain 


Mab    U,  1890. 


ORIGINAL  CUMMUNI0ATION8- 


Th«  Mbdioal  Pbb*8.     259 


•traightlorwaid  ease  of  paroyarian  cyst,  unlets  the  pediele 

Im  sesBile,  on  which  point  yon  cannot  be  certain  antil  you 

are  there." 

Operationt  April  SiOth,  18d5. — Median  incision,  tumour 

adherent  in  front  and  caref idly  peeled  off ;  wall  in  places 
^▼ery  thick  ;  growth  mostly  omental,  but  it  has  spread 
over  the  whole  peritoneal  canty ;  wall  of  gut  very  thin  in 
places  and  riddled  with  miliary  tubercle.  Part  of  the 
omentum  which  had  been  adherent  in  front  was  removed. 
Abdomen  flushed  out  and  a  drainage  tube  inserted. 
Patient  rallied  fairly  well,  and  continued  t«>  do  better  than 
was  expected.  On  April  25th  f48  hours  after  operation) 
the  disdiarge  became  distinctly  fecal.  On  April  29th 
albumen  appeared  in  the  urine,  and  continued  to  do  so. 
The  faecal  discharge  steadily  increased  until  on  May  14th 
a  large  slough  from  the  intestinal  wall  came  away. 
Patient  gradually  emaciated  more  and  more,  and  died 
quietly  on  May  27th  (a  month  and  three  days  after  opera- 
tion). The  temperature  was  hectic  throughout.  The 
difficulty  of  diagnosis  was  the  chief  point  of  interest. 
There  was  no  history  of  phthisis,  and  pnor  to  her  man*iage 
she  was  a  stronir,  stout,  healthy  cirL  The  rapid  growth  of 
the  disease  and  the  fact  of  it  snowing  no  signs,  except 
wasting,  until  six  weeks  before  operation,  were  the  chief 
points  which  made  one  think  of  something  more  than  a 
simple  parovarian  cyst. 

Cass  59.— Mrs.  C ,  idt.  36.    Patient  was  a  married 

woman  who  had  had  eight  children  and  three  miscarriages 
at  early  dates.  Her  youngest  child  was  bom  three  years 
ago.  About  two  years  ago  she  got  gradually  run  down 
and  weak.  In  June,  1895,  sheBrst  noticed  a  swelling  of 
the  abdomen,  and  first  had  pain  in  July,  1895,  and  three 
weeks  ago  (Oct  30)  firstdetected  a  definitelump.  Catamenia 
regular  and  inclined  to  monorrhagia,  lasting  six,  eight,  or 
ten  days.  She  had  had  pressure  symptoms  on  rectum 
about  three  months,  and  on  bladder  about  two  months. 
She  was  a  pale  woman  with  an  anxious  expression,  in 
awful  pain  and  symptoms  of  obstruction.  There  was  a 
tumour  nearly  up  to  the  umbilicus,  slightly  to  the  left 
side,  hard,  irregular,  and  tender,  and  veir  sUffhtlv  mov- 
able in  all  directions.    No  fluctuation  or  fluid  uirill. 

Per  Vaginam^  cervix  looks  upward  and  to  the  right. 
Uterus  appears  quite  fixed  and  embedded  in  the  mass  telt 
from  the  abdomen.  There  is  a  large  mass  of  a  similar 
character  to  be  felt  in  Douglas's  pouch  continuous  with  the 
rest.    Myoma  uteri  diagnosed. 

Operattcn^  October  30tb,  1895.— Median  incision  ;  a  large 
mass  of  breaking  down  malignant  tissue  found  adherent 
to  abdominal  wiA.  This  was  peeled  off  and  found  to  be 
part  of  .the  omentum,  which  was  extensively  diseased,  and 
which  formed  part  of  the  tumour  felt  from  about.  After 
its  removal  the  uterus,  with  one  or  two  fibroids,  was 
removed  by  the  extra-peritoneal  method,  the  whole  of  the 
broad  lisaments  being  covered  by  the  growth.  After  this 
the  pelvis  appeared  quite  clear,  and  was  douched  out,  and 
then  the  remainder  of  the  omentum  tied  off  in  sections  ; 
the  subsequent  mass  weighed  4  lbs.  Patient  had  no  pain 
after  the  operation,  nor  subsequently,  whereas  it  was  pre- 
yionsly  dcMribed  as  unbearable.  Her  pulse  kept  steadily 
up  to  a  hundred  and  over,  but  her  temperature  never 
exceeded  100*6.  A  recurrence  of  the  growth  was  felt  on 
Nov.  9th  in  the  epigastrium,  and  other  nodules  appeared 
later.  Persistent  diarrhoea,  which  could  not  be  controlled, 
was  her  one  bad  symptom,  except  for  gradually  increasing 
weakness,  from  which  she  died  at  her  home,  on  December 
18th. 

Micro9eopic  Section. — The  chief  point  of  interest  is  the 
association  of  the  two  diseases — n«pely,  cancer  of  omentum 
(the  primary  source  being  possibly  the  right  ovary  or  tube, 
both  of  which  were  extremely  diseased)  and  myoma  of 
aterus. 

Casb  No.  36.~Mrs.  W ,  rot.  31.    Catamenia  always 

regular  and  painless  until  six  months  after  marriage, 
which  took  place  five  years  ago.  She  then  began  to  have 
abdominal  and  pelvic  pain,  which  was  intensified  at  the 
menstrual  periods  and  was  steadily  on  the  increase.  She 
had  pains  in  the  groins,  thighs,  and  back,  and  was  scarcely 
able  to  get  about.  Appendages  enlarged  and  very  tender. 
Z>ui^mwi9.— Probably  double  pyosalpinx.  After  consul- 
tation with  Mr.  Tait,  operation  advised. 

Operaiion — The  case  turned  out  to  be  one  of  double 
hydrosalpinx..  The  left  tube  was  removed  whole,  the 
right  pieoemeaL    Case  did  well 


The  chief  interest  is  the  fact  of  the  hydrosalpinx  beine 
double.  There  was  a  history  of  gonorrhoea  on  the  part  ot 
the  husband. 

Case  No.  10.— Mrs.  M ,  set.  36.    This  case  was  one 

of  great  interest,  as  it  was  not  until  after  sections  of  th» 
ovary  had  been  cut  that  the  true  disease  was  disoovereoL 
The  chief  complaints  were  general  ill-health,  loss  of  fleehr 
and  intolerable  dvsmenorrhoea.  The  appendages  were* 
enlarged  and  tenaer.  Palliative  treatment  was  tried 
for  some  months  with  eminently  unsatisfactory  results. 
She  was  seen  b^  Mr.  Lawson  Tait,  who  regarded  the  case 
as  one  of  chronic  ovarian  disease,  and  viewing  the  failure 
of  medical  treatment  and  the  gradually  increasing  ill- 
health  and  weakness,  suggested  the  removal  of  the  ap- 
pendages. This  was  decided  on  after  explaining  mattere 
to  the  patient ;  and  the  operation  was  accordingly 
performed.  Both  tubes  were  irregularly  knotty,  and 
impervious  to  the  finest  bristle.  The  left  ovary  showed 
sarcomatous  changes  when  examined  by  the  microscope,, 
though  to  naked  eye  appearance  the  ovary  looked  fairly 
normal,  and  it  was  very  difficult  to  remove. 

Cask  No.  10  —Mrs.  T ,  set.  40.    Patient  had  always 

had  dysmenorrhoea  and  saw  very  little.  Otherwise  well 
till  marriage  in  73.  Gonorrhoea  soon  after  marriaee.  Has 
had  one  child.  For  the  last  seven  or  eight  years  has  had 
several  sharp  attacks  of  pelvic  pain,  mostly  on  the  rightr 
side,  but  of  late,  on  both. 

Per  ro^^inam.— Extensive  pelvic  peritonitis  on  both  side» 
and  a  laree  tumour  to  right  and  back  of  uterus.  During 
the  last  SIX  weeks  before  operation  several  more  sharp 
attacks  of  pain  occurred. 

Diagnowi,— 'Probably  double  pyoaalpinx.  The  case  turned 
out  to  be  one  of  double  pyosalpinx,  associated  xoith  a  stip^ 
purating  ovarian  cyst  on  right  side.  There  was  nothing 
to  suggest  that  the  cyst  was  a  dermoid,  but  it  is  of  interest 
that  the  cyst  was  bilocular,  one  eyst  being  full  of  serum  and 
the  other  full  of  pus.  Patient  did  excellently  well,  and  wrote 
on  Jan.  7th  *<  I  am  goine  on  splendidly."  (There  was 
nothing  definite  to  show  that  the  locale  containing  pna 
was  in  direct  contact  with  the  pyosalpinx,  though  this 
was  probably  the  case.) 

Casi  H.— Mrs.  R— ,  set.  45.  History  very  obscure,  "  pain 
in  womb,"  dysmenorrhoea,  no  definite  monorrhagia,  no 
pregnancy.  Pain  chiefly  on  left,  shooting  down  leg,  some 
pain  also  on  right. 

Per  Fa<7»ikim.— Small  fibroid  in  front  wall  of  uterus. 
Great  thicking  and  matting  around  appendages.  It  wae 
decided  to  remove  the  appendages. 

Operation  —Tubes  vei^  densSy  adherent,  matly  thick- 
ened, and  of  almost  cartilaginous  hardness.  iLumen  quite* 
impervious,  no  attempt  made  at  radical  operation  oi» 
myoma. 

This  woman  was  told  her  operation  was  incomplete,  a» 
her  tumour  was  left ! !  Tait  present  at  operation.  Patient 
seen  a  few  days  ago,  quite  well. 

Case  K— Mrs.  W ,  aet.  39.     Menorrhagia  over  five 

years,  loss  at  times  alarming  and  might  almost  be  classi- 
fied  as  flooding.  Lasts  eight  to  ten  days,  during  which 
time  she  has  to  keep  her  jSdd,  and  is  in  very  great  pain. 
She  had  been  under  several  doctors  and  had  had  a  great 
deal  of  treatment.  Myoma  of  the  uterus  was  diagnosed 
and  operation  was  advised^  as  this  seemed  the  only  proper 
way  of  treating  the  large  myoma  which  was  the  cause  of 
trouble  in  May,  1895.  After  consultation  with  Mr.  Law- 
son  Tait,  patient  refused  operation  unless  I  would  under- 
take only  to  remove  the  fl4)pendages,  which  course  of 
treatment  some  one  had  told  her,  was  only  nece«sary. 
This  I  naturally  declined  to  do  as  I  felt  sure  it  was  im-^ 
possible  to  do  so.  She  continued  to  waste  and  become 
more  and  more  ansemic,  till  she  was  in  a  very  critical  state, 
the  lips  and  conjunctivae  being  almost  colourless.  Patient 
at  last  consented  to  submit  to  whatever  operation  I 
thought  best  to  perform,  and  the  operation  of  extra-peri- 
toneal hysterectomy  was  performea  on  Sept.  7th,  1896. 

Risks  of  hsemorrhage  were  specially  guarded  against 
and  an  ounce  of  blood  would  prooably  cover  the  amount 
lost. 

Patient  did  excellently.  The  clamp  did  not  come  away 
for  three  weeks,  but  the  wound  kept  dean,  and  healed 
well.  Temperature  once  reached  101  (on  second  d^y)  but 
afterwards  was  never  beyond  normal  limits.  Pulse  was 
never  over  100. 

The  patient  went  away  from  hospital  regrettmg  the* 

D 


260      TUE  MEDICAL  Pb»h. 


IBANSACnONS  OF  SOCIETIES. 


Mab.  11,  1896. 


opeiatiOD,  and  maintained  that  she  only  eon  tented  to  the 
removal  of  the  appendages. 

Case  J.— Mrs.  B ,  «Bt.  26.    When  I  first  saw  the 

patient  she  had  jast  returned  from  London,  where  she  had 
beenattendine  for  two  years  at  one  of  the  leading  hospi- 
tals, and  had  been  treated  for  retroflexion.  Came  saflering 
agonies,  largely  relieved  by  removing  a  Hodge  pessary. 
Examined  shortly  after  :  Uterus  enlarged  somewhat  and 
retroflexed,  some  endometritis  to  judge  by  the  everslon  of 
the  lips  of  the  os,  and  by  the  discharge  coming  from  it. 
Large  and  exceedingly  tender  swelling  to  left  of  and 
behind  uterus.    Similar  but  lees  pronounced  tumour  to 

Operation  explained  and  consented  to.  Large  double 
pyoealpinx,  the  larger  about  the  size  of  a  good-sized 
orai^ce.  Both  were  firmly  fixed  in  the  pelvis  by  adhesions. 
Patient  made  an  excellent  recovery. 

Case  No  4.— Mrs.  O'K ,  aet.  21.    A  miserable.  spNsre 

little  woman,  was  suffering  a  great  deal,  and  was  emaciat- 
ing. Had  been  under  a  lot  of  treatment,  and  came 
describing  her  life  as  a  burden  and  misery.  She  had 
suffered  miich  at  the  hands  of  treatment.  Mr.  Tait  saw 
the  case  in  consultation. 

On  examination  of  specimens,  both  ovaries  were 
enlarged,  and  they  were  composed  of  a  number  of  small, 
thinly-walled  cYst«.  The  fluid  in  all  the  small  cysts  was 
clear.  Toe  tunes  were  irregularly  thickened  and  very 
adherent. 

A  typical  case  for  operation ;  not  treated  except  at  a 
special  hospital,  and  could  not  get  relief  in  London 
because  she  was  not  told  what  was  the  matter. 

Case  32.-Miss  C ,  »t.  20,  single.    Very  difficult  to 

obtain  any  definite  history,  except  the  following  -.—Men- 
struated first  at  18  years,  regular  at  first.  In  January, 
1892,  began  to  see  more,  sometimes  two  or  three  times  a 
month.  Great  pain  and  bearing  down.  Yellow  inter- 
menstrual discharge  for  a  vague  period.  Pain  much 
worse  af  cer  she  had  Uie  discharga  No  bad  pain  prior  to 
discharge. 

Per  Fo^tikim.— Large  tumour,  probably  pyosalpinx  on 
right  side,  enlarged  tube  on  left,  hymen  ruptured. 

Opero^ton.— Removal  of  double  pyosalpinx,  both  very 
large.  No  very  great  amount  of  adhesions  considering 
the  size  of  the  two  diseased  tubes.  Patient  did  very  well, 
but  has  had  rather  marked  climacteric  svmptoms  of  pain, 
bearing  down,  &c.  Was  seen  towards  the  end  of  1895  at 
St.  Thomas's  Hospital  by  Dr.  Cullingworth,  who  explained 
to  her  that  all  her  trouble  was  due  to  the  climacteric. 

She  had  been  told  she  had  still  a  lump  left  which  had 
not  been  removed.    She  is  now  quite  welL 


(SlixdaH  JBittotbSL 

CITY  OF  LONDON  HOSPITAL  FOR  DISEASES  OF 
THE  CHEST,  VICTORIA  PARK. 

Case  qf  Dilated  Heairt  vfith  Mitral  and  Tricmpid  Mvrmurs 
much  relieved  by  Treatment. 

Under  the  care  of  Dr.  Thobowoood. 

Resident  Medical  Officer,  Db.  Csappbl. 

Mb&  a.  C.  ,  set.  37,  admitted  into  Victoria  Park  Hospital, 
under  Dr.  Thorowgood,  Nov.  26th,  1895. 

Ten  years  ago  patient  had  rheumatic  fever,  and  some 
years  previously  suffered  from  chorea.  She  has  been 
much  worse  in  her  breathing  since  a  fall  downstairs  twelve 
months  a^.  On  admission,  she  is  livid  in  face,  her 
cough  is  incessant  with  no  expectoration,  voice  almost 
nil,  sweats  much,  and  has  considerable  oedema  of  1^  and 
arms,  abdomen  swelled  and  contains  fluid.  Liver  iulness 
extends  two  inches  below  ribs.  Spleen  normal  Pulse 
112,  small.  Urine,  sp.  g.  1024,  contains  albumen  in  small 
quantity.  Dyspnoea  extreme.  Temperature  normal 
Tongue  furred.  Bowels  open.  Heart  dulness  extends 
from  third  to  sixth  rib  and  laterally  from  mid-sternum  to 
axillary  line. 

At  apex,  praesystolic  and  systolic  murmurs.  Marked 
murmur  at  ensiform  cartilage.  Pulsation  appears  over 
whole  anterior  chest,  and  jugular  vein  pulse  is  very 
evident. 


Some  dulness  with  suborepitant'iale  at  bjth  lung  bases. 
She  was  ordered  tincture  of  digitalis  (mv)  with  acetate  of 
potash  and  spirit  of  nitrons  ether,  and  this  suited  her. 
Whisky  3  oz.  in  24  hours. 

Nov.  SOth.— There  being  but  little  improvement  she 
was  ordered  every  evening  a  pill  of 

Pil.  Hydrarg. 

Ext.  conii.,  aa  gr.  ij 
The  pill  was  taken  with  great  i2l vantage,  and  by  degreee 
the  cardiac  dulness  became  less  extensive  as  if  the  right 
heart  was  less  engorged. 
Dec.  10th.— Dr.  Chappel  prescribed  for  her  :— 

Tr.  digit,  mv; 

Tr.  Hucis  vomi(»B,  nixv  ; 

Sp.  chlorof.  inviij ; 

Decct.  Scoparii,  5j.  M.  T.  d. 
This  suited  well :  she  was  soon  up  and  about,  and  early  in 
February  was  able  to  leave  the  hospital  much  imi>roved 
in  every  wav,  and  able  to  go  up  and  down  stairs  without 
any  marked  distress.  She  gained  13  lbs.  in  weieht  in  the 
hospital.  Pulse,  100.  Very  little  oedema  of  feet  only. 
The  systolic  murmur  was  very  loud  at  apex,  followed  by 
a  ringing  second  sound.  At  ensiform  cartilage  also  the 
murmur  continued.  The  prtesystolic  murmur  vanished 
after  a  few  weeks  in  the  hospital. 

Btmarks  by  Dr.  Thobowgood.— This  case  seemed  to  take 
a  very  favourable  turn  after  a  week  of  the  pil.  hydrargyri. 
This  pill  acted  freely  on  the  bowels,  and  under  its  influence 
the  oedema  rapidly  diminished,  while  the  coagh  ceased, 
and  breathing  became  easy.  The  right  heart  was  relieved 
and  then  the  nux  vomica  tonic  came  in  to  strengthen  the 
action  of  the  heart  with  good  effect.  The  amount  of 
alcohol  used  in  the  case  was  very  smaU.  To  start  off  at 
once  in  a  case  of  this  nature  with  alcoholic  stimulants  in 
large  doses,  and  cardiac  tonics,  is  a  plan  that  seldom 
answers  until  the  engorged  heart  has  been  relieved  by 
pil.  hydrargyri  and  oigitiJis,  and  sometimes  by  a  smaU 
venesection.  A  small  amount  ol  albumen  in  the  urine  is 
by  no  means  a  reason  for  withholding  mercurial 
medicines,  provided  a  free  action  of  the  bowels  be  main- 
tained, 

» 

OBSTETRICAL  SOCIETY  OF  LONDON. 

BdEBTIKO  HELD  WeDNISDAT,  MaBCH  4tH. 

The  President,  Dr.  Champmets,  in  the  Chair. 

HYSTEBECTOMT  FOR  GABCINOMA  UTERI. 

Dr.  a.  Routh  showed  a  specimen  removed  from  a 
woman,  tst.  56,  who  had  ceased  to  menstruate  six  years 
previously.  Although  only  the  cervix  uteri  appeared  to 
be  diseased  he  decided  to  remove  the  uterus  as  a  whole. 
He  gouged  away  the  cervical  growth  and  then  removed 
the  uterus,  and  having  done  so  he  found  on  cutting  it 
open  that  it  too  was  diseased.  This  case  showed  that  it 
was  possible  for  disease  of  the  body  to'escape  recognition, 
and  it  showed  moreover  the  danger  to  which  patients 
were  exposed  if  one  adopted  the  practice  advocated  by 
Dr.  Lewers  and  others  of  removing  only  the  obvious 
cervical  disease. 

DERMOID  CYST  OF  OVARY  REMOVED  DURING  PREONANCY. 

Dr.  Galabin  showed  a  specimen  removed  at  the  fourth 
month  of  pregnancy  which  proved  to  be  a  dermoid  cyst  of 
the  left  ovary  with  the  ttsual  contents.  The  other  ovary 
contained  several  cysts  with  similar  contents.  In  the 
tumour  of  the  left  ovary  was  seen  a  well-marked  corpus 
lutevm  of  pregnancy.  The  patient  made  a  good  recovery 
without  any  threatenings  of  abortion  or  tne  metrotaxis 
which  one  usually  gets  slter  removal  of  both  ovaries.  He 
pointed  out  that  Uie  removal  of  an  ovary  containing  a 
veside  on  the  point  of  rupture  produced  apparently  the 
same  effect  as  if  tfie  vesicle  had  gone  on  to  rupture,  and 
on  this  assumption  one  could  understand  why,  when  there 
was  no  vesicle  approaching  rupture,  there  should  be  no 
metrotaxis. 

CANCEROUS  DEGENERATION  OF  URERIKE  FIBROID. 

Dr.  GAI4ABIN  showed  another  specimen  removed  from  a 
patient,  set  42,  who  had  had  a  large  fibroid  of  the  uterus 


Mab.  11, 1896. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Phbss.     261 


for  many  years,  with  menorrhagia,  and,  for  three  months, 
metrorrhagia.  That  was  in  October,  1894.  He  performed 
odphorectomy,  removing  both  ovaries  and  tunes.  The 
tumour  penetrated  a  good  deal  mto  the  left  broad  liga- 
ment. For  about  six  months  she  remained  free  from  sym- 
gtoms  of  any  kind,  and  then  the  bleeding  recommenced, 
at  she  did  not  apply  for  advice  until  a  year  had  elapsed. 
By  that  time  the  b»morrhage  had  become  continuous,  and 
the  discharge  was  thought  to  be  somewhat  foetid.  He 
dilated  the  oervix,  but  failed  to  detect  any  bigns  of  cancer. 
Nevertheless,  he  thought  it  best  to  remove  the  mass, 
which  was  then  seen  to  be  undergoing  malignant  degen- 
eration. This  case,  he  said,  was  of  interest  as  showing 
that  it  was  possible  to  explore  the  uterus  without  finding 
that  cancer  was  there  although  present. 

CUBIOUS  CONGENITAL  APPSABAUCE  IN  A  FOSTUS. 

Dr.  LswEBS  showed  a  foetus  delivered  at  term  after 
craniotomy,  the  mother  being  a  woman,  set.  36,  with  two 
living  children,  sent  to  him  by  Dr.  Cnrrie,  of  Finsbury 
Park.  It  presented  a  large  pendulous  mass  springing  from 
the  front  of  the  neck  which  a  colleague  suggested  was  of 
the  nature  of  a  cystic  hygroma. 

The  President  pointed  out  that  it  was  a  very  unusual 
appearance  in  the  foetus,  and  on  his  suggestion  it  it  a? 
referred  to  a  committee  for  examination  and  reports 

HTDBONEPHBOSIS  SIMULATING  OVABIAN  CYST. 

Dr.  TiT&NEB  showed  a  specimen  from  a  case  which 
appeared  to  him  to  be  clearly  one  of  unilocuUur  ovarian 
cyst.  By  the  vagina  the  tumour  appeared  somewhat  high 
np,  and  this,  he  admitted,  ought  perhaps  to  have  put  him 
on  his  guard.  He  also  made  out  the  presence  of  a  ceil  of 
intestine  over  the  cyst  which  might  also  have  inspired  a 
doubt  as  to  its  nature.  The  patient  bad  consisted  him  for 
a  supposed  injury  to  the  hip,  and  it  was,  so  to  speak, 
quite  accidentally  that  he  discovered  the  tumour  at  all. 
There  was  nothing  in  her  history  to  indicate  the  nature  of 
the  cyst,  which  had  never  given  rise  to  pain  or  inconveni- 
ence. She  was  5^  years  of  age,  and  presented  marked 
spinal  curvature,  with  pulmonary  lesions  consequent  on 
an  attack  of  pneumonia  many  years  ago.  On  opening  the 
abdomen  he  at  once  saw  that  it  was  not  an  ovarian  cyst, 
and  on  tracing  its  attachments  upwards  he  discovered 
that  it  was  a  hydronephrosis.  The  distended  colon 
stretched  right  across  it  in  front,  and  the  peritoneum 
covering  the  cyst  was  exceedingly  vascular.  He  stripped 
this  off  and  removed  the  cyst  after  ligature  by  enuclea- 
tion. The  operation  was  almost  bloodless  and  the  tempe- 
rature at  once  fell  to  normal.  The  patient  did  well,  and 
he  was  on  the  point  of  authorising  her  gettine  up  when 
one  day  on  attempting  to  pass  water  she  suddenly  oecame 
faint  and  expired  in  three  or  four  minutes.  He  mentioned 
that  the  cyst  contained  four  pints  of  clear  urine  of  normaJ 
specific  gravity  and  free  from  albumen.  The  ureter  was 
not  blocked,  but  was  bifid  up  to  the  pelvis  of  the  kidney. 
He  suggested  that  the  condition  was  probably  consequent 
on  floating  kidney,  and  that  the  ureter  had  somehow  got 
obstructed,  though  there  was  nothing  in  the  history  to 
point  to  such  an  occurrence.  The  appearances  post- 
mortem were  absolutely  satisfactory  as  far  as  the  operation 
was  concerned,  and  he  was  still  at  a  loss  to  explain  the 
real  cause  of  the  syncope,  there  being  nothing  in  the  heart 
or  brain  to  account  for  it.  The  right  kidney  was  larse, 
and  its  ureter  was  also  bifid.    After  the  operation  the 

Quantity  of  urine  had  increased  from  15  ozs.  within  a  few 
ays  to  44  ozs.  in  the  24  hours. 

Dr.  HsTWooD  Smith  mentioned  the  case  of  a  married 
woman,  who  presented  an  abdominal  tumour  extending 
equally  on  both  sides  of  the  pelvis.  There  were  no  sym- 
ptoms to  enable  one  to  say  for  certain  whether  it  was 
ovarian  or  renal,  so  he  aspirated  and  withdrew  only  six 
oonoes  of  urine,  though  the  cavity  contained  several  pints. 
The  patient  died  the  same  day.  Post-7nort€m.—An  enor- 
mous hydronephrosis  was  found  with  calculi  impacted  in 
the  pelvis  of  both  kidneys. 
Aa  jonmed  discussion  on  Dr.  Cbipp  s  paper  on 
ABDOMnrAL  htstebbctohy  with  intba-peeitoneal 

TREATMENT  OF  THE  STUMP. 

Dr.  Cullinowoeth  said  the  author's  paper  reflected  the 
change  at  present  taking  place  in  the  attitude  of  the  pro- 
fession in  respect  of  operations  for  myoma  of  the  uterus. 
These,  he  thought,  are  certainly  becoming  more  frequent. 


partly  because  of  the  diminished  mortality  resulting  from 
improved  technique.  With  the  lessened  risk,  he  urged, 
it  was  justifiable  to  recommend  operative  interference  in 
cases  in  which  formerly  they  would  not  have  ventured. 
These  tumou<*s  were  now  recognised  to  be  a  source  of 
much  later  misery  and  of  menaoe  to  health  and  even  to 
life.  Patients  could  not  be  promised  a  cessation  of  their 
troubles  at  the  menopause,  for  experience  had  shown  that 
they  might  lead  to  various  troublesome  and  even  fatal 
diseases.  One,  therefore,  no  longer  awaited  the  advent  of 
dangerous  complications  before  advising  operation.  Among 
indications  for  operative  interference  not  mentioned  in  the 
author's  list,  he  suggested:  (1)  when  it  becomes  evident 
that  degenerative  cystic  or  other  changes  are  taking 
place  ;  (2)  when  the  rate  of  growth  has  suddenly  begun  to 
increase  ;  and  (3)  when,  after  the  menopause,  the  tumours 
coDt'nue  to  increase  in  size.  He  agreed  that  the  so-called 
intra-peritoneal  method  was  preferable  to  the  extra-peri- 
toneal, the  latter  being  a  clumsy  and  unscientific  proce- 
dure. It  was  necessary,  however,  to  discover  a  means  of 
sf  curing  the  patient  against  the  risks  of  haemorrhage  from 
the  stump,  but  until  it  was  suggested  to  tie  the  uterine 
arteries  as  a  preliminary  step,  the  extra-peritoneal  method 
could  not  be  supplanted.  That  method  had  now  practi- 
cally been  superseded.  The  rivalry  at  present  was  not 
between  the  intra-  and  extra-peritoneal  methods,  but 
between  the  method  of  leaving  tne  cervix  and  that  of  re- 
moving the  entire  uterus.  Recently  the  propriety  of 
removing  the  tumour  through  the  vagina,  with  morceUe- 
ment  if  necessary,  had  come  to  the  front.  He  had  per- 
formed abdominal  hysterectomy  in  40  cases,  in  9  by  the 
extra-peritoneal,  and  in  31  by  the  intra-peritoneal  method, 
the  cervix  being  left  in  all  the  cases.  Since  he  first 
resorted  to  the  intra-peritoneal  method,  he  had  never  once 
returned  to  the  other  plan,  but  he  admitted  that  the  mor- 
tality had  been  higher  since  the  change,  such  increase, 
however,  not  being  the  fault  of  the  operation,  but  due  to 
exceptional  complications.  In  the  favourable  cases  there 
was  a  very  striking  contrast  beeween  the  comfort  of  the 
convalescence  after  the  one  method  and  the  discomfort 
after  the  other.  He  allowed  that  the  question  of  mortality 
was  of  greater  importance  than  that  of  comfort,  but  if,  as 
was  the  case,  the  dangers  attending  the  intra-peritoneal 
method  were  not  greater  than  of  the  other,  then  the  ques- 
tion of  comfort  deserved  consideration.  His  plan  of 
securing  the  vessels  in  the  broad  ligament  was  by  tearing 
or  otherwise  forcing  a  hole  in  the  ligament.  At  each 
extremity  of  the  slit,  thus  made  he  passed  a  silk  ligature^ 
tying  the  one  over  the  free  upper  border  of  the  brosd  liga- 
ment, and  the  other  over  the  inf undibulo-pelvic  ligament, 
the  latter  securing  the  ovarian  artery.  The  inner  one 
prevented  bleeding  during  the  operation  from  the  vessels 
on  the  uteiine  side  of  the  broad  ligament,  and  took  the 
place  of  the  inconvenient  clamp  forceps.  The  tissues 
between  these  two  ligatures  having  been  divided,  the 
upper  patt  of  the  tumour  became  free.  The  next  step  was 
to  tie  the  uterine  artery  on  each  side.  He  felt  for  the 
pulsating  vessel  where  it  approached  the  side  of  the 
uterus,  as  near  asposslble  to  tne  level  of  the  w  irUemumy 
and  secured  it.  He  held,  with  Mr.  Greig  Smith,  that  it 
was  preferable  to  include  the  surrounding  tissues  in  the 
ligature  to  prevent  slipping.  With  regard  to  the  origin  of 
the  sepsis  in  the  author's  cases,  he  thought  it  was  hardly 
justifiable  to  say  absolutely  that  it  was  from  the  vagina, 
for  this  was,  he  umd,  a  less  freauent  cause  of  infection 
than  was  general^  supposed.  The  conclusions  he  had 
arrived  at  from  his  experience  of  odphorectomy  were :  (1) 
that  it  afforded  an  almost  certain  means  of  relieving  all 
the  more  dangerous  symptoms  in  cases  in  which  active 
treatment  was  necessary,  and  in  which  removal  of  the 
tumour  or  tumours  was  either  impracticable  or  likely  to  be 
attended  with  special  difficulty  or  grave  risk  ;  (2)  that  it 
was  unsuitable  in  cases  where  the  tumours  had  attained  a 
very  large  size,  or  had  become  osdematous,  or  had  under- 
gone cystic  or  other  degenerative  change  ;  (3)  that  it  was 
peculiarly  applic  'ble  to  cases  in  which  the  tumours  were, 
for  tbe  most  part,  intra-pelvic,  and  in  which  operative 
interference  was  required  for  the  relief  or  prevention  of 
dangerous  pressure  symptoms ;  (4)  that  its  field  of  useful- 
ness was  likely  to  Mcome  curtailed  in  proportion  as  the 
technique  of  abdominal  hysterectomy  improved,  and  the 
mortality  of  the  latter  operation  diminished;  (5)  that, 
although  in  experienced  hands  its  mortality  was  not  high, 


202     Thb  Mxdical  PBtss. 


TRANSACT  10X8  OF  SOCIETIES. 


Mar    11.  1896. 


it  ahonld  never  be  regarded  or  »poken  of  as  a  slight  or 
minor  operation ;  (6)  that  it  was  impoMible  to  know 
beforehand  whether  it  would  be  an  easv  or  a  difBcult,  or 
eyen  a  practicable,  operation ;  (7)  that  the  relief  was  not 
generally  so  prompt  or  convalesoence  so  free  from  inter- 
ruption as  in  an  ordinary  case  of  ovariotomy,  or  even  of 
abdominal  hysterectomy  ;  (8)  that  before  being  submitted 
to  the  operation,  a  patient  should  be  made  fully  aware  of 
the  uncertamtiee  that  specially  attended  it. 

Dr.  P.  HoBBOCKS  considered  the  extra-peritoneal  method 
to  be  barbarous,  and  preferred  the  intra-peritoneal  method 
on  every  ground.  He  had  performed  Baer's  operation 
four  times,  with  one  death.  He  pointed  out  that  all 
operations  had  been  placed  on  a  different  footing  now  that 
they  could  almost  guarantee  asepsid  bv  means  of  sterilisa- 
tion of  instruments.  He  questioned  the  correctness  of  the 
opinion  that  the  cervical  and  vaginal  secretions  were  the 
cause  of  fatal  sepsis  in  the  case  mentioned,  and  he  could 
see  no  advantage  in  puttinff  a  drainage-tube  into  the 
pelvis  to  draw  off  the  small  quantity  of  serum  which 
might  exude  from  the  peat  of  the  operation. 

Mr.  MEBXDiTif  said  he  was  still  in  favour  of  the  extra- 
peritoneal method  of  dealing  with  the  stump  which  had 
given  him  very  fatisfactory  results  in  the  100  cases  in 
which  he  had  used  it.  He  usually  removed  the  serrenoBud 
and  pin  at  the  end  of  a  week  after  paring  away  all  the 
tissue  external  thereto,  allowing  it  to  drop  back  into  the 
abdomen.  He  did  not  think  there  was  any  necessity  to 
allow  the  external  portion  of  the  pedicle  to  oecome  septic 
and  in  his  own  cases  this  certainly  did  not  take  place.  It 
was  extremely  rare  for  its  return  to  be  followed  by  any 
rise  of  temperature.  One  objection  to  this  plan  was  said 
to  be  the  risk  of  causing  abdominal  obstruction,  but  he 
had  never  seen  such  a  care  nor  had  he  ever  tied  the  ureter 
by  mistake,  though  he  knew  of  a  case  in  which  this  had 
happened.     He  admitted   that  there  mi^ht  be  a  small 

Erotrusion  at  the  site  of  the  stump  but  this  could  easily 
e  controlled  by  an  appropriate  pad  and  need  give  rise  to 
no  inconvenience.  He  had  only  operated  on  one  case  by 
the  intra- peritoneal  method,  but  though  it  turned  out 
all  right  he  was  not  converted  to  the  advantages  claimed 
for  this  procedura  He  said  his  mind  was  open  to  convic- 
tion but  so  far  nothing  had  been  advanced  to  lead  him  to 
consider  the  propriety  of  abandoning  the  extra-peritoneal 
method  of  dealing  with  the  pedicle. 

The  PRBSIDBIVT  did  not  think  they  were  yet  within 
measurable  distance  of  the  time  when  the  removal  of  a 
fibroid  which  was  not  giving  rise  to  painful  symptoms, 
nor  was  menacing  life,  coula  be  considered  a  justifiable 
proceeding.  The  mortality  of  the  operation  would  have 
-  to  be  infinitely  smaller  than  it  was  at  present  to  justify 
their  advising  removal,  except  in  presence  of  urgent  sym- 
ptoms. No  one  was  more  strongly  in  favour  of  operative 
interference  when  necespary  than  ne  was,  but  in  any  case, 
he  considered  oophorectomy  to  be  a  very  unsatisfactory 
operation.  When  an  operation  of  some  kind  was  neces- 
sary, he  thought  it  was  better  for  the  patient  to  incur  the 
slight  additional  risk  and  submit  to  total  extirpation  of 
the  uterus.  They  did  not  know  enough  of  intra-peritoneal 
methods  at  present  to  form  a  definite  opinion.  It  certainly 
seemed  that  however  careful,  and  however  aseptic  a  sur- 
geon might  be,  as  evidenced  by  the  absence  of  septic  com- 
plications in  other  abdominal  operations,  there  was  always 
a  possibility  in  these  intra- peritoneal  cases  of  septic  mis- 
chief supervening.  He  did  not  believe  that  infection 
always  took  place  from  the  vagina,  the  want  of  drainage 
having  probably  much  more  to  do  with  it  One  reason 
why  vaginal  hysterectomies  did  so  well  was  because  fluid 
could  drain  away.  He  suggested  that  the  intra-peri- 
toneal method  would  have  to  be  greatly  improved  be- 
fore it  could  be  safely  recommended  for  general  adoption. 
It  had  been  said  that  the  extra-peritoneal  operation  was 
"  barbarous,''  but  most  of  them,  be  imagined,  would  prefer 
to  preserve  life  by  a  barbarous  operation  than  to  mse  it 
by  a  triumph  of  surgery.  When  the  two  operations  were 
placed  on  an  equal  footing  as  regards  mortality,  then 
doubtless  the  extra-peritoncAl  meth&  would  die  out. 

Mr.  Habbison  Cbipps,  in  reply,  agreed  that  they  were 
still  a  long  way  from  the  time  when  they  would  be  justified 
in  recommending  patients  to  submit  to  the  removal  of  a 
fibroid  which  was  ^ving  rise  to  no  pressure  symptoms, 
or  hemorrhage.  With  fourteen  or  fifteen  cafes  of  his 
own,  treated  oy  the  extra-peritoneal  method,  he  had 
had  one  example  of  intestinal  obstruction,  and  one  of  his  ' 


colleagues  had  met  with  a  similar  aooident.  In  ordinary 
ovarian  operations  it  was  extremely  rare.  He  believed 
that  sepsis  was  very  rare  with  the  extra-peritoneal  treat- 
ment of  the  stump,  but  he  had  had  one  such  case  among 
those  dealt  with  by  the  internal  method,  and  he  had  since 
seen  another  very  unfortunate  case  of  the  kind.  The 
question  of  where  the  sepsis  originated  was  of  great 
interest.  He  had  not  stated  absolutely  that  it  arose  Irom 
the  vagina,  but  he  said  he  could  not  nelp  regarding  that 
canal  with  suspicion.  When  one  had  to  do  with  a  small 
tumour,  say  one  weighing  seven  or  eight  pounds,  it  might 
be  possible  to  pass  a  needle  through  the  broad  ligaments 
and  apply  a  ligature  before  cutting  through  them,  but 
with  a  large  tumour,  one  weighing  twenty-five  pounds  for 
example,  the  layers  of  the  broad  ligaments  were  much  too 
widely  separated  for  this  to  be  practicable.  The  tension, 
indeea,  was  such  that  if  one  passed  a  ligature  over  the 
large  veins  it  would  probably  out  throuffh.  He  main- 
tained, in  conclusion,  that  the  intra-pentoneal  method 
had  not  yet  been  shown  to  be  superior  to  the  older 
method,  and,  under  any  dreumstance,  in  future  he  pro- 
posed to  leave  in  a  drainage-tube  for  the  first  forty-e^ht 
hours. 


R07AL  ACAD£MY  OF   MEDICINE  IN  IRELAND. 

Section  of  Obstbtbics. 

Mbbtino  hbld  Fbidat,  Janxtabt  31st,  1896. 


The  President,  Db.  Lohbb  Atthill,  in  the  Chair. 


OVABIAN  TUMOUB. 

Db.  Alfbid  Smith  showed  an  unilocular  ovarian 
tumour,  the  size  of  an  adult  head,  which  he  removed  from 
a  child  aged  thirteen  years.    Recovery  rapid. 

Dr.  Lanb  wished  to  know  if  the  patient  had  men- 
struated ? 

Dr.  Smith  replied  that  she  had  not. 

BXHIBIT. 

Sir  Thobnlby  Stokeb  exhibited  the  uterus  wiih  a 
number  of  attached  tumours  which  he  had  removed  from 
a  patient,  thirty -five  years  of  age.  The  growths  were  fibro- 
myomata,  all  apparently  of  interstitial  origin,  although 
five  or  six  of  tnem  in  the  process  of  development  had 
become  sub-peritoneal  and  pedunculated.  The  substance 
of  the  uterine  wall  was  the  seat  of  a  number  erf  tumours, 
varying  in  size  from  a  pea  to  an  orange,  and  the  peduncu- 
lated growths  were  from  the  size  of  a  goose  egg  to  one  so 
large  that  it  weighed  15  lbs.  The  entire  weight  of  the 
parts  removed,  when  drained  of  blood,  was  19  lbs.  10  oa., 
and  must,  when  full  of  blood,  have  been  about  24  lbs. 
The  circumference  of  the  large  pedunculated  fibro-myoma 
was  34  in.  in  one  direction,  and  31 J  the  other.  The  growth 
had  existed  for  six  years,  and  had  become  so  bulky  as  to 
render  life  intolerable.  The  operation  performed  was  a 
supra-vaginal,  intra-peritoneal,  hysterectomy.  The  sutures 
securing  the  intra-ligamentous  structures  were,  like  the 
cervix,  rendered  sub-peritoneal  by  careful  suturing  of  the 
peritoneum  from  the  orim  of  the  pelvis  on  one  side  to  the 
other.  The  operation  was  an  exceedingly  protracted  one, 
owing  to  the  difficulty  of  securing  the  stump  of  the  right 
broad  ligament,  which  was  invaded  by  a  cyst  in  such  a 
way  as  to  necessitate  its  division  close  to  the  pelvic  wall. 
The  operation  lasted  2}  hours,  and  the  most  remarkable 
fact  elicited  by  it  was  that  in  spite  of  the  age  and  enormous 
size  of  the  tumours  there  were  absolutely  no  adhesions. 
The  condition  of  the  patient  from  the  time  of  operation  to 
the  date  of  meeting,  ten  days,  was  perfectly  satisfactory. 
She  had  not  even  suffered  inconvenience,  and  was  practi- 
cally out  of  danger. 

Tlie  Pbksidbkt  said  that  the  rapid  growth  in  this  case 
would  be  likely  to  lead  bim  to  think  that  the  tumour  was 
of  a  sarcomatous  nature.  While  connected  with  the 
Rotunda,  a  cape  presenting  some  points  in  common  with 
Sir  T.  Stoker's  case  had  come  under,  his  notice.  Sir 
Knowsley  Thornton  at  the  time  was  over  in  Dublin,  and^ 
having  seen  the  case,  expressed  the  opinion  that  he  would 
not  care  to  touch  it.  He  congratulated  Sir  T.  Stoker  on 
an  operation  calculated  to  uphold  the  reputation  of  Dublin 
as  a  school  of  ivgery 

Dr.  F.  W.  KiDD  read  notes  of  a  case  of  ao-called 
Elephantiasis,  which  will  be  found  on  pi^^  255. 


IdAR.  11,  1896- 


TRANSACTIONS  OF  SOCIETIES. 


Tub  Medical  Pbx>s.     263 


KCLAMPSIA. 

Dr.  Hastj>'gs  Twbsdy  read  a  paper  on  eolampeia,  and 
contended  that  it,  like  uraemic  convnUions,  arose  from 
retention  prodncte  in  the  syetem,  the  normal  reenltants  of 
tisrae  waste.    This  retention  oan  be  brouf^ht  about  in  one 
of  two  ways,  but  both  are  concerned,  as  a  rule,  in  its 
aooompliahment.    There  may  be  either  a  diseased  condi- 
tion of  the  kidnevs  present,  or  else  an  increased  formation 
of  tozine.    This  fatter  factor  is«  during  presnancy,  always 
pnaent,  and  is  in  large  part  to  be  attributed  to  the  growth 
of  the  foetus.    He  stated  that  the  proofs  are  convincing 
that  convulsions  do  not  owe  tbeir  causation  to  the  presence 
of  toiines  in  the  blood,  but  rather  to  the  deposit  of  the 
poisonous  substance  in  the  nervous  centres,  and  believed 
that  it  was  quite  possible  to  quickly  remove  this  substance 
from  the  centres  of  danger  by  depleting  the  blood  of  its 
water,  and  so  causing  a  current  to  flow  in  its  direction 
from  the  nervous  centres.     Purging,  sweating,  or  blood- 
letting would  effect  this  ;  but  the  kidneys  alone  were  to  be 
relied  on  to  directly  get  rid  of  the  hainuul  substance.    Of 
course  the   administration  of  fluids  in  any  form   would 
completely  counteract  any  good  effects  whico  might  follow 
the  above  line  of  treatment.    Throughout  the  eclamptic 
seizure  the  patient  on  no  account  is  to  be  allowed  to  lie  on 
her  back,  for  the  so-called  oedema  of  the  lungs,  constantly 
seen  in  cases  which  end  fatally,  has  its  origin  in  most 
instances  in  the  drowning  of  these  organs  by  fluids  arriving 
to  them  from  the  mouth.    The  power  to  swallow  is  nearly 
alwava  absent  in  eclampsia,  and  the   process     becomes 
absolutely  impossible  when  a  mouth  gag  is  used.     He 
contended  that  of  all  drugs,  morphia  given  hypodermically 
in  large  doses  (up  to  2}  grs.  in  24  hours),  presented  the 
greatest  number  of  advantages  with  the  fewest  disadvan- 
tages in  the  treatment  of  ecbmpsia.    All  now  knew  that 
morphia  had  but  slight  if  any  effect  on  either  the  heart  or 
kidneys.     On  the  other  hana,  it  limited  the  formation  of 
tozinee,  controlled  convulsions,  dried  up  bronchiid  and 
salivary    secretion,    was   a   diaphoretic,   and   above   all 
prevented  the  onset  of  labour.    No  greater  danger  could 
nappen  an  eclamptic  patient  than  that  labour  set  in,  and 
this   is    more  particularly  the  case    if   it    be    induced 
artificially.      Chloroform,   chloral,    and   pilocarpine,    all 
tended  to  kill  in  a  manner  similar  to  the  eclamptic  poison, 
and,  therefore,  ought  not  to  be  employed.    Neither  should 
any  fluid,  or  even  croton  oil,  be  placed  in  the  mouth,  the 
patient  being  unconscious.     In  conclusion,  he  believed 
that  it  was  attention  to  small  details  of  treatment— perhaps 
on  the  lines  indicated  in  the  paper — that  enabled  some 
authorities  to  show  results  immeasureably  superior  to 
those  of  other,  tiiough  both  might  be  pursuing  apparently 
a  similar  line  of  (reatmemt. 

Dr.  HoRNBsaid,  notwithstanding  Dr.  Tweedy's  contribu- 
tion, he  was  still  of  the  opinion  that  as  regards  the  patho- 
If  gy  of  the  disease  they  were  as  much  in  the  dark  as 
hitherto.  In  attributing  the  disease  to  toxines,  they  were, 
he  belie*7ed,  begging  the  question,  for  the  presence  of  those 
toxines  had  not  been  demonstrated.  As  regards  blood- 
letting, he  could  not  understand  how  it  was  a  treatment 
applicable  to  all  cases — for  instance,  to  one  patient  who 
was  plethoric,  and  to  another  who  was  anaemic.  He  spoke 
favourably  of  the  treatment  of  eclampsia  by  ^  gr.  doses  of 
morphia,  or  corresponding  doses  of  opium.  He  also 
expressed  himself  in  favour  of  croton  oil — a  drop  being 
placed  on  the  back  of  the  tongue.  He  bad  experience  of 
pilocarpine  in  one  case,  and.  although,  in  that  case  he 
himself  did  not  administer  the  drug,  under  its  influence 
the  woman  rapidly  develo|)ed  oedema  of  the  larynx.  He 
did  not  assent  to  Dr.  Tweedy's  theory  as  to  the  elimination 
of  ptomaines  by  blood-letting. 

The  Pbxsidbkt  said  that  3>e  danger  of  the  convulsions 
is  infinitely  greater  when  they  occur  in  the  early  stages 
than  when  they  occur  in  the  latter  stages  of  labour.  He 
had  induced  premature  labour  successfully  in  two  or  three 
casee.  Under  certain  conditions  he  would  be  prepared  to 
adopt  the  same  line  of  treatment  again.  However,  he 
re^rded  such  a  procedure  as  a  very  serious  one. 

Dr.  Alfbxd  Smith  pointed  out  t^e  fact  that  some  German 
investigators  were  inclined  to  believe  that  acetones  in  the 
blood  was  the  cause  of  eclampsia.  The  recognised  treat- 
ment of  eclampsia  was  by  large  doees  of  morphia. 

Dr.  Sm TLY  was  of  opinion  that  the  difference  of  opinion 
oo  the  question  of  the  treatment  of  eclampsia  arose  chiefly 
from  the  habit  of  forming  conclusions  on  the  experience 


gained  of  one  or  two  or  a  dozen  cases.  No  matter  what 
the  treatment  they  bad  recourse  to,  sometimes  they  would 
get  a  tun  of  successful  cases,  and  sometimes  the  reverse. 
To  his  mind  the  question  of  inducing  premature  labour  or 
not,  was,  by  no  means,  a  practical  one ;  for  the  induction 
of  labour  occupies  considerable  time,  and  causes  great 
reflex  action.  He  believed  chloroform  increased  the 
tendency  to  death.  If  the  patient's  death  was  inevitable, 
he  did  not  think  it  was  a  matter  of  great  consequence 
whether  f>he  died  in  convulsions  or  not. 

Dr.  McWebkey  did  not  think  there  was  anything  special 
about  the  eclamptic  kidney  or  anything  special  about  the 
toxaemic  condit'on  of  the  urine.  He  held  with  Bouchard 
that  eclampsia  was  an  auto-intoxication.  He  had  not, 
when  examining  for  Dr.  Home  a  ppecimen  of  cclampMc 
urine,  the  means  of  demonstrating  toxines,  otherwise  tnan 
by  experiments  on  animals.  He  said  that  in  eclamptic 
urine  albumen  in  a  greater  or  leeser  degree  was  always 
present.  A  microscopic  examination  of  wat  fluid  in  vat  i- 
ably  revealed  hyaline  tube-casts.  Bouchard  proved  that' 
toxines  could  be  eliminated  by  acting  on  the  bowels  ;  but 
the  question  of  the  administra' ion  of  purgatives  should  be 
determined  by  the  condition  of  the  patient ;  and  mentioned 
that  email  vessels  had  been  found  plugged  with  a  tissue, 
structurally  identical  with  the  chorion. 

Dr.  Lanb  dwelt  on  the  necessity  for  prophylactic  treat- 
ment—dietetic treatment.  He  thought  morphia  inferior 
to  pure  opium.  Dr.  Liane  made  a  passing  reference  to 
serum  treatment. 

Dr.  Pabsons  could  not  consider  the  treatment  by  chlo- 
roform a  rational  method,  since  it  was  well  known  that 
the  drug  depresses  the  higher  cortical  centres.  By  giving 
opium  they  were  likewise  introducing  into  the  system  a 
substance  which  exercises  a  depressing  effect  on  the  heart. 
Opium,  however,  was  a  less  dangerous  drug  than  chloro- 
form. He  failed  to  understand  the  advantage  to  be  derived 
from  sweating  the  patient,  in  face  of  the  fact  that  Dr^ 
Purser  had  assured  him  that  there  was  more  urea  in  one*. 
drop  of  urine  than  in  as  much  sweat  as  would  cover  the 
body  from  head  to  foot  He  regarded  pilocarpine  as 
simply  a  poison  in  this  disease,  since  it  paralyses  the  sen- 
sorium,  already  too  depressed. 

Dr.  Macan  ridiculed  the  theory  that  attributed  eclampsia 
to  plugging  of  small  cerebral  vessels. 

Dr.  Tweedy  said  that  success  in  the  treatment  of 
eclampsia  largely  depended  on  attention  to  details.  He 
mentioned  many  of  those  details— as,  for  instance,  turning 
the  patient  on  her  side  during  administraiion  of  chloro- 
form. 

The  Section  then  adjourned. 


EDINBURGH  MEDICOOHIRURGICAL  SOCTETY. 
Meeting  held  Wednesday,  Mabch  4th. 


The  President,  Dr.  Argyll  Robeetson,  in  the  Chair. 

Patients. 

Db.  Michael  Dswab  showed  a  child  who  had  been 
practically  moribund  from  diphtheria,  but  who,  after 
injection  of  antitoxic  serum,  had  made  a  good  recovery. 

Dr.  James  Carmiohabl  showed  a  boy,  »t.  9,  suffering 
from  chronic  peritonitis,  who  was  recovering  under  treat- 
ment. On  admission  into  the  Sick  Children's  Hospital 
he  had  an  extremely  tubercular  look,  the  abdomen  was 
markedly  distended,  and  be  only  weighed  43  lbs.  In  a 
short  time  his  weight  roce  to  49^  lbs.  The  abdominal 
exudation  was  almost  entirely  solid.  The  question  of 
surgical  interference  was  discussed,  but  he  was  of  opinion 
that  it  was  unnecessary  as  the  patient  was  progressing  so 
favourably  without  it.  Dr.  Carmichael  thought  that  sur- 
gical aid  was  only  necessary  if  there  was  much  tension  in 
the  abdomen  or  the  patient  was  much  debilitated. 

Mr.  Joseph  Bell  showed  a  boy,  let.  8,  with  double 
dislocation  of  the  hip-joints  of  congenital  origin. 

Dr.  Carmichael  showed  for  Dr.  Burn  Mu  doch  a  child 
with  patent  ductus  apteriosus,  she  had  also  acquired 
heait  disease.    There  was  no  cyanosis. 

SPECIMXNb'. 

Mr.  Stiles  exhibited  specimen  of  Prof.  Tavel's  anti- 
diphtheritic  serum,  with  Beck's  syringe  for  mjecting  it. 


264     Thk  Mkdical  Pbbbs. 


IRANSACTIOKS  OF  SOCIETIES. 


Mab   11,  1»6. 


The  senim,  it  was  alleged,  kept  sterile  for  any  length  of 
time. 

Mr.  Gaibd  showed  a  specimen  of  perforation  of  the 
stomach.  The  patient  haa  been  snffering  from  symptoms 
which  pointed  to  cancer  of  the  pyloms,  and  one  night 
perforation  occurred.  Althongh  toe  patient  seemed  to  be 
moribund  with  a  temperature  of  95'5^»  transfusion  was 
tried.  In  three  hours  the  pulse  had  become  good  and  the 
temperature  normal.  Laparotomy  was  then  performed, 
and  a  perforation  of  the  stomach  walls  was  found,  close  to 
the  pylorus  and  in  connection  with  a  cancerous  tumour. 
A  tuoe  was  passed  into  the  stomach  and  the  contents 
removed.  Toe  peritoneal  cavity  was  washed  out.  As 
the  rent  in  the  wall  of  the  stomach  could  not  be  sewn  op 
a  Wertzel's  gastrostomy  was  performed,  the  stomach 
beiDg  aiso  connected  with  the  ilium  by  means  of  a 
Murphy's  button.  For  twelve  hours  the  patient  did  well, 
but  was  again  seized  vnth  symptoms  of  perforation  and 
died.  After  death  it  was  found  tnat  a  fresh  extravasation 
of  the  stomach  contents  had  occurred  along  the  gastros- 
tomy tube. 

Dr.  Gibson  showed  three  photographs  of  patients  with 
ocular  paralysis. 

Dr.  James  read  a  paper  on 

THE  BLOOD  IN  DIABBTBS  MILUTUS. 

He  said  that  the  majority  of  observers  had  found  that, 
although  diabetes  mellitus  was  a  wasting  disease,  the 
blood  of  tliose  suffering  from  it  was  richer  both  in  cor- 
puscles and  beemoglobin  than  normally  was  the  case.  For 
some  years  back  he  hsd  made  a  series  of  observations  on 
this  point  Thus,  out  of  thirteen  cases,  five  presented 
over  6.000,000  red  corpuscles,  ^ve  over  5,000,000  two  over 
4,000,000,  and  in  one  c«se  over  3,000,000.  The  hemoglo- 
bin was  100  per  cent,  in  three,  60  per  cent,  in  eight,  and 
over  50  per  cent,  in  eight.  If  this  increase  in  the  corpus- 
cular elements  of  the  blood  were  due  to  diminution  of  its 
volume  from  the  ereat  loss  of  water  the  specific  gravity  to 
the  blood  would  be  altered.  By  Roy's  method,  however, 
no  increase  in  the  density  of  the  blood  could  be  deter- 
mined. He  thought  that  the  increase  must  be  attributed 
to  the  via  medicatrix  naturce.  As  the  organism  lost  so 
much  of  its  oxidising  material  efibrts  were  made  by  it  to 
supply  part  of  this  loss  by  increasing  the  oxidising  power 
of  the  blood.  A  parallel  might  be  adduced  from  the  effects 
of  starvation.  Tne  increased  appetite  was  also  corrobora- 
tive evidence,  and  especially  the  greater  powers  of  digee- 
tion.  He  thought  that  the  more  vigorous  the  case  the 
richer  was  the  blood. 

Dr.  Gibson  pointed  out  what  appeared  to  him  to  be  a 
similar  compensatory  effort  in  cases  of  congenital  heart 
dipease 

Dr.  Paton  thought  that  Dr.  James'  methods  were  not 
satisfactory.  The  facts,  however,  were  so  marked  that 
they  must  be  regarded  as  accurate.  The  specific  gravity 
of  the  blood  generally  varied  with  the  numoer  of  corpus- 
cles contained  in  it.  If  the  corpuscles  were  formed  in 
larger  numbers  in  diabetes  he  failed  to  see  where  the 
proteid  necessary  for  their  fashioning  came  from,  as  an 
extra  drain  of  proteid  material  was  one  of  the  chief  results 
of  the  disease. 

Dr.  LiiTH  also  spoke,  and  Dr.  James  replied. 

Dr.  W.  G.  Stm  read  a  paper  on 

ophthalmia  neonatorum. 
He  paid  especial  attention  to  its  prevention.  After  review- 
ing the  treatment  by  astringents,  he  stated  that  the  secret 
of  success  lay  in  leaving  no  pus  in  the  conjunctival  sac. 
An  ordinary  hairpin  was  a  better  instrument  than  many 
that  had  been  specially  devised.  A  larse  number  of  indi- 
viduals were  rendered  blind  by  this  disease,  a  form  of 
blindness  which  was  easily  prevented  by  proper  attention 
to  cleansing  the  eyes  of  the  newly-born.  In  England  it 
seemed  to  be  more  common  than  in  Scotland,  probably 
because  there  more  labours  were  conducted  by  mid  wives 
alone  than  in  Scotland.  In  certain  States  in  America  it 
was  a  criminal  offence  if  the  midwife  did  not  call  in  a 
doctor  if  the  child's  eyes  became  affected.  In  Glasgow  a 
pamphlet  was  handed  to  each  couple  registering  a  birth, 
in  which  instructions  were  given  as  to  what  should  be 
done  if  the  eyes  of  the  child  should  become  inflamed.  A 
similar  measure  might  with  advantage  be  adopted  in 
Edinburgh. 

Dr.  Abotll  Robertson  and  Mr.  Bell  spoke, 

And  Dr.  Sym  replied. 


LIVERPOOL    MEDICAL    SOCIETY. 
Meeting  held  Thubsdat,  Fbbbuaby  27th,  1896. 


The  President,  Db.  Catok,  in  the  Chair. 


CASES. 

Db  Rawdon  lead  notes  of  a  "  Case  of  Stricture  of  the 
(Esophagus  "  in  a  woman,  rot.  48.  The  peculiarity  of  the 
symptoms  consisted  in  the  recurrent  character  of  her 
attacks  of  diffioulty  in  swallowing,  which,  at  times,  from 
being  comparatively  slight,  became  almost  complete.  The 
fir»t  stage  in  the  operation  of  eastroetomy  was  performed, 
but  the  patient  only  eurvived  35  hours.  At  the  post- 
mortem examination  a  piece  of  orange  pulp,  shaped  like  a 
cigar,  was  found  to  be  impacted  in  the  oesophagus  imme- 
diately above  the  stricture.  This  was  the  more  remark- 
able, as  its  presence  was  not  suspected,  an  oesophageal 
tube  having  been  repeatedly  passea  beyond  the  stricture. 
The  stricture  was  due  to  fnfiltration  of  **  new  growth  "  in 
the  submucous  and  muscular  tissue.  The  viscera  did  not 
contain  any  **  new  growth,"  but  the  peritoneum,  the 
pleura,  and  the  pericardium  were  studded  with  numbers  of 
malignant  new  growths,  averaging  the  size  of  a  pea. 

REMOVAL  OF  THE  LAMINA  AND  SPINOUS  FBOOESS. 

Dr.  Cartib  showed  a  patient,  rot.  59,  a  sailor,  nho 
nearly  six  years  ago  had  had  the  lamion  and  spinous 
process  of  the  fifin  cervical  vertebra  removed  by  Dr. 
McCosh  at  the  Presbyterian  Hospital,  New  York.  About 
nine  months  previously,  on  Oct  24th,  1889,  he  had  been 
knocked  senseless  by  a  tremendous  blow  on  the  right  side 
of  his  head  from  a  heavy  iron  shackle  at  the  end  of  a 
pennant  5  ft.  long,  which  was  driven  violently  round  in  a 
gale  of  wind.  He  has  no  clear  recollection  of  anything  till 
the  following  Christmas  Day,  when  he  found  himself  m  a 
hospital  at  Boston,  U.S.A.  He  says  that  then  bis  arms 
were  tightly  flexed  across  his  chest,  requiring  some  force 
to  draw  them  away,  that  his  legs  and  thighs  also  were 
flexed  with  the  heels  pressing  against  the  outtocks,  and 
that  the  head  was  bent,  the  chin  touching  the  sternum, 
much  pain  being  caused  when  the  nurses  raised  it  in  order 
to  wash  him.  These  facts  f  eem  to  be  fairly  reliable.  Those 
as  to  anesthesia  are  more  general.  He  says  he  felt 
nothing  in  left  arm  or  leg,  but  could  feel  on  the  right  side 
as  low  as  the  eroin.  He  had  no  control  over  the  oladder 
or  rectum.  Tne  right  underwent  a  certain  measure  of 
imptovement,  but  he  could  not  stand  on  the  day  of  the 
operation,  and  had  to  be  held  up  to  enable  him  to  be 
photographed.  In  a  i^ort  memorandum  from  Dr. 
McCosh  as  to  his  condition  inmoediately  pxeceding  the 
operation  it  is  stated  that  he  could  not  stand  alone,  that 
the  lower  extremities  were  considerably  atrophied,  that 
they  could  not  bear  the  weight  of  the  body,  and  that  he 
possessed  but  little  power  in  legs  or  thighs,  that  the  left 
forearm  was  flexed  upon  the  arm  and  in  a  state  of  spastic 
rigidity  and  utterly  useless,  that  the  right  upper  extremity 
was  also  useless  ;  that  he  could  not  use  hand  or  forearm, 
and  could  not  feed  himself ;  that  the  head  had  dropped 
forward,  the  chin  resting  on  sternum,  and  that  there  was 
no  power  to  raise  it,  that  there  was  severe  pain  in  the 
aims,  legs,  and  chest."  That  is  the  only  statement  refer- 
ring to  sensation.  The  statement  continues :  "  Operation 
nine  months  after  injury.  Fifth  cervical  vertebra  found 
displaced  to  right  side ;  its  spine  being  one  inch  to  right 
of  median  line.  Posterior  arch  of  this  vertebra  removed. 
Dora  mater  found  in  a  condition  of  hsemorrhagic  pachy- 
meningitis much  thickened ;  had  been  adherent  to  bone, 
on  removal  of  which  the  dura  bled  freely.  Dura  also 
adherent  to  spinal  cord  which  itself  did  not  appear 
diseased.  Cause  of  paralysis  was  probably  products  of 
inflammation  pressing  on  spinal  nerve  roots."  If  the 
patient's  account  of  the  position  of  his  arms  on  Christmas 
day,  which  was  two  months  after  the  accident,  can  be 
relied  on,  as  I  think  it  can,  it  proves  that  a  dislocation  of 
the  fifth  cervical  vertebra  can  occur  without  paralysing 
the  adductors  of  the  humerus.  It  also  proves  that  a 
patient  can  live  for  nine  months  with  such  a  dislocation 
unrelieved.  The  condition  of  general  atrophy  which  now 
affects  all  the  muscles  of  the  IcSt  shoulder,  arm,  and  fore- 
arm is  probably  simply  the  result  of  disease.  At  present 
ansQsthesia  is  limited  to  a  small  narrow  strip  on  the  ulnar 
side  of  the  left  hand.  During  his  short  residence  in 
hospital  the  rkin  of  the  atrophied  limb  became  the  subject 
of  purpura  which  afiected  no  other  part  of  the  body.  The 


Mab,  U,  1896. 


.FRANCE 


chin  Btil]  drops  on  the  sternam  neoefldtating  the  use  of  a 
cage  with  slin^  to  aapport  the  head  in  the  nprig^ht  pod- 
turn.  The  patient  oame  to  hospital  for  bronobitis  and 
remained  but  a  short  time  ander  treatment. 

Mr.  R.  W.  MvBBAY  related  a  case  of  "  Abscess  of  the 
Temporo-Sjphenoidal  Lobe,"  following  left  middle-ear 
disease.  The  patient  was  a  girl,  set.  7,  and  the  symptoms 
were  typical  of  this  particular  intra-cranial  complication. 
The  abscess,  which  contained  1  oz.  of  pus,  was  opened  and 
drained.  A  month  later,  when  the  child  had  apparently 
completely  recovered,  she  had  a  sudden  convulsive 
seizure  a&ctiog  the  right  leg,  right  arm,  and  the  right 
side  of  the  face,  with  loss  of  consciousness.  The  left  tern- 
poro-sphenoidal  lobe  was  again  explored,  and  deep  in  its 
substance  pus  was  reached,  about  a  drachm  escaping. 
Next  day  she  was  conscious,  and  there  were  no  convul- 
sions, but  the  day  foUowine  there  were  occasional  convul- 
sive movements  of  the  right  side  of  the  body,  including 
this  side  of  the  face,  together  with  some  retraction  of  the 
head.  The  head  became  more  retracted,  and  the  child 
died  two  days  later.  At  the  autopsy  the  left  temuero- 
sphenoidal  lobe  was  found  to  be  intensely  inflamed  and 
softened  ;  both  lateral  ventricles  and  the  fourth  ventricle 
contained  pus. 

EPILEPSY  RTSULTING  FROM  LEAD-POISONIKO. 

Dr.  Alexander  Davidson  read  a  paper  entitled  *'  Epi- 
lepsy and  other  Cerebral  Symptoms  resulting  from  Lead- 
poisoning  ;  alto  a  Reference  to  the  New  Act  enjoining 
Notification  to  the  Home  Office  of  Lead-poisoning."  After 
drawing  attention  to  the  Act  of  Parliament,  he  narrated 
in  detail  a  very  severe  case  of  lead*  poisoning  occurring  in 
apainter  who  had  been  painting  the  interior  of  a  snip. 
The  large  amount  of  white  leaa  used  and  the  confined 
atmosphere  of  the  cabin  and  passages  of  the  ship  being 
axtremdv  conducive  to  severe  poisoning.  The  man  was 
admitted  to  hospital  on  a  Monday  ;  at  that  time  he  com- 

gained  of  headache  and  behaved  in  an  imbecile  manner, 
e  shortly  became  worse,  had  delirium  and  epileptic  fits, 
the  convulsions  extending  over  the  whole  body  ;  he  became 
nnoonscious,  the  fits  increasing  in  frequency,  and  he  died 
on  the  Friday,  that  is,  four  days  after  admission.  There 
was  no  kidnev  disorder,  so  that  the  fits  could  be  fairly 
considered  to  be  due  to  the  lead.  A  chemical  examination 
of  the  brain  showed  the  presence  of  lead  ;  it  was  estimated 
that  half  a  ffrain  was  tne  amount  present  in  the  entire 
brain.  Lead  was  also  present  in  the  liver  and  intestines. 
Dr.  Davidson  made  some  general  remarks  on  the  frequency 
of  the  various  symptoms  and  on  the  prognosis  and  treat- 
ment of  the  condition. 

Dr.  Bbadshaw  suggested  that  seeing  there  was  such  a 
small  amount  of  lewi  present  in  the  brain  might  not  the 
convulsions  be  due  to  antsmia? 

Drs.  Dickinson,  Barr,  Rawdon,  Carter,  Manby,  Profes- 
sor Brvce,  and  the  President  took  part  in  the  discussion. 

Dr.  Davidson  replied. 

4fmnte. 


[from  oub  own  oorbxspondent  ] 


PABI8,  March  7th,  1896. 
TCTBBRGCTLIN. 

At  the  Academic  de  MMedne  M.  Grasset  read  a  paper 
on  the  early  diagnosis  of  phthisis  in  man  by  means  of 
injections  of  tuberculin.  Everyone  understood  the  utility 
of  detecting  the  nature  of  this  malady  in  its  incipient 
stage,  but  all  practitioners  are  well  aware  that  the  diagno- 
sis is  far  from  being  easy  and  conclusive,  for  the  bacilli  do 
not  appear  in  the  expectoration  until  a  relatively  late 
period.  The  difficulties  are  etill  further  increased  where 
the  tubei'«niloeis  is  seated  in  the  bonee,  the  brain  coverings, 
&o.  Consequently,  a  new  sign,  if  it  be  sure  and  without 
danger,  is  not  to  be  despised.  Tuberculin  seems  to 
furnish  these  two  conditions,  as  testified  by  that  great 
antbority,  M.  Straus,  who  declared  that  **this  substance 
constitutes  an  excellent  diagnostic  means  in  incipient 
phthisis.' 


The  Medioai>  Pbmsb,     265 

The  tuberculin  was  furnished  M.  Grasset  for  his 
experiments  by  the  Pasteur  Institute,  and  the  dose 
employed  was  infinitesimal  but  sufficient,  150th  of  a  grain. 
The  mode  of  using  is  simple.  The  patient  is  kept  in  bed 
two  or  three  days  and  his  temperature  taken  morning  and 
evening  and  marked.  The  hypodermic  injection  is  then 
made  once  a  day  for  two  or  three  days  more  in  the  thigh, 
and  the  temperature  carefully  registered  three  times 
a  day.  No  abscess  follows  or  any  local  irritation.  M. 
Grasset  cited  a  series  of  cases  in  which  he  was  able  to 
arrive  at  an  exact  opinion  on  the  nature  of  the  sfiection. 
A  man,  tst.  43,  entered  the  hospital  presenting  symptoms 
of  rachidian  meningitis,  without  any  external  sign  of 
lesion  of  the  vertebras.  For  four  months  he  had  been 
sufiering  from  inter-costal  pains,  coming  on  in  paroxysms, 
the  spine  was  painful  to  pressure,  especially  over  the 
dorsal  vertebrae.  The  left  eye  showed  symptoms  of  exo- 
phthalmia,  while  the  upper  Ud  dropped.  The  body  had 
evidently  been  wasting  for  some  time.  The  temperature 
was  normal,  but  after  the  injection  of  the  tuberculin,  it 
rose  to  100°.  M.  Grasset  pronounced  the  case  to  be  one  of 
tuberculous  meningitis. 

A  patient,  tst.  23,  presented  the  symptoms  of  Addison's 
disease.  He  had  had  a  costo-vertebral  cold  abscess,  which 
got  well  after  operation.  The  bronzed  colouring  had 
commenced  &ve  months  before  he  entered  the  hospital* 
and  for  the  previous  month  he  had  a  slight  cough.  At 
the  apex  of  the  lung  in  fronts  expiration  was  found  to  be 
slightly  prolonged,  and  behind,  vesicular  expansion  was 
diminished ;  there  were  no  bacilli  in  the  sputa.  The 
temperature,  which  had  been  oscillating  between  97°  and 
98^,  rose  to  100^  six  hours  after  the  injection  of  tubercu- 
lin, justifying  the  tuberculous  nature  of  the  disease  of 
the  renal  capsules. 

After  giving  the  details  of  several  other  oases  (14  in  aU), 
the  report  concluded  by  stating  that  the  results  obtained 
warranted  the  prosecution  of  further  clinical  experiments 
which  would  permit  the  Academy  one  day  to  draw  up 
instructions  for  diagnosis  of  tuberculosis  in  man  by  tuber- 
culin as  it  has  been  called  upon  to  do  in  the  case  of 
the  bovine  species. 

M.  Weber  read,  in  answer  to  a  letter  from  the  Minister 
of  Agriculture,  consoltiug  the  Academy  on  the  value  of 
tuberculin  as  a  means  of  diagnosing  tuberculous  disease 
in  the  bovine  species,  a  report,  of  which  the  following 
is  an  abstract. 

Tuberculin  at  the  dose  of  from  six  to  ten  grains  pro- 
vokes in  tuberculous  animaLe  a  rise  of  temperature  attain- 
ing from  two  to  five  degrees,  a  reaction  sufficient  to  affirm 
the  existence  of  tuberculous  lesions,  in  no  matter  how 
slight  a  degree,  whereas  the  seme  dose  has  no  appreciable 
effect  on  non-tuberculous  animals,  although  they  may  be 
attacked  by  grave  leeions  of  the  lungs  or  of  the  other 
viscera.  Tiie  febrile  reaction  appears  between  the  twelfth 
and  fifteenth  hour  after  the  injection,  and  lasts  several 
hours.  It  was  said  that  tuberculin  produced  no  reaction 
in  certain  animals  recognised  tuberculous  at  the  autopsy. 
The  fact  is  true,  but  these  animals  are  always  in  such  an 
advanced  stage  of  the  malsdy  that  the  diagnosis  is  easily 
made  by  the  ordinary  methods  of  examination  without 
having  recourse  to  tuberculin.  The  reproach  was  also 
made  that  tuberculin  hastened  the  evolution  of  the 
disease.  This  objection  has  no  foundation,  for  tuberculin 
presents  no  danger  to  the  animal. 

Nothing  is  so  easy  to  day  than  the  removal  of  tubercu- 
lous disease  from  a  stable ;  it  is  sufficient  to  submit  all  the 


266     Thb  Msdioal  Prths. 


AUSTRIA. 


Mab.  U,  1896. 


;animal8  to  the  tabercalin  test,  B6par»te  the  healthy 
;aiiifnftla  from  all  those  which  show  a  reaction  after  the  in- 
jeotioD,  disiDfect  the  stable,  and  allow  no  animal  to  enter 
it  without  carefal  examinatiop. 

In  conolndinf^,  the  speaker  proposed  the  following  reso- 
lotion  :— *<  Tabercalin  is  an  excellent  means  of  establish- 
ing the  diagnostic  of  bonne  tnbercalosis,  and  its  employ- 
ment should  be  recommended."    (Adopted). 


[from  OUB  own  OOBiaSPOVDBNT.] 


filBUM,  March  6th. 
Medical  Edugatiok^Luvaot  REQOiBEiiBirTS. 

The  Minister  of  Education  has  lately  surprised  the 
medical  world  by  an  order  bearing  on  the  education  and 
•examination  of  public  medical  officers.  The  order  is  sup- 
posed to  be  an  outcome  of  the  unfortunate  Alexianer  lunacy 
scandal.  For  the  future  candidates  for  these  offices  will 
be  required  to  attend  a  course  of  lectures  on  psychiatry  at 
a  German  University  and  to  attend  the  practice  of  a  lunate 
hospital  for  six  months,  or  to  hold  office  as  interne  of  such 
a  hospital  for  three  months.  A  hospital  in  which  such 
lunacy  practice  is  taken  out  must  not  have  fewer  than  150 
mental  cases  yearly.  The  order  comes  into  force  in  October 
4ji  the  present  year,  and  it  will  apply  to  all  candidates  who 
are  not  already  in  their  last  year  of  study.  It  is  not  under- 
etood  to  be  the  intention  of  the  Minister  to  raise  the  salaries 
of  its  medical  officers  as  a  compensation  for  the  increased 
•cost  of  education  in  this  way  imposed  upon  them. 
Resorption  of  the  SAiirs  or  Ibon. 
In  the  Zeit6cK  J,  Phyaiolog,  Chemie,  jHr.  Weltering  has 
a  paper  giving  the  results  of  an  inquiry  into  the  resorb- 
ability  of  iron  salts  into  the  system.  He  first  repeated 
Kunkel's  experiments,  and  found  that  when  iron  was  given 
to  mice,  rabbits,  or  dogs,  by  the  mouth,  it  accumulated  in 
the  liver  ;  that  in  fact  the  liver  was  possessed  of  the  faculty 
of  storing  up  iron.  The  question  then  arose  as  to  the 
form  in  which  it  was  thus  stored  up.  The  author  found 
that  one  of  the  combinations  was  a  nudeoproteid.  In  this 
form  it  was  firmly  associated  and  could  not  be  discovered 
without  destroying  the  substance.  He  found  also  by 
later  experiment  that  the  accumulation  of  iron  resulted 
directly  from  resorption  and  not  from  any  property  of 
preventing  waste. 

A  further  question  was  whether  the  organism  could 
make  use  of  the  accumulated  iron  in  case  it  required  it  for 
the  production  of  hemoglobin,  and  the  author's  opinion  is 
that  it  can.  On  withdrawing  blood  from  animals  fed  with 
iron,  and  others  as  check  animals,  he  found  that  the  blood 
corpuscles  did  not  fall  so  low  in  the  former  class  as  in  the 
control  animals.  The  blood  returned  to  its  normal  state 
much  more  quickly  and  completely  in  the  animals 
possessed  of  accumulated  iron  than  in  the  others.  It  was 
very  noticeable  also  that  in  the  livers  of  the  animals  not 
fed  with  iron  there  was  much  less  of  it  than  in  the  others, 
and  that  in  the  iron  animals  the  quantity  was  equal  to, 
if  noj;  above,  the  normal  amount.  The  author  does  not 
4tate  how  long  a  time  is  required  for  the  organism  to  use 
ap  its  surplus  iron  stored  in  this  way. 

FoBKAUNB  Gelatine— A  New  Mode  of  Antiseptic 
Treatment. 

In  the  Tfierapeta,  MmcU^ch.  (2-96),  Dr.  Schleich  relates 
iiis  experiences  in  the  use  of  formaline  gelatine  in  the 


treatment  of  wounds.  The  formaiine  gelatine  is  prepared 
by  drying  gelatine  dissolved  in  water  over  formaline 
vapour.  A  firm  resistent  stony  hard  transparent  body  ia 
thus  formed.  The  question  first  to  be  decided  was  whether 
the  gelatine  would  gradually  dissolve  and  give  off  its 
formaline,  and  in  this  way  set  up  a  continued  state  of 
asepsis  in  its  neighbourhood.  In  the  first  experiment 
resection  of  intestine  was  performed  on  a  rabbit,  and  before 
closing  the  abdominal  wound  a  piece  of  formaline  gelatine 
the  size  of  an  apple  was  introduced  into  the  abdominal 
cavity.  The  animal  was  killed  six  and  a  half  weeks  later 
and  only  a  minute  remnant  of  the  gelatine  was  found  in 
the  midst  of  newly-formed  connective  tissue.  Further 
experiments  were  modified  by  the  author  to  the  extent  that 
a  quantity  of  virulent  bacteria  cultures  was  mixed  with 
finely  powered  formaline  gelatine  and  introduced  into  the 
system,  all  of  which  were  absorbed  without  any  reaction. 
These  results  led  the  author  to  use  the  gelatine  in  the 
treatment  of  wounds  in  the  human  subject.  It  was  used 
in  the  form  of  powder,  and  Hr.  Schleich  became  saticfied 
that  it  was  gradually  decomposed  with  continuous  freeing 
of  formaline,  and  consequent  steady  aseptidsm  of  the 
wound.  Up  to  the  time  of  writing  he  had  used  it  in  120 
cases  of  acute  suppuration,  93  aseptic  healings  of  wounds, 
4  compound  fractures,  and  2  deep  scalp  wounds,  and  he 
was  in  a  position  to  state  that  by  its  means,  all  scute 
suppurations  were  cut  short,  and  that  in  every  wound  an 
aseptic  course  could  be  guaranteed  without  the  adoption 
of  any  further  measures.  Where  necrotic  tissue  was 
present,  however,  it  was  powerless,  as  contact  with  sound 
tissue  alone  was  able  to  set  free  the  formaline.  In 
order  to  render  it  serviceable  in  such  cases  a  means  must 
be  discovered  of  setting  the  formaline  free  outside  the 
body,  and  such  a  means  has  already  been  found  by  the 
author  in  a  peptic  acid  solution  (pepsin  5  parts,  acid 
hydrochL  0*3  parts,  water  to  100,  distill).  The  powder 
with  which  the  wound  is  powdered  requires  moistening 
with  the  above  pepsin  solution.  The  mode  of  preparation 
of  the  formaline  gelatine  is  given  by  the  author. 

The  fact  that  when  the  gelatine  was  enclosed  within  the 
system  it  became  eventually  completely  replaced  by  con* 
nective  tissue  led  the  author  to  still  further  experimentSi 
These  led  to  the  oondusion  that  formaline  gelatine,  being 
procurable  in  any  shape,  and  on  being  heated  capable  of 
being  moulded  to  any  form,  it  might  be  employed  for  the 
plastic  connective  tissue  closure  of  defects  of  all  kinds. 
Impregnated  with  lime  salts,  it  proved  itself  capable 
of  replacing  pieces  of  bone  removed  in  the  course  of  resec- 
tion, 

» 

[#MOII  OUB  OWN    COBBKSPONDBVV.] 

VnsHA,  Mar.  eth.  1896 
Operative  Treatment  of  Lupus  Vulgaris. 
RiLLB  showed  at  the  Gesellschaft  two  cases  from  Neu- 
mann's clinic  which  had  been  treated  for  lupus  vulgaris  by 
total  extirpation  of  the  morbid  surface  and  showing  plastic 
repair  induced  by  transplantation  after  Thiersch's  method 
of  grafting.  The  first  patient  was  48  years  of  age,  and  had 
been  troubled  with  the  disease  for  the  last  15  years.  The 
infiltrated  lupous  surface  extended  on  the  right  side  of  the 
face  from  the  ear  to  the  nose  and  from  the  lower  angle  ol 
the  jaw  to  the  lower  margin  of  the  eyelid.  The  case  was 
a  favourable   one  for  operation,   owing  to    the  disease 


Mab.  11,  1990. 


THE  OPERATING  THEAIRES. 


Thb  Medical  Fbyss.    267 


not  hanng  involved  the  maooas  membrane  of  the  noee, 
mootby  or  eye.  There  was  no  eetropinm  present  as  the 
reaalt  of  a  contracting  cioatrix. 

Under  chloroform  an  incuion  waa  made  aroand  the 
^rcnmferenoe  ol  the  morbid  area  about  three-qnartere 
of  a  centimetre  beyond  the  morbid  Btmcture  into  the 
healthy  tiaeae.  The  whole  Inpous  tiseae  was  carefully 
dissected  off  with  very  little  loss  of  blood,  only  three  or 
four  ligatures  being  applied,  torsion  having  sufficed  to 
check  hsmorriiage  throughout  the  operation.  The  whole 
snrfaoe  denuded  in  this  way  was  11  centimetres  by  6 
centimetres  which  was  immediately  after  strewn  over 
with  lamelln  of  graftings  taken  from  the  upper  part  of 
the  leg  as  directed  by  Thiersch,  each  lamella  measuring 
•2  oentimetcee  broad.  Before  the  dressing  |were,  for  the 
-first  time,  removed  the  wound  was  almost  closed,  and  by 
the  end  of  the  first  month  was  completely  healed  leaving 
M  dark  pigmented  surface  which  Rille  accounted  for 
by  the  deep  removal  of  the  tissue. 

The  second  case  was  that  of  a  young  woman,  «et.  18, 
afEeoted  in  the  same  way  as  the  preceding,  and  treated 
in  the  same  manner  with  favourable  results.  This  patient 
had  several  other  patches  of  lupus  on  the  extremitiee 
which  had  been  treated  by  excision.  Since  Thiersch 
introduced  this  method  of  treatment  in  1836  many 
remarkable  cases  of  healing  have  been  recorded  by  his 
admirers,  among  whom  are  Urban,  Bergmann,  Socio,  and 
more  recently,  Steida.  In  Vienna,  Prof.  Lang  has 
recorded  many  severe  cases  complicated  with  lupus,  which 
have  been  completely  restored.  Grafting  in  this  disease 
seems  to  proceed  more  speedily  in  the  repair  of  ulcerated 
tissues  than  in  other  defects  of  the  cuticular  surface. 

CONGKNITAL  HyDBOPHTHALMUS  AlTD  IrIDSCIOMT. 

Bergmeister  exhibited  a  patient  on  whom  he  had  per- 
formed iridectomy  thirteen  years  ago,  on  account  of  in- 
fantile glaucoma.  The  patient  was  bom  in  1882,  and  in 
March  1883,  the  mother  observed  that  the  cornea  of  the 
left  eye  was  gradually  becoming  dull  and  white.  On 
admission  into  hospital,  the  whole  cornea  was  cloudy,  the 
globe  hard  and  resisting  and  greatly  enlarged,  particu- 
larly in  the  anterior  section,  while  the  cornea  appeared 
to  be  bent,  indicating  the  beginning  of  keratoglobup, 
was  diagnosed  as  infantile  glaucoma,  and  forthwith 
iridectomy  was  performed.  This  operation,  when  high 
tension  is  present  in  the  bulbus,  has  often  been  com- 
mended and  eondemned  in  infantile  glaucoma.  The 
advocates  of  the  latter  maintain  that  serious  con- 
sequences will  ensue  when  iridectomy  is  performed 
by  the  extension  of  the  vitreous  humour  which 
will  in  all  probability  occur  owin^  to  the  great  distension 
<rf  the  iris  and  zonule  of  Zinn  which  would  easily  allow  the 
lens  and  contents  of  the  globe  to  bulge  forward  under 
pressure  with  the  eventual  changes  of  panophthalmitis.  It 
must  be  home  in  mind,  however,  that  these  consequences 
only  occur  in  cases  where  the  degeneration  of  the  eye  has 
already  far  advanced.  In  this  young  patient  the  opera- 
tion was  undertaken  at  an  early  stage  of  the  disease. 
After  chloroform  was  administered  the  cornea  was  quite 
opaque,  but  on  the  following  day  after  the  operation  it 
twoame  quite  clear  and  the  wound  healed  speedily.  The 
patient  was  lost  sight  of  for  eight  years  and  when  seen  in 
1890  the  eye  appeared  quite  normal,  and  now,  thirteen 
years  after  the  operation  we  may  confidently  declare  it 
successfully  cured. 

Teleky  thought  that  Bergmeister's  operation  was  an 
enoooragementj  to  perform  [the  operation.    He  related  a 


similar  case  which  he  had  trea\ed  with  eserine  and 
apparently  checked  the  progress  of  the  disease,  but 
subsequently  left  a  buphthalmus  eye  which  had  finally  to 
be  enucleated. 


ST.  THOMAS'S  HOSPITAL. 
G.£8ABiAN  SxcTioN.— Dr.  CuLLiNG WORTH  performed  this 
operation  on  a  woman,  est.  36,  who,  he  said,  might  be  des- 
cribed as  a  ricketty  dwari  As  a  child  she  had  been  put  out 
to  nurse,  and  only  walked  when  7  or  8  years  old.  She 
married  when  26  ;  her  first  pregnancy  terminated  at  seven 
months  in  a  miscarriage  ;  at  the  second,  in  1887,  cranio- 
to  my  was  performed  at  the  full  term ;  for  the  third,  in  1888, 
craniotomy  was  also  done,  as  the  patient  failed  to  oome  up 
at  the  end  of  the  seventh  month  as  advised  for  the  induc- 
tion of  premature  labour  ;  at  the  fourth,  in  1889,  premature 
labour  was  induced  at  the  end  of  the  seventh  month ; 
induction  of  premature  labour  at  the  seventh  month  and 
craniotomy  was  resorted  to  for  the  fifth  in  1892.  The 
present  operation  was  performed  at  the  end  of  the  thirty- 
ninth  week  from  the  date  of  the  cessation  of  the  last 
menstruation.  The  estimated  true  conjugate  diameter 
was  3  inches  ji,  the  diagonal  conjugate  being  3  inches  j. 
The  operation  was  performed  without  waiting  for  labour 
to  begin.  The  ordinary  incision  about  five  inches  long 
was  made.  The  uterus  was  found  tilted  over,  so  as  to  be 
with  its  anterior  turface  to  the  right,  whilst  the  left 
uterine  appendages  were  in  the  middle  line  in  front ;  the 
position  of  the  organ  was  first  of  all  rectified,  and  then  an 
assistant  held  it  in  position  whilst  the  uterine  incision  was 
made,  the  abdominal  wall  being  thus  held  closely  in 
contact  with  the  uterus,  prevented  any  fluid  from  obtaining 
access  to  the  peritoneal  cavity.  The  uterus  was  laid  open 
in  siiu  by  an  incision  of  about  four  inches,  the  attitude  of 
the  child  and  tbo  position  of  the  placenta  having  been  pre^ 
viously  diagnosed  ;  the  bulging  membranes  were  ruptured, 
the  hand  passed  rapidly  into  the  organ,  and  the  child's 
head  grasped  and  brought  to  the  opening,  which  was  just 
large  enough  to  allow  the  head  to  pass  ;  the  remainder  of 
the  child  was  easily  extracted.  The  cord  was  clamped  in 
two  places  and  divided  between  them.  The  child  was 
handed  to  an  assistant  and  cried  almo&t  immediately  ;  it 
was  a  female,  5  lbs.  14  oz.  in  weight,  and  20  inches  in 
length.  The  placenta  and  membranes  were  now 
removed  by  grasping  them  in  the  hand  and  allowing 
the  uterus  to  contract  upon  the  hand.  The  finger 
was  then  passed  into  the  cervical  canal  to  make 
sure  it  was  sufficiently  patulous  to  give  exit  to  the  lochia. 
No  douching  or  swabbing  of  the  uterus  was  employed. 
The  uterus  was  next  brought  out  of  the  abdominal  cavity 
and  protected  with  hot  sponges  while  the  sutures  were 
being  introduced.  The  sutures  used  were  of  silk,  and  the 
plan  of  introduction  the  one  advocated  by  Dr.  Howard 
Kelly,  of  Baltimore,  namely,  by  a  row  of  deep  sutures 
passing  through  the  whole  of  the  uterine  wall  excepting 
the  decidua,  and  then,  instead  of  the  usual  row  of  super* 
ficial  sutures,  a  eeries  of  half-deep  sutures  one  between 
each  two  of  the  deep  ones.  The  uterus  was  now  well  con- 
tracted and  was  returned  within  the  abdomen.  There 
was  very  little  bleeding  during  the  operation ;  once  it  was 
necessary  for  the  assistant  to  oompress  the  cervix  between 
his  two  hands  for  a  minute  or  two,  which  had  the  effect  of 
controlling  the  hemorrhsge  at  once.  No  toilet  of  the 
peritoneum  was  necessary     The    abdominal  wound  was 


268     Thb  Medical  Prws. 


LEAPING  ABTICLE8. 


Mar  11,  1896. 


oloMd  with  ffilkworm  gat  bq tares  in  the  asual  waj,  the 
omentam  hftving  beeo  drawn  down  so  as  to  be  between  the 
uterna  and  the  abdominal  wound.  The  operation,  includ- 
ing the  suturing,  occupied  fifty  minntee,  and  the  patient 
bore  it  exceedingly  well.  Dr.  Cullingworth  remarked  on 
the  obliquity  of  the  uterus  and  the  necessity  of  holding  it 
so  that  the  incision  was  made  in  the  middle  line  of  the 
anterior  wall,  as  the  side  walls  were  very  much  thicker 
and  contained  many  large  vessels. 

ST.  GEORGE'S  HOSPITAL. 

OVABIOTOMY.— EXTINSIVB    ADHESIONS.— Mr.    HXBBBRT 

Alungbam  operated  on  a  woman,  set.  about  35,  whose 
previous  history  was  that  about  ten  years  ago  she  had 
been  tapped  several  times  for  supposed  ascites.  Since  then 
the  abdomen  had  gradually  enlarged,  until  at  the  time  of 
the  present  operation,  when  it  was  enormous  ;  it  was  dull 
on  percussion  right  up  to  the  ensiform  cartilage,  but 
slightly  resonant  in  both  loins.  The  belly  was  opened 
in  the  middle  line  below  the  umbilicus,  and  it  was  found 
impossible  to  differentiate  the  parietal  peritoneum  from 
the  cyst,  which  was  found  adherent  to  i^  The  cyst  was 
therefore  opened  and  the  incision  carried  up  to  the  ensi- 
form cartilage,  in  the  hope  that  by  so  doing  the  surgeon 
would  be  able  to  find  the  upper  limit  of  the  cyst,  and 
thus  it  would  be  possible  to  separate  it  from  the  abdominal 
parietes.  It  was  found,  however,  that  the  cyst  was 
firmly  adherent  to  the  under-surfaoeof  the  liver  and  to  the 
intestines,  so  that  it  was  impossible  to  separate  the  adhe> 
■ions  without  tearing  into  these  parts.  In  a  like  manner 
the  cyst  was  adherent  to  all  the  structures  at  the  back 
pert  of  the  abdomen.  Mr.  Allingham  therefore  considered 
it  would  not  only  be  very  dangerous,  but  also  absolutely 
impossible  to  remove  the  cyst.  Accordingly  the  upper 
and  lower  parts  of  the  abdominal  incision  were  closed,  the 
centre  part  of  about  three  inches  beiog  left  open  so 
as  to  ensure  eufficient  drainage.  Mr.  Allingham  hoped 
that  by  keeping  the  interior  of  the  cyst  aseptic,  in 
time  the  walls  might  adhere  together,  and  so  the  enormous 
oavity  become  obliterated.  He  considered  that  the 
repeated  tapping  which  had  been  done  many  years  ago 
had  been  the  cause  of  extensive  peritonitis,  which  had 
glued  the  cyst  everywhere  to  the  interior  of  the  abdomen, 
end  so  rendered  simply  impossible  the  removal,  which 
ought  to  have  been  an  ordinary  procedure,  as  the  (^st  was 
unilocular.  He  oommented  on  the  neeessity  of  very  free 
drainage  in  such  a  case  as  the  only  chance  for  the  patient. 
GREAT  NORTHERN  HOSPITAL. 
Opx&ation  n>R  Epithsuoma  ivtolviko  thb  Floor  or 
THX  Mouth.— >Mr.  Hxhbbrt  Allikqbam  operated  on  a 
man,  »t.  53,  who  suffered  from  a  growth  situated  about 
the  sublingual  gland  and  encroached  slightly  on  to  the 
tongue.  In  the  submaxillary  region  there  was  a  mass  of 
enlarged  glands.  He  commenced  by  making  a  long  inci- 
sion from  the  angle  of  the  jaw  to  the  apex  of  the  chin»  and 
then  thoroughly  cleared  out  the  enlarged  glands  in  the 
submaxillary  triangle.  After  this  another  incision  was 
carried  up  to  the  angle  of  the  mouth  and  the  cheek 
rtfleoted ;  the  jaw  was  then  sawn  through  about  the  posi- 
tion of  the  first  bicuspid  tooth,  which  proceeding  gave 
free  access  to  the  fioor  of  the  month ;  the  growUi  was 
freely  excised,  and  a  considerable  amount  of  the  ba«e  of 
the  (ongne  also  removed.  The  jaw  was  drilled  and  wired 
together,  and  the  soft  parte  replaoed  and  kept  tn  nr«  by 
stitches.  Mr.  Allingham  remarked  on  the  importance  A 
first  removing  all  the  diseased  glands  in  the  neck,  and 
also  pointed  out  the  great  advantage  of  dividing  the  jaw 
•o  that  the  growth  about  the  floor  M  the  moaih  was  freely 
•zposed  to  view  and  coukl  easily  and  freely  be  dealt  with. 


FOB 


ABEOA]>. 


Pttbliiksd  ST«7  Wtdatsdaj  momlnc,  Prios  id.   Post  fiM,  W^ 
ADVBRTIUMBin. 

lOBOBBlBlBBnoB:— WliolsPsft,ittOi.Od.;  HaU  Psft,  M  lOp.  (ML 
<|asrttrP8C0,«lBi.;  Ons-di^itli,  Ui.  6d. 

Fob  a  Bbbibs  oi  Ibsbbhobs  :— Whols  Pigs,  IblrtsMi  ImertUnB 
(wmMj,  fortnightlj,  or  numthly)  at  iBS  lOi.  Od. ;  twwtF-siz  ioatf 
Uam  (woSkly  or  tortoli^tly)  al  iBS  ti.  Od. ;  ilflf -two  imettioiii 
Cwaddj)  at  MZ  eaoh.  Half .pags,  thlrtMD  luflrtlooa  at  tSa. ; 
terantj-tiz  at  Km.  ;  ilflf  ^two  Inaartloni  at  Mk.  moh.  Qaartflr-paga, 
thirtMnloaarttoiiiatUi.;  twuitF-alx  Inasrtloiia  at  Ifla. ;  flftjr-aiz 
iDaartioBi  at  IBs.  oaoh 

Small  Annonnoamenta  of  Praotloca,  AMlttanclca,  'Vacandca,  Book 
dto.— Bores  Unea  or  sador,  4b  por  iDMrtton ;  6d.  per  Una  boyond. 

tattara  In  this  dspartaiaiit  ihould  ba  addraaaad  to  the  Pnbllaiiar* 

■VBBOBIPTIOn. 

POST  PBBB  to  AIIUAL  BUBSOBIBXBS  Bl    1    0 

„  ABBOADiWITHIB  TBB  POSTAL  VBIOB        41    t    S 

„  IBDIA,  CBIBA,  AID  JAPAB  .  .     Bl    B    S 

Poat-oAoa  Ordara  and  Cheoaaa  to  ba  drawn  in  faTou  of— 

A.  A.  TiBDALl,  90-Sl  King  WUUam  Street,  Stiaad,  LoodoB. 
▲.  H.  JACOB,  M  Molaawortk  Stieek,  IhibUn. 

SUBSOBIRIOBS  FOB  PBABCB  aie  received  by  Meana.  RAnJiiBBB,  Baa 
Hautafenllla,  Paiia— poatfrae  in  adTanoa,  Bl  li.  6d.  perannur. 

SVBBOBIFTIOBS  lOB  TBB  UMnBD  Statbs,  poit  free  in  advance 
(Bl  Sl  ed.  per  annua),  ihonld  be  aeat  dfreet  to  the  Ofllcea  In 
thla  country  by  Intematlooal  Poat  (MBoe  Order. 

8cU  AgenU  for  Germany  mnd  Avttro-Bungarjf^ 
W.  A  B.  L0WBBTHAL(0fllce  of  the  Berltiiar  ^draaakiieA),  Qranatnaie 
4,  Berlin. 


ll^t  llibiral  fms  ^  €/inttlar. 


<8ALU8  POPULI  BDPBEMA  LEX.' 


WlDNtSDAY,  MABCH  11,  1896. 


THE  ETIQUETTE  OF  PROFESSIONAL  ADVER- 
TISING. 
The  case  to  which  we  briefly  alladed  last  week,  in 
which  a  medical  man  eaed  the  Editor  of  the  British 
Medical  Journal  for  libel  and  obtained  damagea  for 
£180,  was  the  means  of  bringing  under  the  notice  of 
the  public  seyeral  important  mattera^  with  which  it  is 
now  our  intention  to  deal.  In  the  first  place,  it  may 
be  obseryed  that,  so  far  as  the  *'  libel "  itself  is  con- 
cerned, we  have  nothing  special  to  say.  It  was 
decided  against  our  contemporary,  but  oar  conviction 
is  that  the  Editor  was  deceiyed  as  to  the  extent  of  local 
feeling  which  existed  against  the  plaintiff,  and  thus, 
perhapSi  was  led  into  expressing  himself  in  somewhat 
stronger  terms  than  he  otherwise  wonld  have  done.  It 
most,  also,  be  admitted  that  the  case  for  the  defence 
was  scarcely  as  well  managed  as  it  might  have  been. 
The  defence  was  decidedly  weak  in  the  witnesEca,  and 
the  mention  of  this  matter  brings  ns  to  the  oonadera- 
tion  of  one  of  the  meet  importantf eatnres,  the  exposoie 
of  which  has  excited  so  much  comment  in  the  public 
press.  The  featore  to  which  we  allnde  is  the  evidence 
of  no  less  a  personage  than  the  Treasurer  of  the  Boyal 
College  of  Fbysicians  of  London,  Sir  Dyoe  Dndnrorth. 
From  the  pedestal  of  his  exalted  poation  he  came  to 
blesa  the  defendant,  bat  in  the  end  it  was  a  corse 


Mab.  11,  1896. 


LEADING  ARTICLES. 


Tun  Mbdioal  Pbxss.     269 


which  fen  upon  the  luckless  head  of  the  latter.  The 
jury  could  not  be  hoodwinked  in  a  matter  of  common- 
sense,  even  by  so  mighty  an  official  as  the  Treasurer  of 
the  Royal  Ck)llege  of  Physicians.  The  opinion  of  Sir 
Dyce  Duckworth  on  the  case,  as  given  in  his  evidence, 
was  that "  it  was  objectionable  to  advertise  a  medical 
man's  name  in  connection  with  an  hotel,  and  it  was 
nndeairable,  even  in  the  case  of  a  hydropathic  establish- 
ment" So  far,  so  good.  But  what  did  his  cross- 
examination  elicit  ?  It  was  pointed  out  to  him  that  hb 
own  name,  together  with  the  hospital  with  which  he  is 
connected,  and  his  private  address  appeared  in  an  insur- 
ance prospectus,  which  was  widely  circulated,  and  placed 
in  large  numbers  on  office  counters,  and  even  hung  in 
picture  frames  upon  the  walls  of  hotels  and  other  public 
places.  In  reply,  however.  Sir  Dyce  Duckworth  denied 
that  such  a  practice  amounted  to  advertising.  ''His 
private  address,"  he  added,  '^  was  given  for  the  conven- 
ience of  those  who  had  to  see  him."  Here  is  a  case  of 
Tweedledum  and  Tweedledee.  How  was  it  to  be 
supposed  that  the  jury  could  have  heard  this  evidence 
without  smiling.  Could  anything  have  displayed 
more  clearly  the  readiness  with  which  medical 
men  in  high  places  elaborate  an  excuse  when  a 
charge  of  advertising  is  brought  against  themselves, 
and  how  keen  they  are  to  condemn  an  unfortunate 
general  practitioner  who  has  overstepped  the  line  of 
ethical  conduct  in,  perhaps,  a  less  offensive  kind  of 
way.  Truly,  it  would  seem  that  there  is  one  law  for 
the  rich  and  another  for  the  poor,  so  far  as  the  question 
of  advertising  by  members  of  the  medical  profession  is 
concerned.  In  view,  however,  of  the  deliberate  pro- 
nouncement of  its  Treasurer,  in  this  matter,  we  should 
like  to  know  what  the  Royal  College  of  Physicians 
considers  is,  and  what  isnot,  advertising.  The  profes- 
sion is  always  led  by  the  officials  of  the  Institution  to 
believe  that  its  Fellows  are  an  immaculate  community 
of  commercially  pure-minded  persons,  whose  last 
thought  in  the  world  would  be  that  of  parading  them- 
selves before  the  public.  We  sadly  fear,  however,  that 
whatever  the  ideal  may  be  in  this  respect,  few  attain  to 
it  Indeed,  the  Fellows  of  the  College  must  admit  that 
many  of  their  best  known  colleagues  aie,  in  this  re- 
spect, Pharisees.  The  case  of  ''Kingsbury  v.  Hart" 
has  done  good  in  one  sense,  it  has  shown  the  public 
that  whenever  a  practitioner  holding  the  position  of  Sir 
Dyce  Duckworth  allows  himself  to  be  advertised  in  a 
shameless  manner,  nothing  is  said  of  it  by  his  com- 
peers, but  when  a  hapless  medical  man  in  a  small  coun- 
try town  adopts  any  species  of  self-advertisement,  the 
haods  of  the  powers  that  be  are  held  up  in  horror  at 
the  iniquity  of  the  offence,  and  he  is  condemned  accord- 
ingly. The  truth  of  these  facts  became  so  apparent  at 
the  trial  during  the  cross-examination  of  Sir  Dyce 
Duckworth  that  a  lay  contemporary  waxed  merry  over 
the  inconsistency  which  was  displayed.  But  the  trial 
has  virtually  decided  another  point.  Practitioners 
who  were  fearful  of  incurring  the  wrath  of  the  Royal 
Colleges  may  now,  on  the  authority  of  Sir  Dyce 
Duckworth,  indulge  in  a  good  deal  of  advertising. 
They  have  his  authority  for  it  that  if  they  can  secure 
the  good  offices  of  a  friend  to   send   their  names, 


addresses,  and  qualifications  broadcast  over  the  landf 
they  cannot  be  held  guilty  of  offence,  for  has  not 
the  Treasurer  of  the  Royal  College  ol  Phyndans, 
London,  denied  on  oath  that  this  practice  amounted  to 
advertising  ?  He  did  not  add  in  his  evidence, "  Qo, 
and  do  thou  likewLse,"  to  the  members  of  his  prof es' 
sion,  but  that  was  to  have  been  expected.  That  is  pre- 
cisely where  the  Royal  College  of  Physicians,  London, 
draws  the  line  in  this  matter. 


THE   ARMY   MEDICAL   COMPETITIVES. 

We  understand  that  the  Royal  College  of  Surgeons 
of  Ireland  and  the  University  of  Dublin,  possibly  witb 
the  co-operation  of  the  Rojral  University,  have  taken 
steps  to  open  up  the  whole  subject  of  these  examina^ 
tians  by  a  discussion  upon  the  Army  Estimates,  which 
appear  on  the  Notice  Paper  of  the  House  of  Commons 
for  to-morrow  (Thursday).  The  salient  fact  is  that 
these  examinations  are  no  longer  competitive,  inas^ 
much  as  the  demand  for  admission  to  the  Army 
Medical  Service  has  come  to  be  so  small  that  there  are 
more  vacancies  than  candidates,  and,  in  fact,  the 
breaches  in  the  ranks  of  the  Service  cannot  be  filled. 
This,  in  a  general  way,  is  the  natural  outcome  of  the 
policy  of  the  depreciation  of  the  Medical  Department  of 
the  Service  which  the  Duke  of  Cambridge  pursued,  and 
which,  we  regret  to  observe,  his  successor.  Lord 
Wolseley,  and  his  assistant,  Sir  Redvers  Buller,  have 
perpetuated.  It  has  been,  for  years,  the  policy  of  the 
heads  of  the  combatant  Departments  to  snub  and 

depreciate  '*  those  d d  doctors,"  and,  naturally,  the 

combatant  officers,  who  are  dependent  on  the  goodwill 
of  these  chiefs,  have  willingly  followed  the  cue  and 
done  likewise.  It  vn  as  recently  as  the  last  distribution 
of  prizes  at  Netley  that  Sir  Redvers  Buller,  quite 
gratuitously,  took  occasion  to  remind  the  assembled 
probationers  that  an  Army  Medical  Officer  is  only  a 
doctor  after  all,  and  that  he  had  better  stick  to  his 
duty,  like  an  Army  cook,  and  not  seek  to  raise  him- 
self to  the  social  or  service  level  of  the  combatanti 
whose  rank  he  is  supposed  to  hold. 

This  policy  of  depreciation,  however,  strikes  all  Army 
doctors  of  all  nationalities  equaUy,  and  it  is  not  the 
special  reason  for  the  intervention  of  the  Irish  Licen- 
sing Bodies.  They  complain,  though  they  will  not 
put  the  complaint  upon  the  face  of  their  official  com- 
munications, that  Irish  candidates  are  subjected  to  an 
organised  "boycott"  What  they  cannot  say  diploma- 
tically, we  take  liberty  to  say  for  them.  It  will  be  re* 
collected  that,  in  the  year  1893,  a  scandalous  job  was 
perpetrated  by  the  War  Department,  for  the  purpose 
of  giving  the  London  teachers  predominance,  at  this 
examination,  over  all  others.  It  was  then  decreed  that 
the  competitive  examiners  should  be  selected,  exclu- 
sively, from  the  London  Conjoint  Board,  the  obvious 
effect  of  which  arrangement  was  to  ensure  that  the 
candidate,  if  he  desired  to  find  favour,  must  frequent 
the  London  hospitals,  especially  thoee  to  which  the 
Army  examiners  happened  to  be  attached.  So  un- 
fair an  arrangement  called  at  that  time  into  action  the 
College  of  Surgeons  of  Ireland,  which  presented  strong 
remonstrances  to  the  War  Office  but  these  rej  resenta- 


270     Trb  Medical  Pbvs. 


LKADING  ARTICLFS. 


Mab   1MM6. 


tioDB  prodaced  no  effect  Baye  a  promifle  which  never 
was  fulfilled,  because  neither  the  Iriah  Univerritiee  nor 
the  Scotch  College  a  lent  any  osef  al  aid.  The  grieyance 
has  still  existed,  and  has  increased.  The  Army  Ser- 
vice papers  have  avowed  that  the  competitive  exam- 
iners are  bound  to  weed  out,  and  do  weed  out,  Irish 
candidates,  for  the  simple  reason  that  they  present 
Irii^h  qualifications,  and  the  facts  and  figures  support 
the  assertion.  The  examiners  are  supplied  upon 
the  marking  papers  with  the  names  and  qualifica- 
tions of  the  candidates,  and  they  know  that  if  they  give 
a  '*  sticking ''  mark  upon  the  answering,  the  objection- 
able candidate  will  be  excluded.  That  they  have  been 
in  the  habit  of  giving  such  *^ sticking"  marks 
to  the  Irish  candidates  is  shown  by  the  returns  made 
to  the  General  Medical  Council  by  the  Army  Medical 
Department.  For  the  two  examinations  of  1895,  forty 
candidates  presented  themselves  who  held  thirty-seven 
English  qualifications,  and  only  twelve  Irish  and  fifteen 
Scotch.  It  will  thus  be  observed  how  the  boycott  has 
operated  to  secure  a  monopoly  of  these  examinations 
for  the  London  School.  It  is,  however,  more  manifest 
upon  scrutiny  of  the  relative  numbers  of  each  nation- 
ality who  passed  for  commissions.  It  appears  that 
twenty-four  out  of  the  thirty-one  London  qualifications 
secured  77  per  cent  of  the  prizes,  while  only  four  out 
of  eleven  Irish  qualifications  (i.e.,  36  per  cent)  were 
equally  successful,  and  twelve  out  of  eighteen  (66  per 
cent)  for  Scotch  qualifications.  Taking  the  two 
examinations  together  it  is  observable  that  the  rejec- 
tion percentage  was  for  Irish-English  candidates  25 
per  cent,  for  Irish  58  per  cent  We  cannot,  of  course, 
be  certain  that  the  Irishmen  were  as  well  educated  as 
the  Englishmen  at  these  examinations,  but  suspicion 
of  the  bona  fides  of  the  examination  is  aroused  by  the 
observation  that  the  candidates  holding  qualifications 
from  the  highest  Irish  qualifying  bodies,  the  University 
of  Dublin,  for  instance,  have  habitually  suffered  rejection 
at  the  same  examinations  at  which  those  from  the 
London  Apothecaries'  Company  passed  and  obtained 
commissions.  )i^e  trust  that  the  communications 
which  the  Irish  colleges  now  make  to  the  War  Office 
on  the  subject  will  be  something  more  than  the  inter- 
change of  diplomatic  courtesies  which  in  the  past  have 
failed  to  produce  any  satisfactory  result.  Either  the 
Irish  candidates  are  fit  for  Army  service  or  they  are 
not.  If  they  are,  the  Irish  Colleges  should  ensure 
that  their  men  have  every  chance  of  obtaining  admis- 
sion to  the  Service  which  is  enjoyed  by  those  of  English 
and  Scotch  Colleges ;  if  they  are  not,  it  certainly  behoves 
the  Colleges  to  free  themselves  and  their  schools  from 
the  stigma  attaching  to  the  frequent  rejection  of  their 
diplomates. 


We  learn  that,  for  the  purpose  of  making  representa- 
tions on  this  subject,  deputations  have  proceeded  from 
Dublin  to  London.  For  the  Irish  College  of  Surgeons, 
Sir  Thornley  Stoker,  President,  Mr.  Thomson,  Vice- 
President,  and  Mr.  William  Stoker,  Councillor  and  for 
the  University  of  Dublin,  Mr.  Ball,  Regius  Professor 
of  Surgery,  and  Dr.  Cunningham,  Professor  of 
Anatomy. 


POOR-LAW  MEDICAL  SUPERANNUATION. 

The  BDl  introduced  by  the  English  Union  Medical 
Officers'  Association  stands  for  second  reading  on  the 
18th  of  March,  and  it  is  hoped  that  it  will  pass  this 
stage  without  serious  opposition.  A  request  will  be 
then  made  for  the  extenaion  of  the  Bill  to  Ireland,  and 
it  is  expected  that  the  promoters  of  the  Bill,  who  long 
since  expressed  their  willingness  that  it  should  be  so 
extended,  will  accede  to  the  proposition,  unless  they 
see  that  it  is  threatened  with  serious  opposition.  It  is 
also  anticipated  that  both  the  English  and  Irish  Local 
Government  Boards  and  the  Chief  Secretary  will  also 
approve  of  the  Bill,  subject,  of  course,  to  slight  amend- 
ments when  it  gets  into  Committee.  To  promote 
these  arrangements  the  Irish  Medical  Association  has 
been  taking  active  steps  in  order  to  obtain  the  con- 
currence of  the  Boards  of  Guardians,  and  the  Irish 
Union  Officers'  Association  is  co-operating  with  it  An 
epitome  of  the  Bill  has  been  sent  to  every  Board  of 
Guardians  in  Ireland  with  a  letter  to  the  Clerk  of 
Union  asking  him  to  submit  it  to  his  Board  and  tosecure, 
if  possible,  the  passing  of  a  resolution  in  favour  of  the 
Bill.  At  the  same  time  a  copy  of  these  communica- 
tions has  been  sent  to  every  Poor-law  Medical  Officer 
with  the  request  that  he  will  bring  pressure  to  bear 
upon  his  guardians  for  the  same  purpose.  The  effect 
of  these  efforts  by  the  Irish  Medical  Association  has 
been,  so  far,  quite  encouraging.  The  time  has  been 
too  short  to  allow  of  answers  being  received  in  most 
cases,  but  up  to  last  Saturday  about  twenty  Boards 
had  signified  their  approval,  and  only  one  (Trim) 
refused  it,  on  what  grounds  no  one  knows.  The  next 
step  in  the  movement  is  to  bring  the  influence  of  the 
guardians  and  others  to  bear  on  the  Irish  Members,  and 
this  will  be  done  the  moment  the  answers  of  a  sufficient 
number  of  Boards  have  been  received.  If  the  second 
reading  of  the  Bill  should  pass  for  England,  as  is  con- 
fidently expected,  it  will  become  necessary  to  move, 
when  it  is  passing  through  Committee,  the  insertion  of 
a  clause  to  extend  it  to  Ireland,  and  to  make  it  suitable 
to  the  special  conditions  of  Irish  Poor-law,  and  such 
clause  is  now  in  preparation  by  Parliamentary  counsel 
on  behalf  of  the  Irish  Association,  and  if  the  Bill 
passes  with  the  addition  of  this  clause,  the  weary 
superannuation  question  will  have  been  settled  on  a 
somewhat  satisfactory  basis. 

If  the  Poor-law  Medical  Officers  of  Ireland  have 
sufficient  regard  for  their  own  interests,  not  to  speak  of 
the  public  service,  to  make  an  effort  to  pass  a  workable 
Superannuation  Bill,  now  is  their  time.  Here  is  a 
measure,  not  as  perfect  as  we  all  could  wish,  but,  at 
least,  as  consistent  with  medical  interests  as  is 
ever  likely  to  pass.  It  offers  itself  to  the  Irish 
Poor-law  service  matured  by  the  thought  and 
experience  of  the  English  officers  and  with  the 
financial  details  worked  out  by  capable  statisticians, 
and  with  a  force  of  English  Parliamentary  and  depart- 
mental influence  behind  it,  which  no  purely  Irish  Bill 
could  ever  hope  to  secure.  It  is  likely  to  be  accept- 
able to  the  Irish  guardian,  ratepayer,  and  Member  of 
Parliament,  and  wiU,  without  doubt,  be  approved  of  by 
Government  if  serious  opposition  (should  any  arise)  can 


Mar.  11,  1896. 


NOTES  ON  CUltREKT  TOPICS. 


Thv  Mrdical  Pbbss.     271 


be  got  rid  of.  The  opportunity  iB  a  golden  oue,  and  it  is 
sarely  worth  the  while  of  the  Poor-law  officers  to 
expend  half  an  hour  and  a  few  pence  on  paper  and 
postage  to  help  the  measure  forward  by  writing  to 
their  local  memhen— whether  j)er8onally  acquainted 
tvith  them  or  noe— «nd  by  inflaencing  the  local  guar- 
dians. It  is  yery  certain  that  if  they  abstain  from 
assisting  the  IriiEdi  Medical  Association  in  this  way, 
they  will  not,  for  many  years,  have  a  simUar  chance, 
and  it  is  also  certain  that  they  will  have  no  one  to 
blame  but  themselves  if  left  to  starve  in  their  old  age 
for  want  of  a  pension. 


Jl0teB  on  Ctttrent  ^opicB. 

City  Men  and  Railway  Companiea 
The  disr^^ard  which  most  of  the  monopolist  railway 
companies  show  for  the  comfort  of  their  passengers 
has  long  since  passed  into  a  proverb.  Their  neglect, 
however,  ander  the  conditions  of  modern  city  life,  is 
likely  to  develop  into  something  far  more  serious  than 
a  mere  inconvenience.  As  the  centres  of  commerce 
and  industry  become  more  crowded  there  is  a  oorres- 
pondiug  increase  in  the  number  of  those  who  dwell  in 
distant  suburbs  or  in  neighbouring  country  towns  or 
villages,  whence  the  aid  of  a  railway  train  is  an  abso- 
lute necessity  in  order  that  they  may  reach  the  scene 
of  their  daily  labours.  As  a  rule  after  a  hurried 
breakfast  the  city  man  has  a  wild  rush  for  the  morn- 
ing train,  in  which  he  is  boxed  up  for  the  next  half 
hour  or  hour.  The  railway  carriage  is  of  the  old  stage 
coach  pattern,  as  the  companies  do  not  think  it  worth 
their  while  to  provide  modem  corridor  coaches  with 
lavatory  accommodation.  The  practical  outcome  of 
this  early  morning  environment  is  that  the  average 
city  man  dare  not  take  aperient  medicine.  Let  the 
physician  recommend  an  overnight  compound  colo- 
cynth  pill  or  a  mombg  draught  to  a  patient  of  the 
class  in  question,  and  he  will  find  in  nine  cases  out  of 
ten  that  the  remedy  is  shirked.  In  this  way  there  can 
be  no  doubt  that  many  citizens  are  virtually  deprived 
of  one  of  the  most  valuable  means  of  treatment 
known  to  the  whole  art  of  medicine.  Some  day,  per- 
chance, the  railway  companies  will  wake  up  to  the 
wants  of  the  public,  and  will  furnish  modem  cars  for 
the  use  of  travellers,  above  all  for  that  important  sec- 
tion which  oscillates  daily  betwixt  busy  town  and 
breezy  suburb  or  outlying  district. 


Traumatic  Hysteria  from  Use  of  the 
Telephone. 
At  the  last  meeting  of  the  Berlin  Medical  Society, 
Hr.  Lehfeldt  showed-  a  servant  girl  who,  four  weeks 
previously,  had  received  a  shock  while  employed  at 
the  telephone,  and  who  had  since  suffered  from 
hysteria.  The  shock  sustained  was  similar  to  those 
known  to  telephone  workers  from  electrical  discharge 
during  storms.  In  the  house  in  which  the  maid  was 
serving  was  a  switch  from  the  instrament  to  the 
kitchen,  and  while  using  this  switch-apparatus  she 
received  a  sudden  shock  and  fell  to  the  ground  uncon- 
scious.   It  was  to  be  noted  that  the  girl  grasped  the 


handle,  the  isolated  part  of  which  was  only  small,  with  a 
hand  still  wet  from  scouring,  and  in  the  ringing  off  the 
current  passed  through  the  hand.  When  the  small  size 
of  the  isolated  part  is  considered,  the  wonder  is  that 
such  accidents  do  not  happen  more  frequently,  espe- 
cially when  contact  with  the  instrament  is  made  with 
a  moist  hand.  On  recovery,  complete  right  hemiplegia 
was  found  to  be  present  in  this  case,  but  in  a  short 
time  most  of  the  symptoms  improved  considerably  as 
regards  power  of  movement,  but  otherwise  the  condi- 
tion was  much  the  same  as  after  the  injury.  Hearing 
power  on  the  right  greatly  diminished,  sense  of  smell 
quite  gobe,  and  that  of  taste  also  on  the  right  side. 
Cutaneous  sensibility  also  gone  on  the  right  with  the 
exception  of  a  few  spots.  The  sensation  as  regarded 
heat,  on  the  other  hand,  was  decidedly  exaggerated. 
She  had  also  lost  the  sense  of  the  position  of  the 
limbs,  and  also  the  perception  of  objects  held  in  the 
hand  when  the  eyes  were  closed. 

The  Hydrophobia  Scare. 

The  Dublin  Veterinary  Department  is  just  now  par- 
ticularly active  in  promoting  a  hydrophobia  scare,  for 
which,  as  far  as  we  can  judge,  there  is  no  shadow  of 
reason.  The  Department  points  to  a  large  increase  in 
the  number  of  rabid  animals  reported  throughout 
Ireland,  but  it  confesses  on  the  face  of  its  own  official 
report  that  such  increase  followed  suspiciously  dose 
upon  the  passing  of  the  law  which  provided  compensa- 
tion for  the  animals  destroyed,  and  it  broadly  insinuates 
that  the  compensation  and  the  increase  bore  the  relation 
of  cause  and  effect  It  states  candidly  that  ^  there  is 
strong  reason  to  believe  that  in  a  large  proportion  of 
the  cases  reported  the  animals  were  not  affected  with 
rabies.''  We  are  very  much  of  that  opinion,  so  much 
so  that  we  fully  believe  that  of  the  779  cases  of  rabies 
in  animals  reported  at  least  750  were  bogus.  A  glance 
at  the  returns  of  the  number  of  cases  sent  forward 
from  the  various  Irish  Unions  will  prove  this.  It  is 
quite  incredible  that,  if  rabies  were  as  frequent  as  the 
official  records  represent,  it  would  be  confined  to  a 
dozen  or  twenty  Unions.  Yet  the  returns  tell  us  that. 
For  instance,  Athlone  reports  26  cases,  and  the  neigh- 
bouring Union  of  Mullingar  only  one  case.  Cavan 
reports  37  cases,  and  the  neighbouring  Union  of  Bailie 
borough  only  one.  A  writer  in  one  of  the  Dublin 
newspapers  says  last  week  : — 

Do  your  readers  know  the  sort  of  evidence  upon 
which  tiiese  entries  find  their  way  into  the  returns  f  A 
miserable  sick  cur  is  seen  ranning  about,  wild  with 
pun,  fever,  and  thirst,  and,  at  once,  a  hue-and-cry  is 
raised  that  it  is  mad,  and  the  poor  animal  is  hunted 
until  some  one  shoots  it,  or  a  policeman  batons  it  to 
death.  So  far  there  is  not  a  scintilla  of  evidence  that 
it  was  mad.  Then  the  policeman  reports  the  case  to 
the  Department,  and  it  goes  into  the  official  returns.  He 
also  rei>orts  it  to  the  Veterinary  Inspector  of  the  Union, 
who,  with  or  without  a  proper  examination  of  the  car- 
case, pronounces  the  dog  to  have  been  rabic,  and  when 
a  sufficient  number  of  such  records  have  accumulated, 
a  circular  is  sent  round  by  the  Veterinary  Department 
to  the  sanitary  authorities,  who,  thereupon,  fall  into 
an  anti-hydrophobic  panic,  and  order  indiscriminate 
muzzling.  If  Union  Veterinary  Inspectors  are  induced 
to  certify  rabies  from  the  simple  report  of  a  bucolic 
policemao,  the  whole  thing  is  a  farce,  and  if  they  can 


272     Tbb  Mbdipal  Pbe^s. 


SOTES  ON  CURRENT  TOPICS. 


Mab.  11.  1896. 


diafioose  hydrophobia  from  the  external  inspection  of 
a  aog'8  carcase,  they  most  be  remarkably  clever 
fellows. 

The  most  important  aspect  of  this  subject  for  the 
medical  profession  is  the  estimation  of  the  amoant  of 
danger  to  the  public  which  may  arise  from  an  alleged 
prevalenceof  rabies.  Ifweareto  bdieve  what  the  news- 
papers tell  us  an  average  mad  dog  bites  three  or  four 
persons  before  it  is  killed.  Suppose  we  limit  his 
inoculation  of  virus  to  one  human  being,  we 
should  have  had  in  Ireland  526  deaths  of  human 
beings  from  hydrophobia  within  the  year  1894.  As  a 
matter  of  fact,  Ireland  has  had,  on  an  average  of  the 
past  five  years,  420  deaths  nominally  from  hydrophobia 
per  annum  as  appears  from  the  Registrar  Generars 
returns.  Assuming  that  these  were  genuine  cases 
.(which  is  a  very  large  assumption  indeed),  it  may  be 
.concluded  that  each  item  of  the  population  of  Ireland 
,has  just  the  millionth  of  a  chance  of  dying  of  hydro- 
phobia from  the  bite  of  one  or  other  of  the  526  mad 
dogs.  So  homoeopathic  a  risk  as  this  can  scarcely  be 
regarded  as  justification  for  incurring  the  much  greater 
,risk  of  making  a  multitude  of  dogs  snappish  and  savage 
by  muzzling  them.  So  far  as  our  sources  of  information 
go,  we  are  strongly  impressed  with  the  belief  that  the 
wholesystemfor  the  detection  and  notification  of  hydro- 
phobia is  utterly  wrong  and  the  official  records  perfectly 
untrustworthy—  that  rabies  in  the  dog  is  a  rare  disease, 
.and  in  the  human  subject  is  almost  non-eziBtent. 

The  Gloucester  Board  of  Guardians  and 
Vaccination. 

The  remarks  of  Mr.  Justice  Grantham  with  respect 
to  the  neglectful  way  in  which  the  Gloucester  Board  of 
.Guardians  had  enforced  the  Vaccination  Acts  in  their 
.district  were  officially  reported  to  the  Local  Govern- 
,ment  Board,  and  the  latter  authority  last  week  sent  a 
peremptory  letter  to  the  Guardians  asking  for  an  ez- 
planation,  and  inquiring  what  had  been  done   with 
reference  to  vaccination  and  re^vaccination  since  the 
.  outbreak  of  small-poz  in  the  city.  This  communication 
was  duly  considered  at  the  last  meeting  of  the  Guar- 
dians,   and    a    lengthy    reply    to    the    same    was 
drafted   by    the   clerk.     The  facts  with   which   it 
deals   are  curious.    It    appears    that   in    1876   the 
.Guardians  passed   a   resolution  to  the   effect  that 
proceedings  should  be  taken  against  all  persons  fail- 
ing to  comply  with  the  Vaccination  Acts.    In  1887, 
/however,  the  following  resolution  was  adopted  :  *'  That 
the  vaccination  officers  take  no  further  steps  in  vacci- 
nation prosecutions  until  authorised  by  this  Board." 
•The  result  of  this  resolution  has  been  that  since  the 
.date  when  it  was  adopted  vaccination  in  Gloucester 
,has  practically  fallen  into  desuetude,  thus  proving  to 
the  hilt  the  justification  of  Mr.  Justice  Grantham's 
.  severe  strictures  upon  the  policy  of  the  Board.    How- 
.  ever,  the  Guardians  are  now  making  some  effprt  to 
atone  for  the  past.    Since  the  outbreak  of  small-poz 
they  have  issued  a  notice  in  the  city,  urging  upon  the 
parents  of  all  unvaccinated  children  to  have  vaccina- 
tion immediately  performed,  and  special  arrangements 


have  been  made  for  the  attendance  of  the  public  vacci- 
nator. In  consequence  of  this  order  some  2,000  cases 
of  primary  and  re- vaccination  have  been  restored  by 
the  Poor-law  Medical  Officer?,  and  this  number  is 
quite  apart  from  the  private  cases.  A  writer  in  the 
Gloucestershire  Chronicle  of  last  week  well  observes  : 
''The  people,"  in  refusing  vaccination,  '*have  been 
misguided — ^they  now  feel  that  they  have  trusted  too 
long  to  the  rotten  reed  of  anti- vaccination  bigotry,  as 
unneedful  as  it  is  unjustifiable.''  Probably  all  the 
anti-vaccinationist  agitators  of  the  district  are  now 
beginning  to  feel  the  urgent  necessity  of  taking  a 
rearmost  seat. 


The  Responsibilities  of  Quack  Practice. 

It  is  scarcely  necessary  for  us  to  state  that  a  quack 
may  practise  as  eztensively  as  he  pleases  without  in- 
fringing any  law  as  long  as  he  abstains  from  using  a 
designation  purporting  that  he  is  a  duly  registrable 
practitioner.  He  does  so,  however,  subject  to  two 
forms  of  legal  prosecution.  He  may  be  &ued  by  a 
patient  for  damages  sustained  by  reason  of  his  treat- 
ment. So  may  a  legitimate  practitioner,  but  the  latter 
has  the  advantage,  in  such  case,  in  that  he  is  not 
liable  for  any  error  of  judgment  so  long  as  he  gives 
sufficient  care  and  reasonable  skill  to  the  case,  while 
the  quack  is  liable,  under  all  circumstances.  The 
quack  is  also  liable  to  the  police  for  killing 
or  causing  grievous  bodily  harm  to  a  patient 
by  reason  of  his  ignorance  or  negligence,  and 
he  cannot  plead  as  ezcuse  that  what  he  did  he  did 
hondfdcy  and  to  the  best  of  hisability  or  rather  inability. 
Our  object  in  referring  to  this  subject  is  to  point  out 
that  the  latter  method  of  controlling  quack  practice  is 
seldom  or  never  resorted  to.  Scores  of  patients  are 
killed  or  maimed  every  month  by  the  ignorance  of 
quacks,  and  yet  the  police  take  no  notice.  It  is,  in 
fact,  much  more  dangerous  to  ride  a  bicycle  on  the 
footpath  than  to  kill  a  patient.  For  instance,  we  note 
that  aWelsh  farmer  recently  killed  a  child  by  prescribing 
for  it  certain  wares  of  which  he  b  the  proprietor,  for  a 
certain  disease  which  did  not  ezist,  when,  in  fact,  the 
child  was  dying  of  pyaemia  from  a  suppurating  joint 
He  apparently  did  not  diagnose  the  pyaemia  or 
recognise  the  diseased  joint,  and  the  patient  died  in 
consequence.  Surely  this  is  a  case  which  the  police 
ought  to  have  taken  up.  In  Ireland  many  cancer 
curers  have  been  prosecuted  and  sent  to  penal  servitude 
for  killing  patients  by  their  nostrums,  and  it  appears 
to  us  that,  if  such  agitation  were  raised  as  would 
compel  the  police  to  deal  with  such  cases  more  fre- 
quently a  good  deal  would  be  done  to  make  the  quack 
practice  dangerous  and  difficult. 


The  Spanish  Government  at  Havana  has  appointed 
a  commission  to  investigate  the  yellow  fever  of  that 
island.  The  Commission  is  composed  of  medical 
officers  of  the  army  and  navy,  and  of  prominent 
medical  men  of  Havana. 


Uaju  11.  1806. 


NOTES  ON  CUKfiENT  TOPICS: 


Tbb  Medical  Vbmbs,    273 


The  Medical  Society  of  London. 
The  Annual  Dinner  of  the  Medical  Society  of 
London  took  place  at  the  Whitehall  Booms,  Hotel 
Meiropole,  on  Saturday  laat,  the  President,  Sir  James 
Crichton  Browne,  in  the  chair.  As  might  have  been 
anticipated  with  so  accomplished  and  genial  an  orator 
presiding,  the  post-prandial  discourses  were  character- 
ised by  unusual  interest  and  zest.  The  event  of  the 
eyening  was  the  presentation  to  Prof.  Victor  Horsley 
of  the  Fothergillian  medal  and  premium,  for  bis  work 
in  connection  with  the  thyroid  gland  and  the  artificial 
production  of  myzcedema.  In  making  the  presenta- 
tion, the  President  alluded  in  eloquent  and  even 
enthusiastic  terms  to  the  future  opened  up  by  the 
introduction  of,  or  rather  the  revival  of  the  method 
of  treatment  of  which  the  thyroid  treatment  is  the 
type  and  starting  point.  Prof.  Horsley,  in  his  reply, 
pointed  out  that  his  only  claim  to  the  distinction 
conferred  upon  him  was  the  fact  of  his  having  com- 
pleted the  physiological,  pathological,  and  therapeutical 
investigations  of  Scheff,  Ord,  QuU  and  Murray,  by 
affording  experimental  evidence  of  the  truth  of  their 
deductions  based  on  clinical  observation.  The  music 
was  furnished  by  the  Bijou  Orchestre,  and  among  the 
subsequent  proceedings  various  songs,  delivered  in  his 
happiest  style  by  Dr.  Frederick  Roberts,  met  with  a 
▼ery  appreciative  reception. 

The  Treatment  of  Bee  Stings. 
An  unfortunate  accident  recently  befell  Dr.  Qeorge 
King,  of  the  Calcutta  Botanical  Qardens.  While 
engaged  in  Baroda,  says  the  Indian  Medical  Cfazette^ 
he  was  attacked  by  a  swarm  of  bees.  He  was  severely 
atung  on  the  hands,  head,  face,  and  neck,  and  no  fewer 
than  150  stings  were  afterwards  extracted  from  his 
neck  alone.  Belief,  however,  was  at  once  obtained  by 
taking  some  ipecacuanha  powder,  making  it  into  a 
a  paste,  and  smearing  it  all  over  the  affected  parts. 
Both  the  swelling  as  well  as  the  pain  were  immediately 
reduced.  The  use  of  ipecacuanha  in  this  connection  is 
worthy  of  being  remembered. 

The  Medical  Ward  Question  at  Chesterfield. 
It  is  reported  from  Yorkshire  that  the  agitation  for 
wards  for  the  treatment  of  medical  cases  at  the  Chester- 
field and  North  Derbyshire  Hospital  \b  growing.  At 
this  time  of  day  one  would  have  expected  the  move- 
ment to  have  blossomed  and  borne  substantial  fruit, 
for  the  matter  has  been  before  the  public  in  its  present 
form  for  several  years  past.  The  Friendly  Societies 
have  been  considering  the  matter,  but  so  far  do  not 
seem  to  have  been  able  to  furnish  the  substantial  help 
that  is  a  necessary  preliminary  in  the  foundation  of 
new  wards.  Their  attention  has  been  lately  drawn 
afresh  to  the  needs  of  the  situation  by  the  case  of  a  man 
whose  wife  was  ill  of  rheumatic  fever  for  fifteen  weeks. 
The  nearest  place  where  hospital  accommodation  can 
be  obtained  for  medical  cases  is  at  Sheffield,  but  the 
journey  is  far  too  arduous  for  patients  who  are  in  a 
state  of  critical  illness.  In  any  event,  however,  it  is 
suffidentiy  clear  that  a  town  and  district  like  that  of 
Ohesterfidd  requires  ample  medical  accommodation  of 


its  own.  The  statement  tl^at  there  is  now  room  for 
sixty  in-patients  at  the  hospital,  but  that  the  average 
number  is  under  forty,  if  true,  does  not  redound  to  the 
credit  of  North  Derbyshire  folks. 


Medical  Defence. 
The  annual  report  of  the  Medical  Defence  Union 
for  1895  just  issued  must  be  considered  highly  satis> 
factory.  If  the  development  of  the  Union  proceeds  at 
the  present  rate  there  can  be  no  doubt  we  shall  in  time 
see  the  establishment  of  an  institution  of  immense 
importance— one  capable  of  influencing  for  good  the 
position  of  the  whole  body  and  of  every  individual 
member.  The  Union  has  existed  only  eight  years,  its 
members  have  grown  from  442,  in  the  first  year,  to 
3,537,  in  1895,  and  its  guarantee  fund  from  £538  to 
£5,212.  A  careful  survey  of  the  document  before  us 
showsthattheprimeobjects  of  the  Unionhave  never  been 
lost  sight  of;  action  has  been  continually  taken  in 
every  direction  within  the  scope  of  its  powers,  and  a 
long  list  of  cases  is  reported  in  which  members  of  the 
Union  have  been  assisted  or  defended  where  proceed- 
ings involving  questions  of  professional  principle  or 
otherwise  have  been  brought  against  them.  This 
department  appeals  most  strongly  to  the  average  prac- 
titioner, and  the  advantages  which  it  offers  when  more 
widely  known  pught  to  attract  a  vast  increase  of 
members.  The  Council  reports  that  the  work  of  the 
Union  has  exceeded  that  of  any  previous  year,  but 
although  a  large  amount  of  legal  work  has  been  suc- 
cessfully carried  through,  it  has  been  at  the  cost  of 
persons  outside  the  Union.  Libel  actions  have  been 
brought  against  members,  and  the  Union,  on  behalf  of 
members,  has  brought  similar  actions  against  those 
outside  the  profession,  and  in  each  case  the  action  has 
ended  by  the  costs  being  paid  by  the  '*  other  side  '^ 
without  trial,  and  suitable  and  satisfactory  public 
apologies  and  retractions  have  been  obtained.  There 
can  hardly  be  a  doubt  that  the  Ck)uncil  is  right  when 
it  suggests  that  such  a  satisfactory  result  would  not 
have  been  achieved  if  the  member  aggrieved  or 
attacked  had  brought  or  defended  the  action  in  his 
individual  capacity,  and  the  mere  fact  that  the  Union 
was  acting  for  the  injured  person  certainly  influenced 
the  result.  We  commend  to  our  readers  tiie  study  of 
the  report  It  may  be  had  from  the  Secretary,  Dr. 
Bateman,  at  the  office  of  the  Union,  20  and  21  King 
William  Street,  Strand,  and  it  may  be  added  that  the 
Secretary  can  be  seen  at  the  office  every  afternoon, 
or  by  special  appointment  at  other  times. 

Be  Barrack  Accommodation  of  Dublin. 
However  the  blame  may  be  apportioned  for  the  con. 
dition  of  the  Dublin  barracksy  there  can  be  no  doubt 
that  some  one  is  grievously  in  default  Some  years 
ago  the  Boyal  barracks  came  to  be  notorious  as  a 
typhoid  habitat,  and— although  for  a  long  time— the 
military  authorities  refused  to  acknowledge  that  there 
was  cause  of  serious  complaints,  they  were  eventually 
compelled  to  undertake  extensive  works  to  improve  the 
sanitation  of  the  place.  We  believe  that— on  tlus  occa- 
sion—the improvements  recommended  by  sanitarians 


274     The  Mxdioal  Pbks. 


NOTES  ON  CUHRENT  TOPICS. 


Mab.  11.  l«M^ 


were  pared  down  to  the  (possible)  mioimam  for  the 
sake  of  economy,  and  the  result  was  that,  when  the 
barracks  were  again  opened,  typhoid  made  its  appear- 
ance. Eventually  the  entire  barrack,  a  valuable  and 
extensive  range  of  buildings,  had  to  be  abandoned 
for  the  accommodation  of  troops.  Similarly  the 
Island  Bridge  Cavalry  Barracks  have  for  the  past  year 
become  a  typhoid  centre,  and  it  has  become  necessary 
to  draft  off  the  1st  Royal  Dragoons  to  the  Curragh  to 
save  their  lives.  We  apprehend  that  nothing  but  a 
reconstruction  of  the  entire  sanitary  c>ystem  of  these 
barracks  will  make  them  safe,  and  it  is  even  question- 
able whether  the  sub-soil  is  not— as  in  the  case  of  the 
Eoyal  barracks— so  saturated  with  sewage  as  to  make 
effectual  reconstruction  impossible. 


Meat  Extracts. 
In  considering  the  question  of  prescribing  meat 
preparations  for  their  patients,  medical  men  have  two 
main  points  to  recollect,  namely,  the  price  of  the  pre- 
parations, and  their  nutrient  value.  Both  obviously 
call  for  deliberate  reflection  before  a  conclusion  is 
arrived  at.  So  far  as  the  nutrient  value,  however,  is 
concerned  an  instructive  article  appears  in  Food  and 
Sanitation  for  Feb.  29th,  1896,  in  which  this  matter  is 
discussed  in  relation  to  two  well-known  extracts, 
Valentine's  Meat  Juice,  and  ''Bovril."  The  editor 
describes  Valentine's  as  ''merely  an  ordinary  meat 
extract  diluted  with  water,  but  as  far  as  the  nutrient 
value  goes  the  water  in  which  dinner  plates  are  washed 
would  be  about  as  valuable."  To  prove  this  he  pub- 
lishes the  report  of  two  analysts  on  the  preparation  in 
question,  from  which  we  gather  that  the  amount  of 
albumen  was  only  a  tenth  of  one  per  cent.  (010)  in  one 
case,  and  0*55  in  another.  The  latter  result  was 
obtained  by  a  Professor  of  Physiological  Chemistry  in 
Yale  University.  Those  practitioners,  therefore, 
whose  custom  has  been  to  prescribe  Valentine's  Meat 
Juice  would  do  well  to  prove  the  correctness  of  these 
figures,  for  its  high  price,  three  shillings  for  about  two 
fluid  ounces,  must  be  far  in  excess  of  its  value.  Mean- 
while, as  Food  and  Sanitation,  in  the  article  referred 
to,  has  disputed  the  Lancet's  analysis,  the  latter  journal 
has  taken  up  the  cudgels  on  behalf  of  this  American 
preparation  and  a  strongly  worded  paper  battle  is  now 
raging. 

The  Bights  of  Unregistered  Dentists. 
The  unregistered  dentists  havejormed  a  limited 
company,  the  object  of  which  is  to  *'  obtain  Parlia- 
mentary or  other  legal  acknowledgment  of  the  rights 
of  members."  Considering  that,  upon  the  passing  of 
the  Dentists  Act  in  1878,  the  class  to  which  these  per- 
sons belong  was  granted  privileges  in  the  way  of  regis* 
tration  and  monopoly,  which  never  were  accorded  to 
any  other  class,  they  do  not  seem  to  us  to  have  any 
grievance.  At  that  time  Sir  John  Tomes,  Sir  John 
Lubbock,  and  the  Britbh  Dental  Association  insisted 
on  flooding  the  dental  profession  with  tobacconists, 
hairdressers  and  dentists'  boys,  and,  in  fact,  with  any 
one  who  was  willing  to  testify  of  himself  that  he 
was.  in  the  practice  of  dentistry,  and  "had  drawn 


teeth."  Four  thousand  unqualified  persons  were  thus 
admitted  to  the  practice  of  this  speciality  by  the  stroke 
of  the  Association's  pen,  and  it  is  too  much  to  expect 
that  the  culpable  laxity  shown  at  that  time  will  be 
repeated  by  Parliament. 

Rural  Sanitation  in  Devonshire. 
Thb  village  of  Lnstleigb,  which  is  in  the  Newton 
Abbot  Rural  District,  has  lately  been  the  scene  of 
much  disturbance  anent  its  general  sanitary  oonditioo* 
A  severe  epidemic  of  diphtheria  appears  to  have  drawn 
the  attention  of  residents  to  the  state  of  the  drains.  If 
the  statement  of  an  old  inhabitant  at  a  public  meeting 
be  true,  the  experience  of  Lustleigh  in  modem  sanita-* 
tion  has  been  far  from  encouraging.  He  said  that  the 
sewers  were  forced  on  the  parish  against  the  expressed 
wish  of  the  villagers,  and  that  at  the  time  they  were 
laid  only  twenty-one  houses  needed  connection,  and 
they  were  scattered  over  a  distance  of  a  quarter  of  a 
mile.  If  these  things  be  as  reported,  this  Devonshire 
villsge  has  been  more  or  less  sacrificed  to  the  demon  of 
over-sanitation,  so  far  as  its  sewage  disposal  system  ie 
concerned.  However,  the  sewers  appear  to  want  flush' 
ing,  the  water  supply  to  be  contaminated,  and  the 
school  drains  to  be  untrapped,  so  that  there  is  every 
justification  for  the  parishioners  of  Lustleigh  in  hold- 
ing public  meetings  to  consider  sanitary  matters  from 
their  own  point  of  view.  It  is  to  be  hoped  that  their 
action  points  to  an  awakening  sense  of  Devonshire  folk 
to  the  backwardness  of  their  picturesque  county  in 
health  matters. 

Experts'  Fees  at  Royal  Commissions. 
It  is  worthy  of  notice  that  Dr.  Frankland  has 
raised  a  question,  the  solution  of  which  will  be  inter- 
esting to  medical  witnesses.  He  was  called  to  give 
evidence  before  a  Board  of  Trade  Commission  on  a 
question  respecting  the  standard  of  lighting.  He  gave 
the  testimony,  and  wanted  to  be  paid,  but  the  Board 
of  Trade  refused  to  give  him  anything  on  the  ground 
that  services  rendered  to  such  Committees  have  always 
been  regarded  as  honorary.  Dr.  Frankland  appealed 
to  the  County  Council,  and  got  his  money  from  it 
We  hope  to  see  the  ground  occupied  by  him  taken  up 
by  future  scientific  witnesses.  If  it  be  the  custom  for 
the  Government  departments  to  take  the  skill,  experi- 
ence, and  labour  of  experts  without  payment,  it  is  a 
very  bad  custom.  We  do  not  think  that  it  is  supported 
by  kiw,  and  we  do  not  see  why  the  public  should 
not  pay  for  professional  services  as  well  as  the  indi- 
vidual. 

Irish  Medical  Schools'  and  Graduates'  Asso- 
ciation. 
The  annual  general  meeting  of  the  Association  will 
be  held  at  11  Chandos  Street,  Cavendish  Square,  oii 
St  Patrick's  Day,  Tuesday,  March  17tb,at  6  p.m.  On 
the  same  evening  the  Association  will  dine  at  the  Caf6 
Monioo,  Piccadilly  Circus,  at  7.30  p.m.,  the  President,. 
Sir  Richard  Quain,  Bart.,  M.D.,  F.R  S.,  in  the  chair. 


Mab.  11»  1896. 


NOTES  ON  CURRENT  TOPICS. 


The  Msdioal  Pbbss.     275 


The  BlnginR  of  Ohurch  Bells. 
The  ringing  of  church  bells  in  towns  and  thickly 
^Inilated  neighbourhoods  is  apt  to  seriously  affect  the 
iiealth  of  invalids  and  others  who  are  ill.  At  present 
there  does  not  exist  any  law  or  any  authority  by  which 
such  ringing  can  be  curtailed.  The  right  of  having 
ihe  church  bells  rung  belongs  to  the  vicar  of  the  parish, 
■and  if  friendly  intercessions  on  the  part  of  those  who 
complain  of  the  ringing  has  no  impression  upon  the 
•clergyman,  nothing  more  can  be  done.  The  Health 
•Commissioner,  however,  of  Brooklyn,  U.S.A.,  seems  to 
have  the  power  to  intervene  under  these  circumstances. 
He  has  just  sent  a  communication  to  the  ministers  of 
•churches  having  bells,  warning  them  that  there  is  a 
sanitary  ordinance  which  expressly  prohibits  the  ring- 
ing of  laige  bells  in  such  a  manner  as  to  become  a 
^prejudice  or  evU  to  the  life  or  health  of  any  human 
•being.  All  church  authorities  and  others  having  con- 
trol over  the  ringing  of  large  bells  in  thickly  populated 
«ieighbourhopds  are  called  upon  to  prevent  bell  ringing 
tefore  7  a.m.,  and  in  localities  where  complaints  of 
invalids  are  brought  to  their  notice  to  restrict  the  bell 
nnging  in  the  daytime  to  as  few  strokes  as  possible. 

A  Death  from.  Chloroform. 
A  DEATH  from  chloroform  occurred  recently  at 
Dudley,  the  patient  being  a  robust  young  man  who 
required  to  have  eleven  teeth  extracted.  Every 
usual  precaution  was  taken,  a  qualified  surgeon  was 
retained  to  administer  the  anaesthetic^  and  the  heart 
was  duly  examined.  Notwithstanding  that  the  ansBs- 
-thetic  was  taken  well  and  the  operation  performed 
satisfactorily,  the  patient  died  a  few  minutes  after- 
awards.  Though  the  chloroform  was  analysed  and  a  post- 
mortem made  no  cause  whatever  could  be  discovered. 
The  case  seems  to  have  been  one  of  those  which  cause 
-chloroform  to  be  feared,  and  in  which  no  human  pre- 
-caution  can  afford  protection  against  a  fatality. 

"The  Therapeutic  Value  of  the  Localised  Hot- 
Air  Bath. 
There  can  be  little  doubt  that  in  this  local  applica- 
tion of  heated  air  at  a  temperature  of  from  240°  to  260^ 
F.  we  have  a  moet  valuable  therapeutic  agent.  The 
baths  known  by  the  name  of  Tallerman,-Sheffield, 
accomplish  this  application  of  super-heated  dry  air 
perfectly.  The  reports  already  before  the  profession 
•of  the  results  of  the  use  of  these  baths  in  such  affec- 
tions as  rheumatoid  arthritis,  chronic  and  gonorrhoeal 
iheumatiam,  various  forms  of  synovitis,  acute  gout^ 
sprains,  and  in  some  orthopedic  affections,  have  been, 
in  a  fair  proportion  of  cases,  most  satisfactory.  These 
baths  have  been  used  for  some  time  at  St  Bartholo- 
mew's, at  the  North- West  London,  and  at  Charing 
Ooss  Hospitals,  while  Dr.  Ward  Cousins  has  given 
them  a  trial,  with  considerable  success,  at  the 
JR^yal  Portsmouth  Hospital.  Also,  demonstrations 
have  been  given  in  different  i^aces  throughout  the 
United  Kingdom,  and  moet  favourable  effects  have 
been  recorded  in  private  practice.  We  have  recently 
had  an  opportunity  of  seeing  some  cases  that  were 
4nibmitted  to  this  treatment,  and  we  were  much  struck 


with  the  very  great  improvement  in  the  reduction  of 
deformity,  and  in  the  mobility  of  joints  which  followed 
the  application  of  the  heat  The  bath  has  not  been 
tried  as  extensively  as  it  might  have  been  in  some 
types  of  skin  disease.  The  softening  effect  it  has  on 
the  skin  in  chronic  cases  of  eczema  and  psoriasis 
would  certainly  indicate  it  as  a  valuable  adjunct 
to  other  treatment,  both  through  its  action  on 
the  bloodvessels  and  lymphatics  locally,  and  in  assisting 
in  the  absorption  of  other  remedies.  The  action  of  the 
bath  on  the  general  circulation,  and  the  elevation  of 
the  body  temperature  resulting  as  well  as  the  profuse 
diaphoresis  which  attends  on  its  application,  render 
the  caution  necessary  that  its  use  has  tp  be  carefully 
prescribed  in  those  cases  complicated  with  organic 
cardiac  changes.  Indeed,  this  powerful  therapeutic 
agent  should  only  be  entrusted  to  skilled  hands 
in  the  watching  of  its  action  and  its  adminis- 
tration generally,  and  we  should  say  always  under 
some  medical  supervision  from  time  to  time.  The 
price  charged  for  the  hire  of  the  baths  and  their 
administration  has  been  at  such  a  figure  as  to  prac- 
tically prove  prohibitive  to  the  great  bulk  of  sufferers. 
We  hope  that  as  their  use  becomes  more  general  the 
inventors  of  the  baths  will  see  their  way  to  placing 
them  within  the  reach  of  those  who  cannot  afford 
exorbitant  charges  and  fees  for  treatment  Also,  it  is 
to  be  hoped,  that  those  who  employ  the  baths  will 
keep  accurate  records  of  the  effects,  so  as  that  a  true 
judgment  may  be  arrived  at  as  to  the  real  value  of  the 
treatment 

The  New  Director-General  of  the  Army 

Medical  Department. 
Subg.-Majob-Gekebal  J..  Jameson,  M.D.,  who  is 
to  be  appointed  Director^General  of  the  Army  Medical 
Department  in  the  place  of  Surg.-Major-General  Sir 
W.  Mackinnon,  K.C  B.,  is  at  present  employed  at  the 
War  Office,  and  is  second  senior  in  the  department 
He  entered  the  Army  in  1857,  and  attained  his  present 
rank  three  years  ago.  He  has  seen  no  active  service 
with  the  Britbh  Army,  but  during  the  Franco-Qerman 
war  of  1870-71  did  good  service  with  the  English 
ambulance.  He  is  in  his  fifty-ninth  year,  and  would 
therefore  have  been  retired  under  the  age  clause  next 
year.  Consequent  on  his  appointment  to  the  head  of 
the  Army  Medical  Staff  he  will  now  be  able  to  remain 
another  seven  years. 

Dr.  W.  J.  CoUina 
A  BiSTmouisHED  honouf  was  conferred  yesterday 
(Tuesday)  upon  Dr;  W.  J.  Collins,  Chairman  of  the 
Public  Health  Committee  of  the  London  County 
Council.  At  a  full  meeting  of  the  Council  he  was 
unanimously  elected  the  Yice-Chairman  of  that  body. 
Dr.  Collins,  who  Lb  also  Surgeon  to  the  Royal  Eye  Hos- 
pital, Southwark,  and  the  London  Temperance 
Hospital,  is  thus  able  to  combine  important  pro- 
fessional work  with  duties  which  have  already  proved 
to  be  of  great  service  to  the  County  of  London,  of 
which  his  election  to  the  post  here  recordedis  in  part 
some  recognition. 


276     Thi  Mbmoal  Pbi 


SCOTLAND. 


Mar  lU  iSK. 


We  anderatend  that  Sir  Walter  Foster,  M.P.,  intends 
to  call  the  attention  of  the  House  of  Commons  to  the 
case  of  Surgeon-Captain  Fowler,  whom  he  believes  to 
have  been  unjustly  ''retired"  from  the  Army  Medical 
Serrice. 


At  the  Annual  Meeting  of  the  Royal  Medical  and 
Chirurgical  Society  last  week  Dr.  Dickinson  was 
elected  president  for  the  ensuing  year. 


§totlxtiSi. 

[VBOM  CUB  OWN  OOBBMFOKDBHT.] 


Typhus  Fxybr  and  Ovsbcbowding.— A  abort  time  ago 
we  called  attention  to  the  crowded  rookeries  of  many  of 
the  Scottish  cities,  and  to  the  difficulty  of  sappreesinff 
them,  without  serious  injustice  to  their  inhabitants.  A 
report  by  the  Medical  Officer  of  Health  for  Olaegow,  pre- 
sented last  week  to  the  Town  Ck>anci],  illastratee  the 
dangers  attendant  on  the  present  state  of  afifairs.  He 
repwte  that  typhas  fever  hM  been  continoaUy  present  in 
the  city  since  November,  1895.  At  present  there  are  21 
oases  under  treatment  in  the  fever  hospital,  while  45  per- 
sons are  isolated  because  of  their  known  association  with 
those  oases.  In  all,  41  cases  have  been  treated  during  the 
past  winter,  only  one  of  which  came  from  the  south  side 
of  the  river.  Nineteen  cases  occurred  in  the  Kingston 
district,  and  12  of  these  in  a  street,  which  as  far  back  as 
1870,  had  acauired  a  reputation  for  th*' association  of  over- 
crowding ana  tvphns.  At  a  meeting  of  the  Town  Council 
it  was  stated  tkat  one  tenement  had  furnished  a  great 
number  of  oases,  while  another  adjoining  it  had  not  been 
attacked.  In  the  first,  there  was  overcrowding  and  dirt, 
in  the  second,  clean  rooms  and  industrious  tenants.  A 
side  light  is  thrown  on  the  question  by  some  proceedings 
which  took  place  in  two  of  the  police  courts  later  in  the 
week.  The  tenants  of  several  single  roomed  houses  were 
summoned  for  overcrowding  them  by  sub-lettine.  For 
instance,  six  adults  and  three  children  were  huddled  in 
one  room  ;  seven  adults  and  two  children  in  snother  room. 
There  is  no  doubt  that  the  corporation  of  Glssgow  will 
have  to  bestir  itself  and  provide  accommodation  for  some 
of  these  people,  who  at  present  have  no  place  to  go  to  at 
the  rents  which  they  can  afford  to  pay. 

RoTAL  Edinbuboh  Astlum. — At  the  annual  meeting  of 
the  Corporation  of  the  Royal  Edinburgh  Aqrlum,  held  a 
few  days  since,  the  report  was  of  a  very  favourable 
character ;  the  new  buildings  at  Craig  House  had  already 

i'ustified  their  erection,  the  number  of  paying  patients 
tavin^  risen  from  156  to  186.  Dr.  Clouston,  the  Medical 
Superintendent,  as  is  well  known,  is  an  ardent  apostle  of 
the  **  cheerful "  in  the  treatment  of  the  insane^  and  in  his 
report  notes  with  pardonable  pride  the  great  benefit 
already  apparent  in  the  treatment  of  his  patients  in  New 
Craiff  House,  where  the  conditions  are  almost  his  ideal 
Briffht  rooms,  plenty  of  space,  fine  views  from  all  parts  of 
thel>nildinff  and  the  grounds,  and  the  bracing  effect  of 
hill  air  had  all  contributed  to  make  the  patients  more 
contented  with  their  lot,  and,  therefore,  had  increased  the 
chances  of  their  recovery.  As  to  the  general  statistics, 
884  patients  were  in  residence  on  Deo.  31st,  1805 ;  102 
private  and  908  rate  paid  patients  were  admitted  during 
the  year,  while  12  voluntary  patients  were  also  admitted — 
the  largest  number  hitherto.  Dr.  Clouston,  as  usual, 
classifies  the  causes  which  led  to  the  mental  upset  of  those 
admitted.  Out  of  89  oases  in  which  the  mind  had  been 
disturbed  bv  mental  causes  only  17  were  directly  due  to 
overwork,  the  remaining  80  per  cent,  were  from  *'  mental 
worry,''  «  domestic  troubles,'^  and  the  like.  Of  the  physi- 
cal causes  intemperance  headed  the  list  with  87  cases, 
infiuensa  claimed  15,  while  45  came  in  with  paralysis  or 
softening  of  the  brain.  The  percentage  of  recoveries  to 
the  admissions  was  41*5,  this  beinff  above  the  averase. 
Altogether  Dr.  Clouston's  report  is  (S  an  eztremelj  hopelul 
chanoter,  and  speaks  well  for  the  enthusiasm  with  which 
he  and  his  assistants  enter  into  their  work  for  the  good  of 
their  mentally  inflicted  brothers. 


Thi  Savitabt  Condition  of  Paislxt. — The  annual 
report  of  the  chief  sanitary  inspector  of  Fteasley,  which  has 
just  been  issued,  is  really  a  review  of  the  last  quinquennial 
period  and,  as  a  pane^iyrio  on  the  benign  influenoe  of  the 
Notification  Act,  merits  a  notice  in  our  columns.  The  Act 
was  adopted  in  1891,  and  is  described  as  one  of  the  best 
pieces  of  sanitary  administrative  policy  a  local  authority 
can  adopt.  The  evidence  chiefly  rdied  on  to  prove  this 
thesis  is  the  diminished  mortality  from  infectious  diseases 
during  the  period  under  review  as  compared  with  the  pre- 
ceding  five  years.  The  rates  were  2*98  per  1,000  compared 
with  4*55.  We  might  remark  en  pasmtU  that  such  varia- 
tions are  very  common,  as  those  liable  to  take  the  different 
diseases  take  them  perhaps  during  one  epidemic,  leaving  a 
small  number  of  unprotected  individuals  until  the  natural 
increase  of  the  population  a  few  years  afterwards  affords 
mora  possible  victims.  As  the  inspector  truly  says,  he 
must  wait  for  another  five  years  beforo  he  can  be  sure  of 
the  truth  of  his  facts.  The  annual  cost  of  the  notification 
fees  was  £222  A  note  which  is  made  in  the  report  corro- 
borates much  that  has  been  lately  said  as  to  the  agency  of 
schools  in  disseminating  zvmotic  disease.  Thus  the  ei^- 
demicof  measles  which  had  been  provalent  from  November, 
1894,  only  ceased  at  the  end  of  tJulv  shortly  after  the  close 
of  the  schools  for  the  summer  holidays.  Apart  from  these 
facts  the  health  of  the  town  appears  to  be  on  the  up-grade, 
the  death-rate  having  fallen  from  25*6  for  1876  1885  to  22*4 
for  1886  1895. 

Thi  Sohool-Board'8  Idea  of  Hbalth  Conditiok8.~A 
glaring  instance  of  School-Board  ecomomy  and  extrava- 
gance has  come  to  light  in  Edinburgh.  The  Board  has 
built  two  large  and  palatial  schools  roplete  with  all  the 
most  modern  conveniences,  including  baths  forthe  scholars, 
in  the  moro  modern  parts  of  the  town.  At  the  same  time, 
the  schools  in  the  central  parts  aro  being  stinted  in  a  very 
marked  manner.  Thero  is  no  doubt  titat  if  the  new 
schools  had  been  built  moro  economically  the  Board  would 
have  been  able  for  the  same  money  to  improve  the  older 
buildings.  It  is  actually  a  fact  that  several  of  the  classes 
in  one  of  the  schools  aro  held  in  underground  cellars,  whidh 
aro  so  badly  liehted  that  gas  has  to  be  burned  aU  day. 
Naturally,  both  the  teachers  and  taught  suffer  much  from 
this.  The  eyesight  of  each  class  being  especially  affected. 
One  teacher  who  never  had  any  trouble  with  her  eyes 
beforo  had  to  wear  spectacles  after  a  short  time  in  this  den, 
and  in  a  vear  had  to  get  much  stronger  ones.  The  per- 
centage o!  the  children  taught  in  these  cellars  who  have 
to  use  spectacles  is  much  above  that  of  those  taught  &» 
the  better  parts  of  the  same  building.  To  throw  away 
money  in  providing  baths  in  one  buildins — ^tiiero  are 
already  corporation  baths  in  the  town  which  aro  little 
used— while  children  in  another  aro  taught  in  noisome 
cellers,  is  extremely  characteristic  of  public  bodies  dealing 
with  public  funds,  and  whose  proceedings  are  more 
governed  by  the  persistent  faddist  than  by  the  common- 
sense  of  the  majority. 

The  Vacant  Dbputy  Comhissionship  in  Lctkaot  vob 
Scotland.— We  understand  that  the  following  are  candi- 
dates for  the  vacancy  caused  by  the  death  of  Dr.  Lawson  : — 
Drs.  J:  Batty  Tuke  (jun.),  Middlemass,  Hotchkis,  Mao- 
pherson,  and  Rutheriora. 

The  Naw  Fubuo  Hsalth  Bill  fob  Scotland.— The 
state  of  the  law  on  public  health  matten  in  Scotland  is  at 
prf  sent  in  a  very  tansled  condition.  The  original  Bill  for 
the  regulation  of  public  health  was  passed  in  1867,  and 
has  been  amended  on  no  fewer  than  five  different  occasions. 
The  Government  propose  in  their  new  Bill  to  tinker  it  up 
a  sixth  time.  The  existing  legislation  is  already  in  a 
sufficiently  chaotic  state,  and  the  paseing  of  this  BiU 
would  ronder  it  still  more  unintelligiblo,  if  no  consolidation 
of  the  various  enactments  were  to  be  made.  The  Govern- 
ment, however,  propose  to  bring  in  an  Act  later  in  the 
session  to  piece  the  differont  fragments  together  and  to 
crystallise  all  the  law  on  public  health  in  S<»tland  in  one 
measure.  It  is  hardly  our  province  to  express  surprise  at 
the  duplieation  of  the  Bills,  surely  it  would  have  been 
easier  and  better  to  amend  and  consolidate  at  the  same 
time.  When  this  consolidated  Bill  beoou  es  law,  if  the  pro- 
visions of  the  present  Bill  are  passed  as  propoaed  a  great 
benefit  will  be  conferred  on  all  those  connected  with  sani- 
tary affisirs  in  Scotland.  Some  sort  of  order  will  be 
evolved  oat  of  chaos.  The  framen  ci  the  Bill  have  taken 
the  Bin  of  1867  as  their  ground  work.  Many  of  theamend* 


Mar.  U,  IH96. 


EXAMINATION  QUESTIONS. 


The  Mxdioal  Vbkss.     27T 


meoto  have  been  adopted  from  the  Pablic  Health  Aott  of 
London  and  England.  One  of  the  chief  reasons  which 
neceeeitated  the  introduction  of  an  amendinc  Bill  was  the 
replacement  of  the  Board  of  Sapervision  by  the  Local 
Government  Board,  and  the  new  order  of  things  thus 
brought  about.  Most  of  the  new  provisions  have  already 
received  Parliamentary  sanction  and  are  in  operation.  We 
notice  that  the  term  "  occupier  **  has  at  last  been  fully 
defined  in  such  an  Act,  and  that  lawyers  will  no  longer  be 
able  to  argue  from  the  exclusive  use  of  the  authorised  defi- 
nition of  nuisances  as  **  injurious  "  to  health,  that  ill-health 
must  be  proved,  and  not'  only  expected,  as  the  word 
"**  dangerous  "  to  health  has  been  added.  This  addition  is 
made  throughout  the  Bill.  The  removal  of  nuisances  is 
facilitated  by  empowering  the  local  authorities  to  serve 
notices  requiring  the  neoessary  work  to  be  done,  procedure 
by  summary  warrant  following  in  case  of  default.  Among 
the  provisions  taken  from  the  London  Act  are  those  deal- 
ing with  offensive  trades,  unsound  food,  the  licensing  of 
slaughter-houses  and  knackers'  yards,  and  the  sections 
dealinj^  with  infectious  diseases.  The  provisions  of  the 
Infectious  Diseases  Notification  Act  are,  by  a  new  dause, 
to  be  extended  to  every  district  in  Scotland,  and  the 
powers  of  the  local  authorities  increased  by  the  insertion 
of  the  word  "  shall "  into  the  clause  concerning  the  pro- 
viding of  isolation  hospitals.  That  is  to  say,  if  the  Local 
Government  Board  require  it,  the  authorities  must  provide 
these  hospitals,  in  contradistinction  to  the  old  "may." 
Power  is  also  given  to  the  Board  to  compel  the  local 
authorities  to  combine  for  hospital  purposes,  when  indi- 
viduallv  they  have  not  the  resources.  It  is  a  pity  that  a 
clause  nas  been  inserted  allowing  the  authorities  to  make  a 
charge  for  patients  received  into  hospital,  as  this  is  quite 
opposed  to  all  practice  in  Scotland  hitherta  A  clause 
providing  for  building  regulations,  especiaUy  with  regard 
to  the  sanitary  arrangements,  in  houses  built  in  rural 
districts  will  be  hail^  with  satisfaction  by  all  county 
sanitary  authorities.  In  all  the  Bill  thouldmeet  with  the 
approval  of  those  in  charge  of  the  administration  of  public 
health  in  Scotland,  and  if  incorporated  with  the  previous 
Acts  in  the  promieed  Consolidation  Bill,  should  aid  them 
in  a  very  marked  manner  in  the  prosecution  of  their  work. 
It  is  to  be  hoped  that  when  the  codification  of  all  these 
Bills  is  attempted  it  will  not  be  found  necessary  to  modify 
the  present  proposals  in  many  ways. 

Tin  Glasgow  Poucb  Subgbonship.— Glasgow  is  much 
concerned  over  the  appointment  (rf  a  police  surgeon  to 
succeed  Dr.  McGill  who  has  just  resigned  his  post.  The 
question  at  issue  is  whether  one  surgeon  should  be 
appointed  for  the  whole  city,  or  several  oistrict  ofiScers  in 
different  parts  of  the  town.  In  favour  of  the  latter 
arrangement  it  is  pointed  out  that  policemen  when  ill 
have  often  a  long  way  to  go  to  see  the  doctor  in  the 
central  ofSces.  On  the  other  hand,  members  of  the  force 
have  a  right  to  attendance  bv  the  ordinary  district  medi- 
cal officers  if  the  services  of  the  regular  police  surgeon 
cannot  be  had.  The  Committee  of  the  Town  Council 
appointed  to  deal  with  the  question  have  resolved  to 
recommend  that  whoever  is  appointed  will  receive  a  salary 
of  £350,  with  £50  for  travelling  expenses,  and  be  requirea 
to  devote  all  his  time  to  the  duties  of  his  office.  The 
ai^pointment  of  several  district  officials  would  doubtless 
lead  to  some  confusion  with  regard  to  the  areas  served  by 
each,  while  such  an  arrangement  would  necessitate  a  much 
Increased  expenditure. 

A  Dbastic  Rkmkdt  fob  Iksanitabt  Cottages. — We 
have  in  these  columns  before  now  alluded  to  the  extremely 
inaanitary  conditions  under  which  so  many  of  the  West 
Coast  Highlanders  live.  In  a  report  from  the  Harris  Dis- 
trict Committee  of  the  Public  Health  Committee  of  Inver- 
ness it  is  propoeed  to  bum  several  hundred  of  the  "  black 
bouses "  m  that  island,  on  account  of  their  extremely 
insanitary  condition.  Dr.  Ogilvie  Grant,  in  his  report  to 
the  Committee,  ascribes  tM  prevalence  of  relapsing, 
typhus  and  typhoid  fevers,  of  consumption  and  the  hi«i 
infantile  mortality,  to  these  black  houses  being  unfit  for 
human  habitation.  It  is  also  a  striking  fact,  that  where 
town's  people  go  for  health  the  average  longevity  of  ihe 
inhabitants  should  be  as  low  as  39.  The  great  difficulty 
in  the  way,  of  course,  is  the  want  of  money  to  rebuild  the 
hoaees  compulsorily  destroyed.  The  rates  last  year  were 
^,,81d.,.and  most  of  the  inha)l>itants  are  exempt.  There 
JBDodonbc  that  sooner  or  later  these  houses  musib  go,  pro- 


bably  with  the   help   of  the    long-tnfilering  National 
Exchequer. 


MEDICAL  SOCIETY  OF  LONDON. 

The  meetiDg  od  Monday  eyening  last  (March  9)  watf 
deyoted  to  a  paper,  illastrated  by  photographs  on  the 
screen,  by  Professor  Victor  Horsl^y  on  ''The  Physiology 
and  Pathology  of  the  Thyroid  Gland." 

The  lecturer  briefly  reviewed  the  eyolution  of  oaf 
knowledge  of  the  subject  since  1859,  when  SchifiT  first 
directed  attention  to  the  importance  of  the  function 
discharffed  by  the  thyroid  gland,  views  which  were 
promptly  forgotten  until  they  were  revived  in  a  more 
convincing  form  in  1884^  when  SchifiT  showed  that 
the  removal  of  the  |[land  m  carnivorous  animals  was 
followed  by  a  strikmg  train  of  symptoms.  As  the 
gland  is,  in  carnivorous  animals,  essential  to  life,  its 
removal  being  speedily  followed  by  death,  Schiff  never 
had  an  opportunity  of  observing  the  effects  produced 
in  animals  m  whom  the  evolution  was  more  gradual. 
It  was  then  that  the  lecturer  had  carried  out  his  ex- 
periments on  monkeys  in  which  he  had  succeeded  in 
determining  artificiu  myzoedema  by  the  removal  of 
tiie  gland,  taking  special  care  to  avoid  injuring  the 
nerves  in  the  neighbourhood,  because  his  results  had 
been  challenged  on  the  ground  that  the  symptoms  were 
determined,  not  by  the  removal  of  the  gland,  but  by 
the  injury  to  the  sympathetic  nerves.  This  was  a 
perfectly  untenable  nypothesis,  the  vQgue  of  which  he 
confessed  he  was  quite  unable  to  explain.  Dr. 
Murray's  discovery  that  the  effects  of  destruction  or 
removal  of  the  gland  could  be  compensated  by  the  ad- 
ministration of  the  ffland  juice  came  very  opportunely 
to  confirm  the  results  of  his  experiments.  He  then 
proceeded  to  describe  by  the  aid  of  photographs  on  the 
screen  the  changes  observed  in  the  thyroid  gland  when 
undergoing  compensatory  hypertrophy,  pointingout  at 
the  same  time  the  relationship  of  the  para-thyroid 
bodies  to  the  main  gland.  He  then  went  somewhat 
minutely  into  the  histology  of  these  bodies  and  the 
changes  they  underwent  in  hypertrophy  and  also  in 
exophthalmic  goitre.  He  mentioned  that  the  so-called 
vacuolation  of  the  fat  cells  possessed  no  special  patho- 
logical significance,  inasmuch  as  it  had  been  observed 
in  association  with  various  other  conditions. 

Sir  William  Roberts  moved  a  vote  of  thanks  to  the 
lecturer,  and  suggested  that  the  active  properties  of 
the  cells  and  their  secretions  might  explain  the  influ- 
ence of  certain  uncooked  foods  as  compared  with  foods 
in  which  the  cells  had  been  killed  by  previous 
cooking. 

The  motion  was  seconded  by  Dr.  Mitchell  Bruce 
who  expressed  the  pleasure  he  had  felt  as  a  member  of 
the  Fothergillian  Committee  in  selecting  Mr.  Horsl^ 
as  the  recipient  of  the  medal  and  premium.  Needless 
to-  say  the  motion  was  carried  by  acclamation. 


D.P.H.  EXAMINATION  QUESTIONS. 

{Continued  jyom  page  224.) 

ViCTOKiA  Univebsity,  July  1895.— Part  I.  (Three  Honrs.) 

Chemistry^  Ac* 

1.  Deecribe  the  graduation  of  a  mercury  thermometer. 
Ck>Dvert— 10°F.  +  lOT.,  +  SO'^F.  into  degrees  Centigrade. 
If  a  Centigrade  thermometer  in  melting  ice  registers 
+  1°C.  and  in  eteam  from  boiling  water  100<^C.,  what  is 
the  tme  temperature  wheb  this  thermometer  registers  30**  T 

2.  Two-hondred-and-oinetv  cubic  inches  m  air  were 
measured  over  water  at  17  C.  and  under  a  pressure  of 
734*4  mm.  of  mercury.  What  would  be  the  volume  of  the 
dry  gas  at  (f  C  and  760  mm.  ? 

Aqueous  pressure  at  17''  C  =  14*4  mm. 

3.  Explain  the  following  terms :— (1)  relative  humidity^ 
(2)  diathermancy,  (3)  isobar,  (4)  albumenoid  ammonia, 
(5)  temporary  hsraness. 

4.  Describe  the  "  oxygen ''  or  **  moist  combustion  "  pro- 


378     Thi  Ubdical  Pbbss. 


COBRESPONDENCE. 


Mab.  11,  1896. 


06i8  of  Forchammor  for  determining  orsanic  imparity  in 
water.  What  are  its  advantages  and  defects  ?  How  do 
the  results  compare  with  the  "  or|;anio  carbon  "  of  Frank- 
land's  combustion  process? 

5.  Discuss  the  importance  of  the  estimation  of  nitrates 
and  of  nitrites  in  potable  water.  What  are  the  best 
methods  in  use  ?  . 

6.  What  judgment  could  be  formed  as  to  the  sources  of 
the  waters  analysed  with  the  following  results  and  as  to 
their  fitness  for  domestic  supply  ? 

PtfU  in  100.000. 


A 
B 


236 
581 
130-4 
28.0 


I 


Is 


•172 
•06 
•11 
•20 


a 

B 


•017     -008 

I 

•014  -009 
•053  J  -002 
'033      0006 


0 

1-33 
39 
•21 


•75 
4-8 
8-4 


•9 
43  5 
750 


1^7    !  204 


7.  Describe  exactly  how  you  would  measure  the  amount 
of  carbonic  acid  in  a  room. 

Practiced   Chemistry. 

1.  Determine  the  amount  of  Ammonia  present  in  the 
solution  marked  A.  A  standard  solution  of  Ammonium 
Chloride  is  provided. 

2.  Determine  either  a.  the  amount  of  Chlorine  in  the 
solution  A ;  or  6.  the  hardness  of  the  solution  B. 

You  are  required  to  make  your  ovtm  standard  solution. 

3.  Identify  the  simple  salt  C. 

4.  Either  determine  the  dew-point  in  the  Chemistry 
Theatre,  or  read  the  position  of  the  vernier  on  the  scale 
provided. 

Use  of  MiOBOSOOPB.~Pra<rft<wZ  and  Oral.     Three  hours, 
L  Practical  Work  and  Beportin^. 

1.  Spleen  and  lunff  of  diseased  cow,  and  a  microscopical 
unstained  section  of  the  spleen  are  given.  Prepaie  the 
microscopical  section  so  as  to  show  the  nature  of  the 
lesions,  and  give  a  short  report  on  the  state  of  the  organs. 

2.  Given  asection  of  tongue  muscle.  Examine  that  section 
microsoopieally  and  state  the  disease  with  which  the 
animal  was  afifected  at  the  time  of  its  death. 

XL  Oral  Part. 

3.  Examinations  on  specimens  of  animal  and  vegetable 
parasites.  Diseased  foods— Impurities  found  in  air,  water 
and  food  articles. 


ComjBponbtnxe, 

•Smp^H^}^^  <»«»l^e«  wntoMible  for  the  opinions  of  our 

PHARMACOLOGY  AT  THE  LONDON  CONJOINT 
BOARD. 
To  the  Editor  of  Thi  Medical  Passs  and  Cibculaiu 
SiB»~I  ^uite  agree  with  the  views  expresfed  in  the 
leading  article  on  Pharmacology  of  the  London  Conjoint 
Board  which  appeared  in  your  issue  of  Feb.  19th.  To 
exclude  Pharmacology  as  a  separate  subject  at  the 
examination  for  the  Conjoint  Diploma  will  be  an  unfor- 
tunate and  retrograde  step.  In  recent  years  the  depen- 
dence of  the  curative  efiects  of  drugs  and  other  agencies 
on  their  influence  on  the  tissues  and  organs,  and  the 
desirability  of  a  due  knowledge  of  physiological  action 
has  been  generally  recognised.  It  is  true  that  in  practical 
therapeutics  we  are  often  chiefly  guided  by  our  own 
experience,  or  that  of  others,  as  to  the  remedies  we  should 
innploy,  but  even  when  we  use  drugs  on  the  ground  of 
experience,  ideas  concerning  their  pharmacological  action 
are  constantly  before  us,  and  when  experience  is  wanting 


we  rely  almost  wholly  on  the  knowledffe  we  poesees  of 
this  action.  Especially  do  praetitioners  dispend  on  this 
knowledge  in  the  earlier  part  of  their  career.  A  ripe 
experience  may  indeed  enable  those  possessing  it  to  use 
remedial  agents  ^uccessfullv  without  much  thought  of  the 
method  in  which  they  act,  but  ri^  experience  is  not  com* 
municable,  and  other  things  heme  equal,  he  makes  the 
best  practitioner  who  knows  most  lolly  the  exact  nature 
of  the  influence  exerted  by  the  means  he  uses. 

In  accordance  with  tne  growing  value  attached  to 
Pharmacologv  its  importance  as  a  subject  of  study  and 
examination  has  been  increasingly  recognised  b^  examin- 
ing Boards,  in  several  of  which  a  special  examination  in 
Pharmacology  has  been  instituted.  But  the  recent  deci- 
oision  of  the  College  of  Physicians  will  tend  to  limit  the 
acquisition  of  Pharmacology  by  the  student,  and  thus 
sffgravate  the  evil  so  much  complained  of  that  men  pass 
through  the  examination  portals  unfit  for  the  work  of  life. 
For  comprehending  the  due  use  of  therapeutic  M^ts  a 
student  oueht  to  be  taueht  (1)  The  nature  of  drugs 
(Materia  Medica)  ;  (2  The  methods  of  combining  and 
prescribing  them  (Pharmacy)  ;  (3)  Their  action  (Pharma- 
cology)* i  am  by  no  means  inclined  to  depreciate  a  know- 
ledge of  the  nature  of  drugs,  nevertheless  as  far  as  aotoal 
practice  is  concerned  the  second  and  third  subjects  are 
decidedly  of  more  value  than  the  first,  and  the  third 
(Pharmacology)  is  by  far  the  most  important  of  aU.  But 
as  matters  at  present  stand  students  may  only  be  examined 
thoroughly  in  the  first  of  these  subjects  (Materia  Medica), 
for  though  the  one  examination  which  a  student  must  now 
pass  is  wled  Practical  Pharmacy,  the  syllabus  shows  that 
this  is  an  error  in  nomenclature,  the  subjects  being  (a) 
The  general  nature  and  composition  and  the  most 
important  physical  and  chemical  characters  of  the  Phar* 
macopcBial  drugs  named  in  the  Schedule.  (6)  The  com- 
position of  the  Pharmacopoeial  preparation  of  tliese  drugs 
and  the  processes  employed  in  making  them,    (c)  Dosee. 

To  turn  men  into  practice  whose  knowledge  with  reeard 
to  the  nature  and  action  of  drugs  has  onlv  been  testM  by 
such  an  examination,  will  be  unfair  to  the  public  and  in<; 
jurious  to  the  progress  of  medicine.  As  the  alterations 
necessary  to  bring  the  regulations  into  accord  with  the 
omission  of  Pharmacology  as  a  separate  subject  from  the 
final  examination  has  bMn  referred  to  by  the  Committee 
of  Management,  it-is  possible  that  it  may  be  decided  to 
include  pharmacological  questions  in  the  paper  on  medi- 
cine. To  such  an  arrangement  there  are  grave  objections. 
Already  the  questions  in  the  medicine  paper  are  too  few  foc 
testing  properly  whether  a  man's  knowledge  of  medicine 
is  sufficient  to  fit  him  for  practice.  To  introduoe  quest 
tions  on  Pharmacology  is  therefore  undesirable.  Moreover^ 
it  will  add  greatly  to  the  difficulties  of  the  student  if  he 
knows  that  ne  may  be  examined,  not  only  in  all  those  snbn 
jects  met  with  in  text-books  on  medicine,  but  in  those 
which  are  dealt  with  in  text-bocks  on  pharmacology^  It. 
will  probably,  indeed,  come  to  pass  that  pharmacolof^eal 
questions  wul  only  occasionally  appear  in  the  medicine 
papers  or  form  an  unimportant  part  of  them  and  students 
—certainly  the  less  industrious— will  be  tempted  to.  oqut 

Sining  any  knowledge  as  to  the  action  of  medioinee»  on 
e  chance  that  either  no  question  will  be  put  op  Phar*. 
macdogy,  or  the  question  put  will  not  carry  sufficient 
weight  to  prevent  them  passing,  even  if  unable  to 
answer  it. 

If  there  be  a  perfunctory  examination  on  the  subject, 
m^n  will  be  passed  into  the  profession  unfitted  for  their 
work.  If  the  examination  be  a  real  one  the  burden  laid 
on  the  student  will  be  unduly  great. 

I  am,  Sir,  yours,  &c., 

D.  J.  LncH. 
94  Mosley  Street,  Manchester, 
March  3rd«  1896. 


PUBLIC  HEALTH  DIPLOMAS  IN  IRELAND. 

To  the  Editor  oj  Thx  Mxdioal  Paiss  and  Ciboulab. 

Sib, — I  observe  that  you  have  recently  devoted  a  eood 
deal  of  space  to  the  questions  of  public  health  in  England 
and  to  the  qualifications  .for  English  public  health 
diplomas,  whmfore  it  strikes  me  that  your  English 
readers  may  be  interested  toknow  how  their  sister  country 
stands  in  this  respect.  In  1878  Sir  Michael  Hicks-Beaoh, 
then  Chief  Secretary,  passed  a  very  complete  Bill  lor 


Mas.  11,  1896. 


CORRESPONDJENCE. 


Thi  Mbdical  Press.     27 


IreUnd  by  which  all  the  pomuMory  powers  previonaly 
confided  to  Irish  GoardUos  (who  never  used  them)  were 
codified,  added  to,  and  made  compnlsoty.  That  Bill  was 
in  a  great  defi^ree  a  simple  ad^tation  of  the  English  Acts 
to  the  special  case  of  Ireland,  and  if  carried  into  effect  it 
would  have  placed  the  public  health  ^stem  of  Ireland  on 
almofit  identical  groand  with  that  of  England.  It  was 
not  really  carried  into  effect.  Why  ?  Because  the  Guar- 
dians, who  were  the  sanitary  authority  on  whom  its 
enforcement  devolved,  were,  speaking  generally,  abeo- 
Intely  hostile  to  sanitation  in  any  shape  or  form.  The 
typical  Guardian  of  that  date  regarded  a  permanent  family 
manure  heap  and  general  cesspool  within  five  yards  of  the 
parlour  winaow,  a  house  without  fire-grate  or  chimney, 
sleeping  accommodation  for  Byt^  promiscuously,  in  a  bed, 
and  a  water  supply  from  the  nearest  ditch  as  the  normal 
condition  of  thugs,  and  as  to  the  isolation  of  or  removal 
to  hotpital  of  infectious  cases  he  thought  it  a  much 
better  plan  to  "  let  them  get  it  over  on  their  feet " 
in  their  own  cabins,  and  perhaps  as  one  of  the  Art 
.occupants  of  the  family  couch.  The  Local  Government 
Board  of  that  day,  terror-stricken  as  it  was  and 
still  is,  with  the  apprehension  of  offsnding  the  Guardians 
(who  have  Parliamentary  influence)  or  of  asking  the  rate- 
payers for  money,  set  itself  deliberately  to  thwart  the 
intention  of  Parliament,  and  to  make  the  new  Act  a  nul- 
lity. To  understand  how  the  Board  effected  this  purpose, 
it  is  necessary  to  explain  that  the  unit  of  the  sanitaiy 
organisation  in  Ireland  is  the  Dispensary  Medical  Officer, 
of  whom  there  are  about  900,  servants  (and  it  is  important 
to  note  this),  in  the  etrioest  sense,  of  tne  Guardians,  and 
-paid  by  them.  Eadi  such  Officer  is  called,  for  the  nonce, 
Medical  Officer  of  Health,  and  has  a  sort  of  nuisance 
inspector,  called  "  Sanitair  snb-Offioer,"  under  him.  As 
his  superior,  the  Act  provided  a  Superintendent  Medical 
Officer  of  Health,  who,  it  was  contemplated,  would  preside 
over  the  sanitation  of  a  larse  area,  devote  his  whole  time 
to  his  duties,  keep  the  Medical  Officers  up  to  their  work, 
and  receive  some  such  salary  as  the  £500  a  year  which  is 
usual  in  England.  Here  was  a  most  ezcelleiit  scheme  of 
organisation,  complete,  and  comparatively  inexpensive. 
How  did  the  Local  Government  Board  for  Ireland  utilise 
it  ?  It  was  unfriendly  to  the  Act  ah  initio  because  it  had 
been  passed  in  its  teeth  ;  then  asain,  it  anticipated  that 
the  Guardians  would  object  to  the  money  cost,  but  that 
difficulty  might  be  got  over.  The  cardiniu  objection,  how- 
ever, was  that  the  Guaidian  shated  sanitation  in  any  shape 
or  form,  and  would  certainly  turn  rusty  at  any  attempt 
to  enforce  it,  even  if  they  were  not  asked  for  a  penny  for 
the  cost.  Having  these  considerations  in  view,  the  Local 
Government  Board,  as  I  have  said,  determined  as  far  as 
th«y  could,  to  reduce  the  Act  to  a  nullity.  Its  first  official 
act  was  to  issue  a  circular  to  Boards  of  Guardians 
directing  them  not  to  pay  a  Medical  Officer  of  Health  any 
larger  emolument  as  such  than  one-fourth  of  his  dispensary 
salary  which  meant  about  £15  a  vear,  which  hint  the 
Guardians  promptly  availed  themselves  of^  and  fixed  the 
emoluments  as  low,  in  many 


s,  as'£3  or  £5  a  year, 
which  assessment  of  professional  services  the  Local  GU>vem- 
ment  Board  gratefully  accepted  but  proceeded  fortiiwith 
to  pile  up  additioosl  unremunerated  duties  upon  the  Dis- 
pensary Doctor.  It  would  not  have  mattered  much  to 
the  efficiency  of  the  sanitary  organisation  if  these  officers 
were  badly  paid  if  they  had  over  them  a  strong  superin- 
tendent, weU  salaried  and  independent  of  the  Guardians, 
whose  du<^  it  would  be  to  make  the  Medical  Officer  work 
whether  the  Guardians  liked  it  or  not.  Wherefore  to 
avdd  the  calamity  of  such  a  supervisor  the  Local  Govern- 
ment Board  proceeded  to  draw  bis  teeth,  so  to  speak.  To 
hegm  with  tney  reduced  his  status  by  changing  his  title 
to  that  of  "Ckmsnlting  Sanitary  Officer,"  Uie  object  of 
this  move  being  to  let  the  Guardians  know  that  his  ser- 
vices as  supervisor  were  never  required  unless  he  was 
*'consul^d":  then  they  passed  the  word  that  such 
officer  might  be  paid  anything  or  nothing,  and,  under 
this  guidance,  manv  Boards  of  Guardians  got  rid  of  the 
supervision  altosreuier  by  resolving  that  the  Medical 
Superintendent  snould  be  paid  a  guuea  for  every  consul- 
talaon,  and,  thereafter  never  consulting  him. 

The  result  of  all  this  manoeuvering  by  the  Irish  Local 
Board  and  the  Guardians  has  been  that  at  this  moment 
the  Dispensary  Medics^Offioers  receive,  on  an  average,*  a 
five  poimd  note  per  annum  each  on  the  understanding 


that  they  will  not  bother  their  Guardians  or  anyone 
else  with  exuberant  sanitaiy  zeal.  If  any  of  them  feel 
moved  by  a  sense  of  duty  to  do  so  they  probably  find  them- 
selves in  collision  with  some  guardian  who,  or  whose  friend,, 
is  the  proprietor  of  the  nuisance  in  question,  and  he  mAy 
expect  not  onlv  to  be  handsomely  snubbed  for  his  pains, 
but  to  have  the  said  guardian's  hand  against  him  for 
months  and  years  afterwards  and  to  find  that  on  such 
occasions  he  will  receive  no  support  from  the  Irish  Looal 
Government  Board.  For  all  these  reasons  the  Irish  public 
health  service  is,  measured  by  the  English  standard,  a 
disreputable  farce. 

The  purpose  of  this  long  explanatory  prologue  is  to 
point  out  that  the  high  cbss  special  edueaticm  and  exa- 
mination requisite  for  England  is  entirely  out  of  place  for 
Ireland.  No  one  can  be  more  anxious  than  I  am  that  Irish 
Medical  Officers  of  Health  should  have  some  little  know- 
ledge of  their  business  before  tikey  take  it  up,  and  that 
the  supervising  officer  should  be  thoroughly  educated .  in 
the  spedalitv,  out  the  Local  Government  Board  says  that* 
the  Irish  public  wiU  not  pay  for  such  sanitary  luxuries, 
and,  if  so,  it  cannot  have  them*  The.  General  Medical 
Goundl,  however,  has  insisted  that  an  identical  educa- 
tional standard  shall  be  maintained  by  the  Irish  and 
English  Colleges,  a  standard  totally  unsuited  to  the  exist- 
ing conditions  of  Irish  sanitary  organisation,  and  the* 
result  has  been  to  completely  extinguish  the  Irish  Public 
Health  Diploma,  as  far  as  an  Iriui  demand  for  it  goes. 
For  this  reason  scarcely  half-a-dozen  such  diplomas  are 
now  given  annually  in  Ireland. 

I  am.  Sir,  yours,  &c., 

A  FOLLOWXR  OF  THB  PlOUOR. 


SOFT  SORE  ON  THE  TONGUE— A  RARE  CASK 
To  the  Editor  of  the  Mxdioal  Pbbbs  and  Cxboulab. 
Sib,— Will  you  allow  me  to  draw  attention  in  the- 
MsDiOAL  Prbss  and  Ciboulab  to  a  very  interesting  cas» 
of  simple  (so-called  soft)  sore  of  the  tongue,  under  the 
care  of  Dr.  A.  Fournier,  which  was  brought  forward  by 
Drs.  Emery  and  Saboumand  at  the  "Sooi^t^  Frangais 
de  Dermatologie  et  de  Syphili|^phie,"  of  which  Society  I 
have  the  honour  to  be  a  foreign  corresponding  memlier. 
These  gentlemen  give  an  accurate  description  of  the  Un- 
gual lesion,  which  appeared  at  the  same  time  and  was 
derived  from  the  same  source  of  infection  as  three  typioU 
soft  sore^  that  developed  on  the  patient's  prepuce.  From 
the  sore  on  Uie  tongue  two  inoculations  were  made,  one 
on  each  arm,  and  these  each  produced  on  the  following 
day  an  ulceration  which,  in  Dr.  Foumier's  opinion,  was 
that  of  the  inoculation  of  a  typical  soft  chancre.  H& 
furthermore  stated  that  it  was  the  first  case  he  had  ever 
seen  of  absolutely  definite  soft  sore  of  the  tongue,  and 
added  that  the  correct  diagnosis  was  only  made  by  exclu- 
sion, as  the  three  fundamental  characteristics  of  tne  affec- 
tion were  absent ;  he  thought  that  probably  the  rarity  oi 
facial  chancres  being  recorded  might  be  due  to  the  fact 
that  they  do  not  present  all  the  characteristics  of  genital 
sores,  many  for  this  reason  being  unrecognised.  PersonaUv,. 
I  have  never  seen  a  soft  sore  of  the  facial  region,  which, 
as  pointed  out  some  time  ago  by  Drs.  Nanaud,  de  Lise- 
rage,  and  Janselme,  must  be  a  bad  soil  for  the  develop- 
ment of  this  species  of  chancre,  or  I  am  sure,  considering 
the  far  from  cleanly  habits  of  hospital  patients,  we  should* 
very  often  see  them  in  this  situation,  the  infection  being 
carried  through  inoculation  by  the  fineers  of  the  patient 
after  dreesing  the  genital  leisions.  It  would  be  most- 
instructive  to  learn  uie  experience  of  medical  men  in  this- 
country  with  regard  to  soft  chancres  of  the  tongue. 
I  am,  Sir,  yours,  &c,, 

H.  DE  MSBIC. 

Duke  Street,  Portland  Place. 
♦ 
SPECIAL  HOSPITALS— ST.   JOHN'S  HOSPITAL. 

To  the  Editor  of  The  Medical  Pbsss  akd  Cibculab. 

Sib,— Your  correspondent^  «  A  Hospital  Reformer,"  ha» 
quite  justly  called  attention  to  the  opening  in  London  of 
a  new  Hospital  for  Diseases  of  the  Skin,  which  is  an  arm. 
of  the  notorious  St.  John's  (Leicester  Square),  and  he 
states  *'  there  is  no  real  reason  for  the  existence  of  any 
hospital   for  diseases   of   the   skin."     Admitting    that 


t280     Ths  Msdical  Pbiss. 


LITERATURE. 


Mab.  11,  1896 


•there  ia  truth  in  ibis  etatement,  I  believe  the  an- 
tiffonitm  which  eziate  in  the  medical  profeaeion  against 
all  special  hoepitala  to  be  doe  to  the  fact  that  ao  many  of 
themare neither  more  nor  leaa  than  pfoprietarr  diapenaariea 
in  which  patienta  pay  feea  often  ezoe'ding  tfaoae  received 
by  seneraL  pracUtionera.  Thoae  membera  of  the  medical 
proleaaion  who  are  on  the  fAaf  of  anch  inatitntiona  are 
qoite  prepared  to  aacrifioe  thw  time  ao  that  they  may 
lUbtain  the  title  of  a  hottpUtUphyaioian  or  surgeon. 

The  evil  ia  that  auch  inatitntiona  go  cap  in  hand  to  the 
public  and  aak  for  alma.  They,  at  the  aame  time,  are 
takinff  payment  from  ao  many  patienta.  What  the  pnblic 
and  the  profeasion  have  a  right  to  aak  from  every  hoapital 
ia  a  frank  statement  aa  to  toe  maximum  aum  taken  irom 
patienta  for  treatment ;  if  thia  ia  ^iven  depend  upon  it  the 
eeneroeity  of  Uioae  who  allow  their  puraea  to  be  unlooaed 
by  the  oonatant  applicationa  of  an  energetic  aecretary  will 
receive  a  rude  shock. 

There  is  alao  another  aapect  of  the  queatioo,  which  may 
be  stated  as  follows :  If  a  special  hospital  exist  it  must 
Justify  its  existence  by  anawering  the  following  teata : — 

A.  Treatment  of  the  aick  poor  gratuitonaly. 

B.  Teaching  the  profeaaion. 

There  ia  a  small  aum  of  money  which  may  be  quite 
honeatly  received  by  a  hoapital  from  the  patienta  ;  but  I 
believe  there  are  few  who  know  how  large  that  aum  ia 
in  many  inatancea. 

I  am.  Sir,  yours,  &c., 

Another  Hospital  Rifobmeb. 


THE   ETIQUETTE   OF    PROFESSIONAL   ADVER- 
TISING AND  THE  KINGSBURY  CASE. 

To  the  Editor  o/Thx  Mxdigal  Pbbss  and  Ciboulab. 

SiBy— I  think  Dr.  Kingsbury  is  heartily  to  be  congratu- 
lated on  the  issue  of  his  case  before  the  Manchester  AMizes. 
This  so-called  medico-ethical  department  of  the  British 
Medical  Journal  has  been  too  long  used  as  a  pillory  into 
which  the  weak  members  of  the  profession  are  ruthlessly 
committed,  while  the  richer  ones  often  ten  times  more 
guilty  of  unprofessional  or  rather  ungentlemanly  conduct 
are  lulowed  to  pass  scathelesa.  I  have  becm  over  thirty 
yeara  a  member  of  the  medical  profeaaion,  and  I  oonfeaa 
Ihat  I  am  iffnorant  of  any  unwritten  law  binding  upon 
me  aa  a  medical  man  apart  from  the  conduct  which  legu- 
latea  gentlemen  in  their  relationa  with  one  another  (which, 
in  the  medical  profeaaioo,  ia  more  honoured  in  the  breach 
than  in  the  observance) ;  and,  personallv,  I  diatinctly 
refuse  to  acknowledge  any  other  code.  That  what  is  in 
the  General  praiseworthy  ia  in  the  aubaltem  rank 
•blaaphemy,  among  medical  men  baa  been  glarinely  demon- 
atrated  in  Dr.  Kingabnry'a  caae,  and  he  haa  lud  ua  all 
under  obligationa  for  the  conduaion  arrived  at,  that  indi- 
vidual caprice  ia  not  to  determine  what  conduct  is  eentie- 
manly  or  professional,  and  what  is  not.  Sir  Dyce  Duck- 
worth was  compelled  to  confess  to  advertising  not  one  whit 
less  heinous  than  that  with  which  Dr.  Kingsbury  was 
charged,  and  U  Dr.  Ward  Cousins  does  not  advertise  in 
the  manner  which  was  to  him  so  offensive  in  Dr.  Kings- 
bury, for  what  purpose,  might  I  ask,  does  the  "  Royal 
Portsmouth  Hospital  and  the  Portsmouth  and  South 
Hants  Eye  and  Ear  Infirmary  "  exist  7  And  for  what  pur- 
poee  do  all  special  hospitals  exist  except  for  the  pur- 
pojBe,  primarily,  of  medical  advertising?  How  did 
this  special  hospital  come  into  existence  ?  Is  Dr.  Ward 
.  Cousin's  name  not  extensively  advertised  in  connection 
with  it  7  Before  lampooning  and  insnltinff  the  presum- 
ably weak  membera  oi  the  ^lofession,  '<m&cal  advertis- 
ing" ahonld  be  deigned,  the  aoquieaceoce  of  the  profeaaion 
to  it  aa  a  code  of  profeaaional  conduct  ahould  be  obtained, 
and  the  breachea  of  it  could  be  eaaily  demonatrated  and 
punished. 

I  am.  Sir,  youra,  A;g., 
D.  Campbbll  Blaok,  M.D.,  F.R.S.Ed., 


Profeaorof  I 

Med.{ 

Glaagow,  March  7th,  1896. 


'.Ac.  ^^ 


HiteraJtttt 


BROADBENFS  ADHERENT  PERICARDIUM,  (a) 

This  email  book  is  the  work  of  a  careful  and  accurate 
obeerver,  and  the  writer  at  once  makea  hia  claim  to  be 
heard  a  good  one  when  he  atatea  that,  "  The  number  of 
caaea  of  adherent  pericardium  aeen  in  the  post-mortem 
room,  and  the  comparatively  few  caaea  in  which  a  dia- 
gnoaia  of  thia  condition  ia  made  before  death,  make  this 
subject  worthy  of  special  stody  and  investigation." 

Among  eighty-six  cases  of  death  from  heart  disease  in 
St.  Mary's  Hospital  there  were  found  thirty-one  examples 
of  adherent  pericardium.  This  may  date  from  some  acute 
cardiaoaffection  in  early  childhood.  In  lOOfatalcasesof  heart 
disease,  occurring  in  the  Cbildren'sHospital,  Great  Ormond 
Street,  in  six  only  was  there  no  evidence  of  pericarditis. 
Important  as  it  is  to  recognise  this  condition  as  explain- 
ing many  somewhat  anonuilous  heart  symptoms,  there  is 
no  doubt  but  that  the  author  is  right  when  he  says,  "  the 
diagnosis  is  frequently  a  matter  of  considerable  difficulty." 

Passing  over  the  history  and  literature  of  the  subject, 
we  observe  under  the  heads  of  etiology  and  effects  of 
adherent  pericardium,  that  the  heart  may  be  enlarged  and 
hypertropnical,  or  atrophical,  or  normal  in  size.  Hope 
used  to  say  that  adherent  pericardium  always  led  to 
hypertrophy  of  the  heart,  but  further  observation  by 
Kennedy,  Gairdner,  and  others  proves  that  this  is  not  the 
case.  Dr.  Broadbent  points  out  how  dense  pericardial 
adhesions  strangle  and  compress  the  heart  and  so  cause 
that  atrophy  which  he  has  found  in  numerous  cases. 
Cardiac  dilatation  is  due  to  myocarditis,  impairing  the 
contractile  power  of  the  orean. 

A  very  important  practical  outcome  of  this  statement 
is  to  show  the  necessity  of  absolute  rest  for  some  time 
dorinff  convalescence  from  pericarditis.  The  special 
chest  hospitals  of  London  afford  too  frequent  illustration 
of  the  way  in  which  pemMment  heart  diaeaae  is  established 
in  ooc sequence  of  the  patient  having  to  be  up  and  about 
and  earning  his  living  before  this  state  of  myocarditis  has 
fullv  subsided,  the  weak  inflamed  cardiac  muscle  readily 
givmg  way  and  dilating  under  even  very  moderate  strain. 
The  physical  signs  of  adherent  pericardium  are  ablv 
discussed.  Systolic  depression  of  one  or  more  intercostsl 
spaces  to  the  left  of  the  sternum  does  not  prove  that  the 
pericardium  ia  adherent.  When  the  heart  is  much  en- 
larged, so  that  the  lung  tissue  which  normally  overlaps  a 
portion  of  its  surface  is  pushed  aside,  systolic  depression 
may  occur  as  a  result  of  atmospheric  pressure ;  for  a 
negative  pressure  is  produced  in  the  thoracic  cavity  by 
the  diminution  in  sise  of  the  heart  during  systole,  and  as 
the  lung  is  not  present  to  expand  and  occupy  the  place 
left  by  the  receding  walls  of  the  heart,  the  intercostal 
spaces  are  forced  down  by  the  greater  pressure  of  the 
atmosphere  without. 

Impeded  descent  of  the  diaphragm  in  inapiration  ia 
worth  noting  aa  indicative  of  pericardial  adheaion  and  a 
definite  ayatolic  receaaion  of  the  actual  apex  ia  another 
aign  to  be  fairly  depended  upon. 

With  regard  to  the  sounds  of  the  heart  it  is  well  worth 
noting  that  a  weak  pulmonai^,  second  sound  where  there 
is  eviaence  of  hypertrophv  of  the  right  ventricle  is  very 
important  as  it  mdioates  that  the  cause  of  the  hypertrophy 
of  the  rieht  ventricle  was  probably  not  back  pressure 
through  Uie  lungs  due  to  left  ventricle  trouble,  but  some 
intrinsic  cause,  perhaps  adherent  pericardium. 

A  few  words  mn  said  at  page  41  on  the  general 
symptoms  of  adherent  pwicardinm.  These  are  gene- 
rally those  usually  found  in  cases  of  heart  failure. 
The  reasons  why  pericardial  adhesions  affect  the  right 
more  than  f>he  left  ventricle  will  be  peruse4  with  intereeU 
After  a  few  words  on  diagnosis  and  prognosis  we  come  to 
a  car«f  ully  reported  list  d  cases  which  well  illustrate  the 
remarks  previously  made  by  the  author.  Case  C.  page  92, 
is  a  good  example  of  the  obliterating  effect  of  firm  peri- 
cardial adhesions  on  the  right  auricle.  The  ventricle  nere 
was  dilated  and  hypertrophied. 

Such  a  work  as  this  is  a  good  beginning  for  a  phyaician 
aa  an  author,  and  will  form  a  very  naeful  contribution  to 
our  knowledge  of  cardiac  pathology.     ^^^___^^_____ 

(a)  "Adhennt  PerioMdiun.*'  Bv  John  F.  H.  Broadbent.  MJ^., 
1L&.C.P.  London:  BailUerSi  Tin<kU,  and  Cox.  S^  120.  1S96 
Price  8b.  Od. 


Mab.  11,  1895. 


MEDlCAJi  NEW& 


The  Medical  Press. 


281 


DISEASES  OF  THE  SPINAL  CORD,  (a) 

The  preaeot  volume  m  a  iodiciocia  addition  to  the  many 
ezoellent  pnblications  of  The  New  Sydenham  Society. 
Within  the  past  ten  yean  nenrooB  diseaeea  have  had  much 
light  thrown  on  their  etiology  and  pathology  and  the 
cunioal  symptoma  are  better  interpreted. 

No  writer  is  more  suited  for  making  the  subject  of 
^l^^oiMMi  of  the  spinal  cord  interesting  than  Dr.  Marie,  and 
with  perhaps  tne  ezoeptioo  of  his  master,  Charcot,  no 
person  can  speak  with  more  fulness  of  information  and 
practical  mtimacv  with  them. 

As  stated  by  the  author  the  lectures  published  in  the 
book  were  taken  from  those  delivered  at  the  Faculty  of 
Medicine  in  the  summer  of  1891.  From  their  naturo  they 
are  didactic — a  fact  with  which  we  find  no  fault,  for  the 
general  reader  benefits  more  by  havlne  ascertained  facts 
and  an  accepted  theory  placed  clearly  beforo  him  than  by 
getting  two  or  moro  theories  from  which  to  make  a  selec- 
don. 

A  very  considerable  portion  of  the  book  is  occupied  with 
**  Tabes  *' ;  the  symptoms  alone  occupy  120  pi^es,  but 
unfortunately  the  etiolofinr  of  the  disease  is  dismissed  in  a 
few  pages,  Erb's  theory  being  practically  accepted.  The 
question  is  too  big  a  one  for  discussion  in  a  roview,  but 
we  cannot  forego  saving  that  it  is  not  proven. 

The  therapeutics  have  made  little  progress ;  nitrate  of 
silver  still  holds  the  place  of  honour ;  chloride  of  gold, 
arsenic  and  salts  of  zinc  ara  mentioned.  Of  the  alkaloids, 
*' strychnine,  acpnitine,  and  atropine  must  be  specially 
mentioned."  The  urinary  disorders  aro,  he  believes,  very 
successfully  opposed  by  ergot  of  rye.  Counter-irritation, 
electricity,  massage,  nerve-strotching  and  suspension  aro 
all  considered. 

Of  the  other  diseases  treated  of  by  the  author,  space 
does  not  allow  us  to  deal  with  them.  We  can  only  find 
■pace  to  oongratnUte  the  Society  on  the  translation 
which  leaves  nothing  to  be  desired,  the  English  reader 
being  provided  with  a  dear,  terse,  idiomatic  Enslish 
translation  of  a  treatise  on  a  subject  which  is  daily 
becoming  of  more  importance  to  the  general  practitioner. 


with  an  exact  referonce  to  date,  author,  work,  edition, 
volume,  chapter,  ftc.,  and  sent  to  the  Editor,  addressed, 
••  Dr.  Murray,  Oxford."  

CHINOSOL:  A  NEW  DISINFECTANT  AND  ANTI- 
SEPTIC. 
Mb.  Kuhn,36  St.  Mary-at-Hill,  London,  has  aubmitted 
to  us  a  sample  of  a  new  disinfectant  and  antiseptic 
which  he  has  just  introduced  named  Chinosol.  The 
advantages  claimed  for  it  are,  ( i )  that  it  is  non-poisonous, 
(2)  is  non-corrosive,  (3)  is  readily  soluble  in  cold  water 
in  any  proportion,  (4)  acts  as  a  deodoriser,  (5) 
does  not  coagulate  albumen,  (6)  has  scarcely  any 
odour.  From  a  trial  which  we  have  made  of  this  new 
antiseptic  agent,  we  can  fully  bear  out  aU  that  has  been 
said  in  its  favour.  One  of  its  peat  featuros  is  certainly  its 
ready  solubility  in  water,  which  will  add  considerably  to 
its  usefulness.  Chinosol  belongs  to  the  Chinoline  series.  It 
occurs  in  the  form  of  a  crystalline  powder  of  a  yellow 
colour,  and  although  an  aqueous  solution,  is  of  a  bright 
yellow  hue,  it  does  not  cause  any  staining  of  the  hands. 
We  have,  thereforo,  no  heritation  in  saying  that  the  valu- 
able properties  of  Chinosol  should  ensure  for  it  a  wide 
sphere  of  ust  fulness,  and  that  it  constitutes  an  important 
addition  to  our  list  of  antiseptics  and  disinfectants. 


THE  OXFORD  ENGLISH  DICTIONARY.    (6) 
We  have  received  the  Quarterly  number  of  the  Oxford 
English  Dictionary,  whicn  includes  all  the  words  from 
••  Development "  to  "  Diffluency." 

The  section  includes  1,145  main  words,  146  combina- 
tions explained  under  these,  and  138  subordinate  entries, 
1,429  in  all.  The  obvious  combinations,  recorded,  and 
illustrated  by  quotations,  without  individual  definition, 
number  143  moro. 

Compared  with  Johnson's  and  other  dictionaries,  we  find 
that  the  total  words  recorded,  *'  Development "  to  "  Dif- 
inency,"  were  in  Johnson  170,  Casaeirs  £ncyclo|MBdic  945, 
Centuary  Dictionary  1,016,  Funk's  •* Standard"  1,100,  the 
Oxford  1,572. 

Under  the  profiles,  D%  and  2>ta,  the  number  includes 

a  long  series  of  scientific  and  technical  terms  of  ancient, 

medieval,  or  modem  formation.      There   are  also  the 

bsolete  medical  terms  in  Dia,  so  strangely  formed  from 

o  ee  typhones. 

fr  Among  the  articles  of  special  historical  interest  are 
"  Devil "  (occupying  17i  columns),  and  <'  Dicker  "  (a  word 
of  the  skin-trade,  from  the  days  of  Tacitus  to  those  of 
modern  tradere) ;  "DeWitt"  (an  earlier  parallel  to 
"burke,"  <* lynch,"  and  "boycott"),  which  latter  now 
only  recalls  the  patriot  statesmen,  John  and  ComeUus  De 
Witt,  who  were  murdered  by  a  mob  in  1672. 

Dr.  Murray,  it  may  ju^t  be  mentioned,  gives  his 
approval  to  the  use  of  the  word  "Diagnose,"  which  he 
eompares  with  the  words  "  Anastomose  "  and  *'  Metamor- 
phoae,"  coming  to  us  immediately  from  the  French  verbs 
m  oser,  from  a  substantive  in  o««. 

With  the  section  is  published   the  fifteenth   list   of 
special  quotations  wanted  for  some  200  words,  beginning 
with  the  letter  "D." 
It  is  requested  that  every  quotation  should  be  furnished 

(a>  *'  iMtoret  on  IMaeases  of  the  8i»liial  Ooid."  Br  Dr.  FieiM 
UwAb,  I>epato[  Profeawr  of  the  Facility  of  Medlohie  of  Parli,  Pbyil- 


JtUn  of  the  fioepltali.  OontainlDg  244 
Hontagae  Lubboek,  M .D.,  F.R.C.FjLon<L 
hamSoeleiy.    1896. 

(6)  ••  The  Osford  Boi^fsh  Diotionazy." 
Iliufay  Oiford ;  At  the  Clarendon  Fren. 


woodouta.    ITaoalated  by 
London :  The  Kew  Syden* 

Edited  by  Dr.  Jamei  A.H. 
1S90. 


The  Sanitas  Company. 
This  Companv  still  goes  on  the  e^n  tenour  of  its  way 
of  progress,  and  last  week  declared  a  dividend  of  13|  per 
cent.  From  the  published  statement  to  hand,  and  from 
accounts  through  other  sources,  we  learn  that  the  popu- 
larity of  these  disinfectants  has  been  unprecedented  the 
last  few  years,  and  that  the  medical  profession  has  showii 
a  marked  preference  for  "Sanitas^'  in  various  wa^s, 
notably  by  an  increasing  number  of  its  membera  becoming 
shareholders. 

Old-Age  Pensions. 

THsDirectore  of  the  Prudential  Assurance  Company  have 
endeavoured  to  grasp,  and  to  all  appearances  successfully, 
the  question  of  provision  for  old  age  in  the  shape  of  pensions. 
From  the  Annual  Report  to  hand,  an  abstract  of  which 
will  be  found  in  our  advertisement  columns,  we  find  that) 
the  special  tables,  which  combine  life  assurance  with  old 
age  pensions  and  which  were  only  issued  in  September 
last,  have  produced  the  remarkable  result  after  three 
months'  working  of  167,791  policies,  producingan  annual 
premium  income  to  the  society  of  £62,074.  We  cannot 
help  thinking  that  if  this  class  of  insurance  were  generally 
taken  up  by  membera  of  the  medical  profession  there 
would  be  less  necessity  for  those  appeals  for  help  which  so 
frequency  appear  in  the  columns  of  our  medical  journals. 
Medico-Psychological  Association. 

NoTiCB  is  given  that  the  next  examination  for  the  certi- 
ficates in  nursing  and  attending  upon  the  insane,  of  this 
associatioD,  will  oe  held  on  Monday,  May  4th.  Candidates 
should  obtain  from  the  Registrar,  Dr.  Spence,  Burntwood 
Asylum  (near  Lichfield),  a  schedule  to  be  filled  up,  signed, 
ana  returned  to  him  at  least  four  weeks  before  the  date 
of  the  examination. 

Medicine  firom  an  Oil-Shop. 

At  a  coroner's  inquest  last  week  at  Hammersmith  on 
the  body  of  Henry  tJames  Merry,  aged  10  weeks,  the  son 
of  a  Uundryman,  the  mother  said  she  gave  the  child  a 
dose  of  cough  mixture  which  she  obtained  from  an  oil- 
shop.  The  Coroner  :  What !  go  to  an  oil-shop  for  cough 
mixture  ?  "  The  man  said  it  luid  done  his  chilaren  { 
<*  What  was  it  called ?"  «  The  bottle  is  labelled  ' 
Byrup.'"  The  Coroner :  You  trust  the  life  of  your  < 
in  the  hands  of  an  oilman  !  Witness  said  the  medicine 
did  the  child  good.  She  ffave  it  several  doses,  but  it  did 
not  sleep  afterwards.  Thelife  was  insured  only  five  weeks. 
Dr.  Waddle  said  death  was  due  to  convulsioiis  from  im- 
proper feeding.  The  cough  mixture  was  not  injurious, 
containing  oi3y  aniseed  and  syrup.  The  Coroner :  Is  it 
your  experience  that  people  go  to  oil-ehops  for  medidne  ? 
Witness :  Yes.  The  jury  retuned  a  verdict  in  accordance 
wit^  the  medical  evidence. 


282     The  Midioal  Trehs 


NOTICES  TO  CORRESPONDENTS. 


Mar.  11»  1896 


^otirts  to 
(lorrcsponbcnts,  ^hort  %ttUxB,  ice 

K^  CoBSiSPOSDBim  reqnlrliig  m  r^ply  In  this  oolmnn  sn  par- 
tlcttlarly  reqaeited  to  make  hm  of  m  dutifieHve  tignatwre  or  lulitab, 
and  mvold  the  practice  of  liipiliis  themaelTea  "  Header/'  **  BubMriber," 
'* Old BalMcrlber,"  Ac.  Much  oonfnaloii  will  be  ipamd  bj  aMenttoii 
tothiarale. 

ACGBPTBD  PAPERS  AND  LBCTCTRES. 
Thi  foIlowlDg  are  hereby  acknowledged  with  thanki :  - 
Abdominal  Surgery  with  liotes  of  Caies,  by  Bnthecford  Moriftm, 

%r  n       U*   R  C  8 

The  Objecte  and  limits  of  Operations  for  Cancer.  Abstract  of 
Second  Lettsomian  Lec^nw,  by  Watson  Cheyne.  F.R.C.S.,  F.R.8. 

The  Dlagnoals  of  Tnberonlosls  by  Small  J)oaes  of  Tnberealf  n,  by 
Professors  Grasset  and  Vedel  (from  onr  Paris  oonrespondaotX 

Post-Oraduate  Clinical  Demonstrations  on  Diseases  of  the  Skin,  by 
Jonathan  Hutchinson,  F.B^C.S.,  F.B.8. 

The  Treatment  of  Prostatic  Hypertrophy  by  Castration.  (Vienna 
Clinical  Lecture).    By  Prof.  J.  Bnglisch. 

Tubercolar  Diseases  of  the  fllHoint.  by  R.  L.  Swan,  F.R.C.S.I. 

Iritis :  Its  Patholosy  and  Treatment,  by  H«nnr  Juler,  F.R  C.8. 

Episcleritis  Periodica  Fngax,  by  Sydney  Stephensop,  M.B.,  F.B.C8. 

A  llew  Anastomotic  Button  for  Intestinal  Operations  (iUustrated), 
by  Dr.  Chaput  (from  our  French  correepondent). 

ME  A.  MlALBr.-If  the  fscts  are  as  yon  state  the  appointment 
would  appear  to  be  "  a  job  "  put  up  at  the  expense  of  another  who 
haaa  riidit  to  some  consideration.  As,  however,  we  have  no  know, 
ledoe  at  the  circamstances,  and  the  case  U  hardly  one  that  comea 
wltGn  our  proYlnoe,  we  must  decline  to  express  a  definite  opinion. 
Rb  XAUHEIM  TRBATMBNT. 
To  the  Editor  of  Thb  Midioal  Pkbh  ahd  Cibculab. 

gTB  -With  reference  to  the  note  in  the  Medio al  Pbbss  and  Cir- 
CULAB,  of  the  4th  March,  regardmg  the  Nanheim  Treatment  at  Bath, 
permit  mejurtto  mention  that  the  Nanheim  (or  carbooated  brine) 
behave  been  in  use  at  this  establishment  for  the  past  twelve 

months.  I  am.  Sir,  yours  truly. 

M.  ALTDOBFBB.   M.D., 
Besident  Physician  at  St  Anne*s  9U1  Hydropathic. 

Mkd  B  -There  Is  a  popular  superstition  that  one  nostril  is  ma«nly 
used  for  day  (aoUr)  breathing,  and  Uie  other  Jpr  night  (lunar)  respira. 
tlSi  but  data  are  wanttng  bearins  thereon.  Bfainologists  of  eminence 
foreunanimoualy  silent  on  this  point,  and  it  U  nowhere  mentioned  in 
Taxt-books  of  Phyidology. 

DIUXH  OF  A  CBHTBHARIAU  PiLL  DoCTOB.-  A  ^«ath  of  interest  to 
the  DTofeasion  took  place  on  the  tod  lost,  ia  the  Bri^port  Work- 
house A  man  who  went  by  the  name  of  "  Doctor  Gilbert,  and  who 
was  weU-known  in  that  district  in  the  Ume  of  our  progenitors,  as  a 
traTellinff  ^'pOl  doctor  '  and  herbalist,  was  seised  with  apoplexy  st 
^  ripe  ige  of  10#.  When  engaged  in  his  practlw,  which  w«s  lane 
end  lucrattve,  he  travelled  altogether  on  foot,  and  performed  prodl. 

D^  Sutton  (Leeds).— The  principle  of  the  treatment  of  the  medical 
attendantof  Prince  Bismarck  (Dr.  Zwlnigen)  in  cases  of  obesity,  is 
rimply  to  insist  upon  all  kinds  of  Uqnid  being  excluded  from  patients' 
meals. 


4Aeettng0  of  the  Societies 

WBDHB8DAT,  MABOH  llTH. 
HOKTIBIAII  S00IBTT.-8  p.m.  Pathological  Evening.  Dr.  OloTer 
LFon  !  1.  Aneurysm  of  Aorta.  2.  Foetus  one  inch  Iom.  D'.  A^Chap- 
Ita :  A  Hearts  with  Congenital  Disease  of  Its  ValTCS.  rfr.  H.  ff.  Tubby : 
BpedmeBB  of  Scurvy  Rickets.  Dr.  J.  H.  Seqnetra :  lotra-abdomlnal 
Suid  of  Unusual  Length,  and  Normal  Organs  Hardened  In  situ  by 
SjwUons  of  F^atlSr  Dr.  F.  J.  Smith :  Epithelioma  of  BpiglottU. 
Snedmens :  Mr.  Targett. 

OUTH-WIOT  LONDOB  Mbdioal  SodlTY  (SUnley's,  236,  Lavender 
1).-8.S0.  p.m.    Mr.  Biggs :  Puerperal  rever  (so-called)  with  Cases. 

TBUBSDAT,  MABOH  12TB. 
BBITISH  Otb  JBOOLOOICAL  SociBTT  (20  flsnovtr  Square,  W.X— Speci- 
mens •  -Dr.  Pnrcell :  Three  Uteri  removed  per  vaginam  for  Malignant 
DlMase      rr.  Schacht :  Unsuccessful    Tubal  Gestation  containing 
Tffitna  '  A  Discussion  on  "  Ventro-flxatlon,  ventro-iuspension,  and 


Hffl).- 


contslnlng 

^^ ension,  and 

AjSed'OiSrations  wfth  their  Results  "wmbe  totroduoedby  Mr.  Mayo 

^OPHTHALMOUOIOAL  SOOMTY  OF  THB  UHITBD  KIHQDOX  01,  Chau- 

doi  Street.  Cavendish  Square,  W.)-8  p.m.  Card  Specimens :  Mr.  B. 
Stephenson  :  Unusual  Arrangement  of  Retinal  Ve«je^  Mr.  W.  O. 
Lm  *  Case  of  Betloltls  Clrcjiata.  Mr.  E.  aarke :  Specimens  of  De- 
tachm'ent  of  the  Retina,  snd  Sarcoma  of  the  Choroid*  Mr.  Doyne : 
iPeculIar  Condition  of  Retina.  2.  Oislilcatlon  of  Choroid,  &c. 
8  SO  n  m  Papers,  Mr.  K.  Scott  .•  Keratitis  occurring  in  Leprosy.  Dr. 
OrmSrodandMr.  H.  Splcer;  Recurrent  Paralysis  of  Th«i;d  Nerve  in 
Micraine.  Mr.  Rocklufe :  1.  Case  of  Lenoo-sarooma  of  Choroid.  2. 
oJarsct  Extraction  and  Gout.  Mr.  R.  L.  Knsggs :  Recurrent  Reflex 
Amblyopia  due  to  Pregnancy. 


The  Diagnosis  and  Treatment  of  Septic  Peritonitis  (illustrated  by  the 
Lantern). 

Fbidat,  Maboh  19th. 

CLINICAL  SOCIBTT  OF  L0NDO».-Mr.  G.  Bird :    A  Case  of  Lymph 

PcrotmnandlmphVarix.    I>Ji  Coleman  and  Mr.  Ballance:  A  Osae 

of  Subcortical  tumour  of  the^Brato  treated  by  Operjtioii.    DrJJ.  L. 

Benham :  A  Case  of  BeBmorrhage  Into  the  Pons  Varolii ;  Venesection  ; 


Recovery.    Dr.  F.  J.  Smith  and  Mr.  BidweU :  A  Case  of  Tubercular 
Kidney. 

TBUBSDAT,  MABOH  19TH. 
Habvrtan  Sooibtt  (Stafford  Rooms,  Tltchbome  Strset,  Bdgware- 
Road,  W.X-8.90  p.m.    Paper  by  l>r.  Bowles,  *«  Nanheim  and  tbe- 
SihoU  Treatment  of  Diseases  of  the  Heart.** 


BiiaUA  General  HospltaL—House  Surgeon.  —Salary  £120  per  annum. 

with  board,  residence,  'tc.    Applications  to  the  8ecret%'7  on  or 

before  March  18th. 
Chelsea  Hospital  for  Women,  Fulbam  Road,  8.  W.^  Resident  Medical 

OfBoer.    Salaiy  £00  per  annum,  with  board,  lodging,  and  waahlng. 

Applications  and  teatlmonlals  to  the  Secretary  on  or  before  Marob 

Cornwall  County  Lunatfc  Asylum,  Bodmin.— Junior  Assistant  Medical 
oncer.  Salary  £100  a  year,  Increasing  £10  yearly  to  £180,  with 
.....       .  "mstother  '■    ■-  -     -    - 


board,  lodgl  g,  Ac.    Applications  i 
at  the  Asylum,  on  or  before  March  19th. 


Medical  Superintendent 


North  Shields  and  Tynemouth  Dispensary. -Non-ReaidentHouae  Sur- 
geon and  Dispenser.  Salary  £140  per  annum.  Full  information 
from  the  Hon.  Sec.  09,  Howard  Street.  North  Shields,  to  whom 
mllcatioiiB  and  testimonials  must  be  forwarded  by  the  18th 

The  General  Infirmary  at  Leeds.  *  Resident  Sutsical  OlBoer.  Salary 
£100  per  annum,  with  board,  residence,  and  washing.  Applica* 
tlons,  with  testttnonUls.  to  be  sent  in  not  htter  than  the  20th 
l«ist..  addressed  to  the  Secretary  of  the  Faculty. 

West  Sussex  Asylum.  -  Medical  Superintendent.  Salary  £460  a  year, 
with  unfnn<ished  house,  Ught.  wsshlng,  coals,  Ae.  Applloaaons 
and  teatlmonlals  to  the  (ferk  to  the  Committee  on  or  before 
March  26th. 


S^ppoxntmtntM 


BLAKB,  W.  H.,  L.R.C.P.  Lood ,  M.R.C.S.,  Medical  Officer  for  the 
Eighth  Sanitary  District  of  the  Bromley  Union.  ~«    «tK 

Clabkb,  J.  M..  M.D.  Cantb.,M.R.C.P.,  Profeaaor  of  Pathology  and 
Morbid  Anatomy  at  the  University  College,  BrlstoL 

Cook.  J.  W.,  M.D.  Aberd..  M.R.C.S.,  Medical  Officer  of  Health  b/the 
Wniton-oo-thc-Nase  Urban  District  CoundL 

DAVIB8.  Lbwis,  O  ,  B.A.,  M.B.,  B.C.  Cantab.,  Resident  Medical  Officer 
at  the  Carolff  Union. 

EAdTB,  O.  Lbslib,  M.B.,  B.SC  Lond.,  U.R.C.S.,  L.R.C.P.  Lond., 
House  Surgeon  to  the  Royal  Hospital,  Hheffield. 

Bdobwobth,  F.  H.,  M.B.,  B.6.  Camb..  Lecturer  on  Prastical  Physio- 
logy and  Hlatolooy  at  the  University  Collega,  Bristol. 

FIBTB,  J.  L.,  M.I).,  Lond.,  F.R.C.S.,  L.R.C.P.,  M.S.,  B.S.,  AasUtant 
Surgeon  to  the  Bristol  General  Hospital. 

FISHSB,  T  ,  M.D.  Lond..  M.RC.S..  Out-patient  Physician  to  the  Bristol 
Uoapltal  for  Women  and  Children. 

Hbbbt  ,GoRDOH,  O.W..  L.R.C.P.  Lond.,  M.R.C.S.,  Medical  Officer  of 
Health  f.  r  the  Williton  Rural  Sanitary  Discrict. 

HncBlflS,  T.H.,  M.R.C.S.,  Medical  Officer  of  Health  for  Brailes,  Chip- 
ping Camden,  and  Shlpston-on-Stour,  by  the  Rural  District 
Councils. 

JONBS.  Ei)WABD,  M.R.C.S.,  L.R.C.P.,  House  Surgeon  to  the  Chichester 
Infirmary. 

JTONBS,  H.  T.,  L  R.C  P.  Lond .  M.R.C.S.,  Medical  OiBcf  r  for  the  Work- 
house of  the  Pembroke  Union. 

Kbndall,  Gbo.,  L.R.C.P.  Lond.,  M.R.C.S  ,  Out-patient  Surgeon  tithe 
Bristol  Hospital  for  Women  and  Children. 

LANflDOWB,  Bobbbt  6.  Pi  OLB,  M.D.,  M.R.C.&,  LR.C.P.  Suifeon  to 
the  Bristol  (general  Hospital. 

MOBTON.  C.%  ,  F.R.C  S  ^.R.C.P.  Lond.,  Out-patient  Surgeon  to  the 
Bristol  BoqKltalfor  women  and  Children. 

Pbhbt,  W.  J.,  F.R.C.S.,  L.R  C.P.  Lond.,  Consulting  Surgeon  to  the 
Bristol  General  Hospital. 

SWATiTB.  Waltbr  C,  MB.  Loud..  L.E.C.P..  M.R.C.S.,  Lecturer  oo 
Pivotical  Midwifery  at  the  University  College,  Bristol 

TowBBBD,  J.B.,  LR.C  P.  Bdin.,  Medio d  Oilcer  to  the  Strathraore 
Hospital  Christchureh,  New  ZeaUnd. 

Tbbhabhb,  J.  LLBwBLLTjf,  M.R.C.S.,  L.S.A.,  Medical  OSc  sr  at  the 
Cardiff  Prison. 

ftribs. 

DOBDB  —March  1st,  at  St.  John  Street,  Chester,  the  wife  of  Herbert 

Dobie,  M.D.  Edin.,  of  a  son. 
DOVB.— March  8rd,  at    StanwlsE,  Carlisle,  the  wife  of  R.  AtUnsoa 

Dove,  M.a,  UR.C  S.  Edin.,  Brigg,  Llncnlnshlra,  of  a  daughter. 
BoCLts.— Feb.  29th,  at  Harley  Street,  London.  W.,  the  wife  of  W. 

McAdam  Eoeles,  M.S..  F.R.C.S.,  of  a  son. 
WATKI^s.— March  0th,  at  Boecombe,  Boumem  >uth,  th^  wife  of  Walter 

Watklns,  M.R.C.S.,  of  a  son. 


9eath0« 


ADAMS.— March  4th.  at  Eastbourne.  Lewis  Samuel  Adams,  aged  2S, 
fourth  son  of  Dr.  James  Adams,  Springwell,  Barnes. 

ABDBB80H.-Feb.  84th,  at  68,  Talbot  Road,  Bayswatar,  W.,  of  acute 
pleuro-pnenmonia,  A.  F.  Aaderaon,  M J).,  formerly  Ooionlal  Sur- 
geon, Straits  Settlements. 

AKDBBSOB.-Feb  29th,  at  South  Tay  Street,  Dundee,  Alex.  M.  Ander- 
son, M.D.  Olasg.,  late  Medical  Officer  of  Health  for  the  City  of 
Dmidee,  aged  62. 

BABKBB. -March  6,  at  90.  BeanUeu  VUlas,  Finsbary  Park.  N.,  Lydia, 
wife  of  Alfred  Jas.Baiker.M.D.,  aged  66.  «    ^.    ^ 

ROBBBTS.— Feb.  29th,   at  Redcliffe  Square,  London,  S.W.,  Hubert 
WiUlam  Bob«tts,  M.R.C.S. 
NOTICE— AnnouncementM  of  Birttut,  Marrioffet,  and  Deaths  in  CM 

/mmUiM  of  Subwribert  to  this  Journal  ar*  iMnrted  freCf  and  mmt 
ncch  thB  ]^bKdt^tn  not  lot*  r  than  the  Monday  preceding  pubiieaHan 


Wit  ^diai  §m$  mA  €itmkt 


''SALUS    FOPXTLI    SUPREMA    LBX." 


Vol.  CXIL 


WEDNESDAY,    MARCH    18,     1896. 


No.  12 


EPISCLERITIS    PERIODICA  FUGAX. 

By  SYDNEY  STEPHENSON,  M.B.,  F.R.C.S.E., 

flmveoD  feothe  Ophthalmic  School,  Han  well,  W. ;  Ophthalmic  Smgeon 
to  the  NortLEastern  Hoapital  for  Chadrm,  Rhoreditdi,  n.b. 


Pbofessob  Fuchs  has  recently  described  ander  this 
title  (British  Medical  Journal,  October  19tb,  1895)  a 
malady  that  must  be  familiar  to  most  ophthalmic 
enrgeoDs.  It  is  characterised  by  ibflammatioQ  affecting 
-chiefly  the  conjanctiva  of  the  eyeball  and  the  under- 
lying episcleral  tissue.  As  implied  by  the  name,  it  is 
of  a  fleeting  nature,  and  individual  attacks  last  from 
twenty-four  hours  to  eight  days.  It  may  affect  one  or 
both  eyes,  is  exceedingly  prone  to  recur,  and  may  per- 
sist for  years.  In  some  of  Fuchs'  cases  severe  photo- 
phobia and  lacrymation  were  present,  but  in  others 
those  symptoms  were  almost  or  altogether  absent.  A 
degree  of  pain  was  commonly  complained  of,  more 
especiaUy  when  the  eye  was  movea  or  the  patient 
attempted  to.  accommodate.  Spasm  of  the  ciliary 
muscle  and  contraction  of  the  pupil  were  noted  more 
than  once.  As  to  etiology,  Fuchs  believes  that  in 
consequence  of  some  abnormality  of  nutrition,  the 
6ystem  becomes  loaded  with  noxious  substances, 
capable  of  setting  up  inflammation.  According  to  his 
views,  the  exciting  cause  of  an  attack  frequently  lies 
in  some  external  condition,  such  as  change  of  tempera- 
ture. He  has  met  with  the  ailment "  most  frequently 
in  men  of  middle  age,  less  often  in  women." 

The  object  of  the  present  clinical  communication  is 
to  point  out  that  episcleritis  periodica  fuflax  is  bv  no 
means  unknown  in  children,  amongst  whom  I  have 
seen  not  a  few  examples.  Details  may  be  given  of 
some  of  the  more  characteristic  cases  that  have  fallen 
cinder  my  notice.  The  record  is  particularly  instructive, 
since  most  of  my  patients  remained  under  observation 
for  a  considerable  length  of  time. 

Cask  1.— Matilda  R,  a  well-grown  child,  set.  11. 
June  25th,  1889— «  red  patch  made  its  appearance  in 
the  inferior  nasal  quadrant  of  the  left  eye,  involving 
both  the  conjunctival  and  the  episcleral  vessela.  Four 
days  later  every  trace  of  it  had  vanished.  October 
11th— a  similar  condition  was  observed.  The  redness 
subsided  in  four  days.  April  23rd,  1890— another 
patch  noticed  in  the  left  ejre.  This  lasted  for  seven 
<lays.  The  next  attack  of  episcleritis  came  on  about  a 
month  later,  and  passed  away  in  about  seven  days. 
June  6th— the  malady  recurred,  and  did  not  completely 
subside  until  the  16th  of  the  same  month.  November 
13th— inferior  nasal  quadrant  of  Uie  left  eve  again  red 
and  tender.  Next  day  one  drachm  of  the  liquor  h^dr. 
perchloridi  ordered  to  be  taken  twice  a  day.  Notwith* 
standing  this  the  inflammation  recurred  on  December 
find,  and  lasted  until  the  16th  of  that  month.  To  sum 
up  the  facts  :  thisnrl  was  under  observation  for  about 
•eighteen  months,  during  which  time  she  had  upon 
seven  separate  occasions  episderitlB  of  the  inferior 
nasal  quadrant  of  the  left  eye.  The  attacks  lasted 
irom  four  to  ten  days. 

Cask  2.— Florence  H.,  set  9.  When  she  came  under 
notice  on  June  26th,  1889,  the  whole  of  the  conjunctiva 
•of  the  right  eye  was  found  to  be  inflamed.    A  boric 


acid  lotion  was  prescribed,  and  two  days  later  not  a 
trace  of  redness  remained.  A  similar  state  of  things 
was  observed  upon  December  9th,  the  inflammation 
subsiding  in  two  days.  Upon  the  16th  of  the  same 
month  the  right  eye  was  agam  inflamed,  but  the  whole 
of  the  redness  had  disappeared  by  the  following  day. 
From  June  2nd  to  June  4th,  1890,  the  upper  and  lower 
cul-de-sac  of  the  left  eye  were  congested  and  slightly 
thickened.  No  further  attacks  occurred  until  October 
18th,  1892,  when  episcleritis  was  found  to  be  present 
about  each  external  oanthus.  The  affected  parts  were 
somewhat  tender.  Three  days  later  the  eyes  were  well. 
On  November  8th  a  patch  of  episcleritis  was  found  on 
the  outer  hemisphere  of  the  right  eye.  The  inflamed 
area  v^as  tender.  Some  trifling  photophobia  was 
observed.  A  solution  of  atropine  sulphate  (one  per 
cent)  was  applied  to  the  eye  thrice  a  day,  and  all 
redness  had  subsided  by  the  eleventh  of  the  month. 
But  on  the  22nd  the  trouble  had  recurred  upon  the 
outer  side  of  the  right  eye.  Accordingly,  five  minims 
of  a  1  to  5,000  solution  of  corrosive  sublimate  were 
injected  into  the  patch,  and  the  atropine  was  continued. 
The  epiJBcleritis  had  disappeared  by  the  29th  instant, 
but  a  small  eccbymosis  was  still  to  be  seen  at  the  site 
of  the  needle  puncture.  There  was  no  attack  for 
nearly  two  years.  Upon  November  13, 1894.  however, 
the  upper  temporal  quadrant  of  the  ri^ht  eye  became  in- 
flamed, and  next  da^  the  left  eye  was  similarly  involved. 
The  duration  of  this  bilateral  attack,  unfortunately, 
was  not  recorded.    The  patient  was  lost  sight  of  about 

two  months  later.    Florence  H ,  then,  had  eight 

bouts  of  episcleritis  during  the  five  and  a  half  years  she 
remained  under  observation.  Their  duration  ranged 
from  twenty-four  hours  to  seven  days. 

Cask  3.— Mary  C— ,  was  12,  years  of  ase  when 
she  first  came  under  notice,  on  August  28th,  1^89. 
The  lower  half  of  her  left  e^e  was  then  of  a 
dark  red  colour,  due  to  distension  of  the  conjunc- 
tival and  episcleral  vessels  ;  the  conjunctiva  of  her 
lower  lid  was  also  congested,  and  a  flake  of  mucus 
was  present  upon  its  surface.  The  pupil  was  some- 
what contracted,  the  eye  watered  freely,  and  was  pain- 
ful. Although  these  symptoms  haa  vanished  by 
September  2nd,  they  recurred  two  days  later,  and  did 
not  entirely  disappear  until  the  end  of  that  month. 
From  May  18th  to  May  22nd,  1890,  the  left  eye  was 
again  affected  in  a  similar  way.  Four  days  later  the 
condition  recurred,  so  a  strip  of  conjunctiva  and  sub- 
coniunctival  tissue  was  removed  from  around  the  lower 
half  of  the  cornea.  Despite  this  operation  the  parts 
about  the  cicatrix  became  inflamed  up9n  June  9th. 
On  September  9th  another  attack  of  episcleritis  was 
observed  in  the  lower  part  of  the  left  eye ;  the  pupil 
was  small,  lacrymation  and  photophobia  were  present 
and  the  tissues  were  tender.  These  symptoms  lasted 
for  about  three  davs.  Upon  October  4th  a  drachm  of 
liquor  hydr.  perchlor.  was  ordered  twice  a  day.  On 
November  8tn  the  affection  recurred,  and  so  the  dose  of 
mercury  was  doubled.  This  attack  persisted  for  nine 
days.  On  November  21st,  episcleritis  was  found  to  be 
present  about  the  inner  cantnus  of  the  right  eye,  and  for 
the  next  month  the  eyes  were  altematelv  involved  by 
that  affection.  During  the  whole  of  this  ^  time  the 
internal  administration  of  mercury  was  continued,  and 
calomel  was  flicked  into  the  eyes  daily.  On  March  Isf- 


284    Ths  Ms  >ioal  Pbisb. 


uxilGINAL  COMMUNICATIONS. 


Mab.  18,  180e» 


1891,  episcleritiB  was  noticed  in  the  lower  hemisphere 
of  the  left  eye.  A  1  per  cent  aolatioD  of  atropine  was 
dropped  into  the  ^ye  twice  a  day,  hot  fbmentationB 
were  nsed,  and  a  shade  was  men.  The  left  eye  had 
become  pale  and  quiescent  by  March  6th.  On  the  17th 
of  the  same  month,  however,  the  condition  was  again 
nresent  It  was  noted  that  the  bowels  had  been  con- 
nned  lately,  and  that  the  tongae  was  coated  mth  a 
yellow  far.  The  atropine  was  continued,  the  mercury 
stopped,  and  a  mixture  containing  aconite,  colchicum, 
ana  quinine  administered.    Five  days  later  the  right 

Se  beoune  afiEected,  redness  being^  most  marked  about 
e  inner  canthus  and  the  superior  hemisphere.  On 
the  27th  instant  both  eyes  were  well.  A  leaden- 
coloured  patchy  presumablyof  thinning,  was  then  noticed 
for  the  first  time  in  the  lower  hemisphere  of  the  left 
eye.  Upon  April  3rd,  a  small,  peculiar-looking  eleva- 
tion, somewhat  like  a  phlyctenule,  was  seen  upon  the 
lower  marffin  of  the  left  cornea.  After  becoming 
larfjfer  and  losing  its  epithelial  coating,  it  began  to  eat, 
as  It  were,  into  the  sclero-oorneal  margin.  It  was 
deemed  advisable,  therefore,  to  scrape  it  with  a  small 
sharp  spoon,  and  then  to  dust  it  with  iodoform.  It 
had  healed  by  the  28th  of  AprO.  On  the  23rd  of  that 
month  both  the  colchicum  mixture  and  the  atropine 
drops  were  discontinued ;  yellow  ointment  was 
directed  to  be  used  to  the  eyes  twice  a  day.  On  April 
28th  the  disease  recurred  in  the  inferior  hemisphere  of 
the  left  eye.  Atropine  was  again  ordered.  From 
May  28th  to  May  29th,  and  from  July  20th  to  July  23rd, 
the  left  eye  was  inflamed.  Another  attack  came  on 
upon  November  18th2  when  salicylate  of  sodium,  in 
ten  grain  doses,  was  given  twice  a  day.  The  eye  was 
free  from  redness  by  the  21st  instant  The  salicylate 
was  discontinued  on  December  9tlL  Another  attack 
was  observed  in  the  left  eye  upon  March  22Dd,  1892, 
and  this  lasted  for  nine  days.  The  patient  was  lost 
sight  of  shortly  after  this  note  was  nukde. 

Cask  4.— Beatrice  W.,  aet  9.  The  superior  nasal 
quadrant  of  the  right  eye  became  inflamed  upon 
January  14th,  1890,  and  the  redness  persisted  for  five 
days.  Another  attack  came  on  about  a  year  later 
(January  13th,  1891),  when  there  was  congestion  of 
the  upper  half  of  each  globe.  Upon  this  occasion  the 
condition  lasted  for  three  days.  From  April  2nd  to 
April  6th  the  upper  part  of  the  ri^ht  globe  was  red, 
and  the  patient  complained  of  local  smarting.  From 
June  10th  to  June  13th  the  superior  nasal  quadrant  of 
the  right  eye  was  similarly  a£f(Bcted.  On  October  30th, 
the  conjunctiva,  both  of  the  lids  and  globe,  was  injected, 
so  that  the  case  was  at  first  taken  for  one  of  catarrhal 
ophthalmia.  Secretion,  however,  was  almost  absent, 
and  no  organisms  coula  be  found  in  cover-glass  pre- 
parations made  from  what  little  discharge  there  was. 
Upon  the  next  day  the  second  eye  was  affected.  Both 
had  recovered  by  November  2Dd.  She  passed  from 
under  notice  on  February  6th,  1892.  To  recapitulate  : 
this  child  remained  under  observation  for  upwards  of 
two  years,  and  during  that  time  she  had  five  attacks  of 
episcleritis,  which  affected  the  right  eye  on  three 
occasions  and  both  eyes  twice. 

Case  5.— Eliza  W.,  set.  14,  was  first  seen  on 
July  9th,  1891,  when  the  inferior  temporal  quadrant 
of  the  left  eye  was  inflamed,  and  four  white  and  well- 
formed  phlyctenulae  were  scattered  over  the  congested 
area.  The  eye  was  well  by  July  17th.  There  was  no 
recurrence  until  October  3rd,  when  the  left  eye  again 
became  io flamed.  There  was  marked  redness  in  its 
inferior  temporal  quadrant  and  around  the  cornea ; 
three  typical  phlyctenules  were  noted  ;  the  congested 
patch  was  tender  ;  the  eye  was  painful  on  movement 
Ten  days  later  all  the  foregoing  signs  had  vanished. 
On  the  31st  of  the  same  month  another  tender  patch 
had  appeared  in  the  same  place.  The  eye  was  well  on 
November  9th,  but  meanwhile  the  riffht  eye  had  become 
red  in  a  corresponding  position.  Efyins  blisters  were 
ordered  to  be  applied  to  the  right  temple,  and  on  the 


17th  inst,  the  left  eye  having  relapsed,  they  were  used 
to  both  temples.  Two  days'  later  both  eyes  wero 
improving  ;  the  blisters  were  discontinued,  and 
ten  ptASks  of  salicylate  of  soda  pven  thrice  daily* 
Despite  this  treatment,  another  inflamed  area  was 
found  about  the  inner  canthus  of  the  rifht 
^e  on  December  16th.  On  the  following  day- 
the  affected  parts  were  lightly  pencilled  witL 
a  crayon  of  mitigated  lunar  caustic,  and  the 
congestion  had  disappeared  by  December  21st* 
The  salicylate  was  continued,  and  half-a-drachm  of 
mercurial  ointment  directed  to  be  rubbed  into  the  skin 
night  and  momins.  On  the  last  day  of  December^ 
however,  the  outer  hemisphere  of  the  left  eye  was  found 
to  be  affected  with  epiacleritis.  Bun  was  present,, 
and  so  atropine  and  hot  fomentations  were  prescribed.. 
The  redness  had  ^ne  by  January  23rd,  1892.  Hie 
salicylate  was  continued  until  March  28th|  when  it  was- 
stopped,  but  the  mercurial  inunctions  were  persevered 
with.  From  May  I4th  to  May  16th,  the  lett  eye  had 
an  episcleritic  patch  upon  its  outer  side.  The  patient 
passed  from  under  observation  on  May  23rd,  1892. 

Cask  6.— Emily  U.,  set  10,  was  brought  to  me  oik 
June  5th,  1895,  with  her  left  eye  inflamed.  The  lower 
half  of  the  eyeball,  including  the  caruncle,  was  of  a 
violet  hue,  the  tissues  being  slightly  swollen.  Trifling 
photophobia  and  lacrymation  were  present  The  eye 
was  well  in  four  days.  From  December  7th  to  December 
lOtb,  the  caruncle  of  the  same  eye  was  inflamed.  Oik 
the  following  day.  that  eye  relapsed  ;  the  outer  half  of 
the  globe  was  slightly  oedematous,  and  veined  by 
enlarged  conjunctival  vessels.  The  parts  were  tender^ 
and  the  child  complained  of  pain  on  moving  the  eye. 
There  was  no  discharge.  The  pupil  was  not  contracted^ 
but  slight  spasm  of  the  ciliary  muscle  was  found.  These 
appearances  lasted  for  three  days.  The  patient  who  is 
still  under  observation,  has  had  no  further  attack. 

Eemark$.^A\thoQgh  episcleritis  periodica  fugax  is- 
not  usually  a  serious  ailment,  yet  its  tendency  to  recur 
gives  it  an  importance  wmch  it  would  otherwise 
scarcely  merit.  It  is  somewhat  singular  that  (with  one- 
doubtful  exception)  I  have  not  so  far  met  with  it  in  a. 
male  child.  This  fact  is  more  suggestive  seeing  that 
more  boys  than  girls,  come  under  my  notice.  Special 
inquiry  was  made  in  every  case  as  to  the  dependence 
of  the  affection  upon  disorders  of  menstruation,  but 
without  any  very  definite  result  I  have  never  seen- 
this  form  of  episcleritis  occur  in  association  with 
rheumatism  or  gout,  nor  have  I  been  able  to  obtaiir 
any  family  history  of  those  diseases.  Two-thirds  of  my 
patients  were  strumous,  as  shown  by  the  existence  of 
markedly  enlarged  glands  or  by  a  liability  to  relapsing 
pustular  affections  of  the  skin.  There  seemed  in  these 
cases  to  be  some  connection  between  the  episcleritis 
and  ordinary  phlyctenular  inflammation  of  the  con- 
junctiva, inasmuch  as  the  two  conditions  were  not 
infrequently  observed  to  alternate  in  the  same  patient. 
A  notable  number  of  the  children,  too,  showed  marginal 
opacities  of  the  cornea,  which  in  young  subjects  are 
certainly  most  frequently  due  to  phlyctenular  deposits. 
In  some  cases  the  eyes  were  found  to  get  inflamed 
whenever  the  bowels  were  costive  or  the  tongue  coated 
with  a  thick  yellowish  fur.  This  was  especially  notice* 

able  in  Mary  C .    The  attacks  appeared  to  me  to  be 

often  excited  by  some  slight  injury— for  example,  a  blow 
or  a  foreign  body  in  the  eye.  I  was  unable,  however,, 
to  trace  any  connection  with  atmospheric  conditions. 

Fain,  redness,  and  other  symptoms  are,  in  my  expe- 
rience, speedily  relieved  by  a  brisk  purge,  followed  by  the 
instillation  of  a  solution  of  the  sulphate  of  atropine  (2 
grs.  to  the  ounce).  Hot  fomentations,  also,  are  useful  in 
some  cases.  The  effect  of  these  remedies  is  enhanced  if 
the  eye  be  shaded,  and  the  patient  kept  from  work. 
With  the  idea  of  preventing  recurrences,  a  large  number 
of  agents  has  been  employe,  although,  it  must  be  con- 
fessed, without  any  great  measure  of  success.  Thus, 
mercury,  aconite,  colchicum,    quinine,  salicylate  or 


Uab.  18,  1806. 


ORIGINAL  COMMUNICATIOKS. 


The  MxDicAL  Pbbss.     285 


Bodinin.  yeUow  oiatment^  blisters,  the  local  use  of 
dJomel  and  nitrate  of  silver,  and  the  operation  of 
neritomy  have  been  tried,  and.  in  mw  hands,  have 
ndled.  I  cannot  help  thinking  from  what  I  have  seen 
of  these  cases  that  more  is  to  be  hoped  from  chanse  of 
Mr  than  from  any  treatment  either  by  drugs  or  by  local 
aralications  to  Uie  eyes. 

A  word  as  to  diagnosiB.  Episcleritis  periodica 
fngaz,  as  nointed  out  by  Fuchs^  may  be  confounded 
with  two  ciiseases,  namely,  ordinary  episcleritis,  and 
acute  catarrhal  ophthalmia.  From  the  first  it  is  dis- 
tinguished by  its  rapid  course,  comparatively  slight 
qrmptoms,  and  by  the  absence  of  any  distinct  inflam- 
matory nodules  in  the  sclera.  From  the  last  it  may 
be  differentiated  by  the  scantiness  or  absence  of  secre- 
tion, as  well  as  by  the  localised  character  of  the  inflam- 
mation. Acute  catarrhal  ophthalmia,  moreover,  is 
generally  bilateral,  whereas  this  form  of  episcleritis, 
as  a  rule,  attacks  one  eye  alone. 


AGARICINE  IN  PHTHISIS. 
By  GEORGE  FOY,  F.R.C.S., 

Hon.  Fellow  of  the  Southera  Sarvlcal  and  GynKCologloal  Anootation, 
V.S.A.    ^  aigeon  to  the  Whlttworth  Hoepltal.  DramoondA. 

ly  the  ''Formulaire  de  S^^ialites  Pharmaceu- 
tiques/'  for  1895,  the  authors  include  a  formula  for 
agaricine  pills ;  the  drug  having  recently  acquired 
reputation  as  an  antihydrotic  in  phthisis.  Agaricine 
pnncipfdly  consists  of  a£[aric  acid,  and  is  not  ad  alka- 
loid, as  its  discoverer,  Pribram,  thought.  The  acid  is 
obtained  from  the  white  agaric  Polyporus  Officinalis, 
Larch  Agaricus,  a  well-known  fungus,  which  has  long 
enjoyed  a  reputation  for  checking  the  night  sweats  of 
mumonary  disease.  The  fungus  is  described  by 
l>ioscoride9,  who  states  that  it  was  named  from  Agaria, 
in  SiMinatia.  To  avoid  the  unpleasant  taste  of  the 
powdered  agaricus,  Dr.  Toung  (Olaeg.  Med,  Jour.\  in 
1882,  introduced  affaricine. 

Possessed  of  well-marked  purgative  properties,  the 
fungus  was  a  favourite  with  Enslish  physicians  for 
centuries.  Elyot  {"  Castle  of  Health,"  1641)  prescribes. 
**one  dramme  of  Agaryke  and  half  a  dramme  of 
Rheubarbe."  Turner,  in  his  **  Herbal,"  1551,  enumera- 
ting the  virtues  of  the  Larch,  mentions  that  it  giveth 
OS  ^  Te  famous  medicine  called  Agarick." 

Gerard  pictures  the  varieties  of  mushrooms,  and 
distinguishes  between  the  edible  and  poisonous 
fungi : — 

''The  medow  mushrooms  are  in  kinde  the  best, 
It  is  ill  trusting  any  of  the  rest." 
An  anonvmous  writer,  1857,  in  the  "Physician's 
Dictionary,^' states  that  ifpurgeth  th3  phlegm  and 
opens  obstructions  in  the  liver." 

During  the  eighteenth  century  the  literature  of  the 
siubject  was  largely  added  to,  and  from  the  general 
tenour  of  the  writings  it  is  plain  that  the  unpleasant 
taste  of  the  fungus  interfered  with  its  usa  M.  Bouldue 
in  a  paper  read  before  the  Royal  Society  of  Paris,  in 
1714,  declared  that  the  tincture  of  the  agaricus  had 
such  an  abominable  taste  that  one  drop  placed  on  the 
tongue  produced  vomiting.  Bellonius  declared  that  the 
smell  given  out  by  the  fungus  on  being  cut  off  the  tree 
excited  violent  loathing  in  those  present.  Disused  as 
an  internal  remedj  it  (]|uickly  recovered  favour  as  a 
local  stvpic,  even  m  major  operations  it  came  to  be 
generally  used  in  the  eighteenth  century,  its  popularity 
being  due  to  the  recommendation  of  M.  Brossard  in 
1760.  The  GerUleman's  Magazine  in  1756  praises 
**  the  agaric  from  Paris  applied  as  a  styptic  after  opera- 
tions " ;  in  the  same  vear,  however,  Dr.  G*  Nevee  pub- 
lished his  pamphlet,  **  Some  Observations  on  the  use  of 
the  Agaric^  and  its  insufficiency  in  stopping  hsemor- 
rhage/*  which  latter  was  intended  as  a  reply  to  Sharp's 
paper  in  the  "  Philosophical  Transactions  "  telling  of 


his  experiments  with  agaric  as  a  styptic  in  amputations 
in  Guy's  Hospital.  The  styptic  continued  to  hold  its 
own  until  quite  recently,  for  we  find  favourable  men- 
tion  of  "  agaric  and  sponge  which  entangled  Uie  blood 
and  retained  a  coagulum  on  the  spot,"  in  Todd's  well- 
known  Qyclopiedia. 

Agaric  found  a  place  in  the  London  and  Edinburgh 
Pharmacopooias  and  possibly  may  appear  in  the  forth- 
coming British  Pharmacopceia. 

Towards  the  end  of  the  eighteenth  century,  it  had. 
however,  fallen  into  such  cusfavonr  as  an  internal 
remedy,  that  Lewis  (1781)  writes:  — 

"  The  antients  BU|>po6ea  it  to  be  possessed  of  alexe- 
terial  powers^  and  in  consequence  of  this  imaginai^ 
virtue,  made  it  an  ingredient  in  the  theriaca^  which  is 
the  only  officinal  composition  wherein  it  is  now  re* 
tained." 

Dr.  Morris  and  Kendrick  ("Edin.  Med.  Die."  1807> 
write  :— "  Agaric  is  cathartic,  but  hardly  ever  used  m 
our  practice,  as  its  operation  is  both  slow  and  unplea- 
sant, occasioning  sickness,  gripes,  <&c.  The  dose  ia 
from  5j  to  3ii." 

Gray,  in  1847,  suf^gested  the  addition  of  ginger  to 
agaric  to  prevent  gnping. 

Drs.  Pereira,  in  1840,  learned  from  Mr.  Butler,  of 
Covent  Garden  Market,  that  even  amongst  herbcJists 
its  use  bad  been  discontinued ;  nevertheless,  in  Dr. 
Brunton's  *'  Pharmacology  "  (1887),  it  found  a  placa 
amongst  antihydrotics. 

Agaric  would  probably  have  dropped  out  of  use  had 
it  not  been  for  Dr.  Young^s  introduction  of  agaricine, 
which  attracted  the  attention  of  Miller,  of  St.  Peters- 
burgh,  who  found  that  in  one  grain  doses  it  diminished 
the  night-sweats  in  twelve  phthisical  patients  out  of 
seventeen  on  whom  he  tested  it. 

M.  Hofmeister  {Gaz,  Med,  de  Paris,  1888)  ascribes 
the  therapeutic  properties  of  the  agaric  acid.  An 
acid  discovered  by  M.  G.  Fleury  Paris.  1870).  M. 
Hofmeister  found  the  dose  to  vary  from  half  to 
one  and  a  half  grains;  in  full  doses  it  occasionally 
produces  nausea.  Toxic  doses,  7  to  15  grains  cause 
diarrhoea  and  vomiting.  To  correct  the  tendency  to 
purging,  Young  {Ther.  Gaz.,  1888,)  adds  Dover's 
powder  to  the  agaracine.  The  same  journal  quotes 
the  experience  of  Dr.  Julius  Lauschmann,  who  "  found 
it  of  special  value  where  the  perspiration  covers  the 
body  like  a  sort  of  sticky  secretion.  One  pill  (of  Young's 
formula)  given  at  evening  usually  acts  with  promptness. 
The  next  night  also  the  perspiration  will  tail  to  make 
its  appearance,  or,  if  it  does,  it  will  be  in  such  slight 
quantities  chat  the  sleep  of  the  patient  will  not  be 
disturbed  It  will  be  observed  that  the  effect  of  the 
one  dose  will  sometimes  last  for  two  or  three  days.  It 
will  not  act  quite  so  well  in  some  cases  where  it  has 
already  been  used,  but  where  after  a  time  the  perspira- 
tion has  returned.  It  seems,  therefore,  that  the  first 
dose  only  is  accompanied  by  such  marked  results,  as 
the  following  doses  seem  weaker.    In  cases  where  one 

Sill  was  not  sufficient  a  second  was  given,  and  the 
esired  result  obtained.  In  cases  of  partial  or  only 
slight  sweating  the  action  of  the  drug  was  but  slight^ 
and  in  some  cases  seemed  to  exert  no  effect  whatever. 
Neither  a  strong  condition  of  the  patient  nor  rapidly 
advancing  consumption  contraindicates  the  use  of 
agaracin.  Its  use  is  never  accompanied  by  unpleasant 
symptoms,  only  now  and  then  diarrhoea  was  observed, 
in  a  few  cases  the  diarrhoea  was  considerable  and 
necessitated  special  treatment ;  in  one  case  there  were 
two  or  three  loose  movements,  which,  however,  ceased 
as  soon  as  the  drug  was  discontinued.  The  diarrhoea 
is  always  due  to  agaricin,  as  it  irritates  the  bowels  and 
causes  hypersemia.  This  drug  was  not  observed  to 
affect  the  heart's  action,  respiration,  or  temperature  in 
the  least." 

In  a  letter  to  the  Therapeutic  Gazette  (1888),  Dr. 
Pope,  of  Bellevue  Hospital,  New  York,  reports  that 


286    Tbb  Midioal  Fltxn. 


OBIOINAL  COMMUNICATIONS. 


^Tn  several  inBtances  aiiaricine  sacceeded  when  bella- 
donna or  atiopia  fuled,  and  without  giving  rise  to  any 
unpleasant  symptom  wfaateven  «...  My  conclusions 
and  convictions  were  drawn  from  a  series  of  cases,  pro- 
bably, over  one  hundred,  of  advanced  disease." 

^  AD  accounts  of  the  therapeutic  prcmerties  of  agari- 
dne  were  not,  however,  so  favourable.  Dr.  G.  R 
Butler  (BrooMvn  Med.  Joum.)  was  forced  to  the  con- 
clusion that  the  drug  was  of  very  little  value  as  a 
remedy  for  pathological  sweating.  Dr.  Mnrrel  did  not 
€nd  it  superior  to  other  well-known  anti-bydroticfi.  and 
Dr.  Hare  £* Practical  Therapeutics")  writes  of  the 
-extract :  "  The  writer  has  employed  it  frequently  in 
varying  dose,  and  has  never  seen  any  decrease  in  the 
eweats  of  phthisis  produced  by  it  whatever,  although 
lie  has  watched  it  most  closely,  expecting  to  see 
patients  obtain  great  relief  therefrom." 

^  M.  Combema1e(J?i<//.  Gm.  de  T/usr.)  considers  agara- 
•cmic  acid  as  the  only  anti-sudorific  element  of  the 
•drug.  In  doses  of  i  ^rBin  to  i  grain  he  found  it  sup- 
pressed tie  distressing  night  sweats  of  advanced 
phthisis. 

^  A^racinic  acid  was  obtained  by  Jahus  from  agara* 
•cine  in  1883.  It  is  not  to  be  confounded  with  agaric 
^id  or  agaracine ;  the  discoverer  describes  it  as  a 
Dibasic,  triatomic  homologue  of  malic  acid,  to  which 
he  gave  the  formula  Cjo  H30  Os.  H,0. 

Afiaric  acid  is,  according  to  Jahu,  a  homologue  of 
™jnfttic  acid,  and  he  gives  its  formula  as  C24H»(OH), 
(CO3H2). 

It  IS  probable  that  the  samples  of  agaracine  used  by 
the  different  physicians  who  reported  on  the  drug 
were  not  identical  in  the  amount  of  agaracinic  acid 
present,  and  in  future  better  results  might  be  obtained 
than  some  of  those  reported  if  prescribers  ordered  pure 
aganc  acid  instead  of  agaracine. 


THE    OBJECTS    AND    LIMITS    OF 
OPEKATIONS  FOR   CANCER,  {a) 

By    W.    WATSON   CHEYNE,    P.R.S., 
Trofenor  of  Sorgtry  st  King's  OoUege ;  SorgeoD  to  KiDg't  GoUego 

Cakcbb  of  thb  Mouth  and  Throat. 

Hbbs,  as  in  the  case  of  the  breast,  there  is  no  real  alter- 
native operative  procedure  to  that  of  removal  with  the 
view  of  cura  (Eaopbagotomv,  gastrostomy,  or  traobeo- 
ibomy,  although  they  may  prolong  the  patient's  life  for  a 
<very  short  time,  do  not  add  materially  to  his  comfort,  and 
•can  in  no  way  be  looked  on  as  alternatives  to  a  radical 
•operation,  and  in  those  cases,  therefore,  as  in  the  breast, 
I  do  not  think  that  we  can  do  very  much  in  the  way  of 
selection  of  cases  for  operai  ion. 

As  compared  with  cancer  of  the  breast,  the  disease  in 
the  throat  is  in  some  ways  more  favourable  for  cure,  in 
other  ways  less  so.  As  regards  the  primary  diseaee  the 
breast  oauoer  is  by  far  the  most  favourable  of  the  two,  for 
there  it  is  fully  exposed  to  view,  and  there  is  plenty  of 
room  for  its  free  removal  without  eodaogeriDg  important 
structures.  In  the  mouth  and  throat,  on  the  other  hand, 
the  disease  ia  close  to,  if  not  involving,  many  important 
parts  ;  the  space  in  which  one  has  to  work  is  very  limited, 
one  cannot  get  much  margin  of  healthy  tissue  around,  and 
the  early  spread  of  the  cancer  to  muscle,  especially  in  the 
case  of  the  tongue,  tends  to  distribute  it  over  a  consider- 
able area.  In  the  throat,  also,  the  disease  is  much  less 
favourable  for  operation,  because  the  septic  element  comes 
into  play,  and  thus,  instead  of  having  to  do  with  an  opera- 
tion, as  in  the  breast,  where  the  mortality  is  practically 
nilf  we  have  to  face  a  very  considerable  ri«k  of  oeath  from 
septic  direaee. 

On  the  other  hand,  cancer  in  the  mouth  and  throat  is 
more  favourable  as  regards  the  glandular  deposits,  for  in 
the  neck  we  have  an  extensive  elandular  area  exposed  to 
view  which  can  be  much  more  thoroughly  dealt  with  than 

(a)  Abfttnct  of  the  Second  Letteomlui  Leotare,  delivered  before  the 
Modloal  Society  of  Loodon,  Feb.,  1806^ 


Mab.  18,  l€M. 

in  the  ease  of  the  breast  It  is  tnie  that  many  snrgeoiis 
look  on  the  glandular  trouble  as  a  most  serious  part  of  the 
disease,  bnt,  for  reaioos  whiob  will  be  afterwards  stated, 
I  do  not  agrse  with  this  view.  In  one  other  respect,  also, 
cancer  in  the  month  and  throat  is  more  favourable  than 
that  in  the  breast— namely,  that  metastatic  deposits, 
which  so  often  disappoint  us  in  the  latter  case,  are  quite 
infreqnsDt  in  the  fbnner. 

Gaaoer  in  the  month  and  throat  is  most  oonvenienily 
oonsidersd  ondsr  three  heads-^nameiy :  (1)  cancer  of  the 
tongue ;  (2)  oaneer  of  the  pharynx,  tonsil,  soft  piJate,  epi- 
glottis, kc  ;  (3)  cancer  of  the  larynx. 

1.— Camcbb  of  thb  Tokoub. 
The  lecturer  pointed  out  that  in  the  case  of  the  tongue 
the  same  rules  must  guide  the  surgeon  as  in  the  case  of 
the  breast,  namely,  removal  of  the  whole  muscle  if  infected 
and  removal  of  the  whole  glandular  area. 

2.— Cakcbb  of  thb  Pharynx. 

Cancer  may  begin  anywhere  in  the  pharynx,  but  most 
commonly  (apparently  in  over  60  per  cent,  of  the  eases) 
it  commences  in  the  mucous  membrane  over  the  tonsils  or 
pillars  of  the  fauces,  and  spreads  from  thence  over  the 
neighbouring  parts.  From  the  tonsil  the  disease  spreads 
most  often  ana  earliest  on  to  the  pillars  td  the  fauces  and 
upwaf  ds  to  the  soft  palate,  next  most  frequently  down- 
wards on  to  the  base  of  the  tongue,  and  lastly  backwwds 
oyer  the  pharynx  ;  indeed,  in  most  cases  which  come  under 
view,  one  usually  finds  most  or  all  of  these  parts  affected, 
even  on  the  first  occasion  when  one  sees  the  patient. 
Epithelioma  also,  sometimes,  though  not  nearly  so 
commonly,  begins  about  the  epiglottis  and  orifice  of  the 
larynx,  and  the  third  point  of  selection  is  lower  down,  does 
to  or  at  the  commencement  of  the  oftsophagus. 

It  is  remarkable  how  little  trouble  the  disease  causes  at 
an  early  period ;  sometimes  the  patient  does  not  observe 
anything  wrong  till  the  occurrence  of  bleeding  attracts 
his  attention.  In  other  instances  he  first  notices  a  fre- 
quent desire  to  clear  his  throat,  or  again,  a  feeling  of 
uneasiness  and  dryness  about  the  throat,  and  very  com- 
monly pain  shooting  up  to  the  ear.  Indeed,  in  not  a  few 
instances,  the  first  thing  which  leads  him  to  ob1\  in  a 
surgeon  is  the  enlargement  of  the  cervical  glands  in  the 
neighbourhood  of  the  anj^le  of  the  jaw.  Ck>nsequent]y,  as 
epithellomata  in  this  region  apparently  g^w  very  readily 
and  rapidly,  it  is  but  seulom  that  the  patient  seeks  advice 
before  the  disease  has  spread  to  an  alarming  extent,  and 
generally  he  is  condemned  to  palliative  treatment.  Never^ 
theless,  a  considerable  number  of  operations  have  been 
performed  for  cancer  in  this  region,  the  success,  however, 
naturally  beine  limited  owing  to  the  desperate  nature  of 
the  case  and  the  peculiar  position  of  the  disease,  and  also 
to  some  extent  to  the  removal  having  been  imperfectly 
carried  out. 

Before  going  on  with  this  matter  further,  I  shall  in 
to-day's  lecture  narrate  the  cases  in  which  I  have  myself 
operatei,  and  subsequently  refer  to  the  tables,  giving  the 
operative  results  which  have  been  attained  in  this  disease. 
In  the  first  place,  I  shall  describe  three  cases  of  disease  of 
the  naso-pharynx  :— 

Case  J.—Lympho^sareoma  of  the   Left   Side  of  ike 
Na$o  pharynx,  involving  the  Ewtachian  Tube  and 
Growing  from  the  Base  of  the  SkvlL 
Male,  »t.  46 ;  first  seen  by  me  on  March  9th,  1892.  The 
patient  consulted  Dr.  Urbsn  Pritchard  about  a  year  pre- 
viously, on  account  of  buzzing  in  the  left  ear.    At  that 
time  there  was  no  suspicion  of  new  growth.    About  six 
months  afterwards  he  noticed  that  he  was  becoming  deaf 
on  the  left  side,  and  for  the  last  three  months  he  had 
observed  Uiat  there  was  some  obstruction  of  the  left 
nostril.    He  therefore  saw  Dr.  Pritchard  for  the  second 
time  at  the  end  of  February,  1892,  and,  on  examination,  a 

growth  was  found  on  the  left  side  of  the  naso-pharynx, 
locking  and  apparently  involving  the  Eustachian  tube. 
Dr  Pritchard  had  a  consultation  with  Dr.  GreviUe  Mac- 
donald,  and,  as  the  result,  the  situation  and  extent  of  the 
growth  were  described  to  me,  and  the  problem  was  put 
whether  any  operative  interference  was  possible  in  the 
case  of  a  malignant  tumour  in  this  region.  The  patient 
was  particularly  desirous,  in  connection  with  his  private 
affairs,  that  if  possible  some  extension  of  life  might  be 
obtained  for  him. 


Mar    18,  1890. 


OfilGUJAL  COMMUNICATIONS, 


The  Medical  Prks.     287 


Oo  March  16Ui,  1892»  I  performed  the  following  opera- 
tiooy  assisted  by  Messrs.  Stanley  Boyd  and  Bnrghard.  An 
hour  before  the  operation  a  pint  of  water  containing  half 
an  ounce  of  chloride  of  calcium  was  injected  into  the 
rectom,  and  dnr.ng  the  operation  pledgets  of  salicylic 
wool  soaked  in  Wright's  fibrin  ferment  solution  were 
Implied  to  the  freehly-ont  surfaces  under  the  superintend- 
ence of  Dr.  Wright.  Whether  as  the  result  of  this  treat- 
ment or  not,  the  fact  is  that  extremely  little  blood  was 
lost — ^I  do  not  think  more  than  an  ounce  or  an  ounce  and 
a  half  in  alL.  The  glands  were  first  removed  from  the 
neck ;  they  were  deeply  seated,  being  attached  to  the 
fascia  over  the  atlas,  the  spinal  accessory  nerve  running  in 
front. of  them.  In  addition,  the  fat  and  tipsues  of  the 
vicinity  were  of  course  also  taken  away.  Tracheotomy 
and  insertion  of  a  Hahn's  tube.  I  then  proceeded  to  re- 
move the  upper  jaw  on  the  left  side.  The  periosteum  and 
mucous  membrane  of  the  hard  palate  were,  however, 
detached  from  the  bone  and  left  oehind,  and  the  orbitsi 
plate  of  the  superior  maxilla  was  also  left.  After  removal 
of  the  upper  jaw  the  base  of  the  pterygoid  process  was 
divided  with  bone  forceps  and  removed  ;  the  front  of  the 
tumour  could  then  be  seen.  The  tumour  was  then  de- 
tached from  the  external  pterygoid  muscle,  the  other 
tissues  outeide  it,  and  the  soft  palate.  It  was  then  found 
to  have  originated  from  the  periosteum  of  the  base  of  the 
skull,  and  to  have  grown  downwards  along  the  Bide  of  the 
pbaijnx,  involving  the  Eustachian  tube  in  its  course.  A 
portion  of  the  Eustachian  tube  was  removed,  and  the 
mucous  membrane  all  around  the  tumour  was  divided. 
The  periosteum  over  the  whole  roof  of  the  naao-pharynx 
was  then  carefully  detached  as  far  out  as  the  foramina  for 
the  vessels,  and  as  far  forward  as  the  disease  seemed  to 
extend.  A  layer  of  the  surface  of  the  bone  was  then  chipped 
off,  and  the  whole  bare  sutface  cauterised  with  Paquelin's 
cautery  ;  the  bard  pidate  was  then  stitched  to  the  cheek, 
and  the  wound  closed  with  sutures. 

The  temperature  onlv  once  reached  100°  F.,  and  that  was 
on  the  morning  after  the  operation,  and  the  further  pro- 
gress towards  recovery  was  uninterrupted.  Tracheotomy 
tube  was  left  out  on  the  day  after  the  operation ;  all  the 
stitches  were  removed  on  the  filth  day,  the  patient  sot 
np  on  the  tenth  day,  and  left  town  on  the  twenty- third 
day. 

Very  shortly  afterwards  he  was  able  to  resume  busi- 
ness, and  for  about  fifteen  months  there  was  no  sign  of 
recurrence  in  the  nose,  although  in  March,  1893,  x  re- 
moved some  small  glands  from  the  left  posterior  triangle 
of  the  neck.  In  JQly>  1893,  however,  he  began  to  have 
some  bleeding  from  his  nose,  and  accordingly  I  reopened 
the  scar,  and  found  tbat  recurrence  had  taken  place  at  the 
roof  of  the  nasal  cavity,  in  front  of  the  former  seat  of  the 
disease,  the  situation  of  the  original  tumour,  how- 
ever, remaining  perfectly  well.  Disease  cleared  away 
as  thoroughly  as  possible,  and  for  a  time  he  went  on  very 
-well ;  but  in  the  spring  of  1894,  about  two  years  after  the 
first  operation,  he  oegan  to  go  downhill,  bleeding  occur- 
ring a^n  from  the  nose,  and  glands  enlarging  on  the 
other  side  of  the  neck.  He  gradually  became  worse,  and 
ultimately  died  on  December  14th,  1894,  two  and  three- 
quarter  years  after  the  first  operation. 

Casb  II.  Lym'pho  mrcoma  Growing  from  tJie  Base  of 

the  Skvlly  and  Projecting  into  the  Naso-pJutryngeal 

Cavity, 

Female,  set.  24.  Had  noticed  stuffiness  in  right  nostril 
last  August.  It  gradually  became  worse,  and  a  few  days 
ago  she  consulted  Dr.  W.  H.  Dobie,  of  Chester,  who  dia- 
enosed  the  condition  of  matters,  and  sent  her  up  to  me. 
Patient  is  a  young  woman  in  good  health,  only  complain- 
ing of  stuffiness  in  the  nostnl.  Nothing  is  seen  from 
mouth.  With  rhinoscope  rounded  swelling  found  growing 
from  roof  of  naso-pharynx  and  filling  up  most  of  the  space; 
no  ulceration,  and  it  is  not  pedunculated.  No  enlarged 
glands  in  the  neck. 

On  December  22nd,  1895,  soft  palace  split  in  the  middle 
linej  the  incision  being  carried  through  tVe  mucous  mem- 
brane and  periosteum  of  the  hard  palate  nearly  to  the 
front.  The  pteriosteum  of  the  hard  palate  was  then  peeled 
off  the  posterior  part,  and  a  curved  portion  of  the  back 
I>art  of  the  bard  palate  and  the  posterior  part  of  the  vomer 
ped  away,. the  head  hanging  down.  Periosteum  in- 
l  all  round  the  growth,  aiSlas  far  from  it  as  possible, 


and  tumour  detached.  Raw  surface  painted  over  repeat- 
edly with  nitric  acid ;  action  arrested  oy  carbonate  of  soda. 
The  soft  and  hard  palate  were  thisn  united  with  stitches. 
Recovery  uninterrupted.  Palate  united  perfectly,  and 
patient  sent  home  on  Januarv  10th. 

In  this  case  it  will  be  seen  that  a  totally  different  method 
of  procedure  was  adopted  from  that  employed  in  Case  I. 
In  the  former  case,  however,  the  tumour  was  unilateral, 
and  as  far  as  one  could  judge,  extended  well  into  the  side 
of  the  neck,  and  it  did  not  seem  at  all  possible  to  get 
satisfactory  access  to  it  from  below ;  in  the  latter  case  it  was 
centrally  situated,  anditseemed  to  me  that  themethod  em- 
ployed would  be  sufficient.  I  must  say,  however,  that  of  the 
two  plans  I  believe  the  former,  namely,  the  excision  of  the 
upper  jaw,  or  at  any  rate  a  temporary  resection  of  it,  and 
removal  of  the  pterygoid  process,  is  much  the  more  satis- 
factory. In  the  first  case  I  could  see  exactly  what  I  waa 
doing,  and  had  no  difficulty  in  obtaining  complete  access 
to  the  whole  affected  area  ;  in  the  latter  case  it  was  diffi- 
cult to  bo  quite  certain  whether  I  had  got  well  beyond 
the  growth  at  the  anterior  part,  and  though  this  last  plan 
may  be  useful  in  cases  where  the  tumour  is  quite  small 
and  centrally  placed,  I  should  be  inclined  in  most  cases 
to  employ  the  formef  method.  The  remarkable  absence  of 
any  septic  phenomena  in  both  these  cases  is  very  striking, 
and  I  attribute  it  mainly  to  the  free  escape  of  the  dis- 
charge from  the  surface  of  the  wound  as  the  result  of  the 
position  of  the  patient,  and  also  to  scrupulous  care  in 
cleansing  the  mouth  and  in  avoiding  the  introduction  of 
any  septic  infection  from  without.  Both  cases  show  that 
tracheotomy  is  quite  unnecessary  in  these  operations. 

Case  III.-  Spindle  celled  Sarcoma  growing  from  the 
Hoof  of  the  Naml  Cavity,  involving  the  Sphenoidal^ 
Ethmoidal,  and  Frontal  Sinuses,  and  Destroying  the 
Upper  Part  of  the  Nasal  Septum, 

Female,  about  40,  sent  by  Dr.  Edward  Law.  Patient 
had  suffered  from  growths  in  nose  for  ten  years.  She  had 
been  operated  on  many  times  and  in  many  ways.  Re- 
cently she  had  been  under  Professor  Volkmann,  who  used 
the  thermo-caotery,  and  as  a  result  the  orifice  of  the 
nostril  had  been  much  burned,  and  had  become  so  con- 
tracted that  it  was  impossible  to  see  into  it.  Right 
nostril  completely  filled  up  with  growth,  which  distended 
the  nose  and  destroyed  the  nasal  bones,  and  at  the  bridge 
of  the  nose  a  soft  tumour  was  felt  and  seen  projecting 
forwards ;  the  frontal  eminence  was  much  more  marked 
on  the  right  side  than  on  the  left. 

On  March  7th,  1894,  I  performed  the  following  opera- 
tion :— Incision  made  along  the  right  side -of  the  nose, 
from  the  frontal  bone  to  orifice  of  nostril,  and  ala  and  right 
side  of  the  noee  detached  and  turned  over  to  the  left  side. 
The  tumour  was  partly  cystic,  and  was  gradually  separated 
from  its  attachments  along  with  as  much  healthy  tissue 
as  possible.  It  filled  and  distended  the  right  frontal  sinus, 
and  projected  somewhat  into  the  left,  but  it  came  com- 
pletely away,  along  with  the  mucous  membrane.  It 
opened  and  projected  into  the  right  orbital  cavity,  and  it 
grew  from  the  whole  of  the  roof  of  the  nasal  cavity,  espe- 
cially on  the  right  side,  and  had  destroyed  the  vomer  at 
the  upper  part.  After  removal  of  growth  surface  of  the 
bones  was  cauterised  and  sponged  with  undiluted  carbolic 
acid  ;  skin  replaced  in  positidn  and  stitched,  and  a  plug 
was  introdaced  into  the  right  nostril  so  as  to  keep  it  open 
during  the  healing  process.  The  right  antrum  was  full  of 
pus,  and  was  opened  in  the  usual  manner  through  the 
alveolus,  and  a  drainage-tube  inserted  into  it. 

Here,  again,  the  subsequent  progress  of  the  case  was 
absoluaely  free  from  any  fever  or  other  cause  of  anxiety. 
The  temperature  did  not  rise  above  100^  F.,  and  she  left 
the  home  within  three  weeks  apparently  well.  She 
remained  well  up  to  a  year  ago,  since  which  time  I  have 
not  seen  or  heard  of  her. 

In  the  following  cases  we  have  to  do  with  tumours  lower 
down,  in  thejpharynx  proper  or  in  the  neighbouring  parts ; 
first  a  case  affecting  both  {larynx  and  larynx,  then  three 
successful  cases,  then  three  fatol  ones,  and  lastly  one  with 
local  recurrence. 
Cask  iV,^Emthelioma   of  the   Eight  Side  of  the 

Pharynx,  the  Epiglottis,  Might  Ary/teno-Epiglotti- 

dean  Foldy  the  Pharyngeal  mass  being  also  adJierent 

to  t/ie  Thyroid  Cartilage. 

D 


288    The  Medical  Pbess. 


ORIGINAL  COMMUNICATIONS. 


Mab   18,  IW^6. 


Male,  8Bt.  42,  under  Dr.  Rozbuvh,  of  WeetoD-saper- 
Mara.  About  the  end  of  June,  1892,  the  patient  noticed 
a  feeling  of  stiffness  about  the  risht  side  of  the  throat 
when  he  yawned,  but  otherwise  he  had  no  trouble  or  pain. 
He  saw  Dr.  Roxburgh  about  it  for  the  first  time  on  July 
24th,  and  he  diagnosed  a  malignant  ulcer  of  the  pharynx. 
He  saw  also  Dr.  Greville  Macdonald,  who  sent  him  to  me. 

On  examination,  various  organs  healthy ;  nothing  vieible 
on  inspection  from  the  mouth,  but  with  a  laryngoscope  a 
ragged  ulcer,  somewhat  larger  than  a  shilling,  was  seen 
on  the  right  side  of  the  pharynx,  spreading  on  to  the 
right  aryteno-epiglottidean  fold,  and  possibly  as  far  as  the 
rifl^t  side  of  the  epiglottis. 

The  following  wera  the  steps  of  the  operation  (August 
1st,  1892)  :  Preliminary  tracheotomy,  Hahn's  tube :  a  long 
incision  was  then  made  parallel  vdth  the  yesseU,  and  a 
transverse  one  along  the  border  of  the  great  comu  of  the 
hyoid  bone.  The  vessels  wera  pulled  outwards,  and  the 
submaxillary  ffland  was  raised.  Pharynx  opened,  and 
disease  exposed.  It  was  found  to  be  much  more  extensive 
than  had  been  supposed,  because  it  spraad  superficially, 
and  had  not  led  to  any  marked  thickening  of  the  mucous 
membrane  at  the  edge  of  the  growth.  It  reached  to  the 
middle  line  behind  on  to  the  tongue  in  front,  and  was 
adheront  to  the  wing  of  the  thyroidT  cartilage,  but  it  was 
very  difficult  to  define  its  extent  on  account  of  its  super- 
ficial spread.  The  whole  mass  was  ramoved,  namely,  the 
affected  portion  of  the  pharynx,  the  right  aryteno-epi- 
glottidean fold,  a  small  part  of  the  tongue,  the  greater 
part  of  the  epiglottis,  and  a  piece  of  the  wing  of  the 
thyroid  cartilage.  For  three  days  the  patient  went  on 
very  well,  but  on  August  4th  signs  of  septic  pneumonia 
appeared,  and  he  went  very  rapidly  downhill  and  died  on 
the  following  day. 

Case  V. — Bound-celled  Sarcoma  of  the  Right  Tonsil^ 
Side  of  PJuirynXy  Soft  Folate^  and  Lower  Fart  of  the 
Naso-FhatYnx, 

Male,  et.  45.  Sent  by  Dr.  Felix  Semon,  and  seen  by 
me  on  June  13&h,  1894.  Six  months  praviously  an  enlarged 
gland  was  ramoved  by  another  surgeon  from  the  right 
anterior  triangle  of  the  neck,  and  on  microscopical 
examination  was  said  to  be  of  a  simple  character.  At  that 
time  nothing  was  noticed  in  the  throat.  About  four 
months  beforo  I  saw  him  he  began  to  suffer  from  uneasi- 
ness and  pain  in  the  throat.  Right  tonsil  much  enlarged, 
ulcerated,  hard,  and  fixed.  The  disease  extended  to  the 
wall  of  the  pharynx  and  on  to  the  right  side  of  the  soft 
palate,  and  appeared  to  be  adherent  to  the  external  ptery- 
goid process. 

1  did  not  see  the  patient  again  till  August  29th.  I  then 
found  that  the  tumour  had  increased  greatly  in  size,  and 
was  now  filling  up  the  pharynx  to  a  considerable  extent 
and  reaching  well  beyond  the  middle  line.  It  interfered 
ereatly  with  swallowing  and  to  some  extent  with  breath- 
ing ;  be  evidently  had  only  a  few  weeks  to  live.  As  it  had 
not  infiltrated  so  much  as  I  had  expected,  I  reconsidered  the 
question  of  operation,  and  came  to  the  conclusion  that  it 
might  after  all  be  possible  to  remove  the  tumour. 

On  September  11th,  1894,  an  incision  was  made  along 
the  line  of  the  vessels,  some  glands  removed,  and  the 
external  carotid  artery  tied,  cheek  split  from  the  angle  of 
the  month  to  the  masseter  muscle.  An  incision  was  now 
made  through  the  mucous  membrane  in  front  of  the 
growth,  the  lower  part  of  the  pterygoid  process  was 
removed  with  bone  forceps,  and  the  affected  portion  of  the 
soft  palate  was  clipped  away  with  scissors.  At  this  stage 
it  was  found  advisable  to  perform  tracheotomy,  and  a 
Hahn's  tube  was  inserted.  Tumour  then  carefully 
ramoved,  along  with  part  of  internal  pterygoid  muscle 
and  Eustachian  tube.  The  patient  hail  practically  no 
ehock  after  the  operation,  ana  during  the  course  of  the 
case  thera  was  an  entira  absence  of  all  septic  complica- 
tions, the  temperatura  not  once  going  above  100**  F.,  and 
the  patient  went  on  well,  except  for  a  short  attack  of 
"Suakim  liver."  The  tracheotomy  tube  was  left  out  on 
the  day  after  the  operation.  The  patient  left  the  home 
between  three  and  four  weeks  after  the  operation,  and  is 
fltdll  alive  and  well,  and  is  present  hera  to-night. 

Cask  VI. — Emthelioma  of  the  Left  Tonsil  and  Soft 
Folate f  with  a  large  Mass  of  CHands  in  the  Anterior 
Triangle  of  the  Neck  adherent  to  the  Vessels^  extend- 


ing under  the  Stemo-mattoid  Mtude,  and  up  to  the 
Base  of  the  Skull. 

Male,  ffit.  65,  sent  by  Dr.  Felix  Semon  on  October  13th, 
1894.  Patient  began  to  feel  uneasiness  about  the  throat 
during  the  pravious  June.  In  July  he  first  noticed  a 
swelling  on  the  left  side  of  the  neek.  In  September  he 
saw  a  weU-known  surgeon,  who  said  that  the  disease  was 
malignant,  but  that  no  operation  was  possible.  Towards 
the  upper  part  of  left  tonsil  thera  was  a  oatch  of  ulcera- 
tion with  very  hard  base  and  edge  ana  warty  surface, 
spreading  on  to  the  pillan  of  the  fauces  and  the  soft  palate. 
A  very  Itfge  mass  of  slands  in  left  anterior  triangle,  firmly 
adherent  to  the  vessds. 

On  October  15th,  1894,  a  long  incision  was  made  along 
the  anterior  border  of  the  sterno-mastoid,  and  the  jugular 
vein  tied  in  two  parts  below  the  mass  and  divided  between 
the  ligatures.  The  vein  and  glands  wera  then  raised  in 
one  piece,  spinal  accessory  nerve  disentangled  from  the 
mass,  and  the  jugular  vein  again  tied  at  its  point  of  exit 
from  the  skull,  and  the  mass  of  glands,  with  the  vein  and 
all  the  fat  and  glands  under  the  sterno-mastoid  and  well 
into  the  posterior  triangle  taken  away.  External  carotid 
artery  tied,  and  posterior  belly  of  the  dieastric  and  the 
stylo-hyoid  muscles  wera  divided,  head  thrown  over  the 
table,  mouth  held  open  with  a  gag,  soft  palate  clipped 
through  well  beyond  the  disease,  mucous  membrane 
indeed  all  round  the  area  of  the  growth,  and  the  whole 
diseased  mass  clipped  out.  A  large  drainage  tube  was 
inserted  from  the  external  wound,  and  the  skin  incision 
closed  at  the  upper  part  by  sutures. 

The  gatient  was  a  good  deal  collapsed  after  the  opera- 
tion, but  recovered  the  same  evening  and  went  on  remark- 
ably well  As  in  the  pravious  case,  thera  was  no  rise  of 
temperatura  or  septic  oomolication.  He  got  out  of  bed  for 
the  first  timeon  the  sixth  aay,  and  the  drainage  tube  was 
left  out  on  the  eleventh  day.  The  external  sinus  ramained 
open  for  a  few  weeks,  but  closed  befora  the  end  of  the 
year  without  anything  further  being  done  for  it.  When 
I  saw  the  patient  last,  in  the  middle  of  January,  1896,  that 
is  to  say,  fifteen  months  after  the  operation,  thera  was  no 
evidence  of  recurrance,  and  he  was  in  the  enjoyment  of 
perfect  hoslth. 

Case  VII. — Epithelioma  of  the  Base  of  the  Tongue  and 
the  Epiglottis;  a  few  small  Glands  in  the  Neck, 
Male,  »t.  60,  brought  to  me  bv  Dr.  G.  A.  Parker.  For 
about  six  months  the  patient  had  noticed  pain  in  swallow- 
ing, and  lately  had  had  neuralgic  pains  extending  up  to 
the  ear.  A  small  mass  of  enlarged  glands  at  the  angle  of 
the  jaw  on  the  left  side  and  at  the  cornu  of  the  hyoid  bone. 
By  the  aid  of  a  mirror  a  superficially  ulcerated  surface  was 
seen  at  the  base  of  the  tongue,  especially  on  the  left  side, 
and  extending  into  the  hollow  between  the  tongue  and 
the  epiglottis,  partially  filling  it  up.  The  epiglottis  was 
also  thickened  and  ulcerated  on  its  anterior  surface  but 
the  larynx  was  free. 

Operation,  November  23rd,  4894.— Preliminary  trache- 
otomy :  long  incision  in  |the  line  of  the  vessels,  and 
another  along  the  upper  border  of  the  hyoid  bone ;  glands 
removed;  the  external  carotid  artery  tied,  and  the 
pharynx  opened  at  the  level  of  the  comu  of  the  hyoid  bone ; 
comu  of  hyoid  bone  cli pped  awav .  The  superior  laryngea  1 
nerve  was  not  divided;  epiglottis  detached  from  its 
attachment  in  the  angle  of  the  thyroid  cartilage  but  left 
attached  to  the  tongue.  A  transverse  incision  was  then 
made  completely  across  the  tongue,  well  away  from  the 
disease,  and  the  posterior  part,  together  with  the  epiglottis 
was  taken  away.  He  was  fed  for  four  days  by  rectal 
enemata  and  nutrient  suppositories  and  is  now  able  to 
swallow  without  difficulty,  and  only  extremely  rarely  does 
he  have  a  fit  of  coughing  while  doioff  so,  and  he  is  in  ex- 
cellent health  at  the  present  time,  fifteen  months  after  the 
operation. 

Cabb  VIIT. — Epithelioma  of  the  Bighi  Tonsil^  spread- 
ing on  the  l^onguey  Floor  of  the  Mouth,  Soft  Palate^ 
and  Side  of  Fharynx,  A  Mass  of  Glands  at  the  Angle 
of  the  Jaw, 

Male,  set.  44.  Had  noticed  some  hoarseness  for  a  few 
weeks,  and  about  a  fortnight  beforo  admission  he  had 
found  a  swelling  at  the  angle  of  the  jaw.  Large,  ulcerated, 
warty  growtJi  on  the  right  tonsil,  extending  on  to  the  soft 
palate,  pharynx,  floor  of  mouth,  and  bMe   of    tongue. 


Mar   18,  1H96. 


ORIGINAL  COMMUMCATIUNS. 


ThB  lirJXDICAL  VrSBS. 


Jjs^vnx  and  epiglotUB  were  free.  Mue  of  glands  at  the 
aogle  of  the  jaw.  On  Jone  12tb,  1895,  preliminary 
timobeotomy.  Enlarged  glands  with  the  material  under 
the  stemo-mastoid  and  the  jogular  vein  removed.  A 
eeoood  eat  parallel  to  the  hyoid  bone,  and  the  submaxillary 
gland  with  the  adherent  lymphatic  glands  removed, 
external  carotid  artery  tied,  cheek  split  from  angle  to 
maaseter.  With  scissors,  the  healthy  tissne  aronnd  the 
growth  was  divided.  The  posterior  haU  of  the  tongue  on 
the  right  side  was  taken  awav,  along  with  the  floor  of  the 
mouth  at  that  part,  tonsil,  pillars  of  the  fauces,  part  of  soft 
palate,  and  portions  (of  the  pharynx,  the  whole  being  re- 
moved in  one  mass.  There  was  a  sood  deal  of  shock 
after  the  operation,  but  the  patient  had  recovered  from 
that  by  the  next  morning,  and  he  went  on  well,  the  tem- 
peratureonly  twice  reaching  100^  He  began  to  try  to  swal- 
low on  J  une  21st,  but  without  very  much  success.  However, 
this  rapidly  improved,  and  at  the  time  of  his  death  he  was 
able  to  swallow  practically  all  that  was  required  in  the 
way  of  nourishment.  The  patient  was  doing  remarkably 
weU,  and  it  was  a  question  whether  he  should  not  go 
home,  when  on  July  7th,  twenty-five  days  after  the  opera- 
tion, while  he  was  washing  out  his  mouth  previously  to 
taking  some  food,  it  was  noticed  that  the  material  was 
etained  with  red  blood.  This  rapidly  increased  in  amount, 
and  in  three  minutes,  before  assistance  could  reach  him, 
he  was  dead,  the  blood  having  apparently  passed  straight 
down  his  laiynx  and  choked  mm,  the  blood  having  come 
from  the  external  carotid  artery. 

Case  JX.—Epithelwma  of  the  Tonsil.  Sojt  jxdate^  Side 
of  Pkart/nx  and  Bight  Side  of  tfie  Tonaue ;  large 
ifass  of  Gla/nds  on  the  Eight  Side  of  the  JSeck. 
Male,  et.  56,  seen  in  consultation  with  Dr.  Semon 
and  Mr.  Hor^ley  on  June  28bh,  1895-  Three  weeks 
previously  a  quantity  of  blood  suddenly  came  into 
his  mouth  along  with  some  very  foul-smelling  discharge. 
For  some  time  previously  his  throat  had  been  uneasy, 
but  he  had  not  paid  any  attention  to  it.  Consider- 
able mass  of  glands  at  the  upper  part  of  the  right 
anterior  triangle,  evidently  adherent  to  the  vessels, 
and  extending  under  the  sterno-mastoid  muscle ;  project- 
ing warty  mass  on  the  right  side  of  the  throat,  and  extend- 
ing on  to  the  tongue ;  it  had  apparently  beeun  in  the 
tonsil,  which  was  deeply  excavated,  and  from  tnenoe  had 
epread  on  to  the  neighbouring  parts.  Only  the  back  part 
of  the  toneue  was  affected,  but  there  the  diseaee  went 
pretty  dee^y ;  above  it  had  spread  on  to  the  palate,  and 
behind  to  the  side  of  the  pharynx  ;  the  epiglottis  and  the 
pharynx  were  free.  The  ulcer  was  constantly  bleeding. 
and  there  was  much  foul  discharge  from  it.  The  patient 
appeared  to  be  a  robust  man,  but  was  not  so  in  reality  ; 
his  urine  contained  one-eighth  of  albumen,  and  his  pulse 
was  quick  and  readily  compressible,  frequently  numbering 
120. 

On  July  1st,  assisted  by  Mr.  Horsley  and  Dr.  Semon,  I 
fMfformed  tracheotomy,  and  put  in  a  Hahn's  tube.  The 
mass  of  glands,  which  extended  up  to  the  mastoid  process 
and  under  the  muscle,  removed  alons  with  the  jugular 
vein,  the  external  carotid  artei^,  ancT  the  dimtric  and 
etylohyoid  muscles  which  were  involved  ;  cheek  was  then 
split  from  the  angle  as  far  as  the  masseter,  and  the  mass 
in  the  mouth  was  removed  in  one  piece  in  the  same  man- 
ner as  in  the  last  case.  It  was  then  found  that  the  internal 
carotid  artery  was  involved  in  the  growth,  and  lying 
almost  bare  on  the  surface  of  the  ulcer  of  the  tonsil.  As 
the  patient  was  by  this  time  suffering  a  good  deal  from 
shock,  more  so  than  any  of  the  other  cases,  and  as  his  pulse 
was  very  small,  I  feared  that  the  removal  of  the  diseased 
fxirtion  of  the  artery  would  produce  so  much  anaemia  of 
the  brain  as  to  preclude  the  chance  of  his  recovery  from 
the  shock,  and  therefore  I  thought  it  wiser  to  peel  off  the 
tumour  as  far  as  I  could  from  the  artery,  and  tnen  remove 
it  later,  when  he  had  somewhat  recoveied. 

There  was  a  good  deal  of  shock,  but  he  rapidly  picked 
up^  and  on  the  morning  of  the  fourth  day  seemed  quite 
hmiself  again*  I  therefore  thought  that  the  time  had 
•come  when  the  piece  of  the  diseased  artery  might  be  taken 
away  with  safety,  and  accordingly,  dividing  the  stitches, 
I  passed  a  ligature  above  and  befow  the  diseased  area,  tied 
the  vessel,  and  removed  the  intervening  portion.  This 
was  done  quite  easily,  with  almost  no  disturbance  of  the 
^ound,  and  no  bleeding.    The  patient  passed  an  excellent 


day,  but  towards  night  he  began  to  cough,  and  had  much 
difficulty  in  bringing  up  a  quantity  of  tenacious  mucus  ; 
his  temperature  began  rapidly  to  ffo  up,  and  signs  of  septic 
pneumonia  set  in,  of  which  he  died  on  the  morning  of  the 
eixth  day  after  the  operation  ;  it  was  noticed  also  on  the 
fifth  day  that  there  was  paresis  of  the  leg  and  arm  on  the 
left  side. 

Case  X.— Epithelioma  cf  the  Right  Tonsil^  Floor  of 

the  Mouth,  Ba^e  of  Tongue^  Pillars  of  the  Fauces, 

Soft  Paiate^  Side  of  Pharynx,  and  6lands  in  the 

Neck, 

Male,  set.  55,  sent  by  Dr.  Harvey.  Patient  first  noticed 
swelling  of  the  glands  in  the  neck  about  two  months 
before  admission,  and  about  that  time  he  also  had  shoot- 
ing pain  about  the  base  of  the  tongue.  About  a  month 
before  admission  he  first  observed  a  growth  on  his  tongue. 
The  patient  was  old  for  his  age,  was  not  a  very  strong 
man,  but  had  no  organic  disease  of  any  kind.  Glands  in 
the  anterior  triangle  considerably  enlarged,  more  especi- 
ally towards  the  angle  of  the  jaw,  but  also  extending  as 
low  as  the  thyroid  cartilage  :  large  cauliflower  growth  at 
the  back  of  the  right  side  of  the  tongue,  extending  to 
floor  of  mouth,  ri{;nt  tonsil,  and  adjacent  part  of  the  soft 
palate  and  side  of  the  pharynx.  The  entrance  to  the 
uurvnx  and  the  epiglottis  was  apparently  free. 

On  July  24th,  1895,  the  glands  and  the  neighbouring 
tissues  were  dissected  out  from  the  anterior  triangle ; 
internal  jugular  vein  not  removed  ;  the  posterior  belly  of 
the  digastric,  however,  was  found  attached  to  the  growth, 
and  was  taken  away. 

The  wound  healed  by  first  intention,  and  on  July  31st, 
1895,  the  second  part  of  the  operation  was  proceeded  with ; 
trachea  opened  and  a  Hahn's  tube  inserted,  the  greater 
part  of  the  former  incision  was  re- opened,  and  the  external 
carotid  artery  tied.  The  incision  was  then  extended 
forwaids  under  the  angle  of  the  jaw,  and  the  submaxillary 
gland  taken  away,  cheek  split,  and  half  of  the  tongue 
freed  right  down  to  the  hyoid  bone,  and  the  rest  of  the 
growth  removed  in  one  piece. 

The  patient  did  not  have  any  very  marked  collapse,  and 
passed  a  very  good  night  afterwards.  The  next  morning, 
however,  it  was  evident  that  his  mind  was  deranged,  and 
he  was  most  difficult  to  manage,  both  as  to  feeding  and  in 
other  ways  ;  and  I  may  here  say  that  from  this  time  till 
the  end  of  the  case  he  never  recovered  his  reason.  He 
went  on  very  well  for  some  days,  but  there  was  more 
septic  decomposition  about  the  wounds  than  had  occurred 
after  any  of  the  other  operations. 

On  August  14th  there  was  a  repetition  of  the  bleeding, 
and  when  I  opened  up  the  wound  I  found  that  it  simply 
came  from  the  granulations,  and  it  did  not  again  recur. 
The  patient  grfliaually  became  worse  and  died  on  August 
31st. 

On  post-mortem  examination  gangrene  of  the  upper 
lobe  of  the  right  lung  was  found,  with  a  considerable 
quantity  of  pus  lyinff  in  it.  There  was  softening  of  the 
anterior  part  of  the  right  cerebral  hemisphere  as  far  back 
as  the  fissure  of  Rolando.  There  was  no  doc  in  the  carotid 
artery. 
Case  XL^Epithelioma  of  the  Left  Tonsil,  Pillars  of 

the  Fauces  and  Soft  Palate,  spreading  on  to  and 

involving  tJie  Lower  Jaw  at  the  Posterior  Part ;  a 

Mass  of  Glands  in  the  Anterior   Triangle  of  the 

Neck. 

Male,  et.  55,  sent  by  Dr.  Harvey.    Patient  first  noticed 

tenderness  in  his  throat  and  sums  about  six  weeks  before 

admission,  and  very  shortly  afterwards^a  swelling  appeared 

in  the  neck.    There  was  a  mass  of  considerable  size  at  the 

posterior  part  of  the  left  anterior  triangle,  and  extending 

under  the  sterno-mastoid ;  this  mass  was  very  fixed.     On 

!  looking  into  the  mouth  an  ulcer  with  hard  edges  and 

I  warty  surface  was  seen  on  the  left  tonsil,  reaching  and 

,  firmly  adherent  to  the  alveolar  border  of  the  lower  jaw, 

I  spreading^  into  the  soft  palate,  and  to  a  slight  extent  to  the 

gum  of  the  upper  jaw ;  it  i^  reached  the  floor  of  the 

mouth,  but  had  not  yet  affected  the  tongue. 

As  the  disease  was  extensive  and  the  patient  somewhat 
weak,  and  as  I  also  had  to  leave  town  for  a  few  daye,  I 
thought  it  would  be  better  to  divide  the  operation  into 
two  stages,  removine  the  glandular  mass  in  the  first 
instance,  and  then  subsequently  the  dissase  in  the  mouth. 


290     Tub  Mbdioal  Pasrs. 


CLINICAL  BEC0RD9. 


IMab.  18,  1806. 


Aooordin^ly  on  Jaly  lObh,  1895,  I  removed  the  glaods 
aloDg  wiui  the  internal  jognlar  vein,  the  external  carotid 
artery  and  ita  upper  branches,  the  h^pogloMal  nerve,  the 
diga8tric,and  stylohyoid  mascles  (which  wereallinvolved), 
and  all  the  fat  and  gkmds  under  the  stemo-maatoid 
maecle.  As  the  wound  waa  an  aseptic  one,  I  had  no 
anxiety  about  the  matter,  and  the  patient  had  no  bad 
symptom. 

On  July  24th  I  proceeded  to  the  second  part  of  the 
operation,  namely,  the  removal  of  the  mass  in  the  throat. 
After  opening  the  trachea,  the  upper  part  of  the  first 
incision,  which  had  healed,  was  opened  up,  and  a  fresh 
cut  was  carried  forward  from  it  in  a  curved  manner  over 
the  submaxillary  region,  and  the  submaxillary  gland  with 
some  enlar|;ed  lymphatic  glands  adherine  to  it  was 
removed.  This  flap  of  skin,  together  with  the  masaeter 
muscle,  was  then  turned  upwards,  and  the  jaw  sawn 
through  in  front  of  and  behind  the  affected  part.  The 
interior  of  the  throat  could  now  be  well  seen,  and  an  inci- 
aion  waa  made  around  the  growth  and  it  waa  removed,  the 
pterygoid  procesa  being  clipped  off  and  taken  along  with 
the  maaa. 

The  patient  went  on  very  well  without  any  febrile  aym- 
ptoma,  and  he  waa  fed  for  about  a  fortnight  with  the 
stomach  tube,  paased  when  neceaaary.  At  the  end  of  that 
time  he  began  to  awallow,  and  waa  aoon  able  to  take  auffi- 
cient  fluid  nourishment.  He  waa  diacharged  towarda  the 
end  of  Aueuet  in  veiy  good  health.  In  the  beginning  of 
October,  however,  it  waa  found  that  there  was  an  exca- 
vated uloer  in  the  middle  of  the  acar  oppoeite  the  part 
where  the  angle  of  the  jaw  had  previoualy  been.  Exami- 
nation of  acrapinga  from  the  interior  of  the  ulcer  ahowed 
numeroua  epithefial  cella,  and  ita  margina  were  hard.  It 
waa  therefore  evidently  a  recurrence.  The  patient  waa 
accordingly  readmitted  to  the  hoapital  on  October  7th. 

Case  XU.^ Second  Operation, 
Hia  condition  on  admiaaion  waa  that  he  hod  this  hard 
nodule  in  the  mouth.  The  greater  part  of  it  waa  ulcerated 
and  the  other  parts  were  apparently  aound.  On  October 
9th,  1895,  the  following  operation  waa  performed :  A 
curved  incision  was  made  from  just  in  front  of  the  ear 
forwards  for  about  4  inches,  following  the  anterior  border 
of  the  lower  jaw.  A  considerable  portion  of  skin  above 
this  incision,  which  was  somewhat  adherent,  was  removed. 
The  cheek  was  split  from  the  angle  of  the  mouth  to  meet 
the  former  incision,  and  the  whole  of  the  upper  part  was 
disaected  up,  the  edges  of  the  wound  being  well  aeparated, 
when  the  recurrence  waa  aeen  to  be  much  more  extenaive 
than  waa  auppoaed.  It  involved  the  masaeter  and  intemiJ 
pterygoid  muscles,  and  also  the  ascending  ramus  of  the 
lower  jaw.  This  portion  of  the  jaw  was  disarticulated 
and  removed,  and  the  whole  of  the  masseter  and  internal 
ptervgoid  muscles,  part  of  the  pterygoid  plates,  and  as 
much  of  the  scar  tissue  as  possible,  was  taken  away.  As 
I  was  not  quite  certain  with  regard  to  the  scar  tissue 
whether  I  had  quite  got  all  the  disease,  I  applied  nitric 
acid  to  the  raw  surface  ;  the  wound  was  stuffed,  a  large 
gap  being  left ;  no  attempt  at  a  plastic  operation  was  at 
that  time  made.     No  tracheotomy. 

The  patient  was  a  good  deal  collapsed  after  the  opera- 
tion, but  recovered  and  went  on  very  well  tiil  the  ninth 
day,  when  bleeding  occurred  from  the  wound,  and  on 
investigation  it  was  seen  to  come  from  the  internal  carotid 
artery,  which  was  lying  free  on  the  surface  of  the  wound. 
The  artery  was  tied  above  and  below,  and  divided.  The 
greater  part  of  the  wound  having  healed,  the  hole  in  the 
cheek  was  filled  up  by  a  plastic  operation  on  November 
20th,  1895,  the  edges  being  pared  and  a  large  flap  of  skin 
being  brought  over  from  the  back  of  the  neck.  In  three 
or  four  days  he  was  able  to  swallow  verv  well,  and  be  was 
diaoharged  on  December  11th.  When  last  seen  there  was 
no  recurrence. 

♦ 

An  Americao  contemporary  savs  that  the  Buccess  of 
the  Bavarian  qnack-pnest.  Father  Kneip,  has  pre- 
Tentod  many  a  French  theologian  from  sleeping.  The 
fashion  is  now  for  French  clergymen  to  imitate  this 
German  priest.  They  all  want  to  be  doctors  of  medi- 
cine, miracle  workers,  not  for  charity,  bat  for  fees. 
Father  Kneip  is  Eaid  to  prescribe  for  180  people  an 
hour.  The  patients  are  not  examined,  only  a  question 
or  two  is  put  to  them.    Such  is  fame  and  quackery. 


(inhtlMl  JBittatbt. 


JESSOP  HOSPITAL,  SHEFFIELD. 

Cask  h—Dermoid  Cvst  oj   the   Ooary.^OptrcUion— 
Rtcovery,   (a) 

Under  the  care  of  John  W.  Mabtik,  M.D., 
Hon«  Medical  Officer. 

H.  W.,  et.  17,  single,  dressmaker.  Admitted  to  the 
Jessop  Hospital  on  January  20th,  1896.  Menstruation 
commenced  when  about  14  years  of  age ;  periods  most 
irregular,  has  scarcely  been  regular  more  than  a  dozen 
times  up  to  last  Whitsuntide^  dysmenorrbooa.  When- 
ever the  periods  recurred  the  discharge,  which  was  scanty, 
lasted  from  three  to  four  days,  and  was  of  a  pale  odour.  The 
last  time  she  menstruated  was  about  a  week  before  Whit* 
suntide  in  1895,  i.e.,  about  May  26th.  At  the  same  time, 
she  first  noticed  the  swelling  of  her  body,  her  attention 
being  drawn  to  it  by  the  fact  that  her  dresses  would  not 
close  as  usual.  Since  then  the  enlargement  has  been 
gradual. 

On  admission,  she  measured: — Circumference  at  um- 
bilicus, ^\  inches  ;  circumference  two  inches  below,  33^ 
inches  ;  right  ant.  spine  to  umbilicus.  8}  inches :  left  ant. 
spine  to  umbilicus,  71  inches ;  pubis  to  umbilicus,  7 
inches  ;  xiphoid  cartilage  to  umbilicus,  7{  inches. 

Pregnancy  was  excluded.  P.V.  examination  showed  the 
roof  of  the  vagina  to  be  occupied  by  a  rounded  swellings 
and  the  uterus  was  pushed  up  in  front,  with  the  oe  on  a 
level  with  the  superior  border  of  the  symphysis  pubis. 
The  sound  was  passed  for  two  and  a  half  inches,  and  went 
in  well  forwards 

Operation  :  I  did  a  section  on  January  26th,  1896,  assisted 
by  my  colleagues.  A  point  of  interest  in  connection  with 
the  operation  was  the  peculiar  manner  in  which  the  fundus 
uteri  and  the  superior  border  of  the  left  broad  ligament 
were  lying  stretched  upwards  in  the  median  line,  giving 
rise  to  some  difficulty  in  forming  an  opinion  as  to  the  real 
nature  of  the  tumour  with  which  we  had  to  deal,  the 
uterus  and  muscular  tissue  of  the  broad  ligament  pre- 
senting themselves  in  the  opening  through  the  abdominal 
walls.  The  tumour  proved  to  be  a  large  dermoid.  There 
were  free  omental  adhesions  to  be  dealt  with,  as  well  as 
some  very  firm  adhesions  between  the  bowel  and  cyst 
wall,  deep  down  at  the  back,  on  the  right  side.  The 
pedicle  was  very  broad,  but  fortunately  thin,  and  waa 
fairly  easily  dealt  with.  The  operation  was  finished  in 
the  usual  wav,  and  the  abdominal  wound  closed  with  ^^^ 
sutures  of  silk- worm  gut. 

The  patient  made  an  excellent  recovery. 

Oasb  II. — Ovarian  Tumour  —  Papilloma  —  Operation 
— Recovery — Dementia, 

Mbs.  G ,  set.  32,  married  13  years,  has  had  7  chil- 
dren, the  last  4^  years  ago,  this  was  stillborn.  Eight 
months  after  the  birth  of  the  last  child  she  had  a  miscar- 
riage. Nothing  remarkable  in  her  menstrual  history ;  she 
commenced  when  about  12  years  of  age,  and  was  regular 
from  the  first  even^  three  or  four  weeks  both  as  to  quan- 
tity and  colour.  The  last  period  was  on  the  Ist  of  Januarv, 
1896.  She  was  admitted  into  the  hospital  on  Dec.  6th» 
1895.  Never  felt  well  since  the  last  miscarriage.  Fourteen 
months  before  admispion  she  first  noticed  that  ner  body  waa 
swollen.  Previous  to  detecting  the  swelling,  she  sufiered 
from  symptoms  which  she  set  down  to  severe  indigestion. 
The  amount  of  abdominal  swelling  seemed  to  be  very 
variable ;  as  she  described  it,  *'It  went  and  came."  The 
swelling  was  most  noticeable  between  the  periods,  and 
subsid^  when  they  appeared.  Suffered  a  good  deal  from 
intermittent  attacks  of  pain.  Was  under  the  idea 
that  she  had  lost  flesh  pretty  largely,  did  not,  however^ 
give  one  the  idea  very  strikingly,  that  she  was  cachectic, 
as  she  seemed  well  nourished,  and  had  a  fair  complexion.. 
There  has  been  swelling  of  the  legs  from  the  first  of 
the  attack  down  to  her  entering  the  hospital.  Has  had  a 
constant  sense  of  bearing  down,  and  also  experienced  con- 
siderable difficulty  in  passing  water.    On  examining  the 


(n)  The  notes  of  these  caies  were  commmileated  to  the  Sheffield 
Medlco-Chlrmgical  Boclety,  at  iU  meetiog  on  Feb.  27th,  1896,  and 
specimens  shown. 


Mar.  18,  1896 


TBANSACTIOirS  OF  SOCIETIES. 


Tub  Mbdical  Pbbss.     291 


abdomen  one  saw  that  ic  was  swollen.  When  first  seen, 
there  was  dalnees  in  the  left  flank  as  far  forward  as  the 
median  line,  and  as  high  as  aline  drawn  horizontally  about 
two  inches  above  the  ambilicas ;  this  dulnees  was,  how- 
ever, very  shiftine  in  its  character,  the  parts  that  were 
dull  at  one  time  Mcoming  tympanitic  at  the  next.  On 
making  a  per  vaffinam  examination,  I  found  the  cervix 
lacerated ;  the  eoand  passed  in  two  and  a  half  inches.  I 
fonnd  Douglas's  pouch  occupied  by  a  hard  lump.  I 
operated  on  the  31st  of  January,  and  got  the  lump  away  ; 
toe  right  was  the  ovary  sffected  ;  tumour  was  about  the 
size  of  two  laree  oranges.  Her  convalescence  has  been 
complicated  wiUi  an  attack  of  diarrhcea  set  up  by  an  ounce 
of  white  mixture,  given  to  open  the  bowels  about  the  fourth 
day.  I  regret  to  say  that  the  patient  became  demented, 
and  had  to  oe  removed  to  Wadsley  Asylum. 

jRemarbt. — ^The  tumour  in  this  caee  was  very  kindly 
examined  for  me  by  Dr.  Wilkinson,  Curator  of  the  Patho- 
logical Museum  at  the  Sheffield  Medical  School,  &c.,  &c., 
and  I  am  much  indebted  to  him  for  the  following  report : — 
^'Papillomatous  Proliferating  Cyst. — Papillomatous  pro- 
jections are  everywhere  being  developed  from  the  walls  of 
the  cyst.  Some  of  the  cysts  have  been  filled  with  them  ; 
elsewhere  the  papillomatous  projections  have  burst  through 
the  cyst  wall,  and  have  projected  upon  the  surface  of  the 
tumour.  There  is  no  small-celled  infiltration.  Such 
tumours  usuaJly  possess  a  power  of  infecting  the  peri- 
toneum, but  rarely  generalise  through  the  lymphatics  or 
blood  stream.  They  must  be  considered  as  possessing  a 
modified  malignancy." 


CLINICAL  SOCIETY  OF  LONDON. 
Mextinu  hild  Friday,  March  13th,  1896. 

The  President,  Dr.  Buzzard,  in  the  Chair. 


Mb.  Goldino  Bird  read  the  notes  of  a  case  of 

LTHPH  SCROTUM  AND  LYMPH  VARIX. 

The  first  case  occurred  in  an  athletic  young  man  seen  in 
Sept.  1895,  in  consultation  with  Dr.  Patrick  Maoson. 
There  were  cutaneous  swellings  on  the  left  side  of  the 
scrotum ;  these  swellings  had  frequently  burst  and  bad 
discharged  a  milky  fluid.  He  was  bom  in  England  and 
had  never  been  out  of  London.  On  examination  there 
were  veeicles  or  saccules  of  the  size  of  millet  seeds,  form- 
ing mobiliform  lines  converging  towards  the  groin.  There 
were  no  enlarged  glands  in  the  groin  and  no  enlargement 
of  the  spleen.  When  pricked  the  swellings  diecharged  a 
yellowish  milky  fluid,  which  microscopically  had  the 
appearance  of  chyle.  Nothing  abnormal  could  be  found 
in  the  blood.  The  cause  was  regarded  as  pressure  of 
enlarged  tubercular  mediastinal  glands  upon  Uie  thoracic 
duct.  The  right  half  of  the  scrotum  was  excised,  the 
leaking  points  of  divided  lymph  vessels  being  ligatured 
with  silk.  On  examination  of  tne  removed  skin  nuu*erous 
dilated  lymph  vessels  were  found  in  the  dartos.  The  lad 
afterwards  made  a  good  recovery,  the  remainder  of  the 
ecrotnm  was  rather  tightly  stretched  over  the  testes  and 
only  a  few  points  of  dilated  lymph  vessels  were  visible  in- 
the  perineum.  Tbe  patient  was  seen  again  three  weeks 
ago  and  was  quite  well.  In  the  forty-sixth  volume  of  tbe 
Medico- Chirnrgical  '*  Transactions,"  a  paper  was  con- 
tributed by  Dr.  Buchanan,  of  Glasgow,  relating  a  case  of 
lymph  varix  in  the  thigh  of  a  woman,  it  had  developed  21 
jears  previously,  after  her  confinement,  and  there  was 
nothing  suggestive  of  filaria.  The  second  case  was  one  of 
lymph  varix  in  a  ^ntleman  who  had  long  returned  from 
Ceylon.  On  the  right  side  there  was  a  bubonc  sole  and  on 
the  left  a  hydrocele  of  the  tunica  vaginalis  testis.  On  the 
left  side  there  also  appeared  to  be  a  small  inguinal  hernia 
with  contents  feeling  like  omentum,  but  it  was  noticed 
that  the  internal  abdominal  ring  was  a  mere  slit.  The 
hydrocele  was  tapped  and  a  double  inguinal  truss 
dirdered  in  Jul^  1890.  In  April  1891,  it  was  noticed  that 
the  swelling  still  came  down  under  the  truss  on  the  left 
side,  and  it  was  not  completely  reducible.  An  operation 
for  radical  cure  was  performed  in  May,  1891,  and  a  swelling 
iound  in  the  ingninal  canal  looking  Uke  a  varicocele  except 


that  the  large  vessels  were  distended  with  milky  fluid. 
The  vessels  were  isolated  and  ligatured  above  at  the 
external  abdominal  ring  and  below  at  the  testes.  The 
fluid  evacuated  from  tho  vessels  had  the  microscopical 
appearances  of  chyle  and  no  filaria  was  discovered.  In 
the  twelfth  volume  of  the  JRevue  de  Chirurqie  six  cases  of 
filaria  were  related  which  had  a  surgical  aspect.  In  two 
of  them  the  swellings  resembled  herni»,  in  two,  enlarge- 
ments of  the  testes,  and  in  two,  enlsrgement  of  the  lym- 
phatic glands. 

Dr.  CoLMAN  and  Mr.  Ballanob  related  a  case  of 

NB0PLA8M  CYST  IN  THR    REGION    OF    TIJE    AKOULAR  GyRUS 
OAUSIKG    APHASIA,  ALEXIA,   AND  AGRAPHIA. 

The  case  was  that  of  a  lady,  set.  32,  who  had  previously 
had  excellent  health.  The  first  symptom  was  an  isolated 
fit,  which  occurred  in  December,  1^94,  ten  months  before 
death.  She  remained  in  her  usual  health  till  May,  1895, 
when  she  misspelled  words,  but  was  unable  to  recognise 
the  error  when  it  was  pointed  out.  She  had  difficulty  in 
comprehending  the  meaning  of  printed  matter,  and  some 
hesitation  ia  expressing  herself.  There  was  occasional 
vomiting  associated  with  headache,  and  in  June,  weakness 
of  the  right  hand  developed.  These  symptoms  were  re- 
lieved for  a  time  by  iodide  of  potassium,  but  returned 
ultimately  with  greater  intensity.  At  tbe  end  of  July, 
the  first  indication  of  optic  neuritis  occurred.  On  August 
9th,  she  had  been  in  severe  sgonising  pain  for  several  days. 
There  was  no  facial  or  lingual  paralyFis,  but  some  aphasia 
with  paralysis  of  the  right  hand,  partial  hemi-ansasthesia, 
with  analeesia  of  the  arm.  The  right  knee-jerk  could  not 
be  elicited,  and  there  was  definite,  though  slight,  optic 
neuritis.  During  the  previous  nights,  respiration  nad 
been  irregular,  and  had  stopped  several  timep.  The  dia- 
gnosis was  made  that  there  was  a  tumour  in  the  centrum 
ovale,  beneath  the  angular  gyrus  and  temporo-sphenoidal 
convolutions,  intetfering  with  the  fibres  passing  from  them 
to  Broca's  convolution,  and  to  the  region  concerned  in  writ- 
ing movements,  and  with  those  passing  from  the  arm  centre 
in  the  Rolandic  region  to  the  internal  capsule,  and  press- 
ing on  the  internal  capsule  to  produce  the  partial 
hemiansBsthesia.  The  absence  of  hemianopia  appeared 
to  indicate  that  this  pressure  was  not  very  great.  It  was 
decided  to  relieve  the  pressure  in  two  stages ;  first,  by 
removing  freely  the  bone  over  the  region  of  the  brain, 
and,  at  a  later  period,  opening  the  dura.  The  parallelo- 
gram of  bone  was  accordingly  removed,  roughly  about 
three  inches  square,  from  the  parietal  bone.  The  dura 
at  once  bulged  into  the  opening.  This  relief  of  pressure 
wss  followed  at  once  by  great  improvement.  The  pain 
was  entirely  relieved,  the  sensory  troubles  cleared  up, 
and  the  patient  could  read  without  difficulty.  A  week 
later,  the  pain  and  vomiting  returned,  the  optic  neuritis 
increased,  and  a  fiap  of  dura,  the  siste  of  the  opening  in 
tbe  bone,  was  thrown  down.  Tbe  brain  bulged  through 
the  opening,  and  a  large  cyst  was  found  pointing  through 
the  angular  gvrus.  The  cyst  contained  clear  fiuid,  which 
examination  showed  to  be  plasma  simply.  It  coagulated 
when  exposed  to  the  air  or  in  a  drainage-tube,  and  this 
^ave  rise  to  much  difficulty  in  evacuating  the  cyst,  and 
in  the  subsequent  drainage.  After  the  emptying  of  the 
cy»t  there  was  temporary  complete  aphasia,  which  passed 
off  after  a  few  days.  She  was  entirely  relieved  of  the  head- 
ache, read  bookseagerly,and  could  express  herself  accurately 
in  writing.  The  optic  neuritis  completely  subsided.  In 
October,  however,  the  drainage  became  unsatisfactory 
owing  to  the  coagulation  of  the  fiuid,  paralysis  of  the 
right  hand  became  complete,  and  the  patient  became 
totally  word-blind  and  word-deaf  as  well  as  aphasic  A 
few  davs  before  death  the  optic  neuritis  re-appeared.  She 
died  ultimately  from  pneumonia.  Post-mortem  examina- 
tion showed  tbat  there  was  a  large  infiltrating  gliomat 
containing  a  cyst,  in  centrum  ovale.  It  infiltrated  the 
supra-marginal,''angular,  and  superior  temporo-sphenoidal 
convolutions,  without  destroying  the  pyramidal  cells.  It 
reached  nearly  up  to,  but  did  not  involve  the  internal 
capsule.  Careful  microscopic  examination  showed  that 
tbe  inferior  frontal  convolution  and  the  internal  capsule 
were  entirely  free  from  infiltration.  Attention  was  drawn 
to  the  frequency  of  isolated  convulsions  in  the  early  his- 
tory of  cases  of  cerebral  tumour,  and  to  the  fallacious 
temporary  improvement  often  seen  in  such  cases  under 
iodide  of  potassinm.    The  character  of  tbe  aphasia  was 


292     Tbb  lfn>iCAL  Pins. 


TBA5SACnOK8  OF  SOCIETIES. 


Mab  is.  laOb. 


discnttedy  and  cafcaqaoted  justify ine  the  localifation  of 
tiie  tomonr  in  the  angnlar  rather  tbao  in  the  frontal 
ze|rioD« 

Dr.  Bkkvor,  after  eongrmtulating  the  writers  on  the 
deameas  with  which  the  oaae  had  been  brought  forward, 
said  that  the  abeenoe  of  bemianopia  was  interesting.  It 
had  been  rather  a  puzzle  what  the  meaning  6f  this  sym- 
ptom was,  as  this  lesion  was  often  far  away  fiom  fibres, 
damage  to  which  wonld  prodnoe  this  symptom.  It  prob- 
ably resulted  nsnallv  from  affection  of  the  o]^  radiations 
on  their  way  from  the  optic  thalamus  to  the  occipital  lobe. 
In  the  case  related,  it  appeared  that  the  optic  radiations 
were  not  affected.  He  referred  to  a  case  which  had  been 
published  by  himself  and  Mr.  Horsley,  in  which  a  boy, 
after  receiving  a  kick  from  a  horse,  developed  an  abscess 
in  his  left  angular  gyrus.  Word-blindness  and  bemiano- 
pia were  present,  but  in  that  instance,  the  lesion  extended 
and  affected  the  optic  radiations.  In  the  case  under  dis- 
cussion, the  anantbesia  passed  off,  in  spite  of  the  fact  that 
the  parietal  lobule  was  affected.  Another  important  thing 
was  the  opening  of  the  dura  mater  to  relieve  intra  cranial 
pressure.  It  had  been  shown  experimentally  that  when  a 
portion  of  the  cranial  vault  was  removed,  the  pressure  was 
not  much  diminished,  it  was  essential  to  open  the  dura 
mater  to  accomplish  a  material  diminution  of  pressure. 

Dr.  Jamss  Tatlob  inquired  as  to  the  character  of  the 
visual  field,  especially  as  to  the  presence  of  concentric  con- 
traction on  the  side  on  which  the  lesion  existed.  He  dis- 
sented from  the  conclusion  that  pressure  was  not  an 
important  matter  in  the  causation  of  neuritis.  The 
increase  of  the  pressure  before  death  was  accompanied  by 
a  recrudescence  of  the  optic  neuritis. 

The  Prisidbnt  congratulated  the  authors  on  the  clear- 
ness and  conciseness  of  their  paper.  The  patient  had 
been  under  his  own  care  for  a  month,  and  he  had 
found  the  diagnosis  of  tumour  easy,  notwithstanding  the 
late  development  of  the  optic  neuritis.  The  symptoms 
varied  much  in  intensity  and  severity,  and  this  was  true 
of  the  paresis  of  the  face.  He  had  been  in  doubt  as  to  the 
main  seat  of  the  tumour,  and  it  appeared  to  him  likely 
that  the  neighbourhood  of  Broca's  convolution  was  more 
directly  interfered  with  than  the  post-mortem  examination 
afterwards  showed.  He  concluded  that  there  was  a  large 
eubcortical  tumour  present  and  from  the  variation  in  inten- 
sity of  the  svmptoms  he  regarded  it  as  of  vascular  nature 
and  probably  a  glioma,  and  consequently  not  an  advan- 
tageous one  for  operation.  He,  therefore,  prescribed 
iodide  of  potassium  and  mercury,  and  decided  to  await 
their  effect.  The  question  of  surgical  interference  in  these 
cases  of  brain  tumour  was  rather  a  difficult  one.  It  was 
certain  that  where  the  tumour  was  not  capable  of  removal 
the  operation  often  prolonged  life,  but  nevertheless  the 
whole  proceedings  attending  operation  were  formidable, 
and  he  trusted  that  before  long  means  would  be  devised 
to  avoid  operation  for  the  mere  reUef  of  tension,  and  to 
accomplish  this  by  some  other  means.  He  did  not  deny 
that  the  amount  of  relief  given  by  operation  was  enor- 
mous, and  was  usually  well  purchased  at  the  price.  Where 
indications  existed  that  the  tumour  was  likely  to  have 
become  enoapeuled  physicians  readily  hailed  the  assistance 
of  the  surgeon,  but  such  oases  were  not  at  all  numerous. 

Dr.  Stabb  analysed  a  large  number  of  oases  of  cerebral 
tumour,  and  had  found  that  only  7  per  cent  of  them  were 
capable  of  removal  It  was  well  that  this  fact  should  be 
known,  for  the  laity,  and  even  the  medical  public,  seemed 
to  think  that  the  great  majority  of  intra-oranial  tumours 
were  removable  by  surgical  procedures. 

Dr.  CoLMAN,  in  re|3y,  said  that  they  stated  in  their 
paper  that  the  pressure  was  not  the  only  cause  of  optic 
neuritis,  they  by  no  means  denied  its  causative  influence. 
The  vLBual  field  had  not  been  tested  with  a  perimeter.  At 
the  post-mortem  examination  there  was  actual  infiltration 
of  the  optic  radiations,  but  death  took  place  long  after 
the  last  observation  as  to  the  presence  or  absence  of 
bemianopia. 

Mr.  Ballance,  in  reply,  admitted  that  operation  was 
dreadful,  but  it  was  undertaken  as  the  only  relief  of  a  very 
dreadful  disease.  Theonly  way  of  relieving  tension  other  than 
by  operation  would  be  to  discover  som^ing  antagonistic 
to  malignant  growth,  and  to  do  this  the  real  nature  of 
their  cause  must  be  ascertained. 
Dr.  F.  Lucas  Bkiiham  read  the  notes  of  a  case  of 


HJBVOIBBHAGB  INTO  THE  POMS  VABOUI,  TBBATBD  BY  A'BHl- 
SIOnON  AND  VOLLOWID  BT  BEOOYXBT. 

The  case  was  that  of  a  widow,  ast.  03,  whose  mother  had 
died  of  apoplexv  followed  by  hemiplegia  at  the  age  of  5& 
She  was  a  healthy  woman,  rather  stout  in  build.  She  bore 
the  marks  of  old  scrofulous  abscesses  in  the  neck,  but  was 
otherwise  free  from  organic  disease.  She  had  had  two 
attacks  of  influenza  in  the  last  three  years.  The  present 
illness  began  without  any  premonitory  symptoms.  She 
was  suddenly  seized,  while  dressing  one  morning,  with 
apoplexy  attended  by  epileptiform  convulsions,  chiefly  on 
the  left  side,  and  complete  unconsciousness.  The  eyes  were 
shut ;  the  head,  eyeballs,  and  month  were  all  drawn  to 
the  right  side  ;  the  pupils  were  much  contracted,  the  lefb 
being  rather  the  smaller.  Respiration  was  much  embar- 
rassed. There  was  foaming  at  the  mouth,  but  the  tongue 
was  not  bitten.  The  surntce  of  the  body  was  pale  and 
dusky,  with  a  clammy  sweat.  Within  three-onarters  of  an 
hour  from  the  onset  of  the  attack  she  was  bled  from  the 
right  median  cephalic  vein.  Forty-eight  ounces  of  blood 
were  withdrawn.  When  this  was  done  the  convulsions 
ceased  and  breathing  became  easy ;  the  pupils  were 
larger,  and  the  conjugate  deviation  of  the  eyes  and  head 
was  less  marked.  The  skin  was  pale  but  less  dusky.  Ck>n- 
sciousness  had  not  returned.  Calomel,  gr.  v,  was  adminis- 
tered in  addition  to  croton  oil.  There  was  no  return  of 
the  convulsions  at  all ;  the  eyes,  head,  and  limbs  moved 
more  freely  and  spontaneously,  but  there  was  found  to  be 
some  weakness  of  the  right  side ;  and  later,  distinct  an»s- 
thesia  was  detected  in  the  right  arm  and  leg.  Sensibility 
and  consciontness  gradually  returned,  but  complete  con- 
sciousness and  memory  did  not  return  for  twelve  days,  the 
patient  describing  this  interval  afterwards  as  an  absolute 
blank.  There  was  slight  aphasia  during  reoovery.  The 
paralysis  of  the  left  side  of  the  face  and  right  limba  lasted 
but  for  a  short  time,  but  traces  of  anssUieeia  in  certain 
fingers  and  toes  persisted  for  some  weeks.  Retention  of 
urine  occurred  immediately  after  the  apoplexy,  which 
caused  cystitis.  There  was  obstinate  constipation  all 
along.  The  patient  steadily  recovered.  In  a  month's 
time  she  was  able  to  walk  about  the  room,  and  in  six  weeks 
from  the  onset  she  went  out  of  doors  for  a  walk.  She  has 
remained  in  excellent  health  up  to  the  present  time — 
eleven  monfihs  after. 

Dr.  F.  J.  Smith  said  that  if  the  hsBmorrhage  were 
pontine,  it  ought  to  have  given  rise  to  more  organic  dis- 
turbance than  was  afterwards  shown.  He  thought  more 
likely  it  was  a  case  of  cerebral  or  meningeal  congestion. 

Dr.  Bbbvor  thought  that  the  lesion  was  more  l&ely  one 
of  the  left  cerebral  hemisi^ere.  He  quoted  the  case  of  a 
boy  who  was  convulsed  for  twenty  minutes,  and  was 
afterwards  in  a  state  of  coma  for  twenty- four  hours,  and 
he  ultimately  got  well  without  venesection.  The  latter 
procedure,  therefore,  he  regarded  as  ntherposl  hoc 

The  President  was  inclined  to  aeree  with  Dr.  Benham*s 
dia^osis.  Theextremely  contracted  pupil,  the  convulsions^ 
conjugate  deviation  of  the  eyes,  all  pointed  to  pontine 
lesion.  The  lower  temperature  pointed  to  hemorrhage 
rather  than  to  meningitia  The  recovery  of  power  was 
rapid,  but  the  condition  at  the  worst  had  l>een  one  of  pare- 
sis rather  than  paralysia  He  referred  to  the  cased  a 
female  patient,  who  suffered  from  a  lesion  of  the  pons» 
which  oeveloped  suddenly.  He  himself  saw  her  move  all 
her  limbs  shortly  before  death,  yet  at  the  post-mortem 
examination  a  clot  of  blood,  weigning  more  than  an  ounces 
was  found  to  be  lying  on  the  euriace  of  the  pona  He 
thought  also  in  Dr.  Benham's  case  the  blood  was  effused 
upon  the  surface  of  the  pons,  and  not  within  it  ploughing^ 
up  the  nervous  matter  :  the  lesion  was  more  of  pressure 
than  of  destruction.  The  ansesthesia  of  both  legs  below 
the  knee  would  also  point  in  this  direction,  iriiile  this 
could  not  be  explained  by  a  hemispherical  lesion. 

Dr.  Bowles  remarked  that  bleeding  relieved  the  respi* 
ratory  difficulties,  but  this  might  perhaps  have  been  done 
by  another  method .  The  mouth  should  nave  been  opened, 
the  tongue  guarded,  the  patient  placed  on  the  side  to  let 
the  ssBva  flow  away  and  thus  prevent  foaming  end 
obstruction  at  the  fauces 

Dr.  TuBHET  thought  that  it  was  extremely  difficult  te 
accept  the  diagnoeis  of  pontine  lesion  and  suggested  as  an 
alternative  a  meningeal  btemorrhagp.    The  attacks  were 


Vab.  18, 1895. 


TRANSACTIONS  OF  SOCIETIES. 


Tbj»  Mxdioal  Piiiss.     293 


like  the  oonvaluve  attacks  ireqneDcly  moto  wiib  in  general 
paraly^ia. 

Dr.  BiNHAM,  in  reply*  eaid  that  the  diaffnosis  had  been 
based  aixm  the  presence  of  crossed  paralysis  with  extreme 
contraction  of  the  papiL  He  thought  that  the  lesion  was 
rather  towards  the  roof  than  in  the  snbstance  of  the  pons. 
Bleeding  was  eood  for  plethoric  people  and  marked  benefit 
woold  follow  if  sufficient  blood  were  taken. 


R07AL  ACAD£MY  OF    MEDICINE  IN  IRELAND 

Section  of  Statb  Mbdicdib. 

Mbbtino  hbld  Friday,  Febsitast  7th. 


The  President,  Dr.  J.  M.  Redmond,  in  the  Chair. 


prisidrnt's  address  on  crime  and  ths  trratment  of 
criminals. 
Ths  Prbsidbnt,  in  his  Address,  dealt  with  the  causes  of 
<srime  and  the  treatment  of  criminals.  Criminalstatistics, 
pnblished  since  1877,  showed  a  great  and  gradual  fallinff 
off  in  the  number  of  convictions  in  England,  Wales,  and 
Ireland,  but  the  diminution  was  not  so  marked  in  the  case 
of  Scotland.  He  attributed  this  chanee  for  the  better  to 
education  and  the  improvement  in  Uie  condition  under 
which  the  bulk  of  the  working  classes  live.  Legislation 
which  made  minor  offences,  such  as  the  following  (extract 
from  a  Hong  Kong  newspaper)  must  be  condemned  owing 
to  the  danger  of  corrupting  the  innocent  by  causing  them 
to  associate  with  habitual  criminals :  '*  For  State-created 
crime  Hong  Kong  might  easily  take  first  place.  A  singing 
g^rl  is  sent  for  to  attend  an  entertainment  in  the  evening 
at  a  house  in  the  same  street  as  that  in  which  she  lives, 
but  on  the  opposite  side  and  a  little  lower  down.  She 
seta  out  to  cross  the  street  in  an  oblique  direction,  and  i^ 
at  once  pounced  on  by  a  ferocious  minion  of  the  law  and 
haled  to  the  police  station  because  she  has  not  provided 
herself  with  a  lantern."  He  calculated  that  the  annual 
expenditure  in  ciiminal  justice  and  administration — 
prisons,  asylums,  reformatories,  &c. — ^reached  annually  an 
enormous  sum,  which  constituted  a  tremendous  drain  on 
the  resources  of  the  state.  Having  passed  in  review  the 
opinions  of  medical  writers  on  the  suoject  of  insanity  and 
icherited  crime,  he  stated  that  the  treatment  of  crime 
must  come  more  and  more  under  the  jurisdiction  of  the 
medical  profession,  as  modem  science  shows  how  much 
erime  is  due  to  hereditary  causes,  and  modern  philosophy 
how  much  crime  is  the  consequence  of  unhealthy  sur- 
roundings. 

Dr.  Obdhshaw  said  he  was  well  aware  that  it  was  not 
customary  to  make  tl>e  subject  of  an  address  the  ground 
of  discussion.  He  thought  it  would  be  best  to  receive  the 
statementa  of  the  President  as  ex  cathedra  statemento. 
He  (Dr.  Grimshaw)  did  not  rise  to  open  a  discussion  but 
to  move  a  vote  of  thsnks  to  the  President.  To  him,  how- 
ever, the  paper  had  a  peculiar  interest,  for  it  was  his  dutv 
to  draw  up  and  arranse  the  criminal  statistics  of  Irelana. 
It  might  be  thought  by  some  that  the  paper  was  not  one 
which  ought  to  be  read  to  a  medical  association  ;  but  he 
was  of  quite  a  different  opinion — indeed,  he  believed  the 
subject  dealt  with  in  it  was  a  subject  of  great  importance  to 
medical  men.  For  instance,  the  increasing  numbers  of 
crimes  arising  out  of  drink,  and  drunkenness  itself,  were 
matters  that  deeply  concerned  the  medical  profession. 
As  to  the  hereditary  tendency  in  drunkards,  he  thought 
the  desire  for  drink  amongst  many  persons  could  be  ex- 
plained on  erounds  other  than  herecuty.  In  some,  there 
IS  a  want  ofbone  in  the  constitution— a  looseness  of  the 
nervous  system,  which  instinctively  impels  them  to  have 
recourse  to  alcoholic  stimulanta  ;  the  indulgence  grows 
nntil  they  become  confirmed  drunkards.  The  weak-mind- 
edness of  other  individuals  renders  them  incapable  of 
resisting  the  desire  for  drink  when  once  it  has  been  created. 
Many  of  our  social  habits,  too,  fostered  the  vice.  Associa- 
tion of  young  people  with  others  addicted  to  drink  was 
also  a  fact  not  to  be  forgotten.  The  number  of  convictions 
at  the  police  courta  was  some  test— though  not  an  abso- 
lutely true  teet— of  the  extent  to  which  drunkenness  pre- 
vailed in  a  country.  He  was  convinced  that  medical  prac- 
titioners, exercising  so  large  an  amount  of  control  as  they 
did  over  the  bodily  and  mental  health  of  the  oommnnity, 
eould  be  a  power  in  preventing  drunkenness.    There  was 


another  point,  the  law  itself  often  created  crime,  as  in  the 
cave  of  the  Hong  Kong  girl  referred  to  in  the  address.  He 
insisted  on  the  importance  of  preserving  a  proportion 
between  the  gravity  of  the  crime  committed  and  ita  pun- 
ishment. As  regards  crime  in  general,  he  (Dr.  Grimshaw) 
thought  that  too  much  importance  had  been  placed  on  the 
question  of  heredity.  He  moved  a  vote  of  thanks  to  the 
President  for  his  interesting  and  able  paper. 

Dr.  Cox  seconded  the  vote  of  thanks,  and  said  that  the 
President's  papw  was  a  most  interesting  and  able  one. 
As  to  the  questions  raised  in  that  paper,  the  medical 
profession  ignored  them  too  much,  and  the  public  suffered 
thereby,  fie  adverted  to  a  class  of  crimes  that  might  be 
punished  sufficiently  by  compelling  the  offender  to  give 
compttisation  to  the  injured  party.  He  referred  to  the 
disparity  that  was  at  times  to  be  found  between  a  crime 
and  ita  punishment,  and,  going  back  to  sheep-stealing 
times,  related  some  amusing  anecdotes  to  illustrate  his 
meaning.  He  suggested  that  if  the  President's  address 
were  pnnted  it  would  have  an  influence  on  the  minds  of 
legislators* 

The  Prisidrnt  thanked  the  Section  for  the  manner  in 
which  his  address  was  received,  but  thought  the  pnusee 
bestowed  on  it  were  out  of  proportion  to  ita  merits. 

The  Section  then  adjourned. 


WEST-LONDON  MEDICO-CHIRURGICAL  SOCIETY. 
Mbstino  hrld  Friday,  March  6th,  1896. 

A.  Symons  EccLXs,  MB.,  President,  in  the  Chair. 

Clinical  Evbnino. 

LudtoM'9  ^a^'na.— Dr.  Sbymour  Taylor  showed  thi» 
case.  The  patient,  a  man,  set.  30,  had  passed  through  a 
severe  attack  and  recovered  save  for  a  small  amount  of 
residual  induration  on  the  right  side  of  the  neck,  under  th» 
use  of  iodide  of  potassium.  No  incisions  were  found  to 
be  necessary.  The  case  was  one  of  a  series  which  occurred* 
as  if  epidemically,  in  the  Hammersmith  district. 

Sporadic  Cretinism  — Dr.  Chapman  brought  forward  this 
case,  a  girl,  set.  18,  who  presented  most  of  the  typical 
features  of  the  disease.  She  had  never  been  able  to  stend» 
and  had  no  control  over  the  sphincters.  Her  father  had 
been  a  very  heavy  drinker. 

Multiple  Lipomata.—jyr.  Chapman  showed  also  a  man, 
set.  47,  who  hui  a  large  number  of  lobulated  subcuteneous 
growths  presenting  the  physical  characteristics  of  Upomata 
or  fibro-hpomata,  in  size  varyine  from  a  nut  to  an  orange. 
The  first  one  appeared  about  four  years  ago  during  an 
attack  of  malarial  fever,  in  which  there  was  a  marked 
shrinkage  of  his  normal  subcutaneous  fat.  The  only  parte 
of  the  b^y  now  free  from  the  growths  were  those  subjected 
to  pressure.  There  was  no  evidence  of  visceral  disease, 
ana  no  history  of  syphilis.  None  of  the  tumours  had  k>een 
excised  for  examination. 

The  Prbsidrnt  conjectured  that  the  gprowths  might  be 
of  lymphatic  origin.  He  had  seen  similar  cases  in  that 
last  year  which  were  believed  to  be  of  that  nature. 

Drs.  S.  Taylor  and  Alderson  believed  that  the  growth» 
were  lipomatous. 

Braiued  /Sl»n.— Dr.  Suthirland  exhibited  this  caae,  a. 
middle-aged  woman,  whose  symptoms  had  lasted  about 
eight  years,  and  were  those  usually  found  in  Addison's- 
disease.  The  bronsing  was  most  marked  on  the  face,, 
breasts,  axills,  elbows,  buttocks,  and  linea  alba.  Supra^ 
renal  extract  had  been  tried  for  six  weeks  without  benefit.. 

Dr.  Campbbll  Pope  quoted  a  case  of  marked  bronzing 
in  which  eitensive  disease  of  the  spleen  had  been  the  chief 
lesion  found  post-mortem. 

General  Paralysis  in  the  Earljf  Stages. — Dr.  Suthxr- 
LAND  showed  this  case,  a  man,  set.  33,  who  had  some  loss 
of  power  in  the  arms,  partial  loss  of  memory,  slight 
tremulousness  of  the  tongue,  and  inequality  of  the  pupils. 
The  knee-jerks  appeared  to  be  slightly  exaggerated,  but 
this  bad  not  been  previously  noticra.  He  had  been  much 
exposed  to  the  weather,  and  was  addicted  to  alcoholic  and 
other  excesses. 

Dr.  Sbymour  Tukb  discussed  the  case  and  mentioned 
the  frequency  with  which  this  disease  presented  itself  in 
cases  of  untreated  or  badly-treated  svpbilis. 

CardiaeBruiis, — Dr.  A.  L.  Scott  snowed  a  man,  set.  28^ 


294     Thx  Midigal  Pbtss. 


TBANSACnOKS  OF  SOCIETIES. 


who  pretented  an  enormously  hypertrophied  heart.    There 
were  si^s  of  a  thoracic  aoeariam. 

Dr.  Sbymoxtb  Tatlob  admitted  that  all  the  cardinal 
symptoms  of  aneurism  existed,  except  tumour. 

Salivary  Fistula,— Mr,  Bidwbll  showed  a  man,  »t.  45, 
who  had  developed  a  salivary  fistula  in  consequence  of  an 
acute  abscess  of  the  parotid.  The  abscess  had  been  opened 
in  August,  1894,  ana  when  the  discharge  of  pus  ceased  a 
salivary  fistula  became  establiahed,  which  discharged* 
large  Quantities  of  saliva.  The  patient  was  placed  under 
chloroform,  and  a  probe  was  passed  along  the  duct  as 
far  as  possible,  and  then  it  was  cut  down  upon  from 
the  original  wound  in  the  cheek ;  the  probe  was 
then  pushed  through  the  fistulous  opening  and  left 
in  position  for  a  few  days.  When  it  was  withdrawn  a 
couple  of  strands  of  silk-worm  gut  were  passed  through 
the  duct  and  out  at  the  fistula,  and  the  ends  tied  together ; 
after  a  fortnight  they  were  withdrawn,  and  the  fistula 
ceased  discharging,  but  recommenced  in  a  few  days  ;  a 
silk  ligature  was  then  passed  through  the  duct  and  fistula 
in  a  similar  way,  and  left  in  for  a  fortnight ;  this  caused 
considerable  suppuration,  and  after  its  withdrawal  the 
fiatula  healed  up.  A  probe  has  occasionally  been  passed 
up  the  duct  to  prevent  the  stricture  closing.  Mr.  Bidwell 
pointed  out  that  it  apparently  was  necessary  to  set  up 
some  suppuration  along  the  tract  of  the  duct  in  order  to 
efiect  a  cure. 

Adenoma  of  the  Timgne. — Mr.  Bidwbll  also  showed  a 
girl,  et.  14,  with  a  tumour  in  the  left  half  of  the  tip  of  the 
tongue.  This  had  been  noticed  for  nineteen  months.  A 
distinct  tumour  was  felt,  and  veeioles  were  seen  on  the 
surface.  This  vesicular  appearance  being  probably  due  to 
lymphatic  obstruction,  and  their  presence  explained  how 
these  tumours  were  often  descrioed  as  lympnangiomata. 
He  recommended  excision  of  the  tumour. 

Gummata  of  the  Arms. — Mr.  Bidwbll  also  showed  a 
woman,  sBt.  49,  who  presented  large  ffummatous  enlarge- 
ments of  the  upper  end  of  the  right  radius  and  of  the  lower 
end  of  the  left  humerus. 

Mr.  McAdam  ECX3LES  suggested  the  possibility  of  the 
nodules  being  tuberculous. 

Mr.  Bidwell  said  they  were  undoubtedly  gummatous. 
The  patient  had  passed  through  an  attack  of  syphilis,  and 
had  bad  gummata  elsewhere,  which  promptly  yielded  to 
specific  treatment. 

Mr.  S  WIN  FORD  Edwards  showed  two  cases  on  which  he 
bad  performed  nephro-Uthotomy  and  lithdapaxy  respec- 
tively. 

card  specimbns. 

Mr.  McAdah  Eocles  showed  microscopic  sections  of  a 
case  of  rodent  ulcer. 

Dr.  Sbptihds  Sundbrland  showed  broad-based  glandu- 
lar polypi,  with  a  portion  of  the  cervix  uteri,  which  he  had 
recently  removed. 


MAft.  18,  1890. 


SHEFFIELD   MEDIGOCHIRURGICAL   SOCIETY. 
Mbbting  hbld  Thursday,  Fibruart  27th,  1896. 

The  President,  Dr.  Portbr,  in  the  Chair. 

Case  of  Congenital  Hyperkeratosis  of  Palms. — Mr.  Wm. 
Dalb  James  showed : — Mother  and  daughter.  Mother 
has  suffered  more  or  less  for  many  years,  fier  occupation, 
laundress,  has  softened  her  bands  and  reduced  the  morbid 
condition  to  a  minimum.  Daughter  has  decided  hard 
thickening  of  both  palms,  the  creases  and  folds  beine 
deeply  fissured,  completely  laming  the  girl.  No  history  of 
syphilis  is  obtainable,  but  the  mother  has  a  fissured  tongue 
and  the  girl  shows  radiating  lines  around  the  mouth  and 
a  suspicious  facial  expression. 

Mr.  CoFF  showed  :— 1.  A  Central  Spindle-Celled  Sarcoma 
of  the  head  of  the  Tibia. — The  symptoms  which  had  arisen 
in  four  months  simulated  skin  disease  very  closely.  Besides 
fluid  in  the  knee-joint,  and  increased  heat  of  the  skin, 
there  being  an  evening  rise  of  temperature  ranfrinGr  from 
99^-100*>.  ^ 

2.  A  Gastric  Ulcer  situated  on  the  anterior  surface  near 
the  pylorus  which  had  perforated  and  caused  death  from 
peritonitis. 

Mr.RiOHARD  Favbll  showed  a  BmBllMtUtilocular  Ovarian 
Tumour  which  he  removed.    The  tumour  was  situated  low 


down  in  Douglas  pouch,  in  the  middle  line,  behind  the 
uterus.     It  had  given  rise  to  various  reflex  symptoms. 

Mr.  Marriott  showed  specimens  of  Mutiple  Hydatid 
Cysts  of  abdomen  from  a  case  of  Dr.  Burgess's  in  the 
Sheffield  Royal  Hospital 

Mr.  Marriott  read  short  notes  on  a  case  of  so-called 
Idiopathic  Tetanus  under  the  care  of  Dr.  Burgess  in  the 
Royal  HospitaL  The  case  was  interesting  from  the  fact 
that  it  terminated  fatally,  although  the  spasms  were  very 
slight  indeed,  and  the  general  condition  of  the  patient 
good  all  through  till  the  last  day  of  his  illness,  when  the 
temperature  went  up  from  101®  to  105®. 

Bfye  Casts.— VLt,  Snbll  introduced  two  girls  ;  (a)  one 
with  complete  aniridia  in  each  eye  with  nystagmus  and 
central  capsular  opacities ;  (b)  the  other  with  glioma.  Mr. 
Snell  related  notes  of  a  case  of  vaccine  vesicles  on  the  eye* 
lid  and  conjunctiva.  The  patient,  a  woman,  set.  22,  was 
shown  at  the  Isst  meeting.  Her  child  had  been  vaccin- 
ated on  Jan.  20th,  and  on  Feb.  4th  she  noticed  the  spots 
mentioned.  She  came  to  the  General  Infirmary  on  Feb. 
7th,  and  then  on  outer  surface  of  lower  eyelid  was  a  vesicle 
greyish  white  in  appearance,  and  slightly  umbilicated,  and 
containing  a  little  fluid.  Another  vesicle  was  seen  on  the 
conjunctiva  close  to  the  inner  oanthus,  and  a  third  on  the 
conjunctiva  near  the  outer  canthus.  Three  days  later 
they  commenced  to  subside,  and  throughout  there  was  no 
invasion  of  the  cornea.  Mr.  Snell  also  related  partionlan 
of  a  case  of  membranous  ophthalmia  in  an  infant,  et.  6 
months.  The  membrane  covered  the  inner  surface  of  each 
eyelid  in  both  eves.  It  could  be  removed,  but  left  the 
surface  slightly  bleeding.  The  cornea  was  at  no  time  im- 
plicated. The  disease  had  lasted  three  days  before  her 
admission  to  the  infirmary  on  Jan.  24th.  The  membrane 
reappeared  always  after  removal  Two  days  after  admis- 
sion diphtheria  antitoxin  was  injected  and  repeated  the 
next  day,  5  cc.  on  the  first,  and  4  cc.  on  the  next  occasioo. 
The  day  after  there  was  no  membrane  in  the  left  eye,  and 
two  days  later  both  eyes  were  normal  in  every  respect.  An 
erythematous  rash  followed  the  first  administration  of  the 
antitoxin.  Some  improvement  had  commenced  before  the 
antitoxin  was  used,  out  it  was  more  rapid  immediately 
after,  the  membrane,  especiallv  in  the  left  eye,  becoming 
loose  and  verv  little  mjmipulation  allowed  of  its  being 
washed  away  by  the  tears.  The  child  weighed  7i  lbs.  on 
admission  to  the  infirmary,  and  a  week  later  it  had  gained 
three-quarters  of  a  lb.,  and  by  Feb.  25th  it  weighed  10}  lbs. 
and  had  recovered  in  every  way.  The  bacteriological 
examination  was  not  complete  when  the  antitoxin  was 
administered.  In  connection  with  this  case  Mr.  Snell 
referred  to  that  of  a  woman,  S9t.  65,  seen  two  days  previ- 
ously with  most  definite  membrane  in  one  eye  affecting 
the  palpebral  and  ocular  conjunctiva,  but  bacteriological 
examination  did  not  show  any  bacillus. 

Dr.  Addison  showed  cultures  from  two  preceding  < 


BRADFORD  MBDICOCHIRURGICAL  SOCIETY. 
Mebtinq  held  Tuesday,  March  3rd. 


The  President,  Dr.  Bronnbr,  in  the  Chair. 


Lupus  Erythematosus. — Mr.  Chapman  showed  this  i 
for  Dr.  Campbell.  The  patient  was  a  man,  let.  22,  who 
four  years  ago  bad  the  righ  thigh  amputated  for  elephan- 
tiasis. The  area  affected  by  lupus  was  the  lower  part  of 
the  abdomen  and  the  thigh.  Drs.  Wood,  Govder,  Lodge- 
Carter,  Horrocks,  Mitchell,  and  A.  Bronner  discussed  Uie 
case,  and  Mr.  Chapman  replied. 

Case  of  Eczema  Sponfficforme. — Dr.  Mitchell  showed 
photographs  of  a  man  afflicted  with  this  skin  disease 
which  affected  the  chest,  face,  shoulder,  arm,  and  forearm. 
The  skin  was  thickened  and  covered  with  scales  which 
were  easily  detached  and  left  a  moist  surface.  The  con- 
dition was  one  of  long  standing. 

Reduction  of  Dislocation  of  the  Shoulder-Joint.— Mr. 
MiALL  read  notes  on  this  subject  and  advocated  reduction 
of  the  dislocation  by  traction  on  the  limb  held  at  rieht 
angles  to  the  trunk.  A  recent  case  was  narrated  in  which 
this  treatment  was  successful,  chloroform  being  given. 
Dr.  McLeod  drew  attention  to  this  method  in  1886,  but  it 
is  one  of  neat  antiquity,  being  mentioned  by  Celsus. 

Case  of  Hip-Joint  Disease  with  Unusual  Symptoms. — Mr, 
Horrocks  read  notes  on  the  case  d  a  patient  who  for  two 


Mab.  18,  1896. 


GERMANY. 


Thi  Mkdigal  Prkss.     295 


vean  had  worn  a  Idatber  spiiial  jacket,  the  back  haviog 
been  injared  by  a  falL  An  abeoeea  had  formed  in  the  thigh 
and  had  been  inoiaed  and  drained.  Under  chloroform  the 
ainuaee  were  enlareed,  no  bare  bone  waa  detected  and  the 
lemar  moved  freely  at  the  hip- joint.  On  opening  the 
Joint,  the  neck  of  the  femor  and  part  of  the  acetabalum 
were  found  to  be  diaeaaed ;  the  ligamentom  teres  waa 
deatroyed  and  the  head  of  the  femar  waa  necrosed.  The 
latter  was  excised. 

Dr.  Gkat  described  the  after  progress  of  the  case  which 
was  satisfactory. 

Dr.  HoNETBOUBNE  explained  the  necessary  apparatus 
and  gave  a  lantern  demonstration  of  histological,  patho- 
logical, botanical,  and  bacteriological  specimens. 


Jrante. 


[from  OUB  own  CORRXSPONrXNT.] 


Pabis,  March  14th,  1896. 

RoBKTciBN's  Rats. 

Id.  PiNABD  read  a  paper  for  one  of  his  colleagues,  at 
the  Academic  de  M^ecinein  which  was  demonstrated  the 
possibility  of  photographing  a  foetus  in  a  uterus  that  had 
l>een  preserved  for  a  long  time  in  alcohol.  The  organ  in 
question  was  gravid  three  months  and  a  half  and  taken 
from  a  woman  who  had  died  two  years  ago  from  anemia. 
In  the  photograph  accompanying  the  paper  could  be  seen 
the  outline  of  the  uterus  with  its  appendages ;  the 
muscular  wall ;  the  cavity  of  the  organ  as  a  light  spot ; 
ihe  outline  of  the  foetus  adherent  to  the  wall  on  the  right 
4ride.  It  is  permitted,  -said  M.  Pinard,  to  hope  that  the 
living  uterus  will  be  also  amenable  to  those  unknown  but 
enarvellons  rays. 

Tumours  of  thb  Mouth. 

M.  DuMON  Paujbr  presented  three  patients  whose 
^nms  and  tongues  were  the  seat  of  tumours  which  pre- 
sented by  their  evolution  a  certain  gravity.  The  patients 
'were  treated  with  chlorate  of  potash  as  a  topical  applica- 
tion, while  a  drachm  of  the  same  salt  was  given  internally 
•daily  for  three  months.  The  result  was  very  satisfactory 
in  all  the  cases.  The  speaker  added  that  the  integrity  of 
^ihe  kidneys  should  be  assured  before  giving  this  drug,  as 
^hose  organs,  with  the  salivary  glands,  were  the  chief 
■eliminators  of  chlorate  of  potash. 

M.  Reclus  said  he  employed  with  success  for  several 
years  chlorate  of  potash  in  cancroids  of  the  skin,  but  was 
not  so  fortunate  when  the  mucous  membrane  was  the 
iseat  of  the  lesions. 

GUAIAOOL. 

Guaiaool,  as  a  local  ansesthetic,  is  finding  considerable 
favour  with  surgeons,  especially  since  Professor  Lucas 
•Champioiini^re  drew  the  attention  of  the  profession  to  it, 
4Uid  prescribed  the  formula  suiting  each  case.  It  would 
4wem  to  replace  with  great  advantage  hypodermic  injec- 
tions of  cocaine,  which  are  not  without  danger  in  persons 
with  cardiac  afiections  and  in  children.  Dr.  Bellecontre, 
^f  Paris,  strongly  reconunends  guaiaool  in  operations  on  the 
•eyelids.  The  solution  used  is  composed  of  sterilised  olive 
^1,  with  ten  per  cent,  of  guaiacoL    The  needle  of  the 

-  syringe  is  introduced  under  the  skin  of  the  eyelid, 
-in  the  neighbourhood  of  the  intended  operation 
.and  while  being  withdrawn  from  three  to  twelve  drops 
Are  injected.  In  from  five  to  ten  minutes  the  anaesthesia 
is  complete,  and  lasts  about  twenty-five  minutes,  that  is 
to  say,  quite  sufficient  for  an  operation.  A  slight  tume- 
iaetion  is  the  immediate  result,  but  disappears  with  a 

'  little  massage.  As  soon  as  the  skin  is  incised  the  oil  flows 
4mtf  incommoding  in  no  way  the  operator.    The  wound 


heals  by  first  intention.  M.  Pize  reporte  that  the  appli- 
cation of  the  actual  cautery  is  rendered  painless  by  the 
same  agent.  He  places  over  the  region  a  compress  con- 
taining from  twenty  to  fifty  drops  of  pure  guaiaool,  cover- 
ing it  with  oil  silk.  At  the  end  of  ten  minutes  insensibility 
is  obtained,  and  the  thermo-cautery  can  be  applied.  The 
anaesthesia  lasts  for  several  hours. 

Prof.  Lepioe,  of  Lyons,  communicated  to  the  Soci^t^ 
M^dicale  des  Hopitaux  an  interesting  case  of 
Obstinatb  Hicx}ough  Cubxd  by  Rtthhioal  Tractions  of 
the  tongub. 

A  young  non-hysterical  girl  was  seized  with  persistent 
hiccough  (30  times  per  minute)  and  when  he  saw  her  she 
had  already  been  in  that  condition  three  days.  The 
affection  appeared  to  depend  on  eome  malady  of  the 
stomach.  Having  remarked  that  in  examining  the  tongue 
of  the  patient  the  hiccough  ceased,  M.  Lepine  advised  her 
to  execute  during  a  certain  time  traction  of  the  tongue. 
The  result  was  almost  immediate.  It  was  a  case  of  reflex 
action  originating  in  the  mechanical  irritation  of  the  base 
of  the  tongue,  influencing  the  bulbar  respiratory  centre, 
the  seat  of  some  functional  trouble. 

Hydrarthrosis  of  thk  Knsb  joint. 

The  classical  treatment  of  hydrarthrosis  is,  as  everyone 
knows,  compression,  igni-puncture,  injection  of  iodine, 
opening  of  the  serous  bursa.  Even  this  sequence  does  not 
always  give  a  satisfactory  result,  and  in  any  case  the 
treatment  is  very  tedious  to  the  patient.  A  correspondent 
to  a  medical  paper  describes  the  rapid  results  he  obtains 
by  the  application  of  a  blister,  and  replacing  it  by  a  mer- 
curial pUister  kept  on  for  eight  or  ten  days.  When  the 
blister  is  removed  care  is  taken  to  remove  with  it  all  the 
epidermis,  so  as  to  expose  a  raw  surface  to  the  action  of  the 
mercurial  plaister.  The  patient  lies  in  bed  for  the  period 
already  named. 


[from  our  own  oorrbspondent.] 

Bbbldi,  Mardi  13th. 

At  the  last  meeting  of  the  Berlin  Medical  Society  Hr. 
Stadelmann  gave  an  address  on 

Cuolagoguxs. 

The  conclusions  arrived  at  were  based  on  a  large  number 
of  experiments  on  animals,  extending  over  a  period  of  fiv 
years.  In  all  cases  complete  biliary  fistula)  were  eetab* 
lished  in  dogs,  and  it  was  only  when  convalescence  was 
thoroughly  established  that  the  experiments  were  begun. 
Almost  the  whole  of  the  supposed  cholagogues  were  abso- 
lutely inert  as  regarded  the  increase  in  the  secretion  of 
bile.  Water  alone  had  no  eff^ect,  whatever  the  quantity 
given,  whether  500  or  2,000  cm.,  or  whether  hot  or  cold. 
The  drugs  experimented  with  were  taken  from  three 
classes,  such  as  have  no  cholagogue  action,  t.e.,  the  alkalies 
and  their  salts,  sod.  bicarbonate,  common  salt,  sod.  sulph. 
artificial  Carlsbad  salt,  sod.  phosph.,  potass  tart.,  magn. 
sulph.,  potass  carb.,  pot  sulph.  Scarcely  any  change  was 
produced  by  any  of  these  preparations,  with  large  doses 
the  secretion  was  rather  diminished.  The  drastic  purga- 
tives were  next  tried,  these  were  gamboge,  jalap,  aloes, 
rhubarb,  oathartin  acid,  podophyllin,  senna,  and  calomel. 
They  had  no  cholagogue  action  ;  sometimes  the  secretion 
was  increased,  sometimea  diminished  ;  it  frequently 
remained  the  aame,  ao  that  even  when  the  cathartic  action 
was  considerable  the  quantity  of  bile  remained  the  same. 


396     Thi  Mxdical  Pbisb. 


AUSTRIA. 


^AB.  18,  1890. 


Varioofl  rabBtanoes  were  next  tried,  amonget  them  alcohol 
and  olive  oil,  and  from  theee  a  diminntion  rather  than  an 
increase  was  observed.    The  next  series  of  drugs  were 
such  as  diminished  the  secretion  of  bile,  snch  as  piloearpin 
and  atropin.     Whilst  the  action  of  piloearpin  was  doubt- 
ful, that  of  atropine,  he  was  of  opinion,  was  certainly  in 
the  direction  of  diminishing  the  flow.    Tiie  next  class  was 
that  of  drugs  of  doubtful  action,  and  included  anti-febrine, 
anti-pyrine,  caffetine,  diuretine,  and  santonine.    In  general 
the  action  in  this  class  was  uncertain,  little  pronounced, 
and  doubtful.    In  the  next  class  were  the  pronounced 
cholagogues,  sodium  salicylate,    and  the   biliary  acids. 
Sod.  salicylate    sometimes   produced  an   extraordinary 
efiPect,  increasing  the  flow  60  to  70  per  cent,  for  several 
hours — even  as  long  as  24.    Sometimes  the  effect  was 
more  marked  and  the  action  was  somewhat  uncertain. 
He  gave  the  animals  either  their  own  bile  or  ox-gall,  or 
the    biliary    acid    suets    in    pure    preparations.      He 
always   found  a  considerable   increase  in  the  quantity, 
and     it     was     remarkable     that    those    biliary    acids 
produced    the    greatest   efiects    that  were   foreign   to 
the  animal.    Glycocholic  acid  acted  much  more  power- 
fully  than    tanrocholic.      When    a   large   quantity    of 
taurocholic  acid  was  given  to  an  animal,  it  was  excreted 
along  with  the  bile.    In  doses  of  4  to  5  grms.  the  increase 
was  almost  always  100  per  cent.,  and  if  the  quantity  was 
still  increased  an  increased  flow,  even  up  to  120  per  cent, 
could  be  obtained.    The  larger  the  dose  the  ^rreater  the 
efTect,  and  not  only  was  the  bulk  increased  but  that  of  the 
solid  constituents,  and  especially  the  biliary  adds.    He 
had  no  hesitation  in  pronouncing  the  biliary  acids  to  be 
most  powerful,  certain  cholagogues,  they  occupied  a  dis- 
tinct position,  as  they  increased  the  formation  and  of 
course  the  flow  of  biliary  acids,  whilst  the  others  only 
increased  the  flow  of  the  watery   constituents.    These 
effects  as  regarded  sodium  salicylate  and  the  biliary  acids 
were  previously  known,  Prevost,  Pinet,  Lewascheff,  and 
others  had  studied  the  action  of  the  former  before  him. 
Most  people  were  also  convinced  of  the  action  of  the 
biliary  acids,  and  the  only  service  he  had  performed  was 
to  plaoe  the  action  on  a  scientific  basis. 
Before  the  same  society  Hr.  Ewald  gave  an  address  on 

PJERNIOIOUS  ANiEMIA. 

He  said  the  meeting  would  remember  the  case  shown 
on  October  16th,  in  which  life  had  been  saved  by  trana- 
fusion.  At  the  time  he  was  reticent  as  to  prognosis,  as 
he  feared  it  possible  that  the  affair  would  get  into  the 
daily  papers,  and  he  did  not  wish  the  patient  to  read  his 
own  death  sentence  at  breakfast  in  the  daily  news.  A 
short  time  after  the  patient  was  apparently  cured  the  old 
condition  returned.  The  other  day  he  had  serious  collapse, 
and  transfusion  was  again  performed,  300  grms.  of  defi- 
brinated  blood  being  injected  into  the  median  vein.  The 
patient  continued  collapsed,  however,  and  died  in  a  few 
days,  after  a  terminal  pneumonia  had  come  on.  The 
autopsy  confirmed  the  diagnosis,  in  so  far  as  the  fact 
that  no  changes  could  be  found  beyond  advanced 
atrophic  degeneration  of  the  stomach  and  intestinal  tract, 
and  in  the  lungs  the  remnants  of  the  pneumonia.  There 
was  also  fatty  degeneration  of  the  kidneys,  slight  fattiness 
of  the  liver,  and  cardiac  musculature,  the  latter  a  con- 
sequence of  the  inveterate  aniemia.  He  had  had  micro- 
scopic preparations  made  of  the  whole  tract,  from 
the  stomach  to  the  large  intestine,  and  these 
showed  excessive  degenerations  everywhere,  and 
they   were  of   such  a  kind   that  there  was  no  doubt 


the    functions    of    the    stomach    and   intestines   were 
oompromised  by  them.    The  mueoiu  membrane  was  T«ry 
much  thinned,  and  the  glands  had  disappeared,  only  in 
some  places  reomants  of  gland  stroeture  could  be  seen, 
and  theee  even  separated  from  the  intestinal  wall.    These 
ehanges  were  then  so  advanced  as  to  completely  explain 
the  extraordinary  ansdmia  and  the  disturbance   in   the 
tissue  changes  that  had  taken  place.    The  question  now 
arose  as  to  how  far  these  ehanges  werea  cause  or  a  conse- 
quence of  the  affection.    A  London  physician  bad  givsD 
the  opinion  that  the  intestinal  affections  were  secondary. 
In  connection  with  that  case,  he  reported   another,  in 
which,   however,   the  prognosis   was  favourable.     The 
patient,  who  was  then  in  blooming  health,  was  admitted 
into  hospital  in  July,  1805,  in  a  miserable  condition.    Up 
to  the  middle  of  June  he  was  in  good  health,  and  then 
noticed  a  gradually  advancing  yellowish  colour  of  the  skin. 
General  weakness,  loss  of  appetite,  giddiness,  vomiting, 
and  persistent  oonstipation  came  on.     On  admission,  the 
htdmoglobin  was  only  10  per  cent,  and  the  red  blood  oor« 
pusdes  had  fallen  to  1,500,000,  and  the  proportion  of  white 
to  red,  1  to  40.    Microscopically,  however,  only  moderate 
poikilooytosis  was  observed,  and  no  particular  abnormality 
The  normoblasts  were  few,  and  the  megaloblaste  were 
altogether  absent,  and  the  eosinophile  cells  were  not  above 
the  normal.    In  other  respects  also  the  man  was  fairly 
healthy.     He  thought  the   anemia  might  be   due   to 
a  bothriocephalus,  and  especially  so  as  the  man  came 
from  the  neighbourhood  of  Tilsit.    His  weight  had  sunk 
from  140  to  129  lbs.    Examination  of  the  fieces  showed 
no  tsdnia  eggs  or  segments.    On  Oct.  21st  he  passed 
a  large  piece  of  tapeworm.    Ext.  filicis  was  now  given^ 
and  he  parted  with  a  bothriocephalus  later.    From  thie 
time  he  improved  rapidly.    Schaumann  and  other  authors 
had  found  peculiar  changes  in  the  blood    along  with 
normo  and  megaloblasts,  karyokinetic  changes,  so-called 
mitosa,  in  the  nuclei  of  the  red  blood  corpuscles.    He  had 
not  found  anything  of  the  kind^  possibly  because  the 
number  of  examinations  was  not  sufficiently  large,  but  at 
the  same  time  they  could  not  have  been  overlooked  if 
piesent  in  the  numbers  stated  in  connection  with  the 
cases  recorded.    The  death  of  the  bothriocephalus  could 
not  be  the  cause  of  the  anemia  in  this  case  as  it  was  quite 
fresh  when  expelled.    The  connection  between  the  parasite 
and  anemia  was  curious,  as  in  Sweden  and  Norway  it  wae 
very  common  and  anemia  raro,  whilst  in  Russia,  Finland, 
and  Switzerland  the   connection  between  the  two  first 
was  noticed,  and  in  these  countries  the  combination  wae 
by  no  means  a  rarity. 


Jlttfitria. 


[fBOM  OVB  own   OOBBBBPONDBHT.] 

YnmiA,  Mar.  ISth,  1806 
pHTSIOLOaiCAL  ACTION  OF  BUPBA-BXNAL  EXTRACT. 

BiBDL  introduced  his  paperto  the  Gesellschaft,  on  Supra* 
renal  Extract,  by  a  roview  of  the  earlier  experiments  on 
the  spinal  cord  of  the  mammalia.  He  rolated  how  he  out^ 
the  medulla  oblongata  and  removed  the  entiro  spinal 
column,  reducing  the  blood  pressuro  in  the  vessels  to  nine 
millimetres  of  meroury  pressure.  Immediately  after  he 
injected  a  proparation  of  the  supra-ronal  extract  into  the 
eiroulation  of  the  animal,  which  rapidly  brought  the  pres^ 
sure  up  to  160  millimetres  of  meroury.    By  this  method. 


Mas.  18,  1896. 


AUSTRIA. 


Tin  Mbdhul  Fbbss.     297 


he  rastaincd  life  lor  more  then  90  miDutes  after  the  extir- 
patioD  of  the  eord. 

It  may  be  remembered  that  Le  Qallois,  aboat  the  be- 
fCinning  of  the  preeent  ceDtnry,  propoanded  the  theory, 
whieh  he  supported  by  experimental  phyBiolrgy,  that  the 
preeanre  was  lost  in  the  h»matic  circle  when  any 
exteneiTe  lesion  or  deetmotion  in  the  spinal  eolnmnwas 
effected  in  the  mammalia.  Oolts,  in  1864,  confirmed  this 
opinion  of  Le  Oallois,  by  repeated  experiments  on  f  rogp,  &c. 
Strieker,  in  1877»  proved  by  expenments  that  the  heart 
was  inmiediately  bronght  to  a  standstill  after  removal  of 
the  dorsal  and  ceryical  regions  of  the  spinal  colnmn  in  adnlt 
animals^  while  yonnger  ones  if  curarised  lingered  for  some 
time  after  this  matilation.  In  1887,  Ustimowitch  prac- 
tised slow  bnt  regnlar  destniction  of  the  cord,  and  fonnd 
a  few  survived  a  short  time  with  a  blood  pressure  of  30  to 
50  millimetres  of  mercury,  but  the  greater  number  he 
records  died  a  few  minutes  after  the  destructive  operation 
was  commenced. 

It  is  generally  acknowledged  that  the  immediate  cause 
of  death  is  the  annmic  condition  of  the  heart  itself.  The 
tonus  of  the  cord  is  destroyed  or  cut  off  which  allows  the 
blood  to  stagnate  in  the  flaccid  veins  and  produces  what 
Lndwig  termed  internal  hemorrhage.  To  overcome  this 
final  transition,  Qoltz  tried  transfusion  in  the  frog,  while 
Staricker  practised  massage  of  the  abdomen  with  temporary 
I  in  both  cases.  Other  experimenters,  by  different 
s,  have  been  able  to  sustain  life  for  a  short  time  with 
a  pressure  varying  from  10  to  20  millimetres  of  mercury. 
Biedl  has  performed  five  similar  experiments  in  sue- 
oessioo,  and  with  the  injections  of  supra-renal  extract  has 
succeeded  in  every  case  in  maintaining  a  vascular  pressure 
of  160  millimetres  of  mercury.  After  complimenting  Oliver 
and  Sch&fer,  of  London,  and  Cybnlski,  of  Cracow,  he  gave 
it  as  his  opinion,  that  this  action  of  the  supra-renal 
extract  was  due  to  its  stimulating  effect  upon  the  vaso- 
motor centre  which  regulated  the  blood-pressure.  Now, 
seeing  that  the  cord  and  the  medulla  oblongata  were 
destroyed,  no  other  satisfactory  conclusion  to  his  mind 
could  be  established  than  that  this  centre  was  in  the 
periphery. 

Blood  Pressttbb  in  Cholera. 

Several  works  have  recently  occurred  which  confidently 
assert  that  the  blood  pressure  is  reduced  in  cholera,  which 
rapidly  results  in  a  fatal  termination. 

Fedem  laid  testimony  before  the  Gesellschaft  to  prove 
that  the  pressure  is  not  reduced  even  when  the  most  fatal 
symptoms  are  present.  He  showed  tracings  from  patients 
in  the  first  stage  of  the  disease,  with  vomiting,  diarrhcBa, 
cramp,  cold  extremities,  and  absence  of  pulse,  in  whom 
the  blood  pressure  ranged  between  120  and  140  millimetres 
of  mercury.  To  confirm  this  fact  he  travelled  to  Cracow 
in  1894,  when  the  cholera  was  epidemic,  to  take  more 
general  observations.  In  one  case,  a  female,  took  ill  on  the 
24th  September  with  diarrhoea,  vomiting,  frc,  with  a 
blood  pressure  of  120  millimetres  ;  on  the  following  day 
she  was  much  better,  but  the  pressure  had  fallen  to  80 
millimetres  of  mercury. 

The  second  case  was  also  a  female ;  she  was  taken  ill 
on  the  23rd  with  diarrhoea,  vomiting,  and  severe  muscular 
spasms,  with  a  blood  pressure  of  120.  On  the  following  day 
it  was  80  millimetres. 

The  third  case  was  a  male  who  had  been  taken  ill  on 
the  previous  day  with  vomiting  and  diarrhoea,  and  when 
brought  into  hospital  had  a  blood  pressure  of  120,  this  on 
the  following  day  was  found  to  be  80  millimetres  of  mercury. 


He  is,  therefore,  opposed  to  the  idea  of  diminished  piee- 
sure  in  the  vessels  having  anything  to  do  with  the  fatal 
ending  as  the  convalescent  or  algid  period  is  the  com* 
mencement  of  low  pressure. 

Mycosis  Fungoidss  and  Saboomatosis  Cutis. 

Kaposi  showed  two  cases  which  he  considered  of  great 
importance.  He  had  shown  same  patients  to  the  society 
in  September  last. 

The  sarcomatosis  cutis  case,  a  female,  had  been  pro* 
gressiog  favourably  till  a  few  weeks  ago  when  the  menses 
commenced  with  high  fever,  diarrhoBa,  and  general  malaise. 
Off  and  on  the  arsenic  has  been  continued  with  the  effect 
of  reducing  the  nodules. 

In  the  case  of  the  mucosis  the  phenomena  were  more 
remarkable  when  the  arsenic  was  commenced  in  January. 
High  fever,  nephritis,  diffuse  anasarca,  and  utter  prostra- 
tion  was  the  result.  Shortly  after  this  profuse  perspiration 
was  induced,  with  the  speedy  disappearance  of  the  nodules 
and  a  blanching  of  the  cutaneous  (surface  in  place  of  the 
former  infiamed  cutis. 

Catbxtebisino  the  Stomach. 

Pick  next  brought  before  the  meeting  a  catheter,  70 
centimetres  long,  which,  he  assured  the  members,  could 
be  used  for  applying  powder  or  fluids  to  any  part  of  the 
gastric  organ.  To  apply  the  powder  a  sound  is  necessary 
with  a  collapsible  button  attached  to  its  end,  which  is 
ingeniously  arranged  to  throw  out  a  cloud  of  dust  when 
in  the  cavity  of  the  stomach.  Before  the  operation  can 
be  commenced  the  stomach  must  be  emptied  and 
washed  with  an  alkali,  rinsed  with  salt,  and 
lastly  blown  up  with  260  cc.  of  air.  In  the  case  of  chronic 
catarrhs  with  hypersecretion,  he  invariably  employs  a 
solution  of  silver  (0  1  to  0  5  per  cent)  to  the  internal 
wall  of  the  organ.  It  must  be  carefully  borne  in  mind  that 
argyrosis  might  follow  frequent  applications  of  the 
solution. 

LSPBOST. 

Hebra  showed  a  man  who  came  to  him  a  year  ago  with 
every  appearance  of  leprosy.  Where  he  had  acquired  it  is 
not  so  clear,  he  never  having  travelled.  Fourteen  years  ago 
he  was  engaged  taking  photographs  of  leprosy  patients 
for  a  medical  man.  It  is  difficult  to  say  how  much 
etiology  may  be  attached  to  his  part  of  the  history,  if  any. 
It  is  a  well-deflned  fotm  of  lepra  tuberose  where  the 
nodules  are  well  circumscribed.  A  few  weeks  ago  the 
latter  were  several  times  larger  than  they  are  at  the 
present  time,  owing  probably  to  an  attack  of  diarrhoBa, 
fever,  and  general  depletion.  The  skin  still  retains  these 
peculiar  changes  of  the  disease  in  the  form  of  a  reddish- 
grey,  or  brown  colouration.  There  is  no  disturbance  of 
sensibility. 

loDiNB  in  thb  Thyroid. 

From  the  recent  discovery  of  **  Thyreoiodin  "  in  Thyreo« 
idea,  Ewald  attempted  to  test  the  presence  of  this  body  in 
the  thyroid  gland,  which  was  carcinomatous,  with  metas^ 
tasis  in  the  bronchi,  &o.  After  the  gland  was  removed  by 
operation,  it  was  found  to  be  greatly  changed  by  fatty 
degeneratioiL  The  chemical  examination  was  undertaken 
for  thyreoiodine,  bnt  no  trace  of  the  substance  could  be 
found,  although  it  was  present  in  abundance  in  the  bron- 
chial glands. 

Db.  Bbabazon,  for  many  years  Medical  Officer  of 
Health  for  Bath,  died  somewhat  suddenly  at  his  resi- 
dence on  Friday  last  from  the  after  effects  of  influenza. 
Deceased  was  also  senior  physician  to  the  Royal 
Mineral  Water  Hospital  at  Bath. 


298     Thb  Medipal  Psb^s. 


THE  OPERATING  THEATRES. 


Mab.  18,  1896. 


^he  (Dperating  ^hrattcB. 

KING'S  COLLEGE  HOSPITAL. 

TUBIBCULOUS  BiSXASB    OF  ExTSRNAL  MaLLIOLUS    FOI/- 

LowSD  BY  SbptioAbthbitis— Amputation.— Mr. W.  Rose 
operated  on  a  man,  »fc.  24,  who  had  been  previouslj  treated 
for  tnbercnious  lesions  in  the  neighbourhood  of  both  eboal- 
ders  (one  of  which  had  been  excised),  and  also  at  the  lower 
end  of  both  femora.  The  patient  was  admitted  on  this  occa- 
sion wich  a  septic  sore  leading  to  a  sinus  which  communi- 
cated with  the  interior  of  the  external  malleolus ;  this  last 
was  in  a  condition  of  caries.  The  affection  had  been  treated 
a  week  previously  in  the  usual  manner  by  free  gouging 
and  scraping,  and  it  was  probable  that  the  thin  layer  of 
.  tissue  shutting  off  the  focus  of  the  disease  from  the  ankle- 
joint  was  broken  through,  for  at  the  end  of  48  hours 
the  whole  of  the  joint  became  involved  in  an  acute 
inflammation,  and  the  patient's  constitutional  condition 
became  seriously  affected  ;  the  temperature  rose  to  103*", 
and  the  pulse  became  soft  and  rapid  ;  signs  of  suppuration 
were  evident  in  and  around  the  joint,  which  was  freely 
opened  and  irrigated.  In  spite  of  this  the  disease  pro- 
gressed, and  amputation  was  finally  decided  on.  This 
was  accomplished  by  means  of  lateral  flaps,  the  longer 
being  on  the  inner  side;  the  bones  were  divided  at 
the  junction  of  their  lower  and  middle  thirds. 
On  examining  the  ankle*joint  after  removal,  Mr.  Rose 
pointed  out  that,  in  spite  of  the  fact  that  the  mischief  in 
the  joint  bad  been  of  such  short  duration,  the  whole  sub- 
stance of  the  articular  cartilage  had  disappeared  by  a  pro- 
cess of  rapid  disintegration  without  any  necrotic  portions 
having  been  noticed  in  the  discharge.  This  was  a  marked 
contrast  to  the  behaviour  of  the  articular  cartilage  in  most 
forms  of  chronic  tuberculous  disease,  where  large  tracts 
of  this  tissue  are  frequently  seen  undermined  and 
detached.  He  also  remarked  that  infection  of  the  joint, 
though  undoubtedly  determined  by  the  first  operation, 
would  have  occurred  sooner  or  later  if  the  case  had  been 
left  alone,  particularly  if  it  be  considered  how  thoroughly 
the  tuberculous  disease  had  undermined  the  patient's  con- 
etitution. 

ST.  THOMAS'S  HOSPITAL. 
Amputation  at  the  Hip-joivt  fob  Sarcoma  of 
Thigh. — Mr.  Battle  operated  on  a  woman,  8Bt.  49,  who 
had  been  admitted  with  a  tumour  of  her  left  thigh  which 
had  been  growing,  as  far  as  she  knew,  for  only  ^ve  weeks 
before  admission.  She  noticed  a  soreness  in  the  left  thigh 
Afcer  exertion,  and, after  applying  fomentations,  remarked 
a  small  lump  in  the  middle  of  the  front  of  the  thigh,  which 
was  very  sore  to  the  touch,  it  also  caused  great  soreness 
down  the  side  of  the  leg.  She  saw  a  doctor  who  gave  her 
flome  liniment  which  afforded  her  no  relief.  For  the  last 
three  weeks  she  had  suffered  great  pain  in  the  tumour  at 
night,  so  as  to  prevent  her  from  sleeping  ;  the  increase  in 
size  also  had  been  very  rapid.  In  front  of  the  left  thigh 
'was  a  large  fluctuating  broad  swelling  occupying  the 
middle  two-thirds  of  the  part  and  extending  from  side  to 
side  across  the  thigh.  It  was  not  very  painful  except  at  one 
or  two  places  and  was  everywhere  elastic  or  fluctuating. 
There  was  no  beat  or  redness,  but  there  was  oedema 
over  the  outer  side  of  the  growth,  which  at  its  prominent 
part  caused  the  thigh  to  measure  about  three  inches 
more  than  the  opposite  one.  The  patient's  temper- 
jtture  was  lOr.  The  tumour  had  been  aspirated 
«oon  after  admission  and  nine  ounces  of  red-coloured 


fluid  withdrawn,  whilst  the  examination  of  a  piece 
of  growth  which  had  been  caught  in  the  cannula 
showed  it  to  be  a  sarcoma  of  mixed  character.  In  conse- 
quence of  the  extent  of  the  growth  and  its  nature  it  was 
evident  that  nothing  short  of  amputation  at  the  hip-joint 
would  give  the  patient  a  chance  of  becoming  completely 
rid  of  the  tumour  and  reduce  the  likelihood  of  recnrrenoe 
to  a  minimum.  A  careful  examination  showed  that  there 
was  no  internal  deposit  either  in  the  lungs  or  glandular 
system.  Although  there  was  an  apical  murmur,  it  was 
regarded  as  hasmic.  The  urine  was  normal.  It  was  cot 
possible  to  perform  a  Fumeaux  Jordan  amputation,  nor 
to  amputate  by  the  method  of  transfixion,  becaoee  the 
tumour  involved  muscles  and  came  high  up  the  thigb.  A 
modification  of  Guthrie's  amputation  was  therefore  decided 
upon.  The  patient  was  carefully  wrapped  up  and  pre- 
pared against  shock,  and  ether  was  administered  by 
Mr.  Tyrrell.  Mr.  Battle  ligatured  the  main  artery  below 
Poupart's  ligament,  and  cloeed  the  wound;  he  then 
fashioned  (standing  on  the  right  side)  a  fiap,  consisting  of 
skin,  subcutaneous  tissue  and  fascia,  about  four  inches 
long,  commencing  over  the  great  trochanter  and  ending 
on  the  inner  side  in  front  of  the  tuberosity  of  the  iechinm ; 
this  was  dissected  up  about  three  inches.  A  posterior  flap 
was  then  made  extending  from  these  points ;  only  the  flap 
was  made  longer  than  the  one  in  front,  and  for  two  or 
three  inches  contained  no  muscle.  Returning  to  the  front 
of  the  thigh,  the  muscles  were  quickly  severed  down  to  the 
hip- joint  below  the  ligature  placed  on  the  vessel,  the  hip 
disarticulated,  and  the  separation  of  the  limb  completed 
by  a  rapid  section  from  below  upwards  at  the  base  of  the 
posterior  flap.  During  division  of  the  muscles  in  front  of 
the  hip  a  large  vessel  was  cut,  which  spurted  freely,  but 
it  was  at  once  caught  with  forceps  ;  it  was  found  after- 
wards that  the  common  femoral  had  divided  higher  than 
usual,  and  that  the  ligature  had  been  applied  to  the  super- 
ficial femoral.  The  vessels  in  the  posterior  flap  were 
easily  and  rapidly  secured  ;  as  they  were  left  until  the  last^ 
and  rapidly  severed,  when  there  was  nothing  to  inter- 
fere, with  a  view  of  a  full  access  to  them,  very  little  blood 
was  lost,  and  the  amount  of  shock  was  not  more  than  that 
usually  accompanying  an  amputation  of  the  thigh  in  ite 
middle  third.  W^hen  the  patient  was  admitted,  and  be- 
fore the  aspiration,  it  was  a  question,  Mr.  Battle  re- 
marked, whether  she  was  suffering  from  abscess  of  the 
thigh  or  from  sarcoma;  the  continuous  temperature  off 
101^  making  the  diagnosis  one  of  doubt. 


The  death-rate  in  Dublin,  which  had  been  I9'8  and 
16'5  per  1,000  in  the  two  preceding  weeks,  declined 
again  to  234  last  week.  Daring  the  past  ten  weeks  of 
the  carrent  qnarter  the  death-rate  in  Dablin  has  aver- 
aged 25*0  per  1,000,  the  rate  daring  the  same  period 
being  19*7  in  London,  and  17*5  in  Edinbargh. 


Thb  total  nnmbers  of  the  medical  staff  on  the 
British  Army  establishment  amoant  to  614,  at  a  cost 
of  £178,750  for  home,  and  £54,450  for  the  Colonies, 
respectively. 

Db.  R  J.  MoNTGOMBBT,  F.RC.S.I.,  Clinical  Assis- 
tant in  St  Mark's  Hospital,  has  been  appointed 
Ophthalmic  Sargeon  to  the  Whitworth  Hospital 
Dromoondra. 


Mab.  18,  1895. 


LEADING  ARTICLES. 


Thb  Medical  Prbss.     299 


Paldiihtd  CTerr  Wedn«tdaj  monilii«,  Priot  Bd.   Poet  frM,  bid. 


FoKOraUnmtnoM:— wiiol6Pig*,«0k0d.;  Half  Pne«i  ^ lOi- od. 

QouftwPi«*,A5i.;  On^lglitb,  Itt.  fld. 
Fom  ▲  BnnB  ov  imBisiom :— Wliole  Pact,  thlrtMn  InMrttom 
(vMkly,  fortnlglifly,  or  numtldy)  at  itt  10k  Od. ;  twrntf-Ox,  Uumt- 
tloM  (weekly  or  fortelghUy)  aft  itt  Si.  Od. ;  llftj-two  inaeiiioni 
(weekly)  at  4S  aaoli.  Half-pace,  fhirteen  inaertioiii  at  86a. ; 
ftwen|y-dzaftnk;llfty-twotDiertloiiiat80kaaoli.  Quarter-pace, 
rtloiiaatiai.;  tw«Bty-dz  Imerttona  at  Ui. ;  flfty-ilx 
iatl5a.eaflli 


ui  ABBonnoementi  of  Piaetloea,  AaaiftaDolea,  YacaDdea,  Book 
Ae.--8eveBlliieaoriiBder,a  per  Inaertkni ;  6d.  per  line  beyond. 

Leitera  in  thla  department  aliOBld  be  addiened  to  the  PnbUaher. 

lUBBOBIPTIOHS. 

POR  7BXB  VO  AVHUAL  BUBSORIBXBS  £110 

„  ABBOAD,  WITHIH  THS  PO0fAL  VnOM        £18    6 

„  IlDIA,  CHniA,  AHD  JAPAS  .  .£166 

Poat-oOce  Orden  and  Gheqnes  to  be  drawn  In  favour  of— 

A.  A.  TnroiUb,  SO-Sl  Klnc  William  Street,  Strand,  London. 
A.  H.  JAOOB.  88  lioleaworth  Street,  DnbUn. 

SUBSOEipnoHS  VOA  JKASOM  are  reoelTed  by  Menrs.  BAntLTmi,  Rne 
HantefeoOle,  Parli— poet  free  In  adTanoe,  £1  8i.  Od.  per  annnm. 

BrasoBipnoHS  voa  tbm  VmnrnD  scatk, 
(£1  >a.  6d.  per  annnm>,  ibonld  be  eent 
tUi  oonntiy  by  Intemational  Poat  Office  Order. 


,    poat  free  In  advanoe 
direct  to  the  Offlcei  In 


8€U  jMnt9  for  Germany  and  Atutro-Hungarp— 
W.  A  8.  LowmSBAL  (Office  of  the  BerUnsr  A^euHtch),  GranttraBM 
4,Berlln. 


f  Je  P^Mral  ^xm  4c  ^ircttlar. 


'BALUB  POPULI  SUPREMA  LEX." 


WEDNESDAY,  MARCH  18,  1896. 


THE    PRESENT     POSITION    OF     TOTAL 
HYSTERECTOMY. 

The  snrgical  treatment  of  uterine  fibroids  is  still 
hampered  by  the  risk  which  any  radical  means  at  our 
dispoBal  of  effecting  their  removal  still  entail.  The 
operation  of  oophorectomy  has  of  late  years  fallen 
somewhat  into  discredit  on  account  of  the  uncertainty 
of  its  results  and  the  very  varying  degree  of  danger 
which  its  performance  involves,  variations  which  not 
even  the  most  experienced  operator  can  always  foresee. 
We  are  still  far  removed  from  the  time  when  the  patient 
with  a  fibroid  which  is  not  destructive  of  comfort  or 
threatening  to  life  can  be  conscientiously  advised  to 
Bubmit  to  hysterectomy,  but  we  are  gradually  getting 
to  recognise  that  the  presence  of  these  growths  deter- 
mines inconveniences  and  dangers  which,  by  no  means, 
always  cease  with  the  menopause,  and  they  are  now 
known,  moreover,  to  exhibit  a  marked  tendency  to 
undergo  cystic  malignant  degeneration  at  or  about  that 
critical  period.  With  the  introduction  of  the  intra- 
peritoneal method  of  dealing  with  the  pedicle,  it  was 
hoped  that  a  new  era  was  about  to  be  entered 
upon  in  this  department  of  surgery,  but,  so 
far,  no  substantial  reduction  in  the  previous 
somewhat  alarming  mortality  has  been  effected, 
and   surgeons  are  still  divided   in   opinion  aa  to 


which  after  all  is  the  best  operation  in  the  interests  of 
the  patient  The  extra-peritoneal  method  has  been, 
described  as  unscientific  and  barbarous,  but  it  is  not 
likely  to  be  abandoned  until  those  who  have'definitively 
taken  up  with  the  intra-peritoneal  treatment  of  the 
pedicle  are  able  to  show  statistical  advantages  in 
respect  of  the  resulting  mortality,  of  a  nature  to  make 
it  evident  that  the  latter  offers  real  advantages  over 
the  older  procedure.  Of  late  years  an  alternative  plan 
of  dealing  with  these  tumours  has  come  to  the  frontr 
viz.,  the  removal  of  the  tumour  per  vaginavi^  after 
fragmentation  if  necessary.  The  most  coteworthy 
departure  has  been  the  proposal  to  tie  the  uterine 
arteries  as  a  preliminary  step  in  the  performance  of 
total  hysterectomy  by  the  intra-peritoneal  method. 
This  at  any  rate  secures  the  patient  against  the  very 
tangible  risk  of  haemorrhage  from  the  stump,  but 
though  useful  and  tolerably  easy  of  performance  when 
one  has  to  deal  with  tumours  of  comparatively  smal) 
dimensions,  say  from  five  to  ten  pounds  in  weight,  it 
is  well-nigh  impracticable  in  the  case  of  large  tumours,, 
say  of  twenty-five  pounds  and  upwards,  for  the  layers 
of  the  broad  ligaments  are  then  so  widely  separated 
that  it  is  impossible  to  pass  a  ligature  through  them  in 
such  a  way  as  to  include  the  tissues  through  which 
these  vessels  run.  Then  again  there  is  the  fact  that 
septic  complications  are  not  unfrequent  after  the  intra* 
peritoneal  procedure,  and  the  source  of  the  sepsis  is> 
enveloped  in  some  obscurity.  The  vagina  is  strongly 
suspected  of  furnishing  the  materies  morbi,  possibly 
without  adequate  grounds,  but  the  fact  remains  that 
surgeons,  whose  aseptic  experience  is  amply  testified 
to  by  the  absence  of  this  class  of  complications  in  other 
abdominal  operations,  nevertheless  meet  with  a  certain 
proportion  of  cases  in  which  death  occurs  from  septic 
intoxication  after  hysterectomy  with  the  internal 
method  of  dealing  with  the  pedicle.  Another  question 
that  suggests  itself  is  whether  or  not  it  is  desirable 
to  remove  the  uterus  in  tofo,  or  whether  the  cervix  can 
safely  be  left,  even  if  it  can  be  shown,  that  it  can 
be  left  with  safety,  and  it  would  remain  to  be  settled 
whether  it  is  desirable  or  advantageous  to  allow 
it  to  remain  in  situ.  We  have  said  enough 
to  show  that  there  remains  ample  scope  for  ingenuity 
and  study  in  this  branch  of  abdominal  surgery.  We 
hear  so  much  of  the  progress  that  has  been  effected  in 
this  line  that  one  is  apt  to  think  we  are  approaching 
the  goal,  viz.,  the  abolition  of  any  mortality  in  mode* 
rately  favourable  cases.  Such,  alas  !  is  far  from  being 
true,  for  the  mortality  from  either  of  these  operations  is 
still  undesirably,  and  probably  unnecessarily,  high, 
so  much  so,  that  most  surgeons  hesitate  to  intervene 
except  in  the  presence  of  urgent  symptoms  or  of 
signs  indicative  of  cystic  or  malignant  change.  As  to 
the  etiology  of  these  fibroid  masses,  that  is  enveloped 
in  an  obscurity  which  is  as  dense  as  ever.  As  to  why 
the  uterus  should  display  this  unaccountable  tendency 
to  fibroid  overgrovrth  we  know  absolutely  nothing, 
and  bacteriologists  are  silent  as  to  any  possible  micro- 
bial influence.  It  is  evident  that  we  cannot  regard  with 
any  degree  of  equanimity  an  operation  which  is 
attended  by  a  mortality  which  renders  recourse  to  it 


300     The  Medical  Pbi 


LEADING  ASnCLES, 


Mas   is,  1896. 


undesirable,  except  under  compulaior,  in  spite  of  the 
distress  and  risk  to  which  the  presence  of  these  tamoura 
exposes  the  unhappy  patient 


THE  ARMY  MEDICAL  COMPETITIVES. 
The  delegates  from  the  University  of  Dublin  and 
from  the  Irish  College  of  Surgeons,  referred  to  in  our 
last  issue,  had  their  interview  with  the  Marquis  of 
Lansdowne,  Secretary  for  War,  on  Monday,  the  9th 
inst.,  and  submitted  memorials  with  reference  to  the 
cessation  of  candidates,  and  especially  Irish  educated 
candidates,  to  present  themselves  for  the  Army  Medical 
Examinations.  The  Memorial  from  the  College  of 
Surgeons  runs  as  follows :~ 

Royal  College  of  Surceons  in  Ireland, 

Dublin,  March  7th,  1896. 
To  the  Right  Honourable  the  Secretary  of  State  for  War. 

Sib, — In  April,  1893,  the  President  and  Council  of 
the  Royal  College  of  Surgeons  in  Ireland  addressed  a 
letter  to  the  then  Secretary  of  State  for  War,  in  which 
protest  was  made  against  a  decision  that  in  future  the 
examiners  at  the  competitive  examination  for  admis- 
sion to  Her  Majesty's  Medical  Service  should  be 
selected  exclusively  from  past  or  present  examiners  of 
the  Colleges  of  Physicians  and  Surgeons  of  England. 
We  have  to  express  our  regret  that  no  change  m  the 
rule  followed  that  remonstrance. 

Today  we  are  face  to  face  with  the  fact  that  the 
Army  Medical  Service  has  again  become  unpopular. 
The  young  men  who  have  just  been  qualified,  ana  who 
are  starting  their  professional  life,  avoid  it  This  is 
shown  by  the  great  decrease  in  the  number  of  candi- 
dates presenting  themselves  for  examination.  Students 
are  not  now  less  well  taught  nor  less  intelligent  than 
they  were  five  years  ago,  nor  are  they  less  anxious  to 
enter  upon  a  career  in  the  Army.  We  are  in  the  posi- 
tion to  say  that  the  rule  to  which  we  have  alludea  has 
caused  great  dissatisfaction,  and  that  it  has,  with  other 
things,  helped  to  bring  about  the  present  state  of 
affairs,  namely,  that  Irishmen  have  practically  ceased 
to  present  themselves  for  admission  to  the  Army 
Medical  Service.  This  latter  fact  is  the  more  extra- 
ordinary when  we  remember  that  in  1893,  at  the  time  of 
our  remonstrance,  of  the  total  number  of  Medical 
Officers  of  the  Medical  Service  then  in  the  Army 
nearlv  one-half— 429  out  of  891— held  Irish  diplomas, 
a  striking  contrast,  which  we  venture  to  press  upon 
your  consideration. 

1.  With  regard  to  the  examinations,  we  are  strongly 
of  opinion  that  the  rule  by  which  all  the  examiners 
must  belong  to  the  London  Colleges  is  not  a  wise  one, 
and  that  it  is  a  reflection  upon  every  other  licensing 
body  in  the  Kingdom.  We  think  it  is  of  the  utmost 
importance  that  a  Board  of  this  kind  should  always  be 
representative  of  the  various  teaching  centres  in  the 
three  Kingdoms. 

In  order  to  carry  this  into  effect,  we  respectfully 
submit  the  following  suggestions  :— 

2.  That  in  all  compulsory  subjects  two  examiners 
ehould  be  appointed— a  condition  which  has  been 
insisted  upon  bv  the  General  Medical  Council  in  the 
conducting  of  all  examinations  for  license.  This  would 
make  the  Court  as  follows  .—Surgery,  2  ;  Medicine,  2 ; 
Anatomy,  2  ;  Physiology,  2  ;  Chemistry,  2 ;  Biology,  1  ; 
Modem  Lan^ages,  1.— Total,  12. 

3.  We  tbink  it  most  important  that  Physiology 
should  be  examined  in  by  separate  examiners,  and 
ehould  not  be  grouped  with  Anatomy.  In  all  modern 
arrangements  these  subjects  are  taught  by  different 
professors. 

4.  Of  these  twelve  examiners,  four  should  be  ap- 
pointed from  Ireland. 


5.  No  examiner  should  hold  office  for  more  tiian 
four  years,  nor  should  he  be  eligible  for  re-election  for 
one  year  after  his  retirement 

6.  Examiners  in  such  subjects  as  Anatomy,  Physio- 
logy and  Chemistry,  should  be  professors  or  lecturers 
in  a  recognised  Medical  School. 

7.  In  the  case  of  Sursery  and  Medicine,  the  exam- 
iners should  be  selected  from  acting  hospital  physi- 
cians and  surgeons. 

We  feel  bound,  however,  to  say  that  there  are  other 
reasons  why  the  service  has  become  unpopular.  An 
intimate  knowledge  of  the  complaints  which  are  made 
b^  Officers  in  the  Armjr  Medical  Department  has  con- 
vmced  us  that  the  Service^  as  a  body,  is  discontented, 
because  of  the  position  it  holds  in  relation  to  Uie 
other  branches  of  the  Armjr.  This  has  so  often  been 
brought  before  the  Authorities  that  it  is  unnecessary 
to  go  into  details,  but  we  may  state  that  the  practically 
unanimous  view  is  that,  in  order  to  produce  content- 
ment, it  is  essential  that  the  Army  Medical  Depart- 
ment should  be  constituted  a  Royal  Medical  Corps, 
with  a  distinct  individuality,  as  m  the  case  of  the 
Royal  Engineers. 

We  are  further  of  opinion  that  the  Medical  Officers 
should  have  increased  facilities  for  pursuing  studies 
from  time  to  time,  after  they  have  entered  the  Service. 
We  think  that  in  this  way  a  great  deal  of  valuable 
work  might  be  done  which  would  be  of  importance  to 
the  public  and  to  the  army,  and  would  enable  these 
officers  to  keep  abreast  of  the  advances  of  medical 
science. 

Of  other  complaints  we  can  only  mention  the  refusal 
to  give  the  medical  officers  a  status  in  the  army  which 
would  free  them  from  irritating  annoyances  ;  the  need 
of  increased  pay  in  India,  and  generally  the  irksome- 
ness  of  the  present  arrangements  for  foreign  service. 
These  complaints  are  very  well  known  in  the  medical 
schools,  and  coming  from  men  who  have  knowledge  of 
the  Service,  they  strongly  influence  the  students 
against  seeking  appointments  in  the  Army. 

We  may  say,  in  conclusion,  that  the  duty  is  laid  upon 
this  college  by  its  charter  to  provide  for  the  education 
of  surgeons  for  the  army,  and  the  desire  of  the  Presi- 
dent and  Council  is  by  such  suggestions  as  appear  to 
them  wise,  to  assist  in  making  the  Army  Medical 
Department  at  once  efficient  anacontented. 

Nothing  in  the  way  of  a  definite  promise  or  pro- 
nouncement was  elicited  from  the  War  Secretary,  but 
it  was  understood  that,  upon  the  discussion  of  the 
Army  Estimates  in  Parliament  some  statement  relating 
to  the  Army  Medical  Service  would  be  made.  It  has 
happened  that  these  Estimates  have  been  made  the 
battleground  of  obstructionist  parties,  and  there  has 
been  no  useful  discussion  of  any  of  the  items  which 
were  deserving  of  debate. 

It  will  be  observed  that  the  Irish  College  of  Surgeons 
not  only  records,  for  the  second  time,  its  very  reason- 
able complaint  of  the  constitution  of  the  Examining 
Board,  but  formulates  a  scheme  of  reconstruction 
which  would  provide  two  examiners  in  all  compulsory 
subjects.  This  suggestion  scarcely  needs  to  be  dis. 
cussed,  inasmuch  as  it  embodies  the  principle  insisted 
upon  by  the  Qeneral  Medical  Council  at  all  medical 
examinations,  that  under  no  circumstances  should  the 
fate  of  a  candidate  be  decided  by  the  voice  of  a  single 
examiner.  That  is  a  proposition  which  can  scarcely 
be  contested.  The  scheme  propounded  by  the 
College,  however,  appears  to  us  to  be  complicated 
by  the  unnecessary  introduction  of  Examiners  in 
primary  subjects  which,  we  submit,  are  not  essential  to 


Mar.  18,  1896. 


LEADING  ARTICLES. 


Thb  Mbdioal  Psxss.     301 


an  ezamination  of  doubly  qualified  practitionera. 
ABsnmiDg  that  the  purpose  of  the  competitioa  is  to 
afford  goarantees  that  the  Medical  Officer  is  competent 
to  treat  the  diseases  and  iojuries  of  the  soldier  and  to 
provide  hygienic  protection  of  his  health  when  in 
barracks  or  in  the  field,  we  fail  to  see  the  necessity  for 
re-examining  candidates,  for  the  third  or  fonrth  time, 
in  snch  subjects  as  physiology,  or  pure  anatomy,  or 
pure  chemistry.  The  examination  in  anatomy  and 
physiology  might  be  dispensed  with  except  so  far  as 
those  subjects  are  interwoven  with  medicine,  surgery, 
and  pathology,  and  chemistry  might  be  eliminated 
from  the  entrance  examination  altogether,  inasmuch 
as  the  hygienic  applications  of  the  science  are  taught 
at  Netley  and  must  be  studied  there,  as  it  forms  an 
important  part  of  the  examination  which  has  to  be 
passed  at  the  end  of  the  Netley  probation.  We 
submit  that  it  is  not  reasonable  to  require  a  candidate 
who  has  just  qualified  in  the  final  practical  subjects  of 
his  profession,  to  go  back  and  releam  the  minutiae  of 
the  subjects  of  his  first  and  second  years.  In  fact,  he 
does  not  do  so,  but  places  himself  in  charge  of  a  London 
crammer  who  '*  puts  him  up "  in  exactly  the  amount 
of  these  subjects  which  the  examiners  are  known  to 
require.  If  the  authorities  are  desirous  of  attracting 
candidates  to  these  competitions  they  ought  to  con- 
aider  that  there  can  be  no  more  potent  deterrent  than 
the  knowledge  by  the  newly  qualified  student  that,  if 
he  means  to  go  for  the  Army,  he  must  go  back  upon 
the  studies  of  his  early  studentship  and  releam  his 
primary  subjects,  and  we  believe  that  the  sweeping 
away  of  these  subjects  which  do  not  appear  necessary 
as  proofs  of  the  competency  of  the  Army  surgeon, 
would  at  once  produce  an  increased  number  of 
applicants. 

It  will  be  seen  that  the  Irish  Colleges  have  made  the 
defaults  of  the  examination  system  the  special  subject 
of  their  animadversions,  but  they  have  indicated  that 
there  are  nuiny  other  causes  which  make,  and,  for  a 
long  series  of  years,  have  made,  the  Army  Medical 
Service  unpopular.  These  causes  are  familiar  to  our 
readers ;  they  have  formed  the  subjects  of  Boyal  Com- 
missions and  of  endless  newspaper  discussion,  yet  we 
legTBt  to  say  that  no  progress  towards  finding  a  remedy 
has  been  made.  That  they  are  effective  as  deter- 
rents may  be  granted,  considering  that  there  has  ceased 
to  be  any  demand  for  Her  Majesty's  Commission  for 
this  Service.  With  reference  to  the  special  case  of 
Ireland,  this  is  shown  by  the  returns  made  by  the 
Director-Qeneral  to  the  General  Medical  Council. 
Time  was,  not  very  long  since,  when  the  Irish  Schools 
and  Colleges  provided  the  majority  of  Her  Majesty's 
army  surgeons.  We  find  from  these  returns  that  in  the 
ten  years  from  1880  to  1889,  inclusive,  the  Irish  quali- 
fications held  by  candidates  numbered  572,  while  the 
fiooteh  qualifications  were  384,  and  the  English  only 
^S39.  It  is  thus  manifest  that  the  Queen,  owing  to  the 
mismanagement  of  her  ''military  advisers,"  has  lost 
^M  best  source  of  supply  for  army  doctors,  and  it  is, 
moreover,  clear  that  the  supply  cannot  be  done  with- 
4mt  On  the  active  list  of  the  Army  Medical  Staff,  at 
present^  844  in  number,  407,  or  nearly  one  half,  hold 


Irish  qualifications,  England  or  Scotland  coming  in  a 
bad  second. 

It  is  to  be  hoped  that  Lord  Lansdowne  will  lay  these 
facts  to  his  mind,  and  will  utilise  his  high  position  to 
put  an  end  to  a  condition  of  things  which,  for  thirty 
years  past,  has  been  the  opprobrium  of  the  Army  Ser- 
vice. He  may  expect  to  meet  with  resistance,  open  or 
covert,  from  the  ''military  advisers,"  but  he  will 
acquire  distinction  as  a  military  administrator  if  he 
finds  some  means  of  making  the  Army  Medical  Service 
popular  and  effective  which,  at  present,  it  certainly 
is  not. 


THE  METROPOLITAN  WATER  COMPANIES. 
The  water-famine  last  spring  in  the  East-end  of 
London  so  overshadowed  other  local  failures  of  a 
similar  kind  by  the  magnitude  of  its  calamity  that  the 
public  interest  has  waned  in  regard  to  the  minor 
disasters.  None  the  less,  however,  do  the  relations  of 
the  Water  Companies  to  their  customers  in  neighbour- 
ing parts  of  the  Metropolis  deserve  careful  considera- 
tion. In  the  first  week  of  the  present  year  an  important 
official  statement  was  published  dealing  with  a  number 
of  specific  charges  made  by  memorialists  to  the  Local 
Government  Board.  The  inquiry,  on  which  the  docu- 
ment in  question  was  based,  was  conducted  by  Major- 
General  Scott,  who  formally  investigated  the  complaints 
of  numerous  householders  against  the  Grand  Junction, 
the  Kent,  the  Lambeth,  and  the  Southwark  and 
Yauxhall  Waterworks  Companies.  The  chief  conten- 
tions of  the  complainants  were  that  the  companies  had 
neglected  to  lay  their  mains  at  a  sufficient  depth  to 
protect  them  from  the  effects  of  frost,  and  as  a 
consequence  communication  pipes  were  necessarily  also 
laid  at  insufficient  depth.  Further,  that  many  of  the 
mains  were  decayed,  and  consequently  the  statutory 
pressure  could  not  be  kep%  up  :  that  the  Company  did 
not  take  proper  steps  to  make  up  the  failure  of  water 
to  consumers :  and  that  owing  to  these  and  other 
defaults  the  memorialists  had  been  deprived  of  water 
in  some  cases  for  a  period  of  two  month?.  The  first 
complaint,  which  to  a  great  extent  lies  at  the  root  of  the 
whole  matter,  namely,that  the  mains  were  not  laid  at  a 
sufficient  depth,  may  be  regarded  as  proved.  "  It  is  un- 
questionable," writes  General  Scott,  "that  all  these 
companies  have  committed  the  mistake  in  the  past  of 
giving  in  many  instances  too  little  cover  to  their  ser- 
vice mains,  and  that  this  has  led  to  the  destruction  of 
a  considerable  number  of  pipes  from  the  effects  of  the 
frost."  This  important  conclusion  involves  the  further 
one  that  the  communication  pipes  have  also  been  laid 
too  superficially.  The  Act  of  1871  is  read  by  the 
author  of  the  report  as  conferring  on  the  companies  the 
power  to  enforce  upon  householders  the  duty  of  laying 
their  communicating  pipes  at  a  proper  depth.  How 
this  is  to  be  done,  however,  by  the  luckless  customer 
who  finds  the  street  main  a  foot  or  eighteen  inches 
below  the  surface  is  a  mere  detail  quite  outside  the 
scope  of  the  inquiry  under  notice,  The  contention 
that  the  decay  of  pipes  has  ultimatedly  caused  failure 
of  pressure  is  held  not  to  be  proved.  At  the  same 
time,  instances  of  the  existence  of  inferior  pipes  were 


302     The  BAxdical  Pbiss. 


NOTES  ON  CURRENT  TOPICS. 


Mar   18    1886. 


eetablished.  The  complaint  that  the  Company  did 
not  take  proper  steps  to  furnish  water  to  consumers  in 
lieu  of  the  intermitted  supply  was  not  discussed  on 
the  technical  ground  that  under  the  Water  Act  of  1852 
only  those  deficiencies  alleged  to  exist  at  the  actual 
time  of  the  inquiry  could  be  investigated.  The  glaring 
injustice  and  absurdity  of  such  a  red-tape  regulation 
a£fords  a  typical  instance  of  the  reckless  way  in 
which  the  special  Acts  have  in  many  points  been 
framed  in  the  interests  of  the  companies.  The  minor 
complaint  that  due  diligence  was  not  observed  in 
restoring  the  water  supply  after  the  cessation  of  the 
frost  is  dismissed  in  the  report  as  not  proven.  As 
regards  the  final  assertion  that  owing  to  various 
defaults,  a  proper  supply  of  water  had  been  wanting 
during  various  periods,  in  some  instances  extending  to 
two  months,  the  verdict  is  against  the  companies.  The 
report  holds  that  the  statements  of  the  memorialists  in 
this  regard  have  remained  practically  uncontested,  and 
that  the  interruption  of  supply  must,  in  part  at  any 
rate,  be  attributed  to  the  insufficient  depth  of  mains 
and  communication  pipes.  Widespread  failure  of 
pressure  is  held  to  have  been  proved  in  the  district  of 
the  Southwark  and  Yauxhall  Company.  From  this 
short  analysis  it  will  be  seen  that  the  investigation  has 
established  a  highly  damaging  case  against  the  water 
companies,  and  one  that  cannot  fail  to  influence  future 
legislation.  These  trading  corporations  have  been 
granted  the  privilege  of  supplying  Londoners  with  a 
prime  necessity  of  life  on  certain  conditions  extremely 
favourable  to  themselves.  If  their  sins  can  be  gauged 
by  the  extent  to  which  they  have  neglected  the  sim- 
plest and  most  elementary  of  their  statutory  obliga- 
tions, the  record  entered  against  them  by  Qenecal 
Scott,  in  his  studiously  moderate  report,  is,  indeed,  of 
a  most  damning  nature.  The  Southwark  and  Yauxhall 
Company,  the  only  one  in  which  it  was  possible  to  get 
at  these  particular  facts,  was  shown  to  have  ''  a  very 
considerable  proportion  of  the  mains  and  communica- 
tion pipes  laid  at  depths  less  than  safety  requires." 
More  exactly,  98  mains  were  found  to  be  less  than  one 
foot  deep  ;  553  between  one  foot  and  one  foot  nine 
inches ;  264  between  the  latter  depth  and  two  feet  six 
inches ;  while  41  only  were  lower  than  two  feet  six 
inches.  The  report  states  emphatically :  **  It  was 
very  fully  shown  by  a  number  of  the  memorialists  that 
they  were  subjected  to  very  serious  inconvenience, 
hardships,  and  risk  to  health  by  the  state  of  things 
which  prevailed  during  the  period  between  the  end  of 
January  and  the  middle  of  April,  1895."  To  this  may 
be  added  the  obvious  reflection  that  a  vast  amount  of 
the  inconvenience,  the  cost,  and  the  sickness  caused 
by  the  breakdown  of  the  water  supply  must  be  left  to 
the  vaguest  surmise.  To  a  city  that  depends  on  a 
system  of  water  carriage  for  the  removal  of  its  sewage, 
the  slightest  failure  of  the  water-works'  service  bodes 
speedy  and  unerring  disaster.  It  is  to  be  hoped 
that  ere  long  the  control  of  the  whole  Metropolitan 
water  supply  will  be  in  the  hands  of  an  enlightened 
central  body,  and  that  shallow  mains,  intermittent 
service,  failure  of  pressure,  and  water  famines  will 
speedily  become  matters  of  ancient  history. 


^0teB  on  (Eutrent  ^oficB. 

Irate  ComppundeTs  of  a  Quack  Noetrum. 

The  reference,  without  names,  which  we  made  io 
our  issue  of  the  5th  ult.,  to  a  firm  of  manufactures  of 
a  quack  nostrum  has  brought  forth  an  amusingly  irate 
reply  from  the  '^  Ouy's  Tonic  Company  "—the  firm  to- 
which  we  alluded.  Among  other  things,  they  inform 
us  that  they  decidedly  object  to  any  of  tiieir  prepara- 
tions being  dubbed  ^* quack  medicines"  or  ''quack 
nostrums."  It  is  a  matter  for  regret  that  they  should 
feel  displeased  in  this  regard,  and  personally  we  should 
be  most  happy  to  oblige  them  by  using  some  other 
term  if  they  could  suggest  to  us  an  expression  by  which 
the  same  meaning  would  be  conveyed  as  that  in  the 
above  instance.  The  information  is  also  vouchsafed 
that  the  firm  intend  to  pursue  the  even  tenour  of  their 
way,  undeterred  by  anything  that  we  may  urge  to  the 
contrary.  This  very  original  expression  of  opinion  has- 
all  our  sympathy,  and  Guy's  Tonic  Company  may  rest 
assured  that  not  the  slightest  objection  is  taken  to  it 
so  far  as  this  journal  is  concerned.  Furthermore,  we 
learn  that  the  testimonials  published  by  the  firm  are 
from  persons  of  title,  clergymen,  members  of  the 
legal  and  medical  professions,  men  of  eminence 
in  art  and  letters,  "and  others  whose  walk 
in  life  places  them  above  all  suspicion."  In 
these  days  of  universal  uncharitableness  it  is 
quite  refreshing  to  find  that  the  public  statements  of 
men  of  position  and  others,  are  at  least  believed  in  by 
some  body.  Lastly,  we  are  informed  that  Guy's  Tonic- 
Company  are  now  supplying  one  of  their  preparations- 
(which  they  consider  to  be  one  of  the  triumphs  of 
elegant  pharmacy)  to  hospitals  in  town  (sic),  and  also- 
to  members  of  the  medical  profession  for  use  in  their 
private  practice.  These  latter  statements  appeared  to 
be  so  extraordinary,  if  true,  that  we  immediately  re- 
quested the  firm  to  be  so  kind  as  to  send  us  the  nameft 
of  the  hospitals,  as  well  as  those  of  the  members  of  the 
profession  to  which  allusion  was  made.  We  naturally 
considered  that  such  information  would  be  of  unusual 
interest  to  our  readers.  But  the  Gny's  Tonic  Com- 
pany were  evidently  dissatisfied  with  our  methods  of 
discussing  their  afliairs,  and,  in  consequence,  have  so 
far  failed  to  comply  with  the  request.  Therefore,  it  is 
unnecessary  to  say  more  upon  the  matter,  and  our 
readers  will  be  able  to  draw  their  own  conclusions. 

Lactio  Acid  and  the  Diagnosis  of  Gkustric 
Garcinoma. 
In  1892  Martins  and  Luttke  showed  that  lactic  add 
was  not  a  normal  constituent  of  the  gastric  contents, 
and  this  fact  has  been  turned  to  account  by  Boas  in 
respect  to  the  diagnosis  of  carcinoma  of  the  stomach. 
He  devised  a  meal  test,  consisting  of  a  tablespoonf  ul 
of  oatmeal  flour  to  a  litre  of  water.  The  stomach,  to  be 
examined,  is  thoroughly  washed  out  at  bedtime^  and  the 
test  meal  given.  The  contents  are  withdrawn  in  the 
morning  and  examined  for  lactic  acid.  Boas  found  that 
lactic  acid  was  never  present  at  any  stage  of  normal 
digestion,  nor  was  it  present  in  any  abnormal  condition 
of  the  stomach  save  carcinoma,  in  which  disease  it  is* 


Mab.  18,  1686. 


NOTES  0»  CUEKENT  TOPICS. 


Tub  Medical  P&bss.     303 


AlmoBt  UHMablj  preaeDt  io  large  quantitiet.  Oaaes  of 
eaDeertemvnr,  amyaziBt in  whicb  oolacticacid  is  found. 
Inapnetkal  paper  apon  this  sabject  recently  read 
before  tbe  mugkal  aeetion  of  the  Buffalo  Academy  of 
Medieine,  and  published  in  the  New  York  Medical 
News^  Dr.  Allen  Jones  states  that  Boas'  method  had 
afforded  him  valuable  assistance  in  the  diagnosis  of 
cardnoma  and  in  a fewcases  he  had  been  better  able,  by 
its  assistance,  to  make  an  early  proyisional  diagnosis 
before  any  tumour  was  palpable.  These  results  have 
been  confirmed  by  other  observers,  and,  thus,  it  would 
seam,  that  in  all  cases  of  suspected  carcinoma  of  the 
stomach,  the  test  devised  by  Boas  would  be  worthy 
of  atrial. 

The  Appointment  of  the  New  Director- 
General  of  the  Army  Medical  Department. 
It  is  to  be  feared  that  the  officialism  which  has 
tended  as  much  as  anjrthing  to  add  to  the  unpopularity 
of  the  Army  Medical  Service  will  be  continued  with 
the  appointment  of  the  New  Director  •  General. 
Instead  of  Lord  Landsdowne  availing  himself  of  the 
opportunity  to  do  that  which  would  have  satiafied  the 
whole  Department,  he  falls  into  the  error  of  sinking 
his  individuality  by  giving  way  to  the  Military 
Authorities  at  the  War  Office.  As  has  been  proved  on 
many  other  previoas  occasions,  the  powers  that  be  at 
the  War  Office  are  only  too  ready  to  adopt  any  course 
which  they  know  to  be  opposed  to  the  wish  of  the 
Army  Medical  Officer?.  The  present  case  is  distinctly 
one  of  that  description.  The  War  Office's  nominee  for 
the  post  of  Director-General  is  not  likely  to  be  any 
more  successful  in  the  management  of  the  Department 
than  his  predecessors  have  been,  and  when  he  comes 
to  assume  the  reins  of  office,  he  will  be  just  as  much 
under  the  thumb  of  the  military  element. 


The  Madagascar  Gampttign  and  Its  Mortality. 
A  KSCSNT  number  of  a  French  contemporary  givea 
some  remarkable  figures  with  respect  to  the  losses 
sustained  by  the  French  Army  during  the  Madagascar 
Campaign.  According  to  an  officer  who  was  present 
at  the  conclusion  of  the  operations,  the  figures  were— 
Killed  by  the  enemy,  7  ;  wounds  under  fire,  94  ;  deaths 
{rem  disease,  6,000 ;  on  the  sick  list,  15,000.  But  even 
these  numbers  were  exceeded  by  the  deaths  which 
occurred  during  the  ill-fated  expedition  of  1802  to 
Jamaica.  A.  force  of  60,000  men  left  Brest  Harbour 
in  that  year  for  the  island  in  question,  and  in  four 
months  no  less  than  50,000  had  died  from  yellow 
fevisr.  Of  the  10,000  remaining  only  300  ever  saw 
France  again,  and  these  did  not  reach  home  till  seven 
yeare  had  passed. 

Our  Professional  Muster  Boll. 
Thb  Registrar  of  the  General  Medical  Council  has 
aent  us  the  Medical  and  Dentists'  Registers  for 
1896,  which  appear  this  year  with  a  promptitude  and 
punctuality  which  might  well  be  emulated  by  others  of 
our  public  departments,  which  seem  to  consider  that 
July  or  August  is  quite  soon  enough  to  present  their 
new  year's  reports.    We  have  also  received  the  com- 


plete year's  volume  of  the  minutes  of  the  Council. 
From  the  Medical  Register  we  learn  that  33,601 
practitioners  are  duly  recognised  as  British  qualified 
membera  of  the  profession.  This  number  represents 
an  increase  in  the  strength  of  the  profession  of  very 
nearly  1,000  in  the  year.  In  fact  it  may  be  roughly 
stated  that  in  each  of  the  recent  years  about  1,500  new 
names  have  been  added  to  the  list,  and  about  500 
struck  ofif  by  deaths  or  for  other  reasons,  there  being, 
thus,  an  increment  of  about  1,000  in  each  year.  The 
respective  nationalities  of  these  new  practitioners 
have,  however,  undergone  considerable  change  within 
the  past  ten  years ;  for,  while  the  output  of  practi- 
tioners by  Scotland  has  largely,  and  that  of  England 
somewhat,  increased,  the  number  issuing  from  Ireland 
has  materially  fallen  off.  Twenty  years  ago,  Scotland 
sent  out  only  179  practitioners  in  the  year,  whereas  it 
now  issues  565.  England,  which  sent  forth  608  in 
1876,  now  sends  731 ;  while  Ireland,  which  then  sent 
out  222,  and  afterwards  rose  to  318  in  the  year  1887, 
now  only  outputs  150.  The  Dentists'  R<>gister  does 
not  present  a  very  encouraging  view  of  the  educational 
status  of  the  speciality.  There  are  4,935  dentists  on 
the  Register,  but  3,452  of  these  hold  no  qualification  at 
all.  A  large  proportion  of  these  are  chemists,  hair- 
dressers, and  the  like,  who  were  admitted  promiscuously 
to  the  dignity  of  dentistry  when  the  Act  was  passed  in 
1878.  It  is  regrettable  to  observe  that,  in  the  twen^ 
years  which  have  since  elapaed,  time  has  done  so  little 
towards  purging  the  dental  profession  of  these  inter- 
lopers who  now  form  70  per  cent,  of  its  total  strength* 
At  this  rate  of  progress  we  shall  have  entered  upon  a 
new  century  before  it  can  be  claimed  that  a  dentist  is 
necessarily  an  educated  practitioner. 


The  Founder  of  the  Red  Gross. 
It  is  not  known,  save  to  a  few,  that  Henry  Dnrrant, 
the  founder  of  the  Red  Cross  organisation,  is  now,  in 
his  declining  years,  dependent  on  public  charity  for 
support.  This  is  a  sad  fate  to  have  befallen  one  who 
spent  all  that  he  had  in  the  cause  of  the  relief  of 
human  suffering.  Except  for  the  unselfish  and  tireless 
efforts  which  he  displayed,  there  b  every  probability 
that  the  Red  Cross  organisation  would  never  have 
reached  the  perfection  to  which  it  has  attained. 


The  Dangers  of  Street  Ice-Creams. 
Wb  have  had  occasion  before  to  refer  to  the  danger- 
our  character  of  those  suspicious  compounds  known 
as  ice-creams  which  are  sold  from  barrows,  chiefly  by 
Italians,  in  London  streets.  With  commendable  enter- 
prise the  St  Pancras  Vestry  quite  recently  ordered  a 
report  to  be  made  upon  the  subject,  and  the  result  was 
the  disclosure  of  some  remarkable  facts.  "  Whereas  in 
good  drinking  water,"  the  report  says,  *'  there  are  rarely 
more  than  100  bacteria  per  cubic  centimetre,  three 
samples  of  ice-cream  which  were  analysed  contained 
respectively  4,200,000,  2,150,000,  and  5,340,000  bac- 
teria. The  filthy  conditions  under  which  cheap  ice- 
creams are  vended  constitute  a  public  danger,  and 
especially  a  menace  to  the  health  of  the  children  of 
the  poorer  classes,  by  whom  the  ice-creams  are  mainly 


304:    Thb  Msdioal  Pbwb. 


NOTES  ON  CURRENT  TOPICS. 


Mab.  18,  ia>6. 


oonsamed."  The  Vestry,  therefore,  decided  to aek  the 
Local  QoverDment  Board  to  promote  legielation  for  the 
regulation  of  that  commodity  and  to  provide  for  the 
proper  enperraioD  of  its  manufacture  and  sale.  The 
Board  would  be  well  advised  to  fall  in  with  this  sug- 
gestion, more  especially  as  a  very  laige  trade  is  done 
in  the  commodity  in  question,  and  quite  possibly  a 
great  deal  of  harm  follows  in  consequence. 

Vegetable  Diet  in  Relation  to  the  Length  of 
the  Human  Intestine 
The  intestine  of  animal  vegetable  feeders  is  known 
to  be  of  great  length,  but,  so  far,  no  detailed  investiga- 
tions have  been  made  in  this  regard  respecting  those 
human  races  which  mainly  live  on  vegetable  products. 
However,  it  is  interesting  to  note  that  a  professor  of 
anatomy  in  the  Academy  of  Medicine  in  Tokio  has 
made  some  attempt  in  this  direction  by  inquiring  into 
the  length  of  the  intestine  in  Japanese  persons.  The 
inquiries  included  the  measurement  of  the  body  and  of 
the  intestine  in  twenty-five  cadavers,  the  ages  of  which 
varied  from  17  to  60.  The  result  of  the  measurement 
went  to  show  that  the  length  of  the  intestine  in  the 
Japanese  was  half  as  long  again  as  the  average  length 
in  a  European.  ThuF,  the  suggestion  has  been  made 
that  the  rice  diet  so  universally  resorted  to  by  the 
Japanese  would  have  more  chance  of  thorough  diges- 
tion in  them  than  in  Europeans,  whose  intestine  is 
shorter.  We  merely  state  these  facts  for  what  they 
are  worth.  Whether  or  not  they  are  true  is  another 
matter. 

The  International  Oongress  of  Dermatology. 
The  Secretary-General  of  the  Third  International 
Congress  of  Dermatology  asks  us  to  announce  that  it 
will  be  held  in  London,  this  year,  from  August  4th  to 
8th  inclusive.  The  meetings  will  take  place  in  the 
Examination  Hall  of  the  Royal  College  of  Physicians 
and  Surgeons,  on  the  Victoria  Embankment.  Separate 
sections  will  be  established  for  Dermatology  and 
Syphilis,  the  meetings  of  these  being  held  simul- 
taneously. The  scientific  portion  of  the  programme  is 
practically  complete,  and  the  large  number  of  British  as 
well  as  Foreign  medical  men  who  have  testified  their 
intention  of  being  present  ensures  the  success  of  the 
Congress,  of  which  Mr.  Jonathan  Hutchinson,  F.RS.,  is 
President.  The  fee  for  Membership,  which  entitles  to 
the  Volume  of  Transactions  to  be  issued,  is  £l,  payable 
to  the  Hon.  Treasurer,  Mr.  Malcolm  Morris.  The 
Secretary- General  to  whom  all  communications  may 
be  addressed,  is  Dr.  J.  J.  Pringle,  23  Lower  Seymour 
Street,  London,  W. 

Curious  Reprisals. 
It  is  announced  that  in  the  event  of  the  anti  Spanish 
resolutions  of  the  United  States  Senate  being  con- 
firmed, the  chemists  of  Barcelona  will  unanimously 
refuse  to  sell  American  patent  medicines.  This  is 
calculated  to  make  the  advocates  of  the  independence 
of  Cuba  hesitate  before  exposing  their  country  to  the 
risk  of  such  terrible  reprisals,  but  the  possibility  of  this 
unprecedented  embargo  suggests  several  interesting 


oonsideratiooi,  as*  for  instanee,  the  effset  on  the  mor* 
tality  returns.  So  far  as  our  experience  goes,  the  de- 
privation ci  every  tingle  article  oi  the  heterogeneous 
repertoire  of  American  specialities  would  be  likely  only 
to  improve  the  public  health.  In  all  probability,  how- 
ever, they  are  consumed  only  by  transatlantic  visitors, 
who  bring  along  with  them  an  inveterate  habit  of 
taking  ai^rodisiacs  and  other  nerve  stimulants  on  the 
one  hand,  and  hypnotics  on  the  other.  In  view  of 
the  facilities  for  replenishing  the  travelling  medicine 
chest  from  Paris  or  London,  we  doubt  if  the  resolution 
would  have  any  very  obvious  effect ;  certainly  not  that 
of  the  braggadocios  who  proposed  it.  Even  if  the 
remedies  in  question  were  indispensable  to  health  or 
comfort,  it  would  be  unjust  to  visit  the  penalty  of 
political  quarrels  on  unoffending  sufferers. 


Over- Production  in  the  Professions. 
At  the  Annual  Convocation  of  the  Bombay  Univer- ' 
sity,  held  on  the  25th  ult,  the  Report  stated  that  some 
three  thousand  candidates  presented  themselves  at  the 
last  examinations,  of  whom  nearly  one-third  were  suc- 
cessful. This,  said  the  Vice-chancellor,  in  his  address, 
may  be  regarded  as  evidence  of  the  growing  popularity 
of  the  University,  and  the  increased  interest  taken  in 
its  work  by  the  natives  of  India,  comprising  among 
them  Hindus,  Mahomedans,  and  Parsees.    But,  asks 
the  Bombay  Oazette,  are  we  quite  certain  that  some- 
thing   like    an    over-production    of    qualified    pro- 
fessional men  beyond  the  needs  of  the   community 
at  large   is    taking    place    in    India    as    well    ae 
in     other     parts     of     the     world.      This    danger, 
if    such    it    is    found    to    be,    is    by    no    means 
confined   to  India,  nor   our   other  colonial   posses* 
sions.    It  has  probably  reached  its  greatest  develop- 
ment in  Great  Britain  and  other  western  countries, 
where  the  greatest  overproduction  of  the  professional 
elapses  is  taking  place.    In  Qreat  Britain  there  are 
twenty-four  thousand  medical  men,  and  the  medical 
schools   are    yearly   adding   to   the    number.    The 
barristers  at-law  number  over  eight  thousand,  of  whom 
it  is  said  not  a  thousand  can  live  by  their  professional 
earnings.    The  plethora  appeared  so  great  that  last 
year,  for   the  first  time  the  number  of  candidates 
diminished  very  considerably.    It  is  the  same  with 
the  other  learned  professions.    Turn  to  Germany,  six 
thousand  recruits  joined  the  great  army  of  the  unem- 
ployed of  the  professional  classes,  through  the  ever 
open  gates  of  the  universities.    In  France  the  same  dis- 
proportion between  the  successful  and  the  unsuccessful 
entering  the  profession  prevails.    To  look  somewhat 
deeper  into  this   question,  we  may   inquire,   What 
becomes  of  that  far  more  numerous  body  who  strive 
to  enter  one  or  other  of  the  professions,  and,  after 
spending  their  means  and  their  youth,  fail  in  their 
endeavour,  and  are  flung  back  upon  the  world  without 
resources  and  hope  for  the  future?  The  Vice-ChanceUor, 
the  Hon.  Mr.  Justice  Jardine,  in  the  course  of  his  able 
address,  called  attention  to  the  fearful   sacrifice  of 
health  and  life  too  often  entailed  by  students  in  their 
struggle  to  gain  University  honours.    The  early  mor- 
tality among  even  the  more  gifted  and  the  more  sue- 


Mab.  la,  1896. 


NOTES  ON  CUKRENT  TOPICS. 


Tm  MxDioAL  Pbiss.    305 


ceBsfal  8iigge8t8  doubts  aa  to  the  abeolate  perfection  of 
the  system  which  entails  such  lamentable  results.  It 
wDl  not  be  denied  that  in  India  the  benefits  conferred 
by  the  better  and  more  liberal  education  of  the  young 
men  has  done  excellent  service  by  infusing  the  learned 
professions  with  a  higher  standard  of  learning,  and  we 
cordially  reciprocate  the  Vice  Chancellor's  wish  that 
the  princely  and  wealthy  classes  of  the  community  will 
emulate  their  predecessors  by  further  endowing  chairs 
on  the  medical  side  for  the  purposes  of  original  re- 
search and  bacteriological  study. 

The  Presidenoy  of  the  Royal  Oollege  of 
Physicians  of  London. 

Tfii  statement  that  Sir  Russell  Reynolds,  Bart., 
F.R.S.,  President  of  the  Royal  College  of  Physicians, 
does  not  seek  re-election  will  hardly  cause  much  sur- 
prise. The  duties  are  arduous  and  are  hampered  by 
technicalities  and  formalities  which  must  prove  exces- 
sively irksome  and  trying  both  to  the  physical  and 
mental  enericy  of  a  physician  who  took  his  M.D.  as  far 
back  as  1852.  For  some  years  past  the  tendency  has 
been  to  re-elect  the  President  for  ^ve  consecutive 
yean,  but  there  is  a  feeling  that  the  interests  of  the 
College  might  possibly  be  better  served  if  this 
period  were  to  be  curtailed.  The  election  takes  place  on 
March  30th— the  first  Monday  after  Palm  Sunday  - 
and  is  likely  to  excite  considerable  interest.  It  is  a 
curious  circumstance  that  on  this  particular  occasion 
there  is  no  one  candidate  who  stands  out  prominently 
from  the  rest  of  his  colleagues.  It  is  an  open  race,  and 
aa  every  Fellow  is  a  starter  it  is  by  no  means  easy  to 
back  the  winner.  In  so  open  a  contest  it  does  not 
seem  probable  that  Sir  Richard  Quain,  Sir  Henry 
Pitman,  Sir  Edward  Sieveking,  Sir  Qeorge  Johnson, 
and  Dr.  Samuel  Wilks,  though  admittedly  pos- 
sessing high  claims  to  the  honour  will  receive 
the  necessary  amount  of  support.  Dr.  John 
W.  Ogle  is  much  fancied  in  official  circle?, 
and  will  probably  render  a  good  account  of 
himself.  The  fact  of  Dr.  Burdon- Sanderson  having 
accepted  the  Regius  Professorship  of  Medicine  at 
Oxford  practicallydisqualifies  him  fromaccepting  office. 
Sir  William  Roberts'  name  is  freely  mentioned  and  his 
election  would  be  popular,  especially  in  the  provinces. 
Sir  Wm.  Priestley  will  probably  receive  some  support, 
bat  how  much  it  is  difficult  to  say.  Dr.  J.  E.  Pollock, 
who  acted  as  pro-president  on  the  death  of  Sir  Andrew 
Clark,  in  1893,  has  exceptionally  strong  claims  on  the 
College.  Amongst  the  comparatively  junior  Fellows, 
%  William  Broadbent,  and  Dr.  Allchin  are  favoured, 
and  they  will  probably  receive  a  certain  number  of 
votes  with  a  view  not  so  much  to  the  present  election 
as  to  future  contingencies. 


Lamp  Accidents. 
At  this  time  of  day  one  would  think  that  the 
notorious  loss  of  life  and  property  due  to  defective 
lamps  would  have  led  to  some  legislative  interference. 
Nothing  of  the  sort,  however,  has  yet  been  undertaken, 
and  the  holocaust  still  thrives  with  unabated  vigour. 
An  exhaustive  report  on  the  subject  has  been  lately 


issued  by  Mr.  Spencer,  Chief  Officer  of  the  Public  Con^ 
trol  Department  of  the  London  County  Council.  He 
IB  of  opinion  that  if  a  drastic  law  were  passed  prohibit' 
ing  the  sale  of  unsafe  oil  the  bulk  of  lamp  accidents 
would  be  stopped  at  once.  He  further  suggests  that 
the  Home  Secretary  should  issue  an  order  forthwith 
forbidding  the  sale  of  dangerous  lamps.  It  is  to  be 
hoped  that  the  Government  will  no  longer  put  off  the 
passing  of  this  most  useful  and  necessary  piece  of  prac 
tical  domestic  legislation.  Every  day's  delay  means  a 
further  preventable  sacrifice  of  life  and  property  for  the 
profit  of  certain  circles.  Last  year  there  were  no  fewer 
than  473  fires  and  23  deaths  caused  by  lamp  accidents. 
These  figures,  moreover,  for  various  reasons,  un* 
doubtedly  fall  short  of  the  mark.  An  enormous 
number  of  small  fires  and  lesser  injuries  due  to  lampe 
are  not  brought  under  the  notice  of  the  authorities. 

Bacteria  in  Aerated  Waters. 
A  Berlin  medical  man  has  raised  a  new  scientific 
scarecrow.  He  is  reported  to  have  stated  that  after  ao 
elaborate  series  of  experiments,  he  found  bacteria  in 
all  the  bottled  mineral  waters,  natural  as  well  as  arti- 
ficial. Now,  this  result  is  serious,  inasmuch  as  it 
affects  a  large  body  of  consumers,  and  an  enormous- 
trade  interest.  Moreover,  it  is  in  direct  opposition  to 
the  generally  accepted  belief  that  bacteria  cannot  exbt 
for  any  length  of  time  in  bottled  aerated  waters.  The 
experiments  of  English  bacteriologists  in  this  direction 
show  that  the  microorganisms  have  a  life  limited  to  a 
few  days  only  when  imprisoned  within  a  bottle  of 
Seltzer,  Apollinaris,  Johannis,  Rosbacfa,  or  other 
aerated  water ;  and  we  are  certainly  not  disposed  to 
cease  our  faith  in  English  experiments  in  favour  of  a 
German  theory,  until  it  can  be  proved  by  authoritative 
and  unprejudiced  investigations  not  to  be  founded  on 
fact. 


Death-traps  for  Theatre-groers. 
The  risks  to  health  and  life  to  which  theatre-goers 
are  exposed  under  present  conditions  together  furnish 
a  picture  worthy  of  serious  public  attention.  At  the 
doors  of  many  of  our  theatres  may  be  nightly  seen  the 
time-honoured  queue  of  patient  folks,  huddled  together 
in  spite  of  rain,  snow,  hail,  frost,  or  sultry  heat.  Inside^ 
the  theatre  is  often  badly  ventilated,  lighted  with  gas 
(yegods !  what  an  anachronism!!),  and  scantily  furnished 
with  narrow,  twisting  exits  that  must,  in  case  of 
fire,  convert  the  whole  building  into  a  veritable 
death-trap.  Then  there  is  the  sudden  change  at 
the  close  of  the  performance  to  the  outside  atmosphere 
and  perhaps  a  long  journey  home  in  inclement  weather. 
Lately,  the  MetropUtan  Police  have  so  arranged 
the  cab-traffic  in  the  Strand,  where  the  theatres  most 
do  congregate,  that  it  is  impossible  to  get  a  cab,  except 
either  by  waiting  a  long  time  or  by  walking  a  consider- 
able distance.  The  London  County  Council  is  now 
insisting  on  the  proper  construction  of  places  of  amuse- 
ment. Let  it  go  a  step  further,  and  abolish  the  qiieue 
by  refusing  a  licence  unless  all  seats  can  be  booked  io 
advance.  Or  if  that  be  outside  their  powers,  let  them 
prevail  on  Parliament  to  strengthen  their  hands  in  this 


306     Thb  Midioal  Pbim. 


SCOTLAND, 


Mab   h,  18M. 


particular.  It  may  be  safely  aiaerfted  that  most  medical 
«nen  of  wide  experience  would  anheritatiiigly  condemn 
the  environment  of  the  modem  theatre  aystem  as  the 
root  and  fountain-head  of  widespread  catarrhal  and 
•other  mischief,  both  acute  and  long-abiding. 

The  Unvaooinated. 
Oke  of  the  most  striking  statements  in  the  recently- 
issued  report  of  the  Local  Gbyernment  Board  is  that 
which  refers  to  the  growing  neglect  of  vaccination^ 
nearly  15  per  cent  of  the  children  born  in  1894 
were  not  vaccinated.  In  Mile  End  Old  Town  more 
than  half  the  children  were  not  accounted  for,  while 
in  Gloucester,  Wellingborough,  Lutor,  KeigUey, 
•Coventry,  Barrow-onSoar,  Blaby,  Northampton, and 
Leicester  the  proportion  was  over  80  per  cent  Mean- 
while the  state  of  (hings,  so  far  as  the  epidemic  of 
small-poz  at  Gloucester  is  concerned,  is  becoming 
serious.  The  regular  hospital  there,  and  also  a  new 
one  hastily  erected  near  the  city,  are  filled  to  over- 
:flowing.  Forty- nine  fresh  cases  were  notified  in  the 
week  before  last,  sixty-six  last  week,  and  one  hundred 
and  thirty-eight  during  the  week  just  closed  ;  while 
fresh  outbreaks  are  being  notified  at  the  rate  of  ten  to 
fifteen  daily.  Despite,  however,  the  progress  of  the 
-disease  and  the  virulence  which  it  has  displayed,  the 
opportunity  has  been  seized  by  the  anti-vaccinationist 
agitators  to  hold  meetings  and  placard  the  district 
with  their  fatuousand  misleading  statements,  counsel- 
ling their  dupes  to  stand  firm  in  their  opposition 
against  the  vaccination  law.  Thus,  while  the  fathers 
and  mothers  attend  the  meetings  of  these  professional 
agitators,  their  children  contract  small'^pox,  and  are 
•carried  away  to  the  hospital,  frequently  to  die.  There 
appears  to  be  only  one  journal  published  in  Gloucester 
which  gives  support  to  the  anti-viiccinationists.  It  is 
«ad  to  think  that  it  should  have  made  such  a  bid  for 
popularity. 

Sib  William  Hinostok  has  been  appointed  to  a 
seat  in  the  Canadian  Senate.  This  is  the  first  time  in 
the  history  of  the  Dominion  that  the  medical  prof  es- 
^on  in  Montreal  has  been  thus  honoured. 


[VBOM  CUB  OWN  OOBBBSPONDBRT.] 

Lbith  Hospital.— Aa  noted  Id  our  colamne  lately,  a 
tiQmber  of  new  appointmente  have  recently  been  made  to 
thiB  hoepital  to  tiu  vaeaociee  dae  to  reeiffnations  of  the 
former  staff.  Several  details  have  been  poDllshed  in  last 
week's  lay  papers  anent  the  canses  wnich  led  to  Uie 
•changes  in  tne  staff.  The  origin  of  all  the  pother  is  traced 
to  the  old  sonrce— directors  versus  staff.  For  some  time 
back  the  managers  have  been  urged  by  outsiders  to 
appoint  specialists  on  the  hospital  staff,  bnt,  as  is  said, 
the  managers  resented  advice  at  the  time,  only  to  sugeest 
the  same  thing,  apparenUy  spontaneoosly,  last  November. 
What  appears  to  nave  broognt  matters  to  a  head  was  the 
performance  of  a  major  operation  in  the  hospital  by  an 
lidinburgh  gynnooloeical  specialist  withont  the  sanction 
of  the  managers,  very  considerable  friction  occurred 
about  this  small  matter,  and,  as  a  oonsequenoe,  four  of 
the  seven  visiting  doctors  tendered  their  resignations, 
which  were  accepted.  A  fifth  had  resided  for  much  the 
same  reason  about  two   months   previously.      Another 


cause  of  friotioB  Wiethe  assamptioQ  by  the  managers  of  a 
right  which  is  geoerally  regarded  as  belonging  to  the 
honorary  staff,  t.e.,  the  appointment  of  resident  phyeioiaiia. 
The  managers  claimed  this  right,  the  staff  holding  that 
they  shoQuit  as  in  many  hospitals,  have  merely  the  right 
of  vetoing  any  undesirable  appointment. 

The  aanoyanoe  caused  by  these  autocratic  actions  of  tba 
governing  board  is  well  exemplified  by  i  he  fact  that  no 
Leith  practitioner  applied  for  the  vacancies  announoad 
after  the  reeiffUAtions  above  referred  to.  All  the  new 
officials  are  Edinburgh  practitioners,  and  it  is  a  queetion 
whether  the  directors  were  not  acting  ultra  vires  in  making 
these  appointmente.  It  is  open  to  question,  however, 
whether  the  hospital  is  not  better  manned  now  than  be- 
fore, for  it  was  a  matter  of  notorietv,  largely  owing  to  the 
absence  of  specialists,  and,  therefore,  to  the  managers' 
short-sighted  policy,  that  the  hospital  had  not  a  very  good 
reputation,  it  is  always  a  matter  to  be  deplored  when  the 
managers  of  such  a  hospital  choose  to  act  m  a  manner  out 
of  sympathy  with  the  honorary  medical  staff,  andwecannot 
but  feel  regret  that  thev  have  exhibited  so  little  of  the 
suavittr  in  modo,  and  cultivated  such  an  egotistical  and 
uncharitable /oKtter  in  re.  We  believe  that  the  hospital, 
although  to  some  extent  endowed,  i«  dependent  partly  on 
voluntary  subscriptions,  and  it  is  certain  that  the  hasty 
and  iluSonsiderea  action  of  the  managers  will  alienate  a 
numbcNT  of  the  supporters  of  the  institution,  if  only  from 
the  publicity  given  to  their  washing  of,  what  to  them, 
was  soiled  linen. 

Thb  Paislby  iMFiBMABY.^At  the  110th  annual  meeting 
of  the  directors  and  subscribers  to  thi«  charity,  it  was 
mentioned  that  owing  to  the  benefits  of  the  Notifioatioo 
Act,  the  number  of  infectious  diseases  was  lower  than  in 
any  year  since  1891.  It  is  worth  noting  that  the  authori- 
ties of  many  of  the  hospitals  ascribe  this  diminution  to  the 
A«4«,  not  to  the  absence  of  any  serious  epidemic.  The  reet 
of  the  report  calls  for  no  special  comment.  The  finances 
seem  to  be  in  a  fairly  satisfactory  state. 

Tub  Royal  Sooibty  of  EoiNBUBGH.^At  a  recent  meet- 
ing of  this  society,  Mr.  R.  C.  Mossman,  a  well-known 
local  meteorologist,  read  a  paper  entitled,  *'  The  Seasonal 
Death-rate  from  Certain  Diseases  in  Edinburgh  during  the 
period  1878-94  with  remarks  on  the  Relation  between 
Weather  and  Mortality***  The  data  used  were  tabulated 
from  the  weekly  returns  of  the  Registrar-General  for 
Scotland,  and  the  meteorological  observations  from  the 
Edinburgh  stations  of  the  Scottish  Meteorological 
Society.  The  primary  object  of  the  peper  was  to  give  an 
idea  of  the  variations  in  the  mortality  of  some  diseases 
throughout  the  year.  The  maximum  death-ra^e  from  all 
causes  occurred  between  the  middle  of  November  and  the 
end  of  January,  the  minimum  f  lom  the  beginning  of  July 
to  the  end  of  September.  The  number  ot  deaths  from 
scarlet  fever,  croup,  laryng^itis,  diphtheria,  and  ty^dd 
fever,  were  most  numerous  in  November,  least  in  July, 
and  were  above  the  average  from  September  to  February. 
Measles  showed  three  annual  maxima,  viz.,  the  end  of 
December,  the  middle  of  February,  and  the  end  of  March, 
ite  minimum  being  in  the  month  of  August.  Whooping- 
cough  did  not  reach  ite  maximum  until  the  first  week  of 
May,  ite  minimum  in  November.  The  death-rate  from 
diarrhoea  roee  with  great  rapidity  after  June,  and  reached 
ite  heiffht  at  the  beginning  of  September.  The  deaths 
from  (flseases  of  the  respiratory  system  attained  their 
maximum  at  the  beginning  of  Dmmber,  immediately 
following  the  damp,  raw,  dumgeable  weather  common  to 
the  month  of  November  in  the^Sast  of  Scotland.  A  point 
which  Mr.  Mossman  emphasised  coincided  with  one 
hazarded  by  Dr.  Gillespie  in  a  previous  paper  on  much 
the  same  subject.  This  depended  on  the  connection 
between  variability  of  temperature  and  the  incidence  of 
bronchitis,  pneumonia,  and  pleurisy.  That  is  to  say,  that 
periods  of  intense  cold,  if  the  cold  was  continuous,  had 
much  lees  effect  on  the  incidence  of  these  diseases  than  the 
alternation  of  cold,  perhape  much  lees  intense,  and 
warmth.  Mr.  Mossman  introduced  a  new  factor  in  con- 
sidering this  subject,  a  factor  obtained  by  taking  the 
mean  variability  of  temperature  for  each  week.  That  is, 
of  course,  the  total  difference  between  the  daily  maxima 
and  minima  for  the  week  divided  by  seven.  Another 
interesting  point  brought  out  was  that  the  mortality  in 
Loodon  from  five  chief  zymotic  diseases  reached  ite  maxi- 
mum two  to  nine  weeks  earlier  than  in  Edinburgh.    On 


Mab.  18,  1986. 


CORRESPONDENCE. 


Thb  Mbdioal  Pbvs.    307 


tbe  other  haod,  the  minimam  death-rmte  from  wboopiDg- 
ooogh,  scarlet  fever,  and  tjrphoid:  fever  took  place  toD 
weeks  earlier  in  London*  of  measlea  and  diarrhoea  a  month 
Uler. 

QusB^  Mabgabbt  Colukie.— Some  ehort  time  aeo  we 
leierred  to  the  fact  that  Qaeen  Marp^aret  College  watlikely 
to  be  a  finsDcial  burden  on  the  Univerftity  of  (Haagoir,  bat 
this  was  denied  by  a  certain  section  in  connection  with  the 
GoUega  Tbe  fact,  however,  ia  now  eelf-evident.  if  the 
aoooonte  for  1894-95,  joat  pnbllBhed,  are  to  be  trusted. 
From  these  we  gather  that  the  income  from  all  soarces 
from  Queen  Margaret  College  was  J^824'  48. 9d.,  and  the 
recovdetl  expenditure  amounted  to  £3,122  Os.  2dL»  showing 
a  de6cienoy  of  £297 15e.  5d.  This  unfortunately  is  not  al^ 
•a  the  above  disbursements  do  not  include  any  portion  of 
the  expenses  of  preliminary  and  degrse  examinations, 
which  amounts  to  the  sum  of  £1,194  9s.  Id.  Taking  the 
number  of  matriculated  students  as  a  basis  of  allocation. 
Queen  Margaret  College  is  chamable  with  two-nineteenths 
of  this  sum,  in  other  words  £125  149.  8d.,  which  would 
incraape  the  shortcoming  to  £423  10s.  Id.  And  it  must 
also  be  borne  in  mind  that,  up  till  the  present  time,  the 
aeoretaryship  of  Queen  Margaret  Cdllege  has  not  cost  a 
aingleduver,  as  Miss  Galloway  (the  Hon.  Secretary)  has 
always  declined  to  accept  any  remuneration  for  her  valu- 
able and  unwearied  services,  consequently  the  debit 
balance  would  have  considerably  exceeded  £600  had  Queen 
Margaret  CoU^  possessed  a  paid  secretary. 

FuBciPAi.  Caibd's  Hsalth.— We  regret  having  to 
report  the  illness  of  Principal  Caird.  For  some  weeks 
past  be  has  been  confined  to  bis  residence  suffering  from  a 
xather  severe  cold,  the  result  of  chilL  Altbouffh  his 
medical  advisers  do  not  anticipate  any  immediate  danger, 
yet,  considering  the  Principal's  advanced  aee,  they  have 
oome  to  the  conclusion  that  it  will  be  advisable  for  him  to 
relinquish  all  public  duty.  At  a  recent  special  gradua- 
tion the  Principal  had  to  perform  the  ceremony  in  his  own 
boose.  We  wish  the  able  and  respected  Principal  a  speedy 
recovery,  and  a  return  of  his  usual  good  health. 

Medioo-P&tghologioal  AsaooiATioir.— a  meeMng  of 
the  Scottish  Division  of  this  Association  was  held  in  the 
Hall  of  the  Faculty  of  Physicians  and  Surgeons,  Glamiw, 
on  Thursday,  the  12th  inst.  Dr.  T.  W.  McDowell,  c^the 
Northumberland  County  Asylum,  in  the  chair.  Dr. 
Hamilton  Marr,  assistant  physician,  Lenzie  Asylum,  and 
Dr.  Hoesack,  assistant  physician,  Inverness  Asylum,  were 
elected  members  of  the  Association,  The  following 
papers  were  read,  and  led  in  each  case  to  considerable  dis- 
coflsioo  :^"  Certain  Conditions  of  the  Circulatory  Syetem 
in  the  Insane,"  by  Dr.  Edgerley,  Melrose  Asylum  ;  *' A 
Caae  of  Mental  Stupor,  with  Recovery  after  Six  Years' 
Duration,"  by  Dr.  Hotchkins,  Gartnavel  Asylum ;  "  Forms 
for  Case-takieg  and  for  other  Asylum  Records,"  by  Dr. 
Urqnhart,  Murray  Asylum;  and  '* Dangerous  Lunatics 
and  the  Leeal  Provisions  for  dealing  with  Them,"  by  Dr. 
Ganwell,  Glasgow. 


(DbttttatQ. 

DR.  HUGH  J.  BYRNeTj.P.,  ROSS,  TASMANIA. 

Wk  announce  with  regret  the  death  of  Dr.  H.  J.  Byrne, 
at  Ross,  Tasmania.  For  a  considerable  time  his  friends 
became  sadly  convinced  of  his  declining  health.  He  bore 
bis  long  and  trying  illness  with  edifying  patience.  Ih. 
Byrne  was  bom  m  Dublin  in  1854,  made  his  studies  in 
tlie  Royal  CoUeee  of  Surgeons.  Having  secured  his 
diploma,  he  decic&d,  owing  to  delicate  health,  to  go  to 
Tasmania,  ^e  settled  in  Campbell  Town,  where,  for  some 
time,  his  hei^tb  seemed  to  improve.    During  his  seven 

J  rears'  residence  there,  he  built  up  for  himself  a  large  and 
ncrativepractice,and  deservedly  enjoyed  theconfidenceand 
good  will  of  all,  both  rich  and  poor,  in  that  district.  In 
1891,  feeling  that  the  wotk  in  Campbell  Town  was  too 
thuch  for  him,  he  changed  to  Ross.  Whilst  health  lasted 
he  turned  out  in  all  weather  as  cheerfully  to  alleviate 
auffering  in  the  hut  6r  tent  by  the  bush  tract  as  in  the 
mansion.  His  kindtteiM  to  the  sufferine,  and  especally  to 
the  sufferinflL  potbr,.  won  for  him  the  hearts  of  all  in  the 
Midlands.  It  is  not,  therefor^  surprising  that  inhabitants 
of  the  district^  without  distinction  ta  dass  or  creed, 
assembled  at  his  obsequies.    When  the  coffin  was  laid  in 


Its  resting  place.  Dean  ConneU  addressed  a  few  words  to- 
thoee  who  stood  round  the  open  grave— words  fuU  of 
kindly  sympathy.  Dr.  Byrne,  be  said,  was  known  to  all 
of  them  as  a  man  of  sterfing  qualities  of  head  and  heart. 
He  felt  sure  they  all  wished  eternal  rest  to  the  soul  of  their- 
degarted  friend. 

Subsequently  a  public  meeting  was  held  in  the  Town 
HalL  After  some  discussion  it  was  decided  as  the  best 
means  of  showing  the  respect  and  high  esteem  Dr.  Byrne- 
was  held  in  by  all  to  place  some  memorial  over  his  grave. 
If  the  amount  subscribed  is  sufficient,  a  wish  of  the  late 
Doctor  will  be  fulfilled,  in  providing  an  ambulance  vehicle* 
for  Campbell  Town  Hospital. 


fWe  do  not  hold  onmelvM  reipoiiaible  for  the  opinions  of  oni- 
eomqwDdeDta.]  ^ 

THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 
To  the  Editor  of  Thk  Mkdioal  Pbiss  akd  Cibcuiar. 
Snt^— This  is  evidently  becoming  one  of  the  burning 

Siestions  of  the  day,  and  now  that  tne  proceedings  of  the- 
w  courts  are  being  let  loose  upon  it^  we  are.  being  forced 
into  a  very  close  consideration  indeed  of  what  can  be  done 
and  what  cannot  be  with  safsty  condemned.  It  is  but  a 
very  few  years  ago  since  whole  columns  of  the  Time9 
were  occupied  by  medical  publishers  in  the  weekly  adver- 
tisements of  our  very  best  text-books.  A  few  vigorous 
resolutions  of  some  of  the  medical  corporations  suddenly 
p^t  an  end  to  this  practice,  but  it  is  worthy  of  note  that 
many  of  those  who  took  part  in  the  {Mssing  of  those  reso-* 
luttons  were  those  who  occupied  their  dominant  positions- 
byxeason  of  those  very  tezt-books»  and,  inferentially,  hy 
reason  of  that  same  system  of  advertisement.  We  find  the* 
General  Medical  Council  deciding  with  strange  impar* 
tiality,  but  with  a  specious  and  complete  abeence  of  logic, 
as  to  what  is  and  what  ia  not  infamous  conduct  in  a  '*  pro- 
fessional" sense,  and  now  and  then  qualifyinff  their 
judgment  by  exolaining  that  by  " professions!"  they 
really  mean  "  Pidrwickian."  Yet  we  see  to-day  a  pub- 
lished statement  that  «  Qnain's  Dictionary  of  Medieme" 
(its  author  being  PMeident  of  the  said  Council)  has  beei^ 
widely  advertised  in  lay  journals  within  the  last  few 
months.  Verily  and  in  truth,  all  this  is  contradictory  and* 
most  unsatisfactory. 

Dr.  Kinffsbur]^,  of  Blackpool,  has  lust  mulcted  the- 
Editor  of  tne  British  Medical  Journal  of  i*150  for  what  the^ 
court,  called  a  libel,  the  libel  being  what  any  body  will 
find  reported  in  the  Manchester  and  other  papers  of* 
February  SS9th,  that  is,  the  trial  took  place  on  February 
28ih.  In  tbe  Times  of  Februaiy  28tb,  the  same  day,  in^ 
the  run  of  little  bits  of  news  following  on  the  movements- 
of  royalty,  and  headed"  Court  Circuto, '  is  tbe  following  r. 
*< Mr.  Ernest  Hart  has  left. for  a  vachting  tour  in  the 
Riviera  for  the  restoration  of  his  health,  which  has  not 
yet  recovered  from  the  overstrain  of  his  recent  sanitary 
tour  in  India."  I  have  applied  to  the  publisher  of  thSe- 
Times,  and  have  his  printed  repl^  before  me  that  in  the- 
said  column  of  his  paper  such  insertions  are  charged  for 
at  the  rate  of  three  lines  for  a  guinea,  and  ten  shillings- 
and  sixpence  for  every  additional  line. 

Sir,  will  you  help  us  to  know  what  constitutes  fi^lt  and 
what  is  innocence  in  the  matter  of  undue  and  improper 
advertising  ?  I  confess  matters  are  at  present  perplexing 
beyond  all  consistency.    What  in  one  man  is  rank  blai^ 

Ehemy   seems  in  another  to  be  ground  for  a  suoceesful 
bel  action. 

I  am.  Sir,  yours,  &c., 

Lawsok  Tait. 
Birmingham,  Mar.  7tl^,  1896. 


To  the  Editor  ofTsE  MxDiOAL  Pbbss  and  Ciboulab. 

SiB^— I  cordially  and  heartily  agree  with  every  word  of' 
your  excellent  leader  on  medical  advertising,  and  I  am 
sure  that  such  an  outspoken  expression  of  opmion  can  do 
nothing  but  good.  There  may  possibly  be  some  excuse 
for  the  small  man  atruffgling  aumg  with  insufficient  means,, 
and  possibly  pressed  oy  praditors,  but  there  is  none  for 
the  liolder  of  a  high  official  position^  who  is  supposed  to 


308     Trb  Mbdigal  Pbiss. 


CORBESPOIJDEJSCE 


Mab.18,  1896. 


look  after  the  etbiei  of  his  weaker  brethren.  I  hope  the 
matter  will  engage  the  attention  of  the  Geneora*  Board  of 
the  Royal  CoU^of  PhyaioianB. 

I  am,  Sir,  yonra,  &c., 

A  Mbmbbr  or  thb  Collbob. 


To  the  EdUor  of  ftHB  Mbdioal  Pbbss  and  Cibcdlab. 

Sib,— In  oommon,  donbtleif,  with  many  of  yonr  readers, 
I  was  grateful  for  the  trenchant  article  on  this  sabject 
which  appeared  in  your  last  issue.  The  so  called ''  organs 
of  public  opinion  "  obstinately  refuse  to  aUow  us  to  "  bell 
the  cat"  under  similar  circumstances,  and  the  most 
heinous,  because  the  most  influential,  offenders  thus  escape 
soot  free. 

It  is  idle  to  protest  against  self-advertisement  by  medi- 
cal practitioners,  so  long  as  men  in  the  position  of  Sir 
Dyoe  Duckworth  are  allowed  to  perpetrate  it  in  its  most 
unblushinor  form  without  let  or  hindrance.  The  case  of 
Kingsbury  v.  the  BrUish  Medical  Journal  places  the  pre- 
sent position  of  the  question  in  bold  relief  and,  as  a 
memoer  of  the  Medical  Defence  Union,  I  would  suggest 
that  an  early  opportunity  be  taken  by  that  association  to 
obtain  the  opinion  of  the  General  Medical  Council  on  the 
Dermissibility  of  broadcast  advertisement,  aa,  for  instance, 
by  allowing  one's  name  to  appear  on  the  leaflets  of  an 
insurance  company.  Possibly,  also,  though  I  fear  hardly 
probable,  the  Ethical  Committee  of  the  Association  might 
be  induced  to  take  up  the  matter. 

I  do  not  necessarily  impljr  that  such  conduct  is  wrong, 
even  from  a  professional  point  of  view.  All  I  aak  is  that 
the  Council  shall  embody  in  a  resolution  a  deflnition  of 
what  constitutes  unprofessional  conduct  in  the  matter  of 
advertisement  on  the  part  of  a  medical  practitioner.  Fail- 
ing Apronunciamento  by  the  Council  let  us  arrive  by  dis- 
cussion at  some  conclusion  on  the  subject,  in  the  interests 
of  consistency  and  justice.  At  present  we,  with  our 
so-called  ethical  code,  are  the  laughingstock  of  the  public. 
Thouffh  simple  enough  in  its  inception,  this  code  appears 
to  be  oinding  only  on  the  '*  small  fry'*  consultants,  even 
oensors  of  the  Coll^  of  Physicians,  honouring  it  more  in 
the  breach  than  in  uie  observance.  Under  uie  circum- 
stances I  am  sure  your  readers  will  pardon  my  signing 
myself, 

Yours  obediently, 

A  WOULDBB  ABYBBTIBBR. 


To  the  Editor  qf  the  Mbdioal  Pbbbs  and  Giboulab. 
Sir,— My  attention  having  been  called  to  an  article  in 
Thb  Mbdioal  Pbbss  and  Gibcdlar  on  the  recent  libel 
«ase  of  Kingsbury  v.  British  MediecU  Journal  stating  that 
the  medical  men  of  Blackpool  were  backward  in  support- 
ing the  Journal^  I  think  it  only  fair  to  send  you  the 
«nmosed  cutting  from  the  Blackpool  Oaxette.  I  can  vouoh 
for  the  truth  otit  as  I  was  myself  in  court,  having  been 
eubpoenaed.  May  I  ask  you  to  kindly  correct  your  state* 
ment,  and  with  apologies  for  troubling  yon; 
I  am,  Sir^yours,  £c, 

.  H.  Blundbll,  M.B.,  M.Ch. 
Doric  House,  South  Shove,  Blackpool, 
March  10th. 

[The  cutting  referred  to  states  that  there  were  ^ve  local 
practitioners  ready  to  g^ve  evidence  against  the  plaintiff 
but  the  defendant's  counsel  refused  to  call  them. — Ed.] 


PHARMACOLOGY  AS  AN  EXAMINATION 

SUBJECT. 

To  the  Editor  qf  Thb  Mbdioal  PBSdB  and  Ciboular. 

Sib,— I  most  cordially  and  heartily  sme,  not  onlv  with 

the  sentiments  expressed  in  your  admirable  and  lucidleader 

•on  this  subject,  but  with  the  views  enunciated  by  my  friend 

Prof.  Leech,  whose  ezperienoe  both  as  a  teacher  and  as  an 

examiner  in  the  Victoria  University  enables  him  to  speak 

aa  an  authority  of  many  years'  standing     The  abohtion 

•of  Pharmaoology  as  an  examination  subject  will,  I  am 

sure,  exert  a  prejudicial  effect,  not  onlv  on  the  work  of 

ihe  physician,  but  on  the  status  of  the  skilled  pharmacist. 


It  falls  to  my  lot  to  have  to  impart  to  the  students  of  the 
Westminster  Hospital'  who  are  preparing  for  the  final 
examination  of  the  Conjoint  Board  some  knowledge  of  the 
art  and  mystery  of  prescribinff,  a  subjeot  conoeming 
which  th^  are  usually  profound^  ignorant.  A  man  may 
be  an  accomplished  diagnostician  and  a  profound  patholo- 

gst,  and  yet  be  unable  to  write  the  simplest  prescription, 
is  difficulty  is  not  so  much  in  prescribins  the  right  thing 
as  in  prescribtne  anything  at  all.  If  this  has  been  the 
experience  of  tne  piast,  what  are  we  to  expect  in  the 
future  ?  What  chance  is  there  of  teaching  therapeutica 
when  the  student  knows  nothingof  the  very  foundation  on 
which  it  rests  ?  It  is  true  that  Pharmacology  is  still  re- 
tained as  a  lecture  subjeot,  but  no  student  will  devote 
much  attention  to  a  eubject  on  which  he  knows  he  will  not 
be  examined.  We  can  compel  his  bodily  attendance  in 
the  lecture-room,  but  bis  thoughts  will  be  elsewhere.  We 
niav  pla^  on  the  pharmacological  pipe,  but  we  cannot 
make  him  danoe ;  he  will  remain  ignorant  of  the  action 
and  uses  of  drugs,  and  will,  in  due  course,  be  sent  out  into 
the  world  without  knowing  how  to  prescribe  for  the  com- 
monest symptom  or  the  most  simple  disease.  In  five  or 
six  years  from  now,  we  shall  have  growing  up  around  us 
men  who,  from  sheer  timidity,  will  rarely  venture  to  pre- 
scribe anything  but  the  simplest  remedies.  The  pharma- 
cist may  display  the  time-honoured  inscription,  "  Prescrip- 
tions dispensed  with  care,"  but  there  will  be  no  medictnee 
for  him  to  compound.  The  unfortunate  qualified  practi- 
tioner, whilst  cursing  the  stupiditv  of  the  authorities  who 
made  him  devote  the  best  veare  of  his  life  to  the  acquire* 
ment  of  much  useless  knowledge,  and  left  him  i^orant  of 
the  means  of  alleviating  the  simerings  of  his  patients,  will 
in  despair,  fall  back  on  the  preparations  of  the  advertia- 
ing  chemist.  When  he  has  a  case  of  sciatica,  he  will  pre- 
scribe someone's  "  Antisciaticine  " ;  when  a  patient  com- 
plains of  lumlMtgo,  he  will  recommend  him  to  try  '*  Anti- 
iumbaginine,"  and  when  hemorrhoids  engase  his  atten- 
tion, he  will  have  nothing  better  to  suggest  Aan  a  careful 
application  of  the  popular  remedy  "Antipiline."  These 
and  similar  preparations — all  made  m  Germany,  and  of 
unknown  composition— will  be  his  stock-in-trade.  Patients 
will  cease  to  respect  him  and  to  consult  him,  unless,  per- 
chance, thev  want  an  autopsv  performed,  whilst  the  un- 
fortunate chemist,  finding  his  legitimat<e  occupation  gone, 
will  be  compelled  to  eke  out  a  miserable  subsistenoe  by 
selling  bed-pans  and  "  specialities  "  at  store  prices. 
I  am.  Sir,  yours  truly, 

William  Mubbbll. 
Welbeok  Street,  London,  W. 


To  the  Editor  of  Thb  Mbdioal  Pbbss  and  Giboulab. 

Sib,— Itiswithfeelincsof  regret  that  I  find  tbat  the  Royal 
College  of  Physicians  of  London  has  decided  to  expunge 
pharmaoology  from  its  curriculum.  It  has  been  stated  and 
widely  circulated  on  the  authority  of  one  of  its  most  dia- 
tinguiehed  Fellows  that  pharmacology  does  not  enter  into 
the  examination  of  students  at  the  Edinburgh  University. 
I  wish  to  give  an  emphatic  denial  to  this  statement  I 
speak  from  authority,  as  I  have  served  as  an  Examiner 
in  that  University  for  five  years,  and  I  can  assert  tbat 
pharmacolitty  enters  largely  into  each  examination.  I  am 
at  present  Examiner  for  the  University  of  Glasgow,  and 
can  equally  vouch  for  the  fact  that  there,  likewise,  Phar- 
maoolo^  fully  enters  into  each  examination. 

It  is  to  be  deplored  that  the  Royal  College  of  Physidana 
of  London  should  have  thought  fit  to  lake  such  a  retro- 
grade step  as  to  expunge  Pharmacology  from  its  curri- 
culum. Pharmacology  is  the  kevstone  to  therapeutice, 
and  a  man  who  does  not  thorougnly  understand  tne  one^ 
must  be  almost  totally  ignorant  of  the  other.  I  am  daily 
surprised  at  the  ignorance  of  various  Fellows  of  this 
College  with  whom  I  come  in  contact  on  the  subject  c^ 
therapeutics,  and  I  am  ashamed  of  the  boastful  position 
many  of  them  adept  in  igoonDg  any  advantage  derived 
from  therapeutics  in  the  treatment  of  disease. 
I  am,  Sir,  yours  truly, 

Ci  D.  F.  FmLLiP8» 

London,  March  16th,  1896. 


llAB,  18,  1896. 


MEDICAL  NEWS. 


Thb  Mbdioal  Pubs.     309 


HOSPITAL    REFORMERS    AND    ST.    JOHN% 

HOSPITAL. 

To  the  Editor  of  Thb  BIxdioal  Prbbs  and  CnionLAB 

Sib,— Like  the  poor,  the  hospital  reformer  is  alwavs 
with  UB,  bat  anlike  the  poor  one  never  knows  what  the 
hoepital  reformer  wants.  There  are  so  many  Tarieties  of 
the  geDQs  thai  it  is  unkind  of  year  correspondents  to  hide 
their  identity.  Besides  the  honesty  of  the  motives  of  the 
writer  is  Itkeiy  to  be  so  mach  more  oonvincing  when  the 
letter  is  signed.  If  year  latest  correspondent  had  not 
aUnded  to  &  John's  Hospital,  I  for  one  wonld  have  been 
qnite  content  to  leave  yoor  correspondents  in  the  obecuricy 
of  their  anonymity  to  join  their  views  to  those  other 
reformers,  so-called,  who,  not  content  with  alienating 
foods  from  general  and  special  hosmtals  alike,  are  now 
endeavooriiu;  to  wreck  both.  Neea  I  say  I  specially 
allude  to  the  champions  o{  the  *'dear  animals"  and 
opponents  of  the  *'  hospital  devil  doctors,"  the  sentlemen 
w1h>  think  the  best  way  to  remedy  the  defects  of  the  oat- 
patient  department  system  is  to  sweep  it  away  altogether, 
and  the  many  other  fauldists,  lay  and  medi<»l,  who  have 
a  special  axe  to  grind. 

I  am,  however,  ^nite  in  accord  with,  the  statement  that 
'*if  a  special  hospital  exists,  it  mast  justify  its  existence 
by  answering  the  following  tests  "  : — (a)  Treatment  of  the 
flick  poor  gratuitously,  (h)  Teaching  the  profession. 
Applying  these  tests  to  St.  John's  Hospital,  I  find  that 
6,403  new  patients  attended  last  year,  of  whom  3.500 
contributed  sums  varying  from  threepence  to  two-shillings 
and  threepence  per  week,  the  balance,  2,903,  being  treatM 
mratui^nslv.  Of  the  paying  patients  many  are  sent  by 
their  own  oootors,  to  whom  some  are  returned  with  letters 
fldggeeting  the  line  of  treatment  to  be  carried  out.  Some 
remain  for  a  short  time  under  treatment  and  are  then 
letomed,  while  others  are  kept  till  cured  by  special  request 
of  the  medical  man. 

Speaking  for  my  own  share  in  the  teaching  work  carried 
on  at  St.  <n>hn's,  during  the  jpast  three  years,  I  have  given 
three  post-graduate  courses  in  each  year,  which  have  been 
attended  l^  upwards  of  a  hundred  and  fifty  doctors.  Since 
the  1st  of  January  this  year  there  have  been  two  hundred 
and  fifty- nine  attendances  of  medical  men,  mostly  prac- 
tising m  and  around  London,  at  my  out-patient  depart- 
ment. Lastly,  **  Another  Hospital  Reformer  "  alludes  to 
the  notorious  St.  John's  (Leicester  Square),  and  he  is  right. 
It  is  notorious  for — (1)  being  the  first  hospital  to  become 
repstered  under  the  Friendly  Societies'  Act.  (2)  Sub- 
mitting its  books  to  be  examined  by  the  representatives  of 
S^rtUh,  who,  as  a  result  of  their  inquiry,  published  an 
article  approving  of  the  integrity  of  the  financial  manage- 
ment of  the  hospitaL  (3)  Having  at  the  end  of  last  year, 
after  all  liabilities  were  paid,  a  Balance  to  its  credit.  (4) 
Bemg  the  largest  Skin  Hospital  in  the  United  Kingdom, 
with  an  in-patient  department  of  sixty  beds. 

I  am.  Sir,  yours,  fta, 

MOBOAH  DOCKBBLL. 

0  Cavendish  Square. 

March  14th,  1896. 


few  instancee  in  which  a  large  number  of  teeth  need  to  be 
extracted  —  teeth  beyond  the  reach  of  conservative 
treatment  wMch  now-a^days  is  able  to  save  so  many 
—it  ii,  as  a  rule,  not  necessary  to  remove  all  at  one 
sitting.  There  is,  moreover,  no  difficulty  in  giving  gas 
on  one  occasion  repeatedly  or  at  least  two  or  three  times 
in  succession.  In  many  cases  a  few  teeth  or  stumps  having 
been  drawn,  and  the  effect  of  the  antesthetio  passing  ofl^ 
the  inhaler  can  be  re-applied,  antesthesia  agam  induced, 
and  more  extractions  periormed  without  the  patient 
regaining  consciousness.  In  cases  where  jaws  are  closed, 
in  consequence  of  inflammation  extending  from  around 
molars,  and  gas  anesthesia  would  not  afford  time  to  force 
the  jaws  apitft  and  remove  the  offending  tooth,  the  operar 
tion  may  be  divided  into  two  parts.  The  mouth,  under 
gas,  may  first  be  opened  by  the  screw  gag,  and  then  the 
gas  may  be  given  again  for  the  extraction.  In  most  cases 
the  second  administration  may  bo  begun  before  the  effect 
of  the  first  has  passed  off,  and  the  patient  may  be  as  effec- 
tually spared  both  terror  and  pain  as  with  any  other 
agent. 

In  the  very  few  complicated  dental  cases,  where  chloro- 
form or  ether  may  be  really  called  for,  they  ought  never  to 
be  given  in  a  chair.  The  patient  should  always  be  recum-r 
bent^  undressed,  and  prepared  in  the  way  usual  when 
other  operations  are  contemplated.  The  patient  may 
recUne  on  an  ordinary  couch  with  the  shoulders  raised  on 
pillows,  and  the  head  thrown  slightly  back,  the  dentist 
standing  either  on  the  patient's  right,  or  behind  the  head. 
In  one  or  other  of  these  positions  the  operator  can  conve- 
nientiy  deal  with  any  tooth  in  either  jaw. 

I  am.  Sir,  yours,  Ac., 

HXKBT  SbWILL.     • 

9a  Cavendish  Sq.,  W.,  March  11th,  1896. 


DEATH  UNDER  CHLOROFORM  IN  A  DENTAL 
SURGERY. 

To  ihe  EdUor  oj  Thb  Mbdioal  Pbbss  abd  Ciboulab. 
Sib, — Knowing  nothing  of  the  case  beyond  what  I  have 
read  in  your  note  headed  ^  Death  from  Chloroform,"  in  the 
Hbdical  Pbbbs,  of  March  11th,  I  make  no  comment  on 
this,  the  latest  fatality  from  chloroform  in  the  dentist's 
obsir,  nor  would  I  suggest  that  employment  of  the 
choeen  anesthetic  was  not  fnll^  justified  by  special  cir- 
enmstancee ;  bntrafter  an  experience  of  over  a  Quarter  of  a 
4»entary  in  hospital  and  private  practice,  I  do  ven- 
ture most  emphatically  to  affirm  that  the  cases 
tA  dental  operation  in  which  chloroform  or  ether 
be  considered  indispensable,  are  so  rare  that 
Uy  it  may  be  said  the  use  of  these  always 
BS  agents  in  ordinary  dental  surgery  is 
onjiiBtlfiable.  Nitrous  oxide  gas  is  par  exodUnce  the 
iteital  anesthetic.  The  cases  in  which  it  does  not  in  every 
way  suffice,  are  highly  exceptional ;  and  much  more  can 
ht  done  with  it  than  seems  commonly  supposed.    In  the 


'  The  Boyal  College  of  Surgeons  of  England. 

At  the  meeting  of  the  Council  on  Thursday  last,  Mr. 
Christopher  Heath,  President,  in  the  Chair,  Mr.  Thomaa 
Bryant  (Guy's  Hospital)  waf  unanimously  re-elected 
representative  of  the  College  on  the  General  Medical 
Council  for  a  further  period  offive  years.  The  Council,  in 
pursuance  of  their  Resolution  of  the  13th  ult.,  having 
considered  the  question  whether  "  members "  should  or 
should  not  be  directiy  represented  on  the  Council,  adopted 
the  following  reeofution  :—'*  As  the  members  of  this 
Council  ....  .....    ^      . 

lege, 
'Felloe    , 

repreeentation  of  the  members  is  desirable."  A  letter  wks 
read  from  Dr.  Liveing,  reportinj^  that  the  Royal  CoUege 
of  Physicians,  at  a  special  meetmg  held  on  the  13th  ult., 
had  re-elected  Dr.  G.  Sims  Woodhead  Director  of  the 
Laboratories  for  another  year,  and  had  adopted,  subject 
to  the  approval  of  this  College,  the  following  Resolutions 
in  reference  to  the  Regnlatfauis  for  the  five  years'  curri- 
culum, viz.,  1.  That  to  Paragraph  6,  at  the  head  of  pege 
6  of  the  Reflations  (relating  to  the  Practice  of  Medicine 
and  Surgery,  Clinical  Instruction,  Demonstrations  in  the 
Post-mortem  Room,  Clinical  Lectures  on  Medicine  and 
Surgery,  Practi<»l  Instruction  in  Diseases  of  Women; 
Medical  Clinical  Clerkship  and  Surgical  Dressership),  the 
words  **  after  passing  the  second  examination"  be  added, 
so  that  it  may  read  thus :— 6.  Of  having  attended  at  a 
recognised  Hospital  with  a  Medical  School,  after  passing 
the   second   examination  (the   lectures,  &c.,  as  above). 

2.  That  "Pharmacologr"  as  a  separate  subject  be 
omitted  from  the  third  or  final  examination,  and  the 
synopsis  headed  "  Pharmacology "  from  the  Regulations. 

3.  That  the  alteration  neceesary  to  bring  the  Regula- 
tions into  accord  with  the  above  Resolutions  be  referred 
to  the  Committee  of  Management,  and  that,  if  the  Royal 
College  of  Surgeons  agree,  on  their  part,  the  Regulations 
be  issued.  The  Council  having  agreed  to  the  alterations 
proposed  bv  the  Royal  College  of  Phvsicians,  it  was  re- 
tened  to  the  Committee  to  revise  the   Regulations  in 

I  accordance  therewith,  and  to  issue  them. 


310      TSS  MiDIOAL  Pmm 


N0TECE8  TO  CORRESPONDENTS. 


Mab.  18.  1896 


^tXttB  to 

Correspottbtttta,  ^Ixort  Xetttra,  Ac 

i^  COBUVonn»  nqvliliig  a  nplj  tn  tbli  eotana  an  pi 
ttenUrly  iwiiiMlad  to  mika  vie  ol  a  diatkuHm  tigmmtw  «r 
and  aToMthapcagliceofiignli^ftwMtbnM  "BMd«r/ 
" OldSabMribOT,"  *o.   Mooh  eonfarion  will  ba  ipand  bj 
lothlirala. 

AOCAPTED  FAP1B8,  LECTUBB8.  AND  CA8I8. 

Thb  lollowiBg  ara  baraby  aokaowledcad  at  reoeivad  dnoa  Um  imbU- 
cation  of  oar  last  week's  list :—  frum 

DB.  F.  HouiB  Wiooui  (New  York) :  "  MaameU'i  Method  o<  Intae. 
tlDal  Anattimoeia,"  with  MTenteen  woodcati. 

DB.  J.  O'OonoR  (Briiidi  HoiDitel.  Baenof  Ayrae):  "  On  Ezeitioii 
ol  Toagoe  lor  Canoerone  DtMaw,'^  with  tUairtntloii. 

DB.  T.  MOBi  MADDER :  "On  Some  Potnte  in  the  HTgiene  of  Infanay 
and  Childhood.*' 

Dr.  H.  Macbaughtor  Jobbs:  **Krron  of  BtfhMtlon  In  Nenrae- 


Hr.  Mato  Bobsob,  F.K.C.8.  :  *'  VentroAzatlon  or  Tantroaiiipenslon 
of  UtaniB." 

MR.  J.  E.  PLATT,  F.R.C.S. :  "CeM  if  Bopton  of  the  Abdominal 
Aorta  from  Xxtemal  Vloienee  wtthont  Fenetnting  Wound"  (Man- 
oheeter  Royal  Inflrmaiy). 

Dr.  p.  a.  Pdrcill  :  "  Catee  of  Bcmoval  of  Uteri  bj  Vaginal  Hytte- 
reotomy  for  Malignant  Diaeaae." 

THK  MOBTAUTY  OF  FOBBION  CtTIBS. 
A  OORBBBPOBDBBT  a«ka  UB  if  the  weekly  ratnna  of  Mortality  of 
Foreign  Citiea  are  for  the  aame  week.  To  thia  we  reply  that  the 
atatlstica  are  ▼alnalcm  lor  oompariaon,  aa  the  Begiatrar-Oeneral  ran 
only  pabllah|Uiem  aa  anpplied  to  him,  and  that  while  the  flgnrea  for 
London  and  Paria  may  be  for  a  week  in  Febmary,  thoae  for  Borne 
(alwaya  the  laat  to  hand)  may  refer  to  a  week  in  Dooember,  and  thoee 
for  New  York  or  Bombay  to  one  tn  Jaanary. 

G.  P.  -  A  marked  oopy  of  the  Joomal  In  qneation  had  already  been 
forwarded  to  thia  oSoe,  and  our  correspondent  will  aee  that  we  haTe 
dealt  with  the  matter  In  oar  editorial  oolamoa. 

THE  WOMAN  DOCTOB  COULD  KOT  COMB. 

IT  was  at  the  time  when,  tn  Baltimore  at  leaat.  the  woman  doctor 
had  joat  appeared  upon  ihe  acene,  and  a  propo§  of  woman'a  naef  alneas 
and  her  ttmftetloos  in  this  new  fleld  the  late  Dr.  W.  C.  Van  BIbbert 
related  this  story :  Awakened  late  one  nl^t  by  a  ring  at  hla  beO,  he 
called  down  thespeaking  tube  to  know  who  it  waa.  "  iPa  I,  doctor,  Mr. 

.    I  want  yon  to  come  at  onoe  to  my  wife.    She  is  in  labnnr," 

*'  Yea,  bnt  I  don't  attend  yonr  fAmily.  Way  don't  yoa  go  for  your 
own  pbyaMaB}"  And  back  came  the  reply:  **I  did,  doctor;  but 
ahe*8  aboat  to  be  confined  heiaelt"-l<r«w  York  Medical  iueord, 

8TUDBR1.— Apply  to  the  pobliahers  of  thia  Joomal  who  will  give  the 
Hat  of  hooka  reqoired. 

/,  M.  &— Under  consideration. 

IPBCACOAMHA    IN   INSECT    BITI8    AND    STINOS. 
7b  (he  Editor  qf  THB  MBDIOAL  PRMB  AND  ClBOULAB. 

Sir.— Beferring  to  yoor  annotation  on  thiaaobjeot,  vonr  readera  will 
And  in  Sectioaa  898 : 4  and  486  : 4  of  the  "  Medical  DIgeat "  that  the 
manrelloas  ralneof  ipecaooanha,  applied  estamally.  in  wavp.  bae,  and 
soorpioo  stings,  in  moiqutto  bites,  &c.,  can  be  readily  atadied.  It  is 
fifty  years  since  Mr.  Coles  dre  9  attention  to  the  sabjeet. 

1  am.  Sir,  years,  Ac, 

BiCHD.  NBALB.  M.D.Lond. 
60  Bonndaij  Bead,  South  Hampatead,  8.W., 
March  10th,  1806. 

feelings  of  ^orittitB,  f  ttturee,  *c 

WIDNBSDAT,   MAROH     ISTIL 

BOTAL  CoLLEOB  OF  SuBaiOBS.-  6  p.m.  Bfr.  W.  G.  Pponcer :  The 
General  Pathology  of  Bone.    (Krasmos  Wilaon  Lectnre.) 

BoTAL  MBTBOBOLoeiCAL  BomBTT  (22  Great  George  St..  Weet- 
minster).-7.80  p.nL  Mr.  F.  Gaster :  Weather  FbreoaaU  and  Storm 
Wamittga,  how  they  are  Prepared  and  made  Known  (lUnatrated  by 
diagrama.  &&) 

BoTAL  MIOB0800PIOAL  SOOIBTT  (90  HanoTcr  Sq.X— 8  p.m.  Dr.  A .  C. 
Stokaa  :  On  aome  American  Botlfera. 

THVRflDAT,  MABOH  19IH. 

Harybian  Socibtt  (Stafford  Booms,  TItcbbome  Strset.  Edgware 
Boad,  W.X-8.30  p.m.  Dr.  Bowles:  Nanhelm  and  the  SdhoU Treat- 
ment of  blseeaes  of  the  Heart 

SooiBTY  OF  Arts  (imperial  Institate,  Sooth  Kensington)  —8.80  p.m. 
Mr.  J.  U.  (Hess:  Ihe  Greas  Landship at  Gobns,  in  Oorhwal,  and  the 
Meaaarea  adopted  to  Prevent  aerions  Loas  of  Life. 

SoaETT  OF  A«iBSTHBTisi8(20HanoTer  Sq.).-Paper  by  Star  Banj. 
Ward  Bichardson. 

Friday,  March  2orH. 

BOTAL  COLLBGB  OF  SuBOBOBB.— 5  p.m.  Mr.  W.  G.  Spencor:  The 
General  Pathology  of  Bone.    (Braamna  Wilson  Leetnre.) 

Botal  lB8TiTunoN.-9  p.m.  Prd  T.  B.  Fraser:  Immnaiaation 
against  Scrpenta'  Venom  and  the  Treatment  of  Snake-bite  with  Antt- 


BATUBDAT,  MABOH  8l8T. 

BOTAL  iBBTnuTiOB.— 8  p.m.    Lord  Bayleigh :  Light. 


BtanliMdiam  and  Midland  FMa  HomMal  for  8ii  k  Chlldian.- 

Meaieal  Ofllcer  and  a  Beildent  Sofgiotf  Olllce-.    The  aalarias  win 


he  £70  and  £60  reepeeUTely,  with  boaid,  washiiMi,  and  I 
^  be  sent  to  the  Seeratary,  ChUdian's 


Steelhoaae  Lane,  Birmingham,  not  later  than  April  Oih. 

Bradford  loflrmary.— DIapaaaary  Boiaeon    Palary  £100  per  i . 

with  board  and  rssldeaca.  Also  Jnnfor  Hoosis  Sntgoon.  Salar/ 
£U)  per  anmim,  with  board  and  realdenoe.  Both  candMatas  moi* 
be  amgie.    Applications  and  tasttmonials  to  the  Secretary  on  or 


before  Marcha 


City  of  Mancheater.-OhSMical  and  Baotnlologlcal  Aaalatani 
gSOOperaanoBL  AppUeatloaa  and  teatfanonlaK  to  the  O 
of  tne  BIrws  Oom^tlee  on  or  baCors  slat  March. 

Dandee  Boyal  Lnnatlc  Aajrlnm.- Assistant  Medical  Oflesr.  SalaiT 
£100  per  annom,  with  board,  l«|ging,4te.  AppUeatloaa  and  teatl- 
■MMuala  to  Dr.  Borie  at  Asylamon  or  before  4Ui  AprlL 

Hon  Boyal  Infirmary. —Janlor  Assistant  House  BoiBeoo.  Salaiy  £iO» 
with  board  and  lodging.  AppUca'ions  and  testtanoniali  to  the 
Chalrmaa,  Honae  Committee,  not  later  than  If  areh  tSrd. 

Boyal  Albert  Bdward  Infirmary,  WIgan.  Joaior  Hoaae  Sorgeon. 
Salary  £80  par  annum,  with  ratioBa  an  i  anartmeaU  (antaalTe  oC 
washing,  *&).  AppHcatloosaadteatlmonialatotheaeerolaiynot 
later  than  March  SSth. 


The  General  Infimarf  at  Leeila.— Bealdeat  Sualoal 
£100  per  annum,  with  board,  raaldenee,  and  wa 
tioaa,  with  teatlmoalala,  to  be  aent  in  not  li 
i«*st..  addrsaaed  to  the  Secretary  of  the  facnlty. 


not 

Salarr 


Unlvenlty  College, 

sar      — - 


nUty  Ooilege,  Bristol— FBcolty 
ilftry£l26.  AppUoatlona  and  k 
an  March  Slat. 


of   Medieina-Medlcal  Tutor. 
taatfanoBiala  to  the  Dean  not  lalsr 


Wcaton-snper-Mare  HospltaL— ] 
£00  per  annum,  aritn  boar 
teettmoniJatothcHoa  Sec.  not  later  than  Mth  Mandi. 


SumaoB,  unmarried.    Salary 
raaldenoe.    AppUcationa  and 


S^ppttintmtntM 


Baokha^ 


•HAWB,  A.  G.,  M.a,  aaOamb..  M.B.C.8.,  L.B.C.P.Lond., 
Physician  to  the  Great  Northern  Central  Ho^itaL 
BLAOBBR,  G.  F.,  M.D.Lond.,  B.S.,  F.ltart..  M.B.C.P.,  Obstetric  Phy- 
'     to  Out-patienU  at  the  Great  Northern  C    "~      '    ' 


OantrU  HoepitaL 
BOBD.  C.  S,   M.&,   ail.Camb.,  UB.O.P.Lonl,  M.B.a^,  Seeond 

Medical  Ofllesr  to  the  Chelaaa  Bowd  of  Gnardiana. 
CLABBB.  3  M.,  M.  A  ,  M.D.Camb.,  M.B.C.P.Lond..  Pmfraaor  of  Patho- 
logy and  Morbid  Anatomy  to  UnlTersity  Oolege.  Bristol. 
COBBtBOHAM,  G^  M.A.Oantab.,  D.M.D.  Harr.  UdIt.,  L.D.8.  1LC.8. 

Bng ,  Dental  Sargaon  to  the  London  HoepitaL 
DoLAMOBB,  W.  H..  M.R  aS.,  L.B.C.l'.,  L.D.S.  B.a8.Bag.,  Dsatal 

Sorgeon  to  the  London  HoapitaL 
DOBBBLLT,  W.  T.  B.,  M.B.,  CM.Duh.,   L.B.C.P.Lood.,  M.B.a8., 

Honoiary  Medical  Ofltoer  to  the  MlUer  HoapttaL  Greenwich. 
Bdgbwobth,  F.  H.,  M.BCambL,  B.A.,  BCh..  B.Se..  Lecturar  la  Prae- 

tioal  Phyafology  and  Histology  to  UniTerslty  CoIImo.  Briatol. 
HALB.  G.  &,  M.B.,   BC.Camb..  mi.C.P.i.ond.,  MB.CS..  Medleal 

OOoar  for  the  Eton  Sanitary  District  of  the  Eton  Union. 
MA8RBLL,  J.  W.,  M.B.C.S..  L.B.aP.l4md.,  Jailor  Houae  Svgeoo  to 

the  Bootle  Boroogh  HoopitaL 
MVMBT.B.  H.,M.D.AberdTrM.B.aS.,D.P.H.Camb.,  Medical SoperiU' 

teodent  to  the  Borough  Lunatie  Aaylnm,  Fortamouth. 
SWATBB.  W,  a,  M.BLond.,  M.lLC.8rL.B.G.P.,  Laeturar  in  Praetica& 

Midwifery  to  UnlTonity  College,  BriatoL 


§ittlXB. 


ABDBBW-March  18th,  at  Hetheraett,  Hendoa, N.W.,  the  wife  of  F, 

W.  Andrew.  M.B.C.S.,  of  a  eon. 
FOic-Mareh  18th,  at  BrIsUagton  Honae,  near  Briatol,  the  wifo  of 

Bonrille  Bradley  Fox,  M.D..  of  a  aon. 
MAOPHAIL.— March  10th,  at  Bowdltoh,  Derby,  the  wUe  of  Buthesfordl 

Macphail,  MD.Edln.,  of  a  son. 
MVRDOoa.-March  11th,  at  thi  Oaks.  Hythe.  the  wlf^  of  Alan  Mar- 

dooh.  M.1LC.S.,  L.K.C.P.,  prsmatureiy,  of  a  daaghtar. 
NASH.— Mandi  10th,  at  S6  St.  Peter's,  Bedford,  the  wUe  of  W.  Glfford 

Naah,  r.B.C.8.,  of  a  daoj^ter. 
UBTBOir.-  March  10th,  at  WaTertree  Houae,  Brighton,  the  wite  of 

John  CaldweU  Uhthoff,  y  D..  of  a  dan^iter. 
WALLK-MarrhlOth,  at  (Md  Stone  Houae.  laat  Grinatead,  the  wile  of 

Percy  Brerahed  Wallls,  M.R.C.S.,  L.B.C.P.,  of  a  daughter. 


ffintxitqtB. 


MoBns-WBraBT.— March  llth,  at  the  Parish  Chorch,  Markfield, 
Leioeater,  Harold  Bdward  Mortia,  L.B  C.P.i:rf>ad.,  L.S.A..  of  Un- 
nerley,  Osweatry,  to  Amy  Florence,  third  daoghlar  of  the  lata 
John  Wright,  M.B  C.8.,  L.S.A.,  of  Markfield. 

Btbbb.— Dec.  18th,  1886,  at  Boea,  Taamaai«,  Dr.  Hugh  J.  B^ma, 
Surgeon,  yoongeat  son  of  the  late  Hn^  J.  ftrme.  City  Arohnectf 
F.EXAX,  and  grandaonof  Patrick  B> me,  B.H.A.,  V.-P.  Boyal 
Inatltute  of  Architectare,  Ireland. 

DDCOB.— March  7th,  at  Nurmea,  Fmland,  A.  U  Hoper  Dlzon,  Suinon. 
Captain  A.M.D.,  only  son  of  the  late  Hoper  Dixon,  of  Ashfotd. 

SUTHtRLABD.-Mardi  6th,  W.  Hope  Bntheriand,  M.B.,  CM.,  Haaltb 
Ofllcer.  Bangoon  Manioipattty,  eldeat  aon  of  the  late  Dr.  John 
Suthailanl.  Inspector-Oeaeral  of  Hoepltals,  Bengal  Amy. 

BBYBLL.-MarBh  let,  anddenly,  at  Saltaah,  Cornwall,  Blehard  C, 
Berell,  J.P..  C  C,  Suigeon  (Mayor  of  Salta^ 

Wbatbbrs.— March  8th.  at  Batoum  Gardena,  Hammanmlth,  Georga 
Weathara,  M.a.C.3.£ag.,  aged  80. 


Wh  ^tAmi  ^xt$$  mA  ^mulut 


*'SALUS    POPULI    SUPRBMA    LEX." 


vou  cxn. 


WEDNESDAY,    MARCH    25,     1896. 


No.  13, 


EEROES    OF^EFEACTION 

IN 

NEUEASTHENIC  WOMEN. 

By  H.  MACNAUGHTON-JONES,  M.D.,  M.Ch., 
M.A.O.,  F.RC.ai.  and  R 

From  my  recollection  of  the  advances  that  have  been 
made  in  ophthalmology  during  the  last  twenty-five 
yean,  I  believe  that  there  is  not  one  that  has  had  a 
more  important  bearing  on  ^neral  medical  treatment 
than  the  recognition  of  the  influence  which  astigma- 
tism, even  in  a  slight  degree,  may  exert  on  the  general 
health.  This  is  a  fact  now  so  wideljr,  if  not  universiJly. 
acknowledged  by  all  interested  in  the  science  ot 
ophthalmology,  that  it  is  needless  to  comment  on  it. 

Yet  there  are  still  many  intelligent  medical  men 
who  are  sceptical  of  the  subtle  influences  exerted  by  eve 
strain  on  the  nervous  system.    If  this  happens  in  the 


)  of  an  otherwise  healthy  man  or  woman,  how  much 
more  likely  is  it  to  occur  in  that  of  one  in  whom 
fanctional  or  organic  affections  of  any  of  the  viscera 
have  enfeebled  the  general  health.  That  such  serious 
consequences  may  follow  from  eye  strain  in  men  as  to 
com|Ml  them  to  abandon  their  callings,  I  have  had 
striking  examples  of.  The  rectification  of  the  refrac- 
tive error  has  cured  the  train  of  nervous  phenomena, 
and  enabled  them  to  pursue  their  avocations  with 
comfort,  But  my  principal  desire  in  this  communica- 
tion is  more  especially  to  call  attention  to  the  frequent 
correlation  which  exists  between  those  nervous  disturb- 
ances so  commonly  observed  in  women  at  the  age  of 
puberty,  during  pregnancy,  and  in  the  climacteric, 
and  eye  strain  consequent  upon  an  undiscovered 
astigmatism. 

Foremost  amongst  these  symptoms  is  headache  of 
varying  degree  of  intensity ;  next  probably  in  frequency 
comes  migraine,  with  or  without  nausea,  but  in  some 
cases  there  can  be  no  doubt  that  more  serious  nerve 
disturbance  can  be  traced  to  the  ocular  defect  and 
consequent  accommodative  spasm.    During  menstrua- 1 
tion  also  such  refractive  disorders  become  more  manifest,  i 
and  are  apt  to  be  accentuated  with  corresponding  I 
development  of  the  distressing  symptoms.    This  is  a  i 
fact  particularly  worthy  of  recollection  by  the  gynseco- ! 
logists,  inasmuch  as  ocular  and  oculomotor  disturbances 
are  not  infrequently  started  during  the  catamenia, 
and  further,  in  disorders  of  this  latter  function,  more 
particularly  associated  with  suppression  or  irregularity 
of  the  menstrual  discharge,  are  such  eye  affections 
observed.      But  as  oftentimes  these  aberrations   of 
menstruation  are  dependent  upon,  or  are  associated  with, 
some  abnormal  state  of  the  uterus  and  annexa,  it 
behoves  us,  when  such  nervous  troubles  as  those  I  have 
referred  to  are  complained  of,  to  put  out  of  court  the 
possibility  of  their  being  caused  or  aggravated  by 
defects  in  ocular  accommodation. 

If  I  may  take  an  illustration  of  the  clinical  import- 
ance of  the  application  of  this  knowledge  in  one  social 
direction,  I  would  refer  to  a  recent  paper  by  Mr.  Dodd 
on  the  treatment  of  Epilepsy  by  the  Correction  of  the 
Abnormalities  of    Kefraction.     Those  observations, 


made  in  the  West  End  Hospital  for  Nervous  Diseases, 
showed  that  in  the  instance  of  75  epileptics  who  were 
affected  by  errors  of  refraction,  49  were  benefited  by 
correction  of  these  errors;  and  in  13  instances  the 
attacks  ceased  while  wearing  the  glasses.  In  the  re- 
maining 36  the  improvement  was  marked,  23  failing 
either  to  wear  the  glasses  or  to  report  themselves.  I 
had  a  somewhat  striking  example  of  the  consequences 
of  this  optical  irritation  in  the  case  of  a  young  lady  who 
suffered  from  semi-epileptiform  attacks,  and  whom  I 
was  testing  for  astigmatism  not  long  since.  On  trying 
her  vision  with  the  astigmatic  dial  and  tests,  a  tran- 
sient attack  at  once  followed.  This  recurred  on  two  or 
three  occasions^  making  it  extremely  difficult  to  test 
the  eyes—a  difficulty  still  further  increased  by  a  slight 
degree  of  nystagmus  present.  In  this  particular  case 
there  was  hyperopic  astigmatism,  corrected  by  -f  '75 
cyl.  with  +  05  spnerical  in  the  right  eye ;  -f  "75  cyl. 
+  I.  D.  spherical  in  the  left. 

I  may  at  once  say  with  regard  to  the  cases  illustrat- 
ing this  paper  that  not  in  a  sinale  case  I  am  quoting 
had  the  patients  any  idea  that  the  eye  was  in  any  way 
connected  with  their  sufferings,    Inaeed,  in  several  of 
the  cases  the  vision  was,  on  interrogation,  declared  to 
be  perfect,  and,  in  not  a  few  instances,  the  idea  of  any 
defect    was    rather    indignantly    repudiated.     The 
greater  number  came  to  me  believing  that  the  source 
of  all  their  trouble  was  to  be  found  in  some  uterine  or 
ovarian  affection.    I  have  selected  from  a  compara- 
tively recent  period  sufficient  evidence  to  establish  the 
simple  practiced  clinical  point  it  is  my  desire  to  insist 
upon,  viz.,  that  in  women  who  are  suffering  from  such 
symptoms  as  headache  of  various  degrees,  nausea  with 
migraine,  and  those  erratic  head  symptoms  which  are 
found  to  be  presetit  during  the  climacteric  period  of 
life  ;  also,  in  cases  in  which  mental  fatigue  and  want  of 
concentration  after  prolonged  near  work  is  complained 
of,  any  error  of  refraction  should  be  carefully  sought 
for  and  corrected,  as  an  essential  part  of  the  general 
treatment  of  the  case.    When  I  use  the  term  '*  neuras- 
thenia "  in  association  with  errors  of  refraction,  I  refer 
especially  here  to  that  unstable  state  of  nervous  excit- 
ability or  irritability,  predisposing  the  sufferer  to  cen- 
tral effects  of  possibly  slight  peripheral  ailments.    The 
latter  thus  give  rise  to  exaggerated  reflex  phenomena 
in  distant  organs  or  remote  nervous  areas.    Such  reflex 
irritations  are  common  in  affections  of  the   pelvic 
viscera  in  women,  more  especially  in  the  case  of  dis- 
orders of  the  uterine  annexa.    They  are  not  infrequent 
in  affections  of  the  nasal  bones  and  mucous  membrane. 
They  are  common  in  disorders  of  digestion  and  gastric 
derangements.    They  are  frequent  during  the  pregnant 
state   and  occasionally  persist  as   its   consequence. 
During  the  critical  climacteric,  when  psychical  distur- 
bances and  mental  disequilibration  are  common,  such 
a  general  susceptibility  to  reflex  excitation  is  a  fre- 
auent  source  of  the  legion  of  troubles  met  with  during 
tnis  critical  time  of  physiological  change.     The  un- 
fortunate term  *'  neurotic ''  has  vulgarly  come  into  use 
as  a  sufficiently  exact  expression  to  define  the  general 
state  of  hypersensitiveness  and  loss  of  will  control 
frequently  seen  in  women,  with  the  result  that  hysteria 
and  the  fanciful  ailments  of  the  malade  imaqinaire 
are  often  confounded  with  true  visceral  and  other 
neuroses  which  have  a  distinct  functional  derangement 


312     Tbi  Mbdioal  Pbxss. 


OKIGINAL  COMMUNICATIOKS. 


Mab.  26.  1896. 


or  pathological  change  aa  their  causa  Naturally,  any 
one  who  is  brought  into  contact  with  a  Iwrge  number 
of  such  sufferers,  is  apt  to  concentrate  all  his  attention 
more  specially  on  the  particular  orean  or  organs,  the 
functions  of  which  are  at  the  time  disturbed,  and  this 
remark  applies  with  peculiar  force  where  the  genera- 
tive  organs  of  women  are  those  in  question.  In  the 
instances  of  two  hundred  and  seventy  women,  who 
consecutively  consulted  me  for  various  affections  of 
these  organs,  I  found  that  fifty-three  complained  of 
head  symptoms,  such  aa  aggravated  headache,  fulness 
in  the  nead,  loss  of  memory,  and  facial  neuralgia ;  six- 
teen suffered  from  migraine  ;  three  from  epilepsy  ;  two 
from  catalepsy;  fifteen  from  ophthalmic  symptoms 
depending  upon  abnormal  retinal  states  ;  and  fourteen 
from  other  cerebral  disorders.  This  fact  is  in  itself 
stuSicient  to  show  how  common  is  the  concurrent 
occurrence  of  aberration  of  function  in  the  generative 
organs  with  disturbance  of  the  brain  or  cranial  nerves. 
It  also  indicates  how  easily  one  may  be  misled  into 
attributing  to  these  uterine  conditions  such  nervous 
disturbances  as  headache,  migraine,  neuralgia,  inability 
to  study,  to  write,  or  to  continue  other  kinds  of 
protracted  near  work  for  any  time.  My  desire  then  is  to 
show  that  in  all  such  cases,  when  the  general  tone  of  the 
entire  vascular,  nervous,  and  muscular  systems  is 
reduced,  latent  refractive  disorders  are  likely  to  becaome 
manifest,  and  want  of  accommodative  control  or  assis- 
tance to  be  felt.  This  tendency  should  indicate  in  all 
cases  where  such  symptoms  as  those  to  which  I  have 
referred  are  present,  the  need  for  careful  examination 
of  the  vision,  and  particularly  for  astigmatic  errors  of 
refraction.  The  following  cases  I  have  taken  from 
quite  recent  work,  and  they  are  sufficient  for  the  pur- 
poses of  this  paper : — 


OB 

Symptoms. 

1 

lit 

m 

KesulC 
as 

noted. 

84,      M. 

rrreguUrity     of    cata- 

Erosion 

ol 

H.A. 

fteifeved. 

• 

menlP.  Head  aod  brow 
aches. 

oerrix. 

40.     M. 

Beadache     and     ctber 
bead  symptoms. 

Lacerstion 
cerrtz. 

of 

MA. 

!>7ot  noted 

82.      B. 

"Dreadful    headache.' 

Clothing 

ab- 

H.A. 

Greatly 
iropr  V  d. 

Maasea.   Genen]  neu- 

normal 

in 

rotic        symptoms 

uterus 

or 

Vesical  initati.  D. 

anneza. 

46,     M 

Headache    at    periods. 

Uterus 

en- 

H.A 

Relieved. 

Climacteric        sj  mp- 

lai ge( 

1. 

toms.    Carloiu  teeth. 

Some  endo- 

metriUs. 

28,     M. 

Headache.    General 

Laceration 

of 

H.A. 

Headache 

neurotic     symptoms. 

cervix. 

cured. 

Throat  affected.     Scl 

atica. 

£8,     iL 

M  ental  d epreision.    In- 
soiunia 

H.A 

Not  noted 

81,     M. 

Dy^menurihcea.     Head- 
scbe      and     nausea. 
Annmla. 

Erosion. 

H.A. 

Bead  ache 

cureJ. 

3S,     M. 

-'Desperate  headache.' 

intra  -  uterine 

H.A. 

Headache 

Very  neurotic. 

growth 

re- 

42,       S 

"Desperate  headache' 

moved. 
Enlargement 

H.A. 

lead ache 

at  periods.  Dysmenor- 

of  oTaiy. 

cured. 

rhceaandovaralgla. 

84,     M. 

*'  Desperate  headache.' 

Erosion  of  < 

ser- 

H.A. 

Headache 

AmenorrhoBa.     Endo- 

Tix. Cooical 

cured. 

metritis. 

OS. 

27.       8. 

Ovaries     had 

H.A. 

Not 

been 

re- 

noted. 

moved. 

28.       S. 

EpUepsy. 

HA 

Cannot 
give  final 
result. 

Headache 

40.     M. 

"SeTere        headache." 

Uterine 

ft- 

H.A. 

Menorrhagia.       An»- 

broid. 

lelieTed. 

mia. 

16.       8. 


42,       B. 


22. 

8. 

16, 

8. 

18. 

B. 

'Severe        headache.' 
Burning  skin.     Nasal 
symptoms.       Chronic 
hypmtrophic  rhinitis. 

Head    symptoms— pain. 

iriddineas.  Depression. 

Insomnia. 
Hemicrania.        General 


40.  M 

88.  M. 

89,  M. 
40,  M. 


S. 

M 


16. 

40, 
27. 

14,       S. 

34, 
85, 

41.     M. 

18.       S. 
25.      S 

80,      8. 


Symptoms. 


Constant  headache 

Amenorrhoea. 

Epileptic  "petit  mal" 
**  Felt  queer,  and  could 
not  see  before  the 
sUgU  attacks  of  un- 
consdousneas  I  " 

Den)erate  nausea.  Head- 
ache. Carious  teeth 


Headache.  Hemicrania. 
JNanaea  and  vomiting. 
Carious  teeth. 

Dysmenorrhcsa.  Spinal 
pain.  General  ner. 
vousness.  '*Mist  be- 
fore the  eyes." 

Very  bad  hea<lache. 
Other  nervous  sym- 
ptoms. 

Pain  in  back.  Bad  Head, 
aches.    Nearaloia. 

"  Dreadful    headache 
after  influenza.    Bad 
had  uterine  displace- 
ment and  other  uter- 
ine trouble. 

Headache  and  nausea. 

Headaches  since  child* 
hood.  "Cannot  des- 
cribe her  sufferings.*' 

Choking  sensation  in 
throat  t  follicular 
I  hatyngitis.  Dlffl- 
cultT  in  reading,  and 
headache. 

Tinnitus  Deafness. 

Headache. 

"Desperate  headache." 
Dysmenorrhoea.  Con- 
stipation. Carious 
teeth. 

Nasal  symptoms.  Devia- 
tion of  septum.  Head- 
aches. 


Severe  neuralgia  in  the 
head.  Spinal  and 
saoral  pain.  General 
debility. 

Neuralgia.  Pain  in  back. 
Ovarian  pain.  Severe 
headache.  Intermit- 
tent attacks  of  fever. 

Mental  depression.  In- 
somnia. HMdache. 
Tinnitus. 

Hemichoiea. 

Deafness.  Noises.  Nasal 
obstruction.  Migraine 
and  headache. 


Headache,  nausea,  and 
neuralgia. 


Uterine  ero- 
sion. Endo- 
metritis. 


Bnlarg  e  d 
uterus. 


Betroflexlon 
of  uterus 

Nothing  ab- 
normal In 
uterus 
anneza. 


.Vothing  ab- 
normal in 
uterus  or 
anneza. 


Betroverslon 
of  uterus. 


Anneza     en- 
enlarged. 


OSphorec- 
tomy  hid 
been  per- 
formed. 


H.A. 

H.A. 

H.A. 
HA. 
H.A. 

M.4. 

H.A. 
H.A. 

M.A 

MA. 

H.A. 


H.A. 
H.A 


H.A. 

H.A. 
H.A. 

H.A. 

M.A. 

H.A. 

H.A. 

M.A. 
Diplopia. 

H.A. 


Headache 
cured 
(nasal 
opera- 
tionX 

Greatly 
relieved. 

Believed. 

Headache 

cured. 
BetultDot 
reeorded. 


Headaohe 
c  o  m- 
pletebr 
cured. 
(Teeth 
eztraot- 
ad). 

Believed. 
(Teetti 
extract- 
ed). 

Believed. 


BeUevad. 


noted. 


Cured. 
Cured. 


Relieved. 

Greatly 

relieved. 

Headache 
relieved. 


Headache 
relieved. 

Headache 
cured. 
(Teeth 
extract* 
ed.) 

Bead ache 
cured. 
(Nasal 
opera- 
tion.) 

Unascer* 


Headache 
relieved. 


Not  noted 


Believed. 

Greatly 
relleTed. 
(Nasal 
opera- 
tion.) 

Headaoha 
cured. 


It  would  not  be  possible  to  enter  into  details  of 
cases,  nor,  for  my  object,  is  it  necessary.    I  could 


Max.  26,  1896. 


ORIGINAL  COMMUNICATIONS, 


ThS  MkDIGAL  PlUBbS.      313 


take  aeveral  as  typical  ozamplee  of  the  cla6S  I  speak  of, 
bat  I  will  only  quote  three  instances.  I  may  say  that 
every  case  was  corrected  under  homatropine,  and  in 
the  mat  majorihr  retinoecopy  was  employed  as  well  as 
cardfnl  final  verification  by  test  types.  A  young  lady, 
set  22«  a  proficient  musician,  sunered  from  various 
local  and  other  symptoms,  which,  upon  examination, 
were  found  to  be  due  to  retroversion  of  the  uterus. 
Attendant  upon  these  was  constant  and  severe  head- 
ache. This,  it  was  hoped,  would  disappear  with  the 
rectification  of  the  displacement  As  she  had  to  leave 
home  for  some  time  she  was  advised  to  see  me,  to 
ascertain  whether  the  uterus  was  keeping  its  position, 
and  as  to  the  need  for  continuing  to  wear  the  support 
This  she  did,  complaining  at  the  same  time  of  the 
continuance  of  the  very  bad  headaches,  though  she  had 
recovered  from  her  other  local  troubles.  On  examining 
the  eyes  I  found  that  she  had  myopic  astigmatism 
which  had  never  been  corrected,  as  she  was  wearing 
simple  spherical  glasses  for  all  work.  With  — *75  cyl. 
added  to  her  spherical  lenses,  this  was  completely 
corrected,  and  when  last  I  saw  her,  her  headaches  had 
ceased. 

Mrs. ,  sdt  46,  had  suffered  from  severe  headaches 

on  and  off  for  years.  She  was  now  in  the  menopause, 
with  irregular  catamenia.  Her  headaches  had  of  late 
become  much  worse.  Further  than  an  enlarf^ed  uterus, 
with  some  tenderness,  there  was  no  pelvic  trouble. 
She  had  never  suspected  her  eyes  as  a  cause  of  her 
headaches.  Several  teeth  were  carious.  These  were 
removed.  On  examination  I  found  hyperopic  astig- 
matism, which  was  completely  corrected.  When  I  last 
heard  of  her,  about  one  month  after  wearing  the 
fi^lasses,  her  headaches  were  completely  removed. 

Mrs.  H ,  8dt  40,  consulted  me  for  general  ill- 
health,  including  metrorrhagia  and  other  pelvic  sym- 
ptoms. She  hadf  as  violent  head  pain  as  I  have  ever 
known  of.  All  the  teeth  in  the  upper  jaw,  being 
carious,  had  been  extracted  for  this  latter  symptom, 
without  affording  relief.  She  had  a  uterine  cervical 
erosion  and  endometritis.  She  was  cured  of  these 
latter  troubles,  but  the  head  symptoms  continued.  On 
examination  of  the  eyes  I  found  myopic  astigma- 
tism of  the  right,  and  hjrperopic  of  the  left  eye— 
2'6  cyl.  (vertical)  in  the  right ;  +  0-26  spher.  and  + 
0*25  cyl.  (horizontal)  in  the  left  eye  brought  her  to 
nearly  ^.  She  has  been  completely  relieved.  Careful 
attention  in  all  cases  was  ^d  to  any  attendant 
asthenopia,  and  any  errors  of  insufficiency  were  cor- 
rected by  prisms. 

Before  referring  to  the  table  of  cases,  I  should  like 
lust  to  hint  that  the  converse  deduction  to  be  drawn 
from  it  must  not  be  forgotten,  viz. :— That  when  we  are 
consulted  by  asthenic  or  neurasthenic  women  for  errors 
of  refraction,  the  possibility  of  these  errors  being 
aggravated  hy  nerve  disturbances,  and  affections  in 
other  organs  m  women,  especially  in  those  of  the  pelvis, 
should  not  be  overlooked. 

'*1  cannot  but  think,"  says  Ernest  Clarke  in  his 
admirable  work  on  "Eye  Strain,"  "  that  there  is  a  grea 
tendency  for  ophthalmologists  to  be  too  special,  to 
treat  the  eyes  and  their  appendages  as  if  tney  were 
isolated  organs  and  to  ignore  the  immense  influence 
that  the  constitutional  condition  has  upon  them."  Of 
the  strict  truth  of  this  statement  I  have  not  the  least 
doubt  Equally  certain  am  I  that  low  degrees  of 
asthenopic  astigmatism  are  often  directly  due  to 
functional  disorders  of  the  digestive  organs^  to  general 
nerve  tire,  to  anaemic  states  and  reflex  disturbances, 
caused  by  affections  of  the  sexual  organs  and  those  of 
special  sense,  and  that  in  attention  to  such  disordered 
states  may  be  found  the  proper  cure  for  the  asthenopia 
rather  than  in  glasses. 


VENTKU-FIXATION 

OB 

VENTKO-SUSPENSION  of  UTERUS,  (a) 
By  MAYO  ROBSON,  RRCS., 

Vice-Fresldent  of  the  BriUih  GyiUBoological  Society ;  Hon.  Preiideiitt 

•     inimtlonalC  •  "      " 

Inflrmary  I 


Internattonal  CongreM  of  OyDiMSology ;  Boo.  Surgeon,  Oeneral 
r  at  Leeds ;  and  Professor  of  Snrgeiy  iu  the 


i  orkshire  CoU^ge. 

Mb.  Pbbsident,— When  I  acceded  to  your  kind 
request  to  open  this  discussion  I  think  1  scarcely 
realised  the  importance  of  the  task  for  which  I  was 
making  myself  responsible  until  I  sat  down  to  put  my 
thoughts  on  pajser.  for  the  subject  is  an  extremely 
important  one^  m  tnat  it  deals  with  a  method  of  treat- 
ment the  position  of  which  is  not  yet  fixed  in  gynaeco- 
logical practice,  since  these  operations  are  as  vigorously 
defended  by  many  able  gynseoologists  as  they  are 
denounced  as  unnecessary  or  unsatisfactory  by  others. 

As  is  usually  the  case,  the  truth  probably  lies  between 
the  two  extremes,  and  I  trust  that  in  the  discussion 
to-night  we  shall  be  able  to  assist  in  more  nearly  fixing 
the  real  value  of  the  operations  both  as  to  their 
mmediate  and  ultimate  results. 

In  estimating  the  value  of  operations  of  expediency 
which  are  done  for  the  j^urpose  of  giving  relief  to  suffer- 
ing and  not  for  the  saving  of  life,  we  have  to  consider 
them  from  four  points  of  view.  First,  with  regard  to 
their  necessity  ;  next,  as  to  their  safety ;  thirdly,  as  to 
their  efSciency ;  and  fourthly,  as  to  whether  they  leave 
a  patient  less  fitted  for  life  in  other  ways. 

In  discussing  the  subject  of  ventro- fixation  or  of 
ventrosuspension  of  the  uterus  we  are  considering 
operations  of  expediency  undertaken  for  the  relief  or 
symptoms  dependent  on  retro- flexion  or  retro- version 
of  the  uterus  with  or  without  adhesions,  or  on  severe 
prolapsus  uteri,  all  of  which,  though  not  placing  life  in 
jeopardy,  may  make  existence  so  wretched  as  to  lead 
their  suDJects  to  seek  some  relief,  even  if  attended  with 
a  little  risk. 

The  recent  advances  in  surgery  have  led  to  many 
developments  of  a  like  nature,  as  witnessed  by  the 
radioEUcure  of  non-strangulated  hernia,  the  removal  of 
the  vermiform  appendix  in  recurrent  appendicitis, 
osteotomy  for  deformities,  laparotomy  for  the  removal 
of  adhesions  in  recurring  abdominal  pains,  and  many 
other  similar  procedures,  all  of  which  are  sanctioned 
by  professional  opinion  and  demanded  by  suffering 
humanity. 

It  seems  to  me  that  we  may  with  advantage  consider 
the  question  of  necessity  first,  and  in  answering  this, 
the  gynaecological  surgeon  must  satisfy  himself  that  all 
minor  measures  have  been  first  tried,  and  that  every 
api>arent  complication  has  been  corrected  without 
giving  relief,  before  the  question  of  operation  is  entered 
on.  If,  then,  he  is  satisfied  that  all  that  is  possible  has 
been  done,  short  of  operation,  and  that  ventro-fixation 
or  suspension  will  be  likel  v  to  prove  of  benefit,  and  if 
the  patient  after  a  full  explanation  as  to  the  nature  of 
the  procedure,  and  the  possible  risk,  elects  to  submit 
to  operation  rather  than  to  continue  in  a  chronic  state 
of  discomfort  and  pain,  I  should  think  the  advisability 
of  operating  fully  established. 

In  answer  to  the  question— Is  it  safe  ? 

Unless  we  can  reasonably  answer  this  in  the  affirma- 
tive, we  must  be  content  to  give  as  much  relief  as  is 
possible  by  minor  remedial  measures,  and  by  mechani- 
cal supports,  and  to  eschew  ventro-fixation.  I  antici- 
pate, however,  we  shfldl  find  from  those  present  that 
the  general  experience  of  these  operations,  as  far  as 
safety  is  concerned,  is  the  same  as  my  own,  for  the  six- 
teen cases  on  which  I  have  operated,  have  recovered 
without  giving  me  the  least  anxiety.    Moreover,  I  can- 

(a)  Paper  opening  a  discassion  before  the  British  Gynaecological 
odety,  March  12th,  1896. 


314    Ths  Mbdioal  Pans. 


ORIGINAL  COMMUNICATIONS. 


Mab   25,  1886. 


not  see  why,  if  careful  asepsis  be  observed,  and  if 
ordinary  skill  be  exercised,  there  should  be  any  risk, 
even  when,  as  in  hysterorrhaphy,  the  i)eritoneam  has 
to  be  opened.  In  Alexander's  ojperation,  where  the 
serous  cavity  is  not  interfered  with,  I  think  we  can 
confidently  say  that  the  operation  is  practically  devoid 
of  risk.  There  are,  however,  in  all  operations,  no 
nlatter  how  safe  in  themselves,  accidental  dangers  in 
the  shape  of  anaesthetic  accidents,  chest  complications, 
or  wound  complications,  which  may  give  anxiety,  or 
even  lead  to  a  fatal  termination,  and  which  have 
always  to  be  taken  into  consideration  when  the  medical 
attendant  recommends  operation. 

The  answer  to  the  third  question — Are  these  opera- 
tions efficient  ?~is  what  we  should  be  able  to  deter- 
mine in  a  great  measure  in  the  discussion  this  evening, 
for  sufficient  time  has  elapsed  since  the  earlier  of  these 

erations  was  performed  for  us  to  have  ascertained 


the  after  histones  in  many  cases.  There  can  be  no 
doubt  about  the  immediate  relief  to  pain  and  pelvic 
distress,  or  as  to  the  beneficial  effect  on  the  patient's 
general  health  in  nearly  every  case,  but  what  we  want 
to  ascertain  is,  does  the  relief  last,  or  is  there  a  tend- 
ency to  relapse  ? 

Again,  probably  some  members  may  be  able  to  give 
their  experience  of  the  influence  of  pregnancy  on  the 
uterus  after  fixation  by  hysterorrhaphy.  It  will  be 
interesting  also  to  know  whether  the  adventitious 
adhesions  predispose  to  abortion  or  cause  pain  during 
the  expansion  necessitated  by  the  uprising  of  the  gravid 
womb ;  as  well  a3  to  know  whether  after  the  puerperal 
period  has  passed  there  is  a  tendency  to  a  resumption 
of  the  old  displacement  for  which  the  operation  was 
originally  performed. 

My  colleague,  Dr.  Braithwaite,  tells  me  that  he 
knows  of  one  case,  in  which  after  ventro-fixaticn  the 
patient  aborted  at  the  fourth  month,  apparently  as  the 
result  of  the  abnormal  fixation  of  the  uterus,  but  that 
after  recovery  the  uterus  did  not  relapse  into  the  pre- 
vious retroflexion.  In  another  case,  pregnancy  advanced 
to  the  full  time,  and  delivery  was  effected  without 
inconvenience  or  difficulty. 

I  am  myself  able  to  speak  as  to  the  immediate  relief 
following  on  operation  as  well  as  to  the  improvement 
in  genenu  health.  I  am  also  able  to  vouch  for  the  per- 
manent beneficial  effects  of  the  operation  on  some  of 
my  patients  as  shown  by  the  complete  restoration  to 
health,  the  resumption  of  marital  relations  previously 
impracticable  on  account  of  dyspareunia,  the  loss  of  all 
pelvic  discomfort,  and  the  absence  of  the  necessity  of 
turther  medical  attention.  While  I  am  able  to  give 
this  good  testimony  in  some  cases,  in  others,  and  these 
have  been  hospital  patients  for  the  most  part  suffering 
from  severe  procidentia  who  have  had  to  resume  work 
not  long  after  leaving  my  hand,  the  relief  has  been 
merely  temporary  and  the  displacement  has  after  all 
required  treating  by  mechanical  supports.  Fourthly— 
Do  these  operations  leave  a  patient  in  any  way  less 
fitted  for  life  ?  This  question  is  of  no  little  import, 
and  can  be  best  answered  by  mentioning  an^  possible 
sources  of  weakness,  such  as  hernia  or  intestinal 
obstruction. 

After  any  abdominal  section,  a  ventral  hernia  is  a 
possibility,  bat  by  carefully  suturing  the  parietes,  layer 
by  layer,  and  by  careful  after-treatment,  there  is  very 
little  fear  of  permanently  weakening  the  abdominal 
walls,  and,  therefore,  the  danger  of  subsequent  hernia 
should  be  reduced  to  a  minimum.  The  danger  of 
intestinal  obstruction  from  the  incarceration  or  stran- 
gulation of  a  knuckle  of  bowel  by  an  adventitious  band 
left  between  the  abdominal  wall  and  the  uterus  is  a 
possibility.  So  far  no  case  of  this  kind  has  been 
reported.  The  danger  is,  however,  a  real  though  a 
remote  one,  and  Worth,  of  Keil,  meets  the  objection  by 
suturing  the  uterus  to  the  bladder,  and  in  addition 
attaches  them  to  the  abdominal  wall.    The  fixation  of 


the  uterus  in  a  false  position,  and  its  immobility  are 
conditions  of  no  import  to  the  patient  if  they  are  asso- 
ciated with  relief  to  distressing  synaptoms  and  uncon- 
nected with  any  symptoms  of  their  own  as  appears  to 
be  the  case,  tnough  it  certainly  does  appear  to  be 
anomalous  to  try  to  relieve  one  displacement  by  pro- 
ducing another. 

Practically,  there  are  two  classes  of  operations  to  be 
taken  into  consideration  :  the  one  extra-peritoneal, 
consisting  of  Alexander's  operation  or  its  modifications, 
the  other,  intra-peritoneal,  in  which  an  abdominal  sec- 
tionformsanecessary  preliminary  to  thehysterorrhaphy. 
It  is  quite  unnecessary  to  enter  into  a  description  of 
these  operations  in  a  society  like  this,  where  everyone 
must  be  so  fully  acquainted  with  the  various  proce- 
dures, but  there  are  certain  modifications  which  may 
be  worth  mentioning  :  for  instance,  Alexander's  opera- 
tion, as  described  by  its  originator,  is  not  so  simple  as 
it  would  appear,  but  if  the  modification  of  laying  open 
the  inguinal  canal  be  adopted,  the  round  ligaments  are 
most  easily  discovered,  and  can  be  drawn  on  until  the 
appearance  of  the  collar  of  peritoneum,  which  may  be 
peeled  back  as  far  as  needful,  or  until  the  ligaments 
are  taut,  after  which  they  are  easily  &ed  by 
several  sutures,  the  inguinal  canal  being  repaired 
before  closins:  the  wound. 

Professor  Kocher,  of  Berne,  speaks  most  favourably 
of  this  operation,  and  in  the  few  cases  where  I  have 
employed  it,  I  have  thought  it  to  be  very  satisfactory 
from  an  anatomical  point  of  view,  so  that  if  Alexan- 
der's operation  be  thought  advisable,  this  would  seem 
to  me  to  be  the  most  efficient  method  of  performing  it. 
On  the  whole,  I  have  been  disappointed  with  the 
permanent  results  of  Alexander's  operation  in  "  pro- 
lapsus uteri,''  unless  other  plastic  procedures  to  tiie 
perineum  and  vagina  have  been  employed  as  supple- 
mentary measures.  In  retroflexion  with  adherent 
appendages,  it  is  quite  useless,  and  although  in  retro- 
flexion, or  in  retroversion  without  adhesions,  the  opera- 
tion would  probably  be  efficient,  I  have  yet  to  find  the 
case  where  the  other  measures  have  proved  so  ineffi- 
cient as  to  render  operative  treatment  of  this  kind 
necessary. 

Perhaps,  in  some  cases  of  prolapse  of  the  ovaries 
with  a  backward  displacement  of  the  uterus,  where 
any  mechanical  support  tends  to  irritate,  and  where 
rest  and  general  treatment  fail  to  benefit,  Alexander's 
operation  may  be  called  for,  and  may  prove  serviceable. 
On  the  whole,  I  think  that  this  operation  has  a 
decidedly  limited  field  of  usefulness,  much  more  so  in 
fact  than  in  theory,  one  might  be  led  to  expect. 

I  have  performed  the  operation  five  times,  and  in 
only  one  nave  I  been  completely  satisfied  with  the 
permanent  result,  that  being  a  case  of  retroflexion  with 
prolape,  the  uterus  being  in  very  good  position  six 
montns  after,  and  the  patient  being  in  good  health  two 
years  after. 

One  case  of  extreme  procidentia  uteri,  operated  on 
six  weeks  as[o,  is  well,  and  the  uterus  is  in  good  posi- 
tion, but  it  IS  too  early  to  speak  of  results,  as  she  has 
not  yet  completely  recovered  from  the  subsequent 
colporrhapby  and  perinsBrrhaphy  which  I  thought  to 
be  necessary  to  give  permanent  relief. 

In  one  case  of  procidentia  the  operation  was  a  com- 
plete failure,  and  had  to  be  supplemented  by  hysteror- 
rhaphy, which,  when  the  patient  was  last  seen,  seemed 
to  have  completely  answered.  One  patient  was  well 
three  months  afterwards,  but  on  writing  to  her  she 
had  changed  her  address,  and  I  was  unable  to  get  her 
further  history,  In  the  fifth  case,  one  of  retroflexion, 
the  relief  was  only  temporary,  probably  on  account  of 
adhesions,  and  subsequent  treatment  has  been 
required. 

Between  Alexander's  operation  and  ventro-fixation 
are  the  two  operations  known  as  Wylie's  or  Baer'a 
operation,  and  that  proposed  by  Dr.  Dudley.     They 


Mab.  25,  1H96. 


ORIGINAL  COMMUNICATIONS. 


Thb  Mxdigal  Press.     315 


and  draw  forward  the  ateros  by  shorteniDg  the 
roand  ligamentB,  which,  however,  are  reached  through 
an  opened  peritoneam. 

Ihaye  no  experience  of  either  operation,  and  I  fail 
to  aee  in  what  particulars  they  present  advantages  over 
bysterorrhaphy,  though  I  should  think  the  support 
must  be  both  less  satisfactory  at  the  time  and  sub- 
seauently. 

Wh^re  it  is  necessary  to  lift  up  and  fix  forward  the 
uterus  bysterorrhaphy  or  ventro-fixation  is  un- 
doubtedly the  most  efficient  method,  and  where  there 
are  adhesions  in  the  pelvis  caused  by  apnendaffe 
disease,  or  by  pelvic  peritonitis,  it  may  be  tne  only 
effectual  means  of  giving  relief;  moreover,  this  is 
often  a  truly  conservative  operation,  since  it  enables 
many  cases  which  wereformerly  treated  byoophorectomy 
to  be  saved  that  undesirable  mutilation,  for  after  the 
appendages  have  been  detached  from  their  abnormal 
positions  they  alon^  with  the  uterus  are  raised  and  pre- 
vented from  resuming  their  former  faulty  attachments. 
With  the  results  of  this  operation,  in  retro-flexion  or 
version  with  adhesions,  I  have  been  vei^  gratified,  and 
in  those  exceptional  cases  where  the  patienf  s  sufferings 
are  incapable  of  relief  by  any  of  the  ordinary  means, 
short  of  operation,  or  where  the  patient  through  want 
of  leisure  or  want  of  means  is  incapable  of  following 
out  treatment  by  rest,  this  method  is  certainly  one 
worthy  of  serious  consideration.  In  prolapsus  uteri 
hysterorrhaphy  is  recommended  bv  some  authorities  as 
an  efficient  means  of  treatment  when  supplemented  by 
colporrhaphy  and  perinseorrhaphy. 

fiut  the  fact  of  certain  of  these  advanced  gynaecolo- 
gists recommending  hysterectomy  where  the  patient  is 
past  the  menopause  proves  to  my  mind  that  their 
experience  of  hysterorrhaphy  in  complete  procidentia  is 
somewlutt  like  my  own,  not  altogether  satisfactory. 

Hysterectomy  in  these  cases  does  not  enter  into  the 

?ue8tion,  but  I  cannot  help  mentioning  it  in  order  that 
may  express  my  view  that  I  consider  it  utterly 
UDJustifiable. 

Keith's  opHBration  of  removing  the  ovaries  and  fixing 
the  pedicles  in  the  abdominal  wound  would  come  under 
the  same  dass  of  operations  as  ovariotomv  combined 
with  hysterorrhaphy,  but  here  it  is  somewhat  difficult 
to  apportion  the  l>enefits  resultin|[  from  the  ventro- 
fixation, as  other  and  distinct  questions  are  raised. 

In  some  cases  of  chronic  invalidism  the  result  of 
appendage  disease  associated  with  retroflexion,  and 
when  tibe  appendages  are  too  much  diseased  to  be  worth 
retaining,  there  is  a  distinct  advantage  in  performing 
ventro-nxation  at  the  time  the  ovariotomy  is  done.  In 
the  four  cases  where  I  have  done  this  combined  opera- 
tion three  of  the  patients  are  quite  well  after  three 
years,  eiffhteen  months,  and  nine  months  respectively, 
and  uie  fourth  case  was  quite  well  when  last  heard  of 
three  months  subsequent  to  operation.  These  opera- 
tions were,  however,  not  done  by  Keith's  method. 

Of  the  seven  other  hysterorrhaphles  which  I  have 
performed  two  were  done  for  retroflexion  with  adhe- 
rent appendages,  and  after  the  appendages  had  been 
loosened  without  being  removed  the  uterus  was  raised 
and  fixed.  Both  patients  were  quite  well  when  heard 
of  some  months  alter. 

A  third  case  of  retroflexion  with  slight  adhesions 
incapable  of  treatment  by  pessaries  was  also  well  when 
last  neardof.  Of  the  remaining  cases  where  ventro- 
fixation was  performed  for  severe  prolapse,  two  were 
well  some  months  afterwards,  one  was  considerablv 
benefited  but  required  to  wear  a  pessary,  and  the  fourth 
was  only  temporarily  relieved  and  returned  nine 
months  luterwards  for  the  treatment  of  a  rectocele  and 
"  prolapsus  uteri*' 

My  colleague,  Dr.  Braithwaite,  has  been  kind  enough 
to  furnish  me  with  a  Ust  of  the  cases,  eleven  in  number, 
in  which  he  has  performed  ventro-fixation  for  back- 
ward displacements  of  the  uterus ;  in  five^  ovariotomy 
and  ventre- fixation  were  combined,  and  m  all  but  one 


very  good  results  followed.  In  the  exceptional  case  a 
pessary  was  subsequently  required.  In  the  remaining 
six  cases  the  patients  when  last  seen,  at  varying  periods 
after  operation,  expressed  themselves  as  satisned  with 
the  results,  and  the  uterus  on  examination  was  in  good 
position. 

From  the  foregoing  remarks,  it  will  be  seen  (1) 
That,  in  my  opinion,  in  the  treatment  of  retro- flexion 
or  retro-version,  after  the  failure  of  other  meaxis, 
ventro-fixation  offers  a  means  of  treatment  leading  in 
so  many  cases  to  permanent  relief  or  cure,  that  the 
operation  b  one  which  is  likely  to  have  a  permanent 
place  in  surgery. 

(2)  That  the  necessity  for  the  operation  usually  only 
arises  where  adhesions  are  present,  other  cases  with  few 
exceptions  ^nerally  yielding  to  less  heroic  measures, 
or,  if  operation  be  thought  needful,  to  the  less  serious 
procedure  of  shortening  the  round  ligaments. 

(3)  That  in  the  treatment  of  extreme  prolapse  or 
procidentia  uteri,  ventro-fixation  or  ventrosuspension 
without  other  supplementary  operative  procedures 
usually  result  in  disappointment,  but  that  in  certain 
cases,  when  supplemented  by  colporrhaphvandperinseor- 
rhaphy,  the  results  are  sufficiently  j^ood  to  encourage 
the  gynsecologist  to  advise  operation,  where  all  the 
ordinary  means  have  failed  to  give  sufficient  relief. 


TUBEKCULOUS  DISEASE  OF  THE 

HIP-JOINT. 

By  R.  L.  SWAN,  F.II.C.S.I, 

Surgeon  to  SteeTeoi'  apd  the  Oithopsedic  Hoepitali,  DabUo. 

A  CONSENSUS  of  opinion  amon(;st  surgeons  who  have 
paid  attention  to  this  subject  exists  as  to  the  adoption 
of  expectant  treatment  in  the  great  majority  of  cases 
of  hip-joint  disease  at  a  period  before  active  disorgani- 
sation of  the  tissues  bBgin.  Allusion  has,  however, 
been  made  to  cases  in  which  there  appears  to  be  a 
tuberculous  deposit  in  the  neck  of  the  femur,  either 
within  or  without  the  epiphysial  line.  When  there  is 
a  distinct  tibickening  of  the  trochanter  and  neck  cf  the 
bone,  without  any  apparent  infection  as  yet  of  the 
crynovial  membrane,  where  there  is  no  fixation,  no 
flexion  or  shortening,  and  no  discernible  involvement 
of  the  pelvic  wall  of  uie  acetabulum.  In  such  circum- 
stances the  attention  of  the  surgeon  would  naturally  be 
directed  to  the  possibility  of  removing  at  once  the 
entire  tuberculous  mass  by  cutting  down  on  the  tro- 
chanters and  explorioff  the  bone.  There  is  an  interest- 
ing paper  on  this  subject  in  the  Dvblin  Journal  of 
Medical  Science,  May  1886,  by  Sir  Thornley  Stoker, 
Pres.Il.C.S.I.,  in  which  he  advocated  tunnelling  of  the 
femoral  neck  for  the  immediate  removal  of  the  tuber- 
culous deposit.  Cases  have  also  been  recorded  by  Mr. 
Watson  Cheyne,  and  I  have  myself,  on  a  few  occasions, 
adopted  this  plan  of  treatment  with  fair  results.  But 
although  I  do  not  deny  that  such  cases  may  be  dealt 
with  as  occasion  offers,  by  a  surgeon  who  is  accustomed 
to  deal  constantly  with  them,  and  who  can  form  that 
accurate  diagnosis  which  represents  a  high  degree  of 
skill,  I  should  be  slow  to  advise  this  as  a  routine 
treatment,  for  the  following  reasons  :— It  must  alwavs 
be  of  extreme  difficulty  to  estimate  the  extent  of  the 
mischief,  as  regards  its  relative  contiguity  to  the  articu- 
lar structures,  and  how  far  we  may  safely  proceed  in 
our  effort  to  thoroughly  eliminate  the  disease.  We  are 
also  '.forced  to  consider  the  retrograde  changes  that 
often  happen  in  the  nature  of  the  deposit,  and  the 
probability  of  spontaneous  restoration  of  functional 
usefulness.  It  is  (even  when  disease  has  advanced  so 
far  that  there  can  be  no  doubt  of  the  presence  of  exten- 
sive tuberculous  deposition)  a  common  experience  to 
witness,  under  judicious  management,  a  recession  of 
morbid  signs,  and  although  on  careful  examination  some 

D 


316     The  Medical  Prbcs. 


CLINICAL  RECOBD;S. 


Mab.  25,  1896. 


ahorteninff  of  the  limb,  or  slight  limitation  of  move- 
ment in  the  joints  may  be  discovered,  yet,  practically, 
the  disease  has  terminated  in  recovery. 

This  recovery  is  most  likely  vhen  the  tnbercnloas 
deposits  are  small  and  discrete,  or  when  encapsulation 
in  a  fibroas  envelope  has  occurred.  The  result  may  be 
a  mere  fibrous  induration  or  fibrous  tissue  in  such 
quantity  as  to  cause  at  the  worst  some  impairment  of 
motion,  dependent  as  to  its  extent  on  its  relation  to  the 
joint 

Even  when  large  tuberculous  masses  become  con- 
crete and  caseation  has  occurred  either  partially  or 
completely,  and  the  joint  has  become  invaded,  we 
know  that  a  useful  limb  may  result.  In  auch  a  case 
large  masses  of  fibrous  tissue  are  thrown  out  around 
the  remaining  tuberculous  mass,  and  in  the  neighbour- 
ing structures.  The  morbid  tissue  is  converted  into 
an  inorganic  material  interspersed  with  nodules  of 
sabulous  matter,  composed  of  lime  salts,  probably 
degenerate  bone  earth.  Shortening  and  ankylosis  thus 
result.  This  is  the  most  common  progress  of  disease 
in  the  vertebrae,  and  although  occurring  in  a  locomo- 
tive organ  like  the  hip,  such  a  termination  cannot  be 
regarded  as  the  best  possible,  still  its  function  is  so 
wonderfullv  subsidised  by  the  mobility  of  the  lumbar 
vertebrae  that  we  must  view  it  witii  satisfaction,  as 
compared  with  the  greater  evils  attendant  on  prolonged 
suppuratioc. 

We  must  also  not  forget  the  possibilities  of  the 
accident  of  sepsis  after  operation,  m  spite  of  careful 
management,  as  it  is  universally  acknowledged  that 
not  only  do  septic  organisms,  by  reason  of  the  products 
of  their  growth,  lower  the  vitality  of  the  tissues  and 
render  them  liable  to  the  local  deposition  of  bacilli, 
but  that  disseminated  tuberculosis  is  more  common 
when  septic  conditions  exist  This  has  been  proved  by 
direct  experiment  on  animals.  It  was  found  to  be 
more  rapid  when  septic  tuberculous  matter  was  injected 
than  where  a  pure  cultivation  of  tubercle  bacilli  was 
used. 

Konig  also  pointed  out  that  tuberculous  meningitis 
was  more  common  in  tuberculous  joint  disease  when 
septic  than  when  aseptic.  Phthisis  has  also  been 
shown  to  have  supervened  more  frequently  on  joint 
diseases  which  were  septic. 


CANCER  HOSPITAL,  LONDON. 

Three  Uteri  removed  by  Vaginal  HyaterecUmy  for  Mali^nofU 

IHsease. 

Under  the  care  of  P.  A.  Pubobll,  M.D. 

Case  I. —Mary  C,  the  wife  of  a  R.  A.  guoner.  quartered 
m  Ireland,  set  33,  admitted  into  the  Caooer  Hoepitol  on 
January  21et,  1896.  Married  at  19.  Mother  of  three 
chUdren;  youngest  11  years  old.  No  miecarriaffes.  Cata- 
menia  commenced  at  age  of  14.  Has  always  been  in  eood 
health.  Regular,  and  bad  no  great  losses.  No  pain.  Aree 
years  ago  she  suffered  from  a  watery  discbarge,  frequently 
blood-stained.  Had  pain  in  the  back  and  hips.  Proeres- 
Mve  weakness  and  emadation.  In  May,  1895,  at  the 
Rotunda  Hospital,  Dublin,  Dr.  Smyly  amputated  the  neck 
snpra-vagin^;  during  the  last  six  months  her  symptoms 
returned,  and  now  has  a  foul  smelling  vaginal  dischanre, 
and  backache.  The  stump  left  after  the  previous  opeTa- 
tion  IS  found  ulcerated  and  excavated,  the  edses  of  the 
cavity  infiltrated  by  hard  growth,  more  so  anteriorly; 
vaeinal  walls  are  not  affected ;  the  body  of  uterus  is  mobile, 
and  the  broad  ligaments  apparently  normal. 

Jan.  25th.--Vaginal  hysterectomy  was  performed ;  owine 
to  the  cicatrisation  after  the  supravaginal  operation,  the 
anterior  jwrtion  of  the  body  was  very  strongly  united  with 
the  bladder  wall,  m  trying  to  separate  them  the  bladder 
^\i.  u?  T?  "**'^"«  was  delivered,  after  which  the  rent 
in  the  bladder  was  closed  by  ^ve  silk  sutures,  a  self- 
retammg  catheter  was  inserted  into  the  bladder  and  not 


clamped^the  vagina  had  a  drain  put  in,  and  was  loosely 
packed  with  iodoform  gauze.  During  the  next  fonr  days 
20  to  30  ounces  of  urine  per  diem  came  away  by  catheter  ; 
on  the  fifth  dav  some  leakage  took  place  per  vaginam,  which 
gradually  got  less,  and  has  now  ceased  without  doing  any- 
thing farther  to  the  rent.  She  has  made  a  good  recovery. 
The  specimen  in  this  case  consists  of  the  rounded  body 
of  the  uterus  only,  the  cervix  is  absent,  the  lower  part 
where  the  cervix  should  be  is  deeply  excavated  and  exten- 
sively ulcerated,  and  here  the  tissue  is  very  friable.  The 
body  of  tbe  uterus  is  somewhat  enlarsed  and  very  hard. 
The  peritoneal  surface  is  quite  smootE,  and  the  uterine 
cavity  is  not  dilated  and  is  smooth.  The  disease  to  the 
naked  eye  is  mainly  confined  to  the  lower  portion  adjoin- 
ing the  cervix,  but  there  is  a  mass  of  disease  infiltrating 
the  uterine  wall  (as  seen  on  section)  and  extending  to 
within  a  short  distance  of  the  fundus,  becoming  lees  as  it 
advances  upwards. 

The  microscopical  appearances  are  those  of  epithelioma, 
masses  of  epithelial  cells,  irregular  in  size  and  shape,  are 
extending  tbroughout  the  section  in  all  its  extent  throngh 
intertwining  strands  of  fibro-muscular  tissue.  Many  cell 
neste,  some  large  size,  are  seen.  Evidence  of  rapid  prolife- 
ration. The  section  was  taken  from  the  lower  part  of  the 
body  about  the  situation  of  the  oe  internum. 

This  case  is  one  of  recurrence  and  the  disease  exteDding 
upwards ;  it  proves  how  much  more  satisfactory  would 
have  been  the  present  condition  of  this  case  if  total  extir- 
pation had  been  performed  at  tbe  time  she  was  admitted 
into  tbe  Rotunda  Hospital  under  Dr.  Smyly. 

Casb  II. — Maria  M.  S.,  from  Portsmouth » recommended 
from  The  Chelsea  Hospital  for  Women,  admitted  to 
The  Cancer  Hospital,  4cb  February,  1896,  »t.  55, 
married,  mother  of  eight  children  (including  twins)  and 
four  miscarriages,  no  previous  severe  illness.  Complains 
of  a  vaginal  cUscharge  uid  pain  in  the  back.  Dates  her 
present  condition  from  June  1895,  when  severe  haemor- 
rhage came  on,  compellin^er  to  lie  up,  since  which  she  has 
had  several  losses,  foul  discharge,  pain  in  the  back  and 
down  the  hips,  progressive  emaciation  and  weakness. 
Present  conditton.^hmitrKtion  of  thecervix  with  carcinoma, 
breakinj^  down  posteriorly,  mobility  impaired,  some 
thiekenmg  of  the  left  broad  ligament,  disease  in  the  body. 
Feb.  8th.— Va^^inal  hysterectomy,  performed,  there  was 
some  difficulty  in  ante- verting  the  fundus,  caused  by 
posterior  adhesions.  The  uterus  gave  way  during  its 
extraction,  through  its  neck,  friabto  from  infiltration  of 
disease,  the  neck  portion  was  eot  away  after  separating 
the  fundus,  some  forceps  were  aUowed  to  remain  on,  which 
were  taken  off  36  hours  after,  a  vaginal  drain  was  insMted 
and  parts  loosely  packed  with  iodoform  gauze,  a  catheter 
placed  in  the  bladder.  Patient  has  made  an  uninterrupted 
recovery. 

This  specimen  consists  of  the  body  of  the  uterus  only, 
together  with  the  left  tube  and  ovary  and  part  of  the  right 
tube  and  broad  ligament,  the  cervix  having  been  appa- 
rently torn  off  (probably  got  mislaid  and  not  saved).  The 
uterus  is  somewhat  enlarged  and  the  torn  lower  portion 
shows  extensive  disease  of  the  whole  thickness  of  the  wall. 
The  cavity  of  the  uterus  is  dilated,  but  smooth :  the  walls 
at  the  fundus  do  not  show  any  extensive  naked  eye  changes, 
the  disease  being  mainly  confined  to  die  lower  portion, 
though  strands  and  nodules  of  infiltrating  disease  may  be 
traced  almost  to  the  fundus. 

The  exterior  of  the  uterus  is  smooth,  except  laterally, 
where  it  is  much  torn,  especially  at  the  lower  part  (appa- 
rently during  operation). 

Microscopically,  the  condition  is  one  of  extensive  epithe- 
liomatous  infiltration,  masses  and  columns  of  epitbelial 
cells  extending  through  the  tissue  in  all  directions.  The 
individual  cells  are  very  irregular  in  size  and  shape,  and 
there  is  a  marked  karyokinesis,  evidence  of  active  cell 
division,  cell  nests  few  in  number. 

Casb  IIL— Emma  H.,  set.  50,  of  Shepherd's  Bush,  sent 
to  me  by  Mr.  Alfred  £.  Barrett,  of  Addison  Terrace, 
admitted  to  the  Cancer  Hospital  31st  January,  1896, 
mother  of  one  child,  aged  25  years.  Two  years  ago  had 
uterine  hnmorrhage  and  a  thin  watery  discharge,  constant 
desire  to  micturate,  constipation  habitual,  slight  emacia- 
tion. Buffered  from  inflammation  of  the  womb  seventeen 
years  ago. 
Present  i^^o^— Vaginal  mucous  membrane  is  red  and 


Mar  25,  ISOCT 


TEANSACTI0N8  OF  SOCIETIES. 


ThK  MbDICAL  PBBbS.       317 


ioflamed,  hypertrophy  of  cervix,  uteroa  enlarged  with 
impaired  mobility,  os  not  ulcerated. 

Feb.  8th.— Vaginal  hysterectomy  performed,  extreme 
difficalty  experienced  in  anteverting  the  fundus  and  in 
extracting  it,  owing  to  hardness  and  size  of  body  of 
uterus,  ^he  walls  of  the  neck  friable  from  disease  gave  way 
and  tore  away  leaving  the  oe,  which  was  removed  after  the 
body. 

A  pair  of  forceps  was  left  on.  Iodoform  gauze  loosely 
packed  and  a  catheter  passed  wto  bladder.  Thirty-six 
hours  after  operation  the  forceps  was  removed,  when  the 
vagina  was  repacked  ;  very  little  discharge.  Urine  copious. 
Has  made  a  good  recovery. 

The  Speeifnen—Tbe  uterus  in  this  case  is  much  enlarged. 
The  cervix  is  separate  from  the  rest  of  the  uterus,  having 
been  torn  off  during  the  course  of  t  he  operation.  The  mucosa 
of  the  vaginal  surface  of  the  cervix  is  quite  smooth  and 
presents  no  naked  eye  change,  except  a  smooth,  rounded 
nodule,  specially  projecting  from  os,  but  the  torn  surface 
and  the  interior  of  the  cervical  canal  present  evidences  of 
very  extensive  disease,  the  tissue  being  infiltrated  through 
its  whole  thickness,  and  the  canal  being  rough  from  ulcera- 
tion. The  cavity  of  the  body  is  much  dilated  and  is  filled 
by  a  large,  ragged  polypoid  mass  of  f ungating  tissue.  The 
walla  are  infiltrated  throu(;hout,  and  the  peritoneal  sur- 
face is  ragged  and  irregular  from  adhesions.  Microscopi- 
cally, it  presents  the  appearances  of  an  adeno-carcinoma 
There  are  traoee  of  atypical  gland  formation  of  the 
pattern  of  the  uterine  glands,  penetrating  the  tissue  in 
every  direction.  There  is  also  a  fair  amount  of  fibrous 
tissue. 

I  thank  our  pathologist,  Mr.  H.  G.  Plimmer,  for  his 
examinations  and  reports  of  the  specimens,  and  my  house 
surgeon,  Mr.  Chas.  Ryall,  for  hU  assiduous  care  of  the 


Gross  Characteristiesofthe  Uteri  upon  Removal,  by 

H.    6.    FLIMHEB. 

Case  I. — Uterus  measured  3^  inches  in  length,  and 
3  inches  in  breadth.  Wall  very  much  thickened,  but 
soft.  There  was  an  excavated  growth,  very  vascular, 
which  had  completely  destroyed  the  cervix. 

Cask  IL— Uterus  measured  3  inches  in  length  and  2} 
inches  in  width.  The  cervix  was  completely  destroyed  by 
a  fungating  growth,  not  very  vascular. 

Casb  m.— Uterus  measured  4}  inches  at  long^  part, 
but  aa  cervix  was  torn  off,  ic  is  not  sufiScient ;  width  was 
^  inches ;  very  soft,  thick,  and  vascular  ;  a  large  maaa  of 
irregular,  aof t,  red  growth,  filled  the  body  of  the  uterus. 


BRITISH  GYNiECOLOGICAL  SOdETY. 
Mecting  hbld  Thubsdat,  March  12th,  1896. 


The  President,  Glbmbht  Godson,  M.D.,  in  the  Ghair. 


GASBS  OF  0A90CBOUS  DTKBI  BXMOVBD  BT  VAGINAL 
HYSTBSBGTOMT. 

Db.  Poboell  showed  cancerous  uteri  which  he  had  re- 
moved at  the  Ganoer  Hospital,  notes  of  which  will  be 
found  in  another  column,  under  the  heading  of  **  GUnical 
Records."    In  the  discussion  that  followed. 

Dr.  Hbywood  Smith  asked  whether  there  waa  an^  ad- 
vantage in  anteverting  or  retroverting  the  uterus  prior  to 
removal  ?  In  two  of  Dr.  PurceU's  cases  the  cervix  was 
torn  off,  and,  even  if  this  did  not  occur,  there  must  bo 
some  risk  of  peritoneal  infection  if  the  cancerous  cervix 
were  turned  into  the  peritoneal  cavity. 

Mr.  BowRBMAN  Jessbtt  thought  anteversion  or  retrover- 
sion had  the  advantajge  of  allowing  freer  access  to  the 
broad  ligaments,  which  could  then  be  separated  outside 
the  tubes  and  ovaries,  and  thus  the  principle  of  cutting 
wide  of  the  disease  was  carried  out.  He  had  seen  the  cervix 
torn  away  when  it  was  being  drawn  straight  down.  The 
question  arose  how  far,  in  these  cases,  the  patients  were 
ultimately  benefited  ;  of  the  immediate  relief  from  pain  and 
discharge  there  could  be  of  course  no  doubt. 

Dr.  Bantook  observed  that  the  first  case  illustrated  the 
importance  of  total  extirpation  in  cases  of  cancer  of  the 
cervix.    Like  Dr.  Hey  wood  Smith,  he  did  not  see  the  ad- 


vantage of  anteverting  the  uterus ;  the  risk  of  soiling  the 
peritoneum  must  be  increased  b^  the  procedure. 

Mr.  Tatlob  (Birmingham)  said  it  would  be  interesting 
and  instructive  to  hear  from  Dr.  Purcell,  at  a  later  date, 
the  after-history  of  these  cases ;  he  thought  all  of  them 
were  too  far  advanced  for  good  results  to  be  expected.  He 
agreed  with  Mr.  jJessett  as  to  the  temporary  benefit  to  be 
derived,  but  he  questioned  whether  life  waa  prolonged. 

Dr.  PcTRCBLL  replied. 

vxntbo-fixation  and  vbntbo-suspxnsion  of  the  utbbus. 

Profeaeor  Mayo  Robson,  of  Leeds,  opened  a  discussion 
on  "  Ventre- fixation  and  Ventro-suspension  of  the  Uterus 
and  Allied  Operationa,  with  their  Result-a,"  which  will  be 
found  on  page  313 

Dr.  Lbith  Nafibb  said  he  wished  to  supplement  rather 
than  criticise  Professor  Mayo  Robson's  remarks,  and  he 
judged  that  the  object  of  the  discnasion  waa  the  reaulta 
rather  than  the  methods  of  operation.  In  a  recent  number 
of  the  Zeitschriftfiir  Oeh  u.  Oyn»  was  an  important  paper 
on  the  subject,  in  which  the  results  of  154  operations  were 
given.  Id  63  oases  pregnancy  followed,  54  being  delivered 
at  term,  and  3  prematurely ;  while  6  aborted,  8  were 
delivered  a  second  time,  and  3  a  third  time.  He  hoped  to 
give  a  fuU  account  of  this  paper  in  the  next  number  of  the 
British  QyruBcological  Journal,  It  had  been  stated  as 
an  objection  to  the  operation  that  when  followed  by  preg- 
nancy a  larger  proportion  than  usual  required  artificial 
deliverv,  and  that  croea-birtha  were  more  common  owing 
to  the  fact  that  the  uterus  expanded  transversely.  But  the 
criticism  was  somewhat  exaggerated,  because  such  patients 
would  not  have  become  pregnant  at  all,  without  the  opera- 
tion, but  would  have  been  chronic  invalids.  Two  cases 
had  been  recorded  in  which  Gsaaarian  section  had  been 
required;  but  in  neither  case  was  the  ventro-fixation 
performed  in  accordance  with  the  sursical  principles 
reauired  for  this  operation.  He  proceecbd,  he  said,  to 
redeem  a  promise  made  to  the  Society  when  he  read  a 
paper  on  this  subject  in  1893,  namely,  to  give  some 
account  of  after-results.  In  the  British  Medical  Journal 
of  the  same  year  he  published,  with  Dr.  Schacht,  the  cases 
operated  upon  at  the  Ghelsea  Hospital  for  Women.  He 
would  now  give  the  histories  of  his  own  cases.  1.  Opera- 
tion in  February,  1892.  In  May,  1893,  she  was  delivered 
normally  bv  the  St.  Bartholomew's  Hospital  Charity  ;  Drs. 
Griffith  and  Robinson  took  ereat  interest  in  the  case,  and 
aaw  the  confiaement.  She  bad  a  second  natural  labour  in 
August,  1895.  After  each  confinement,  he  saw  her,  and 
found  the  uterus  in  good  position.  2.  Operation  in  August, 
1892.  She  was  manied  in  December,  1893,  at  the  age  of 
36,  and  in  December,  1895,  she  had  a  normal  labour.  He 
saw  her  in  the  following  February,  when  he  found  the 
uterus  in  good  position,  and  the  patient  had  been  able  to 
do  her  work  well  since  the  operation.  3.  Operation  in 
March,  1893.  In  Au^st,  1894,  she  had  hsemorrhage, 
though  she  had  not  missed  a  peiiod.  In  January  of  this 
year,  he  saw  her,  and  found  she  was  six  weeks  preffnant^ 
A  fortnight  later,  after  waiting  in  a  crowd  outside  a  t£eatre 
and  being  jostled,  she  miscarried.  4.  This  patient  had 
passed  through  the  menopause  early,  viz ,  at  38.  The 
uterus  had  given  no  further  trouble.  5.  This  patient  had 
not  become  pregnant ;  she  was  in  good  health  when  he 
last  heard  from  her.  He  agreed  with  Professor  Mayo 
Robson  that  the  operation  was  disappointing  in  the  caae 
of  procidentia,  and  that  retroflexio  fixata  waa  the  one  con- 
dition where  it  waa  strongly  indicated. 

Dr.  Gbobob  Kbith  wished  to  correct  an  impression  con- 
veyed in  Mr.  Robson's  paper  concerning  the  operation 
practised  by  the  late  Dr.  Thomas  Keith.  His  father  never 
removed  both  ovaries  unless  they  were  diseased,  and  he 
then  fixed  only  one  broad  ligament  in  the  wound.  Other- 
wise he  removed  one  ovary,  commonly  the  right,  and  fixed 
the  stumpto  the  wound. 

Mr.  J.  W.  Taylob  (Birmingham)  thought  they  ought 
to  lay  it  down  very  plainly  tlwt  only  a  small  minority  of 
cases  required  these  operations.  He  commenced  with 
Alexander's  operation,  but  eave  it  up  after  about  a  dozen 
cases,  for  two  reasons :  mrst,  the  abdomen  had  to  be 
opened  on  both  sides  at  once,  and  there  was  thus  consider- 
able risk  of  hernia ;  secondly,  the  presence  of  adhesions 
could  not  be  always  ascertained  before  operation,  and  if 
present  they  effectually  prevented  the  drawing  forwards  of 
the  round  ugamenta.     in  uncomplicated  cases  the  results 


318    Thx  Msdioal  Pbis& 


TRANSACTIONS  OF  SOCIETIES, 


Mab.  25,  1896. 


were  fairly  good,  and  fcwo  of  his  patients  became  preffoant 
afterwards  and  went  on  to  fall  term.  But,  finding  that  in 
order  to  deal  with  adhesions  he  had  to  open  the  abdomen, 
he  be^an  to  do  ▼entro-fixation,  and  performed  this  opera- 
tion about  twenty  times.  In  the  first  three  oaras  the 
sutnres  were  not  baried,  and  the  condition  relapsed  ;  in 
the  remaininR  seventeen  a  core  was  effected.  Gases  of 
procidentia,  however,  geoerally  required  some  plastic 
operation  in  addition,  and  so  he  had  besun  to  do  vagino- 
fixation. It  was  possible  to  combine  the  fixation  with 
other  procedures,  ench  as  removal  of  diseased  appendages 
and  igni puncture  of  the  ovaries,  and  though  he  opened  the 
peritoneal  cavity  he  thought  there  was  much  less  risk  than 
in  ventre- fixation.  His  seventeen  cases  of  vagino- fixation 
had  all  been  puccessfnl. 

Dr.  Fbsd  Edge  (Wolverhampton)  said  his  experience 
was  much  the  same  as  Mr.  Taylor's ;  he  first  performed 
Kocher's  modification  of  Alexander's  operation,  but  gave 
it  up  on  tbe  grounds  mentioned  by  Mr.  Taylor,  and  pro- 
ceeded to  do  ventro-fixation.  In  one  case  there  was 
relapse,  and  he  decided  to  try  vagino- fixation  on  the  same 
patient,  for  he  thought  the  adhesions  must  have  given 
way.  He  found,  however,  considerable  difiiculty  in  the 
operation,  owing  to  the  fact  that  adhesions  were  present. 
One  in  particular  was  three  inches  long,  and  as  thick  as  a 
finger.  It  bad  stretched.  The  case  was  interesting  in 
that  an  opportunity  did  not  often  occur  of  ascertaining 
the  condition  of  parts  after  ventro-fixation.  After  the 
vagino-fixation  the  trouble  did  not  recur.  In  all,  he  had 
done  ventro-fixation  twelve  times,  but,  like  Mr.  Tavlor,  he 
now  only  employed  it  in  combination  with  other  abdominal 
operations.  He  had  done  vagino-fixation  twenty  times, 
and  had  been  greatly  impressed  by  its  wonderfully  good 
results.  For  cystocele  he  regarded  it  as  the  one  valuable 
procedure,  for  after  operation  the  cystocele  could  not  oocur 
without  dragging  the  fundus  forwards,  and  the  fundus 
oould  not  fall  back  without  drawing  the  cystocele  up,  and 
the  two  tendencies,  therefore,  balanced  each  other. 

Dr.  SoHAOHT*s  experience  led  him  to  endorse  Professor 
Mayo  Robson's  views.  Dr.  Napier  had  referred  to  the 
cases  which  they  had  published  together ;  two  of  them 
had  been  under  his  own  care,  and  he  would  give  their 
after  histories.  One  of  them  he  had  seen  at  intervals 
since  the  operation,  and  the  last  reports  were  very  satis- 
factory, but  of  late  he  had  lost  wight  of  her.  The  second 
case  was  operated  on  in  July,  1892  ;  in  February,  1893,  she 
miscarried  at  four  months.  She  became  pregnant  again, 
and  went  on  to  term ;  the  labour  was  natural,  except  that 
the  placenta  remained  behind  longer  than  usual,  and  her 
medical  attendant  sent  for  him.  Ordinary  expression  was 
i>ufficientto  expel  the  placenta,  which  was  not  adherent, 
and  he  had  the  opportunity  of  feeling  the  uterus.  There 
was  a  prominent  ridge  in  the  situation  of  the  sutures, 
while  on  each  side  was  softer  uterine  tissue.  Iliis  ridge 
may  have  hindered  the  normal  uterine  expansion  at  the 
time  of  the  miscarriage,  and  it  may  have  interfered  with 
the  normal  contraction  after  labour,  as  there  was  rather 
more  hsBmorrhage  than  usual.  He  saw  her  on  March  11th 
of  this  year,  the  confinement  being  in  January,  and  found 
the  uterus  three  inches  long,  and  in  good  position.  This 
was  her  first  term  pregnancy,  although  she  had  had  one 
miscarriage  before  the  operation.  It  seemed  to  him  that 
in  cases  wnare  there  was  a  possibility  of  pregnancy  follow- 
ing, the  question  of  the  position  of  the  sutures  was  impor- 
tant, thev  should  be  as  low  down  as  possible,  in  order  not 
to  interfere  with  subsequent  uterine  expansion.  He 
thought  also  that  ventro-suspension  by  means  of  the 
broad  ligaments,  would  allow  of  less  free  expansion  than 
ventrofixation. 

The  discussion  was  then  adjourned  to  the  next  meeting. 


OPHTHALMOLOGICAL  SOCIETY. 
Meeting  held  Thdesdat,  March  12.  1896. 

The  President,  Mr.NETTLisHip,  in  the  Chair. 


Messrs.  Ormerod  and  Sficer's  paper  on 

RECURRENT  PARALYSIS  OF  OCULAR  NERVES. 

Seven  cases  were  narrated,  three  of  which  were  of  the 
third  nei  Vd.  The  patients  had  suffered  from  a  periodically 
recurring  onc-jided  headache  attended  by  vomiting  and  a 


sense  of  illness,  the  attacks  varying  verv  much  in  inten- 
sity ;  the  slighter  ones  had  passed  off  after  a  few  hoan» 
the  more  serious  ones  had  lasted  several  days,  and  wt-re 
accompanied  by  sndden  more  or  lass  complete  panip 
lysis  of  the  corresponding  third  nerve.  In  the  ostrlier 
attacks  the  paralysis  was  recovered  from,  but  after  several 
recurrences  some  of  the  parts  of  the  third  nerve  became 
permanently  pwalysed.  In  one  of  the  eases  there  was 
partial  atrophy  of  tne  optic  nerve  on  the  side  of  the  pars* 
lysed  third  nerve.  The  fourth  case  had  recurrent  paralyeia 
of  both  third  nerves  occurring  after  a  long  course  of 
periodic  headaches,  in  which  Uie  ultimate  condition  was 
one  of  complete  ophthalmoplegia  externa  of  both  eyes. 
The  remaining  oases  were  examples  of  paralysis  of  the 
sixth  nerve  which  had  recurred,  in  one  of  which  the 
seventh  nerve  was  involved  later  on,  and  in  the  other  the 
third  nerve  was  partly  involved.  The  opinion  waa 
expressed  that  the  term  migraine  which  was  commonly 
applied  to  these  cases  was  an  unfortunate  one ;  there  was 
no  history  of  anv  of  the  other  migraine  phenomena  in  any 
of  the  published  cases,  such  as  hemianopsia  or  sootomate 
or  visual  spectra ;  moreover,  the  motor  character  of  the 
affec'ion  and  the  persistence  of  impairment  of  movement 
depended  on  a  definite  focal  lesion  of  the  base  of  the  brain, 
an  opinion  which  was  supported  by  the  results  of  post- 
mortem examination. 

The  PRESIDEKT  observed  that  the  subject  was  still  very 
obscure  and  further  facts  were  necessary  before  it  conld 
be  thoroughly  understood. 

Mr.  Grimsdau  related  a  case  in  which  the  patient  had 
had  six  attacks.  Recovery  ensued  between  them.  The 
attacks  always  occurred  in  the  cold  weather  and  there  waa 
no  affection  of  vision  of  the  visual  fields  Accommodation 
was  completely  paralysed  and  the  pnpil  of  the  affected  eye 
did  not  act  as  well  as  the  other  to  light. 

Dr.  James  Taylor  said  the  lesion  did  not  appear  to 
involve  the  nerve  trunk  or  the  nucleus.  He  was  unable  to 
see  any  analogy  between  attacks  of  recurrent  paralysis 
involving  the  third  nerve  and  the  oases  of  trigeminal 
paralysis,  there  being  great  differences  between  the  two. 

Dr.  CoLMAN  relatM  a  case  in  which,  during  the  com- 
mencement of  the  attack,  the  eyelid  underwent  a  sort  of 
spasm,  after  which  the  attack  ran  the  usual  course.  The 
patient  ultimately  developed  complete  paralysis  of  tbe 
internal  and  external  branches  of  the  third  nerve.  It  was 
difficult,  he  said,  to  believe  that  the  trunk  of  the  nerve 
was  involved,  because,  in  addition  to  the  vomiting  with 
which  the  attacks  usnaUy  commenoed  there  were  other 
symptoms  such  as  lacrymation  and  salivalion.  The  cases 
seemed  to  have  little  relation  to  migraine.  He  had  eeen 
30  recorded  cases  and  in  not  one  were  there  any  of  the 
optic  phenomena  usually  asfociated  with  mieraine. 

Dr.  Priestley  Smith  recalled  a  case  in  which  the  attacks 
had  been  cut  short  by  treatment  directed  towards  the 
elimination  of  an  excees  of  uric  acid.  He  believed  that  if 
the  treatment  had  been  instituted  earlier  the  patient 
would  not  have  remained  permanently  paralysed  in  respect 
of  the  third  nerve,  this  having  remained  after  his  last 
attack. 

Mr.  E.^  Clarke  mentioned  a  case  of  recurring  paralysis 
of  the  third  nerve  in  which  correction  of  2*5  D  of  hyper- 
metropic astigmatism  led  to  tbe  subsidence  of  the  attacks. 
Mr.  Power  mentioned  that  be  had  seen  cases  in  which 
this  symptom  had  appeared  to  be  dependent  on  the  pre- 
sence of  worms,  and  he  asked  if  this  had  been  noted  in 
any  of  the  recorded  cases. 

Dr.  Hill  Griffiths  asked  if  anyone  had  met  with  the 
cutaneous  nodules  on  the  trunk  of  the  fifth  nerve  mentioned 
by  Henschen  and  others. 

RECURRING  REFLEX  AMBLYOPIA,   DUB  TO  PREGNANCY. 

Dr.  R.  Lawford  Knagos  said  that,  in  1893,  he  had  pub- 
lished a  case  of  reflex  amblyopia  during  pregnancy,  in 
which  blindness  advancing  during  the  progress  of  a  preg- 
nancy, recovered  after  the  induction  of  premature  labour. 
He  now  supplemented  that  case  by  the  details  of  another 
at  present  under  observation.  A  woman,  mt.  40,  came  to 
the  Leeds  Public  Dispensary  an  April  11th,  1892,  to  be 
examined  for  spectacles,  being  then  four  months  pregnant. 
The  left  eye  diverged,  there  was  no  perception  of  light  in 
it,  and  the  optic  disc  was  atrophied.  Between  eisht  and 
nine  years  previously,  during  a  pregnancy,  she  bad 
noticed  a  dimness  towards  the  left  side,  but  did  not  <Ua- 


25,1896. 


TRANSACnONS  OF  SOCIETIES. 


Thb  Mbdig^l  Prcss.     319 


oorer  that  her  left  eye  was  blind  antil  a  month  later, 
after  her  oonfinemeot.  Darinfi;  the  interval  she  had  had 
four  children,  bat  had  noticed  nothing  wrong  in  the 
sight  of  the  right  e^e  at  her  confinements  or  at  her  men- 
stmal  periods.  The  rieht  disc  and  the  fandos  were 
normaL  y=5/10,  and  Uie  shadow  test  showed  3  D  of 
hTpermetropia.  When  next  seen,  on  May  23rd,  vision 
had  fallen  to  5/30,  and  the  visual  field  was  then  found  to 
be  much  smaller  than  normal.  She  was  kept  under  obser- 
vation, and  the  sieht  of  the  right  eye  gradually  got  worse, 
and  the  field  smiJler.  Colour  vision  was  also  abolished, 
though  there  was  no  noticeable  change  in  the  disc  or 
fundus.  Premature  labour  was  induMd  on  June  29th, 
but  before  that  the  sight  became  so  bad  that  the  patient 
oould  not  see  her  fingers  when  held  before  the  face. 
Thereupon,  a  general  improvement  set  in,  and  visual 
acuity  and  the  visual  field  steadily  increased,  until,  in 
October,  the  former  was  5/6,  and  the  latter  of  fair  size. 
In  January,  1893,  the  field  was  almost  normal  in  size, 
except  for  the  obliteration  of  the  right  inferior  quad- 
rant, and,  in  April,  vision,  including  colour  vision, 
was  completely  restored.  The  appearance  of  the  disc, 
however,  was  very  suggestive  of  partial  atrophy,  being  of 
a  dull  erey  colour  wiw  a  faint  bluish  tinge  at  its  outer 
side.  He  elicited  the  information  that  ever  since  the  last 
confinement  sight  had  been  afiected  at  the  menstrual 
periods,  though  the  periods  were  not  profuse  or  unnatural 
m  any  way.  SighD  returned  as  soon  as  the  period  came 
to  an  end.  During  the  intervals  it  was  stead v  and  did  not 
▼ar^.  After  she  came  under  observation,  however,  she 
noticed  that  her  eyesight  was  more  variable,  worse  one  day 
and  better  the  next.  In  his  former  paper  he  had  accepted 
Dr.  Priestley  Smith's  theory  of  reflex  amblyopia  as  an 
explanation  of  the  phenomenon.  That  theory  attributed 
the  advancing  blindness  to  a  constriction  of  the  intra-ocular 
vessels  produced  bv  a  reflex  stimulus  acting  through  the 
sympathetic.  Each  loss  of  vision  during  successive  preg* 
nancies  probably  represented  a  stase  in  the  production  of 
optic  nerve  atrophy,  and  if  this  explanation  were  correct, 
it  was  obviously  an  atrophy  dependent  on  an  intra-ocular 
cause.  Intra-ocular  hemianopsia  due  to  a  central  cause 
was  rare,  Drs.  Landolb  and  Wecker  stating  that  it  had 
only  once  been  observed,  and  then  as  the  consequence  of 
a  wound  of  the  occipital  lobe  during  trephining.  The 
whole  history  of  the  case  pointed  to  the  close  relationship 
between  the  failure  of  signt  and  conditions  afiecting  the 
eeperative  organs.  The  prognosis  was  very  grave  when 
uiis  condition  was  met  with  in  pregnant  women,  and  if 
the  pregnancy  were  permitted  to  run  its  course  the  ten- 
dency of  this  form  of  reflex  amblyopia  was  to  end  in  optic 
atrophy,  but  if  recognised  early,  and  if  the  pregnancy 
were  promptly  terminated  by  artificial  means,  cure  seemed 
to  be  not  onl^  probable  but  certain.  It  was  therefore  of 
the  utmost  importance  that  in  pregnant  women  any 
increasing  failure  of  vision  should  be  carefully  investigatd. 
If  the  results  of  repeated  observations  showed — (1)  that 
the  acuteness  of  vision  was  rapidly  diminishing  ;  (2)  that 
there  was  concentric  contraction  of  one  or  both  fields,  and 
that  this  contraction  was  progressive;  (3)  that  colour 
perception  was  impaired ;  and  (4)  that  there  was  no 
disease  of  the  fundus  to  be  made  out  with  the  ophthalmo- 
ecope,  then  the  prognosis,  as  far  as  sight  was  concerned, 
was  very  serious,  and  abortion  or  premature  labour  should 
be  induced  witLcut  delay. 

Dr.  Jabos  Tatlob  questioned  the  propriety  of  using  the 
term  reflex  amblyopia  in  such  a  case.  In  reflex  amblyopia 
there  was  concentric  contraction  of  the  fields  of  vision  and 
not  a  hemiopic  defect. 

Dr.  F&ixsTLBT  Smith  explained  that  the  case  of  his  own 
to  which  the  author  bad  rererred  was  one  of  amblyopia  due 
to  spasmodic  contraction  of  the  retinal  vessels,  in  one  eye 
this  contraction  ultimately  led  to  blockage  of  the  vessel 
irith  consequent  blindness.  That,  he  thought,  was  reason- 
ably described  as  a  case  of  reflex  amblyopia.  That  patient 
sufTered  from  pyosalpinx,  and  when  this  was  operated  upon 
she  recovered.  He  asked  whether  the  field  in  the  author's 
«ase  underwent  spiral  contraction  while  under  examina* 
tion. 

Mr.  JoHNSOK  Tatlob  suggested  that  the  case  was  pos- 
eibly  one  of  primary  optic  atrophy,  the  attacks  during 
prmiancy  being  of  the  nature  of  exacerbations. 

Toe  Pbbsidbnt  suggested  that  a  lesion  of  the  optic 
nerve  where  it  left  the  chiasma  would  account  for  the 


symptoms.  There  still  remained  the  oscillations,  which 
he  admitted  mieht  still  be  reflex.  Nevertheless,  he  did 
not  think  that  the  case  ought  to  be  labeUed  as  one  of  reflex 
amblyopia  without  any  explanation. 

Dr.  Khaqqq  briefly  replied,  pointing  out  in  conclusion, 
that  these  cases  might  account  for  the  instances  of  optic 
atrophy  met  With  after  child-bearing.  The  condition 
tended  to  go  on  to  complete  atrophy  if  unrecognised,  and 
untreated,  but  if  properly  taken  in  hand,  the  results  were 
likely  to  be  most  satisfactory  to  the  patient. 


HARVEIAN  SOCIETY. 
MsiTiNG  HXLD  Thubsday,  Mabgh  5th,  1896. 

Dr.  Wm.  Hill,  Vice-President,  in  the  Chair. 

casbs. 

Thb  following  were  exhibited  : — 

Case  of  Ancesthelic  Leprosy  in  a  Bay. — Dr.  ElSOWS- 
LEY  SiBLXY  exhibited  a  boy,  set.  16,  who  was  bom  in 
India,  of  English  parents.  At  the  present  time  he  was 
employed  on  the  railway,  and  had  been  in  England  four 

J  ears,  having  spent  the  first  twelve  years  of  his  life  in 
ndia  and  Burma.  His  family  and  previous  history 
presented  no  special  features.  For  about  two  years 
be  had  noticed  some  numbness  and  gradual  loss  of 
sensation  over  the  region  of  the  left  g£Mt  toe  and  the  inner 
part  of  the  lower  third  of  this  leg.  He  came  under  treat- 
ment at  the  North- West  London  Hospital  a  few  weeks 
ago,  on  account  of  a  ^ore  about  the  dorsum  of  this  great 
toe,  and  it  was  then  discovered  that  there  was  a  complete 
loss  of  sensation  about  the  region  of  the  ulcer  and  over 
the  cutaneous  distribution  of  the  long  saphenous  nerve 
and  part  of  the  anterior  tibial.  There  was  some  hyper- 
seathesia  over  the  shin  bone  in  the  upper  half.  The  patellar 
reflex  on  this  side  was  exageeratMl,  and  there  appeared 
to  be  some  wasting  of  the  calf  muscles  on  this  side.  The 
boy  was  markedly  freckled,  but  there  were  no  other  patches 
of  discolouration  to  be  seen  about  his  body.  The  external 
popliteal  nerve  on  the  afiected  side  was  more  readily  felt 
than  on  the  opposite  side,  the  ulnar  nerves  were  very 
easily  felt,  but  one  could  not  be  certain  of  any  enlargement, 
though  there  appeared  to  be  some  dulling  of  sensation 
over  the  ulnar  distribution  about  the  palms.  Dr.  Sibley 
discussed  the  other  pathoLgical  conditions  which  mi^ht 
have  accounted  for  the  symptoms,  namely,  a  condition 
allied  to  Raynaud's  disease,  post-diphtheritic  paresis,  post- 
influenzal neuritis,  but  he  considered,  on  the  whole,  the 
elephantiasis  theory  the  most  probable  one. 

l>r.  Knowsley  Sibley  also  brought  forward  a  case  of  an 
Extensive  Syphilitic  Eruption  in  a  woman,  sBt.  40,  who 
had  been  the  subject  of  lues  for  twelve  years. 

Case  of  Morbus  Coertdetut  with  Spina  Bifida  Ocetdta, 
—Dr.  Lbomabd  Gttthbib  exhibited  a  case  of  this  disease 
in  a  female  child,  »t.  3.  There  were  well-marked  cardiac 
symptoms  pointing  to  patent  foramen  ovale  and  ductus 
arteriosus,  also  a  remarkable  paretic  condition  of  the 
lower  limbs.  The  child  could  move  them,  but  was  totally 
unable  to  walk.  The  limbs  could  be  freely  moved  into 
almost  any  position. 

Dr.  Guthrie  also  showed  a  case  of  Myxoedema  improv- 
ing considerably  under  thvroid  treatment. 

Mr.  Jaokson  Clabke  tnought  Dr.  Guthrie's  interpreta- 
tion of  the  over-mobility  of  the  lower  limbs  as  being  aue  to 
the  spina  bifida  occulta  reasonable,  but  it  would  be  diffi- 
cult to  exclude  the  possibility  of  its  depending  on  an 
asphyxiated  condition  of  the  tissues.  There  was  no  indica- 
tion of  congenital  dislocation  of  the  hip. 

Case  of  Acromegaly. —Mr.  R.  W.  Dodgson  showed 
this  case  in  a  young  woman,  set.  23.  The  history  was  that 
she  had  always  enjoyed  eood  health  until  three  years  ago, 
when  she  began  to  suner  from  severe  frontal  headacne, 
pains  in  joints,  &c.  About  the  same  time  she  noticed 
that  her  bands  and  feet  were  growing  larger,  which 
has  continued  steadily  since.  She  first  noticed  enlarge- 
ment of  face  two  years  ago.  She  had  been  very 
languid  and  sleepy  during  this  period.  Sight  was 
go<Kl  till  six  months  ago,  when  it  began  to  fail. 
Memory  has  been  greatly  impaired.  Present  Condition, — 
There  is  ffreat  and  characteristic  enlargement  of  bands, 
feet,  and  face,  alao  clavicles  and  upper  two  ribs.    The  soft 


320    The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


Mab.  2%  189^ 


partfl  of  OOB6  and  superior  maxilla  specially  eula*'geH  ;  ears 
aod  tODgae  normal.  OciJar  Symptoms.-^Then  is  com- 
plete bomonymons  hemianopia  of  left  fields  of  yision.  The 
temporal  side  of  right  retina  and  nasal  side  of  left  retina 
insensitive  to  light.  No  optic  atrophy,  nystagmus,  or 
other  abnormality.  Thyroid  gland  somewhat  enlarged. 
2Veafm«n^ —Constipation  treat^.  Also  tabloids  of  pituit- 
ary body  (Burroughs  k  Wellcome).  Since  admission  has 
become  much  lees  lethargic,  and  memory  has  improved. 
Photographs  taken  during  last  three  years  were  shown, 
showing  the  gradual  enlargement.  The  case  was  shown 
by  kind  permission  of  Sir  Wm.  Broadbent. 

Ca»e  of  Acromegaly. — Dr.  LssLiETHORNBTHORNEshowed 
a  man,  net.  48,  suffering  from  acromogalv,  in  whom  the  first 
symptoms  of  the  disease  appeared  when  he  was  21  jrears  old. 
He  pointed  out  that  in  this  patient  most  of  the  signs  and 
symptoms  of  the  disease  were  well  marked,  but  that  the 
case  was  unusual  in  that  most  of  the  long  bones  were 
markedly  affected,  especially  the  tibi»  and  fibulae,  which 
were  greatly  thickened,  and  showed  a  marked  curve 
outwards  aca  forwards.  He  also  showed  a  list  of  measure- 
ments of  the  hypertrophied  parts,  which  list  he  made  out 
in  March,  1895,  and  mentioned  that  those  measurements 
were  unaltered  at  the  present  time. 

Cases  of  Pityriasis  Rosta  and  Lichen  Riiber  AcvmincUis. 
— Dr.  P.  8.  Abrahams  exhibited  these  cases,  and  noted  the 
points  of  difference  between  the  first  and  leborrhoeic 
eczema,  and  between  the  second  case  and  D^vergie's 
disease. 

Dr.  SiBLBT  looked  upon  pityriasis  rosea  as  a  more  or  less 
acute  disease,  beginning  possibly  insiduously,  but  then 
rapidly  developing  and  running  a  very  definite  course  of 
five  or  six  weeks,  and  disappeanng  with  or  without  treat- 
ment, and  also  never  recurring  again  in  the  same  indi- 
vidual. He  was  disposed  rather  to  consider  this  case  one 
of  seborrhoeic  eczema. 

Mr.  Jackson  Clarke  thought  that  the  absence  of  a 
crinkled  surface  in  the  central  parts  of  the  lesions,  th^ 
long  duration  of  the  affection,  and  the  response  to  treat- 
ment in  the  first  case,  favoured  a  diagnosis  of  seborrhoeic 
eczema  rather  than  of  pityriasis  rosea.  The  secord  case 
raised  the  knotty  point  of  the  identity  or  non-identity  of 
D^vergie's  pityriasis  rubra  pilaris  with  lichen  ruber 
acuminatus.  Kaposi  and  Malcolm  Morris,  amongst  others, 
regarded  them  as  identical.  Mr.  Clarke  thought  that  Dr. 
Abraham's  case  was  certainly  not  pityriasis  rubra  pilaris. 

A  Cast  for  Diaynosis. — Dr.  G.  A.  Sutherland 
showed  an  abdominal  case  for  diagnosis.  The  patient 
was  a  boy,  set.  14,  who  had  sufferea  from  infancy  from 
vomiting  during  meals,  uuaccompanied  by  many  others 
signs  of  gastric  disturbance.  The  attacks  of  vomitine 
would  persist  for  months,  and  lead  to  great  weakness  and 
emaciation,  after  which  there  would  follow  a  period  of 
partial  recovery.  The  abdomen  was,  as  a  rule,  distended, 
but  during  the  previous  six  weeks  it  had  become  much 
more  prominent,  and  the  liver  had  enlarged  rapidly,  until 
it  now  extended  two  inches  below  the  levd  of  the  umbilicus. 
The  other  systems  were  apparently  normal,  the  vomiting 
had  ceased  for  a  fortnight,  there  had  been  no  pyrexia,  and 
he  had  gained  eleven  pounds  in  weight  during  the  last  two 
months. 

Dr.  Luff  Inclined  to  the  opinion  that  the  liver  enlarge- 
ment was  syphilitic  in  origin. 

Dr.  Alex,  M  orison.  Dr.  Guthrie,  and  D-.  Siblet  also 
remarked  on  the  case. 

In  reply.  Dr.  Sutherland  said  that  he  thought  syphilis 
might  be  excluded,  from  the  fact  that  the  liver  had  been 
enlarging  during  a  course  of  mercurial  inunction.  Hydatid 
of  the  liver  was  a  possible  cause,  although  at  present  no 
localising  mass  could  be  detected. 

Case  of  Pericranial  Effusion  following  Influenza. — 
Dr.  Essex  Wynter  exhibited  the  patient,  a  man,  rot.  30, 
who  had  an  attack  of  this  disease  at  the  end  of  January, 
1896.  About  a  fortnight  later  he  noticed  tender  bumps  on 
the  head  situated  over  the  brow,  temples,  and  vertex, 
seven  or  eight  in  number,  about  the  size  and  shape  of  half 
a  hazel-nut,  aod,  in  the  first  instance,  almost  as  hard  as 
bone.  After  three  weeks  some  had  nearly  disappeared, 
and  others  fluctuated,  and  were  evidently  fluid.  They 
were  firmly  fixed  to  the  bone,  and  the  scalp  moved  freely 
over  them.  There  was  no  redness  and  no  history  of 
syphilis.    Dr.  Wynter  quoted  two  other  cases  he  had  met 


with  in  the  spring  of  18v5,  in  a  man  and  womon,  both  set, 
50.  In  the  latter,  one  bump  suppurated,  and  the  condi- 
tion recurrsd. 


THE  HUNTERIAN  SOCIETY. 
Meeting  held  Wednesday,  March  11th,  1896. 


The  President,  Db.  G.  E.  Herman,  in  the  Chair. 

After  some  introductoiy  remarks  from  the  President, 
the  remainder  of  the  evening  was  |;iven  to  the  exhibition 
and  discussion  of  pathological  specimens. 

CASES  AND  specimens. 

Dr.  Arnold  Chapun  showed  a  heart  with  well-marked 
stenosis  of  the  pulmonary  valve  and  phthisis. 

Dr.  CoTMAN  brought  forward  a  patient  in  whose  case 
the  Rontgen  rays  were  used  to  diagnose  the  nature  and 
extent  of  the  deformity  after  :i  fracture  of  the  first  phalanx 
of  the  left  forefinger. 

Dr.  Glover  Lyon  showed  a  specimen  of  sacculated 
aneurism  of  the  second  and  third  part  of  the  arch  of  the 
aorta,  in  which  a  clot  wts  present  nearly  filling  the  sac  of 
the  aneurism.  In  the  case  from  which  the  specimen  was 
taken,  the  left  pulse  was  longer  than  the  right,  and  the 
left  bronchus  was  dilated.  The  patient  subsequently  died 
of  dyspncea,  for  which  at  the  post-mortem  no  cause  could 
be  assigned. 

Drs.  F.  J.  Smith,  Sequeira,  and  Hingston  Fox  die 
cussed  the  two  preceding  specimens. 

Dr.  Glover  Lyon  broueht  forward  a  preparation  of  m 
cavity  in  the  lungs  in  which  the  origin  was  obscure,  it 
being  doubtful  whether  the  cause  was  an  aneurismal  dila- 
tation which  had  burst  into  a  bronchus  or  a  pulmonary 
cavity  with  a  hiemorrhage  into  it  due  to  rupture  of  a  pul- 
monary aneurism. 

Dr.  Chaslewood  Turner  thought  the  cavity  was  a 
dilated  bronchus  filled  with  hismorrhage  from  a  ruptured 
pulmonary  aneurism.  

Mr.  Tubby  showed  specimens  of  the  bones  in  scurvy 
rickets.  The  points  emphasised  were  the  separation  of 
the  epiphyses  and  the  hemorrhage  beneath  the  perios- 
teum. 

Drs.  Charlewood  Turner,  F.  J.  Smith,  Glover,  Lyon, 
and  Messrs.  Targett  and  Hoar  joined  in  the  discussion. 

Dr.  Sequeira  showed  a  specimen  of  intra-abdominal 
band  of  unusual  length,  which  was  evidently  produced  by 
adbeeion  of  the  hydatid  of  Morgagni  to  the  greist  omentuea 
and  the  subsequent  stretching  and  elongation  of  the 
pedicle  by  the  excursions  of  the  great  omentum. 

Mr.  Targett  showed  the  trunk  of  an  anencephalic 
foetus  with  a  slender  fibrous  cord  passing  from  the  root  of 
the  mesentery  to  the  umbilicus.  A  second  foetus  was 
shown  in  which  a  cord  passed  from  the  left  groin  to  the 
liver.  Ectopia  vesicas  was  present  The  cord  was  evi- 
dently not  the  round  ligament,  but  probably  a  deep  epi- 
gastric artery  which,  on  account  of  the  ectopia  vesicas,  had 
lost  its  proper  attachment  and  found  a  new  one  at  the 
liver.  Mr.  Targett  also  showed  two  other  specimens,  one 
of  non- tuberculous  epidydimitis,  in  which  pus  had  formed* 
and  the  other  of  gangrene  of  the  teetis  produced  by  tor- 
sion of  the  cord. 


LIVERPOOL    MEDICAL    SOCIETY. 
Meeting  held  Thitrsday,  March  12th,  1896. 


The  President,  Dr.  Caton,  in  the  Chair. 


CASE  OF  RODENT  ULCER  OF  THE  NOSE. 

Mr.  Kushton  Parker  showed  a  man,  ist.  55,  on  whon» 
he  had  operated  several  timee  for  rodent  ulcer,  affecting 
the  right  tip  of  the  nose  at  first.  The  patient  was  intro- 
duced by  Dr.  Hugh  K  Jones,  in  November,  1894,  when* 
the  dieease  was  excised  on  a  small  scale,  and  Thieracb 
grafts  applied.  This  failed  to  heal,  and  a  month  later,  a. 
further  small  excision  was  performed,  with  reconstruction- 
of  the  right  ala  by  a  flap  raised  from  the  adjoining  cheeky 
Recurrence  occurred,  and  accordingly,  the  disease  wafr 
excised  in  May,  1895,  without  any  attempt  at  plastic  repair. 
In  December,  1895,  the  nose  was  not  only  much  deformed. 


Mab.  25,  1896. 


GERMANY. 


Thi  Mbdigal  Pembs.     321 


been  i 


but  the  eeat  of  fortber  recnrreDoe  of  the  rodent ;  lo,  on 
the  18th  of  that  month,  the  diaease  was  cnt  awav  widely, 
icdodine  the  cheek  fl%p  which  was  also  involved.  There 
remained  now  only  the  outer  half  of  the  left  fide  of  the 
akin  of  the  nose,  and  that  over  the  nasal  bonee  (themaelveB 
iotact)  which  was  next  dissected  np  and  tamed  doWn  with 
ita  epidermic  sarfaoe  backwards  as  a  lining.  Then  a  large 
flap  from  the  forehead,  with  pedicle  at  the  left  eyebrow 
was  fashioned  to  fit  by  a  straightedge  along  the  remaining 
left  side  of  the  nasal  skin  ana  forming  a  new  colamnie  and 
large  right  alie  extending  into  the  gap  left  on  the  cheek. 
The  granulating  surface  of  the  forehead  was  covered  on 
Jan.  6th,  1896,  with  two  large  Thiersch  grafts  sliced  from 
the  thigh,  with  excellent  effect.  Even  after  this,  a  small 
recurrence  appeared  in  the  edge  near  the  right  lower  eye- 
lid, and  was  excised  a  few  weeks  later,  rapid  healing  result- 
ing. Union  by  first  intention  occurred  through  the 
ater  part  of  the  laree  flap,  and  the  patient  has  all  along 
i  in  excellent  healtn  and  vigour. 

TBEATHBKT  OF  OORNXAL  OPACITIIS  BT  SLKCTTBOLTSIS. 

Mr.  Edgar  Stbvxkson  read  a  note  on  the  Treatment  of 
Corneal  Opacities  by  Electrolysis,  which  he  claimed  to  be 
a  great  advance  on  any  other  method  of  treating  this 
affection.  He  finds  that  a  current  of  i  milliamp^re 
applied  to  the  cornea  for  one  minute  every  other  day  gave 
the  best  results.  Under  cocaine  the  application  is  paimees. 
He  gave  details  of  some  cases  considerably  improved  by 
the  treatment,  and  advocated  its  employment  in  ophthal- 
mic institutions. 

Dr.  Gbossman  said,  as  far  as  the  method  of  electrolysis 
was  concerned,  be  had  tried  it  himself  for  more  than  a 
▼ear  now  for  clearing  up  corneal  opscitiee  ;  but  at  his 
hands  results  had  not  been  encouraging.  Electrolysis  was 
acting  here  almost  exactly  as  calomel  or  yellow  ointment ; 
in  the  young  and  in  slight  opacities  fair  improvement  wa  j 
obtained,  while  in  old  individuals  and  in  dense  white  scars 
the  results  had  been  almost  nil.  Nor  had  there  been  the 
ellghteet  effect  on  an  existing  astigmatism.  He  would 
continue  with  his  trials  of  electrolysis  in  cases  of  corneal 
opacities ;  for  his  patt,  however,  .he  prefers  the  circum- 
script  massage  of  corneal  spots,  a  modified  Mahlahofi^s 
method,  which  has  given  him  better  results  on  which  he 
will  report  on  a  future  occasion. 

Dr.  Jamks  Wilson  read  a  pa[>er  on 

DISBASBS  OF  THE  NOSS  AMD  NASO-PHABYKX, 

in  which  the  galvanic  cauterv  is  applicable,  and  laid 
special  stress  upon  the  part  which  turbinal  hvpertrophy 
plays  in  some  cases  of  deafness,  tinnitus,  headache,  vertigo, 
asthma,  hay  fever,  chronic  cough,  frontal  neuralgia,  and 
in  some  cases,  epilepsy.  Dr.  Wilson  was  of  opinion  that 
otologists  did  not,  as  a  rule,  pay  sufficient  attention  to  the 
nasal  cavities  in  some  cases  of  deafness  and  tinnitus.  They 
treat  the  ear  and  throat,  but  do  not  appear  to  regard  the 
noae  a3  a  possible  factor  in  causing  deafness,  and  he 
ioatanced  a  case,  by  no  means  exceptional,  in  which  a 
lad^  bad  been  for  several  years  under  some  of  the  most 
emment  ear  and  throat  specialists,  &c.,  for  her  deafness. 
None  of  them  had  ever  examined  the  nose,  whereas  the 
key  of  the  whole  situation  lay  there  in  an  enlarged  turbinal 
interfering  with  the  equilibration  of  air  in  the  tympanum, 
and  all  &e  secondary  consequences  arising  from  this 
interference  ;  by  removing  the  nasal  obstruction  he  was 
able  to  effect  a  complete  cure.  Dr.  Wilson  also  pointed 
oat  that  in  the  future  rhinology  will  have  to  receive  more 
attention  at  the  hands  of  the  physician  and  general  prao- 
tlticmer  than  it  has  hitherto  done. 


[from  our  own  oorrbspondrnt.] 

fiXBXJN,  March  2rth. 
A  Jennsr  Cklbbsation. 
At  the  Aerztekammer,  after  a  lively  discussion  on 
advertising  by  physicians  and  professors,  especially  with 
regard  to  recommendation  of  drugs,  the  President 
announced  that  a  celebration  would  be  held  in  Berlin  in 
the  coming  May,  in  commemoration  of  the  first  inocula 
tion  of  the  small-pox  by  Jeoner.    The  intention  of  th^ 


celebration  is  a  double  one,  first  to  do  honour  to  the 
immortal  English  physician,  Jenner,  the  greatest  bene* 
factor  of  the  human  race  the  world  has  ever  seen,  and 
second,  as  a  sturdy  protest  against  anti-vaccination  and 
antl-vacdnators.  Anti-vaccinators  whose  scientific  know- 
ledge is  in  inverse  proportion  to  their  zeal  and  barefaced- 
ness  are  more  active  than  ever.  They  have  succeeded  in 
gaining  over  to  their  side  fiO  (some  say  80)  deputies.  The 
celebration  will  make  known  to  the  public  that  the  medical 
profession  unconditionally  recognise  the  importance  of 
universal  compulsory  vaccination,  and  that  they  will  strive 
to  the  utmost  of  their  power  to  prevent  the  laws  relating 
thereto  being  in  the  slightest  degree  relaxed.  Small-pox, 
as  far  as  Germany  is  concerned,  is  happily  a  thing  practi- 
cally of  the  past,  and  it  behoves  us  to  prevent  the  monster 
again  showing  its  head  in  our  midstb 

At  the  Medical  Society's  meeting  of  the  26th  ult.  Hr . 
Mackenrodit  gave  an  address  on 

Vaginal  Adnsxa  Opkrations. 

He  said  that  until  recently  the  principal  operation  for 
disease  of  the  adnexa  had  been  laparotomy,  and  the  results 
had,  no  doubt,  been  brilliant.  One  reason  for  the  change 
of  operation  had  been  that  laparotomy  seemed  too  great 
an  o[>eration  for  the  simple  [>elvic  adhesions  that  led  to 
collections  in  the  tubes,  &c  A  second  reason  was 
that,  whilst  laparotomy  was  a  [>erfectly  safe  o[>eration  in 
cases  where  the  suppuration  had  worked  itself  out,  so  to 
speak,  it  was  not  so  whilst  the  infection  was  still  active, 
that  is  in  acute  suppurations  and  abscesses  in  the  ovaries 
and  tubes,  and  in  those  that  tended  to  empty  into  the 
rectum,  vagina,  and  bladder.  In  a  restricted  number  of 
cases  he  had  arrived  at  the  idea  of  opening  Douglas's 
pouch,  whereby  the  adnexa  could  be  removed,  and  of 
closing  the  operation  by  simple  drainage  of  the  cavity 
without  suture.  The  operation  performed  in  this  way  is 
much  simpler  than  that  of  opening  the  anterior 
vaginal  arch.  Adhesions  are  separated  easily  by  the 
combined  method.  Operation  may  be  [>erformed  in  this 
way  in  cases  of  perforating  suppurating  collections,  that 
would  be  impossible  by  laparotomy.  The  technique  is 
very  simple  and  comprised  in  five  acts  : — 1.  Curettement 
and  raising  of  the  closed  uterus  (preparatory).  2.  Incision 
(transverse,  sagittal  or  combined).  3.  Separation  of  adhe- 
sions (hi- manual).  4.  Dragging  down  by  means  of  forceps 
and  formation  of  pedicles.  5.  Closure  by  drainage.  In 
case  ligature  is  difficulc  the  forceps  must  be  left  on  and 
iodoform  gauze  introduced.  The  speaker  had  operated  on 
31  cases  in  this  way.  These  cases  were  divisible  into  the 
following  classes:— 1.  Simple  adhesions  (three  cases) 
where  it  was  possible  to  break  down  the  adhesions  around 
the  tubes  and  ovaries.  Gases  of  adherent  retro-flexion  of 
the  uterus  could  only  be  treated  in  this  way.  2.  Six 
cases  of  closure  of  the  tubes  and  follicular  degeneration 
of  the  ovaries.  3.  Six  cases  of  extra-uterine  gestation 
(tubal).  4.  Seven  cases  of  suppuration  of  the  adnexa.  5. 
Seven  cases  of  la^ge  cystomata  and  dermoids.  6.  One  ca^e 
of  myoma.  7.  One  case  of  removal  of  the  tubes  for 
sterility.  Recovery  took  place  in  all  cases  without 
the  least  interruption.  The  drainage  was  removed  on 
^e  third  day.  Generally,  the  patients  left  their  beds  on 
the  seventh  or  eighth  day,  ».e.,  in  cases  that  had  not 
required  further  operation,  such  as  incision  of  the  peri 
n»um,  &o.  In  one  of  the  cases  of  ovarian  tumour  he 
operated  without  an  an»3thetic.  The  patient  was  76 
years  of  age,  and  in  a  very  "  desolate  "  condition.  She  was 
well  on  the  eighth  day.    One  criterion  was  of  special  im- 


322     TsB  MsDiCAL  Pbk^ 


AUSTRIA. 


Mab.  26,  lS96b 


portaaoe  in  oonteinplaUDg  vaij^iiud  operation,  and  that  waa 
to  operate  by  the  vagina  only  when  it  was  poeeible  by  the 
bi-manaal  method  to  reach  the  tumour  from  below.  The 
more  easily  this  could  be  done  the  easier  would  be  the 
operation,  it  was  possible  also  with  nnUipars.  Bearing  in 
mind  the  simple  technique  it  would  not  be  necessary  to 
treat  pelvic  inflammation  from  any  cause  for  such  a  length 
of  time  by  palliative  methods. 

GnsATTvi  Resorts  vob  Pulmonabt  Disxasbs. 
At  the  meeting  of  the  Society  for  Innere  Medisin  of  the 
24th  nit.,  Pn>f.  Leyden  made  a  communication  on  the 
institutions  for  the  treatment  of  pulmonary  diseases  for 
those  with  small  incomes.  The  plan  that  has  been  pro- 
posed is  approaching  its  realisation,  as  a  society  has  been 
already  formed  under  "  Allerbochster  Protection."  Up  to 
the  present  a  "  centrum  "  has  been  wanting,  but  this  has  at 
last  been  obtained  by  the  formation  of  a  Society  called  the 
"  Berlin-Brandenburger  Heilstfttten-Yerein  fiir  Lungen- 
Kranke,"  under  the  presidency  of  the  Imperial  Chancellor 
Prinz  von  Hohenlohe.  The  Society  does  not  expressly 
make  a  distinction  between  those  with  scanty  and  those 
with  no  means,  but  for  admission  to  the  institution  it  will 
require,  either  from  the  patient  or  patient's  friends,  the 
sum  of  3  marks  per  day. 

Bad  Nauhxim  in  Gbbmant. 

Years  ago,  Hr.  Schott,  of  Nauheim,  was  like  a  man 
crying  in  the  wilderness,  but  with  perseverance,  both  in 
doing  good  work  and  in  compelling  attention  to  it,  he  is 
better  known  than  he  war.  At  the  same  meeUng  of  the 
Verein  for  Innere  Medirin,  Prof.  Heynmann,  of  New  York, 
gave  an  address  on  the  mechanical  treatment  of  cardiac 
diseases.  He  thought  the  best  reeulU  were  to  be  obUined 
by  combined  bath  and  gymnastic  treatment.  Even  after 
half  an  hour's  exercise  there  was  a  deeper  pulse  wave,  with 
increased  pressure  and  dilated  arteries,  and  this  im- 
provemenc  often  lasted  half  an  hour.  Even  during 
the  exercise,  the  feeling  of  pressure  over  the  heart  was 
of  ten  relieved.  Theeflect  was  difiScult  to  explain.  Psy- 
chical excitement  also  played  a  part.  In  Nauheim,  he 
had  thoroughly  observed  77  cases.  Of  these,  40  were  there 
for  the  first  time ;  37,  several  times.  He  had  not  only 
observed  transient  improvement,  but  complete  recovery, 
and  this  in  people  from  all  parts  of  the  world.  The  treat- 
ment was  indicated  in  all  cases  of  heart  disease,  in  Base- 
dow's disease,  in  haemophilia  and  angina  pectoris ;  oedema 
and  anasarca  were  not  contra-indicative,  but  extensive 
arterio-sderosis,  chronic  kidney  disease,  especially  con- 
tracted kidney,  and  aneurism,  were. 

Prof.  Leyden  thanked  the  speaker  for  drawing  attention 
to  the  subject.  Whilst  Nauheim  had  acquired  great  fame 
in  America  and  England  as  a  remedy  for  diseases  of  the 
heart,  it  had  not  yet  done  so  thoroughly  in  Germany.  He 
would  remark  that  it  was  characteristic  of  this  that  during 
last  year,  160  physicians  had  been  there,  and  that  they 
were  principally  foreigners. 

Pbofxssob  Lbtdxn. 
This  distlDguished  physician  has  recently  been  raised 
o  the  rank  of  a  noble. 

X  Rat's  Again. 
Dr.  Breitung,  Coburg,  reports  removing  a  needle  from 
the  hand  of  a  child,  after  it  had  been  there  for  years.  He 
apologises,  however,  for  not  having  made  use  of  the  newly 
discovered  rays,  and  acknowledges  that  his  action  in 
removing  the  needle  unpJiotographed  was  quite  unmodem, 
♦ 


Jlnstm 


[tBUM  OUB  OWN    GOBBIBPOVDBHV.] 

"~""       VlxnA.  Mtr.  SOtli,  ISM. 

Thtbboidin  and  Obisity. 

SoHBSiNGBB  showcd  to  the  Medical  Club  a  patient  whom 
he  had  successfully  treated  with  thyreoidin  for  a  fatty 
heart.  The  case  was  that  of  a  nurse  who  weighed 
120  kilogrammes  or  18  st.  12  lbs.  Her  constant 
complaint  was  weight,  breathlessness,  and  palpitstion. 
The  internal  organs  were  healthy ;  the  cardiac  dulness 
was  slightly  increased,  the  sounds  irregular,  and  the  pulse 
easily  compressed.  Treatment  consisted  in  the  adminis- 
tration of  thyroid  gland,  as  prepared  by  the  well-known 
English  firm,  Burroughs,  Wellcome,  &  Co.,  of  which  one 
to  four  tabloids  were  given  daily.  For  thirteen  months 
the  drug  was  duly  taken  with  the  result  that  the  patient 
now  weighs  88  kilogrammes  or  13  st.  11  lbs. 

It  i^  worthy  of  note  that  the  gland  of  the  ox  was  tried 
for  a  short  time  in  this  case  with  the  same  result  as  in 
other  experiments,  viz.,  the  patients  began  to  make  flesh 
rapidly.  This  forcibly  sustains  the  opinion  that  the 
thymus  and  thyroid  glands  of  the  sheep  are  the  most 
active,  a  fact  which  is  also  borne  out  chemically  by  ^he 
absence  of  iodine  in  the  ox's  gland,  although  it  is  present 
in  large  quantity  in  the  sheep.  He  compared  his  reenlte 
with  those  of  Prof.  Schrotter  who  ha^  used  the  drug  in  his 
clinique  for  the  last  year  and  a  half  with  remarkable  success 
in  obesity.  It  is  also  a  potent  drug  in  struma,  althoogh 
in  morbus  Basedowii,  where  the  thyroid  gland  is  enor- 
mously enlarged,  it  is  of  little  or  no  use  on  the  disease 
itself.  Acromegalil^  lymphosarcoma,  and  pseudoleucsemia 
appear  to  undergo  no  change  by  this  treatment.  In 
order  to  control  the  activity  of  the  drug,  it  is  better  to 
allow  regular  intervals  to  occur  during  the  treatment,  so 
that  the  reduction  of  weight  may  be  carefully  observed. 
Where  the  reduction  is  rapid  half  a  tabloid  twice  a  day 
is  quite  sufficient. 

Dr.  Weiss  thought  that  these  facts  tended  to  show  that 
the  prognosis  of  morbus  Basedowii  was  not  to  be  enter- 
tained with  such  gloom  as  medical  literature  described  it, 
seeing  that  the  disease  is  not  improved  by  iodine  and 
digitalis 

Hr.  Steckel  was  of  opinion  that  the  explanation  given 

by  Ewald  of  morbus  Basedowii,  that  its  morbid  origin 

depended  on  a  neurosis  associated  with  hyper-secretion  of 

the  thyroid,  appeared  to  be  the  most  correct  theory  given. 

Anohtlostohiasis. 

Stein  next  read  a  few  notes  on  his  investigation  into 
the  pernicious  form  of  helminthiasis  which  sppeare 
common  in  the  mines  of  Brennberg.  According  to  the 
patient's  story,  who  is  32  years  of  age,  and  a  miner  from 
Brennberg,  where  700  men  are  employed,  100  of  whom 
suffer  from  this  endemic  disease,  he  began  to  feel  unwell 
about  half  a  year  ago,  becoming  gradually  pallid,  with 
palpitation,  vertigo,  dyspnoea,  alternate  diarrhoea  and 
constipation.  The  early  treatment  in  the  disease  wae 
mostly  directed  towards  clearing  the  prima  via.  After  he 
came  to  Yienna  he  attended  Scbrotter's  Clinique.  It  ^aa 
difficult  at  first  to  form  an  opinion  as  to  the  cause,  yet  the 
locality  became  from  raised  grave  suspicions  of  the  parasitic 
origin  of  the  disease.  The  fat  was  present  in  fair  quantity ; 
there  was  hypertrophy  of  the  left  ventricle,  while  a 
blowing  systolic  murmur  was  easily  observed  ;  but  all  the 
other  organs  were  healthy.    The  urine  contained  a  larger 


Hab.  25,  1886 


THE  0PERAT1^'G  THEATRE.*^. 


The  MFDiOAL  Prfss.     323 


amoont  of  indioan  than  ia  osiially  met  with.  The  Btoole, 
oa  stated,  were  of  a  normal  colour  and  contained  no  blood. 
The  nnmber  of  white  and  red  corpasclee  were  unchanged, 
the  bmnoglobin  averaged  40,  while  the  eorinophile  oella 
oonld  not  be  found.  No  confirmation  of  the  euepicion 
could  be  obtained  till  laxative  medicinee  were  resorted  to 
when  the  eggs  of  the  anchyloetomnm  were  discovered. 

Zappert  confirmed  the  difficulty  in  diagnosis  from  his 
personal  experience  in  Brennberg.  He  is  inclined  to  dis- 
agree with  Leichtenstem  in  the  discovery  of  eosinophile 
cells  as  he  has  never  yet  once  met  with  them. 

It  would  appear  from  the  prevalence  of  the  disease  in 
Brennberg  that  the  workers  transmitted  it  from  one  to 
the  other.  The  high  temperature  of  Brennberg  is  favour- 
able to  the  growth  of  the  parasite.  The  prognosis  of  the 
diraase  is  not  always  free  from  danger. 

CoUGBlETIOir  IN  THX  BbONOHI. 

Pollak  showed  a  concretion  of  a  chalky  nature  which  had 
been  coughed  up  by  a  female,  nt.  35.  During'the  winter 
she  was  troubled  with  a  bronchial  catarrh  which  recently 
bf  came  more  aggravated.  On  auscultation,  loud  singing 
r&les  were  heard.  Twelve  days  after,  in  one  of  her  fits  of 
coughing,  a  small  calculus  was  expectorated.  At  first  a 
tuberculous  cavity  was  suspected,  but  closer  examination 
showed  that  the  concretion  came  from  the  bronchi  It  was 
again  conjectured  that  the  stone  was  a  foreign  body 
covered  over,  or  a  calcareous  lymph  gland.  In  bronchio- 
lithiasis  a  large  number  of  stones  may  be  formed. 
Health  Statistics. 

From  the  report  of  the  Vienna  Medical  Officers  of 
Health,  comprising  a  period  of  four  years,  we  learn  that 
the  death  rate  of  the  city  is  diminishing.  In  1891  it  was 
24*32  per  1,000  Uving :  1893,  23  34  per  1,000 ;  and  in  1894 
22-44  per  1,000. 

♦ 

MIDDLESEX   HOSPITAL. 

DSRBIOID    CtST    of    THX  OVABT    119    A    GiBL,  JET.   13 — 

TwiSTXD  PiDiGLB.— Mr.  Akdrew  Clabk  Operated  on  a 
girl,  aet.  13,  sent  up  from  SuiTolk,  who  had  been  admitted 
complaining  of  discomfort  on  the  right  side  of  the  abdo- 
men. Externally  there  was  no  obvious  sign  of  any  tumour, 
but  there  was  decidedly  more  resistance  on  palpation  on 
the  right  than  on  the  other  side.  She  always  had  good 
health  but  a  few  weeks  before  admission  had  consulted  Dr. 
Kirby,  of  Hanley,  for  the  same  symptoms,  and  he  had 
sent  her  up  to  the  hospital  with  the  idea  of  an  exploratory 
operation.  She  had  never  menstruated :  she  was  a  strong, 
rosy,  healthy-looking  girl.  Incidentally  it  might  be  men- 
tioned, Mr.  Clark  said,  that  she  had  been  treated  by  the 
local  application  of  belladonna,  and  on  admission  the 
charactOTistic  belladonna  rash  resembling  measles  was 
well  marked.  With  a  view  to  an  accurate  diagnosis,  she 
had  been  put  under  an  anesthetic,  and  a  bimanual  exami- 
nation demonstrated  the  presence  of  a  tumour  about  the 
sise  of  an  orange  in  the  situation  of  the  right  ovary ; 
it  was  movable  and  the  uterus  was  normal.  The  diagnosis 
then  arrived  at  was  that  it  was  an  ovarian  cyst,  in  all 
probability  a  dermoid.  As  soon  as  arrangements 
could  be  made  it  was  determined  to  open  the  abdomen 
with  a  view  to  its  removal;  accordingly  about 
ten  days  afterwards  she  was  again  ansesthetised,  and  an 
incision  made  about  four  inches  long  between  the  umbili- 
cus and  the  pube«.    After  divition  of  the  abdominal  wall. 


a  swelling  presented  itself  at  once  in  the  middle  line, 
exactly  like  the  uterus  distended  by  an  accumulation  of 
menstrual  fluid,  and  on  introducing  the  finger  and  passing 
it  round  the  swelling,  this  last  turned  out  to  be  attached 
on  the  right  side  of  the  uterus ;  the  omentum  was  adherent 
to  it ;  this  was  carefully  separated  ;  the  tumour  was  drawn 
to  the  wound  and  punctured ;  several  ounces  of  bloody  fluid 
were  evacuated ;  the  puncture  was  next  closed  with  forci- 
pressure  forceps,  and  the  tumour  having  been  so  far  re- 
duced in  size,  was  brought  outside  the  abdomen,  it  was  then 
discovered  that  the  pedicle  was  twisted  ;  this  was  ligatured 
by  transfixion  with  a  double  piece  of  silk,  and  the  cyst  re- 
moved ;  it  was  found  to  contain  hair  and  teeth.  The  other 
ovary  was  examined,  and  a  simple  cyst,  about  the  size  of 
a  cob  nut,  was  found  there ;  it  was  not,  however,  deemed 
desirable  to  interfere  with  that,  as  it  probably  would  never 
give  her  any  trouble,  and  its  removal  with  the  ovary  would 
have  practically  unsexed  the  girl.  After  the  usual  toilet 
of  the  peritoneum,  the  abdominal  wound  was  closed  layer 
by  layer;  the  edges  of  the  peritoneum  being  joined 
by  a  continuous  silk  suture,  the  muscles  by  buried 
interrupted  sutures,  and  the  skin  in  the  same  manner. 
Dry  dressings  were  applied  after  the  wound  had  been 
powdered  with  iodoform.  Mr.  Clark  said  the  points 
about  the  case  were '—First,  the  difficulty  of 
the  diagnosis;  secondly,  the  comparative  rarity  of 
ovarian  cysts  in  children  ;  thirdly,  the  twisting  of  the 
pedicle.  With  regard  to  the  first  point  as  already  re- 
marked by  him  in  the  ward,  until  the  patient  was  under 
the  aosestbetic  it  was  doubtful  whether  the  resistance  was 
due  to  muscular  contraction  only  and  the  condition  known 
as  phantom  tumour,  but  the  bimanual  examinacion  deter- 
mined without  difficulty  the  presence  of  an  actual  tumour. 
In  speaking  of  the  second  point  he  remarked  that  ovarian 
tumours  were  very  rare  in  children,  the  history  of 
this  case  pointing  rather  to  the  presence  of  a  dermoid 
than  of  a  single  cyst.  In  referring  to  the  pedicle  being 
twisted,  he  called  attention  to  the  fact  of  the  tumour 
appearing  in  the  middle  line  at  the  time  of  operation  and 
simulating  a  distended  utenis ;  this  was  probably  due,  he 
said,  to  ^e  effusion  of  blood  into  the  cyst  before  the 
operation,  which  was  caused  by  the  twisting  of  the  pedicle 
previously  to  the  operation  interfering  with  the  circulation, 
an  accident  which  not  infrequently  happens  to  tumours 
with  long  pedicles.  In  sewing  up  the  wound,  each  layer 
of  the  abdominal  wall  was  taken  separately,  he  pointed 
out,  with  a  view  to  prevent  the  subsequent  tendency  to 
ventral  hernia. 

It  is  satisfactory  to  state  that  the  wound  healed  by  first 
intention  and  the  child  was  convalescent  a  fortnight  after 
the  operation. 

Obsgubb  Abdominal  Tumour.— The  same  eurgeon 
on  the  same  Taftemoon  also  operated  on  a  woman,  set. 
about  60,  who  had  been  in  hospital  under  the  care  of  Dr. 
Wynter,  with  a  tumour  on  the  right  side  of  the  abdomen, 
the  nature  of  which  was  doubtful,  though  it  was  believed 
to  be  connected  with  the  kidney,  but  owing  to  the  small 
space  available  in  the  loin  (the  patient  being  very  fat)  it 
was  thought  better  to  attack  it  from  the  front.  Accord- 
ingly, an  indsion  of  about  6  inches  long  was  made  over  the 
most  prominent  part  of  the  swelling  which  was  over  the 
right  linea  semilunaris.  On  opening  the  abdomen  the 
intestine  was  found  fixed  to  the  tumour  by  firm  adhesions, 
and  on  separating  these  the  cyst  wall  gave  way  and  a 
quantity  of  putty-like  material  exuded  ;  the  peritoneal 
cavity  having  been  carefully  »but  off  with  sponges,  as  much 


324)     Thi  Mxdioal  Pbis^. 


LEADING  AETICLE8. 


Mar  25,  1896. 


as  possible  of  this  matorUl  was  scooped  oat,  ezamiDation  of 
which  however  threw  do  light  on  the  organ  from  which  the 
tumour  originated  ;  exploring  the  abdomen  with  the  hand 
showed  the  growth  was  not  attached  to  the  liver  above  or  to 
the  uterus  below,  and  although  the  kidney  oonld  not  be 
felt  the  conclusion  arrived  at  was  that  its  origin  was  there. 
The  wound  was  thoroughly  irrigated,  the  peritoneum 
carefully  »hut  oiT  by  sutures,  an  india-rubber  drainage- 
tube  insetted,  and  the  abdominal  wound  dosed  except 
round  the  drainage  tube  where  it  was  carefully  packed 
with  iodoform  gauze.  The  question  Mr.  Clark  considered 
in  this  operation  was  whether  to  clear  out  the  whole  of  the 
putty-like  material  or  to  treat  it  as  was  done  ;  all  idea  of 
removing  the  cyst  itself  being  quite  impossible  owing  to  the 
very  extensive  and  close  adhesions  between  it  and  the 
intestines. 

Fifteen  days  after  the  operation  the  patient  is  doing  well, 
the  putty-like  material  is  gradually  being  discharged 
through  the  tube,  and  the  general  condition  of  the  woman 
is  satisfactory. 

KaeisnEB)  rem  TBAraasszos  AnoAH. 

^hc  JRebicd  fxzM  atib  dircular. 

Pnblldied  every  WedDeeday  mornlnf ,  Price  id.   Poet  free,  ft|d. 
ADVBBTUBMBKTI. 

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A.  H.  JAOOB,  80  Moleiworth  Street,  Dublin. 

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Iff  ^tiiM  f riss  *  Cirrwlar. 


•SALUB  POPULI  8DPRKMA  LEX.' 


WFDNPSPAy,  MARCH  25,  1896. 


ANTISEPTICS  IN  INFANTILE  DIARRHCEA. 

It  has  been  assumed,  possibly  not  always  on  strictly 
scientific  grounds,  that  many  forms  of  infantile  diar- 
rhoea are  due  to  the  action  of  pathogenic  microbes,  or, 
at  any  rate,  to  a  disorganisation  of  normal  microbial 
activity  within  the  gastro-intestinal  tract  There  is, 
indeed,  some  reason  to  suppose  that  the  protean  coli- 


bacillus may,  in  one  or  other  of  its  transformations  of 
activity,  be  responsible  for  the  abnormal  fermentation 
and  excessive  decomposition  which  characterise  many 
of  the  gastro-intestinal  affections  of  infancy  and  child- 
hood.   Once  this  view  had  gained  ground  the  treat- 
ment of  these  complaints  by  the  internal  administra- 
tion of  antiseptics  was  inevitable,  and,  from  a  clinical 
point  of  view,  the  results  certainly  seem  to  favour  the 
supposition  that  it  is  possible,  within  certain  limits,  to 
control,  at  any  rate,  the  perverted  or  fortuitous  activity 
of  these  organs.    This  method  of  treatment^  more  or 
less  empirical,  was  warmly  received,  though  doubts 
have  from  time  to  time  been  inspired  by  the  reports  of 
bacteriologists  at  home  and  abroad  who,  on  the  strength 
of  observations  carried  out,  in  some  instances,  on  cul- 
tivations of  incriminated  bacilli  in  vitro  ;  in  others  on 
the  bacterial  richness  of  the  stools,  have  denied  to  the 
substances  most   commonly  employed  any  tangible 
effect  in  the  direction  hoped  for.    So  long  as  the 
identity  and  rdle  of  the  various  bacilli  normally  found 
in  the  healthy  intestine  remains  a  matter  of  conjecture, 
sollong  must  the  antiseptic  treatment  of  affections  of  that 
tract  remain  empirical,  counter-experiments  in  vitro  to 
the  contrary  notwithstanding.  We  are  indebted  to  Drs. 
Hay  ward  and  Bnttar  for  a  coherent  attempt  to  discuss 
the  subject  on  scientific  and  practical  lines  in  a  paper 
which  was  read  before  the  Royal  Medical  and  Chirur- 
gical  Society,  last   week.    They  are  profuse  in  their 
apologies  for  the  lack  of  precision  which  characteriBes 
the  present  state  of  our  knowledge  of  the  bacteri- 
ology of   the    intestines,  but   they   are   careful   to 
postulate  the  conditions  under  which,  alone,  further 
observations   can    be    made   on    strictly    scientific 
lines.     More  than  this,  they  have  endeavoured  to 
furnish  an  outline  of  the  indications  for  the  rational 
employment  of  this  class  of  remedies,  and  they  have 
completed  their  contribution  by  notes  of  experiments 
of  their  own  in  respect  of  the  antiseptic  activity  (4 
the  various  substances  employed  in  medicine  under 
the  rank  and  title  of  intestinal  antiseptics.     Salol, 
naphthaline,  and  $  naphthol  have  survived  the  ordeal 
with  varying  degrees  of  success,  though  the  clinical 
results  do  not  seem  to  have  invariably  confirmed  a 
priori  conceptions  based  on  bacteriological  investiga- 
tion.     The   various    forms   of    infantile    diarrhoea 
are    provisionally    scheduled    under    three    hesds, 
viz.,  the  irritant,  the  toxic,  and  the  infective,  according 
as  the  symptoms  of  one  or  the  other  group  predominate, 
for  it  must  always  be  bcrne  in  mind  that  all  varieties 
of  diarrhoeas  partake  more  or  less  of  the  three  kinds  of 
pathogenic  action.    Ever  since  the  inception  of  the 
bacteriological  etiology  of  disease,  the  dream  of  the 
therapeutists  has  been  to  attack  the  invader  and  to 
smite  him  hip  and  thigh  in  the  parts  of  the  organism 
which  it  has  selected  for  its  nefarious  pursuits.     The 
endeavour  has,  so  far,  not  been  crowned  with  success 
in  respect  of  organisms  which  permeate  the  organism, 
or  even  in  respect  of  those  which  are  known,  or  sus- 
pected, to  affect  and  undergo  development  in  particular 
localities.  If  ever  it  can  be  possible  to  reach  the  invader^ 
and  to  destroy  it  by  direct  means  it  must  surely  be  in 
the  intestine    where,  for  therapeutical   purposes,  it 


Mab.  25,  1896. 

may  stOl  h%  regarded  as  outside  the  body*  th® 
pathogenic  effects  to  which  its  presence  gives 
rise  being  due  to  the  absorption  of  toxic  products  by 
it  elaborated  in  situ.  Owing  to  the  poisonous  action 
of  the  most  powerful  germicides,  and  the  danger  to 
the  patient  which  would  follow  their  passage  into  the 
blood,  the  employment  of  insoluble,  or  sparingly 
soluble,  substances  has  been  recognised  to  be  impera- 
tive. Moreover,  their  local  effect  must  not  be  irritant, 
or  at  any  rate,  not  to  any  injurious  extent.  Whether 
/s  naphthol,  which  appears  to  be  the  favoured  remedy 
of  the  author,  complies  with  the  latter  requirement  is 
open  to  question,  judging  from  the  sensation  which 
follow  cachet  containing  it  accidentally  rupturing  in 
the  mouth.  In  conclusion,  we  are  fain  to  admit  that  for 
the  present  we  must  continue  to  resort  to  this  class  of 
remedies  on  purely  clinical  evidence,  but  these  results 
are  sufficiently  encouraging  to  warrant  physicians 
adhering  to  the  method  of  treatment  in  spite  of  what 
pessimistic  bacteriologists  may  say  and  write  in  dis- 
paragement. 

THE  NOTIFICATION  OF  MEASLES. 
To  wipe  away  the  existing  margin  of  preventable 
disease  is  the  exalted  and  laudable  aim  of  the  modem 
apostles  of  sanitary  science.  That  the  desire  is  not 
altogether  Utopian  is  abundantly  shown  by  the  enor- 
mous improvement  in  the  expectation  of  life  which  has 
been  achieved  during  the  past  half  century.  During 
the  ten  years  1841-50,  the  death-rate  for  the  whole  of 
London  was  25  per  1,000  of  persons  living,  and  that 
figure  has  steadily  fallen  through  successive  decennia 
to  20-5  in  1881-90,  or  to  20*4  for  the  period  1883  92. 
Of  this  substantial  reduction  there  can  be  no  doubt 
that  a  large  part  may  be  traced  to  the  better  control 
which  has  of  late  years  been  established  over  zymotic 
maladies.  Thus  we  find  that  in  England  and  Wales 
the  death-rate  from  that  class  of  disease  for  the  period 
1871-80  reached  3'47  per  1,000  persons  living,  whUe 
for  1881-90  it  was  2'36.  The  figures  for  London  alone 
are  stUl  more  striking,  for  during  1871-80  they  mounted 
to  3  90,  whereas  in  the  ten  years  1881-90  they  had 
fallen  to  0  024.  Broadly  stated,  the  decrease  has 
taken  place  in  small-pox,  scarlet  fever,  cholera, 
and  fevers  generally  (including  typhoid).  Measles 
and  whooping-cough  have  shown  neither  relative  nor 
absolute  increase.  Diphtheria,  on  the  other  hand,  has 
of  late  years  undergone  a  very  great  development,  a 
fact  which  is  in  all  likelihood  due  to  the  modern 
system  of  Board  schools,  whereby  large  numbers  of 
children  are  massed  together,  and  the  chances  for  the 
spread  of  infectious  disease  well-nigh  indefinitely 
multiplied.  Apart  from  these  three  specific  affections, 
however,  there  can  be  no  shred  of  doubt  that  during 
the  h»t  generation  or  two  there  has  been  a  marked 
reduction  of  mortality  from  infectious  diseases  in  this 
eonntry.  The  causes  at  the  root  of  this  happy  result 
may  be  traced  to  a  better  knowledge  of  the  etiology 
and  the  treatment  of  dieease,  to  increased  powers  of 
local  authorities  for  the  isolation  and  disinfection  of 
infectious  cases,  and  lastly— although,  on  this  point, 
medical  men  are  not  absolutely  unanimous— to  compul- 


LEADING  ARTICLES. 


Thk  Mxdioal  Pbess. 


sory  notification.  Now,  of  the  three  diseases  that  have 
shown  an  increase,  two,  namely,  measles  and  whooping" 
cough,  do  not  come  within  the  schedule  of  notifiable 
diseases.  The  reason  for  this  legislative  omission 
is  not  clear.  Measles  is  a  highly  infectious  and 
fatal  disease,  and  if  those  two  attributes  justify 
the  compulsory  notification  of  small-pox  and 
others  on  the  list,  it  is  difficult  to  surmise  on 
^hat  grouods  this  particular  complaint  is  left 
out.  The  brunt  of  the  measles  mortality  falls  upon 
the  poorer  population,  whereas  the  children  of  the  well" 
to-do  classes,  as  a  rule,  make  a  rapid  recovery.  In 
some  of  the  poverty-stricken  and  densely  crowded 
Metropolitan  districts,  such  as  that  of  St.  George  the 
Martyr,  Southwark,  the  proportion  of  deaths  to  attacks 
reaches  the  extremely  high  ratio  of  20  to  30  per  cent* 
There  can  be  no  question  that  one  element  in  this 
disastrous  record  is  the  ignorance  of  parents,  who  live 
in  the  belief  that  measles  is  a  trifling  complaint  which 
requires  little  or  no  nursing.  Then  there  is  practically 
in  connection  with  this  zymotic  condition  very  often 
an  entire  absence  of  any  attempt  to  disinfect  or  to 
isolate.  Under  such  circumstances,  then,  it  is  no 
wocder  that  measles  stalks  through  the  streets  of  our 
great  towns  and  scatters  destruction  wholesale  among 
the  young.  For  the  sake  of  illustration,  we  will  take 
at  random  one  of  the  weekly  London  returns  of  the 
Registrar- General.  The  first  that  comes  to  hand  is 
the  opening  week  of  March.  During  that  period,  we 
find  that  of  1,846  deaths  in  London,  2  were  due  to  small- 
pox, 15  to  scarlet  fever,  7  to  enteric  fever,  9  to  diar-> 
rboea,  85  to  whooping-cough,  and  152  to  measles.  In 
other  words,  the  mortality  from  measles  amounted  to 
upwards  of  four  and  a  half  times  the  number  ascribed 
to  four  other  deadly  zymotic  diseases.  In  the  statistics 
for  the  metropolis  in  1893,  published  by  the  London 
County  Council,  we  find  that  during  the  year  in  ques- 
tion,  1,659  deaths  were  due  to  measles,  as  against  1 
from  small-pox,  1,588  from  scarlet  fever,  3,197  from 
diphtheria,  5  from  typhus,  677  from  enteric  fever,  an 
3,445  from  diarrhoea.  In  many  respects,  this  ta 
affords  an  interesting  field  for  study  and  investigation, 
and,  so  far  as  measles  goes,  it  shows  that  more  deaths 
are  caused  by  that  malady  than  by  scarlet  fever,  a 
disease  which  is  jealously  guarded  with  a  ring  fence  of 
stringent  precautions.  The  question  naturally  arises, 
if  scarlet  fever  is  to  be  so  controlled,  why  not  the 
unromantic  measles,  which  kills  more  people  every 
week  in  the  year  ?  Many  authorities  in  public  health 
consistently  and  persistently  advocate  the  compulsory 
notification  of  measles.  Whether  such  a  course  should 
ultimately  commend  itself  or  not  to  the  wisdom  of  the 
legislature,  there  can  be  no  doubt  in  the  minds  of  most 
reasonable  and  thinking  members  of  the  medical  pro- 
fession that  the  time  has  now  come  when  some  steps 
must  be  taken,  in  order  to  stay  the  yearly  massacre  of 
our  infantile  population  due  to  a  malady  that  is  alto- 
gether preventable. 

♦ 

We  understand  that  it  is  the  intention  of  the  Senate 
of  the  University  of  Edinburgh  to  confer  the  honorary 
degree  of  LL.D.  on  Sir.  J.  Russell  Reynolds,  President 
of  the  Royal  (College  of  Physicians  of  London. 


Thi  Medical  Pitfg. 


N0TF8  ON  CURRENT  TOPICS. 


Mab.  26,  l»d. 


THE  ROYAL  COLLEGE  OF  SURGEONS, 

ENGLAND. 
The  CouDcil  of  the  Royal  College  of  SargeoDS, 
EDgland,  have  just  placed  on  record  another  of  those 
contentions  resolutions  for  which  they  have  made 
themselves  famous,  and  it  may  be  said  upon  this 
occasion  that  they  have  particularly  distinguished 
themselves.  The  resolution  has  reference,  of  course, 
to  the  representation  of  the  Members  on  the  Council, 
respecting  which,  it  will  be  remembered,  that  at  the 
January  meeting  of  the  Fellows  a  motion  was  agreed 
to,  strongly  endorsing  the  recommendation.  Despite, 
however,  the  pronounced  advocacy  of  this  legitimate 
reform  by  the  Fellows,  the  Council  have  come  to  the 
following  decision,  which,  as  we  think,  surpasses  any- 
thing in  the  science  of  quibbling  in  our  experience. 
These  are  the  exact  terms  of  the  resolution  :— '*That 
as  the  Members  of  this  Council  represent  the  body 
corporate  of  the  Royal  College  of  Surgeons,  and  con- 
sequently its  Members  as  well  as  its  Fellows,  it  is  the 
opinion  of  this  Council  that  no  further  representation 
of  the  Members  is  desirable.''  *  It  is  quite  impossible 
to  take  this  remarkable  expression  of  opinion  seriously. 
There  is,  however,  no  doubt  that  it  has  a  strong  flavour 
of  officialism  about  it,  and  it  may  be  described  as 
a  fricoisee  of  the  clauses  in  the  Charters  which 
bear  upon  the  subject.  If  the  future  proceedings  of 
the  Council  are  always  to  be  based  upon  the  antiquated 
Charters  of  the  College,  and  if,  moreover,  the  Council 
continue  to  allow  themselves  to  be  persuaded  into  the 
belief  that  it  would  be  nothing  but  sacrilege  to  attempt 
to  amend  them,  the  ultimate  result  to  the  College  will 
be  certain  to  be  disastrous.  The  present  position  of 
affairs  in  regard  to  this  matter  appears  to  be  this : 
namely,  that  che  Council  have  made  up  their  minds  to 
hold  on  to  the  present  Charters  at  all  costs,  and  pull 
the  strings  accordingly.  When  recommendations  for 
reforms  and  amendments  in  the  Charters  are  brought 
before  them,  they  go  through  the  formality  of  appoint- 
ing committees  to  discuss  the  questions  raised.  These 
committees  meet  and  transact  the  business  alloted  to 
them.  But,  practically,  their  deliberations  are  a  farce. 
When  it  happens  tiiat  any  important  reform  is 
under  discussion,  the  strength  of  the  party  represent- 
ing the  lauser  /aire  policy  is  always  greater,  either 
designedly  or  not,  than  the  party  which  is  in  favour  of 
reform.  Thus  it  comes  to  pass  that  the  reports  of  these 
committees  to  the  Council  often  take  a  stereotyped 
form,  to  the  effect  that  ''the  committee  are  of  the 
opinion  that  no  change  is  necessary."  Upon  the  present 
occasion,  the  proposer  of  the  resolution  above  quoted, 
appears  to  have  thought  that  the  importance 
of  the  matter  required  that  some  explanation 
should  be  incorporated  into  the  motion  for  the 
purpose  of  showing  how  it  had  been  arrived  at  Hence, 
in  all  probability  it  was  that  the  preamble  was  intro- 
duced, and  that  instead  of  a  bald  negative,  an  attempt 
was  made  to  soften  the  peremptoriness  of  the  resolu- 
tion. However,  as  a  matter  of  fact,  not  much  concern 
need  be  felt  for  this  latest  example  of  the  obstructive- 
ness  of  the  Council.  The  Fellows  and  Members  of  the 
College  have  now  an  opportunity  of  taking  conunon 


ground  in  regard  to  a  question  of  reasonable  reform, 
and  we  trust  that  time  will  soonshow  the  Council  the 
error  into  which  th^y  have  again  fallen. 


Jt0teB  on  Current  ^opuB. 

What  is  Profeesional  Advertising^? 
Asacontributiontothediscussionnowgoingoninour 
columns,  a  correspondent  has  kindly  sent  us  for  perusal 
a  copy  of  the  March  number  of  the  Rochester  Diocesan 
Chronicle,  The  periodical  is  a  monthly  one,  circulatiDg 
among  the  clergy,  and  the  laity  of  the  diocese  who  s^e 
more  especially  engaged  in  Church  work.  We  learn 
also  that  it  is  published  with  the  sanction  of  the 
Bishop,  and,  as  might  be  supposed,  the  bulk  of  its  con- 
tents comprises  the  reports  and  notices  in  connection 
with  diocesan  work.  But  in  addition  to  this,  in  the 
present  number,  a  new  feature  appears,  to  which  we 
desire  to  draw  special  attention.  The  following  may 
be  read  on  page  41  of  the  issue  in  question, 

"ON  CLERICAL  BREAKDOWN." 

^  A  paper  read  before  the  Chapter  of  tLe  Deanery  of 
Xennington,  at  the  House  of  the  Rural  Dean,  on 
Wednesday  afternoon,  February  5th,  1896,  and 
printed  by  request." 

"By  Sa  Dyck  Duckworth,  M.D.,  L.L.D.,  F.RC.P., 

Fhvsician  and  Lecturer  on  Medicine,  St.  Bartho- 
lomew's Hospital ;  Hon.  Physician  to  H.R.H. 
the  Prince  of  Wales ;  Lay-reader  in 
the  Diocese  of  Rochester." 

Here,  then,  is  the  Treasurer  of  the  Royal  College  of 
Physicians,  London,  an  official  of  the  Institution  which 
is  supposed  to  represent  the  palace  of  professional 
integrity,  parading  his  name,  qualifications,  and 
appointments  in  a  local  periodical,  and,  by  so  doing, 
making  a  bid  for  the  clerical  and  other  patients  of  the 
general  practitioners  residing  in  the  diocese.  Bat* 
bearing  upon  this  paper,  a  remarkable  editorial  poff 
appears  on  page  39  of  the  same  number,  and  it  is  as 
follows  :— "  The  editor,  in  order  not  to  disappoint  the 
many  who  have  most  kindly  sent  him  much  news  at 
the  eleventh  hour,  and  in  order  to  give  the  Diocese 
the  whole  of  Sir  Dyce  Duckworth's  valuable  paper 
on  '  Clerical  Breakdown,'  has,  at  his  own  expense, 
added  additional  pages  to  this  number.  This  cannot 
occur  again.  He  hopes  he  will  have  done  the 
Chronicle  good  by  this  Lenten  Indulgence.  This 
is  the  voice  of  the  much-enduring  publisher 
on  this  proceeding :— '  I  note  what  you  say 
as  to  additional  pages  for  March.  You  know 
my  view,  however,  about  extra  pages.  They 
don't  pay.' "  What  a  pathetic  picture  is  here  afforded 
of  the  editor,  out  of  his  own  pocket,  defraying  the 
expense  of  adding  more  pages  to  his  journal  in  order 
that  Sir  Dyce  Duckworth's  paper  might  not  be  lost  to 
the  diocese.  The  publisher's  comment  upon  the  tran- 
saction is  doubtless  quite  to  the  point,  but  whether 
Sir  Dyce  Duckworth  would  agree  with  him  is.Unother 
matter.  Further  comment  upon  the  whol^  case  is 
superfluous.  x 


Mab.  25,  1896. 


NOTES  ON  CUKRENT  TOPICS. 


Tbb  Mkdioal  Puss.    327 


The  Poor-Law  Offioers'  Superannuation  BilL 
Wb  report,  for  the  benefit  of  oar  Irish  readers, 
in  a  Special  Sapplement,  the  debate  upon  this  Bill, 
and  present  a  fnll  explanatory  statement  thereon. 
It  is  not  necessary  to  say  more  in  this  place  than 
that  the  Bill,  so  far  as  it  relates  to  England,  received  its 
second  reading  on  Wednesday  last  without  a  division 
under  the  most  encouraging  circumstances.  The  only 
opposition  emanated  from  Mr.  Logan  and  Mr.  John 
Boms,  on  the  part  of  the  Radical  section,  who  objected, 
on  principle,  that  any  measure  should  be  passed 
which  might  prevent  Guardians  from  turning  their 
worn-out  Officers  into  the  streets  to  starve  if  it  pleased 
them  to  do  BO.  As  to  the  extension  of  the  Bill  to 
Scotland  and  Ireland,  the  opinion  of  the  Scotch  local 
authorities  has  yet  to  be  ascertained  before  it  gets  into 
Committee.  As  regards  Ireland,  that  opinion  has 
been  already  expressed  to  a  considerable  extent,  and  it 
is  entirely  in  favour  of  the  extension  of  the 
measure  to  Ireland.  We  note  with  surprise  a  state- 
ment contained  in  the  British  Medical  Journal  of 
last  week  as  follows  :->'*  We  should  be  glad 
to  see  the  scope  of  the  Bill  extended,  but 
we  cannot  shut  our  eyes  to  the  fact  that  there  has  been 
no  demand  for  it  in  either  country."  Our  contempor- 
ary is  singularly  badly  informed  with  reference  to  the 
situation  in  Ireland.  It  might  have  been  expected  to 
know  that,  more  than  a  year  ago,  every  Poor-law  Medi- 
cal Officer  in  Ireland  was  asked  his  opinion  as  regards 
the  extension  of  the  Bill  to  Ireland,  and  that  a  verdict 
was  recorded  in  favour  of  that  extension  by  more  than 
two  to  one.  We  furthermore  beg  to  inform  our  con- 
temporary, that  so  far  as  the  views  of  Irish  Boards  of 
Guardians  have  been  yet  ascertained,  about  sixty  of 
them  have  exi^ressed  their  approval  of  the  extension  to 
Ireland,  and  only  three  as  against  that  proposition,  and 
that  the  answers^  most  of  them  favourable,  are  coming 
in  daily.  It  is  to  be  regretted  that  a  statement  was 
permitted  by  our  contemporary  in  its  columns  which 
might  have  the  effect  of  discouraging  those  who  are 
working  for  the  extension. 


The  Army  Medical  Competitive. 
Mb.  William  Stoksb,  who  recently  formed  one  of 
the  deputation  from  the  Royal  College  of  Surgeons, 
Ireland,  to  the  Secretary  for  War,  on  this  subject,  has 
sent  us  the  following  memorandum  in  which  he  has 
'^put  in  a  nut-shell"  his  opinion  as  to  the  changes 
which  he  regards  as  most  essentially  necessary  to  restore 
popularity  and  prosperity  to  the  somewhat  dilapidated 
Army  Medical  Department  :— 

1.  The  obligatory  subjects  at  examinations  for  com- 
missions in  the  Army  Medical  Staff  to  be  limited  to 
those  required  for  the  qualifying  examinations  of  the 
Medi<^  Licensing  Boards,   viz..  Medicine,  Surgery, 
Midwifery,  and  Applied  Anatomy. 
Advantages  claimed : 
L  Subjects  requisite  to  practise  alone  retained,  a 
higher  standard  of  knowledge  would  be  reached, 
il  Candidates  would   c[0  up  directly  from    the 
qualifying  examinations  without  being  delated 
or  deterred  by  the  necessity  for  cramming 
chemistry,  physics,  physiology  and  materia 
medica  at  which  they  have  not  worked  for 


three  to  five  yean.  (Pathology  and  hygiene 
not  included  as  instruction  in  these  subjects 
is  provided  at  Netley.) 

2.  Examining  Board  to  be  made  representative  of  all 
the  medical  schools. 

3.  Examination  in  a  subject  not  in  any  case  to  be 
relegated  to  a  single  examiner.  Vide  B^;ulations  of 
General  Medical  Council. 

4.  A  Eoyal  Medical  Corps  is  to  be  established  with 
rank  and  command  within  it  Vide  Report  Camper- 
down  Commission.  Military  titles  are  usual  symbols 
of  rank,  but  rank  itself  is  uie  necessity,  as  shown  in 
Army  Service  Corp,  etc. 

5.  Numbers  in  Army  Medical  Staff  to  be  so  increased 
as  to  permit  of  (a)  fair  amount  of  furlough,  (6)  facilities 
for  scientific  work,  (c)  shorter  tours  of  foreign  service. 
Vide  Beport  Camperdown  Commission. 

6  Pay  and  allowances  on  Indian  Service  to  be 
brought  into  accordance  with  the  conditions  of  the  last 
Royal  Warrant. 

7.  Instruction  to  be  provided  on  medical  subjects 
for  the  Army  Medical  Staff  as  for  the  other  scientific 
corps. 

Mr.  Stoker  ought  to  be  able  to  express  a  competent 
opinion  on  tlus  subject^  at  least  from  the  Irish  point  of 
view,  for  there  is  no  man  in  Ireland  who  has  served  » 
more  dose  apprenticeship  to  the  teaching  of  Irish 
medical  candidates,  many  of  whom  have  offered  them- 
selves at  the  Army  competitives,  and  many  now  hold  Her 
Majesty's  commission.  As  a  very  distinguished  states- 
man once  said,  that  ''it  passed  the  wit  of  man"  to  please 
all  parties  to  a  certain  political  controversy,  it  is  not 
within  human  capacity  to  bring  to  a  level  the  varied 
aspirations  of  various  classes  of  Army  medical  officers^ 
but  in  a  genend  way  Mr.  Stoker  seems  to  go  as  near  to 
suggesting  a  reasonable  modtu  vivendi  as  any  one  can 
be  expected  to  do.  What  a  pity  our  brethren  of  the 
Service  cannot  evolve,  by  organisation  and  mutual  con- 
ference, some  scheme  which  journalists  and  practical 
politicians  couldadvocate  with  thecertaintythatit  would 
satisfy  the  general  feeling  of  the  Service  and  be  consis- 
tent with  the  military  necessities  of  the  Empire  and  the 
good  of  the  soldier. 

Indecent  Journalism. 
No  one  who  reads  the  newspapers,  especially  the 
weekly  journals,  can  entertain  a  doubt  as  to  the  neces- 
sity of  placing  further  restrictions  on  the  publication  of 
indecent  reports.  Their  columns  abound  with  details 
of  a  grossly  immoral  character,  culled  from  the 
''spicy  "cases  which  have  occupied  judicial  attention 
during  the  preceding  week.  We  have,  however,  grave 
doubts  as  to  the  probable  efficacy  of  the  Bill  which  has 
just  passed  a  second  reading.  The  responsibility  of  pro- 
hibiting the  publication  of  undesirable  details  would^ 
under  its  provisions,  devolve  on  the  judges,  a  procedure 
which  might  conceivably  be  open  to  grave  abuse,  and 
would  almost  certainly  fail  to  attain  the  object  in  view. 
It  would,  moreover,  leave  untouched  cases  heard  before 
magistrates  and  at  sessions.  The  only  trustworthy 
plan  would  appear  to  be  to  prohibit  the  publication  of 
reports  of  cases  in  the  Divorce  Court,  and  generaUy  of 
all  trials  for  offences  against  public  morality.  Nobody 
can  pretend  that  it  is  to  the  public  interest  that  the 
necessarily  repulsive  details  of  the  evidence  in  such 
cases  should  be  made  public.  It  is  not  to  be  supposed 
for  a  moment  that  the  publicity  can  act  as  an  additional 


328     Thx  Mbdicjll  Pbesp. 


NOTES  ON  CURRENT  TOPICS. 


Mab   25,  1896. 


detriment  to  offenders  of  thu  kind,  while  the  tone  of 
public  morality  is  in  conseqaence  appreciably  lowered. 
We  willingly  admit  that  most  of  oar  daily  contempo- 
raries show  a  prudent  discretion  in  this  matter,  bat,  on 
the  other  hand,  there  is  a  section  of  the  press  which 
ootorionsly  lends  itself  to  the  publication  of  reports,  not 
only  singularly  unedifying,  bat  distinctly  immoral.  It 
is  to  be  hoped  that  the  Bill  will  not  pass  into  law  in 
its  present  form,  indeed,  we  would  far  rather  matters 
remained  as  they  are  than  that  so  insidious  a  power 
should  be  placed  in  the  hands  of  the  judges,  unless 
indeed,  an  adequate  court  of  appeal,  by  jury, 
be  provided.  It  woald,  moreover,  be  necessary  to 
jexempt  medical  journals  from  the  application  of  such 
A  law,  in  view  of  the  medico-legal  interest  which 
jcertain  cases  possess. 

High  Caste  Women  in  India  and  Medical 

Attendance. 
A  oooD  deal  of  difficulty  is  experienced  with  the 
High  Caste  Women  in  India,  in  the  matter  of  medical 
attendance.  The  admirable  work  done  by  the 
Countess  of  Dafferin's  fund  in  affording  medical 
and  surgical  relief  to  the  women  of  India,  has  met  with 
a  large  amount  of  appreciation,  but  its  scope  is  limited 
by  the  action  of  the  patients  and  their  friends.  The 
medical  woman  in  charge  of  the  Victoria  Hospital  at 
Calcutta  assigns  two  reasons  for  this  state  of  affairs 
O)  the  fact  that  high  caste  women  are  not  allowed  to 
eat  or  drink  away  from  their  own  homes,  and  con- 
sequently cannot  be  treated  as  in-patients,  and, 
aecondly,  the  almost  universal  lack  of  physical  and 
moral  courage  on  the  partof  patients  when  an  operation 
is  necessary.  So  strictly  do  these  women  adhere  to 
their  rules  of  diet  that  nothing  will  ever  induce  them 
to  become  in-patients  of  a  hospital.  Another  trouble 
with  the  high  caste  patients  is  that  they  are  apt  to 
meet  at  the  hospitals  women  of  a  lower  caste  than 
themselves,  and  the  result  frequently  is,  when  this  is 
the  case,  that  they  do  not  attend  a  second  time,  no 
matter  how  urgent  the  need.  Despite,  however,  the 
difficulties  encountered  in  ministering  to  the  needs 
jof  these  patients,  the  Times  of  India  points  out  that 
the  Bengal  Branch  of  the  Fund  during  the  past  year 
had  an  attendance  of  no  less  than  107,000  in  and  out- 
patients, an  increase  of  nearly  7,000  over  the  total  of 
the  previous  year.  Of  last  year's  total  number  of 
patients,  it  is  interesting  to  note  that  42,000  were 
•children. 

The  Cost  of  Opposing  the  Midwives' 
Registration  Bill. 
When  a  champion— enthusiastic^  and  capable— 
undertakes  the  advocacy  of  a  cause,  and,  without 
prospect  of  personal  advantage)  to  himself,  devotes  his 
time,  labour,  and  mind  to  it,  it  is  too  much  to  expect 
that  he  will  also  expend  his  money  in'quantity  for  the 
advantage  of  those  in  whose  interest  he  is  working. 
For  very  many  of  our  profession  it  is  impossible  to 
engage  actively  in  medico-political  propaganda,  and, 
in  fact,  the  working- up  of  an  agitation  usually  devolves 
upon  a  few.  It  is,  however,  possible  for  everyone  who 
^sympathises  to  give  effective  aid  by  contributing  to 


the  sinews  of  war,  and  thus  showing  his  approval,  and 
encouraging  others.  Too  often,  the  workers  find  that 
there  are  very  many  who  are  well  content  to  enjoy 
the  benefits  secured  for  them  without  helping  to 
purchase  those  benefiits  by  contributing  a  thought 
or  a  penny.  Dr.  Rentoul,  of  Liverpool,  to  whom 
the  general  practitioners  of  England  owe  a  deep 
debt  of  gratitude  for  effectively  resisting  the 
invasion  of  the  army  of  ill-educated  women  who  are 
seeking  admission,  by  back-door  entrance,  to  the  ranks 
of  the  profession,  has  experienced  this  aspect  of  human 
nature.  He  drew  on  his  private  resources  for  £322  to 
carry  on  the  war  against  the  Midwives'  Registration 
Bill,  and,  though  recouped  to  some  extent  by  subscrip- 
tions, still  remains  £130  out  of  pocket.  We  trust  that 
our  brethren  will  not  allow  such  a  discreditable  fact 
to  be  cast  in  their  teeth.  The  midwives  have  had 
little  difficulty  in  getting  together  nearly  £1,000  to 
purchase  their  admission  to  quasi-medical  diplomas, 
and  it  is  surely  not  too  much  to  ask  the  profession  to 
spare  a  few  shillings  or  pence  to  save  Dr.  Rentoul 
from  monetary  loss. 

Water-Gas. 
The  facility  with  which  gas  for  illuminating  and 
heating  purposes  can  be  made  by  the  decomposition  of 
water  vapour,  and  the  comparative  cheapness  of  the 
resulting  product,  render  it  somewhat  surprising  that 
advantage  should  not  have  been  more  largely  taken 
of  this  discovery  for  domestic  purposes.  One  reason 
why  the  use  of  this  water-gas  has,  so  far,  been  virtually 
restricted  to  industrial  pursuits  is  the  extremely 
poisonous  effects  to  which  it  gives  rise  when  inhaled. 
The  decomposition  of  the  water  is  effected  by  passing 
the  vapour  over  incandescent  carbon,  the  oxygen  of 
the  water  combining  with  the  latter  to  form  the 
oxides  of  carbon,  which  dilute  the  hydrogen  thereby 
set  free.  It  is  practically  devoid  of  odour,  so  that  the 
usual  warning  afforded  by  an  escape  of  coal-gas  is 
wanting.  In  the  United  States,  where  water-gas  Lb 
largely  employed  for  domestic  purposes,  fatal  accidents 
have  been  very  numerous.  This  drawback  can,  to 
some  extent,  be  overcome,  either  by  mixing  the  pro- 
duct with  coal-gas,  the  characteristic  odour  of  which 
betrays  its  presence,  or  by  adding  some  powerfully 
odorous  substance,  such  as  mercaptan,  to  render  it 
recognisable  by  smell.  The  former  precaution  is  to  be 
adopted  at  Birmingham,  where  the  process  is  shortly 
to  be  introduced  on  a  large  scale.  In  view  of  the  con- 
venience and  cleanliness  of  heating  and  cooking  by 
gas,  any  means  of  reducing  the  cost  to  the  consumer 
will  be  welcome,  and  if  the  Birmingham  experiment 
proves  a  success  we  may  look  forward  to  the  example 
being  followed  in  other  large  towns  where  the  gas 
supply  is  under  municipal  control. 


The  Smallpox  Lesson  at  Gloucester. 
The  eyes  of  the  whole  country  may  be  said  to  be 
turned  upon  the  ill-fated  city,  Gloucester,  whose  anti- 
vaccinationist  citizens  have  brought  upon  the  com- 
munity an  epidemic  of  small-pox,  which  every  day  is 
exciting  more  and  more  alarm.  The  spread  of  the 
disease  has  assumed  such  proportions  that  a  veritable 


Mar.  25,  1896. 


NOTES  ON  CURRENT  TOPICS. 


Thb  Mbdioal  Pbess.     329 


panic  has  set  in,  and  parents  are  sending  their  chil- 
dren away  to  different  parts  of  the  country.  In  two 
instances  children  were  sent  to  some  friends  in  the 
Forest  of  Dean,  but  soon  after  their  arrival  they  were 
found  to  be  suffering  from  small-pox,  and  they  were, 
therefore,  promptly  returned  to  their  parents.  Mean- 
while, there  is  no  saying  how  many  healthy  persons 
they  did  not  infect  during  the  course  of  their  transit. 
The  Medical  Officer  of  Health  for  Bristol,  Dr.  Davies, 
has  published  a  timely  warning  in  the  local  press 
urging  upon  the  people  of  Gloucester  to  submit  to 
vaccination.  Of  course,  his  communication  has  been 
followed  by  protests  on  the  part  of  the  anti-vacdna- 
tionist  party,  who  still  maintain  that  the  outbreak  has 
nothing  to  do  with  the  neglect  of  the  Vaccination 
Laws.  Their  last  effort  in  this  direction  has  not  been 
more  happy  than  their  previous  attempts  to  persuade 
persons,  not  faddists  like  themselves,  to  accept  their 
statements. 


The  Presidency  of  the  Royal  College  of 

Physicians  of  London. 
It  is  stated  that  Dr.  \>^^lks,  yielding  to  the  solicita- 
Uon  of  his  friends,  has  at  |last  consented  to  serve  as 
President  of  the  Royal  College  of  Physicians  of  London, 
and  it  is  added  that,  considering  the  personal  affection 
and  esteem  in  which  he  is  held  by  his  former  pupils  at 
Guy's  Hospital,  the  result  of  the  ballot  on  the  30th 
inst,  IB  almost  a  foregone  conclusion.  This  is  certainly 
very  satisfactory,  and  the  only  possible  difficulty  seems 
to  arise  from  the  fact  that  the  choice  of  President  rests 
with  the  Fellows,  and  not  with  the  students,  past  or 
{Mresent,  of  Guy's  Hospital.  Dr.  Wilks  has  undoubtedly 
high  claims  to  the  office  to  which  he  aspires,  but  it  will  be 
remembwed  that  when  three  years  ago  he  placed  him- 
self unreservedly  in  the  hands  of  hu  friends  he  was 
not  elected.  AU  such  attempts  to  advance  the  claims 
of  any  particular  candidate  are  a  mistake,  and  not 
unnaturally  lead  to  the  suspicion  that  without  such 
adventitious  aids  he  could  not  stand  alone.  We  have 
no  doubt  that  Dr.  Wilks  will  receive  a  fair  measure  of 
support,  but  if  he  is  to  become  a  strong  candidate,  he 
will  find  that  it  is  absolutely  necessary  to  rely  on  him- 
self, and  not  trust  to  the  ^  representations  "  of  friends. 


Immunisation  against  Serpents'  Venom. 

ONthe20th  inst,Prof.  T.  R  Eraser,  delivered  alecture 
at  the  Boyal  Institution,  on  "Immunisation  against 
Serpents'  Venom  and  the  Treatment  of  Snake  Bite  with 
Antivenene."  The  audience,  which  was  a  large  and  dis- 
tinguished one,  included  Lord  Rayleigh,  Prof.  Dewar, 
7.RS.,  Dr.  Franklin,  Dr.  Farquharson,  Dr.  Lauder 
Brunton,  Dr.  Murrell,  Dr.  C.  D.  F.  Phillips,  Sir  J. 
Orichton  Browne,  Dr.  Beevor,  Sir  William  Priestley, 
and  Dr.  Playfair.  The  lecturer  gave  an  interesting 
account  of  his  recent  experiments,  demonstrating  that 
animals  can  be  rendered  immune  against  the  poison  of 
venomous  serpents  by  the  administration  of  small  and 
frequently  repeated  doses  of  the  venom.  This  is  prob- 
ably the  greatest  advance  which  has  been  made  in  this 
interesting  investigation  and  affords  a  ready  explana- 


tion of  the  impunity  with  which  snake  charmers  handle 
cobras  and  other  poisonous  snakes  in  India  and  other 
countries  where  these  animals  abound.  Dr.  Fraser 
showed  an  interesting  collection  of  dried  venoms,  one 
'  of  which,  weighing  about  twenty  grammes,  was  stated 
to  be  sufficiently  toxic  to  prove  fatal  to  over  six  thou- 
sand human  beings. 

The  Civil  Bights  Defence  Conmiittee  and  the 
Progess  of  its  Work. 
Thebe  is  much  evidence  to  show  that  the  Civil 
Rights  Defence  Committee,  so  ably  presided  over  by 
the  Earl  of  Stamford,  is  now  making  its  influence  felt 
upon  the  public.  The  progress  made  with  its  im- 
portant work  during  the  past  few  weeks  has  been 
remarkable.  The  case  of  Mr.  R  B.  Anderson  has  been 
by  its  aid,  clearly  shown  to  be  one  in  which  constitu- 
tional privileges  are  involved^  and  that  those  who 
bring  their  influence  and  assistance  to  bear  in  further- 
ing his  claims  for  justice,  are  helping  forward  the  recti- 
fication of  a  grievous  constitutional  wrong,  in  which  the 
whole  nation  is  concerned.  We  are  glad  to  see  that  the 
matter  is  being  brought  under  the  notice  of  Members 
of  Parliament  throughout  the  country  by  their  consti- 
tuent s.  A  very  clear  statement  of  Mr.  Anderson's 
case  appears  in  the  current  number  of  the  Westminstef 
Review^  in  an  article  entitled,  "A  Judicial  Scandal,"  a 
further  instalment  of  which  is  promised  for  next 
month  (April). 

GK>vemment  and  the  Army  Medical 
Department. 
Last  week,  the  War  Secretary,  Mr.  Brodrick,  made 
an  official  statement  which  may  cast  a  ray  of  hope 
into  the  dismal  shades  of  the  Army  Medical  Depart- 
ment In  the  Committee  of  Supply  on  the  Army 
Estimates  in  the  House  of  Commons,  he  alluded  to 
the  falling  ofiF  in  the  number  of  Army  Medical  Officers. 
He  then  went  on  to  say  that  no  stone  would  be  left 
unturned  in  order  to  ascertain  the  cause  of  the 
grievances  in  regard  to  the  Medical  Depart- 
ment. This  assurance  is,  to  some  extent  reas- 
suring, although  it  is  to  be  regretted  that 
Members  did  not  draw  more  attention  to  the 
subject  in  the  subsequent  discussion.  The  want  of 
adequate  parliamentary  representation  of  the  profes- 
sion is  evidenced  in  a  disastrous  manner  when  a  matter 
closely  affecting  the  interests  of  a  large  body  of  medi- 
cal men  is  brought  before  the  House,  and  simply 
allowed  to  pass  out  of  court  for  lack  of  proper  support. 
Of  one  thing  the  War  Office  may  be  certain,  namely, 
that  when  the  time  comes  for  inquiry  there  will  be  no 
dearth  of  evidence  as  to  the  slights,  abuses,  disadvan- 
tages, and,  in  not  a  few  instances,  the  absolute 
injustices  to  which  the  medical  branch  of  the  Army 
Service  for  many  years  has  been  subjected. 

The  question  of  experiments  with  germ-destroying 
filters  is  now  under  the  consideration  of  the  Qovem- 
ment  of  India.  Some  large  cantonments  in  which 
typhoid  has  been,  or  is,  prevalent  will  probably  be 
selected,  and  a  complete  installation  of  filters  will  be 
made  in  such  places. 


330     Thb  Mbdioal  Psjira. 


BOTES  ON  CURRENT  TOPICS. 


Mab.  25.  1896. 


The  Food  and  Drugs  Act. 
Medical  Officers  of  Health  and  Pablic  Analysts  have 
long  had  cause  to  complain  of  the  shortcomings  of  the 
present  law  in  regard  to  adulteration  of  food.  Many 
of  them  have  had  an  opportunity  of  stating  their  views 
before  the  Select  Committee  of  the  House  of  Commons, 
which  has  resumed  its  inquiry  into  the  Food  and  Drugs 
Act  From  the  evidence  already  given  it  appears  that 
the  existing  state  of  affairs  allows  adulteration  to  be 
carried  on  with  impunity.  A  clear  definition  of  food 
is  required,  and  the  administration  of  the  Act  should 
be  made  compulsory,  if  any  widespread  benefit  is  to 
result  to  the  community.  Another  point  is  that  a 
minimum  penalty  should  be  fixed  as  well  as  a  maxi- 
mum. Under  the  present  system,  for  instance,  as  we 
have  again  and  again  pointed  out  in  these  columns, 
that  a  fraudulent  milkman  can  well  afford  to  pay  fines 
ad  libitum  out  of  the  relatively  enormous  profits  of  his 
fraud.  Another  deficiency  of  the  Act  is  that  the 
magistrate  has  no  power  to  send  an  offender  to  prison, 
however  hardened  and  gross  his  offenca  There  is 
some  prospect  that  the  Committee  will  complete  the 
work  during  the  current  session.  Should  this  be  the 
case,  one  may  hope  that  Government  will  lose  no  time 
in  bringing  forward  a  comprehensive  Bill  founded  on 
their  report,  for  hardly  any  piece  of  domestic  legisla- 
tion within  the  range  of  practical  politics  is  likely  to 
do  80  much  immediate  and  lasting  good. 


Pathogenic  Yeaste. 
Yeast  organisms  have  hitherto  rejoiced  in  a  reputa- 
tion of  freedom  from  pathogenic  properties,  but  accord- 
ing to  the  researches  of  Busse  and  others  seven,  at 
least,  out  of  fifty  varieties  that  were  examined  gave 
evidence  of  disease-producing  proclivities.  One  of 
them,  the  monilia  Candida,  proved  fatal  to  rabbits  and 
mice,  although  guinea-pigs  were  in  no  way  affected 
thereby.  According  to  Nature,  another  yeast,  patho- 
genic to  mice,  was  obtained  from  some  figs  which  had 
been  allowed  to  ferment,  while  a  so-called  "wild" 
yeast,  found  on  grapes,  killed  both  rabbits  and  mice. 
Another  variety  of  yeast,  isolated  by  Prof.  Delbriick 
from  ale,  was  also  found  to  be  fatal  to  rabbits  in  about 
ten  days  and  to  mice  in  from  four  to  six  days,  when 
injected  subcutaneously.  The  abundant  proliferation 
of  the  organisms  in  the  blood  and  its  presence  in  large 
numbers  in  the  various  tissues  of  the  body  points  to  the 
conclusion  that  the  lethal  effects  are  not  due  to  intoxi- 
cation from  the  products  elaborated  thereby,  but  are  to 
be  attributed  to  direct  infection.  This,  at  any  rate,  is 
the  conclusion  arrived  at  by  Dr.  Rabinowitsch,  but  we 
must  confess  to  a  difficulty  in  grasping  the  distinction 
between  intoxication  by  secreted  products  and  the 
so-called  direct  infection. 

The  Barker  Anatomical  Prizes. 
Two  prizes,  of  £26  58.  each,  are  offered  for  competi- 
tion this  year,  and  are  open  to  any  student  whose  name 
is  on  the  anatomical  class  list  of  any  school  in  the 
United  Kingdom.  The  preparations  entered  must  be 
placed  in  charge  of  the  Curator  of  the  Boyal  College  of 
Surgeons,  Ireland,  before  June  Ist,  1896.    One  prize 


will  be  allotted  to  a  dissection  showing  the  relations  of 
the  pleura,  pericardium,  and  lungs  to  the  anterior  chesi 
waU,  the  dissection  to  be  planned  with  special  lefoenoe 
to  the  operation  of  tapping  or  incising  and  dnimng 
the  i)ericardium  for  pyocarditis.  The  other  prize  will 
be  allotted  to  a  dissection  displaying  the  surgical  rela- 
tions of  the  lateral  sinus,  the  mastoidal  antrum,  and 
the  semicircular  canals,  as  exhibited  by  a  dissectioD 
through  the  bones  from  without;  with  the  view  of 
illustrating  operations  in  the  middle  ear  and  lateral 
sinus.  The  exact  conditions  under  which  the  competi- 
tion is  to  be  carried  out  can  be  had  by  writing  to  the 
Registrar  of  the  College.  The  preparation  must  be 
sent  to  the  Curator  of  the  Museums,  Royal  College  of 
Surgeons,  Dublin,  each  being  marked  with  a  fictitiooa 
signature,  and  accompanied  by  a  sealed  envelope 
bearing  outside  the  same  endorsement 


The  New  Chief  Inepeotor  of  Faotoriea 
The  appointment  of  Dr.  Arthur  Whitelegge  by  the 
Home  Secretary  to  the  vacant  post  of  Chief  Inspector 
of  Factories  has  been  officially  announced.  His  quali- 
fications for  this  important  post  are  great.  He  is  M.D. 
of  London  University,  a  member  of  the  Royal  College 
of  Physicians,  and  D.P.H.  of  Cambridge.  His  first 
public  health  appointment  was  in  the  borough  of 
Nottingham,  where  he  acted  as  Medical  Officer  from 
1884  to  1889.  From  thence  he  went  to  the  West  Riding 
of  Yorkshire.  In  1894  he  was  appointed  Medical 
Officer  to  the  newly-formed  West  Riding  Rivers  Board, 
in  which  capacity  he  organised  the  survey  of  the 
rivers  of  the  district,  and  the  work  of  preventing 
their  pollution.  Lately,  Dr.  Whitelegge  has  been 
ap^inted  Lecturer  on  Public  Health  at  Charing  Cross 
Hospital.  It  should  be  mentioned  also  that  he  has 
served  on  two  Home  Office  Commissions  ;  the  first  waa 
one  which  sat  two  years  ago  to  inquire  into  factory 
statistics ;  the  second,  which  is  still  sitting,  to  report 
on  dangerous  industries.  It  will  thus  be  seen  that  the 
new  chief  Inspector  brings  a  ripe  experience  to  bear 
on  the  duties  of  his  post. 

Edieon  and  the  Bontgen  Bays. 
News  has  arrived  from  New  York  to  the  effect  that 
Mr.  Edison  has  made  some  important  discoveries  in 
the  modification  of  Professor  Rontgen's  X  rays.  One 
detailed  account  telegraphed  here  states  that  the 
American  scit-ntist,  after  testing  1,800  different  sub- 
stances, at  length  succeeded  in  finding  a  potential  one 
for  the  new  rays.  This  particular  substance  is  said  to 
be  a  crystalline  form  of  tungstate  of  calcium,  and  by  its- 
use  an  observer  is  said  to  be  able  to  look  through  eight 
inches  of  solid  timber,  and  with  the  naked  eye  to  see 
the  bones  of  the  arm  and  hand.  Should  this  news  be 
confirmed  it  will  considerably  enlarge  the  immediate 
field  of  the  new  photography  in  its  application  to- 
practical  surgery. 


Db.  Fblix  Semon  has  been  elected  an  honorary^ 
member  of  the  Vienna  Society  of  Laryngology,  and  oi 
the  Italian  Society  of  Laryngology. 


Ma&  25,  1896. 


SCOTLAND. 


Thi  Mbdioal  Puss.     331 


The  Medical  Service  and  the  War  in  Cuba. 
Thb  Cross  of  San  Fernando  has  been  conferred  on 
Dr.  Senor  D.  Urbane  Orad  for  distinguished  services 
with  the  Royal  Army  of  Spain  in  Cuba.  On  more 
than  one  occasion  Dr.  Orad  was  seriously  wounded 
whilst  in  discharge  of  his  duties,  and  has  been  reported 
as  killed.  The  honour  conferred  on  him  is  a  very 
•gratifying  acknowledgment  that  the  Oovernment  is  not 
indififerent  to  the  zeal  and  skill  of  the  medical  officers 
in  this  much  to  be  regretted  war.  From  the  latest  pub- 
lished reports  we  learn  that  the  mortality  of  the  medical 
fitaff  in  Cuba  is  very  high  ;  within  a  short  time  there 
were  twenty  deaths:  three  from  woudcIb,  two  from 
common  fever,  and  fifteen  from  endemic  fever.  The 
endemic  diseases  of  Cuba  include  dengue,  malaria, 
yellow  fever  on  the  coast,  and  typhoid.  Medical 
returns  from  the  island,  says  our  contemporary,  El 
Stglio  Medico,  are  very  scant  in  information,  and  very 
seldom  appear,  a  state  of  affairs  probably  more  the 
result  of  Government  interference  than  indifference 
to  professional  curiosity  by  the  medical  staff. 

The  Anti-Diphtheritic  Serum  Treatment. 

Our  Berlin  correBpondent  states  that  the  result  of  a 
year's  trial  of  the  serum  treatment  at  the  Am  Urban 
Hospital  in  Berlin  has  been  to  reduce  the  mortality 
from  diphtheria  from  41*90  per  cent,  to  28  per  cent., 
the  number  of  cases  treated  being  245.  He  also 
remarks  that,  in  those  cases  where  the  remedy  failed 
no  ill  results  from  its  use  were  observed,  and  post- 
mortem examinations  revealed  no  serious  pathological 
changes. 

The  Huxley  Memorial. 
The  sum  realised  up  to  the  present  by  the  appeal 
for  funds  for  a  memorial  to  the  late  Prof.  Huxley  is 
£2,300,  which  enables  the  Committee  to  decide  upon 
a  statue  for  the  Natural  History  Museum,  and  a  medal 
for  the  Royal  College  of  Surgeons  of  London.  The 
Committee,  however,  hopes  yet  to  receive  sufficient 
funds  to  enable  it  to  endow  some  means  for  the 
furtherance  of  biological  research. 

V7e  understand  that  the  Countess  of  Warwick 
has  established  a  home  at  Warwick  for  the 
surgical  care  and  treatment  of  crippled  patients. 
The  home,  which  will  contain  accommodation 
for  sixteen  patients,  has  been  established  and  will 
be  maintained  entirely  at  Lady  Warwick's  own  cost 
Two  professional  nurses  have  been  engaged  to  attend 
on  the  inmates. 


SukgeonCaptain  F.  W.  Harris,  of  the  Aldershot 
Medical  Establishment,  who  has  been  selected  for 
Egyptian  Service,  has  been  for  some  time  attached  to 
the  Medical  Dep6t  and  Training  School,  of  which  he 
Ib  adjutant,  and  his  addition  will  bring  up  the  number 
of  British  medical  officers  in  the  Khedive's  service 
to  ten. 


mnnicated  to  Surgeon- Colonel  Taylor,  Surgeon-Captain 
Hilliard,  and  the  other  Medical  Officers  who  had 
charge  of  the  late  Prince  Henry  of  Battenberg,  the 
Queen's  thanks  for  their  attention  to  him. 

The  charge  of  wilful  murder  preferred  against  a 
Liverpool  dentist,  on  account  of  the  death  of  his  wife, 
ended  last  week  in  an  acquittal.  The  trial  occu- 
pied two  days,  and  turned  entirely  upon  the  medical 
evidence,  several  well-known  members  of  the  profes- 
sion being  in  Court. 

LoBD  Balfour  of  Burleigh,  Secretary  for  Scotland 
has  appointed  Thomas  Richard  Eraser,  M.D.,  (Pro- 
fessor of  Materia  Medica  in  the  University  of  Edin- 
burgh), to  be  Medical  Adviser  to  the  Prison 
Commissioners,  in  succession  to  Sir  Douglas  McLagan, 
resigned. 

The  National  Hospital  for  Consumption  for  Ireland, 
situated  midway  between  Newcastle  and  Newtown 
mountkennedy,  in  the  County  Wicklow,  was  formally 
opened  last  week  by  the  Marchioness  of  Zetland. 

The  Committee  of  Visitors  of  the  Essex  County 
Lunatic  Asylum,  Brentwood,  have  appointed  a  medical 
woman  as  Third  Medical  Officer  to  the  Institution. 


The  Director-General  of  the  Army  Medical  Depart- 
ment has,  by  direction  of  the  Secretary  for  War,  com- 1 


[VBI'M   CUB  OWN  OORBISPOKDBNT.] 

East  Lotuian  Savitart  Affairs.— The  motion  aboot 
the  Medical  Officers  of  Health  for  the  County  was,  as  mij^hb 
have  been  expected,  qaietly  shelved  at  the  last  meeting  of 
the  Eastern  District  Committee,  until  a  report  bad  Imoo 
received  from  the  Local  Govemmeni;  Board.  As  the 
Board,  however,  has  invariably  discountenanced  the  ap- 
pointment of  Medical  Officers  engaged  in  private  practice, 
lb  is  well-known  what  its  answer  wul  be.  and  appealing  to 
it  savours  of  procrastination.  The  Committee  evidently 
felt  that  they  must  do  something,  and  recommended  the 
appointment  of  an  Assistant  Sanitary  Inspector.  The 
proceed iogs  lemind  us  of  the  fable  of  the  mountain  and 
the  mouse.  Meanwhile,  Dunbar  has  introduced  a  new 
water-supply,  at  the  cost  of  £3,000,  but  we  are  afraid  that, 
for  this  year  at  least,  the  popularity  of  the  town,  as  a  holi- 
day resort,  will  have  suStrdd  greatly. 

Thb  Public  Health  (Scotland)  Bill. — The  debate 
on  this  Bill  in  the  Lords  was  of  an  instiuctive  character, 
and  Lord  Balfour  was  most  conciliatory  If  the  Bill  only 
were  successful  in  rendering  the  tenure  of  office  of  Medical 
Officers  of  Health  more  secure,  it  would  justify  its  intro- 
duction. After  the  second  reading  it  was  referred  to  a 
Select  Committiee,  perhaps  the  best  course  to  pursue, 
unices  the  Consolidation  Bill  which  has  been  promised 
be  brought  forward  too  soon.  In  those  circumstances, 
proceedings  would  be  much  simplified  if  the  same  Com- 
mittee were  given  the  larger  Bill^  with  instructions  to 
incorporate  their  suggestions  as  to  the  smaller  into  the 
provisions  of  the  complete  measure. 

Sbbious  Chabgb  against  a  Mbdical  Man.— Medical 
circles  have  been  somewhat  shocked  during  the  week  by 
the  arrest  and  committal  for  trial  of  an  Edinburgh  practi- 
tioner, whose  name  we  forbear  to  mention  as  the  case  is 
nibjudice,  on  a  criminal  charge  said  to  be  connected  with 
an  illegal  operation,  death  having  rdsulted  therefrom.  Sir 
Hy.  Littlejohn  and  Dr.  Joseph  Bell  were  instructed  to 
make  the  post-mortem,  the  eirl  being  about  ei^^h  teen  years 
of  age.  On  the  strensth  of  their  report  the  accused  was 
arrested  and  charged,  out  it  is  stated  that  he  is  prepared 


332     Thi  Mxdioal  Pxno. 


CORRESPONDENCE. 


^th  a  satisfactory  answer  when  the  proper  time  arrives 
We  sinoerely  trost  this  may  prove  to  be  the  ease. 

U>BD  RiGTOBSHip  OF  GLASGOW  UsivMRanPT.— A  meetloff 
of  Glasgow  University  Conservative  Clab  was  held  on  the 
18th  inst  for  the  purpose  of  confirming  the  selection  of  a 
Unionisb  candidate  for  the  Lord  Rectorship,  when  the 
chairman  announced  to  the  members  that  their  candidate 
was  to  be  the  Right  Hon.  Joseph  Chamberlain.  The 
announcement  was  received  with  great  and  prolonged 
applause.  The  Liberal  students  willhave  to  bestir  them- 
selves if  they  purpose  to  oppose  the  Conservative  candi- 
date, but  this  appears  to  be  somewhat  doubtful ;  in  any 
case,  It  is  thought  that  any  other  candidate  will  stand  a 
very  poor  chance  of  election  against  eo  strong  a  candidate 

Glasgow  Hospital  Sunday — The  second  annual  meet- 
ing in  connection  with  the  Glaiigow  Hospital  Sunday 
Fund  was  held  on  the  17th  inst.  The  report  states  that 
the  income  shows  an  increase  of  j£423  2d.  lid.,  on  the 
preceding  twelve  months;  330  churches  and  222  Sunday 
schools  took  part  in  the  collection,  and  the  total  sum  con- 
tributed amounted  to  £4.069  2*.  The  sum  set  apart  for 
the  infirmaries  was  £3.852,  and  the  division  made  in 
proportion  to  the  number  of  beds  in  each  infirmary  :-- 
Rnyal  Infirmary,  650  beds,  £1,980 ;  Western  Infirmary, 
392  beds,  £1,411 ;  Victoria  Infirmary,  128  beds,  £460  16s. 
The  next  annual  collection  is  fixed  to  take  place  on  the 
last  Sunday  in  November. 

ViLTBR  Bbds  in  Connection  with  Bactbkia.— An 
experiment  is  being  carried  out  at  present  at  the  Dalmar- 
nock  Sewage  Works  as  to  the  efficiency  of  filter  beds. 
Certain  chemical  experts  have  recently  stated  that  the 
efficiency  of  a  filter  bed  depends  largely  upon  the  pre- 
sence of  a  certain  kind  of  bacteria,  which,  however,  are 
not  discoverable  until  the  filter  bed  has  been  in  use  for  some 
time.  A  filter  bed  was  considered  formerly  to  be  unservice- 
able and  dirty  as  soon  as  it  had  become,  or  supposed  to 
have  become,  the  residence  of  bacteria,  but  it  is  now 
considered  by  these  experts  that  a  filter  bed.  which  may 
ordinarily  appear  to  be  dirty,  is  only  then  in  a  higher 
condition  of  efficiency  than  when  first  brought  into  use, 
for  which  superlative  sUte  of  efficiency  the  dreaded  micro- 
scopical creature  must,  instead  of  curses,  receive  our 
thanks  and  our  blessings. 

MEDICAL  SOCIETY  OP  LONDON. 

Thb  meeting  on  Monday  evening  last  (March  23rd)  was 
devoted  to  two  papers  by  Mr.  Harrison  Cripps  and  Mr. 
Alban  Doran,  respectively,  on  the  "  Diagnosis  and  Treat- 
ment of  Extra-Uterine  Pre^ancy,"  a  class  of  cases  which 
seems  daily  to  be  becoming  more  frequent,  doubtless 
owing  to  greater  facility  of  diagnosis.  Mr.  Doran  had 
had  four  cases  in  less  than  four  months.  In  one  case  of 
apparent  rupture  of  an  ectopic  gestation  sac  it  was  thought 
proper  to  postpone  operative  interference,  and  ultimately 
the  tumour  disappeared  or  nearly  so.  He  insisted  on 
u  y^^^"^^^'  importance  of  sudden  pain  associated  with 
the  development  of  a  tumour  on  one  or  the  other  side  of 
the  uterus,  displacing  that  organ.  Operation  should 
always  be  undertaken  except  in  cases  in  which  there  is  a 
history  of  steady  subsidence  of  pain  and  swelling  after  a 
single  acute  attack. 

Mr.  Cripps  laid  special  stress  on  the  frequency  of  the 
blood  effused  after  rupture  of  a  gestation  sac  becoming 
encysted  in  Douglas's  pouch.  Owing  to  slight  oozing, 
localised  [>eritonitis  shut  off  the  general  peritoneal  cavity 
before  the  great  rush  of  blood  took  place.  He  discussed 
the  difference  in  the  symptomatology  of  the  three  varieties, 
and,  basing  his  belief  on  some  statistics  published  by  Mr. 
Bland  Sutton,  he  advised,  in  cases  of  extra-uterine  gesta- 
tion with  a  living  foetus,  that  operation  should  be  deferred 
until  a  short  time  after  the  death  of  the  fcetus. 

Dr.  Lowers  mentioned  a  case  in  which  the  opposite  tube 
to  that  containing  the  ruptured  bag  was  founa  to  be  dis- 
tended with  blood. 

Dr.  Rottth  insisted  on  the  importance  of  a  coffee  coloured 
or  shreddy  discharge  in  the  diagnosis  of  pregnancy,  and 
expressed  surprise  that  more  use  was  not  made  of  his 
bin^ral  vaginoscope  by  the  aid  of  which  the  characteristic 
souffle  could  be  heard,  thus  supplementing  or  even  replac- 
ing the  other  usual  signs  of  pregnancy.  He  deprecated  too 
implicit  reliance  on  breast  changes  as  indicative  of  preg- 
nancy, and  he  questioned  the  view  that  h»matocele  was 
invariably  due  to  rupture  of  an  ectopic  gestation  sac. 


Mae  25.  1886. 


^i^'Jll^  ^^^"^  "^^^  •tt<«*^on  to  the  marked  pulsa- 

occasion  enabled  him  to  arrive  at  a  correct  diagnosis. 

Mr.  Marmaduke  Sheild,  Dr.  Bruce  Cla^  kS  B£r. 
Malcolm  also  joined  in  the  diseosrion. 


(tarrtBjronbtnxe. 


(Ws  do,  not  hold  oonelvBs  reqK>odble  for  the 
ooRHponoenta]  __^___ 


oplnloiu  of  onx 


THE  ETHICS  OF  PROFESSIONAL  ADVERTISING, 
To  the  Editor  of  Turn  Mkdioal  Pbws  and  Ciboulab. 
Sib,— As  vou  alone  of  the  medicsl  journals  have  had  tb« 
courage  and  honesty  to  open  your  columns  to  the  discuB- 
sion  of  this  important  question,  I  think  that  the  fact 
should  be  made  known  that  no  less  a  sum  than  £500  waa 
divided  among  the  witnesses  who  appeared  for  the  BritiBh 
Medical  Journal  in  the  recent  trial  of  Kingsbury  v.  Hart. 
That  is  to  say,  that  Sir  Dyce  Duckworth  was  paid  upwards 
of  £100  from  the  funds  of  the  Association  for  evidence 
which  practically  decided  the  case  against  your  contem- 
porary. Who,  I  should  like  to  know,  sanctioned  this  pay- 
ment? Who,  again,  "invited"  Dr.  Ward  Cousina, 
another  of  the  witnesses,  to  journey  down  to  Mancheeter 
for  the  same  purpose.  Dr.  Cousins  is  the  chairman  of  the 
Council  of  the  A[ssociation,  and  as  an  ofiScial  of  the  Asaoci* 
ation,  and,  moreover,  as  being  one  of  the  reference  com- 
mittee having  an  editorial  control  upon  the  Journal,  he 
should  have  made  no  daim  for  his  services.  I  trust  that 
the  whole  matter  will  be  brought  before  the  annual  meet^- 
ing  of  the  Association  in  July  next,  and  that  a  fuU 
explanation  be  demanded  by  some  influential  member. 
I  am,  Sir,  your  obedient  servant, 

A  Mbmbiu  B.M.A. 
Liverpool,  March  19th,  1896. 

To  the  Editor  of  Thi  Mkdioal  Pbxss  and  Cirgulaiu 

Sir,— In  a  letter  regarding  a  recent  libel  action,  which 
appeared  in  your  issue  of  the  11th  inst.,  the  writer,  Dr.  D. 
Campbell  Black,  of  Glasgow,  states  that  after  being  a  mem- 
ber of  the  medical  profession  for  over  thirty  years,  he  haa 
found  that  the  unwritten  law  of  conduct  which  regulates 
gentlemen  in  their  relations  to  one  another  is,  in  that  pro- 
fession,  more  honoured  in  the  breach  than  in  the  observ^- 
ance.  And,  as  if  to  prove  the  fact,  he  proceeds  at  once,  I 
hope  "  in  his  haste,"  to  cast  a  most  unmerited  slur  on  » 
number  of  his  fellow-members  by  asking  "  for  what  pur- 
pose do  all  special  hospitals  exist,  except  for  the  purpose^ 
primarily,  of  medical  advertising  ?'' 

As  one  of  the  staff  of  a  special  hospital,  which  I  helped 
to  found,  I  can  repud<ate  most  warmly  the  insinuatioo 
that  advertising  was  the  object  which  my  colleagues  or  I 
bad  in  view.  They,  being  on  the  staff  of  the  infirmary, 
wished  me  to  teach  the  students,  and  recognised  that  the 
opportunities  for  doing  so  successfully  would  be  greater  ia 
a  special  hospital  than  in  a  special  department  of  a  general 
hospital.  For  my  part,  I  wished  for  more  abundant 
material  on  which  to  continue  my  studies  in  a  branch  of 
medicine  which  had  greatly  attracted  me,  and  to  which  I 
had  devoted  my  main  attention.  This  is,  I  know,  the 
feeling  which  has  prompted  several  friends,  in  different 
parts  of  the  country,  to  try  to  form  clinics  for  the  treat- 
ment of  some  special  class  of  diseases.  There  is  no  queetioa 
of  philanthropy,  primarily,  in  the  matter,  and  we  have  oar 
livings  to  earn ;  but  we  are  quite  capable  of  taking  ae 
great  a  scientific  interest  in  our  work  as  Dr.  Blac^  may 
take  in  physiology,  and  as  much  appreciate  the  advantages 
of  working  in  a  commodious  hospital  with  abundance  of 
material,  as  he  would  prefer  a  large  and  well-equipped 
laboratory  to  an  ill-furnished  room,  with  untrained 
assistants,  in  a  crowded  building.  But  as  regards 
the  advertising  powers  of  the  two  classes  of  institu- 
tion, it  may  be  said  without  fear  of  contradictioo, 
that  the  post  of  physician  or  surgeon  to  a  general  hos- 
pital, even  if  newly  founded,  is  in  itself  a  better  medical 
advertisement  than  a  post  on  any  special  hospital  is  ever 
likel;^  to  be. 

It  is  to  be  hoped,  therefore,  that  Dr.  Black  will  be  able^ 
on  maturer  consideration,  to  withdraw  an  insinuation 
which  not  merely  offends  against  the  ''  unwritten  law," 


Mar.  25.  1996. 


COEEESrONDENC  E. 


Thb  Mbdioal  Pbiss.    333 


bnt  whieb  is,  moreoYor.  in  the  sweeping  manner  in  which 
he  has  inadeib»  not  only  inaoenrate  but  insalting. 

I  am.  Sir,  yours,  &c., 

H.  G.  Bbooke. 
Manoheeter,  March  IStb,  1896. 


To  the  Editor  of  Thx  Mkdioal  Pbiss  akd  Cibculab 

Sib,— It  18  satisfactory  to  find  that  the  mask  has  at  last 
been  torn  off,  and  that  tne  anthorship  of  the  varioas  little 
newppaper  pnfiEs  has  been  brought  home.  The  bread  thus 
cast  upon  the  waters  has  retomed  after  many  days — pos- 
sibly rather  the  worse  for  wear. 

AxL  this  angry  protest,  however,  is  to  a  large  extent  an 
idle  expenditure  of  energy.  Medical  advertising  is  an 
offence  against  professions!  ethics,  but  in  the  form  now 
under  discuraion  it  is  an  offence  for  which  no  punishment 
has  been  devised,  and  it  therefore  remains  a  dead  letter 
in  respect  of  those  who  occupy  a  position  in  the  hierarchy 
which  (they  believe)  places  them  beyond  the  reach  of 
censure. 

Might  I  suggest  that  the  following,  or  some  analogous, 
sche£ile  of  advertising  offences  be  submitted  to,  ana  pro- 
mulgated by,  the  Medical  Defence  Union,  coupled  wito  an 
intimation  that  the  attention  of  the  General  Medical 
Council  will  be  formally  called  to  all  infractions  thereof  ? 
We  should  then,  in  due  course,  have  a  series  of  test  cases, 
as  to  which  the  Goimcil  would  have  pronounced.  We 
shall  then  know  where  we  are,  and  even  the  more  eminent 
will  hesitate  to  expose  themselves  to  the  risk  of  being 
gibbeted. 

Those  of  us  who  are  members  of  the  Royal  College  of 
Physicians  of  London  have  all  along  anticipated  that  the 
Censors  would  take  the  necessary  steps  to  prevent  the 
repetition  of  such  scandals  on  the  part  of  the  Members 
and  Fellows,  but  so  far  we  have  been  disappointed.  The 
inference  is  that  the  disciplinary  powers  wielded  by  these 
venerable  gentlemen  are  so  feeble  that  they  fear  to  subject 
them  to  any  strain.  Moreover,  to  wield  such  powers  in  an 
effectual  manner,  the  Censors  themselves  must  be  above 
suspicion,  and  this,  with  deep  contrition,  I  am  fain  to 
admit  is  not  always  the  ease. 

It  is  to  the  General  Medical  Council,  via  the  Medical 
Defence  Union,  that  we  mu(»t  look  to  place  the  matter  on 
solid  ^ound.  With  a  little  persistence  we  ought  to  be 
enabled  to  trace  a  line  of  demarcation  separating  what  is 
admissible  from  what  is  forbidden. 

I  am,  Sir,  yours,  &c. , 

M.R.C.P.Lond. 

Suggested  Schedule  as  to  methods  of  advertising  to  be 
r^gsrded  as  unprofessional : — 

(1)  Advertisements  in  lay  ioumals  of  medical  works. 

(2)  The  sending  of  medical  works  for  review  in  the  lay 
journals. 

(3)  Announcements  in  the  lay  journals  of  abaence  from 
or  return  to  town. 

(4)  Furnishing  information  for  publication  (with  name 
attached^  concerning  the  condition  of  particular  patients. 

(5)  Allowing  one's  name  and  address  to  appear  outside 
or  inside  hospitals  and  similar  institutions. 

(6)  Allowing  one's  name  coupled  with  professional 
description  and  address  to  appear  on  prospectuses  and 
advertisements  of  non-medical  companies  or  societies. 

To  the  Editor  of  the  Mbbical  Pbbss  asj>  Oibotjxab. 

Sib,— Why  do  not  the  lawyers  advertise  ?  The  answer 
is,  I  take  it,  because  they  belong  to  a  profession  that  is 
shrewd  enough  to  protect  its  own  interests,  and  strong 
enough  to  enforce  its  corporate  rules.  Lawyers  keep  up 
their  prices,  control  anj  black  sheep  in  their  own  flock 
with  a  strong  hand,  and  have  reducfMl  pirate  practice  to  a 
mere  nothing.  Compare  that  state  of  things  with  our 
own  professional  ethics. 

We,  of  the  medical  profession,  have  absolutely  no  cor- 
porate protection  for  keeping  up  prices  at  a  fair  average. 
Hence  the  visit  and  bottle  of  medicine  for  a  few  pence. 
We  have  a  loose  and  uncertain  control,  wielded  by  the 
General  Medical  Council  on  a  shifting  code,  against 
ofienders  in  our  own  ranks.  We  have  weapons  so  meagre 
and  ineffectual  against  pirates  that  they  practioslly  batten 
on  the  public  and  profession  at  their  own  sweet  wilL 
Lastly,  we  have  an  unwritten  code  preached  by  the  leaders 


of  the  profession,  but  broken  by  them  in  a  flagrant 
manner  at  every  turn.  The  fact  appears  to  be  that  theinr 
is  the  only  trade  anion  circle  within  the  profession,  a 
"  ring,"  in  short,  that  maintains  prices  and  combines  to 
exclude  unwelcome  competitors  and  rivals. 

The  fihanks  of  the  profession.  Sir,  are  due  to  you  iot 
bringing  the  matter  forward.  For  reasons  that  will  be 
obvious  to  your  readers  I  omit  to  sign  my  name,  but 
enclose  my  card,  and  remain. 

Faithfully  yours, 
A  DisnxusioNiD  Pbagtitioxeb. 

Manchester,  March  21st,  1896. 


HOSPITAL  REFORMERS   AND   ST.  JOHN'S  HOS- 
PITAL. 

To  the  Editor  oj  Thx  Mbdioal  Pbvss   and  Ciboulab. 

Sib,— Dr.  Morgan  DockreH's  letter  was  not  needed  bv 
members  of  special  hospital  staffs — ^no  doubt  they  are  all 
more  than  satisfied  as  to  the  necessity  of  these  institutions  f 
and  it  will  not  be  accepted  as  an  answer  by  those  who 
know  what  are  the  shameful  abases  associated  with  the 
existence  of  unnecessary  and  sham  special  hospitals.  The 
fact  that  that  immaculate  and  impeccable  tribunal  of 
public  and  private  morality.  Truth,  has  approved  of  the 
''  integrity  of  the  financial  arrangements  of  the  hospital," 
puts  this  department,  of  course,  above  criticism,  and  we 
may  be  sure  that  at  St.  John's,  at  any  rat^  a  vast  per- 
centage of  the  income  is  not  wasted  in  paying  collectors 
and  in  advertising. 

I  know  noUiing  about  the  regenerated  St.  John's  Hos- 
pital, and  I  do  not  dispute  that  it  may  now  be — whatever 
its  past  history — one  of  the  few  special  hospitals  against 
which  no  charge  can  be  made ;  but  it  is  one  of  a' very  few« 

I  merely  insist  that  it  is  an  unnecessary  special  hospital 
and  involves  at  least  a  waste  of  force  and  of  public  money* 
Many  of  these  institutions  have  been  started  and  are 
carried  on  for  the  sole  purpose  of  enabling  medical  adven- 
turers to*advertise  themselves  and  palm  themselves  off  upOD 
the  public  as  distinguished  specialists.  Many  of  these 
men  show  by  their  daily  practice  either  that  they  are 
ignorant  of  the  speciality  which  they  profess,  that  they 
are  unable  to  diagnose  simple  cases  of  the  maladies  to 
whose  treatment  they  devote  themselves,  or  that  they  look 
upon  their  suffering  clients  merely  as  useful  individuids 
from  whom  guineas  are  to  be  extorted.  These  are  the 
gentlemen,  for  example,  who  find  that  every  delicate  chUd 
suffering  [>erhaps  from  "growing  pains,"  and  having  a 
weak  frame,  has  spinal  disease  and  needs  long  and  costly 
treatment  and  supervision,  and  who  discover  diseased  spote 
in  the  naso-pharyngeal  regions  which  need  local  daily 
manipulations,  the  disease  being  [>erhaps  aphonia  due  to* 
hysteria,  nervous  debility,  or  some  other  affection  having 
no  possible  relation  to  any  local  morbid  condition  if  such 
condition  (as  it  usually  is  not)  be  discoverable. 

Special  departments  exist  at  all  general  hospitals,  and 
can  be  enlarged,  and  their  staffs  can  be  increased  to  meet 
any  demand  upon  them.  The  waste  and  abuses  connected 
with  separate  establishments  can  be  prevented ;  and  the 
appointments  of  the  members  of  the  staff  being  controlled 
by  professional  opinion,  and  being  based  upon  merit,  or 
performance  of  first-rate  scientific  work,  genuine  specialists 
will  have  charge  of  the  special  departments.  The  charac- 
ter  and  tone  of  applicants  for  special  appointments  at 
general  hospitals  will  be  known  to  those  having  the  gift  of 
the  posts,  and  the  danger  of  the  offices  being  filled 
by  ignorant  pretenders,  as  they  now  often  are  at  sham 
special  hospitals,  will  be  reduced  to  the  lowest  possible 
point. 

I  am.  Sir,  yours,  &c.. 

Hospital  Refobmeb. 

March  21  st,  1896. 


PHARMACOLOGY  AS   AN   EXAMINATION 

SUBJECT. 

To  the  Editor  of  the  Mbdigal  Pbbss  and  Ciboitlab. 

Sib,— Your  leader  on  the  action  taken  by  the  Royal 

College  of  Physicians  of  London  with  reference  to  the 

omission  of  pharmacology  as  a  separate  subject  from  the 

examination  of  the  Conjoint  Board,  and  the  erasure  of  the 


334    Thb  Hxdigai.  Pkvtf. 


CORBESPONDENCE. 


Hab.  25,  1896. 


BdMdoleof  PhMrmaeologyfroaitiMBcffiilatioiMp 

■o  ooEMtly  my  ▼ww  io  Um  msbtor  t£«t  1  haTv  iiuie  or 

notiiiiBg  to  add  to  wliat  is  tbare  so  ezooUaDtly  •totod. 

It  WM  a  nMiMer  ol  great  rsffret  to  me  that  I  ooold  not 
bo  praMot  at  tho  adjooniod  CoUefco  maettng  to  pioiaat 
againat  thia  ratrograda  atop,  one  which  will  vaty 
matoriaUy  roiaid  the  progvaaa  of  adaotifio  Oierapoatica, 
and  ODOOuraga  tho  atndoot  of  oMdiciDO  to  nagloet  thia 
moat  important  branch  of  hia  odocation.  Sandy,  it  ia  as 
otaential  to  teat  wbothor  a  aindont's  knowledge  of  tho 
action  of  remodiea  in  health  and  diaeaae  ia  aoenrate  as  to 
examine  ^im  in  elementary  biolo^  and  in  the  natorml 
hiatory  and  preparmtion  of  dmga.  U  treatment  la  not  to 
be  empirical,  it  aeema  to  me  that  a  knowledge  of  pharma- 
cology ia  abK>lately  naeentiil.  The  aim  of  tSoae  who  have 
been  reaponnble  for  the  edneation  of  medical  atndenta  haa 
been  to  make  them  cultivate  their  reaaoning  qoalitiea,  and 
not  to  tmat  to  memory  alone,  and  pharmacology,  which 
ia  the  Hepping-atone  from  phyriology  to  therapentica, 
ie  an  ezoellent  aabject  for  thia  parpoee. 

Now|  that  laboratoriea  and  ezoellent  teaching  on  the 
aabject  are  provided  in  moat  medical  achoola,  there  ia  no 
ezcoae  for  ite  omiaeion  from  the  examination  ecbedale, 
and  my  hope  ia  that  if  the  Conjoint  Board  doee  not  aee 
proper  to  rectify  what  I  ventare  to  caU  ita  miatake,  the 
Oeneral  Medical  CJonncil  will  atop  in  and  inaiat  apon  the 
inclnaion  of  the  aabject  in  all  examinationa  recogniaed  by 
it. 

I  may  add  that  the  Univeraity  of  Gambridse  haa  for 
i^ara  required  of  all  ita  candidatea  for  medidU  deeieee  a 
knowledge  of  pharmacology  and  therapeatica,  and  that  one 
of  the  papera  in  the  aeoond  part  of  the  Third  M.B.  Exam- 
ination ia  entirely  devoted  to  this  aabject. 

I  am.  Sir,  yoara,  ftc,, 
J.  B,  Bradbubt,  M.D.Gantob., 
DovnioR  Prof,  of  Hed.  in  ths  UoIt.  of  Caaib. 

Cambridge,  Mar.  2Ut,  1896. 


EXAMINATIONS  FOR  THE  DIPLOMA  IN  PUBLIC 
HEALTH. 

To  the  Editor  of  the  Mbdical  Pbbs  aitd  Ciboulaju 

Sib, — Will  yon  allow  me  to  offer  a  few  remarka  for  the 
parpoee  of  farther  comparison  of  variona  examinationa  for 
the  Diploma  in  Pablic  Health  ? 

First,  as  regards  special  regalations  :  - 

University  of  Oxford  :— The  examination  is  only  held 
once  a  year.  There  is  no  regalation  as  to  attending  the 
clinical  practice  of  a  hospital  for  infectioas  diseases,  bat 
candidates  are  examined  on  the  cases  in  the  hospitaL 
Candidates  in  Part  II  mast  send  certificates  showing  that 
their  B.P.H.  work  has  been  done  since  registration  and 
that  their  namea  have  been  on  the  Medical  Reeister  of  the 
United  Kingdom  for  a  period  of  at  least  twelve  months, 
not  merely  that  they  possess  a  registrable  qualification. 

University  of  Cambridge:— A  candidate  must  have 
attained  twenty-four  years  of  age  before  he  preeente  him- 
aelf  for  a  second  part ;  he  must  prodace  evidence  of 
having,  before  or  after  obtaining  a  registrable  qualifica- 
tion, attended  the  clinical  practice  of  a  hospitel  for  infec- 
tious diseases.  No  time  is  fixed,  a  two  months'  course  has 
been  accepted,  but  it  is  safer  to  take  a  three  months'  course 
as  that  is  required  for  the  M.B.  New  regulations  come 
into  force  this  year  increasing  the  time  devoted  to  practi- 
cal work  in  the  examination  and  the  fee  is  raised  to 
£6  6s.  Od.  for  admiseion  or  re-admission  to  each  part. 

University  of  Durham:— The  examination  for  the 
B.P.H.  is  the  same  in  every  respect  as  that  for  the  B  Hy., 
the  degree  is  given  on  payment  of  £6  69.  Od.  ex t'a  to  those 
gentlemen  possessing  a  degree  at  a  recognised  university. 
The  examination  is  not  divided  into  two  parts.  The  can- 
didate must  give  evidence  of  three  months  attendance 
on  the  clinical  practice  and  instruction  at  a  hospital  for 
infectious  diseases  of  not  less  than  fifty  beds,  subsequent 
to  the  atteinment  of  his  first  registrable  qualification.  If 
this  regulation  is  not  altered  it  will  mean,  in  many  cases, 
a  second  attendance  at  such  a  hospital,  as  such  a  course 
is  now  part  of  the  general  medical  education.  The  can- 
didate is  also  requirod  to  pass  an  examination  on  medioU 
clinical  cases  at  the  '*  City  Hospital  for  Infectioas 
Diseases,"  or  elsewhere ;  to  describe  the  construction  and 
nse  of  instrumente  employed  in  meteorology,  hygienic 
pparatus,  and  sanitary  appliances. 


Victoria  University  Diploma  in  Sanitary  Scienee  :- 
The  examination  ia  held  yearly  in  Joly,  in  two  parta. 
candidatea  before  entering  for  either  part  meat  have  held 
for  not  leas  than  twelve  montha  a  regiatrable  qaalificatioo. 
The  lee  for  each  part  ia  £4  4a.,  and  for  any  aabaeqoent 
examination  in  the  aame  part  £2  2s.  No  attendanoa  mt » 
Fever  Hoapital  ia  reqaired.  The  examination  only 
eztenda  over  four  days.  Only  two  houra  ia  allowed  for 
the  written  examination  on  cnemittry,  warming,  veatilat- 
ing,  and  the  nee  of  meteorological  inatrnmento,  and  four 
hoora  for  the  practical  and  or^  examinations  for  the  enme 
snbjecta. 

Royal  College  of  Physicians  of  London  and  Royal 
College  of  Sargeona  of  England  :— The  regulationa  ma  to 
age  and  attendance  at  the  clinical  practice  o!  a  hospital 
for  infectioas  diseases  are  the  aame  aa  thoae  of  the 
Univeraity  of  Cambridge. 

There  is  no  regalation  preventing  a  candidate  rejected  at 
one  place  presenting  hia&self  at  another  in  the  coarse  of  a 
week  or  twa  A  man  may  preeent  himaelf  at  Durham*  mad 
failing,  may  go  to  Cambridge  within  a  fortnight  and  pass  ; 
this  occurr^  at  the  recent  examinations.  Failing;  at 
Durham  late  in  September,  he  might  try  Cambridge  in 
October,  Oxfordin  November,  and  London  early  in  January, 
thas  getting  four  chancea  in  four  montha.  Such  a  state  of 
things  is  calcalated  to  bring  more  discredit  on  oar  preeent 
system  of  examinationa.  The  Conjoint  Boarda  of  Scotland 
recognise  this,  and  do  not  allow  men  to  present  themaelvea 
who  have  been  rejected  elsewhere  during  the  previooe  six 
months. 

Regalations  of  the  Conjoint  Boards  of  Scotland  : — 

This  mast  meaa  at  least  150  boors  in  a  chemical  labora- 
tory, and  another  150  hours  in  other  laboratoriea  ;  cer- 
tainly none  too  much  for  the  work  mentioned  in  their 
synopsis  of  the  snbjecte  of  examination,  which  I  ask  yon 
to  pnoltsh  as  worthy  of  imitetion. 

Synopsii  of  the  Subjects  of  Examination. 

First  Examination. 

L  The  Laboratory  work  shall  embrace  the  followine  : — 

1.  Analysis  of  Air — ^Temperature,  Pressore,  Humidity, 
Carbonic  Acid,  Ozone,  Micro-organisms,  Organic  Matttt:, 
Noxious  Emanations. 

2.  Analysis  of  Water  for  Drinking  Purpoees,  including 
qualitative  and  quantitative  estimation  of  total  solida 
(Lime,  Magnesia,  Chloiidee,  Sulphatee,  Nitratea  atnd 
Nitritee,  Ammonia,  and  Lead),  and  loss  on  ignition  ctf 
solida— determination  of  Hardness,  of  Organic  Imparities, 
and  of  Acidity  and  Alkalinity— Physictu  and  Biologicsd 
Examination. 

3.  Examination  of  Foods — Milk,  Batter,  Margarine, 
Flour,  Bread,  Starchy  Foods,  Sugar,  Honey,  Butoher 
Meat,  Fish,  V^Ubles,  &c. 

4.  Examination  of  Beverai^es — Tea,  Coffee,  Cocoa,  Al- 
coholic Bevera^ee,  Aerated  Watera,  Ac 

5  Examination  of  Condimente— Salt,  Pepper,  Mustard, 
Vinegar,  and  Preserves,  &c. 

6.  Gases,  their  Physical  and  Chemical  Properties — 
Anemometers,  Manometers,  Barometers,  Thermometers. 

7.  Detection  of  Poisons  in  articles  of  dress  and  decora- 
tions. 

8.  Sewage — Analysis  of  Sewage  and  Effluente  after 
treatment,  and  Chemistry  of  Sewage  treatment. 

9.  Soils— Temperature,  Humidity,  Permeability,  Chenu- 
cal  Composition,  Gases  oi  the  Soil,  Micro-organisms. 

10.  Disinfectante  and  Deodorisers— Chemical  examina- 
tion of  the  Materiids,  Determination  of  their  comparative 
power. 

U.  Building  Materials — Chemical  and  Physical  Proper- 
tiea. 

12.  Bacteriology — Micro-organisms  in  relation  to  Epi- 
demic and  other  Diseases. 

13.  Examination  of  Parasites  and  other  Organisms 
infecting  the  Body  and  Human  Food  Stuffs. 

11.  Physics  and  Meteorology : — 

(a)  Physios.— (7aM«^Pres8ure,  Volume,  Temperature, 
Solubility  in  Liquids,  Absorption  of  Solids,  Diffu- 
sion, Movemento  of  Air  in  relation  to  Ventilation^ 
Instrumente  employed  in  relation  thereto. 

Z»9«u28— Effecte  of  Variationa  of  Temperat-ure,  Capil- 
larity, OsfDosis,  Solution,  Vapour,  Preeaore  of 
Liquids,  Movemento  of  Liquids. 


Mab.  25,  1895. 


LITERATURE. 


ThX  MrDIOAL  PBB88.       335 


ElemenU  of  Dynamics  of  Solids  and  Fluids. 
^ea<— Temperature.  Latent  Heat,  Si>ecific  Heat, 
Fusion,  Boiling,  Evaporation,  Radiation,  Ckinduc- 
lion,  Convection. 
On  reference  to  the  examina*  ion  papers  published  by  the 
University  of  Cambridge  and  by  tne  London  Conjoint 
Board,  we  find  that  candidates  nave  only  been  expected 
to  perform  elementary  water  and  air  analysis,  for  which 
they  could  be  easily  coached  up  in  twenty-four  hours.  It 
is  to  be  hoped  that  now,  at  Cambridge,  as  at  least  one  day 
will  be  devoted  to  practical  laboratory  work,  something 
moie  will  be  expected  of  them.  It  is  true  we  do  not  ex- 
pect Medical  Officers  of  Health  to  be  of  necessity  com- 
petent analysts,  but  they  should  at  least  have  such  a 
training  as  would  enable  them  to  understand  and  check 
analytical  reports,  such  training  is,  in  my  opinion,  as 
necessary  for  tnem  as  mechanical  training  is  for  the  En- 
nneer.  The  number  of  men  seeking  enployment  in  the 
Pablic  Health  Service  justifies  the  opinion  that  there  will 
always  be  plenty  who  will  bring  themselves  up  to  the 
required  standard. 

As  regards  the  oral  examination  in  Chemistry  and 
Physics,  there  was  none  at  Oxford ;  but  at  Durham,  there 
was  an  oral  examination  in  each  of  the  following  sub- 
jects :— Chemistry,  Physics,  Bacteriology,  Sanitary  Lc^- 
lation,  Statistics,  Meteorology,  and  the  Practical  Use  of 
Meteorological  Appliances,  £mitary  Medicine,  and  Practi- 
cal Hygiene,  There  were  thus  eight  viva  vove  examinations, 
the  examiners  having  in  most  oases  the  candidate's  written 
paper  before  him.  Such  an  examination  is  most  helpful 
Doth  to  the  examiner  and  examinee,  especially  in  Practical 
Chemistry,  where  the  candidate's  practical  work  is  some- 
times  done  under  great  disadvantage,  working  as  he  does 
in  a  strange  laboratory,  often  badly  equipped,  and  ill- 
adapted  for  examination  purposes. 

•'Out-door  Sanitary  Work."— Candidates  are  usuaUy 
started  out  alone  to  make  the  inspection,  and  afterwards 
return  to  the  Examination  Hall  to  write  their  reports ; 
but  at  Oxford,  last  November,  each  candidate  was  visited 
by  the  examiner,  and  had  a  quarter  of  an  hour's  vivd  there 
and  then.  This  is  a  most  valuable  innovation,  but  one 
which  it  would  be  hardly  possible  to  carry  out  with  the 
large  number  of  men  who  present  themiielves  at  Cam- 
bridge. 

Practical  work  in  Bacteriolo^  appears  to  be  equally 
insist^jd  on,  and  admirably  earned  out  at  all  the  centres. 
The  papers  on  the  other  subjects  speak  for  themselves, 
they  are,  I  think,  fairly  eqnaL  In  some  quarters  there 
appears  to  be  the  opinion  that  more  mathematical  work  is 
xe^uired  at  Cambridge,  and  that  candidates  avoid  Cam- 
bridge in  consequence,  as  a  matter  of  fact  the  lailures  are 
more  numerous,  as  far  as  I  have  been  able  to  ascertain,  at 
other  centres,  and  published  lists  show  that,  whereas  423 
gentlemen  possess  the  Cambridge  D.P.H.,  only  241  have 
that  of  the  tkmjoint  Board  of  London,  and  fewer  men  take 
tbis  qualification  every  year.  I  believe  the  following  to 
represent  the  numbers  of  diplomas  issued,  but  some 
gentlemen  hold  more  than  one  diploma— one  has  registered 
five :— Cambridge  423,  Conjoint  Board  of  London  Sil  (this 
number  does  not  include  the  ten  who  passed  in  January 
last),  Durham  56,  including5C.S.Sc.,36L.S.Sc.,  13B.Hy., 
3  D.P.H.  (two  of  these  were  granted  in  aJtMntia^  so  only 
one  is  registered),  Victoria  37,  Oxford  4  (?)  Then  at 
London  University  20  gentlemen  have  taken  the  M.D.  in 
State  Medidne,  and  7  others  have  been  examined  in 
Public  Health. 

PftMstioal  Chemistry,  Practical  Physics,  and  Practical 
Sanitation  appear  to  me  to  be  the  subjects  meet  neglected 
by  the  two  popular  Examining  Boards,  and  unless  a  more 
tPCTTongh  knowledge  of  sanitary  appliances  is  demanded 
from  future  Diplomates,  they  can  nardly  be  expected  to 
command  the  confidence  of  Sanitary  Inspectors,  whose 
superior  officers  they  should  be. 

I  am.  Sir,  yours,  &c., 

W.  H.  Symons,  M.D.(Brux.) 
60  Holmdale  Road, 

West  Hampstead,  N.W. 
♦ 
MIDWIVES'  BILLS  OPPOSITION  EXPENSES. 
To  the  Editor  of  Tarn  Mkdioal  Pbiss  and  Ciboulab. 
Sib, — ^I  wish  through  your  journal  to  ask  practitioners 
to  subscribe  to  the  above  fund. 


Since  the  first  of  the  five  eo-called  Mid  wives'  Bills  was 
introduced  into  Parliament  in  1890, 1  have  expended,  up 
to  October  25th,  1895,  out  of  my  private  means, 
£321  15s.  9d.  In  1891,  when  I  had  expended  £180,  Dr. 
H.  Woods  established  a  fund  to  repay  my  out-of-pocket 
expenses,  and  so  refunded  me  £50.  In  1893,  Mr.  Colin 
Campbell  started  a  eimilar  fund,  and  so  refunded  me  £30. 
In  1894,  the  Committee  of  the  Lancashire  and  Cheshire 
Branch  refunded  me  £37  Id*.  2d.,  opposite  expenses 
incurred  by  me  in  connection  with  that  Committee. 
The  vouchers  for  the  £180  I  submitted  to  Dr.  Collins, 
Manchester,  those  for  the  £37  13s.  2d.,  to  Dr.  Chamber- 
layne,  Stalybridge ;  while  those  for  the  remainder  were 
submitted  to  Dr.  O'Sullivan,  Southport. 

Thus,  of  the  total  expenditure  only  £117  13d.  2d.  was  re- 
funded up  to  October,  1895,  leaving  me  then  out  of  pocket 
and  liable  for  £204  24  fid.  Since  that  date,  £75  2s.  6d. 
has  been  repaid,  leaving  me  now  £130  out  of  pocket. 

When  the  first  Midwives*  Bill  was  introduced  in  1890, 
the  Mid  wives'  Institute  obtained  no  less  than  £986  in 
subscriptions  and  guarantees,  and  since  then  the  Mid- 
wives'  Registration  Association  has  collected  more.  I 
think  we  also  should  have  a  guarantee  fund.  In  1895 
there  were  27,395  practitioners  resident  in  the  United 
Kingdom,  and  if  each  of  these  gave  a  few  pence,  a  large 
amount  would  soon  be  subscribed. 

It  is  to  be  remembered  that  all  the  Midwives*  Bills 
proposed  to  establish  an  inferior  order  of  singly  qualified 
midwifery  practitioners  who  (as  it  is  not  propcMed  to  make 
it  an  offence  if  any  practised  medicine,  surgery,  or  phar- 
macy and  vaccination)  would  be  if  not  de  jure  de  /ado 
medical  practitioners  also  ;  thus  aiming  at  the  repeal  of 
the  Medical  Act,  1886. 

I  shall  be  glad  to  acknowledge  subscriptions,  and  as 
Mr.  Skewee-Cox,  M.P.,  intends  to  ask  Uie  House  of 
Commons  to  read  his  new  Midwives*  Bill  on  May  6th 
next,  I  shall  be  glad  if  those  in  sympathy  with  our  oppo- 
sition will  help  to  wipe  ofi*  the  above  debt. 

I  am.  Sir,  yours,  &c., 

ROBT.   B.    BSNTOULv 

78  Hartington  Road,  Liverpool. 


JAKOB  S  ATLAS  OF  THE  NERVOUS  SYSTEM,  (a) 

Of  the  many  devices  attempted  in  order  to  attract  the 
medical  reader,  the  system  of  book  illustration,  which  has 
become  so  diversified  of  recent  years,  is  the  meet  remark- 
able. Few  books,  so  far  as  their  letter  press  is  concerned 
can  claim  to  more  than  a  moderate  share  of  originality,  for 
they  simply  repeat  and  reiterate  much  of  what  has  been 
discovered  and  described  before.  Some  books  have  an 
obvious  market  as  soon  as  they  appear,  but  this  can  only 
be  said  of  a  few.  The  book  now  under  consideration  can 
not  be  char|^ed  with  the  crime  of  repetition  or  plagiarism, 
and  except  m  its  latter  part,  it  is  more  given  to  illustra- 
tion than  to  literary  exposition.  It  contains  a  reproduc- 
tion of  results  obtainedf  by  the  author  himself,  represent- 
ing a  large  collection  of  histological  and  macroscopic 
E reparations.  The  atlas  is  almost  entirely  the  work  of 
^r.  Jakob  himself,  and  the  method  adopted  is  as  true  to 
nature  as  illustrations  can  be.  By  means  of  superimposed 
layers,  which  are  movable  one  from  another,  the  anatomy 
of  the  brain  can  be  etudied  as  if  it  were  being  done  on  the 
actual  specimen  in  the  post-mortem  room,  with  ^is  difler- 
enoe,  however,  that  some  of  the  names  of  parts  areprinted, 
and  very  little  additional  reading  is  required,  llie  sub- 
ject of  pathology  and  therapeutics  dealt  with  in  the  last 
section  of  the  work  is  succinct,  but  some  of  its  statements, 
especially  in  the  domain  of  therapeutics,  are  unnecessarily 
brief.  A  short  chapter  ie  given  on  anatomy  and  physio- 
loS7>  ^^^  h^ra  "^  there  is  a  brevity  which  is  perhaps 
worse  than  a  too  copious  description,  and  the  attempt  to 
define  the  tract  of  tne  will,  considering  how  much  the  fact 
of  the  existence  of  a  will  is  in  dispute  at  the  present  time, 
is,  to  say  the  least,  hazardous.  These  drawbacks,  not- 
withstanding, the  coloured  plates  are  sufficient  in  them- 


(a)  '*  An  AtlM  of  the  Normtl  aad  Pathological  Nenrons  STitenu." 
By  Dr.  ChrUtfried  Jakob.  TranaUtod  by  J.  GoIUni,  M.D.  Loodon  : 
BaiUitee,  TindaU,  A  Cox.  Kew  ITork :  Wood  A  Co.  1890.  With  7S 
platM.   Price  10a.  6d. 


336     Thx  Mboioal  1*r«ss. 


LITERARY  NOTFS  AND  GOSSIP. 


Mab   25.  iw»6. 


selves  to  make  the  book  popular,  at  no  other  book  on  the 
sabject  can  boast  of  such  a  wealth  of  illustration*,  or  com- 
pare with  it  in  the  moderate  price  at  which  it  is  issoed. 

Wx  anderstand  that  at  the  next  Convocation  of  the 
University  of  Oiford,  the  degree  of  M.A.  {hmoriit  ctMisd)^ 
will  be  conferred  on  Dr.  J.  A.  H.  Murray,  editor  of  '*  The 
;^ew  English  Dictionary." 

**TxoHNic"  is  the  latest  ortho|n;aphical  barbarity  with 
which  a  medical  journal,  published  in  Philadelphia,  embel- 
lishes its  pages.  Presumably  the  editor  means  "tech- 
nique," •,• 

Turn  formation  of  the  library  of  the  New  York  Academy 
.of  Medicine  was  begun  in  1847,  and  now  contains  33,100 
volumes  and  13,000  pamphlets.  The  medical  department 
.of  the  public  library  of  Boeton  was  founded  in  1882  and 

now  includes  19,600  volumes. 

•  * 

The  editorship  of  the  Annals  of  Surgery  has  just  under- 
gone some  modification.  Instead  of  the  names  of  four 
.editors  appearing  upon  the  cover,  there  are  now  only 
three,  namely,  those  of  Dr.  MacEwen,  of  Glasgow  ;  Dr. 
White,  of  Philadelphia  ;  and  Dr.  Pilcher,  of  Brooklyn. 
The  London  editor  has  passed  out  of  the  list. 

Wk  hear  that  it  is  the  intention  of  Mr.  Noble  Smith  to 
discontinue  theiEsueof  Cliniccd  Sketches  after  the  present 
number.  This  monthly  has  appeared  regularly  for  rome 
time  past,  first  as  a  shilling,  then  as  a  sixpenny  journal, 
i>nt  support  hae  not  been  forthcoming  from  the  profession 
that  the  enterprise  of  its  editor  deserved,  and  we  regret  to 
Jbave  to  record  its  decease.    *»* 

Thx  Photogram  for  March  contains  an  article  bearine 
the  somewhat  awkward  title  ^'Stereophotomicrograms.'' 
The  term  is  a  new  one,  which  has  been  applied  to  a  new 
procees  for  lighting  microscopic  objects  in  micro* photo- 
eraphy,  by  which  the  objects  are  shown  up  in  bold  relief. 
Mr.  lies,  the  inventor,  not  content  also  with  merej[y 
finishing  his  transparencies  in  monotone,  has  worked  out 
A  process  of  local  toning,  which  in  his  hands  has  yielded 
excellent  results.  *«* 

Dr.  R.  B.  Wild,  Assistant  Lecturer  on  Materia  Medica 
and  Therapeutics  in  the  Owens  College,  has  been  awarded 
the  Parkin  Prize  for  his  essay  on  "  Charcoal  as  a  Thera- 
peutic Agent."  The  prize,  which  is  of  the  value  of  one 
hundred  pounds,  and  is  open  to  competitors  of  all  nations 
is  offered  triennially,  for  the  beet  essay  on  some  subject 
connected  with  medicine,  in  terms  of  a  bequest  made  to 
the  Royal  College  of  Physicians  of  Edinburgh  by  tbe  late 
Dr.  PaJkin.  %• 

Wb  have  received  a  copy  of  the  first  number  of  the 
Intercolonial  Medical  Journal  of  Jiutralasia,  a  monthly 
periodical  which  has  arisen  out  of  the  amalgamation  of  the 
Intercolonial  (Quarterly  Journal  of  Medicine  and  Surgerywith 
the  Auitralian  Medical  Journal,  Dr.  David  Grant,  oi  Mel- 
bourne, is  the  Editor-in-chief,  and  with  him  are  associated, 
editors  for  each  of  the  other  colonies  concerned  in  the 
.  enterprise.  The  first  number  is  certainly  a  good  one,  the 
.  contents  being  varied,  and  of  a  high  class  description.  We 
wish  this  journal  every  success. 
♦  • 

Among  forthcoming  literary  ventures,  Messrs  Wright 
and  Co.,  of  Bristol,  announce  for  publication  in  May  a 
*<  Text- Book  of  Histology,"  with  176  coloured  figures. 
Messrs.  Churchill  announce  for  publication  in  book  form 
the  Lectures  recently  delivered  at  the  Royal  College  of 
Burgeons,  England,  by  Prof.  Hill  on  "  Cerebral  Pressure 
and  Cerebral  Circulation."  Messrs.  Bailli^re,  Tindall,  and 
Cox  announce  the  second  of  the  <*  Hand-Atlases,"  with  78 
plates,  mostly  in  colours,  entitled  "  The  Normal  and  Patho- 
logical Nervous  Systems,"  by  Professors  Jakob  and  Striim- 
pell,  translated  by  Dr.  J.  Collins,  and  a  new  work  on 
"Dental  Surgery,"  by  Mr.  Woodbum." 

With  reference  to  our  recent  remarks   on   American 
piracy  of  English  authors,  Messrs.  Lea  Brothers,  pub- 
lishers, of  Philadelphia,  write  us  that  the  "  '  New  System 
.  of  Surgery  by  American  Authors '  is  not  a  plagiarism,  U&e 


names  of  the  contributors  to  chat  work  being  a  sufficient 
guarantee  of  honest  authorship."  They  add  that  the  sale 
of  the  work'*  was  forbidden  in  Great  Britain  because  of 
the  inclusion  of  a  few  illustrations  from  English  works, 
which  were  redrawn  and  re-engraved  for  use  in  the 
'American  System  of  Surgery.'"  In  justice  to  Messrs.  Lea, 
it  affords  us  pleasure  to  give  space  to  their  explaaation, 
but  we  have  it  on  good  authority  that  plagiarism  did  not 
stop  at  "  a  few  illnstrationa" 
•  • 

Thb  new  issue  of  Kell>'s  London  Medical  Directory  for 
1896  shows  the  further  accumulation  of  details  which  is  a 
sure  sign  of  vigorous  growth  One  or  two  suggestions 
may,  perhaps,  be  permitted  as  to  future  editions.  In  a 
casual  survey,  we  have  come  across  the  names  of  men 
long  pinoe  dead,  besides  frequent  cases  of  inaccurate  de- 
scription. For  instance,  the  senior  surgeon  of  a  leading 
hospital  is  described  as  "MR.C.S  1862,  L.S.A.  1862,^' 
which  would,  if  correct,  disqualify  him  for  the  post. 
Would  it  not  be  well  to  revise  such  entries  from  other 
available  sources  of  information  ?  The  Directory  would  be 
a  presentable  and  convenient  volume  for  all  who  want  a 
London  reference  to  medical  men.  but  for  these  preventible 
errors  **• 

Mr.  Ernsst  Hart  has  just  published  a  new  edition,  the 
second,  of  his  well-known  work,  <*  Hypnotism,  Mesmerism, 
and  the  New  Witchcraft."  The  book,  he  tells  us  in  the 
preface,  had  been  for  some  time  out  of  print,  and  he  had 
not  intended  to  republish  it  because  of  the  more  or  lees 
ephemeral  interest  of  its  contents.  However,  he  found 
that  a  considerable  demand  for  it  still  existed,  and  he 
came  to  the  conclusion  that  a  new  edition  should  be 
brought  out.  This  was  a  wise  decision  to  have  arrived  at, 
for  there  is  no  publication  of  the  kind  which,  in  a  small 
compass,  gives  so  good  an  account  of  hypnotism  as  that 
under  discussion.  It  is  a  book  which  everyone  interested 
in  the  subject  should  not  fail  to  read. 

Mr.  Clat,  of  Edinburgh,  has  just  published  a  transla- 
tion of  Unna's  "  Diseases  of  the  Skin,"  by  Dr.  Norman 
Walker,  and  a  new  edition  of  Byrom  Bramweirs  *'  Dis- 
eases of  the  Spinal  Cord."  Messrs.  F.  A.  Daviee  k  Co.,  of 
Philadelphia,  have  sent  us  a  new  edition  of  Shoemaker's 
"  Materia  Medica  and  Therapeutics.'*  Messrs.  J.  k  A. 
Churchill,  "  The  Theory  and  Practice  of  Hyeiene,"  founded 
on  the  well  known  woik  of  the  late  Dr.  Parkes,  by  Messrs. 
Notter  and  Lane.  Messrs.  Ke^^an  Paul  &  Ca,  "  The  Dia- 
gnosis and  Treatment  of  Skm  Diseases,"  by  Dr.  Van 
Harlingen.  Messrs.  Sampson,  Low  k  Co.,  the  fourth 
volume  of  *'  Twentieth  Century  Practice,"  Messrs.  Long- 
mans, ATranslntion  of  Angelo  Mosso's  "Fear,"  and  Messrs. 
Wright  k  Co.,  "The  Medical  Annual  for  1896." 

New  Books  and  Nbw  Editions. — ^The  following  have 
been  received  for  review  since  the  publication  of  our  last 
monthly  list :— Text-Book  ot  General  Pathology  and  Patho- 
logical Anatomy,  by  Prof.  R.  Thoma,  of  Dorpat,  translated 
byAlex.Bruce,  M.D.,F.R.C.P.Ed.  Traumatic  Infection,  by 
C.  B.  Lockwood,  M.D.,  F.R.C  S.  Deaf-Mutism,  A  Clinical 
and  Pathological  Study,  by  J.  K.  Love,  M.D.,  and  W.  A« 
Addison,  A. C.  P.  Handbook  of  the  Diagnosis  and  Treatment 
of  Skin  Diseases,  by  A.  Van  Hariingen,  Ph.B.,  M.D.Tale.  A 
Practical  Treatise  on  Materia  Medica  and  Therapeutics, 
by  John  V.  Shoemaker,  M.D.,  LL.D.  Aseptic  Surgery,  by 
C.  B.  Lockwood,  F.R.C.S.  The  Schott  Methods  of  Treat- 
ment of  the  Chronic  Diseases  of  the  Heart,  by  W.  Bezley 
Thome,  M.D.  A  Hand- Book  of  Leprosy,  by  S.  P.  Impey, 
M.D.  Manual  of  Practical  Anatomy,  oy  I).  J.  Cuming 
Hart,  M.D..  LL  D.,  F  R.S.,  vol.  I.  Report  of  the  Scientific 
Study  of  the  Mental  and  Physical  Conditions  of  Child- 
hood. Transactions  of  the  Obstetrical  Society  of  London, 
vol.  xxxvii.  Twentieth  Century  Practice,  edited  by  Thoe. 
L.  Stedman,  M.D.,  voL  iv.  Histopathology  of  Diseases  of 
the  Skin,  by  Dr.  Unna,  translated  by  Norman  Walker, 
M.D.,  F.R.C.P.Ed.  Youthful  Eccentricty  a  Precursor  of 
Crime,  by  Forbes  Winslow,  D.CLuOxon,  M.B.  Fear,  by 
Angelo  Mosso,  translated  by  Messrs.  Loueh  and  Keisow. 
The  Medical  Annual  and  Practitioners'  Index  for  1896. 
Appendix  to  the  Catalogue  of  Specimens  in  the  Royal 
College  of  Surgeons  of  £ngland.  Researches  into  the 
Anatomy  and  Pathology  ot  the  Eye,  by  E.  Treacher 
Collins,  F.R.C.S.  Colour- vision  and  Colour-blindness,  by 
J.  Ellis  Jennings,  M.D« 


Mael  25,  1896. 


MEDICAL  NEWS. 


The  Medical  Pbbss.     337 


APENTA    (APEBIENT)    WATEE. 

By   CHARLES  R.    C.    TIOHBORNE,  P.LC,   F.C.S., 

IMp.  in  Pnblie  Health  and  JL&.G.S  L :  Analyrt  to  tbe  Coanty  of 
Longford ;  Author  of  *'  Mineral  Waten  of  Europe,"  Ac. 

The  Apenta  Water  was  sabmitted  to  oarefal  analyBis, 
and|tbe  figures  given  below  represent  the  composition  of 
this  water  as  tattled  by  the  Uj.  Hunyadi,  Ckimpany 
Limited,  at  the  Uj.  Hanyadi  Springs,  Bada  Pest. 

Apenta  Water  belongs  to  tnat  large  dass  of  aperient 
waters  which  come  from  the  neighbourhood  of  Buda  Pest, 
commonly  known  under  the  generic  name  of  Hunyadi, 
such  as  Hunyadi  Mattyas,  Hunyadi  Janos,  Hunyadi  liajos, 
Honyadi  Ferencz,  Hunyadi  Alajos,  kc. 

We  learn  that  tiie  Uj.  Hunyadi  Springs,  from  which  the 
Apenta  Water  is  drawn,  have  been  pla^  under  the  con- 
trol of  the  State  Chemical  Institute  of  the  Ministry  of 
Agriculture  of  Hungary,  and  the  bottling  of  the  Water 
takes  place  subject  to  the  direct  supervision  of  this 
]>epArtment. 

The  writer  examined  this  water  many  years  ago,  and 
finds  that  it  is  constant  as  regards  its  general  character- 
istics This  water,  on  careful  analysis,  gave  the  fo\lowing 
as  its  composition  in  parts  per  10,000  : — 

Parts  per  10,000. 

Biagnesia(MgO)         70*2 

Llme(CaO)      115 

Iron  (FeA)     0  43 

Alumina  (AlaO,)         0*30 

Silica  (SiOa)      032 

Potash  (KaO) 0-45 

Boda(N8,0)     92-45 

LithU(LiaO) ...  020 

Sulphuric  Acid  (S  Os)  25966 

Chlorine  (CI) 1081 

Bromine  (Br) 010 

Carbonic  Acid  (CO,) 3*94 

Fluorine trace 

Ammonia  trace 

When  arranged  and  calculated,  according  to  their 
affinities,  these  results  give  the  following  as  the  composi- 
tion of  the  Apenta  Water  :— 

Gms.  per  Gal.  Parts  per  10,000. 
Magnesia  Sulphate    ...     1474-2  210  6 

Magnesia  Carbonate  ...        12*8  1  '82 

Magnesia  Bromide     ...  085  0*12 

Sodic  Sulphate  ...     1307-9  18684 

Calcic        184-31  -26  33 

Potassic    „      5-92  0  84 

Lithic       „      5-31  075 

Sodic  Chloride  ...      123  80  1769 

Flaorine  traces.  — 

Sodic  Carbonate        ...        33*47  4*78 

Calcic      , 8  20  117 

Ferrous   „      542  0-77 

Ammonia     (free     and 
albumenoid)  tra^pes  0*004  0*0005 

Alumina  210  0*30 

Silica 2*24  0*32 


Totol         (Anhydrous) 
Solids  3166-56 


452  3 


Carbonic  Acid  Gras  not  determined. 

The  above  salts  are  all  estimated  in  their  anhydrous 
eondition,  and  the  carbonates  of  lime  and  magnesia 
directly  determined  in  the  precipitate  obtained  on  boiling. 
Vhis  water  is  practically  free  from  organic  matter,  and 
when  examined  bacteriofogically  with  nutrient  gelatine, 
iseemed  to  act  almost  as  a  preservative  when  placed  in  the 
incubator— rather  than  as  a  carrier  of  germ  life. 

The  Apenta  Water  is  a  strong  purgative  water,  con- 
taining tne  two  valuable  aperient  udts  known  as  £p8om 
«alta  (or  sulphate  of  magnesia)  and  Glauber  salts  (or  sul- 

Shate  of  soda)  in  lai^  proportions,  the  former  prepon- 
erating  in  a  very  markea  degree,  and  thus  giving  to  the 
water  the  right  to  be  styled  a  bitter  water,  and  one 
which  for  the  same  reason  is  most  pleasant  to  the  palate, 
jmd  is  highly  valued  by  the  medical  profession.  The  result 


is  a  purgative  combining  a  secretion-promoting  and  peri- 
staltic action. 

The  tumbler  (10  ozs.)  of  this  water  would  contain — 
Purgatives.  Antacids.  Salines. 

370  grains.  3*6  grains         8*5  grains. 

This  Apenta  water,  however,  possesses  special  pro- 
perties which  are  found  combined  in  very  few  natural 
mineral  waters,  and  which  specially  marks  it  out  for  the 
treatment  of  gouty  patients. 

First  amount  these  peculiarities  is  the  large  amount  of 
lithia,  which  is  almost  unique  amongst  strong  purgative 
waters.  The  Uthia  sulphate  was  directly  eetimateoT  after 
separating  it  by  alcohol.  It  is  also  markedly  chalybeate, 
although  not  excessive  in  astringent  properties. 

When  examined  with  litmus  paper,  it  shows  a  faint 
acid  reaction,  due  to  free  carbonic  acid.  On  boiling  this 
off,  it  is  found  to  be  alkaline,  chiefly  from  the  presence  of 
sodium  carbonate.  This  alkalinity  is  a  most  desirable 
adjunct  to  a  water  of  this  character.  The  presence  of 
a  small  proportion  of  bromine  is  of  some  therapeutio 
value. 

To  sum  up  my  remarks  apon  the  Apenta  water,  we  may 
pay  that,  taken  as  a  whole,  we  could  hardly  wish  for  a 
more  happy  combination  for  a  strong  aperient  water,  both 
for  genercd  use,  and  as  a  special  remedial  agent.  From  a 
bacteriological  point  of  view,  it  is  everything  that  can  be 
desired. 


JStbttal   c^tD0. 


Pasteur   International    Memorial. 

A  HBETiNo  of  the  Provisional  Committee  of  the  British 
Secdon  of  the  Pasteur  International  Memorial  was  held 
in  London  on  Friday  last  at  the  Royal  Society's  Rooms, 
Sir  Joseph  Lister  in  the  chair.  It  was  unaniniously 
decided  to  apply  for  subscriptions  towards  the  erection  of 
a  monument  to  Pasteur  in  Paris  from  persons  in  the 
United  Kingdom,  India,  and  the  C!olonies  interested  in 
science  and  the  various  industries  which  have  benefited  by 
Pasteur's  labours.  An  Executive  Committee  was  formed, 
consisting  of  Sir  Joseph  Lister,  Sir  John  Evans,  Sir  Henry 
Roecoe,  Dr.  Thome  Thome,  and  Professor  Percy  Frank- 
land  (hon.  secretary).  Subscriptions  can  be  sent  to  Sir 
John  Evans,  who  will  act  as  hon.  treasurer,  at  the  Royal 
Society,  Burlington  House. 

Belgrave  Hospital  for  Children. 

Last  week  a  special  meeting  of  the  €k>vemors  of  the 
Belgrave  Hospital  for  Children  was  held  at  Grosvenor 
House  to  consider  the  question  of  rebuilding  the  hospitaL 
Sir  John  Tillev  (Vice-President)  occupied  toe  chair.  Dr. 
Farquharson,  M.P.,  moved,  *'  That  it  is  desirable  that  the 
hospital  should  be  reconstituted  as  a  Hospital  for  Chil- 
dren in  South  London."  O>lonel  Hay  garth  seconded.  The 
Rev.  R.  D.  Storr  moved  as  an  amendment  that  the  hospi- 
tal should  be  reconstituted  in  its  present  neighbourhood, 
and  this  Mr.  H.  Porter  seconded.  After  some  discussion 
the  amendment  was  carried  by  38  votes  to  25.  A  further 
resolution  was  then  carried  appointing  a  Committee  to 
reconstitute  the  hospital  in  its  present  neighbourhood,  and 
the  proceedings  came  to  an  ena. 

Society  of  Apothecaries  of  London. 

The  following  candidates  passed  during  March,  1896, 
in : — 

Suigery.-F.  L.  Angior,  H.  Clapham  &.  Goulden,  A.  J.  Hayes.  T. 
Jones*  C.  H.  N^lcbolson,  W.  A.  Pierce,  W.  J.  Woodman. 

Medidne^Porensic  Medicine,  and  Midwifery.— E.  C.  Hope,  3.  Lang- 
ton,  J.  Winder. 

Medicine  and  Forensic  Medicine.— F.  L.  Angior,  P.  0.  HIgglns. 

Medicine  and  Midwifery.— A.  Hilton,  J,  M.  A.  Lamb. 

Medicine.— H.  H.  Monckton,  A.  Kobioson,  D.  D.  Stewart,  T.  W. 
Wakem.  W.  B.  Welch. 

Forensic  Medicine  and  Midwifery.— W.  O.  Piper. 

Forensic  Medidnc^B.  Gonlden. 

Midwifery.— D.  A.  Main,  8.  E.  H.  Martin. 

To  Messrs.  Coulden,  Jones,  Lamb,  Stewart,  Welch,  and 
Winder  was  granted  the  diploma  of  the  Society  entitling 
them  to  practice  medicine,  surgery,  and  midwifery. 
Enabling  the  holder  to  compete  for  medical  appointments 
in  the  Army,  Navy,  and  Indian  Service,  also  for  Poor-law 
appointments. 


338     Thb  Midioal  Pkbbs 


NOnCES  TO  CORRESPONDENTS. 


Mar.  25.  1896. 


^oiktB  to 
goncsponbents,  ;Short  %ttttVB,  &c. 

Cir  COBBBVOMDim  raqvlring  a  rapljr  In  this  eoliiiiiii  an  pi 
tkmlarlj  reqaaitod  to  make  we  of  a  dftttntttm  fifffuHun  or 
and  aTold  the  praotlee  of  tlgDlng  thomaalrei  "  Baader,"  " 
'*  Old  Sobioitber,"  dko.    Mnbh  oonfniloa  wUI  be  apand  bf 
to  thli  rale. 

BVADiHO  Cms.  -  Cloth  board  caaei,  gilt-lettered,  oontafadnffeirentsr- 
ilx  itrlngs  for  bolitlog  the  nambert  of  TBI  MBDICAL  Pu8S  AKB 
CiROULAB,  maj  DOW  be  had  at  either  offlce  of  thia  Journal,  price  St.  <id. 
Thete  catei  will  be  foand  Terj  nsefnl  to  keep  each  weekly  number 
Intact,  clean,  and  flat  after  It  hai  paaaed  tbroogh  the  post 

Local  Bipoe«  avd  Nbwb— Ck>rrespondents  destrons  of  drawing 
attention  to  these  are  reqnested  kindly  to  mark  the  nawspapsts  whan 
sending  them  to  the  Iditor. 

INTEANATIONAL  PBBIODICAL  CONORE^  OF  OTNiBOOLOOY 

AKD  OBrriTBTCB. 

To  (JU  EdUor  o/THI  MBDICAl  Pans  AND  ClBOULAl. 

BIB.— I  regret  to  Inform  yoa  that  Prof.  Vnlliet,  Prseldent  of  the 

International  Gongrrss  to  be  held  at  Geneya  in  ^^ptember,  died  last 


I  am,  Sir,  yonrs,  Ac., 


LlITH  NAPin. 


March  19th.  189e. 

Dr  J.  8b  AW  Macksszis's  paper  on  "  The  Prognosis  of  Syphilis  "  is 
marked  foresrly  isaertion. 

STUDENT.^Speelal  classes  are  giren  to  nrepare  for  the  Preliminary 
gdentlflo  Examination  of  the  LiNidon  UniTorsltf  at  the  UniTsrsity 
Tatort«l  College,  Red  lion  Sqnare,  W.C,  Ton  can  obtain  all  informa- 
tion from  the  Principal,  Mr.  Briggs. 

A.  D.  8.— We  are  qnlte  unable  (and  are  otftUnly  unwilling)  to 
pnretit  the  lay  papers  qu'^ing  from  our  columns  arttdes  of  general 
interrst  White  we  ayoid  aa  f  ar  as  possible  gMog  undue  prominence 
to  indiTldoals  there  are  occasions  on  which  to  abstain  fhMn  "naming 
the  name  *'  would  be  to  taka  the  point  out  of  our  remarks. 
8HAM    OT8TKR9. 

ONI  might  imagine  that  shell-flsh  would  be  about  the  last  edible  to 
sttract  the  adulterator's  attention,  yet  we  are  credibly  informed  that 
a  Frenchman  is  now  manufacturing  avtillcial  oysters  which  are  so 
natursl,  both  in  appesranoe  and  tsste,  that,  unleas  they  are  subjected 
to  a  chemical  tes^,  they  cannot  be  distinguished  from  oennine  ones. 
Natural  shells  are  used,  and  after  having  been  ftUed  with  certain  sub- 
stances, they  sre  fastered  together  with  islnglsss  and  immersed  in  a 
llonor  that  speedily  eoT^rs  them  with  s  thin  silicate  deposit.  These 
iham  ovsters  are  being  »'  Id  freely  in  Paris,  at  a  price  greatly  below 
that  which  is  charged  for  blue-points. 

STUDBKT.-We  should  advise  our  correspondent  to  take  no  further 
BoMce  of  the  Incident. 

Z.  v.— Stammering  is  usually  a  rpmediaMe  functional  hrregularity, 
eapeciall}  so  when  It  is  dependent  upon  spasmodic  contraction  of  the 
diaphragm  or  a  want  of  co-ordination  between  the  Tarious  factors  of 
MtlcQiate  speech.  Stammering,  hownver,  must  not  be  confoanded 
with  hesitation,  which  is  a  psyohloal  phenomenon  leas  amenable  to 
training.  Mr.  Bmll  Behnlce.  of  18  Earl's  Court  Square,  a  W.,  inUr  alia 
undertakes  the  cm  e  of  thts  distressing  condition. 


^ftcctJttQB  of  ^mttks,  fectttrce,  *c 

WgDNHDAT,  March  ssth. 

DKBMAXOLOGIOALSOOnTTOFORSATBBnAni  AlTD  lB>LAB]>.-6p.m., 

Dr.  Eddowes :  Wartt  on  the  Feeiw     Dr.   Sarill :    Morphaaa  Nigra. 
Cases  by  Dis.  Abraham,  Eddowes,  and  others. 

80CIBTT  OF  AR1S.-8  p.m.  Prot.  J.  Long:  Our  Food  Supply,  as 
Affected  by  the  Farming  of  the  Future. 

HUHTERIAN  Sochtt.— Clinical  Evening  (Uving  Caaes).  Dr.  Arnold 
Chaplin :  Bronchiectasis  treated  by  Creasote  Inhalations.  Mr.  H.  P. 
Dean :  loiniy  to  Elbow  in  a  Child.  Cases  have  been  promised  by 
several  otJier  Fellows. 

RotalCollsobofSurobons.— 5  p.m.  Frot  J.  A.  Contts:  Infantile 
Syphilis. 

Friday,  March  27th. 

CUBICAL  SOCIBTT  OF  LoBDOV.— 8.80  p.m.  Dr.  F.  J.  Smith  and  Mr. 
Bidwell :  A  Case  of  Tubercular  Kidney.  Mr.  Mayo  Robson :  A  Series 
of  Cases  of  Enterectomy,  with  Remarks  on  the  various  Methods  em- 

Jloyed  in  Securing  Union  of  Divided  Kdgea  of  the  Hollow  Viacera. 
Ir.  L.  A.  Dunn  :  A  Caae  of  Sncceaafol  Suture  of  a  Daodenal  Ulcer. 
Mr.  R.  J .  God  ee :  Two  Caaes  of  Acute  Abscess  of  the  Liver. 

ROTAL  CuLLBQB  OF  SURO&OMS. -  5  p.m.  ProL  J.  A.  Coutts :  Infantile 
Syphilis. 


^ticnnazB. 


Anooats  Hospital,  Manchester.— Resident  Junior  House  Surgeon. 
Salary  £60,  with  board  and  washing.  Appllcstlons  and  teacimo- 
niab  to  the  Seeretaiy  on  or  before  March  Slat, 

Bradford  Infirmary.— Dlapenaary  Surgeon.  Salary  £100  per  annum, 
with  board  and  residence.  Also  Junior  House  Burgoen,  Salary 
£60  per  annum,  with  board  and  residence.  Both  candidates  m  ust 
be  single.  Applications  and  teatimonials  to  the  Secretary  on  or 
before  March  80th. 


City  of  London  Hnsnital  for  Dissisa  of  the  Chest,  Victocta  Park.  E. 

— Pathologiat.   Salary  100  guineas  per  annum.    AppHcatloaa,  witb 

testimonials,  to  the  Secretary  not  latar  than  April  0th. 
ConuMea  Asylum.  Carlisle.-  Junior  Medical  Assistant    Salary  £80  per 

annum,   with  board.    Applications,  with  testtanonlals.  to  Dr. 

Campbell,  Garlands,  CarUsie,  on  or  before  March  fSth. 
Donegal  District  Lunatie  Asylum.— Assistant  Medloal  Ofllcn.     Salary 

£100  per  annum,  with  fumlahad  apartment^  board,  waiiilng,  Ac. 

(See  advert.) 
Dundee  Royal  uinatle  Asylum.- Assistant  Medical  OfB#r.    8^0 


£100  per  annum,  with  board,  lodging,  *c 
montala  to  Dr.  Rorie  at  Asylum  on  or  before 


Appllcatlooa 
B  4th  April. 


and  I 


London  Lock  HospitaL- House  Surgeon,  Male  Hosplial.  Salary  £60* 
with  board,  lodging,  and  washing.  Also  Assistaal  Surgean, 
Female  Hospital,  Harrow  Road,  with  board,  lodging,  and  wasfalnc- 
Appllcatlona,  with  testimonials,  to  the  Secretary,  not  later  than 
March  80th. 

Sunderland  Infirmary.— House  Surgeon.  Salary  £80,  rising  £10 
snnually  to  £100,  with  board  and  residence.  AptfMeatlons.  wttlr 
testlmoniids,  to  the  Chairman  of  the  Medical  Bom  on  or  beforw 
April  2nd. 

University  Collrge,  Briatol— numlty  of  MedicineL— Medical  Tutor. 
Satary  £125.  Applications  and  testimonials  to  the  Dean  not  lator 
than  March  SUt. 

Woroeater  General  Infirmary.— Assistant  House  Suiireou  and  Dia 
penser  (nnmaniedX  Salary  £70  per  annum,  with  board,  xesldenoa, 
and  washing.  Application*,  with  teatimonials,  to  the  Sceretarj 
on  or  before  Mar^  80th. 

Yoric  Dispensary.  -  Reside  t  Medloal  Ofllcer  (onmarriedX  Salary  £190, 
wi'h  furnished  apartments,  coala,  and  gas.  Applioatioos  an  *  ' 
monlals  to  W.  Draper,  Esq.,  De  Grey  House,  York,  not  lati 
March  81st 


Ollloar 


Hopkins,  W.  K.,  M.R.C.S.frng.,  L.R.C.P.Lond.,  Senior  House  Surgeon 

to  the  Western  (Jent-ral  Dispensary,  Manlebone. 
JOLLT,  8.  A.,  L.R.O.P.,  L.ft.C.8.Edin  ,  lLF.P.&Glaai|.,  Medical 

for  the  Acton  Sanicaiy  LMstrict  of  the  Brentford  Union. 
J0BB8,  W.  B ,  M.  D.;  b.^.  ond.  Physician  to  the  Bathing  btablla 

at  TJangammarch  Weils,  Central  Wales. 
JoNBs.  R  f:,  LR  C.P.,  L.H.o.*I.Ed.,  Deputy  Medical  Officer  for  tli» 

>o.  1  District  of  the  Llandovery  Union. 
Kino.  H.  D.,  M.D ,  BJScBd.  Medical  Ofllcer  to  the  St.  Leonard's  Hoa^ 

pital,  Sudbury. 
MAOKBNZB,  J.,  L.R.aP..  L.R  C.8.Ed.,  L.F.P.S.,  Glasg.,  Medical Offloer 

for  the  Parish  of  Klrfeb»-in-A8hfield,  Notts. 
MAflOB,  W.  J.,  L.R.C.P.Bd.,  M.R.C.S.,  Medical  Officer  to  the  St. 

Leonard's  Hospital,  Sudbury. 
MlssniR,  A.  F.,  L.R.C.P.Lond.,  M.R.aS.,  Medical  Officer  for  the 

Belton  Sanitary  District  of  the  Thome  Union. 
PORBBLL,  R.,  J.P..  M.D.St.And.,  M.R.C.8.,  L.8.A  ,  Medical  Ofltoer  of 

Health  for  WellsL  Someraet. 
Rna«BLL,  J.  R.,  M.D.Bdin.,  M.R.C.P.Lon  t..  Pathologist  to  the  Bational 

Hospital  for  the  Paiulysed,  vice  Dr.  W.  8.  Oolman  appointed 


8ANDBRS,  C,  M.B.Lond.,  M.R.C.S.Bug.,  Medical  Officer  f6r  the  Weat 
Ham  Diatrict  of  the  London  and  luilla  i»cks. 

SORLBT,  J*.  M.B..C.M.Ed.,  Senior  AssisUns  Medloal  Oflkw  to  tko 
Sheffield  Workhouse. 

THOMAS,  F.  W.,  M.R.aS  ,  Medical  Offioer  for  the  Rudiy  Saoitarr  Dia- 
trict. 


§itth8. 


BURflBAlLD.~Mareh  20th,  at  46  Weymouth  Street,  London,  W.,  the 

wife  of  Frederic  F.  Boighard,  M.S.Lond.,  F.R.aS.,  of  a  son  (stUl 

bom). 
FUCK.- March  14th,  at  80  High  Street,  High  Wyoombe,  tha  wife  of 

wiillnm  Fleck.  M.D.,  of  a  daughter. 
PIN00TT.-Marchl4th,  at  Calverley  Parade,  Tunbridge  Wells,  the  wile 

of  James  C.  i  IncoM,  lk.R.O.S.,  L.R.C.P.,  dtc.,  of  a  daughter. 


^ttUqtB. 


PiBRSB—RicB.— March  16ih  (by  special  dispensation  from  the  Holy 
See),  at Stw  John's  Church,  Tralee,  by  the  Rev.  M.  McCarthy,  P.P., 
Caoaeway,  asslated  by  the  Rev.  J.  Crowley,  CO.,  Tralee.  Gerard  J, 
Plerae,  M.D  ,  B  Ch.,  B.A.a,  RU.I.,  Mecnophane,  Causeway,  oo. 
Kerry,  to  AUen  Mary  youngest  daughter  of  the  late  Mr.  Justice 
D.Rlce,  Busbmount,  co  Kerry. 


9tatfc». 


BRABAZON.— March  18th,  at  Darlington  Street,  Bath,  Anthony  Beaufort 

Brabason,  M.D.Aberd.,  aged  74. 
Gatnob.-  March  17th.  at  16  Upper  Pembroke  Street,  DubUn,  John  J. 

Gaynor,  M  D.,  eldest  son  of  the  late  James  J.  Gsynor,  Esq.,  J.P^ 

Roxbotough. 
J0NB8.— Ms«eh  20th,  at  Bhrewsbnry,   Thomas  J.  Jones,   MJl.C.B^ 

L.R.C.P..  sged  88. 
MABYiLLB.— March  14th.  at  Castellaln  Road,  W.,  B.  B.  Manvlllo 

M.B.C.S.,sged6L 
Mtlbb. -March  14th,  at  Colehln.  co.  Longford,  Dr.  Henry  O.  Mylea, 

Medical  Officer  Abbeyshmle  Dispensary  Distriot,  aged  88. 
WiLLAHS.— March  nth,  at  Mentone.  William  Henry  WlUaaa,  L.R.aP. 

Load.,  and  M 3.C.S.Eng.,  sged  61. 

NOTICE— A 'nurufC'iHenut  oj  J.irthM,  MarriagM^  and  Deaths  in  tha 
familiM  o/  Subreribert  to  thig  JtAtmal  art  ituerted  /r««,  and  fnuBt 
riceA  th^  publuhftrt  notlaUr  than  the  Mondat;  preeedinif  pubUeatictL, 


lb  ^tAiml  ^tm  mA  €ivmUt 


*'SALUS    POPULI    SUPREMA    LEX." 


VouCXIL 


WEDNESDAY,    APRIL    1,    1896. 


No.  U. 


©rignml  (SLommmnactions. 


NAUHEIM 

AND  THE  SCflOTT  TREATMENT  OF 

DISEASES  OF  THE  HEART,  (a) 

By  ROBT.  L.  BOWLES,  M.D.,  F.R.C.P.Loin>., 

CoDiiiltlng  Phyiiciaa  to  the  Folkettooe  HospltaL 

Atteh  referring  to  the  revolatioQ  which  had  taken 
place  in  the  public  mind  on  the  snbject  of  rest  in  the 
general  treatment  of  diseases  of  the  heart,  the  aathor 
stated  that  twenty-two  years  aii^  Dr.  Hermann  Weber 
had  transferred  to  his  care  at  Folkestone  a  serioas  case 
of  heart  disease^  with  general  drousy,  effusion  into  the 

{>learal  and  peritoneal  cavities,  ana  enlarged  heart  and 
iver.  The  nsaal  treatment  had  been  previonslv  folly 
carried  oat  with  no  benefit  whatever.  As  a  last  re- 
Boorce,  a  coarse  of  soar  milk  was  resorted  to,  and  all 
dropsy  disappeared,  except  from  the  abdominal  cavity, 
where  effasion  still  remained,  notwithstanding  all 
effortfl  for  its  removal,  inclading  five  tappings.  On 
Dr.  Weber's  advice,  the  patient  was  then  sent  to 
Nauheim,  and  in  a  month  ne  returned  perfectly  cured. 
Recent  writings  had  again  drawn  his  attention  to 
Nauheim,  and,  with  an  open  and  somewhat  sceptical 
mind,  he  went  there  to  judge  for  himself  whetner  it 
were  possible  that  the  diminution  of  the  heart's  size 
(when  pathological)  could  be  so  uniformly  brought 
about  in  a  short  time  as  to  be  always  accurately 
measured  in  centimetres. 

He  had  long  ago  been  convinced  that  hearts,  healthy 
and  diseased,  constantly  varied  in  size,  and,  like  the 
ins,  the  uterus,  the  arterial  s^rstem,  the  abdominal 
viscera  and  all  parts  supplied  with  involuntary  mus- 
cular fibre,  were  subject  to  the  influence  of  specific 
medicinal  agents,  and  to  physics,  such  as  heat  and 
cold,  light,  electricity,  and  so  forth.  During  thirty 
years  he  had  collected  a  large  number  of  observations 
germane  to  the  subject,  and  especially  on  localised 
and  chan^ng  dilatations  of  the  larger  vessels.  While 
at  Nauheim  last  vear,  he  had  ample  material  and 
every  possible  kindness  and  assistance  from  Dr.  Schott 
and  Dr.  Heineman.  These  gentlemen  never  attempted 
to  influence  his  observations  in  any  way ;  indeed,  they 
insisted  that  he  should  take  his  own  course  and  judge 
for  himselL  He  directed  his  attention  strictly  to  main 
points — 

1st.  Was  it  possible  to  reduce  the  size  of  a  dilated, 
enlarged,  and  diseased  heart  (a)  by  baths,  (b)  by 
exercises? 

2nd.  Was  this  reduction,  if  produced,  beneficial,  and 
could  it  be  rendered  permanent  ? 

3rd.  The  state  of  the  heart  before  and  after  a  course 
of  treatment. 

It  was  of  the  first  importance  to  define  well  the  size 
of  the  heart  and  its  relations  before  and  after  baths 
and  exercises,  and  before  and  after  a  course  of  treat- 
ment ;  these  points  were  the  subject  of  careful  experi- 

(a)  Tvpet  FMd  before  the  Harrelan  Society  of  London,  Meroh  19th, 
1806.    Ine  dUcoiiion  will  be  foand  in  another  colamn. 


ment.  Cases  of  all  these' conditions  were  related,  and 
tracings  shown  of  the  actual  relations  of  organs  at  the 
time  of  the  respective  observations. 

Casb  I.— Mr.  L.,  a  Russian.  Chronic  myocarditis, 
with  marked  dilatation  of  both  ventricles,  slight  effusion 
into  both  pleural  cavities,  general  anasarca,  albuminous 
urine,  suspicion  of  incipient  tabes,  heart  much  enlarged, 
apex  beat  5^  centimetres  left  of  the  nipple,  area  of  car- 
diac dulness  enormous. 

After  twenty  minutes  exercises,  remarkable  diminu- 
tion of  area  of  heart  dulness  and  shifting  of  its  apex 
2i  centimetres  nearer  to  the  left  nipple  and  I  centi- 
metre lower  down.  This  was  distinctly  appreciable 
to  the  finger.  After  a  month's  treatment  all  signs  of 
dropsy  disappeared,  the  albumen  had  gone,  the  area  rf 
caraiac  dulness  was  normal,  the  patient  could  walk 
freely  uphill,  and  sud  he  felt  perfectly  well. 

Case  IT.— Before  bath  of  10  minutes.  Marked 
mitral  stenosis,  with  extreme  dilatations  of  auricles  ; 
a  previous  history  of  rheumatism  and  pleurisy.  Apex 
beat  Si  centimetres  to  left  of  nipple,  after  bath  only 
5i  centimetres  distant,  and  slightly  at  a  higher  level. 
The  general  area  of  dulness  was  also  considerably 
reduced. 

Case  III.— Rheumatism  in  the  preceding  winter.  A 
young  girl,  set.  14,  stenosis  and  insufS^iency^  of  the 
mitral  valve.  She  had  been  treated  at  Nauheim  by  a 
medical  man  for  two  months  by  baths  alone,  and  was 
no  better ;  then,  under  Dr.  Schott,  she  was  treated 
with  baths  and  gymnastics,  the  local  conditions  were 
very  much  improved,  the  marked  dyspnoea  and  all 
precordial  pains  disappeared,  and  she  considered 
herself  perfectly  well.  Before  an  exercise  of  16 
minutes  the  apex  beat  was  4i  centimetres  to  the  left 
and  below  the  nipple  ;  after  the  exercise  it  was  only 
2^  to  the  left  and  below. 

Case  IY.— Fifth  season  at  Nauheim,  generally  much 
improved,  area  of  dulness  normal,  apex  beat  4  centi- 
metres beiow  and  just  to  inside  of  nipple  line ;  after 
six  movements  of  the  exercises  apex  was  distinctly  felt 
2  centimetres  nearer  median  line.  Diagnosis:  Aortic 
stenosis  and  slight  mitral  regurgitation. 

All  the  cases  now  reported  had  been  of  the  most 
unpromising  tsrpe  and  carefully  treated  by  the  best 
physicians  before  going  to  Nauheim,  and  all  those, 
which  the  author  had  observed  there,  made  surprising 
improvement  in  the  general  symptoms  and  in  the 
recovery  of  compensation. 

Great  stress  was  laid  on  the  point  that  such  immedi- 
ate and  prompt  changes  are  not  ordinarily  to  be 
expected  after  a  single  sitting  or  a  single  bath,  nor 
ought  they  to  be  sought  for,  as  they  may  mislead  the 
doctor  into  using  stronger  efforts  than  would  be  wise  ; 
the  improvement  should  come  about  gradually  and  in 
its  own  proper  time. 

Another  point  to  be  remembered  was,  that  the  bath 
treatment  especially,  gives  rise  to  quite  a  degree  of 
weakness,  which  is  often  very  discouraging  to  the 
patient  and  leads  him  to  believe  that  he  has  received 
no  benefit.  To  the  physician  tie  disappearance  of  the 
bad  signs,  such  as  oedema,  dyspnoea,  and  the  changes 
in  the  heart,  afford  sofficient  indications  for  him  to 
recognise  how  his  case  is  progressing. 


340    Th«  Midioal  PBtsi'. 


ORIGINAL  COMMUNIOATTONS. 


April  1.  1W6. 


NAUHEIM 
AND  THE  SCHOTT    TREATMENT 


OP 

DISEASES  OF  THE  HEART,  (a) 
By  H.  NEWTON  HEINEMAN,  M.D., 

New  York. 

As  Dr.  Bowlefi,  with  singular  and  exceptional  origin- 
ality, haa  himself  better  paid,  he  was  prenared  by  his 
own  olMervation  to  accept  the  possibility  of  such 
changes  in  the  heart  and  circulatory  system  as  have 
beAu  described  at  first  by  others,  but  was  rather  scepti- 
cal of  the  fact  that  these  thprnpeutic  processes  could 
produce  such  definite  and  decided  dumges  as  had  been 
claimed  for  them. 

Dr.  Bowles  was  extremely  fortunate  in  being  able  to 
nee  cases  in  which  it  was  possible  to  see  these  changes 
that  only  occasionally  occur  within  a  very  short  space 
of  time.  This  good  fortune  waa  in  part  the  result  of 
tnere  chance,  but  also  the  result  of  a  more  than  usual 
i^arnest  desire  upon  the  part  of  Dr.  Schott  to  demona- 
tr^te  to  a  sceptical  collesffue  what  the  system  acoom- 
pli^hed  in  most  proj^erly  adapted  cases  sooner  or 
later. 

Then,  too,  the  well-known  zeal,  earnestness,  fairness, 
and  amiability  of  your  colleague,  was  an  additional 
support  to  ransack  the  whole  of  Nauheira  in  a  deter- 
mined hunt  to  find  suitable  oases.  Here  I  would 
remark  that  the  result  of  the  treatment  in  a  giv<Kh 
cane,  however  successful  it  might  be  in  the  end,  does 
no'  by  any  meiusB  manifest  itself  after  a  single  bath,  or 
A^ter  a  single  application  of  the  muscular  exercises. 
Often  a  week,  or  even  a  fortnight,  of  treatment  may  be 
required  to  effect  changes  in  the  neart  that  are  beyond 
any  doubt  In  determining  these  changes  I  have 
made  use  of  the  following  precautions  :  —Percussion 
of  the  heart,  its  relative  and  absolute  dulness  (flatness) ; 
the  determination  of  the  level  of  the  diaphragm  ;  the 
lower  border  of  both  lungs,  laterally  and  posteriorly  ; 
the  upper  and  lower  limits  of  the  liver,  more  or  less 
often  even  the  upper  and  lower  limits  of  the  spleen  : 
the  circumference  of  the  chest  in  the  sub-axillary  and 
sub-mammary  lines,  the  circumference  of  the  abdomen : 
and,  occasionally,  the  antero-posterior  diameter  ana 
transverse  diameter  oi  the  thorax;  all  theae  beins 
made  both  before  and  after  the  treatment.  When  all 
these  precautions  are  taken  the  fact  of  the  diminu- 
tion in  the  size  of  the  heart  still  remains.  The  direction 
of  this  diminution  depends  upon  the  condition  of  the 
ventricles  and  auricles.  Sometimes  the  auricles,  at 
times  the  right  ventricle,  again  the  left  ventricle,  mani- 
fest this  diminution  most  markedly,  but  occasionally  it 
ifi  uniform,  though  this  is  comparatively  rare.  The 
maintenance  of  this  diminution  is  a  matter  of  interest. 
As  a  matter  of  fact,  we  find  that  by  the  following  day, 
before  the  renewed  treatment,  it  has  been  lost  for  the 
most  part,  but  something  remains,  and  to  this  is  added 
the  improvement  of  the  succeeding  treatment.  Oo 
the  morrow  again,  we  have  a  diminution  of  the  toted 
gain,  though  the  permanent  remainder  is  greater  than 
it  was  upon  the  previous  day.  In  this  manner  the 
dimicution  proceeds  towards  a  more  or  less  complete 
recovery  of  compensation.  Occasionally*  however,  aa 
the  result  of  indiscretion  on  the  part  of  the  patient, 
aometimes  from  the  nature  of  the  case  itself,  a  relapse 
occurs  which  permits  the  heart  to  go  back  to  its  original 
size  before  treatment,  sometimes  even  a  little  bevond 
this,  but  this  is  almost  always  recovered  from  within  a 

(a)  A  contribatlon  to  the  Diicaosioo  on  the  purer  of  nr.  b.  L. 
Bowles,  before  the  Harveiwi  Society  of  London,  Much  19th,  1896, 
irht^h  wlU  be  (oapd  Ui  f^npther  oo^aiuQ. 


short  period  of  time  (requiring  medicinal  aid  at  times, 
however),  but  ultimately,  all  goes  well,  and  the  im- 
provement referred  to  ultimately  takes  place. 

/'Aj/fto/o^.— Physiology  and  clinical  medicine  often 
work  in  parallel  grooves  for  a  long  time  without  meet- 
ing. So  it  has  been  in  this  case.  While  the  clinical 
teacher  has  been  wondering  whether  such  things  are 
possible,  the  physiologist  has  proven  it  not  only  possible, 
out  actual  in  the  lower  animals,  in  whom  the  heart 
has  been  shown  to  be  an  exceedingly  variable  quantity, 
so  that  its  probaJbUity  in  mankind  from  the  physio- 
logical standpoint  should  be  beyond  questinn  It  is 
well  here  to  note  that  gross  differenccM  in  the  size  of 
the  heart  of  1  or  |  centimetre  are  not  taken  into  con- 
sideration by  me,  since  such  minute  changes  mast  be 
considered  within  the  limits  of  error.  In  observations 
made  for  several  years  upon  day  labourers,  examioing 
them  before  and  after  the  day's  work,  and  in  examina- 
tions of  other  persons  leading  more  or  less  sedentary 
lives,  I  have  learnt  to  recognise  and  appreciate  thn 
normal  diurnal  variation,  the  result  of  position,  work, 
mental  labour,  strain  and  other  causes  so  that  the 
above  measurements  of  the  heart  are  taken  with  the 
full  knowledge  of  these  facts. 


Indications.— It  is  fully  recognised  that  many  * 
of  heart  disease  require  treatment  for  the  heart  con- 
dition, likewise  the  association  of  a  disordered  stomach, 
or  liver,  or  other  slight  intercurrent  ailments  are  often 
suflBciently  well  treated,  when  this  secondary  disease 
is  alone  disposed  of.  So  far  as  the  nature  of  the 
valvular  lesion  is  concerned,  these  afford  less  certain 
indications  for  the  application  of  this  treatmnnt,  than 
does  the  condition  of  the  heart  muscle  itself,  to  wit, 
the  (question  of  the  degree  of  myocarditis,  and  more 
especuilly  the  amount  of  loss  of  compensation. 

Contra- Indications — Arterio-sclerosis  when  in  an 
advanced  stage ;  aneurism  in  every  but  its  initial  sta£^ 
acute  Bright  8  disease  and  the  atrophic  form  of  chronic 
Bright's  disease. 

Indications  from  Condition  of  Patient. — In  feeble 
patients  or  in  cases  in  bed,  moderate  exercise  may  be 
administered  with  decided  benefit,  until  by  this  agency, 
with  possibly  the  aid  of  medicinal  agents,  the  patient 
is  able  to  be  up.  The  question  of  bath  or  exercise  or 
both,  must  always  be  determined  to  some  extent  from 
the  nature  of  the  individual  case. 

Prognosis,—!  have  seen  numerous  cases  which  have 
been  enabled  to  return  to  Bad  Nauheim  every  summer 
for  periods  of  from  three  to  ten  years.  In  many  cases 
the  patient  who  was  on  the  point  of  giving  up  his 
ordinary  occupation,  has  been  enabled  to  continue  in 
it  for  many  years,  simply  as  the  result  of  this 
treatment 

While  in  Berlin  this  winter  the  courtesy  of  Geheim- 
rath  von  Lejden  enabled  me  to  apply  the  exercises 
daily  for  a  neriod  of  nearly  three  months  to  a  number 
of  cases.  Unfortunately  the  cases  were  of  the  kind 
that  come  under  the  cate^ry  of  those  contra  indicated. 
But  as  the  Charity  Hospital  afforded  no  others,  I  pro- 
ceeded in  my  work  with  the  idea  that  if  any  improve- 
ment, even  temporary,  could  be  effected  it  would  imply 
so  much  more  for  the  cases  properly  suited  for  the 
treatment.  I  am  happy  to  say  the  results  exceeded 
my  expectations. 

General  Iiema.rks,— The  treatment  should  not  be 
considered  oA  initio  a  panacea  for  every  case  of  heart 
or  circulatory  disease,  out  there  are  few  forms  of  this 
disease,  of  which  some  cases  will  not,  more  or  less 
often^  receive  greater  or  lesser  benefit.  If  we  always 
keep  m  mind  exactly  what  we  may  expect  in  cardiac 
disease,  this  plan  of  treatment  will  more  than  fulfil  qxxx 
anticipation^. 


AnoL.  1»  IIM. 


OBIOINAL  COMMXTNICATTONR 


Th»  Mi  PfOUL  PBKff.      2141 


THE    OBJECTS    AND    LIMITS    OF 
OPERATIONS  FOE   CANCER,  (a) 

By   W.   WATSON   CHEYNE,   F.R.S., 
frofetaor  of  Surgery  aft  King's  College ;  Snrgeon  to  King's  College 

In  thiB  lecture  I  shall  hef^  by  discussiiig  the 
following  points  with  regard  to  cancer  of  the  pharynx  : 
(1)  The  qaestion  of  preuminary  tracheotomy  ;  (2)  the 
oontrol  of  the  bleeding  ;  (3)  the  removal  of  the  glands  ; 
and  (4)  the  methods  of  gaming  access  to  the  primary 
cancerous  mass.  After  considering  these  points,  I 
shall  refer  to  the  after-treatment  and  the  results. 

L— Thk  Quistiok  of  Pkbldonakt  Trachbotomt. 

It  is,  of  course,  an  advantage,  if  one  can  manage  it, 
to  avoid  preliminary  tracheotomy,  for  that  adds 
additional  complications  in  several  ways.  In  the  first 
place,  it  means  another  wound  which  must  become 
septic  ;  it  means  irritation  of  the  trachea  by  the  pre- 
sence of  the  tube  and  the  admission  of  cold  air ;  and 
it  also  means  very  distinct  interference  with  coughing 
and  the  power  of  expelling  any  discharges  which  may 
have  entered  the  larynx.  Where  the  external  carotid 
artery  is  ligatured,  and  the  bleeding  is  consex^uently 
▼ery  small,  there  is  not  much  chance  of  blood  entering 
the  trachea,  especially  if  the  h^ad  is  thrown  well  back ; 
and  in  cases  where  the  Jaw  is  divided,  and  more  especi- 
ally where  a  portion  is  taken  away,  it  may  also  be 
possible  to  avoid  the  risk  of  blood  passing  into  the 
lung.  Where,  however,  an  attempt  is  made  to  remove 
the  tumour  without  division  of  the  jaw,  or  without 
ligature  of  the  external  carotid  artery,  and  where  the 
mass  fills  up  the  throat,  and  more  especially  where  it 
mns  down  towards  the  entrance  of  the  lar3mx,  and  on 
to  the  tongue,  the  necessary  manipulations  cannot  be 
carried  out  without  interfering  with  the  breathing, 
and  exciting  so  much  effort  on  the  part  of  the  patient, 
that  there  is  very  ^eat  risk  of  septic  discharge  and 
blood  being  drawn  into  the  lungs ;  and  besides,  it  is 
▼ery  necessary  in  these  operations,  in  order  to  insure 
that  the  disease  is  as  thoroughly  removed  as  possible, 
that  there  shall  be  no  haste  in  their  performance,  and 
that  the  surgeon  shall  be  able  to  see  exactly  what  he  is 
doing.  Some  prefer  to  do  the  tracheotomy  three  or 
four  days  before  the  maior  operation,  but  I  fail  to  see 
the  advantage  of  this ;  on  the  contrary,  it  must  be 
remembered  that  after  three  or  four  days  the  discharge 
from  the  tracheotomy  wound  has  become  more  or  less 
septic,  and  consequently,  in  introducing  a  big  tube  such 
as  Hahn's,  some  of  the  pus  may  be  pushed  before  it 
into  the  trachea.  It  is  well  to  bear  in  mind  that 
where  septic  pneumonia  occurs  by  direct  entrance  of 
materials  into  the  air  passages,  and  not  as  the  result 
of  general  infection,  it  is  not  the  entrance  of  pure 
blood  which  sets  it  up,  but  of  blood  mixed  with  the 
septic  discharges  from  the  throat,  or  of  pure  blood  in 
the  first  instance  fouled  subsequently  by  the  inhidation 
of  the  putrid  materials  from  the  wound. 

IL— COHTEOL  OF    THB   HjEMOBRHAOE. 

In  most  of  my  cases  I  have  tied  the  external  carotid 
artery  so  As  to  have  the  seat  of  the  primary  tumour 
free  from  bleedine,  and  as  regards  this  point  the  result 
has  been  extremely  satisfactory.  In  none  of  the  cases 
had  I  to  tie  or  clamp  any  vessels  with  the  exception  of 
one  or  two  veins.  Practically  no  blood  was  lost,  and 
the  area  of  the  operation  being  more  or  less  bloodless, 
one  could  remove  the  disease  with  precision  and  feel 
pjretty  sure  that  one  was  cutting  wide  of  it  in  all  direc- 
tions. The  control  of  the  bleeding  in  this  way  is  of  the 
greatest  importance  from  the  point  of  view  on  the  one 
and  of  the  immediate  danger  of  the  operation,  namely, 
the  entrance  of  blood  into  the  air  passages,  and  on  the 

(d)  Abitraei  o)  tto  Third  Lettiomlui  Leeth^e,  dellTerdd  befoH  the 
HfdM  0odei7  o|  l^doo,  Feb.  Sithj  189^ 


other  6f  the  radical  removal  of  the  disease  ;  but  there 
are  very  serious  objections  to  it,  ftnd  I  doubt  if  it  is  an 
advisable  {Mractice  as  a  general  rule.  Working  so  much 
with  aseptic  wounds  as  one  does  nowadays,  one  is  apt 
to  forget  that  there  is  such  a  thing  as  secondary 
haemorrhage,  and  that  where  a  wound  become?  septic, 
ligatures  around  large  vessels  very  commonly  ulcerate 
through,  and  then  the  main  obstacle  to  haemorrhage  is 
the  clot  in  the  vessel.  In  the  case  of  Uie  external 
carotid  artery  little  or  no  clot  forms  on  the  proximal 
side  of  the  ligature,  and  therefore  if  it  separates  too 
soon  there  is  practically  no  barrier,  and  bleeding  is 
very  apt  to  occur.  Hence  it  has  happened  that  in 
most  ot  the  cases  in  which  the  external  carotid  artery 
has  been  tied  severe,  and  sometimes  fatal,  secondaiy 
haemorrhage  has  occurred  from  the  artery.  It  was 
partly  with  the  view  of  avoiding  this  risk  that  I  divided 
the  operation  into  two  stages  in  Case  II,  and  in  that 
instance  there  was  no  trouble  whatever  with  the  liga 
tnred  artery,  and  the  result  as  re^rds  h»morrhage 
during  the  second  operation  was  perfectly  satisfactory. 
Whether  this  division  of  the  operation  into  two  stages 
is  a  good  thing  or  not  I  shall  discuss  by-md-by ;  it 
certainly  gives  us  a  means  of  avoiding  secondary  haemor- 
rhage from  the  ligatured  external  carotid  artery,  and  at 
the  same  time  gives  us  a  bloodless  wound.  Failing 
this  division  of  the  operation  into  two  stages,  I  am 
inclined,  much  against  my  will,  to  give  up  the  prelimi- 
nary ligature  of  the  external  carotid  artery  m  most 
cases,  and  either  tie  its  branches,  or  control  tiie 
bleeding  by  temporary  compression  of  the  artery  during 
the  removal  of  the  tumour.  That,  however,  introduced 
another  problem,  namely,  division  of  the  lower  jaw,  for 
without  that,  where  the  disease  is  situated  in  the  ton- 
sillar region,  one  roij^ht  have  difficulty  in  getting  proper 
access  to  the  bleeding  points,  while  I  think  it  is  an 
advantage  if  possible  not  to  interfere  with  the  jaw. 
Where,  however,  for  any  reason  the  jaw  has  been 
divided,  one  can  get  good  access  to  the  bleeding  points 
and  need  not  tie  the  artery  previously. 

III.— The  Removal  of  thb  Glands. 

The  remarks  made  with  regard  to  the  removal  of  the 
lymphatic  area  in  cases  of  breast  cancer  apply  with 
equal  force  to  these  cases.  It  is  seldom  incieed  that 
no  enlarged  glands  can  be  felt,  and  in  most  instances 
they  are  of  very  considerable  size.  Whether  glands 
are  felt  or  not,  however,  the  lymphatic  area  ought  to  be 
cleared  out,  and  as  I  have  already  said,  one  of  the  great 
advantages  of  the  cervical  region  \s  that  a  very  Targe 
glandular  area  is  accessible,  and  not  only  can  a  large 
portion  be  cleared  out  at  the  time  of  the  operation,  but 
also  glandular  recurrences  beyond  the  anterior  triangle 
if  seen  early  can  be  freely  and  hopefully  dealt  with. 

Most  surgeons  look  on  the  presence  of  enlarged 
malignant  glands  in  the  neck — unless  they  are  quite 
small  and  non-adherent  to  the  vessels,  and  only  one  or 
two  in  number — as  a  contraindication  to  operation  in 
these  and  in  tongue  and  laryngeal  cases,  or,  at  any  rate, 
as  a  very  grave  complication.  For  my  own  part,  I  do 
not  at  all  agree  witn  this  view  unless  the  glandular 
enlargement  is  very  extensive,  or  adherent  to  a  variety 
of  structures  in  the  neck  and  not  merely  to  the  sheaths 
of  the  vessels,  and  I  see  no  contraindication  to  opera- 
tion in  their  presence ;  on  the  contrary,  I  think  the 
operation  will  be  more  thoroughly  done  and  the  patient 
will  have  a  better  chance  of  recovery  and  cure  if 
enlarged  glands  are  already  present ;  for  in  the  first 
place,  where  the  glands  are  already  enlarged  it  is  much 
more  easy  to  remove  the  whole  glandular  area  in  one 
mass  than  it  is  where  there  are  no  enlarged  glands 
to  be  felt ;  and  in  the  second  place,  the  presence  of 
enlarged  glands  in  the  anterior  triangle  renders  it 
imperative  to  remove  the  neighbouring  lymphatic  area, 
especiallv  that  under  the  stemo-mastoid  muscle,  so 
that  if  glandular  recurrence  subsequently  takes  place, 
it  will  in  all  probability  be  in  the  posterior  tpangle| 


342    Tmi  MiDiGAL  Pusb. 


ORIGINAL  COMMUNICATIONS. 


Afbii/  1,  18M. 


that  is  to  say,  in  a  part  which  is  easily  accessible  for 
future  operation.  vHiere  there  is  no  noticeable 
enlargement  of  the  glands,  on  the  other  hand,  it  is  a 
-veTjT  difficult  matter  to  take  away  all  the  glands  and 
fat  in  the  anterior  triangle,  while  one  is  very  apt  in  an 
extensive  operation  to  leave  the  material  under  the 
stemo-mastoid  alone^  and  yet  the  glands  in  that  situa- 
tion are  very  early  infected.  Where  an  attempt  has 
been  made  to  remove  this  Ijnnphatic  area,  and  where  it 
has  not  been  successful  and  glandular  recurrence  sub- 
sequently takes  place  in  the  anterior  triangle,  we  have 
in  the  second  operation  to  deal  with  glands  lying  in 
scar  tissue,  and  their  subsequent  satisfactory  removal 
is  a  very  difficult  and  sometimes  almost  impossible 
matter.  These  statements  are  not  in  any  way  theore- 
tical, but  are  founded  on  considerable  experience  in 
cancer  of  the  tongue  and  other  regions  in  that  neigh- 
bourhood, and  al^  on  a  very  extensive  experience  of 
radical  operations  for  tuberculous  cervical  glands. 

With  regard  to  the  removal  of  the  jugular  vein,  I 
may  say  that  it  need  not  give  rise  to  the  least  anxiety ; 
it  does  not  add  anything  whatever  to  the  danger  of  the 
operation,  and  I  have  often  had  to  do  it  in  cases  of 
operation  for  tuberculous  glands  without  any  harm 
resulting.  I  have  never  seen  reason  to  regret  having 
taken  it  away,  but  I  have  more  than  once  regretted 
that  I  had  not  done  so,  recurrence  having  taken  place 
in  small  glands  which  had  been  left  attached  to  the 
sheath  and  overlooked,  but  which  would  have  been 
removed  if  the  vein,  sheath,  and  everything  in  front  of 
it  had  been  taken  away  in  the  manner  described.  Be- 
sides, I  think  that  there  is  another  advantage  in 
removing  the  vein  in  these  pharyngeal  cases,  for  if  a 
septic  thrombus  should  form  in  one  of  the  small  veins 
alK>ut  the  wound— as  may  very  likely  happen— it  can- 
not get  anv  further,  and  I  have  been  much  surprised 
at  the  small  amount  of  septic  disturbance  in  my  cases. 

[The  lecturer  then  referred  to  objections  against 
dividing  the  operation  into  two  stages.] 

IV.— Access  to  the  Primaey  Disease. 
There  are  many  ways  in  which  access  has  been  ob- 
tained to  the  tonsillar  region,  but  it  is  unnecessary  for 
me  to  discuss  them  all.  The  essential  point  centres 
round  the  question  as  to  whether  it  is  necessary  or  not 
to  divide  the  lower  jaw,  and,  as  regards  this,  we  have 
again  two  points  for  consideration — namely,  whether 
it  is  sufficient  to  divide  the  lower  jaw  as  in  Langen- 
beck's  operation,  or  whether  it  is  not  better  to  remove 
the  ascending  ramus  altogether  as  in  Mikulicz's  plan. 
Division  of  the  lower  jaw  or  removal  of  the  ascending 
ramus  are,  of  course,  procedures  which  it  is  desirable 
to  avoid  if  possible.  In  the  first  place,  the  division  of 
the  bone  must  add  considerably  to  the  septic  risk  by 
leaving  a  compound  fracture  in  a  septic  wound,  and  it 
also  must  add  to  the  shock.  In  the  second  place,  the 
divided  ends  of  the  bone  have  in  several  instances 
failed  to  unite,  and  a  false  joint  has  been  left.  Not 
that  this  is  always  a  disadvantage,  for  where  the 
disease  involves  the  mucous  membrane  in  front  of  the 
fauces,  between  the  upper  and  lower  jaws,  the  subse- 
quent contraction  of  the  wound  is  very  likelv  to  lead 
to  more  or  less  closure  of  the  jaws,  which,  however, 
does  not  cause  any  very  great  inconvenience  if  there  is 
a  false  joint  in  front.  And  lastly,  necrosis  of  the 
divided  ends  of  the  bone  has  more  than  once  occurred. 
On  the  other  hand,  there  are  great  advantages  to  be 
gained  by  division  of  the  jaw,  and  in  some  cases  it  is 
absolutely  necessary.  When  the  jaw  is  divided  in  front 
of  the  masseter  and  thn  two  parts  pulled  aside,  espe- 
cially after  division  of  the  posterior  belly  of  the 
digastric  and  the  stylo-hyoid  muscles,  and  with  a  skin 
incision  running  from  the  angle  of  the  mouth  to  the 
upper  part  of  the  oblique  incision  in  the  anterior 
triangle,  the  whole  region  of  the  tonsil  and  side  of  the 
pharynx  is  completely  exposed  to  view,  and  can  be 
dealt  with  as  precisely  as  if  one  were  operating  on  a 


cutaneous  surface,  and  if  this  is  done  there  is,  of 
course,  no  necessity  for  ligature  of  the  external  carotid 
artery,  the  bleeding  points  being  easily  secured. 
Where  the  disease  involves  the  periosteum  over  the 
jaw,  necessitating  removal  of  a  portion  of  it,  or  of  the 
ascending  ramus,  the  view  obtained  is  stUl  more 
perfect. 

[The  lecturer  then  referred  to  the  after-treatment  of 
the  cases  and  the  mode  of  feeding,  laying  special  stress 
on  the  careful  cleansing  of  the  mouth,  and  especially  of 
the  teeth,  before  the  operation,  and  on  free  drainage  of 
the  wound.] 

Intestinal  Cancee. 

I  shall  confine  my  remarks  to  cancer  of  the  rectum. 
Up  till  now  I  have  been  speaking  of  cancer  in  parts 
where  practically  the  only  object  in  operation  was  with 
the  view  of  curing  the  disease ;  but  here  we  have  a 
region  where  on  the  one  hand  the  conditions  as  regards 
cure  are  not  so  favourable,  while  on  the  other,  aitoma- 
tive  procedures  have  to  oe  considered  which,  while 
they  do  not  aim  at  cure,  often  prolong  life  markedly, 
and  what  is  more,  remove  a  great  deal  of  the  agony  of 
the  disease. 

In  cases  of  intestinal  cancer  we  have  to  do  with  a 
disease  which,  as  elsewhere,  varies  much  in  malignancy, 
but  is,  on  the  whole,  less  malignant  than  cancer  in  the 
situations  which  we  have  been  considering.  More 
especially  is  this  true  as  regards  the  glandular  and 
metastatic  deposite,  in  which  the  disease  sometimes 
progresses  very  slowly,  and  if  only  the  risks  attending 
the  situation  of  the  primary  diseiase  can  be  avoided, 
the  patient  may,  in  the  less  malignant  forms,  live  for 
a  very  considerable  time.  In  accordance  with  this 
lesser  malignancy,  recurrences  after  operation  are  not 
uncommonly  late,  a  considerable  proportion  taking 
place  after  several  years.  Thus  in  Czerny*s  statistics, 
10  were  well  after  three  years,  but  4  of  these  (40  per 
cent)  subsequently  showed  disease.  Metastases  are 
also  late  in  occurring,  and  as  regards  the  latter  point, 
Iverseu  stetes  that  in  47  post-mortem  examinations  of 
long-stending  cancer  of  tne  rectum  (he  does  not  say  of 
how  long  stonding)  he  found  21  in  which  there  where  no 
metastases.  As  regards  the  hope  of  cure,  however,  the 
glandular  area  is  not  nearly  so  accessible  as  in  the 
breast  or  the  throat,  and  therefore,  when  the  disease  is 
of  the  rapidly  advancing  form,  there  is  little  chance  of 
gettinij^  beyond  it  by  operation.  Uence  the  radical 
operation  cannot  be  so  thorough,  and  were  it  not  for 
the  fact  just  mentioned  as  to  tne  lesser  malignancy 
of  the  disease  the  chances  of  benefit  by  removal 
of  the  disease  would  be  very  slight.  Further,  the 
operations  necessary  for  the  removal  of  the  prim- 
ary disease,  more  especially  where  it  is  high  up, 
are  accompanied  by  a  considerable  mortality.  And 
lastly,  the  functional  result  after  operation  often 
leaves  much  to  be  desired,  both  as  regards  con- 
tinence on  the  one  hand,  and  stricture  with  ite 
troubles  on  the  other.  On  the  contrary,  we  have  in 
colotomy  an  alternative  procedure  which  removes  the 
immediate  risk  to  life  (obstruction),  and  thus  prolongs 
life  often  very  considerably,  while  it  also  rids  the 
patient  of  much  of  his  pain  and  discomfort,  by  relieving 
the  impending  obstruction  and  by  getting  rid  of  the 
inflammatory  condition  at  the  seat  of  disease,  which 
not  only  adds  much  to  the  patient's  discomfort,  but 
also  no  doubt  increases  the  rapidity  of  growth  of  the 
disease. 

Thus  we  have  in  these  cases  a  choice  of  procedures, 
and  it  is  no  longer,  as  in  the  former  instences,  a  ques- 
tion of  a  radical  operation  or  nothing  ;  and  further,  as 
the  palliative  procedure  offers  much  relief,  and  as  only 
a  small  proportion  of  radical  operations  give  any  hope 
of  permanent  benefit,  there  is  not  the  same  urgent  need 
for  the  radical  operation.  Hence  the  question  of  selec- 
tion of  casesand  our  mode  of  advisingthepatiento  is  much 
altered.  We  shall  find  that  in  a  large  proportion  of  ( 


Afbil  1,  1800. 


TRANSACTIONS  OF  SOCIETIES. 


Thi  Mbdioal  Pbbbs.     343 


the  hope  of  benefit  from  a  radical  operation  is  so  very 
slight  that  wecan,  without  hesitation,  exclude  them  from 
the  radical  procedure  and  at  the  same  time  help  them 
much  by  colotomy ;  and  thus  the  cases  in  which  the 
choice  of  an  operation  has  to  be  left  to  the  patient  are 
comparatively  few.  We  can  in  most  instances  say 
definitely  that  the  case  is  suitable  for  the  one  or  the 
other  procedure  ;  there  are  only  a  few  on  the  border 
line  that  we  need  leave  to  the  patient  to  decide. 

J' A  number  of  statistical  and  other  facts  were  then 
ened  to  in  support  of  the  foregoing.statements.] 


By  GEORGE  TOY,  F.RC.S., 

Hon.  FeUow  of  the  Southern  SuKloal  and  Oynnooloaloal  AMooiAtion, 
U.8.A.    Bnrgeon  to  the  Wmteworth  Hoepltal,  Dramoondn. 

Femoral  Ctstocelb. 

M.  Thubieb,  of  Brussels,  reports  a  case  of  this 
very  uncommon  disease.  The  patient,  a  man,  »t  51, 
presented  himself  with  a  well-marked  femoral  hernia, 
which  was  easily  reducible,  and  he  was  anxious  to 
have  a  radical  operation  performed.  On  cutting  down 
on  the  tumour  something  unusual  was  recognised,  and 
the  protruding  sac  opened.  A  free  flow  of  urinous- 
like  fluid  followed  '*  upon  the  incision,  and  by  passins 
a  catheter  by  the  urethra  it  was  plainly  demonstrated 
that  the  tumour  consisted  of  the  bladder.  Femond 
cystocele  is  one  of  the  least  common  of  tumours. 

Ruysch,  in  1737,  reported  some  cases  of  inguinal 
cystocele,  and  cautions  the  surgeon  that  a  hernia  may 
contain  any  of  the  contents  of  the  abdomen.  Baron 
Haller,  in  1755,  copies  the  advice  and  cases  of  Ruysch, 
who,  though  he  appears  to  have  recognised  the  possi- 
bility of  femoral  cystocele,  does  not  appear  to  have 
ever  seen  one. 

Pott,  whof e  treatise  on  ruptures  was  published  in 
1756,  writes  :  **  A  hernia  formed  by  a  protrusion  of  a 
portion  of  the  urinary  bladder  through  the  opening:  in 
the  abdominal  muscle  into  the  groin,  or  scrotum  is  a 
disease  sometimes,  but  not  ver^  frec[uently,  met  wiUi." 

He  describes  two  cases  of  inguinal  cystocele  that 
came  under  his  own  notice.  Cystocde,  perineal, 
inguinal,  and  femoral,  is  menticned  by  Mr.  Samuel 
Sharp  (1740),  M.  C.  Verdier  (1784),  Morgagni  (letter  42), 
Petit,  Bonetus.  and  Bartholin,  who  credits  Dom.  L 
Sala  (1623)  with  being  the  first  to  describe  inguinal 
cystocele, 

PBSFosATiNa  Gastbic  Ulcer. 

Dr.  Garling  [Bir,Med,R€c,)  states  that  the  moment 
of  perforation  m  a  case  of  gastric  ulcer  is  marked  by 
extreme  pain,  usually  in  the  left  upper  part  of  the 
abdomen,  with  collapse.  Abdominal  rigidity,  speedily 
follows  with  thoracic  respiration  and  subnormiu 
temperature. 

Without  surgical  interference  such  cases  are— 
(a)  Acute,  with  rapidly  developing  general  peritonitis 
and  death  in  12  or  48  nours  ;  (b)  sub-acute,  with  sub- 
sidence of  the  first  symptoms,  and  a  further  attack  in  a 
few  hours  or  a  day  or  so,  as  a  result  of  renewed  leaking 
from  the  stomach,  or  the  spread  of  what  was  at  first  a 
local  peritonitis,  and  death  in  four  or  five  days ; 
(p  )  chronic— in  which  case  the  escaped  fiuid  forms  an 
abscess,  almost  always,  between  the  left  lobe  of  the 
liver  and  the  diaphragm. 

Is  is  not  necessary  to  excise  the  ulcer.  In  eight  of 
eleven  recoveries  recorded  no  excision  was  attempted, 
and  the  perforation  was  simply  closed,  Lembert  style. 
The  importance  of  an  early  operation  is  evident  Nine 
of  the  eleven  successful  operations  were  performed  in 
less  than  ten  hours  after  the  perforation. 
Equino-Vabus. 

In  an  unusually  bad  case  of  eqnino- varus  Dr.  R  H. 
Sayre  has  obtained  good  results  by  removing  a  wedge 


of  bone  from  the  tibia,  the  base  of  the  wedge  being  in 
front,  and  about  an  inch  broad.  A  corresponding 
piece  was  removed  from  the  fibula,  and  the  foot  was 
Drought  to  a  right  angle  with  the  leg,  and  retained  in 
position  by  plaster-of -paria  dressings,  which  were  worn 
tor  eight  or  nine  weeks,  when  they  were  removed  for  a 
time,  to  be  re-applied,  as  the  union  between  the 
broken  bones  did  not  seem  sufficiently  firm  to  prevent 
a  slight  recurrence  of  equinus  when  wearing  ordinary 
shoes.  *'  He  can  now  walk  two  miles,  and  is  gaining 
steadily.  The  feet  are  flat  on  the  floor  and  at  right 
angles  to  the  leg."    {Am.  M,  A  8.  BvlL) 

Insebtion  of  the  Ubetbks  in  the  Rectum. 

At  the  last  general  meeting  of  the  Medical  Society, 
in  Cracow,  Poland,  M.  Eeynskey  exhibited  a  patient 
in  whom  he  had  inserted  the  ureters  into  the  rectum. 
The  anal  sphincter  retained  the  urine  which  collected 
in  the  ampulla  of  the  rectum  for  three  or  four  hours  at 
a  time.  The  patient  was  in  good  health,  and  the  urine 
was  considerable  in  amount 

Bectal  tolerance  of  urine  has  been  known  for  many 
years.  Bonetus  reports  (Sepulchretum)  the  casepf  a 
man  who,  from  childhood  till  his  fiftieth  year,  had 
uniformly  passed  urine  through  the  anus.  "For  a 
lithotomist  having  extracted  a  ^culus  from  him  when 
a  boy  had  so  far  injured  the  bladder,  that  after  death, 
an  aperture  a  digit  wide  was  found  between  the  bladder 
and  the  rectum."  And  he  also  mentions  the  case  of  a 
boy  whose  ureters  were  found,  on  examining  the  body, 
to  nave  opened  into  the  rectum.  "The  bladder  was 
not  perforated,  and  urine  was  discharged  from  the 
anus." 

Reusnerus  relates  a  curious  case  of  a  child  :  *'  That 
on  the  seventh  day  of  complete  suppression,  .  .  . 
voided  urine  from  the  intestines,  which  in  colour,  smell, 
and  quantity,  resembled  that  which  is  naturally 
excreted." 

Ureters  are  not  unfrequently  abnormal  in  number 
and  position  (Dr.  Baker,  N,  T.  M.  J„  1878.).  M. 
Scheyron  found  in  one  case  that  the  ureters  opened  into 
the  vagina.  In  1685,  Ty^on  drew  the  attention  of  the 
Eoyal  Society  of  London  to  the  abnormalities  of  these 
ducts.  Mr.  Reed,  in  18d2,  published  an  account  of  bis 
experimental  research  on  the  implantation  of  the  ureters 
into  the  rectum ;  the  theory  he  advocated  has  been 
borne  out  by  the  case  of  M.  Keynskey. 


^^ErattBacttoitB  of  gocitfttft. 

CLINICAL  SOCIBTY  OF  LONDON. 
Msimru  hild  Fbidat,  Mabou  27th,  1896. 


The  President,  Dr.  Buzzard,  in  the  Chair. 
M&.  Mato  Robson  on  a 

8BBIB8  or  OASBS  OF  BNTBRBOTOlffT,  WITH  KBMABKS  ON 
THB  VARIOUS  METHODS  BMPLOTBD  IN  SECURING  UNION 
OF  THB  DIVIDBD  ADOBS  OF  THB  HOLLOW  VISCBRA. 

The  author  remarked  that  the  whole  of  hie  pereonal 
ezperieDoe  of  enterectomy  was  famished  in  the  table  of 
cases,  twelve  io  D  amber,  which  he  handed  round  ;  and  that 
by  the  kind  permission  of  his  collea^i^ues  he  had  been  able 
to  add  the  whole  of  the  entereotomies  which  had  been 
performed  in  the  Leeds  Infirmary  to  the  table,  which  thus 
represented  a  series  of  26  cases,  on  which  his  argamenta 
were   based.    He  divided  the  series  into  three  classes. 

1.  Those  operated  on  by  simple  suture,  nine  in  number, 
of  which  five  died,  yielding  a  mortality  of  55  5  per  cent. 

2.  Those  operated  on  by  the  Murphy  button,  five  in 
number,  of  which  one  died,  giving  a  rate  of  mortality  of 
20  per  cent. ;  two  had  had  fistulse  and  a  retarded  conva- 
lescence, and  in  one  the  button  had  not  parsed  while  the 

Satiect   was    under  observation.    3.   Those  in  which  a 
eealcified  bone  support  in  the  shape  of  a  button  or  some 
similar  oontrivanoe  was  employed  to  support  the  sutures, 

0 


344    Thb  Mbmcal  Prsss. 


TRANSACTIONS  OF  SOCIETIES. 


AniiL  1,  1896 


of  which  there  were  twelve  cases  with  one  death,  (i;iving 
a  rate  of  mortality  of  8'3  per  oeot.  After  remarking 
OD  the  disadvantages  actendiog  simple  suture,  such 
as  multiplicity  of  stitches  required,  the  danger  of 
stenosis  and  the   fear   of   infection  through  the  needle 

Eunctures,  and  after  mentioning  the  advantages  of 
[aunsell's  method  in  intussusception  and  its  dis- 
advantages in  other  forms  of  entereotomy.  The  author 
referred  to  the  ura  of  the  Murphy  button,  which  he  said 
he  preferred  for  cholecystenterostomy  and  for  short  cir- 
cuiting in  intestinal  obstruction,  but  which  he  thought 
had  great  disadvantages  in  enterectomy.  He  mentioned 
cases  where  the  button  had  caused  ulceration,  where  it 
had  produced  obstruction,  and  where  it  had  never  passed  ; 
he  al8o  dwelt  on  the  necessary  pressure- necrosis,  and  the 
fear  of  gangrene  spreading  beyond  the  parts  embraced, 
leading  to  perforative  peritonitis,  or  in  case  of  recovery  to 
after-contraction  in  the  newly-established  fistula.  Mr. 
Robson  said  that  before  all  other  methods  he  preferred 
to  suture  the  intestine  by  a  continuous  stitch  and 
to  support  the  line  of  union  by  a  hollow  decalcified 
bone  bobbin,  the  safety  of  which,  be  thought,  be  had 
proved  by  the  lif»t  of  cases  given  in  the  paper  and  by  the 
rate  of  mortality  being  reduced  so  low  as  8  per  cent.  The 
advalttages  he  claimed  were  a  saving  of  time  from  the  use 
of  only  one,  or  at  most,  two  stitches ;  the  prevention  of 
subeequent  stricture  by  the  establishment  of  a  continuous 
mucous  canal ;  the  perfect  security  against  leakage  ;  the 
absence  of  a  foreign  body  in  the  intestine,  as  the  bone 
dissolves  when  its  work  is  done  ;  the  prevention  of  infec- 
tion of  the  line  of  suture ;  the  immediate  continuity  of  the 
newly-made  osnal ;  and  lastly,  the  applicability  of  the 
bobbin  to  any  of  the  operations  required  for  the  establish- 
ment of  continuity  of  the  intestinal  canal.  After  describing 
by  the  aid  of  diagrams  and  models  the  operation,  be 
generally  adopted,  he  said,  that,  though  it  might  be  more 
ideal  to  do  without  any  mechanical  aids  in  these  opera- 
tions, it  was  incumbent  on  the  surgeon  to  carefully  study 
the  advantages  and  disadvantages  of  the  different  pro- 
cedures before  adopting  any  method  because  it  was  sup- 
posed to  be  the  ideal  one. 

Mr.  BowKEHAN  Jkssktt  observed  that  not  so  many 
years  ago  operations  of  this  class  were  almost  uniformly 
fatal,  but  thanks  to  the  labours  of  Senn  of  Chicago,  Paul 
of  Liverpool,  Maunsell,  and  finally  Murphy,  they  had 
been  rendered  comparatively  safe.  The  operation  with 
Murphy's  button  was  certainly  simple  and  ingenious,  but 
though  simple,  the  manoeuvre  required  considerable 
delicacy  of  manipulation  or  it  might  end  in  disaster. 
Duriijg  a  gastro-enterostomy  he  had  seen  the  button 
drop  back  into  the  stomach,  a  contingency  which  neces- 
sarily entailed  great  risk  of  subsequent  ulceration  and 
perforation.  He,  himself  had  used  MaunseH's  method  in 
three  cases,  and  Mayo  Robson's  bobbin  in  two  Maunseirs 
operation  appeared  to  be  better  suited  for  entereccomy 
than  for  operations  on  the  colon.  All  his  bobbin  operation 
cases  bad  recovered  as  did  two  of  the  other  three.  He 
recalled  the  case  of  a  demented  girl  who,  after  removal  of 
the  ovaries,  suffered  from  faecal  fistula  for  which  she  had 
been  operated  on  several  times  without  success.  He 
opened  the  abdomen  and  after  removing  several  inches  of 
intestine  he  joined  the  ends  by  Mauneell's  method.  She 
made  excellent  progress,  and  six  weeks  after  was  about  to 
go  home  when  suddenly  the  abdominal  wound  reopened 
(»«.,  vas  reopened  by  the  patient)  and  a  pecond  faecal 
fistula  formed.  He  then  cut  down,  removed  four  inches 
more  of  intestine  and  joined  the  ends  of  the  divided  gut 
by  means  of  Mayo  Robson's  bobbin,  this  time,  thanks  to 
the  precautions  which  he  took  to  avoid  interference  with 
the  wound,  with  permanent  success.  It  seemed,  there- 
fore, that  either  procedure  was  satisfactory. 

Mr.  W.  G.  Sfenosb  asked  whether  the  author  had  never 
thought  of  some  simpler  plan  for  joining  the  ends  of 
intestine.  He  pointed  out  that  a  decalcified  bone  bobbin 
might  not  always  be  available  and  suggested  that  a  bobbin 
might  be  constructed  of  simpler  material  such  as  potato 
or  turnip.  Perhaps  the  author  would  consider  the  desir- 
ability of  putting  this  suggestion  to  the  test.  He  asked 
if  the  author  had  used  his  bobbin  in  any  operation  on 
the  descending  colon  where  the  gut  was  not  covered  by 
peritoneum, 

Mr.  H.  Allinoham  referred  to  the  paper  read  by  him 
^fore  the  Medical  Society  in  which  be  had  shown  that 


intestinal  rejection  practised  on  distended  intestine  was 
verv  likely  to  prove  fatal,  in  fact,  all  his  operations  done 
under  such  conditions  bad  proved  unsatisfactory.  He 
commented  on  the  curious  dislike  that  certain  surgeons 
manifested  for  decalcified  plates  of  every  description. 
Personally,  be  thought  that  they  greatly  assisted  in 
carrying  out  the  operation,  acting  as  a  splint  while  repair 
was  taking  place.  He  had  tried  Murphy's  button  but 
had  made  up  his  mind  in  future  always  to  use  a  bone  plate 
of  some  kind.  He  mentioned  that  all  the  cases  at  St. 
George's  Hospital  in  which  Murphy's  button  has  been 
usedhad  terminated  fatally. 

Mr.  Bbbohabd  said  he  had  used  Murphy's  button  in 
four  cases,  two  of  them  dying  immediately  from  shock,  so 
that  no  opinion  with  respect  to  the  button  could  be  based 
thereon.  He  had  employed  MaunselPs  method  in  two 
cases.  When  there  was-  plenty  of  mesentery  there  was 
no  difficulty,  but  when,  as  in  an  operation  just  above  the 
sigmoid  flexure,  the  mesentery  was  short,  the  operation 
was  attended  by  considerable  difficulty.  The  difficulty 
arose  in  endeavouring  to  approximate  the  ends  of  the  gut 
when  the  bowel  is  greatly  distended  and  thickened.  In 
one  case  the  button  did  not  come  away  until  the  thirty- 
sixth  day,  but  it  gave  rise  to  no  trouble. 

Mr.  BowLBT  said  that  the  operation  described  by  the 
author  was  exceedingly  ingenious  and  simple,  but  in 
operating  for  gangrenous  gut  from  strangulated  hernia, 
he  had  found  it  very  difficult.  When  the  one  part  of  the 
gut  was  distended,  and  the  other  part  contracted,  the 
invagination  of  the  ends  was  extremely  difficult  to  effect. 
His  patient  had  died,  and  after  death,  they  found  a  con- 
siderable amount  of  the  lumen  of  the  intestine  excluded 
by  the  in  turned  walls  of  the  bowel.  He  bad  come  to  the 
conclusion  that  the  method  was  good  in  cases  of  undis- 
tended  intestine,  but  not  in  others.  The  bobbin  was 
certainly  useful  as  furnishing  a  passage  for  faeces  and 
flatus  immediately  after  operation. 

Mr.  Glutton  suggested  that  in  many  of  these  cases 
lateral  anastomosis  offered  certain  advantages.  His  own 
experience  with  Murphy's  button,  however,  had  been  very 
satisfactory.  Possibly  the  cases  referred  to  by  Mr. 
Aliingham  were  instances  of  operations  undertaken  on 
distended  intestine.  The  trouble  with  Murphy's  button 
was  that  it  did  not  pass  through,  and  he  referred  to  a 
patient  of  his  own  who  had  one  in  her  intestine  since 
November  last,  and  the  same  calamity  had  happened  to 
various  surgical  friends.  All  his  cases  of  lateral  anastomosis 
had  been  successful,  whereas  with  other  methods,  he  had 
had  a  certain  proportion  of  failures.  It  was  especially  in 
distended  intestine  that  the  lateral  operation  might  prove 
useful 

Mr.  Mayo  Robsok,  in  reply,  said  his  object  in  reading 
this  paper  was  to  bring  before  them  the  results  of  personal 
experience,  both  hospital  and  private,  at  the  Leeds  Gen- 
eral Infirmarv.  He  mentioned  that  his  regretted  colleague, 
Mr.  McGill,  had  sketched  out  to  him  Maunsell's  operation 
many  years  ago,  and  had  he  not  prematurely  died,  he  had 
no  doubt  that  this  procedure  would  have  been  known 
under  his  name.  He  had  heard  that  Gzemy  was  employing 
sutures  alone  with  great  success,  but  he  pointed  out  that 
with  the  continuous  suture  there  was  always  risk  of  subse- 
quent stenosis.  This  method  appeared  to  be  peculiarly 
applicable  to  operations  on  the  colon.  There  was  indis- 
putably great  aanger  in  operating  on  distended  intestine, 
but  they  were  not  always  free  to  choose,  and  whenever  it 
was  possible  to  dispense  with  the  preliminary  colotomy, 
he  thought,  for  the  patient's  sake,  that  this  should  be  done. 
He  explained  that  lateral  anastomosis  really  involved  an 
extra  and  unnecessary  amount  of  suturing,  but  when  indi- 
cated it,  too,  could  very  well  be  done  by  the  aid  of  two 
bobbins.  In  view  of  the  difficulty  which  was  sometimes 
met  with  in  inserting  the  end  of  Murphy's  button  into  the 
distal  gut,  he  had  suggested  to  him  to  make  the  flange 
somewhat  larger. 

Mr.  L.  A.  Dunk  reported  the  case  of  a  man  who  had  been 
the  subject  of  a 

PEBFORATINO  ULCSK  OF  THB  DUODENUM. 

The  patient  whilst  at  work,  felt  a  sudden  pain  in  the 
epigastrium,  attended  with  nausea  and  faintness.  He 
was  taken  home,  and  subsequently  brought  to  Guy's  Hos- 
pital on  August  2nd,  1895.  The  abdomen  was  distended 
and  remarkably  tympanitic.    The  normal  hepatic  dulneas 


April  1,  ISQ^ 


TRANSACTIONS  OF  SOCIETIES. 


THv^MiDiCiWL  Pbbss.     345 


was  absent}.  He  was  suiSeriDg  great  pain,  and  had  an 
anxioaa  expression  of  coantenance.  The  abdomen  was 
opened  by  a  median  incision  above  the  umbilicus,  which 
allowed  of  the  escape  of  a  quantity  of  gas  and  yellowish 
fluid.  A  small  perforation  was  found  in  the  anterior  wall 
of  the  first  part  of  the  duodenum.  This  was  closed  with 
fine  silk  Lembert  sutures,  and  the  abdominal  cavity 
fiushed  out  with  boiled  water.  The  flushing  process  inter- 
fered with  respiration,  and  so  could  not  be  thoroughly 
carried  out,  hence  a  Keith's  tube  was  put  into  the  upper 
parts  of  the  wound  for  the  first  twenty-four  hours.  The 
patient  progressed  well  for  ten  days,  when  his  pain 
returned,  and  his  temperature  was  raised.  He  became  worse 
tUl  August  27th,  when  the  abdomen  was  opened  a  second 
time,  on  this  occasion  aloni?  the  right  costal  margin,  as  it 
was  thought  that  a  collection  of  pus  had  formed  between 
the  liver  and  the  diaphraf^m.  Nothing  was  discovered 
except  a  few  adhesions  in  this  region,  chiefly  beyond  the 
reach  of  the  finger.  An  exploring  needle  passed  throneh 
the  eighth  intercostal  space  was  felt  to  traverse  the  abdo- 
men and  perforate  these  adhesiona  A  drop  of  pus  was 
evacuated  by  this  method.  The  wound  was  closed,  the 
intention  being  to  open  and  drain  the  abscess  through  the 
thorax  at  a  later  date.  This  was  not,  however,  required 
as  the  temperature  fell  immediately  after  the  operation, 
and  remained  low  till  the  sixth  day,  when  the  wound 
was  found  to  be  distended  with  pus.  The  removal  of  two 
sutures  sufficed  to  evacuate  this,  after  which  the  recovery 
was  rapid. 

Mr.  Bland  SnTTOir  said  that  years  ago  he  had  came  to 
the  conclusion  that  duodenal  ulcer  was  pathologically 
quite  difierent  to  the  gastric  ulcer  met  with  in  chlorotic 
girls.  Though  not  mentioned  in  text  books,  these  patients 
seemed  alwavs  to  have  been  persons  addicted  to  spirit 
drinking,  and  were  consequently  bad  subjects  for  surgical 
treatment.  It  occurred  to  him  that  the  interference  with 
respiration  noted  in  the  author's  case  when  the  abdomen 
was  fiushed  with  water  might  have  been  due  to  the  tem- 
perature having  been  too  low.  In  his  opinion  the  tempera- 
ture should  not  exceed  115®,  nor  fall  below  110^,  otherwise 
shock  might  be  caused. 

Mr.  Dunn,  in  reply,  said  the  patient  was  not  addicted 
to  spirit  drinkiug,  though  he  was  not  altogether  temperate. 
He  had  often  used  injections  at  lOO"*  F.  before,  but  had 
never  noticed  any  such  interference  with  respiration,  as  in 
this  instance. 


HARVEIAN  SOCIETY. 
Mksteno  held  Thctbsdat,  Maboh  19th,  1896. 


Dr.  Wm.  Hill,  Vice-President,  in  the  Chair. 


HAUHEIM  AND  THB  SCHOTT  TBBATMENT  Or  DISKASSS  07  THB 
HBABT. 

Dr.  R.  L.  Bowlbs  read  a  paper  on  the  above  subject,  a 
full  abstract  of  which  will  be  found  in  another  column. 
In  the  discussion  which  followed, 

Mr.  Eastbs  thanked  the  author  for  his  interesting  paper, 
which  would  direct  increasing  attention  to  the  subject. 
He  asked  those  who  had  seen  the  treatment  carried  out 
at  Nauheim  (of  whom  many  were  present)  to  what  cases 
the  Schott  method  was  especially  applicable,  and  if  idl 
cases,  whether  of  lesions  of  the  vaJves  or  substence  of  the 
heart,  and,  amongst  the  former,  oases  of  stenosis  as  well  as 
incompetency,  were  all  equally  benefited  by  the  treatment? 
One  heard  much  of  the  successes,  but  were  there  no 
failures  ?  Ordinary  methods  of  treatment — rest,  di^talis, 
iron,  Ac — were  usually  successful,  though  occasionally 
failing  to  relieve.    Similarly,  the  Schott  method  doubtless 

Eve  good  resulte  generally  ;  did  it  always  do  so,  partiou- 
'ly  when  treatment  bv  the  older  and  more  generally 
adopted  methods  had  failed  of  success  ? 

Dr.  BxzLBT  Thorns  said  that  he  could  not  be  surprised 
at  the  scepticism  with  which  the  merito  of  the  Schott 
methods  are  regarded  by  those  who  have  not  themselves 
enjoyed  opportunities  of  observing  their  demonstrable 
resulte.  The  names  of  Broadbent,  Grainger  Stewart,  and 
Saundby  had  been  mentioned.  Those  physicians  and 
scientiste  had  each  one  approached  the  subject  in  a  spirit 
of  reasonable  and  scientinc  unbelief,  and,  in  the  event, 
hiMl  become  cooy^rte  apd  iidvoQates.    Ue^  himaelli  had 


been  a  sceptic  of  the  most  advanced  order,  for  he  had  been, 
in  the  first  instonce,  unable  to  accept  the  evidence  of  his 
senses,  but  he  had  been  compelled  to  yield  to  the  per- 
suasive eloquence  of  striking  results.  With  regard  to  the 
case  of  L.,  he  had  wat<;hed  it  in  the  first  few  days  of  treat- 
ment, and  had  enterteined  serious  misgivings  as  to  the 
ultimate  resulb  on  account  of  the  extreme  gravity  of  the 
symptoms,  and  yet  they  had  the  evidence  of  Dr.  Bowles 
as  to  the  remarkably  satisfactory  recovery,  of  which  he 
had  been  an  eye-witness.  The  case  of  Capt.  B.,  had,  for 
like  reasons,  inspired  him  with  similar  forebodings.  As 
to  unsuccessful  cases,  very  few  had  been  recorded  for 
the  reason  that  they  had  been  rare.  He  called  to 
mind  one  which  he  haa  reason  to  believe  had  been  quoted 
as  an  instance  of  a  man  having  been  killed  by  the 
Schott  treatment.  The  patient  had  been  treated  in  Eng- 
land for  aneurism,  and  after  having  been  unable  to 
perform  his  official  duties  for  a  period  of  something  like 
two  years,  had  left  his  bed  to  repair  to  Nauheim.  He 
(the  speaker)  had  seen  him  for  the  first  time,  some  three 
weeks  later.  On  that  occasion,  the  patient  had  walked  a 
distance  of  about  a  mile,  part  of  which  was  up  a  steep 
incline,  and  after  spending  more  than  an  hour  in  conversa- 
tion, had  walked  back  again.  He  expressed  himself  as 
feeling  better  than  he  had  done  for  years.  Shortly  after- 
wards, he  had  contracted  a  severe  chill  from  sitting  in  the 
open  air  in  the  course  of  a  cold  evening  which  had  suc- 
ceeded on  a  singularly  hot  and  sultry  day,  which  resulted 
in  pleuro-pneumonia  and  in  death.  A  post-mortem  exam- 
ination had  been  made  by  the  pathologist  attached  to  the 
University  of  Gieesen,  and  revealed  the  existence  of  an- 
eurism of  the  heart  and  calcification  of  the  coronary 
arteries.  Such  cases  of  failure  could  not  be  held  to  ofier 
evidence  against  the  system.  That  particular  one  was 
the  more  interesting  as  it  was  one,  among  others,  which 
had  led  Dr.  Schott  to  modify  his  dictum  as  to  the  non- 
applicability  of  his  methods  to  cases  of  aneurism.  He, 
himself,  could  not  help  thinking  that  a  system  which 
induced  repair  of  atheroma,  and  of  other  degenerative  pro- 
cesses to  which  the  cardio- vascular  structures  are  liable, 
and  which,  by  relieving  peripheral  resistance,  reduced 
hydrestetic  pressure  on  the  walls  of  the  heart  and  great 
vessels,  was  worthy  of  a  cautions  trial  even  in  cases  of 
aneurism.  He  added  that  long-standing  cases  of  myo- 
cardial degeneration,  and  of  Graves'  disease  would  be 
found  to  require  prolonged  treatment. 

Dr.  WsTHVRBD  said  that,  about  two  years  ago,  he  paid 
a  visit  to  Nauheim,  and  was  much  astonished  by  the 
resulte  of  the  special  treatment  for  chronic  cardiac  disease 
which  he  saw  there.  He  felt  deeply  grateful  to  Dr.  Schott 
for  the  trouble  he  had  token  in  affording  him  opportunities 
for  observing  patiente  under  treatment.  He  (Dr.  Wethered) 
fully  corroborated  the  remarkable  stetement  made  by  Dr. 
Bezly  Thome  that  all  forms  of  chronic  heart  disease  de- 
rived benefit  from  the  baths  and  exercises.  But  it  was  a 
little  difficult  to  answer  the  question  asked  by  a  preceding 
speaker,  as  to  what  cases  proved  most  successful  under 
treatment,  because  it  all  depended  upon  what  was  meant 
by  *'  successful."  If  *'  cure  "  was  meant,  a  large  number 
of  cases  sent  to  Nauheim  were  unsuccessful;  but  if 
"  relief,"  and  often  very  great  relief,  was  synonymous  with 
successful,  then  nearly  all  cases  were  succeesfuL  He  had 
seen  esses  there,  which  in  England  would  have  been 
regarded  as  hopeless,  and  in  which  digitelis  and  all  ordi- 
nary treatment  had  been  taed  in  vain,  yet.  under  the 
Nauheim  treatment,  the  improvement  was  marvellous; 
but  as  soon  as  the  treatment  was   discontinued,  these 

Satiento  b^an  to  relapse.  Yet,  some  of  the  worst  cases 
uring  the  months  they  were  at  Nauheim  seemed  to  reap 
sufficient  benefit  to  carry  them  over  the  winter  months 
until  they  could  return  to  Nauheim  and  receive  a  new 
lease  of  life.  He  considered  that,  in  a  great  measure,  the 
success  at  Nauheim  depended  upon  the  strict  regime 
which  the  patients  were  compelled  to  follow.  If  patiente 
in  England  would  consent  to  submit  themselves  to  tne  same 
rigid  rules  of  life,  he  saw  no  reason  why  the  treatment 
should  not  be  adopted  in  this  country,  more  especially 
with  regard  to  the  exercises,  but  they  were  useless  unless 
properly  carried  out  for  some  time.  He  thoneht  the  capes 
which  were  most  suiteble  were  those  of  dilated  heart 
without  valvular  mischief,  and  neurotic  cases,  although 
many  cases  of  valvular  disease  obtained  mueh  benefit. 
Qftses  of  Orayes'  disease  wer^  not  so  satisfactory. 


346    Thb  Mbdioal  Pbiss. 


TRANSACTIONS  OF  SOCIETIES. 


Apbil  1»  1896. 


Dr.  Caonst  Mid  that  he  desired  to  leera  all  he  ooald 
cooceming  this  remarkable  treatment,  and  he  intervened 
at  that  point  so  as  to  get  the  benefit  of  the  knowledge  of 
speakers  yet  to  come,  and  especialW  of  Dr.  Heineman's 
eight  years' study  and  experience.    Dr.  Bowies' paper  did 
not  profess  to  taie  exhaustive.    It  was  a  most  interesting 
account  of  clinical  observation,  and  what  he  saw  himself 
but  it  snffgested  inquiries  which  many  would  like  to  have 
answered.  Dr.  Bezley  Thorne,  who  followed,  spoke  no  less 
decidedly  than  Dr.  Bowles  in  favour  of  the  Nauheim  treat- 
ment, and  they  were  glad  to  hear  that  it  could  be  practised 
successfully  without  going  to  Germany.     For  most  of 
them,  however,  the  important  question  was,  in  what  class 
of  patients  to  advise  this  treatment,  and  what  prospect  of 
relief,  at  what  cost  of  time,  money,  and  inconvenience  to 
extend  to  them.  The  impression  left  upon  his  mind  by  Dr. 
Bowles  was  that,  given  a  case  of  cardiac  enlargement  a  cure 
was  to  be  found  at  Nauheim,  and  in  the  Schott  treatment. 
This  idea  is  obviously  too  crude  to  be  of  use.  They  were  all 
in  the  habitof  thinking  a  case  of  cardiac  enlargement  in  con- 
nection with  its  cause,  and  his  first  inquiry  was,  how  far  the 
prognosis  depended  upon  the  cause  ?     Dr.  Thorne  had 
incidentally  given  a  part  answer  by  excluding  aneurism 
and  arterio-sclerosis,  and  (one  might  perhaps  infer)  heart 
disease  secondary  to  kidney  mischief  from  the  operation  of 
the  cure.    It  then  remained  probable  that  it  was  valvular 
disease  of  the  heart  which  yielded  the  most  promising 
cases.     Was  Uiis  true  of  all  forms  of  valvular  disease,  and 
was  the  prognosis  equally  good  in  all  ?    Mention  had  been 
made  by  Dr.  Wethered  of  nenefit  derived  in  Graves'  dis- 
ease and  neurotic  tachycardia,  and  while  he  admitted  that 
an  easy  and  effective  treatment  for  these   troublesome 
complaints  was  a  boon  to  be  thankful  for,  relief  in  such 
cases  would  give  no  support,  from  the  sceptic  points  of 
view,  to  the  contention  of  a  cure  in  valvular  disease.  It  had 
been  made  plain  that  the  results  of  failing  compensation 
— albuminuria,  oedema,  venous  congestion,  were  removed. 
His  next  inquiry  would  be,  did  the  cure  consist  in  this  ? 
If  so,  in  the  case  of  valvular  disease,  it  would  be  no  cure  at 
all,  only  a  temporary  relief,  since  these  conditions  must 
return.    If  it  is  upheld  as  a  cure  for  heart  disease,  it  will 
be  necessary  to  give  it  pathological  relevancy,  and  the 
remedy  of  the  original  lesion  has  to  be  accounted  for.    A 
point  of  equal  interest,  and  one  which  surprised  him,  was 
involved  in  Dr.  Thome's  statement  that   degenerating 
vessel  walls  and  atheromatous  arteries  underwent  repair, 
and  renovation  of  tissue  as  a  result  of  the  treatment.   This 
also  was  a  matter  of  great  pathological  interest,  but  diffi- 
cult of  proof,  and  he  would  like  to  hear  more  in  favour  of 
the  contention. 

Dr.  G  W.  Ghafmak  doubted  the  possibility  of  so 
accurately  defining  the  variations  of  cardiac  dulnees,  as 
the  drawings  we  were  accustomed  to  see  in  papers  on  the 
Schott  treatment,  would  appear  to  indicate.  He  pointed 
out  the  fallacies  in  auscultatory  percussion,  and  stated  that 
the  note  varied  with  the  distance  between  the  chest  piece 
and  the  part  struck,  irrespective  of  what  was  beneath,  and 
that  firm  pressure  on  the  chest  piece  made  sometimes  a 
difference  of  a  semitone.  He  remarked  on  the  toning 
down  by  the  last  two  speakers  of  the  optimistic  view  of 
Dr.  Bezley  Thome. 

Dr.  Lksldb  Thobnb  Thorns,  in  answer  to  the  question 
as  to  the  possibility  of  the  Schott  treatment  being  success- 
fully carried  out  in  England,  said  that  he  had  treated  a 
number  of  cases  of  heart  disease  by  this  method,  both  at 
Llaneammarch  Wells,  in  Wales,  and  also  in  London,  and 
out  of  30  cases  so  treated,  29  had  given  excellent  results, 
the  unsuccessful  case  being  one  in  which  calcareous  degen- 
eration of  the  vessel  walls  played  a  prominent  part  in  the 
circulatory  trouble.  He  hid  made  careful  examinations 
as  to  the  results  of  the  baths  and  exercises  upon  the  area 
of  cardiac  dulness,  obtaining  similar  results  to  those  of 
Dr.  Bowles.  He  had  studied  the  effect  of  the  baths  and 
exercises  upon  the  pulse,  and  found  as  an  almost  constant 
result  that  the  pulse  was  slowed  in  rate,  increased  in 
volume,  and  rendered  more  natural  in  tension,  both  by  the 
baths  and  the  exercises.  Among  his  ca>>es  were  several  of 
valvular  disease,  of  various  forms,  and  although  he  did  not 
maintain  that  the  diseased  valves  retnmed  to  their  normal 
shape  and  consistency  under  the  Schott  treatment,  still 
the  disappearance  of  such  symptoms  as  oedema,  albumin- 
uria, dyspnoea,  &c.,  indicated  an  improvement  which  could 
not  be  disregarded  even  by  thoee  who  were  most  sceptical 


with  regard  to  the  diminution  of  cardiac  dulnees  brought 
about  by  this  treatment. 

Dr.  Alexandbb  Morrison  'acknowledged  that  benefit 
was  to  be  derived  from  the  use  of  the  baths  and  exercices 
carried  out  at  Nauheim.  He  considered  that  the  justifica- 
tion for  sending  patients  to  that  watering  place  lay  in  the 
large  supply  of  carbonic  acid  naturally  evolved  in  the  baths 
there,  and  the  mental  stimulus  imparted  to  the  patient 
who  betakes  himself  to  a  Bethesda  where  he  devotes  him- 
self conscientiously  to  his  '*  kur."  The  exercises  based 
upon  the  eternal  principles  of  physiology  could,  of  course, 
be  carried  out  anywhere.  He  criticised  the  degree  of 
cardiac  shriukage  related  by  many  advocates  of  the 
method,  and  referred  to  Dr.  Leith's  paper  on  the  subject, 
with  the  views  in  which  he  agreed.  The  benefits  arising 
from  the  system  he  attribute  to  the  exaggeration  of  the 
peripheral  and  pulmonary  aids  to  circulation,  as  well  as  to 
direct  stimulation  of  the  heart,  and  considered  that  those 
who  regarded  lung  encroachment  on  the  cardiac  area  as  one 
of  the  causes  of  the  apparent  shrinks^  of  the  latter, 
really  spoke  in  favour  of  the  system,  which  was  initiated 
by  Stokes,  of  Dublin,  has  been  elaborated  on  the  Gon- 
tinent  by  the  physicians  at  Nauheim,  on  the  lines  of 
Zander's  gymnastics,  and  adopted  by  Oertel,  of  Munich, 
and  elucidated  by  him  in  a  work  of  the  highest  scientific 
order. 

Dr.  John  Bboadbbnt  agreed  with  the  previous  speaker 
that  one  of  the  important  contributing  agisnts  to  the  bene- 
ficial results  obtained  in  the  treatment  of  heart  disease  at 
Nauheim  was  the  regular  routine  life  led  there,  with 
freedom  from  worry  and  excitement  of  all  kinds.  While 
admittinar  that  the  treatment  by  baths  and  exercises  was 
of  great  service  in  suitable  cases,  he  wished  to  protest 
against  the  idea  that  it  was  advisable  or  beneficial  in  all 
varieties  of  morbus  cordis,  or  that  equally  good  results 
could  not  be  obtained  by  other  methods  in  many  cases. 
He  instanced  the  rapid  recoveries  that  take  place  every 
day  in  hospital  as  a  result  of  rest  and  suitable  treatment, 
by  mercuriid  purgatives  and  digitalis,  in  cases  of  valvular 
disease  where  compensation  has  broken  down  in  conse- 
quence of  overwork  or  imprudence  on  the  part  of  the 
patient,  or  in  consequence  of  an  intercurrent  attack  of 
bronchitis.  He  had  not  found  the  Schott  treatment  of 
service  in  advanced  cases  of  valvular  disease  with  complete 
failure  of  compensation  where  drugs  and  rest  had  not 
been  of  avail  to  alleviate  the  symptoms ;  nor  did  he  consider 
it  safe  or  advisable  in  cases  of  aortic  regurgitation  of  any 
severity,  as  he  had  twice  kn<  wn  of  syncopal  attacks  occur- 
ring while  the  patient  was  in  the  bath.  He  thought  that  its 
employment  was  indicated  in  mitral  diseaee,  more  espe- 
cially in  mitral  stenosis,  when  compensation  has  not 
actually  broken  down,  but  is  maintained  with  difiiculty  ; 
in  such  cases,  digitalis,  though  it  might  for  a  time  appear 
to  do  good  by  increasing  the  energy  of  the  systole  of  the 
right  ventricle,  was  not  of  permanent  or  real  service. 
One  such  case  he  had  known  to  derive  great  benefit  from  a 
visit  to  Nauheim.  He  also  thought  that  the  Schott  treat- 
ment was  often  of  service  in  cases  of  tachycardia,  or  of 
loss  of  tone  of  the  heart  after  influenza,  but  he  deprecated 
its  employment  in  cases  of  cardiac  dilatation,  the  result  of 
overstrain  from  football  or  rowing,  in  young  adults,  for 
they  would  recover  without  it  by  abstaining  from  violent 
exercise ;  in  fact,  in  such  cases,  gentle  walking  exercise 
had  the  effect  of  bringing  in  the  apex  of  the  heart  in  the 
same  way  as  the  Schot^  movement*,  and  had  similar  good 
results.  He  thought  its  employment  in  such  ca^es,  and  in 
the  case  of  many  of  the  numerous  class  of  patient  who  com- 
plain of  a  "  weak "  heart,  was  inadvitable  as  a  regular 
course  of  treatment  ostensibly,  for  heart  disease,  would 
be  liable  to  make  them  nervous  and  over  anxious  in  the 
future,  and  encourage  a  tendency  to  cardiac  hypochon- 
driasis. 

Dr.  Hkineman,  of  New  York,  followed  with  "  Notes  on 
the  Treatment,"  which  will  be  found  in  another  column. 
Dr.  Bowles  replied  to  the  various  points  raised,  and 
the  meeting  adjourned. 


The  deaths  from  alcoholism  are  stated  to  amount  in 
Stockholm  to  90  per  1,000.  This  is  the  highest  rate  in 
the  world. 


Apbil  l,lgto. 


TRAKBACnOirS  Of"  SOdETtBS. 


Ybb  Mmwiui. 


347 


ROSTAL  ACADEMY  OF   MEDIdNS  IN  IRELAND 

SBCnOM  OP  SUBOBRT. 

MunNo  HBLD  Fbidat.  Fxb&uabt  2l8r. 


The  Preddeot,  8r  Thobhut  8tokbb,  in  tbe  Chair. 

In  refenooe  to  a  case  of  ligature  of  tbe  eeoond  stage  of 
the  rabdaviaa  artery  exhibited  by  Mr.  Croly,  Dr.  Cbaunt 
asked  why  the  arterj  was  lisatiued  in  the  seoood  stase? 

Prof.  BaKunr  inquired  wliether  or  not  the  woona  was 


Prof.  Fjlaser  asked  what  was  the  natnre  of  theligatore  ? 

Snrgeon-Major  Daly  wished  to  know  whether  the 
patient  was  a  soldier,  and  whether  he  had  syphilis  ? 

Mr.  Cboly  said  he  tied  in  the  seeond  stage  because  he 
coold  not  tie  the  artery  in  its  third  sta^  which  was 
involved  in  the  aneorysm.  The  woond  had  healed,  but 
re-opened  slightly,  probably  owing  to  a  small  bgatore. 
The  ligatare  was  one  of  gold-beater's  skin,  UeepM  in  a 
solation  of  perchloride  of  mercory,  and  warmed  io  a  20 
per  ceot.  solation  of  carbolic  acid.  He  coold  not  trace  a 
nistory  of  syphilis. 


Prof.  CuirviKGHAM  exhibited  a  series  of  casts  which  had 
been  taken  from  living  lepers  in  the  Lassret  of  New  South 
Wales.  They  had  been  sent  to  him  by  Professor  Ander- 
son Stoart,  of  the  University  of  Sy<bMy.  Two  of  the 
casts  were  taken  from  patients  sofferiog  from  lepra 
toberosa ;  the  others  from  typical  cases  of  lepra  nervosa. 

Mr.  Dau^as  Pratt  said  be  had  seen  900  cases  of  leprosy 
in  Norway.  On  the  question  of  infection,  he  thought  a 
person  could  contract  leprosy  after  a  long  residence,  say 
five  years,  in  a  place  where  the  disease  existed. 

Prof.  McWxBNKT  said  he  met  Prof.  Kitasato  in  Berlin 
in  1892.  He  believed  that  leprosy  was  due  to  a  bacillus, 
and  be,  the  speaker,  concurred.  He  had  made  patholo- 
gical examination  in  Dr.  CCarroll's  case,  and  had  no  diffi- 
culty in  discovering  enormous  masseo  of  bacilli.  He  also 
found  cells  analogous  to  tubercle  cells.  He  agreed  with 
Prof.  Kitasato  when  the  latter  expressed  the  opinion  that 
be  saw  no  reason  why  leprosy  should  not  be  curable  by 
the  antitoxin  or  serum  treatment 

A  NSW  HRHOD  OF  UMAIASISa    BBAINLBSIOKS. 

Mr.  RoBKBT  Cox  read  a  paper  on  "  A  New  Method  for 
IxNsalising  Brain-leeioos,*'  and  exhibited  tbe  necessary 
apparatus  for  its  employment.  He  pointed  out  that  there 
was  need  for  a  more  perfect  method  of  loontioe  the  im- 
portant areas  of  the  cerebral  cortex  on  the  overling  sur- 
face of  tbe  scalp,  seeing  that  most,  if  not  all,  the  methods 
generally  employed  are  either  limited  in  their  scope,  or 
complicated  m  their  application,  while  many  give  nse  to 
error  by  the  use  of  a  standard  measure — the  mch  or  the 
centimetre  for  varying  surfaces.  He  thousht  the  method 
which  he  was  about  to  describe  would  be  found  devoid  of 
these  objections.  For  its  use  two  things  were  necessary — 
(a)  an  instrument  which  he  had  invented  and  called  a 
cerebro-grapbometer,  and  (b)  a  diagrammatic  map  of  a 
hemisphere  of  tbe  brain,  prepared  from  readings  mi^e  by 
the  use  of  the  same  instrument  on  the  cadaver  and  casts 
of  the  brain  in  nttL  This  map  might  be  substituted,  or 
augmented,  by  a  list  of  indices  made  in  tbe  same  way. 
The  instrument  consisted  entirely  of  tbe  mechanical 
device,  technicaUy  known  as  "lazv  tongs,"  formed 
into  a  circle  with  two  accessory  loops  attached  to 
the  circle  by  their  ends  in  such  a  way  that  they  arch 
over  it  at  right  angles  to  each  other.  One  loop  bears 
the  numerals,  beginning  at  each  end  with  1,  and  ending 
in  the  middle  with  10;  while  the  other  loop  has  the 
letters  A  and  V  in  consecutive  order  from  bnore  back- 
wards. That  bearing  T  forming  the  junction  with  the 
circle  behind.  The  map  is  made  on  a  guomonic  projec- 
tion, with  the  radii  or  longitudinal  lines  marked  by  letters, 
and  the  semicircles  or  lines  of  latitude  by  numerals.  In 
using  the  instrument  it  is  necessary  to  extend  it  in  all 
parts,  and  apply  it  to  the  head  wiw  the  rivet,  forming 
the  junction  of  the  lettered  loop  with  the  circle  in  front : 
on  the  glabella  and  the  rivet-marked  V,  at  the  other  end 
to  the  ocdpitfld  protuberance ;  then  press  down  the  loop 
between  these  two  points  in  the  middle  line,  and  close  the 
circle  round  the  head  on  such  a  plane  that  the  numeral 
10  will  rest  on  the  lettered  band.    The  instrument  is  then 


in  position,  when,  to  find  any  given  point— aay  Brooa'fe 
lobe— it  is  only  necessaiy  to  conenlt  the  map  or  list  of 
indices  for  the  bearing,  there  gfven  as  "C4,  left  side.** 
and  place  the  10  of  the  numbered  kM»  on  the  0  of  the 
lettered  loop,  when  the  numeral  4  wiU  lie  over  the  pari. 
Having  thus  shown  the  simplicity  of  the  method,  for  the 
carrying  out  of  which  no  recourse  need  be  had  to  any 
science,  and  the  almost  automatic  action  of  the  cerebro^ 
|rraphometer,  he  proceeded  to  explain  its  aocuracnr,  show- 
mg  that  it  was  applicable  to  all  siaed  heads,  and  formed 
its  own  unit  of  measurement  for  each,  thus  eliminalang 
the  errors  doe  to  the  use  of  a  standard  measure  for  a 
varving  surface.  The  two  fixed  points  thken,  the  glabella 
ana  the  occipital  protoberanoe,  place  tbe  circle  on  that 
plane  considered  so  important  by  I^rof,  Fraser  as  bearing 
a  fixed  relation  to  all  important  parts  of  the  brain.  His 
opportunities  of  testing  its  accuracy  were  verv  few,  but  in 
those  it  gave  excellent  results,  iHiile,  with  regard  to 
Rolsndo's  fissure,  perfection  seeined  to  have  been  reached. 
In  conclusion,  he  added  that  the  instrument  was  simple, 
compact,  durabls,  and  capable  of  being  rendered  aseptic 
by  boiling,  and  was  made  by  Measre.  Arnold  and  Sona. 

GANOKK  or  THB  BSXA8T. 

Mr.  WiLUAM  Thomson  read  a  paper  on  cancer  of  the 
breast,  and  discussed  the  question,  its  curabilitv  bv 
operation,  and  shortly  detailed  the  advances  which  baa 
been  made  in  the  thoroughness  of  operative  procedure. 
He  had  shown  a  case  within  the  past  three  months  from 
which  he  removed  an  undoubted  scirrhus  seven  years  ago, 
and  he  had  seen  another  some  years  since  in  which  six 
years  had  elapsed  without  any  sign  of  return.  Two  others 
are  at  present  living  two  and  a  half  years  after  operation  ; 
tbere  was  no  indication  of  reappearance  of  disease.  He 
advocated  complete  clearing  of  the  axilla,  of  the  fascia, 
and  removal  of  portion  of  tne  pectoral  muscles  if  these 
were  at  all  suspected.  He  believed  that  cancer  was 
curable  in  a  fair  peroentage  of  cases  when  operation  was 
early  and  thorough.  He  expressed  his  belief  that  cancer 
was  a  local  disease,  afterwards  infecting  the  whole  body  ; 
that  infection,  however,  being  delayed  by  tbe  line  of 
defence  provided  by  the  lymphatic  glands.  He  admitted 
that  in  some  instances  a  line  of  heredity  in  cancerous 
patients  provided  a  condition  in  which  cancer,  beginning 
locaUy,  was  likely  to  spread  with  greater  rapidity.  The 
paper  was  followed  by  a  lengthy  discussion,  and  Mr. 
Thomson  replied. 


THE  HUNTERIAN  SOCIETY. 
Mbbtoio  held  Wbdkesdat,  Maboh  2fiTH,  1896. 


The  President,  Db.  Q.  E.  Hbbman,  in  the  Chair. 

CUmOAIi    OASBS. 

Sib  Hugh  Bbbvob  showed  for  Dr.  Woods  a  ease  of 
"  Spasmodic  Tremor  in  tbe  Riffht  Hand  and  Forearm," 
which  had  been  treated  by  short  nypnotic  sleeps  for  about 
six  weeks.  Gradual  recovery  took  place }  also  another 
case  of  a  man,  8Bt.  43,  who  was  succes^fuUv  treated  by  the 
same  means  for  localised  headache  and  giddiness. 

Dr.  F.  J.  Smith  showed  a  man,  the  subject  of  "  Addison's 
Disease,"  treated  bv  supra-renal  extract  twice  daily.  Tbe 
pulse  had  improveo,  and  the  vomiting  was  less. 

Dr.  Arthcjr  Dayies  brought  before  tbe  Society  a  case 
of  *<  Imperfect  Closure  of  tbe  Left  Upper  Eyelid  in  a 
patient  who  suffered  from  Mitral  Regurgitation." 

Suggestions  as  to  the  cause  of  the  imperfect  closure  of 
the  eye  were  made  by  the  President,  Dr.  F.  J.  Smith,  Sir 
Hugh  Beevor,  Mr.  Rawes,  and  Mr.  Tubby. 

Dr.  Davixs  finall^^  expressed  his  opinion  that  the  cause 
of  the  apparent  projection  of  tbe  eye  was  spasm  of  the  left 
orbitalis  muscle. 

Dr.  Arnold  Chapun  presented  the  case  of  a  man,  adt. 
46,  by  occupation  a  seaman,  the  subject  of  '*  Bronchiecta- 
sis of  the  Lower  Lobe  of  the  Left  Lung."  He  was  placed 
in  a  room  8  ft.  in  each  of  its  dimensions  and  subjected  to 
the  vapour  of  creosote  for  from  a  half  to  one  hour  daily. 
After  some  weeks  tbe  following  results  were  noticed  :— 
The  temperature  fell  to  normal,  the  foetor  of  tbe  breath 
was  less  ;  there  was  a  decrease  in  the  moist  sounds  of  the 
chest ;  the  patient  had  gained  6  lbs  in  weight. 


348     Thb  Mbdioal  Priss. 


TRANSACtlONS  OP  SOCIETIES, 


Apbxl  1,  189^. 


Sir  Hugh  Bee^or,  Dr.  Davie?,  Dr.  F.  J.  Smith,  and  Mr. 
Tubby  joined  in  the  diBcuasion  which  followed,  and  Dr. 
Chaplin  replied. 

Dr.  Glovbb  Lton  showed  a  patient,  the  snbject  of 
extensive  *'Painfal  Glandular  Growths/'  probably  dae  to 
lymphadenoma. 

Dr.  Da  VIES  inquired  if  bone  marrow  had  been  given. 

In  his  reply,  Dr.  Lton  stated  that  there  was  no  annmia 
present. 

♦ 

THE   LARYNGOLOGICAL  SOCIETY  OF   LONDON. 
Ordinary  Meeting  held  March  11th. 

Dr.  Felix  Sehon,  President,  in  the  Chair. 

CASES. 

Dr.  Cutford  Beale  showed  a  man,  et.  38,  who  stated 
that  he  felt  something  at  the  back  of  his  tonene,  but  felt 
no  other  inconvenience.  Examination  showea  a  soft  vas- 
cular tumour,  about  the  size  of  a  cherry,  attached  by  a 
broad  base  to  the  left  glosso-epiglottic  fold.  Marked  for  a 
decision  as  to  the  best  method  of  treatment. 

Dr.  Bond  su^ested  the  use  of  the  galvano-cautery  and 
currette ;  The  raisiDENT,  a  free  incision  ;  Mr.  Symonds, 
cutting  off  the  top  of  the  cyst. 

Dr.  Clifford  Beale  also  showed  a  man  who  had  been 
before  the  Society  at  a  previous  meeting.  He  had  been 
kept  under  pot.  iod.,  and  good  diet  for  three  months,  and 
latterly,  under  Mr.  Steward's  advice,  with  local  applica- 
tions of  zinc  chloride.  The  swelling  from  under  tne  left 
ventricle  had  become  much  smaller  and  less  red.  The 
vocal  cord  was  less  thick,  and  the  movements  were  not 
impaired.  Dr.  Beale  was  of  an  opinion  that  the  case  was 
one  of  chronic  tuberculous  infiltration. 

Dr.  Bond  showed  a  case  of  maggots  in  the  nose,  with 
specimens  of  the  larvsB  and  flies.  They  were  pronounced 
to  be  *'Piophila  Casei."  Cases  of  this  description  were 
extremely  rare  in  this  country.  Dr.  Bond  aUo  showed  a 
man,  set.  50,  who  had  huekiness  and  loss  of  voice  for  twenty 
years.  Examination,  on  January  18th,  showed  a  growth, 
the  size  of  a  pea,  on  the  right  cord.  It  was  removed  on 
February  15th.  Microscopically,  it  seemed  to  be  a 
pure  myxoma. 

Dr.  A.  Clair  Thomson  showed  a  woman,  est.  38,  who 
had  a  partial  loss  of  voice  for  the  last  three  months.  ▲ 
small  growth,  about  the  size  of  a  pin's  head,  was  found  in 
the  right  vocal  cord.  The  growth  was  removed,  and 
section  showed  it  was  a  myxoma. 

The  Prbsidbkt  having  remarked  that  in  a  comparatively 
short  space  of  time  three  cases  had  been  shown  at  the 
Society,  although,  until  recently,  only  six  cases  had  been 
recorded. 

Dr.  Kanthaok  stated  that  he  thought  most  of  these 
cases  were  rather  more  ones  of  myxomatous  degeneration, 
which  was  comparatively  common,  than  pure  myxomata, 
wh  ich  were  extremely  rare.  He  suggested  that  the  growth 
should  be  sent  to  the  Morbid  GroMrths  Committee  lor  re- 
port. 

Mr.  S.  Lawrence  showed  a  eirl,  ast.  11,  with  a  flat 
warty -looking  growth  springing  Irom  the  mucous  mem- 
brane of  the  hard  palate.  Mr.  Lawrence  also  showed  a 
specimen  of  growth  removed  from  the  naso-pharynx  of  a 
patient  shown  to  the  Society  at  the  end  of  last  year. 

Dr.  Dundas  Grant  showed  a  patient,  set.  19,  who  com- 
plained last  October  of  an  inflamed  swelling  in  the  neck. 
It  was  fluctuating,  thinly  covered  at  the  anterior  margin 
of  the  right  stemo-mastoid.  To  the  inner  side  was 
another  similar  swelling  with  which  it  communicated. 
There  was  an  enlarged  gland  near  the  angle  of  the  jaw, 
and  a  firm  cord  could  be  felt  running  from  the  lower 
swelling  to  this  j^land.  An  incision  was  made  and  the 
lining  scraped.  Dr.  Dundas  Grant  also  read  notes  of  the 
sequel  of  a  case  shown  at  the  January  meeting.  Death 
had  taken  place  twenty  days  after  operation  for  thyro- 
tomy. 

Mr.  Spencer  showed  a  case  of  chronic  hoarseness  in  a 
girl,  rot  19.  The  vocal  cords  did  not  meet  properly,  and 
there  was  a  chronic  dry  rhinitis  and  pharyngitis  with 
crusts. 

Dr.  H.  TiLLEY  showed  a  woman,  rot.  33,  who  complained 
of  a  stifling  sensation  in  the  throat  since  January.  Exa- 
mination showed  a  large  ovoid  swelling  on  the  posterior 


wall  of  the  pharynx.  There  was  a  distinctly  syphilitic 
history. 

Dr.  W.  Hill  showed  a  case  of  tuberculosis  of  the  noee. 
The  specimen  was  referred  to  the  Morbid  Growth  Com- 
mittee. 

Mr.  Stabb  showed  a  ease  of  lupus  of  the  palate  and 
larynx. 

Dr.  MdBRiDB  tried  the  galvano-cautery  and  chromic 
acid  in  these  casee. 

The  President,  when  the  parts  were  easily  accessible, 
used  the  curette  and  strong  lactic  acid.  He  would  not  use 
it  in  the  larynx  from  fear  of  stenosis  resulting. 

Mr.  Stewart  had  a  case  under  treeatment  where 
arsenic  was  administered  internally  only,  and  the  patient 
was  getting  welL 

Mr.  Stabb  also  showed  a  case  of  tumour  of  the  palate. 


BRADFORD  MBDICOCHIRURGICAL  SOCIETY. 
Meeting  held  Tuesday,  March  17th. 


The  President,  Dr.  Bronnbr,  in  the  Chair, 


CUNIOAL  EyBNINO. 

Dr.  Major  showed  the  following  casee  : — 

(1.)  *'  Sporadic  Cretinism  greaSy  benefited  by  Thyroid 
Feeding."  The  patient  was  a  girl,  nt.  6,  who,  on  admis- 
sion, preeented  a  typical  picture  of  a  cretin.  The 
improvement  was  both  mental  and  physical ;  the  child 
being  now  able  to  walk  and  to  speak,  and  was  attending 
school.  (2.)  <*  Splenic  Leukssmia :  with  Microscopic 
Demonstration  of  Blood."  The  patient  was  a  woman, 
et.  38,  whose  spleen  extended  down  to  the  iliac  fossa. 
(3.)  ▲  man,  est.  23,  who  for  many  vears  had  disease  of  the 
left  ear.  For  two  days  before  admission  he  had  severe 
headache  and  giddiness.  There  were  also  Jacksonian 
convulsions  affecting  the  right  arm,  face,  and  leg. 
He  appeared  to  be  dyin^.  Mr.  Appleyard  trephined  over 
the  lett  tempore  sphenoidal  region  and  explored  the  left 
hemisphere  of  the  brain  with  a  needle,  with  a  negative 
result.  Patient  made  an  excellent  recovery  and  was  now 
able  to  work. 

Mr.  Crawford,  Dr.  H.  Bronner,  and  the  President  dis- 
cussed the  cases,  and  Dr.  Major  replied. 

Dr.  Campbell  showed  the  following  casee : — 

(1.)  ''Peripheral  Neuritis"  in  a  man,  alcoholic  in  origin. 
(2J  ''Congenital  Pulmonary  Stenosis"  in  a  child.  (3) 
"  Interstitial  Pneumonia"  in  a  child.  (4)  "  Pericarditis.^' 
(6.)  '•  Progressive  Muscular  Atrophy." 

The  cases  were  discussed  by  Drs.  Major,  Rabagliatt, 
and  H.  Bronner. 

Dr.  H.  Bronner  showed  :— 

(1.)  A  case  of  extensive  "  Lupus  of  the  Face  '  treated 
with  tuberculin.  (2.)  A  girl,  est  12,  who  had  recovered 
her  sight  under  treatment  with  mercurial  inunction 
and  iooTide  of  potassium  internally.  (3.)  Casee  of  "Con- 
genital Specinc  Choroido-Retinitis." 

Drs.  Rabagliati  and  Greenbnry  spoke,  and  Dr.  Bronner 
replied. 

Dr.  S.  Lodge  demonstrated  the  use  of  "Kirstein's 
Autoscope"  for  larynx  and  trachea — without  mirror; 
and  also  showed  a  man,  sot  67,  on  whom  he  had  operated 
in  1891,  removing  a  cataract  from  the  right  eve  by 
MacNamara's  metnod.  The  patient  had  done  well,  ana 
at  the  present  time  could  read  |.  with  +  8*0  D  spp.  and 

with  +  12  0  D  could  read  '^'^^'  ^' 

33  cm. 

Mr.  WiLMOT  showed  a  patient  with  a  "Congenital 
Malformation  of  the  Forearm ;"  probably  an  intra-uterine 
amputation  below  the  elbow-joint. 

Drs.  Crawford  and  Monkwell  spoke  on  the  case. 

Dr.  H.  Bronner  showed  a  case  of  "  Ophthalmoplegia 
Interna." 

Dr.  Crawford  showed  a  man  with  an  "Aneurismal 
Varix  of  the  Right  Thumb." 


Sir  Joseph  Lister,  F.R.S.,  has  been  elected  an 
HoDorarjr  Member  in  the  Department  of  Science, 
Roval  Irish  Academy,  of  which  the  Eari  of  Bosse 
F.lLS.,  is  the  newly-elected  President 


Afeil  1, 


GERMAN?, 


Tm  Mxdioal  t^Rjfiss.     34d 


4fmnce. 


[ntOM  OUB  OWN  GORItBSP0NPET?T.] 


PABIS,  March  28th,  1896. 
Appendicitis. 

At  tbo  Academie  de  M^decine,  M.  Le  Dentu  spoke  on 
the  indicationa  for  operating  in  cases  of  perityphlitis.  He 
said  that  if  it  were  trae  that  the  greater  number  of  these 
cases  required  active  interference,  there  are  some  which 
can  be  treated  medicinally,  those  in  which  peritonitis  does 
not  exist.  On  the  other  hand  can  be  seen  cases  in  which 
the  inflammation  causes  no  bad  symptoms  in  its  evolution 
towards  suppuration  requiring  no  interference  until  the 
abscess  was  properly  defined.  In  these  an  early  operation 
might  be  attended  with  danger,  as  the  agents  of  infec- 
tion concentrated  at  first  in  one  point  might  be  scattered 
and  septicaemia  be  provoked. 

In  the  following  circumstances,  however,  an  operation 
should  not  be  delayed  : — When  the  affection  threatens  to 
provoke  general  peritonitis ;  when  great  prostration  is 
present,  marked  by  absence  of  pain,  with  the  temperature 
normal,  or  almost  normal,  with  small  and  frequent  de- 
crease of  the  urinary  secretion,  abdomen  retracted,  face 
pinched,  blueieh  colouration  of  the  extremities,  and  espe- 
cially of  the  nails,  and  the  respiration  accelerated.  There 
is  always  danger  in  abstaining  from  all  intervention  when 
symptoms  of  appendicitis  recur  several  times,  while  the 
operation  is  inoffensive.  The  best  time  to  operate  is  six 
weeks  after  the  attack,  for  at  this  moment  adherences 
have  generally  disappeared.  Success  is  certain,  and  the 
patients  are  for  ever  delivered  from  a  constantly  threaten- 
ing danger,  and  but  too  often  realised. 

Infantilb  Bronchitis. 
M.  Benaut,  of  Lyons,  communicated  his  method 
of  treating  infantile  bronchitis.  There  exists,  he  said,  a 
simple  and  entirely  inoffensive  therapeutic  means  for  pre- 
venting general  bronchitis  in  infants  from  developing  into 
the  much  dreaded  capillary  form— that  of  warm  baths. 
During  the  last  ten  years  that  he  had  adopted  this  method 
he  never  saw  one  case  of  ordinary  bronchitis,  treated  from 
the  second  day,  become  capillary.  Every  three  hours 
night  and  day,  the  rectal  temperature  is  taken,  and  each 
time  that  102^  are  reached,  the  child  is  placed  for  five 
minutes  in  a  bath  of  100^,  the  head  covered  with  a  folded 
handkerchief.  If  the  little  patient  shows  symptoms  of 
congestion,  a  stream  of  water  of  the  temperature  of  the 
room  is  poured  on  the  head.  When  the  child  is  two  or 
three  years  old  a  Utile  champagne,  or  brandy  and  water, 
is  given  him  while  in  the  b«kth.  When  taken  out,  he  is 
quickly  dried  with  warm  towels,  and  put  back  to  his  bed. 
Frequently,  after  the  third  or  fourth  bath,  the  fever 
falls,  the  rftles  diminish,  and  the  affection  assumes  the 
character  of  a  slight  and  superficial  bronchitis.  At  other 
timee  the  efforts  must  be  prolonged,  but  the  result  is 
always  the  same.  Concurrently  with  the  baths,  M. 
Renaut  orders  suppositories  of  quinine,  three  to  five 
grains. 

In  general,  these  means  are  sufiBcient  without  having  to 
resort  to  blisters  or  painting  with  tincture  of  iodine. 
However,  when  he  was  only  called  in  at  the  end  of  several 
days,  and  that  he  found  the  chest  of  the  patient  full  of 
ik\ea,  he  administered  a  vomitive  with  advantage. 

When  at  his  first  visit  he  found  that  capillary  bronchitis 
had  already  set  in,  he  continued  the  baths  until  the  fever 
had  shown  signs  of  abating.      Where  the  capillary  bron- 


chitis provokes  symptoms  of  cyanoeie,  he  directs  slowly, 
a  current  of  oxygen  on  the  face  of  the  patient  and  then 
puts  him  itf  the  bath  from  which  he  emerges  transformed 
and  delivered  for  an  hour  or  two  from  impending  danger. 

M.  Benaut  said  in  conclusion  that  the  bath  acted  by 
influencing  the  nervous  centres  and  preventing  the  inces- 
sant germination  of  the  bacteriee  contaminating  the 
bronchial  mucous  membrane. 

The  difficulties  of  practice  in  France  by  Englishmen  and 
other  foreigners  are  becoming  more  pronounced.  The 
French  students  are  raising  an  agitation  because  they  say 
that  the  Faculty  of  Medicine  is  becoming  overcrowded 
with  foreign  pupils,  and  efforts  are  being  made  to  induce 
the  Government  to  exclude  foreigners  from  practice.  It 
seems  likely  that  it  will  be  increasingly  more  difficult  to 
obtain  the  necessary  authorisation  for  practice  by  English- 
men in  France. 

» 

[from  our  own  corrbspondbnt.] 

BBRUN,  March  27th. 
Thb  Balnbolooioal  Congrbss. 

Thb  17th  Balneological  Congress  was  held  here  from  the 
6th  to  the  9th  of  March.  Prof.  Langold,  in  a  paper  on 
Argon,  showed  that  this  new  element  was  of  no  therapeu- 
tic importance.  This  paper  was  followed  by  one  on  the 
Treatment  of  Chrpnic  Myelitis  by  Dr.  Schuster,  of  Aachen. 
On  the  ba^is  of  his  own  experience  he  recommended  hot 
baths  and  mercury.  Prof.  Wint«rnitz,  of  Vienna,  thought 
hot  b%ths  had  not  such  a  stimulating  influence  on  the 
organism  as  cold,  and  that  lukewarm  baths  had  a  bad 
influence  on  cases  of  central  nerye  affection. 

Prof.  Wintemitz  then  spoke  on  * 

CCTRATIVB    SbBUM. 

He  first  of  all  pointed  out  that  infective  diseases  could 
of  themselves  get  well.  How  this  came  to  pass  was  not 
yet  known,  but  the  fact  stood  fast  that  toxines  and  anti- 
toxines  played  a  part  in  the  process  of  recovery,  without 
question  also  the  energy  of  the  body  as  opposed  to  the 
poison  of  the  disease.  They  must  attempt  to  strengthen 
this  natural  energy  on  the  one  hand  by  curative  serum, 
and  on  the  other  by  tissue  juices.  Both  these  methods 
at  present  ruled  clinical  thought,  and  both  ran 
in  the  line  of  oxidation  treatment.  But  the  most 
efficient  excitor  of  oxidation  in  the  system  was  cold 
water  bathing,  the  essential  result  of  this  in  infective 
diseases  is  its  influence  on  the  nervous  system  and  the 
fever.  Hydriatic  treatment  led  to  increase  of  both  red  and 
white  blood  corpuscles  as  well  as  increase  of  the  hsemo- 
globin  and  the  specific  gravity  of  the  blood.  The  inter- 
obange  of  tissues  became  more  active,  the  toxines  wc  re 
more  quickly  eliminated  and  the  alkalinity  of  the  blocd 
was  increased.  Hydriatic  treatment  heightened  the  bac- 
tericide action  of  the  blood  and  in  this  sense  was 
auto-serum  therapeutics.  In  the  course  of  an  active 
discussion  that  followed  this  paper  a  proposal  was  made 
to  petition  the  Prussian  House  of  Deputies  to  institute  a 
Professoriate  of  hydro-therapeutics  in  Berlin.  The  serum 
treatment  of  diphtheria  came  under  review,  one  party 
maintaining  that  it  was  a  complete  failure,  and  the  other 
party  the  opposite.  It  was  pointed  out  that  in  the 
Charity  Klinik  for  Children's  Diseases,  Prof.  Heubner 
combined  hydro- therapeutics  with  the  serum  treatment 
I  and  obtained  better  results  than  by  the  serum  treatment 


350    The  Mbdical  Pbbbb* 


AtJSTfilA. 


ArBH.  1,  1890. 


alone  Prof.  Liebreiob  said  this  oombination  was  only 
justified  when  tbe  specific  action  of  seram  had  been  proved 
and  this  was  not  the  case. 

Prof.  Strasser  read  a  paper  in  which  he  maintained  that 
tbe  alkalinity  of  the  blood  was  increased  by  cold  and 
diminished  by  warm  applications. 

Dr.  Klemperer,  Berlin,  then  spoke  on 

Htdbothirapxtjtics  and  Tubmboulosib. 
He  said  it  had  been  shown  that  the  bodily  processes  were 
inflaenced  by  baths  ;  that  lenoocytosis  and  the  alkalinity 
of  the  blood  were  increased.  The  action  of  baths  did  not 
lie  here  however,  bat  in  their  property  of  stimnlating  the 
nervous  system.  Hydropathic  treatment  was  only  an 
adjunct,  and  it  had  its  limits  of  nsefnlness.  In  von 
Leyden^s  Klinik,  bath  treatment  had  only  proved  of  ser- 
vice in  disturbances  of  innervation,  in  neurasthenia, 
asthma,  nervous  cardiac  affections.  It  might  act  favour- 
ably in  organic  heart  disease  as  weU,  but  one  need  not 
expect  it  to  influence  the  morbid  process  itself.  In  gastric 
and  intestinal  diseases,  it  acted  very  weU,  as  these  were 
(generally  associated  with  nerve  disturbances.  A  discus, 
sion  was  followed  by  an  address  on  an  allied  subject, — 

Hydbopatht  and  Pctlmonaby  Consumption 
by  Prof.  Winternitz.  He  said  that  pulmonary  tuberculosis 
was  a  curable  disease.  Encapsuled  tubercle  were  found 
in  half  the  sections  of  tuberculous  bodies,  and  these  were 
signs  of  cured  tubercle.  It  was  the  duty  of  the  physician 
to  support  to  the  utmost  of  his  power  this  curability.  In 
this  endeavour  he  had  turned  tohydriatic  treatment,  and 
had  seen  considerable  increase  in  the  power  of  resistance 
of  the  system.  He  had  seen  recovery  take  place  in  from 
27  to  30  per  cent,  of  all  recent  cases  of  tuberculosis.  The 
treatment,  however,  did  harm  in  the  chronic  and  advanced 
cases.  He  asked  his  hearers  to  put  the  method  to  the 
test,  it  possessed  the  advantage  of  sometimes  arresting 
bad  cases,  and  of  at  least  exciting  some  hope. 

Dr.  Kaatzer,  of  Rehburg,  then  gave  the  results  of  a  five 
years'  experience  with 

TUBBBOULIN  IN  PHTHISIS. 

From  December,  1891,  to  January,  1896,  he  had  treated 
70  cases  of  tuberculosis  with  Koch's  tuberculin.  Of 
these,  31  died,  21  recovered,  12  were  improved,  and  6  were 
unimproved.  The  average  number  of  injections  was  42 
per  patient,  and  the  period  under  treatment  varied 
between  7  and  51  weeks.  He  said  tbe  patients  must  be 
watched  for  weeks,  and  the  condition  as  to  fever  and 
nutrition  determined.  If  there  were  no  complication,  and 
the  phthisis  was  without  fever,  good  results  would  always 
follow.  With  caution,  the  injections  were  entirely  free 
from  danger.  Mixed  forms  of  tbe  disease  demanded  a 
combined  method  of  treatment,  hygienic,  dietetic  and 
climatic.  Treatment  in  institutions  secured  the  greatest 
certainty.  The  rejection  of  tuberculin  treatment  was  not 
justifiable.  Tbe  speaker  concluded  by  saying  that  in  a 
short  time  Prof.  Koch  himself  would  probably  issue  a 
larger  publication  on  the  subject. 

Dr.  Hansemann  and  Prof.  Liebreich  were  opposed  to 
the  views  of  Kaatzer.  The  former  said  that  natural 
recovery  from  tuberculosis  was  more  frequent  than  was 
imagined.  Recovery  from  tuberculous  peritonitis  and 
tuberculous  ulceration  of  the  intestine  was  very  frequent. 
Tuberculin  did  not  bring  about  recovery,  it  merely  led 
to  breaking  down  of  the  tuberculous  nodules  and  mining 
them  mobile,  and  herein  lay  the  great  danger. 

At  the  Medical  Society  (March  4th)  Hr«  Roeenheim 
described 


A  NbW  GASTBOeOOPB. 

After  an  introduction  in  which  he  recapitnlated  what 
had  already  been  done  in  gastrofroopy,  he  said  that  his  own 
instrument  was  only  an  enlarged  cystoscope  with  addi- 
tions to  it  that  were  demanded  by  the  nature  of  the  part 
to  be  explored.  It  was  a  straight  instrument  and  not 
curved  like  that  of  Mikulicz. 

The  most  important  improvement  in  his  apparatus  was 
the  emplojrment  of  vaiious  prisms.  In  addition  to 
rectangular  ones  he  used  some  with  angles  of  60  to  70 
degrees.  If  one  wanted  to  look  at  the  pylorus,  and  that 
could  be  seen,  this  was  difficult  with  a  rectangular  prism, 
but  it  was  quite  different  with  an  acute-angled  one.  One 
should  be  able  to  change  the  prism  quickly,  and  in  his 
instrument  this  could  be  done.  The  instrument  was  not 
difficult  to  use.  The  difficulties  on  the  part  of  patients 
were  not  great  when  the  cases  were  suitable.  Most  of  the 
cases  in  which  he  had  hitherto  used  it  were  ambulatory 
ones  in  the  policlinic,  who  were  able  to  return  home  after- 
wards. A  certain  amount  of  pressure  in  the  throat  was 
the  only  thing  complained  of,  and  this  disappeared  within 
twenty-four  hours.  He  had  lately  had  a  thinner  and  more 
simple  instrument  constructed,  with  a  diameter  of  only 
lOctm.  The  optical  parts  were  the  same  size  as  in  the 
larger  instrument,  and  the  i eduction  in  size  had  been 
obtained  by  omitting  the  cooling  apparatus.  It  had, 
therefore,  to  be  used  more  quickly  than  the  other.  The 
light  could  be  on  from  10  to  12  seconds  without  raising 
the  temperature  to  a  disagreeable  or  injurious  height. 


[PBOM  CUB  OWN    0OBBB8PONDBNV.] 

VlXHA,  Mar.  S7th,  1896. 
AppBNDiciTifi  Simplex. 

FooBB  read  to  the  Gesellschaft  a  paper  in  which  he  dis- 
cussed the  cansatum  of  appendidtis,  and  expressed  a 
strong  disbelief  in  its  csscal  origin,  as  taught  by  Sahli  and 
Sonnenburg.  There  are  still,  he  remarked,  a  few  who 
believe  in  a  typhlitis  sterooralis  origin,  with  whom  he 
sjrmpathised,  as  he  had  seen  cases  where  the  lumen  of  the 
appendix  was  distended  with  faces  and  mucus,  with  a 
laif^e  fsBcal  concretion  of  the  same  character  lying  in  the 
csBCum.  He  was  now  convinced,  from  recent  experience, 
that  the  primordial  causes  might  be  arranged  in  three 
classes  :  (a)  by  a  transportation  of  any  inflammatory 
thickening  of  the  mucous  membrane  of  the  large  intes- 
tine, (b)  an  abnormally  long  appendix,  (c)  sharp  bending 
or  twisting  of  the  organ  with  subsequent  adhesions. 

The  author  then  related  two  oases  of  colica  appondicu- 
laris  which  were  so  obscure  in  diagnosis  that  an  accident 
by  laparotomy  only  revealed  the  typical  morbid  condition 
present  in  the  appendicitis. 

The  colic  pain  in  the  iliac  region  was,  he  said,  always  a 
favourable  guide  to  the  morbid  lesion,  but»  in  many  cases, 
it  is  misleading,  owing  to  the  remoteness  of  the  pain  from 
the  site  of  the  disease,  which  is  sometimes  referred  to  tbe 
umbilicus,  and  at  others,  to  the  opposite  side  of  the  median 
line^  not  infrequently  leading  to  a  false  diagnosis. 

GbAUBOSIS  VULYiB. 

Nenmann  showed  a  patient  to  the  same  society  with  a 

dry  harsh  condition  of  the  vulvae  that  Briesky,  in  1885, 

described  as  a  characteristic  disease   recognised  by  a 

shrinking  of  the  cutaneous  coverings  of  the  genitals.    The 

]  natuza]|folds  of  the  skin  disappear,  the  moooas  membcane 


ArazL  1,  1890. 


THE  OPERATING  THEATRES. 


Tm  MsDioAL  Pans.     351 


becomes  dry  and  brittle  with  a  white  ehining  snrfaoe. 
HtBtologically  ezainined,  the  papillary  bodies  are  found  to 
be  sclerotic  and  contracted  with  an  apparent  atrophy  of 
the  rete  mncoea.  Ohman  Damenil  records  eleven  cases 
▼arying  in  age  from  twenty  to  thirty  years,  while 
seven  were  between  55  and  6$  years.  Several  authors 
have  attributed  its  origin  to  blennorrhcea  and  complicated 
carcinoma.  Clinically  and  histologioally  the  process  re- 
sembles vulvitis  with  simultaneous  atrophy  of  the  integu- 
ments. The  patient  before  them  was  28  years  of  age,  had 
always  been  healthy  till  two  years  ago,  when  she  consulted 
a  physician  for  a  vaginal  discharge,  and  was  treated  with 
tampons.  She  is  now  very  sclerotic,  the  subcutanens  fat 
of  ae  labia  absent^  the  skin  lax  and  dry,  and  the  inner  sur- 
face o  a  bluish  colour.  From  this  absence  of  the  margins 
the  space  is  left  as  a  shallow  opening  with  the  clitoris 
lying  exposed.  The  vaginal  mucous  membrane  is  pale  but 
normaL  The  microscopic  examination  revealed  a  thick 
epidermic  layer  lying  in  wavy  bands ;  the  nuclei  of  the 
deepw  layers  could  hardly  be  observed,  while  the  sebace- 
ous glands  were  nowhere  to  be  found.  The  vessels  were 
greatly  thickened  and  contracted  in  their  lumen. 

From  the  great  thickening  of  the  epithelial  layer  or 
external  covering  it  might  be  inferred  that  the  cause  is 
extemaL  In  all  the  cases  recorded  only  two  are  stated  to 
be  virgins,  which  may  have  been  induced  in  these  by  mas- 
turbation or  eczema,  the  latter  often  occurring  in  advanced 
years. 

Cranrosis  differs  from  senile  atrophy  in  its  anatomical 
changes;  from  scleroderma  it  is  differentiated  by  the 
increase  of  the  deeper  tissues  lying  in  bands  along  the 
paths  of  the  vessels. 

Labtnosal  Stbmosis. 

Ohiari  showed  a  patient  who,  two  years  ago,  was  mur- 
derously attacked  in  Rotterdam.  He  was  taken  to  hos- 
pital in  a  senseless  condition,  where  he  was  fed  for  three 
weeks  through  a  tube^  and  was  finally  dismissed  with  a 
fine  canula  in  the  opening.  Soon  after  this,  a  fietula  ap- 
pears to  have  been  established  through  which  mucus, 
sputa,  and  food  were  ejected.  He  was  again  admitted  to 
the  Warsaw  hospital,  and  dismissed  with  no  improvement* 
He  was  received  in  the  Vienna  Clinic  about  the 
beginning  of  December  last,  with  a  granulating  fistula,  and 
a  foreign  body  moving  in  che  orifice,  which  proved  to 
be  one  of  the  arytenoid  cartilages.  The  operation  was 
conducted  in  two  stages.  The  cartilage  was  removed; 
the  edges  of  the  wound  freshened  and  closed  with  sutures. 
After  union,  a  flap  of  skin  from  the  surrounding  ori/ice 
was  brought  round,  and  the  fietula  quite  closed. 
Innsbvation  of  thb  Rbotum. 

Pal  related  the  result  of  seventeen  experiments  with  the 
object  of  discovering  how  far  the  splanchnic,  vagus,  or 
spinal  cord  was  involved  in  the  movement  of  the  bowels. 
These  experiments  were  prompted  by  the  results  of 
Ewald,  who  assured  the  Medical  Congress  at  Berne  last 
year  that  he  had  removed  the  lower  part  of  the  dorsal 
column,  and  all  the  lumbar  portion  of  a  dog,  with  the 
result  of  checking  defaecation. 

No  physiologist  believes  in  a  splanchnic  origin  for 
the  bowel  movement  which  would  be  annihilated  by 
this  proposition,  although  it  would  appear  to  be 
partially  true.  Langley  and  Andersen  have  shown  by 
experiments  that  the  innervation  of  the  pelvic  organs  is 
confined  to  the  anterior  roots  of  the  lumbar  and  sacral 
region  of  the  spinal  oord.  This  assertion  specially  applies 
to  the  anns  and  ectom,  which  are  undoubtedly  supplied 


from  this  source.  The  circular  muscle  of  the  rectum  is 
supplied  by  a  branch  of  the  nervi  hypogastric,  while  the 
longitudinal  fibres  are  innervated  by  branches  of  the 
nervi  erigentes.  Pal  found  by  irritating  the  splanchnicus 
in  dogs  he  could  produce  contractions  in  the  length  of  the 
descending  colon  and  rectum,  raising  the  gut  and  causing 
the  sphincter  ani  to  contract  at  the  same  time.  This 
confirms  Ewald's  assertion  that  defecation  is  an  act  of 
the  spinal  oord  whose  centre  is  located  somewhere  in  the 
upper  half  of  the  lumbar  region. 

DiPHTHBSinO  SXRUM. 

From  the  report  of  the  Diphtheritic  institution  we  learn 
that  429  operations  and  255  control  operations  have  been 
performed.  That  the  future  filling  of  the  tubes  will  be 
regulated  on  the  basis  of  one  cubic  centimetre  containing 
200  immunising  units,  instead  of  100  to  150  as  hitherto 
practised.  The  tubes  will  be  labelled: — ^No.  0  (yellow 
label),  containing  0*8  cubic  centimetres  =  200  immunising 
units ;  No*  I,  (green  label)  2*4  cubic  centimetres  =  GOO 
immunislDg  units ;  Na  H,  (white  label)  4  cubic  centi- 
metres =»  1,000  units  ;  No.  HI,  (red  label)  6*0  cubic  centi- 
metres ^=  1,5(X)  units.  The  manufacture  is  carried  on  in 
the  special  laboratory  of  Meister  Lucius  and  Bruning,  at 
Hoescht,  on  the  Maine,  under  the  control  of  Professors 
Behring  and  Ehrlich.  The  preparation  of  the  serum,  the 
determination  of  its  activity,  and  the  bacteriological 
examination  is  further  subject  to  State  control,  Behring's 
remedy  can  be  obtained  in  London  at  6  and  7  Cross  Lane, 
London. 


CITY  OF  DUBLIN  HOSPITAL. 

NBPHR«7roMT.~Mr.  Hbnbt  Gray  Croly  removed  the 
right  kidney  from  a  man,  »t.  25,  who  suffered  previously 
from  a  very  tight  organic  urethral  stricture  and  was 
operated  on  by  external  urethrotomy.  The  wound  in  the 
perineum  had  healed,  and  the  patient  passed  urine  in  a 
good  stream.  A  week  before  the  present  operation  he 
complained  of  pain  in  the  region  of  the  right  kidney  and 
subsequently  was  attacked  with  severe  rigors.  Mr.  Croly 
cut  down  on  the  kidney  by  the  lumbar  incision,  and  on 
passing  in  the  needle  of  a  hypodermic  syringe  found  pus. 
The  kidney  was  then  indeed,  and  about  8  oz.  of  pus 
escaped.  On  exploring  with  the  finger  two  calculi  were 
found,  and  as  the  kulney  was  much  enlarged  and  contained 
large  cysts,  Mr.  Croly  removed  it,  having  ligatured  the 
renal  artery  vein  and  the  ureter.  The  ureter  was  secured 
to  the  lower  magin  of  the  wound. 

The  patient  is  going  on  well  and  is  passing  urine  freely. 
ST.   THOMAS'S   HOSPITAL. 

Cholbcystotomy.— Mr.  Battlv  operated  on  a  woman  , 
sot.  28,  a  patient  under  the  care  of  Dr.  Ord  ;  she  had  had 
symptoms  pointing  to  the  presence  of  gall-stones  for 
several  months,  and  these  included  attacks  of  biliary  colic. 
She  was  a  stout  woman  with  a  slight  tinge  of  jaundice, 
but  she  stated  that  her  attacks  of  colic  had  not  been 
followed  with  jaundice.  The  liver  was  somewhat  enlarged 
and  in  the  region  of  the  gall-bladder  there  was  a  well- 
marked  tumour  about  the  size  of  a  oocoanut.  At  the 
operation  a  vertical  incision  was  made  in  the  right  linea 
semilunaris  over  the  tumour.  This  was  found  to  be  caused 
by  distended  gall-bladder,  liver,  and  omentum.  The  gall- 
bladder formed  a  comparatively  small  part  of  the  swelling  ; 
the  omentum  was  adhering  to  the  gaU-bladder  covering 


352     *^BM  Mbpigal  Pkebb, 


LEADING  ABtlCLfiS. 


April  1,  1896. 


moeti  of  the  fandus  and  extending  to  the  liver,  which 

was  lifted  so  as  to  make  a  considerable  portion  of  the 

rounded  swelling  which  had  been  felt  through  the  abdo- 
minal wall.    The  area  of  operation  was  packed  around 

with  sponges  and  the  omentum  separated  from  a  portion 

of  the  fundus  of  the  gall-bladder,  this  was  then  tapped, 

partly  emptied  of  its  contents,  and  incised.    A  quantity 

of  thick  bile  came  away,  and,  as  the  bladder  became  more 

empty,  a  quantity  of  purulent  fluid ;  there  were  several 

gall  stones  of  varying  siee  present  which  were  removed 

with  a  scoop  and  by  syringing,  but  it  was  found  that 

the  cystic  duct  was  blocked  by   a   stone  which  proved 

very  difficult  to  disimpsict.    It  was  a  long  way  from  the 

surface,  and  the  gall  bladder  made  a  sudden  bend  not  far 

from  the  stone,  which  rendered  it  very  difficult  to  apply 

forceps  for  the  purpose  of  extraction.    Ultimately,  the 

whole  of  this    stone    was]  removed,  being  considerably 

broken   up   in    the   process.    The  wound  was  carefully 

cleansed,    the    parietal   peritoneum  stitched  around  the 

opening,  a  large  drainage-tube  passed  into  the  gall- 
bladder, and  the  external  wound  closed  around  the  tube. 

Mr.  Battle  said  that  the  condition  found  at  the  operation, 

whilst  it  indicated  that  there   had   been    ra*her   acute 

inflammation   of  the   wall  of   the  gall-bladder   was   not 

unfavourable  to  a  successful  operation  for,  by  the  adhesion 

of  the  omentum  to  the  gall-bladder,  the  general  peritoneal 

cavity  was  to  some  extent  shut  off.    The  chief  difficulty  in 

the  operation  was  that  presented  by  the  removal  of  the 

stone  in  the  cystic  duct ;  this  was  caused  so  by  the  bend 
in  the  gall-bladder  near  the  duct,  a  fold  of  mucous 
membrane  fell  down  like  a  curtain,  and  it  was  difficult  to 
get  forceps  of  a  shape  adapted  to  pass  under  it,  and  it  bled 
rather  freely  when  rubbed  by  any  instrument. 

It^is  satisfactory  to  state  that  a  month  after  the  opera- 
tion the  woman  is  convalescent. 

Removal  of  Nubdlb  aftsb  Localisation  by  the 
Nbw  Method  of  Photoorapht. — The  same  surgeon 
operated  on  a  police  constable,  set.  about  38,  a  robust  man, 
who  had  run  a  needle  into  the  inner  side  of  his  right  hand 
when  brushing  his  uniform.  A  portion  of  the  needle  had 
remained  in  his  hand  and  could  not  be  localised.  A  pho- 
tograph was  taken,  which  showed  that  the  portion  of  the 
needle  was  lying  across  the  metacarpo-phalangeal  joint  of 
the  little  finger.  About  a  week  after  the  foreign  body  got 
into  the  band,  an  attempt  was  made,  following  the  indica- 
tion in  the  photograph  to  remove  the  needle,  but  it  was 
ansucoestful ;  eight  days  later,  a  second  attempt  wa» 
made,  the  patient  being  under  ether  (whereas  cocaine  was 
employed  in  the  first  instance)  ;  a  very  careful  search  was 
made,  and  the  patient  was  under  the  aneBSthetic  for  about 
two  hours,  but  this  attempt  was  also  unsuccessful.  The 
patient  was  admitted  to  the  hospital,  and  as  a  second 
photograph  showed  the  needle  to  be  still  in  the  same  posi- 
tion, and  the  maa  wished  to  have  it  extracted,  Mr.  Battle 
operated,  using  the  incision  which  had  been  employed  by 
the  former  operator.  This  cut  was  explored  right 
away  to  the  back  of  the  metacarpal,  and  the  surgeon  felt 
some  metalic  point  with  a  steel  director,  but  in  order  to 
remove  the  needle,  an  incision  had  to  be  made  through  a 
greater  partof  a  very  thick  glenoid  ligamentatapoint  behind 
the  flexor  sheath,  which  had  been  opened  in  the  previous 

operations.    The  eye  portion  of  the  needle  was  exposed,  PRTVTTFrF 

bntan  attempt  to  remove  it  with  forceps  broke  oflF  the  A^J^  rLitLA  UJ?  mi  V  ILii^jrlk 

tip,  and  it  was  necessary  to  expose  the  needle  more  fully  TflE  trial  which  has  absorbed  so  much  public  atten- 
before  it  could  be  extracted.  It  was  about  2  of  an  inch  in  I  tion  during  the  greater  part  of  the  past  week,  is  not 
length,  and  had  become  quite  black  as  usual.    It  was  com- 1  without  it8  important  prof  osaioDal  lesaoDS  and  waro- 


pletely  buried,  and  very  difficult  to  find.  The  wound  was 
perfectly  aseptic.  Mr.  Battle  considered  that  this  case 
showed  the  usefulness  of  this  method  of  discovering 
foreign  bodies,  as  without  it  no  surgeon  could  have 
undertaken  an  operation  involving  such  extensive  inter- 
ference with  the  palm  of  the  hand,  for  he  would  have 
been  without  the  certainty,  which  could  alone  justify  ^uch 
procedure.  The  hand  was  a  very  large  one,  and  the 
needle  quite  beyond  reach,  excepting  through  a  deep 
incision.  The  former  operator  had  evidently  passed  close 
to  the  end  of  the  ;needle,  but  had  not  kept  the  line  of 
incision  sufficiently  over  the  needle  itself. 

ROYAL  FREE   HOSPITAL 

Removal  of  Needle  after  Localisation  by  the 
New  Method  of  Photoorapht.— The  patient  was  a 
woman,  about  40  years  old,  who,  a  few  days  before  ehe 
applied  at  the  hospital,  had  run  the  end  of  a  needle  into 
the  palmar  aspect  of  her  right  forefinger.  There  was 
considerable  pain  after  the  infliction  of  the  injury,  and 
when  she  applied  for  relief,  there  was  a  subcutaneous 
abscess.  The  senior  resident  medical  officer,  Mr.  Bottomly , 
had  a  photograph  taken  of  the  hand,  and  this  showed  that 
the  needle  had  passed  away  from  the  {>oint  of  entry,  and 
that  the  broken  off  portion,  about  half  an  inch  in  length, 
was  lying  to  the  outer  side  of  the  second  phalanx  away 
from  the  abscess.  At  Mr.  Batt1e*8  request,  Mr.  Bottomly 
opened  the  abscess  and  washed  it  out  with  antiseptics, 
and  then  cut  down  upon  and  removed  the  needle. 

In  both  the  cases,  the  one  at  St.  Thomas's  and  that  at 
the  Royal  Free,  the  photographs  were  taken  by  Mr. 
Sydney  Rowland,  and  in  both  instances  showed  admirably 
the  position  of  the  foreign  body. 

RBOIBTBRBD  POE  TkABSMISSIOB  ABBOAB. 


attb 


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^t  l^thml  §«8S  ic  Circular. 


*8ALUS  POPULI  SUPREMA  LEX.' 


WEDNESDAY,  APRIL  1,  1896. 


Apbil  1,  1896. 


LEADING  ARTICLES. 


Thx  Msdigal  PsEas.     353 


ings.  The  veiy  suddenness  with  which  the  disclosarea 
made  before  the  jary  and  Mr.  Justice  Hawkins  were 
sprang  upon  pablic  attention  only  farther  tended  to 
increase  the  interest  which  the  trial  excited.  The 
high  professional  standing  of  the  defendant,  and  the 
social  position  of  the  plaintiffs  family  also  contribated 
to  heighten  pablic  cariosity  as  to  the  resalt  The 
medical  facts  of  the  case  are  already  so  well  known  to 
oar  readers  that  it  is  not  necessary  to  recapitulate 
them  here.  There  are,  however,  some  few  undisputed 
points  of  medical  moment,  which  are  outside  the  main 
issue  on  which  the  verdict  of  the  jury  was  arrived  at, 
that  it  may  be  well  here  to  recall  to  mind.  The 
plaintiff  was  a  woman  who  had  apparently  acquired 
a  '*  habit ''  of  miscarrying,  and  had  been  subjected  to 
a  variety  of  medical  treatment  for  uterine  troubles. 
The  last  miscarriage  occurred  at  the  close  of  1892,  and 
there  was  no  legitimate  source  of  conception  from  that 
time  to  the  date  of  the  discovery  of  some  placental 
tissue  in  the  uterus  in  the  early  paurt  of  1894.  During 
this  interval  it  would  appear  that  there  were  constant 
symptoms  of  uterine  trouble  present  such  as  one 
might  expect  in  a  hyperplastic  womb  enlarged  from 
repeated  previous  abortions.  Finally,  the  train  of 
symptoms  led  to  the  interference  which  brought  about 
the  discovery  of  an  enlarged  and  patulous  os  uteri, 
with  the  other  signs  of  recent  or  remote  pregnancy  to 
which  we  have  referred.  Examination  of  the  sub- 
stance removed  appeared  to  confirm  the  operators 
belief  that  the  pregnancy  was  of  a  comparatively  recent 
date.  In  other  words,  portions  examined  were  said  to 
be  composed  of  fresh  placental  tissue.  But  it  would 
seem  that  before  the  cracial  test  of  microscopical  exa- 
mination was  applied,  even  at  the  time  of  operation, 
the  conclusion  tiiat  the  conception  was  recent  was 
arrived  at,  and  the  coarse  was  taken  which  finally 
brought  about  the  deplorable  consequences  of  a  pos- 
sibly somewhat  hasty  decision.  It  is  a  fact  of  common 
obstetrical  observation  and  experience  that  in  a  woman 
of  middle  life  who  has  borae  children,  and  who  has  had 
repeated  miscarriages,  followed  by  hyperplastic  uterine 
duknges,  considerable  enlargement  of  the  womb,  with 
or  without  intra-uterine  formations,  may  persist  for 
years.  Nor  does  such  a  condition  prevent  the  possibi- 
lity of  conception  occurring,  to  be  frequentiy  followed  by 
miscarriage,  and  the  increased  risk  of  further  degenera- 
tive changes,  with  retention  of  placental  and  embryonic 
remains.  In  all  such  cases  it  is  hardly  necessary  to 
insist  on  the  caution  with  which  the  anus  prohandi 
should  be  assumed  by  any  medical  man  of  asserting 
that  the  woman  has  been  guilty  of  unchastity.  We 
have  constant  proofs  of  the  fallibility  of  pathological 
reports,  even  when  sustained  by  microscopical  experts. 
And  if  there  be  a  suspicion  of  doubt,  unquestionably 
the  woman  should  be  given  the  benefit  of  it. 

But  now  we  turn  to  the  vital  question^  so  largely 
affecting  the  honour  of  the  profession  at  large  which  is 
involved  in  the  considerittion  of  this  case,  and  which, 
so  far  as  the  jury  were  concerned,  was  described  with 
no  uncertain  voice.  We  prefer,  in  dealing  with  this 
point  of  professional  privilege*  to  do  so  with  broad  and 
unbiassed  views,  quite  iadq[»Dd0nily  of  the  side  issues 


involved  in  this  particular  instance.  In  the  recent 
trial  the  question  of  the  guilt  or  innocence  of  the 
plaintiff,  though  incidentally  raised  during  its  progress, 
was  not  before  the  jury.  Having  come  to  a  conclusion 
as  to  whether  the  alleged  words  were  uttered  under 
the  belief  that  they  were  true,  they  had  to  decide 
whether  they  were  maliciously  spoken,  and  with  an  in- 
direct object,  hostile  to  the  plaintiff.  Arising  out  of  this 
latter  question,  came  the  plea  of  privilege,  viz.,  that, 
under  certain  conditions  and  circumstances,  either  to 
his  wife,  in  a  court  of  law  or  otherwise,  a  medical  man 
is  justified  in  revealing  secrets  that  have  been  reposed 
in  him  or  discovered  in  his  professional  capacity  as  the 
confidential  adviser.  In  this  particular  instance  the 
plea,  M  it  had  been  accepted,  would  not  alone  have 
covered  the  right  of  the  medical  adviser  to  disclose  a 
secret  thus  acquired  to  bis  wife,  but  also  the  exposure 
of  it  to  a  third  party  in  the  person  of  her  brother. 

It  has  always  been  regarded  as  a  sacred  and  invio- 
lable right  appertaining  to  the  profession  of  medicine, 
that  the  trust  reposed  in  its  members  by  those  who 
consult  them  for  their  physical  ills  should  never  be 
betrayed.  And  it  is  one  of  its  proudest  traditions  that 
this  principle  of  honour  should  require  no  written  law 
for  its  enforcement,  and  no  judicial  declaration  to  pro- 
tect those  who  are  guided  by  it.  In  the  privacy  of  a 
consulting-room,  questions  have  to  be  asked  and 
answered  under  a  tadt  pledge  of  mutual  confidence, 
that  it  would  be  dishonourable  and  cruel  in  the  highest 
degree  to  disregard  or  break.  It  is  most  dangerous  to 
try  to  make  exceptions  to  this  universally  recognised 
rule.  On  its  strict  observance  depends  in  great 
measure  the  peculiar  relation  that  the  physician  holds 
under  all  circumstances  to  his  patient,  and  on  it  also 
depends,  to  a  large  extent,  the  respect  in  which 
the  profession  generally  is  held  by  the  public.  Each 
medical  breast  is  the  repository  of  family  secrets 
unknown  to  any  other.  To  the  ''doctor"  alone  is 
that  dreaded  **  skeleton  in  the  cupboard "  revealed, 
and  rare  indeed  must  be  the  occasions,  and  most 
exceptional  the  circumstances,  that  can  justify  a 
betrayal  of  that  knowledge,  even  to  a  wife,  much  less 
to  any  interested  or  inquisitive  outsider.  And  if  in 
the  hour  of  her  extremity  the  tortured  Magdalen 
should  come  to  him  for  advice  and  comfort, 

Not  his  the  thankless  task  to  lure 

His  trusting  victim  to  her  doom, 

Her  secrets  bare  upon  the  rack 

Of  dread  expectancy  and  shame. 

The  privilege  rather  his,  to  stand  above 

All  threats  of  law,  all  "doctrines  damnable." 

Of  false  expediency  and  social  lies, 

Her  solitary  confident  and  friend. 

This  is  the  unwritten  law  of  medical  honour  and  medical 
charity.  As  Judge  Hawkins  well  said,  '*  the  medical  pro- 
fession "  (in  this  instance  the  College  of  Physicians) 
^'  might  discuss  among  themselves  the  rales  they  made 
for  their  own  guidance,  but  they  had  not  the  power  to 
impose  those  rules  upon  the  public."  The  fact  is,  as 
pointed  out  by  his  lordship,  there  is  no  hard  and  fast 
rale  which  can  be  drawn.    There  may  be  cases  and 


354    Tub  Mbdiohi  Paibfi. 


LEADING  ARTICL18. 


Apbil  1,  1896. 


circumstances  anjder  which  it  would  be  perhaps  jaati- 
fiable   for  a   physician   to   communicate   with   the 
authorities,  or  with  some  near  relative  of  the  patient, 
or  possibly  with  his  own  wife  or  children  in  order  to 
protect  the  latter.    But  it  must  be  absolutely  clear 
that  any  such  communication  in  this  last  instance  is 
Only   made   where   such   protection  is  imperatively 
demanded,  and  where  every  possible  safeguard  is  taken 
to  prevent  any  ill  consequences  ensuing  from  the  dis- 
closure  to   the   person   through    whom   the   know- 
ledge of    the   facts   has    been    acquired.     We   do 
not     desire     to    see     the    medical    profession    of 
this,  or  any  other  country,   converted  into  a  huge 
detective  agency,  and,  so  far  as  evidence  in  courts  of 
law  is  concerned,  judges  have,  as  a  rule,  respected  this 
plea  of  privilege,    To  do  otherwise  would  be  to  act 
contrary  to  every  idea  of  English  justice  and  fair  play. 
We  have  no  fear  on  this  score,  nor  do  we  think  that 
any  upright  medical  man  would  be  forced  to  sacrifice 
his  honour  by  the  threat  of  contempt  of  court.    We 
know  of  instances  where,  even  in  the  face  of  a  subpoena, 
refusal  to  give  evidence  has  been  persisted  in.    The 
most  importunate  solicitor  rarely  persists  at  the  cost  of 
dragging  an  unwilling  and  protesting  witness  into 
court    Public  opinion  and  sympathy  will  ever  be  on 
the  side  of  such  men,,  and  we  may  safely  leave  the 
paramount  considerations  of  the  safety  of  the  state  and 
society  to  such  public  opinion,  influenced  by  its  recog- 
nition of  the  obligations  of  a  great  profession,  and  its 
respect  for  the  higher  demands  of  the  law.    Among 
the  minor  lessons  to  be  learned  from  this  trial,  there 
are  three  that  we  would  particularise.  The  imprudence 
has  been  shown  of  making  any  comments  bearing  on  the 
nature  of  a  case  while  a  patient  is  recovering  from 
the  influence  of  an  anaesthetic.    This  precaution  is 
often  forgotten,  with  the  consequence  that  the  half- 
conscious  person  may  have  distorted  recollections  from 
the  impressions  received  during  the  dreamy  state  of 
semi -anaesthesia.    No  reference  whatever  should  be 
made  at  this  stage  of  an  operation  to  the  case.    Again, 
we  learn  the  need  for  extreme  care  on  the  part  of  the 
ordinary  medical  adviser  when  called  upon  to  furnish 
any  report  that  may  be  used  in  a  court  of  law,  more 
particularly  if  he  is  sounded  by  the  side  opposed  to  his 
patient's  interests.    Any  hesitation  in  this  respect  is 
sure  to  redound  to  his  discredit.    Neither  directly  nor 
indirectly  should  he  by  hint  or  auggestion  play  into  the 
hands  of  those  who  are  conducting  the  case  for  the 
opposite  side.    Every  sense  of  honour  forbids  this. 
And  lastly,  the  attitude  of  the  judge  and  the  verdict  of 
the  jury  prove  how  dangerous  it  may  be  to  multiply  weak 
medical  evidence  in  a  court  of  law,  evidence  that,  no 
matter  how  distinguiahed  the  aource  from  which  it  is 
derived,  serves  only  to  prove  to  the  court  and  the 
public  that  medical  men,  even  when  the  position  is 
clearly  a  weak  one,  will,  as  is  popularly  said,  *'  hang 
together."  Never  was  this  made  more  manifest  than  in 
the  trial  of  Kitson  veratis  Playfair. 


WHEN  DOES  SCARLATINA  INFECTION 

CEASE? 
A  OMSK  of  oonsidexaUe  importance,  not  only  to 


medical  men,  but  also  to  the  public  generally,  has 
lately  been  decided  in  the  Birmingham  County  Court. 
The  facts  brought  before  his   Honour   were   simple 
enough,  and  do  not  appear  to  have  been  seriously  dis- 
puted.   They  established  the  case  of  the  plaintiff,  who 
brought  an  action  for  damages  against  the  Birmingham 
Corporation  for  neglect  on  the  part  of  the  authorities 
of  the  Fever  Hospital  in  discharging  one  of  his  children 
before  being  completely  cured  of  scarlet  fever.    After 
his  child  had  b^n  under  treatment  for  six  weeks  in 
hospital,  the  father  was  notified  that  the  lad  might  be 
removed  home.    Plaintiff  accordingly  took  him  away, 
but  noticed  that  the  boy  had  a  discharging  sore  behind 
the  ear,  and  was  still  <*  skinning."    Next  day  he  called 
in  a  doctor,  who  certified  that  the  lad  was  still  suffering 
from  scarlet  fever,  and  was  in  an  infectious  condition. 
Every  possible  precaution  was  thereupon  taken  to  pre- 
vent the  spread  of  the  disease,  but,  unfortunately, 
several  other  children  were  infected,  and  one  of  them 
died.   On  these  facts  the  jury  did  not  hesitate  to  grant 
damages  to  the  full  amount  claimed,  £50,  and,  while 
they  absolved  the  Medical  Officer  of  the  Infectious 
Hospital  from  blame,  they  expressed  an  opinion  that 
the  institution   was   under  staffed.    The  line  of  the 
defence  was,  in  the  first  place,  that  six  weeks  was  the 
usual   time   for  a   patient  to   be  kept  at  hospital. 
This   period,  in   our   opinion,   if   meant  to  include 
the   whole    period    of    the    disease,    is    too    short 
for     the     average    detention     of    a    convalescent. 
It     is    obviously     impossible,     however,     to     lay 
down  any  absolutely  hard  and  fast  line  as  to  the  exact 
number  of  days  a  patient  should  remain,  as  much 
must  always  depend  on  the   circumstances  of  the 
individual  case.    Then  the  defence  went  on  to  prove, 
on  the  evidence  of  medical  men  experienced  in  the 
treatment  of  infectious  diseases,  that  desquamation 
was  useless  as  a  test  of  infectiveness.    Now,  whether 
that  is  or  is  not  the  case,  we  nevertheless  confidently 
claim  that  the  majority  of  medical  men  would  not 
venture  to  act  on  the  assumption  that  the  desquamat- 
ing epithelium  of  a  scarlet-fever  convalescent  was 
non-infectious.    Further,  we  hold  that  in  our  present 
stage  of  knowledge,  for  men  to  pose  as  experts  in  the 
witness  box  and  to  assert  that  ''peeling"  is  no  test, 
and  by  inference  that  it  is  not  infectious,  is  to  place 
themselves  in  a  false  position.    Where  is  the  scientific 
proof  of  their  contention  1    One  single  instance,  let  us 
remind  them,  of  specific  infection  conveyed  by  des- 
quamated scales  would  scatter  their  theory  to  the  four 
winds  of  heaven.     Moreover,  as  pointed  out  in  the 
Biimingham  Mail,  doctors  have  always  drummed  into 
the  heads  of  the  public  that  desquamation  indicates  a 
peculiar  liability  to  communicate  infection.    Nor,  let 
it  be  remarked  en  pcLssant,  do  we  see  any  definite 
reason  so  far  why  the  belief  should  be  drummed  oat 
of  their  heads.    Then  the  same  journal  pertinently 
refers  to  a  police  court  prosecution  of  the  same  date 
where  two  parents  were  fined  for  sending  their  children 
to  a  National  School  while  "  peeling  "  from  scarlatina. 
How  is  desquamation  a  danger  in  the  one  case  and  not 
in  the  other  1     Perhaps  the  medical  experts  for  the 
defence  in  the  Birmingham  trial  will  point  the  wi^  oat 


April  1,  1895. 


NOTES  ON  CITRBENT  TOPICS 


Thi  Mxdigal  Pews.     355 


of  this  dilemma.  The  su>  ject  of  the  preyention  of  the 
spread  of  scarlet-fever  is  one  of  Dational  importance, 
and  affects  every  inhabitant  of  the  British  Islands  to 
their  remotest  comer.  Bat  there  is  all  the  more 
reason  on  that  account  that  all  preventive  measures 
should  be  undertaken  only  after  a  careful  and  cautious 
review  of  the  situation.  In  our  opinion  it  is  extremely 
hazardous  to  make  public  assertions  as  to  the  infectivity 
or  otherwise  of  scarlet-fever  desquamations  before  the 
matter  has  received  decisive  scientific  proof.  It  is 
esprcially  needfal  that  Medical  OflScers  of  Health 
dhould  secure  and  retain  the  full  confidence  of  the 
public,  for  without  support  of  that  kind  there  can  be 
no  real  enforcement  of  sanitary  measures.  It  is  plain 
enough  that  to  send  back  patients  to  reinfect  house- 
holds with  scarlet  fever  is  to  invite  the  wreckage  of 
the  present  preventive  system.  It  may  be  hoped  that 
the  Birmingham  Corporation  will  appeal  on  the  ground 
that  medical  men  cannot  be  held  legally  responsible 
for  professional  acts  committed  in  absolutely  good 
faith  and  in  accordance  with  the  principles  of  current 
medical  knowledge. 


THE  BACTERIOLOGY  OF  OYSTERS. 
The  repeated  assertions  that  oysters  have  been  the 
medium  by  which  the  infection  of  typhoid  fever  has 
been  conveyed  renders  the  subject  of  the  bacteriology 
of  these  molluscs  an  important  one.  At  one  time  the 
whole  of  the  evidence  seemed  to  point  to  the  fact  that 
raw  oysters  were  guilty  in  this  connection,  and  that  a 
oonsiderable  risk  was,  in  consequence,  run  by  everyone 
who  ate  them  uncooked.  Then,  towards  the  end  of 
last  year,  an  outbreak  of  fever  among  thirty  guests 
who  were  present  at  a  ball  at  Stirling  was  attributed 
at  first  to  the  oysters  which  were  eaten.  The  matter 
waa  made  the  subject  of  an  exhaustive  inquiry  ;  every 
paiiks  was  taken  in  order  to  ascertain  the  truth  of  the 
all^^tion.  Thus  the  oysters,  for  a  second  time,  sud- 
denly acquired  an  unenviable  notoriety.  Previously, 
however,  to  ihis  unfortunate  occurrence,  public  confi- 
dence in  them,  after  having  been  thoroughly  destroyed, 
leading  almost  to  the  annihilation  of  the  oyster  industry, 
had  begun  to  become  reestablished,  but  no  sooner 
had  the  announcement  of  the  outbreak  at  Stirling 
been  made,  than  most  persons  with  common  sense 
felt  that  there  was  no  other  alternative  than  to  cease 
eating  the  molluscs.  Despite,  however,  the  deep- 
rooted  conviction  which  found  expression  among  a 
large  section  of  the  public  that  the  oysters,  in  this 
instance,  were  to  blame,  it  cannot  be  said  that  the 
investigations  of  the  experts  were  altogether  able  to 
show  that  this  was  the  case.  That  is  to  say  the  evi- 
dence was  conclusive  that  the  guests  who  contracted 
the  disease  became  infected  at  the  ball,  but  no  clear 
and  unequivocal  proof  was  forthcoming  to  show  that 
the  oysters  were  the  medium  of  the  infection.  The 
scare  thus  excited,  however  was  more  than  sufficient 
to  cause  considerable  damage  to  the  oyster  trade,  and 
many  persons  have  in  consequence  persistenly  denied 
themselves  the  luxury  of  uncooked  oysters  from  that 
period.  All  these  fact8,then,  as  we  have  observed  above, 
diatincUy  add  tothe  importance  of  investigations  under- 


taken for  the  purpose  of  determining  the  bacteriology 
of  oysters.  Freytag,  for  example,  has  found  that  the 
typhoid  bacillus  will  live  in  a  concentrated  salt  solution 
for  five  months.  Again,  Giaxa  was  able  to  detect 
typhoid  bacilli  in  unsterilised  sea- water  nine  days  after 
infection,  and  in  sterilised  water  twenty-five  days  after 
infection.  Some  further  experiments  have  been 
recently  made  in  the  same  direction  by  Dr.  Foote,  of 
the  Yale  University.  He  observed  that  a  low  temper- 
ature preserved  the  life  of  the  bacillus,  and  that  its 
vitality  was  not  injured  by  freezing.  Again,  he  care- 
fully examined  the  stomach  and  liver  of  a  serios  of 
oysters,  and  he  found  that  living  microbes  were  fre- 
quently present  in  both  organs.  He  then  conceived 
the  idea  of  testing  how  long  the  typhoid  bacillus  was 
able  to  retain  its  vitality  in  the  oyster  itself.  In  order 
to  carry  out  this  experiment  he  inoculated  some  oysters 
with  typhoid  bacilli,  and  subsequently  examined  at 
various  intervals  the  oyster  juice  as  well  as  the 
oysters  themselvep.  The  results  of  these  experiments 
were  to  the  effect  that  the  typhoid  baciUus  lives 
readily  in  oyster  juice,  and  possibly  multiplies  thereirt, 
and  that  it  penetrates  the  stomach  of  the  moUusc.  A 
most  significant  point,  moreover,  was  that  many  of  the 
bacilli  were  found  in  the  oyster  juice  and  in  the 
stomach  of  the  oyster  a  month  after  infection.  Thus 
it  would  appear  that  typhoid  bacilli  may  live  even 
longer  in  the  oyster  than  in  the  water  which  surrounds 
it,  inasmuch  as,  unless  fresh  infection  takes  place, 
their  vitality  only  lasts  about  three  weeks,  when  they 
have  not  the  oyster  for  a  host  It  is  clear,  then,  from 
these  experiments  that  the  oyster  is  not  only  a  carrier 
of  typhoid  bacilli,  but  a  means  of  preserving  them, 
compelling  the  conclusion  that  the  use  of  uncooked 
oysters  is  really  more  dangerous  to  health  than  the  use 
of  water  which  is  liable  to  pollution.  It  would  be 
interesting  if  further  experiments  were  made  in  this 
direction,  and  the  bacteriology  of  the  oyster  made  the 
subject  of  an  exhaustive  inquiry. 


SottB  on  (Current  ^ajrkB. 

A  Life  Sacrificed  to  Guardians'  Economy. 

Thb  economists  of  the  Downpatrick  Board  of  Guar- 
dians, have,  we  should  hope,  been  brought  to  their 
senses  by  the  facts  stated  at  an  inquest,  recently  held 
upon  the  body  of  a  man  who  had  died  without  medi- 
cal attendance  within  their  bailiewick.  The  circum- 
stances were  as  follows:— Dr.  Olpherts,  the  Dispen- 
sary Medical  Officer,  had  been  summoned  to  attend  to 
give  evidence  at  the  assizes.  He,  in  due  form,  notified 
his  peremptory  absence  to  his  Committee,  who,  there- 
upon, nominated  a  locum  teneru  at  a  payment  of  a 
guinea  a  day  for  the  few  days  of  Dr.  Olpherts  absence. 
This  appointment  was  reported  to  the  Guardians  on 
the  same  day,  and  they  intimated  that  they  would  not 
pay  the  substitute,  bat  that  the  doctor  should  do  so. 
Accordingly,  the  locum  tenens,  who  had  been  nomin- 
ated, refused  to  attend,  and  Dr.  Olpherts  had  no 
alternative  but  to  go  to  the  Believing  Officer  and 
instruct  him  to  be  on  the  look-out  for  dispensary  cases 
and,  if  any  presented  themselves   to  make  provision 


356     Thb  MBDIG4L  Pbbbs. 


NOTES  ON  CURRENT  TOPICS. 


Afbil  1,  1896. 


for  their  medical  care  by  calling  in  any  one  he  pleased. 
After  Dr.  Olpherta  departure,  an  urgent  case  did  at 
once  turn  up,  but  thelBelievinf;  Officer,  being  apparently 
afraid  to  call  in  any  one  after  the  refusal  of  the  Guar- 
dians to  pay,  did  not  do  so,  and  consequently  the 
patient  died.  An  inquest  was  held  and  a  verdict  was 
returned  that  "  the  Board  of  Ouardians  was  culpably 
negligent  for  not  providing  propermedical  assistance  for 
theDownpatrick  Dispensary  Districtduring  the  absence 
of  the  Medical  Officer  at  the  assizes."  On  this  occasion 
Dr.  Olpherts  acted  in  strict  conformity  with  his  duty, 
and  no  one  is  to  blame  for  the  man's  death  save  the  Quar- 
dians  and  the  Local  Government  Board,  the  former  for 
refusing  to  allow  the  Dispensary  Committee  to  provide 
for  the  care  of  the  district,  and  the  latter  for  not 
having  the  strength  of  mind  to  say  candidly  and  at 
once  that  the  Guardians  are  bound  under  such  circum- 
stances to  pay  the  substitute.  That  department 
informed  the  Guardians  that  "  they  understcmd  that  in 
a  somewhat  similar  case  it  has  been  decided  by  a  court 
f  law  that  the  Guardians  are  bound  under  such 
circumstances  to  pay  the  substitute."  This  method  of 
expression  conveyed,  and  perhaps  was  intended  to 
convey,  to  the  Guardians  the  hint  that  the  law  on  the 
subject  is  ill-defined,  and  that  they  might  probably 
succeed  in  doine  the  locum  tenem  out  of  his  fees  if  they 
liked  to  try  to  do  so.  The  Local  Government  Board  is 
appointed  and  paid  to  know  the  law  wbic||  it  admin- 
isters, and  to  give  explicit  instructions  thereoa  to 
Guardians  who  do  not  know  it,  and  we  say  that  .^; 
Local  Government  Board  is  morally  responsible,  for 
any  death  which  may  occur  by  reason  of  its  omission 
to  state  plainly  and  honestly  the  law  which  it  well 
knows  governs  such  questions. 


Spartan  Justioe  upon  an  Indian  Medical 
Officer. 

A  SUKOEON- MAJOR  iu  the  Indian  Medical  Service  has 
been  dismissed  the  Service  because  he  asked  a  married 
lady  for  a  kiss.  .  So  far  as  we  are  in  possession  of 
the  facts,  we  must  certainly  say  that  in  this  case  the 
*^  punishment  does  not  fit  the  crime,"  and  has  been,  in 
fact,  unnecessarily  severe  and  cruel,  and  unjust.  If 
there  be  any  other  circumstances  to  justify  such  a 
punishment  the  public  knows  nothing  about  them,  and 
they  should  not  influence  anyone.  .  It  goes  without 
saying  that  the  officer  erred  gravely  in  making  such  a 
request,  almost  as  much  as  if  he  had  snatched  the 
osculatory  bliss,  and  we  admit  that  he  left  himself  open 
to  a  very  serious  reprimand,  and  perhaps  to  some  visita- 
tion of  disci  plinary  penalty.  But  we  have  not  been  accus- 
tomed to  observe  that  it  is  a  hanging  matter  to  take  a 
kiss,  nor  have  we  observed  that  the  military  service 
has  hitherto  been  particularly  straight-laced  in  its  pro- 
fessional morality.  The  records  of  the  Divorce  Court 
have  made  the  world  familiar  with  the  fact  that  the 
sons  of  Mars  have  occasionally  been  more  than  sus- 
pected of  straying  from  the  path  of  virtue,  and  yet  we 
have  not  noticed  any  Ehadamanthine  determination 
on  the  part  of  the  Horse  Guards  to  vindicate  the 
morality  of  the  Army  by  expelling  officers  who  have 
thus  erred.    On  the  contrary,  the  spectacle  has  been 


presented  to  the  public  of  the  administrators  of  the 
Service  quietly  ignoring  such  peccadilloes,  even  when 
forced  to  see  them  in  the  newspapers,  and  calmly  per- 
mitting the  culprits  to  retain  every  position,  social  and 
professional,  which  they  possessed.  Truly,  ''that  in 
the  captain's  but  a  choleric  word,  which  in  the  soldier 
is  flat  blasphemy,"  and  it  seems  probable  that  if  the 

sinner  in  this  case  had  been  anyone  but  a  d d 

doctor  he  would  have  been  let  off  with  a  mild  indica' 
tion  of  the  displeasure  of  his  superiors. 


Vioe-Goardians'  Assessment  of  Medical  Fees. 
Wb  note  that  the  Vice  Guardians  appointed  to 
supersede  the  Guardians  of  the  Eillarney  Union  have 
adopted  a  resolution  that  *'  the  maximum  fee  to  be 
allowed  to  medical  officers  for  assisting  other  medical 
officers  shall  be  £2  Ss.**  We  apprehend  that  the  assist- 
ance here  referred  to  is  in  the  nature  of  a  consultation 
or  help  at  an  operation  upon  a  particular  case,  but, 
whatever  it  may  mean,  we  take  leave  to  say  that  the 
Vice-Guardians  have  no  more  power  to  make  such  a 
rule  or  to  enforce  it  than  we  have,  and  we  submit  that 
it  would  be  wiser  for  them  not  to  assume  authority 
which  they  do  not  possess,  and  which  can  be  laughed 
at  by  anyone  who  feels  disposed  to  treat  it  with  dis- 
respect. How  often  must  we  repeat  that  Guardians  or 
Vice-Guardians  must  pay  for  medical  assistance  the 
market  price.  They  may  proclaim  their  own  esti- . 
mate  of  the  value  of  the  services  rendered,  but 
that  estimate  binds  no  cue,  and,  in  any  case, 
they  cannot  make  a  general  rule  as  to  fee  to 
govern  particular  cases,  li  the  consultant  gives 
his  services  with  full  knowledge  that  he  will  only 
receive  a  definite  fee  he  must,  of  course,  be  content 
with  that  fee,  but  if  he  is  called  upon  to  attend  without 
such  specific  contract  he  must  be  paid  the  market 
price,  regard  being  had  to  the  distance  he  has  had  to 
travel,  the  time  he  has  lost,  the  hour  of  his  attendance, 
and  the  nature  of  the  services  rendered.  .  They  may 
vapour  as  they  please,  but  they  must  pay.  It  is  worthy 
of  notice  that  the  Vice-Guardians  who  have  thus 
sought  to  clip  the  fees  of  the  Medical  Officers  are  the 
representatives  of  the  Local  Government  Board,  and 
this  episode,  coupled  with  the  recent  refusal  of  the 
Athlone  Vice-Guardians  to  approve  of  the  Superannua- 
tion Bill  will  serve  to  illustrate  the  attitude  of  the 
Local  Government  Board  towards  its  Medical  Officers. 
It  seems  to  us  that  no  opportunity  is  lost  by  it  to  dis- 
credit and  injure  those  Officers,  and  we  fail  to  recollect 
a  single  instance  in  which  the  Board  has  taken  the  side 
of  its  medical  officers  in  any  controversial  queetion. 

Amateur  Diploma  Granting. 
Some  months  ago  we  called  attention  to  the  fact 
that  certain  local  representatives  of  the  Medico- 
Psychological  Association  in  Ireland  had  taken  upon 
themselves  to  hold  examinations  of  asylum  attendants 
—to  issue  certificates  of  competency— and  to  found 
upon  the  certificates  so  granted  a  claim  that  the 
holders  should  be  entitled  to  higher  pay  and  privileges 
than  non-holders.  It  seemed  to  us  that  the  issue  of  such 
semi-official  certificates  of  qualification  was  very  much 


'April  1,  1896. 


NOTES  ON  CURRENT  TOPICS. 


Thb  Mkdioal  Press.     357 


OD  all  fours  with  the  grant  by  Societies,  Hospitals, 
and  irresponsible  individuals  of  soi  disant  Midwifery 
Diplomas  which  the  General  Medical  Council  has 
denounced  ex-cathedrOy  and  which  the  holders  and 
granters  are  now  trying  to  get  recognised  as  legal 
qualifications  to  practice.  We  emphatically  warn  the 
profession  against  encouraging  or  even  tolerating  an 
extension  of  amateur  diploma  granting  either  in 
psychology  or  in  any  other  direction,  for,  if  the 
principle  be  once  acknowledged  that  a  self- elected 
group  of  specialists  can  issue  recognisable  documents 
testifying  to  special  competency,  there  is  no  limit 
to  the  extent  to  which  the  practice  may  run.  It 
is  equally  permissible  for  the  Ophthalmological 
Society,  the  Dental  Association,  the  Liryngological 
Society,  or  any  other  special  organisation,  to  institute 
an  examination,  to  delegate  one  or  two  of  their 
number  to  hold  it  in  any  pait  of  the  Kingdom, 
to  issue,  thereupon,  a  flaring  certificate  of  competency 
in  the  speciality,  and  to  insist  that  such  certificate 
shall  confer  upon  the  holder  at  least  a  moral  right  to 
superior  position  and  higher  pay.  We  return  to  this 
subject  now  because  we  notice  that  this  system  is 
being  extended  to  the  speciality  of  Hygiene.  The 
Belfast  Corporation  has  set  up  an  examination  of  its 
own  for  Sanitary  inspectors,  and  has  delegated  two 
members  of  the  Public  Health  Committee  to  hold  such 
examination  in  the  Council  Chamber,  the  subjects 
including,  amongst  others.  Hygiene  and  Elementary 
Chemistry,  and  any  candidate  not  up  to  the  mark  in 
these  subjects  is  to  be  excluded  from  the  competition. 
We  entertain  the  gravest  doubt  that  such  exclusion 
would  be  lawful,  but  in  any  case  the  establishment 
of  such  a  precedent  would  be  most  objectionable.  As 
well  might  every  Board  of  Guardians  direct  a  couple 
of  their  number  to  question  the  candidates  for  an 
Apothecaryship,  upon  Pharmacy,  and  thereupon  issue 
to  the  successful  answerers  pseudo-diplomas  of  com- 
petency. 

Counter  Prescribing. 
The  gradual  development  of  the  system  of  prescrib- 
ing by  chemists  has  been  brought  under  notice 
recently  by  an  inquest  held  in  Dublin  by  Dr.  Kenny, 
M.P.,  upon  the  body  of  a  child  who  had  died  after  it 
had  swallowed  some  medicine  prescribed  by  a  pharma- 
ceutical chemist  named  Allen,  without  seeing  the 
patient.  This  gentleman  on  being  asked  in  the  witness 
box  whether  he  thought  it-  legal  for  him  to  prescribe, 
though  not  holding  any  medical  qualification,  said  he 
thought  it  was  legal  "in  minor  cases"  and  that,  in  his 
opinion,  the  person  who  brings  the  case  to  him  is  the 
judge  whether  it  is  a  minor  or  a  migor  case.  The  jury 
adopted  a  condemnatory  verdict.  We  regret  to  say 
that,  in  Ireland,  no  law  exists  which  can  be  used  to 
put  a  stop  to  this  sort  of  thing.  The  Medical  Acts  do 
not  forbid  illicit  prescribing,  as  long  as  the  prescriber 
does  not  represent  himself  to  be  a  registrable  medical 
practitioner,  nor  can  the  College  Charters  reach  any- 
one save  their  own  licentiates.  The  Irish  Medical 
Association  can  find  no  law  under  which  it  could 
successfully  prosecute,  and  the  only  authorities  which 


might  exercise  control  are  the  Pharmaceutical  Society, 
of  which  this  practitioner  is  a  licentiate,  and  the  police. 
The  police  can  only  intervene  when  there  is  evidence 
to  show  that  the  prescription  hastened  the  death,  of 
which  proof  can  seldom  be  had.  It  seems  to  us  that 
the  Pharmaceutical  Society  owes  it  to  itself  to  put 
down  this  sort  of  malpraxis  with  a  strong  hand.  We 
are  aware  that  some  years  ago  it  strongly  discouraged 
counter  prescribing,  and  we  would  suggest  that  occas- 
sion  exists  for  surther  consideration  of  the  subject  and 
for  the  infliction  of  such  disciplinary  penalty  as  may 
be  within  its  power.  In  London  this  practitioner 
might  be  prosecuted  under  the  old  Apothecaries'  Act 
of  1815,  but  that  law  has,  unfortunately,  no  validity  in 
Ireland. 


Medical  Practice  in  Spain. 
Medical  organisation  is  greatly  wanted  in  Spain, 
every  week  the  medical  journals  report  lists  of  vacan- 
cies for  district  medical  oflScers  for  the  poor,  appoint- 
ments of  a  similar  kind  to  dispensaries  in  this  country  ; 
but  the  appointment  is  made  for  a  term  of  years  ;  when 
no  term  is  fixed  the  doctor  is  liable  to  dismissal  at  any 
moment.  The  payment  is,  as  a  rule,  very  small,  as  the 
following  will  show  :— District  C,  population  1,021, 
salary,  995  pesetas  (£Z9  17s.  6d.).  But  the  advertise- 
ment naively  states  that  the  doctor  shall  be  at  liberty 
to  attend  wealthy  families  in  the  neighbourhood.  For 
the  district  of  P.,  population  5,411,  the  salary  is  875 
pesetas,  and  there  is  no  mention  of  any  wealthy 
families  being  in  the  neighbourhood.  District  V.,  popu- 
lation 593,  salary  150  pesetas  for  attendance  on  17  poor 
families,  and  liberty  granted  to  attend  the  156  wealthy 
ones  in  the  neighbourhood.  The  contract  to  be  for  a 
term  of  four  years.  By  the  termination  of  contract 
the  district  of  A,  which  includes  three  towns,  offers 
3,000  pesetas  (£120),  the  contract  to  be  for  four  years. 
The  advertisement  states  that  there  is  a  good  road 
connecting  the  towns,  and  that  the  country  is  very 
beautiful.  In  all  cases  the  application  is  to  be  made  to 
the  alcade.  Such  conditions  are  not  likely  to  advance 
medicine  and  they  have  undoubtedly  been  injurious  to 
the  people.  Under  the  startling  heading  "Dinami- 
teros,"  M  Siglo  Medico  has  published  a  series  of  long 
articles  on  the  present  condition  of  Spanish  society, 
which  that  journal  states,  is  being  undermined  by 
drunkenness  and  clandestine  prostitution,  and  appeals 
urgently  for  a  better  system  of  education,  which  it 
looks  to  as  a  remedy  capable  of  raising  Spanish  women 
to  a  sense  of  the  worth  of  purity. 

The  Queen's  Hospital  at  Birmingham. 
The  annual  meeting  of  the  governors  of  the  Queen's 
Hospital,  Birmingham,  is  of  interest,  as  it  raised 
matters  of  importance  to  the  medical  profession  gene- 
rally throughout  the  United  Kingdom.  First  of  all, 
there  is  the  usual  falling  off  in  subscriptions  and 
legacies.  The  chairman  made  the  remarkable  state- 
ment that  the  subscription  list  twenty  years  ago  was 
£1,100  more  than  at  the  present  time.  We  quite  agree 
with  him  that  this  is  not  a  healthy  sign  for  the  future 
of  hospitals,  especially  wheo  the  fact  is  taken  into  con- 


358 


Thb  Mxdical  PlHB. 


NOTES  ON  CURRENT  TOPICS. 


Apbil  It  1806. 


sideration  that  there  are  now  far  more  wealthy  people 
in  Birmingham  than  there  were  at  the  former  period. 
Go  the  other  hand,  the  Saturday  and  Sunday  Funds 
have  sprung  into  existence,  and  the  contribution  of  the 
former  to  '^Qaeen's"  for  last  year  was  £2,206.  The 
number  of  out-patients  is  stiU  excessive,  ''far  too  large 
to  make  it  possible  for  the  staff  to  give  that  attention 
to  each  which  is  desirable.''  Moreover,  it  is  the  delibe- 
rate conclusion  of  the  Medical  Committee  that  the  abuse 
'^  largelyarises  from  the  attendance  of  many  persons  who 
would  be  treated  much  more  appropriately  in  connection 
withsome provident  institution."  Now,  considering  that 
Birmingham  folks  had  a  full  inquiry  into  the  system 
of  Medical  Charities  in  their  town  some  six  or  eight 
years  ago,  and  strongly  advocated  a  central  control  of 
all  such  institutions,  it  is  about  time  they  took  some 
steps  in  the  matter  of  reform.  Something  of  the  kind 
appears  to  be  required  to  restore  the  confidence  of  the 
public  in  hospitals  generally.  By  the  way,  we  see  that 
the  Medical  Officers  of  the  Queen's  Hospital  are  de- 
scribed as  ^  honorary."  That  hardly  seems  a  fair  title, 
if  it  still  be  the  case,  as  formerly,  that  each  one  of 
the  staff  receives  a  substantial  annual  payment.  In 
making  this  remark,  we  do  not  in  the  least  wish  to 
speak  against  the  principle  of  paying  the  medical  staff. 
It  is  our  fixed  opinion  that  all  such  officers  should  be 
paid,  and  that  the  system  whereby  charities  are  main- 
tained at  the  cost  of  gratuitous  medical  services  is  a 
snare  and  a  delusion. 


Medical  Advertising  by  Lady  Doctors. 
A  coR&BSPONDKNT,  whoso  letter  we  publish  in 
another  column,  calls  attention,  not  a  moment  too  early, 
to  certain  highly  unprofessional  practices  on  the  part 
of  women  practitioners.  If  such  practices  are  found 
to  be  at  all  general,  it  may  be  inferred  that  those  who 
are  responsible  for  the  medical  education  of  women 
have  neglected  that  part  of  their  education  which 
bears  on  the  duties  and  responsibilities  of  the  medical 
practitioner,  male  or  female,  towards  his  or  her  fellows. 
Possibly,  this  absence  of  the  ethical  sense  is  the 
result  of  the  plan  of  segregating  female  students 
instead  of  allowing  them  to  mix  from  the  first  with 
those  who  are  to  be  their  rivals  later  on.  It  Lb  a 
notorious  fact  that  women  fail  to  derive  the  social 
benefit  from  a  collegiate  education,  which  is  the  most 
coveted  outcome  of  an  university  education  for  young 
men,  and  no  one  can  feel  any  surprise  that  this  should 
be  the  case,  in  view  of  the  absurd  restrictions  to  which, 
while  in  statu  pupillari^  women  are  subjected.  If 
necessary,  steps  will  certainly  have  to  be  taken  to  imbue 
female  members  of  the  profession  with  a  proper  measure 
of  respect  forthe  code  of  ethics  which  governs  intra-pro- 
f  essional  relations,  and  they  will  do  well  to  bear  in  mind 
that  offences  of  the  kind  to  which  our  correspondent  has 
called  attention,  if  continuously  persisted  in,  would 
probably  be  viewed  by  the  General  Medical  Council  as 
constituting  infamous  conduct  in  a  professional  respect 
It  has  already  been  found  necessary  to  remove  the  name 
of  one  lady  doctor  from  the  Register  for  advertising 
practices,  and  it  must  be  clearly  understood  that  the 
female  sex  confers  no  exemption  from  the  regulations 


which  bind  the  profession  as  a  whole.  We  prefer  to 
believe  that  the  complaints  in  question  refer  to  isolated 
instances  of  misconduct,  for  it  is  hardly  necessary  to 
have  gone  through  the  corriculum  to  understand  that 
touting  for  practice  under  a  more  or  less  specious 
pretext  is  at  once  derogatory  to  the  profession  and 
degrading  to  the  individual. 

Professor  AnnandaJe  in  South  AfHccL 
A  Fsw  weeks  since  we  announced  with  regret  that 
Prof.  Annandale,  of  Edinburgh,  had  been  compeUed 
to  relinquish  work  for  a  time  and  to  take  a  sea  voyage 
in  quest  of  health.  A  correspondent  writes  us  from 
Durban,  under  date  of  February  26th  stating  that"  the 
eminent  Scotch  surgeon  had  arrived  in  that  town  on 
his  way  home  from  the  Transvaal.  He  was  greatly 
rejoiced  to  meet  a  large  number  of  his  old  pupils 
among  the  South  African  doctors ;  a  banquet  was  then 
being  organised  in  his  honour  by  the  medical  pro- 
fession in  Cape  Town."  Our  correspondent  further 
states  Prof.  Annandale  has  been  much  struck  by  the 
truly  Spartan  philosophy  of  the  Kaffir  under  the  most 
painful  surgical  operations,  to  which  he  will  submit 
himself  when  necessary,  without  anssthetic,  and 
almost  without  wincing.  Since  receiving  the  fore- 
going intelligence  we  learn  that  the  visitor  to  South 
Africa  has  now  arrived  home,  much  benefited  by  the 
change  and  rest,  and  already  has  begun  his  work 
preparatory  to  the  opening  of  the  Edinburgh  schook 
for  the  summer  session 

The  "Puff"  Direct 
Of  course,  the  irrepressible  medical  scribe  of  the 
Star  newspaper  takes  advantage  of  the  occasion  to 
^  puff  "  the  most  discussed  medical  practitioner  of  the 
hour.  This  is  what  he  says  :  '*  Dr.  Playfair,  the  defen- 
dant in  the  case  which  is  now  exciting  so  much  atten- 
tion, is  one  of  the  most  distinguished  of  living  gynaeco- 
logists. The  public  rush  to  his  consulting  room,  and 
his  house  in  Qeorge  Street,  Hanover  Square,  is  the 
resort  of  much  talent,'some  rank,  and  a  certain  amount 
of  fashion.  Dr.  Playfair  is  below  the  middle  height, 
not  especially  attractive  in  appearance,  and  wearing 
thick,  disfiguring  glasses.  In  manner  he  is  urbane, 
and  he  has  a  habit  of  rubbing  his  hands  softly  together 
in  a  way  that  suggests  that  his  treatment  would  be 
gentle.^'  The  description  is  certainly  humorous  and  by 
no  means  in  good  taste.  But  the  medical  men  whose 
names  from  time  to  time  appear  in  this  column  of  our 
contemporary  are  not  consulted  in  the  matter.  This 
we  have  on  the  authority  of  the  Sta/r  itself,  and  judg- 
ing from  the  previous  announcements  which  have  been 
published  of  well-known  members  of  the  profession, 
we  have  no  reason  for  doubting  the  correctness  of  this 
assertion. 


A  SUM  of  upwards  of  £2,300  has  been  received  by 
the  Huxley  Memorial  General  Committee.  This  will 
be  sufficient  for  the  erection  of  the  statue  of  the  great 
scientist  in  the  Natural  History  Museum,  and  for  the 
establishment  of  a  medal  at  the  Boyal  CoUege  of 
Science. 


Afbil  1;  1896. 


NOTES  ON  CUKRENT  TOPICS. 


Ths  Medical  Pbbbs.    369< 


The  Tom  of  the  Anti-Vacoination  Tide  at 
Gloucester. 
A  FBELINO  of  relief  has  preeamably  now  begnn  to  pre- 
vail amoDg  the  sensible  minded  persons  of  Qloucester 
at  the  decision  of  the  Qoardians  of  the  Borough  to 
enforce  the  compulsory  clause  in  the  Vaccination  Acts. 
Thus,  after  nine  years  of  neglect  of  their  duty  in  this 
respect,  the  guardians  have  at  last  become  alive  to  the 
necessity  of  action.  The  anti-vaccination  tide  has 
now  turned,  and  as  it  recedes  from  the  position  of  high 
water  mark,  which  it  had  attained,  it  goes  %vithout 
saying  that  for  many  a  year  its  sad  effects  will  remain 
manifest  and  form  the  subject  of  painful  memories. 
But  the  harm  which  the  anti-vaccinationist  party  has 
done,  led,  we  much  regret  to  say,  by  a  young  medical 
practitioner,  Mr.  Had  wen,  will  afford  a  sound  lesson 
to  the  residents  in  other  towns  in  the  country  among 
whom  agitators  have  sown  the  evil  of  resistance  to 
vaccination.  In  the  present  state  of  the  law  we  are 
not  certain  whether  an  action  for  damages  could  not 
be  sustained  against  an  anti-vaccinationist  agitator, 
who,  on  certain  representations,  persuaded  a  man  not 
to  have  his  child  vaccinated,  the  child  shortly  after- 
wards dying  of  virulent  small -pox.  Doubtless,  many  of 
the  defaulters  under  theVaccination  Acts,  are  defaulters 
in  consequence  of  the  advice  which  is  given  them 
against  vaccination  ;  the  matter  is  by  no  means  one  of 
merely  free  will  on  the  part  of  these  deluded  persons ; 
they  are  told  not  to  have  their  children  vaccinated, 
and  are  led  into  the  belief  that  there  is  nothing  to  fear. 
It  would,  however,  be  an  amusing  spectacle  to  see  an 
anti-vaccinationist  agitator  arraigned  in  an  action  for 
damages  by  some  person  who  had  taken  his  advice, 
and  in  consequence  suffered  grievous  harm  through 
the  loss  of  relatives.  We  are  glad  to  see  from  the 
Gloucester $hire  Chronicle  that  one  myth  of  the  anti- 
vaccinationists  has  been  effectually  exploded,  namely, 
that  the  epidemic  of  small-pox  was  due  to  the  insanicary 
condition  of  the  town.  Both  the  city  surveyor,  as 
well  as  the  Medical  Officer  of  Health,  show  in 
official  communications  the  true  state  of  affairs  in  this 
respect,  and  demonstrate  unequivocally  the  fallacy  of 
the  statement  The  following  is  the  record  of  the 
cases  of  smallpox,  up.  to  and  including  the  26ch  ult 
Cases  notified,  693  ;  deaths,  118.  Hospital  cases,  369  ; 
deaths,  90.  Of  the  90  deaths,  74  were  in  unvaccinated 
persons,  and  the  remaining  16  had  only  been  vaccin- 
ated in  infancy.  Only  one  re-vaccinated  person  had 
been  admitted,  and  she  had  been  re- vaccinated  14  years 
ago;  she  became  infected  in  a  private  house  while 
nursing  small-pox  patients.  Despite,  however,  figures, 
common- sense,  and  everything  else,  the  anti- vaccina- 
tionists in  Gloucester  have,  so  far,  persisted  in  their 
course  of  obstruction.  Thus  they  have  brought  a  plague 
on  their  town  and  its  inhabitants,  the  effects  of  which 
are  not  likely  to  be  forgotten  for  some  time  to  come. 

Deoiduoma  Malignum. 
To-NIOHT  (Wednesday,  April  1st)  three  contribu- 
tions will  be  read  at  the  Obstetrical  Society  of  London 
on  the  important  subject  of  deciduoma  malignum.  Dr. 
Herbert  Spencer  and  Mr.  Rutherford    Morison,  of 


Newcastle-on-Tyne,  will  each  relate  a  case  in  their  own 
experience.  Dr.  Eden,  who  has  already  published 
valuable  work  relating  to  the  histology  of  the  foetal 
envelopes,  will  read  notes  on  "  Deciduoma  and  the  dis- 
tinction between  Sarcoma  Cells  and  so-called  Deci- 
duoma Cella."  The  profession  cannot  treat  lightly  the 
theory  of  Sanger  and  others  that  a  very  malignant 
uterine  tumour  has  been  known  to  develop  in  a  young 
subject  shortly  after  delivery  or  abortion.  Metastatic 
deposits  form  within  a  few  months,  the  lungs,  as  well 
as  the  abdominal  viscera,  becoming  invaded.  These 
deposits,  it  is  declared,  consist  of  true  decidual  tissue. 
Over  a  score  of  cases  have  been  reported  within  eight 
years,  but  none  were  in  this  country.  We  believe 
that  there  is  an  impression  amongst  British  authorities 
that  the  disease  may  prove  after  all  to  be  a  simple 
coincidence  of  sarcoma  of  the  uterus  with  pregnancy, 
the  notmal  stimulating  the  abnormal  process.  Hence 
an  instructive  discussion  is  expected. 

Holidays    for    Hospital    Physioians    and 
Surgeons. 

These  are  probably  no  more  hardly-worked  men 
than- the  physicians  and  surgeons  attached  to  our  large 
general  hospitals,  many  of  whom  are  so  anxious  to 
relieve  suffering  that  they  voluntarily  devote  several 
mornings  or  afternoons  a  week  to  the  discharge  of 
unremunerated  and  fatiguing  duties  at  various  insti- 
tutions. Their  spirit  of  self-sacrifice  is  ill-requited  by 
the  indifference  shown  by  the  management  to  their 
comfort,  as  evidenced  by  the  fact  of  the  out-patient 
departments  being  opened  as  usual  to  the  public  on 
the  Saturday  following  Good  Friday.  Seeing  that 
urgent  cases  would,  under  any  circumstances  be  seen 
by  the  Resident  Medical  Officers  on  duty,  there  cannot 
be  any  justification  for  thus  depriving  the  out-patient 
physicians  and  surgeons  of  their  chance  of  a  holiday 
extending  from  Friday  until  Monday  inclusively.  In 
all  probability  the  matter  is  one  which  has  hitherto 
escaped  attention  and  it  is  to  be  hoped  that  in  future 
this  rule  will  be  honoured  in  the  breach.  This  matter 
is  further  dealt  with  in  a  letter  which  we  publish  in 
our  correspondence  columns. 


The  Jubilee  of  the  Discovery  of  Chloroform. 
In  the  year  1847  the  late  Sir  James  Simpson  made 
the  great  discovery  of  the  anaesthetic  properties  of 
chloroform.  We  are  on  the  eve,  so  to  speak,  of  the 
fiftieth  year  of  its  use  as  an  anesthetic  agent,  and  the 
knowledge  of  this  fact  seems  to  suggest  that  this  jubilee 
might  be  made  the  subject  of  some  special  celebration. 
In  reflecting  upon  the  inconceivable  amount  of  human 
suffering  saved  by  the  introduction  of  chloroform,  the 
conclusion  is  unavoidable  that  a  more  worthy  object 
for  such  a  celebration  could  scarcely  be  found.  Happily 
operating  theatres  are  now  never  the  scene  of  the 
horrors  which  distinguished  them  when  patients  were 
compelled  to  submit  to  the  ordeal  of  operations  without 
an  anesthetic.  Probably  a  number  of  surgeons  are 
still  living  by  whom  such  horrOrs  can  be  recalled,  but 
since  the  discovery  of  chloroform  many  generations  of 
medical  practitioners  have  never  had  an  opportunity  of 


^     tM  Mgbibii  PAlBS. 


ftl^M  ^  A:mTOXW. 


AMifei  If  19Ml 


forming  any  conception  of  what  tlid  {^dtf dHnaivM  61  A 
large  operation  without.the  assifttahbe  of  an  an^thetfc 
really  meant,  both  to  jihe  snrgeon  and  the  patient 
Imagination,  perhaps,  might  Mppl;^  some  of  th^'defi- 
dency  in  this  respect,  bat  it  Wotid  fMi  altogether 
adequately  to  depict  the  scene  of  hnman  angnish  with 
which  the  operating  theatres  in  fohmfr  days  1MM 
associated. 

The  Cade  of  Kitson  t.  FIsyAttr. 

Ik  another  part  of  this  issne  we  have  commented  on 
the  general  aspect  of  ''The  Plea  of  Privilege"  arisiDg 
ont  of  this  eaniM  M^bre,  bat  have  refrained  from 
expi-essing  our  opinions  on  the  case  itself,  as  it  may 
be  still  oonsideted  inb  judice^  the  appeal  for  a  new 
trial  by  Dr.  Playfair's  legal  advisers  having  been 
granted  on  the  90th  alt.  by  the  jadge  who  tried 
the  case.  In  granting  the  stay  of  ezecntion  Mr. 
Justice  Hawkins  stated  that  he  had  considered  it 
in  all  its  bearings,  and  had  made  up  his  mind  as 
to  the  course  he  onght  to  adopt.  If  he  had  disap- 
proved of  the  verdict*  and  thought  it  was  against  the 
evidence,  or  had  reason  to  disagree  with  it,  he  shoold 
have  granted  a  stay  upon  certain  terms,  but  he  always 
felt  that  after  a  jury  had  given  a  verdict  a  judge  ought 
not*  unless  he  had  reason  to  disagree  with  it)  to  inter- 
feroi  but  inasmuch  as  he  knew  the  only  redress  was 
by  entering  an  appeal,  he  would  grant  it  in  this  case^ 
unless  opposing  counsel  came  to  some  arrangements 
between  themselves.  Sir  F.  Lockwood,  having  con- 
sulted with  Mr.  Lawson  Waltoui  replied  that  he  had 
made  an  arrangement  by  which  a  sum  of  money 
would  be  unconditionally  paid  over  to  the  solicitors 
representing  the  lady,  and  there  would  be  a  stay  pend- 
ing an  appesl,  which  would  be  proceeded  with  at  all 
speed.  Mr.  Justice  Hawkins  :  I  think  if  there  is  an 
intention  to  go  to  the  Qouit  of  Appeal  at  all,  it  should 
be  with  the  least  possible  delay.  Sir  F.  Lockwood : 
Certainly.  I  am  very  glad  I  have  been  able  to  arrange 
this,  raUier  than  have  the  matter  go  further  and  be 
contested;  

Thb  Church  of  St.  Sauveur,  in  Lille»  was  totally 
destroyed  by  fire  on  the  28th  ult  The  flames 
spread  to  the  adjoining  St.  Sauveur  Hospital,  in  which 
were  200  patients ;  these  were  all  carried  or  assisted 
to  places  of  safety*  but  eight  died  from  shock.  During 
the  removal  an  extraordinary  accident  occurred  i  some 
soldiers  engaged  in  conveying  chemicals  from  the 
laboratory  of  the  hosfHtal  opened  a  bottle  of  poison, 
which  they  mistook  for  gin.  Of  ten  who  drank  the 
liquid  four  have  already  died,  and  the  other  six  are 
not  expected  to  recover.  The  hospital  was  partially 
burnt  down. 


[vBoif  CUB  oWK  oonaisFOKnxNt.] 

Thb  Member  of  Parliament  fob  Edinbubgj^  and 
St.  Andrews  Univebsities.— There  is  a  very  good  pros- 
pect of  the  medical  mettbert  of  the  Hon^e  of  Ck>mmon8 
being  recruited  by  the  election  of  Sir  James  Crichton 
Browne,  M.D.,  LL.D.,  F.R.S.,  for  the  Uhivereitiee  of 
SSdinbargh  and  9t,  Andrews,    Owing  to  t|i9  tesignatidn 


dr  one  dt  the  d6Sntm,fktk  bl  tht  SMicM  B^oh  in  Scotland, 
the  present  member  for  these  Univertitiee,  Sir  Charles 
Pearson,  who  is  also  Lord  Advocate  for  Scotland,  will  pro- 
bably elect  to  take  the  vacant  Jadgeship.  Bir  James 
OrichMM  Browne  will  shortly,  we  understand,  resign  his 
office  of  Lord  Chancellor's  Visitor  with  the  view  of  entering 
Parliament.  We  need  {not  say  that  his  presence  in  the 
House  would  be  of  the  greatest  value  to  the  profession, 
not  only  becanse  of  his  professional  attainments,  but 
because  of  his  linquistie  powers  also. 

The  Extension  of  Aberdeen  Uniyebsitt.— At  a 
meeting  of  the  Executive  Council  in  connection  with  the 
University  fii tension  Fund,  held  last  week,  the  Mar- 
quis of  Huntly  presidine,  it  was  announced  that  £6,466 
of  the  £10,000  required  before  the  Isb  of  May,  to  secure 
the  conditional  donation  ol  Mr.  C.  W.  Mitchell, Newcastle, 
for  £6,000^  had  been  subscribed.  It  wan  determined  to 
endeavour  to  obtain  the  neoessary  £3,534  by  personal 
inflnenoe.  not  by  any  formal  appeal. 

WottEN  Students  at  St.  Andbews.— The  University 
authorities  of  Oxford  and  Cambridge  should  read  with 
interest  Principal  Donaldson's  remark  at  the  annual 
firaduatiou  oeremonv  of  the  University  of  St.  Andrews. 
Many  had  deemed  the  inclusion  of  women  students  in  the 
regular  classes  a  doubtful  experiment,  but  it  had  been 
justified  b^  the  result  The  women  students  had  exerted 
a  healthy  mfluence  on  all.  The^  had  worked  with  great 
diligence,  and  the  lists  of  distmctions  which  the^  had 
gained,  was  proof  that  they  oould  attain  the  highest 
eminence  in  any  branch  of  s^uHy. 

The  Union  of  Dundee  with  St.  Andbews  Uviveb- 
siTT.~The  Scottish  Universities'  Commissioners  have 
found  it  impossible  to  proceed  with  their  plan  for  the  union 
of  Dundee  University  College  with  St.  Andrews'  Univer- 
sity, and  it  is  not  unlikely  that  a  Bill  may  be  introduced 
into  Parliament  giving  them  the  compulsory  powers  neoes- 
sary owing  to  the  recent  decision  of  the  Court  of  Session. 

Health  Conobess  in  Glasgow.— It  has  been  definitely 
settled  that  the  Annual  Congress  of  the  British  Institute 
of  Publie  Health  will  be  held  in  Glasgow  from  Thursday, 
83rd,  to  Tuesday,  SSnh  July  next,  inclusive,  in  the  Univer- 
sity of  Glasfcow*  The  Congress  will  be  arraufjred  in  three 
sections,  vis.  :  {a)  Preventive  Medicine,  (6)  Chemistry  and 
Engineering  in  relation  to  Public  Health,  (c)  Municipal 
and  Parliamentary.  All  the  municipal  undertakings  of 
the  city  will  be  thrown  open  for  inspection,  and  their 
workings  explained  to  delegates.  Corporation  and  other 
hospitalfties  will  be  eitended  to  themj  and  eitenriions  to 
places  of  interest  will  also  be  arranged  with  a  view  to  lend 
pleasant  variety  to  the  meeting. 


THE  REPORT  ON  ANTITOXIN. 
A  most  valuable  report  was  issued  by  the  Metropolitan 
Asylums  Board  at  the  end  of  last  week,  namely,  that 
containing  the  results  following  the  nse  of  antitoxin  in 
the  treatment  of  diphtheria  at  the  hospitals  under  the 
authority  of  the  Board.  The  results  were  obtained  durine 
the  year  1895  in  all  the  six  hospitals  in  which  cases  (» 
diphtheria  were  treated,  and  the  report  is  jointly  signed 
by  the  six  medical  superintendents,  who  thus  make  then)- 

?lvee  equally  responsible  for  tiie  conclusions  expressed. 
he  total  number  of  cases  treated  with  antitoxin  waS 
2,18^  of  Which  616  died,  irepresentin^  a  mortality  of  28*1 
per  cent.  The  drug  was  not  uwd  m  all  the  cases  which 
came  under  treatment,  but,  generallv  speaking,  only  in 
the  severer  instances.  The  effects  of  the  treatment  were 
to  rednoe  the  mortality  to  the  extent  of  7*1  per  cent,  in 
comparison  with  the  preyious  year.  That  is  to  say,  the 
death-rate  jfrom  diphtheria  in  1894  was  29*6,  while  in  1895 
it  was  22*5.  The  conclusion,  then,  based  upon  these 
figures,  is  that  in  the  latter  year  the  use  of  the  antitoxin 
was  the  means  by  which  260  lives  ip  London  were  saved. 
But  the  effica^  A  the  treatment  is  further  shown  in  con- 
nection with  the  laryngeal  and  tracheotomy  oase^.  In  the 
former  during  1894  the  mortality  was  62*0.  while  in  1895 
it  was  reduced  to  41*8.  In  the  latter  in  1894  it  was  70*4, 
and  in  1895  the  death-rate  fell  to  49  S.  Thus,  the  im- 
provement in  the  mortality  rate  was  as  much  is  fiO.2  per 
cent  in  the  laryngeal  cases,  and  21*2  per  cent,  in  the 
tracheotomy  cases.  The  report  further  siffnificantly  adds 
that  "  rathef  more  ihan  50  per  cent,  of  chlldreh  on  Whom 
Uie  opefation  of  traoheotoni^  has  been  |jerfdrmed  har^ 


A^aiL  I,  18Mb 


COERESPOKDENCE. 


TBI  BlsMOiL  PlUM.      MI 


been  saved  feiofSe  the  employmi^ot  of  ftbtitozia.  Id 
one  of  the  boepitala  no  le^B  than  a  fraction  nnder 
60  per  cent,  eurvived,  although  the  recoveries  in 
that  hospital  in  any  former  year  did  not  exceed 
25  percent,  and  in  the  preceding;  year  (1894)  were  as  low 
as  10  per  cent.  With  regard  to  the  question  of  complica- 
tions upon  which  so  much  stress  has  been  laid  by  some 
observers  who  have  been  led  to  believe  that  the  antitoxin 
is  mainlv  concerned  in  augmenting,  the  report  explicitly 
Ftatee  that  if  any  method  of  treatment  for  diphtheria  is 
more  efScacious  than  another  in  tiding  the  patient  over 
the  acute  stage  of  the  disease,  it  is  only  to  be  expected 
that  the  comparative  incidence  of  complications  among 
cases  so  treated  would  arise.  Moreover,  the  figures  cer- 
tainly do  not  warrant  the  statement  that  has  been  made 
in  some  quarters  that  antitoxin  frequently  leads  to  renal 
inflammation,  nor  has  any  such  connection  been  observed 
in  the  post-mortem  room.  Upon  the  question  of  the  dosage 
the  report  states  that  our  knowledge  is  *'at  present 
mainly  emniricaU  but  that  the  best  repults  may  probably 
be  obtainea  by  giving  a  dose  of  1,000  Behring's  immunis- 
ation unite  every  12  hours  for  the  first  24,  36,  or  48  hours 
according  to  the  gravity  of  the  case." 

The  clinical  effects  which  have  been  observed  to  follow 
the  administration  of  antitoxin  are  : — 

(1)  Diminution  of  faucial  swelling  and  of  the  consequent 
dip  tress ; 

(2)  Lessening  or  entire  cessation  of  the  irritating  and 
offensive  discharge  from  the  nose  ; 

(3)  Limitation  of  the  extension  of  membrane ; 

(4)  Earlier  separation  of  the  exudation  ; 

(5)  Limitation  and  earlier  separation  of  membrane  in 
laryngeal  cases ; 

(6)  Improvement  in  general  condition  and  aspect  of 
patients ; 

(7)  Prolongation  of  life,  in  cases  which  terminate  fatally, 
to  an  extent  not  obtained  with  former  methods  of  treat- 
ment. 

The  report  concludes  with  the  following  sammary  : — 

The  improved  results  in  the  diphtheria  cases  treated 
during  the  year  1895,  which  are  indicated  by  the  foregoing 
statistics  and  clinical  observations,  are : — 

(I.)  A  great  reduction  in  the  mortality  of  cases  brought 
under  treatment  on  the  first  and  second  day  of  illness. 

(II.)  The  lowering  of  the  combined  general  mortality  to 
a  point  below  that  of  any  former  year. 

(III.)  The  still  more  remarkable  reduction  in  the  mor- 
tality of  the  laryngeal  cases. 

(IV.)  The  uniform  improvement  in  the  results  of 
tracheotomy  at  each  separate  hospital. 

(V  }  The  oeneficial  effect  produced  on  the  clinical  course 
of  the  disease. 

A  consideration  of  the  foregoing  statistical  tables  and 
clinical  observations,  covering  a  period  of  12  months  and 
embracing  a  large  number  of  cases,  in  our  opinion  suflS- 
ciently  demonstrates  the  value  of  antitoxin  in  the  treat- 
mpnt  of  diphtheria. 

It  must  be  clearly  understood,  however,  that  to  obtain 
the  largest  measure  of  success  with  antitoxin  it  is  essential 
that  the  patient  be  brought  under  its  influence  at  a  com- 
paratively early  date — if  possible  not  later  than  the  second 
day  of  disease.  From  this  time  onwards  the  chance  of  a 
successful  issue  will  diminish  in  proportion  to  the  length 
of  time  which  has  elapsed  before  treatment  is  commenced. 
This,  though,  doubtless,  true  of  other  methods,  is  of  still 
greater  moment  in  the  case  of  treatment  by  antitoxin. 

Certain  secondary  effects  not  infrequently  ari^e  as  a 
direct  result  of  the  injection  of  antitoxin  in  the  form  in 
which  it  has  at  present  to  be  administered,  and,  even 
assuming  that  the  incidence  of  the  normal  complications 
of  diphtheria  is  greater  than  can  be  accounted  for  by  the 
increased  number  of  recoveries,  we  have  no  hesitation  in 
expressing  the  opinion  that  these  drawbacks  are  insignifi 
cant  when  taken  in  conjunction  with  the  lessened  fatolity 
which  has  been  associated  with  the  use  of  this  remedy. 

We  are  further  of  the  opinion  that  in  antitoxin  serum 
we  {>ossess  a  remedy  of  distinctly  greater  value  in  the 
treatment  of  diphtheria  than  any  other  with  which  we  are 
acquainted. 

This  important  report  thus  establishes,  unequivocally, 
^bo  efficacy  of  antitoxin  in  the  treatment  of  diphtheria. 


(Jtartc5}ronbtnce. 


tWe  do  not  Jiold  ourselTes  respooBible  for  the  opinioiia  o!  odt 
OTtteBpondeDta]  

n-HB  ETHICS  OF  PROFESSIONAL  ADVftBTlSOK* 

To  the  Editor  of  Thb  Mbdioal  Pbxss  and  Ciboulmu 

Sib,— The  oode  of  medical  ethics,  such  as  it  isi  oma  only 
be  intended,  I  presume,  to  regulate  the  conduct  of  knedloM 
practitioners,  and  the  mere  possession  of  a  licence  to  prae- 
tise  or  a  medical  degree  per  se  cannot  bring  its  owner 
within  the  purview  of  its  restrictions.  It  wonld  be 
absurd  for  example  to  seek  to  impose  on  retired  Army 
medical  officers,  who  are  en joyingthe  blissful  ease  begotten 
of  many  years  of  monotonous  work,  the  burden  of  a  code 
which  has  for  object  simply  to  preventing  practitioners 
from  eating  each  other's  heads  off.  For  this  reason  it 
seems  to  me  that  Mr.  Lawson  Tait's  gibe  at  Mr.  Ernest 
Hart  is  ultra  vires.  Mr.  Hart  s  thirst  for  notoriety  can  be 
indulged  in  without  detriment  to  professional  usageS} 
because  he  is  only  in  a  technical  sense  a  medical  maok 
Moreover,  he  does  not,  I  imagine,  profess  to  be  a  pattern 
to  us  all,  nor  does  he  desire  that  we  should  take  him  ae 
*<  the  glass  of  fashion  and  the  mould  of  form." 

Pf»rsonaUy,  I  liave  never  been  able  to  see  sny  objeotioB 
to  the  practice,  observed  by  some,  of  announcing  their 
departure  from,  or  return  to,  town,  while^  on  the  other 
hand,  I  have  always  felt  jealous  of  underhand  methods 
of  advertising  by  means  of  the  publicity  given  to  medical 
or  quasi-medical  books  in  the  lay  prees. 

By  frowning  on  practices  which  appear  to  the  lay  mind 
not  onlv  inoffensive  but  really  of  practical  ntility,  we  run 
the  risk  of  exciting  public  opinion  against  a  legitimate 
objection  to  unprofessional  advertising. 
I  am,  Sir,  yours,  &c., 

Bbioadb-Sobobon  (retired)* 


To  the  Editor  of  Thb  Mbdioal  Pbbss  and  Ciboulak 

Sib, — ^I  notice  with  much  satisfaction  that  you  have 
opened  your  columns  to  discussion  on  medical  advertising. 
In  the  letters  that  have  appeared  a  very  grave  indictment 
is  framed  against  many  of  the  leaders  and  law  makers  of 
our  profession.  For  long  has  the  bitter  cry  gone  up  from 
the  unfortunate  general  practitioner,  who  daily  sees  his 
patients  taken  from  him  by  the  open  advertising  of  these 
gentlemen,  until  the  very  name  of  specialist  and  con- 
sultant has  got  to  sound  harshly  in  his  ear.  It  is  surely 
time  now  for  it  to  be  authoritatively  decided  whether  a 
medical  man  may  or  may  not  advertise,  and  what  exactly 
constitutes  advertising;  if,  as  everyone  wishes,  it  is 
decided  to  stop  all  kinds  of  advertising,  whether  under 
the  form  of  daily  bulletins  or  calling  the  attention  of  the 
lay  public  to  the  virtues  of  a  medical  man's  publication  \ 
surely  the  highest  as  well  as  the  lowest  should  be  made  to 
suffer  for  an  infringement  of  this  ethical  law. 

I  cannot  quite  follow  the  reasoning  of  a  correspondent 
who  asks  "why  do  not  lawyers  advertise?"  They  do 
advertise  and  in  the  most  successful  manner.  When  we 
see  in  the  papers  the  names  of  cases  with  the  names  of  the 
barristers  and  solicitors  engaged  in  ir,  and  the  full  report 
of  all  they  said  and  did,  surely  the  names  of  these  gentle- 
men are  impressed  on  our  minds  with  a  Vividness  and 
force  that  the  wildest  dreams  of  ordinary  advertisers 
would  not  lead  them  to  hope  for.  It  is,  however»  their 
splendid  organisation  and  the  hard  and  fast  rules  of  their 
executive  bodies  to  which  they  owe  the  position  of  their 
profession  and  the  total  absence  of  touting  and  piracy 
to-day.  The  barrister  occupies  somewhat  the  position  of 
the  consultant,  only  he,  unlike  the  consultant,  is  absolutely 
restrained  from  dealing  with  the  lay  public  directly»  and 
by  this  means  both  secures  his  own  position  and  is  pre- 
vented  from  interfering  with  the  practioe  oi  the  solicitors 
who  represent  the  general  practitioners.  There  is  no 
profession,  no  corporate  body  id  existenoe  lii  this  country 
blessed  with  such  plenary  powers  as  the  medical  profes- 
sion and  there  is  Oertainly  notie  so  blind  to  their  own 
interest,  so  disunited,  and  consequently  so  p3werless. 
With  the  improved  modes  of  transit  Of  the  |}resent  day 
and  the  accommodating  fees  of  speoialistfi)  th6  general 
practitioner  is  in  a  bad  way. 

.     I  am,  ko*,  Riohabd  J.  Cows^r, 

m  9aro|)'B  Ck>urt  Road,  Kenain^n, 


362    Thb  Mbdical  Psmb. 


OBmJABT. 


Apbil  h  190^ 


To  the  Editor  of  Thb  Mkdioal  Pbbss  and  Ciboular. 

Sib, — While  the  important  eabject  of  advertising  by 
medic^ftl  men  is  nnder  discussion  it  may  not  be  inappro- 
priate if  I  direct  attention  to  some  incidents  that  have 
recently  come  nnder  my  notice  in  which  the  offenders — 
for  sQch  I  deem  them  to  be— appear  to  have  been  women 
doctors. 

A  patient  of  mine,  residing  in  Camden  Town,  told  me 
last  week,  that  within  the  space  of  a  few  months  she  had 
received  the  visits  of  two,  if  not  three,  8oi  discMt  "  medical 
women."  Their  plan  of  campaign  seems  to  have  been 
delightfully  simple,  and  each  of  them  adopted  much  the 
same  procedure.  There  is  a  knock  at  the  door  followed  by 
an  inquiry  for  the  lady  of  the  house.  On  access  being 
obtained  to  her  she  is  asked  whether  she  does  not  require 
medical  attendance.  When  told  that  she  has  her  own 
doctor  she  is  assured  that  she  looks  as  if  she  required 
careful  treatment,  and  so  on.  Unfortunately,  the  lady  of 
the  house  in  this  instance  is  rather  touchy  and  did  not 
even  invite  the  applicants  to  enter,  so  that  I  am  unfor- 
tunately unable  to  furnish  the  names  of  the  fair  visitors, 
which  I  should  otherwise  have  had  much  plea<9ure  in 
doin^,  for  the  edification  of  the  Medical  Defence  Union. 

Within  the  last  day  or  two  another  instance  of  the 
pushing  activity  of  women  doctors  has  come  to  my  know- 
ledge. A  young  woman  patient  of  mine  who  is  afflicted 
with  external  strabismus  and  prominence  of  one  eyeball 
consequent  on  an  attack  of  choroido-retinitis  was  accosted 
in  an  omnibus  by  a  lady  of  engaging  manners,  who  after 
inquiring  into  the  history  of  the  eye  affection  urged  the 
patient  t/O  attend  at  a  certain  institution  in  Oxford  Street 
(as  to  which  I  am  making  inquiries).  She  actually 
managed  to  elicit  the  name  and  address  of  the  patient 
and  subsequently  called  on  her,  still  urging  that  her 
condition  was  obviously  one  beyond  the  competence  of  an 
ordinary  practitioner.  She  only  desisted  on  oeing  assured 
that  several  of  the  best  oculists  in  London  had  had  the 
case  in  hand. 

Possibly  some  of  your  readers  may  be  able  to  supple- 
ment my  two  instances  by  others,  and  if  so  I  trust  they 
may  be  enabled  to  supply  the  namep.  If  this  sort  of 
thing  is  not  to  become  general,  it  is  high  time  *'o  take 
steps  to  bring  home  to  our  female  associates  i  hat  there  is 
a  code  of  medical  ethics  which  cannot  be  set  at  defiance 
with  impunity.  It  is,  however,  to  be  feared  that  in  many 
instances  a  plausible  excuse  for  what  would  otherwise 
pass  for  unblushing  touting  would  be  found  in  the  con- 
nection of  the  lady  tout  with  some  diocesan  or  sectarian 
sisterhood,  in  which  religi'^us  aims  S'  rve  to  mask  the  true 
nature  of  the  mission. 

Women  practitioners  will  learn  by  and  bve  that  the 
confidence  of  the  public  is  not  to  be  gained  by  any  such 
practices.  It  is  not  because  I  think  there  is  any  reason  to 
fear  competition  of  such  a  kind  that  I  publish  my  experi- 
ence, but  because  the  status  of  the  profession  is  thereby 
depreciated,  and  because  the  ultimate  success  of  a  claims  of 
practitioners  for  whom  I  have  the  greatest  respect  may  be 
jeopardised  or,  at  any  rate,  delayed. 

I  am.  Sir,  yours,  &c., 

Central  Lohdok. 


To  the  Editor  of  Thb  Mbdigal  Priss  and  Cirottlar. 

Sir, — Apropos  of  your  leader  and  the  correspondence 
now  going  on  in  your  columns  on  this  subject,  permit  me 
to  send  you  an  item  which  I  think  bears  strongly  on  your 
contention  that  the  powers  that  be"  advertise  or  permit 
their  names  to  be  freely  advertised  "  without  let  or  hin- 
drance," and  apparently  without  remonstrance,  from  those 
who  affect  a  virtuous  indignation  when  the  name  of  a 
smaller  man  is  concerned.  A  day  or  two  since  a  patient 
handed  me  an  advertising  placard  which  she,  and 
doubtless  thousands  of  others,  had  received  through  the 
post,  the  heading  of  which  ran  thus  :--**  Milk  Humanised 

at  Home  for  Hanoi-fed  Infants.     S k,  Co.  desire  to 

bring  to  the  notice  of  English  mothers  their  newly- 
invented  steriliser  or  patent  close  milk-boiler,  which  has 
been  need  to  prepare  toe  milk  for  Prince  Edward  of  York 
from  the  first.  Jiecommended  bv  Dr.  Gee,  Consulting  Pby- 
pip^^n.  Hospital  for  Sick  Children,  Great  Ormond  Street, 
&c."  I  enclose  you  this  placard,  and  with  it  my  card. 
I  am,  Sir,  yours,  &c., 

A  Fbllow  or  thb  samb  Collbgb. 


EASTER  HOLIDAYS   AT   HOSPITAI^. 
To  the  Editor  of  Thb  Mbdioal  Pbbss  abd  Ciboulab. 


Sir,— At  a  time  when  most  of  us  are  making  prepara- 

[ms  for  getting  away  for  our  Easter  holidays  and  for 

obtaining  a  few  days  much-needed  rest  I  venture  to  make 


a  suggestion  whidh  I  think  is  worthy  of  the  coneideratioii 
of  those  who  are  responsible  for  the  management  of  our 
various  hospitals  both  in  London  and  in  the  provinces.  At 
most  hospitals  it  is  customary  to  close  the  out-patient 
department  on  Good  Friday  and  on  Easter  Monday,  bub 
to  remain  open  on  the  intervening  Saturday,  and  this 
custom  has  prevailed  for  many  years.  It  inflicts  a  distiiiob 
hardship  not  only  on  certain  members  of  the  staff,  but  on 
the  large  body  of  nurses,  dispensers,  porters,  cleaners,  and 
others,  whose  duties,  although  performed  unobtrusively, 
are  essential  to  the  efficient  maintenance  of  the  department. 
They  are  precluded  from  obtaining  a  real  holiday  and  are 
deprived  of  thefopportunity  of  getting  a  few  days'  country 
air  or  of  visiting  friends  who  may  reside  at  a  distance.  By 
closing  on  the  Saturday  no  hardship  would  be  inflicted  on 
the  patients,  for  everyone  who  has  been  long  engaged  in 
out-patient  work  knows  that  the  attendance  on  this  parti- 
cular day,  especially  when  the  weather  is  fine,  is  extremely 
smalL  The  casualty  room  is  always  open,  and  any  argent 
case  could  be  admitted  to  the  wards  at  once.    It  seems  to 


me  that  this  suggestion  has  only  to  be  made  to  meet  with 
universally  acceptance. 

I  am,  Sir,  yours,  &c., 

William  Mubbbll,  M.D. 
London,  March  28th« 

♦ 

EXAMINATIONS  FOR  THE  DIPLOMA  IN  PUBLIC 
HEALTH. 

To  the  Editor  of  The  Medical  Prbss  and  Circular. 

SiR,~In  my  letter  on  the  above  subject,  which  yon 
were  good  enough  to  publish  in  your  issue  of  March  26th, 
somehow  two  paragraphs  were  omitted,  and  this  rather 
destroys  the  sense  of  the  remainder.  The  following  should 
have  been  inserted  after  the  3rd  paragraph,  in  the  second 
column,  on  page  334 :— Secondly,  pomts  of  difference 
in  the  examinations :  Practical  Chemistry ;  this  is  the 
subject,  I  believe,  to  be  most  dreaded  by  candidates,  as  it 
is  almost  entirely  neglected  in  their  general  medical  educa- 
tion, and  the  deficiency  cannot  be  removed  by  such  a 
course  as  satisfies  all  the  English  Examining  Boards,  sixty 
hours  laboratory  work  being  sufficient  to  meet  their  re- 
quirements. Here,  again,  it  is  worth  while  to  refer  to  the 
Regulations  of  the  Conjoint  Boards  of  Scotland. 

No.  2.  Attendance  by  Candidates  on  Special  Courses  of 
Instruction  on  all  subjects  included  in  the  examination 
for  the  Diploma  is  recommended  by  the  Board  ;  but  it  is 
imperative  that  every  Candidate,  after  he  has  obtained  a 
Registrable  Qualification,  shall  attend  six  months'  practi- 
cal instruction  in  a  Sanitary  Science  Laboratory  approved 
by  the  Board,  and  the  Certificate  of  such  attendance  must 
bear  evidence  that  the  Candidate  has  worked  in  such  Labo- 
ratory for  at  least  fifteen  hours  per  week,  and  must  specify 
that  he  has  conducted  analyses  of  Air,  Water,  Sewage, 
and  Food£. 

This  must  mean  at  least  300  hours,  a  minimum   of 
**  fifteen  hours  per  week,"  as  against  a  minimum  of  four 
hours  per  week  in  English  Regulations. 
I  am.  Sir,  yours,  &c., 

W.  a.  Symoxs,  M.D.  (Brux.). 

60  Holmdale  Road,  WePt  Hampstead, 
London,  N.W. 


DR.  SLEVIN,  OP  LONGFORD. 

Thb  death  of  this  gentleman,  at  the  ripe  age  of  81, 
marks  an  epoch  in  the  medical  history  of  the  County 
Longford.  The  deceased  was  very  popular  during  the 
half  a  century  he  practised  as  a  medical  man  in  Longford, 
and  his  death  has  caused  great  regret.  His  ability  and 
skill  were  widely  recognised,  and  in  1869  he  was  appointed 
to  Longford  dispensary,  followed  ten  years  later  by  his 
election  to  the  position  of  medical  officer  to  the  work- 
house, which  he  retained  with  the  utmost  satisfaction  to 
his  patients  and  the  guardians  until  the|beginning   of 


Artm.  1,  1866. 


MEDICAL  NEWS. 


Thb  MiDioiii  Pans.     363 


1895.  At  his  resiflrnation  the  board  granted  him  a  retiring 
Allowanoe.  Dr.  Slerin  was  a  Fellow  of  the  Boyal  College 
of  Sor^ieons,  and  a  central  figure  in  all  aflPairs  of  his  own 
profeenon  for  half  a  century. 

DR.  J.  S.  GUNNING,  OF  ENNISKILLEN. 

Wb  regret  to  record  the  death  of  this  gentleman,  whioh 
ooonrred  at  his  residence,  on  Monday  week,  and  caused 
much  grief  throughout  a  yery  extended  circle.  Dr.  Gun- 
ning was  held  in  the  most  affectionate  regard,  not  only  by 
his  patients,  but  by  the  general  public,  and  that,  too,  by 
all  sorts  and  conditions  of  men.  It  might  be  said  that  in 
Enniskillen  there  was  not  a  man,  woman,  or  child,  who  did 
not  know  him.  He  was  reaUy  a  man  of  the  most  extraordia- 
ary  popularity,  being  gifted  with  an  exceedingly  taking  and 
cheerful  manner.  He  long  enjoyed  the  leadmg  practice 
in  the  place,  and  in  fact  it  was  far  too  g^reatfor  him,  as  it 
was  simply  owing  to  the  never-ceasing  strain  and  anxiety 
that  his  nealtb  b^an  to  giro  way  some  few  years  a^  ;  Dr. 
Gunning  was  Medical  Officer  to  the  Enniskillen  Union  and 
Assistant  Surgeon  to  the  County  Infirmary.  In  the 
former,  he  hatf  introduced  many  improvements  tending  to 
the  comfort  and  well-being  of  the  poor.  These  appoint- 
ments he  held  almost  to  the  last,  having  resigned  tbem  only 
on  the  Ist  January  last.  Indeed,  the  sympathy  which  has 
been  extended  to  the  family  during  his  illness  has  been  a 
very  pleasing  evidence  to  the  family  of  the  high  esteem 
in  which  he  was  held  by  everybody. 


SURGEONGENBRAL  JOHN  HENDLEY,  C.B. 

Tms  gentleman  died  at  his  residence,  The  Croft,  Wal- 
lingforcC  Berks,  last  week,  at  the  age  of  68,  having  been 
bom  in  June,  1827.  In  March,  1851,  be  was  appointed 
an  assistant  surgeon  in  the  Army,  and  in  1855  received 
contusions  on  the  chest  and  forehead  from  musket  balls, 
during  an  engagement  at  which  he  was  present,  between 
the  BritiBh  troops  and  the  Mohammedans  of  Corubo,  in 
the  Gambia  region  of  West  Africa.  A  little  later,  in  the 
same  year,  he  served  with  the  combined  French  and 
British  forces  when  the  stockaded  town  of  Sabiuee  was 
taken  and  destroyed.  In  the  Indian  North-West  Frontier 
War  of  1863,  he  served  in  the  7th  Fusiliers  with  the 
Eusafzye  Field  Force,  and  was  present  at  the  defence  of 
the  Sungidis  at  the  Umbevla  Pass,  and  at  the  attack  on 
and  storming  of  the  Conical  Hill  and  destruction  of  Lalloo, 
as  also  in  the  attack  on  Umbeyla  and  the  destruction  of  a 
village  at  the  foot  of  a  pass,  which  ended  in  the  complete 
rout  of  the  enemy  and  the  submission  of  the  bill  tribes. 
For  these  services  he  received  the  medal  with  clasp. 
Having  reached  the  rank  of  Deputy  Surgeon-General,  in 
1877,  he  served  in  the  Afghan  War  of  1878-9,  being  Prin- 
cipal  Medical  Officer  with  the  Western  Afghanistan  Field 
Force,  and  was  rewarded  with  the  Companionship  of  the 
Bath  and  the  medaL  In  1884  he  became  Surgeon-General, 
and  from  that  year  till  1887  was  Principal  Medical  Officer 
at  Aldershot,  when  he  was  placed  on  the  retired  list. 


Jftebiral  ^etoB. 

The  Rational  Ck>]i8iuiiption  Hospital  for  Ireland. 

This  meritorious  institution  made  a  very  successful 
dehui  on  Thursday  last  when  a  large  part^  of  influential 
supporters  and  of  the  medical  profession  visited  Newcastle, 
in  the  County  Wicklow,  for  the  purpose  of  formallv  open- 
ing the  Hospital.  The  idea  of  providing  Dublin  with  an  in- 
s^ution  similar  to  that  at  Ventnor  originated  about  four 
years  ago  with  Miss  Florence  Wynne,  who  threw  herself 
mtothe  work  of  organisation  with  so  much  enthusiasm  as 
to  inspire  philanthropists  of  all  ^prades  with  similar  zeaL 
A  committee  was  formed,  which  included  the  late  Duchess 
of  Leineter,  and  afterwards,  the  Marchioness  of  Zetland, 
wife  of  the  then  Lord  Lieutenant.  Earl  Fitzwilliam  most 
generously  presented  the  site,  which  comprised  nineteen 
acres,  in  a  most  beautiful  situation,  and  Mr.  Caimee,  and 
other  philanthropists  of  large  means,  subscribed  liberallv. 
The  result  of  the  efforts  of  the  Committee,  and  of  Lady 
Zetland's  patronage,  was  to  produce  a  sum  of  £10,000» 
most  of  which  has  been  expended  in  building  and  equip- 


ping the  Hospital  in  the  most  approved  manner.  At 
present,  it  does  not  aspire  to  ma8nt>ain  more  than  twenty- 
six  patients,  but  provision  has  been  made  for  further 
extension  whenever  funds  may  permit.  Each  patient  will 
have  a  bedroom  entirely  separate  from  l^e  others,  and 
every  room  in  the  establishment  is  maintained  at  a  suitable 
temperature  by  means  of  an  elaborate  plant  which  drives 
the  air  current  through  a  heated  chamber  and  forces  it 
through  the  system  of  flues  which  carry  it  to  the  res- 
pective rooms.  Neither  thought,  labour,  nor  money  have 
oeen  spared  in  the  effort  to  have  all  the  arrangements  as 
perfect  as  noesible.  At  the  opening  ceremony,  on  Thurs- 
dav,  Lady  Zetland  was  present,  as  well  as  Lord  Milton  to 
represent  Lord  Fitzwilliam,  Lord  Belmore,  and  many  other 
distinguished  persons,  as  well  as  the  President  of  the  Ro^al 
College  of  Physicians,  and  other  leaders  of  the  profession 
in  Dublin.  Nothing  seems  to  be  wanting  to  the  success 
of  the  institution  but  money,  which,  we  doubt  not,  will 
be  forthcoming  in  due  course,  if  the  initial  experiment  of 
the  treatment  of  tuberculosis,  under  such  favourable  cir- 
cumstances, turns  out  a  success,  which  we  earnestly  trust 
it  may.  It  is  right  to  mection  that  the  plans  of  the  Hos- 
pital, for  which  there  was  no  precedent  in  Ireland,  were 
produced,  and  its  architectural  details  carried  out  by  Mr. 
T.  N.  Deane,  of  Dublin.  The  entire  establishment  is 
lighted  by  electricity.  The  water  supply,  which  other- 
wise would  have  involved  a  large  expense,  has  been 
luckily  amply  provided  for,  by  tne  sinking  of  wells  at 
some  distance  from  the  Hospital,  which  provide  an  abun- 
dance of  water  of  the  purest  quality. 

Bnioe's  Bellsctor  Safety  Lamp. 

Ownvo  to  the  dangers  of  ordinary  paraffin  lamps,  and 
the  fatal  accidents  that  have  of  late  become  unfortunately 
numerous,  manufacturers  have  not  been  slow  to  avail 
themselves  of  public  requirements,  and  the  press  has 
recognised  this,  and  assisted  in  bringing  each  successive 
improvement  into  prominence.  We  have  now  before  us  a 
most  useful  little  invention  which  affords  us  much  pleasure 
to  bring  to  the  notice  of  our  readers.  We  have  tried  it 
under  various  conditions :  as  an  ordinary  bed-room  lamp 
without  the  reflector,  as  a  reading  lamp  and  microscopic 
lamp  with  reflector,  and  in  each  case  it  answered  the  pur- 
pose claimed.  As  a  safety  lamp,  it  was  turned  over  and 
went  out  instantly.  As  a  reflector  lamp,  the  concentrated 
rays  are  very  intense  from  so  small  a  lamp  ;  and  when  we 
adid  that  its  cost  without  reflector  is  only  two  shillings 
and  ninepenoe,  and  with  reflector,  four  shillings  and  three 
pence,  it  will  be  conceded  that  the  inventor  has  achieved 
a  success  which  deserves  recognition.  The  manufacturers 
are  Messrs.  Bruce  &  Co.,  232  Borough  High  Street, 
London,  S.E. 

The  Late  Dr.  Kldd,  of  Dublin. 

At  the  recent  annual  meeting  of  the  Governors  of  the 
Stewart  Institution  for  ImbecilM,  near  Dublin,  the  Chair- 
man, Sir  Kobt.  Sexton,  gave  expression  to  a  well-deserved 
tribute  to  the  labours  of  the  late  Dr.  Kidd  for  tbe  benefit 
of  the  Institution.  So  well  he  might,  for  Dr.  Elidd  might 
be  regarded  as  the  actual  founder  of  the  Instituticm,  and 
in  the  progress  of  which  he  showed  a  deep  interest  down 
to  the  time  of  his  death.  The  report  then  gave  a  brief 
outline  of  the  part  taken  by  Dr.  Kidd  in  establishing  the 
Institution.  Byhiseffortsasnmof  £8,000  was  collected.  Dr. 
Kidd  undertook  and  carried  through  this  work  from  pure 
philanthropy,  for  from  the  success  of  the  Institute  he 
could  derive  no  material  benefit  whatever,  and  with 
characteristic  energy  and  the  domination  of  his  strong 
individuality  he  placed  it  in  a  position  of  prosperity  and 
financial  independence,  which  it  must  have  gratifiea  him 
to  contemplate. 

Glasgow  VDlvenity. 

The  followioff  oandldatet  paased  the  Third  Frofearional  ExamiDS- 
tion  (old  regnlMloDS)  for  the  degreeB  of  Bachelor  of  ICedldne  (1C.B.) 
and  Master  in  Sugery  (CU.),  at  the  March  ezamliiatioiu  :— 

(A)  IndadiDff  Patholoer.— James  Francis  Agnew.  WlUlam  Baohan 
Annstrong,  John  Tait  Bowie,  Charles  Calmie,  MA. ;  Janes  Banks 
Gamming,  James  Donald  Holmes,  Archibald  tivingston*  George  Bain 
Mnrdook,  Neil  MTallmn,  John  ADan  Cndsle  Maoewen,  B.Sc  :  Joseph 
M*Oowan.  Robert  Bhanks,  James  Weir.  WoMni.— Annie  Kixbby  An- 
dsfson,  Norah  Kemp,  Boberta  Henrietta  Margaeretta  Stewart. 
Marbai  Ardesir  YaUl,  fi.A. 

(B)  Not  including  Pathology.— Andrew  PhUlins  Altken,  John  Bitchle 
Bnms.  John  Herbert  Lawson,  Bobert  Hugh  lielUe,  James  Millar, 
John  Alexander  Faton. 


$64    TptoMou.  Pam ISTOHCIA  TO  COBktemNDENtS. 


Apb    1,  180i  ■ 


^OtlCtB  to 

€oTtwpimhrnt«i.   *4hort  Xcttcrs.  Set 

tS^  OouUHionNnnB  reqalzliig  %  rtply  in  lUi  oolnmn  m  ptf- 
Monlarly  reqaeitwl  lo  make  me  of  i  difMneMvf  <ifin»a<«r0  or  WUiaU, 
uid  ftTold  the  inrMtlee  of  ilgiiliig  tboDMlTM  "  SMder/' "  SntMorfber," 
"  OldSabioriber, "  4c.  Maeh  eonfoglon  wfll  be  ipMned  hj  aUention 
lothianile. 

Pro*.  Lm  QMMDmiu  CllBloal  LadDN  on  '*  Broiiolio.PneQvonUi  In 
Children  "  U  herebj  •Gkiiowledgmllh>m  Our  IWiich  GorreqKmdmt 

TB3I  COST  or  OPPOBrNO  THE  HIOWIVBS'  BBGIBTRATIOK 
BILU 
To  tJu  MUcr  0/  TBI  MlDIOAL  TKKtS  AND  CiRCULlIL 
SllL— Id  yoor  last  iMne  yon  pay  Dr.  Robert  Bentonl  a  well-merited 
tdbate   Id   regard  to  hie  extraordinary   efforis  In    i»ppoaina   this 
Qbnozloni  meaanre,  and  U  appears,  therefore,  he  soflers  a  deficU  of 
£180  oot  of  pocket  eipenses.    No  doubt  this  amount  Is  triTi»]  com- 
pared with  the  ezpendltare  of  energy  (let  us  hope,  not  wmted  eneno), 
Hme.  and  unremnnerated  services,  dtc  ,  but  this  is  no  n  ason  wby  he 
ahooid  raatain  the  loss.    Seeing  the  great  amount  of  oppostUon  to  the 
HldwlTes'  Bin  Dr.  Bentonl  has  been  the  means  of  evoking,  it  Is  not 
-  too  much  to  expect  tnat  he  will  te  fully  recouped  by  subscriptions 
from  his  brother  practitioners. 

Khould  this  not  result,  it  mav  be  taken  aa  presnmptlva  evidence  of 
th^  impecuniosity  of  the  medical  profession,  and  might  weil  cAUse  the 
promoters  of  the  objectionable  measure  to  pause  before  exciting 
rarther  competition  in  a  profession  already  so  overworked  and  under- 
paid. 

I  am,  Sir,  yoQii^  Ao., 

Peokbam.lfarehSSth.  **•—*         ««. 

DB. 
"  Veatro-Bysteroi 
CUilcle'        ■    ^ 


Thubsdat,  apehi  9xb, 

BkmSB  OnJVOOLOGiOAL  SoOIITT.-  8l80  p.iD.  The  adlonned  dia- 
CQssion  oo  "  Yentro-Fix«tiou,  Ventro-Su^ pension,  and  Allied  Opera- 
tions, wlUi  tbeir  B«solts."  Paper -Mr.  Ikiwremui  J«*Bsett :  The 
Importance  of  Barly  Diagnosis  ol  Cancer  of  the  Uterus,  illustrated  by 
numerous  specimens  and  the  reauits  of  treatment. 
VBIDAT,  AtBlh  lOTH. 

WlkT  Kbht  IdKDioo-CBIBUiiOlOAL  SocitTT  (BoTal  Kent  Dispens^rj. 
Oreenwioh  Bond,  &!(.)- 8. 15  p.ni.  Mr.  Howard  ILirsb:  Beoent  Pro- 
aress  in  Pathology  and  Treatmeui  of  Diseases  of  the  Juints.  Illustrated 
by  specimens. 


Bethlem  HoapitaL— Two  Resident  Clinical  Assistants.  Term  six 
months  from  Mar  1st,  apartments,  board,  and  waahlog  being 
provided,    (.iee  advert.) 

Ckij  of  Birmingham.— Deputy  Kedioal  Superintendent  for  tbe  City 
Hospital.  Lfttle  Bromwich.  Salary  £176  per  annum,  with  reddei/oe, 
raii«ins,  and  attendance.  Full  particulars  of  Mr.  J.  Keyte,  Coun- 
cil House,  Birmingham. 

Ooiuty  A»ylum,  Lancaster.— Assistant  Medical  Offlcer  wanted  for  Ave 
or  six  months.  Salary  2  guineas  p«3r  week,  with  board,  &c. 
Apply  to  Medical  Superiotendeut. 

Dondee  Royal  Lunatic  Asylum.  Assistant  Medical  Offlcer.  Salary 
£100  per  annum,  with  board,  lodging,  «ic.  Applications  and  teati- 
nioQials  to  l>r.  Korie  at  Asvlum  on  or  before  4iu  April. 

Hereford  County  and  City  Asylum.— Medloel  Muperlntendent.  Salary 
A 400  per  annum,  with  lumisbed  house,  coals,  gas.  vegetables,  and 
washlDg.  Appllcationa  to  Chairman,  Asylum  Committer,  Shlre- 
hall,  Hereford. 

Kestevan  and  Grantham  District  Asylum.— Resident  Medical  Super- 
intendent Salary  £800,  with  ratious,  coals,  light,  and  washing. 
ITnll  particulars  of  Jos.  ehlUlps,  Clerk  to  the  Visitors,  Stamford. 


J.  O.  CoNHOR  (Britiah  Hoapltal.  Buenos  Ayres).-Pu>er  on 
tro-BysteroMxy  "  and  case  of  "  lniplac«ment  of  Scapula  fh>m 
tie  "  received. 

THB  CARB  OF  LUNATICS. 
T»  (he  Bdiior  of  Thb  Mkdioal  Prus  aKD  CIRCULAR. 
Sir,— In  order  to  prevent  misanderstanding,  might  I  ask  you  to 
refer  me  to  any  Act,  rule,  or  regulatiun  which  Implies  that  any 
so-called  harmless,  or  daogeroua  lunatic,  not  dwUitU,  is  to  be  admitted 
Into  the  workbou«e,  and  the  cost  of  maintenance  there,  or  of  trftiiS- 
ference  to  the  asylum,  thrown  upon  the  Poor  Rates. 

I  am.  Sir,  yours,  Ac, 

**  ALTQUn  " 
[We  know  of  no  explicit  rule  on  the  subject.  The  law  throws  the 
cam  of  a  lunatic  primarily  upon  bis  relattvea.  If  they  do  Dot  put  him 
under  reatralnt,  the  police  can  do  so  by  virtpe  of  the  Dangerouf 
lAnatioa  Act.  If  he  is  not  dangerous  there  is  no  handy  legal  mechanism 
by  which  he  can  be  Incarcerated,  if  tbe  relatlres  do  nut  care  to  take 
action.  If  he  is  destitute,  and  in  no  one's  care,  he  may  go  or  be  sent 
to  the  workhouse  like  any  other  sick  person,  snd  can  then  be  trans- 
ferred to  the  asylum  at  the  expense  of  the  Onardlans.— Ed.] 

Dr.  Edoar  Flihs.— We  hope  to  have  space  for  your  mper  in  our 
Proof  will  be  sent  y  on  for  fhe  addition  y  on  speak  of. 
THB  BTBIC3  OF  ADVERTIdlNO. 

Such  has  been  the  stir  recently  created  by  the  caw  of  "  Kingsbury 
V.  Bart,"  that  He  «re  quite  unable  to  dnd  space  for  all  the  letters  sent 
us.  Several  are  in  type,  and  will  ai/pear  in  our  next  Mote- 
over,  the  British  Medical  Association,  recoenising  its  burning 
Importance,  have  suggested  It  as  a  subject  to  be  discussed  at  the  annuid 
meetliig  in  July,  and  are  inviting  contributors  to  take  part  therein. 

Dr.  Francis  T.  Hxcstob's  paper  on  "  The  Radical  Cure  of  ilnguina^ 
Hernia  "  is  marked  for  early  lusertion. 

Dr.  BRHin  BouRKB'e  cases  are  in  hand.  Prtwf  will  be  sent  to  him 
tanduecouTBe. 

MB.  F.  W.  OOLLOigov.^The  matter  Is  under  consideration. 
DREADFUL  I 

A  OOBMBPOHIMI,  a  short  time  aso,  sent  us  a  letter  for  publication. 
Just  before  his  communleation  had  been  passed  for  prevs  we  received 
a  note  from  hhn  requesting,  as  a  penonal  favour  to  himself,  that  we 
would  withhold  publi>hlng  his  leUr  for  a  week,  and  stating  as  a 
reason  thst  the  snb-Bditor  of  the  Lanctt  had  written  to  him  to  the 
effect  that  "  he  (the  sun.Bditor)  will  oot  Insert  an>  thing  which  nppears 
in  snother  Journal  on  Wednesday."  This  amuslnff  fulminatiou  was 
too  paltry  to  call  for  serious  treatment,  and  arcordiugly,  for  friendly 
motives,  and  as  the  matter  was  perfectly  immaterial  tons,  we  deferred 
to  our  correspondent's  wish,  for  which  we  have  received  his  cordial 
thanks.  The  fact,  however,  that  such  an  incident  should  have 
occurred  Is  worth  notlDg,  and  the  latter  will  probably  toll  iU  own  tale 
to  our  readers  and  our  other  contemporaries,  as  it  told  ita  tale  to  us. 

Db.  &  Barrbit.- Tour  letter  Is  uiiavoldahly  hahloveF; 

J^ctKngB  of  ^odttufi,  l^tcturtB,  «t 

WBPBIBDAT*  APRIL  lA 
OagXBRiOAL  Soonrr  of  Lobdon.-S  p.m.  Specimens  by  Dr. 
pnacan,  Dr.  Spencer,  Dr.  OaUbfai,  and  others.  Papers.— Mr.  J.  Ruther- 
ford M  orison  (communicated  by  Mr.  A.  Doran):  Case  of  Declduoma 
Mslignum  occurring  in  England.  Dr.  H.  R.  Spencer:  Case  of  Deci- 
dnoma  lUHgnuDi.  Dr.T.  W.  Bden:  Deoidnomn  Mallgnom  :  a  (Mtt- 
dain. 


Jlirjrotntments 

HOUKSFIBLD.S.  C,  M.R.C.S.£ng  ,  L.R.C.P.Lond  ,  SecNnd  House  Sur- 

geon  to  the  Beat  Suffolk  Uoswital.  Ipswich. 
Huouxfl,  R.  F..  L.R.C.P.Lond.,  M.R.C.S.,  Resident  Medical  Offlcer  at 

the  tfirkenhead  Workhouse. 
jBFfBRSON,  A.  J.,  M  D.Lond.,  B.8.,   M.B.O.9..   Hooorary  Medical 

Omcer  to  the  Bochdale  Infirmary. 
JoBBS,  F.  K..  M.B.C.S..  D.P.H.iLng.,  Medical  Offlcer  of  Health  by  the 

Llanfyllm  Rural  Dlitrict  CouticiL 
Kbrr,  w.  J.,  M.D.Vict.,  Ch.B.,  L.R.C.P.Lond.,  M.R.C.8.,  Honorary 

Medical  Offlcer  to  the  Rochdale  InHrmary. 
KBRR,  W.  J.,  M.D.,  ch.B.Vict.,  M.R.C.S.Bog.,  L.R.C.P  Lood..  Honor- 
ary Soigeon  to  the  RochJaie  lunrmarjr. 
Mradows,  G.,  M.B..  C.M.hdiu.,  Medical  Offlcer  for  the  Fourth  Sani- 
tary uistrictol  Khe  St.  Oeruians  Unioo. 
MURRO,  A.  C,  M.B..  tt.8c..  D.Sc  (PnoUc  Beslth).  M.R.C.P.rdiD., 

Medical  ufflcer  for  the  burKb,  ulii«g«»w. 
Roth,  ISRhnard,  F.R.C.3.,  J. P.,  durgeon  for  the  Orthopsedic  Denart- 

meot  of    the  Ruyal    Alexabdiu  Hospital   for    Sick  Children, 

Brighton. 
SSJJUW,  A.  B.,  L.R.C.P.Lond.,  M.R.C.S.,  Medical  Officer  of  Health 

by  the  Thomhill  Urban  District  Cauooil. 
SXBWAKT,  J.  ti.,  l^».«'.P.,  L.K  C  S.Irel.,  Medical  Offlcer  of  Health  for 

the  Borough  of  LostwithieU 
WalkbR,Q.  B.,  L.R.C.r.i^nd.,  M.R.C.a.,  D.P.H.Camb.,  Governor  of 

the  Jremale  Convict  Prison  at  Aylesbury. 


$trih«. 


MooRB.- March  24th,  at  The  Dene,  Dartford,  Kent,  the  wife  of  S.  J. 

Miiore,  M.D.Ire).,  of  a  ton. 
SMALLPBicB.  -  March  SSrd,  Cicely,  wife  of  Donald  Smallpeice,  L.R.C.P. 

Loud.,  of  a  sou. 
Uab BR. -March  24fcb,  at  Haslemere,  Thorney  Hedge  Road,  Gunners- 

bury,  the  wife  of  f.  S.  U»her,  M.D..  St  And.,  of  a  dauKUter. 
WliMoT— March  27th,  at  Alrewas,  Burton-on. Trent,  the   wife    of 

Claude  B.  Wilmot,  M.D ,  of  a  son. 


BBH80R  -^JXMOHPS.— March  20th,  at  5k  Paul's,  Heme  BUI,  Henry 
Mitohell  Benson.  M.S.,  C..\Ll£din.,  eldest  son  uf  John  Beosoo, 
Broomhill.  eheffield  to  rteUa  Theodora,  third  daughter  of  the  late 
benry  Simmonis,  Aylesford  House,  Heme  Hill. 

LiRiSBT— CO ATBs.— Marco  24tb,  at  St.  Pancrss  Church,  London, 
Ai«xandra  Undsey,  M.D.  M.Ch.,  M.A.O.R.U.I.,  o(  bursletti, 
h  t%irordshlre,  to  Abuie  Martha,  only  daughter  of  the  late  Frederkk 
Ooaies,  Esq.,  of  St.  John,  Hertford. 

STXPHK5—HBLT.— March  26th,  at  St.  Stephen's,  Wettminster,  John 
Stephen  Stephen,  M.B..  C.M.£d.,  of  O«llowcrook,  Elgin,  to  Emmie 
Cundell,  second  daughter  of  J.  Helt,  Esq.,  Headlam  Hall, 
Darlington. 


9t«tfc«* 


KIBBBIT. -March  18th.  at  his  residence,  Overcliffe,  Graveaend,  Robert 
Innes  Nlsbett,  M.  K,G.S.BDg.,  L.S.A.,  in  his  70th  year, 

WnsoN— Maruh  82nd,  at  The  Cedars,  Kenninghall,  Norfolk,  Joseph 
Henry  Wilson,  M.R. C.S.Bug.,  aged  48. 

WTNNB-JoNBtt.— March  20th.  at  63  Port  Hill  Road,  Shrewsbury, 
Thomas  J.  Wynno-Jonesi  L.R.C.P.,  L.R«C.S.,  aged  8& 

^''lHjt^—AunAtniic- inrm*  tjj  i,tmi*,  jiurnaijcif^  and  Dearth*  inUtA 
/amiliet  nf  SvlMcHbers  to  thin  JuunuU  art  ijuk-rted  free,  and  nticel 
L  rtaoh  the  pubtiOsn  not  later  than  the  Monday  preeeding  publieatunk 


Q^kt  Mdirnl  Wtm  mA  Similar. 


"SALUS    P0PX7LI    SUPRBMA    LEX." 


Vol.  CXn. 


WEDNESDAY,    APBIL    8,     1896. 


No.  15. 


fDngtttal  Cowmutticjttions. 
A  NEW  ANASTOMOTIC  BUTTON 

FOS 

INTESTINAL  OPERATIONS. 

By  Dr.  CHAPUT, 

Chlrarglen  Um  HOpltaux. 

L— Description  of  the  Instrument. 

Under  my  direction  five  modeb  of  my  button  have 
been  made  each  of  a  different  size. 

As  type  for  description  I  will  take  the  large  one 
depicted  in  Fig.  I.,  destined  for  gastroenterostomy 
and  for  intestinal  anastomosis.  This  button  seen  from 
the  front  has  the  form  of  an  elliptical  ring ;  its  central 
orifice  measures  6  millimetres  from  side  to  side,  and 
30  millimetres  from  top  to  bottom.  The  circumference 
of  the  orifice  is  formed  of  laminae  separated  by  six  deep 
indentations. 


Fia.  1.— No.  5  batton  seeo  from  the  front  aod  in  profile. 

Seen  in  profile  it  is  apparent  that  the  external  cir- 
cumference is  hollowea  out  so  as  to  form  a  gutter ; 
this  circular  gutter  has  a  depth  of  7  millimetres  and  a 
breadth  of  1  centimetre,  and  its  borders  consist  of  the 
laminffi  and  indentations  before  mentioned. 

The  entire  length  of  the  instrument  is  46  millimetres 
and  its  breadth  from  21  to  22  millimetres. 

Of  the  other  four  buttons  the  next  in  size,  (orifice,  Y 
millimetres,  gutter,  -^  millimetres)  is  intended  for 
circular  suture  of  the  intestine. 
»  The  next,  (orifice  ^  millimetres,  gutter,  ^  milli- 
metres) as  well  as  a  still  smaller  one,  orifice  ^  milli- 
metres, gutter  -^  millimetres,  is  for  circular  suture  of 
the  small  intestine. 

The  smallest  of  all :  (orifice  ^  millimetres,,  gutter  ^ 
milimetres)  is  for  cholecystenterostomy,  or  for  circular 
suture  of  small  intestine  having  an  exceptionally  small 
calibre. 

n.  General  Idea  of  the  Part  Played  by  the 
Instrument  in  the  Operation. 
Let  us  suppose  we  are  about  to  perform  an  intestinal 
anastomosis  with  the  aid  of  the  largest  button.  A 
longitudinal  incision  of  sufficient  length  to  admit  the 
button  is  made  in  the  intestine  ;  round  the  lips  of  the 


cut  a  purse-string  suture  is  inserted,  and  the  button 
having  been  placed  in  the  opening,  the  purse-string 
suture  is  drawn  tight  and  fastened  at  the  bottom  of  the 
gutter  round  the  button  ;  at  this  stage,  therefore,  half 
the  button  is  inside,  the  other  half  outside  the  intes- 
tine. 

Then  another  similar  longitudinal  incision  is  made 
in  the  part  of  intestine  we  wish  to  join  to  the  first, 
around  which  a  purse-string  suture  is  inserted ;  into  this 
opening  the  free  portion  of  the  button  is  introduced, 
and  the  purse  string  suture  pulled  tight  and  knotted 
at  the  bottom  of  the  gutter.  We  have  now  arrived  at 
the  stage  shown  in  Fig.  2.  The  next  step  is  to  approxi- 
mate the  edges  of  the  gutter  through  the  intestinal 
wall  with  the  finprers  ;  by  this  means  we  economise.one 
row  of  sutures.  (Fig.  3.)  --^c-^ 

The  insertion  of  a  few  Lembert's  stitches  widely 
apart  will  now  complete  the  operation. 


Fio.    2. — Entero-anastomosis.      The  bottoa  in   position, 
the  groove  being  open« 

The  great  principle  of  the  instrument  is  that  the 
edges  of  the  gutter  are  malleable  and  can  easily  be 
brought  together  by  the  pressure  of  the  fingers. 

The  indentations  allow  of  an  increase  in  the  flexi- 
bility of  the  metal  and  also  enable  the  surgeon  to  bring 
together  the  edges  by  several  segments  each  being 
treated  successively.  A  curious  fact  is  that  it  is  far 
easier  to  close  the  gutter  than  to  open  it  after  having 
once  closed  it ;  it  is  thus  evident  that  the  gutter  con- 
stitutes a  genuine  method  of  keeping  the  edges  of  the 
intestine  m  apposition,  and  at  the  same  time  is  not  in 
any  wav  dangerous.  The  technique  just  described  is 
admirable  for  the  purpose  of  demonstration,  but  in 
practice  it  presents  many  disadvantages. 

I  ¥dll  now  describe  the  real  operative  procedures. 

III.— The  Operation. 
1st.  — Entero-anastomosis. 

First  Fart, — After  having  made  the  necessarv  inci- 
sion in  each  of  the  two  portions  of  intestine,  I  unite 


^66 


ThA  Msdical  Prkm. 


dMGlNAL  COitMUMCATlOJfg. 


April  8, 


the  posterior  lips  of  the  two  iacisiooa,  that  is  to  say, 
the  lips  farthest  from  the  operator  by  a.  purse-string 
satare  leaving  both  ends  long.  (Fig.  4.) 


Fio.  3, — Entero-anastomosis.    The  gutter  closed. 

Second  Part.— 1  place  the  posterior  part  of  the 
groove  of  the  button  on  the  seam,  then  I  bring  down 
the  upper  end  of  the  suture  over  the  anterior  part  of 
the  gutter  and  tie  it  to  the  lower  extremity  of  the 
suture,  not  in  the  centre  of  the  groove,  but  in  its 
lower  portion.  (Fig.  4.) 


of  the  groove,  in  which  I  place  the  centre  portion  of 
another  ligature ;  this  being  firmly  held  in  place,  the 
button  is  returned  to  its  original  position.  (Fig.  5, 
ligature  CD.) 


Flo.  5.— The  thread  A  B  of  the  posterior  sotore  has  been 
tied  in  the  groove.  The  thread  C  D  is  placed  Iq  the 
posterior  part  of  the  groove,  as  shown  by  the  dotted  line. 

Fourth  Part— With  the  free  extremi^  C  of  the  lipi- 
ture  C.  D.,  I  make  a  continuous  suture  in  the  antenor 
lips  of  the  intestinal  incisions  ;  the  suture  is  not  finished 
in  Fig.  6,  but  is  complete  in  Fig  7.  I  have  only  now  to 
tie  ends  C.  and  D. 

Fifth  Part.— The  anterior  suture  being  maintained 
in  position  by  a  grooved  probe,  I  squeeze  together  with 
my  fingers  the  edges  of  the  groove  through  the  intea 
tinal  wall. 


Fio.   4.-  Entero-anastomoeis.      First  sti^e.   Continuoas 
sutare  of  the  posterior  lips  of  the  intestiDal  openings. 

Third  Part.—  I  turn  the  buttOB  ehrer  either  to  the 
right  or  to  the  left,  so  as  to  expoiie  the  posterior  part 


Fig.  6. — Satnre  of  the  anterior  lips  with  the  part  C  of 
the  thread  CD. 

If  perfect  apposition  is  obtained,  extra  sutures  are 


A?BIL.  6,  18^ 


O&lGlNAt  COMMtTJWCATIONS. 


tHB  iiMDlCAL  VWHS.       ^67 


unnecessary,  if  not,  only  a  few  Lembert's  sntures  will 
be  required,  these  should  have  about  a  centimetre 
between  them,  eight  will  suffice  for  the  No.  4  button. 
The  technique  of  j^tro-enterostomy  and  of  chole- 
cystenteioetomy  is  identical  with  that  of  intestinal 
anaifeomoais. 


Fig.  7.— Completion  of  the  suture  of  the  anterior  lips  ; 
the  ends  C  D  being  tied. 

2nd.  Circular  Suture. — 

The  two  circular  orifices  would  be  treated  in  the  same 
way  as  in  entero-anastomosis  ;  a  continuous  suture  is 
inserted  into  the  posterior  half  circumference  of  the 
orifices,  the  ends  of  which  are  tied  together  on  the 
button ;  a  second  ligature  is  slid  into  the  posterior 
groove  of  the  button,  with  one  end  of  which  a  con- 
tinnous  suture  is  inserted  into  the  anterior  lips  of  the 
orifices ;  the  two  ends  are  then  tied  and  the  groove  closed. 


Fig.  8,— Gironlar  suture  completed  with  tbe  button.  Eod 
of  operation.    Groove  tightened. 

An  indispensable  point  before  commencing  this  part 
of  the  operation  is  to  ascertain  if  the  size  of  tne  button 
allows  of  its  being  maintained  in  the  intestine  perpen- 
cticnlarly  to  the  axis  of  the  latter.  If  one  of  the  intes- 
tiaal  onficeB  is  smaller  than  the  other,  it  should  be 


enlarged  by  a  longitudinal  incision,  from  which  the 
surgeon  would  excise  triangular  flaps. 

N.B.— I  strongly  advise  the  sutures  to  be  of  silk  of 
medium  thickness  (fiue  silk  would  be  liable  to  break). 
The  ordinary  straight  Keverdin's  needle,  such  as  is 
used  for  suture  of  the  skin,  is  a  very  convenient  one 
for  this  operation. 

IV.— Advantages    op    the    New    Buttok.     Its 
Superiority  over  Murphy's  Button. 

The  operation  with  mv  button  is  very  rapid,  more  so 
even  than  with  Murphy  s  button,  for  I  oodyput  in  one 
suture  (in  two  portions),  whilst  in  Murphy's  operation 
there  are  two. 

My  button  is  less  bulky  (in  circumference)  than  the 
smallest  Murphy's  button,  which  is  66  millimetres  in 
circumference,  whilst  mine,  after  the  gutter  has  been 
closed,  hardly  exceeds  55  to  60  millimetres. 

The  orifice  of  each  of  my  buttons  is  infinitely  larger 
than  that  of  the  corresponding  Murphy^s  button. 
With  my  own  button  I  know  exactly  the  aegree  of  con- 
striction I  exercise  in  the  operation  ;  moreover,  it  is  an 
impossibility  for  me  to  tighten  too  much,  for  the  flex- 
ibility of  the  laminae  prevents  their  exercising  too 
great  a  pressure. 

On  the  contrary,  with  Murphy's  button  there  is  a 
tendency  to  tighten  too  much  ;  this  frequently  results 
in  sphacelus  of  the  the  gut  and  perforation  where  the 
instrument  cuts  through. 

Every  surgeon  has  found  out  the  disadvantage  of 
not  being  able  to  disartioulato  a  Murphy's  button  when 
once  it  has  been  articulated  ;  this  does  not  hold  good 
with  my  button,  as  nothing  is  easier  than  to  loosen  it 
with  the  end  of  a  grooved  probe,  and  so,  if  necessary, 
remove  it. 

On  several  occasions,  it  has  been  reported  that  the 
canal  of  a  Murphy's  button  has  become  blocked  by 
food  or  fsBces ;  tnis  dangerous  complication  b  much 
less  to  be  feared  with  mine,  the  passage  through  the 
orifice  of  which  is  very  short,  only  a  few  millimetres. 

Other  objections  which  have  been  made,  and  on 
good  grounds,  to  Murphy's  button  are :  its  delicacy,  the 
tacility  with  which  it  gets  out  of  order,  it  is  asserted 
that  its  springs,  which  are  badly  soldered  on  to  the 
metal,  are  often  lost  or  strained;  my  instrument,  of 
much  greater  simplicity,  cannot  get  out  of  order ;  there 
is  no  complicated  mechanism  in  its  structure,  and  its 
functions  are  entirely  based  on  a  well-known  physical 
property— the  malleableness  of  tin 

Murphy's  button  gives  an  insufficient  orifice  in 
gastroenterostomy ;  with  my  instrument  a  definite 
orifice  of  6  or  8  centimetres  long  is  left,  which  besides 
is  much  less  liable  to  consecutive  stenosis. 

I  have  left  to  the  last  the  most  important  point  in 
the  new  method. 

Murphy's  button  is  freed  only  by  sphacelus  of  tbe 
intestine ;  with  my  button  there  is  no  sphacelus.  Of 
this  I  have  had  ample  proof  in  two  casea :  in  one 
death  occurred  48  hours  after  the  operation  (pulmonary 
congestion  due  to  ether),  in  the  other  death  took 
place  ten  days  after  the  operation,  and  was  due  to 
absolutely  intractable  vomiting  ;  in  both  these  cases  the 
tissues  held  by  the  button  were  not  in  the  least  sphacc  - 
lated. 

Agaio,  in  a  third  case  in  which  the  button  reached 
the  rectum  on  the  tenth  day,  the  silk  of  the  two  purse- 
string  sutures  could  be  plainly  seen  at  the  bottom  of 
the  groove,  but  there  was  no  sphacelated  tissue  be- 
tween the  edges, 
y.  Mechanism  of  the  Elimination  op  the  Button 

The  bringing  together  of  the  edges  of  the  groove 
mainteins  the  intestine,  but  does  not  exercise  any 
great  amount  of  pressure  on  it ;  it  is  very  easv,  after 
having  applied  and  fixed  the  button,  to  verify  (by  cut- 
ting the  intestine  across  and  dividing  the  purse-string 
I  sutures),  the  fact  that  it  is  possible  oy  slight  traction 


868     IHB  MlDIGAL  PSIBS. 


ORIGINAL  COMMUNICATIONS. 


Afbil  8,  1890. 


to  draw  away  the  portion  of  the  bowel  caught  in  the 
groove. 

The  pnrse-Btrinf^  sntures  which  fix  the  edges  of  the 
large  intestinal  onfices  around  the  much  flmaller  orifice 
of  the  button  firmly  nip  the  tissues  which  they  divide 
after  a  few  days,  and  then  the  pressure  of  the  groove  is 
notsufilcient  to  prevent  the  tissues  from  escaping, 
aided  as  they  are  oy  their  own  natural  elasticity. 

The  intestinal  orifice,  constricted  by  the  purse  string 
sutures,  has  thus  a  tendency  to  recum  to  its  natural 
dimension,  in  fact,  it  does  return  to  it  as  it  escapes  from 
the  groove  the  instant  it  is  no  longer  restrained  by 
the  purse-string  sutures.  When  the  edges  of  the  anas- 
tomotic orifice  are  quite  diseng^tged  the  button  is  freed 
and  falls  into  the  inferior  portion  of  intestine  and  is 
then  carried  along  by  the  alimentary  current 

VI.— Clinical  Results. 

One  of  the  first  cases  wasacancer  of  the  pylorus  occur- 
ring in  a  man  not  only  very  cachectic,  but  also  tuber' 
culous.  On  this  patient  I  performed  a  gastro-enteros- 
tomy  using  my  button.  I  also  tied  up  the  superior 
portion  of  intestine  with  iodoform  gauze  ana  then 
established  an  entero-anastomosis  between  the  coil  which 
ascended  to  the  stomach  and  the  one  descending  from 
it,  so  as  to  establish  the  bile  current  The  ether  with 
which  this  patient  was  anaesthetised  set  up  pulmonary 
congestion,  from  which  he  succumbed  in  forty-eight 
hours.  The  auto]My  confirmed  the  pulmonary  lesions, 
and  at  the  same  time,  the  soundness  of  the  peritoneum 
and  of  the  suture.  There  was  no  sphac^us  of  the 
tissues  held  by  the  gutter. 

My  second  case  presented  the  signs  of  grave  pyloric 
stenosis ;  all  that  was  brought  to  light  by  an  explora- 
tory laparotomy  was  a  kiuK  in  the  pyloric  region.  I 
penormed  a  gastro-enterostomy,  usm^^  my  button  ; 
after  the  operation,  the  patient  was  seized  with  such 
repeated  and  intense  vomiting  that  the  sutures  in  the 
abdominal  wall  were  torn  asunder,  and  it  was  necessarv 
to  reduce  the  protruded  intestine,  and  put  in  fresh 
sutures.    He  died  of  exhaustion  on  the  tenth  day. 

After  careful  consideration  of  all  the  facts  in  the 
history  of  this  patient,  we  came  to  the  conclusion  that 
the  vomiting;  could  be  explained  by  a  beginnins  of 
tabes,  and  circumstantial  details  can  he  found  auuior- 
ising  this  opinion. 

•4  Whatever  may  have  been  the  causation  of  the  vomit- 
ing it  was  conclusively  shown  at  the  autopsy  that  the 
peritoneum  was  perfectly  sound,  the  ^tro-enteros- 
tomy  too  was  in  an  excellent  condition.  It  would  seem 
then  that  the  method  must  be  a  very  perfect  one  for 
the  anastomosis  to  resist  ten  days  of  vomiting  violent 
enough  to  tear  open  the  abdominal  wound.  The 
button  was  stUl  in  situ  and  the  tissues  held  by  the 
gutter  were  joined  and  not  sphacelated. 

My  third  case  was  that  of  an  old  man,  set  71,  who 
suffered  from  carcinoma  of  the  transverse  colon.  I 
did  anastomosis  of  the  small  intestine  with  the  sig- 
moid flexure,  using  my  button.  The  patient  bore  the 
operation  well,  and  at  first  improved  rapidly,  but 
ultimately  was  seized  with  signs  of  intestine  paralysis 
which  had  no  connection  with  the  operation  but  was 
due  to  distension  of  the  large  intestine  caused  by  the 
accumulation  of  fecal  matter  for  which  there  was  no 
possible  exit  owing  to  the  cancer  on  the  one  hand  and 
the  ileo-csBcal  valve  on  the  other. 

This  paralysis  rendered  a  second  laparotomy  neces- 
sary, during  the  performance  of  which  I  was  enabled 
to  verify  the  inte^ty  of  the  peritoneum,  and  of  the 
suture,  and  the  disappearance  of  the  button.  I  per- 
formed complete  section  and  obliteration  of  the  end 
of  the  small  intestine  between  the  anastomosis  and  the 
caecum,  leavine  a  culde-sac,  and  finally  made  an  arti- 
ficial anus  on  tne  transverse  colon. 

At[  the  end  of  the  operation,  with  the  'aid  of  my 
finder,  I  extracted  the  button  from  the  rectum,  into 
which  it  had  fallen ;  at  the  bottom  of  the  groove  in  the 


instrument  were  the  two  purse-string  sutures,  but 
there  was  not  a  trace  of  sphacelated  tissue  between 
the  laminae. 

My  fourth  case  was  a  woman,  aet.  68,  the  subject  of 
cancer  of  the  pylorus.  I  performed  on  this  patient — 
(1)  Gastro-enterostomy  using  my  button  ;  (2)  ligature 
of  the  upper  end  of  the  intestine ;  (3)  entero-anasto- 
mosis  to  restore  the  bile  current,  arrested  by  the 
ligature. 

The  operation  was  done  on  September  27tb.  and  the 
patient  is  alive  at  the  present  time,  December  11th, 
1895  ;  she  digests  pretty  well,  there  is  no  vomiting,  and 
all  signs  of  gastric  dilatation  have  disappeared.  The 
buttons  employed  have  not  yet  been  passed  per 
rectum. 

These  four  cases  show :  1st,  that  the  employment 
of  the  button  is  quite  rational  and  safe,  and  that  up  to 
the  present  no  objection  can  be  found  to  this  method  of 
operation ;  2Dd,  that  the  button  is  easily  eliminated  ; 
3rd,  that  it  does  not  set  up  sphacelus  in  the  tissues 
held  by  the  gutter. 


RUPTURE  OF  THE  ABDOMINAL 
AORTA 

FROM    EXTERNAL    VIOLENCE    WITHOUT 

PENETRATING    WOUND. 

By  J.  E.  PLATT,  M.S.  (Lond.).  F.R.C.S., 

Betident  Snrgicftl  Offloer,  Manchester  Bojal  loflrmary. 

The  following  case,  which  came  under  my  notice 
about  tw^ve  months  ago,  is  an  example  of  a  very  rare 
accident  :— 

A.  T~-,  a  strong,  well-nourished  young  man,  mt. 
20,  and  a  butcher  by  occupation,  was  admitted  to  the 
Manchester  Royal  Infirmary  on  March  4tfa,  18d5,  at 
6.45  p.m.  The  history  given  was  that  about  three- 
quarters  of  an  hour  before  admission  he  and  another 
man  were  carrying  an  iron  stove,  weighing  about  one 
and  a  half  hundredweights,  up  some  steps,  when  he 
slipped  and  the  stove  fell  on  him.  Probably  one  of 
the  edges  of  the  stove  struck  him  on  the  abdomen. 
When  brought  to  the  infirmary  he  was  in  a  state  of 
collapse  with  signs  of  internal  haemorrhage,  and  he  died 
twenty  minutes  after  admission.  The  only  mark  of  ex- 
ternal injur]r  was  a  bruise  on  the  abdomen  a  little  below 
and  to  the  right  of  the  umbilicus.  The  post-mortem 
examination,  which  was  made  on  the  following  day, 
showed  slight  extravasation  of  blood  into  thc)  tissues  of 
the  abdommal  wall  at  a  point  corresponding  to  the 
bruise  of  the  skin.  The  abdominal  viscera  were  un- 
injured with  the  exception  of  the  aorta  which  pre- 
sented a  transverse  rupture  at  the  level  of  the  lower 
border  of  the  third  lumbar  vertebra.  From  the  rupture 
an  immense  effusion  of  blood  had  taken  place  into  the 
retro-peritoneal  connective  tissue,  extending  outwards 
to  eacn  loin  and  downwards  to  the  iliac  fossse :  it  sur- 
rounded the  kidneys  and  passed  for  a  short  distance 
into  the  mesentery.  At  the  point  of  rupture  the  inter- 
niJ  and  middle  coats  of  the  aorta  were  torn  in  a  trans- 
verse direction,  the  tear  extending  completely  around 
the  vessel  except  for  a  small  portion,  about  one-eighth 
of  an  inch  wide,  posteriorly.  On  each  side  of  the  tear 
the  internal  coats  had  retracted  for  a  short  distance 
exposing  the  adventitia,  the  separation  being  most 
marked  in  front  where  the  interval  was  nearly  half  an 
inch  wide.  The  adventitia  was  uninjured  except  at  the 
anterior  part  of  the  vessel,  in  which  situation  it  pre- 
sented two  small  perforations  each  large  enough  to 
admit  an  ordinary  probe.  The  thoracic  aorta  showed 
several  patches  of  commencing  atheroma,  and  on 
careful  examination  a  small  patch  of  the  same  disease 
was  discovered  on  the  posterior  wall  of  the  abdcmunal 
aorta  about  an  inch  above  the  rupture.    With  this 


Apbil  8,  1896* 


OBIOINAL  GOMMgNIGATIONS. 


Turn  MiDicuLL  Prks.     369 


exception  there  was  no  sign  of  disease  of  the  abdominal 
portion  of  the  vessel.  The  other  abdominal  organs,  the 
thoracic  organs,  and  the  brain,  showed  no  sign  of  iniary 
or  disease.  From  the  histoij  of  the  case  and  from  the 
aatnre  of  the  injuries  I  think  there  om  be  ao  doubt 
thai  the  vessel  had  been  emshed  between  the  heavj 
stove  and  the  lower  border  of  the  thiM  Itimbar  verte- 
bra and  the  raptnre  so  prodaced. 

I  have  been  able  to  find  very  few  cases  of  similar 
injuries  to  the  aorta  t  so  far  as  t  know,  only  four 
(^itfes  have  been  reported  during  recent  years.  They 
are  as  follows  :— 

1.  Recorded  by  Mr.  Jeremiah  McCarthy  ia  the 
"Patholorical  Society's  Transactions  for"  1881.  A 
girl,  set.  12,  who  was  admitted  to  the  London  Hospital, 
with  a  history  that  a  pony  had  knocked  her  down  and 
trodden  on  her  chest,  and  who  died  fourteen  hoars  after 
Admission.  Post-mortem  examination  showed  no 
fracture  of  the  stemutn  or  ribs  ;  the  posterior  medias- 
tinum was  full  of  blood  ;  there  was  a  small  aperture 
in  the  posterior  aspect  of  the  descending  part  of  the 
arch  of  the  aorta  ;  the  middle  and  internal  coats  pre- 
sented a  sharply-defined  transverse  rupture,  and  Uie 
external  coat  was  detached  to  a  slight  extent  and  per- 
forated by  a  small  irregular  hole.  The  report  of  this 
ease  goes  on  to  say  :  *'The  head  of  the  third  left  rib 
was  unusually  prominent,  and  the  prominence  became 
more  marked  on  pressure  upon  the  anterior  extremity 
of  the  rib.  It  is  probable  that  the  anterior  wall  of  the 
chest  had  been  pressed  back,  and  the  aorta  thus 
squeezed  against  this  projection,  and  the  rupture  so 
froduced.'^ 

2.  Reported  by  Capdeville  in  the  Journal  de  Mede- 
tine  de  Bordeaux,  August  24th,  1884.  The  patient,  a 
man,  set.  28,  who  had  fallen  for  a  distance  of  four  metres, 
lived  forty-eight  hours  after  the  accident.  The  aorta 
was  ruptured  at  the  junction  of  the  arch  and  thoracic 
portion ;  the  internal  and  middle  coats  were  com- 
pletely divided  in  the  whole  circumference  of  the 
vessel,  and  the  torn  ends  were  separated  from  the 
external  coats  for  half-an-inch.  The  adventitia  was 
perforated  by  a  small  opening  posteriorly,  from  which 
a  large  amount  of  blood  had  escaped  into  the  cellular 
tissue  of  the  posterior  mediastinum  and  into  both 
pleural  cavities.  There  was  no  siffn  of  atheroma.  The 
other  viscera  were  uniigured  and  free  from  signs  of 
disease,  but  there  was  a  fracture  of  the  shaft  of  the 
left  femur  and  a  small  superficial  wound  of  the  fore- 
head. The  mechanism  of  rupture  is  explained  by 
CapdeviUe  by  supposing  that  at  the  time  of  injury, 
owing  to  the  contraction  of  the  abdominal  muscles,  the 
abdominal  vessels  were  compressed  and  a  stream  of 
blood  sent  back  into  the  thoracic  aorta;  the  heart,  at 
the  same  time,  making  an  extra  effort,  the  pressure  in 
this  vessel  Was  greatly  increased,  and  rupture  occurred 
when  its  maximum  of  elasticity  was  overreached. 

3.  Reported  by  Chiari  in  the  Praeger  Medizinuche 
WochenschriA  March  Slst,  1896.  It  was  caused  by 
the  patient  bending  his  body  suddenly  backwards  to 
save  himself  from  falling,  and  the  rupture  was  near  the 
termination  of  the  arch  of  the  aorta.  The  intima  and 
media  had  first  j^ven  way,  and  this  led  to  the  forma- 
tion of  a  dissecting  aneurism  which  burst  into  the 
right  pleura.  There  was  advanced  arterio  sclerosis 
and  also  cirrhosis  of  the  kidneys  and  hypertrophied 
left  heart. 

4  Admitted  to  the  Middlesex  Hospital  under  the 
care  of  Mr.  George  Lawson,  and  reported  in  the 
Lancet,  Dec.  1st,  1894.  The  patient  was  a  man,  ae^.  60, 
whose  injuries  were  caused  by  falling  from  a  cab.  The 
intima  and  media  of  the  abdominal  aorta  were  rup- 
tured in  three  situations ;  one  of  the  ruptures  extended 
completely  across  the  vessel,  and  at  this  point  the 
internal  coats  had  curled  inwards  and  obstructed  the 
lumen.  The  adventitia  was  uninjured.  The  aorta 
was  stberomatons.  In  addition  to  the  injury  to  the 
YM«1  tliera  tere  ilight  ruptures  of  tde  fiubst^noes  of 


the  liver  and  kidney,  laceration  cf  the  mucous  mem- 
brane of  the  stomacA,  and  fracture  of  sevef&l  of  the 
lower  ribs  and  of  the  transverse  processes  of  the  upper 
lumbar  vertebra,  showing  that  the  amount  of  violence 
must  have  been  very  great.  Hia  man  lived  for  thirty- 
six  hours  alter  the  Acoidenk 

From  a  review  of  these  eases  it  appeara  that  when 
rapture  of  a  large  bl  vid-vessel  takes  piaee  the  internal 
and  middle  coats  lirst  give  way ;  next,  tlief  retract 
for  a  greater  or  less  distance  from  the  exteml  eoat 
and  finally,  if  the  violence  be  extreme  the  extemil 
coat  also  ruptures.  These  different  stages  m$y  follcrw 
each  other  very  rapidly,  as  was  the  case  in  my  own 
and  in  Mr.  McCarthy's  patients,  or  there  may  be  ft  m(^6 
or  less  prolonged  interval  between  the  runture  of  thd 
interna]  coats  and  of  the  external  coaL  as  nappened  in 
the  cases  reported  by  Capdeville  and  ChiarL  Some- 
times the  adventitious  coat  remains  uninjured,  as  in  the 
case  observed  at  the  Middlesex  Hospital  and  it  is  veiy 
possible  that  some  dissecting  aneurisms  may  have  their 
starting  point  in  such  an  injury.  The  duration  of  Hfe 
after  the  accident  appears  to  depend  very  largely  upon 
the  amount  of  injury  to  the  external  coat,  and  it  is 
quite  probable  that  some  cases  of  injury  to  the  internal 
coats  alone  will  recover. 

Of  the  cases  I  have  quoted  the  only  one  auiie 
parallel  to  my  own  is  that  of  Mr.  McCarthy  ;  in  Doth 
the  aorta  was  squeezed  between  two  resisting  sub- 
stances and  was  ruptured  without  injury  to  anv  other 
organ.  Rupture  appears  to  take  place  much  more 
readily  in  vessels  affected  by  atheroma.  In  two  of  the 
cases  referred  to  there  was  advanced  arterio-scleiosia, 
but  although  there  were  signs  of  an  early  stage  of  this 
disease  in  my  own  patient,  the  vessel  was  apparently 
quite  healthy  at  the  seat  of  injury,  and  I  do  not  think 
tnat  the  slight  degree  of  atheroma  observed  in  other 
parts  of  the  vessel  had  anything  to  do  with  the  rupture. 
The  specimen  is  now  in  the  museum  of  the  Owens 
College. 

♦ 

REFUSE    DISPOSAL: 

THE   "DESTRUCTOR''   SYSTEM. 

By  D.  EDGAR  FLINN,  D.P.H.,  F.RCS.L,  M.B.O.P., 

Examiner  In  SUt«  Medicine,  tjujtl  Colleges  of  Plijilolans  and  Snrgeon's 

Ounjoint  Board,  Ireland ;  iz  LTiioer  tn  Hygiene,  Royal  College  ef 

borgeont  and  Apotbecariea'  Hall  ConjoTot  Board ;  Sargeon 

St.  Michael'8  Hospital,  Kingstown  ;  Bx-Pres.  State 

Medldne  Section,  Soy.  Acad.  Med.,  Ac. 

It  is  recorded  how  the  Romaos  and  Greeks  caltivated 
asaidaoasly  the  custom  of  dealing  with  their  insanitary 
sanroandings  by  the  process  of  Doming,  in  fact,  they 
regarded  '*fire"  as  the  great  panacea  for  naisanoes  and 
ancleanliness  of  every  kind,  and  now  at  the  threshold  of 
the  twentieth  century  it  may  well  he  said  that  history  here 
repeats  itself,  for  we  find  the  sanitarian  of  oar  time  strenn- 
oasly  advocating  cremation  as  the  sole  and  only  efficient 
way  in  which  to  cleanse  oar  cities  and  towns,  and  rid  them 
of  their  filth  products  and  organic  debris. 

The  collection  and  disposal  of  refase  in  larse  centres  of 
popalation  is  a  sanitary  problem  only  second  in  import- 
ance to  the  treatment  of  sewage.  Manicipal  and  local 
aathorities  are  almost  everywhere  waking  ap  to  the  neces- 
sity of  adopting  the  very  best  appliances  which  the  powers 
of  inventive  skill  have  placed  within  their  reach.  It  has 
become  the  opinion  of  experts  that  fire  is  the  beet  instru- 
mentality whereby  the  conglomerate  masses  of  refase 
which  find  their  way  into  the  household  dustbin  and  ashpit, 
and  the  street  refase  could  be  rendered  innocuous,  and  the 
refase  destructors  now  coming  into  use  are  designed  with 
a  view  of  subjecting  them  to  a  heat  so  great  that  no  dis- 
agreeable or  dangerous  efflovia  should  be  given  off  in  the 
process,  and  that  the  products  of  combustion  should  be 
wholly  harmless. 

It  was  Lord  Palmerston  who  aptly  described  '*  refase  and 
dirt  as  matter  in  the  wrong  place  "—a  definition  full  of  sig- 
nificance—and  certainly  it  will  be  conceded  that  wherever 
the  proper  place  for  their  existent  may  be  found  It  is  Hot 

0 


370     ThS  MlDIOAL  Psiss. 


ORIGINAL  COMMUNICATIONS. 


Apbil  8,  1896. 


in  the  dwelling-houBe  or  ite  near  enrroundingd,  nor  yet 
ehonld  their  piesenoe  be  tolerated  unduly  long  in  the 
BtreetB  and  thoroughfares  which  are  our  daily  and  hourly 
reeort.  I  am  aware  of  more  tban  one  important  town  in 
Ireland  where  the  sanitary  authorities,  having  exbaufted  i 
practically  all  the  places  where  it  was  possible  to  di*poee 
of  the  refupe  of  the  town,  are  now  at  their  wits*  end  to 
discover  a  further  means  of  getting  rid  of  the  rapidly 
growing  amount  of  refuse  accumulations. 

I  am  not  here  concerned  with  the  cost  incidental  to  the 
introduction  of  the  "  destructor  "  system,  but  of  its  utility 
and  advantage  from  a  sanitary  point  of  view  there  are 
strong  proofs  ;  the  daily  and  prompt  removal,  and  subse- 
quent destruction  of  laree  masses  of  all  kinds  of  refuse 
must  surely  be  recognisea  and  admitted  to  be  a  bene6t  to 
the  health  of  a  community.  I  quite  recognise  that  the 
question  of  expenditure  may  prove  for  the  moment  some- 
what of  a  barrier  to  the  introduction  of  the  system  into 
Ireland,  yet  nowhere  is  there  apparently  a  more  urgent 
need  of  reform  and  improvement  indicated. 

Cities  like  Dublin,  Belfast,  and  Cork,  where  the  Corpora- 
tions  have  undertaken  a  general  house-to-house  system  of 
refuse  removal,  must  sooner  or  later  re-consider  the 
question  of  the  best  and  most  expeditions  method  of  refu^ 
disposal,  every  town  must  necessarily  adopt  the  means 
that  are  best  suited  to  its  requirements,  and  it  is  question- 
able whether  the  methods  emploved  in  the  Irish  capital 
•  might  not  be  improved  upon,  and  the  thousands  of  tons 
of  refuse  that  are  conveyed  to  sea  utilised  in  the  produc- 
tion of  heat  and  generation  of  steam. 

To  a  visitor,  the  appearance  of  the  thoroughfares  and 
bye-ways  of  the  average  country  town  is  by  no  means 
inviting,  and  leaves  an  unfavourable  imoreesion.    Two 
principal  causes  apparently  are  responsible  for  this,  the 
one  being  the  absence  of  any  regular  or  systematic  method 
of  refuse  removal,  and  the  other  cause  being  attributed  to 
the  fact  of  the  existence  of  a  dual  control.    The  county 
Grand  Juries  having  jurisdiction  over  the  roadways,  the 
Public  Health  Administration  being  vested  in  the  urban 
or  rural  sanitary  authority  as  the  case  may  be,  the  inevi- 
table result  of  tnis  dual  control  being,  as  often  happens,  a 
complete  deadlock;  it  is  evident  that  no  system  of  refuse 
disposal  can  be  properly  or  efficiently  carried  out,  if  there 
be  a  conflict  of  responsibility  in  regard  to  it,  and  it  is  this 
very  conflict  of  responsibility  that  hinders  the  due  adminis- 
tration of    the   Public   Health  Acts  in  this  important 
particular.    It  does  seem  an  anomaly  that  an  urban  sani 
tary  authority  should  not  have  complete  jurisdiction  over 
the  roads  and  bye-thoroughfares,  within  the  boundary  of 
its  own  district,  and  when  it  is  remembered  that  ^he^e  are 
a  large  number  of  9mall  towns  in  Ireland  with  a  population 
averaging  about  500,  which  are  subject  to  the  jurisdiction 
of  Boards  of  Guardians,  as  rural  sanitary  aathorities,  it 
will  be  seen  that  difficulties  must  and  do  present  them- 
selves in  many  questions  aflecting  the  public  health,  and 
thus  the  sanitary  condition  of   these  towns  is  in  the 
majority  of  instances  indifferent,  indeed. 

** Destructors"  op  Town  Refuse. 
This  question  of  the  disposal  of  town  refuse  has  recently 
been  attracting  the  attention  of  sanitary  bodies  through- 
out the  United  Kingdom,  and  great  strides  have  been 
made  in  the  more  important  towns  in  England,  in  the 
method  and  manner  of  collecting  and  disposing  of  refuse 
matter— the  last  ten  years  especially  have  b^n  notable 
for  the  various  forms  of  destructors  that  have  come  into 
existence,  and  for  the  steadily  growing  opinion  that  the 
best  means  for  the  disposal  of  refuse  is  by  burning— it  is, 
however,  notorious  that  one  of  the  principal  drawbacks  in 
the  first  or  early  period  of  the  construction  of  the  destruc- 
tor, was  the  fact  that  unpleasant  vapours  were  given  off 
during  the  process  of  burning.  This  ciroumstance  has 
tended  to  somewhat  retard  the  general  adoption  of  the 
destructor  system.  In  the  more  recent  forme  a  remedy 
has  been  devised  which  effectually  prevents  this.  Not 
long  since  I  had  an  opportunity  of  visiting  the  original 
destructors  erected  in  Liverpool,  and  on  the  occasion 
referred  to,  no  appreciable  or  unpleasant  odour  could  be 
detected.  A  large  number  of  the  more  important  English 
towns  have  partially  or  wholly  adopted  the  burning  sys- 
tem, notably  Bradford,  Bristol,  Buxton,  Leicester,  j^eds, 
Liverpool,  Manchester,  Nottingham,  Southampton, 
Warrington,  Woolwich,  &c. 


It  will  be  conceded  that  the  methods  of  disposal  of  refuse 
in  Ireland  are  yet  primitive  to  a  degree,  even  in  the  larger 
towns  very  little  noticeable  improvement  has  taken  place, 
the  appearance  of  the  thoroughfares  in  any  country  town 
gives  ample  evidence  of  this,  the  old-fashioned  manure 
depos  or  dumping  ground  is  still  to  be  seen  in  very  many 
places,  feeterins  mud  heaps  lie  in  the  streets  and  lanee  for 
many  days  before  being  removed,  vegetable  refuse  and 
houee  sweepings  of  all  kinds  lie  scatter^  for  days  without 
any  attempt  at  collection,  and  give  a  very  insanitary 
appearance  to  the  country  town.  Sub-soil  pollution  must 
in  consequence  inevitably  exist,  in  some  instances  the 
refuse  is  cast  into  the  nearest  water-course;  in  the  majority 
of  the  smaller  villages,  it  is  the  rule  to  gather  the  road 
and  house  refuse  and  manure,  and  pile  it  into  a  large 
mound  or  heap  within  a  few  yards  of  the  doorway.  Even 
in  some  of  the  best  towns  the  system  yet  prevails  of  cart- 
ing all  kinds  of  refuse  to  the  nearest  waste  ground,  often 
near  a  populous  centre.  Such  rongh-and-rwul)r  means  of 
getting  rid  of  refuse  is  happily  becoming  more  infrequent 
than  heretofore,  and  here  it  must  be  remembered  that  in  all 
these  methods  there  is  always  the  danger  that  particlee 
of  clothing,  food,  &c.,  that  have  been  in  contact  with 
patients  suffering  from  an  infectious  disease,  may  find 
their  way  into  the  street  refuse  heap,  the  ash-pit,  or  duet- 
bin,  and  ultimately  the  manure  depdt. 

The  question  of  refuse  disposal  in  Ireland  is  essentially 
an  important  one,  and  the  public  bodies  entrusted  with 
administrative  duties  in  the  country  towns  do  not  yet 
appear  to  realise  its  importance,  and  how  closely  it  affects 
the  public  weal.  Of  course,  the  personal  habits  of  the 
people  must  necessarily  influence  the  solution  of  thie 
question. 

The  old  adage  "  What  is  everybody's  business  is 
nobody's  business  '*  applies  foroibly  to  the  question  under 
consideration  People  of  education  and  intelligence  are 
content  with  a  very  moderate  degree  of  sanita^  protec- 
tion in  their  own  dwellings  and  their  immediate  surround- 
ings, they  are  slow  to  recognise  the  dangers  involved  in 
the  respiration  of  bad  air,  the  drinking  of  impure  water, 
or  the  effects  of  bad  drainage,  and,  least  of  all,  do  they 
appear  to  concern  themselves  with  what  becomes  of  the 
vast  amount  of  refuse  matter  and  filth,  that  must  neces- 
sarily daily  gather  within  the  precincts  of  their  own  and 
their  neighbours'  dwelling,  or  the  boundaries  of  the  town 
or  village  in  which  they  live. 

In  Ireland,  no  doubt,  the  question  of  the  erection  of 
''destructors"  for  the  removal  of  towns'  refuse  will  be 
IT'^verned  to  a  large  extent  by  the  cost  it  will  involve 
This  is  but  natural,  but  the  initial  expenditure  entailed 
bhould  be  an  ample  recompense  for  tbe  subsequent  health 
flidvantages  to  be  derived  from  this  process.  A  2  or  3-cell 
destructor  can  be  erected  at  an  outlay  of  a  sum  varying 
from  £1,300  to  £1,500,  perhaps  a  little  more,  and  will 
suffice  for  a  town  up  to  10,000  in  population. 

Mr.  Charles  Jones,  C  E.,  the  inventor  of  tbe  "  Fume 
Cremator,"  speaking  of  the  cost  of  construction  of 
destructora,  says : — '*  My  own  experience  in  this  matter 
leads  me  to  say  that,  in  the  majority  of  cases,  excluding 
excessive  cost  for  foundations,  and  what  may  be  considered 
as  an  ordinary  cost  for  chimney  shaft,  the  cells,  including 
cremator  and  shaft,  ought  not  to  exceed  £400  per  cell, 
and  in  some  cases  I  have  details  showing  the  cost  from 
£200  to  £250  per  cell.  This  has  been  the  case  at  Win- 
chester." This  estimate  of  the  expenditure  necessary  for 
the  erection  of  a  destructor  does  not  appear  to  be  extrava- 
gant, and  the  cost  of  erection  of  a  two-cell  destructor, 
which  would  suit  an  average  town,  should  not  prove  an 
excessive  item  or  an  insurmountable  barrier  to  its 
adoption. 

In  several  important  towns,  notably  Hastings,  Leicester, 
Southampton,  Ealing,  successful  efforts  have  been  made 
to  utilise  the  heat  generated  by  the  destructor  and  test  ite 
steam-producing  properties,  the  power  thus  obtained 
being  u«-ed  in  pumping  and  working  machinery  of  various 
kinds  ;  it  is  also  being  used  for  the  purposes  of  electric 
lighting  at  Southampton,  St.  Pancras,  and  Ealing.  To 
the  municipal  economist,  as  well  as  to  the  sanitarian,  the 
disposal  of  refuse  by  burning  must  eventually  commend 
itself,  and  convincing  evidence  is  being  established  to 
show  that  it  is  the  most  economical  sanitary  and  scientific 
method  of  getting  rid  of  town  refuse,  and  though  objec- 
tions have  been  cMJIvanced  that  the  burning  of  such  refuse 


Apbil  8, 1896. 


ORIGINAL  COMMUNICATIONS. 


Thb  Mbdigal  Pbms.     S71 


means  a  wfaoleeale  waste  of  materials,  yet  there  is  ample 
and  undeniable  proof  that  the  heat  (^nerated  by  a 
destractor  is  infinitely  more  valaable  than  anv  return 
from  the  sortings  of  refoee— an  antiquated  and  filthy  pro- 
oeedine. 

In  rae  more  important  Irish  towns,  sach  as  Dablin, 
Belfast,  and  Cork,  the  disposal  of  refuse,  of  late  years,  has 
engaged  the  attention  of  the  sanitary  authorities,  and 
these  towns  bear  visible  evidence  of  the  improvements 
effeoted  by  the  several  corporate  bodies  undertaking  the 
systematic  collection  and  disposal  of  refuse.  In  Dublin 
the  city  refuse,  consisting  of  the  scavenge  from  paved 
streets,  dry  ash-pit  refuse,  and  the  contents  of  dust-bins 
(described  as  unsaleable  scavenge),  is  conveyed  to  sea  in 
a  hopper  barge,  thousands  of  tons  of  material  being  thus 
yearly  dispoMd  of,  which  might  be  utilised  in  the  produc- 
tion of  heat,  and  its  transit,  no  doubt,  costing  a  large 
annual  outlay.  This  system  was  largely  availed  of  in 
Liverpool  up  to  the  year  1891,  and  at  least 80  per  cent,  of  the 
refuse  of  the  city  was  conveyed  to  sea  by  steam  barges. 
Since  1891  it  was  considered  desirable,  from  a  health  point  of 
view,  to  introduce  the  burning  system,  and  destructors 
were  erected,  and  the  Corporation  are  said  to  be  so 
thoroughly  satisfied  with  the  results  that  the  destructor 
system  by  burning  is  now  idtogether  adopted  there. 
Each  cell,  or  furnace,  at  Liverpool,  consumes  between 
seven  and  eight  tons  of  refuse  per  day  of  twenty-four 
hours,  and  the  heat  which  is  generated  in  the  combustion 
generates  steam  in  the  boiler,  and  is  used  both  for  a 
mortar  mill  and  for  a  disinfector  installation  on  the 
•'  Washington  Lyon  **  system. 

It  is  computed  approximately  that  about  one  ton  of  refuse 
is  collected  daily  from  1,000  inhabitants,  and  it  will  thus  be 
seen  that  in  Ireland,  where  there  are  so  many  small  and 
medium  towns,  the  erection  of  a  one-cell  destructor  would 
suffice  in  many  instances,  and  the  cost  of  erection,  to  say 
nothine  of  its  health  advantages,  would  in  a  short  time 
repay  itself.  Unquestionably,  the  days  of  manure  depots 
and  dumping  grounds  are  numbered,  and  the  whole  ques- 
tion of  refuse  disposal,  as  at  present  understood,  must 
sooner  or  later,  be  considered  by  our  public  bodies.  The 
improvements  noticeable  in  such  towns  as  have  adopted  a 
system  of  public  cleansing,  and  gathering  of  town  dehria 
at  frequent  intervals,  is  most  marked.  In  a  former  paper  (a) 
I  drew  attention  to  this  and  to  the  iact,  as  evidenced  by 
the  reports  of  several  medical  officers  of  health,  that  not 
only  Uie  zymotic,  but  the  general  death-rate,  had  con- 
siderably decreased  in  those  towns  where  a  systematic 
removal  of  town's  refuse  and  public  and  domestic  cleansing 
wds  undertaken  by  the  sanitary  authority. 

The  destructor  system  appears  to  be  the  most  economi- 
cal, and  at  the  same  time  tne  most  sanitary  way  of  getting 
rid  of  refuse,  and  it  is  evident  that  we  are  fast  approach- 
ing a  time  when  its  general  adoption  for  cities  and  towns 
will  be  the  rule.  The  Medical  Officer  of  Health  and  the 
Eogineer  to  the  London  County  Council  in  a  joint  report 
as  to  the  value  of  "destructors,"  mention  the  following 
points  as  demanding  special  attention. 

(1)  <<The  temperature  obtained  should  be  sufficiently 
high.  (2)  The  duration  of  exposure  to  a  high  temperature 
should  be  sufficiently  long.  (3)  All  the  vapours  escap- 
ing from  the  refuse  should  be  heated  to  a  sufficient  extent, 
aid  there  should  be  no  possibility  of  the  escape  of  any 
undecomposed  vapours  into  the  chimney  shaft."  It  is 
evident  from  this  report  that  a  perfect  destructor  should 
give  a  powerful  and  regular  heat,  and  that  there  should 
be  perfect  combustion  and  no  escape  of  ofl'ensive  odours. 

In  resrard  to  the  latter  question,  at  Leicester  (where 
previous  to  the  erection  of  destructors  there  was  consider- 
able difficulty  as  to  the  disposal  of  the  town  refuse)  the 
process  of  burning  is  yery  satisfactorily  carried  out.  The 
destructor  buildings  are  only  a  few  yards  from  a  large 
Board  School,  and  there  are  a  considerable  number  of 
houses  immediately  adjoining.  Here  there  has  been  a 
six-celled  destructor  at  work  for  some  years  with  <*  fume 
cremator,"  and  there  is  no  complaint  of  any  unpleasant 
or  noxious  odours,  and  it  is  intended  to  erect  two  other 
destructors,  one  of  six  cells,  and  one  of  ten  cells.  In 
Whitechapel,  a  refuse  destructor  is  placed  in  the  midst  of 
a  very  populous  district,  and  within  a  few  yards  of  dwell- 
ing-houses, and  at  Ealing,  where  a  destructor  has  been 

(a)  "  The  Influenoe  of  Pablfc  aeanstmr  on  the  Mortality  of  Towni." 
feVwy,  1808.    £07.  Aoad  o(  K«d.,  PabUo  Hetltb  ^ecUon. 


working  for  ten  years,  it  is  situated  within  380  yards  of 
houses,  of  a  rateable  value  ranging  from  £120  and  upwards, 
within  180  yards  of  two  isolation  hospitals,  and  within 
600  yards  of  a  convent  and  large  military  college.  At 
Homsey  and  Woolwich  the  destructors  are  built  in  oloee 
proximity  to  dwelling-houses,  and  the  result  is  satisfac- 
tory. The  earlier  form  of  refuse  destructors  encountered 
a  great  deal  of  opposition,  and  iustly  so,  as  in  their  first 
construction  they  were  no  doubt  a  nuisance  to  the  im- 
mediate neighbourhood  around  them,  partly  from  the 
noxious  odours  evolved,  and  from  the  o>oape  of  unbumt 
matter,  such  as  particles  of  paper,  rags,  oirt,  &c.,  from 
the  top  of  the  destructor  chimney  shaft,  and  it  is  only 
during  the  past  eighteen  years  that  anything  approaching 
a  successful  form  of  destructor  was  brought  into  work. 
To  Mr.  Charles  Jones,  C.E.,  the  unquestionable  credit  is 
due  of  having  devised  a  remedy  for  combating  the  offen- 
sive odour.  The  "  fume  cremator,"  which  bears  his  name 
and  which  is  now  attached  to  most,  if  not  all,  of  the 
destructors.  It  is  placed  between  the  furnaces  and  shafts 
thus  preventing  the  escape  of  offensive  vapours  as  wcAl  as 
of  patches  of  unbumt  dirt,  &c.  Further,  the  odour  g^ven 
off  in  the  first  staffe  of  the  burning  process — the  drying 
period — were,  in  the  earlier  times  of  the  destructor  system, 
very  perceptible,  and  a  strong  cause  of  complaint— the 
heat  generated  in  the  cremator  is  very  intense,  from  1,500 
to  1,S)0  degrees  Fahr.  of  heat  being  generally  maintained. 

Dr.  William  Odling,  of  Oxfora  University,  not  long 
since  having  been  asked  by  the  Sanitary  Committee  of  the 
Bradford  Corporation  to  make  a  personal  examination  of 
the  Fryer  Refuse  Destructors  in  Bradford  and  to  report 
thereon,  states  : — 

''Speaking  generally,  the  process  consists  in  setting 
fire  to  the  refuse,  as  collected,  and  allowing  it  to  bum 
itself  out.  This  burning  is  conducted  in  long  nearly  hori- 
zontal furnaces,  called  destructors ;  the  refuse,  just  as  it 
is  delivered  by  the  carts,  being  introduced  at  the  slightly 
higher  end  or  back  of  the  furnace,  and  the  ash  or  olinkere 
being  raked  out  at  the  front  and  sltehtly  lower  end,  where 
the  fire-bars  are  situated.  It  is  nouceable  that  the  burn- 
ing of  refuse  is  carried  on  without  resort  to  any  fuel  other 
than  combustible  matter  present  in  the  refuse  itself,  and 
that  despite  the  frequently  wet  state  of  the  refuse,  its 
burning  in  the  destructors  takes  place  steadily  and  com- 
pletely. The  burning  of  the  refuse  constitutes  further  an 
available  source  of  heat,  actually  made  use  of  at  one  of  the 
stations  to  raise  steam  for  the  supply  of  an  engine  used 
for  crushing  and  grinding  the  clinkers  of  the  refuse  into  a 
valuable  mortar.  It  is  impossible  for  anyone  not  to  be 
struck  with  the  very  efficient  way  in  which  the  destruc- 
tors do  their  work,  having  re^ird  to  the  quality  and 
character  of  the  refuse  they  so  completely  dispose  of  in'  the 
course  of  but  a  few  hours.  This  continuous  and  rapid 
destruction  of  the  town  refuse  as  fast  as  collected,  with 
avoidance  of  all  decomposing  and  offensive  accumulations, 
cannot  but  be  of  great  sanitary  advantage  to  the  town. 

"It  must  be  admitted  that  the  burning  process  as  at 
present  conducted,  is  not  wholly  unattencMd'  with  a  dis- 
charge frum  the  chimney  shaft  of  a  little  unconsnmed 
vapour,  which  under  some  conditions,  may  be  leoognised 
at  a  distance  as  offensive,  but  this  offence,  at  the  worst,  is 
as  nothing  compared  with  the  offence  and  injury  to  health 
whic^  are  so  successfully  obviated  by  the  rapid  destruc- 
tion, daily  effected,  of  tons  upon  tons  of  objectionable 
matter  which  must,  in  some  way  or  other  be  dealt  with  in 
the  borough,  as  its  deposit  elsewhere  would  not  now  be 
permitted." 

Since  Dr.  Odling's  report  "  Fume  Cremators  "  have  been 
censtructed  in  connection  with  the  refuse  destructors  at 
Bradford,  and  Mr.  Remmington, F.C.S.,  states  that"  the 
effect  of  the  gases  from  the  furnaces  passing  through 
the  fume  cremators  appeared  to  be  that  all  compounds  are 
decomposed  and  scarcely  a  vestige  of  any  that  can  be 
construed  to  be  offensive  or  obnoxious  esoapes,  and  the 
result  is  as  nearly  perfect  as  it  can  be." 

There  are  several  "destructors'*  now  in  use.  Fryer's, 
Warner's,  Horsfall's,  Beaman  and  Deas  being  amonest  the 
principal,  each  claiming  its  own  special  advantage  m  the 
treatment  of  refuse. 

The  Fume  Cremator  (Jones)  which  came  into  existence 
with  the  object  of  destroying  any  noxious  vapours  that 
might  be  given  off  from  the  destructor  consists  of  a  rever- 
batory  arcm  with  rings  of  fire-bricks  placed  in  the  direction 


i7i  •mmmMPidss. 


IfRiifSACfidffg  OF  SOCIETIES. 


A^fL  9,  189S 


of  ttle  j^awetf.  Ribri  dt  f<^briek8  projeotlbg  from  ibis  arch 
serre  to  defleiet  tna  gftMP,  fttiel  dir^t  them  on  to  the  top  of 
a  red  hot  maaa  of  fird.  Ao  intense  heat  from  1,000  to  1,500 
degrees  is  maintained  at  little  expense  of  fnel,  fine  eoke 
breete  alone,  or  with  the  ashes  screened  from  the  refuse, 
being  all  that  is  reqaired,  together  with  a  supply  of  air 
beneath  the  fire-bars  and  *  farther  "^PP^y  to  feed  the 
vaponri  as  they  pass  into  the  cremator.  The  cremator 
appears  to  have  met  with  comparative  success.  The  objec- 
tions nHsed  as  to  the  noxious  odours  emitted  in  the  process 
of  Combustion  by  the  destructor.  The  additional  outlay 
involved  in  the  construction  of  a  fume  cremator  has 
hitherto  somewhat  hindered  itif  more  general  introduction, 
but  of  its  utility  in  dealing  with  offensive  gases  there  can 
be  not  the  slightest  doubt  Horsfall's  destructor  claims  the 
advantage  that  the  flctes  are  arranged  in  such  a  manner 
that  the  outlets  tor  the  products  of  combustion  are  ovet 
the  hottest  part  of  the  fire,  so  that  all  the  fumes  given  off 
by  the  refuse  In  orving  have  to  pass  through  the  hottest 
part  of  the  furnace  before  they  can  escape  to  the  chimney, 
and  are  thus  ''cremated"  within  the  furnace  itself,  no 
extraneous  fuel  being  required.  Both  "  Warner's  "  and 
Beaman  and  Deas^  destructors  claim  that  complete  com- 
bustion and  the  destruction  of  offensive  gases  take  place 
within  the  furnace  or  cell  itself  and  before  the  shaft  is 
reached. 

A  series  of  questions  were  submitted  some  time  since  to 
the  authorities  of  forty-six  large  towns  in  fiogland  where 
the  destructor  system  of  refuf>e  disposal  is  in  operation, 
one  of  thft  questions  being :  **  tl&ve  complaints  ever  been 
made  as  to  noxious  odours  from  destructor  or  otherwise." 
In  only  a  very  few  places,  hardly  1}  per  cent ,  were  slight 
complaints  made  of  any  odour  beinff  perceptible.  As  an 
important  question  affteting  the  pubhc  health,  the  destruc- 
tion of  dirt  and  all  organic  debris  by  fire  should  commend 
itself  to  the  consideration  of  every  sanitarv  authority,  and 
it  is  only  a  matter  of  time  when  we  may  hope  to  see  the 
system  generally  adopted  throughout  the  United 
Kingdom. 

(fUtitcal  Jlfcarbg. 


A  OLINfCAL  NOtE   OF  A  CASE  OF  HISTRIONIC 

SPASM. 

By  Dr.  Abthub  Hall, 
Hon.  Pbytlolan  to  Sheffield  fioyal  doepital. 

DiL  Abthcb  Hall  showed  a  case,  at  a  meeting  of  the 
Sheffield  Medico-Chirurgical  Society,  of  histrionic  spasm 
oocurring  in  an  elderly  man,  affecting  almost  all  the  mus- 
cles of  face  and  jaws.  The  disease  had  been  coming  on 
insidiouslv  for  many  vears,  but  had  been  much  worse 
lately.  Violent  twitchmgs  of  the  eyes  and  facial  muscles ; 
spasmodic  contraction  of  the  various  muscles  of  mastica- 
tion, either  in  the  vertical  or  side-to-side  motions,  accom- 
panied by  profuse  salivary  discharge,  were  the  most 
noticeable  features  of  the  affection.  The  patient  noticed 
that  when  the  movements  first  became  violent  all  his 
lower  teeth  on  the  right  side,  and  all  his  upper  on  the  left 
side,  became  loose,  and  fell  out.  When  at  its  worst  he 
could  only  get  to  sleep  by  putting  a  small  prop  between 
his  jaws,  which  fell  out  when  he  went  to  sleep.  He  can 
restrain  the  movement  for  a  short  timo,  but  after  doing  so 
they  become  much  more  violent.  The  disease  seems  to 
be  of  the  nature  of  a  neurosis,  and  has  been  much  bene- 
fited by  a  course  of  quinine  and  iron. 


OBSTETRICAL  SOCIETY  OF  LONDON. 
ME&Tiiio  Held  Wbdnesoat,  April  1st. 

The  President,  Dr.  Champnets,  in  the  Chair. 

deoiduoma  malign um. 

Mr.  Alban  Doran  brought  forward  the  notes  of  a  case 

of   allesed   deciduoma   malignum    contributed  by    Mr.  , 

Rutherford  Morison^  df  Newcaatld^m-Tyne,  and  showed  | 


the  df^rus  together  #ith  t#o  mitsroecopic  dides  of  tb« 
growth  in  its  cavity.  He  believed  it  to  be  possible  that 
the  growth  was  originally  a  submucous  myoma  which  had 
become  invaded  by  so-called  decidual  cells.  The  patient 
was  a  married  woman,  eet.  35,  with  nine  children,  all  borrt 
at  term,  the  eldest  being  twelve  years  of  a^.  She  had 
never  menstruated  between  her  pregnancies.  When  admit* 
ted  she  was  profoundly  ansstnic,  with  a  waxy  skin.  Her 
tiioracic  and  abdominal  organs  appeared  to  be  healthy. 
The  09  uteri  was  found  to  be  patulous  and  the  uterus 
considerably  enlarged.  Her  last  confinement,  nine  weeks 
previously,  was  with  transverse  presentation,  and  delivery 
was  effected  bv  turning.  Nevertheless,  she  was  up  and 
about  in  less  than  a  fortnight.  The  local  discharge  did 
not  cease  entirety  but  had  become  insignificant  in  amount 
and  light  in  colour,  when  six  wews  later  a  serious 
hemorrhage  set  in,  so  profuse,  that  she  lost  conscious- 
ness. This  was  repeated  twice  during  the  following 
fortnight.  On  November  1st,  1894,  the  uterus  was  explored 
ouret^  and  swabbed  with  chloride  of  zinc.  On  introduc- 
ing the  finger  the  enlarged  cavity  of  the  uterus  was  felt 
to  ne  occupied  by  a  soft  friable  structure  and  the  amount 
removed  with  the  curette  half -filled  a  saucer.  Microscopi- 
cally this  consisted  chiefly  of  changed  blood  dot,  but 
Slscental  tissue  was  recognised  in  one  section.  On 
fovember  10th  she  complained  of  bearing-down  pains,  and 
On  the  2drd  violent  bsemorrbage  once  more  set  in.  As  no 
remedies  checked  the  flow  the  uterus  was  plugged  on  the 
following  day,  by  whicn  time  her  condition  had  become 
very  serious.  There  was  no  further  haemorrhage  after  the 
removal  of  the  plug,  but  on  the  25th  her  whole  body  was 
Swollen  (anasmic  dropsy)  and  her  pallor  Was  extreme.  On 
the  26(>h  the  uterus  was  again  explored  under  an  ansssthe- 
tic  and  the  same  condition  was  found  as  on  the  previous 
occasion.  The  cavity  was  again  curretted,  swabbed  and 
stuffed  with  iodoform  gauze.  Microscopical  examination 
6f  the  tissue  removed  showed  it  to  be  a  squamous* celled 
Epithelioma.  On  December  1 1th,  1894,  the  uterus  and  both 
ovaries  and  tubes  were  therefore  removed  per  txiginam.  Not 
more  than  half  an  ounce  of  blood  was  lost,  but  recovery 
was  interrupted  by  an  attack  of  phlebitis  of  the  internal 
saphena  vein.  The  patient,  however,  went  home  much 
improved  on  the  29th,  and  soon  recovered  her  usual 
strength  and  energy.  The  extirpated  uterus  was  about 
twice  its  normal  size,  soft  and  flaoby.  Extemallv  a  small 
vascular  nodule  was  seen  at  the  fundus,  not  involving  the 
peritoneum.  The  uterus  contained  a  growth  the  size  of  a 
tanfferine  orange,  which  infiltrated  the  upper  and  posterior 
walls  of,  and  was  continuous  with,  the  nodule  outside.  It 
had  a  distinct  broad  pedicle  half  the  circumference  of  the 
body.  Four  months  after  the  operation  hsdmop'ivsis  came 
on,  followed  by  dyspnoea  and  oedema  of  both  legs,  with 
signs  of  a  tumour  in  the  lung.  Death  occurred  on  July 
1 1  tb ,  1 895.    No  post- mortem  was  obtained . 

Dr.  H.  R.  Spencer  gave  a  full  clinical  history  and  post- 
mortem record  of  a  case  of  deciduoma  malignum  occur- 
ring in  1889— the  first  case,  he  believed,  observed  in  this 
country.  The  disease  occurred  in  a  young  Danish  woman, 
set.  27,  a  secundipara  (whose  previous  labour  took  place 
at  the  age  of  twenty)  The  first  symptom  of  the  disesse 
Tpaseaee  of  masses  of  the  growth)  occurred  twenty-eight 
clays  i^ter  a  normal  labour  which  was  followed  by  a 
normal  pnerperium.  Subsequently  there  was  repeated 
discharge  of  massess  of  growth  and  of  blood,  and 
the  disease  ran  a  septic  course  and  terminated  fatally 
within  ten  and  a  half  weeks  of  delivery.  At  the  necropsy 
an  ulcerated  and  gangrenous  growth  was  found  at  the 
placental  site,  the  ulceration  and  gangrene  having  nearly 
periorated  the  fundus.  Secondary  growth  was  also  found 
in  the  cervix  and  in  the  lungs,  nut  nowhere  else  in  the 
bodv.  The  growth  in  all  three  situations  Is  similar  and 
is  cnaracteristic  of  deciduoma  malignum,  being  apparently 
a  large  celled  sarcoma  with  the  typical  "  syncytium."  A 
full  account  of  the  microscopic  appearances  is  given.  The 
necessity  of  early  dia(nio»»  and  treatment  by  vaffioal 
hysterectomy  is  pointed  out.  The  specimens,  araw- 
ines  photographs,  sections,  and  temperature  chart  were 
exhibited. 

Dr.  T.  W  Eden  referred  ti  the  number  of  cases  of 
malignant  uterine  growths  occurring  subeequenc  to  gesta- 
tion, which  had  been  recently  recorded,  mostly  by  Oermati 
observers.  The  most  important  cases  were  thos6  of 
Sanger,  Gottechallt,  Marehand,  and  Whitridge  WilliaiQS, 


.^pRiL  8,  im 


TRAJ^SAqifOpS  QF  SOCIETIES.  The  Mmdical  J>bb8s.     373 


99  obaerved  that  SaQfj^er  bad  introduced  the  term 
'*  Becidttoma  noualignnin."  He  thooght  that  in  this  case  the 
tamoor  arose  in  the  decidua,  and  was  composed  largely  of 
80'Called  "  decidaal  cells."  He  himself  believed  that  cells 
precisely  like  those  found  by  Saoger  occurred  in  the 
qterus  under  various  conditions,  and  did  not  prove  the 
origin  of  the  growth  in  the  decidua.  Gottschalk,  on  the 
other  hand,  Mlieved  that  in  his  case  the  gronrth  arose 
from  a  "sarcomatous  transformation"  of  we  stroma  of 
retained  chorionic  villi.  The  author  showed,  however, 
that  there  was  doubt  as  to  the  occurrence  of  a  preceding 
gestation  in  this  case,  and  pointed  out  that  the  structures 
figured  by  Grottechalk  as  sarcomatous  villi  bore  very  little 
resemblance  to  villi  at  all.    Further,  a  sarcomatous  change 

3  the  stroma  would  not  account  for  the  buddine  of  the 
aemodial  layer  described  by  Gbttschalk.  Whitridge 
Williams'  case  again  possessed  the  general  characters  of  a 
sarcoma ;  tumours  were  present  in  the  uterus,  vagina,  apd 
vulva,  and  it  was  not  dear  which  was  the  primary  growth. 
Williams  relied  for  his  diagnosis  upon  the  presence  in  the 
tumours  of  plasmodial  masses  whicn  he  believed  to  be  syn- 
cytial in  origin.  He  then  referred  to  Marchand's  two 
cases,  in  both  of  which  he  found  similar  syncytial  masses  $ 
that  obeerver  also  claimed  to  have  found  cells  derived  from 
the  foetal  ectoderm.  In  one  case,  represented  as  a  tubal 
gestation  in  a  girl  of  seventeen,  there  was,  however,  no 
anatomical  evidence  of  pregnancy  discovered  ;  the  tubal 
mass  might  therefore  have  been  a  primary  malignant 
growth.  The  author  believed  that  plasmodia,  not  unlike 
those  figured  by  Williams  and  Aiarchand  as  syncytial 
masses,  were  frequentlv  found  in  sarcomatous  growths  in 
other  parts  of  the  body,  and  doubted  whether  there  was 
sufficient  evidence  to  justify  the  view  that  they  arose  from 
placental  relics.  A  case  recorded  by  Meyer  was  referred 
to,  in  whidi  there  seemed  to  be  proof  of  the  origin  of  a 
malignant  growth  in  retained  myxomatous  villi  (hydatidi- 
form  mole). 


ROYAL  ACADEMY   OF    MEDICINE  IN  IRELAND. 

Sbgtion  op  Patholoot. 

Mkbtino  hjeld  Friday,  Febbuaby  14th. 


Db.  Nixon  (in  the  absence  of  the  President)  in  the  Chair. 

Thb  following  papers  were  read : — 

1.  Dr.  E.  J.  McWEBNiY — *'  Peritonitis  from  Abscess  of 
Spleen,  and  Cavernous  Angioma  of  Liver  from  same 
Patient." 

2.  Dr.  C.  B.  Bali/— *'  Myxomatous  Tumour  of  Bladder 
•imulating  Sciatic  Hernia.^'    (Lantern  Illustrations). 

3.  Dr.  Lanofoiid  Symes— "  Pathological  Aspect^  pf  the 
Wicklow  Murder.'' 

No  abstracts  were  furnished  of  the  foregoing  papers. 


Section  of  Mbdiciks. 
Mbetibg  ujsld  Fbiday,  Fjebbuaby  28th. 

Dr.  Waltbb  G.  Smith  in  the  Chair. 

LTVINO  BXHIBIT8. 

Ca9B  of  athetosis,  shown  by  Dr.  J.  B.  Oolsman. 

Case  of  favns  of  the  scalp,  in  a  child,  with  mtoropoopic 
slide  of  the  characteristic  fungus,  shown  by  Dr.  Waltbb 
G.  Smith. 

Patient,  a  woman,  exhibiting  trophic  disturb<incea,  fol- 
lowing injury  to  the  median  nerve,  shown  by  Dr.  A.  R. 
Parsons. 

Dr.  H.  C.  Tweedy  asked  what  treatm^t  was  being 
einployed  for  the  case  of  f^vus. 

Dr.  Waltbb  Smith  said  he  was  using  cfarysarobin  oint- 
ment on  one-half,  and  a  weak  resorcin  ointment  on  the 
other  half  of  the  scalp,  but  it  was  too  aooi^  a^  ^^  to  say 
which  gave  the  best  results. 

OASB  OF  CHOBEIO  8PA8MS. 

Dr.  Waltbb  Bbbnabd  (Londonderry),  exhibited  a  tall, 
stout,  well-nourished,  healthy  man,  sd.  22,  a  twin.  No 
family  history  of  nervous  diseases.  Parents  state  positively 
thmt  be  nevet  had  evvo  a  alight  attnees,  vilib  Jiie  Azooixbkiii 
flf  niAAsiaa  i***^  iriioftPiiMr-flfii^  gh .  jont  cm  which  ht  msudbd 


good  recoveries.  Eight  years  ago,  when  writing  at  school, 
a  slight  jerky  movement  was  observed  about  his  right 
shoulder,  which,  since  then,  has  gradually  increaMd. 
The  muscles  of  the  right  shoulder,  arm,  aod  forearm  are 
in  a  constant  state  of  movement,  and  the  flexors  of  the 
fingers  are  also  in  frequent  action,  quite  independent  of 
the  will.  He  wrinkles  his  brow  frequently  ;  is  unable  to 
put  his  right  hand  to  the  top  of  his  head  or  to  button  his 
coat,  to  write,  or  to  feed  himself  with  his  right  hand. 
Shoulder,  arm,  and  hand  are  at  rest  only  when  Uftine 
heavy  weights,  pushing  forward  a  cart,  or  at  manual 
labour  requiring  much  effort.  Movements  are  worse  on 
Sunday,  and  are  increased  by  rest.  When  standing  he 
keeps  his  hand  on  a  chair  to  steady  bis  am.  His  family 
say  the  constant  movement  is  present  during  sleep.  The 
shoulder  and  arm  muscles  are  remarkablv  hypertrophied. 
He  walks  with  his  hand  a  little  behind,  the  arm  being 
stretched  out.  There  are  no  signs  of  antecedent  hemi- 
plegia, and  the  *' mobile  spasms''  are  not  conjoined  with 
rigidity. 

The  Chaibman  said  the  case  seemed  to  him  to  belong 
to  the  choreic  group  of  diseases. 

Dr.  Cabboll  said  he  believed  the  movements  were 
simply  habits  acquired  in  boyhood,  and  thaJb  these  habits 
became  more  marked  as  the  patient  advanced  in  years. 
To  illustrate  his  meaning,  he  described  some  instances  of 
habit  spasms. 

Dr.  Dbuby  thought  the  condition  resembled  tortiooUis, 
but  without  involvement  of  the  ^eck  muscles. 

Dr.  Craio  considered  that  the  disease  affection  in  the 
arm  was  of  a  choreic  character,  and  that  in  all  probability 
it  was  the  result  of  an  infantile  monoplegia  that  had  noii 
been  recognised. 

Dr.  Bbbnabd,  in  reply,  admitted  that  the  movement  to 
be  observed  in  his  patient  simulated  chorea;  but  the 
muscles  were  enormously  hypertrophied,  the  movements 
ceased  whenever  the  patient  bad  to  do  heavy  work,  lifting 
weights,  kc.  He  had  never  seen  a  case  of  chorea  in  whioE 
the  movements  did  not  cease  during  the  night. 

two  oasbs  of  pabapleoia. 

Dr.  H.  T.  Bbwlsy  read  the  notes  of  two  remarkable 
cases  of  paraplegia. 

The  Chaibman  said  Dr.  Bewley  was  to  be  congratulated 
on  his  lucid  exposition  of  two  obscure  and  difficult  cases 
of  nervous  disease.  He  dwelt  on  the  terms  functional  and 
organic,  in  reference  to  nervous  disease.  He  thought  one 
should  be  cautious  in  accepting  the  precise  rules  laid  down 
in  text  books.  He  gave  the  details  of  one  case,  in  which  a 
pathologist  would  expect  to  find  a  healthy  cord,  with 
perhaps  islands  of  disease  here  and  there.  On  the  contrary, 
an  autopsy  revealed  a  cord  uniformly  diseased. 

Dr.  Falkinbb  thought  it  would  be  difficult  to  discuss 
Dr.  Bewley 's  cases.  For  the  purpose  of  bringing  about  a 
debate,  however,  he  would  enter  into  the  history  of  a  case 
that  was  under  bis  own  treatment  for  some  time.  A  com 
porter  got  a  chill ;  twenty -four  houre  after  he  had  a  severe 
pain  in  his  back.  Soon  after  he  lost  sensation  and 
motorial  power  in  the  lower  extremities.  The  slightest 
movement  of  the  body  caused  a  copious  flow  of  urine. 
He  was  sent  to  Baggot  Stnwl;  Hoecatal,  vk«»  b«  was 
under  treatment  for  a  long  tinjie. 

Dr.  Cbaio  reported  a  case  of  transverse  mvelitis^  in- 
volving the  lower  dorsal  and  lumbar  regions  of  the  cord, 
in  which  there  were  a  rapid  wasting,  loss  of  motion, 
sensation,  and  reflexes  in  the  lower  limb^,  with  retention 
of  urine,  cystitis,  and  acute  bedsore.  Partial  recovery 
took  place,  but  the  limbs  were  now  contracted.  The 
bladder  had  been  washed  out  daily,  and  every  care  taken 
to  prevent  the  sore  spreading. 

Dr.  Daitby  stated  some  views  of  Dr.  Gower's  on  ankle 
clonus.  He  discussed  the  phenomenon  of  ankle  clonus  as 
an  aid  in  differentiating  functional  from  organic  diseases. 
He  discussed  Dr.  Qower's  method  of  measuring  paralysed 
limbs. 

Dr.  Bbwlby  said,  in  reply,  that  as  regarded  Dr.  Drury  s 
remarks  on  ankle  clonus,  the  term  had  for  him  the  mean- 
ing ordinarily  attached  to  it.  He  described  what  he 
meant  by  ankle  clonus ;  also  the  manner  in  which  the 
phenomenon  is  prodoeed.  Ankle  clonus  wap  not,  in  his 
opinicp,  ^  symptom  qi  what  w»^  kQOwn  4t0  ^wu^tional 

j^.vGii9#  ^mnsw. 

TJ^e  Q^on  then  ^kdjounv^d. 


374     The  Medical  Pbess 


GERMANY. 


Afbil  8,  1896i 


4fwncc, 


[IBOM  OUR  OWN  OORBISPONPINT.] 

PAKI8,  April  4tll,  1896. 

The  Flt  Blister. 

At  the  Socf^U  de  Tb^rapeotique,  M.  Ferraad  referred 
to  a  case  of  albaminnria  with  sobaoute  ursdmia  provoked 
by  the  application  of  the  fly  blister,  and  said  that  several 
of  his  conf^rea  were  inclined  to  consider  this  method  of 
counter  irritation  as  dangerous,  bat  he  thought  that  they 
were  going  too  far.  He  had  never  witnessed  any  evil  e£fects 
from  it.  Cantharides  was  a  diuretic  in  small  doses,  and 
Lancereaux  had  recommended  it  in  epithelial  nephritis. 

M.  Huchard  supposed  that  the  accident  above  men- 
tioned arose  from  a  too  long  application  of  the  blister. 
He  admitted  that  it  was  useful  in  certain  affections,  but 
hurtful  in  infectious  diseases,  in  pneumonia,  in  broncho- 
pneumonia, in  typhoid  fever,  kc  ;  it  was  highly  dangerous 
in  children  and  in  the  aged.  For  him  he  had  learned  to 
distrust  it  so  much  that  he  replaced  it  with  advantage  by 
other  therapeutic  measures. 

M,  Adrian  said  that,  looking  at  the  question  on  purely 
pharmaceutic  grounds,  he  considered  cantharides  to  be 
the  best  blistering  agent,  and  could  only  be  replaced  by 
two  other  agents,  ammonia  and  chloroform,  but  these 
were  very  painful,  although  being  almost  instantaneous. 
However,  the  fly  blirter,  as  commonly  used,  that  is  to  say, 
in  the  form  of  plaster,  often  is  dangerous,  from  the  fact 
that  when  removed  particles  of  it  adhere  to  the  wound, 
and  act  as  an  irritant  poison.  If,  on  the  contrary,  the 
cantharides  were  used  in  the  liquid  form  with  chloroform 
and  a  little  squills  added,  all  danger  would  be  avoided. 

M.  Mathien  declared  himself  an  irreconcilable  adversary 
of  the  blister.  There  was,  in  his  opinion,  only  one  affec- 
tion in  which  the  blister  might  be  prescribed  with  good 
effect— hydrasthroeis.  It  provokes  an  unnecessary  wound, 
•nd  consUtutee  in  any  case  but  a  very  limited  revulsive, 
for  once  applied,  it  hinders  every  other  local  treatment. 

M.  Le  Gendre  agreed  with  this  last  assertion,  especially 
in  the  case  of  brtmcho-pneumonia  in  chUdren,  as  it  rendered 
impossible  balneotherapy,  so  important  in  this  affection. 
A  Prophetess. 

The  Parisian  mind  would  afford  an  interesting  study  to 
tbe  psychologist.  For  some  time  the  Ville  Lumi^re  has 
been  in  a  state  of  chronic  excitement  over  international 
and  home  questions.  Egypt,  Madagascar,  China  and  Siam, 
have  been  the  topics  of  the  street,  not  to  speak  of  the 
salons,  and  just  at  the  moment  when  the  political  atmos- 
phere seemed  to  be  charged  with  electricity  of  very  dan- 
gerous intent,  the  popular  excitement,  without  any 
transition,  became  diverted  into  a  new  channel  running  in 
a  widely  different  sense,  to  the  great  relief,  I  have  no  doubt, 
of  those  who  have  the  destinies  of  the  nation  in  trust.  A 
few  days  ago  it  was  announced  by  the  gravest  of  all  Paris 
journals,  Le  Temps,  that  a  prophetess  of  no  humble 
origin,  the  daughter  of  an  honourable  lawyer,  had 
appeared  in  the  firmament  of  this  enchanting 
city.  This  charming  girl,  of  very  tender  years- 
she  Ib  not  in  her  teens— suddenly  discovered  that  she 
had  been  used  by  the  Angel  Gabriel  to  convey  to  the 
world  the  secret  of  his  celestial  abode.  In  any  case,  the 
reporter  of  the  paper  in  question,  who  interviewed  d  la 
manUre  AngkUse,  Mademoiselle,  affirmed  that  she  revealed 
to  him  his  past  life  as  none  but  he  could  know  it,  and 
finally  predicted  that  France  would  be  chastised,  that 
England  would  be  humiliated,  and  that  the  whole  world 


would  be  ablaze  by  the  close  of  the  year.  This  reassuring 
announcement  had  the  desired  effect.  Men  and  women  of 
all  degrees  flocked  to  this  hysterical  young  lady's  abode 
to  hold  communion  with  the  Angel  Gabriel.  Grave  senators, 
and  still  graver  priests^  ladies  of  title,  and  shopkeepers' 
wives,  elbowed  each  other  on  the  stain  leading  to  the 
apartments  of  the  Parisian  Prophetess,  and  at  the  preeent 
moment,  the  street  is  blocked— I  am  not  exaggerating— 
by  carriages  and  people  eager  to  be  received. 

Several  members  of  the  Psychological  Society,  have 
interviewed  this  young  lady,  and  a  report  on  her  mental 
condition  is  to  be  given  to  the  world  next  week.  In  the 
meantime,  the  medical  profession,  through  several  of  its 
competent  organs,  has  not  been  slow  in  pronouncing  the 
case  as  one  of  vulgar  hysteria,  for  which  bromide  of  potas- 
sium and  the  cold  douche  would  be  the  best  treatment ! 
Of  course,  the  public  consider  such  plain  speaking  as 
bordering  on  the  profane,  and  the  papere,  by  publishing 
long  columns  about  the  interesting  person,  fan  the  flame 
of  this  timely  popular  excitement.  I  forgot  to  mention  that 
tbe  prophetess  lives  in  the  Rue  de  Faradis,  and,  perhaps, 
that  accounts  for  her  intimacy  with  the  Angel  Gabriel  1 


[from  our  own  oorrbspohdbnt.] 

BBRLIH,  April  8rd. 

At  the  last  meeting  of  the  Free  Society  of  Surgeons  Hr. 
Korte  related  a  case  of 

Rupture  op  the  Colon. 

He  said  it  was  difficult  to  decide  when  operation  was 
necessary,  and  especially  in  cases  in  which  there  was  no 
external  wound.  Such  injuries  might  take  place  where 
intestine  was  pushed  on  to  a  bone.  In  a  case  lately  under 
his  treatment  a  man  received  a  blow  from  the  shaft  of  a 
wagon  on  the  left  side  of  the  lower  abdomen,  and  imme- 
diately afterwards  felt  great  pain.  When  he  was  admitted 
into  hospital  two  days  later  this  was  very  severe,  the 
abdomen  was  distended,  but  there  were  no  signs  of  diffuse 
peritonitis;  the  pulse  was  strong.  As  the  stools  were 
bloody,  but  as  the  blood  was  dark  coloured,  indicat- 
ing that  it  came  from  high  up  in  the  intestines,  he  came 
to  the  conclusion  that  the  sigmoid  flexure  was  the  site  of 
the  injury,  and  that  the  mucous  membrane  of  the  part 
was  torn.  Although  the  bowel  was  clearly  adherent  he 
concluded  to  operate  as  he  feared  the  adhesions  might 
give  way.  He  made  an  incision  in  the  middle  line,  and 
felt  some  adhesions  on  the  left  side  and  on  separating  them 
a  quantity  of  foul  bloody  faecal  matter  escaped.  He  found 
the  flexure  perforated,  the  perforation  not  closed.  The 
flexure  was  adherent  to  the  sacrum,  the  neighbourhood  of 
it  bruieed.  Not  being  able  to  get  to  the  back  part  of  the 
flexure,  he  dii  not  resect,  but  excised  a  piece  around 
the  perforation  and  introduced  sutures.  He  then  dosed 
the  abdominal  opening  as  far  as  the  lower  angle,  through 
which  was  passed  a  strip  of  iodoform  gauze  lying  on  the 
intestines.  No  peritonitis  followed,  and  recovery  took 
place  without  interruption.  He  thought  the  condition 
met  with  justified  the  operation. 

Hr.  Israel  related  a  case  in  which  an  attempt  had  been 
made  to  restore  the  nose  by 

Rhinoplastt. 

He  had  for  some  years  rejected  the  method  of  obtaining 
the  material  for  restoration  from  the  forehead,  and  had  re- 
turned to  the  long^lisused  Italian  method  of  procuring  it 
from  the  arm.  In  this  case,  however,  it  was  not  taken  from 


April  8,  1896. 


AUSTBIA. 


Thi  Mbdigal  Pbmbs.     375 


the  upper  arm,  bat  from  the  forearm,  from  near  the  aogle 
of  the  ulna.  The  result  was  not  an  ideal  one,  but  drawings 
of  the  profile  of  the  patient  before  and  after  the  eeriee  of 
operations  showed  that  a  material  improvement  had  been 
effected. 

He  then  related  a  case  of 
Akubia  fbom  Blocking  by  Renal  Calculi— Operation. 

The  patient,  a  [woman,  set.  45,  had  buffered  for  eight 
years  off  and  on  from  renal  colio,  sometimes  the  right, 
sometimes  the  left  side  being  the  one  attacked.  On  Jan. 
14th,  she  had  another  attack,  this  time  accompanied  by 
anuria. 

This  was  not,  however,  quite  absolute,  but  so  nearly  so 
that  the  bladder  contained  only  a  few  drops  of  nearly 
colourless  fluid.  The  patient  vomited  every  day  but  other- 
wise had  no  symptom  pointing  to  uraemia.  The  right 
kidney  was  palpable  and  tender  and  the  pulse  intermittent, 
and  she  was  brought  to  operation  on  the  sixth  day  of  the 
anuria.  Whilst  the  preparations  for  the  operation  were 
going  on  she  had  a  ursemio  attack  and  the  operation  was 
performed  without  any  anaesthetic  whilst  she  lay  in  a  state 
of  coma.  The  kidney  was  freed  from  behind;  between 
the  fatty  capsule  and  the  albuginea  were  numerous  adhe- 
sions. The  kidney  itself  was  enlarged,  the  pelvis  of  the 
kidney  and  the  ureter  filled  with  fluid,  but  no  stone  could 
be  felt.  The  block  must  therefore  lie  down.  The  ureter 
was  now  freed  extra-peritoneally  and  two  ctm.  below  the 
linea  areuata  pelvis  a  stone  was  found.  Whilst  the  opera- 
tor tried  to  push  this  back  between  the  fingers,  the  pelvis 
of  the  kidney  suddenly  tore  away  from  the  kidney.  He 
sutured  this  without  however  putting  in  fine  sutures,  and 
put  in  a  tampon.  At  first  all  the  urine  came  through  the 
wound,  gradually,  however,  it  began  to  go  through  the 
ureter  and  bladder,  and  did  so  until  at  last  the  wound 
healed  completely.  The  case,  he  added,  was  probably 
the  first  in  which  an  operation  had  been  performed  whilst 
the  patient  was  in  a  state  of  unemio  coma,  and  where  the 
ureter  was  so  extensively  laid  bare  without  being  opened. 

A  second  case  was  that  of  a  man  who  had  an  attack  of 
anuria  for  the  first  time  and  came  into  hospital  on  the 
sixth  day  in  a  marked  ursemio  condition.  At  the  opera- 
tion the  kidney  was  found  to  be  so  large  that  the  speaker 
at  onoe  concluded  it  was  solitary.  There  was  no 
pelvis,  but  the  ureter  passed  directly  into  the  kidney. 
Two  ctm.  below  its  point  of  exit  a  stone  was  found  fixed 
in  the  canal,  from  where  it  could  not  be  moved.  The 
ureter  was  therefore  opened  and  the  stone  removed. 
Several  stones  were  now  found  in  the  kidney,  and  he  was 
obliged  to  open  the  kidney  on  its  convexity  in  order  to 
remove  them.  When  this  was  done  a  sound  could  not  be 
passed  into  the  ureter,  and  there  was  a  possibility  that  a 
stone  was  present  lower  down,  and  on  this  account  the 
ureter  was  not  done  by  suture.  In  this  case  also  the  urine 
at  first  all  escaped  through  the  wound,  but  later  on  it 
came  the  natural  way.  That  the  kidney  was  solitary  was 
shown  by  the  fact  that  whilst  the  urine  escaped  through 
the  wound,  nob  a  drop  came  through  the  bladder,  and 
when,  a  fortnight  later,  the  fistula  again  opened,  the  same 
thing  happened  for  a  couple  of  days. 

Hr.  Langenbuoh  related  a  case  in  which  he  had  the 
misfortune  to  tear  away  the  pelvis  from  the  kidney  during 
an  operation.  He  had  hitherto  drained  in  such  cases  but 
after  the  experience  of  Hr.  Israel,  he  had  come  to  the 
conclusion  that  drainage  was  superfluous. 

Hr.  Sonnenburg  then  showed  a  man  with  an  abdominal 
tumour  that  had  been  growing  lately.    It  lay  in  the 


middle  line,  was  movable  and  nodular.  It  was  situated 
in  front  of  the  intestines  and  apparently  belonged  to  the 
bladder.  Hr.  Nitze  had  however  cystoeooped  the  bladder, 
and  saw  no  reason  for  this  assumption.  Possibly  it  was 
a  myoma.  It  was  not  a  case  for  operation.  The  tumour 
was  solid.  Several  speakers  then  mentioned  cases  more 
or  less  similar,  Langenbuch  one  that  proved  to  be  a 
dermoid ;  Nioolai,  one  that  proved  to  belong  to  the  mesen- 
tery ;  and  Mankiewicz,  one  that  he  had  seen  in  Paris,  in 
Guyon's  wards,  that  proved  to  be  a  malignant  growth 
starting  from  the  uraohus. 


[prom  our  own    00RR18P0NDBKS.] 

yiXHNA,  April  8rd,  1896. 
The  Physiology  and  Function  of  Hair. 

Prof.  Exnsr  treated  the  Gesellschaf  t  to  a  lengthy  review 
of  the  different  opinions  entertained  by  historic  authors  on 
the  growth  of  hair.  Many  volumes  had,  he  said,  been 
written  on  this  momentous  eubject,  yet  the  function  of 
this  integumentary  structure  is  not  to  be  found  in  one 
single  text  book.  Sohein,  of  this  city,  has  advanced  the 
idea  of  hair  being  the  outcome  of  stunted  growth  of 
the  tissues  and  that  where  activity  abounds,  hair  always 
disappears  on  the  surface.  Within  the  last  twenty  years 
the  subject  has  been  much  discussed  in  connection  with 
the  presumed  transformation  of  man  from  monkey. 
Climate  and  sunshine  have  been  adduced  by  Datwin. 
Even  taste  by  selection  has  not  been  without  its  devotees 
in  ascribing  the  cause  of  depilation  to  the  human  race, 
while  Maurer  has  more  recently  assigned  hair  to  be  the  out- 
come of  more  sentient  structures,  as  testified  in  fish  and 
reptiles,  where  hairs  are  connected  sensitive  papillae  of 
nerve  structure  are  found. 

In  animals  higher  in  the  scale  we  find  the  rudiments 
of  these  appendages,  which  have  become  obsolete  through 
disuse.  The  hair  appears  yet  on  the  head  of  the  human 
foetus,  which  would  show  that  the  time  was  too  short  for 
denuding  the  body,  or  that  it  yet  serves  some  useful  end 
Exner  is  in  favour  of  a  sensory  function,  which  Mieses  has 
undertaken  to  demonstrate  histologically  by  the  nerve 
apparatus  of  the  cilia,  which  sensory  connection  Jaubert 
of  Paris  has  confirmed  as  a  protection  for  the  eye. 

The  hair  of  the  eyebrows  as  well  as  the  fine  hair  over 
the  whole  body  act  in  a  similar  manner.  The  hair  of  the 
armpits  and  genitals  are  evidently  to  prevent  chaffing 
as  described  by  the  Grecian  writers.  The  thick  covering 
on  animals  of  hair  or  wool  have  an  electrical  property 
beside  the  covering  it  provides  for  inclement  weather ; 
the  hair  being  positive  while  the  fine  wool  is  negative. 

Both  are  bad  ronduotors  of  heat,  and  thus  moderate  the 
heat  of  the  body  by  retaining  the  physiological  product  of 
combustion,  at  the  same  time  moderating  the  transmission 
of  cold  or  hot  rays  from  the  existing  climate.  The  orna- 
mental function  of  Darwin  was  no  unimportant  feature,  as 
the  beard  of  man  and  the  long  hair  of  woman  have  still  an 
adorning  influence. 

Analysis  of  Suprabbkal  and  Thyroid  Glands. 

Frankl,  in  introducing  this  subject  to  the  Gesellechaft, 
paid  Oliver  and  Schiifer  a  tribute  for  their  early  discovery 
of  increased  blood  pressure  after  injection  with  these 
glandular  extracts.  These  investigations,  he  said,  were 
inclined  to  locate  the  source  of  stimulationjto  the  action 
on  the  peripheral  [vessels,  while  Cybulsky  favoured  the 


97p     9lUI  ttSDXOAJj  PKM* 


THE  OPEHULliiirG  ICfiEATEES. 


Af  SKi  8,  laiML 


idea  of  placing  it  as  a  oentral  cause.  Yelich  and  Bicdl 
have  ooncloded  from  their  experiments  that  the  centre 
excited  Is  the  medulla  which  reacts  on  the  spinal  cord. 

The  active  part  of  the  gland  seems  to  undergo  no 
change  with  hydrogen  peroxide  nor  in  solution  with  other 
Bubstanoes  as  it  still  retains  the  active  principle  after 
crystalisation.  Dissolved  in  water  it  gives  a  slight  green 
colour  with  chloride  of  iron,  which  soon  disappears.  In 
solution  with  nitrate  of  silver  and  a  few  drops  of  ammonia 
the  salt  is  decomposed.  It  has  also  the  property  of  sepa. 
rating  the  iodide  in  iodic  acid.  Fr&nkel  has  also  separated 
a  double  salt  of  platinum  analogous  to  neurin  from  the 
suprarenal  body,  which  he  designates  as  sphygmogenium 
from  its  action  on  the  blood  pressure. 

The  discovery  of  iodine  in  the  suprarenal  extract  by 
Baumann,  can  hardly  be  utilised  as  an  argument  in  favour 
of  iodine  treatment.  According  to  his  description  the 
extract  had  to  be  boiled  thirty  hours  with  nitric  acid 
before  the  iodine  could  be  discovered.  He  tiierefore  con- 
cludes that  it  was  not  preformed.  It  is  not  to  be  found  in 
the  blood  nor  in  the  gland  itself  until  this  chemical  opera- 
tion is  performed.  Dreohsel's  control  experiment  is  also 
against  the  iodine  activity  of  the  gland.  After  removing 
the  thyroid  gland  from  an  animal,  the  latter  was  fed  on 
boHed  hyroid  glands,  with  a  negative  result. 
The  Ubio  Acid  Diathisis. 

Kolisch  in  conjunction  with  Llostal  have  prepared  a 
long  series  of  experiments  in  the  separation  of  the  alox- 
urine  bodies  found  in  the  urine  when  normal  or  morbid. 
Hitherto,  it  has  generally  been  accepted  that  these  pro* 
ducts  were  derived  from  the  breaking  up  of  the  albumi- 
noidq,  but  Kolisch  is  of  opinion  that  it  is  specially  derived 
from  the  nuclein  of  the  cells  by  a  retrograde  degeneration. 
Between  these  two  points  a  number  of  toxic  bodies  exists 
such  as  hypoxanthin,  xanthin,  adenin,  kc,  which  are 
found  as  traces  in  normal  urine^  but  are  increased  i* 
quantity  according  to  the  morbid  condition  of  the 
organism* 


MIDDLBSEX  HOSPITAL. 

C^SSABIAIY    SiCnOK,    -WITH    A    DbBMOID    CtOT    OF    THJ 

OvABT  OBSTBUcnuo  Labottr.— Br.  BoxALL  operated  on  a 
woman,  »t.  about  25,  eight  months  pregnant  with  her 
first  child.  The  cervix  was  fully  dilated,  and  the  mem- 
branes had  been  ruptured  for  some  houcs  when  she  wa^ ' 
admitted  to  the  hospital.  There  was  a  space  of  one  inch 
only  between  the  tumour  and  the  symphysis  pubis.  An 
incision  was  made  in  the  middle  line  reaching  almost  tp 
the  umbilicus.  On  incising  the  uterus  the  placentfk 
bulged  into  the  wound,  and  was  torn  through  by  the  hand. 
The  right  leg  of  the  foetus  was  seized,  and  the  child 
extracted.  The  child  was  living.  The  placenta  and 
membranes  were  then  removed,the  cavity  of  the  uterus  wii^ 
packed  with  hot  sponges  wrung  out  in  a  sublimate  solu- 
tion, and  the  organ  turned  out  of  the  abdomen ;  np ' 
elastic  ligature  was  employed  ;  the  amount  of  blood  lost 
was  very  slight.  The  tumour  in  the  pelvis  was,  vrith  somfo 
difficulty,  raised  from  the  pouch  of  Douglas,  and  was 
found  to  have  a  long  pedicle,  which  was  transfixed  and 
tied  with  silk,  the  tumour  being  then  removed.  It  w^s 
ovoid  in  shape,  and  four  inches  in  its  longest  diameter ; 
it  mainly  contained  fetted  hair,  also  a  mass  df  fat  as 
big  as  a  large  chestnut,  some  skin  bearing  hair,   the' 


articular  end  of  a  bone,  and  some  fatty  and  mucoid 
material.  Deep  silk  sutures  were  passed  into  the  uterus, 
avoiding  the  mucous  lining ;  the  sponges  were  next 
removed,  and  the  deep  sutures  tied.  Superficial  peritoneal 
sutures  of  fine  silk  were  inserted  in  the  intervals  of  the 
deep  stitches,  both  were  eight  or  nine  in  number.  The 
pelvis  was  mopped  oat,  and  found  to  be  quite  clean.  The 
abdominal  wound  was  dosed  by  deep  silk  sutures  of  the 
peritoneum,  a  separate  silk  suturing  the  fascia,  and  by 
silkworm-gut  stitches  of  the  integumentary  stmetures. 
Dr.  Boxall  remarked  that,  in  this  case,  ^ere  was  no 
alternative  but  to  perform  abdominal  section,  for,  in  the 
first  place,  the  tumour  so  completely  blocked  the  pelvis 
that  craniotomy  was  impossible,  and  even  had  the  tumour 
been  of  less  sise  and  craniotomy  been  performed,  there 
would  still  have  remained  a  Ferious  risk  of  suppuration 
subsequently  taking  place,  and,  in  any  event,  the  twaour 
itself  would  only  have  been  satisfactorily  dealt  with  by 
abdominal  section. 

CHELSEA  HOSPITAL  FOR  WOMEN. 
RuPTUBBD  Tubal  Obstation— Abdominal  Sbctiov  ov 
THB  samb  Dat— Rbcovbby.— Dr.  William  Duncan  ope- 
rated on  a  woman,  mt,  SO,  who  was  sent  in  from  the  out- 
patient department  with  a  diagnosis  of  dilated  tube. 
Eighteen  months  previoudy  she  had  been  an  in-patient 
under  his  care  with  pelvic  haBmatocele  and  peritonitis  ;  the 
hsematocele  had  gradually  become  absorbed,  and  she  was 
discharged  practically  well.  Since  leaving  the  hospital 
the  periods  were  regular  and  not  excessive  ;  the  last  one 
wa9  due  on  Feb,  10th  (about  a  mondi  and  a  half  before 
the  present  operation),  but  did  not  appear  till  five  days 
later,  from  iriiich  date  up  to  the  time  of  her  admission  she 
had  had  a  regular  loss  with  pelvic  pain.  On  the  morning 
of  the  operation  it  appears  that  when  the  bowels  acted  she 
had  great  pain  in  the  abdomen  and  felt  faint.  Fortunately 
in  the  afternoon,  sfter  having  performed  two  alMbminal 
sections,  Br.  Duncan  went  into  the  ward  where  the  patient 
was,  and  was  at  once  struck  by  her  blanched  appearance ; 
he  then  discovered  that  her  temperature  was  subnormal, 
96^.  On  examining  4^e  abdomen  he  found  it  doll  over  the 
greater  part  of  its  extent :  he  diagnosed  intemid  hiemor- 
rhage  probably  from  ruptured  tubal  pregnancy.  The  patient 
was  at  once  taken  to  the  operating  theatre  and  abdominal 
section  performed.  When  the  peritoneal  cavity  was  opened  a 
large  quantity  of  recently  extravasated  blood  flowed  out 
throu^  the  incision ;  the  fingers  were  passed  down,  and 
the  left  tube,  whidi  was  found  to  be  enlarged,  was  seised, 
and  the  hemorrhage  controlled.  The  remainder  of  the 
blood  and  a  large  quantity  of  recent  clot  having  been 
removed,  it  was  found  that  the  broad  ligament  had  been 
distended  with  Mood,  and  had  ruptured  eecondarHy  into 
the  peritoneal  cavity ;  the  ligament  was  tran^xed  with 
the  pedicle  needle  and  silk,  tied  in  the  usual  manner, 
and,  with  the  tube,  removed.  The  abdominal  cavity  was 
irrigated  with  a  large  quantity  of  boiled  water  at  a  tem- 
perature of  106,  a  drainage-'tube  passed  down  to  the 
floor  of  the  pelvis,  and  the  abdomen  dosed  in  the  ordinary 
way.  Dr.  Duncan  remarked  that  Uiese^oaeee  were  always 
most  interesting,  and  that  the  one  in  point  |iffi>rded 
another  proof  that  the  proper  treatment  where  there  is 
effusion  of  blood  taking  place,  even  though  there  be  no 
definite  history  of  tubal  pregnancy,  is  to  performimmediate 
abdominal  section.  l%is  patient,  he  said,  was  in  such  a 
dangerous  condition  at  the  time  of  operatien  Aat  she 
could  hot  have'bome  the  lose  -of  much  move  Wood ;  it  so 
^happened  that,  owing  to  other  optrattons,  ohe  ted  «ob 


Afvx.6,  UI96. 


tEADiNG  ARTICLES. 


This  Msdjoal  Press.     377 


htfoa  9tm  U^  a  i«v  boors  «ther  by  tbi9  r^iid^nt  mudioal 
loffioeror  tib#  aUffourae,  «o  Uiikt  it  w«e  lortuoate  that  hp 
bjniaell  had  chanced  to  go  into  the  ward  before  leaving 
th^hoepitaly  and  thus  no  precioas  time  was  lost  in  having 
to  send  for  him.  The  patient's  general  appearance  and 
condition,  together  with  the  blanched  look,  the  rapid  and 
almost  imperceptible  pulse,  and  the  subnormal  tempera- 
ture showed  unmistakeably  that  internal  hsemorrbage  to  a 
dangerous  extent  had  already  taken  place,  and  that  no 
time  was  to  be  lost  if  the  woman's  life  were  to  be  saved 
Owing  to  the  administration  of  ether  and  to  the  flushing 
of  the  alMlominal  cavity  with  hot  water,  the  pulse  was 
mueh  improved  at  the  end  of  the  operation  which  lasted 
diree-qaarters  of  an  hoar.  Dr.  Duncan  said  this  was  a 
case  of  tubal  pregnancy  in  the  anterior  third  of  the  tube 
in  whieh  primary  rupture  had  occurred,  the  blood  being 
flffuaed  between  the  layers  of  the  broad  ligament,  and 
eSQpndary  rupture  of  the  broad  ligament  had  taken  place 
into  the  general  peritoneal  cavity.  The  tube  was  removed 
in  thirty-six  hours,  there  not  having  been  much  effusion, 
and  the  patient  made  an  uninterrupted  recovery. 

SJ    ■    ll      Ml'.  ■ 

vammmBMJ}  fob  tbavsmissioi  abroad. 

Publldiod  evacy  Wadnaaday  morning,  Prloa  M.   Poat  fraa,  6}d. 
ADYBBTIBBMBNTS. 

FOB  On  IBSBBSIOV .'— Wliola  Paga,  ^£6  Oi.  Od. ;  BaW  Faga,  <S  10a.  M. 
qnartar  Faga,  Al  6a. ;  Ona-algbtli,  ISa.  6d. 

Fob  a  Sbbiis  07  Ihsbbhovs  :— Wliola  Faga,  thlrtaan  Inaartlont 
(waeUy,  fottni^itly,  or  monthly)  at  iBS  lOa.  Od. ;  twan^-alz  Inaer- 
tiona  (vaakly  or  foiinighUy)  at  JB8  Si.  Od. ;  flUy-two  Inaartlont 
(waaUy)  at  £$  aach.  Half -imga,  thirtaen  Inaartlona  at  86a. ; 
iwantjr-alz  at  SSa. ;  llfty-two  inaartlona  at  SOi.  aaoh.  Qoarter-paga, 
ttiirtaeD  laaertlona  at  ISi. ;  twauty-alz  inaartlona  at  ISa. ;  llfty^ix 
iaaertloBa  at  Ifia.  aach 

Miall  AnnonBcamanta  of  Fractlcaa,  AaiJataBoSaa,  Tacandaa,  Bcok 
te.— fiavan  llnaa  or  nndar,  4a  per  iniertlon ;  M.  per  Una  beyond. 

Lattarata  thla  department  ahonld  be  addretted  to  the  PnbUtberi 

BVBIOBIFTIOHS. 
FMt  fBFB  TO  ABVIJAL  8DBSGBIBBBS      .        .  ill    1    0 

„        ABBOAD.wiTHnr  THB  PosxALUnoa      «i  B  e 
„        laniA,  GmvA,  abd  Japab  .  .    <1  6  e 

Ksia-oftea  Orden  and  Chaqaeato  be  drawn  in  favour  of— 

A.  A.  TIBDALL,  20-81  King  William  Street,  Strand,  London. 
A.  H.  JACOB,  m  Moleaworth  Street,  Dublin. 


%\lt  SJjeMal  §r«s  ^  Cirritlar. 


'SALUB  POPULI  flUPRBMA  LBX." 


WEDNESDAY,  APRIL  8,  1896. 


AM  ANTIVACCINATION  BILL  OF  COSTS. 
Ab  object  lenon  of  the  dangers  iDcnrred  by  the  neglect 
ef  vaceinatioa  is  bow  on  view  at  Qloacester.  Carionsly 
Moagh,  it  is  loeated  within  a  few  miles  of  the  very 
•pot  where  Jeoner  worked  out  the  f  amoos  theory  wMch 
his  since  been  fraught  with  untold  benefits  to  the  oom- 
BHiiii^.  Gloucester,  however,  is  one  of  the  places  that 
iiMro  been  eaptured  hj  the  fallacious  sentimentality 
Af  the  BBti-vaoeiAationiBto.  For  the  last  nine  years  its 
laaal  Mithorities  have  failed  grievously  in  the  enforce- 
b  oi  the  VaeciBation  Acts.  As  an  inevitable  conae- 
a  QaB8i4enLUe  popttlatim  at  iuivaeciiMt#d 

to  «reU  Hm  9m 


viously  existing  margin  of   individuals  unprotected 
against  that  most  loathsomi^,  disfiguring,  and  deadly  of 
specific  infectious  complaints,  small-pox.  When,  there- 
fore, the  disease  in  question  invaded  the  place  it  found 
plenty  of  material  ready  for  coi  flagration,  and  after 
some  amount  of  flickering  and  smouldering  combustion, 
it  has  burst  out  in  the  full  force  of  a  virulent  and 
fiercely  spreading  outbreak.  From  the  figures  recorded 
in  last  week's  issue  of  the  Msdical  Press  and  Cib- 
CULAR,  it  will  be  at  once  seen  that  the  brunt  of  the 
mortality  has  fallen  upon  the  unprotected  individuals. 
Thus,  of  the  90  deaths  that  occurred  in  369  hospital 
cases,  no  less  than  74  were  of  ul vaccinated  persons, 
while  the  remaining  16  had  not  been  vaccinated  since 
infancy.    Another  striking  feature  is  the  large  propor- 
tion of  attacks  and  deaths  among  tbe  infantile  popula- 
tion.   A  still  more  distressing  factor  is  the  number  of 
cases  of  blindness  that  have  been  caused  by  the  present 
epidemic.    It  would  be  a  fair  chaUenge  to  the  anti- 
vaccinationists  to  produce  even  a  few  cases  of  loss  of 
sight  due  to  small- pox  in  properly  vaccinated  persons. 
On  the  other  hand,  everyone  knows  that  the  condition 
was  formerly  extremely  common,  and  that  a  large  per- 
centage of  the  blind  now  among  us  were  disabled  by 
small-pox  in  the  old  pre- vaccination  times.  What  have 
the  anti- vaccinationists  to  say  to  that  ?    It  seems  hope- 
less, however,  to  persuade  these  enthusiastic  faddists 
to  submit  their  views  to  the  sifting  of  ordinary  logic. 
Now  and  then,  however,  as  in  the  case  of  Gloucester, 
the  world  is  afforded  a  glimpse  of  the  disastrous  results 
of  the  theory  of  anti-vuccination  when  applied  in  the 
form  of  a  great  natural  experiment  to  a  centre  of  popu- 
lation.   Under  the  influence  of  panic,  the  inhabitants 
of  this  somewhat  sleepy  cathedral  town  have  flocked  in 
scores  of  hundreds  to  the  public  vaccinators,  but  this 
sudden  repentance  comes  all  too  late  in  the  face  of  a 
serious  epidemic.     Apart  from  the  mere  element  of 
fear,  however,  there  is  another  potent  appeal  to  the 
good  citizens,  namely,  that  which  applies  to  the  pocket. 
Never  was  any  town  made   to   suffer  for  its  sins 
more  swiftly  and  surely  than  Gloucester  in  the  pre- 
sent instance.    As  an  ancient  county  town,  it  has  from 
early  times  been  a  centre  for  the  commercial  and  ad- 
ministrative, as  well  as  the  social  needs  of  the  district. 
All  these  functions  have  been  dislocated,  and  the  townsii 
folk  will  suffer  in  consequence  a  very  heavy  direct  loss 
in  the  turning  away  of  mon^  from  their  doors.  Perhaps 
the  anti-vaccinationists,  who  are  ever-fertile  in  attempt- 
ing to  prove  black  is  white,  will  be  able  to  show  that 
the  material  prospects    of  Gloucester  people   have 
not  been  adversely  affected  by  the  present  outbreak, 
and  that  the  latter  is  not  due  to  the  existence  of  an 
unvaccinated  population.     Some  time  since  the  pre- 
siding judge  announced  that  the  Assizes,  in  consequence 
of  the  prevalence  of  small-pox,  would  be  removed  to 
Cheltenham.     Now,  following  on  the  heels  of  that 
reverse  comes  a  crop  of  similar  announcements  that 
must  fill  the  hearts  of  the  townspeople  with  dismay. 
For  instance,  the  two  great  railway  companies— the 
Great  Western  and  Midland— have  cancelled  all  excur- 
sions to  Gloucester,  and  have  stopped  the  issue  of  week- 
m4  tiekii^ts.    7te  mwbors  of  Om  CSotowold  Qimt  have 


378     Thi  Midigal  Pbcsb. 


LEADING  AKHCLES. 


April  8,  1806. 


moved  to  Cbelteoham.  Lastly,  the  Gloucestershire 
Yeomanry  will  not  be  called  up  for  training  this  year. 
This  latter  fact  alone  involves  a  severe  loss  to  the  town 
as  it  means  the  abandonment  of  an  intended  visit  by 
the  Prince  of  Wales.  From  these  statements  it  will  be 
evident  that  Gloucester  is  under  ban  as  a  plague- 
stricken  district.  To  recover  the  solid  advantages  that 
have  been  lost  to  the  revenues  and  prestige  of  the  town  by 
the  epidetpic  will  doubtless  be  the  work  of  years.  For 
all  this  the  citizens  have  to  thank  themselves.  In 
addition  to  this,  this  infected  spot  has  acted  as  a  centre 
of  infection  for  Bath,  Cardiff,  Bristol,  and  many  other 
towns  and  districts,  chiefly  through  the  agency  of 
trampp.  Taking  a  broad  view  of  the  facts,  it  almost 
looks  as  if  Providence  had  expressly  interfered  to  point 
the  moral  of  vaccination  at  the  expense  of  the  victims 
to  this  scourge,  which,  although  preventible,  is  not 
prevented,  and  which  has  run  riot  through  the  ranks 
of  the  unprotected  in  Gloucester. 


WHAT  IS  THERAPEUSIS1 
Thebapbusis,  as  was  recently  observed  by  Dr. 
Chauffard,  is  the  touchstone  of  medicine.  Nosology 
and  pathology  no  doubt  possess  an  interest  of  their 
own,  they  are  branches  of  natural  history  applied  to 
the  study  of  perversions  of  physiological  activity  and 
alterations  of  structure  in  living  beings,  but  thay  lack 
the  peculiar  and  all-absorbing  interest  of  curative 
medicine.  Medicine,  after  all,  is  not  the  science  of 
disease,  nor  is  ito  object  the  study  of  disease-producing 
causes  or  the  phenomena  of  disease,  as  observed  in  the 
course  of  an  attack.  It  is  the  possession,  or  the 
research,  of  the  means  of  curing  or,  at  least,  of  relieving. 
It  is  quite  possible  to  be  an  accomplished  pathologist 
without  being  a  medical  practitioner,  indeed,  the 
medical  practitioner  differs  from  the  former  in  that  his 
scientific  studies  have  for  object  the  cure  of  disease, 
the  relief  of  pain,  and  the  postponement  of  the  fatal 
termination.  Pasteur,  who,  perhaps,  more  than  any 
other  scientist  of  the  present  century  has  assisted  in 
the  prevention  and  the  cure  of  disease,  was,  in  no 
sense,  a  medical  man.  It  remained  for  others  to  apply 
the  marvellous  resulte  obtained  by  him  in  the  depart- 
ment of  bacteriology  to  the  prevention  and  the  cure  of 
disease.  In  years  gone  by  a  disease  was  known  only 
in  ito  symptoms,  the  relief  of  which  constituted  the 
palliative  therapeusis  so  long  in  vogue.  To  combat 
these  symptoms,  which,  in  the  aggregate,  were 
assumed  to  he  the  disease,  recourse  was  had  to 
various  remedies  which  appeared  to  produce 
effecte  more  or  less  antogonistic  to  the  morbid 
manifestations,  the  practitioner  sought  to  modify 
certain  physiological  processes  or  to  dull  the  sen- 
sory apparatus,  thus  subduing  spasm,  reducing 
the  temperature,  dilating  or  constricting  the  vessels, 
provoking  or  restraining  certain  secretions,  or  deter- 
mining sleep.  We  have  long  since  made  up  our 
minds  as  to  the  therapeutical  value  of  this  kind 
of  medication  which,  at  the  best,  can  only  be  pal- 
liative. Not  indeed  that  such  measures  are 
therefore  to  be  despised ;  on  the  contrary,  it  is  to  such 


measures  that  medicine  owes  its  present  position,  and 
without  it  medicine  would  long  since  have  fallen  into 
contempt.  When  we  are  unable  to  cure,  it  is  our  duty 
to  seek  to  relieve,  and  this  system  of  therapeutics, 
palliative  in  its  aims,  is  essentially  physiological  in  its 
action.  The  therapeusis  of  the  present  day  is  based 
on  quite  another  principle,  being  pathogenic  in  ito  con- 
ception. Etiological  therapeusis,  in  a  more  or  less 
general  way,  has  long  been  known  and  practised. 
When  the  cause  of  the  disease  was  known,  it  was 
eliminated  or  destroyed  or  neutralised,  foreign  bodies 
were  removed,  parasites  were  killed  or  expelled,  and 
poisons  were  evacuated  or  their  elimination  facili- 
tated. In  view  of  the  effecte  following  our  in- 
tervention, we  were  but  too  apt  to  claim  the  credit 
of  having  cured  the  patient,  whereas  in  reality 
we  are  only  entitled  to  the  credit  of  having 
removed  the  obstacle  to  recovery,  nature  doing 
the  rest  Pathogenic  therapeusis  must  be  carefully 
distinguished  from  etiological  therapeusis.  The  former 
reveals  the  method  of  action  of  the  disease-producing 
agent  and  the  reaction  of  the  organism  to  this  cause, 
this  being  the  malady  properly  so-called.  It  enables 
us  to  distinguish  the  reactive  phenomena  which  tend 
to  protect  the  organism  against  the  effecte  of  the  cause, 
and  those  which  prepare  and  ultimately  accomplish 
the  cure.  The  practitioner's  duty,  then,  is  to  assist 
those  phenomena  which  are  recognised  to  have  a 
curative  tendency,  to  provoke  them  or  to  imitete  them, 
in  fact,  with  the  object  of  bringing  about  the  natural 
cure  he  introduces  them  artificially  into  the  body  when 
these  curative  manifestotions  do  not  sponteneously 
declare  themselves.  Recovery  is  seldom  or  never  the 
direct  result  of  artificial  means.  With  or  without 
the  aid  of  medicine  it  tekes  place  on  natural  lines,  but  it 
belongs  to  the  practitioner,  usually  to  assist,  sometimes 
to  provoke,  the  curative  reaction,  or  even  to  determine 
it  by  the  aid  of  an  organism  foreign  to  the  economy.  It 
very  ofton  happens  that  the  [morbid  manifestotions 
provoked  by  a  comparatively  insignificant  cause 
are  in  reality  purely  accidentel,  that  is  to  say, 
they  are  due  to  tiie  action  of  the  cause  on 
an  organism  possessing  special  tendencies.  For 
instonce,  intestinal  worms  have  been  known  occa- 
sionally to  give  rise  to  convulsions,  but  this  can 
only  be  the  case  in  individuals  prone  by  heredity,  or 
otherwise,  to  nervous  phenomena  of  this  kind.  We 
remove  the  cause  and  the  convulsions  cease,  but  we 
have  not  cured  the  morbid  condition  which  is  still 
there,  ready  to  break  out  afresh  lator  on  in  response  to 
slight  stimuli.  It  is  not  altogether  fair  to  assert  that 
recovery  is  in  every  instance  brought  about  by  the  vis 
medicairix  naturce,  but  it  is  nevertheless  true  that  our 
intervention  is  principally  in  the  direction  of  favour- 
ing or  assisting  natural  curative  processes.  There  is 
nothing  necessarily  humiliating  in  this  admission. 
When  the  practitioner  is  unable  to  discern  any  indica- 
tions for  treatment  he  is  fain  to  have  recourse  to  the 
empirical  means  bequeathed  to  him  by  his  predecessors 
In  default  of  a  cure,  he  may,  at  any  rate,  bring  relief 
and  restore  mental  calm,  and  when  he  has  done  this 
much  he  may  rest  satisfied  with  having  done  his  dutj. 


Apbil  8,  1896. 


NOTES  ON  CURRENT  TOPICS 


Thb  Mkdical  Press.     379 


If  it  be  esaential  that  the  practitioner  should  learn 
how  and  when  to  intervene  in  the  direction  of  facili- 
tating processes  recognised  to  be  curative  in  their 
tendencies,  it  is  not  less  important  that  he  should  be 
taught  not  to  interfere  with  their  evolution  by  ill- 
timed  and  active  measures.  Where  science  is  mute, 
he  must  understand  that  it  is  dangerous  to  risk  the 
disturbance  of  natural  methods  of  cure  by  more  or  less 
violent  means.  We  live  at  present  in  a  period  of  hasty 
empiricism,  in  which  commercialism  jostles  science, 
but  there  is  no  royal,  still  less  any  commercial,  road  to 
therapeutical  success.  Injudicious  and  immature 
experiments,  inadequate  and  hasty  observations,  wild 
generalisations  and  unscrupulous  affirmations,  delay 
progress  and  tend  to  bring  science  into  discredit  Pro- 
gress is  slow,  and  not  always  sure,  but  it  is  in 
the  resources  of  pathogenic  therapeusis  that  we  shall 
probably  find  most  assistance  in  grappling  with  the 
problems  which  remain  to  be  solved  in  the  domain  of 
curative  medicine. 


"AS  OTHERS  SEE  US." 
It  is  a  useful  discipline  for  anyone  to  submit  him- 
self to  the  monitions  of  the  **  candid  friend,"  and, 
indeed,  it  would  do  ourprofession  nogreatharmif  wehad 
occasionally  to  bear  *'  the  slings  and  arrows"  of  adverse 
criticism,  considering  that  we  are  so  constantly  assured 
that  we  are  the  noblest  of  created  beings,  and  are 
superior  to  all  considerations  of  personal  aggrandise- 
ment or  filthy  lucre,  such  being  the  staple  of  introduc- 
tory lectures  and  poet-prandial  speeches.  Here  is  what 
the  Chemist  and  Druggist  says  of  us  :— 

^  It  is  curious  to  note,  too,  the  sublime  persistence 
with  which  medical  practitioners  cling  to  tbeir  belief 
in  their  own  superhuman  morality.  The  Ten  Com- 
mandments are  not  enough  for  them.  They  have  sup- 
plemented these  with  a  jumble  of  other  regulations^  a 
tew  of  which  have  an  ethical  basis,  while  the  majority 
are  merely  manifestations  of  trade-union  policy.  They 
must  not  advertise,  they  must  not  consult  with  a 
homoeopath,  thev  must  not  take  less  than  a  guinea  for 
a  consultation,  they  must  not  recognise  a  secret  remedy 
— ^ese  are  among  the  rules  which  govern  their  own 
conduct :  the  public  is  under  a  much  severer  control. 
The  patient  who  surreptitiously  consults  another 
medi(»d  man  while  he  is  under  Ids  regular  doctor's 
treatment  is  as  criminal  as  the  one  who  asks  for  a 
detailed  statement  of  his  medical  attendant's  account ; 
whDe  any  poor  wretch  who  may  have  bought  a  powder 
from  a  chemist  for  her  baby  before  she  called  in  a 
doctor  is  liable  to  a  reprimand  from  a  coroner— if  this 
official  should  be  a  medical  man.  The  practitioners  at 
the  bottom  of  the  profession,  who  find  it  none  too 
easy  to  get  a  shilling  for  medicine  and  advice,  and 
never  dream  of  the  ffuinea,  are  only  lij^htly  bound  by 
the  chains  of  medical  etiquette  ;  and  it  appears  that 
gentlemen  at  the  very  head  of  the  profession  are  not 
bound  by  them  at  all. 

It  must  be  admitted  that  there  is  a  substantial  amount 
of  truth  in  this  objurgation,  as  much,  at  least,  as  can 
be  expected  from  a  prescribing  chemist  when  speaking 
of  a  competing  general  practitioner ;  but  it  may  be 
answered  that,  if  our  profession  is  obliged  to  make 
laws  for  itself,  it  does  so  because  the  public  omits  or 
declines  to  make  laws  for  itself.  Not  even  the 
jounuJiatic  representative  of  the  prescribing  chemist 


can  maintain  that  it  is  consistent  with  the  well-being 
of  the  community,  not  to  speak  of  the  doctors,  that 
traders  who  have  admittedly,  never  learned  how 
to  detect  or  treat  disease,  and  who,  commonly,  never 
see  the  patient,  should  sell  advice  which  they  are  mani- 
festly incompetent  in  many  instances  to  give,  aiid 
should  cause  potent  drugs  to  be  administered,  on  the 
effect  of  which,  in  the  particular  case,  they  can  have 
only  the  dimmest  idea.  Nor  can  any  one  suggest  that 
it  is  a  good  thing  that  parents  should  be  encouraged, 
by  laxity  of  system,  to  imperil  the  lives  of  those  for 
whom  they  are  responsible  by  dealing  with  their  sick- 
nesses by  this  method.  We  avow  ourselves  as  free- 
traders, but  we  say  that  the  existing  medical  system 
is  an  illustration  of  free-trade  gone  mad.  The  existing 
law  declares  that  any  one,  however  ignorant,  may 
trifle  with  human  life,  may  administer  potent  drugs 
without  being  practically  responsible  for  any  fatality 
which  may  ensue  therefrom.  It  also  declares  that  any 
parent  may  be  accessory  to  this  process  and  cannot  be 
held  liable  for  damage  or  death  of  the  child,  for 
whose  care  and  nurture  he  or  she  is  responsible. 
While  it  thus  encourages  the  utmost  laxity  in  matters 
of  health  and  life,  it  surrounds  the  practice  of  trade 
with  the  strictest  barriers  and  the  narrowest  limits. 
Thus,  the  business  of  the  chemist  is  a  most  cogent 
instance  of  this.  The  Inland  Revenue  people  and  the 
Pharmaceutical  Societies  join  together  in  exercising 
the  closest  watchfulness  lest  any  person  not  legally 
qualified  should  sell  a  pennyworth  of  anything  to  any 
one.  Both  bodies  have  theircorps  of  detectives,  and  much 
of  their  resources  is  expended  in  prosecuting  without 
mercy  every  poor  trader  who  treads  on  the  hem  of  the 
pharmaceutical  toga.  We  do  not  complain  of  this, 
but  we  do  protest  that  the  profession  is  fully  justified 
in  providing  for  itself  a  sort  of  unwritten  law,  and  is 
doing  excellent  public  service  in  enforcing  it  as  far  as 
it  can.  The  time  is  coming,  we  hope,  when  thepublic  will 
be  educated  up  to  a  recognition  of  the  fact  that  it  can- 
not be  for  the  general  benefit  that  unrestricted  medical 
practice  and  unlimited  prescribing  of  dangerous  drugs 
should  be  permitted.  Until  that  time  arrives,  we  trust 
that,  so  far  as  it  may  be  possible  to  exercise  moral 
pressure  to  keep  the  practice  of  our  profession  pure, 
that  pressure  will  be  unsparingly  exercised. 


J[0te0  on  (ffutrent  ^opiw. 

The  Relative  Value  of  the  Various  Digitalinee 
Thb  one  drawback  to  the  otherwise  great  advantages 
of  prescribing  active  principles  of  medicinal  plantp, 
instead  of  crude  vegetable  products  nas  so  far  been  tbe 
difficulty  experienced  in  obtaining  alkaloids  perfectly 
uniform  in  composition  and  physiological  activity. 
Little  by  little  this  uncertainty  has  been  obviated, 
thanks  to  the  efforts  of  individual  chemists,  who,  for 
the  most  part,  have  bequeathed  their  names  to  a  par- 
ticular salt,  as  a  guarantee  of  chemical  and  therapeu- 
tical identity.  For  instance,  the  number  of  the 
so-called  active  principles  of  digitalis  in  the  market  is 
considerable,  and  has  been  so  for  some  years.    Inas 


$80    Tn  Medical  t^nvs. 


KOTES  ON  CtTRREHt  TOPICS. 


Apbil  8,  I8i6« 


mucb  aa  these  various  digit^lines,  knowo  as  ciystallised 
and  amorphous,  or  as  digitozin,  differ  considerably  in 
physiological  activity,  medical  men  have  been  some- 
what chary  of  prescribing  them  in  view  of  the  possi- 
bility of  inadvertently  ordering  a  drug  of  which  the 
effects  would  fall  short,  or  be  in  excess,  of  requirements. 
With  the  object  of  clearing  up  a  quisstion  of  consider- 
able therapeutical  importance,  the  French  Therapeu- 
tical Society  recently  appointed  a  committee  to 
investigate  and  report  upon  the  various  active 
principles  of  digitalis  actually  in  the  market  Accord- 
ing to  their  report  there  is  only  one  alkaloid  of  digitalis 
which  can  justly  be  described  as  possessing  a  definite 
chemical  composition— the  crystallised  digitaline  dis- 
covered some  years  since  by  Nativelle.  Uniformity  of 
composition  of  necessity  infers  uniformity  of  effect,  and 
this  consideration  led  the  committee  to  recommend 
that  this  crystallised  digitaline  should  alone  receive 
official  recognition  in  the  French  Codex.  The  German 
Digitozine  is  an  undefined  mixture  of  active  principles 
whiJb  is  sometimes  equal  in  activity  to  the  crystallised 
salti  and  is  sometimes  twice,  or  even  three  times  as 
^tiFe.  Amorphous  digitaline  is  open  to  the  same 
objection,  viz.,  that  it  contains  a  variable  proportion  of 
i^  very  active  glucoside.  What  the  practitioner  re- 
quires is  not  so  much  intrinsic  activity  as  assured  uni- 
formi^r  of  action,  and  under  existing  circumstances  the 
only  product  that  can  be  safely  prescribed  is  Nativelle's 
chloroformic  or  crystallised  digitaline.  The  matter 
possesses  special  int  erest  in  view  of  the  forthcoming 
edition  of  the  British  Fhamuicopoeia, 


A  Surgeon's  Eye. 
Ths  human  eye  has  many  unspeakable  gifts,  some 
of  which  unmistakably  add  to  its  attractiveness,  and 
some  do  not  Our  readers  will  probably  be  interested 
to  learn  what  a  surgeon  at  a  large  London  Hospital 
thinks  of  the  eye  which  distinguished  a  late  colleague, 
whose  personality  has  often  been  the  subject  of  admira- 
tion. In  an  able,  thoughtful  "  In  Memoriam  "  notice 
of  Sir  William  Savory,  contributed  to  the  new  volume 
of  ''  St.  Bartholomew's  Hospital  Reports,"  Mr.  Howard 
Marsh  writes  as  f oUows  :— ^*  His  (Savory's)  eye  was  pale 
blue,  inclining  to  be  gray.  Its  general  expression  was 
that  of  calm  intelligence,  but  it  was  singularly  expres- 
sive, and  its  range  of  expression  was  remarkable.  It 
is  a  truism  to  say  that  the  eye  often  discloses  the 
whole  man,  and  tiiat  the  more  remarkable  the  man,  the 
more  telling  is  the  eye.*  Savory's  eye  was  clear, 
steady,  and  alert,  it  seemed  to  give  a  pledge  more 
binding  than  any  words ;  it  could  be  eloquent 
in  thanks,  it  could  convey  generous  approval.  These 
were  its  quiet  moments.  But  in  an  instant  it 
became  all  aglow,  and  expressive,  as  the  occasion 
ruled,  of  keen  attention,  intense  amusement,  or 
blank  incredulity ;  or  it  would  cloud  over  and 
darken,  and  launch  a  sudden  ultimatum.  Steele,  in 
the  Spectator,  tells  us  that  he  has  seen  an  eyebrow  call 
a  man  a  scoundrel.  Savory's  eye,  at  all  events  till 
years  brought  larger  tolerance  and  restraint,  not  only 
pronounced  sentence,  but  it  passed  on  to  slay  tiie 
enemy  ^wtece  h»  stood."    AJU  old  Bailhoiomew'ji  «nen 


who  were  students  in  Savory's  time  will  appreciate  the 
truths  contained  in  these  remarks.  The  slaying  pro- 
cess was  one  which  was  not  infrequently  seen.  The 
scene  was  usually  the  operating  theatre,  and  the  time 
Thursday  afternoons,  when  the  consultations  were 
held,  ^vory  was,  perhaps,  intolerant  of  any  diversity 
of  opinion  when  it  applied  to  himself.  There  were 
occasions  at  these  consultations  when  his  opinion  was 
entirely  in  a  minority^  the  minority  being  represented 
by  himself.  It  was  then  that  the  slaying  process  was 
displayed  in  the  fulness  of  its  power.  Like  a  flock  of 
sheep,  as  it  appeared  to  Savory,  colleague  after  colleague 
would  reiterate  with  worrying  monotony,  the  opinion 
expressed  on  the  case  by  the  senior  colleague 
who  spoke  first.  At  last  the  most  junior  colleague  on 
the  staff  would  give  his  verdict  in  the  same  terms,  and 
then  it  was  that  the  colour  would  come  and  go  in 
Savory's  face,  that  the  eyes  would  flash,  and  the 
trembling  features  show  the  tumult  of  his  feelings. 
These  weie  sights  for  students  to  see  and  remember, 
and  they  have  been  vividly  recalled  by  the  description 
quoted  above  from  Mr.  Marsh's  notice.  Still  Savory 
was  a  worthy  successor  of  Lawrence,  and  the  power 
that  he  swayed  was,  perhaps,  equally  as  great.  But 
with  him  there  died  the  reginU  of  a  mannerism  of  which 
the  model  and  type  was  Lawrence. 


Quackery  in  High  Places. 
Thb  fedings  of  a  number  of  the  members  of  the 
medical  profession  in  Berlin  have  lately  been  disturbed, 
our  German  correspondent  informs  us,  by  an  occurrence 
that  is  fortunately  somewhat  of  a  rarity.  It  is  no  less 
than  that  of  a  quack  being  called  in  to  attend  a  patient 
in  a  public  hospital.  The  curator  of  the  hospital  in 
question  has  thought  fit  to  publish  an  '*  explanation  "of 
the  occurrence,  which,  however,  is  scarcely  an  explana- 
tion, being,  in  fact,  nothing  more  than  a  bare  state- 
ment On  February  2nd  of  this  year^  it  appears 
Qeneral-Major  Herr  von  lippe,  Fliigel  Adjutant  of 
the  Emperor,  was  admitted  into  the  Augusta  Hospital, 
suffering  from  a  grave  organic  lesion  of  the  spine, 
H^lthough  there  was  no  difficulty  in  the  diagnosis,  and 
the  mode  of  treatment  was  clear,  a  consultation  was 
held  between  the  physician  in  attendance  and  Pr. 
Jolly,  Director  of  the  University  KUnik  for  Nervous 
Diseases,  in  which  Dr.  JoUy  agreed  with  Dr.  Ewald  on 
every  point.  The  further  course  of  the  disease  led  Dr- 
Ewald  to  point  out  to  Frau  von  Lippe  the  hopeless 
nature  of  the  disease,  and  he  proposed  on  the  same  day 
another  consultation  with  a  nerve  specialist  This  was 
declined,and  a  counter  proposal  was  made  by  the  lady  to 
call  in  an  unqualified  man  from  Dresden,  named  QosseL 
The  introduction  of  the  quack  was  insisted  on,  and  under 
these  circumstances  Dr.  Ewald  felt  compelled  to  retire 
from  the  case  as  he  could  not  hold  a  consultation  with  an 
unqualified  man,  nor  work  in  connection  with  him. 
This  decision  was  communicated  by  Dr.  Ewald  to  the 
*'  Curatorium  "  of  the  hospital.  In  the  meantime  Herr 
Gossel  had,  in  fact,  entered  i^>on  the  treatment  of  the 
case,  and  was  already  in  the  hospital  as  the  patient 
was  too  ill  to  be  removed  againet  his  .wishes.  .On  4iie 
ie  between  Bmk  iippe  end  4he 


April  H,  ISMl 


NOnse  ON  OUHBBNT  TOPICS. 


Tn  Medkuel  Pntt.    981 


hospital  was  seveted.  He  had  Mb  own  attendants,  and 
procured  his  food  from  without,  and  he  only  used  the 
hospital  as  a  shelter  while  continuing  to  be  unfit  for 
removal.  As  a  proof  of  the  wonderful  ability  of  the 
quack,  it  is  adduced  that  he  made  his  diagnosis  at  a 
distance  by  simply  smelling  the  patient's  stockings. 
The  patient  improved  under  the  new  treatment,  and  it 
remains  to  be  seen  whether  the  improvement  is  illusory, 
transient,  or  permanent.  It  is  said  that  such  occurrences 
as  the  above  are  not  very  rare  with  the  higher  German 
aristocracy,  although  it  is  unusual  for  them  to  occur 
while  one  is  actually  under  treatment  in  a  public 
hospital. 

Hydrophobia. 
We  have  recently,  in  view  of  the  increased  strin- 
gency of  muzzling  orders,  endeavoured  to  show  that 
rabies  is  a  rare  disease  in  the  dog,  and  still  more 
rare  in  the  human  subject,  and,  therefore,  that  muzzling 
orders  are  not  always  justified  by  the  risks  to  any- 
one from  hydrophobia.  We  publish  to-day  a  letter 
from  a  correspondent  who  takes  the  opposite  view, 
and  who  brings  to  the  subject  a  good  deal  of  personal 
trustworthy  experience,  and  we  commend  his  statements 
to  the  attention  of  those  who  are  interested  in  the  con- 
troversy. Meanwhile,  we  can  shed  some  light  upon 
the  disputed  questions  by  printing  the  returns  of  the 
Pasteur  Institute  for  the  past  ten  years,  which  we  take 
from  the  Annales  de  V Institute, 


Number  of 

Number 

Rate  of 
Mortality. 

Year. 

personi 
iQucolated. 

of 
Deaths. 

1886 

2671 

25 

0-94 

1887 

1770 

14 

0-79 

1888 

1622 

9 

055 

1889 

1830 

7 

0  38 

1890 

1540 

5 

0-.^2 

1891 

1559 

4 

0-25 

1892 

1790 

4 

0-22 

1893 

1648 

6 

0  36 

1894 

1387 

7 

OtO 

1895 

1520 

2 

013 

i 

If  these  figures  do  noc  prove  that  the  danger  dJT 
hydrophobia  is  greatly  exaggerated  in  the  popular 
mind,  we  do  not  know  what  proofs  can  do  so.  Hero 
were  1,520  persons,  not  only  bitten,  but  so  badly  bitten 
that  they  thought  it  worth  while  to  travel  and  seek 
Pasteur's  aid,  and  bitten  under  such  circumstances  that 
Pasteur  recognised  some  danger.  They  represented, 
probably,  the  worst  cases  out  of  many  ^ousands,  the 
great  majority  of  whom  did  not  resort  to  Pasteur.  Of 
the  1,520  patients  who  were  thought  worthy  of  inocula- 
tion, only  two  died.  Why,  according  to  these  figures, 
a  cold  in  the  head  is  as  dangerous  as  the  bite  of  a  so- 
called  rabid  dog.  The  explanation  is  forthcoming, 
however,  when  we  are  told  that,  out  of  the  1,520 
patients,  only  122  were  bitten  by  dogs  proved  to  be 
rabic  ;  in  every  other  case  the  animal  was  only  sus- 
pected. In  the  case,  therefore,  of  persons  bitten  by 
dogs  positively  mad,  the  mortality,  after  the  patients 
had  been  subjected  to  Pasteur's  inoculation,  was  only 
*016  per  cent,    How  much  of  this  happy  immunity  from 


hydrophobia  was  due  to  the  inoculation,  and  how  much 
to  Nature,  cannot  be  judged  until  we  can  compare  with 
these  cases  a  sufficient  number  of  other  cases  bitten  by 
unquestionably  rabid  dogs,  but  never  inoculated  by 
Pasteur.  We  believe,  however,  that  the  rigid  enforce- 
ment of  the  law  against  stray  dogs  is  due,  to  a  great 
extent,  not  to  the  dread  of  hydrophobia,  but  to  the 
desire  of  everyone  to  reduce  the  excessive  number  of 
useless  curs,  which,  rabic  or  not,  have  come  to  be  an 
utter  nuisance.  We  sympathise  in  such  d  'sire,  and 
would  be  glad  to  see  a  wholesale  weeding  out  effected 
by  doubling  the  dog  tax  and  by  ordering  that  those 
animals  not  taxed,  registered,  and  effectually  controlled 
and  cared  for,  should  be  "  removed,"  only  we  object 
to  have  that  purpose  effected  by  creating  in  the  public 
mind  a  hydro-  phobia  scare,  for  which,  as  we  have 
shown,  there  is  little  scientific  or  statistical  ground. 


"A  PubHo  Warning." 
Under  the  heading  of  **  A  Public  Warning,''  a  corre- 
spondent wrote  last  week  to  the  Western  Mercury^  a 
letter  commenting  upon  the  Kitson  v,  Playfair  case,  in 
the  course  of  which  he  makes  an  attack  upon  the 
Medical  Defence  Union,  *'  a  union,"  he  says,  '*  consist- 
ing of  medical  men  in  various  parts  of  the  country 
who,  for  a  small  yearly  subscription,  combine  in  order 
to  place  all  legal  matters  in  which  they  are  interested, 
either  as  plaintiffs  or  defendants,  in  the  hands  of  the 
Union's  legal  advisers."  He  then  hazards  the  won- 
derful suggestion  that  '*  it  is  possible,  nay  probable, 
that  Dr.  Playfair  is  a  member,  and,  if  so,  the  payment 
of  the  damages  will  be  a  very  serious  question 
for  his  Union  to  consider."  For  the  most 
part,  his  remarks  are  more  humorous  than  harmful, 
and,  as  such,  scarcely  call  for  notice.  But 
his  serious  misrepresentations  with  respect  to  the 
objects  and  aims  of  the  Union  must  not  be 
passed  over  in  silence.  He  begins  by  stating  that  the 
union  has  been  founded  for  the  purpose  of  having  all 
matters  connected  with  medicine  under  its  control,  to 
charge  whatever  scales  of  fees  it  likes,  and  to  enable 
its  members  to  deal  as  cavalierly  as  they  like  with  their 
patients.  Then  he  proceeds  to  say  that  it  will  be  a 
highly  dangerous  thing  to  admit  a  member  of  such  a 
union  into  the  sanctities  and  friendships  of  social  life, 
and  still  further  in  case  of  illiiess  would  it  be  unsafe  to 
seek  their  aid ;  he  codcludes  with  the  sage  advice 
that  the  people  must  protect  themselves  against  "  the 
doctors,"  and  when  the  attendance  of  a  medical  man  \a 
required,  he  recommends  that  steps  should  be  taken 
first  to  ascertain  whether  the  practitioner  is  a  member 
of  any  defence  society  or  union,  for  if  he  should  prove 
to  be  so,  then  his  services  should  be  immediately  de- 
clined. This  melancholy  exhibition  of  ignorance,  mis- 
conception, and  false  representation  is  a  good  example 
of  the  nonsense  which  is  conjured  up  in  the  minds  of 
certain  persons  who  believe  that  they  can  speak  with 
authority.  It  is  plain  to  see  that  this  would-be  critic 
has  evidentiy  made  up  his  mind  that  all  unions  must 
be  worked  upon  the  same  principles,  that  in  other  wordp, 
the  Medical  Defence  Union  is  nothing  more  nor  less 
tbao  9  trade  union,  comparable  to  those  to  iiehich 


382     Thb  Mbdioal  Pbbbs. 


NOTES  ON  CURRENT  TOPICS. 


Apbzl  8.  18M. 


artisans  belong.  Fortunately,  however,  for  the  public 
such  is  not  the  case  ;  the  authorities,  for  example,  of 
the  Medical  Defence  Union  have  not  the  power  to 
organise  a  general  strike  among  medical  men. 

A  Matter  for  Inquiry. 

A  CORRESPONDENT  has  SBut  US  a  cutting  from  the 
Liverpool  Post  describing  a  meeting  which  was  held 
last  week  of  the  '*  Civil  Service  Medical  Association," 
an  association  which,  as  we  gather,  has  been  in  exist- 
ence in  Liverpool  for  upwards  of  twelve  months. 
According  to  the  report,  civil  servants  of  all  depart- 
ments are  eligible  for  membership,  and  the  Committee 
are  of  the  firm  belief  that  as  the  Society  becomes  more 
widely  known  its  benefits  will  be  taken  advantage  of 
by  the  great  bulk  of  those  on  the  established  and 
retired  list.  The  name  of  one  medical  man, 
that  of  a  Dr.  Murray,  is  mentioned  as  having 
attended  the  meeting,  and  he  expressed  the  con- 
viction that  there  did  not  appear  to  be  any 
reason  why  the  Association  should  not  become 
one  of  the  largest  in  the  country.  We  are  quite  in 
ignorance  of  what  this  undertaking  means,  and 
whether  it  meets  with  the  approval  of  the  bulk  of  the 
profession  in  Liverpool.  The  title  of  it,  however,  is 
somewhat  suggestive  of  a  bid  being  made  to  attract  a 
large^number  of  persons  to  enter  into  a  combination  for 
the  purpose  of  securing  medical  attendance  at  a  cheap 
rate.  Of  course,  the  proper  designation  of  such  an 
undertaking  would  be  a  *'  Sick  Club."  But  is  it  to  be 
supposed  that  civil  servants  are  only  able  to  afford  so 
much  per  week  for  medical  attendance?  If  the 
" Civil  Service  Medical  Association"  has  been  organ- 
ised for  this  purpose,  then  we  have  no  hesitation  in 
saying  that  it  is  bound  to  dolharm  to  a  large  number 
of  local  practitioners.     We  should  be  glad  to  hear 

further  of  this  scheme. 

Sterilised  Town  Water. 

An  offer  has  been  made  by  an  inventor  to  the  Muni- 
cipality of  the  City  of  Paris  to  sterilise  5,000  cubic 
metres  daily  of  water  for  public  consumption  at  his 
own  expense,  and,  after  preliminary  inquiry,  it  has 
been  decided  by  the  municipality  to  obtain  a  formal 
expert  report  upon  which  a  decision  may  be  arrived  at 
whether  the  offer  ought  to  be  rejected  or  accepted. 

The  ''Li^rht"  Cure. 
The  law  regulating  the  practice  of  medicine  in 
Germany  is  the  same  as  the  English  law,  in  that  every- 
one is  free  to  treat  patients  on  condition  of  not  arro- 
gating to  themselves  titles  to  which  they  have  no 
right.  This,  in  part,  explains  why  it  is  that  nowhere 
are  empirical  practitioners  more  numerous  than  in 
these  two  countries.  According  to  La  Semaine 
Medicate  the  medical  practitioners  of  that  country 
are  too  accustomed  to  this  sort  of  thing  to  express 
either  surprise  or  disgust,  for  it  seems  that  it  is 
even  now  the  custom,  in  certain  quasi  Royal 
families,  to  employ,  for  the  cure  of  epilepsy,  the  eyes 
of  magpies  killed  on  the  31st  of  December.  The 
latest  departure  in  the  direction  of  what  is  popularly 
called  **  natural  medicine,''  is  that  introduced  by  one 
Rikli,  who  has  founded  an^  institute  on  the  Camiole 


mountains,  near  Trieste,  for  the  treatment  of  all  kinds 
of  ailments  by  *'  mountain  air.''  His  idea  is  to  expoee 
the  patient  as  completely  as  possible  to  the  effects  of 
''luminous  radiation."  The  method  involves  the 
exposure  of  the  absolutely  naked  body  to  sunlight  and 
air,  irrespective  of  atmospheric  vicissitudes.  The 
patients  are  enjoined  to  pass  the  greater  part  of  the 
day  in  a  state  of  nudity,  and  little  by  little,  they  are 
expected  to  develop  such  a  measure  of  **  resistance  " 
as  will  enable  them  to  withstand  ail  changes  of 
temperature,  humidity,  <Ssc.  The  institute  opens  in 
May  and  closes  in  October.  It  is  situated  at  an  eleva- 
tion of  about  3,000  feet,  and  the  sexes  are  separated 
by  a  high  wall.  When  the  sun  is  high  the  patients  lie 
round  on  the  dry  turf  or  on  phinks  exposed  to  the  full 
force  of  the  summer  sun  for  periods  varying  from 
fifteen  minutes  to  an  hour,  the  head  only  being  pro- 
tected by  a  parasol.  One  effect  of  the  exposure  is  to 
provoke  profuse  perspiration,  but,  in  new  comers  more 
or  less  superficial  inflammation  of  the  skin  not  infre- 
quently follows.  It  is  not  only  the  sunlight  that  is 
employed,  for  the  treatment  involves  expoeure  to  rain 
and  wind.  This  method  of  treatment  is  not  new,  for  it 
takes  us  back  to  the  groves  surrounding  the  temples  of 
the  Asclepiades  where  *'  natural  medicine"  hadfree  play. 
It  is,  perhaps,  hardly  likely  to  become  popular,  but  it  ia 
quite  conceivable  that  it  would  prove  beneficial  in  a 
large  number  of  *' ailments,"  as  distinguished  from 

organic  diseases.  

Indecent  Journalism. 
It  appears  tolerably  certain  that  the  Bill  to  restrain 
the  publication  of  indecent  reports  will  undergo  con- 
siderable, even  fundamental,  modification  before  it 
can  become  law.  The  point  that  concerns  us  is  the 
possibility  of  more  or  less  drastic  restrictions  being 
applied  to  reports  of  cases  in  professional  organs. 
Although  we  cannot  help  thinking  that  the  risk  of 
interference  is  small,  we  rely  on  our  medical  Members  of 
Parliament  to'secure  the  insertion  of  a  provision  in  the 
Bill  exempting  medical  journals  from  the  prohibition 
when  the  matter  is  obviously  one  of  scientific  or 
medical  interest.  The  suggestion,  made  by  a  contem- 
porary, to  empower  the  General  Medical  Council  to 
compile  a  list  of  medical  journals  for  exemption,  is 
simply  ridiculous.  The  Council  comprises  among  its 
members  several  men  of  undoubted  intelligence,  but 
we  defy  them  to  formulate  a  satisfactory  definition  of 
what  constitutes  a  '*  medical  journal."  Moreover,  the 
Council  might,  under  conceivable  circumstances, 
avail  themselves  of  the  power  to  strike  an  unfriendly 
journal  off  the  list  as  a  punishment  for  too  searching 
criticisms,  a  right  of  censure  which  the  legislature 
could  not  possibly  connive  at.  All  we  want  is  a  clause 
affirming  the  right  of  medical  journals  to  report  and 
discuss  matters  of  scientific  and  medical  interest,  and, 
in  the  event  of  a  prosecution,  it  must  be  for  a  jury  to 
decide— (a)  whether  the  subject  matter  is  indecent,  and 
(b)  whether  its  reproduction  can  be  justified  on  the 
ground  of  its  scientific  importance.  We  will  venture 
to  assert  that  no  publications  are  more  fastidiously 
edited  than  those  which  appeal  to  medical  readers,  and, 
artisans  belong.    Fortunately,  however,  for  ithe  public 


Apbil  8,  1896. 


NOTES  ON  CURRENT  TOPICS. 


The  Msdioal  Press.     383 


however  delicate  the  topic,  the  prarieat-minded  lay 
reader  would  be  baffled  by  the  technical  sobriety  of  the 
terms  employed.  The  literature  of  the  operating 
table  and  the  post-mortem  room  could  hardly  stimulate 
even  the  most  excitable  or  imaginative  of  readers.  Sur- 
gical or  pathological  nudity  can  never  be  anything  but 
chaste,  and  we  know  of  no  more  powerful  moralising 
influence  than  a  visit  to  the  out-patient  department  of 
a  hospital  for  the  treatment  of  venereal  diseases.  The 
consequences  of  vice,  seen  through  medical  spectacles, 
certainly  does  not  bear  out  Pope's  assertion  that, 

'*  Seen  too  oft,  familiar  with  its  face, 
We  first  endure,  then  pity,  then  embrace." 


A  Generous  Bequest. 
The  Academy  of  Medicine  of  Paris  has  been  autho- 
rised to  accept  a  legacy  of  £960  per  annum,  that  is  to 
say,  a  capital  sum  of  £32,000,  bequeathed  by  Madame 
Andiffred,  nee  Jonanique,  on  trust  to  be  paid  over  to  the 
person,  without  distinction  of  nationality  or  profession, 
who,  within  twenty-five  years,  shall  have  discovered  a 
preventive  or  curative  remedy,  acknowledged  by  the 
Academy  to  give  certain  and  permanent  effects  in 
respect  of  tuberculosis.  It  is  to  be  styled  the  Francois- 
Joseph  Andiffred  Prize,  and  until  such  discovery  shall 
take  place,  the  annual  income  shall  belong  to  the 
Academy,  to  be  applied  to  such  purposes  as  may  be 
thought  proper.  This  last  provision  is  certain  to  render 
the  Academy  very  circumspect  in  admitting  the  value 
of  all  future  "  cures  "  for  tuberculosis,  unless,  indeed, 
the  happy  discoverer  should  happen  to  belong  to  that 
very  select  body,  a  special  proviso  in  the  will  rendering 
such  member  eligible  to  compete.  It  is  doubtful, 
nevertheless,  whether  any  pecuniary  reward  will  act  as 
an  additional  incentive  to  research  in  this  direction. 
The  honour  and  fame  which  will  inevitably  accrue  to 
him  who  lights  upon  a  prophylactic  or  curative  remedy 
for  the  fell  disease  must  transcend  all  mercenary  con- 
siderations, and  the  testatrix  would  probably  have  done 
more  to  attain  her  object  had  she  endowed  research 
laboratories,  or  founded  research  scholarships.  Never- 
theless, all  honour  is  due  to  the  noble-minded  bene- 
factrice  who  has  striven  to  contribute  her  widow's  mite 
to  the  elucidation  of  a  problem  of  the  greatest  possible 
importance  to  the  world  at  large. 


A  New  Order  of  Medical  Practitioners  in 
America. 
Thb  State  of  New  York  has  just  distinguished  itself 
by  passing  a  law  authorising  the  incorporation  of  a 
society  called  "  The  Pedic  Society  of  New  York."  By 
this  means  all  persons  who  wish  to  practice  chiropody 
will  be  compelled  to  qualify  for  their  profession.  A 
board  of  three  examiners  has  been  constituted,  who 
will  conduct  examinations,  either  orally  or  by  papers. 
The  subjects  will  be  the  anatomy  and  physiology  of 
the  feet,  therapeutics,  chemistry,  minor  surgery,  and 
bandaging,  also,  we  may  presume,  of  the  feet.  All  the 
candidates  desirous  of  qualifying  must  be  over  21  years 
of  age,  citizens  of  the  United  States,  and  residents  of 
the  State  of  New  York.  It  is  stated  that  the  Society 
is  entitled  to  all  the  privileges  and  immunities  granted 


to  Medical,  Dental,  and  Veterinary  Societies  of  the 
State.  Moreover,  that  a  register  of  chiropodists  will  be 
kept  by  a  certain  official  with  whom  registration  will 
have  to  be  made.  One  clause  in  the  new  law  is  worthy 
of  note,  and  that  is  that  no  duly  and  legally  qualified 
physician  or  surgeon  shall  be  prohibited  from  practising 
chiropody  or  any  branch  thereof.  So  far  so  good,  but 
this  at  once  shows  that  it  was  perfectly  unnecessary  to 
have  made  a  new  order  of  practitioners  when  chiropody 
is  already  provided  for  among  the  general  practitioners 
of  medicine  and  surgery. 


Some  Health  Facts  fi*oni  Dublin. 
The  year's  report  for  1894,  of  Sir  Charles  Cameron, 
for  Dublin  City,  is  encouraging.  It  tells  us  that  the 
death-rate  was  only  23*8  par  1,000,  being  3  below  the 
average  of  the  previous  ten  years,  and  the  lowest  on 
record  since  the  accurate  registration  of  deaths  com- 
menced in  Dublin.  As  many  as  34*7  per  cent  of  these 
deaths  occurred  in  public  institutions,  which  shows 
that  in  Dublin,  a  much  larger  proportion  of  the  popula- 
tion than  elsewhere  is  dependent  on  hospital  relief, 
for  we  find  that,  in  English  towns,  the  proportion 
dying  in  hospitals  is  only  about  18  per.  cent. 
The  year  1895  was  singularly  free  from  zymotic 
disease  in  Dublin.  The  deaths  were  196  (or  15*3 
per  cent,  below  the  average)  and  447  less  than  in  the 
year  1893.  The  total  deaths  in  the  year  1891  numbered 
6,519.  There  was  a  saving  of  life  to  the  number  of 
620  as  compared  with  1893,  and  of  1,300  as  compared 
with  1892.  As  regards  the  small-pox  epidemic.  Sir 
Charles  Cameron  reports  that  within  the  year  1894  73 
persons  died  from  the  disease.  He  estimates  that 
at  the  time  of  the  outbreak  there  were  nearly 
40,000  unvaccinated  persons  in  the  city,  and  that 
40,000  were  revaccinated,  but  of  course  these  were  not 
necessarily  the  unvaccinated  cases.  The  Registrar  of 
Cork  Street  Hospital,  reports  that  534  small-pox 
patients  passed  through  his  hands  in  the  year,  and  that 
the  mortality  of  these  was  7*36  per  cent,  for  the 
vaccinated  patients,  and  23'35  for  those  unvaccinated. 


Sanitary  Sidmouth. 
According  to  the  annual  report  of  Dr.  PuUin,  the 
Medical  Officer  of  Health  for  Sidmouth,  those  who 
visit  that  charming  seaside  resort  will  invade  a  region 
of  extreme  healthiness.  The  death-rate  for  last 
year,  after  correction  for  deaths  of  visitors,  touches  the 
low  point  of  15  per  1,000,  as  against  196  for  all 
England.  Moreover,  the  returns  under  the  Notification 
of  Infectious  Diseases  Act  is  of  a  reassuring  nature  ; 
70  cases  of  scarlet  fevtr,  one  of  typhoid,  two  of  puerperal 
fever,  and  two  of  diphtheria  were  notified  during  the 
year.  Another  striking  fact  mentioned  in  the  report  is 
that  no  death  from  diarrhoea  has  been  registered  in  the 
district  for  the  last  sixteen  years.  We  quite  agree  with 
Dr.  Pullin  when  he  says  that  it  is  doubtful  whether 
another  place  in  the  United  Kingdom  with  a  similar 
population~3,500  to  4,000— could  furnish  such  a  record. 
Of  late  some  adverse  rumours  have  been  circulated 
concerning  the  sanitary  condition  of  Sidmouth,  but 
these  do  not  appear  to  be  warranted  by  the  facts  of  the 


3S4     tat  HsmoAi,  ttiiSB. 


NcrtEs  ON  CtJlJRianr  f oftcs. 


AMBtL  S,  }8M. 


case.  On  the  contrary,  the  local  aathoritiee  seem  to  have 
shown  a  great  deal  more  activity  in  public  health 
administration  than  is  usually  met  with  in  the  County 
of  Devon. 

The  Preparation  of  Antitoxic  Serum. 
Although^  no  doubt,  most  of  our  readers  are  well 
versed  in  the  therapeutic  value  of  the  serum  we  fancy 
that  few  of  them  know  the  exact  method  by  which  the 
serum  is  prepared,  and  it  seems,  therefore,  worth 
while  to  refer  to  the  matter.  The  bacillus  diphtherise 
is  grown  in  a  broth  culture  for  nearly  a  month.  The 
culture  is  then  filtered  through  a  porcelain  (Pasteur) 
filter,  and  the  resulting  filtrate  contains  the  toxins  of 
diphtheria,  but  is  free  from  bacilli.  Horses  previously 
tested  and  proved  to  be  free  from  glanders,  are  re- 
peatedly injected  with  the  fluid  containing  these 
toxins.  The  process  takes  several  weeks  before  the 
animals  are  sufficiently  immunised.  This  is  estimated 
by  injecting  a  fraction  of  a  centimetre  of  their  serum 
into  a  guinea-pig  inoculated  with  a  known  quantity  of 
the  diphtheria  toxin.  When  the  serum  completely 
protects  the  guinea-pig,  the  horses  are  ready  for  use. 
They  are  then  bled,  but  not  to  such  an  extent  as  to 
endanger  life,  and  the  resulting  serum  is  the  antitoxin 
serum.  This  naturally  prepared  antitoxin  is  rendered 
aseptic  by  dropping  a  piece  of  ignited  camphor  in  each 
bottleful  of  serum. 

The    Presidential   Election  at    the  Boya] 
OolleRe  of  Physicians,   London. 

On  the  30th  ult.,  being  the  Monday  after  Palm 
Sunday,  the  Fellows  of  the  Royal  College  of  Physicians 
of  London,  assembled  in  accordance  with  ancient 
custom  to  elect  a  President  for  the  ensuing  year.  At 
the  first  enumeration  it  was  found  that  Dr.  Samuel 
Wilks  had  obtained  75  votes,  as  against  65  recorded  in 
favour  of  other  candidates.  No  one  having  obtained 
the  requisite  two-thirds  majority,  a  second  ballot  was 
called  for,  when  the  docision  of  the  College  was  given 
in  favour  of  Dr.  Wilks,  Sir  William  Broadbent  being 
second.  The  retiring  President,  Sir  Russell  Reynolds, 
was  prevented  from  being  present,  and  the  chair  was 
taken  by  Sir  William  Broadbent,  Senior  Censor.  Dr. 
Wilks  was  educated  at  Guy's  Hospital,  and  is  a 
member  of  Senate  of  the  University  of  London,  and 
Consulting  Physician  to  Guy's  Hospital.  According 
to  precedent,  he  will,  on  his  appointment  as  President, 
receive  a  marked  favour  at  Her  Majesty's  hands  as 
soon  as  the  formal  election  is  signified  to  the  Queen. 

Serotherapy  ad  Absurdum. 
The  last  suggestion  in  serotherapy  is  the  injection  of 
the  blood-serum  of  dogs  which  have  been  subjected  to 
large  daily  doses  of  ethylic  alcohol.  According  to  Dr. 
Toulouse,  the  injection  of  24  cc.  thrice  repeated  of  this 
serum  produced  markedly  beneficial  effects  in  a 
case  of  alcoholic  delirium.  He  is  now  about  to 
institute  researches  with  the  object  of  finding  out 
whether  the  serum  acts  as  an  ''anti-alcoholic  "serum, 
or  merely  qud  serum,     It  would  |)erhaps  have  been 


more  in  accordance  with  scientific  principles  if  he  had 
made  his  oontrol  etperiments  before  taking  up  the  tiiae 
of  the  Academy  of  Medicine  of  Paris  with  an  obaerr*- 
tion  which  is  ealeolated  to  bring  snretkerapy  n^ 
contempt. 


A  Chemist  Foreign  Minister  of  France. 
M.  BxRTHELOT,  the  distinguished  chemist  attfd 
physicist,  who  was  taken  from  his  laboratory  and  put 
to  manage  the  foreign  aff^airs  of  the  French  nation,  has 
found  it  necessary  to  return  to  his  more  congenial  em- 
ployment as  an  investigator.  As  an  active  politician 
he  has  proved  a  dismal  failure,  and  it  is  not  surprising 
that  it  should  be  so.  The  patient  and  untiring  colla- 
tion of  scientific  data,  and  the  calm  and  impartial  de- 
duction of  conclusions  from  those  data,  is  by  no  aieans 
the*  sort  of  training  fof  a  Foreign  Minister,  who  is  called 
upon  at  every  moment  to  fo^m  hasty,  yet  Wise,  deri- 
sions, and  to  carry  them  into  effect  without  delay.  AH 
are  agreed  that  M  Berthelotwas  personally  a  most  efX' 
cellent  man,  but  equally  agreed  that  he  was  a  moet 
ineffective  Foreign  Minister. 

Among  the  Bottles. 
An  amusing  episode  took  place  recently  in  the 
Borriaokane  (co.  Tipperary)  Dispensary.  One  of  the 
pauper  patients  was  dissatisfied  with  her  medicine, 
and  began  to  abuse  the  medical  officer,  who  ordered 
her  to  leave  the  surgery.  As  she  would  not  go,  he 
went  out  to  fetch  the  porter,  whereupon  the  patient 
locked  herself  up  in  the  pharmacy,  of  which  the  key 
happened  to  be  at  hand,  and  occupied  herself  until 
the  door  could  be  broken  open,  in  mixing  the  contents 
of  all  the  bottles.  Before  she  could  be  removed  she 
is  said  to  have  perpetrated  damage  to  the  amount 
of  about  £60. 

Thb  Greeham  Lectures  will  be  delivered  in  Greeham 
College,  Basinghall  Street,  on  April  Uth,  15th,  16th, 
and  17ch,  1896,  at  6  o'clock,  by  Dr.  K  Symes  Thomp- 
son, Greeham  Professor  of  Medicine,  the  subject  being 
"  The  Latency  of  Disease." 


The  official  journal  in  Vienna  publishes  an  order  of 
the  Minister  of  Public  Instruction  admitting  women 
holding  foreign  medical  diplomas  to  registrntion  in 
Austria. 


Glasgow  is  to  be  the  place  of  meeting  of  the  Con- 
gress of  the  British  Institute  of  Public  Health  for  the 
present  year.  Its  sittings  wiU  commence  on  July  23rdy 
and  will  last  over  the  88th,  and  will  be  held  in  the 
University  buildings. 


The  Paris  Society  of  Medicine  celebftkted  its  bi- 
centenary the  week  before  last  by  a  banquet,  at  which 
the  leaders  of  the  profession  in  Paris  were  present 
Dr.  Ogilvie,  of  London,  attended  to  represent  the 
profession  in  England,  and  proposed  the  toast  of  the 
evening--"  The  Two^bundreth  ^nniTeraarjr  of  Ae 
Society." 


^x^nsL  8.  1880 


CORRESPONDENCE, 


Thb  Mxdigal  Pbbss.     985 


Sheffield  and  its  Medical  Officer  of  Health. 
Wealthy  SheflSeld  has  never  been  credited  with 
a  too  exalted  appreciation  of  the  services  of  its  Health 
OflScers.  On  previous  occasions  the  City  Council  has 
parted  with  valuable,  if  not  valued,  servants  because 
of  the  existence  of  a  parsimonious  discharge  of  its 
duties  in  this  direction,  and  it  is  highly  probable 
that  it  may  soon  lose  the  services  of  its 
present  Medical  Officer,  Dr.  Harvey  Littlejohn, 
whose  application  for  increase  of  salary  has  been  re- 
fused. It  afifbrds  us,  therefore,  unqualified  pleasure  to 
record  that  almost  the  entire  body  of  the  medical 
profession  in  that  town  have  cotne  forward  with 
striking  unanimity  to  testify  their  appreciation  of  the 
eminent  services  Dr.  Littlejohn  has  rendered,  and  their 
cordial  sympathy  with  him  in  the  refusal  of  adequate 
pecuniary  remuneration.  The  movement  took  practical 
shape  when,  on  Thursday  last,  Dr.  Littlejohn 
was  publicly  entertained  at  dinner,  and  a 
memorial  was  presented  to  him  signed  by  upwards 
of  one  hundred  of  the  leading  medical  men.  Dr.  Dyson, 
Consulting  Physician  to  the  Sheffield  Public  Hospital, 
was  in  the  chair.  Mr.  Snell  made  the  presentation, 
and  the  greatest  enthusiasm  prevailed.  After  such  an 
expression  of  opinion  the  City  Council  must  be  indeed 
obtuse  if  they  persist  in  their  present  course. 


[FSOM  cub  OWK  OOBBUFONDBITT.] 

DniTBAR.— Ricx)oinTioN  op  the  Sbbviobs  of  a  Local 
Mbdigal  Offiobb  of  Hbalth.— We  are  elad  to  see  that  the 

?»ablicin  Danbar,  thesceneof  the  late  typnoid  epidemic,  are 
nlly  aenpibleof  the  energy  and  ability  shown  by  the  Acting 
Medical  Officer  of  Health,  Dr.  Sinclair,  in  combating  the  ra- 
vagea  of  the  disease  ander  difficult  circumstances.  The  mem- 
bers of  the  Town  Goancil  do  not  seem  to  consider  it  worth 
their  whileto  mention  his  services,  at  least  in  the  panegyri- 
cal remarks  made  at  the  opening  of  the  new  water  supply 
the  other  day,  they  were  not  alluded  to.  The  ratepayers, 
however,  judging  by  their  letters  to  the  papers,  are  fully 
sensible  of  the  value  of  his  work.  Although  the  system 
under  which  the  sanitary  affairs  of  East  Lothian  are 
conducted  is  the  reverse  of  ideal,  honour  should  be 
awarded  to  whom  honour  is  due,  and  Dr.  Sinclair  has 
carried  through  a  difficult  part  with  much  success. 

Glasgow  Univbrsitt  Honobabt  Degbbbs.  -Among 
the  long  list  of  names  proposed  to  be  honoured  by  the 
University  of  Glasgow  on  the  occasion  of  the  annual 
graduation  ceremony  by  the  bestowal  of  different  degrees, 
we  find  the  names  of  Thomas  Reid,  M.D.,  for  the  last 
twenty-seven  years  Waltonian  Lecturer  and  Lecturer  on 
the  Diseases  of  the  Eye  in  the  University  of  Glasgow, 
and  John  Ure,  Lord  Provost  of  Glasgow,  1880-83,  first 
chairman  of  the  Committee  on  Health,  which  did  a  great 
deal  towards  organising  the  sanitary  system  of  the  citv. 

OuTBBBAK  OF  Ttphus  IN  Ediububoh.  —  At  the  last 
meeting  of  the  Edinburgh  Town  Council  it  was  reported 
that  an  outbreak  of  typhus  fever  had  occurred  in  the  city. 
Six  cases  bad  in  all  occurred,  the  first  having  been  certified 
after  death  as  bronchitis  by  the  medical  attendant,  at 
least  the  Lord  Provost  is  reported  to  have  stated  as  much, 
and  to  have  addo5*hat  inquiry  should  be  made  into  the 
facts  and  into  the  question  of  how  it  was  that  the  physician 
attending  knew  so  little  about  his  business  as  to  diagnose 
the  case  wrongly.  We  suspect  that  Lord  Provost  Mao- 
dooald,  douce  body  as  be  is,  fails  to  grasp  the  difficulty  in 
diupoeis  attendant  on  many  cases  of  typhus  fever,  espe- 
dafiy  as  the  fever  is  not  at  all  common  in  Edinburgh. 

Closb  upon  £7,000  have  been  received  in  le^usies  and 
donations  (over  £100)  by  the  Edinburgh  Royal  infirmary 
daring  the  last  six  months. 


SorreBponbenxe. 

(We  do  not  hold  ounelvet  responaible  for  the  opinions  of  oat 
OorrMpondentt.]  

THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 

To  the  Editor  of  the  Medical  Pbess  and  Oibculab. 

Sib,— I  should  regret  exceedingly  if  I  have  brought 
down  on  my  devoted  head  the  justifiable  wrath  of  Dr.  H. 
G.  Brooke,  or  any  other  man,  but  I  am  afraid  his  display 
of  choler  is  just  another  illustration  of  the  iniquity  of 
direct  speaking  or  writing  in  these  reflective  and  Phari- 
saical times.  I  think  I  shall  best  isolate  Dr.  Brooke's 
disagreement  from  me  by  pointing  out  the  large  extent  of 
his  agreement  with  me.  Dr.  Brooke  quite  frankly  states 
that  he  helped  to  found  a  special  hospital,  and  that 
his  object  in  doing  so  was  to  **  get  more  abundant  material 
on  which  to  continue  my  studies  in  a  branch  of  medicine 
which  had  greatly  attracted  me,  and  to  which  I  had  de- 
voted my  main  attention."  This  is  fair  and  straight,  and 
I  see  no  ethical  or  other  objection  to  Dr.  Brooke  having 
done  so,  only  he  must  remember  that  there  are  other  pro- 
fessional enthusiasts  in  the  profession  than  he,  and  the 
ri|2:ht  which  he  arrogates  to  himself  must  be  conceded 
all  round,  and  then  every  man  has  a  perfect  ri|;ht  to  found 
a  special  institution  to  **  get  more  material "  in  the  shape 
of  patients,  and  **  more  material "  in  the  shape  of  guineas. 
As,' E  matter  of  commercial  business,  this  is  honest,  and  it 
is  to  the  credit  of  Dr.  Brooke  *^^hat  he  says,  "  there  is  no 
question  of  philanthropy  primarily  in  the  matter.*'  Not  a 
bit  of  it;  nor  is  there  any  "question  of  philanthropy" 
primarily,  in  the  case  of  any  hospital,  I  take  a  more 
mundane  view  of  it ;  hospitals,  general  as  well  as  special, 
exist,  primarily,  to  subserve  the  ends  of  medical  men,  and 
they  do  so  bv  furnishing  to  them  "abundant  material *'  in 
the  shape  of  patients  from  aU  classes  of  society,  through 
which  they  bring  themselves  before  the  public,  by  writing, 
performing  cures,  &c.,  and  by  the  multiform  methods  in 
which  the  nospitals  are  advertised.  It  is  the  inerest  dis- 
ingenuousnoM  to  say  that  this  is  not  the  attraction  which 
hospitals  possess  for  medical  men,  and  that  it  is  not  in 
this  manner  the  so-called  '*  heads "  of  the  profession 
are  made.  The  same  remarks  apply  even  more 
strongly  to  special  hospitals ;  and,  notwiths&nd- 
ing  Dr.  Brooke's  warm  repudiation,  I  adhere  to 
my  opinion.  But  if  there  is  '*no  philanthropy"  pri- 
marily, or  otherwise,  in  the  matter  of  special  hospitals, 
why  do  those  who  run  special  hospitals  base  appeals  for 
their  support  to  the  public,  on  Christianity,  philanthropy, 
and  charity?  This  is  the  straw  with  which  the  puolio 
are  tickled,  and  which  clinks  the  coin  out  of  the 
pockets  of  the  Pharisees.  If  Dr.  Brooke  maintains  that 
one  man  has  as  good  a  right  as  another  to  found  a 
special  hospital  or  a  genera!  hospital,  and  tha^  there  is 
'*no  philanthropy,  primarily,  in  the  matter,"  then  I 
entirely  agree  with  him.  With  the  exception  of  four  or 
Jivt  of  the  general  hospitals  in  London,  the  remainder  were 
founded  by  medical  men,  to  further  their  own  professional 
and  pecuniary  ends,  and  there  certainly  "  was  no  philan- 
thropy, primarily,  in  the  matter."  I  demur  to  Dr. 
Brooke's  contention,  which  appears  to  me  only  a  specious 
extenuation  of  his  founding  a  special  hospital,  that  the 
opportunities  for  cultivating  successfully  his  department 
would  be  greater  in  a  special  hospital  than  in  a  special 
department  of  a  general  hospital.  No.  The  "special 
hospital"  is  more  under  the  thumb  of  the  staff,  and  is 
otherwise  a  better  advertising  medium.  Dr.  Brooke  is 
indignant  at  my  calling  this  sort  of  thing  advertising.  I 
am  sorry  I  cannot  find  a  word  less  ofiensive  to  express 
what  I  understand  by  it.  If  a  man  comes  into  my  con- 
sulting room  and  surreptitiouslv  removes  property  which 
does  not  belong  to  him,  I  call  him  a  thief,  while  Dr. 
Brooke  would  euphemistically  designate  the  gentleman  as 
an  abstractor  of  material  not  his.  Again,  if  it  be  profes- 
sionally  ethieal  to  advertipe  special  institutions  ad 
nartgeam  in  the  public  newspapers,  why  should  it  be 
unprofessional  to  advertise  a  book,  as  censors  of  the 
College  of  Physicians  do  ?  The  writing  of  a  ^ood  book,  to 
my  mind,  implies  more  brain  power  than  the  founding  of  a 
special  hospital,  and  is  a  much  fairer  means  of  **  advertis- 
ing *'  than  the  latter.  I  deal  more  with  this  question  in 
another  quarter,  next  month. 


386    Th9  Medical  t^^a. 


CORRE8tONt)¥:fC|l 


Afbil  8, 18M. 


I  have  nothing  bat  contempfc  for  the  affectation  of 
medical  men  that  they  do  not  advertise,  and  worse  than 
contempt  for  the  dishonesty  which  proclaims  that 
<*  charity,"  and  not  greed  is  the  greatest  factor  in  the 
hospital  system. 

I  am,  Sir,  years,  &o., 

D.  Campbbll  Black,  M.D., 
Professor  of  Physiology  in  Andeison'a 
College  Medioal  SehooL 
Glasgow,  March  26th,  18M. 

To  tht  Editor  of  the  Medical  Pbess  and  Ciboulab. 
Sib,— To  those  who  have  the  welfare  of  the  profession 
at  heart  the  correspondence  and  the  facts  which  it  dis- 
closes ander  the  above  heading  in  year  admirable  joamal 
most  be  sorry  reading.  It  is  qaite  evident  that  no 
written  code  of  ethics  can  ever  be  effectual  unless  the 
bulk  of  the  profession  are  imbued  with  the  professional 
and  ffentlemanly  instincts  of  which  an  ethical  code  forms 
but  the  expression.  It  is  further  quite  obvious  that  it  is, 
and  will  remain  useless,  to  try  to  enforce  discipline  in 
matters  of  gentlemanly  conduct  so  long  as  men  holding 
positions  as  leaders  and  occapyine  high  poets  in  Medical 
Oor{>oration8  lend  themselves  to  Sie  vulgar  arts  exempli- 
fied in  your  columns.  If  a  leading  physician  can  allow 
his  quslifications  (and  his  piety)  to  oe  paraded  in  a  vnlf^ 
puff  of  the  kind  one  might  expect  from  an  advertising 
dentist — a  puff  not  distinguishable  from  those  which  no 
one  doubts  are  used  as  biuts  for  patients — can  it  be  won- 
dered at  if  men,  less  fortunate,  pinched,  perhaps,  by  the 
rea  augusta  domi,  should  descend  to  those  lower  and  more 
vulgar  tricks  of  which  complaints  is  so  often  nowadays 
hee^.  It  will  be  impossible  until  the  upper  ranks  of  the 
profession  become  absolutely  above  suspicion  in  these 
matters  that  the  General  Medical  Council  can  attempt  to 
enforce  discipline  or  to  promulgate  the  mucb-needea  law 
that  professional  advertising  is  an  infamous  offence. 
I  am,  Sir,  yours,  &c.. 

An  Obsouke  Pbactitionsb, 
March  27th,  1896. 


To  the  Editor  of  Tbx  Medical  Pbess  and  Circular. 

Sir, — A  correspondent  riehtly  points  to  the  superior 
reetifbtive  measures  as  to  advertising  prevailing  in  legal 
cirdee,  as  compared  with  our  own.  But,  then,  is  it  to  be 
wondered  at  ?  The  lawyer  '*  goes  for  "  the  right  party, 
the  lay  adventurer,  whereas  the  medical  profession  con- 
centrates all  its  attention  upon  its  junior  members,  while 
it  leaves  scot  free  the  weighty  delinquents  in  the  penons  of 
'*  the  heads  of  the  profession." 

Who  has  not  wearied,  when  waiting  at  railway  stations, 
with  reading  the  names  and  addresses  of  thof  e  who  are 
ready  to  examine  applicants  for  this  or  that  form  of 
insurance  policy,  or  who  manage  hotels,  otherwise  called 
hydropathic  establishments,  and  who  has  not  noticed,  in 
walking  through  our  streets,  the  number  of  eczema  curers, 
deaf  specialists,  and  dermatologists,  whose  lamps  and  brass 
plates  show  how  much  easier  it  is  to  make  a  living  without 
a  diploma  than  with  one ;  let  the  Medical  Defence  Union 
deal  with  these  latter  gentry,  before  they  attempt  to 
restrict  the  actions  of  tbeir  own  professional  colleagues. 
Fraud  ought  to  be  punished  before  unprofessional  conduct 
is  dealt  with,  though  both  call  for  activity. 

In  this  respect  only  we  compare  to  advantage  with  law'> 
we  do  not  let  the  Government  grind  down  our  members, 
and  have  compelled  it  to  increase  the  pay  of  both  Army 
and  Navy  surgeons,  whereas  the  offices  open  to  solicitors 
are  badly  paid^  and  to  their  shame  severely  competed  for. 

I  am,  Sir,  yours,  &c^ 

27th  Mareh,  1896.  M.D. 


KITSON  V.  PLAYFAIR. 

To  the  Editor  qf  TnR  Medical  Press  and  Circular. 

Sir,— Sir  John  Williams  has  carefully  insisted,  in  the 
Times,  on  the  exact  phraseology  of  his  reply  in  respect  of  the 
duty  of  a  medical  man  who  has  professional  co^isance  of  an 
attempt  to  prooure  abortion.  He  does  this  m  such  a  way 
as  to  lead  one  to  infer  that  he  himself  does  not  necessarily 
endorse  the  legal  ooiaion  obtained  by  tlie  Royal  College  of 
Physicians  as  to  the  obligation  on  medioal  men  to 


municate  with  the  polipe.  It  most,  however,  be  within 
the  recollection  of  many  of  yonr  readers  that  in  a  ease  of 
this  kind  which  was  tried  at  the  Central  Criminal  Oourt 
not  many  months  ago,  it  was  stated  that  he,  in  conjanc* 
tion  with  Dr.  Fenton,  did,  as  a  matter  of  fact,  place  tho 
police  in  possession  of  the  drcnmstanoes,  but  the  jury, 
possibly  with  the  objeet  of  expressing  their  aense  el  a 
prosecution  initiated  under  sucn  peoufiar  circomatanew, 
promptly  acquitted  the  accused  persons. 

The  matter  is  one  of  sach  extreme  importance  in  regard 
to  the  relations  of  the  profession  to  the  paUic  that  I 
venture  to  ask  your  permiiaion  to  call  attention  to  theiQ 
facts.  I  am.  Sir,  yours,  &c.. 

M.D.,  M.S. 
# 

EVILS  OF  PRESCRIBING  BY  PHARMACEUTICAL 
CHEMISTS. 

To  the  Editor  oj  The  Medical  Press  and  Circular. 
Sir,— Your  editorial  note  on  the  evils  of  presoribing  by 

Sharmaoeutical  chemists   is   very  welcome  to    all  who 
e^ire  the  public  welfare. 

I  have  had  bitter  experience  of  the  danger  to  the  safety 
of  the  people  of  these  illegitimate  and  very  incompetent 
prescribers. 

In  one  case  of  strangulated  inguinal  hernia  the  chemist 
visited  and  prescribed  for  two  days  ;  result— death. 

A  child  suffering  from  intussusception  had  from  i^ 
pharmaceutical  chemist  aperient  powders  for  four  days  ; 
result— death. 

A  severe  scald,  extending  from  the  hips  to  the  toes  of  an 
infant,  was  undertaken  by  a  pharmaoeutioal  chemist,  with 
the  result  that  the  legs  biecame  gaugrenous,  and  the  child 
died  within  a  week. 

In  each  of  these  cases  the  defence  offered  was  that  the 
remedies  prescribed  were  of  themselves  harmless.  Bat 
notbine  was  said  about  the  valuable  time  lost  before  a 
medical  man  was  called. 

Everyone  of  these  three  cases  met  their  death  by  the 
ace  of  a  pharmacsutical  chemist. 

No  body  of  men  ra  jealously  guard  their  privileges  and 
tbeir  electives  travel  the  country  to  ensure  that  their 
rights  are  rigidly  enforced,  and  yet  we  never  hear  any 
objection  raised  to  tbeir  death* dealing  prescriptions  ana 
barefaced  quackery. 

I  am,  Sir,  yours,  &c.,  X. 


THE  HYDROPHOBIA  SCARE.— THE  DIAGNOSIS 
OF  RABIES. 

To  the  Editor  ofTia  Medical  Press  and  Circular. 

Sir,— I  agree  with  you  that  many  so-called  rabies  are 
not  rabies  at  all,  but  are  animals  hunted  from  place  to 
place,  until  in  the  end  they  are  so  bewildered  that  they  do 
not  know  what  they  are  doing,  but  this  does  not  prove  that, 
unfortunately,  the  disease  is  not  constantly  in  our  midst 
(how  produced  it  is  not  here  necessary  to  discuss)  I  know 
this  to  my  oost,  having  lost  several  valuable  animals 
during  the  past  fifteen  or  sixteen  years.  If  a  dog  were 
stupid,  queer  in  manner,  particular  in  its  food,  and  had 
been  chained  up  for  two  days  after  the  first  symptoms,  I 
should  have  no  more  difficulty  in  diagnosing  a  case  of 
rabies  than  a  case  of  measles.  There  are,  as  yoii 
doubtless  are  aware,  two  forms,  commonly  called  dumb 
and  raffing  rabies.  The  former,  according  to  Suggon,  is 
caused  by  a  stronger  dose  of  the  virus.  In  it,  one  of  the 
first  symptoms  is  a  dropping  of  the  lower  jaw,  caused  by 
paralysis  of  the  masseter  and  temporal  muscles.  After  this, 
the  animal  tries,  as  it  were,  to  get  rid  of  something  in  ite 
throat,  the  saliva  hangs  in  viscid  strings  from  the  montht 
and  the  tongue  is  often  half  out.  During  this  stage  the 
animal  tears,  with  its  feet,  it  cannot  use  its  teeth  in  con« 
sequence  of  paralysis,  staegers  come  on,  and  in  four  or 
five  days,  it  is  paralysed  aU  over,  and  if  not  put  oat  of 
misery,  would  die  on  about  the  seventh  day,  but  up  to  the 
last,  the  intellectual  faculties  are  unimpaired.  I  give  yo« 
these  symptoms  from  my  own  personal  observation. 

Some  years  ago,  I  knew  a  medioal  man  here — ^now  dead 
—to  put  his  hand  down  his  dog's  throat,  thinking  that  a 
bone  was  stuck  there.  He  never  suspected  rabies  until  he 
brooght  the  animal  to  the  veterioarv  satgeoo.  Loekily 
there  was  no  abrasion  of  the  skin,  bad  thecv  been,  he  wa» 


Ap^  8,  ^8flft, 


COfeRjSfOKb^NCJgL 


Tbts  Medical  Pbmss,     ^8? 


aa 
doge 


9VfC€Jff  ia  for  hydrophobia  sub  if  h^  had  been  bittei^  by  a 

2  eiiffering  xirom  raging  rabiea. 

la  raging  rabies,  one  of  the  moat  prominent  symptoms 
is  t^  pocnliar  bs^k— between  a  bark  and  a  howl,  if  I 
mi^i  so  describe  it— as  if  the  throat  were  constriotedi^ 
probably  caneed  by  partial  paralysis  of  the  larynx.  Later 
on  the  animal  snaps  and'  tears  with  its  teeth  and  feet 
every  tiling  that  oomes  in  its  way. 

Some  years  ago  I  had  a  pointer  over  which  I  shot— say 
on  a  Monday.  On  the  Tuesday,  I  did  not  half  like  hie 
look,  so  had  him  chained  ap.  The  next  day  he  com-, 
menced  the  pecaliar  bark,  all  the  other  symptoms  deve- 
loped in  due  course,    He  died  in  eight  days. 

About  five  years  ago,  a  farmer  near  here,  observed  a 
strange  dog  snapping  at  his  sheep.  In  about  three  weeks, 
^ve  of  them  had  to  be  destroyed. 

In  sheep,  the  symptoms  are  most  peculiar ;  thev  run 
here  and  there,  buck  jump,  fall  on  the  back,  kick  out, 
run  again,  &c.,  &c.,  until  finally  exhausted. 

I  know  another  farmer  who  about  fifteen  years  ago  lost 
every  cow  (about  thirteen)  he  had.  They  were  all  seen  to 
be  bitten  by  the  same  dog.  So  you  c  ^n  see  that  from  my 
own  knowledge  the  existence  of  rabies  is  a  sad  reality, 
and,  therefore,  hydrophobia  a  very  possible  disease.  You 
are  right  in  saying  that  the  muzzling  order,  as  at  present 
carrira  out,  is  a  wrong. 

To  be  effectual  it  should  be  perfect,  which  is  impossible. 
There  are  other  grounds  beside  the  all-important  one— 
viz.,  the  prevention  of  rabies  -which  ought  to  make  us 
take  advantage  of  the  present  scare  and  strike  the  iron 
while  hot  with  a  view  of  exterminating  the  present  race  of 
valueless  curs  which  overfiood  our  streets  by  putting  a 
prohibition  tax  on  tJiem.  Few  know  the  damage  to  sheep 
and  game  caused  bv  these  curs,  nor  the  source  of  danger 
they  are  to  the  riders  of  voung  horses.  There  is  another 
side  of  the  question  which,  though  not  exactly  scientific, 
is  of  great  interest  to  dog  breeders  and  fanciers.  If  the 
present  race  of  mongrels  were  exterminated  their  place 
would  be  taken  by  recognised  breeds  of  economic  value, 
which  would  naturally  be  well  cared  for  and  kept  under 
proper  oontroL 

I  am,  Sir,~yoar8,  &c., 
H  S. 

14th  March,  1896. 


THE  DEATH  FROM  CHLOROFORM  AT   DUDLEY. 

To  the  Editor  oj  Thb  Mbdioal  Pbbss  and  Ciboulab. 

Sib, — ^I  cannot  acquiesce  in  the  complacent  remarks  in 
your  issue  of  March  11th  with  whicn  you  dismiss  the 
catastrophe  that  befell  the  "robust  young  man"  at 
Dudley  while  undergoing  a  trivial  dental  operation  under 
chloroform,  nor  does  it  appear  from  the  report  that  (to 
^uote  your  words)  *'  the  case  was  one  of  those  .... 
in  which  no  human  precaution  can  afford  protection 
against  a  fatality.**  It  may  or  may  not  be  true,  as  urged 
so  pointedly  by  Mr.  SewiU,  that  the  use  of  chloroform  in 
dental  operations  is  almost  always  unjustifiable,  but  no 
one  will  dispute  that  the  administration  of  a  fluid  ounce  of 
the  drug  affords  presumptive  evidence  of  death  having 
been  due  to  an  overdose.  In  spite  of  the  fact  that  the 
exhibition  of  chloroform  in  a  sitting  posture  is  generally 
recognised  to  entail  special  risk,  no  particular  care  seems 
to  have  been  taken,  seeing  that  the  chloroform  was 
administered  by  the  slipshoo,  hazardous,  '  open  method.' 
Sorely  it  is  an  abuse  of  terms  to  state  that  "  every  pre- 
caution was  taken  "  when  the  most  important  precaution 
of  all,  i,e,t  the  use  of  a  regulating  apparatus,  was  omitted. 
What  should  we  say,  mutatis  mutandis,  if  in  a  case  of 
death  from  morphine  poisoning  it  were  stated  that  the 
dispenser  had  taken  every  precaution — except  that  of  weigh- 
ing the  quantity  of  morphine  ?  It  is  to  this  complacent 
acquiescence  in  what  is,  in  most  instances,  an  eminently 
avoidable  accident,  that  we  owe  the  indifference  of  medical 
men  to  their  responsibilities  in  this  connection,  apd  their 
persistence  in  methods  of  anaBsthetisation  now  generally 
conceded  to  be  intrinsically  dangerous.  In  conclusion, 
I  may  say  that  if  anyone  in  whom  I  am  interested  lopes 
his  lue  under  similar  circumstances,  the  anesthetist  would 
pass  a  ratJier  uneomfortable  quarter  of  an  hour  in  the 
witness-box. 

Yours,  faithfully,^ 

SUB^SON. 


THE  RECENT  LIBEL  ACTION— KINGSBURY 
V.  HART. 

The  Fylde  Medical  Society,  of  which  Dr.  Kingsbury  is 
the  Hon.  Secretary,  held  a  special  meeting  in  Blackpool 
pn  the  20th  of  Maidi,  lt>96,  to  hear  an  explanation  from 
him  of  the  charges  brought  against  him  in  the  British 
Medical  Journal  of  18th  January,  1896,  deeming  it  mora 
satisfactory  that  his  conduct  snould  either  be  vindicated 
or  condemned.by  members  of  his  own  profession,  than  that 
the  verdict  of  a  lay  jury,  already  given  in  his  favour,  at  the 
Manchester  Assizes,  should  be  accepted  as  final. 

Dr.  Kingsbury  dealt  fully  with  the  anonymous  accu- 
sations of  "  Ethics,"  and  the  comments  thereon  by  the 
Editor  of  the  British  MedicalJoumal^  and  gave  a  detailed 
account  of  his  long  connection  wich  both  the  hydropathic 
establishments  of  Blackpool,  and  answered  all  the  ques- 
tions submitted  to  him  by  the  members  of  the  society. 

Dr.  Day  proposed: — '*That,  having  heard  the  ex- 
planation given  by  Dr  Kingsbury,  the  Fylde  Medical 
Society  hereby  unreservedly  accepts  the  same  as  satiB- 
factory." 

Mr.  Eason  seconded  the  proposition,  and  expressed  his 
perfect  confidence  in  the  Hon.  Secretary,  who  had  always 
taken  the  keenest  interest  in  maintaining  the  ethics  of  bue 
profession. 

The  resolution  having  been  supported  by  Drs.  Brown. 
Blundell,  Dunderdale,  Lenihan,  and  Calvert,  was  carried 
unanimously. 

Dr.  Stott  then  proposed : — '*  That,  in  the  opinion  of  this 
Society,  the  attack  of  '  Ethics '  upon  Dr.  Kingsbury  and 
the  method  adopted  by  *  Ethics  '  in  making  such  attack 
are  to  be  strongly  condemned." 

Dr.  Mcintosh,  having  seconded  this  resolution,  it  was 
also  carried  unanimously. 

Dr.  Kingsbury  then  read  a  letter,  which  he  had 
addressed  to  the  Editor  of  the  British  Medical  Journal^ 
the  moment  that  gentleman  had  publicly  stated  that 
he  accepted  the  Manchester  jury's  verdict  as  a  just 
one,  in  which,  among  other  things,  he  says : — '*  As  to  the 
charges  made  against  me,  they  were :  That,  being  the 
physician  to  two  hydropathic  establishments,  and  having 
a  consulting-room  in  each,  I  allowed  the  respective  pro- 
prietors to  announce  the  fact  by  name  plates  giving  my 
nours  of  attendance,  and  in  their  prospectuses  and  news- 
paper advertisements.  In  each  case,  tnis  had  been  done 
for  over  twelve  years,  and  was  in  accordance  with  the 
custom  of  similar  establishments  elsewhere ;  at  one  of 
these  establishments  my  name  was  the  fifth  that  had  been 
so  employed,  and  I  had  never  heard  the  faintest  whisper 
of  dissent  from  any  of  the  local  medical  men,  nor  from  any 
i  of  the  hundreds  of  medical  men  who  yearly  viait  Black- 
pool. More  than  this,  the  various  Presidents  of  the 
Lancashire  and  Cheshire  branch  have  been  familiar  with 
the  usages  of  these  hydropathic  establishments,  and  have 
frequently  met  me  in  consultation  in  them,  and  on  one 
occasion  the  proprietors  of  the  South  Shore  Hydropathic 
entertained  the  members  of  the  Association  when  they 
visited  a  neighbouring  city. 

"  Had  any  of  these  gentlemen  ;  had  the  youngest  of  my 
medical  brethren,  had  the  Editor  of  the  journal,  ever  so 
much  as  hinted  that  any  use  which  was  being  made  of  my 
name  was  even  open  to  criticism,  I  would  at  once  have 
taken  steps  to  prevent  the  continuance  of  it,  but  I  was  in 
absolute  ignorance  that  the  subject  was  even  being  dis- 
cussed, and  well  I  might  be,  for  even  now  the  journal 
contains  the  weekly  advertisement  of  one  of  the  Matlock 
hydropathic  establishments,  setting  forth  the  name  and 
qualifications  of  its  doctor,  who  is  at  the  moment  the 
President  of  the  Midland  Branch  of  the  Association  ;  this 
same  advertisement  may  be  seen  in  nearly  every  railway- 
guide  in  the  kinedom,  and  in  illustrated  mrm  displayed  in 
the  halls  of  London  hotels.  Again,  the  journal  regularly 
advertises  the  names  of  mMical  gentlemen  as  the 
physicians  to  Private  Asylums,  Inebriate  Homes,  etc., 
and  the  Public  Schools  and  Insurance  Companies  of  the 
countiy  publish  widely  the  names,  qualificationis  and  in 
many  instances  the  addresses  of  their  medical  officers  ;  in 
one  of  the  latter,  an  instance  was  mentioned  in  Court 
where  the  hospital  appointment  of  the  'honorary 
physician,'  Sir  Dyce- Duckworth,  waa  advertised. 

"  There  are  other  issues  raised  by  the  recent  trial,  bnjb 
these  I  will  lea^e  the  members  to  discuss  at  Carlisle,  e.y., 


390    The  Mbdioal  Prbh 


NOTICES  TO  CORRESPONDENTa 


Apbil  8,  1896. 


Corrcspairhmts.  i^hort  Xctters,  Ac- 

OT*'  COEMBPOiiDBiHB  reqQlrlng  m  nply  tii  Ihli  column  tfo  par- 
Veularly  reqaefted  to  make  xm  at  %  dittkuHvt  t(gnaitwr§  or  UvUUU, 
ftDd  ftTold  the  pnotlce  of  lignliig  thomiolTM  "  Ba«d«r,"  "  Bnbteilbor,'' 
"  Old  SnlMcribtr,"  dke.  Hach  oonfuioii  WIU  bo  ■p«Kd  by  altoDtloD 
tothifrale. 

THE  PABUAMSNTAR7   BRFSESBNTaTION  OF  THE  BOOTOH 
TJNIVSBfllTIES. 

Ironrcorrwpordent  J.  A,  H.  will  refer  to  oar  lait  week's  IwQe, 
page  860,  he  will  lee  that  we  have  antldpated  hfs  inquiry  With- 
out regard  to  the  poiitioi  whirh  Sir  Jamei  Crichton  Browne  pro- 
feaaea,  we  hope  that  at  a  medical  man,  he  will  noDaed.  He,  moreover, 
ii  one  of  the  moit  diatinguiBhed  paychulogfsta  in  Bompe  and  would  be 
a  moat  valuable  accession  to  the  ranks  oftbe  profeaston  in  the  Howe 
of  Commons.  The  contest  ta,  however,  llkeiy  to  be  severe  inasmuch 
as  the  Liberal  element  has  always  been  in  the  aacendancy  In  the  con- 
stituency. Booie  years  ago  the  seat  was  unsuccesafully  contested  in 
the  Conservative  intereat  oy  Sir  J.  Eric  Bricbaen. 

Dr.  J.  O.  CoNiroitXBritiah  Hoapltal,  Bnenoa  Ayrea).— Your  "  Note  on 
Carbuncle  with  Cases  "  received. 

M.  0.  N.— We  are  gratifled  by  the  asaurance  that  you  have  oome  to  ns 
"  as  a  last  resort,"  but  sitting  aa  a  Court  of  Appeal,  we  have  come  to 
the  conclusion  that  our  oontemporariea  were  fully  ustlfled  in  refuaing 
to  insert  your  communication.    Appeal  refused ! 

Dk.  O.  p.— The  only  wav  we  oan  suggest  to  aaotttain  whatahare  of 
the  mental  symptoms  is  due  to  the  uterine  affeetioii^  is  to  cure  the 
latter,  and  to  observe  the  degree  of  improvement.  If  the  delusioos 
oersist,  the  propriety  of  plscing  the  patfent  under  reatraint  may  well 
be  raised. 

CBIHIKAL  LAW   AND  PitlSOK   REFORM. 
To  th4  Editor  0/  TBI  MlDICAL  PRISS  AVD  CIRCULAR. 

SIR,— Drastic  reforms  are  Indeed  needed  in  our  oilmlnal  law  and 
prison  system,  and  we  are  very  glad  to  aee  that  the  subject  is  now 
attracting  more  public  attention.  Mr.  Jnstloe  Hathew,  in  his  speech 
to  the  grand  Jury  at  the  last  Birmingham  Assises,  remarks  that  the 
present  state  of  the  criminal  law  Is  a  hundrsd  years  behind  the  times, 
administering  it,  as  we  do,  without  observing  the  golden  rule  of  hear- 
ing both  sides.  That  tbe  prison  system  is  dehumanlaing  ami  educa- 
tionally useleu  Is  also  to-day  admitted  by  all  decent  experts.  The 
proof  of  excellence  in  a  prison  system  surely  is  that  It  should  humanise 
the  offender  and  diminish  crime.  We  oan  now  take  as  our  authority 
the  recent "  Blue  Book  of  the  Committee  on  Prisons"  for  stating 
that  the  present  system  of  prison  adminlatration  is  neither  a  humania- 
Ing  agency  nor  a  dimiolsher  of  crime.  It  Is  the  belltf  of  tbe  Com- 
mratee  that "  much  good  can  be  done  by  the  recognition  of  the  plain 
fact  that  the  great  majority  of  prisoners  are  ordinary  men  and  women 
amenable,  more  or  less,  to  all  thoae  inilnenoea  which  affect  persons 
outside  " ;  that  the  so-called  criminals  are  not  as  a  class  hopeless 
and  Irreclaimable. 

Tonn  faithfully, 

JO0RPH  COLLDIBOir. 

Brent  Street,  Hendon,  K.W. 

Dr.  Hsusioh's  paper  on  "The  Radical  Cora  of  Inguinal  Henia** 
will  appear  in  our  next. 

Antitoxin.— On  account  of  the  Baster  holidays  yonr  communica- 
tion was  not  received  in  time  for  present  number. 

Q.B.-The  quotation  runs  as  follows:-*' Nowhere  is  the  folly  of 
mankind  more  manifest  than  in  the  little  care  devoted  to  the  preserva- 
tion of  that  most  precious  of  man's  possessions— health.  Uisease  is 
most  frequently  brought  on  by  his  own  faulty  and  he  himself  thna 
opens  the  door  to  Death." 


Socutt  vor  TBI  Stupt  or  IxxBRnTT.—A  p.m.  A  Qasrteriy 
General  Meeting  wiU  be  held  In  the  Rooms  of  the  Medical  Society  of 
London,  11  Chandoa  Street,  Cavendish  Square,  W.  Paper  :  Dr.  A  B. 
T.  Longhwat :  The  Relation  of  Alcoholic  Bttmulanta  to  Trae  Fliyslo- 
loglcal  Health  and  their  Value  in  the  Treatment  of  Dlseasa. 

MORDAT,  APRIL  UIB. 

Odovtolooioal  Booiitt  op  Griat  BRRAnr.— 8  B.m. 
Mr.  A.  Marmaduke  BheUd,  Mr.  htorer  Bennett,  Mr.  Chatlea 


by 


Batancttd. 


Balfymahon  Union.  Abbeyshmle  Dispensary  District —Medleal  Ofloer 
Balary  £100,  and  £S0  extra  as  Health  Officer    (See  advert.)     . 

Bath  Urban  Sanitary  Authority.  -Medical  Officer  uf  Health.  Salary 
£aOi>  a  year.  Applicarions  and  teatimonlals  to  the  Chairman  of 
the  Sanitary  Committee  not  later  than  Wednesday,  April  SSnd. 

City  of  Btarmlngham.— Deputy  Medical  Superintendent  for  tne  City 
Hospital.  Little  Bromwich.  Salary  £176  per  annum,  with  residence, 
rations,  and  attendance.  Full  particulars  of  fifr.  J.  Keyte,  Coun- 
cil House,  Birmingham. 

Dublin,  8teevens'  Hospital— Hons^  Sutfeon.  Balary  £100per  annum, 
with  apartmenta,  lire,  and  light  Applications  and  testimonials 
1 1  the  Governors  and  Guardians  of  Dr.  Steevens'  Hospital,  not 
later  than  Saturday,  April  11th. 

B»st  London  Hospital  for  Children  and  Dispensary  lor  Women,  Olamla 
Boad,  Shadwell,  £.— Resident  Medical  Officer.  Salwy  £80  per 
annum,  with  board  and  residence.  Applications  and  testimonials 
tn  the  Secretary  on  or  before  Saturday,  April  ISih. 

Hereford  County  and  City  Asylum. -Medical  Superintendent.  Salary 
«400  per  annum,  with  furnished  house,  coals,  gas.  vegeUblea,  and 
washiDg.  Applications  to  Chairman,  Asylum  Uommittee,  Bhire- 
hall,  Herefonf. 

Liverpool  Northern  HospltaL— Assistant  House  Sniveon.  Salary  €70 
per  annum,  with  reaidence  and  maintenance  In  the  house.  Appli- 
ca'iona  aua  teatimonlals  to  the  Chairman  not  later  than  April 
17th. 

Manoheater  Royal  Bye  Hospital.— House  Surgeon.  Salary  £70  per 
annum,  with  reaidence,  ooard.  and  washing.  Applications  and 
testimonials  to  the  Chairman  of  the  Board  of  Management  not 
Uter  than  April  14th. 


JKcctingB  of  ^cdjcticB,  ^trturcB,  tec 

WiDHisDAT,  April  stb. 

HmrTKRiAK  SodBTT.— (I<ondon  Institution). -8. 80  p.m.     Dr.   P. 
Warner :  >otes  on  a  case  of  Typhlitis ;  Mr.  Symonds  (late  President), 
who  operated  on  the  case,  will  also  contribute  hia  notea. 
Tbursdat,  April  9tb. 

BRinsB  OTHJWJOLOOICAL  SooiRTT.-  8.80  p.m.  The  adjoumed  dis- 
cussion on  "  Ventro-Flxatlnn,  Ventro-Suspenslon,  and  Allied  Opera- 
tions, with  tbrir  Results."  Paper- Mr.  Bowreman  J«>esett :  The 
Importance  of  Early  Diagnods  of  Cancer  of  the  Uterus,  Illustrated  by 
numerous  specimens  and  the  resulto  of  treatment 
FRIDAY,  April  iotb. 

Wr8T  Kbnt  MBDioo-CBiRVROiaAL  SooiRTT  (Royal  Kent  Dispensary. 
Greenwich  Road.  S. EL). -8.16  p.m.  Mr.  H.  Marsh:  Recent  Progress 
in  the  Pathology  and  Treatment  oC  Diseases  of  the  Jolnte  (Ulnstrated 
by  specimens). 

Clirioal  hociXTT  OP  LORDOH.-8.80  p.m.  Mr.  R.  J.  Oodlee :  Two 
Cases  of  Acute  Ahscess  of  the  Liver.  Dr.  S.  West;  On  Albuminous 
or  Serous  Expectorations.  Dr.  O.  N.  Pitt  and  Mr.  Arbuthnot  Lane  : 
Cranial  Cyst  of  Sarcomatous  Origin  ;  no  recurrence  two  years  after 
Operation.  Mr.  H.  W.  Page :  Sequel  to  a  Case  of  Syphilitic  Cranial 
liecrosis  recorded  in  voL  xxviii  of  tlie  Transactions;  Oumma  of 
Frontal  Lobe ;  Death.  Mr.  L.  Hudson :  A  Case  of  Malingering  in  a 
Bogrot  Eleven. 

West  London  Mrdioo-Cbiruroigal  Sooibtt  (West  London  Hospi- 
tal, W.).— 8.80  p.m.  Papers:— Mr.  J.  B.  Jessett :  A  Case  of  Faxjal 
UstuUt  cured  by  Resection  of  Small  Intestine  by  MaunseU's  Method. 
Dr.  Thndlchum  :  The  Chemistry  of  the  Carbohydratea,  #lth  s^ial 
reference  to  Diabetes.    Pathological  specimen  by  Mr.  A,  Doran. 


Jlpp0intmentf 


BABKBR,  W.  H..  M.R.C.S.Eng.,  L.R.C.P.Edin.,  Acting  Medical  S.iper- 

Intandent  of  the  Ararat  Lunatic  Asylum,  Australia. 
Blaxand,  H.,  L.&C.P.Lon<L,  M.R.C.S.,  Deputy- Inspector  General  of 

the  Insane,  New  South  wales.  . 

CL4PBAM,  O.  P.P.,  L.R.C.P.,  L.R.C.a.Ed.,  L.F.P.aC,  Assistant  Medi- 
cal Officer  for  the  Workhouse  of  the  Parish  of  Liverpool. 
CR088,  G.  F.,  M.B.,  B.3.,  Medical  Officer  of  Health  to  tM  Djwo- 

ham  Rural  District  CouncIL 
Foreman,  J^  L  R.C.P.Edln.,  M.R.C.8  Eng.,  Government  Director  of 

Sydney  Hospital,  New  South  Waltis. 
GoaxLBT,  J.  W.,  L.K.Q.C.P.,  L.R.C.8.IreL,  Health  Officer  for  North 

Ovens  Shire,  Victoria.  AustraUa. 
GOUGB,  U.  E.,  L.R.C.P.Lond.,  M.R.C.<«.,  Medical  Officer  of  Sealth  for 

the  Northwich  Urban  Sanitary  District. 
Grabax,  J..M.U.Edin.,  a  Director  of  the  Prince  Alfred  BospitaL 

Sydney,  New  South  Wales. 
PLATRRfC.  R.,  M.B.,  Ch.aMelb.,  Actinc  MedicU  Superintendent  to 

the  Sudbury  Lunatle  Asylum.  Victoria,  Australia.       ^ 
RANDOLPB,  C,  M.R.C.S.,  L.I1.C.P..  L.M.  Kdln.,  Mwlioal  Officer  for  the 

No.  6  District  of  the  Wellington  (Somerset)  Union. 
SALTRR.C.  E.,  M.D.Lond.,  B.S ,  L.R.C.^'.,  F.R.C.S.,  Honorary  Surgeon 

to  tne  Scarborouah  BospitaL 
Santi,  p.  R.  W.  dr,  P.R.C.S.,  Assistant  Surgeon  (rice  C.  8tonham)and 

Aural  Surgeon  to  the  Wastmlnstor  Hispltal 
TBOBAfl,  J.  T.,  LJLC.P.Lond.,  M  &C.S  ,  Medical  Officer  of  Health  for 

the  Camborne  Urban  Sanitary  District. 
TB0M80N.  J.  A.  M.,  L.R.C.P.Irel.,  L.M.,  L.R.C.S.IreL,  Medical  Officer 

of  Health  for  Bradford-on- Avon. 


§mhB, 


Clowrs.— March  81st,  at  Coogeshall.  Easex,  the  wife  of  Wm.  F.  A. 

Clowes,  M.R.C.S.,  L.R.C.Pr  of  a  son. 
CROpoRR.— April  1st,  at  Syston  House,  Boscomhe,  Bournemouth,  the 

wife  of  John  Oopper.  Ii.  A.,  M.B.,  B.C.Cantab.,  of  a  daughter. 
H0LMI8.— March  80th.  at  Femdale,  Wotum  Sands,  Beds,  the  wife  of 

T.  D.  Bolmea,  M.D.Edlo..  of  a  daughter. 
MARTIN.-April  Srd,  at  2  <4outhalck  Place,  Byde  Park,  Lond  m,  W., 

the  wife  of  Beory  C,  Martin*  M.D.,  of  a  son. 
Smith.— March  20th,  at  Brook  Btnet,  Grosvenor  Square,  the  wife  of 

Dr.  Pye  Smith,  of  a  son. 


^AttiaqtB. 


SHVTRR  TlPPBlT.— March  25th,  at  the  Parish  (Hiurch,  CShiswick. 
Geoige  Percy  Shutar,  M.A.,  M.S.,  R.C  Cantab..  D.P.H  ,  of  Oak- 
lands,  Chiswick  Lane.  W.,  toBUen  France*  Tiopets,  of  Cleveland 
House,  (Chiswick,  second  daughter,  of  G.  F  Tippett,  of  Bromley. 


§tAihB. 


(^PRLAND.— March  26th,  at  Stalndrop,  William  Copeland,  M.R.C.8. , 

aged  80. 
MoNCKTON.— March  26th,  at  Maidstone,  D^vid  Henry  Monekton,  M.D. 

Lond.,  aged  67. 
Tbomas. -March  31st,  at  Mile  End  House,  LUndoviiry,  David  Thomaa, 

M  R.C.'*.,  J.P..  in  his  82nd  year 
TU0KRR.-I4arch  29th,  at  Olaalyn,  St.  Leonards-on-Sea,  John  Dunning 

Tucker,  aged  67. 
Wilson.— April  Ut,  at  No.  8  Plazsa  Madonna,  Florence,: WUllatn  WU- 

aon,  M.D.|  F.R.C,S.,  inhis  88nd  year. 


^h  ^dmi  ^xt&$  mi  €itmhx. 


-•SALUS    POPULI    SUPRBMA    LEX." 


WEDNESDAY,    APRIL    15,     18-96. 


Vou  cxn. 


No.  16. 


©rifltiml  (fl;otnmttnijDfrticm& 

ABDOMINAL  SURGERY— NOTES  OF 

CASES. 
By  RUTHERFORD  MORISON,  M.B.,  F.R.C.S, 

SeDlor  AMbtant  Sargeon  Soyal  Infirmary,  Newoattle-oii-Tyiie ; 
Couulilng  Surgeon  Newcastle  Dantal  UoepitaL 

The  accusation  is  frequently  brought  against  sur- 
geons, especially  abdominal  ones,  that  they  record 
fiieir  successes  and  bury  their  failures. 

In  the  present  paper  my  intention  is  to  record,  first, 
all  deaths  that  have  occurred  after  abdominal  opera- 
tions performed  by  me  during  1895,  and  afterwards  to 
relate  such  cases  as  are  of  any  special  interest,  and 
were  operated  upon  during  the  same  period.  The  list 
of  deaths  includes  : — 

Five  cases  of  intestinal  obstruction. 

Two  cases  of  cancer  of  the  pylorus. 

One  gall-stone  case. 

One  case  of  pyonephrosis. 

Two  cases  of  verified  appendicitis,  of  which  I  have 
accurate  notes  and  three  or  four  cases  of  purulent 
itonitis,  simply  drained  as  a  last  chance,  in  which  a 
niosis  of  appendicitis  with  diffuse  peritonitis  was 
made  from  the  history  but  was  not  verified  by  operation 
or  post-mortem.  I  regret,  for  the  sake  of  absolute  accu- 
racy, having  kept  no  record  of  the  exact  number  of 
these  cases  and  having  to  trust  to  memory,  but  offer 
as  my  excuse,  their  urgency,  their  lack  of  specisJ 
interest,  and  my  dislike  to  statistics. 

INTESTINAL  OBSTRUCTION  CASES. 

Case  L  Femoral  Hernia— StrangulaUd  for  a 
week  —Herniotomy  —  Gangrenous  Omentum — Death 
tenth  day  after  operation  from  Peritonitis, 

A  woman,  aet  63,  feeble  looking,  with  a  pulse  of  110, 
a  dry,  brown  tongue,  and  fecal  odour  of  breath,  was 
seen  on  May  8th,  1895. 

History.— A  week  ago  her  illness  commenced  sud- 
denly with  pain  round  the  umbilicus  and  severe  vomit- 
ing. The  pain  and  the  sickness  were  relieved  by 
morphia,  but  on  the  fourth  day  of  her  illness  a  large 
quantity  of  fsecal  matter  was  vomited.  A  small,  bard 
lump  was  now  discovered  by  the  doctor,  in  the  groin, 
but  as  she  made  no  oomi>laint  when  it  was  handled, 
and  as  the  pain  was  entirelv  abdominal,  and  because 
the  swelling  was  very  hard,  the  doctor  regarded  it  as 
an  enlarged  gland,  and  thought,  as  she  did,  that  it  had 
no  connection  with  her  illness.  Two  days  later,  I  saw 
her  in  consultation.  Her  abdomen  was  enormously 
swollen  and  hard  ;  she  was  frequently  sick,  vomiting 
f SBcal  matter,  and  had  never  paased  flatus,  nor  had  her 
bowels  moved  since  the  attack  commenced. 

Operation.—!  cut  down  at  once  on  the  small,  hard, 
rounded  swelling  in  the  right  groin,  and  opened  the  sac 
of  a  femoral  hernia.  The  sac  contained  a  small  quan- 
tity of  bloody  fluid,  a  piece  of  gangrenous  omentum 
which  was  ligatured  and  cut  off,  and  a  small  knuckle 
of  bowel  which  was  not  gangrenous  and  was  returned. 

After  Progress.— SkknesB  soon  ceased  after  recovery 
from  the  anaasthetic  On  the  third  day  llie  boweu 
were  spontaneously  relieved.    For  the  next  few  days 


diarrhoea  was  a  troublesome  symptom.  Up  to  the 
evening  of  the  eighth  day  progress  appeared  tobe  satis- 
factorv,  except  that  the  abdominal  swelling  never 
entirely  went  down.  On  the  evening  of  the  eighth  day 
the  patient  complained  of  sudden  severe  pain  in  the 
abdomen,  and  vomited.  All  the  symptoms  of  acute 
peritonitis  then  developed,  and  she  died  on  the  tenth 
day  after  operation. 

There  was  no  post-mortem.  The  most  probable  ex- 
planation is  that  a  slow  ulceration  of  tne  damaged 
intestine  perforated  and  set  up  the  fatal  peritonitis. 

Case  II.  Ovariotomy  for  Ovarian  Cyst  vnth 
Ttaisted  Pedicle  and  Peritonitis,  followed  a  week  later 
by  Intestinal  Obstruction — Syncope — Post-Mortem. 

An  unmarried  woman,  set  45,  had  ovariotomy 
performed  on  September  23rd,  1895.  The  tumour 
was  a  large  multilocular  cyst  with  twisted  pedicle. 
Subacute  peritonitis  was  present  at  the  time  of  the 
operation,  and  the  tumour  was  adherent  to  portions  of 
intestine,  parietes,  &c. 

On  Sept.  29th,  her  recovery  up  to  this  having  been 
uninterrupted,  after  a  tea  of  bread  and  butter  at  5  p.m.. 
she  vomited  and  complained  of  pain  in  her  stomach  and 
flatulence.  A  dose  of  castor  oil  was  administered  at 
6  p.m.^  and  at  10  p.m.  her  bowels  were  weU  moved,  and 
she  passed  a  good  night. 

30th.— She  was  sick  and  a  little  pained  at  11  a.m. 
At  her  own  suggestion  small  doses  of  rhubarb  and  soda 
were  prescribe,  and  she  was  reduced  to  a  slop  diet 
As  she  said  she  was  subject  to  such  attacks  which  were 
always  relieved  by  the  medicine  ordered,  her  condition 
was  not  regarded  as  serious.  The  wound  was  looked  at 
for  the  first  time.  It  was  healed  throughout  There 
was  no  abdominal  distension.  At  7  p.m.  she  vomited 
again. 

Oct  1st— I  saw  her  at  9  a.m.  She  had  taken  two 
doses  of  rhubarb  and  soda  and  frequent  drinks  of 
barley  water  and  milk  during  the  night  Vomited  at 
12  a.m.,  2.0,  2.15,  and  5.30.  Her  abdomen  was  dis- 
tended and  very  tender  ;  pulse  135,  temp.  98°.  I  now 
recognised  that  the  symptoms  were  due  to  intestinal 
obstruction,  and  as  she  had  suffered  from  a  long  illness 
and  was  naturally  a  feeble  woman  that  her  condition 
was  serious.  Directions  were  given  to  have  every- 
thing prepared  for  abdominal  section  at  11  a.m. ;  m 
mouth  feeling  was  stopped  and  rectal  injections  of 
beef-tea,  milk,  and  whisky  were  ordered.  On  return- 
ing at  11  to  do  the  operation  I  found  her  so  much 
improved  that  operation  appeared  to  be  unnecessary. 
The  pain  and  rumbling  had  ceased ;  she  had  passed 
a  little  flatus,  and  the  abdomen  was  soft  and  could  be 
manipulated  without  causing  pain.  She  passed  a  good 
day,  and  at  5.30  was  so  well  that  a  cup  of  tea  was 
allowed  and  enjoved.  At  8  p.m.  her  oowels  were 
slightly  moved  after  an  enema.  Except  that  the 
pulse  continued  quick  (130),  everything  looked  satis- 
factory. 

2nd.— At  2.30  a.m.  she  ajgain  complained  of  pain  and 
vomited  matter  with  a  distinctly  faecal  odour.  This 
was  repeated  at  5  and  5.30  a.m.,  when  I  saw  her  and 
arranged  to  operate  at  11.  A  few  minutes  before 
my  arrival  she  had  turned  suddenly  faint  and  cold, 
and  I  found  her  hopelessly  ill.  She  died  at  11.30  a.m. 
on  the  tenth  day  after  the  ovariotomy. 

Post-mortem.— A  portion  of  small  intestine  close  to 


^9^     tm  Mbdiual  Pbbsb. 


OFiOlNAL   COAOtTT^^CATtONS. 


April  iS,  1^. 


the  end  of  the  ileum  was  firmly  adherent  to  the  parietes 
on  the  left  side  immediately  above  Poupart's  ligament. 
The  mesentery  of  the  adherent  coil  of  intestine  was 
tightly  stretched  across  the  pelvis  and  the  larger  part 
of  the  small  intestines  had  passed  underneath  it.  The 
coils  that  had  done  so  were  much  distended  with  fluid 
faBces.  A  portion  of  jejunum  which  was  wedged  into 
the  angle  formed  between  the  tightened  mesentery 
and  its  point  of  attachment  was  so  severely  gripped 
that  it  looked  as  if  a  cord  had  been  tied  round  it. 
Above  the  constriction  the  intestines  and  stomach 
were  distended. 
Ca3E  It  I.     Volvulus  of  Small  Intestine  necessitating 

Evisceration— Death  from  Intestinal  Paresis, 
.  A  man,  set  42,  had  complained  frequently  during 
the  past  six  months  of  griping  pains  and  had  lost  flesh. 
He  was  suddenly  seized,  on  the  23rd  of  July,  1895, 
^ith  excruciating  pain  in  his  abdomen  and  vomited. 
The  doctor  sent  for  found  him  collapsed  and  in  agony, 
and  at  once  injected  half  a  grain  of  morphia  hypo- 
dermically.  For  two  or  three  hours  he  was  relieved 
but  vomited  continuously,  and  this  lasted  all  ni^ht. 
In  the  early  morning  he  required  another  injection. 
Vomiting  continued  incessantly.  I  saw  him  within 
twenty-four  hours  of  the  commencement  of  the  attack. 
He  was  grey,  looked  pinched  and  anxious  about  him- 
self)  and  evidently  seriously  ill.  His  abdomen  was 
prominent  in  front,  tense  and  distended.  There  was 
no  hernia,  no  tumour,  nothing  to  be  felt  per  rectum, 
And  nothing  was  discovered  to  lead  to  a  diagnosis  of 
the  cause  of  the  obstruction. 

Operations—On  opening  the  abdomen,  tensely  dis- 
tended, small  intestine  presented  at  the  wound.  My 
hand  introduced  discovered  only  that  the  obstruction 
M&i  in  the  small  intestine,  for  the  large  bowel  was  empty 
dnd  contracted.  No  explanation  of  the  condition  could 
be  found  till  the  entire  small  intestines  were  lifted  out 
of  the  abdomen.  It  was  then  seen  that  nearly  the 
whole  of  the  small  intestine  formed  a  volvulus  by 
twisting  of  the  mesenteric  attachment,  the  jejunum 
above  and  the  ileum  below  the  involved  part  being 
empty.  The  last  portion  of  ileum  engaged  in  the 
volvulus  was  deeply  indented  by  pressure  against  the 
tense  mesentery.  The  o^ration  occupied  nearly  an 
honri  the  distended  intestine  was  reduced  with  diffi- 
culty, and  at  the  termination  of  the  operation  it  was 
uncertain  whether  the  torsion  from  right  to  left,  em- 
ployed for  the  reduction  of  the  displacement,  had 
satisfactorily  accomplished  its  object. 

After  Progress,— July  25th.  During  the  night 
folio  win£[  operation  the  patient  vomited  three  times 
a  quantity  of  cofl'ee-ground  fluid  and  had  passed 
no  flatus.  He  was  easy  and  his  abdomen,  though 
somewhat  distended,  was  not  tense.  His  general  con- 
dition was  fair. 

26th.— Had  a  bad  nigbt,  still  occasionally  vomits 
cofl'ee-ground  flaid.  No  flatus  passed.  Pulse  quick 
and  feeble.  Qeneral  appearance  bad.  Died  in  the 
evening.    No  post-mortem. 

Case  IV.  Malignant  Stricture  of  Small  Intestine — 
Sudden  Obstruction  —  Enterostomy  —  Gafigrene  and 
Perforation  qf  Bowel  above  Enterostomy  Opening— 
Peritonitis, 

A  stout  woman,8et.  59,  was  admitted  to  the  Infirmary, 
under  my  care,  on  the  evening  of  Aufnist  15th,  1895. 

At  Easter  she  had  an  attack  of  abdominal  pain,  fol- 
lowed by  jaundice,  and  attributed  to  gall  stones.  She 
had  subsequently  been  well  up  to  three  weeks  before 
admission.  She  was  then  suddenly  seized  with  ab- 
dominal pain  and  vomiting.  For  the  first  three  days 
the  sickness  and  vomiting  were  incessant,  then  she 
improved,  and  was  sick  only  two  or  three  limes  in  each 
twenty-four  hours.  Since  the  commencement  of  the 
attack  she  had  been  unable  to  pass  flatus,  though  much 
troubled  with  noisy  painful  rumblings^  and  there  had 
been  no  evacuation  from  the  bowels. 

On  admission  she  was  much  exhausted,  and  her  ab- 


domen  was  tense  and  enormously  distended.  Running 
across  transversely  from  the  hepatic  towards  the  splenic 
region  a  largely  distended  coil  of  intestine  was  plainly 
visible.  There  seemed  to  be  little  doubt  that  this  was 
the  transverse  colon,  and  this  sign,  with  her  history, 
suggested  an  obstruction  below  the  splenic  flexure  of 
the  colon. 

Operation,- On  August  16th,  1895,  an  incision  as  for 
inguinal  colotomy  was  made.  The  sigmoid  flexure 
and  the  descending  colon  were  found  to  be  contracted. 
The  distended  small  intestine  was  drawn  out  of  the 
opening  without  further  loss  of  time,  and  in  the  part 
exposed  the  obstruction  was  found.  A  ring  of  malig- 
nant growth  spread  from  the  mesentery  round  the 
intestine  and  comj[>letely  blocked  it.  The  mesenteric 
glands  were  extensively  diseased.  That  excellent  and 
ingenious  device,  a  Paul's  tube,  was  tied  into  the  intes- 
tine above  the  obstruction,  and  the  gut  was  sutured  to 
theabdomincJ  wall.  O^er  a  quart  of  faeces  and  a 
quantity  of  flatus  soon  escaped  from  the  tube,  and  the 
patient  was  put  to  bed  apparently  no  worse  for  the 
operation. 

After  Progress,— Onthemotningol  Aug.  17thIfound 
the  patient  remarkably  well.  She  had  not  been  sick 
since  the  operation,  bad  a  normal  temperature,  a 
good  pulse,  and  the  abdominal  distension  was  almost 
gone.  Improvement  continued  till  eight  in  the  even- 
inir,  when  she  complained  of  sudden  severe  abdominal 
pain.  Shortly  after,  the  house-surgeon  found  her 
collapsed,  and  evidently  very  ill.  She  died  during  the 
nigbt. 

Post-mortem  —On  opening  the  abdomen  there  was 
evidence  of  commencing  peritonitis,  and  traces  here 
and  there  of  fluid  f  seal  matter.  The  tube  in  the  intes- 
tine was  firmljr  held,  and  sufficient  adhesion  had 
occurred  round  it  to  close  the  wound.  The  enterostomy 
opening  was  about  \\  feet  from  the  end  of  the  ileuroi 
and  6  inches  above  the  obstruction.  Two  feet  above 
the  enterostomy  opening  there  was  a  gangrenous  per- 
forated patch  in  the  convexity  of  the  intestine  opposite 
a  malignant  growth  in  the  mesentery.  Dr.  Beattie, 
Pathologist  to  the  Royal  Infirmary,  who  made  the 
post-mortem,  agreed  with  me  in  thinking  that  the 
gangrene  was  in  great  part  due  to  the  interference  of 
the  bloody  supply  by  the  growth  in  the  mesentery,  and 
in  part  to  the  long  previous  distension.  At  several 
different  parts  of  the  mesentery  were  other  malignant 
growths.  All  had  the  same  character  as  the  one  which 
had  caused  complete  obstruction,  t.e.,  commencing  in 
the  mesentery  near  the  intestine  they  spread  from  it 
round  the  gut,  forming  annular  strictures.  There  were 
several  gall-stoDen  in  the  irall-bl adder. 

Casb  V.  Malignant  Stricture  of  End  q/"  Descend- 
vng  Colon^  causing  Sudden  Obstruction — Typhlotomy 
-  Death  from  Intestinal  Paresis, 

A  man,  »t.  62,  who  had  never  been  troubled  with  his 
bowels  before,  a rd  so  far  as  he  knew  was  in  perfect 
health,  was  suddenly  seized  two  weeks  ago  with  pain 
in  bis  abdomen.  The  pain  was  very  bad,  and  was 
accompanied  by  loud  rumblings,  but  he  had  passed  no 
flatus  and  had  no  motion  since.  A  variety  of  purga- 
tives, including  jalap,  and  all  sorts  of  enemata  had 
been  used,  bnt  their  only  effect  was  to  increase  his 
pain.  He  had  never  vomited.  This  he  attributes  to 
taking  no  food  and  very  little  drink. 

When  I  saw  him  his  abdomen  was  distended,  and  to 
add,  like  a  drum,  best  describes  his  condition.  There 
was  no  hernia,  no  rectal  disease,  and  nothing  could  be 
felt  in  the  abdomen.  Succussion  was  very  distinct  over 
the  caecum,  and  metallic  tinkling  over  the  splenic 
flexure  of  the  colon.  Not  more  than  a  pint  of  fluid 
con M  be  retained  as  an  enema. 

Operation,— ^ov,  5th,  1895.  The  abdomen  was 
opened  in  the  middle  line  below  the  umbilicus.  The 
distended  csecum  lay  underneath  the  incision,  and 
was  gently  assisted  outside.  As  it  was  delivering 
itself,  two  round  black  spots,  the  size  of  split  peas,  were 


rApML»i6,'i8w. 


OMGINAL  COMMaNICATIONS. 


Thb  Mbdigjll  P&»8.     3d3 


noticed  on  the  anterior  waU,  and  as  soon  as  it  escaped 
fasces  began  to  ooze  from  both  spots.  An  opening  was 
now  made  in  the  caecnm,  ana  there  was  a  rush  of 
fluid  faeces  and  flatus.  About  a  quart  of  fluid  fiecal 
matter  soon  escaped.  The  opening  in  the  gut  was 
temporarily  clamped  with  forceps  and  washed  up»  and 
the  gangrenous  patches  were  depressed  into  the  caecum 
and  retained  by  Lembert's  sutures,  I  now  introduced 
my  hand  into  the  abdominal  cavity  to  explore  and  found 
a  narrow  hard  annular  non-adhen^nt  growth  at  the  lower 
end  of  the  descending  colon.  There  were  no  enlarged 
glandp.  APaul's  tube  was  tied  into  thecsBcum,  which  was 
sutured  round  the  tube  to  the  lower  end  of  the  pari«^tal 
incision,  the  remainder  of  which  was  closed.  The 
patient,  on  being  put  to  bed,  appeared  to  be  no  worse 
for  the  operation. 

Afiefi  Frogress.—Qth.  He  has  passed  the  first  com- 
fortable night  since  his  illness  commenced,  and  is  free 
from  pain.  The  abdominal  swelling  is  very  consider- 
ably reduced.  A  quantity  of  flatus  has  escaped  through 
the  tube,  but  very  little  fiscal  matter. 

The  improvement  was  only  temporary  for  less  passed 
through  the  tube  each  day,  and  strychnine,  castor  oil, 
calomel,  turpentine  and  aU  else  failed  to  produce 
further  evacuation,  the  abdomen  gradually  swelled 
again,  and  he  died  on  Nov.  11th  (seventh  day  after  ope- 
ration). 

Post  mor^tfw.— There  was  some  plastic  lymph  cover- 
ing the  caecum,  otherwise,  there  was  no  ei^n  of  perito- 
nitis. The  whole  of  the  intestines  were  still  distended 
with  fluid  faeces  and  gas.  At  the  end  of  the  descend- 
ing colon  a  hard  annular  stricture,  not  wider  than  a 
slate  pencil,  was  found.  There  were  no  enlarged 
glands  and  no  secondary  deposits  in  the  viscera.  The 
caecum  was  of  enormous  size.  No  trace  of  the 
gangrenous  patches  was  visible  from  the  outside. 
On  opening  the  colon  a  small  ulcer  was  seen 
in  the  anterior  wall  of  the  caecum ;  a  soft  ]X)lypoid 
mass  about  the  size  of  a  green  fig  hung  projecting  into 
the  lumen  near  the  splenic  flexure  ;  the  stricture  at  the 
end  of  the  descending  colon  was  ulcerated  and  brittle, 
and  admitted  the  tip  of  my  little  finger. 

Microscopically,  the  stricture  was  a  cylindrical- celled 
carcinoma,  the  noYypus  a  soft  fibroma. 

Case  VF.  Hydronephrosis  dtie  to  Stricture  of  Ureter 
--  Suppuration— Rupture  of  Abscess  into  Duodenum-^ 
Nephrectomy. 

A  delicate  woman,  set.  35,  with  maiks  of  chronic 
abscesses  on  her  neck  and  on  her  arm  and  knee,  from 
which  bone  had  escaped. 

History,— Tvo  years  ago  she  had  a  pain  in  the  right 
side,  and  discovered  a  swelling  under  her  ribs  which 
was  tender  when  pressed.  After  rubbing  it  with  oint- 
ment for  three  months  the  swelling  disappeared,  and 
was  not  noticed  again  till  June  of  this  year.  In 
June  a  similar  swelling  made  its  appearance  in  the 
same  place  and  caused  some  uneasiness,  but  did  not 
interfere  much  with  her  health  till  August,  when 
she  began  to  have  plight  rigors  at  night,  took  to  bed, 
and  got  a  doctor.  When  he  saw  her  she  was  weak  and 
ill,  had  a  temperature  of  104®,  profuse  sweats,  and 
vomited  frequently.  For  six  weeks  poultices  were 
constantly  applied  to  relieve  the  pain.  For  the  last 
three  weeks  she  had  vomited  after  every  thing  she  took. 
The  vomited  matter  was  mostly  green,  sometimes 
yellow,  and  had  a  bad  smell.  She  had  been  frequently 
purged  and  her  motion  was  very  offensive.  There 
never  had  been  any  urinary  trouble. 

Oa  examination  the  abdomen  was  seen  to  be 
prominent  under  the  right  ribs  and  all  the  signs  of  a 
kiduey  mnch  enlarged  and  distended  by  fluid  were 
present.  The  urine  was  normal- though  limited  in 
quantity  (37  ounces  average  of  24  hours),  sp.  g.  1020. 
Had  no  deposit. 

The  patient  was  sent  to  Newcastle  for  operation, 
but  on  ner  arrival  appeared  to  be  so  ill  that  operation 
WHS  p0dt|Kmed.    She  iBAmediau»ly  began  to  iuipruvt) 


and  retain  small  quantities  of  mUk.  She  was  kept  in 
bed  and  carefully  nursed  and  fed  for  a  week.  During 
the  first  five  days  her  morning  and  evening  tempera- 
tures were  normal.  On  the  last  two  evenings  her 
temperatures  were  100**  and  101^ 

Operation.— Oct  7th,  1895.  The  abdomen  was  opened 
in  the  linea  semilunaris  and  the  diagnosis  of  kidney 
tumour  verified.  A  second  incision  was  carried  from 
the  centre  of  the  first  transversely  into  the  ilio  costal 
space  and  back  to  the  loin.  (I  have  advocated  and 
practised  this  incision  for  some  years  believing  it  to  be 
the  best  in  cases  requiring  nephrectomy.)  The  capsule 
of  the  kidney  was  next  divided  and  the  kidney  easily 
peeled  out.  After  the  pedicle  had  been  tied  (a)  ap 
opening  was  observed  at  the  deepest  part  of  the  wound« 
It  was  thought  at  first  to  be  the  dilated  ureter  but  a 
more  careful  examination  showed  it  to  be  the  duo- 
denum. Valvular  oomidantes  were  visible  and  mjr 
finger  passed  for  some  distance  upwards  engag6d  the 
pylorus.  An  attempt  was  made  to  suture  this  opening 
with  catgut.  The  wound  was  closed  except  posteriorly, 
and  there  a  drainage-tube  was  left.  The  patient  was 
much  collapsed  after  the  operation,  never  fairif 
recovered  from  the  shock,  and  died  the  same  night. 

Fost-mortern.— The  stomach  and  duodenum,  the 
left  kidney  and  ureter,  the  capsule  of  the  right  kidney 
and  its  ureter,  bladder,  uterus  and  appendages*  and 
broad  ligaments  were  removed  (exhibited).  The  duo- 
denum was  opened,  and  in  its  second  part  an  oval 
aperture  with  smooth  edges,  evidently  of  some  standings 
and  which  would  admit  my  fioger,  was  seen.  It  went 
directly  into  the  gap  left  by  removal  of  the  kidney,  and 
the  remaining  capsule  was  firmly  adherent  all  round  it. 
The  ureter  was  dilated  in  the  upper  two-thirds  of  its 
extent,  and  filled  with  thick  pus.  The  dilatation 
ended  abruptly  at  the  junction  of  the  upper  two-thirds 
with  the  lower  one-third,  and  a  small  probe  could  not 
be  passed  through  the  commencement  of  the  constricted 
portion.  A  probe  introduced  from  the  bladder  end  of 
the  ureter  passed  up  to  this  spot,  and  was  arreated 
there.  A  fine  stilet  passed  through.  There  was  a 
tight  stricture  of  the  ureter.  Nothing  was  found  in 
the  pelvis  or  external  to  the  ureter  to  account  for  this. 
The  ovary  tubes  and  broad  ligaments  on  both  sides 
were  healthy  (demonstrated).  The  opposite  kidney 
and  ureter  and  the  bladder  were  normal. 

Microscopically,  tubercle  was  specially  sought  for. 
Neither  bacilli  nor  histological  evidence  of  tubercle 
were  discovered.  The  microscopic  appearances  sug- 
gested an  ascending  nephritis. 

Case  VIl.  Gallstones  with  dense  adhesions  of  Gall- 
bladder— Hectic  Tevijyerature, 

A  woman,  aet.  62,  in  bad  health  for  the  last  At 
months,  actually  ill  for  the  last  three  weeks. 

For  many  years  she  had  been  subject  to  attacks  of 
"spasms,"  and  eight  years  a^,  after  an  unusually 
severe  bout,  was  ill  with  jaundice.  , 

Six  months  ago  her  present  illness  commenced  with 
pain  over  the  liver  and  stomach,  and  vomiting.  For 
five  months  she  was  an  invalid,  seldom  free  from  pain, 
and  sick  every  day.  A  change  of  air  had  always  '*  set 
her  up"  before,  and  thinking  it  might  do  so  on  this 
occasion,  she  went  to  a  part  of  the  country  which  had 
always  suited  her.  At  tne  end  of  a  week  she  became 
so  much  worse  that  she  returned  home.  When  I 
saw  her  she  had  been  acutely  ill  for  three  weeks.  A 
temperature  chart  had  been  regularly  kept  during  this 
time,  and  showed  a  temperature  strongly  sugffestiveof 

Eus  (98^100«>  in  the  morning.  101°-104*  at  night).  She 
ad  frequently  been  disturbed  by  rigors,  and  sweated 
profusely  during  the  night.  The  pulse  was  120  ;  the 
tongue  dry,  glazed,  and  red.  There  was  no  iaundice 
and  no  sign  of  disease  anywhere,  exsept  in  the  abdo- 
men.   Over  the  liver  there  was  marked  tenderness 

(a)  ^  hit  is  the  secret  of  the  operation  in  such  a^caw.    Ihe  capeuJe 
Ineres  io  daodenum,  pancreas  and  vena  cava  so  ftrmly  that  removal 


/sdl 


with  it  18  iiiipoBftib.e.  *  xr.  Blaud  Sutton  has  taught  us  thi-. 


in    Tnk 


■DIGAL  PlUnS. 


ORlGDf AL  COMMUNICATlOl^S. 


Apbil  15,  189^. 


The  liyer  dnlness  was  not  increased.  At  the  lower 
edge  of  the  lirer  in  the  gall-bladder  neighbourhood  an 
ill-defined  resistance  eonld  be  felt,  and  oyer  this  area 
the  tenderness  was  greatest. 

Operatumr^UBj  6th,  1895.  The  abdomen  was  opened 
by  a  transverse  incision  immediately  below  the  costal 
margin  extending  from  the  outer  border  of  the  right 
rectus  muscle  to  the  outer  edffe  of  the  quadratus  lum- 
brium.  The  under  surface  of  the  liver,  the  omentum, 
the  colon,  and  the  pyloric  end  of  the  stomach  were 
matted  together  by  dense  adhesions,  which  were  sepa- 
rated with  diflSculty,  but  without  loss  of  blood.  After 
making  the  separation  for  some  distance  inwards  I 
could  feel  a  gall-stone,  the  size  of  an  ordinary  nut,  1  ving 
buried  at  some  depth.  Fixing  this  between  the  fore- 
finger and  thumb  of  my  left  hand,  I  got  down  to  it  by 
cuttinff  and  tearing,  squeezed  it  out  of  its  bed  into  the 
wouna  and  removed  it.  Immediately  after  its  escape 
bile  flowed  from  the  opening  made,  and  I  could  feel  no 
more  stones.  No  pus  was  seen.  I  could  not  say 
where  the  stone  was  lying.  The  operation  was  com- 
pleted by  the  insertion  of  a  full-sized  rubber  drainage 
tube,  one  end  at  the  opening  discharging  bile,  the 
other  at  the  posterior  extremity  of  the  parietal  wound, 
and  suture  of  the  parietes. 

The  patient  when  put  back  to  bed  was  in  fair 
condition. 

After  Progress,  May  7th,  1895.— The  patient  has  had 
a  fair  night,  has  recovered  from  the  shock  of  the  opera- 
tion ;  the  tube  is  discharging  bile  freely,  and  she  looks 
as  if  she  had  a  chance  of  getting  better. 

8th.— A  bad  night,  much  exhausted,  prognosis  bad. 
Died  to-night ;  no  post-mortem. 

(To  be  continued,) 


OBSERVATIONS  ON  THE 

RADICAL     CURE      OF      INGUINAL 

HERNIA,  (a) 

By  FRANCIS  T.  HEUSTON,  M.D.,  M.Ch. 
F.RC.S.I., 

Hember  of  Coandl.  ILG.&L.    Surgeon  to  the  AdeUide  Hoipltal, 

CoDfolting  Buegeoii  to  tbe  Ooombe  Lyiog-ia  Ho«pitai,  and  to  the 

CMpiile*'  Home. 

DiTRiNO  the  past  few  years  so  many  methods  have 
been  intioducea  for  the  radical  cure  of  inguinal  hernia 
that  the  present  seems  to  me  a  proper  time  to  bring 
the  subject  forward  for  discussion,  with  the  hope  of 
coming  to  a  definite  opinion  as  to  which  method  is 
likely  to  give  the  most  satisfactory  results  to  the  sur- 
geon and  the  patient.  It  is  so  well  understood  tiiat 
this  affection  is  due  to  an  abnormal  condition  of  the 
internal  abdominal  ring,  and  of  the  structures  enterinff 
into  the  formation  of  the  poeterior  wall  of  the  inguin&3 
canal,  that  I  would  wish  to  say  a  few  words  as  to  the 
anatomy  of  this  re^on.  As  to  the  internal  abdominis 
ring,  it  is  most  important  to  remember  that  it  is 
rendered  the  weakest  position  by  the  coalescence  of 
the  structures  forming  tne  cord,  and  the  prolongation 
on  those  structures  of  the  fascia  transversalis  as  the 
infundibuliform  fasda.  The  j^osterior  wall  of  the 
inguinal  canal  is  naturally  divided  bvthe  deep  epi- 
^tric  artery  and  its  vena  comities,  by  far  tibe  most 
important  in  relation  to  hernia,  being  that  portion 
external  to  the  vessels  which  is  formea  by  the  peri- 
toneum, subperitoneal  fascia, fascia  transversalis,  the 
reflected  fibres  from  the  internal  oblique  and  transver- 
salis muscles  to  Poupart's  ligament  and  deep  crural 
arch,  *' Cooper's  fibres,"  with  occasionally  some 
fibres  of  the  transversalis  muscle  close  to 
the    ring,     ''Guthrie's     fibres,"     this     constituting 

(a)  BeMlhefore  the  Siir«lcal  Section,  JUnral  Aoademj  of  Medldaeln 
IreUnd,  on  Mwoh  iOth.  1880. 


the  weakest  portion  of  the  poeterior  wall  of  the  canal 
is  usually  implicated  in  oblique  hernia  and  liable  to  be 
the  seat  of  recurrence  after  operation.  Of  that  portion 
of  the  canal  internal  to  the  epigastric  vessels,  we  need 
only  consider  that  situated  between  those  vessels  and 
the  outward  border  of  the  rectus  muscles,  correspond- 
ing to  Hesselbach's  triangle,  and  the  usual  position  of 
direct  hernise,  here  we  find  the  following  structures : 
peritoneum,  sub-peritoneal  fascia,  fascia  transversalis, 
conjoined  tendon  of  the  internal  oblique  and  transver- 
salis muscles,  the  inner  and  strongest  portion  of 
Cooper's  fibres,  and  the  outer  fibres  of  ColWs  triangu- 
lar ligament,  which,  it  will  be  seen,  renders  the  canal  in 
tlus  position  much  stronger  than  that  portion  external 
to  the  vessels.  Of  the  structures  f omung  the  posterior 
wall  of  the  canal,  by  far  the  most  important  is  the  fascia 
transversalis,  as  can  readily  be  demonstrated  on  dis- 
secting this  region,  when,  if  the  structures  forming 
the  abdominal  wall  superficial  to  it  be  removed,  there 
will  be  no  tendency  to  protrusion,  even  if  the  internal 
pressure  be  great,  but  when  the  fascia  is  removed, 
slight  pressure  is  sufficient  to  cause  protrusion,  when 
a  hernia  occurs  there  is  not  on!  v  a  weakening  of  this 
fascia  at  the  point  of  exit,  but  from  the  result  of  its 
pressure,  there  is  a  general  weakness  or  sagging  of  the 
fascia  in  the  inguinal  re^on.  I,  therefore,  consider 
that  in  any  operation  aiming  at  radical  cure,  it  is  not 
alone  necessary  to  close  the  opening  or  prolongation  of 
the  fascia,  where  the  hernia  has  found  its  way  out,  but 
it  is  also  to  strengthen  and  support  the  wakened 
fascia  in  the  immediate  neighbourhood,  it  being  my 
belief  that  the  frequency  of  recurrence  noticed  after 
some  of  the  recent  operations  is  due  in  a  great  extent 
to  neglect  of  this  point.  So  many  operations  have 
been  recently  advocated  that  it  would  serve  no  good 
purpose  to  mention  them  in  detail.  I  will,  however, 
shortly  describe  a  few  of  those  in  most  general  favour. 
Opens  anterior  wall  of  canal  to  full  extent. 

Bassini— Separates  sac  from  cord,  ligatures  neck  of 
sac,  removes  sac  if  it  be  small  and  hernia  incomplete, 
but  idlows  it  to  remain  if  it  be  large,  sutures  conjoint 
tendon  to  Poupart's  ligament  beneath  the  cord,  anterior 
wall  of  canal  united,  cord  remaining  in  canal. 

Kocher— Separates  sac  from  cord,  passes  sac  through 
opening,  in  aponeurosis  of  external  oblique  correspond- 
ing to  exit  from  abdominal  cavity,  twists  sac,  and 
fastens  it  to  external  oblique  in  direction  of  inguinal 
canal. 

Halsted— External  oblique,  internal  oblique,  and 
transversalis  muscles  cut  from  external  ring  two  centi- 
metres above  internal  ring,  sac  separated  from  cord  and 
removed,  veins  of  cord  excised,  fascia  transversalis  and 
muscles  sutured,  cord  removed  from  canal,  and  fixed  to 
superficial  fascia  of  inguinal  region. 

Mitchell  Banks — Sac  separated  from  cord,  neck  liga- 
tured as  hi^  as  possible,  sac  removed,  canal  sutured 
by  silver  wire. 

Ball— Sac  separated  from  cord,  neck  of  sac  twisted 
and  ligatured,  sac  removed  and  4SAntA  sutured. 

MacEwen— Sac  separated,  puckered  and  retained  in 
canal  bv  suture,  canal  sutured. 

It  will  be  seen  that  these  operations  can  be  divided 
into— (1)  Where  the  inguinal  canal  is  freely  opened. 
(2)  Where  the  inguinal  canal  is  not  opened.  Taking 
statistics,  we  find  that  the  tendency  to  recurrence  after 
the  first  is  much  less  than  after  the  second,  but  I 
question  if  the  results  wiU  be  so  favourable  after  a 
lapse  of  years,  as  time  is  such  a  potent  factor  in  caus- 
ing the  absorption  of  cicatricial  tissue.  There  can, 
however,  be  no  doubt  but  that  operations  which  give  a 
full  and  clear  view  of  the  floor  of  the  inguinal  canal, 
enable  the  operator  to  see  which  of  the  structures,  in  a 
given  case,  require  moat  attention. 

I  will  now  describe  an  operation  which  I  have  per- 
formed on  32  occasions  (hospital  and  private),  die 
patients  varying  in  a^se  between  18  months  and  03 
years.    All  of  the  patients  recovered,  and,  as  far  as  I 


April.  15,  1K96. 


ORIGINAL  COMMUNICATIONS. 


Thb  Mxdioal  Press.     395 


have  been  able  to  ascertaiD,  there  has  been  no  recur- 
rence of  the  hernia,  although  the  cases  were  not  in  any 
way  selected  ones,  some  being  of  many  years'  standing 
and  of  very  severe  type. 

The  skin  in  the  inguinal  region  is  drawn  down- 
wards, and  an  incision  of  about  three  inches  in  length 
is  made  over  the  inguinal  canal,  the  inner  extremity  of 
the  incision  corresponding  to  the  crest  of  the  pubes, 
the  aponeurosis  of  the  external  oblique  and  the  external 
abdominal  ring  are  thus  exposed,  the  inter- columnar 
fascia  being  opened,  the  sac  is  found  and  separated 
from  the  cord.  Should  the  hernia  prove  to  be  a  con- 
genital one,  the  sac  is  cut  across  above  the  tes- 
ticle, and  the  lower  portion  sutured  to  form  a 
tunica  vaginalis ;  the  sac  is  now  separated 
from  the  cord  in  its  entire  extent,  it  is  thus 
saved  from  injury  in  the  subsequent  steps 
of  the  operation,  the  sac  is  twisted  suflficiently  to  render 
its  neck  a  solid  cord,  which  is  transfixed  at  its  exit 
from  the  external  abdominal  ring  by  a  needle  armed 
with  strong  gut  which  is  then  tied  by  a  Staffordshire 
knot.  A  Wood's  hernia  needle  is  then  passed  through 
the  aponeurosis  of  the  external  oblique  close  above 
Poupart's  ligament,  and  at  a  point  corresponding  to  the 
exit  of  the  twisted  sac  from  the  abdominal  cavity,  the 
surgeon's  finger  in  the  inguinal  canal  determines  the 
proper  place,  also  the  depth  to  which  the  needle  should 
be  passed,  and  protect  tne  cord.  The  needle  is  now 
passed  through  the  twisted  neck  of  the  sac  which 
should  be  drawn  down  as  well  as  possible,  as  the 
higher  the  sac  is  pierced  the  better.  If  the  curved 
needle  be  now  lateralised,  its  point,  guided  by  the  finger 
in  the  canal,  can  readily  be  protruded  through  the 
external  ring,  and  armed  with  a  strong  catgut  suture, 
the  needle  is  now  withdrawn.  The  surgeon's  finger  is 
again  passed  into  the  canal,  and  the  needle  is  again 
passed  throu^  the  abdominal  wall  about  half  an 
inch  above  and  external  to  the  exit  of  the  twisted 
neck  of  sac  from  the  abdominal  cavity,  it  should  be 
passed  sufficiently  deep  to  include  the  internal  oblique 
and  transversalis  muscles  with  the  transversalis  fascia 
and  having  reached  the  canal  is  guided  by  the  finger 
through  the  external  ring.  It  is  now  armed  by  that 
end  of  the  suture  protruding  from  the  ring  and  with- 
drawn. A  second  suture  is  passed  in  a  similar  manner 
through  the  walls  of  the  canal  about  midway  between 
the  former  and  external  ring,  itagain  piercing  the  twisted 
sac  and  deep  abdominal  muscles  and  fascia  on  a  lower 
plane  than  the  former.  The  ends  of  the  ligature  which 
was  originally  applied  round  the  sac  are  now  passed 
respectively  through  the  superior  and  inferior  pillars  of 
the  external  abdominal  ring.  The  deepest  suture  is 
now  tied  drawing  the  sac  upwards  and  outwards,  and 
at  the  same  time  approximating  the  deep  abdominal 
muscles  and  fswcia  to  Poupart's  ligament  and  twisted 
sac  ;  the  second  suture  is  now  tied  approximating  the 
conjoint  tendon,  fascia  transversalis,  and  sac  to  Poupart's 
ligament  in  the  middle  third  of  the  canal,  the  effect 
being  that  the  posterior  wall  of  the  canal  is  closed 
throughout  by  the  approximation  of  the  superior  and 
inferior  walls  assisted  by  the  twisted  neck  of  the  sac, 
which  thus  hinders  any  tendency  to  protrusion.  It  will 
be  seen  that  both  the  sutures  pass  superficial  to  the 
cord,  which  is  retained  in  a  position  somewhat  below 
that  which  it  normally  occupies.  The  operation  is  now 
completed  by  removing  the  sac  beyond  the  third  liga- 
ture, which  on  being  tied  closes  the  upper  part  of  the 
external  ring  and  fixes  the  cut  end  of  the  sac  against  its 
internal  aspect.  A  drainage  tube  is  inserted  into  the 
canal,  the  superficial  fascia  united  by  a  buried  suture 
of  catgut  and  the  skin  by  silkworm  sutures.  I  usually 
remove  the  drainage  tube  on  the  third  day,  the  silk- 
worm sutures  about  the  fifth  and  sixth,  and  allow  the 
patient  out  of  bed  in  about  three  weeks,  a  spica  bandi^e 
being  applied  for  another  week. 


Igaris  (Elinical  l^tJCturtJB. 


BRONCHO-PNEUMONIA    IN    CHILDEEN. 
By  Dr.  LE  GENDRE, 

Physician  to  the  Children's  Hospital,  Paris. 
[F£0M  our  FRENCH    CORRESPONDENT.] 

Two  children  were  recently  brought  to  the  pavilion 
set  apart  for  measles  on  the  same  day,  one  aged  18, 
and  tne  other  20  months,  with  the  same,  at  least  in 
appearance,  complication  of  pneumonia.  One  is  quite 
well  to-day,  while  the  other  succumbed,  although 
treated  in  the  same  way.  The  first  was  a  child  without 
any  morbid  antecedent,  the  second  was,  on  the  contrary, 
affected  with  rickets,  and  the  mother  stated  that  her 
two  first  children  had  died  young,  one  from  meningitis, 
the  other  from  dysentery.  The  result  justified  in  both 
cases  the  prognosis  that  I  had  formed  at  the  first  exa- 
mination. Broncho- pneumonia  is  always  a  secondary 
infection,  the  primary  being,  to  cite  the  most  common, 
measles,  whooping-cough,  diphtheria,  and,  I  would 
add,  tuberculo8is,*as  Profs.  Landouzy  and  Queyrat  have 
proved  by  histological  and  bacteriological  examination, 
the  frequency  with  which  tuberculosis  lies  hidden 
behind  the  scenes  of  broncho-pneumonia  in  ^oung 
children.  Daily  observation  shows  that  the  gravity  of 
broncho-pneumonia  varies  according  to  the  course  of 
the  affection  of  which  it  is  the  sequence.  Yon 
Zeimssen  gives  as  the  mortality  of  broncho-pneumonia 
following  measles,  11  deaths  out  of  43  cases  ;  in  that 
consecutive  to  bronchitis,  14  in  32 ;  after  whooping- 
cough,  13  in  24  ;  and  it  can  be  said  that  where  it  is  a 
complication  of  croup,  it  is  the  most  dangerous  of  all. 
Amongst  the  symptoms  which,  in  the  course  of  the 
malady,  aggravate  the  prognostic  are  the  excessive 
rapidity  of  the  respiration,  and,  above  all,  the  Cheyne- 
Stokes  tvpe,  quick  and  irregular  pulse,  cyanosis  or  wax 
colour  of  the  face  indicating  blue  or  white  asphyxia,  a 
temperature  of  104"^  without  remission,  and  still  more, 
a  sudden  fall  without  any  parallel  decrease  in  the 
pulse,  and  the  respiration.  On  the  side  of  the  nervous 
system  extreme  agitation  is  not  as  dangerous  as  ex- 
treme prostration,  while  convulsions  at  the  commence- 
ment should  not  give  rise  to  much  uneasiness,  whereas 
if  they  set  in  at  an  advanced  period,  they  indicate 
asphyxia  from  insufficient  hsematosis  or  the  existence 
of  cerebral  thrombosis.  A  rapid  decrease  or  suppression 
of  the  cough  is  also  a  bad  symptom  when  auscultation 
shows  that  the  respiratory  field  is  not  yet  free,  for  if 
the  cough  has  disappeared,  it  is  a  proof  that  the  central 
nervous  system  is  incapable  of  exciting  the  reflex 
movement. 

The  treatment  of  broncho-pneumonia  comprises  at 
first  hygienic  measures  and  which  are  of  great  import- 
ance. Unfortunately,  many  practitioners  neglect 
them,  giving  as  an  excuse  the  poverty  of  their  clients, 
and  it  is  certainly  difficult  to  obtain  the  proper  execu- 
tion of  these  measures  amongst  the  poor.  The  child 
should  be  placed  in  a  large  well-ventilated  room  with 
the  windows  open  in  summer  from  time  to  time  to 
renew  the  air.  In  winter  a  good  fire  will  keep  the  room 
at  64^,  and  it  will  be  found  useful  to  steam  the  room 
constantly  with  boiling  water,  to  which  some  antiseptic 
agents,  such  as  phenic  acid,  tincture  of  benzoine, 
eucalyptus  leaves,  &c,,  can  be  added.  Very  young 
children  should  not  be  left  long  in  the  cradle  nor  in 
the  dorsal  position  ;  they  must  be  frequently  held  in 
the  arms.  Older  children  should  be  propped  up  in 
bed,  the  feet  and  legs  kept  warm  by  being  wrapped  in 
cotton  wadding. 

The  most  constant  element  in  broncho-pneumonia  is 
the  congestion  for  which  counter-irritation  has  been 
employ^  from  time  immemorial,  such  as  cupping, 
mustard,  blisters,  actual  cautery.  But  this  treatment 
is  no  longer  in  harmony  with  our  present  knowledge  of 

0 


396     iHE  Mbdioal  Pbkss. 


ORIGINAL  COMMUNICATIONS. 


April  15,  1896. 


the  physiology  of  the  vaso* motor  system,  and  for  this 
reason  I  give  unhesitating  confidence  to  the  application 
of  cold  to  the  thorax  according  to  the  following 
method.  We  prepare  compresses,  tarlatnn  folded 
several  times,  of  a  length  and  breadth  sufficient  to 
envelope  the  whole  thorax.  They  are  steeped  in  cold 
water,  with  a  fourth  of  alcohol  added  ;  the  compress 
is  wrung  so  as  to  he  only  well  damped.  The  child  is 
undressed  as  quickly  as  possible,  and  the  cloth  rolled 
around  him  ;  oil  silk  is  placed  over  all,  while  the  rest 
of  the  body  is  wrapped  in  blankets.  At  the  end  of  a 
quarter  of  an  hour  the  compress  is  removed,  steeped 
again  and  replaced,  and  so  on  every  quarter  of  an  hour 
at  first,  then  every  half  hour,  and  finally,  every  hour, 
according  to  the  improvement  obtained  in  the  respira- 
tion, circulation,  and  the  nervous  system,  for  the 
habitual  effect  of  this  treatment  is  the  attenuation  of 
all  these  symptoms.  If  no  improvement  takes  place, 
recourse  should  be  had  to  the  wet  sheet.  D'Espine 
and  Picot  advises  the  warm  bath  at  96**  twice  a  day, 
with  the  cold  application  in  the  interval.  Hutinel  is  a 
strong  partisan  of  cold  baths  where  the  local  lesions  were 
not  considerable.  He  find  that  it  increases  notably  the 
urinary  secretion  which  facilitates  the  elimination  of 
the  toxines  ;  the  cold  bath  also  increases  the  salivary 
and  digestive  secretions,  rendering  the  tongue  moist, 
and  permitting  the  digestion  of  liquid  aliments. 

When  the  temperature  attains  106^.  the  cold  bath  is 
always  indicated  the  first  being  at  82'',  the  other  lower, 
but  never  below  64°.  Cold  water  should  be  applied  to 
the  head  while  the  child  is  in  the  bath.  For  my  part, 
I  have  frequently  employed,  with  success,  baths  at 
gradually  cooling  temperatures.  I  commence  at  102<^, 
an  hour  later.  I  give  it  at  95®,  two  hours  aft**'*,  at  89*", 
and  every  three  hours  subsequently  at  86°.  The  effect 
produced  is  very  marked  ;  the  child  gets  calm,  the 
dyspnc&a  is  decreased,  and  sleep  comes  on.  Imme- 
diately after  each  bath  something  warm  is  given  the 
patient. 

The  internal  treatment  should  consist  in  stimulant 
mixtures,  alcohol,  cafeine,  ether,  while  depressants  of 
every  kind  should  be  discarded,  as  well  as  the  blister 
which  is  so  often  applied  with  evil  effects  to  the  little 
patient.  I  am  more  and  more  convinced  that 
broncho-pneumonia  in  children  gets  well  better  by 
hydro-therapy,  hypodermic  injections  of  cafeine, 
alcohol,  and  good  hygienic  treatment  than  by  the  old 
methods. 


NOTE  ON 

EXCISION    OF    THE    TONGUE    FOR 
CANCEROUS  DISEASE. 

By  J.  O.  CONOR,  M.A.,  M.D.,  B.Ch.,  T.C.D., 

Senior  Medical  Officer  to  the  British  Hoapltil,  Baenot  Ayres, 
Argentiua. 

As  the  following  method  combines  rapidity  of  execu- 
tion with  a  very  small  loss  of  blood,  it  maybe  interest- 
ing to  publish  it  ;— 

I.— A  Mason's  gag  having  been  introduced,  the 
tongue  is  seized,  one  inch  from  tip,  with  a  pair  of 
forceps  (vide  Arnold's  Catalogue,  1895,  figure  1,855). 
By  using  these,  instead  of  the  orthodox  silk  threads, 
there  is  a  great  advantage,  in  that,  the  operator  has 
got  a  firm  hold  of  the  organ,  and  can  move  it  "  in  one 
piece"  at  will,  which  is  most  useful  throughout  the 
operation  :  by  this  means  the  tongue  is  drawn  forwards 
and  upwards,  thus  the  floor  of  the  mouth  is  thoroughly 
exposed  and  the  frenum  made  tense. 

II.— With  a  blunt-pointed  scissors,  angular  on  flat, 
the  frenum  is  divided,  downwards  and  backwards,  then 
the  mucous  membrane  on  floor  of  the  mouth,  and  if 
the  cancer  is  situated  far  back,  some  fibres  of  genio- 
byo^lossi  must  b^  eevered,  also  the  attacbm^nta  to 


anterior  pillars  of  fauces.  The  tongue  can  now  be 
drawn  well  outside  the  mouth,  in  fact,  as  Mr.  White- 
head states, "  the  operation  is  practically  converted  into 
an  extra-oral  excision."  Also,  I  most  fully  endorse 
this  gentleman's  opinion,  that  it  is  unnecessary  and 
losing  valuable  time  in  bothering  about  the  small 
amount  of  haemorrhage  that  occurs  from  above  detach- 
ments. 

III. — A  transverse  incision  is  next  made  with  a  sharp 
knife,  if  possible  one  inch  posterior  to  cancer ;  this  cut 
must  extend  the  whole  width  of  tongue,  with  two  or 
three  bold  touches  of  the  knife  an  incision  half  an  inch 
in  depth  is  made  ;  the  haemorrhage  from  this  source 
does  not  deserve  the  application  of  a  torsion  forceps. 
(Note. — The  depth  of  incision  must  vary  according  to 
portion  of  tongue  incised ;  if  too  deep  the  Unguals 
would  be  cut.) 

IV.— The  tongue  is  now  seized  by  a  strong  double- 
handled  forceps  (vide  diagram).with  upper  blade  placed 
in  groove  made  by  transverse  incision,  and  lower  one 
under  tongue  at  same  line.  The  forceps  is  tightly 
locked,  and  with  very  little  traction  the  whole  field  of 
operation  is  advanced,  fixed,  and  any  haemorrhage  there 
is.  ceases. 

v.— A  lateral  cut,  with  an  angular  scissors,  is  next 
made,  behind  forceps,  on  each  side,  to  the  extent  of 
one  quarter  the  diameter  of  tongue. 

YL— An  aneurism  needle,  threaded  with  a  strong 
double  silk  ligature,  is  passed,  exactly  in  median  line, 
behind  and  quite  close  to  forceps,  the  silk  loop  is 
grasped,  divided,  and  needle  withdrawn ;  for  the 
moment  it  is  expedient  to  attach  an  artery  forceps  to 
each  end  of  silk  ligatures,  this  prevents  any  subsequent 
confusion  ;  before  tying,  the  tissues  containing  lingual 
arteries  may  be  yet  further  divided  bjr  gentle  sawing 
movements  with  each  ligature  ;  when  tied,  the  tongue 
is  cut  away  anteriorly  to  forceps,  the  latter  removed, 
and  any  superfluous  tissue  anterior  to  ligatures  snipped 
awftv. 

This  almost  bloodless  operation  takes  about  ten 
minutes  to  perform;  if  the  patient  is  deeply  chloro- 
formed before  commencing,  it  is  quite  unnecessary  to 
continue  it ;  the  anaesthetist  can  lend  much  more 
called- for  assistance  by  keeping  the  head  pushed 
forwards  and  to  one  side. 

For  the  removal  of  a  cancer  in  anterior  half  of  tongue 
five  minutes  deliberate  work  will  readily  suffice.  In 
this  calculation  the  possible  supervention  of  "  surgical 
delirium  "  is,  of  course,  not  reckoned. 

This  forceps  renders  the  operation  rapid,  safe,  and 
easy,  in  fact,  reduces  the  immediate  operative  gravity 
of  the  procedure  to  the  small  risk  of  an  operator  with  a 
"  shaky  mind  "  cutting  the  Unguals  when  dividing  the 
orftl  attachments. 

The  advantages  I  claim  for  this  method  are  :  (a)  The 
portion  of  tongue  posterior  to  cancer  is  securely  fixed 
and  cannot  slip  back,  (b)  Forward  traction  is  secured, 
thus  the  operative  field  is  kept  easily  "  in  hand  "  ard 
well  in  view,  (c)  No  respiratory  or  haemorrhagic  diffi- 
culty takes  place,  in  fact,  "you  have  got  him  tight." 
(d)  The  fixed  handles  of  forceps  serve  as  self-retaining 
mouth  retractors. 

To  a  recent  publication  by  Mr.  Christopher  Heath, 
**  a  bloodless  method  of  removal  of  half  the  tongue,"  I 
am  indebted  for  the  main  idea  in  this  operation. 

A  few  remark^  as  to  the  construction  of  the  forceps 
may  be  useful.  The  blades  are  7  centimetres  in  length, 
and  are  of  the  same  bulk  as  those  in  Well's  strong 
angular  pressure  forceps.  At  each  end  of  one  blade  a 
pin  is  fitted,  in  order  that  the  tongue  cannot  slip  (  ut- 
side  grasp  of  forceps.  Thp  grooves  in  blades  are 
horizontal,  not  oblique  as  in  Well'o,  and  are  placed  at 
an  angle  of  120''  with  blades.  The  joints  are  placed 
one  inch  from  blades,  in  order  to  give  a  wide  range  of 
movement. 

I  have  asked  Messrs.  Arnold  and  Sons,  West  Smitb* 
field,  to  make  the  forceps. 


April  16,  1896. 


TRANSACTIONS  OF  SOCIETIES.         Thb  Medical  Pbbrs.     397 


CLINICAL  SOCIETY  OF  LONDON. 
Mbstin(>>  hbld  Friday,  April  10th,  1896. 

The  President,  Dr.  Buzzard,  in  the  Chair. 

Mr.  Godlee  on 

TWO  CASES  OP  AOUTB  ABSCESS  OF    THE  LIVEB. 

L  Pylephlebitis.  A  warehouseman,  set.  41,  had  an  acute 
illness  in  June,  1895,  which  left  him  with  pain  in  the 
region  of  the  liver,  for  which  he  was  seen  in  September. 
He  had  a  hectic  temperature  and  one  rigor.  There  was 
obvious  swelling  of  the  liver.  The  diagnosis  lay  between 
suppurating  hydatid  and  abscess.  The  abdomen  was 
opened  on  the  18th  of  October,  and  a  large  abscess  found 
at  the  front  of  the  liver.  A  drainage  tube  was  inserted. 
There  was  slight  improvement  for  a  day  or  two  which 
was  not  maintained.  Post-mortem  there  was  old  inflam- 
mation about  the  caecum,  clotting  of  the  right  branch  of 
the  portal  vein,  and  the  corresponding  part  of  the  liver 
was  riddled  with  abscesses.  The  left  portal  vein  was 
patent,  and  the  left  lobe  of  the  liver  was  free  from  suppu- 
ration, the  patient  had  also  purulent  meningitis.  Remarks 
are  mside  on  the  pathology  and  treatment  of  this  condi- 
tion. 2.  Patient  a  previously  healthy  Scotch  manufac- 
turer, 8Bt.  58.  Disease  began  insidiously  a  month  before 
he  came  under  notice,  there  was  very  rapid  enlargement  oi 
the  liver  accompanied  by  rieors.  An  abscess  was  found 
upon  the  under  surface  of  the  liver,  containing  about  one 
pint  and  a  half  of  stinking  pus.  The  patient  was  very 
feeble  before  the  operation  and  died  of  shock. 

Mr.  Arbuthnot  Lake  recalled  the  case  of  a  patient 
who  had  suffered  from  attacks  of  what  at  first  appeared 
to  be  biliary  colic,  but  the  distension  of  the  gall-bladder 
was  associated  with  tenderness  over  that  region,  and  her 
temperature  rose  to  103"*  F.  He  made  out  the  presence  of 
stones  in  the  gall-bladder,  and  cut  down  and  removed 
them.  It  was  Adherent  to  the  large  intestine.  He  left  a 
tube  in,  though  he  made  no  attempt  to  see  whether  there  was 
anything  in  the  transverse  fissure  owing  to  the  numerous 
adhesions.  Moreover,  there  was  no  jaundice.  He  saw  her  a 
morning  or  two  after  the  operation  just  after  an  attack  of 
the  old  pain  had  come  on.  Her  temperature  was  then 
normal  but  it  rapidly  ran  up  to  107''  F. ,  and  frhe  died  seven 
hours  later.  Post-mortem  they  found  an  abscess  behind 
the  portal  vein,  and  the  liver  was  filled  with  large  hasmor- 
rhagic  patches.  Although  no  opening  into  the  vein  could 
be  made  out  it  seemed  absolutely  certain  that  the  abscess 
had  burst  directly  into  it,  or  one  of  its  branches. 

Mr.  Spurrell  asked  why  the  author  passed  his  sutures 
only  half  an  inch  into  the  liver  in  fixing  that  organ  ? 

Mr.  Godlee,  in  reply,  said  he  had  passed  the  needles  in 
somewhat  superficially  because  there  was  reason  to  believe 
that  the  matter  was  near  the  surface. 

cranial    cyst  of  SARCOMATOUS    0RI6IN-*-N0    RECCRRENCB 
TWO  YEARS   AFTER  OPKRATION. 

Dr.  PiTT  and  Mr.  Lane  showed  a  patient  who,  in  1891, 
first  complained  of  pain  in  the  top  of  his  head  where  he 
found  a' soft  area.  He  paid  little  attention  to  this  con- 
dition till  September  1893,  when  it  bulged  outwards  form- 
ing a  tumour  as  large  as  an  egg.  This  swelling  gradually 
subsided.  On  four  occasions  it  became  enlarged  ana 
painful,  subsiding  by  the  discharge  of  a  considerable 
quantity  of  serum  through  an  orifice  which  formed  in  the 
scalp.  He  was  first  seen  in  November  1892,  when  the 
swelling  measured  about  2i  by  2  inches.  It  fluctuated 
and  also  pulsated  distinctly.  A  few  days  after  its  contents 
discharged  themselves,  about  an  ounce  being  collected  and 
examined,  when  it  was  found  to  be  simply  serous.  A 
depression  three-quarters  of  an  inch  deep  replaced  the 
Bwellintr  and  was  bounded  by  a  thin  irregular  bony  margin 
which  in  parte  yielded  slightly  to  pressure.  In  December 
1892,  the  scalp  over  this  area  was  freely  divided,  when  a 
space  was  exposed  which  extended  some  little  way  beneath 
toe  overlapping  edge  of  bone.  Covering  the  whole  of  the 
floor,  being  most  abundant  at  its  limits  and  destroying 
the  overlapping  bone,  was  a  quantity  of  some  material 
which  was  apparently  sarcomatous  in  structure.  This 
Btmcture  was  verified  by  subseciuent  examination.  As 
the  ^wth  wf^  BO  BQ(t  apd  extensive  it  was  not  felt 


advisable  to  remove  such  a  large  area  of  bone  and  dura 
mater  as  would  be  required  for  its  entire  elimination  so 
the  wound  wan  closed.  Since  the  operation,  except  for  a 
temporary  leakage  of  serum  and  for  a  subsequent  attack 
of  erysipelas,  the  patient  has  enjoyed  excellent  health  and 
has  had  no  return  of  the  headache  from  which  he  suffered 
previous  to  the  operation. 

Mr.  Maktns  recalled  a  case  which  somewhat  resembled 
this  one.  Some  years  ago  a  patient  came  with  a  large 
tumour  of  the  upper  jaw,  which  had  formed  within  a  year, 
and  was  attended  by  severe  haBmorrhage.  He  admitted 
having  had  pyphilis,  but  the  tumour  did  not  present  the  ap- 
pearances of  a  gumma.  He.  therefore,  removed  the  upper 
jaw  and  scraped  the  base  of  the  skull.  It  healed  ud  by  pri- 
mary union  and  he  left  the  hospital  in  a  fortnight.  He  heard 
nothing  more  of  the  patient  for  between  two  and  three 
years,  when  he  came  back  with  a  large  recurrence,  and  a 
large  open  ulcer  with  thick  edges  involving  nearly  the 
whole  of  his  cheek.  He  was  told  that  nothing  could  be 
done  for  him  and  he  retnmed  home,  where  he  resorted  to 
some  quack  remedy.  After  a  time  the  tumour  underwent 
shrinkage,  and  in  the  course  of  five  or  six  months  it 
entirely  cicatrized.  The  question  arose  whether  or  not  it 
was  a  gumma,  but  a  number  of  competent  microscopiAts 
who  haid  been  shown  the  sections  were  strongly  of  opinion 
that  the  appearances  were  those  of  a  sarcoma.  He  believed 
there  were  several  other  cases  of  the  kind  on  record. 

Dr.  Pitt  called  attention  to  the  small  amount  of  growth 
in  this  case  and  the  large  amount  of  fluid,  the  growth 
proper  being  limited  to  what  looked  like  granulation  tissue 
at  the  base  of  the  cavity. 

sequel   to   a   case  of  syphilitic  cranial  necrosis — 
gumma  of  frontal  lobe -death. 

Mr.  Page  related  the  after-history  of  a  patient  who  in 
July,  1894,  had  had  compression  of  brain  and  frequent 
convulsion »  satisfactorily  dealt  with  by  trephining  over 
the  right  Rolandic  area  and  the  removal  of  a  large  quantity 
of  broken  down  gummatous  material  from  between  the 
dura  and  the  bone.  A  large  piece  of  necrosed  eroded  bone 
was  taken  away  at  the  same  time.  The  lesions  were  obvi- 
ously syphilitic  The  patient  returned  to  his  work,  and 
was  free  from  fits  until  early  in  November,  1895,  when 
they  suddenly  returned  and  rapidly  regained  their  former 
frequency,  numbering  from  four  to  ten  every  hour.  The 
fits  seemed  to  begin  in  the  left  hand  or  the  left  angle  of  the 
mouth,  but  so  quickly  became  general  that  it  was  impos- 
sible to  be  certain  on  this  point.  The  site  of  the  former 
operation  was  exposed,  but  no  fresh  diseape  was  discover- 
able either  there  or  in  the  immediate  neighbourhood,  and 
it  was  obligatory  to  desist  from  further  exploration  as 
there  was  nothing  in  the  symptoms  to  show  where  disess<^ 
lay.  It  was  strongly  suspected  that  there  was  a  cerebr'*! 
gumma  beyond  surgical  interference.  The  fits  continued 
to  increase  in  frequency  and  severity,  and  in  two  days  the 
man  died  exhausted.  At  the  necropsy  a  large  broken- 
down  gumma  which  it  would  have  been  impossible  to 
remove  was  found  in  the  right  frontal  lobe. 

Mr.  Clement  Lucas  said  the  case  reminded  him  of  that 
of  a  woman  who  was  supposed  to  have  cancer  of  the  breast. 
She  had  a  ragged  ulcer  of  one  breast  exposing  a  cartilage, 
and  the  lung  on  the  same  side  was  dull  to  percussion, 
with  the  usual  signs  of  consolidation.  It  was  thought 
possible  that  it  was  syphilitic  disease  and  she  was  given 
large  doses  of  iodide  of  potassium  but  without  producing 
any  appaurent  effect.  After  some  weeks  she  suddenly 
became  subject  to  epileptic  seizures,  in  one  of  which  she 
died.  Her  real  history  was  not  found  out  until  after  her 
death.  She  entered  the  hospital  as  a  cook  in  a  respectable 
family,  and  all  possibility  of  syphilitic  infection  was 
strenuously  denied,  but  it  turned  out  that  she  had  formerly 
been  a  prostitute.  The  lung  was  fibrous  throughout  and 
she  had  a  tumour  growing  from  the  dura  mater  which 
projected  into  the  frontal  lobe.  She  presented  other 
signs  of  syphilis. 

Dr.  Chapman  ask^^d  whether  the  patient  was  treated 
with  iodide  of  potassium  in  the  interval  between  the  first 
and  second  attacks  ? 

The  President  said  he  was  about  to  ask  the  same  ques- 
tion. He  asked  whether  any  ophthalmoscopic  examination 
W818  made  on  his  second  admission  ?  Unfortunately  the 
case  did  not  appreciably  advance  their  knowledge  of  the 
subject.    Th9  lesion  ip*  the  fropt»l  lob^  cQuld  uot  be  held 


398     Thb  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


April  15,  1896. 


to  account  for  the  motor  dittmbanoee  which  oharacteriaed 
the  attack  up  to  the  patient'e  death.  He  BUffgested  that 
the  tumour  in  the  Rolandic  area  might  poeBibTy  have  been 
present  when  the  patient  was  first  seen,  for  it  had  often 
been  observed  that  such  lesions  might  exist  without  giving 
any  manifestation  of  their  presence.  He  mentioned  that 
when  an  operation  had  been  performed  for  epilepsy, 
although  the  fits  might  have  been  relieved  thereby  even 
for  a  considerable  time,  they  often  returned,  apparently  in 
consequence  of  the  formation  of  cicatricial  tissue  at  the 
site  of  the  operation,  which  acted  as  a  new  formation 
pressing  upon  the  brain  surface.  Possibly  the  attacks  in 
this  case  were  due  to  this  cause.  He  admitted  that  these 
cases  were  extremely  difiicult  to  explain. 

Mr.  Paok,  in  reply,  said  the  patient  took  iodide  of  potas- 
sium on  leaving  the  hospital,  but  he  probably  did  not 
follow  any  syptematic  treatment.  When  first  in  the  hos- 
pital he  had  large  doses  without  appreciable  effect.  It 
was  quite  possible  that  the  convulsions  might  have  been 
due  to  the  cicatricial  tissue,  but,  on  the  other  hand,  there 
was  the  fact  that  the  subjacent  membranes  were  practi- 
cally healthy.  He  remembered  the  case  of  a  patient  with 
fits,  obviously  due  to  some  lesion  in  the  Rolandic  area, 
in  whom  the  first  indication  of  a  gross  lesion 
was  the  appearance  of  the  growth  through  the 
scalp.  It  was  supposed  to  be  a  new  growth  of 
the  nature  of  sarcoma,  but  it  was  obviously  syphilitic, 
and  was  dealt  with  as  in  the  case  he  had  brought  before 
them.  The  patient  died  of  pyasmia,  the  extent  of  the 
surface  mischief  gradually  extending  meanwhile.  He  also 
referred  to  a  case  at  present  in  hospital  of  a  boy  who  came 
in  with  a  scalp  wound  which  had  been  suppurating  pro- 
fusely for  three  weeks.  The  probe  gave  the  sensation  of 
dead  bone,  so  he  explored  it,  and  found  a  minute  opening 
in  the  bone  from  which  much  pus  escaped.  He  made  a  small 
opening  with  a  trephine,  and  this  led  down  to  a  large 
abscess  in  the  frontal  lobe,  which  was  dealt  with  in  t£e 
usual  way,  and  the  child  was  now  nearly  well.  There  had 
been,  as  far  as  they  could  judge,  no  cerebral  symptoms 
whatever,  but  after  the  operation,  from  dull  he  became 
bright,  from  morose  and  irritable  he  became  cheerful  and 
playful ;  in  fact,  he  became  a  totally  different  boy.  There 
had  never  been  any  rise  of  temperature  or,  paralytic 
phenomena. 

Dr.  Samitel  West  on 

ALBUMINOUS  OR  SEROUS    EXPECTORATION    AFTER    PARACEN- 
TESIS FOR  SEROUS  BFFUSIOX. 

It  sometimes  happens  that,  during  the  paracentesis,  the 
patient  begins  to  cough  and  complain  of  some  shortness 
of  breath,  and  soon  after  to  expectorate  a  quantity  of 
clear,  frothy  fluid.  The  cough  is  almost  constant,  though 
not  very  violent  or  paroxysmal,  and  with  it  there  is  some 
shortness  of  breath,  and,  occasionally,  also  even  consider- 
able dyspnoea.  Wheezing  and  crepitation  are  heard  over 
the  lung,  usually  over  the  affected  side  only,  but  occasion- 
ally on  both  sides.  After  the  symptoms  have  lasted  for  an 
hour  or  two,  or  perhaps  a  little  longer,  they  usually  sub- 
side, and  the  case  runs  its  ordinary  course,  but  every  now 
and  then  the  symptomsare  extremely  severe,  and  the  patient 
dies  of  suffocation.  Albuminous  expectoration  is  really 
very  rare — one,  I  believe,  of  the  rarest  events  in  pleuritic 
effusion.  My  own  case  occurred  in  a  man,  set.  about  40, 
who  had  a  right-sided  effusion  for  about  three  or  four 
weeks.  I  performed  paracentesis  myself,  using  the  syphon 
and  not  the  aspirator.  The  fluid  flowed  readily,  and  after 
about  40  ounces  had  been  withdrawn  the  patient  began 
to  cough.  The  cough  increased  in  frequency  and  caused 
much  distress.  This  was  soon  followed  by  a  little  dys- 
pnoea. Expectoration  commenced  in  about  ten  minutes, 
and  in  an  hour  the  patient  brought  up  eight  ounces. 
The  attack  lasted  for  three  hours,  during  which  a  pint  of 
frothy  fluid  in  all  was  coughed  up.  Over  the  right  side 
(that  is,  the  side  of  effusion)  there  was  a  good  deal  of 
wheezing  and  crepitation,  and  a  little  also  on  the  left.  The 
patient's  condition  was  in  no  wise  such  as  to  cause  alarm, 
the  symptoms  rapidly  subsided,  and  the  patient  made  a 
good  recovery.  The  case?  of  albuminous  expectoration 
differ  a  good  deal  tjiter  se.  The  attacks  usually  come  on 
during  paracentesis  or  immediately  after  it,  sometimes  as 
long  0.9  two  hours.  They  last  for  a  short  time,  usually  not 
more  than  an  hour  or  two,  but  occasionally  longer.  The 
quantity  of  fluid  varies  from  a  few  ounces  to  even  more 


than  three  pints.  In  character « it  is  frothy,  like  that  of 
acute  bronchitis.  It  contains  much  mucin  and  little 
albumen.  The  physical  signs  are  those  of  congestion  of 
the  lungs.  There  appears  to  be  no  necessary  relation 
between  the  duration  of  the  pleurisy  prior  to  paracentesis 
and  the  liability  to  serous  expectoration,  but,  as  a  rule,  the 
cases  have  lasted  some  little  time.  It  is  not  to  be  con- 
nected with  the  use  of  the  aspirator,  for  some  of  the  cases, 
as  in  the  present,  occurred  when  the  fluid  was  removed  by 
the  syphon  only.  The  result  is  rarely  fatal,  and  among 
the  fatal  cases  some  complication  besides  the  effusion  is 
ji^nerally  found.  The  condition  seems  less  common  than 
it  used  to  be  twenty  or  thirty  years  ago,  probably  because 
of  the  earlier  performance  of  paracentesis.  There  are  three 
explanations  given  of  the  phenomenon  ;  1.  Perforation 
of  the  lung  during  paracentesis,  and  the  discharge  of 
the  pleural  effusion  through  the  lung  ;  but  the  difference 
of  the  chemical  characters  of  the  two  fluids  shows  that 
this  explanation  cannot  be  correct.  2.  The  absorption  of 
effusion  by  the  lung.  3.  CEdema  of  the  lung,  and  this  is 
the  only  satisfactory  theory.  In  the  non-fatal  cases  this 
oedema  must  be  due  to  some  transitory  condition,  and  is 
probably  in  most  oases  to  be  connected  with  the  sudden 
distension  of  the  lung  after  it  has  been  ooUapeed  for  some 
time.  In  the  fatal  cases  some  organic  lesion  is  generally 
found  in  addition  which  would  account  for  the  result.  In 
some  of  them  the  lesion  is  such  as  would  cause  obstruction 
either  of  the  vessels  of  the  lung  or  of  the  bronchial  tubes, 
and  possibly  also  of  the  lymphatics ;  in  others  there  is 
disease  of  the  opposite  lung,  e.g.,  general  pleural  adhesion 
or  morbus  cordis.  The  subject  has  been  brought  forth 
before  the  Society  with  the  object  of  eliciting  the  expe- 
rience i  f  others  ;  especially  as  to  its  frequencv,  which 
appears  to  be  very  much  less  than  it  is  commonly  stated 
to  oe,  for  the  present  instance  is  the  only  one  which  has 
come  under  the  author's  observation  out  of  a  very  large 
number  of  cases  of  pleural  effusion. 

Dr.  F.  DE  Havili^akd  Hall  said  that  many  years  ago, 
when  collecting  materials  for  a  paper  on  pleurisy,  he  had 
occasion  to  look  up  this  question,  and  he  found  that  the 
only  cases  then  recorded  were  foreign.  Athough  he  had 
since  been  on  the  look-out  for  such  a  case,  he  had  never 
seen  one  nor  heard  of  one  until  he  read  an  account  in  the 
December  number  of  the  British  Medical  Journal  from  the 
Canterbury  Hospital.  It  was  obvious,  therefore,  that  such 
cases  must  be  exceedingly  rare.  The  statistics  to  which 
he  had  referred  showed  great  gravity.  He  agreed  that  the 
symptom  was  probably  due  to  oedema  of  the  lung.  He 
bad  a»ked  himself  what  he  should  do  in  such  a  case,  and 
he  had  come  t  the  conclusion  that  he  would  first  try 
the  effect  of  di  y  cupping,  following  by  sinapisms  to  the 
chest,  while,  internally,  be  would  have  recourse  to  drugs 
such  8 s  nitrite  ff  am>l  or  nitro-glycerine. 

Dr.  Hale  White  related  the  case  of  a  patient  recently 
admitted  whose  chest  was  full  of  fluid.  As  no  improve- 
ment followed  she  was  aspirated.  Soon  after,  she  began 
to  expectorate  this  albuminous  fluid  for  four  or  five  days, 
and  when  he  saw  her,  she  was  expectorating  it  in  consid- 
erable quantities.  The  temperature  after  the  first  aspira- 
tion began  to  mount,  and  as  fluid  was  again  collecting  in 
the  chest,  it  might  be  necessary  to  aspirate  a  Becond  time. 

Dr.  L  Bbnham  af>ked  why,  if  this  phenomenon  were 
due  to  pulmonary  oedema,  it  was  not  met  with  in  oedema 
from  ordinary  causes,  and  he  suggested  as  a  more  prob- 
able explanation  that  there  was  thrombosis  of  the  pulmon- 
ary vessels. 

Dr.  S.  West,  in  reply,  said  that  in  the  recorded  cases 
pulmonary  thrombosis  was  very  commonly  observed.and  he 
thought  this  was  a  very  probable  explanation  of  the 
disease.  It  certainly  looked  as  if  it  must  be  due  to  some 
complete  obstruction  of  the  vessels.  In  respect  of  Dr. 
Hale  White'*  case,  he  pointed  out  that  it  was  rare  for  a 
case  to  go  on  several  days,  as  in  the  one  narrated  by  him, 
forty-eight  hours  having  hitherto  been  the  longest  period. 
Minor  cases  of  the  d  if  ease  did  not  require  any  active 
treatment,  and  in  the  acuter  cases  there  was  no  time  to  do 
anything. 


A  Medicax  Officer  is  to  be  appointed  by  the  Govern- 
ment of;India  to  examine  into  the  causes  of  Kola  azar, 
the  fever  which  has  caused  such  high  mortality  io 


Apbil  15, 1896. 


FRANCE. 


Thb  Mbdigjll  Pbms.     399 


ROYAL  ACADEMY   OF   MEDICINE  IN  IRELAND. 

SXCTIOK  OF  ObSTSTRICS. 

MxBTiKO  HBLD  Fbidat,  Maboh  Oth,  1896. 


The  President,  Db.  Lombb  Atthill,  in  the  Chair. 

AN    QITBBI8TING    GASB    OF    BUPTTmBD  TUBAL  PBBGirANGT, 
WITH  HJEHATOOBLB  OF  THB  OFFOtUTB  SIDB. 

Db.  Alfred  Smith  read  notes  of  an  interesting  case  of 
the  above  rubject,  snccessfully  operated  on  by  him  in  St. 
Vincent's  Hospital.  The  chief  points  of  interest  seemed 
to  him  to  be---lst.  The  question  of  diagnosis ;  2nd.  The 
patholoeioal  condition  fonnd  daring  operation.  There 
was  no  history  of  pregnancy  ;  the  menstrnation  was  qnite 
regular  np  to  the  very  day  when  she  was  first  seized  with 
the  abdominal  pain  and  heavy  menstrual  flow.  The  pain 
was  referred  to  the  lower  part  of  the  abdomen,  but  was  not 
so  severe  as  to  cause  the  patient  to  collapse.  She  was 
able  to  walk  to  hospital  without  assistance ;  still,  on 
vaginal  examination,  nearly  all  the  typical  signs  of  rup- 
tured tubal  pregnancy  were  present.  The  pathological 
condition  found  at  operation  showed  the  condition  on  the 
right  side  to  be  an  example  of  "  tubal  abortion  "  As  to 
the  cyst  on  the  left  side,  its  exact  nature  was  not  so  clear — 
it  was  undoubtedly  full  of  blood  and  seemed  to  be  in  the 
outer  third  of  the  Fallopian  tube,  and  had  certainly  all  the 
microscopic  appearances  of  a  tubal  pregnancy.  But  the 
microscopic  examination  by  Professor  McWeeney  proved 
it  to  be  not  a  case  of  tubal  pregnancy  but  an  hsematosalpinx. 
The  interesting  query  now  is  how  to  explain  the  hsBmor- 
rhage  into  the  outer  third  of  the  Fallopian  tube. 

Dr.  Alfbed  Smith  also  showed  a  small  cystic  ovary,  size 
of  a  turkey  egg,  removed  from  a  married  woman,  set.  38. 
The  patient  suffered  from  hsBmorrhagia,  which  was  not 
controlled  by  repeated  curettingp.    Recovery. 

Dr.  Jbllbt  showed  for  Dr.  W.  J.  Smyly  fuur  myomatous 
uteri  removed  by  panhysterectomy.  Tubes  removed  for 
double  pyosalplnx,  tubal  pregnancy  and  other  interesting 
specimens. 

CASB  OF  SUPPUBATION  IN  AN  OVART,  THB  BBSUIA  OF  DIBHOT 
VIOLINOB. 

The  Hon.  Sbgrbtart  read,  for  Dr.  Purefoy,  a  paper  on 
the  above  subject  and  showed  specimen. 

When  we  have  regard  to  the  anatomical  structure  and 
marvellous  functional  activity  of  the  ovaries  in  a  healthy 
woman,  and  how  easily  the  regular  performance  of  these 
functions  is  disturbed  even  bv  trifling  emotional  causes, 
no  surprise  will  be  felt  at  the  frequent  occurrence  of 
disease  in  these  organs.  It  will,  I  think,  be  admitted 
that  even  acute  inflammation  of  an  ovary  seldom  terminates 
in  suppuration,  except  in  cases  of  puerperal  sepsis,  and 
also  m  cases  where  gonorrhooal  vaginitis  has  been  the 
origin  of  the  mischief.  The  view  has  been  advanced  that 
in  some  cases  of  protracted  and  difficult  labour  the  ovary 
may  be  subjected  to  injurious  pressure,  and  most  of  us 
have  seen  patients  who  could  trace  back  to  some  particular 
lying-in  the  beginning  of  the  pain  and  suffering  which  so 
often  attend  chronic  ovaritis.  The  brief  history  which  I 
proceed  to  lay  before  you  will  serye  to  demonstrate  that 
mechanical  pressure,  if  considerable  in  degree  and  sud- 
denly applied,  mav  bring  about  inflammatory  mischief  in 
an  ovary,  and  such  as  may  end  in  suppuration  and  the 
structural  disintegration  of  the  organ.  In  February, 
1895,  a  young  woman,  nt.  21,  in  good  condition  and  of 
healthy  aspect,  sought  my  advice  for  various  pelvic  and 
menstrual  troubles,  and  gave  me  the  following  history  :  — 
She  had  been  earning  her  bread  as  a  governess,  and  in 
October,  1891,  one  of  the  children  in  her  charge  jumped 
on  her  as  she  lay  in  bed,  hurting  her  considerably  with 
her  feet,  and  causing  her  much  pain  in  the  left  ovarian 
region,  and  in  the  left  leg.  Immediately  afterwards  she 
b^me  unwell  for  some  days,  and  during  the  succeeding 
four  years,  till  she  came  under  my  care,  menstruation 
continued  profuse,  irregular,  and  attended  with  so  much 
pain  in  the  lower  bellv  and  left  leg  that  much  impairment 
of  her  general  health  ensued.  For  the  relief  of  these 
troubles  she  was  sent  home  by  my  friend.  Dr.  Wynne.  A 
vaginal  examination  enabled  me  to  detect  an  enlarged  and 
much-retroverted  uterus,  and  the  left  ovary  enlarged,  very 
sensitive  to  pressure,  and  somewhat  prolapsed.  The  right 
ovary  i^peaied  to  be  normal  and  healthy.    I  explained  to 


her  that  nothing  save  the  removal  of  the  injured  organ 
would  ensure  any  permanent  relief  to  her  sufferings,  and 
she  readily  consented,  and  shortly  afterwards  was  admitted 
to  the  Adelaide  Hospital  for  the  purpose.  The  operation 
was  followed  by  an  easy  convalescence,  and  menstruation 
now  recurs  regularly  without  pain  and  normal  in  amount, 
though  for  some  months  the  patient  complained  occasionally 
of  rather  severe  pain  in  left  side  and  left  leg. 

The  PRBSIDENT  regretted  very  much  thao  they  had  not 
before  them  the  report  of  a  pathologist  on  Dr.  Purefoy'e 
case,  as  suppuration  of  the  ovary  was  a  very  rare  occur- 
rence indeed. 

The  Section  then  adjourned. 


SHEFFIELD   MEDICO-CHIRURGICAL   SOCIETY. 
Mbbting  HBLD  Thubsdat,  Maboh  12th,  1890. 


The  President,  Dr.  Pobtbb,  in  the  Chair. 

Db.  Maunsbll  (Rotherham)  showed  three  relatives  with 
congenital  onychatrophia  and  other  malformations  of  the 
fingers  and  toes.  A  detailed  family  history  was  given 
tracing  the  abnormalities  through  several  generations. 

Dr.  Andbbw  Walker  read  a  paper  on  **  Hssmorrbagic 
Salpingitis,"  which  was  illustrated  by  numerous  micro- 
scopic slides  and  drawings. 

Mr.  Cuff  showed  a  lurynx,  imbedded  in  the  substance 
of  the  arytssnoid  muscles  of  the  right  side  of  which  was  a 
circumscribed,  non-encapsuled  tumour.  The  tumour, 
which  was  of  about  the  size  of  a  large  pea,  was  of  a  greyish 
pink  colour,  and  in  that  part,  and  abutting  upon  the  ary- 
tsenoid  cartilage,  was  breaking  down.  A  sinus  led  from 
the  posterior  end  of  the  laryngeal  sacculus  directly  back- 
wards into  this  softened  tissue,  at  the  bottom  of  which 
was  the  sxposed  and  bare  cartila^.  The  tumour  was 
believed  to  be  a  gumma.  The  patient  had  had  syphilis, 
and  also  later  ague  in  India,  and  had  come  under  treat- 
ment for  splenic  ansBmia.  (Edema  of  the  larynx  supervened, 
and  on  laryngoscopic  examination  great  tumefaction  and 
redness  of  the  whole  glottis  was  revealed.  The  swelling 
was  more  marked  on  the  right  side.  On  the  upper 
surface  of  the  epiglottis  an  irregular  ulcer,  with  a  yellowish 
base,  and  injected  margins  was  also  to  be  observed.  The 
diagnosis  of  svphilitio  perichondritis  with  secondary 
oedema  was  made  from  the  history  and  his  laryng^oscopic 
appearance. 

Dr.  Abthub  Hall  read  a  short  paper  on  the  <*  Possible 
Dangers  of  Treating  Extensive  Bums  with  Boracic  Oint- 
ment." The  case  which  formed  the  text  of  the  paper  was 
one  of  a  boy  who  was  admitted  into  the  Royal  Hospital 
under  Dr.  White  with  extensive  bums.  He  was  treated 
as  usual  with  ung.  boracis.  On  the  fifth  day  he  developed 
an  extensive  erythematous  eruption  over  the  limbs,  trunk 
and  face,  for  which  the  writer  was  asked  to  see  him. 
During  t^e  next  few  days  he  gradually  became  worse,  and 
died  on  the  ninth  day.  At  the  autopsy  nothing  was 
found  to  account  for  death,  and  previous  to  the  eruption 
the  boy  was  doing  very  well.  There  were  no  throat 
symptoms  whatever ;  there  was  delirium  at  night ;  the 
rash  developed  more  each  day.  Dr.  Hall  quot^  many 
recorded  cases  of  similar  groups  of  symptoms  occurring 
definitely  from  boracic  acid  poisoning,  and  pointed  out 
that  the  extent  of  surface  for  possible  absorption  was 
very  great,  and  although  not  pressing  the  connection 
between  the  boracic  aciaand  the  symptoms,  thought  that 
if  there  was  no  connection  between  the  two,  still  the 
occurrence  of  such  fatel  symptoms  was  worthy  of  more 
extended  inquiry  than  was  at  present  fgiven,  with  a  view 
to  preventing  their  occurrence  by  a  more  rigid  antiseptic 
treatment. 

Jffrjincc. 


[fboh  oub  own  corbbspondbnt.] 

Pabis,  April  lltb,  1896. 
Hbabt  Disbasb. 
At  the  Soci^t^  de  M^decine,  Dr.  Duroziez  spoke  on  the 
method  of  diagnosing  the  pathological  bruits  of  the  heart. 
He  said  that  frequently,  in  order  to  be  able  to  distinguish 


400    Ths  Mbdical  Priss" 


AU8TKIA. 


Apbil  16,  1896. 


between  the  leeions  of  the  different  orifices,  it  was  necea- 
eary  to  anscaltate  at  a  distance.  Over  the  heart  itself  the 
bruits  were  often  confased,  difficult  to  separate,  the  cavi- 
ties not  always  bearing  the  same  relation  to  each  other, 
while  the  pericardium  masked  the  sounds. 

The  souffle  of  aortic  insufficiency,  for  instance,  is  easily 
distinguished  in  the  inguinal  region  by  the  double  crural 
souffle,  which  sometimes  reveals  an  insufficiency  undetected 
by  direct  auscultation,  and,  in  any  case,  where  the  crural 
phenomenon  is  absent  there  is  no  insufficiency.  Mitral 
insufficiency  can  be  always  heard  at  the  back,  no  other 
heart  sound  is  heard  in  that  spot.  Frequently  a  tricuspid 
souffle  is  confounded  with  the  mitral  lesion,  and  yet  the 
former  goes  only  from  the  sternum  to  the  apex,  while 
the  latter  goes  ;to  the  vertebral  column.  Insufficiency  of 
the  tricuspid  is  revealed  by  the  venous  pulse  felt  in  the 
jugular  hepatic  and  crural  veins,  while  stenosis  of  the 
aortic  valves  can  be  detected  in  the  carotids. 

The  souffle  of  chlorosis  has  unfortunately  been  frequently 
attributed  to  mitral  disease  giving  manifest  concern  to  the 
patient,  and  yet  by  a  little  care  confusion  ought  not  to 
take  place,  for  when  the  souffle  is  not  heard  behind  it  is 
never  mitral. 

The  pulse  also  gives  very  important  indications.  In 
lesions  of  the  right  heart  it  is  quick  (90),  in  mitral  stenosis 
it  stands  at  60,  while  in  aortic  insufficiency  we  have  the 
pulse  to  which  is  attached  the  name  of  Corrigan.  The 
humoral  aitery  should  be  preferred  to  the  radial,  and  fre- 
quently it  will  be  necessary  to  examine  the  femoral  in 
order  to  establish  the  quantity  and  quality  of  the  circula- 
tion. 

Efithilioma. 

Dr.  Dumontpellier  spoke  on  the  advantages  of  treating 
locally  and  generally  epithelioma  of  the  mouth  with 
chlorate  of  potash.  Internally  be  gives  a  drachm  daily  of 
the  salt,  while  externally  he  applies  it  in  powder  on  the 
sore.  In  some  the  malignant  tumour  had  disappeared 
after  three  months'  treatment. 

In  a  second  case,  that  of  a  man  of  52,  who  had  been 
operated  on  for  epithelioma  of  the  tongue,  and  who,  when 
seen  soon  afterwards  by  the  honourable  professor,  had 
shown  all  the  symptoms  of  relapse,  the  same  treatment 
was  adopted,  and  with  a  like  result  at  the  end  of  six  weeks. 
A  third  case  was  that  of  a  man  who  had  undergone  the 
anti-syphilitic  treatment  for  an  ulceration  of  the  tongue  of 
an  inch  in  length  without  success.  Eight  days  after  the 
chlorate  of  potash  treatment  improvement  was  manifest, 
and  at  the  end  of  three  months  the  cure  was  complete. 

According  to  M.  Dumontpellier,  success  was  chiefly  due 
to  the  internal  use  of  the  salt,  which  is  eliminated  through 
the  salivary  glands,  thus  bathing  permanently  the  parts. 


r^UStriil. 


[#&0M  OUB  OWir   00SBB8P0KDBVT.] 

VIKHNA,  April  10th,  1890. 

Ulceration  of  Middle  Eab. 

PoLiTZER  showed  a  young  woman,  set.  19,  who  had  suf- 
fered for  three  years  from  a  chronic  discharge  from  the 
middle  ear  without  deriving  any  appreciable  benefit  from 
the  different  forms  of  treatment  employed. 

About  the  middle  of  last  year  dangerous  symptoms 
supervened  with  pain  in  the  head,  vertigo,  &c.,  when  it 
was  resolved  to  lay  the  middle  ear  open  in  conjunction 
with  Komer's  plastic  operation. 


After  removing  the  skin  and  periosteum  of  the  mastoid 
process  by  means  of  a  crescentic  chisel  applied  behind 
the  insertion  of  the  aural  muscles,  the  membranous  covering 
of  the  outer  ear  with  the  cartilage  was  lifted  forward,  after 
which  the  bone  was  carefully  chiselled  out,  opening  the 
atticus  and  removing  the  ossicles  The  granulation  tissue 
was  then  removed  from  the  middle  ear  and  antrum,  the 
soft  tissues  of  the  outer  ear  replaced  and  allowed  to  unite 
with  the  support  of  tampons  and  stitches.  There  was  no 
rise  of  temperature  ;  the  patient  soon  recovering,  being 
able  to  leave  hospital  on  the  fourteenth  day  after  admis- 
sion. The  promontorial  wall  of  mucous  membrane  is  now 
dry  and  healthy,  although  the  '*  atticus"  is  lying  exposed. 
Whispering  can  be  heard  three  metres  off,  and  the 
otometer  at  fifteen  centimetres. 

Gholestsatoma  in  Middle  Eab. 

Gompey  exhibited  a  patient,  et.  40,  who|had  a  cholestea- 
toma in  the  right  middle  ear  for  which  he  had  operated. 
The  case  had  a  long  history  extending  back  to  1892.  The 
activesymptomscommenced  about  April,  1895,  with  vertigo 
and  pain  in  the  ear,  and  a  small  opening,  in  the  posterior 
quadrant  of  the  tympanum.  In  a  few  days  a  large  granu- 
lating swelling  protruded  like  a  polypus.  Three  months 
later  the  radical  operation  was  performed  by  separating 
the  ear  from  the  bony  attachments  posteriorly,  and 
chiselling  into  the  antrum  of  the  mastoid  process,  where 
a  cylindrical  space,  2  by  1  centimetres,  was  found  filled  with 
a  brittle  choleaostomatons  mass.  The  only  remaining  part 
of  the  ossicles  was  the  malleus,  which  was  removed.  The 
periosteum,  skin,  and  concha  were  next  replaced,  sup- 
ported with  stitches  and  tampons,  which  were  not  touched 
for  sixteen  days  after  the  operation.  The  next  dressing 
was  made  of  sterilised  oil  and  iodoform  gauze.  On  the 
twenty-fifth  day  after  the  operation  a  thin  pellicle  of 
skin  was  observed  over  the  internal  wound,  but  it  was  not 
before  the  forty-fifth  day  after  the  operation  tha^i  the 
wound  could  be  said  to  be  healed. 

Urbantschitsch,   in  criticising  Gompey 's  results,  said 
that  the  healing  in  these  prolonged  cases  was  often  much 
accelerated  by  transplantation  of  skin. 
Morbus  Mekieri. 

Prof.  Raufmann  brought  an  interesting  case  of  morbus 
M^ni^ri  to  the  notice  of  the  meeting.  The  patient  was 
31  years  of  age,  who  had  never  had  anything  to  complain 
of  in  her  ears  till  after  an  attack  of  influenza.  Her  story 
was  that  she  went  to  the  theatre  one  night,  drank  some 
warm  water  as  she  usually  did,  and  returned  home  per- 
fectly well.  After  arriving  home  her  ears  began  to  sing ; 
he  went  to  bed  and  slept  for  an  hour-and-a-half,  but  was 
awakened  suddenly  with  vomiting,  malaise,  vertigo,  great 
rushing  in  the  ears  and  complete  deafness. 

On  examining  the  ears  nothing  could  be  observed  to 
account  for  this  disturbance,  neither  could  any  hysterical 
symptom  be  noted  that  might  assist  in  solving  the 
problem.  The  left  ear  was  perfectly  deaf.  The  vomiting 
persisted  three  days  after  the  first  attack,  occurring  six  to 
eighttimesin  the  day.  The  giddiness  continued  toafflict  the 
patient  so  much  that  she  could  not  leave  her  bed  for 
twelve  days.  The  giddiness,  however,  was  now  periodic, 
and  no  treatment  seemed  to  assist  it  He  had  now  com- 
menced the  pilocarpin  treatment  with  the  hope  of  obtain- 
ing some  relief. 

Politzer  remarked  that  this  case  very  much  resembled 
the  first  one  he  had  ever  seen  of  M^ni^re's  disease. 

G  ruber  said  that  most  of  the  cases  he  had  observed 
coming  on  suddenly   with  giddiness  and  deafness  were 


April  15,  189d. 


TflE  OMRATING  THRATRES. 


ThI  MeDIOAL  PRtfSS        401 


usually  bilateraL  Unilateral  symptoms  like  those  de- 
scribed in  this  case  were  very  rare.  As  to  the  value  of  the 
tnniDf;r.fork  In  these  cases,  his  opinion  was  that  it  was 
useless. 

Urbantschitfch  related  a  similar  case  to  this  of  Gruber's 
which  came  under  his  notice  in  private  practice. 

Politzer  thought  that  Kanfmann's  case  was  caused  by 
labyrinthic  hsBmorrhage,  and  was  not  nervoas  in  its  origin. 
He  did  not  agree  with  Gruber  that  the  tuning-fork  was  of 
no  value  in  the  diagnosis  of  M^ni^re's  diseace,  as  the  deep 
tones,  in  conjunction  with  other  symptoms,  often  confirmed 
the  diagnosis. 

Suoci. 

This  professional  faster  does  not  seem  to  meet  with  that 
favour  here  which  has  been  afforded  in  other  places. 
Physiologiste,  anatomiste,  physicists,  &c.,  were  ever  ready 
elsewhere  to  watch  and  record  every  minutiae  with  faithful 
accuracy,  but  in  Yieima,  happily,  nobody  will  recognise 
the  martyr.  He  starves  himself  under  the  surveillance  of 
the  police. 


^UBSta. 


[from  an  OCCASTONAL  00SRF8P0KDKNT.] 


of  excluding  the  English  language,  and  have  arranged  that 
authors  will  be  accepted  in  the  sections  to  read  their 
papers  in  that  language. 


ST.  PBTIBSBUBO,  April  Sth,  1806. 

Invagination  and  Laparotomy. 

At  thelast  meeting  of  the  Medical  Society  here  Dr.  Remig 
showed  the  members  the  intestines  of  a  patient  whom  he 
had  exhibited  at  a  previous  meeting.  The  disease  was  dia- 
gnosed at  first  as  invagination  of  the  bowel.  Subsequently 
Kemig  performed  laparotomy,  but  the  patient  did  not  long 
survive  the  operation,  dying  soon  af ^er  from  peritonitis  in 
the  pelvis.  The  post-mortem  revealed  a  beautiful  polypi 
running  in  close  succession  from  the  stomach  to  the 
rectum.  Patobes  here  and  there  were  non-pediculated, 
but  the  greater  length  of  the  bowel  was  affected.  A  few 
of  the  polypi  when  examined  microscopically  were  carci- 
nomatous and  of  the  adenoid  type, 

Finland  in  thk  Trsatment  op  Phtbists. 

Musing  read  a  long  paper  to  the  Society  on  the  medi- 
cinal virtues  of  Finland  in  the  treatment  of  phthisical 
patients. 

In  the  discussion  that  followed,  Luigen  said  that  he  had 
had  patients  who  seemed  to  improve  after  residing  in  Fin- 
land. 

Kemig  also  testified  to  the  salutary  effect  produced  on 
patients  of  this  class  in  Finland,  but  thoaght  that  there 
were  places  on  tbe  Baltic  nearer  St.  Petersburg  where 
phthisical  patients  progressed  equally  well. 

Moritz  said  that  a  summer  residence  in  Finland  might 
do  good,  but  considered  that  residence  there,  in  the  winter, 
would  be  a  dangerous  experiment. 

Assmuth  affirmed  that  there  was  a  great  difference  of 
climate  between  the  east  and  west  of  Finland.  The  east 
coast  seems  to  be  the  best  for  oonsumpcive  patiente,  but 
tbe  disease  itself  was  not  uncommon  there  also. 

Musing,  in  reply,  said  that  he  did  not  deny  that  there 
were  many  places  within  easier  reach  of  St.  Petersburg 
where  phthisical  patients  improved,  but  he  challenged  any 
one  to  find  as  good  a  resort  for  this  class  of  patients  as 
the  Government  or  County  of  Wiborg  in  the  south-east  of 
Finland. 

The  International  Congress  of  Warsaw. 
I  am  glad  to  be  able  to  record  that  the  Committee  of  the 
International  Congress  have  acknowledged  the  injustice 


^ke  ©perating  ^keatres. 

LONDON  HOSPITAL. 
Sarcoma  of  the  Palate— Cirvioal  Ltmfhatio 
Qlands  Affected — Ligature  of  External  Carotid 
Artery — Removal  of  Glands — ^Tracheotomy— Removal 
OF  the  Tumour. — Mr.  Dean  operated  on  a  woman,  set. 
40,  who,  besides  a  tumour  of  the  palate  and  enlarged 
glands,  presented  a  large  goitre,  which  she  had  had  for  15 
years,  and  which  she  did  not  think  had  increased  in  size 
lately.  Two  months  before  the  operation  she  noticed 
a  swelling  at  the  back  of  the  mouth  which  interfered  with 
swallowing  ;  this  gradually  increased  in  size,  and  about  a 
month  ago,  small  swellings  appeared  on  the  left  side  of 
the  neck  in  front  of  the  left  ear  and  on  the  right  side  of 
the  neck.  On  admission  there  was  a  large,  fleshy  tumour, 
with  its  surface  ulcerating,  growing  from  the  left  side  of 
the  soft  palate  and  of  the  wall  of  the  pharynx,  somewhat 
pyriform  in  shape,  and  about  the  size  of  a  large  pear.  This 
rendered  the  swallowing  of  solid  food  impossible,  and 
liquid  food  was  taken  with  difficulty.  In  certain  positions 
of  the  body,  especially  dorsal  decubitus,  respiration  was 
much  impeded  by  the  growth.  The  glands  in  the 
neck  and  in  front  of  the  ear  were  soft,  but  solid.  The 
diagnosis  arrived  at  was  sarcoma  of  the  soft  palate  with 
secondary  infection  of  the  lymphatic  glands.  Chloroform 
was  administered  through  a  Junker's  inhaler,  an  incision 
made  along  the  anterior  border  of  the  left  sterno  mastoid, 
and  four  enlarged  lymphatic  glands,  apparently  sarcoma- 
tous, removed  ;  the  incision  was  then  extended  upwards 
in  front  of  the  ear  and  a  similar  gland  removed  from 
that  region.  The  bifurcation  of  the  common  carotid 
artery  was  next  exposed  and  the  external  carotid 
ligatured  about  half  an  inch  beyond  the  division ; 
the  ascending  pharyngeal  artery  which  came  off  from 
the  bifurcation  was  ligatured  about  half  an  inch 
beyond  its  origin.  An  attempt  was  now  made 
to  remove  the  sarcoma  from  the  pharynx,  but,  although 
there  was  scarcely  any  hemorrhage,  the  surgical  manipu- 
lations interfered  so  much  with  respiration  that  trachec  - 
tomy  was  found  necessary.  Owing  to  the  presence  of  tbe 
gottrCjthis  was  no  easy  matter,  and,  in  order  to  expose  the 
trachea,  Mr.  Dean  was  obliged  to  remove  the  upper  por- 
tion of  the  right  lobe ;  on  cutting  into  this  lobe,  the 
appearance  was  almost  identical  with  that  of  a  section 
of  the  enlarged  lymphatic  glands  which  had  been  pre- 
viously taken  away.  After  a  tracheotomy  tube  had  been 
inserted  the  sarcoma  was^excised  from  the  pharynx  with 
comparatively  little  hemorrhage.  The  tumour  was  found 
to  extend  widely  to  the  left  side  and  back  on  to  the  pos- 
terior wall  of  the  pharynx,  reaching  upwards  to  the  base 
of  the  skull ;  this  region  was  thoroughly  scraped  with  a 
sharp  spoon  and  plugged  with  iodoform  gauze.  As  the 
patient  was  rather  collapsed,  it  was  thought  advisable  not 
to  remove  the  enlarged  glands  on  the  right  side  of  the  neok 
for  a  few  days.  Mr.  Dean  remarked  that  before  the 
operation  the  case  seemed  a  straightforward  one  of  Sir- 
coma  of  the  palate  with  secondary  deposits  in  the  cervical 
lymphatic  glands.  In  his  experience  vascular  tumours  of 
the  palate  can  be  removed  with  very  little  loss  of  blood 
after  the  external  carotid  artery  has  been  ligatured,  special 
precaution  being  taken  to  see  that  the  ascending  pbaryn- 


402     Turn  MsDiOAL  Pbiss. 


LEADING  ARTICLES. 


Apbil  15,  1896. 


geal  is  givea  off  above  the  level  of  the  ligatare  ;  in  the 
present  case  this  artery  was  given  off  at  the  bifurcation, 
and  so  had  to  be  ligatared  separately.  The  interference 
with  respiration  during  the  attempted  removal  of  the 
growth  was  not  due  to  haemorrhage,  but  to  the  fact  that, 
as  the  attachment  of  the  tumour  was  divided  above,  the 
latter  naturally  dropped  down  into  the  region  of  the 
glottis;  this  rendered  tracheotomy  necessary,  and  the 
portion  of  the  thyroid  tumour  removed  was  so  similar  to 
the  enlarged  lymphatic  glands  that  Mr.  Dean  was  inclined 
to  think  that  perhaps  the  case  might  turn  out  on  micro* 
scopical  examination  to  be  rather  different  from  the 
originai  diagnosis.  He  thought  it  quite  powible  that  the 
goitre  had  recently  become  malignant,  and  that  the 
growths  in  the  pharynx  and  in  the  cervical  lymphatic 
glands  were  secondary  to  the  goitre.  He  pointed  out  that 
it  was  more  common  for  malignant  disease  of  the  thyroid 
gland  to  start  in  a  gland  that  had  been  enlarged  for  some 
years,  although  the  goitre  may  have  remained  quiescent 
for  many  years,  even  as  long  as  20,  it  was  not  uncommon 
for  malignant  disease  to  develop  suddenly  without  any 
assignable  cause. 

ST.  THOMAS'S  HOSPITAL. 
Abthbectomt  of  ths  AnklB'Joiht  by  tub  Anterior 
jdBTHOD.— Mr.  AwDEteON  operated  on  a  boy,  let.  7,  for 
tubercular  disease  of  the  right  ankle.  An  anterior  incision 
was  made  through  the  integuments  over  the  line  of  the 
ankle-joint  from  malleolus  to  malleolus.  The  musculo- 
cutaneous nerve  was  secured  by  means  of  two  threads,  and 
divided  between,  the  threads  being  left  with  the  needles 
attached.  The  tendons  of  the  tibialis  anticus,  extensor 
pollicis,  extensor  digitorum,  and  peroneus  tertius  were  in 
like  manner  pierced  each  by  two  thread?  separated  by  a 
distance  of  half  an  inch,  and  all  divided  between 
the  threads ;  the  anterior  tibial  artery  was  divided  and 
secured.  There  was  now  a  row  of  threads  with  needles 
attached  connected  with  each  end  of  the  divided  tendons 
and  nerves.  The  ankle-joint  was  then  opened,  and  after 
division  of  the  anterior  fibres  of  the  internal  and  external 
lateral  ligaments  the  whole  interior  of  the  joint  could  be 
exposed  without  interference  with  the  peronei  or  the 
tibialis  posticus.  Extensive  disease  was  found  in  the 
bones  and  synovial  membrane  ;  this  was  removed  with  the 
aid  of  scissors  and  gouge ;  the  surfaces  were  saturated  with 
iodoform  emuUion  ;  the  tendons  and  also  the  musculo-cuta- 
neous  nerve  were  sutured  by  means  of  the  threads 
employed  at  the  early  stage  of  the  operation,  the  needle 
connected  with  the  upper  thread  being  carried  through 
the  lower  section  of  tendon,  that  connected  with  the  lower 
being  passed  through  the  upper  section,  so  that  each 
tendon  was  united  by  two  sutures.  In  the  case  of  the  nerve 
a  single  suture  was  used.  The  skin  wound  was  then 
united  by  continuous  catgut  sutura  The  line  of 
wound  was  sealed  with  cotton  wool  soaked  in  collo- 
dion and  dusted  over  with  iodoform,  the  whole  being 
covered  in  with  dressing,  and  the  foot  fixed  in  plaster.  Mr. 
Anderson  remarked  that  this  was  the  fifth  case  in  which 
he  had  operated  in  this  manner :  all  had  united  by  first 
intention,  and  in  all  the  functions  of  tendon  and  nerve 
were  completely  restored.  In  one  case  where  the  disease 
was  but  slight,  a  movable  ankle  had  resulted  ;  in  the 
others  ankylosis  had  taken  place  leaving  a  useful  foot. 
The  anterior  operation  had  been  first  practised  by  Mr. 
Arbuthnot  Lane  who  divided  not  only  the  anterior 
tendons,  but  also  the  peronei  and  tibialis  posticus  ;  these 
latter,  however,  Mr.  Anderson  thought,  may  well  be  spared 


as  shown  by  the  cases  referred  to,  the  operation  thus  gaining 
in  simplicity  and  rapidity.  As  compared  with  the  older 
operations  this  one  offers  great  advantages,  it  is  more  rapid 
and  allows  a  more  complete  and  ready  exposure  of  the 
diseased  parts  and  their  removal  with  the  greatest  possible 
economy  of  healthy  structures. 


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%]lt  ^t^ml  frm  ^  Circular. 


<BALU8  POPULI  8UPREHA  LEX.' 


WEDNESDAY,  APRIL  15,  1896. 


SECRECY  AND  PRIVILEGK 
The  eagerness  with  which  the  questions  raised 
daring  the  recent  catise  celebre  have  been  discussed 
in  and  by  the  daily  press  shows  the  importance  which 
the  public  attach  to  professional  secrecy,  a  moral 
obligation  which  has  throughout  the  history  of  medi- 
cine been  proudly  acknowledged  by  medical  practi- 
tioners in  all  climes,  but  which  many  of  the  public 
would  like  to  see  established  in  this  country  under  a 
penal  statute.  The  perusal  of  the  letters  and  comments 
which  have  appeared  in  the  lay  press  suggest  a  number 
of  points  which  were  not  touched  upon  in  our  former 
article  on  this  subject  for  want  of  space,  but  which  are 
yet  of  sufficient  importance  to  warrant  our  returning  to 
the  matter.  It  must  be  premised  that  there  is  no  legal 
obligation  to  professional  secrecy  outside  the  provisions 
of  the  common  law  in  regard  to  the  dissemination  of 
defamatory  matter  which  apply  to  medical  and  non- 
medical men  alike.  In  practice,  however,  the  liability 
to  damages  for  contravention  works  out  much  more 
severely  when  the  transgressor  is  a  medical  man  than 
in  the  case  of  a  layman,  for  the  simple  reason  that 
juries  are  composed  of  laymen  who  feel  intuitively  ^at 
they  are  interested  in  enforcing  a  high  standard  of 


Apbil  15,  1896. 


LEADTNO  ARTICLES. 


Thx  Medioal  Pbbbs.     403 


professional  morality  in  this  respect.  All  are  agreed 
that  a  medical  man  ought  to  hold  his  tongue  under 
ordinary  circumstances  and  the  majority  of  extra- 
ordinary circumstances,  but  this  question  has  been 
discussed  on  the  basis  that  he  ought  to  do  so  under 
all  conceivable  circumstances  under  a  penalty.  The 
recent  case  did  not  decide  that  reticence,  in  respect 
of  non-defamatory  matter,  is  a  legal  obligation, 
indeed,  the  contrary  ia  to  be  inferred.  The  law 
in  fact  expressly  obliges  the  practitioner  to  violate 
professional  confidences  in  a  number  of  ways,  as  for 
example,  in  filling  up  a  certificate  of  death,  in  the 
notification  of  infectious  diseases  as  well  as  in  the 
witness  box.  The  moment  the  obligation  ceases  to  be 
absolute  the  opportuneness  of  departing  from  estab- 
lished usages  must  obviously  devolve  upon  the  practi- 
tioner who  is  called  upon,  at  his  risk  and  peri],  to 
decide  whether  or  not  particular  circumstances  justify 
his  action  or  compel  him  thereto.  We  should  be 
disinclined  to  allow  the  private  interests  of  the 
practitioner  to  constitute  an  exemption  under  any  cir- 
cumstances, but  when  public  interests  of  a  high  order  are 
in  jeopardy,  the  propriety  of  enforcing  silence  is  certainly 
open  to  question.  Take  for  instance  the  case  quoted  by 
Dr.  Murrell,  of  the  signalman  suffering  from  aortic  dis- 
ease which  might  at  any  moment,  without  warning, 
entail  results  involving  unknown  but  considerable  risks 
to  the  travelling  public ;  or  the  case  of  a  dairyman 
whose  manipulation  of  the  milk  may  be  the  means  of 
infecting  generations  as  yet  unborn.  What  scruples 
must  even  the  most  discreet  of  medical  men  feel  when 
he  becomes  aware  of  the  danger  to  which  an  innocent 
and  healthy  young  woman  is  about  to  be  wantonly 
exposed  by  an  unscrupulous  rascal  whose  diseased  and 
infectious  condition  is  within  his  cognisance,  than 
which  there  can  be  no  more  delicate  and  responsible 
position.  Then  again  a  medical  man  is  often  called  in  by 
an  anxious  parent  or  guardian  or  by  an  employer,  who, 
and  not  the  patient,  is  called  upon  to  pay  for  informa- 
tion which,  if  professional  secrecy  were  absolute,  must 
be  evasive  if  not  absolutely  false.  What  is  the  position 
of  a  practitioner  who  is  called  in  to  give  an  opinion  as 
to  the  pregnancy  of  a  maid-servant.  We  doubt  very  much 
whether  his  communication  to  the  mistress  would  be 
regarded  as  privileged  by  a  jury  should  the  girl  subse- 
quently bring  an  action  for  damages,  and  in  view  of 
the  common  practice  in  such  matters  greater  circum- 
spection is  advisable  in  the  future.  This  question 
crops  up  in  a  multitude  of  circumstances,  as 
for  instance,  in  respect  -of  what  one  writer  in 
the  Times  calls  ''the  thoughtless  and  reprehensible 
disclosures  by  medical  men,  not  defamatory,  as  to  their 
patient  having  cancer  or  consumption."  Ought  we 
in  every  instance  to  assume  a  peremptory  attitude 
when  questioned  by  friends  or  relatives,  and  curtly 
refuse  to  gratify  a  very  legitimate  curiosity.  The  ques- 
tion is  rendered  all  the  more  delicate  from  this  point 
of  view  when  it  Is  remembered  that  the  patient  is  often 
the  very  last  person  to  whom  it  is  desirable  to  confide 
information  of  this  kind,  yet,  it  must  perforce  be 
imparted  to  someone  in  the  best  interests  of  the  patient. 
It  is  as  cruel  as  it  is  unnecessary  in  the  majority  of 
inatanoeii  to  tell  a  patient  that  he  is  suffering  from  a 


fatal  and  incurable  disease,  but  unless  someone  is  made 
the  depository  of  the  secret  the  immediate  future  of 
the  patient  may  be  compromised,  and  the  ultimate 
reputation  of  his  medical  adviser  may  suffer.  These 
are  only  a  few  of  the  many  difficulties  which 
surround  this  all-important  question  but  they 
suffice  to  demonstrate  the  impracticability  of 
laying  down  any  hard  and  fast  rule.  Conceding  that 
the  occasions  under  which  a  medical  man  is  not  bound 
by  law  and  under  legal  penalties  to  keep  silence,  should 
be  very  extreme  and  very  few,  justice  requires  that  if 
his  liabilities  are  to  differ  from  those  of  the  ordinary 
layman  he  is  entitled  to  have  them  clearly  defined  and 
to  know  exactly  what  they  are.  There  might  be  great 
danger,  as  well  as  hardship,  in  imposing  by  law  on  the 
physician  a  greater  obligation  to  silence  than  he  at 
present  lies  under,  i.e.,  not  to  publish  libels  or  slanders 
on  occasions  not  privileged.  A  sufficient  safeguard  of 
the  secrets  and  honour  of  patients  will,  we  believe,  be 
found  in  the  high  sense  of  honour  generally  admitted  to 
prevail  in  the  medical  profession  and  translated  into  a 
professional  obligation  by  the  traditions  handed  down 
by  the  fathers  of  the  healing  art. 

SPARTAN  JUSTICE  ON  ARMY 
MEDICAL  OFFICERS. 
In  our  issue  for  April  1st  we  commented  upon  the 
case  of  a  Surgeon- Major  in  the  Indian  Medical  Service 
who  had  been  dismissed  the  Service  because  he  asked 
a  married  lady  for  a  kiss,  and  we  ventured  to  suggest 
that,  if  the  officer  had  belonged  to  any  other  depart- 
ment of  the  Service  save  the  Medical  he  might  have 
committed  this  minor  discretion,  and  a  great  many 
additional  major  ones,  without  any  serious  indication 
of  official  displeasure.  The  case  of  Surgeon- Captain 
John  Francis  Scott  Fowler  is,  we  understand,  about  to 
be  brought  under  the  notice  of  Parliament  by  Sir 
Walter  Foster,  and  it  repeats  the  lesson  taught  by  the 
previous  case,  t.e.,  that  a  Medical  Officer  of  Her 
Majesty's  Army  cannot  expect  from  Her  Majesty's 
*' military  advisers'^  the  same  measure  of  fair  and 
honourable  treatment  which  is  supposed  to  be  meted 
out  to  combatant  officers.  Surgeon-Captain  Fowler 
has  been  dismissed  because,  having  been  present  for  a 
few  moments  at  some  blackguardly  conduct  by 
officers  of  the  Limerick  Militia  (to  which  regiment  he 
had  been  temporarily  attached),  he  omitted  to  report 
the  matter  to  his  superiors.  His  defence  was  (a)  that 
the  Senior  Captain  of  the  Regiment  was  present, 
whose  duty  it  was  to  report,  and  (6)  that 
he  had  done  all  in  his  power  to  prevent  the 
conduct  complained  of  when  present.  It  was 
charged,  also,  against  him  by  his  accusers  that 
on  examination,  he  had  equivocated  about  the  exact 
time,  during  which  he  had  been  present,  which  he 
stated  to  have  been  *'  a  few  minutes,"  when  it  was 
actually  **  about  half  a  minute."  This,  so  far  as  we 
have  been  able  to  ascertain,  has  been  the  whole  head 
and  front  of  the  Officer's  offending.  On  the  other 
hand,  it  is  stated  that  the  entire  proceedings  of  the 
military  authorities  were  tainted  with  irregularity, 
and  were  in  accordance  neither  with  regulation  nor 
justice.    The  cbargea  werej  sprung  upon  Surgeon- 


^    Tot  Mkdioal  Prv^a. 


l^OTES  OJf  CURRENt  TOf ICS. 


Ayail15,  1896. 


Captain  Fowler  without  any  notice  whatever.  No 
opportunity  was  afforded  to  him  to  defend  himself, 
and  he  has  been  refused  the  opportunity  which  he 
aaked  to  vindicate  his  character  before  a  court-martial 
or  other  competent  tribunal.  Even  the  time-honoured* 
but  most  unjust,  excuse  for  ruining  an  officer,  that  he 
"had  a  bad  record,"  cannot  be  alleged  against  Mr. 
Fowler,  to  whom  the  highest  character,  both  personal 
and  official,  was  given  by  the  Director-Qeneral  of  his 
own  Department.  The  simple  fact  is  divulged  by 
the  narrative,  so  far  as  we  can  read  it,  that 
Sir  Kedvers  Buller,  the  determined  and  vindictive 
enemy  of  the  Army  Medical  Officers,  had  determined 
to  smash  another  victim,  and  smashed  he  has  been. 
We  sincerely  trust,  however,  that  a  majority  in  the 
House  of  Commons  will  be  found  to  vote  for  fair  play 
against  military  prejudice  and  iofiuence.  At  any  rate, 
the  occasion  will  be  afforded  for  some  Member  to  ask 
whether  it  is  the  fact  that  several  officers  with  no  less 
disciplinary  powers  than  Surgeon  Captain  Fowler  were 
present  on  the  occasion  of  offence,  and  were  all  let  off 
with  a  mild  reprimand,  while  he  was  dismissed  and 
ruined  for  life.  The  whole  business  will  serve  as  a 
useful  object  lesson  for  candidates  who  may  contem- 
plate competing  for  the  Army  Medical  Service,  and 
these  two  instances  of  official  partiality  and  prejudice 
may  help  to  teach  them  that  if  they  accept  Her 
Majesty's  Commission  as  a  Medical  Officer  under  the 
present  conditions  they  may  expect  to  meet  with  the 
covert  hostility  and  ill-will  of  their  official  superiors, 
and  will  be  liable  at  any  moment  to  be  cashiered  and 
ruined  loth  in  professional  and  personal  reputation  for 
any  little  peccadillo  which  may  give  the  "military 
advisers ''  the  chance  of  destroying  one  more  doctor. 


THE    FRIENDLY  SOCIETIES   QUESTION 
IN  AUSTRALIA. 

The  Friendly  Societies  question,  about  which  so 
much  discussion  has  arisen  during  the  past  year  in  this 
country,  is  becoming  a  burning  one  in  Australia.  A 
general  meeting  of  the  profession  in  New  South  Wales 
was  held  in  Sydney,  in  January  last,  to  discuss  the 
matter.  There  is  abundant  evidence  to  show  that  our 
confrh-es  also,  in  the  Australian  Colonies,  have  been 
for  long  '*  sweated  "  by  the  managers  of  these  societies. 
The  same  practices  in  this  regard  prevail  in  the  Anti- 
podes as  in  this  country  ;  but  apparently,  if  anything, 
to  a  larger  extent  in  the  former.  Mention  at  the 
meeting  in  question  was  made  by  the  chairman  of  a 
benefit  association  consisting  of  5,000  members,  that  the 
medical  attendance  of  the  latter  was  obtained  for  £]  ,000 
at  the  rate  of  four  shillings  per  year  per  member,  or 
less  than  one  penny  per  week.  This  then  was  a  flagrant 
instance  of  **  sweating,"  and  clearly  called  for  remon- 
strance. But  so  far  it  would  appear  that  the  "  sweat- 
ing "  process  has  to  a  certain  extent  been  tolerated,  and 
that  it  is  only  a  new  proposal  to  enlarge  the  scope  of 
these  benefit  societies  which  has  led  to  active  steps 
being  taken  by  the  profession  in  this  regard.  The 
proposal  now  is  to  bring  into  the  societies  a  different 
class  of  persons  —those  well  abb  to  pay  at  a  respectable 
rate  for  professional  advice  and  attendance.   Of  course, 


any  such  arrangement,  if  carried  out,  can  only  have  a 
serious  effect  upon  the  practices  of  those  medical  men 
whose  patients  would  thus  be  alienated  from  them. 
If  comparatively  well-to-do  persons  are  permitted  to 
become  members  of  such  societies,  and  be  provided 
with  medical  attendance  at  the  rate  of  one  penny  per 
week,  it  is  high  time  that  the  profession  took  a  firm 
stand,  and  entered  a  protest  against  the  arrangement. 
After  all,  it  is  needless  to  point  out  that  the  whole 
success  of  these  benefit  societies  depends  upon 
the  work  of  the  medical  officers ;  the  profits  which 
are  made  out  of  the  concerns  are  simply  derived 
from  the  saving  on  the  disgracefully  inadequate  pay- 
ments provided  for  the  medical  attendance.  It  is 
satibfactory  to  see  that  the  speakers  at  the  meeting  in 
Sydney  showed  that  they  were  determined  to  bring 
about  a  change  in  this  matter,  and  as  a  first  step  the 
meeting  unanimously  endorsed  the  following  resolu- 
tion :  "  That  medical  aid  and  benefit  societies  are 
intended  for  the  use  of  poorer  members  of  the  commu- 
nity, and  not  for  the  well-to-do ;  and  that,  in  the 
opinion  of  this  meeting,  it  is  not  desirable  that  persons 
in  receipt  of  incomes  of  £200  per  annum  should  receive 
medical  attendance  and  medicines  from  societies  as  at 
present  organised.''  Subsequently  the  following  reso- 
lution, after  much  discussion,  was  also  carried  :  "  That 
one  per  cent  on  their  annual  earnings  is  a  fair  propor- 
tion to  be  paid  by  all  members  of  benefit  societies  for 
medical  attendance  and  medicines  ;  and  as  the  present 
recognised  minimum  rate  of  fixteen  shillings  per 
annum  is  already  below  this,  no  further  diminution 
should  be  accepted  by  medical  men."  After  this 
expression  of  opinion,  it  is  clear  that  the  medical  practi- 
tioners of  New  South  Wales  are  agreed  as  to  a  common 
ground  of  action  in  regard  to  the  payment  made  by 
members  of  these  benefit  societies.  The  point  raised 
is,  in  truth,  one  of  great  import ;  there  is  undoubtedly 
more  or  less  competition  among  the  promoters  of 
these  societies,  and  the  bait  that  they  rely  on  by  which 
to  attract  members  is  the  reduction  in  the  annual  sub- 
scription. If  by  making  the  subscription  smaller  a 
society  can  outstrip  its  competitors,  the  means,  in  the 
opinion  of  the  promoters,  quite  justifies  the  end.  But 
meanwhile,  in  order  to  attain  this  end,  the  "  sweating '' 
of  the  medical  officers  comes  into  force,  and  thus  the 
evils  of  these  demoralising  agencies  are  further 
disseminated. 


^0tc0  on  Current  ^opks. 

The  Charge  Against  an  Edinburgh  Practi- 
tioner. 
We  mentioned  the  fact  in  one  of  our  recent  issues 
that  one  of  the  medical  practitioners  of  Edinburgh  had 
been  arrested  on  a  charge  of  homicide.  As  the  Crown 
has  departed  from  the  charge  we  are  at  liberty  to  anim- 
advert on  the  proceedings.  It  appears  that  Dr.  Stocks, 
of  Eankeillor  Street,  was  called  early  in  March  to  see  a 
girl  suffering  from  the  effects  of  a  decoction  adminis- 
tered by  a  female  friend  for  the  purposes  of  procuring 
abortion.  This  precious  decoction  had  been  procured  at 
a  herbalist's.  After  endeavouring  to  allay  the  irritation 


April  15,  189^. 


^OTfis  OK  cuKJaEinr  totics. 


1?HB  Mbdioal  Press.    405 


caused  by  the  drag  by  giving  morphia,  Dr.  Stocks 
prescribed  ergot,  but  finding  the  patient  very  collapsed, 
proceeded  to  induce  abortion  in  the  hope  of  saving  her 
life.  After  this  had  been  successfully  accomplished 
he  ordered  her  to  remain  quietly  in  bed  for  some  days. 
The  patient,  however,  disregarded  his  advice,  got  up, 
and  drank  a  quantity  of  spirits.  Symptoms  of  per^~ 
tonitiB  appeared,  which  were  treated  successfully,  but 
the  patient  was  so  weak  that  she  never  rallied,  and  died 
from  collapse.  It  has  also  transpired  that  before  Dr. 
Stocks  was  called  in  two  medical  students,  presumably 
from  a  dispensary,  had  been  in  regular  attendance,  and 
had  attempted  some  kind  of  operation.  Notwithstand- 
ing all  these  facts,  the  Crown  Authorities  allowed  Dr. 
Stocks  to  remain  in  prison  for  a  fortnight,he  having  been 
sent  there  handcuffed  between  two  pickpockets.  Dr. 
Stocks  does  not  seem  to  have  had  the  barest  justice 
done  him.  One  of  the  most  serious  blots  on  the  ad- 
ministration of  the  present  police-surgeoncy  for  Edin- 
burgh, good  though  it  may  be  in  other  respects,  is  the 
want  of  regard  for  the  feelings  and  rights  of  the 
medical  practitioners  in  town.  As  occurred  in  this 
case,  the  doctor  in  whose  practice  there  has  been  a 
sudden  death  necessitating  an  official  post-mortem,  is 
seldom  asked  to  be  present,  a  right  which  belongs  to 
him,  and  which  is  often  absolutely  necessary  for  the 
proper  interpretation  of  the  morbid  anatomy  disclosed. 
We  may  fairly  assert  that  if  Dr.  Stocks  had  been 
requested  to  attend  the  post-mortem,  no  mistake  would 
have  been  possible,  and  an  innocent  practitioner  would 
have  been  saved  much  indignity  and  worry.  We  hope 
that  the  autocratic  police-surgeon  of  Edinburgh  will  be 
warned  by  this  case  that  it  is  one  of  the  most  dangerous 
and  ill-advised  modes  of  conducting  autopsies  in  legal 
cases  to  contemptuously  ignore  the  practitioner  who 
has  treated  the  patient,  and  who  has  a  right  to  be 
present  and  check  the  proceedings  on  his  own  behalf. 
We  have  known  of  several  other  instances  in  which 
the  post-mortem  examinations  in  Edinburgh  have  been 
officially  performed  without  the  knowledge  of  the 
medical  attendant,  and  it  is  now  time  that  such  mere- 
tricious proceedings  should  be  put  an  end  to. 

The  Late  Count  Mattel. 
There  are  some  men  who  have  owed  their  success 
in  life  almost  entirely  to  their  friends,  and  it  must  be 
confessed  that  the  late  Count  Mattel  was  one  of  these. 
He  was  puffed  in  this  country  to  an  extent  which  has 
surpassed  anything  of  the  kind  which  had  ever  been 
attempted  before.  Here  was  a  quack,  dealing  with  a 
quack  commodity,  who  pretended  that  he  could  cure 
cancer.  His  preparations  consisted  of  bottles  of  dis- 
tilled water,  to  which  he  gave  the  fanciful  names  of 
blue,  green,  and  yellow  electricity,  and  in  addition  he 
dealt  in  pilules  of  starch  and  sugar.  With  these  as 
his  stock  in  trade  he  was  able  to  convert  a  too  impres- 
sionable wife  of  an  English  ambassador,  who  took  the 
first  opportunity  to  write  in  an  English  Keview  of  the 
marvellous  virtues  of  distilled  water  in  curing  cancer, 
in  arresting  haemorrhage  and  healing  wounds.  Soon 
after  these  platitudes  of  nonsense  had  been  brought 
under   public   notice,   the    redoubtable   Mr.    Stead 


championed  the  cause  of  Count  Mattel,  and  made  it 
appear  that  he  seriously  believed  in  the  efficacy  of 
the  "electricities"  to  cure  cancer.  The  subsequent 
history  of  the  Mattel  fiasco  is  well  known.  A  com- 
mittee was  formed  to  watch  the  process  of  the  cancer 
**  cures,"  and  for  this  purpose  five  patients  sufferin;< 
from  malignant  disease  were  placed  in  a  private 
hospital  under  the  care  of  two  medical  men  named 
Kennedy  who  had  professed  their  belief  in  the  Mattel 
**  remedies."  The  committee  consisted  of  Mr.  Lavrson 
Tait,  the  late  Sir  Morel  Mackenzie,  Dr.  Potter,  and 
Dr.  John  Hopkins.  While,  however,  the  inquiry  was 
still  being  carried  out,  we  took  occasion  to  refer  to  it 
in  somewhat  pronounced  critical  terms,  as  the  result 
of  which  a  letter  was  published  in  The  Medical  Pbebs 
AND  CiRCirLAR,  from  Mr.  Lawson  Tait,  one  of  the 
committee,  giving  some  details  of  the  inquiry  and  of  the 
mode  under  which  it  was  being  conducted.  Ihe 
revelations  of  Mr.  Lawson  Tait  were  received  with  \u». 
strongest  expressions  of  disapproval  on  the  part  of  the 
Messrs.  Kennedy,  so  much  so,  that  the  latter  refused 
forthwith  to  have  anything  more  to  do  with  the  com- 
mittee. Thus  the  curtain  fell  upon  the  only  scientific 
attempt  which  had  ever  been  made  to  ascertain  the 
truth  of  Count  Mattel's  protestations  in  favour  of  his 
'*  remedies.''  Enough,  however,  had  been  seen  by  the 
committee  to  prove  that  the  electricities  were  absolutely 
worthless  from  a  therapeutical  point  of  view.  Of  the 
five  patients  who  became  the  subject  of  the  inquiry, 
four  are  now  dead,  and  the  last  one  is  dying,  and  this 
despite  the  fact  that  ''Matteism"  has  been  carried 
out  to  the  bitter  end.  Count  Mattel  was  admitted  by 
all  his  friends  to  be  eccentric,  and  now  that  he  is  dead 
we  may  charitably  suppose  that  this  was  the  case. 

Spain  and  Cuba. 
The  Cuban  troubles  have  at  last  roused  the  Spanish 
authorities  to  a  recognition  of  the  necessity  of  providing 
suitable  accommodation  for  the  sick  and  wounded 
royal  troops  in  the  Queen  of  the  Antilles.  Doii  Cesareo 
Fernandez  Losada,  Medical  Director  of  the  Royal 
Army  in  the  Island,  accompanied  by  a  brilliant  staff, 
laid  the  foundation  stone  of  a  new  hospital  in  Havana. 
In  honour  of  the  boy-king  the  hospital  is  named 
"Alphonsus  XIII  Hospital.*'  The  building  will  con- 
sist of  a  number  of  isolated  pavilions,  and  will  contain 
every  improvement  that  experience  could  suggest 
The  old  hospital  of  San  Ambrosio,  which  was  situated 
in  one  of  the  most  unhealthy  suburbs  of  Havana,  has 
been  closed,  and  a  very  decided  lowering  of  the  mor- 
tality of  the  troops  is  being  hopefully  looked  forward 
to.  The  patriotism  of  the  medical  profession  in  Spain 
is  the  subject  of  a  warm  eulogy  in  El  Siglo  Medico^ 
and  it  is  not  undeserved,  for  we  learn  that  the  members 
of  the  profession  are  giving  a  month's  receipts  for  the 
bettering  of  the  condition  of  the  wounded  troops  in 
Cuba.  A  subscription  has  been  commenced,  and  is  being 
quickly  responded  to,  for  the  purpose  of  presenting  Dr. 
Urbano  Orad  with  the  jewels  of  the  Order  of  San 
Fernando,  which  has  been  so  recently  conferred  on  him. 
The  Medico  Pharmaceutical  College  of  Alicante,  at  the 
instance  of  Drs.  Segin  and  Manero,  have  resolved  to  at>k 


406     Thi  Medical  Pbkfs. 


NOTES  ON  CURRENT  TOPICS. 


Apbil  15, 1896, 


their  licentiates  to  (1)  give  their  services  gratuitoasly 
to  military  garrisons  in  their  districts  during  the  war. 
(2)  To  double  their  licentiate  fee  until  the  insurrection 
IS  stamped  out.  (3)  To  resign  all  connection  with 
North  American  insurance  companies.  (4)  To  totally 
discontinue  the  use  of  North-American  proprietary 
medicines.  It  is  probably  that  Alicante  will  not  be 
alone  in  her  declaration  of  antipathy  to  the  enemies  of 
her  country  and  assertion  of  her  patriotism. 

An  Alleged  Death  firom  AntiDiphtheritio 
Serum. 

The  sensational  details  forwarded  from  Vienna  by 
the  correspondents  of  certain  newspapers  respecting 
an  alleged  death  in  that  city  from  an  injection  of  the 
antitoxin  serum  for  diphtheria  have  undeniably  been 
made  the  moat  of  by  the  public  press  in  this  country, 
and  especially  so  by  those  newspapers  whoFe  editors 
profeps  to  condemn  this  form  of  treatment.  The  facts 
as  reported  are  these :— A  housemaid,  employed  by 
Professor  Robert  LaDgerhaus,of  the  Moabit  Hospital, 
was  taken  ill  with  diphtheria,  and  was  removed  to  the 
hospital.  It  was  decided,  in  view  of  the  fact  that  the 
professor's  son  had  come  in  contact  with  the  servant, 
to  give  him  an  '  injection  of  the  antitoxin  serum,  as  a 
prophylactic'  The  injection  was  accordingly  admin- 
istered to  the  child,  whose  age  was  one  year  and  nine 
months,  but  shortly  afterwards  death  took  place,  appar- 
ently from  the  injection.  This  affair,  sad  though  it  may 
be  to  the  grief -stricken  parents,  must  still  be  discussed 
dispassionately.  In  the  first  place,  we  cannot  admit  that 
the  injection  was  at  all  necessary.  In  this  country  it 
has  so  far  never  been  the  practice  to  use  the  serum  as 
a  prophylactic.  Hitherto  its  use  has  been  simply  con- 
fined to  the  worst  cases  of  the  disease  when  it  was 
evident  that  all  the  known  forms  of  treatment  had 
failed.  We  do  not  know  enough  yet  of  the  properties, 
uses,  and  advantages  of  the  serum  to  warrant  its 
administration  in  any  case  otherwise  than  as  a  dernier 
ressort.  Moreover,  nothing  has  up  to  the  present  been 
published  upon  the  effects  of  its  administration  for 
prophylactic  purposes.  If  our  German  confreres  have, 
as  it  is  reported,  been  in  the  habit  lately  of  giving 
'*  preventive "  injections  to  the  healthy  members  of 
households  in  which  diphtheria  has  broken  out,  it  is 
only  fair  to  admit  that  no  such  practice  has  as  yet  pre- 
vailed in  this  country.  Nor  is  it  advisable  that  such  a 
practice  should  be  followed ;  inasmuch  as,  however 
valuable  the  antitoxin  serum  may  be  in  the  presence 
of  virulent  attacks  of  diphtheria,  it  is  undeniable  that 
our  knowledge  of  the  full  extent  of  its  potentiality  has 
even  now  still  to  be  elucidated. 

The  Frees  and  the  Outbreak  of  Small-Pox 
in  Glouceeter. 
Nemesis  seems  really  at  last  to  have  fallen  upon  the 
anti-vaccinationist  faddists,  in  consequence  of  the 
serious  epidemic  of  small-pox  in  Gloucester.  Almost 
without  exception  throughout  the  country  the  Press 
has  condemned  them  and  attributed  to  their  folly  and 
faddism  the  sad  mortality^ which  has  occurred  among 
the  victims  of  their  teaching.  It  must  be  rather  galling 
to  these  .irresponsible  agitators  to  know  tiiat  despite 


their  vehement  diatribes,  their  converts  in  Qloucester 
have  cast  them  off,  and  are  now  rushing  to  the  vaccina- 
tion stations  there,  seeking  that  protection  against  the 
virulent  disease  which  they  had  been  led  to  suppose 
was  a  filthy  and  disgusting  rite.  Again,  Boards  of 
Guardians  in  many  towns  have  rescinded  their  resolu- 
tions not  to  take  proceedings  against  defaulters  under 
the  Vaccination  Acts.  Thus  all  sensible  persons  will 
rejoice  that  the  anti-vaccinationist  faddists,  despite 
their  irresponsibility,  will  have  a  long  time  to  wait 
before  their  "  arguments  "  will  be  again  likely  to  bring 
them  converts.  Meanwhile,  some  measure  of  sympathy 
will  be  felt  for  the  poor  unvaccinated  children  who 
have  suffered  so  severely  in  Gloucester,  in  consequence 
of  the  folly  and  neglect  of  their  misguided  parents. 
Some  of  these  children  seem  to  have  survived  the 
attack  of  the  disease,  but  only  with  their  comese 
destroyed  by  which  they  have  been  rendered  blind. 
The  parents  of  such  children  will,  it  may  be  assumed, 
in  theee  cates,  have  an  ever  present  and  painful  proof 
of  their  stupid  folly  in  neglecting  to  comply  with  the 

law  of  the  land.  

The  Uncontrolled  Trade  in  Poisons. 
*'  Death  by  misadventure  and  no  evidence  of  crimi- 
nal negligence."  This  is  the  usual  formula  by  which 
pharmaceutical  carelessness  is  usually  indicated  in 
the  verdicts  of  coroners'  juries,  of  which  we  have  two 
samples  before  us.  In  one  case  a  man  stole  a  bottle  of 
cocaine  from  the  woman  with  whom  he  lived,  who  was 
in  the  habit  of  taking  it,  and  poisoned  himself  with  it 
The  testimony  disclosed  the  fact  that  a  little  girl  had, 
without  any  difficulty  whatever,  bought  a  five-shilling 
bottle  of  the  drug  at  the  Civil  Service  Stores,  and  that 
the  bottle  was  left  in  control  of  the  deceased,  although 
it  was  known  that  he  had  threatened  suicide  and  had 
secreted  the  cocaine  under  his  mattress  for  that 
purpose.  In  the  second  case  an  apothecary  was  called 
upon  for  a  repeat  of  a  sleeping  prescription  which  had 
been  previously  dispensed  by  his  manager,  who 
happened  to  be  absent  at  the  time.  The  apothecary 
had  never  seen  the  prescription,  and  knew  nothing 
about  its  contents  or  about  the  patient  who  was  to 
take  it,  save  from  the  verbal  account  given  by  the 
messenger,  but  he  made  up  something  of  which  he 
refused  to  tell  the  ingredients,  and  also  refused  to  say 
whether  he  had  weighed  the  constituents,  and  he  gave 
it  to  the  messenger  without  any  written  instruction  as 
to  administration.  The  result  was  death  from  narcotic 
poisoning.  It  certainly  appears  that  the  intervention 
of  a  public  prosecutor  is  frequently  wanted  when  it  is 
not  forthcoming. 

Bacteria  in  Milk. 
The  important  subject  of  milk  in  relation  to  health 
is  by  no  means  worked  out  from  a  scientific  point  of 
view.  There  can  be  little  doubt  that  this  important 
article  of  food,  which  forms  the  staple  diet  of  infants, 
has  much  to  do  with  diarrhoea  and  other  diseases  that 
work  such  disaster  among  our  infantile  population. 
The  bacteriology  of  milk  was  dealt  with  very  fully  last 
week  by  Drs.  Hunter  Stewart  and  Young,  who 
read  an  important  paper  on    the    auliao^    before 


Afril  15,  1S96. 


NOTES  ON  CURRENT  TOPICS 


The  Msdical  Pbiss.     407 


the  Edinburgh  Royal  Society.  From  a  number 
of  experiments  carried  out  in  Edinburgh,  it  was 
found  that,  three  hours  after  milkinr,  there 
were,  on  the  average,  per  cubic  cebtimetrp, 
in  winter,  24,000  bacteria ;  in  spring  and  early  summer, 
44,000;  and  in  late  summer  and  autumn,  173,000.  It 
was  further  found  that  in  dairies  supplied  by  milk 
from  the  country  the  average  number  of  micro  organ- 
isms, five  hours  after  milking,  was  44,000  per  cubic 
centimetre,  while  in  dairies  supplied  by  milk  from 
town  byres,  the  average  was  352,000  per  cubic  centi- 
metre. Numerous  important  observations  on  tbe 
sterilisation  of  milk  were  reported  in  this  paper,  which 
should  be  read  by  all  who  are  interested  in  the  practi- 
cal issue  of  the  prevention  of  disease. 

The  Modem  Gunshot  Wound. 
Senor  Psna  y  Buelta,  Medical  Director  of  the 
Royal  Army  in  Cuba,  has  published  a  very  interesting 
account  (Bemsta  de  Clinica)  of  a  bullet  wound  pro- 
duced by  the  new  Spanish  rifle,  the  Mauser.  The 
patient,  Leandro  Moral  Ebro,  with  the  column  of 
General  Luiares,  received  a  gunshot  wound  on 
September  23rd  last.  Tbe  bullet  struck  the  outer 
side  of  the  shaft  of  the  right  thigh  bone,  and  traversed 
the  neck  of  the  femur  and  smashed  the  tuberosity  of 
the  ischium.  The  exit  opening  was  not  larger  than  the 
entrance,  and  the  appearance  more  resembled  an 
incised  wound  than  a  wound  of  the  old  round  bullet 
pattern.  Dressed  with  splints,  oil  of  turpentine,  boric 
acid,  and  absorbent  cotton,  the  wounds  healed  rapidly 
and  the  bones  soon  united.  Unfortunately  Senor 
Pena  does  not  give  any  information  on  the  weight  or 
velocity  of  the  bullet ;  nevertheless,  it  is  instructive  to 
know  that  the  bullet  pierced  the  femur  without  com- 
pletely fracturing  it,  and  still  had  sufficient  force  to 
smash  the  tuberosity  of  the  ischium.  It  is  probable 
that  the  immediate  fatality  from  bullet  wounds  will  be 
less  than  it  has  been ;  but  that  owing  to  the  great 
velocity  and  range  of  the  missile  a  greater  number  will 
be  wounded. 

Milk  for  Paupers. 
The  proceedings  of  the  last  meeting  of  the  North 
Dublin  Guardians  illustrate  the  ease  of  conscience  with 
which  some  people  regard  laxity  in  commercial  matters, 
and  especially  when  the  money  obtained  by  such 
laxity  is  not  their  own.  Tbe  time  for  making  milk 
contracts  for  the  ensuing  year  had  arrived,  and  most 
of  the  outgoing  contractors  put  in  fresh  tenders.  It 
was  stated  in  the  discusbion  that  there  was  scarcely 
one  of  them  who  had  not  been  detected,  some  of  them 
many  times,  in  the  attempt  to  palm  off  adulterated 
milk  upon  the  paupers,  and  fined,  while  several  of 
them  had  been  legally  prosecuted,  condemned,  and 
punished.  A  few  of  the  Guardians  thought,  reason- 
ably enough,  that  traders  who  had  been  guilty  of  these 
offences  on  one  or  more  occasions  ought  not  to  be 
afforded  the  opportunity  of  doing  so  again,  and  should 
be  excluded  from  the  competition,  but  the  rest  of  the 
Board,  by  a  majority  of  two  to  one,  decided  that  such 
tricks  are  only  in  tbe  ordinary  way  of  business,  and 


accordingly  gave  the  contracts  to  the  convicted  con- 
tractors. It  would,  of  course,  be  ridiculous  to  bother 
about  the  nutriment  of  paupers  when  one's  political  or 
religious  ally  is  in  the  way  of  making  a  handsome 
profit  by  serving  them  with  *'  skim  sky  blue." 

An  Amende  Honorable. 
A  SHOKT  time  ago  attention  was  called  in  these 
columns  to  the  fact  that  t  he  Russian  Committee  of  the 
International  Medical  Congress,  which  will  be  held  in 
Moscow  next  year,  had  declined  to  include  the  English 
language  among  the  official  languages  of  the  meeting. 
We  are  now,  however,  glad  to  announce  that  wiser 
counsels  have  prevailed,  and  that  the  Committee  have 
rescinded  their  resolution  upon  this  point  The 
English  language  will  be  placed  upon  the  same  footing 
as  that  assigned  to  the  German,  both  for  the  reading 
of  papers  and  for  use  in  debate  ;  but  all  the  official 
business  will  be  conducted  in  the  French  language. 
This  latter  decision  on  the  part  of  the  Russian  Medical 
men  may,  or  may  not,  be  the  result  of  political  intrigue  ; 
nevertheless,  the  honour  assigned  to  the  representatives 
of  France  in  this  respect  will  probably  meet  with  the 
appreciation  which  it  will  doubtless  produce.  In 
making  the  amende  honorable,  however,  to  English- 
speaking  practitioners,  the  Committee  of  the  Congress 
have  simply  done  their  duty.  No  Congress  could  be 
strictly  called  an  international  one  from  which  the 
English  language  was  excluded. 


Medical  Women  in  Austria. 
The  field  for  medical  women  has  just  been  enlarged 
by  a  decree  of  the  Minister  of  Public  Instruction  in 
Austria.  This  official  has  intimated  that  women 
medical  graduates  of  foreign  universities  will  be 
allowed  to  practise  medicine  in  Austria  under  the  fol- 
lowing conditions :— (a)  They  must  be  or  become 
Austrian  subjects ;  (b)  have  completed  their  twenty- 
fourth  year ;  (c)  have  passed  a  matriculation  examina- 
tion in  an  Austrian  college ;  and  (d)  have  attended 
successfully  ten  consecutive  terms  at  a  foreign  medical 
school  ranking  with  an  Austrian  university,  during 
which  period  their  moral  conduct  must  have  been 
blameless.  This  last  proviso  seems  somewhat  unusual 
at  first ;  it  is  quite  common  among  the  conditions  of 
studentship  so  far  as  men  are  concerned,  but,  so  far, 
we  have  not  yet  become  accustomed  to  such  inquiries 
in  relation  to  student  or  qualified  females.  The  Austrian 
authorities  are  of  the  belief  that  many  foreign  women 
graduates  will  avail  themselves  of  these  privileges,  and 
qualify  themselves  under  the  regulations.  In  Bosnia 
and  Herzegovina  women  doctors  are  stated  to  be 
greatly  in  demand.  Many  Mahometan  women  reside 
in  these  provinces  who  have  hitherto  been  deprived  of 
medical  aid. 

In  Brittany  cider  is  drunk  ;  in  Paris,  wine  ;  in  Nor- 
mandy, coffee  mixed  with  alcohol.  Delirium  tremens 
is  frequent  in  Rennes,  and  the  form  it  assumes  is  of  a 
grave  character.  The  same  delirium  when  met  with  in 
Parisians  is  of  a  slight  form,  while  in  Normandy  it  ia 
scarcely  ever  seen. 


408     The  Mbdioal  Press. 


NOTES  ON  CUKRENT  TOPICS. 


April  15,  1896. 


Child  Murder  and  Baby  Farming. 
A  SENSATIONAL  murder  trial  is  now  in  its  police- 
court  stafi^e.  For  a  loner  time  past  numerous  bodies  of 
infanta  have  been  taken  from  the  Thames  by  the 
London  police  under  circumstances  that  pointed 
unmistakeably  to  murder.  Recently  some  evidence 
has  been  gained,  bv  reason  of  which  two  persons  have 
been  arrested  at  Readinsr  and  charged  with  murder. 
Three  nurse  children  were  found  in  the  hous^  of  the 
prisoners,  and  witnesses  came  forward  to  state  that 
they  h^d  placed  children  there  in  answer  to  an  adver- 
tisement oflferin^  adoption  for  a  premium  of  £10. 
However  the  present  case  end-*,  there  can  be  no  doubt 
that  a  widespread  and  abominable  traffic  gof  s  on  under 
the  pretence  of  adopting  and  caring  fi)r  illegitimate 
children.  It  is  high  time  that  the  trade  of  the  baby 
farmer  were  made  impossible,  save  under  rigid  restric- 
tions. Ooly  under  stringent  and  constant  police 
supervision  would  these  |:>oor  waifs  and  strays  of 
humanity  have  any  chance  of  fair  treatment.  So  far  as 
London  goes,  the  extent  of  the  evil  may  be  surmised 
from  the  statement  that  from  30  to  40  bodies  of 
strangled  infants  were  found  in  the  Thames  last  year. 

English  Horse-flesh  for  Hollanders. 
Some  curious  facts  transpired  last  week  at  the 
Thames  Police  Court  in  connection  with  the  exporta- 
tion to  Rotterdam  of  worn  out  English  horses  to  be 
used  for  human  food.  The  immediate  occasion  of  the 
disclosure  was  the  prosecution  of  a  groom  for  leading 
a  lame  horse  through  the  streets.  A  dealer  admitted 
that  he  had  bought  the  horse  at  a  repository  and  was 
sending  it,  along  with  others,  over  to  Rotterdam.  The 
value  of  the  beast  was  stated  by  a  veterinary  surgeon 
to  be  about  35s.  in  England,  but  that  value  would  be 
increased  to  £7  or  £8  in  Holland.  The  magistrate 
fined  defendant  £4  and  costs,  which  seems  a  somewhat 
excessive  punishment  for  the  mere  cruelty  of  leading 
about  a  lame  horse.  It  is  to  be  trusted  that  the 
magistrate  has  not  allowed  himself  to  be  influenced  by 
the  purely  aesthetic  side  of  the  question.  Because 
most  Englishmen  regard  the  eating  of  horse-flesh  with 
aversion,  it  does  not  at  all  follow  that  they  are  not  deny- 
ing themselves  a  wholesome  and  desirable  article  of 
food. 

A  New  Industry. 
The  development  of  the  Rontgen's  rays  business  is 
beginning  to  assume  the  proportions  of  a  new  iudustry. 
Laboratories  are  now  being  started,  on  commercial 
lines,  for  the  purpose  of  enabling  practitioners  and 
their  patients  to  benefit  by  the  famous  discovery.  A 
correspondent  has  sent  us  a  circular  of  a  laboratory  of 
the  kind  which  has  just  been  opened  in  Oxford  Street. 
Arrangements  have  been  made  by  which,  doubtless,  in 
return  for  a  suitable  fee,  photographs  for  diagnostic 
purposes,  will  be  taken  in  cases  of  disease  of  bones, 
malformations  and  fractures,  and  with  the  view  of 
determining  the  exact  position  of  the  foreign  bodies  in 
cases  of  needles  and  fragments  of  glass  impacted  in  the 
tissues.  There  is  undeniably  an  opening  for  such  an 
enterprise  as  this,  and  it  ia  somewhat  remarkable,  after 


so  short  an  interval  since  Rootgen  announced  his  dis- 
covery, that  its  utility  for  commercial  purposes  should 
have  been  recognised,  and  acted  upon. 


A  New  Method  for  Removing  a  Carcino- 
matous Rectum. 

A  NEW  method,  somewhat  attractive  from  its 
description,  has  been  devised  for  dealing  with  a  rectum 
the  seat  of  carcinoma.  The  author  is  M.  Gaudier,  of 
Lille,  and  the  following  are  the  steps  of  his  operation. 
Laparotomy  is  first  performed,  the  large  intestine 
divided  at  the  sigmoid  flexure,  the  recto- vesical  pouch 
is  then  opened,  and  the  rectum  separated  from  its 
attachments  from  above ;  this  having  been  done,  the 
patient  is  next  placed  in  the  lithotomy  position,  and  a 
circular  incision  made  round  the  anus  ;  the  incision  is 
extended  along  the  side  of  the  rectum  until  the  separa- 
tion of  the  rectum  is  completed  by  the  union  of  the 
external  with  the  internal  dissection.  The  rectum  is 
next  withdrawn  through  the  perineal  wound ;  the 
latter  is  then  closed,  and  the  loose  end  of  the  large 
intestine  brought  to  the  surface  in  the  laparotomy 
wound,  and  an  artificial  anus  established.  The  author 
has  performed  his  operation  once  only,  but  the  patient 
died  on  the  fifth  day.  The  cause  of  death  is  not 
stated. 

Prizes  at  the  Royal  College  of  Surgeons, 
England. 

At  the  meeting  of  the  Council  of  the  Royal  College 
of  Surgeons,  England,  held  last  week,  the  Jacksonian 
Prize  for  1895  was  awarded  to  Dr.  A.  A.  Kanthack,  for 
his  Essay  on  *'  Tetanus."  Also,  the  Walker  Priz^,  for 
the  best  work  in  advancing  the  knowledge  of  the 
Pathology  and  Therapeutics  of  Cancer,  done  either 
partially  or  wholly  within  the  five  years  preceding  the 
year  in  which  the  prize  shall  be  awarded,  was  at  the 
same  time  awarded  to  Mr.  Harold  Jalland  Stiles,  M.B., 
O.M.  Edin.,  F.R.C.S.  Edin.,  of  Edinburgh  University. 
The  prize  consists  of  a  gift  of  £100  -  except  on  this, 
the  first  occasion,  when  it  is  only  £60— and  a  docu- 
ment declaratory  of  the  award.  It  id  open  to  foreigners 
as  well  as  to  British  subjects,  and  the  committee  are 
not  restricted  in  any  way  as  to  the  selection  of  persons 
qualified  to  receive  the  prize,  with  the  exception  that 
members  of  the  Council  are  not  eligible. 

Hydrophobia. 
What  would  appear  to  have  been  an  undoubted 
case  of  hydrophobia  came  from  Dr.  Barnardo's  Reform- 
atory to  the  London  Hospital  last  week.  The  patient 
had  been  unexpectedly  bitten  by  his  pet  dog  a  month 
since  and  died  with  all  the  symptoms  of  rabies, 
although  he  had,  at  the  time,  caused  the  wound  to  be 
cauterised,  and  had  taken  every  other  usual  precau- 
tion. It  is  to  be  regretted  that  the  common  error  was 
committed  of  killing  the  dog  for  which  reason  no  proof 
is  available  that  the  animal  was  actually  rabic. 

Db.  James  Scott,  H.M.  Prison,  StaflFord,  and  late  of 
Dartmoor  Convict  Prison,  has  been  appointed  Medicid 
Officer  to  B-M-  Priaop  at  HoUowajr. 


Apbil  15.  1896. 


CORRESPONDENCE. 


Thb  Mkdioal  Prtos.     409 


Dr.  J.  B.  Kenny,  M.P. 
By  the  retirement  of  Dr.  J.  E.  Kenoy  from  the 
representation  of  the  College  Green  division  of  the 
city  of  Dablin  in  Parliament  the  profession  loses  one 
of  its  exponents  in  the  House  of  Commons.  Dr.  Kenny's 
avocations  as  coroner  for  the  city  of  Dublin  and,  up  to 
recently,  as  Medical  Officer  of  the  North  Dublin 
Union,  and  as  a  private  practitioner,  were  so  engross- 
ing that  his  attendance  in  Parliament,  and  his  appear- 
ances in  debate  were  only  occasional  but  his  advice  and 
influence  were  always  at  the  disposal  of  his  brethren 
in  Ireland  who  will,  therefore,  miss  his  presence  as 
their  Parliamentary  representative. 


One- Price  Pharmacy. 
A  Chicago  firm  has  recently  started  a  "  dime " 
pharmacy,  and  undertakes  to  supply  any  medicine, 
however  costly,  at  the  price  of  a  dime,  i.e,^  5d.  This 
is,  however,  no  improvement  on  the  other  chemist  who 
offers  to  dispense  and  give  for  nothing  as  much  medi- 
cine as  any  patient  can  consume  on  the  premises. 


[FBOM   0I7B  OWN  OOBBISPONDBKT.] 

Thb  Deputy  Commission  bb  in  Lunacy  fob  Scotland. 
— Lord  Balfour,  of  Burleif^h,  Secretary  for  Scotland,  has 
appointed  Charles  Macphereon,  M.D.,  parochial  medical 
officer,  Bonar  Bridge,  Subherlandshire,  to  be  a  Deputy 
Commiaeioner  in  Lunacy  for  Scotland,  in  room  of  Dr. 
Lawson  deceased.  We  do  not  wish  to  decry  Dr.  Mac- 
pherpon'e  professional  attainments,  but  seriously  we  ques- 
tion the  advisability  of  appointing  to  such  a  post  one  who, 
if  the  record  of  his  work  in  the  Medical  Directory  be 
correct,  can  have  had  much  less  experience  in  all  matters 
pertaining  to  the  management  of  the  insane  than  many  of 
the  other  candidates  for  the  post.  It  would  be  interest- 
ing to  know,  for  all  parties  concerned,  what  was  the  nature 
of  the  influence  broaghb  to  bear  on  the  Scottish  Office  on 
his  behalf.  Can  it  be  that  he  lives  at  Bonar  Bridge?  We 
make  this  common^'  because  only  the  other  ^day  a  public 
appointment  was  conferred  on  a  respected  member  of  the 
profession  in  Scotland  who,  a  short  time  befoie,  had 
written  to  a  contemporary  stating  that  he  was  not  a  candi- 
date. The  method  employed  in  official  appointments  is 
difficult  to  fathom. 

FiBB  Appliances  in  thi  Edinbuboh  Royal  Infibm- 
ABY. — The  managers  of  this  infirmary  must  have  felt  many 
a  qualm  of  conscience  when  the  report  of  the  Edinburgh 
Firemaster  on  the  fire-extinguishing  appliances  of  the 
institution  was  read  at  their  meeting  last  week.  From 
this  report  all  the  appliances  seem  to  have  been  woefully 
neglected.  The  resident  staff  are  never  instructed  in  their 
use,  and  most  of  the  apparatus  is  unserviceable,  even  if 
the  staff  did  understand  its  working.  The  report  on  the 
dangers  contingent  on  a  fire  anywhere  near  the  dispensary 
is  not  reassuring,  owing  to  the  large  quantities  of  ether, 
chloroform,  and  alcohol  stored  in  it.  The  very  good 
suggestion  that  the  whole  staff  should  go  through  a  fire 
drill  several  times  a  year  should  be  acted  on. 

Edinbubgh  Univkbsity  Honobary  Degbxes.— At  a 
Convocation  of  the  University  of  Edinburgh  on  Saturday 
last  (April  11th)  tbo  honorary  decree  of  LL,D.  was  con- 


ferred on  Sir  J.  Russell  Reynolds,  Bart.,  and  Professor  E. 
von  Beneden,  of  the  University  of  Li^ge. 


[We  do  not  hold  oonelves  retponslble  for  the  opinions  of  oar 
ooiTMpondeats.]  

THE  REPORT  ON  ANTITOXIN. 

To  the  Edito7'  of  the  Medical  Peess  and  Cibculab, 

Sib,— I  trust  that  the  remarks  which  follow  will  be  held 
to  justify  my  continued  scepticism  as  to  the  efficacy  of 
aDtitoxin  as  a  specific  in  the  treatment  ot  diphtheria,  or  at 
least  to  warrant  my  contention  that  it  is  not  so  unequivo- 
cally established  as  at  first  sight  appears  on  perusal  of  the 
Metropolitan  Asylums'  Board  report. 

I  regret  to  see  that  you,  in  common  with  many  other 
I  e viewers,  assume  that  the  reduced  mortality  of  7'1  per 
cent  on  the  past  year  is  entirely  due  to  antitoxin  ; 
that  is  not  so,  although  the  Report  is  so  worded  as  to 
convey  that  impression.  The  mortality  of  22'5  for  1895  is 
obtained  on  the  total  of  3,529  cases,  of  which  only  2,182 
were  treated  with  antitoxin,  of  whom  615  died,  giving  a 
mortality  of  28*  1  per  cent.  Toe  remaining  1,347  canes 
were  treated  tdthout  antitoxin^  and  of  these  there  were 
but  181  deaths,  giving  the  astonishingly  low  mortality  of 
13*4  per  cent.  It  is  therefore  evident  to  the  most  casual 
reader  that  only  1*5  per  cent,  of  the  improved  death-rate 
of  7'1  is  due  to  the  antitoxin. 

With  a  curious  want  of  candour  no  figures  are  given  in 
the  Report  showing  the  result  in  these  cases  treated  in 
1895  by  the  methods  in  vogue  before  the  use  of  antitoxin. 
Permit  me  to  supply  them  : —  _ 

Table  I. — Gboss  Mobtalitt  uudbb  Thbkb  Classes  of 
Tbeatment. 


tl 

Year. 

Trestment. 

CateB. 

Deaths. 

2S 

1^ 

1895 

Table  XIV 

With    and 
without 

Antitoxin. 

3,529 

796 

22-5 

it 

Table  VII 

With  Anti- 

toxin. 

2,182 

615 

28-1 

t» 

New  Figures. 

Without 

Antitoxin. 

1,347 

181 

13-4 

ff 

Table  XX 

Without 

Antitoxin. 

3.042 

902 

29-6 

It  is  true  that,  with  certain  exceptions,  "  the  serum  was 
administered  only  to  cases  which  at  the  time  of  admission 
were  severe,  or  which  threatened  to  become  so  "  ;  you  dis- 
count those  eiceptions  by  the  terms  *'  generally  speaking," 
but  the  exceptions  are  really  important,  and  if  we  multiply 
the  six  hospitals  by  twelve  months,  we  shall  find  that  for 
at  least  a  fourth — indeed  for  nearly  a  fifth — of  the  time  all 
cases,  mild  and  severe,  had  been  treated  without  serum. 

For  at  one  hospital  (the  Eastern)  the  use  of  antitoxin 
was  altogether  **  suspended  for  an  interval  of  three  months." 
For  "  periods  of  four  months  at  the  Western  and  North 
Western,  of  three  months  at  the  Fountain,  and  to  a  con- 
siderable extent  throughout  the  year  at  the  South-Eastem 
Hospital,  all  cases  were  consecutively  treated  [with 
antitoxin]  irrespective  of  severitv."  Let  us  compare  the 
results  at  these  five  hospitals,  and  to  make  the  table  com- 
plete add  those  of  the  South  Western,  the  only  hospital 
concerning  which  no  exception  is  made,  but  the  one  in 
which  the  mortality  on  the  non-antitoxin  cases  was  lowest, 
namely,  3*3  per^cent.,  as  represented  by  5  deaths  on  151 
cases. 

It  is  true  there  were  more  cases  under  5  years  of  ase 
treated  with  antitoxin  than  without,  but  the  figures  do 
not  bear  out  the  t-tatement  that  the  mortality  of  those 
treated  with  serum  was  less  than  that  of  those  treated 
without. 

Thus  the  mortality  of  cases  treated  without  serum  under 
5  year?,  in  1895  is  more  than  20  per  cent,  less  than  that  of 
those  treated  under  the  same  conditions  in  1894,  where  it 
was  47'4  ;  and  more  than  10  per  cent,  lees  than  that  of  th^ 
eornm  troated  oases. 


410    Ths  Mxdical  Pbiss. 


CORRESPONDENCR 


Apbil  16, 1896. 


Table  II.   Showinc;  Mortality  at  Individual  Hospi- 
tals Under  Thrbb  Classes  of  Treat^ibnt. 


Hospital. 

Ireatment. 

Cases. 

Deaths. 

Cum 
per 

31  1 

blQtd 
cent. 

EMtom  — (anti- 

With  anti- 

276 

86 

) 

tx)xin  saspende^ 

toxin 

25-5 

three  months) 

Without  „ 

365 

78 

213 

Weatera- (anti- 

With anti- 

432 

110 

25-4 

) 

toxin  in  all  ca^e" 

toxin 

[    20-8 

four  months) 

Without  „ 

143 

10 

6-9 

North  Western— 

With  anti- 

363 

117 

322 

1   24-5 

(antitoxin  in  all 

toxin 

cases  4  months) 

Without  „ 

367 

62 

16  8 

Fountain — (anti- 

With anti- 

334 

99 

29  6 

/ 

toxin  in  all  cases 

toxin 

[   20-2 

three  months) 

Without  „ 

230 

15 

6  5 

South  Eastern— 

With  anti- 

461 

109 

23  6 

\ 

(antitoxin  in  all 

toxin 

[   21-7 

cases,  say  eight 

Without  „ 

91 

11 

120 

months). 
South  Western 

) 

With  anti- 

316 

94 

29-7 

) 

toxin 

}    21-1 

Without ,, 

151 

5 

3  3 

) 

Table  III.  —  Showing  Variations  of  Mortality 
Obtained  Under  Threu  Headings  up  Trbatmint 
AT  Different  Ages. 


Antitoxin  Cases,  1895. 

Ages. 

Cases. 

Death*.      1    Morta.ity  per  cent. 

Under  5 
»  10 
..       15 

All  ages 

1,013 
1,829 
2,056 
2,182 

379 
575 
606 
615 

37-4 
314 
294 
28  1 

Non  Aiititoxiii  Cases,  18*»5. 

Ages. 

Cases. 

Deaths. 

Mortality  per     ^^^-J^^J.^'^^"* 
^®"^            1                 1895. 

Under  5 
.,  10 
,.      15 

All  ages 

440 

891 

1,088 

1,347 

1 

118 
169 
173 
181 

26-8                       10-6 
28-9                          2  5 
15-8                       13-6 
134                        147 

All  these  facts  go  to  swell  the  number  of  both  classes 
of  treatment,  with  so  many  exceptions  that  we  are  no 
more  able  to  say  with  even  approximate  accuracy  that  one 
class  was  entirely  of  a  grave  type,  than  we  are  justified 
in  contending  that  the  other  included  only  the  mild. 

But  this  is  not  all :  **  in  a  certain  number  the  patients 
being  moribund  at  the  time  of  their  arrival  and  beyond 
the  reach  of  any  treatment,  no  antitoxin  was  given." 

These  hopeless  cases  were  therefore  included  in  the 
non -antitoxin  class  which  have  been  described  as  mild 
The  number  of  them  is  not  given  in  the  report,  but  we 
can  approximately  gauge  the  proportion  from  details 
afforded  in  the  Annual  Report  for  1894,  of  two  of  the 
Medical  Superintendents,  namely,  of  the  North  Western 
and  South  Western  Hospitals.  We  there  find  it  stated 
that  of  484  deaths,  72,  or  as  nearly  as  possible  15  per  cent, 
died  within  24  hours  of  admission  ;  so  of  the  181  deaths 
out  of  1,347  '*  mild  "  cases  in  this  report  27  were  hopeless 
on  admission,  and  if  we  omitted  them  the  mortality  of 
13-4  on  the  whole  1,347  would  be  still  farther  reduced  to 
a  percentage  almost  incredibly  low  even  on  the  very 
mildest  of  cases  on  suoh  a  large  total. 

The  public  are  naturally  most  interested  in  the  ques- 
tion of  mortality  and  they  cannot  be  expected  to  greatly 
concern  themselves  with  the  fact  that  "  no  change  has 
taken  place  during  the  year  in  the  local  treatment  of  the 
ca«es." 

It  is,  however,  clear  that  if  gargles,  month  washes,  and 
local  applications  formerly  in  vogi\e  for  the  porpoee  of 


loosening  the  membrane  and  of  destroying  the  micro- 
Ofganisms  held  to  be  the  cause  of  the  disease  are  still 
employed,  the  scientific  claims  of  antitoxin  serum  as  a 
'*  specific"  are  considerably  discounted  with  regard  to  these 
vitally  important  points.  This  is  a  fallacy  at  the  root  of 
many  ser um-t  i  eated  cases.  I  will  not  trouble  you  with  any 
other  objections  to  this  report,  because  although  many 
tables  appear  to,  and  some  probably  do,  demonstrate  the 
value  of  antitoxin  in  some  varieties  of  diphtheria,  all 
results  are  vitiated  by  the  want  of  candour  in  the  figures 
on  which  the  deductions  are  based. 

Finally,  it  may  be  asked  what  is  the  cause  of  this  great 
reduction  of  mortality  in  non  serum -treated  cases.  With- 
out doubt  it  is  due  to  the  increased  vigilance  on  the  part 
of  both  doctor  and  nurse,  and  of  all  those  causes  wnich 
have  brought  the  mortality  of  nearly  over  60  per  cent., 
in  18S8  to  under  39  per  cent,  in  1894. 

I  am,  Sir,  yours,  &c. , 

Lennox  Browne. 

Mansfield  Street,  Portland  Place,  W. 


THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 
To  the  Editor  o/  The  Medical  Press  and  Circular. 

Sir, — It  does  not  seem  of  much  use  discussing  what 
wire  the  motives  of  long  dead  and  gone  founders  of  hos- 
pitals which  have  grown,  after  lapse  of  years,  into  what 
must  now  be  described  as  noble  public  institutions ;  and  it 
is  even  possible,  evidence  to  the  contrary  notwithstanding, 
that  the  founders  of  hiitoric  institutions  like,  for  example, 
Guy's  and  Bartholomew's  were  men  of  ignoble  aims 
and  sordid  aspirations.  The  question  of  the  day  is 
whether  it  is  desirable  that  any  private  individual  should 
be  allowed  to  start  a  hospital  and  carry  it  on  without 
permission,  or  control  of  any  public  authority. 

Dr.  BroolEO,  no  doubt,  was  actuated  by  the  purest  motives 
in  founding  the  hospital  which  Dr.  Campbell  Black  criti- 
cises, but  this  does  not  alter  the  fact  that,  with  few  excep- 
tions in  recent  years,  special  hospitals  have  been 
started  and  conducted  merely  as  cloaks  under  which  to 
advertise  at  the  public  expense  medical  adventurers — 
— ^men  greedy  of  gain,  or  incapable  of  making  a  practice 
by  legitimate  means.  These  hospitals  have  been  system- 
atically used  as  touting  shops  for  patients  ;  they  have 
tended  to  pauperise  the  poor;  to  rob  legitimate  prac- 
titioners of  their  dues  ;  and  worse  than  all  -  a  demoralising 
spectacle — ^have  shown  that  through  their  aid  ic  is  possible 
for  any  needy  medical  adventurer  wanting  in  r^  pro- 
fessional knowledge,  and  furnished  only  with  an  inex- 
haustible fund  of  impudence  to  prey  upon  the 
credulous  public  and  amass  wealtn  beyond  the 
ordinary  dreams  of  medical  avarice.  These  are  the 
men  whose  quackery  and  rapacity  are  constantly  being 
found  out  by  a  minority  of  more  intelligent  patients  who 
are  lured  into  their  nets.  Many  such  patients  take  these 
harpies  as  fair  samples  of  meidical  men,  and  thus  the 
whole  body  is  brought  into  disrepute  fand  the  advance  of 
the  profession  in  public  esteem  is,  by  these  means,  re- 
tarded to  a  greater  extent  than  by  any  other  at  present 
existing  cause. 

I  am,  Sir,  yours,  &c., 

Anti  Quack. 

April  10th,  1896. 

To  the  Editor  of  TKJt  Medical  Press  and  Ctrcclab. 

Sir, — My  attention  has  been  called  to  an  article  in  your 
issue  of  March  25th,  entitled  "What  is  Professional 
Advertising?"  in  which  you  seriously  criticise  the  action 
of  Sir  Dyce  Duckworth  in  printing  a  paper  which  he  read 
before  the  Clergy  of  the  Rural  Deanery  of  Kennington,  and 
as  you  put  it  <*in  parading  his  name,  qualifications,  and 
appointments  in  a  local  periodical,  and  by  so  doing  making 
a  bid  for  the  clerical  and  other  patients  of  the  general 
practitioners  residing  in  the  Diocese." 

I  venture  to  write  a  line— which  I  do  without  Sir  Dyce'e 
sanction  or  knowledge — to  say  that  your  criticism  might 
perhaps  have  been  just  if  only  it  had  been  accurate. 
Unfortunately,  itlacks  accuracy  in  the  most  importantessen- 
tial.  Sir  Dyce  Duck  wordi  had  no  more  to  do  with  the  inser- 
tion of  his  qualifications  and  appointments  than  you  had  ; 
and  he  only  coasented  to  the  publication  of  his  paper  at  all 
at  the  urgent  and  unanimous  request  of  the  clergy  who 
heard  it. 


.^BIL  15,  189t. 


COERfiSPONDENCE. 


ThS  liBDIGAlJFt'BXSS.       ill 


It  was  I  who  Bont  the  paper  to  the  Diocesan  Chronicle, 
and  followin|<  what  I  helieved,  and  still  believe,  to  be  a  very 
proper  precedent,  I  added  after  his  name  one  or  two  of 
the  distinctions  that  his  abilities  have  {gained  for  him. 

Sir  Dyce  Dockworth  came  at  oar  request  to  do  ns  a 
valuable  service,  for  which  we  were  all  gratefaL  and  so 
far  from  its  advantagin^r  the  speaker,  the  nnanimoos  feel- 
ing^ of  the  clersy  was  that  it  was  all  the  other  way.  I  am 
sorry  to  trouble  you,  but  your  sense  of  fairness  will,  I  am 
sure,  allow  the  real  facte  to  be  told. 
I  am,  Sir,  yours  truly, 

AhLES  £dwabi>s.  Junk., 

Rural  Dean  of  Rennington. 

April  8th,  1896. 

[We  trust  that  our  correspondent  has  learnt  something 
from  our  criticism  for  his  guidance  on  a  future  occasion. 
It  was  altogether  opposed  to  the  ethical  law  of  the  pro- 
fession for  him  to  have  added  to  Sir  Dyce  Duckworth's 
name  ''one  or  two  of  the  distinctions  that  his  abilities 
have  gained  for  him."] 

THE  REPRESENTATION  OF  THE  UNIVERSITIES 

OF  EDINBURGH  AND  ST.  ANDREWS. 
To  the  Editor  of  The  Mkdioal  Pbsss  and  Ciroulaiu 
Sib,-  Tou  have  fallen  into  error  re  the  Parliamentary 
representation  of  these  two  universities  in  the  notice  to  a 
correspondent  printed  in  your  last  issue.  It  is  some  years 
since  a  Liberal  sat  for  them,  and  it  will  be  in  all  proba- 
bility many  years  more,  thanks  to  Mr.  Gladstone's  Home 
Rule  escapade,  before  one  of  the  present  so-called  Liberal 


jMuty  can  nope  to  win  the  seat.  The  present  representa- 
tive is  a  Conservative  and  will  probably  be  succeeded  by 
another.  If  my  memory  does  not  play  me  false  Sir  J. 
Eric  Erichsen  contested  the  seat  in  the  Liberal  interest, 
not  the  Conservative,  as  you  mention,  and  was  defeated  by 
a  large  majority. 

I  iMar  that  Sir  James  Crichton  Browne  has  [found  it  im- 
possible to  stand  for  the  constituency,  but  that  Sir  William 
Priestley  has  consented  to  allow  his  name  to  be  put 
forward. 

The  seat  has  for  some  time  back  been  a  sinecure  for 
legal  members  of  the  (Government,  no  sooner  has  one  the 
prospect  of  an  appointment  to  a  higher  sphere  of  useful- 
ness than  his  successor,  if  not  alrmdy  provided  with  a 
seat,  is  pitchforked  into  Parliament  by  means  of  this 
legal  pocket-borough.  Such  procedure  gives  a  handle  to 
those  who  object  to  university  representation,  of  which 
they  are  not  slow  to  avail  themselves.  A  rumour  is  current 
that  the  prospective  Solicitor-General  for  Scotland,  who 
is  not  in  the  House  at  present,  will  be  put  up  for  the 
vacancy.  If  this  is  true  the  medical  members  of  the  con- 
stituency have  a  good  right  to  object,  for  though  by  far 
the  most  numerous  on  the  roster  they  have  not  had  an 
opportunity  of  being  represented  by  a  member  of  the 
profession  for  a  very  long  time. 

There  is  one  member  of  the  profession  in  Edinburgh  who 
has  only  to  consent  to  his  nomination  to  be  electea  by  an 
overwheming  majority,  but  unfortunately  he  is,  as  yet, 
too  diffident. 

I  hope  that  a  medical  man  from  some  part  of  the  king- 
dom will  get  the  seat,  but  am  afraid  that  Governmental 
necessities  may  ordain  otherwise. 

I  am.  Sir,  yours,  &c., 

M.D.Edin. 

•'COUNTER  PRESCRIBING." 
To  the  Editor  qf  the  Mbdioal  Pbbbs  akd  Ciboulab. 

Sib, — ^An  excerpt  from  your  issue  of  this  week,  headed 
as  above,  has  been  posted  to  me,  possibly  by  one  of  my 
patrons  who  may  wiiah  in  this  way  to  draw  a  reply.  Having 
oonfidenoe  in  your  Uberality  and  breadth  of  view,  and 
knowing  that  you  allow  a  fair  scope  to  correspondents  on 
enbjects  raised  in  your  valuable  journal,  I  will  venture  to 
place  one  before  you. 

I  will  first  of  all  deny  that  I  recognise,  or  have  encour- 
aged '*a  development  of  the  system  of  prescribing  by 
demists,"  and  would  assure  you  that,  so  far  as  I  know  my 
txmfrtrtA^  I  believe  it  is  not  only  not  practised,  but  con- 
demned. I  do  not  deny  that  such  a  thing  exists,  for  I  do 
act  profess  to  have  the  extended  knowledge  which  Mr. 


Allen  and  the  Coroner  assert  they  have  of  what  is  done, 
and,  I  believe  very  few  principals  have  knowledge  of  their 
neighbour's  business. 

I  beg  to  differ  with  you  in  the  reading  of  the  evidence 
and  the  conclusion  you  draw.  You  infer  that  Mr.  Allen 
said  he  "  thought  it  was  legal  in  minor  cases  "  to  prescribe 
hecatue  he  toas  an  L,P^.  His  answers  to  the  Coroner  were 
perfectly  straight,  as  reported  in  The  Independent  of  10th 
March,  viz.,  "  His  licence  only  permitted  him  to  dispense 
and  sell  medicines  and  poisons."  And  again  in  reply  to 
the  Coroner's  double  question,  <<  On  what  do  you  found 
your  belief  ?  What  is  there  in  your  licence  that  gives  you 
that  opinion ? "  "I  have  it  on  the  ground  that  I  have 
served  my  time  with  a  qualified  medical  man  for  prescrib- 
ing medicine."  Now,  Sir,  in  my  opinion,  this  indicates 
where  your  shaft  should  strike.  This  Mr.  Allen  had  been 
prescribing  in  the  establishment  of  a  medioBd  gentleman 
during  his  period  of  service,  and  he  does  not  see  an  impro- 
priety in  continuing  to  do  so  now  he  is  older,  more  experi- 
enced, has  a  competent  knowledge  of  his  Pharmacopcsia, 
has  his  own  counter,  and  consequent  increased  personal 
responsibility  to  promote  caution.  With  this  the  Pharma- 
ceutical Society  has  nothing  to  do  ;  they  can  only  take  care 
that  their  licence  is  not  given  to  incompetent  hands,  and 
prosecute  only  for  an  offence  against  their  own  Act.  They 
have  no  power  "for  the  infliction  of  such  disciplinary 
penalty  "  as  your  article  suggests. 

Your  reference  to  "the  old  Apothecaries  Act  of  1815  " 
surprises  me.  Have  you  forgotten  the  older  Act  of  1791  ? 
I  know  the  Apothecaries  Hail  of  Ireland  used  to  recover 
penalties  for  "  practising  as  an  apothecary,"  and  I  do  not 
think  their  powers  have  ceased,  though  they  are  in  diffi- 
culties as  regards  their  licence. 

Before  closing  I  would  like  to  ask,  Can  you  define  the 
line  between  *'  prescribing  "  and  <*  advising  '*  ?  I  presume 
we  are  not  precluded  from  giving  neij^hbourly  advice  or 
answering  questions  as  to  the  suitabiUty  of  medicines  or 
suitable  doses  ;  if  so,  are  we  when  asked  for  i  oz.  of  tinc- 
ture of  jalap  for  a  child  not  at  liberty  to  suggest  that  a 
dose  of  compound  lianorice  powder  would  be  safer  and 
more  suitable.  If  asked  for  a  draught  for  cramps  or 
nervousness,  or  a  mixture  for  a  couffh,  are  we  to  withhold 
what  knowledge  experience  may  nave  given,  and  direct 
a  consultation  with  a  physician.  The  public  may  be 
entirely  wrong  and  foolish  besides,  but  they  will  ask  these 
things  and  they  will  judge  their  cases  "  minor"  and  refuse 
to  consult  a  physician  until  they  first  judge  that  their 
case  is  serious  and  requires  one,  and  though  *'  two  blacks 
do  not  make  a  white,"  if  the  chemist  professes  his  ignor- 
ance and  incompetence,  they  will  discuss  their  complaints 
with  their  next  neighbour,  and  they  will  "  lose  time."  The 
greengrocer  will  recommend  his  celery  for  rheumatism, 
and  tomatoes  for  the  liver,  and  carrot  poulcicesfor  bunions, 
and  the  limited  company  will  advise  Powell's  Balsam,  or 
ELaye's  Essence  for  coughs,  chlorodyne  for  cramps  and 
cholera,  Nimrod  for  asthma,  and  EUiman  for  sprains  and 
stiffness. 

The  doctor's  best  friend  is  the  chemist  who  does  not 
refuse  to  bear  complaints  and  to  advise,  for  most  certainly 
his  advice  will  be  taken  when  it  is  to  *' consult  a  doctor," 
because  he  has  the  confidence  of  his  patrons,  but  if  he 
refuses  to  listen  and  advise  he  loses  that  hold  and  oppor* 
tunities  for  good. 

I  am.  Sir,  yours,  ftc., 

R.  J.   DOWNM. 

[We  are  well  aware  that  the  most  respected  members  of 
the  Irish  Pharmaceutical  Society  have  always  discouraged 
counter  prescribing,  but  neither  thoy  nor  the  Council  of 
the  Society  have  been  able  to  prevent  it,  and  we  have^ 
therefore,  asked  whether  that  Council  might  not,  at  least, 
put  moral  pressure  upon  any  one  of  its  licentiates  who 
appears  as  publicly  condemned  for  doing  so.  We  do  nob 
know  whether  the  Council  has  jurisdiction  to  suspend  or 
withdraw  a  licence  for  breach  of  regulation,  but  we  are 
certain  that  an  official  remonstrance  from  the  Council  to 
the  counter  prescriber  would  have  much  effect.  The 
excuse  offered  by  our  correspondent — ^that  unqualified 
persons  are  allowed  to  prescribe  under  the  cover  of  quali- 
fied medical  practitioners  savours  of  the  *'  ^  quoque^ 


41 2     Thi  Midioal  Pbisb. 


MEDICAL  J&fEWS. 


April  16,  1S06. 


and,  also,  ia  not  consistent  with  the  fact.  If  sach  a  person 
is  allowed  by  the  criminal  connivance  of  his  master,  to 
prescribe,  his  doing  so  is  totally  contrary  to  medical 
principle  and  meiical  law,  and  his  master  is  liable  to  be 
expunged  from  the  Register  for  allowing  his  name  to  be 
used  for  snob  pnrpose.  Oar  correspondent  asks  us,  "  if 
asked  for  a  draught  for  cramps  or  nervousness  or  a  mix- 
ture for  a  cough,  are  we  to  withhold  what  knowledge  ex- 
perience may  have  given  and  direct  a  consultation  with 
a  physician  ?  "  to  which  we  unhesitatingly  aaawer.  Yes, 
especially  if  the  advice  is  to  be  given  in  ahsejitia  of  the 
patient.  The  plea  that,  if  the  chemist  refuses  to  prescribe 
the  grocer  will  do  so,  is  no  plea  at  all,  except  that  it  may 
afford  a  commercial  reason  for  doing  what  is  wrong.  If 
the  law  is  not  strong  enough  to  reach  the  prescribing 
grocer  it  should  be  made  so,  but  its  laxity  cannot  excuse 
the  prescribing  chemist. — Ed.] 


To  the  Editor  of  the  Mkdiga.l  Pbbss  and  Ciboulab. 

Sir,  -  It  is  a  pity  that  pharmaceutical  chemists,  instead 
of  practii*ing  quackery,  do  not  give  more  attention  to  their 
legitimate  business.  Within  a  comparatively  short  time 
the  following  subbtitutions  have  been  practised  on  my 
patients  by  Dublin  pharmacists  : — 

1.  Gallic  acid  given  for  agaric  acid. 

2.  Phenol  given  for  formol. 

3.  Chloral  given  for  chloraloae. 

4.  Liq.  Opii  (B<ittley)  given  for  liq.  hyos* 

ciami  (Bdittley) 
In  each  case  the  pharmaceutical  chemist  considered  he 
had  completely  exonerated  himself  when  he  confessed  total 
ignorance  of  the  drug  ordered.  I  mav  ju^t  add  that  in 
every  case  the  customer  was  charged  tor  the  incorrectly 
compounded  prescription. 

Yours  truly. 

Geobgb  Foy. 
♦ 

MEDICAL  SOCIETY  OF  LONDON. 

TuF.  meeting  on  Monday  last,  April  13th,  was  the  last 
clinical  evening  of  the  session.  Among  the  cases  phown 
was  an  interesting  case  for  diagnosis  by  Dr.  F.  de  Havil- 
land  Hall. 

The  patient,  a  man,  had  suffered  from  vomiting  and 
diarrhoea,  followed  by  some  jaundice.  On  admission  to 
the  Westminster  Ho^^pital  his  liver  was  found  to  extend 
below  the  umbilicus,  constituting  a  smooth,  rounded 
tumour,  evidently  containing  fluid.  It  is  supposed  to  be 
a  hydatid  cyst,  as  the  patient  is  only  31,  and  this  view  is 
supported  by  the  fact  that  it  has  undergone  some  diminu- 
tion in  size  since  he  has  been  under  observation.  The 
jaundice,  which  Dr.  Hall  was  disposed  to  attribute  to 
gastro- duodenal  catarrh,  has,  however,  persisted  to  some 
extent 

Dr.  Hall  also  showed  a  well-marked  example  of  ele- 
phantiasis in  a  young  woman,  let  23.  She  first  noticed  a 
swelling  of  the  left  loot  four  year8  ago,  since  which  time 
the  swelling  has  extended  to  the  leg  and  thigh,  which  are 
now  enormously  swollen  The  girl  has  never  lived  out  of 
England,  and  her  urine  has  always  been  normal,  so  it  is 
classed  as  a  case  of  lymphatic  obstruction  of  unknown 
origin. 

Mr.  Clutton  called  attention  to  the  futility  of  all  endea- 
vours hitherto  made,  even  under  an  aniesthetic,  to  discover 
the  seat  of  the  blockage.  The  condition  is  associated 
wi^h  an  increase  in  length  of  the  affected  limb. 

Dr.  Cautley  showed  an  infant  with  a  strange  swelling 
of  the  neck  which  was  only  rendered  evident  when  it  cried, 
and  the  more  it  cried,  the  more  prominent  and  dusky  did 
it  become.  He  inclined  to  the  view  that  it  was  a  venous 
angioma,  the  dulness  of  the  tumour  on  percussion  neg  - 
tivingthe  possibility  of  its  being  a  pneumomatocele 

Mr.  Clinton  Dent  showed  a  lad  on  whom  he  had  operated 
for  a  large  hairy  mole  on  the  face.  Treatment  had  con- 
sisted in  paring  away  the  whole  thickness  of  the  cutis,  but 
with  only  moderate  success  because  the  scar  shows  a  ten- 
dency to  keloid.  He  proposes  to  remove  it  later  on  in  its 
entirety,  filling  up  the  gap  by  skin  grafts  after  the  method 
of  Thiersch. 


Mr.  G.  R.  Turner  pointed  out  that  this  could  only  be 
done  at  the  risk  of  producing  ectropion  of  the  correspond- 
ing eye,  and  he  suggested,  not  without  reason,  that  "  'tis 
best  to  bear  the  ills  we  have  than  fly  to  those  we  know 
noh  of." 

Mr.  Clinton  Dent  also  showed  a  girl  with  a  tumour  of 
the  abdominal  wall,  probably  sarcomatous,  dating  from  an 
iojary  early  la-t  year. 

Dr.  Gilbart  Smith  showed  a  larynx  removed  from  a  man, 
»t.  51,  of  which  the  interest  lay  in  the  fact  that  although 
t  he  entrance  to  the  larynx  was  from  the  first  almost  com- 
pletely obstructed  by  growths  springing  from  the  epiglot- 
tic, respiration  had  been  comparatively  easy  until  the  day 
before  his  death,  when  in  consequence  of  an  attack  of 
violent  dyspnoea  tracheotomy  was  performed  under  an 
anssthetic.  His  death,  seven  hours  after,  wai«  attributed 
by  the  author  to  the  employment  of  the  anas^thetic,  from 
the  effects  of  which  the  patient  never  completely  rallied. 


Proposed  Central  HoBpltal  Board. 
Av  influentiM  meeting,  under  the  auspices  of  the  Charity 
Organisation  Society,  and  presided  over  by  the  Earl  of 
Stamford,  was  held  yesterday  in  London  for  the  purpose 
nf  considering  a  "cheme  for  the  form v  ion  of  a  Central 
Hospital  Board  for  London,  with  169  representatives 
drawn  from  the  general  hospitals,  medical  schools,  special 
hospitals,  provident  dispensaries,  and  other  medical 
charities,  including  five  representatives  from  general  prac- 
titioners resident  in  the  metropolitan  area.  The  Secretary 
of  the  Charity  Organisation  Society  reported  that  658 
general  practitiooers  had  written  approving  the  scheme, 
together  with  106  physicians  and  surgeons  on  the  various 
hospital  staffs.  After  discussion  of  the  various  points  put 
forward,  a  motion  wss  carried  pledging  the  approval  of 
the  meeting  to  the  establishment  of  a  Central  Hoepitftl 
Board  for  Ixindon  on  a  representative  basis. 

The  Society  for  Relief  of  Widows   and  Orphans  of 

Medical  Men. 
A  QtTABTBRLT  CoUBT  of  the  Direotors  of  this  Sc^tety 
was  held  on  the  8th  inst,  Mr.  Christopher  Heath,  V.P., 
i  n  the  chair.  The  deaths  of  two  widows  were  reportaH,  one 
having  been  in  receipt  of  grants  since  May  8tb,  1860,  and 
had  received  £1,798,  her  husband  having  previously  sub- 
scribed 36  guineas.  Freeh  applications  for  grants  were 
read  from  four  widows  and  four  orphan%  and  a  sum  of 
£S0  10s.  given  among  them.  Applications  for  further 
assistance  were  made  from  forty-eight  widows  and  seven 
orphans,  and  a  sam  of  ;£1,141  lOd.  recommended  to  be 
distributed  at  the  July  court.  Four  new  members  were 
elected,  and  the  deaths  of  four  announced.  The  receipt  of 
a  further  sum  of  £215  was  acknowledged  from  the  exe- 
cutors of  Miss  Carpue,  making  in  all  £3.215  paid.  The 
following  gentlemen  were  nominated  for  election  as 
directors  at  the  annual  general  meeting  to  fill  the  vacancies 
caused  by  the  death  of  Mr.  Mouse  and  the  retirement  of 
the  six  senior,  viz.,  Mr.  W.  H.  Bennett,  Dr.  Wilks,  Dr. 
Frederick  Roberts,  Dr.  Svlvester,  Mr.  Maloom  Morris, 
Mr.  Fountaine,  and  Mr.  iButb'n.  The  annual  general 
meeting  was  fixed  to  be  held  on  May  20th,  at  5  p.m. 

Royal  College  of  Surgeons  in  Ireland. 
Schools  of  Subobbt  :  Class  prizes  (Winter  Session 
1895-96).— Descriptive  Anatomy:  Junior,  W.  J.  Trem- 
bath,  first ;  J.  S-  P.  Stewart,  second.  Senior,  D.  A. 
Fitzgerald,  first ;  W.  J  An  glim,  second.  PracMcU  Ana- 
tomy (first  year)  :  Miss  R.  F.  Lynn,  first ;  F.  G.  Fitzgerald, 
second  ;  (second  year)  G.  W.  Li^tle,  first ;  J.  J.  Huston, 
second;  (third  year)  W  M.  Falkner  and  D.  Hadd«>a 
(equal),  first ;  P.  H.  Falkner,  second.  Physiology  :  W. 
Gavin,  first ;  P.  S.  O.  ReiMy,  second.  Practice  of  Medi- 
cine :  D.  Hadden,  first ;  F.  J.  Palmer,  second.  Surgery  : 
F.  A.  Benson,  first ;  W.  H.  May,  second.  Midwifery : 
S.  G.  Longworth,  first ;  MisA  L.  F.  S.  Strangman,  second. 
Theoretical  Chemistry  :  C  B.  Vance  and  S  L.  Worthing- 
t'On  (ecrual),  first;  J.  S.  P.  Stewart,  second.  Patholo^  : 
F.  J.  ralmer,  first ;  S.  G.  Longman,  second.  Physics : 
J.  S.  P.  Stewart,  first.  The  schools  opened  on  Tuesday, 
April  7th,  for  three  months'  courses  of  operative  sur- 
gery,   practical  chemistry,  practical  pharmacy,    public 


Apbil  15,  1896. 


MEbldAL  NEWS. 


1^     ifEDICAL  P]UEf-&       4li 


health,  and  forensic  medicine,  materia  medioa,  practical 
histology,  biology,  and  dissections. 

Vital  Statistics. 

Thb  deaths  registered  last  week  in  thirtv-three  great 
towns  of  England  and  Wales  corresponded  to  an  annnal 
rate  of  18*3  per  1,000  of  their  aggregate  population,  which 
is  estimated  at  10,860,971  persons  in  the  middle  of  this 
year.  The  deaths  registered  in  each  of  the  last  four  weeks 
m  the  several  towns,  alphabetically  arranged,  corres- 
ponded to  the  following  annnal  rates  per  1,000  :— 

Birkenhead  26,  Birmingham  18,  Blackburn  15,  Bolton 

17,  Bradford  21,  Brighton  16,  Bristol  18.  Burnley  18, 
Cardiff  13,  Croydon  16,  Derby  21,  Dublin  25,  Edinburgh 

18,  Glasgow  20,  Gateshead  15,  Halifax  20,  Huddersfieid 
13,  Hull  18,  Leeds  20.  Leicester  16,  Liverpool  22,  London 
17,  Manchester  22,  Newcastle-on-Tyne  16,  Norwich  15, 
Nottingham  16,  Oldham  20,  Plymouth  21,  Portsmouth  11, 
Preston  21,  Salford  24,  Sheffield  16,  Sunderland  18, 
Swansea  18,  West  Ham  12,  Wolverhampton  17.  The 
highest  annual  death-rates  per  1,000  living,  as  measured 
by  last  week's  mortality,  were :— From  measles,  2  4  in 
Manchester,  4*5  in  Sunderland,  and  6*2  in  Birkenhead  ; 
from  scarlet  fever,  1*3  in  Bolton  ;  from  whoopinK-cough, 
1  2  in  London  and  in  Plymouth,  1*4  in  Sheffield,  1*5  in 
Birmingham,  and  1*9  in  Leeds;  from  "fever/*  12  in 
Blackburn  and  1  4  in  Norwich  ;  and  from  diarrhoea,  1  1  in 
Gateshead.  The  72  deaths  from  diphtheria  included  45  in 
London,  5  in  Birmingham,  4  in  West  Ham,  and  3  in 
Liverpool  No  death  from  small-pox  was  registered  in  any 
of  the  large  towns. 

Royal  College  ol  Burgeons  of  England. 

Ak  election  of  examiners  under  the  examining  board  in 
England  bv  the  Royal  Colleges  of  Physicians  and  Surgeons 
will  take  place  in  June  next,  viz.  :— 

four  examiners  in  elementary  biology  (first  examina- 
tion). 

Four  examiners  in  anatomy  (second  examination)  ;  and 
three  examiners  in  physiology. 

Four  examiners  in  midwifery  (third  examination). 

Two  examiners  in  public  health  ;  also. 

Four  examiners  in  anatomy  and  four  examiners  in 
physiology  (all  the  present  examiners  being  eligible  and 
candidates  for  re-election)  for  the  fellowship. 

Candidates  must  send  written  application  to  the  Secre- 
tary on  or  before  Monday,  the  4th  of  May  next.    Full 
particulars  will  be  found  in  our  sdvertisine  columns, 
Vaodnatloa  Btatlstics-Free  Fin-points. 

Mrb.  Ernest  Habt  has  just  brought  out  a  little  hrochurt 
in  which  the  statistics  of  mortality  irom  small-pox,  before 
and  since  the  introduction  of  vaccination,  are  succinctly 
and  simply  set  forth.  If  figures  prove  anything  these 
prove  the  inestimable  protection  afforded  by  a  trivial 
operation  against  a  loathsome  and  formerly  very  common 
di»-ease.  It  is,  however,  very  necessary  to  bring  home 
these  simple  facts  to  the  class  of  people  most  amenable  to 
the  declamatory  and  mendacious  eloquence  of  the  *'  anti 
faddists  and  the  present  crisis  is  possible  to  a  large  extenb 
due  to  our  apathy  in  joining  issues  with  the  restless  an«l 
indefatigable  opponents  of  vaccination.  There  are,  on 
the  other  hand,  certain  improvements  in  the  technique  of 
vaccination  which  urgently  call  for  adoption,  t  e.,  the 
uniform  employment  of  animal  lymph  and  precautions 
having  for  object  the  prevention  of  accidental  contamina- 
tion. We  may  note  en  paasant  that  Dr.  Worlomont's 
Association  for  the  Supply  of  Pure  Calf  Vaccine  Lymph 
(Pall  Mall,  London),  have  some  time  supplied  **  pin-points  " 
specialUr  designed  with  this  object  in  view.  The  skin  is 
abraded  with  the  point  and  the  vaccine  is  rubbed  in  with 
the  flattened  glass  knob,  which  answers  the  purpose  of  a 
handle,  and  is  supplied  gratuitously  to  medical  men  by  the 
Association. 

French  Hospital  and  Dispensary. 

Ths  Twentv-Eighth  Anniversary  Banquet  on  behalf  of 
the  funds  of  this  institution  is  announced  to  take  place  at 
the  Whitehall  Rooms  on  Saturday,  April  25th,  His 
Excellency  the  French  Ambassador  (Baron  de  Courcel)  in 
the  chair,  supported  by  the  Lord  Mayor  of  London. 
Tickets  (£1  Is.)  may  be  obtained  from  the  Hon.  Sec., 
French  Hospital,  172  Shaftesbury  Avenue,  W.C. 
UnlTtrsity  of  Alierdeen. 

At  the  Graduation  Ceremony  on  April  4th,  1896,  the 
following  Degrees  in  Medicine  were  conferred  :— 


Degree  of  M.D. 
Clark,  wniiam  Reniy,  M.B.,  C.¥.,  Woodside,  Aberdeen. 
Davidaon.  David  M.,  M.B.,  CM.,  Sargeoa-Captain,  Indian  Medical 

Rervioe. 
Mackintoeh.  Aahley  WatiOD,  M.A.,  M.B.,  CM.,  U  Toirington  Square, 

London,  W.C 
Mansfield,  CyrilJamea,  M.B.,  CM.,  Surgeon,  K.N.,  H.M.S.  Anson, 
RideaL  Arthnr  Henry,  M.B.,  CM.,  Athol  House,  Mancheeter. 
Boas.  William, M.B.,  CM.,  66  Ashlar  ye,  Hyde  Park,  Leeds. 
Wilson,  Jame«,  M.A.,  M.B.,  CM.,  WllU  County  Asylnm,  DeTlces. 
Wilson,  John  Thomson,  M.B.,  CM.,  Inyerclyde,  tk>thwell. 

The  Theses  of  Ashley  W.  Macklnt'^h  were  considered  worthy  of 
"  Highest  Honours."  and  thove  of  James  Wilson  and  John  T.  Wilson 
were  considered  worthy  of  "  Commendation." 

The  Degrees  of  M.D.  and  CM. 

Clifford  Thiselton  Bell,  Aberdeen  :  George  Brown,  Aberdeen  ;  Dnvid 
Bnchan,  Aberdeen ;  William  John  B}res,  M.A..  Aberdeen  ;  Robert 
Frarer  Compbell,  Wark-on-Tyne ;  George  Chalmers,  Huntley; 
Clarence  Isidore  Ellis.  Plymouth;  William  Arthnr  Irvine 
Fortescae,  Elngraosie;  Andrew  Thomas  Gage,  M.A..  B.Hc.  Aber- 
f^een;  John  LyaJl  Graot  Gillanders,  London;  James  Leslie  Gordon, 
Old  Aberdeen;  John  A.  Alex.  Gordon,  M.A^DiuKwall;  Patrick 
Qrant,  M.A.,  Grantown-nn-Spey ;  Thomas  Harper,  l^fetherton, 
losah;  Francis  Irvine,  Aberdeen;  John  G'ant  Jone«,  Olenlossle, 
Elgin;  Cbnrles  Alex.  B^jrclry  Laing,  M.A.,  Pitsligo;  James 
Alexander  Mearns,  Kinella- ;  James  Adam  Milne,  M.  A..  Aberdeen  i 
Huph  Osborne,  Kirkcudbright;  Alexander  Preaslie.  Aberdteo; 
Archibald  Bamssy,  Stonehaven ;  Andrew  Bic  tar<lson,  At>erloar. 
on-Spey;  George  Prebner  Scott,  Petercnlter;  Henry  Ashfield 
Sinclair,  C>ilts;  James  Ramsay  Smith,  M.A..  Rllon:  G«k>ck« 
Stephen,  Ellon;  Geo.  Irvine  Thompoon  Stewart  M.A.,  Aberl'^en; 
Andrew  Thomson,  El«in;  *\ndrew  George  Anderaon  Th-imv^i , 
M.A .  Keith;  Frederick  Mayfleld  TlndaU,  Fraaerbnrght  Aleia-id  r 
Watt,  Stonehaven;  Thomas  Duncan  Webster,  Old  Aberdeen: 
Charles  Frederick  Weinman,  Colombo,  Ceylon;  Jamea  Btrachan 
Wilson,  Aberdeen. 
John  tieddes  Ptrie,  Buckie,  has  passed  the  Bxaminationa  for  the 

Pegrees  of  M.B.  and  CM.,  bat  will  not  gradoate  until  he  has  attained 

the  necessary  age. 

•Andrew  G.  A.  Thomson  gradoatea  with  '*  Honourable  Distinction.  ** 

The  Degrees  of  M.B.  and  Ch.B.  (under  the  New  Begnla- 
tions). 
Maokenack,  Peter,  B.8c.,  Kinlota,  Forrea. 
The  Diploma  in  Public  Health  was  conferred  on  :^ 
Dnthie,  Wm.  B.  G.,  M.A.,  M.B.,  O.M.,  Woodside,  Aberdeen, 
Robb,  Alex.,  M.A.,  M.B.,  C  M.,  Peterhead  (with  credit). 
Swaine,  CharleaL.,  M.D.,  Indian  Medical  service,  Madras. 

The  fo  lowing  is  a  list  of  etndente  who  goined  pHzep  and 
medals  in  the  Faculty  of  Medicine,  Winter  Session, 
18S5-96  :— 

University  Oold  Medals. 
Fife  Jamieson   Memorial  Gold  Medal  in    Anatomy,    John  J.   B. 

Macleod. 
Keith  Gold  Medal  for  Systematic  and  CUnioal  Surgery,  Bobert  Bruce, 

M.A. 
Shepherd  Memorial  Gold  Medal  for  Systematic  and  Practical  Surgery, 

Henry  J.  M*Grlgor 
Matthews  Duncan  Gold  Medal  in  Obstetrics,  C  A.  Barclay  Lalng, 

M.A 
Dr.  Jamea  Anderson  Gold  Medal  in  Clinical  Medicine,  WlUam  Hunter. 

Class  Prizes. — Anatomy. 
Osteology— Henry  Fraser,    Aberdeen   (prize);    Arthur    Westerman, 

Aberdeen  (prizeX 
Jarior  Students  -  Arthur  Leslie  Sutherland,  M.a.  Aberdeen  (prlxe)^ 
Advanced  Students- John  J  B.  Macleod,. Aberdeen  (prizeX 
Practical  Work  In  Dissecting  Boom— John  J.  B.  Macleod,  Aberdeen 
(prize). 

Theoretical  Chemistry. 

First  Year  Stu<fent8.  Silver  Medal  —  Alexander  Wh^te  rassie, 
Hopemsn.  Bronze  Medals— Jobn  Anderson,  Beauly,  91  percent.; 
Alex.  <  ram  Gavin,  Grangemouth,  90  per  cent 

Second  Year  Students,  Silver  Medal— Harold  G.  W.  Adan,  Aberdeen. 

Surgery. 
Juniors,  MedalUsfcs  and  First    Honours  Certiflcatea-Thoa    Fns'W, 

M.A.;  Fred  Philip  ;  Fred.  Wm.  BlUs.    Bronie  Medal  and  First 

Honours  Certificate— Joseph  A.  Thomson. 
Seniors,  Bronze  Medal  and  First  Honours  Certificate— Wm.  M.  Smith, 

Practical  Surgery. 
Medal  and  First  Honours  Certlficate-C  G.  £.  Mmmlk. 

Physiology. 

Junior  Division,  Medalllfets- George  A.  Finlayson,  M.A.,  Aberdeen; 

James  A.  Tulmie,  M.A.,  Portsoy;  Alexander  w.  M.  Sutberiaad, 

I»  vergordoo. 

Senior  Division.  Medallists— Thomas  Fraser,  M.A.,  Newmachar;  J«>hn 

lit»in,  limavady.  County  Derry  ;  David  B.  Moir,  M.A,  Aberdeen. 

Materia  Medica. 
Jonior  Division,  Medals  and  First  Class  Certificates  -F.  Philip.  Aber- 
deen ;  J.  A.  Thomson,  B.8c.,  Cullen  ;  W.  L  MoIr,  Aberdeen. 

Midwifery. 

MedaUlstB  and  First  Class  Certlfloates  -D.  Buohan,  Aberdeen ;  lliomaa 
Snowball,  Hontly ;  G.  I.  T.  Stewart,  Banchory-Devenick. 

Practice  of  Medicine. 
Silver  Med«l  aod  Fhrst  Class  Certifl  «te— A.  G.  A.  Thomson.    Bronze 
Medals  and  Bint  Class  Oertlfloatea— J.  G.  Jonea  and  C  A.  B. 

Laiiig— e4ittal. 


414    Thi  Mbdioal  ISum« 


NOtlCJES  TO  OORRESPOitoEiTTS. 


Apbil  15,  1806. 


c|l0tia0  to 
CorrtgyottbttttB,  ghxrrt  j^ttterg,  At, 

THB  BO^ALLBD  KBOlST&AllON  OF  MIOWIVXB. 
To  iJU  MUor  oS  THI  MlDIOAL  PRIM  AXD  CIROULAS. 
8n,— At  the  rapporten  of  tlw  lo-cfttted  Beclttratloii  of  MMwItm 
are  tiTlsff  to  give  oolonr  to  the  mmoar  that  the  PrimioM  Leegoe  to 
•opportlug  registration,  will  you  pleaae  iosert  the  endoeed  F  At  the 
•ame  time  let  me  adTtoe  all  practHloDen  to  Ignorei  or  treat  with  the 
graveat  maploloD,  all  mch  mmoim. 

I  am.  Sir,  jonn,  Ac, 

E.  &.  JilirTOUL. 
Harttngton  Boad,  literpooL 

**  The  Primroae  League, 

64  VlctonaBtreet,  Weetmineter,  S.W. 
DiAX  Snt,— The  Prlmroee  League  haa  taken  no  acUon  in  the  matter 
of  tne  Mid»lTe«'  Begiatratlon  Bill.    The  queation  la  one  of  opinion, 
and  not  of  principle,  and  altogether  ooteide  tiie  provlnoe  of  the 
League. 

Toon  faithfully, 
BloniAU)  BlaHKTT,  Clerk  to  Cooodl.'* 
IL  B.  Bentonl,  Esq.,  M.D. 

P.8.— 1  ehall  he  glad  to  hear  from  any  practitioner  who  will  help  to 
oppoae  the  MidwiTea  BilL 

IIB88I18.  ASH  A  Son,  Lti. -We  are  onahle  to  comply  with  year 
reqneet.  It  wooid  b«  kltogetber  »t  Tadance  with  profeHional  uaagea 
for  ue  to  giTe  pablicity  to  toe  fact  that  a  certain  American  soigeon  is 
prepared  to  perform  hia  wonderfol  operatiou  at  Bomebod>'a  "olilee  " 
in  Dresden,  even  though  this  operation,  as  described,  be  **  applicable 
to  the  meet  despe.ate  ca»ea  and  especially  soccessful  in  children." 
The  gentleman  in  question  will  have  to  be  caretnlhow  he  sets  to  work 
if  he  to  to  steer  dear  of  the  law  regulating  the  praoMoe  of  medidne  on 
the  Gonlinent. 

M188R8.  B  A  8.— It  to  useless  to  set  the  ipn  dixU  of  a  firm  against 
the  results  of  clinical  observation,  and  we  certainly  cannot  undertake 
to  purge  our  columns  of  ezpresdons  of  opinion  which  may  cooodV' 
ably  interfere  with  the  sale  of  particular  preparatlona. 
Dft.  STM0S8.— Your  eomraunlcation  to  unavoidably  hdd  over. 
lKATn8.~It  to  Idle  to  cavil  at  the  perstotence  and  ingenuity  with 
which  ut  w  pharmaceutical  products  are  brought  before  this  profession. 
However  ezoellent  a  product^  success  can  only  be  atuined  by 
publicity.    It  to  open  to  any  qualUied  practitioner  to  ezpreas  approval 


of  a  drug  or  of  a  nceparktlon  after  proper  luvestigatlon,  and,"  within 
iln  umlta,  ancn  a  course  to  perfectly  admisdble. 


certalnl 


^tttingg  of  5cattuo,  jitcmrtB,  tec 

iriDinBDAT,  AFBIL  ISTH. 

Lartvoolooioal  Sooutt  or  Lohdoh  (20  Hanover  Square,  W.)- 
6  p,m.  Adjourned  DiscoMlon  on  Foreign  Bodies  in  tho  Upper  Air 
and  Food  i»assagea,  introdnoed  by  Mr.  Charters  Bymonds  at  the 
Ifebruarv  meeting. 

BoTAL  MRsoBOLoaiOAL  BooiirT,  (Ot  Qeorge  Street,  Weetminst«r>. 
—7  80  p.m.  Papers  by  Mr.  W.  Blito  and  Major  H.  B.  Bawson.  Mr. 
B.  D.  kridJaader  will  open  a  Dtocncdou  on  Atmospheric  Dust  ubserva- 
tions  from  various  parts  of  the  world. 

BBRISH  BAUIIOLOOICAL  AlTD  GUHATOLOeiOAL  BOODRT  (Ummer's 
0otel.>-g  p.m.    Dr.  F.  Fox  (Strathpeffer  bpa) :  The  Varieties  and 
Treatment  of  Articular  Gout.    Discussion  on  Necesdty  of  Increased 
Travelling  FadliUes  to  the  British  Health  Beaorts. 
THUMDAT,  AniL  lOTH. 

BAmvKAR  SociRT,  (Stafford  Booma.  Bdgwars 

?^pers:  Dr.  W.  Hill:  Pl04nosto  in  Ohronic  Won-sa,^ 

of  the  Mkldle  Bar.  Mr.  B.  Johnson  :  Some  (Tnusual  Gasss  of  Swelling 
of  the  Parotid  Gland.  Mr.  uodgson :  A  Demonstratlou  of  the  Progress 
€i  Photography  by  meana  of  Boentgen's  Bays. 

FftlDAT,  APBIL  17tH. 
P  Tn  BnlflBH  LAMYWiOUJQlOAL,  BuHOLOOICAL,  AKn  OTOLOQICAL 
AMOdAXiOH,  ((aiandoa  Street,  London,  W.)-8  p.m.  Cases  wiU  be 
shown  by  the  Preddent  (Dr.  Geoige  SiokerX  Dr.  Whistler,  Dr.  Mno- 
Banghton  Jones,  and  Mr.  Lake,  m  icrosoopicaltfectlons  by  Dr.  Fegler. 
DtfCttsdon  on  the  dymptoms  and  Treatment  of  Attic  DIaeaae,  luuo- 
dttoed  by  Dr.  Adolph  Bronner  (Bradford),  and  Dr.  Dundas  Grant. 
Demonstration  of  the  Boenigen  Bay  Photography  as  applied  to  Lar^n- 
gdbgjr,  by  Dr.  John  Madntyrs  (GlMgowX 


I  Boad).~8.80  p.m. 
lon-soppnratlve  Usterrh 


_     _  md  Dtopensaryi 

Boad,  Sbadweli,  B.— Beddent  MedieaTofflcer.    Salary  ^BSO  per 
with  boanl  and  resldenoe.    AppUoatlons  and  testlmoniato 


Bawnboy  Union,  Swanllnbar  Dtopeaaary  Dtotrlot— Medloal  OJIloer. 
Salsnr  £90  per  annum,  and  £15  additk>nal  as  Health  OHIoer. 
togetlier  with  the  usual  extra  f«ea.    (See  advert) 

Donegal  District  LnnaHo  Avium.— Asatotant  Medical  Oflloer.  daiaiy 
£100  with  board  and  residence.    (See  advert.) 

■eat  London  Hospital  for  Chikirea  and  Dtopensary  for  Women,  Glamto 

"— •, Shadwdl,  "     ---^— *  -'---'^-^ »-- 

m,  withboai 
B8eeretary< 

inilrmary  ai         _  _      _ 

married).  Salary  £60  per  auniun,  with  reddence,  board  and  waah< 
log*  Applications  and  teatlmoniato  to  the  Secretary  on  or  before 
Wadneeday*  apnlSind. 

Hastings,  St.  Leonards,  and  East  Snaaex  Hospital.— Honorary  Ophthal- 
mic Sufgeon.  Applioatlona  and  testimonials  to  the  Secretary  not 
Uter  than  May  Sud. 

Ldeeater  Infirmary.— Assistant  House  Surgeon.  Salary  £n  for  dz 
montha,  with  reddence,  board  and  waahlng.  Appllcatloaa  and 
testlmoniato  to  the  Secretary  on  or  before  April  SZOi. 

Uveipool  Koithera  Hoivital.— Aastoiant  House  Surgeon.   Salary  £70 


num.  with  boanl 
to  the  Secretary  on  or  before 
Halifax  li  ' 


,  April^lSUL 


(nn- 


per  annum,  with  reddence  and  malntenanoe  In  the  house.  AppU- 
caiions  and  testlmoniato  to  the  Chairman  not  later  than  April 
17th. 
Sussex  County  Hospital,  Brlghton.-Beddent  Medical  Officer.  Salary 
£90  per  annum,  reddence,  board  and  washing.  Applicatlona  and 
testlmoniato  to  the  Secretary  not  toter  than  April  Sind. 


The  Uoepitd  for  Sick  Children,  Great  Ormond  Street,  Bloomshury.— 
Surgical  Begistrar.  Salary  £40  per  annum.  Applicatlona  and 
testlmoniato  to  the  Secretary  not  later  than  April  SSih. 


Wrexham  Infirmary  and  Dtopenaary.-  House  Burgeon.     Salary  £80 
per  annum,  with  furnished  rooms,  gaa,  coal,  and  attendance. 


per , .  „    . 

Applications  to  the  Secretary  not  toter  than  April  2Snd. 

S^ppainimtntM 

Bl&RT.    WILU4K.    L.B.C.P..    L.B.C3.Bd..    F.B.O.S.L,    M-ILaS. 

D>.H.GIasg.,  Medical  offloer  of  Health  to  the  Hanley  Urban 

District. 
CHBISTU,  MAKOAiar,  M.  T.,  M.BLond.,  Junior  Medieal  Officer  for 

tbe  Greenwich  Workhouse. 
OOGHLAH.  T.,  L.B.&S..  L.M.IreL,  Medical  Offloer  for  the  Kllmacow 

Dispensary. 
CaiHioH.  L.  A.  J.,  M.B.,  B  Ch.Ird.,  Medical  Officer  for  the  Bathmora 

Dtopmsary  District. 
GALLOWAT  A.  B., M.B.  CM.Aberd.,  Asstotant  Anssthettot  and  Aasto- 

tant  Medieal  Bleetridan  to  the  Aberdeen  Boyal  Infirmary. 
GIBBS,   CHABLis,  F.ILC.S.,   Asstotant   tturgeon  to  Charing  Cross 


Hawkins,  B.,  M.D.,  C.M.BdiB.,  Medieal  Offloer  of  Bedth,  Sunder- 

Und. 
HOPTOH,  BAL«H,  M.B.,  B.8.Lond.,  M.B.O.8.,  L.B.aP.,  Houae  Surgeon 

to  the  Boapital  for  Women  and  children  at  liceds. 
LB  Fabu,  H.  O.  p.,  L.B.C.P.,  L.B  C.S.,  Honorary  Medical  Ofltoer  to 

the  Derbyshire  Hospltd  for  Sick  Children. 
MIYABT,  F.  ST.  GBOBOB,  M.D.Louvdu,  L.B.aP.,F.B.a8JSd.,  MJLC.8., 

Medieal  Inspector  by  the  Looal  Government  Board. 
MOBTOOMBBT.  K.  J.,  M.A.,  M.B.T.C.U.,  F.ILa&L,  Ophthalmlo  8urw 

geon  to  the  Drumconara  Hoepitd  (wliitworthX  Dublin. 
BOBBXTB.  Llbwblltb  W.,  m.B.  Mdb.,  ^fcc,  Bouse  Surgeon  to  the 

Victoria  Hoepitd.  Folkestone. 
Sabkbt,  J.  IvoB,  M.B.C.S.,  L.B  aP.,  Medical  Ofltoer  for  the  Sixth 

(Brenchley)  Dtotri at  of  the  Tonbridge  Union. 
SBBakBR,  B.  P.,  M.B ,  aM.Glasg.  Meaicd  Offlcer  of  Health  for  the 

Gotham  Babitary  District  of  the  Badord  Union. 
Walub,  J .  D..  M.B.,  M.&  Aberd.,  Junior  Assistant  Medioal  Offloer  to 

the  Oomwail  County  Aqrlnm. 

BDWABM.— Aprtt  ISth,  at  88  Brunswiek  Square,  London,  the  wif^  of 

Bobt.  Bdwarda.  M.D..  of  a  son. 
roLKBB. -April  7th,^at  Havdock  Place,  Hanley,  Staflbrdshtre,  the 

wife  of  Herbert  H.  Folker,  L.B.aP.,  M.B.aS .  of  a  daughter. 
Oaob-Bbowh.  -April  0th,  at  7t  Csdog»n  Place,  London,  8.  W.,  the  wife 

of  C.  H.  Gage-lirown,  M.D.,  of  a  «taoghter. 
LABaDOB-DoWB.j- April  6th,  at  Harley  street,  W.  the  wife  of  BughiaW 

wife  of 

SABB1QBD-8XITH.— April  6th,  at  JBltham;  X[ent,  the  wife  of  H.  Sand- 
ford-smiih,  M.B.<XS.,  L.8JL,  of  a  daughter. 


BUL-SOABTH.— April  7th,  at  BInscarth.  Orkney,  Walter  Leonard  BeD, 
M.D.,    Lowestoft,   HnlTolk,    to    Mar^nt    Lendcura,  youngest 


of  the  late  Bobert  Scarth,  of  BInsoarth. 

BULLucK-GBimTBB. -April  9th,  at  the  Pariah  Churdi.  BUesmers, 
Charles  Penry  BuIIooIl  M. A.Ozon,  M.B.a&,  L  B.C.P.,  of  Oswee- 
try,  to  Ftanoee  BUsabeth  (Beasto)  younger  daughter  of  Mrs 
CMffltha,  of  Bilesmere. 

BADT—bOTLB.— April  11th,  at  Chrtot  Chordi,  Chelsea,  Geo.  John 
Kadv,  M.D.,  of  Bnfleld,  to  Luna,  daughter  of  the  late  Joeeph 
Boyle,  of  Clapham  Common. 

FoiOHAX-GiBBOB.^Aprll  8th,  at  St  Mary's,  Honsey  Bise,  B.. 
Bmest  C.  Fincham,  M.B.C.S.Bng.,  LblLaP.Lond.,  only  son  of 
Jamea  Fincham,  MlnstCB.,  of  Hobart.  Tasmania,  to  Blanche, 
yuungeat  daughter  of  the  late  Blchard  Gibbon,  of  Shanghai. 

MACKAT-MofiAKbT.— April  8tb,  at  the  Cathedral  Gnurofa  of  St. 
Mary,  Bdlnburgh,  by  the  Bight  Beverend  the  Bbbop  of  Bdln- 
burgh,  George  Mackay.  M  D.,  F.B.C.S.K.,  ekieat  son  of  Deputy- 
Burveon-Oenerd  Geo.  M«Gkay,  M.D.,  to  lOise  Marjjry,  younger 
daughter  of  Lieutenant-Colond  Alex.  Bumees  McHardy,  ILB. 

Bbid-Mawbb.-  April  Uth.  at  Uaity  HaU,  Wood  Green.  Arthur  U 
Bdd,  M.ILC.a,  L.B.C>.,  to  LJdUa  Ada,  eldest  danghtsr  of  W 
Mawer,  F.G.8.,  of  Sontl«ate. 

BUBPOBIK-Aiiiil  1st,  at  GrevOto  Boad»    Kflbuni,    K.W.,  Henry 

Thomaa  Buttanahaw  Burford,  Mlkas.,  aged  00. 
KABB.-Ba8ter  Sunday,  at  Bishopsteignton,  Joseph  George  Auriot 

Kane,  M.D.I>ab.,  c^Bxmouth,  aged  80, 
BHABP.-Aprii  loth.,  at  LUndudno,  IfilUam  Sharp,  M.D.,  FJL8.,  of 

Bugby,  aged  Oi. 
BMITH.-Aprii  Ut.  at  Hammersmith,  WUbecforoe  Smith.  M.D.,  Hddd* 

beig,  ci  Stratford  Piaoe.  London,  W.,aged  61. 
WBL8H.-April  7th,  at  uakdene.  Oak  flffl  Boad,  Surfolton,  Fhoieto 

Fawoett  Wetoh,  FJUCS.,  aged  70. 

fmmOSst  qr  3ubtorib0n  to  this  Journal  nre  ^SStod  fno,  amd  wmm 
rtaoh  tho  jmNisMrt  n^tlaUr  than  the  Monia't;  prtced  »ij  pUiioutioi^ 


Wht  ^dimi  fvtm  mA  ^ivmhx. 


••SALUS    POPULI    SUPREMA    LEX." 


WEDNESDAY,    APRIL    22,     1896.  No.  17. 


Vol.  CXII. 


©trgtnal  Qr0tnmttTttC3rtt(m& 
PROGNOSIS    IN    SYPHILIS. 

By  JOHN  A.  SHAW-MACKENZIE,  M.D.Lond 

The  aDDotatioD  in  Thb  Medical  Paess  ^nd 
CiKCULAB  of  March  4th,  with  the  kind  invitation^  for 
opinions  on  syphiliB  from  an  insurance  point  of  view, 
enconrages  me  to  think  the  following  cases  and  obser- 
vations may  be  of  interest. 

The  following  series  of  355  cases,  by  the  kindness  of 
Mr.  Henry  Lee,  have  been  collected  mainly  from  some 
of  his  case  books.  They  indicate  some  of  the  seqnelse  of 
syphilis,  for  which  relief  has  been  sought  at  different 
periods  of  time  from  primary  infection.  These  patients 
had  been  under  usual  methods  of  treatment,  and  their 
circumstances  had  permitted  their  treatment  to  have 
been  presumably  "  proper." 

The  8  cases  which  died  came  under  my  own  notice, 
and  are  in  the  following  order : — 

4  years  from  i)rimary.  Enormously  enlarged  testicles 
Necrosis  of  cranial  bones.  Meningitis.  Phthisis  in  family. 

5  years  from  primary.    General  paralysis. 

6  years  from  primary.    General  paralvsis. 

14  vears  from  primary.  Pneumonia  from  chill  (got 
wet  through). 

16  years  from  primary.    Impotence.    Suicide. 

18  years  from  primary.    Suicide. 

30  years  from  primary.    Cerebral  haemorrhage. 

30  years  from  primary.    Found  dead  in  bed.  Mitral 
calcareous  vegetations.    Contracted  kidneys.    Small 
slaty-coloured  liver.    In  habit  of  taking  chlorodyne. 
Thbee  Years— 41  Cases. 

Scaly  eruption. 

Suppurating  tubercles  of  neck,  arms,  and  lower  parts 
of  body.    Onychia.    Throat  affection  (2  cases). 

Loss  of  hair. 

Loss  of  sexual  power.    Double  vision. 

Node  of  tibia.    Rupia. 

Acneform  rash  on  shoulders. 

Rheumatism.  Eruption  of  skin.   Numbness.   Iritis. 

Eruption  on  skin.    Throat  affections. 

Soreness  of  tongue  (3). 

Periostitis  of  right  tibia.    Cachectic  ulceration. 

Circular  brown  patches  of  trunk. 

Urethritis. 

Muddy  water. 

Headache. 

Brown  stains.    Loss  of  hair. 

Eruption  on  chest.    Node. 

Periostitis.    Epilepsy. 

Eczema.    Iritis. 

Ulceration  (rectum).    Enlarged  glands  (inguinal). 

Eruption  on  skin  and  ankles. 

Eruption  on  skin.    Enlarged  submaxillary  glands. 

Vanoocele. 

Urethral  stricture.    Rupia. 

Psoriasis.    Nasal  bones  affected  and  discharge. 

Urethritis. 

Circular  raised  tubercles  of  face  and  arms. 

Dark  stains  of  skin. 

Ulceration  of  tongue.    Patches  of  eruption  on  skin. 

Mental  depression.  Loss  of  flesh.  Enlarged  vas  deferens. 

Xnceration  of  tongue.    Has  had  dysentery  and  fever. 

Pityriasis.    Brown  spots  on  legs. 

Sore  of  prepuce. 

Iritis  and  tnroat 


Ulceration  of  tongue. 
Ringing  in  the  ears. 
Vague  persistent  headache,  dizziness. 
Rheumatism  of  shoulder. 

Psoriasis  of  hands.    Discolouration  of  fingers.    Sore 
throat.    Sores  on  penis. 

Four  Years.— 32  Cases. 

Pain  in  forehead,  ulcers  on  legs,  eruption  on  shoulders. 

Slough  of  throat.    Nodes. 

Excess  of  moisture  of  glans  penis.  Psoriasis  palmaris. 

Throat  affection.    Eruption  on  shoulders. 

Tongue  soreness.    Constipation.    Redness  alas  nasi 

Tongue  ulceration. 

Tongue  soreness.    Nervous.    Shaky, 

Ulceration  of  cartilage  of  ear. 

Glazed  tongue.    Haemorrhoids. 

Lepra  of  skin. 

Ulceration  of  phalanx  of  toe. 

Circular  indurations  of  skin. 

Chronic  sores   of   tongue  and   repeated    throats. 
Debility.    Acne. 

Pains  in  head. 

Headache.    Eruption  on  skin. 

Urethritis. 

Throat  affection.    Milky  appearance. 

Loss  of  hair.    Urethral  stricture.    Boils. 

OzsBua.    Scrotal  eruption. 

Eruption  on  arm  and  back. 

General  eruption.    Ulceration  of  tongue.    Psoriasis 
palmaris. 

Eruption  in  skin  of  back.  Enlar^  inguinal  glands. 

General  eruption.    Throat  affection 

Impotence.  Fissure  of  anus. 

OzaBua. 

Sore  ton^e.    Headache.    Urethral  stricture. 

Blind  boils. 

Scrotal  eruption. 

Pain  in  tibia. 

Nil.    No  manifestation.    Came  to  report  himself. 

Enlarged  inguinal  glands.     Vesicular  eruption  of 
glans  penis. 

Enormous   testicles.      Necrosis   of   cranial  bones. 
Meningitis.    Phthisis  in  family.    Died. 
Five  Years.— 30  Cases. 

Node. 

Eruption  on  skin. 

Onychia.    Haemorrhoids. 

Mottled  ton^e. 

Throataffection.  Headache  (frontal).  Eruption  on  back* 

Loss  of  hair.    Psoriasis  palmaris. 

Eruption  on  hands.    Cold  extremities.    Diarrhoea. 

Paraplegia.    Skin  affection  of  nose  and  ear. 

Throat  affection.    Eruption  on  shoulders  and  scalp. 

Loss  of  hair.    Sore  of  penis. 

Eruption  on  hands. 

Sciatica. 

Throat  and  tongue  ulceration. 

Spots  in  throat.    Inflamed  eye. 

Throat  affection  (2). 

Gout.    Insomnia.    Acne. 

Circular  sore  on  skin  and  general  eruption. 

Pityriasis.    Gumma  of  leg  affecting  muscle. 

Nodes  (2). 

Papules  on  shoulders.    Sore  throat    Enlarged  left 
inguinal  glands. 

Iritis. 

Throat  and  tongue  affection^ 


4L6    iHi  Medioal  Pbbbs. 


ORIGINAL  COMMUNICATIONS. 


April  22,  18f>6. 


EmaciatioD.    Eraption  of  skin. 

Va^e  persistent  headache,  dizziness. 

Irritable  sore  roof  of  mouth. 

Excavation  of  surface  of  tongue. 

Ulceration  of  lips  and  tongue. 

Riffht  femoral  glands  greatly  enlarged.  A  large 
glana  in  Hunter's  canal  and  middle  of  left  arm. 
Ulceration  of  throat. 

Died. 

General  paralysis. 

Six  Yeam.— 27  Cases. 

Eruption  on  shoulders,  increased  by  baths  at  first, 
subsequently  cured. 

Rupia. 

Affection  of  skin  of  nose. 

Headache. 

Necrosis  of  mesial  bones. 

Loss  of  hair.    Eruption  on  back.    Varicose  ulcers. 

Throat  affection.    Enlarged  glands  of  neck  and  groin. 

Eruption   of  upper  lip. 

Loss  of  hair. 

Brown  spots  of  skin. 

General  eruption  of  skin. 

Soft  sore  of  p^nis.    Re-infection. 

Sore  on  tongue  and  skin  of  leg. 

Painful  node  of  sternum. 

Ulceration  of  nose.    Urethritis.    Enlarged  liver. 

Pimi>les  on  legs. 

Hemiplegia. 

Enlarged  testes. 

Nervous.    General  eruption.    Palpitation. 

Sore  tongue. 

Eruption  on  skin. 

Ozsena. 

Prostatic  discharge. 

Soreness  of  tongue. 

Aphasia.    General  paralvsis.    Died. 

Ulcerating  gummata  of  skin,  svmmetrically  over  body 
and  limbs,  from  size  of  pea  to  shilling-piece. 

Nil.    Permitted  to  marry. 

Seven  Years.— 27  Cases. 

Pityriasis  on  stomach.  This  is  the  first  manifesta- 
tion after  primary. 

Copper-coloured  spots  on  back  and  loins. 

Slight  eruption  on  arms  and  ankle. 

Mottled  skin.   Hydrocele. 

Rasi>berry  spots  on  penis. 

Psoriasis  patmaris. 

Pain  in  head,  Brain  troubles.  Constipation.  Swim- 
ming in  head.  Indurated  glands  of  grom.  Slight  en- 
largement of  liver. 

Iritis.    Eruption  on  nates. 

Herpetic  eruption  on  trunk,  circular  on  legs. 

Bilious  attacks.    Copper-coloured  eruption  on  skin. 

Onychia. 

Iritis.    Deafness.    Pains  of  sternum  and  joints. 

Node. 

Node.    Left  testis  enlarged. 

Ulceration  of  skin  of  foot. 

Throat  affection.    Bullous  eruption. 

Ulceration  of  tongue. 

Affection  of  throat.    Prostatitis.    Stricture. 

Eruption  on  hands.    Enlarged  glands. 

Eruption  on  arms. 

Affection  of  tongue  and  throat. 

Pimples  on  back.  Ulceration  of  mucous  membrane 
of  mouth. 

Throat  affection. 

Gk)uty^  cystitis. 

Eruption  of  skin. 

Loss  of  hair. 

Gumma  of  skin. 

Eight  Years.— 12  Cases. 
Throat  sore.    Eruption  of  skin,  on  and  off.  Married, 
4  years,  first  child  healthy,  next  two  syphilitic. 
Frequent  desire  to  pass  water. 


Eruption  on  skin.  Soft  sore  of  penis.  Enlarged 
glands  in  groin. 

Eruption  behind  ears  and  on  neck. 

Eruption  on  face  and  back  slightlv. 

Node.  Eruption  on  face  and  shoulders.  Weak  chest. 

Hemiple^a. 

Iritis.    Circular  eruption  of  skin. 

Nodes. 

Node  of  tibia.    Necrosis  of  left  nasal  bone. 

Deafness.  Remains  of  node  of  forehead  in  deep 
depression.  Node  of  tibia.  Hoarseness.  Numbness 
of  scalp  at  times. 

Ulceration  of  tongue.    Submaxillary  |;land  enlarged 
left  side,  and  slight  enlargement  of  inguinal  glands. 
Nine  YEAJts.— 17  Cases. 

Brown  spots,  papular  on  back.    Epigastric  pain. 

Rupia.    Ulceration  of  skin  of  big  nodes. 

Sore  throat. 

Iritis.  Tingling  left  hand.  Left  eyelid  and  left  toe 
swollen.    Haemorrhoids. 

Stains  between  eyes. 

Debility.    Neuralgia.    Haemorrhoids.    Urethritis. 

Sore  of  left  ear. 

Pain  in  head.    Twitching  of  hands,  arms  and  legs. 

Eruption  on  scrotum. 

Eruption  on  skin.    Facial  paralysis. 

Throat  affection. 

Aching  of  bones. 

Deep  ulceration  of  throat 

Node  of  forehead. 

Urethritis.    Lichen  on  back. 

Rheumatism.    Mottled  skin.    Twitchings. 

Slight  eruption  on  arms. 

Ten  Years.— 31  Cases. 

Ulceration  of  lips. 

Soreness  of  roof  of  mouth. 

Eruptions  on  back. 

Node  of  clavicle.    Enlarged  testis. 

Scaly  eruption  of  nose  and  trunk. 

Age  71,  married  two  years.    No  symptoms. 

NU.  No  manifestations.  Came  forpermission  to  marry. 

Irritable  throat. 

Eruption  on  skin. 

Eruption  on  skin.    Enlarged  inguinal  glands. 

Sore  moutii.    Coated  and  foul  tongue. 

Ulceration  of  back  of  tongue. 

Throat  affection.  Soreness  of  tongue.  Loss  of  hair 
of  eyebrows  and  head. 

Giddiness.    Eruption  of  back  and  sides. 

Specific  urethritis.    Gouty. 

Rneumatic  pains. 

Spots  on  back  and  nates.    Iritis. 

Eczema  of  nose  and  fingers. 

(2)  Reinfection. 

Loss  of  memory  and  power  of  right  arm. 

Eruption  on  legs,  round  umbilicus  and  forehead. 

(2)  Throat  affection. 

Inveterate  psoriasis.  Insomnia.  Enlarged  inguinal 
glands. 

Impotence.    Mental  depression. 

Sore  of  prepuce.    Throat. 

Throat  and  tongue  affection. 

Glycosuria. 

Spots  of  inveterate  psoriasis  on  arms  and  legs. 

Roughness  of  mouth.  Excoriation  of  penis  after 
intercourse. 

Eleven  Years.— 11  Cases. 

Node  of  forehead.    Ankle  bones  enlarged. 

Rupia. 

Psoriasis. 

Throat  affection. 

Node. 

Loss  of  hair.    Eruption  of  skin  of  neck. 

Pityriasis.    Sore  on  prepuce. 

Pitjrriasis. 

Necrosis  of  nasal  bones. 


April.  22,  1H96. 


OhIGlNAL  COMMITNICATIOKS. 


Thb  Mjidioal  PbibR'     ^17 


Doll  heaviness  of  head  and  back  of  nesk.    Circular 
eniption  on  chest 

Herpetic  eruption  of  penis. 

Twelve  Years.— 18  Cases. 

Impotence.    Spermatorrhoea. 

Testis  enlarged.    Node  and  tenderness  of  tibia  and 
joints. 

Psoriasis  palmaris.   Pain  of  hips.    Irritable  general 
rash.    Urethritis. 

Iritis. 

Sore  tongue.    Constipation.    Eruption  of  scrotum. 

Swollen  testicle. 

(2)  Throat  affection. 

Affection  of  tongue. 

Affection  of  tongue.    Enlarged  glands  of  neck. 

Affection  of  tongue  and  throat    Circular  eruption 
on  skin. 

Nodes. 

Necrosis  of  nasal  bones. 

Eruption  of  skin. 

Tongue  sore.    Mottled  skin.    General  eruption. 

Enlarged  inguinal  gland?. 

Mitraldisease.    Syphilonhobia.    Neurasthenia, 

Headache    constant     Rheumatism.    Nervous   ex- 
haustion.   Malarial  fever,  several  times. 
Thirteen  Years.— 11  Cases. 

Enlarged  testis.    Redness  of  forehead. 

Deafness.    Ear  discharge.    Sore  tongue.    Redeyep. 
Noises  in  head.    Discharge  from  nose. 

Throat  affections  on  and  off  last  four  years. 

Irritable  ulceration  of  leg. 

Affection  of  throat     Reinfection.     Sore  primarily 
and  previously  excised. 

Rheumatic  pains. 

Hasmorrhoids.    Eruption  on  skin. 

Pityriasis.    Urethrafstricture. 

Eruption  of  back  and  nose. 

Eruption  on  forehead. 

Circular  sore  size  of  threepenny  piece  on  prepuce. 
Relapse  of  sore. 

FoiTRTEEN  Years.— 12  Cases. 

Nodes.    Eruption  on  skin. 

Sore  tongue. 

Rheumatism.    Swollen  joints.    Urethritis.    Rupial 
sore  of  skin  and  leg. 

Pityriasis.    Married  three  years,  infected  wife. 

Affection  of  tongue. 

Enlarged  inguinal  glands. 

Eruption  of  scalp,  face  and  sides. 

Eruption  of  skin.    Diplopia. 

Eruption  of  skin.     Urethritis. 

Eruption  on  arms  and  shoulders. 

Indolent  ulceration  right  shin.    Tubercular  acne- 
form  spot  of  rim  of  ear.    Follicular  tonsillitis. 

Ragged  soft  sore  at  fr»num.    Slight  throat  sym- 
ptoms.   Married  two  years.    Died,  pneumonia. 
Fifteen  Years.— 9  Cases. 

Eruption  of  thighs  and  back. 

Affection  of  throat  Sciatica.  Slight  eruption  on  head. 

Node  of  right  tibia  and  head.    Iritis. 

Node  on  tibia.    Loss  of  nasal  bone.    Qained  three 
stone  under  general  fumigation. 

Affection  of  tongue  (Uxor). 

Ulceration  of  throat  and  lip. 

Nil.    (Measles.) 

Necrosis  of  nasal  bones  and  inferior  maxilla. 

Severe   inflamed  pharynx  and  tonsils.    Patches  of 
ulceration,  attributed  to  severe  cold. 

Sixteen  Years.— 13  Cases. 

Hoarseness.    Ulceration  of  tongue. 

Specific  haemorrhoids. 

Nil.    No  manifestations. 

Vague  pains.    Hemidegia.    Palpitation. 

Affection  of  throat.    Discolouration  of  skin  of  nose. 

Eruption  on  nates  and  back. 


Periostitis  tibia.    Soft  palate  inflamed. 

Pains  of  lower  extremities.    Insomnia. 

Excoriation  of  prepuce. 

Loss  of  smell. 

Impotence.    Melancholia.    Suicide. 

Superficial  neuritis.  Patdies  of  numbness.   Tremor. 

Severe  gout.    Enlargement  of  ankles  and  wrists. 
Seventeen  Years.—6  Cases. 

Eruption  of  hand  and  foot 

Eruption  of  skin,  enlarged  glands.   Induration  like  a 
piece  of  bone. 

Painsinhead,browague.  Ulcers  on  leg.  Enlarged  testis 

Roughness  of  skin. 

Eruption  of  skin  of  arms  and  trunk.     Deafness. 
Affection  of  tongue. 

Deafness.    Catarrh  of  meatus. 

(To  be  concluded  in  our  next,) 


ABDOMINAL  SURGERY— NOTES  OF 

CASES. 

By  RUTHERFORD  MORISON,  M.B.,  F.R.C.S., 

Senior  AiftiBtant  Surgeon  Boyal  Inflmary,  Newcutle-on-Iyne 
CoDtnlUng  SorgeoD  ^ewcM(leI>»ntal  fioei^ltal. 

(GofUinuid  from  p<Mffe  394). 
Ths  cases  of  intestinal  obstruction  referred  to  in  the 
first  portion  of  my  paper  point  out  two   plain  les* 
sons  :— 

1.  The  di£5culty  of  diagnosis  in  many  instances,  and 

2.  The  fact  that  operation  is  often  too  long  post* 
poned. 

These  two  are  cause  and  effect,  for  uncertain  dia- 
gnosis makes  decision  difficult,  and  operations  for  intes* 
tinal  obstruction  still  remain  the  most  dangerous  in 
abdominal  snidery.  Three  of  the  five  cases  would 
almost  certainly  hare  been  saved  by  earlier  operation  ; 
no  case  was  lost  by  unnecessary  operative  inter- 
ference. 

In  this  series  the  absence  of  deaths  following  synse- 
cological  abdominal  cases  will  be  noticed,  though  the 
operations  for  diseases  of  ovaries,  tubes,  and  uterus - 
make  up  75  per  cent,  of  the  whole  number  of  abdo- 
minal operations.  The  mortality  from  ovariotomy  and 
hysterectomv  has  been  reduced  to  almost  vanishing 
point,  and  there  are  many  other  conditions  capable  of 
nearly  as  successful  treatment. 

Cask  VIII.  Cancerous  Stricture  of  Pylorus — 
Pylorus  adherent  to  head  o/  Pancreas — Gastro-Hnte- 
rostomy^Regurp^tation  from  titomach  qf  Bile  and 
Pancreatic  Fluids. 

A  man,  ast  46,  emaciated  and  feeble-looking,  about 
three  years  affo  first  felt  discomfort  in  his  stomach  like 
heart-bum.  For  two  years  he  continued  much  the 
same,  and  vomited  about  three  times  a  week.  The 
vomited  matter  was  frothy  like  yeast,  and  smelt  badly. 
He  gradually  got  thinner.  Ei^ht  weeks  ago  he  was 
obliged  to  leave  work  with  pains  in  the  stomach,  and 
has  been  unable  to  do  anything  since.  The  pains 
were  accompanied  by  swelling  over  the  stomach,  were 
relieved  by  vomiting  and  were  aggravated  by  taking 
food.  The  patient  often  felt  hungry,  but  dare  not 
eat  His  stomach  had  been  washed  out  several  times 
with  temporary  relief.  All  his  organs  appeared  to  be 
sound  with  the  exception  of  his  stomach. 

The  stomach  was  much  dilated,  as  shown  by  succus- 
sion,  percussion,  and  auscultation.  It  extended  below 
the  umbilicus,  and  held  41  pints  of  water.  No  tumour 
could  be  felt. 

Operation,  Beo,  12th,  1895. —The  abdomen  was 
opened  above  the  umbilicus,  and  the  pylorus  exploied. 
It  was  fixed  high  up  behind  and  under  the  liver,  attd 
gave  the  impression  of  being  involved  in  a  large  tumour. 
Qastro-enterostomy  was  performed  by  attacfainK  tiie 
jejunum  as  near  its  commencement  as  convenientto  Um 


418     Thb  Mkdioal  Prbss. 


ORIGINAL  COMMUMCATIONS. 


Apbil  22,  1896. 


anterior  wall  of  the  stomach.  Care  was  taken  to  make 
the  attachment  in  such  a  manner  that  the  proximal 
end  of  the  jejunum  lay  towards  the  cardiac  end  of  the 
stoinach,  and  the  diatal  end  towards  the  pylorus,  and 
the  jejunum  was  left  without  Idnk.  An  opening  about 
two  inches  long  was  made  in  the  jejunum  and  stomach, 
and  the  openings  in  the  viscera  were  united  by  a  con- 
tinuous catgut  suture  close  to  the  margin  of  each  open- 
in^,  and  through  the  whole  of  each  wall.  Outside  of 
this  a  row  of  interrupted  Lembert's  sutures  were 
placed  all  round,  about  one-fiith  of  an  inch  from  the 
edges,  united  by  catgut.  The  operation  was  easy,  and 
rapidly  performed,  and  the  patient  was  put  to  bed 
apparently  no  worse  for  it. 

After  progrtM^  Dec.  13ch,  1896.— Has  had  a  good 
night  Was  sick  once  immediately  after  being  put  to 
bed.  Pulse  and  temperature  normal.  Continued  well 
all  day.    Took  small  quantities  of  water. 

14th.— Has  had  a  bad  night.  Constantly  sick  and 
bringing  up  quantities  of  green  foul-smelling  fluid. 
Pulse  and  temperature  normal.  No  pain.  After  being 
raised  in  bed  into  a  sitting  posture  the  sickness  ceased 
and  he  had  small  quantities  of  whisky  and  soda  water 
which  he  retained.  In  the  afternoon  the  sickness  com- 
menced again.  Green  offensive  fluid  was  frequently 
vomited.  Change  of  posture  now  effected  no  improve- 
ment. The  vomiting  continued  incessantly.  On  the 
morning  of  the  fourth  day  it  was  evident  that  he  was 

going  to  die,  and  he  was  permitted  to  drink  anything 
e  fancied.    He    partook   freely  of  champagne  and 
other  fluids  and  died  in  the  afternoon. 

Post  mortem.— Th»tQ  was  no  trace  of  peritonitis  and 
the  union  between  jejunum  and  stomacn  was  perfect. 
The  stomach  and  jejunum,  as  far  as  the  opening  in  the 
latter,  were  distended  with  the  same  green  stinking 
fluid  as  had  been  vomited  during  life.  The  jejunum 
beyond  the  opening  was  empty  and  contracted.  It 
was  lying  parallel  with  the  anterior  stomach  wall,  and 
there  was  no  mechanical  obstruction  whatever.  The 
stomach  was  very  large  and  its  walls  appeared  to  be 
thicker  than  normal.  A  round  ring  of  malignant 
growth  surrounded  the  pylorus  and  constricted  it  to 
such  an  extent  that  an  ordinary  slate  pencil  could  be 
passed  through  it  with  difficulty.  The  pylorus  was 
adherent  to  the  head  of  the  pancreas  behind,  and  the 
malignant  growth  had  invaded  the  pancreas.  It  was 
this  that  mislead  me  as  to  the  size  of  the  tumour 
during  the  operation.  On  opening  the  stomach  the 
anastomosis  between  it  and  the  jejunum  was  found  to 
admit  the  tips  of  three  fingers.  It  was  round-edged, 
smooth,  and  the  passage  from  it  into  the  distal  por- 
tion of  the  jejunum  was  perfectly  free.  There  were 
no  secondary  deposits  in  any  of  the  viscera  and  no 
enlarged  glands. 

NoTS.— In  the  Surgical  Section  of  the  British  Medi- 
cal Association  at  Newcastle  in  1893, 1  showed  a  series 
of  specimens  from  cases  of  gastro-enterostomy,  and 
drew  special  attention  to  the  result  obtained  in  this 
case,  demonstrating  on  my  specimens  that  when  re- 
gurgitation of  of  intestinal  fluids  occurred  the  stomach 
was  dilated  and  incompetent.  The  explanation  given 
by  me  then  was  that  if  the  stomach  operated  upon  was 
incapable  of  perfect  systole,  the  intestinal  contents 
would  not  pass  the  opening  in  it  but  would  fill  the 
stomach  instead  of  going  on  through  the  intestine. 
This  I  still  believe  to  be  true.  The  ease  with  which 
such  an  operation  can  be  performed  and  the  occasion- 
ally brilliant  result  of  it  have  made  it  popular  with 
surgeons.  That  popularity,  I  feel  assured,  would  im- 
mediately disappear  if  the  true  results  were  known. 
This  would  be  one  of  the  advantages,  not  the  least 
perhaps,  of  publishing  unsuccessful  as  well  as  successful 
cases.  The  opportunities  I  have  had  of  observing 
results  have  convinced  me  that  though  the  principle  of 
operation  is  good,  the  details  of  this  gastro-enterostomy 
a^  at  present  performed  make  it  one  of  the  worst 
operations  ever    invented.    The  mortality,  which  is 


appalling,  depends  upon  conditions  over  which  the 
surgeon  has  no  control.  The  new  operation  must  more 
closely  imitate  natural  conditions.  I  am  at  present 
working  at  the  subject  and  hope  next  year  to  report 
my  results*. 

Case  IX.  Carcinor/M  of  Pyloric  End  of  Stomach 
and  Glands  in  Lesser  Om^ntum—Excision  of  Growth — 
Gastro-enttr ostomy  with  Murphy* s  Button — Retention 
of  Button  in  Stomath — Persistent  Vomiting — Death  on 
\bth  day, 

A  woman,  set.  42,  pale,  thin,  and  always  delicate. 
She  had  a  cnild  eleven  years  ago  and  has  never  since 
been  well.  Sick  headaches  and  pain  in  the  stomach 
have  been  her  chief  troubles.  Ten  weeks  ago  she 
noticed  a  lump  in  the  pit  of  her  stomach  ;  found  she 
was  getting  weaker  ;  could  eat  no  solid  food  on  account 
of  pain,  and  was  frequently  sick,  no  matter  what  she  took. 

Previous  to  the  birth  of  her  child  eleven  years  ago 
she  had  fair  health.  All  her  organs  appeared  to  be 
sound  with  the  exception  of  the  stomach. 

On  examination  of  the  abdomen  a  swelling  could  be 
seen  under  the  upper  half  of  the  left  rectus  muscle, 
which  descended  a  full  inch  on  deep  inspiration.  It 
felt  of  somewhat  square  shape,  measured  about  li  in. 
in  each  diameter,  was  hard  and  nodulated  on  the 
surface,  had  a  well-defined  sharp  edge  below,  and  an 
ill -marked  outline  above.  It  was  freely  movable  from 
side  to  side  and  from  above  downwards.  It  could  be 
pushed  into  and  distinctly  felt  from  the  left  loin. 
When  the  patient  lay  on  her  right  side  the  tumour, 
except  a  narrow  margin,  passed  over  to  the  right  of  the 
middle  line.  It  could  be  pushed  above  under  the 
costal  margin  and  below  entirely  beneath  the  umbilical 
level.  After  a  seidlitz  powder  administered  as  two 
drinks  the  tumour  passed  over  to  the  right  side. 

Operation,  May  13th,  1896.— The  abdomen  was 
opened  above  the  umbilicus  and  the  pyloric  tumour 
drawn  out.  It  was  larger,  perhaps  double  the  size,  that 
it  seemed  to  be  before  it  was  fully  exposed.  The  tumour 
was  isolated  by  separating  the  great  omentum  below 
and  the  lesser  omentum  above.  In  the  lesser  omentum 
and  close  to  the  tumour  there  were  two  glands  the  size 
of  filberts  which  were  left  attached  to  it.  Clamp 
forceps  were  applied  to  .the  stomach  and  duodenum 
half  an  inch  from  the  growth,  both  were  divided  with 
scissors  beyond  the  forceps,  and  growth  and  glands 
with  the  involved  portions  of  stomach  and  duodenum 
were  removed  in  one  piece.  A  few  vessels  were  tied  in 
the  cut  edges  of  the  stomach,  and  then  the  opening  in 
the  stomach  was  closed  by  a  continuous  suture  through 
all  its  walls.  The  cut  end  of  the  duodenum  was  simi- 
larly closed,  because  such  an  amount  of  tissue  had 
been  taken  away  that  it  was  impossible  to  attach  the 
duodenum  to  the  stomach.  Each  row  of  sutures  in 
stomach  and  duodenum  was  inverted  and  buried  by  a 
second  row  of  interrupted  Lembert's  sutures.  The 
jfjunum  was  now  drawn  forward  with  the  object  of 
doing  gastro-enterostomy.  The  portion  of  stomach 
left  was  too  small  to  allow  of  this  being  done  by  simple 
suture,  the  method  I  prefer,  but  it  was  accomplished 
with  the  aid  of  a  Murphy  button.  The  operation 
occupied  an  hour,  and  the  patient  was  put  to  bed  in 
good  condition. 

A  fter  Progress, — Istdav. — Vomited  three  timessmall 
quantities  ot  dark  odourless  fluid.  Nutrient  enemata 
ordered.  (These  were  continued  regularly  till  she  died.) 

2od  dny.— Hot  water  to  drink  at  intervals.  £arly 
in  the  morning  (4.30  a.m.)  vomited  two  ounces  of 
greenish  fluid. 

3rd  day.— General  condition  good.  Pulse  and 
temperature  normal.  Propped  up  in  bed.  Had  bowels 
freely  moved  after  a  soap  and  water  enema.  Barley 
water  and  milk  in  half -ounce  doses  and  a  little  brandy 
and  soda  occasionally  to  drink. 

4th  day.—  One  ounce  of  barley  water  and  milk  every 
hour.    Complains  of  pain  ii  stomach. 

5th  day.^Cup  of  tea.    Took  twelve  ounces  of  milk 


Apbil  22»  1896. 


ORIGINAL  COMMCJNICATIONS. 


Turn  Mbdioal  Pbks.     419 


and  twelve  ouDcea  of  barley  water  during  last  twenty- 
four  hours.    Menstruating. 

6th  day.— Wound  dressed  for  the  first  time.  Edges 
red. 

7th  day.— Looks  well  but  complains  of  pain  in 
stomach. 

8th  day.— Wound  dressed  on  account  of  bad  smell. 
A  small  quantity  of  some  feculent-looking  discharge 
had  come  through  between  the  edges  of  the  wound  to 
the  dressing. 

9th  day.— Wound  dressed.  A  larger  quantity  than 
jresterday  of  similar  foul  smelling  discharge  on  dress- 
ing. At  8  p.m.,  half  a  teacupful  of  arrowroot. 
8.40  p.m.,  vomited  first  time  since  early  on  second  day. 
Vomited  matter  consists  of  arrowroot  and  changed 
milk. 

10th  day.— Good  night.  A  quantity  of  dirty  facu- 
lent  smelling  discharge  from  wound.  Wound  ordered 
to  be  frequently  washed  into  with  boracic  lotion.  This 
was  continued  till  her  death.  Vomited  at  4.30  a.m., 
8.45  a.m.,  11  a.m.,  12..10  p.m<,  d  p.m.,  and  9  p.m. 

12th  day.— Fair  night.  Vomited  at  8.45  a.m.,  12  p.m., 
and  1.50  p.m.  On  each  occasion  the  vomit  was  dis* 
tinctly  faecal  and  of  the  same  character  as  that  coming 
from  the  abdominal  wound. 

13th  day.— A  very  bad  night.  Vomited  seven  times 
a  thin  yellow  ficcal  matter. 

I4th  day.— Vomited  feecal  matter  so  frequently  that 
the  number  of  times  was  not  noted.  After  five  grains 
of  calomel  the  bowels  were  moved.  The  motion  was 
a  white  frothy  liquid  with  verjr  little  odour. 

16th  day.— Passed  a  fair  night  with  morphia  but 
frequently  sick.    Died  at  3  p.m.  somewhat  suddenly. 

Po9t'7iiortem.  —  The  abdominal  wound  was  not 
entirely  healed  and  was  red  round  the  edges.  A  sinus 
large  enough  to  admit  a  slate  pencil  went  into  the 
abdominal  cavity.  On  opening  tne  abdomen  the  sinus 
was  seen  to  lead  down  to  a  point  between  the  remains 
of  the  stomach  and  duodenum*  It  was  small  through- 
out)  and  was  entirely  shut  off  from  the  general  abdo- 
minal cavity  by  adhesions.  There  was  no  peritonitis 
and  no  sign  of  intestinal  obstruction.  The  whole 
gastrointestinal  tract  Was  nearly  empty.  There  was 
no  distension.  The  whole  of  the  abdominal  contents 
were  removed  in  onis  block  without  disturbing  the 
relations  any  more  than  was  possible.  A  water  tap 
was  fitted  on  to  the  gastric  end  of  the  oesophagus,  and 
water  was  allowed  to  trickle  into  the  stomach.  A 
small  quantity  oo^ed  out  of  the  sutured  ends  of  boih 
stomach  and  duodenum  into  the  sinus  which  had  com- 
municated with  the  surface.  The  water  passed  readily 
down  and  through  the  whole  intestinal  tract.  Only 
the  cardiac  end  of  the  stomach  was  left  More  than 
half  of  it  had  been  removed.  The  anastomosis 
between  the  stomach  and  jejunum  was  perfect  and  the 
opening  good.  The  Murpby  button  was  lying  free  in 
the  remaining  portion  of  stomach.  There  was  no 
evidence  of  disease,  all  appeared  to  have  been  removed. 
No  secondary  deposits. 

Case  X.  Acute  Appendicitis— Early  Involvement  of 
Pelvic  Peritoneum  Diffuse  Peritonitis— Drainage 
— Death. 

A  very  big  stout  man,  set.  42,  had  never  been  ill 
before,  but  two  days  previous  to  the  sudden  and  severe 
commencement  of  his  present  illness,  he  had  felt  some 
uneasiness  in  his  bowels.  There  was  no  bad  pain,  and 
he  went  about  his  duties  and  was  able  to  sleep. 

Early  on  the  morning  of  the  third  day  he  was 
awakened  by  an  agonising  pain  all  over  the  bowels, 
which  made  him  feel  sick  and  faint,  cold  and  sweating. 
He  knew  he  was  very  ill  and  sent  for  the  doctor.  After 
a  hypodermic  injection  of  morphia,  hot  applications, 
<kc.,  he  got  relief,  but  never  complete,  for  he  was  unable 
to  pass  flatus,  felt  his  bowels  swollen,  was  very  thirsty, 
and  occasionally  sick.  At  the  end  of  the  fourth  day  I 
.saw  him.  He  spoke  cheerfully  and  made  little  com- 
jplaint,  except  of  having  to  lie  in  bed,  but  his  grey. 


pinched  face,  and  dark-rimmed  eyes,  told  a  different 
stoiy.  Every  now  and  again  he  swallowed  forcibly, 
as  if  to  dispose  of  a  rising  in  his  throat  which  he  was 
attempting  to  keep  back.  There  was  nothing  in  his 
temperature  or  pulse  to  excite  suspicion.  His  abdomen 
was  swollen,  and  more  rigid  than  normal,  and  this  was 
specially  msrked  on  the  ri^ht  side,  low  down,  where 
there  was  also  some  tenderness.  On  examination 
per  rectum,  fulness  and  fluctuation  were  dis- 
covered in  the  pelvis.  We  agreed  on  the  dia 
gnosis  of  acute  perforating  appendicitis,  with 
extensive  pelvic  peritonitis  and  fluid  in  the  pelvis,  and 
made  a  very  gloomy  prognosis.  Operation  was  dis- 
cussed, but  decided  against,  for  it  was  considered  too 
late  to  attempt  a  radical  operation  with  any  fair 
chance  of  success,  and  too  early  to  deal  with  a  possibly 
localised  collection  of  fluid,  deep  in  the  pelvis,  by 
simple  drainage.  The  progress  of  the  case  was  steadily 
down  MlJ,  tympanitis  increased,  vomiting  was  with 
greatest  difficulty  restrained,  hiccough  became  a 
troublesome  symptom,  and  it  was  evident  to  all  of  us 
on  the  eighth  day  that,  unless  somethins;  more  could  be 
done,  the  patient  was  about  to  die.  In  consultation 
on  the  eighth  day,  it  was  decided  to  give  the  patient 
what  chance  drainage  of  the  collection  offered. 

On  July  23rd,  1895,  an  oblique  incision  was  made 
over  the  csecum  which  was  exposed.  My  finger  pushed 
over  to  the  inner  side  of  this,  allowed  of  the  escape  of 
a  little  foetid  pus,  which  slowly  oozed  out,  and  I  could 
feel  the  firm  enlarged  appendix  dipping  over  the  pelvic 
brim.  A  full-sized  india-rubber  drainage  tube  was  left 
in  position.  The  patient  soon  recovered  from  the 
anaesthetic  and  appeared  to  be  relieved,  but  six  hours 
later  he  suddenly  collapsed  and  died  nine  hours  after 
the  drainage  tube  was  introduced.  A  limited  post- 
mortem examination  showed  diffuse  peritonitis  due  to 
gangrenous  perforation  of  the  end  of  the  appendix.  A 
fsBcsA  concretion  was  found  in  the  peritoneal  cavity, 
clcise  to  the  appendix  from  which  it  had  escaped. 

Case  XL  Acute  Appendicitis— Gangrene  of  Ajypen- 
dix  and  C cecum— Remf/val  of  Appendix  and  Suture  of 
Coecum.    Death  from  Extension  of  Ga7igrene. 

A  woman,  set.  30,  gave  the  following  history.  On 
Saturday,  June  28,  abdominal  pain  commenced  after  re- 
turning from  a  walk  about  7  p.m.  Hot  fomentations  and 
brandy  were  tried,  but  no  relief  was  obtained.  At  1  a.m. 
the  doctor  found  the  patient  in  severe  pain  referred  to 
the  lower  part  of  the  abdomen  but  especially  to  the 
right  inguinal  region.  The  temperature  was  normal. 
The  bowels  had  been  moved  the  previous  day  and  there 
was  no  vomiting.  Morphia  was  given  hypodermically. 
Later  on  Sunday  morning  the  patient  was  easy  and 
seemed  better.  An  enema  was  administered  in  the 
afternoon  and  opened  her  bowels.  On  Sunday  even- 
ing vomiting  commenced  and  some  abdominal  di»ten- 
sion  was  noticed.  Her  temperature  was  elevated. 
From  this  time  her  progress  was  steadily  downwards. 
The  abdominal  distension  increased,  the  temperature 
remained  high  and  vomiting  became  more  frequent. 

Three  days  after  the  attack  I  saw  her  and  agreed 
with  her  medical  attendant's  opinion  that  the  appendix 
should  be  removed  without  delay. 

Operation.— Ju\y  2nd,  1895.  The  abdomen,  a  fat 
one,  was  opened  in  the  linea  semilunaris  and  the  caecum 
exposed.  It  was  red,  roughened,  and  adherent  on  its 
outer  side  to  the  parietal  peritoneum.  A  second 
incision  was  now  carried  from  the  centre  of  the  first, 
obliquely  backwards  and  outwards  to  the  posterior 
surface  of  the  iliocostal  space.  The  abdomen  on  the 
inner  side  of  and  below  the  caecum  was  thoroughly 
packed  with  sponges.  The  adhesions  on  the  outer 
side  of  the  caecum  were  next  separated  (they  were  very 
feeble)  and  a  cavity  with  stinking  fluid  contents  was 
opened.  On  drying  and  exposing  this  a  yellow 
sausage-shaped  swelling  was  seen  lying  in  the  groove 
between  the  caecum  and  ascending  colon  on  the  inner 
side  and  the  peritoneum  lining,  the  parietes  on  the 

D 


420     Thk  Mbdioal  Prxss. 


ORIGINAL  COMMUNICATIONS. 


Apsil  22,  18%. 


outer.  This  was  easily  detached  and  tamed  out  to  be 
the  appendix.  No  cutting  was  needed  to  separate  it 
from  the  cascum  to  which  it  was  only  attached  by 
a  small  gangrenous  thread  of  tissue.  A  gangrenous 
ulcer  perforating  the  caecum,  the  size  of  sixpence, 
represented  the  place  of  attachment  of  the  appendix. 
The  gangrenous  ulcer  was  dried,  then  swabbed  with 
pure  carbolic  acid,  dried  again,  inverted  into  the 
caecum  and  retained  by  Lembert's  sutures.  The  cavitv 
on  the  outer  side  of  caecum  and  colon  was  packed  with 
iodoform  gauze  and  drained  by  a  large  india-rubber 
tube  from  the  loin.  The  abdominal  wound  was 
entirely  closed  except  the  portion  behind  where  the 
tube  and  gauze  were  left  protruding.  The  appendix 
was  nearly  four  inches  long,  looked  as  if  it  was  filled 
with  pus,  the  colour  of  which  could  be  seen  shining 
through,  and  the  thickness  of  an  ordinary  middle 
finger.  On  sticking  it  up  the  whole  interior  was 
occupied  by  a  dark,  foetid  slough,  but  there  was  no 
pus.    Only  the  peritoneal  coat  remained. 

The  patient  recovered  satisfactorily  from  the  opera- 
tion and  for  the  first  four  days  promised  well. 

On  the  fifth  day  the  discharge  from  the  tube,  pre- 
viously sweet,  became  abominably  foetid,  and  on  the 
sixth  day  the  patient  died. 

There  was  no  post-mortem,  but  the  doctor's  belief, 
in  which  I  share,  was  that  death  resulted  from  an 
extension  of  the  gangrenous  ulceration  of  the  caecum. 

Case  XII.  Pelvis  Abscess  reaching  to  UnMlic^is— 
Incision  and  Drainage  from  Abdomen  and  Vagina. 

A  girl,aet.  18,  with  a  history  of  abdominal  pain  and 
illness  of  a  fortnight's  duration.  The  history  was 
suggestive  of  ruptured  appendix  and  to  this  the  pelvic 
peritonitis  present  was  ascribed. 

When  I  saw  her  she  was  delirious  and  could  not  be 
properly  aroused ;  her  pupils  were  dilated,  and  pulse 
quick,  but  of  fair  strength.  How  far  her  mental  con- 
dition might  be  due  to  the  drugs  she  had  taken  in  her 
illness  I  was  unable  to  determine.  Her  abdomen  was 
swollen  and  hard  below  the  umbilicus  and  dull  on 
percussion. 

Per  vaginam,— The  whole  pelvis  was  blocked  with 
exudation. 

On  May  12th,  1895,  the  abdomen  was  opened  above 
the  pelvis,  and  over  a  quart  of  stinking  pus  escaped. 
The  patient  was  then  placed  in  the  lithotomy  posture, 
and  an  opening  made  behind  the  uterine  cervix  into 
Douglas's  pouch.  A  tube  was  passed  from  above  and 
through  the  vaginal  opening  for  irrigation  purposes. 
The  patient  never  recovered  consciousness  and  died 
on  the  following  day.  There  was  no  post-mortem. 
{To  be  continued.) 


THE  LOCAL  APPLICATION  OF 
GUAIACOL     AS     A     MEANS     OF 

REDUCING  TEMPERATUKF. 
By  ERNEST  A.  BOURKE,  L.R.C.RI.,  L.R.C.S.I., 

AsBistunt  Resident  Physician,  Cork  Street  Fever  Hospital,  Dublin. 

Having  had  an  opportunity  during  the  past  few 
months  of  observing  the  action  of  guaiacol  when 
applied  locally  as  a  means  of  reducing  temperature, 
I  give  briefly  the  notes  on  a  few  of  the  cases.  As  to  its 
mode  of  application,  we  generally  select  the  axilla  as 
being  most  convenient,  the  axilla  is  first  washed  with  a 
little  soap  and  tepid  water,  then  dried  ;  the  guaiacol  is 
then  gently  rubbed  in  with  the  finger  and  covered 
with  oil  silk  to  prevent  evaporation  ;  in  cases  of  enteric 
fever  it  may  be  applied  to  abdomen,  and  in  phthisis  it 
is  better  perhaps  to  apply  it  directly  over  the  affected 
lung  beneath  the  clavicle.  After  rubbing  in  the 
guaiacol  it  causes  only  veiy  slight  irritation  which 
rapidly  passes  ofif.  it  may  also  be  applied  in  solution  in 
oil  or  glycerine. 


Case  1.— Male,  set.  18,  acute  phthisis,  both  lungs 
and  larynx  affected,  profuse  night  sweats.  Average 
evening  temperature  for  the  first  24  days  in  hospital 
102^,  and  for  the  last  six  days  of  that  time  it  averaged 
102•6^  Guaiacol  T([x  was  then  ordered  to  be 
applied  every  night.  The  notes  are  as  follow — 
From  half  to  one  hour  after  the  application  of  guaiacol 
the  skin  becomes  moist  accompanied  by  a  fall  in  Hie 
temperature  ran£[ing  from  V  to  3°,  the  nidit  sweats, 
which  were  previously  severe,  became  much  lessened 
and  sometimes  absent,  the  patient  slept  better  during 
the  time  it  was  applied,  and  the  pulse  rate  diminished 
in  frequency.  Tne  guaiacol  was  applied  in  this  case 
for  eight  successive  evenings  with  the  following  results, 
average  fall  in  the  temi)erature  three  quarters  of  an 
hour  after  each  application  was  1'9°  witi^  a  decided 
drop  in  the  morning  temperature,  so  that  when  the 
guaiacol  was  stopped  the  evening  temperature  was 
100",  and  it  only  exceeded  this  on  two  evenings  for  a 
period  of  three  weeks,  when  the  case  terminated  fatally. 

Case  2.— Also  a  case  of  Acute  Phthisis.  In  this 
case  we  used  the  guaiacol  from  his  admission.  In  this 
case  the  average  evening  reduction  was  only  1*3*"  during 
the  26  days  the  patient  remained  in  hospital.  The  fall 
in  temperature  I  feel  sure  would  be  much  greater,  but 
in  this  case  only  l\vi  were  used  at  each  application, 
and  the  temperature  was  taken  half  an  hour  after, 
whereas,  as  a  rule,  a  much  greater  fall  in  the  tempera- 
ture occurs  about  an  hour  after.  Here  also  the  night 
sweats  were  diminished  and  patient  left  hospital  very 
much  improved. 

Case  3.— Tabes  mesenterica  ;  average  evening  tem- 
perature for  the  ten  days  previous  to  the  application  of 
guaiacol  was  103°.  After  the  first  application  of  5 
minims,  the  temperature  fell  from  102  2  to  100°,  and 
on  the  second  evening  it  fell  to  normal,  and  practically 
remained  at  normal  for  four  days,  when,  the  guaiacol 
being  stopped,  it  rose  again  to  near  its  former  level. 

Cases  4  <k  5.— Two  cases  of  puerperal  fever,  both  with 
a  temperature  range  between  103°  and  106° ;  average 
fall  in  temperature  after  the  application  of  10  minims 
of  guaiacol  was  2*5°. 

Case  6.— Enteric  fever ;  in  this  case  the  only  bad 
symptom  was  the  protracted  high  temperature. 
Sponging  had  no  effect  on  the  temperature,  the  appli- 
cation of  ice  cloths  continued  for  twenty  minutes  only 
brought  down  the  temperature  a  little  over  half  a 
degree.  Guaiacol  n\^x  was  then  ordered,  the  average 
fall  in  the  temperature  during  the  eleven  days  it  was 
applied  being  2°,  the  lowest  fall  being  1°,  and  the 
highest  3  5°. 

In  about  ei^ht  other  cases  of  enteric  the  average  re- 
duction after  its  use  from  1°  to  4°. 

Case  7.— Patient  under  observation  (suspected 
smallpox).  On  the  first  day  of  illness  the  temperature 
was  104°  ;  after  sponging  temperature  continued  to 
rise  ;  ten  minims  guaiacol  then  applied,  thirty  minutes 
afterwards  thermometer  registered  101*2^  and  two 
hours  afterwards  100°.  On  the  second  day  at  1  p.m. 
patient's  temperature  was  105^^,  application  of  ice- 
cloths  for  twenty  minutes  only  caused  a  further  slight 
rise  in  temperature,  then  the  guaiacol  was  applied  and 
succeeded  in  bringing  down  the  temperature  a  little 
over  1°.  On  the  morning  of  the  third  day  small-pox 
eruption  appeared  on  face.  In  severe  cases  of  scarla- 
tina, both  in  children  and  adults,  associated  with  high 
temperature  and  hot  dry  skin,  the  application  of 
guaiacol  was  equally  effective,  a  short  time  after  its 
application  the  skin  becoming  soft,  and  moist  together 
with  an  average  reduction  of  temperature  of  over  two 
degrees. 

In  one  case  only  did  its  application  seem  to  have  no 
effect,  this  being  a  case  of  phthisis,  however,  in  this 
case  there  was  very  slight  fever  as  evening  tempera- 
ture rarely  exceeded  100° ;  in  this  case  also  it  seems  to 
have  diminished  the  night  sweats.  Not  only,  as  a  rule, 
^oes  the  temperature  fall  in  a  short  time  after  its 


Afril  22,  1806. 


ORIGINAL  COMlffUNICATlONS. 


The  Msdioal  Prbss.     421 


application,  bat  it  does  not  tend  to  rise  again  as  very 
often  occurs  after  sponging,  iceing,  &c.  In  acute 
phthisis  it  seems  specially  indicated,  as  it  often  checks 
to  a  great  extent  the  night  sweating  of  this  disease ;  in 
many  of  the  cases  also  it  seemed  to  relieve  the  cough, 
and  also  when  continued  for  some  time  the  temperature 
approaches  to  normal,  and  even  when  its  application  is 
stopped  the  temperature  as  a  rule  remains  at  a  lower 
range  than  formerly. 

In  enteric  fever,  where  there  is  a  protracted  high 
temperature,  or  in  those  cases  where  sponging  the  patient 
has  no  effect,  guaiacol  rarely  fails,  otnerwise  it  does  not 
seem  to  have  any  effect  upon  the  disease  itself,  or  cut 
it  short  in  any  way.  During  its  application  the  urine 
is  increased  in  quantity. 

In  none  of  the  cases  did  we  notice  any  bad  effect 
from  its  use,  possibly  because  we  only  used  5  to  10 
minims  at  each  application,  and  in  young  children  3  to 
5  minims.  In  the  notes  of  the  above  cases  the  guaiacol 
was  only  used  in  the  evening ;  I  feel  sure  if  20  or  30 
minims  were  used  the  results  would  be  much  more 
manifest.  The  only  contra-indication  to  its  use  as  far 
as  I  am  aware  is  cardiac  failure.  To  sum  up,  guaiacol 
is  useful  in  acute  phthisis  and  other  tubercular  diseases, 
also  in  fever,  both  in  children  and  adults,  more  especi- 
ally in  enteric  and  pneumonia,  and  also  in  scarlatina 
where  the  temperature  remains  high  and  the  skin  is 
not  acting  ;  it  causes  a  fall  in  the  temperature  in  from  i 
to  1  hour  after  its  application  of  from  1  to  4  degrees, 
accompanied  by  moderate  perspiration.  My  thanks 
are  due  to  Dr.  Day,  also  to  Dr.  St.  George  Ashe  and 
Dr.  Drury,  Visiting  Physicians,  for  allowing  me  to 
publish  the  notes  on  the  cases. 
♦ 

THE  CHEMICAL  CONSTITUTION 

CARBOHYDRATJh-S       AND       ALBU- 
MINOUS SUBSTANCES, 

WITH   SPECIAL   EEFEKENCE  TO   THE 

TREATMENT  OF  DLABETES.  {a) 

By  J.  L.  W.  THUDICHUM,  M.D.,  F.R.C  P.Lond., 

Ez-FresideDt  West  London  Medlco-Cbirurgical  Society. 

Shobt  reference  was  made  to  the  genesis  of  carbo- 
hydrate by  the  pdymen^ation  of  formic  aldehyde,  and 
how  this  gave  the  opportunitv  for  the  formation  of 
many  bodies  homologous  to  the  sugars,  which  were 
named  with  Greek  numerals,  to  which  the  terminal  o«6, 
from  dextrose  or  glucose,  was  attached.  We  had  thus 
diose,  triose  (of  the  glycerol  series),  tetrose,  pentose, 
hezose,  heptose,  and  so  on  to  dodecatose.  To  this 
series  corresponded  parallel  a  series  of  dehydratedbodies. 
which  were  calUd  carbohydranes^  and  were  recognisea 
by  the  numeral  and  the  ending  ane.  Such  bodies  were 
glycogen  formed  in  the  liver,  and  the  various  starches. 
Another  parallel  series  were  the  carbohydintes,  more 
hydrogenUedy  of  which  mannite  was  the  type.  Of  the 
carbohydrates  many  served  as  food,  being  vegetable 
products,  others  were  produced  in  the  body,  and  entered 
into  the  composition  of  the  albuminous  substances. 
The  chanp;es  of  carbohydrates  by  enzymes 
and  chemical  reagents  were  then  alluded  to. 
Eryptophanic  acid,  the  extractive  acid  of  the 
urine,  was  shown  to  be  a  nitrogenised  derivate 
of  the  pentane  series  (Cg).  Of  new  combinations  of 
the  carbohydrates,  the  one  with  phewylhydrazine  was 
the  most  important,  as  it  enabled  the  inquirer  to 
separate  in  a  crystalline  form  those  carbohydrates 
which  reduced  an  alkaline  copper-solution.  8uch  a 
compound  of  a  sugar  with  phenylhydrazine  was  called 
an  osazone,  the  ose  being  derived  from  the  terminal 

(c)  Abstract  of  Ptper  read  before  the  meeting  of  the  West  London 
Ve&co-Oiinifica]  Society  April  10th,  1806. 


syllable  of  glucose,  and  the  azone  from  the  azinc  of  tbe 
phenyl-com pound.  The  author  then  showed  that  all 
the  albununoics  substances  contained  carbohydrate  radi- 
cles, as  he  had  proved  in  1879  in  **  Annales  of  Chemical 
Medicine,''  vol.  1,  p.  1.  But  they  were  not  sugars, 
although  they  appeared  as  such  on  chemical  decom- 
position, there  were  other  bodies  besides  sugar  pro- 
duced, similar  to  dextrine  or  gum,  and,  therSore,  it 
was  clear  that  the  carbohydrates  in  albumins  bad  a 
composition  similar  to  that  of  starch ;  and  the 
albuminous  substances  should  therefore  nqt  be  called 
glucosides,  which  they  were  not,  but  amyloi(ddQ$ ; 
this  was  the  more  necessary  as  there  were  true 
glucosides  present  in  the  body,  in  the  brain,  c^ 
nervous  svstem.  Such  was  phrenosin,  of  which  thfiee 
were  perhaps  a  hundred  grammes  in  eacb  brain,  anil 
which  by  chemical  means,  or  by  disease,  split  up  jix^ 
a  su^ar,  galactose  (being  the  half  su|;ar  of  lactQ^, 
or  milk-sugar),  neurostearic  acid,  melting  at  84**  C., 
and  an  alkaloid  sphingosin,  which  was  now  maDufi^;- 
tured  as  a  medicine.  The  albuminous  spibatanco^ 
could  yield  4  per  cent,  of  sugar,  or  a  pound  of  meat 
could  yield  five  drachms,  therefore  not  much  of  the 
sugar  of  diabetic  patients  could  be  derived  from  fleah. 
But  if  any  were  so  derived,  the  albuminous  molecde 
was  broken  up  entirely  ;  for  the  amylonide  radicle 
kept  the  other  radicles  together  as  the  frame,  lliere 
might  be  seventy  radicles  with  six  carbon  each  com- 
bined, and  each  might  give  rise  to  the  entrance  of  six 
new  radicles,  so  that  an  albuminous  matter  mieht 
contain  420  radicles,  besides  the  amylonide  onef>.  The 
author  then  considered  the  glycogenic  theory,  and 
came  to  the  conclusion  that  the  evidence  for  it  ended  in 
the  liver^  and  that  beyond  that  it  was  not  proved.  The 
liver  acted  as  a  filter  and  reservoir,  and  purified  portal 
blood  from  excess  of  carbohydrates  over  the  I'l  per 
mille  contained  in  all  blood  and  juices.  If  the  liver  failed 
in  this  then  glycoh»mia  and  glycosuria  resulted.  Tlie 
glycosgon  in  the  liver  after  i)u  rely  animal  food  was  derived 
from  amylonides  of  albumins  by  the  biolytic  action  of 
the  intestinal  ferments.  But  the  amount  of  carbohy- 
drate thus  formed  would  probably  not  exceed  4  per 
cent,  of  the  weight  of  the  dry  matter  of  meat  or  alou- 
men.  From  a  variety  of  data,  both  qualitative  and 
quantitative,  the  author  came  to  the  conclusion  that  of 
the  uses  to  which  glycogen  is  put  in  the  liver,  the 
formation  of  dextrose  is  only  a  part  ;  the  other  pro- 
ducts had  to  be  investigated.  The  liver  transformed 
the  constituents  of  its  protoplasm  in  a  manner  which 
was  mainly  (speaking  of  quantity)  and  absolutely  (i.e., 
unavoidably)  connected  with  or  consisted  in  the  biliary 
function.  It  was  an  astonishing  fact  that  the  adherents 
of  the  glycogenetic  hypothesis  had  never  attempted, 
and  never  been  able  to  connect  this  with  the  cholo- 
poetic  function.  About  this  latter,  both  physiologists 
and  physiological  chemists  so-called  were  very  badly 
informed  ;  e,g.,  all  handbooks  stated  that  bilirubin 
was  the  normal  colouring  matter  of  the  bile  of  the  ox 
and  of  man,  but  no  one  had  ever  extracted  it  from 
healthy  bile.  It  was  present  only^  as  a  precipitate  in 
unhealthy  bile  in  combination  with  calcium  ;  it  was 
formed  only  by  decomposition,  e.flr.,  putrefaction. 

The  mere  presence  of  bilirubin  therefore,  always 
indicated  concurrent  or  previous  disease.  Hence  the 
speculations  of  some  pathological  authors, « .^.,  Naunyn, 
to  the  contrary,  were  erroneous.  The  formation  of  the 
biliary  acids,  and  their  constitution  was  quite  unknown. 
On  other  essential  ingredients  of  the  bile  the  informa- 
tion proffered  in  books  was  absolutely  erroneous,^.^^.,  on 
the  alleged  presence  of  lecithin,  whereas,  the  phospha- 
tide present  contained  four  atoms  of  nitrogen,  and 
crystallised  as  platino- chloride  in  great  purity.  The 
specific  biliary  alkaloids  were  quite  neglected,  no 
notice  at  all  was  taken  of  them.  Cadaverous  results 
were  mistaken  for  healthy  life  action,  just  like  to  sugar 
formed  after  death.  The  author  then  discussed  the 
baring  of  sugar  in  blood,  its  normal  quantities  and 


422     The  Medioal  Prbss. 


TRANSACTIONS  OF  SOCIETIES. 


Afbil  22,  1896. 


allefred  diBappearaace  on  Btanding.  In  blood  from 
diabetic  patients  he  had  found  no  change  as  regards 
(quantity  of  sugar  on  standing.  The  question  of  sugar 
in  normal  urine  was  much  contested,  lut  happily  of  no 
practical  importance  ;  it  gave,  however,  rise  to  much 
analytical  blundering,  e,g.^  when  the  reducing  action  of 
creatinin  was  mistaken  for  that  of  glucose.  The 
quantity  of  sugar  in  the  tissues,  and  blood  gave 
rise  to  voluminous  blundering,  and  not  rarely 
authors  ate  their  own  children  at  an  age  of  less  than 
twelve  months.  The  author  distinguished  three  forms 
of  glycosuria  recognised  by  the  presence  of  a  sugar. 
Cerebral  glycosuria  was  caused  uy  mechanical,  chemi- 
cal, or  mental  injury  to  the  nervous  system,  and  was 
diagnosed  by  the  presence  of  galactose  in  the  urine 
(the  sugar  present  in  any  obstruction  of  the  lacteal 
ducts  in  suckling  women  was  lactose ;  galactose  j^elded 
mitcic  add  by  ozydation,  which  dextrose  did  not. 
Albuminous  glycosuria  also  yielded  no  dextrose,  but 
an  optically  inactive  isomer.      Intestinal  glycosuria 

Save  larger  amounts  of  dextrose  in  the  urine,  and  so 
id  the  hejxitic  form.  In  all  cases  a  decomposition 
ensued,  by  external  influence,  until,  as  in  the  case  of 
general  saccharopathy,  the  diabetes  of  young  adults,  all 
tissues  and  liquid  seemed  to  form  the  morbid  material, 
and  hasten  to  the  destruction  of  life.  The  formation 
o//a^  from  sugar  was  a  difficult  problem,  seeing  that 
three  molecles  of  sugar  had  to  unite,  and  then  lose  16 
atoms  of  oxygen,  to  form  a  molecle  of  stearic  acid. 

C6Hi20g  X  3  =  CisHsgOig  Oio   =   Ci8H3fl02. 

In  diabetes  of  the  pronounced  kind  in  young  persons 
the  well- known  special  diet  was  a  useful  palliative,  but 
in  aged  persons  it  was  not  rarely  injurious,  and  was 
frequently  cast  aside  by  all.  In  cerebral  glycosuria 
nitrate  of  sphingosin  was  of  great  effect,  and  better 
than  ordinary  sedatives,  which,  however,  healed  many 
cases.  In  the  author's  experience  the  waters  of  some 
reputed  springs  were  a  delusion  in  diabetes  as  in  gall- 
stone disease  and  jaundice,  or  fatty  liver.  The  glyco- 
genic theory  so-called  had  given  no  aid  whatever  in 
the  treatment  of  the  disease.  Glycosuria  was  eminently 
a  subject  for  chemical  study,  but  only  systematic 
researches  by  experienced  savants  could  advance  the 
subject.  The  late  development  of  the  chemistry  of  the 
carbohydrates  and  albuminous  matters  had  opened  a 
new  field  on  which  rich  harvests  might  reward  the 
assiduous  inquirer. 


ROYAL  ACADEMY   OF    MEDICINE  IN  IRELAND. 

Skction  op  Fatholooy. 

Meeting  held  Friday,  March  13th,  1896. 

The  Preaident,  Dr.  Conolly  Norman,  in  the  Chair. 


STENOSIS   OF  TRACHBA  AND   BRONCai,    DUE  TO  SYPHILIS. 

Mr.  F.  Alcock  Nixon  showed  the  trachea  and  bronchi 
which  were  the  seat  of  pyphilitic  steno^i^.  A  large  gum- 
matoa?  mass,  implicating  the  lymphatic  glandp,  and 
moulded  round  these  tubes,  diminished  their  size,  so  that 
a  No.  4  catheter  could  with  difficulty  be  passed  through 
the  trachea  from  above.  The  lesion  was  diagnosed  as 
syphilitic,  and  the  patient  was  treated  with  mercury,  and 
subsequently  with  large  doses  of  iodide  of  potassium,  up 
to  several  ounces,  but  without  effect.  The  diseased  masp, 
gradually  contracting  round  the  air  tubed,  slowly  strangled 
the  patient  in  the  course  of  seven  weeka.  An  examination 
of  the  specimen  showed  that,  even  if  the  disease  had  been 
accu<*ately  localised,  no  operation  could  have  saved  life,  as 
it  was  deeply  situated  behind  the  aorta  and  implicated 
extenfiively  both  bronchi,  as  well  as  the  lower  half  of  the 
trachea.     The  larynx  was  quite  healthy. 

SrODEN  DEATH  DUB  TO  ATHEROMATOUS  CORONARY  ARTERIES. 

Dr.  Finny  exhibited  a  heart  (with  microscopic  sections) 


which  was  taken  from  the  body  of  a  female  patient,  »t.  58, 
who  died  very  suddenly  after  ten  days*  residence  in  Sir 
Patrick  Dun's  Hospital,  where  she  was  admitted  for 
debility,  general  dropsy,  and  purpura  of  the  extremities. 
The  more  distressing  symptoms  were  breathlessness  and 
orrhopnoea  at  night,  and  considerable  substernal  pain,  and 
this  last  was  much  complained  of  towards  the  fatal  termina- 
tion. The  left  ventricle  of  the  heart  was  exoentrically 
bypertrophied,  and  mitral  incompetence  was  evident  from 
the  physical  signs.  During  the  last  three  days  double 
hydrothorax  came  on  with  some  pulmonary  oedema,  and 
hematuria  with  renal  casts  (granular,  blood,  epithelial) 
set  in  about  the  same  time,  although  on  admission  the 
urine  contained  but  a  trace  of  albumen,  and  no  blood. 
Following  a  sleepless  night,  the  patient  took  no  breakfast, 
and  was  speaking  to  the  nurse  when  she  suddenly  expired, 
I  he  pnUe  instantly  ceased,  and  the  heart  sonnds  were 
arrested.  The  pathological  oonditions  found  were  a  heart 
with  slight  fatty  infiltration,  and  moderate  fatty  degenera- 
tion in  various  spots  of  the  ventricles,  and  of  the  right 
ventricle  in  particular.  Advanced  arteritis  deformans  of 
the  coronary  arteries,  but  especially  of  the  left,  so  that  the 
branches  of  the  vessel  could  be  seen  and  felt  running  down 
the  front  of  the  septum  to  the  apex  as  rigid  calcareous 
tubes.  This  left  artery  contained  a  clot,  the  u[>per  part  of 
which  was  recent,  and  extended  back  to  its  origin  from  the 
aorta,  and  th»  re  the  clot  filled  the  left  sinus  of  Valsalva, 
<  he  rest  of  the  aorta,  as  well  as  the  left  ventricle,  being 
free  from  clots.  The  aortic  valves  were  thickened  and 
rough  on  the  ventricular  surface,  though  they  filled  the 
ostium.  The  mitral  valve  was  incompetent  owing  to 
atheroma  and  calcareous  plates.  The  liver  was  a  good 
example  of  cyanotic  induration,  and  the  kidneys  presented 
evidences  of  moderate,  chronic,  interstitial  inflammation, 
with  thickening  of  the  arteries  in  some  places,  and  of 
reoent  hsemorrhages  into  the  tubules.  This  bleeding  wae 
explicable  only  on  the  supposition  that  the  renal  capil- 
laries were  diseased  and  (?ave  way.  Sudden  death,  with 
instantaneous  cessation  of  the  heart  and  pulse,  occurred  on 
November  18,  1895,  and  wae  in  all  probability  due  to  the 
closure  of  one  of  the  main  coronary  arteries  by  a  clot,  and 
the  resultant  paralysis  of  the  organ  which  was  already 
weakened  by  persistent  disease  in  the  kidneys,  the  mitral 
valves  and  atheromatous  vessels,  and  was  Undergoing  fatty 
degeneration  of  the  muscular  fibres  in  spots  in  the  neigh- 
bourhood of  the  coronary  arteries. 

Dr.  M'Wesnby  said  that  the  subject  was  a  highly 
important  one,  in  view  of  the  difficulty  sometimes 
encountered  in  arriving  at  a  conclusion  as  to  the  cause  of 
••udden  death.  Atheroma  of  the  coronaries  should  always 
be  carefully  sought  for.  In  his  experience  death  wae  not 
due  directly  to  this  cause  but  to  the  email  patches  of 
fibrous  tissue,  the  so-called  Herz-schwielen  of  the  Germans. 
These  were  the  almost  invariable  result  of  atheroma  of  the 
coronaries,  and  would  account  for  death  independently  of 
either  valvular  disease  or  thrombosis. 

TESTING  DRINKING   WATER  FOR  COLON-BACILLI. 

Dr.  M'Webney  gave  a  demonstration  of  some  recent 
methods  of  testing  dringing-water  for  colon-bacilli.  The 
importance  of  the  subject  from  the  hygienic  point  of  view 
was  very  great.  When  outbreaks  of  typhoid  were 
traceable  to  drinking-water,  it  was  only  rarely  that  flaw- 
lesd  demonstration  of  Eberth'i!  bacillus  in  the  water  was 
effected.  The  period  of  specific  contamination  had  in  too 
many  cases  passed  before  the  water  was  subjected  to 
analysis.  All  h}gienist8  are  agreed  that  the  demonstration 
of  B.  coli  possesses  a  high  significance,  as  affording 
evidence  of  the  possibility  of  specific  contamination.  He 
now  showed  the  results  of  three  modern  tests— Parietti's. 
V.  Frendenreich*s,  and  Abba's,  as  applied  to  three  samples 
of  water.  Each  sample  consisted  of  half  a  litre  of  Vartiy 
water  drawn  oflF  into  a  clean  flask  48  hours  previously.  To 
flask  1  was  added  a  trace  of  typhoid  stool  obtained  by  once 
dipping  a  straight  platinum  needle  into  the  stool  and  then 
into  the  water.  To  No.  2  was  added  a  trace  of  pure  culture 
of  B.  coli,  var.  lactis  oerogenes  from  the  f»ces  of  a  suckling. 
Sample  3  was  left  untouched.  After  24  hours  Parietti's 
test  was  performed,  }  c.c  of  each  water  being  added  to  a 
series  of  tubes  containing  broth  acidified  "with  HCl,  and 
containing  phenol  in  various  proportions.  The  tubes  were 
now  shown,  after  24  hours*  incubation,  when  it  was  at  once 
seen  that  those  corresponding  to  the  infected  samplts  were 


Apbil  22,  1896. 


TRANSACTIONS  OF  SOCIETIES.         Thb  Medical  Pbhss.     423 


tarbid,  whilst  the  uninfected  were  limpid,  and  showed  no 
aif^QB  of  growth.  V.  Frendenreich'e  and  Abba>  methods 
depend  on  the  abilitv  of  B.  ooli  to  develop  at  blood-heat  in 
solutions  containing  lactose.  V.  Frendenreich  causes  this 
to  take  place  in  a  fermentation  tube — as  originally  recom- 
mendeabyTh.  Smith, of  Washington,  and  observes  whetbnr 

gas  has  accumulated  in  the  dosed  side  by  the  end  of  24 
ours.  The  tabes  were  passed  round,  showing  that  one- 
third  of  the  fluid  in  one  tube  (that  oorresponaing  to  the 
typhoid  sample),  and  nearly  two-thirds  in  the  other  (the 
coli  sample),  had  been  expelled  from  the  dosed  limb  by 
gas.  The  pure  sample  nad  not  evolved  the  smallest 
bubble.  Abba's  method  consists  in  converting  the  whole 
sample,  or  1  litre  of  it,  into  a  nutrient  solution  by  the 
addition  of  100  c.c.  of  a  concentrated  s'^lutlon  of  peptone 
and  lactose,  then  adding  a  little  phenolphthalein  and  im- 
porting a  rose-colour  with  soda.  After  24  hours'  incuba- 
tion the  samples  inoculated  with  typhoid  stools  and  coli 
were  completely  decolourised  and  turbid,  whilst  the  pure 
Vartry  sample  showed  but  little  growth,  and  was  not  in 
the  least  decolourised,  as  comparison  with  an  uniqcu bated 
portion  shows.  The  bleaching  of  the  two  infected  speci- 
mens was,  of  course,  caused  by  the  neutralisation  of  the 
alkali  by  the  lactic  acid  developed  from  the  fermentation 
of  lactose  by  Ixieilltu  coii.  All  three  methods  yielded,  on 
plating  out  the  fluid,  abundant  colonies  of  bacillus  coli. 
Whilst  Parietti's  method  permitted  only  quantities  under 
1  C.C.  to  be  used,  and  v.  Frendenreich*s  about  5c.c., 
Abba's  method  placed  the  analyst  in  a  position  to  detect 
colon -bacilli  in  a  litre  of  the  water.  After  giving  further 
details  as  to  the  respective  merits  of  the  plans  exhibited, 
the  speaker  pointed  out  that  too  much  importance  ought 
not  to  be  attached  to  the  presence  of  small  numbers  of 
btteUlua  coli  in  water.  The  originally-sterile  intestine  of 
the  breast-fed  infant  came  to  contain  this  or^^anism  in 
millions  a  few  days  after  birth— a  fact  pointmg  to  its 
universal  diffusion  through  the  air.  It  was  only  when 
present  in  large  numbers,  and  associated  with  organic 
matter  capable  of  affording  it  pabulum,  that  its  presence 
could  cause  the  condemnation  of  the  water. 

Dr.  O'SuLLiYAN  said  that  it  was  an  extremely  interesting 
communication.  He  wished  to  know  what  was  the  time 
limit  of  the  changes  diagnostic  of  the  bacillus  coli  com- 
munis. Other  bacilli— for  instance,  the  diphtheria  ba- 
cillus— also  rendered  the  medium  acid  in  which  they 
grew. 

Dr.  Pabsoks  pointed  out  that  the  tests  were  tests  not  for 
the  typhoid  bacillus,  but  for  the  bacillus  coli  communis. 
Formerly,  from  a  bacteriological  point  of  view,  water  was 
oonsiderod  bad  which  contained  a  great  number  of  micro- 
organisms. Now,  if  the  bacillus  coli  communis  was  present 
in  larffe  numbers,  the  water  was  rejected,  as  it  showed 
probability  of  the  water  having  been  contaminated.  If 
only  a  few  were  found,  it  was  not  looked  upon  as  impure. 
He  wished  to  know  whether  the  tests  they  had  seen  would 
show  the  typhoid  bacillus  in  the  urine ;  also  whether  the 
bacillus  coli  communis  was  present  in  the  urine  of  typhoid 
patients. 

Dr.  M<WsKNKY,  replying,  said  that  with  reference  to 
the  time  limit  no  attention  should  be  given  to  any  result 
that  took  over  twenty-four  hours  to  develop.  It  was 
true  that  other  organisms  made  the  medium  acid,  but  they 
were  distinguished  from  the  bacillus  coli  communis  in  that 
they  would  not  develop  in  a  solution  containing  a  large 
quantity  of  lactose.  He  could  not,  however,  speak  with 
certainty  of  the  diphtheria  bacillus.  Two  of  the  tests 
were  not  for  the  typhoid  bacillus,  but  Parietti's  (?)  test 
reached  to  both  it  and  the  bacillus  coli  communis,  and  by 
plating  out  it  was  easy  to  known  which  was  present.  He 
did  not  bdieve  that  there  was  a  radicle  division  between 
the  typhoid  badllus  and  the  bacillus  coli  communis.  The 
four  characters  which  distinguish  them — viz.,  the  growth 
on  potato,  the  mobility,  the  fermentation  of  lactose,  and 
the  coagulation  of  milk — are  all  mutable.  As  regards  the 
fermentation,  however,  he  had  only  found  it  to  occur  with 
the  colon  bacillus.  There  are  clinical  facts  which  show 
auto-infection  from  one's  own  bowels  may  take  place,  and 
the  bacillus  coli  communis  may  set  up  inflammation  in 
Peter's  patches,  and  toxic  substances  may  be  absorbed 
giving  rise  to  symptoms  the  same  as  in  typhoid  fever. 
He  did  not  know  whether  a  rash  would  be  present  or  not. 
Parietti's  test  would  enable  the  typhoid  bacillus  to  be 
loand  in  th9  urine,  but  in  any  catarrhal  or  inflammatory 


condition  of  the  urinary  tract  the  bacillus  coli  communis 
would  also  be  present. 


WEST-LONDON  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  Friday,  April  IOtu,  1896. 

A.  Symons  EocLBS,  M.B.,  President,  in  the  Chair. 

LoccUised  Scleroderma,—DR,  Dickman  showed  this 
case,  a  girl,  set.  6,  who  presented  two  ovoid  patches 
about  1^  inch  long,  of  a  dead,  white  colour,  one  of  them 
showing  distinct  induration.  Both  were  situated  on  the 
back,  one  nearly  in  the  middle  line,  the  other  to  the  left 
of  it.  They  were  first  noticed  nineteen  months  pre- 
viously as  minute  spots  of  pinkish  colour,  with  a  sur- 
rounding capillary  injection. 

Dr.  H.  Mbnzies  read  some  notes  on  a  case  of 

infantile  scurvy. 

The  patient,  E.H.,  a  male  infant,  et,  11  monthf>,  the 
younger  child  of  healthy,  well-to-do  parents.  Be  was 
well  grown,  and  until  the  present  attack  had  always  been 
healthy.  Afcer  a  few  days'  malaise,  on  February  18th 
of  the  present  year,  his  left  eye  suddenly  swelled  and 
became  discoloured,  and  all  the  classical  signs  of  the  dis- 
ease rapidly  developed,  viz.,  loss  of  strength,  pallor,  limb- 
swelling,  proptosis  of  the  left  eye,  spongy  gums,  bruise - 
like  ecchymoses,  and  minute  purpuric  spots.  A  rapid 
disappearance  of  all  the  symptoms  followed  the  ad- 
ministration of  anti-scorbutic  dietary  of  freeh  milk 
raw  meat  juice,  potato  pulp,  and  orange  juice.  The  caee 
was  instructive  in  two  ways: — (1.)  The  absence  of  sll 
positive  signs  of  rickets.  (2.)  The  dan^r  of  a  long  con- 
tinued use  of  sterilised  milk  upon  which  the  child  had 
been  brought  up.  After  referring  to  the  writings  of  Drs. 
Cheadle  and  Barlow  on  the  subject  the  author  pointed  out 
the  curious  fact  that  while  authorities  in  England  and 
America  agree  in  recognising  the  scorbutic  nature  of  the 
affection,  many  German  and  some  Danish  writers  stiU 
regard  as  improved  this  etiological  factor,  and  maintain 
that  rickets,  plus  a  hemorrhagic  tendency,  is  the  real 
malady— a  view  which  seems  to  be  oppoeed  to  all  the  evi- 
dence of  its  morbid  anatomy,  and  certainly  contradicted 
by  the  result  of  dietetic  treatment,  for  the  rapid  improve- 
ment which  follows  the  administration  of  anti-ecoroutics 
is  one  of  the  most  remarkable  facte  in  medicine. 

Mr.  Alban  Doran  doubted  whether  sterilised  milk  was 
wholesome  and  nutritions,  and  suggested  that  some  of 
our  efforts  at  the  exclusion  of  germ  life  might  be  mie- 
directed. 

Mr.  Kbrtlby  considered  that  the  advantages  of  giving 
sterilised  food  to  infants  quite  outweighed  its  ds^gers, 
which  could  be  averted  by  the  addition  of  a  due  propor- 
tion of  anti'scorbutics.  He  afiSrmed  the  distinction 
between  infantile  scurvy  and  rickets,  which  latter  might 
be  produced  by  more  than  one  micro-organism  including 
that  of  syphilis. 

Dr.  Suthsbland  bdieved  that  from  a  scorbutic  stand- 
point the  boiling  of  milk,  as  usually  practised,  wss  pro- 
bably harmless,  but  the  use  of  milk  exposed  to  a  very  hiffh 
temperatore  for  a  longtime  was  notto  oe  regarded  as  siJe. 

Dr.  CouTTS  bdieved  that  the  milder  forms  of  infantile 
scurvy  were  common,  and  frequently  unrecognised.  He 
advocated  the  addition  of  anti-scorbutics  to  sterilised 
milk. 

Mr.  Alban  Doran  showed  three  specimens, 

TRUS  AND  FALSE  CAPSULES  OP  OVARIAN  CYSTS. 

(I)  The  patient  was  single,  »t.  25.  A  small  c^st  filled 
the  lower  iMkrt  of  the  abdomen  and  intestine,  lay  m  front ; 
the  fundus  of  the  uterus  could  be  felt  in  the 
right  groin.  No  part  of  the  cyst  came  down  into 
the  pelvis.  On  tapping,  a  pint  and  six  ounces 
of  fluid  escaped.  On  inspecting  the  tapping  hole 
two  distinct  layers  could  be  seen  as  though  there  were  a 
true  capsule.  On  pushing  the  hand  down  behind  the 
supposed  capsule  the  entire  cyst  was  displaced  with  a 
normd  pedicle.  There  were  no  adhesions  and  the  opposite 
ovary  was  healthy  ;  the  *' capsule"  was  simply  the  ovary 
itself  distended  by  the  cyst  within  its  substance.  The 
true  cyst  wall  was  connected  w^th  the  ovarian  capsule  by 
very  loose  connective  tissue.     Had  th9  union  been  dose 


424    Ths  Mbdioai.  FBua. 


TRANSACTIONS  OP  SOCIETIES. 


Apbil  ii,  1806. 


and  firm  that  would  have  been  the  nsaal  condition  in 
ovarian  oyBtoma,  and  no  two  layers  would  have  been  eeen 
on  inspecting];  the  trocar  wound.  On  the  other  hand,  had 
the  capsule  of  ovarian  tissue  been  adherent  to  pelvic  struc- 
tures the  cyst  might  have  been  deliberately  enucleated 
from  the  ovary  itself ;  the  appearance  after  enucleation 
would  then  have  been  puzzling.  (2)  Hypertrophied  tube 
on  the  surface  of  an  inflamed  ovarian  cyst.  Meso-salpinz 
adhered  firmly  to  the  cyst,  so  that  at  first  the  cyst  seemed 
as  though  it  had  furrowed  into  its  layers.  This  is  a  "  false 
capsule  cyst."  ^3)  A  dissection  showing  the  relations  of 
a  cyst  developea  between  the  folds  of  the  meso-salpinx. 
The  greatly  elongated  Fallopian  tube  runs  on  the  surface 
of  the  waU  of  a  similar  but  very  much  larger  cyst,  the 
gceater  part  of  which  has  been  cut  away.  These  are 
typical  encapsuled  cysts. 

Mr.  DoRAN  remarked  on  the  non-identity  of  pathological 
and  surgical  cysts,  and  on  the  grave  results  which  might 
ensue  on  their  confusion,  for  if  the  surgeon  mistook  these 
adhesions  for  a  capsule  and  attempted  enucleation,  intes- 
tine vessels  or  the  uterus  might  be  damaged. 

Dr.  Thudiohum  read  a  paper  on 

THE  OABBO-HTDRATKS   IN  THE  TRXATMINT  OF   DIABETES, 

which  will  be  found  in  another  column. 


Hi/FF1£LD   MEDICO-CHIRURGICAL   SOCIETY. 
Mbetino  held  Thubsdat,  Mabch  26tu,  1896. 


The  President,  Dr.  Porter,  in  the  Chair. 

OASS  OV  ACgniRBD  NY8TAGMCS. 

Mb.  Skell  introduced  a  patient,  set.  33,  a  sanitary  tube 
maker,  the  snbjeet  of  acquired  nystagmus,  due  to  the 
manner  of  work  followed  at-  his  occupation.  The  man 
had  been  compelled  to  relinquish  his  employment  on  two 
or  three  previous  occasions,  for  lengthened  periods,  owing 
to  the  distress  ooeasioned  by  the  subjective  symptoms  of 
the  nystagmus.  Mr.  Snell  referred  to  nystagmus  in  other 
ooeupfbtiono/  remarking  that,  if  looked  for,  the  affection 
would  be  found  to  be  associated  with  other  employment, 
aod  not  entirely  that  of  coal-mining.  Since  he  hflUl 
recorded,  some  years  ago,  the  case  of  a  compositor  with 
acquired  nystagmus,  he  had  met  with  other  cases  in  the 
same  class  of  work,  and  had  observed  a  fairly  large  number 
of  instances  in  other  occupations. 

Mr.  Snell  also  showed  a  ghrl,  et.  18,  with  doable  papil- 
litis (passing  into  atrophy)  the  result  of  plumbism  due  to 
her  work  as  a  file-cutter. 

SPECIMENS. 

Dr.  Arthur  Hall  showed  specimens  of  (1)  cerebellar 
tumour,  the  size  of  a  hen's  egg,  sarcomatous,  with  second* 
ary  difttensiota  of  the  lateral  aod  third  ventricles  to  a  very 
lai^  extent.  The  affection  had  lasted  eighteen  months, 
and  the  grfekdual  enlargement  of  the  head  had  been 
watched.  Lumbar  puncture  was  performed  by  Mr.  Pye 
Smith,  but  without  benefit,  in  fact,  it  aggravated  the  p^n. 
and*  the  boy  didd  the  following  day.  Two  drachms  of  fluid 
wei^  removed.  (2)  Heemorrhage  into  the  pone,  extending 
over  the  base  of  the  brain  and  into  the  left  lateral  ven- 
tricle.   (3)'  Softening  of  the  right  optic  thalamus. 

Mr.  Marriott  showed :  (1)  An  intra- pericardial  rapture 
of  1}he  aorta;  which  8h6wed  marked  atheromatous  changes, 
and  was  the  seat  of  a  small  aneurism  at  the  point  of 
rupture.  (2)  A  large  gall-stone  from  a  patient  of  Mr. 
Lockwood's,  which  had  been  passed  by  the  bowel  without 
any  symf)toms. 

Dr.  S^OLAiR  White  showed  a  very  large  gall-stone 
which  he  had  removed  by  operation. 

Dr.  Ray  read  a  short  paper  on  some 

FATHOLOqiOAL    CHANGES  IN  THE  CEREBRAL  CORTEX   OF 
THE  BRAIN. 

Description  of  fresh  method  of  preparing  brain  sections 
idt  microscopical  examinations ;  advantages ;  minute 
anatomy  of  the  normal  cerebral  cortex  ;  arrangement  and 
description  of  nerve  cells  in  various  layers ;  neuroglia, 
theories  as  to  its  nature ;  structure  of  lymphatic  and  vascu- 
lar system  ;  relation  of  blood  supply  of  brain  to  its  patho- 
logical changes  ;  early  changes  in  the  cortex  in  insanity  ; 
description  of j^the  stages  in  fuscous  degeneration  of  nenrv 


cells,  illustrated  by  microscopical  specimens  showing  each 
stage ;  the  spider  cell  or  Deiter's  cell,  its  nature  and 
pronable  function  ;  concluding  with  a  few  remarks  on  the 
nerve  cell  in  idiocy.  The  paper  was  illustrated  with 
drawings  of  microscopic  specimens  showing  :  The  normal 
cerebral  cortex ;  first  stage  of  fuscous  degeneration  ;  second 
stage  of  fuscoQS  degeneration  ;  third  stage  of  fuscous 
degeneration ;  spider  cells  in  superficial  layer  of  cortex ; 
also  microscopic  specimen  showing  the  above. 
Dr.  Ernest  Knioht  showed  a 

CASE  OP  ACUTE  SUPPURATIVE  CHOLANGITIS. 

A  man,  sat.  47,  first  felt  ill  at  the  end  of  October,  1895, 
with  symptoms  of  hepatic  colic.  He  began  with  rigors 
and  profuse  sweats  two  days  afterwards  accompanied  by 
slight  jaundice,  which  latter  symptom  passed  off  within 
a  week.  The  rigors  went  on  and  glycosuria  developed. 
There  was  considerable  tenderness  and  fulness  in  the 
epigastric  region.  The  glvcosuria  intermitted  for  a  time, 
but  reappeared  one  montn  before  death,  the  rigors  and 
sweats  continuing  daily  and  nightly  up  to  the  time  he 
died  comatose  on  Jan.  7th,  1806,  Tnere  was  no  return  of 
jaundice,  there  was  varying  tenderness  and  fulness  in  the 
epigastric  region.  No  operative  measures  were  deemed 
advisable.  Foat-mortem. — The  liver  was  found  much 
enlarged.  The  cystic  duct  entirely  and  the  common  duct 
partly  blocked  by  several  soft  gall-stones,  consisting 
largely  of  colouring  matter  each  about  the  size  of  a  horse 
bean.  The  gall-b&dder  was  empty,  except  for  a  little 
thick  bile.  Suppuration  extended  up  the  ducts  through 
both  right  and  left  lobes  of  the  liver,  and  formed  numerous 
small  abscesses.  The  lobulus  quadratus  was  converted 
entirely  into  an  abscess  cavity.  The  kidneys  were  rather 
small  and  the  cortex  reduced  in  vigo. 


THE  HUNTERIAN  SOCIETY. 
Meeting  held  Wednesday,  April  8th,  1896. 


The  President,  Dr.  G.  £.  Herman,  in  the  Chair. 
Dr.  Percy  Warner  read  a  paper  on  a  case  of 

PERITYPHLITIS. 

The  patient,  et.  35,  was  suddenly  taken  ill  on  July  24th, 
1896,  with  pain  in  renal  region  running  in  the  direction  of 
the  ureter,  marked  tenderness  in  front  and  b^ind,  vomit- 
ing, and  rise  of  temperature.  There  was  also  a  rigid  con- 
dition of  muscles  on  the  right  side  of  abdomen,  and  fre- 
quent micturition.  No  well-defined  tumour  could  be 
made  out  un^  convalescence  was  established.  Patient 
had  a  relapse  on  September  9th,  with  great  pain  and  much 
swelling  above  the  crest  of  the  ilium.  Mr.  Charters 
Symonds  operated,  and  a  quantity  of  foul  pus  was  dis- 
charged. The  patient  made  a  good  recovery.  Dr.  Warner 
remarked  on  the  frequency  of  micturition,  which  at  first 
suggested  a  renal  origin  of  attack,  but  showed  how  the 
variabilitv  in  length  and  position  of  appendix  would 
account  for  varying  site  of  pain  after  suppuration  has 
taken  place.  The  position  of  pain  depends  on  position  of 
libscess,  which  in  the  case  related  was  situated  at  a  point 

Sn  the  crest  of  the  ilium  at  the  junction  of  poet  and  middle 
tiirds,  where  the  abscess  had  burrowed  out  of  the  iliac 
fossa  into  cellular  tissue  of  the  gluteal  region.  The 
tenderness  behind  was  remarkable.  He  point^  out  that 
die  treatment  of  this  disease  might  be  divided  under  the 
three  forms  of  the  malady  :— (1)  simple  perityphlitis  ;  (?) 
perityphlitic  abscess,  probably  due  to  perforation ;  (3) 
perityphlitis,  followed  by  general  peritonitis,  due  to  acute 
perforation.  The  great  difiiculty  consisted  in  deciding 
when  to  operate,  and  he  remarked  that  no  two  symptoms 
can  determine  this,  and  that  he  relied,  not  only  on  local 
rfgns,  but  also  greatly  on  the  general  condition  of  the 
patient. 

He  also  referred  to  the  important  question  of  surgical 
treatment  in  the  early  sta^e,  and  quoted  the  opinion  of 
American  surgeons,  who  advocated  the  removal  of  appendix 
in  all  cases  of  perityphlitis.  Lastly,  he  pointed  out  that 
in  cases  of  relapsing  typhlitis,  there  was  a  fair  consensus 
of  opinion  that  the  operation  should  be  done  in  the  quies- 
cent period. 

Mr.  Charters  Symonds,  after  |making  supplementary 
remarks  as  to  the  operation*  gave  an  aeoonnt  of  his  ezperi- 


April  ^,  1896. 


Germany. 


Thb  Mbdioal  Press.     425 


ence  in  each  cases  and  referred  to  the  fact  that  symptoms 
of  perityphlitis  were  simulated  sometimes  by  malignant 
disease,  sapparatine  kidney  and  active  mycosis,  and  are 
apt  to  resemble  typhoid  fever  sometimes.  He  considered 
it  doubtf  al  whether  iu  acute  cases  an  operation  can  be  too 
early  performed,  and  showed  a  perforated  appendix 
removed  from  such  a  case  with  successful  result. 

The  Prendent,  Dr.  F.  J.  Smith,  Drs.  H.  Sequeira,  Hope 
Gran*^,  and  Artiinr  Davies  took  part  in  the  discussioui  and 
I>r.  Warner  replied. 


Jrance. 


[prom  our  own  cjorresponwbxt.] 

Paris,  AprU  I8th,  1896. 

PaERPERAL  FSVBR. 

At  the  meeting  of  the  Obstetrical  Society  held  here  last 
week,  M.  Gharpentier  spoke  at  great  length  on  the  treat- 
ment of  puerperal  fever  by  serotherapy,    He  said  that  in 
the  month  of  February  last  year  MM  Roger  and  Gharrin 
announced  the  discovery  of  anti- streptococcic  serum,  and 
signalised  at  the  same  time  a  case  of  puerperal  fever  cured 
by  their  serum.    A  few  days  later  another  patient  was 
declared  cured  by  the  same  method,  while  Marmorek  pub- 
lished a  list  of  45  cases  of  erysipelas  treated  and  cured  by 
the  serum.    Through  the  kindness  of  his  colleagues,  M. 
Gharpentier  was  able  to  collect  40  new  cases  of  puerperal 
fever,  for  which  the  treatment  in  question  was  applied. 
The  result  was  22  cures  and  18  deaths.    A  bacteriological 
examination  was  made  in  25  instances,  the  streptococcus 
was  found  in  16.    In  none  of  the  cases  was  the  treatment 
limited  to  the  injections  of  serum,  it  was  only  employed 
concurrently  with  the  usual  medication  applied  to  this 
affection.    From  this  it  would   appear  that  the   serum 
treatment  cannot  be  considered  as  efficacious  as  had  been 
believed  by  those  who  first  introduced  it  to  the  profession. 
M.    Bar   considered    that   the   question    was  a  very 
important  one  and  merited  to  be  examined  in  detail.    It 
was  necessary  first  of  all  to  give  a  proper  definition  of 
puerperal  fever,  what  it  really  was,  for  the  term  itself  was 
not  dear  enough  to-day  to  the  mind  of  the  new  school.    It 
is  said  to  be  due  to  the  presence  of  streptococci,  but  more 
frequently  other  septic  agents  are  associated  with  them, 
qnch  as  pneumooocci,  bacterium  coli,  ataphylococci,  kc, 
apd  it  is  possible  that  the  serum  of  M.  Marmorek  or  that 
ol.M.   Roger,  while  it  destroys   the  bacilla  of  Lofiier, 
inoreMee  the  virulence  of  the  streptococcus.    In  any  case, 
the  somm  diflers  acc<Mrding  to  its  provenance,  the  sheep, 
the  IMS,  or  the  horse.    That  from  the  sheep  has  been 
kno¥m  to  cause  toxic  accidents,  while  the  serum  of  the  ass 
is  not  well  tolerated.    On  the  other  hand,  the  method  of 
preparing  the  serum  is  not  always  the  same,  and  as  a  con- 
sequence the  immunising  effect  is  seriously  compromised. 
He  admitted  that  very  good  results  were  obtained  in  the 
treatment  of  erysipelas,  but   neither  the  serum  of  M. 
Marmorek  nor  that  of  M.  Roger  could  be  regarded  as 
ppecifics  for  puerperal  fever,  and  the  medical  attendant 
who  neglected  the  intra-uterine  treatment  of  that  affection 
would  incur  very  grave  responsibilities. 

POST-PARTUM    Hi£M0RRHAGB. 

M.  Tamier  introduced  the  subject  of  Post-partum 
Haemorrhage  and  its  Treatment.  He  said  it  was  import- 
ant to  localise  the  complication  with  precision  as  the 
treatment  differed.  The  hasmorrhage  comes  either  from 
the  OS  or  vagina,  or  from  the  body  of  the  uterus.  In  the 
former  case,  theoanse  will  be  found  to  arise  from  a  rent  of 
t-he  cervix  or  of  the  vagina,  and  will  require  plugging  or 


the  ligature  of  the  bleeding  vessels.  In  haemorrhage  from 
the  body  of  the  uterus,  inertia  of  the  muscle  is  the  origin 
of  the  trouble,  and  the  treatment  should  be  prophylactic, 
curative  and  consecutive. 

The  prophylactic  treatment,  consisting  in  hastening  the 
delivery,  should  be  applied  in  women  who  were  found  to 
be  suffering  from  albuminuria,  or  who  were  naturally  pre- 
disposed to  hasmorrhages.  The  curative  treatment  was 
simply  that  of  evacuating  completely  the  contents  of  the 
uterus,  repeated  twice  or  three  times  if  necessary. 

The  patients  will  frequently  protest  boldly  against  it, 
but  this  manoeuvre  must  be  resorted  to  in  grave  cases. 
Tonics,  stimulants,  ergot,  transfusion  form  the  consecutive 
treatment. 

M.  Bossi  agreed  with  the  last  speaker  on  the  frequent 
necessity  of  cleaning  out  the  uterus,  but  added  that  he 
obtained  very  satisfactory  results  from  injections  of  salt 
water,  renewed  every  two  hours. 
Scabies. 
M.  Jullien  declared  before  the  Soci^t^  de  Dermatology 
that  he  had  successfully  treated   300   cases    of   scabies 
with  Peruvian  balsam.     This  agent  contains  an  essential 
oil,  cinnameine,  the  vapours  of  which  are  extremely  toxic 
for  acartu.    The  patient  rubs  himself  in  the  evening  for 
a  quarter  of  an  hour  with  the  Peruvian  balsam,  and  lies  all 
night  in  a  shirt  impregnated  with  the  vapour  of  the  acairi- 
cide ;  the  next  day  he  takes  a  soap  bath.     This  treatment 
is  not  more  expensive  than  the  classical  treatment,  and  is, 
moreover,  particularly  adapted  to  cases  complicated  with 
eczema  or  other  skin  affections  in  peirsons  weakened  from 
cardiac  disease,  in  pregnant  women,  and  in  infants. 
An  excellent  diuretic  in  cardiac  affections  : — 
Theobromine,  xgrs.; 
Powdered  digitalis,  i.  gr.; 
Gamphor,  ii.  g^^s.; 
Galomel,  i.  gr. 
For  one  wafer. 

Four  daily. 


[FROM  OUR  OWN  OORRBSPONDBNT.  ] 

Berlim,  April  17tb. 
At   the  meeting  of  the  Medical   Society   Hr.  Singer 
showed  a  young  woman,  aet.  18,  who  was  the  subject  of 

Port-Hrmipligig  Athetosis, 
with  marked  muscular  hypertrophy.  Some  time  before 
,  the  patient  had  jerkings  of  the  limbs,  as  she  stated, 
without  loss  of  consciousness.  The  head  and  mouth  were 
drawn  to  the  left  side,  and  both  left  extremities  were 
paralysed,  the  fingers,  later  on,  began  to  have  some  power 
of  movement.  These  statements  of  the  patient  were  not 
however,  reliable,  as  the  mother,  who  came  from  Russia, 
was  not  present  at  the  time  they  were  made.  She  was 
admitted  into  the  Jewish  Hospital.  The  patient  was  a 
well-nourished  girl,  mentally  sound,  her  left  arm  was 
persistently  held  to  the  side,  the  elbow  being  flexed. 
The  left  leg  was  flexed  inwards,  the  foot  pointed,  the  toes 
dorsally  retracted,  but  the  weight  of  the  body  was  enough 
to  flatten  the  foot  on  the  ground.  The  left  arm  could  be 
raised  to  a  right  angle.  It  was  remarkable  that  the 
flexure  of  the  left  arm  was  sometimes  absent,  and  the 
patient  could  then  voluntarily  extend  and  flex  it.  Both 
'  hand  and  foot  were  in  exaggerated  flexure ;  all  the 
muscles  of  the  forearm  were  highly  hypertrophied.     The 


426     The  Medical  Press. 


AUSTRIA^ 


April  22,  1896. 


difference  between  the  risrht  and  left  upper  arm  was  31 
ctm.,  and  between  the  forearms  1  ctm.  The  hypertrophy 
was  therefore  most  prononoced  in  the  upper  arm.  It  was 
worthy  of  note  that  the  biceps  contracted  on  ex  tending; 
the  arm.  Passing  movements  of  the  joints  of  the  hand 
were  always  painful.  In  both  left  extremities  giowch 
lengthwise  was  retarded.  The  athetosic  movements  in- 
creased with  psychical  excitement,  and  durinf^  sleep  they 
ceased  altogether.  Formerly,  the  movements  were  much 
stronger  than  at  present.  Sensibility  nearly  normal  on 
both  sides,  and  the  muscular  reactions  were  unchanged  on 
both  sides.  The  cause  was  probably  that  that  underlay 
infantile  paralysis,  either  softening,  embolism,  or  (Gowers) 
venous  thrombosis. 

Notes  oy  Morbus  Basedowii. 

In  the  Munch.  Mtd.  Woch,,  for  February  2,  1896,  Dr.  von 
Hoesslin  has  an  interesting  paper  on  this  subject.  In  a 
long  course  of  observation  of  a  case  extending  over  six 
years,  the  author  observed  a  good  ddal  that  is  either  not 
found  at  all  in  the  literature  of  the  subject,  or  only  slightly 
noticed.  His  first  observation  is  on  rhythmic  variations  in 
the  pulse  rate.  This  showed  itself  constantly  dependent 
on  the  time  of  day,  so  long  as  there  were  no  acute  attacks. 
The  morning  pulse  always  exceeded  that  of  the  evening 
at  a  constant  rate  whatever  the  latter  might  be.  A  simi- 
lar condition  was  observed  in  another  case. 

The  next  observation  is  in  relation  to  tachycardia  and 
its  course.  Besides  the  habitual  tachycardia  of  the  dis- 
ease there  are,  as  is  known,  paroxysmal  exacerbations ;  true 
tachycardial  attacks.  In  the  author's  case,  these  attacks 
came  on  oftener,  and  lasted  longer,  than  is  usual.  An 
attack  would  sometimes  come  on  suddenly,  so  that  the 
pulse  would  at  once  jump  from  130  or  120  beats  per  minute 
to  220  or  250,  and  this  rate  would  drop  as  suddenly  as  it 
came  on. 

The  third  observation  relates  to  the  variations  that 
take  place  in  the  size  of  the  heart  and  its  cavities.  As 
the  disease  became  worse  hypertrophy  of  the  heart  took 
place  with  dilatation,  and  as  the  disease  improved,  both 
the  hypertrophy  and  the  dilatation  receded. 

As  regarded  the  relation  between  the  size  of  the  struma 
ahd  the  paroxysmal  tachycardia,  it  was  constantly 
observed  that  during  .the  course  of  such  an  attack  the 
struma  diminished  in  size.  The  worse  and  more  prolonged 
the  attack  was  the  smaller  became  the  struma.  When  the 
attack  ceased,  the  struma  began  to  return  to  its  ordinary 
dimensions. 

Another  observation  was  on  leucoplasia  linguae  and  its 
dependence  on  the  severity  of  the  disease.  The  leuco- 
plasia came  on  during  the  course  of  the  disease  in  con- 
sequence of  implication  of  the  sympathetic ;  it  was  the 
more  marked  the  worse  the  disease  was,  and  improved 
when  the  tachycardia  and  the  general  condition  of  the 
patient  improved. 

As  regards  treatment  during  the  whole  of  this  lengthened 
course  of  observation,  the  author  draws  attention  to  only 
two  points,  the  treatment  of  the  tachycardiac  attacks  by 
opium  and  v^etarian  regime.  Opium  enemata— 20  to  30 
drops  of  tinct.  opii  repeated  during  an  attack  had  a 
striking  influence  on  its  course,  even  the  worst  could  be 
cut  short  by  the  opium.  Author  believes  that  the  vege- 
tarian regime  carried  out  during  three  years  had  a  great 
influence  on  the  permanent  recovery  that  took  place.  A 
meat  diet  was  not  returned  to  until  the  patient  was  able 
to  sit  up. 


At  the  Medical  Society,  Hr.  James  Israel   showed    a 
patient  on  whom  an 

Anus  Praeternaturalis 
had  been  made  on  account  of  ileus,  in  Konigsberg  i.  P., 
in  November  last.  The  patient  was  a  woman,  »t.  44.  No 
information  could  be  gained'  as  to  the  nature  and  peat  of 
the  disease.  There  was  a  tumour  in  the  pelvis  larger  than 
a  child's  head,  which  appeared  to  be  a  malignant  tumour 
proceeding  from  the  ovary.  With  the  thought  that  this 
had  become  attached  to  the  bowel,  and  thus  given  rise  to 
the  ileus,  he  opened  the  abdomen,  and  found  the  tumour 
to  be  free  from  adhesions.  On  searching  the  bowel 
below  the  artificial  opening,  he  found  a  carcinoma 
that  had  shrunk  until  the  intestine  was  little 
more  than  a  thread.  As  the  tumour  could  not 
be  drawn  into  the  median  line,  he  made  a  second  opening 
on  the  left  side,  drew  out  the  portion  of  bowel  that  was 
the  site  of  the  carcinoma,  surrounded  it  with  a  peritoneal 
margin,  and  healing  took  place  by  first  intention.  At  a 
second  operation  on  Feb.  19th,  the  loop  of  intestine  along 
with  the  carcinoma  was  excised  and  the  ends  of  the  bowel 
were  united  to  the  mesenterical  attachment.  The  patient 
now  had  two  artificial  bowel  openings,  one  on  each  side. 
At  a  third  operation  he  first  closed  the  left  opening,  free- 
ing the  b  jwel  without  opening  the  peritoneal  cavity,  and 
putting  it  in  two  rows  of  intestinal  sutures.  The  opening 
on  the  right  side  now  alone  remained,  and  this  he  closed 
at  the  beginning  of  March  with  as  much  care  as  the  other. 
The  patient  had  now  completely  recovered  after  a  number 
of  operations,  viz.,  three  laparotomies,  the  extirpation  of 
an  ovarian  tumour,  resection  of  the  carcinomatous  flexure 
and  the  closure  of  both  artificial  anal  openings. 


[IBUM  OUB  OWH   00BB18P0VDBNT.] 

VIBBRA,  April  17th,  189e. 

Lupus  of  the  Face. 

The  treatment  of  lupus  at  the  best  is  very  unsatisfactory 
notwithstanding  the  variety  of  methods  proposed  as 
curative.  Han  exhibits  two  cases  which  he  has  happily 
succeeded  in  curing  by  means  of  electrolysis.  His 
method  of  operation  was  the  application  of  two  plati- 
num needles  situated  near  each  other  into  the  lupoid 
tissue.  An  electric  current  of  ten  to  thirty  milliamperes 
was  applied  in  each  puncture  for  twenty  to  tnirty  seconds 
at  a  time.  The  procedure  is  painless,  we  are  assured,  if 
care  be  taken  to  avoid  the  healthy  tissue  in  puncturing. 
In  the  cases  reported  no  recurrence  of  the  disease  has  been 
observed 

The  form  of  treatment  promises  to  supersede  the  exci- 
sion of  diseased  tissue  and  subsequent  plastic  operations 
which  have  been  undertaken  here  with  marked  success. 
The  "  tuberculin  *'  injections  have  already  become  obsolete 
although  scarification  and  eecarotics  are  still  practised  as 
rational  treatment. 

Carcinoma  Aubis. 

Hrubesch  presented  a  man  to  the  Otological  Society, 
»t.  60,  who  appeared  in  Gruber's  Clinic  last  August  with 
the  history  of  a  discharge  from  the  left  ear  since  childhood. 
About  the  end  of  April,  left-sided  facial  paralysis  appears 
to  have  commenced,  but  no  pain  is  recorded  to  have 
occurred  till  about  the  time  of  admission.  On  examining 
the  ear  it  was  found  to  be  filled  with  polypi  in  a  gan- 


Afril  22,  1896. 


THE  OPERATING  THEATRES. 


Thi  Mbdioal  Paifiss.     427 


grenoas  condition,  bat  it  oonld  not  l>e  determined 
whether  these  had  their  origin  in  the  outer  or  middle 
ear.  The  external  appearance  of  the  mastoid  process 
was  normal,  perfectly  deaf  for  otometer  and  vocal  sound, 
while  the  <*  Weber  "  was  present  on  the  right  side. 

From  observations  taken  at  the  time  a  diagnosis  of 
otitis  media  suppurativa  chronica  was  arrived  at.  The 
radical  operation  was  undertaken  owing  to  the  sus- 
picion of  some  connection  with  the  mastoid  process  which 
was  ultimately  found  to  be  perfectly  sclerosed  with  no 
cells  in  the  antrum  at  all.  The  tympanic  cavity  was 
filled  with  firm  granulating  tissue  which  rapidly  formed 
again  before  the  external  wounds  healed  up.  By  the  end 
of  September  a  hard  infiltrated  mass  appeared  round  the 
lines  of  incision  which  confirmed  the  suspicion  of  a  malignant 
neoplasm  which  was  further  ratified  by  the  microscope. 
The  new  growth  appeared  to  have  its  origin  in  the  mucous 
membrane  of  the  middle  ear.  At  the  present  time  a  large 
ulcerated  cancerous  mass  protrades  from  the  ear  covering 
the  surrounding  tissues  Bshini  the  ear  there  is  another 
mefcastatic  growth  afifecbing  the  glands  in  the  supra* 
clavicular  space  which  are  greatly  swollen  and  hard. 

Gruber  said  that  he  suspected  carcinoma  in  this  case 
at  the  time  of  the  first  operation.  He  has  seen  three  similar 
cases  very  recently,  all  of  which  have  been  operated  on 
without  any  proof  of  carcinoma  being  present,  yet  they 
were  immediately  declared  to  be  malignant  after  the 
operation.  Analogous  cases  present  themselves  in  caries 
when  early  seen  which  often  seduce  us  into  an  operation. 
In  all  such  cases  this  contingency  hould  be  carefully 
borne  in  mind. 

AcuTB  Inplammation  of  Middlv  Ear  from  Phlbbitis. 
r  ubesch  showed  a  pathological  preparation  of  otitis 
media  acuta  without  perforation  of  the  tympanum,  where 
the  patient  died  from  pyssmia  in  consequence  of  phlebitis 
having  been  set  up  in  the  bnlbus  venae  jugularis.  This  was 
a  woman,  aet.  19,  who  came  from  the  Lying-in  Hospital  to 
Grubet's  Ambulitorium  complaining  of  pain  in  ear,  which 
was  diagnosed  as  due  to  otitis  media  acuta.  Paracen- 
tesis was  not  performed,  but  the  patient  was  enjoined  to 
return  the  following  day  for  this  purpose.  On  the  follow- 
ing day  she  was  attacked  with  high  fever,  which  seemingly 
induced  labour  that  was  normally  completed.  Pains  in  the 
joints,  malaise,  and  delirium  were  protracted  for  two  days 
more,  when  she  died.  The  post-mortem  revealed  a  pyo. 
septicsemia  from  thrombo-phlebitis  of  the  vense  jugularis 
after  an  acute  inflammation  of  the  left  middle  ear.  There 
was  also  a  metastatic  inflammation  of  the  lower  lobe  of  the 
left  lung. 

Latb  Stitching  of  Wounds. 

Gruber  is  in  favour  of  delaying|the  sewing  up  of  wounds, 
and  after  opening  up  the  mastoid  process  in  particular. 
He  points,  for  instance,  to  the  case  of  a  man,  »t.  54, 
who  was  operated  on  for  empyema  in  the  antrum.  The 
wound  was  3  centimetres  long,  IJ  broad,  and  1  deep,  con- 
taining a  large  quantity  of  pus  and  foul  matter  in  the 
cavity  of  the  process.  After  ten  days  exposure  and 
cleansing  of  the  wound,  and  the  temperature  had  gone 
down,  Gruber  drew  the  wound  together  with  eight  stitches 
endceing  a  tent,  which  was  withdrawn  in  two  or  three 
days.  The  stitches  were  removed  in  eight  days  after 
application. 

Thus,  in  twenty-eight  days  from  the  commencement  of 
the  operation  the  wound  was  quite  healed,  without  a 
single  adverse  symptom. 


Calcarkoos  Dboinsration. 
Politzer  exhibited  a  pathological  preparation  taken  from 
the  head  of  a  clergyman  who  was  very  deaf,  owing  to  a 
long-standing  discharge  from  the  middle  ear.  The  speci- 
men showed  a  hardened  calcareous  1  tympanum  greatly 
thickened.  The  mucous  membrane  of  the  middle  ear  was 
also  thick  and  hard  with  limey  deposit.  The  most  pecu- 
liar point  was  the  large  sacular  cavity  of  a  calcareous 
structure  in  the  antrum. 


GUY'S  HOSPITAL. 
AcDTB  Portal  Py-«:mia. — Mr.  Arbuthnot  Lanb  oper- 
ated on  what  seemed  to  be  an  ordinary  case  of  recurrent 
trouble  from  obstruction  of  the  cystic  duct.  The  patient, 
a  woman,  ast.  60,  had  been  subject  to  attacks  of  biliary 
colic  for  over  thirteen  years  and  these  had  recently 
increased  in  violence  and  frequency,  so  that  during  the 
last  twelve  months  she  had  about  fifty  attacks.  She  was 
under  the  care  of  Dr.  Campbell  Gowan,  of  Stanmore,  who 
said  that  the  only  thing  that  had  struck  him]  about  the 
more  recent  attacks  was  a  rise  of  temperature  in  excess 
of  that  usually  present  in  this  condition.  Mr.  Lane  was 
able  to  feel  the  gall-bladder  in  which  there  appeared  to  be 
some  stones  It  was  very  tender  on  pressure.  It  could 
not  be  felt  in  the  ordinary  recumbent  position,  but  was 
readily  discovered  when  the  patient  was  placed  in  the 
slouching  sedentary  posture  described  by  Mr.  Lane  in  the 
Lancet,  Oct.  7th,  1893.  This  method,  he  said,  originally 
suggested  to  him  by  Mr.  Parkin,  of  Hull,  had  been  on  very 
many  occasions  of  the  greatest  service  to  him  in  difierentia- 
ting  and  ilefining  tumours  in  the  abdomen.  The  patient 
was  put  under  an  anaesthetic,  a  third  of  a  grain  of  morphia 
being  given  ten  minutes  before.  This  combination  of 
morphia  amd  anaesthetic  Mr.  Lane  has  used  for  a 
long  time,  especially  in  tedious  abdominal  cases.  It 
hais  the  advantage  of  rendering  the  patient  cheerful 
and  free  from  anxiety ;  it  necessitates  the  adminis- 
tration of  a  very  small  quantity  of  the  anaesthetic, 
and  after  the  patient  is  once  under  its  influence  a  very 
small  quantity  is  required  to  continue  anaesthesia ;  the 
patient  sufiers  less  from  the  anaesthetic  sifter  the  operation, 
and  again,  what  is  a  very  important  thing  in  some  cases, 
there  is  no  struggling  as  consciousness  is  regained  and  a 
sleep  of  several  hours  follows  the  operation.  This  last 
Mr.  Lane  has  found  of  the  greatest  importance  in  cases  in 
which  he  hats  wired  or  screwed  bones  together.  Such 
patients  in  hospitals  are  very  often  alcoholic,  and  are 
particularly  liable  to  struggle  as  they  regain  conscious- 
ness, and  any  forcible  movement  may  by  chance  tear 
apart  the  fragments,  especially  if  the  broken  ends  were 
comminuted  or  fissured.  The  gall-bladder  was  exposed 
amd  was  found  to  be  matted  to  the  transverse  colon,  under 
surface  of  liver,  amd  parts  adjoining.  Its  summit  was 
cleared  and  an  opening  made  in  it.  A  quantity  of  mucus 
or  mucopus  was  evacuated  and  several  facetted  calculi, 
not  very  fiim  in  consistence.  As  there  had  been  no  history 
of  jaundice  the  common  duct  wa»  not  explored,  especially 
as  in  doing  so  there  would  have  been  much  risk  of  open- 
ing the  bowel.  A  tube  was  tied  into  the  gall-bladder. 
The  patient  is  reported  to  have  been  perfectly  comfortable 
till  10.15  on  the  next  morning,  when  she  said  she  felt  one 
of  her  attacks  coming  on.  The  stomach  became  painful 
and  tender,  especially  in  the  position  of  the  gall-bladder, 


4^8 


Thi  Midioal  Priess. 


LfeADiNG  ARfcdLES. 


April  22, 18^. 


the  palae  increased  in  rapidity  and  the  temperature  roes 
steadily  and  rapidly.  She  expressed  no  anxiety  since  she 
was  certain  the  attack  would  pass  off  as  it  usually  did  in 
a  few  hours.  Instead  of  this,  however,  she  became  drowsy 
and  delirious,  and  died  ab  4.30  on  the  following  morning, 
the  temperature  rising  from  normal  at  6  p.m.,  to 
105*2^  at  the  time  of  her  death  on  the  day  following. 
At  the  post-mortem  examination,  an  old  abscess  cavity 
containing  about  four  ounces  of  pus,  lay  behind  the  liver 
omentum,  having  the  portal  vein  in  its  anterior  wall. 
There  was  no  stone  in  it  or  in  the  common  duct,  nor  was 
there  any  obvious  cause  for  the  presence  of  this  abscess, 
which  had  existed  evidently  for  some  time.  Scattered 
through  the  liver  were  a  number  of  very  recent  hsemor- 
rhagic  infarcts.  It  was  obvious  that  this  abscess  had 
discharged  into  the  portal  circulation  a  number  of  minute 
thrombi  or  some  of  its  contents  through  a  branch  of  the 
portal  vein.  It  had  not  been  disturbed  at  the  time  of  the 
operation,  which  apparently  had  no  direct  causal  relation- 
ship with  the  fatal  termination.  How  far  her  recent 
attacks  with  rises  of  temperature  were  due  to  the  abscess 
it  is  difficult  to  say,  but  there  were  no  infarcts  other  than 
these  most  recent  ones. 

MIDDLESEX  HOSPITAL. 
Operation  for  Csphal  -  htdrogble.  —  Mr.  Bland 
SoTTON  operated  on  a  child,  et.  2,  for  the  relief  of  old 
depressed  fracture.  When  the  patient  was  three  months 
old  he  received  a  blow  on  the  head  from  a  cricket  ball,  and 
although  it  was  then  clearly  made  out  that  there  was  a 
depressed  fracture  nothing  was  done.  As  the  child  grew 
up  its  parents  noticed  that  it  was  an  idiot ;  subsequently 
it  was  taken  to  the  West  Indies,  where  proposals  were 
made  for  trephining,  but  the  parents  preferred  to  bring  it 
back  to  England.  The  boy  was  well  nourished,  but  was 
clearly  imbecile.  On  the  right  side  of  the  head  in  the 
regi'^n  of  the  parietal  eminence  there  was  a  swelling  which 
pulsated  with  respiration,  and  on  pressing  this  point  a 
depression  the  size  of  a  crown  piece  could  be  clearly  made 
out,  and  this  communicated  with  another  and  smaller 
pulsating  swelling  near  the  bregma.  The  swellings  were 
regarded  as  a  cephal-hydrooele.  There  was  marked 
atrophy  of  the  optic  discs  and  an  increase  in 
the  knee-jerks,  indicating  that  there  were  secondary 
lesions  consequent  on  the  primary  injury.  The  head 
was  carefully  shaved  and  rendered  aseptic ;  a  large  flap 
of  the  scalp  was  turned  up  so  as  to  expose  the  whole  of 
the  right  parietal  bone ;  a  large  depression,  three  inches 
long,  filled  with  fibrous  tissue  was  found  extending  hori- 
zontally across  the  parietal  bone;  beneath  the  fibrous 
tissue  was  a  collection  of  cerebro-spinal  fluid  communica- 
ting with  the  subdural  space  by  a  large  irregular  opening 
in  the  dura  mater.  The  boundaries  of  the  communicating 
space  consisted'  mainly  of  fragments  of  Obe  parietal  bone 
driven  inwards  towards  the  cranial  cavity,  the  largest 
fragment  measuring  2x3  centimetres.  After  the  removal 
of  these  fragments  of  bone  a  large  hole,  capable  of  accom- 
modating the  terminal  segment  of  the  thumb,  was  dis- 
covered in  the  cerebral  cortex.  The  adhesions  of  the 
dura  and  brain  were  carefully  detached  from  the  bone,  all 
bleeding  checked,  and  the  flaps  secured  with  sutures. 
M^  Sutton  said  it  was  recognised  among  surgeons  that 
operative  treatment  of  cephal-hydrocele  was  rarely 
required  and  he  was  dubious  as  to  its  advisability 
in  the  present  case,  especially  as  there  was  clear  evi- 
dence of  optic  atrophy  and  of  secondary  changes  ;  however, 
it' was  dear  from  a  study  of  the  case  that  active  changes 


were  in  progress  round  the  primary  lesion,  and  the  child, 
though  obviously  stupid,  displayed  unequivocal  signs  of 
pain  even  when  the  head  was  lightly  pressed  by  the  exam- 
ining finger ;  besides,  although  clearly  an  idiot,  its  move- 
ments were,  to  a  certain  extent,  purposeful,  and  as  the 
boy  had  nothing  to  lose  and,  perhaps,  much  to  gain  by  an 
examination  of  the  injured  skull,  it  was  deemed  advisable 
to  afford  him  the  chance  of  relief  by  surgery.  The  case, 
Mr.  Sutton  pointed  out,  was  an  interesting  one,  as  it 
served  to  demonstrate  that  although  a  depressed  fracture 
in  a  young  child  may  not  give  rise  to  immediate  signs, 
the  effects  of  the  pressure  are  very  liable  to  make  them- 
selves evident  by  producing  an  incurable  optic  atrophy. 

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8UB8CBIPTIONI. 
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„  ABBOAP,  WXTHIB  THB  POSTAL  UHIOB        £18    0 

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A.  A.  TiHDALL,  80-81  &ing  WllUam  Street,  Strand,  London. 
A.  H.  Jacob,  89  Molesworth  Street,  Dublin. 

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4,  Berlin. 


^ft  IPtMral  f  WS5  d^  Circular. 


*8ALU8  POPULI  SUPREMA  LEX.' 


WEDNESDAY,  APRIL  22,  1896. 


MEDICAL  ADVERTISING.-L 
Our  correspondence  columns  daring  the  last  few 
weeks  have  furnished  ample  evidence  of  a  widely- 
spread  spirit  of  dissatif  action  with  the  actual  condi- 
tions of  things  in  the  matter  of  medical  advertising, 
nor  could  it  well  be  otherwise,  for  a  regrettable  degree, 
of  laxity  in  the  interpretation  of  the  unwritten  code 
prevails  amongst  the  highest  and  the  lowest  strata  of 
medical  practitioners.  The  former  appear  to  cooside/ 
themselves  above  the  rule  and  the  others  deliberately 
set  the  rule  more  or  less  overtly  at  defiance.  Most  of 
the  correspondence  with  which  we  have  had  to  deal 
has  been  characterised  by  a  tone  of  jealous  hostility, 
but  with  one  exception  none  of  our  correspondents 


April  22,  IS96. 


LteADTNG  ARTICLE. 


Thb  Mkdioal  Press.     429 


has  attempted  to  formulate  a  scheme  by  which  the 
evils  complained  of  might  be  effectually  guarded 
against  or  repressed.  This  is  essentially  a  matter  of 
intra-professional  discipline  and  medical  men  have  it 
in  their  hands  to  a  great  extent  to  do  what  is  neces- 
sary. Whatever  course  is  decided  upon  it  must  be  one 
that  shall  be  binding  equally  on  members  of  the  pro- 
fession, irre[q)ective  of  social  status,  and  what  is 
adjudged  to  be  rank  blasphemy  in  the  soldier 
must  be  dealt  with  as  such  in  the  officer— be 
that  officer  one  of  the  censors  of  the  College  of 
Fhsrsicians  of  London.  At  the  same  time,  the  measures 
to  be  enforced  must  be  carefully  drafted  in  order  not  to 
overstep  the  limits  of  the  possible.  It  must  be  recog- 
nised that  there  is  a  tide  in  the  affairs  of  men  when, 
after  all,  the  appearance  of  the  name  in  print  in  asso- 
ciation with  this  or  that  sick  grandee  ceases  to  have 
the  advertisement  value  that  would  obtain  in  the  case 
of  a  man  still  in  the  ranks.  When  persons  socially 
eminent  are  ill,  the  public  will  insist  upon  having 
bulletins  authenticated  by  the  name  of  the  medical 
attendant,  and  it  is  undesirable,  as  well  as  useless,  to 
seek  to  prevent  the  public  curiosity  being  gratified. 
What  the  practitioner  fears,  after  all,  is  not  the  rivalry 
of  the  medical  baronets  and  court  apothecaries,  but 
the  insidious  and  illicit  self-advertisement  of  his  equals 
in  the  field  of  medical  practice,  the  varieties  of  which 
are  endless.  Then,  too,  there  are  forms  of  advertise- 
ment which  we  are  fain  to  consider  as  legitimate,  as, 
for  example,  when  a  medical  man  gives  popular 
lectures,  or  brings  himself  forward  in  connection  with 
town  councils  and  the  like.  It  is  impossible  to  repress 
these  forms  of  quasi-professional  activity,  and  we 
doubt  whether  it  would  be  to  the  advantage  of  the 
profession  or  of  the  community  to  stop  them  if  we 
could.  All  we  can  do  is  to  restrict  what  we  may  call 
methodical  advertising,  especially  in  connection  with 
commercial  undertakings.  Here,  however,  we  are  con- 
fronted with  the  difficulty  that  medical  examinations 
for  purposes  of  life  assurance  is  a  recognised  and 
honourable  department  of  medical  practice.  We  do 
not  see  our  way  to  suggesting  any  plan  by  which  such 
companies  can  be  prevented  from  advertising  their 
Medical  Officers,  whose  address  is  necessary  to  the 
insurer,  and  whose  qualifications  afford  a  guarantee  of 
their  ability  to  discharge  responsible  functions.  On 
the  other  hand,  it  is  quite  open  to  question  whether 
this  kind  of  publicity  does  a  practitioner  much  good 
outside  his  particular  rdle.  If  a  medical  man  happens 
to  be  the  medical  referee  or  inspector  of  a  company, 
there  is  no  valid  reason  why  the  fact  should  not 
be  made  public ;  yet  this  is  the  head  and  front  of  the 
offence  alleged  against  Sir  Dyce  Duckworth,  whose 
fault,  after  all,  was  less  that  he  did  this  thing 
than  ttat,  with  this  beam  in  his  eye,  he 
sought  to  condemn  a  brother  practitioner  whose 
shortcomings  differed  from  his  only  in  that  they  were 
of  vastly  lees  dimensions.  The  most  rampant  form  of 
medical  advertising  is,  without  doubt,  that  which  is 
daily  practised  in  connection  with  new  hospitals, 
special  or  otherwise,  but  unless  some  means  can  be 
brought  to  bear  to  prevent  the  first  comer  founding  a 


private  venture  concern  under  some  more  or  less 
specious  guise,  we  fear  it  is  idle  to  seek  to  stop  it.  The 
more  we  discuss  the  matter  the  more  does  it  become 
apparent  that  it  bristles  with  difficulties,  many  of  which 
apparently  defy  solution.  In  a  future  article  we  shall 
discuss  the  question  of  repression  and  prevention, 
if  only  for  the  purpose  of  emphasising  the  pitfalls 
which  surround  all  would-be  reformers. 


PAUPER  SCHOOLS  AND  DISEASE. 
It  is  seldom  that  the  report  of  a  committee,  such  as 
that  appointed  to  inquire  into  the  condition  of  the 
Metropolitan  Pauper  Schools,  has  excited  so  much 
comment  in  the  public  press.  But  there  can  be  no 
question  that  the  report  is  a  most  valuable  one  from 
many  points  of  view ;  it  has  thrown  a  lurid  light  upon 
the  system  under  which  the  '^children  of  the  State" 
have  hitherto  been  brought  up.  Perhaps,  however,  the 
moat  important  facts  to  which  attention  is  drawn  are 
those  which  relate  to  the  Barrack  Schools.  Upon  this 
subject  the  Committee  recommend ''  that  no  more  large 
schools  be  built,  that  the  existing  schools  be  not 
enlarged,  and  that  the  numbers  for  which  they  are 
at  present  certified  be  considerably  reduced," 
an  emphatic  pronouncement  which  is  especially 
worthy  of  note  in  view  of  the  circumstances 
which  led  to  the  inquiry  being  agreed  to. 
It  will  probably  be  remembered  that  the  necessity  for 
such  an  inquiry  was  brought  under  the  notice  of  the 
(Government  by  means  of  a  deputation,  introduced  by 
Mr.  Ernest  Hart.  Mr.  Hart  urged  that  granular 
ophthalmia  was  chiefly  a  pauper  disease,  practically 
created  by  the  Local  Government  Board,  in  the  Barrack 
Schools.  This  statement  was  warmly  contested  at  the 
time,  nevertheless  it  has  been  amply  confirmed  by  the 
inquiries  of  the  Committee.  For  example,  fourteen 
thousand  seven  hundred  and  ninety-seven  children 
living  under  normal  conditions  were  visited  and  pro- 
fessionally examined,  and  it  was  found  that  trachoma 
was  present  in  only  046  per  cent,  of  them  ;  on  the 
other  hand,  the  examination  of  the  children  in  the  Metro- 
politan Pauper  Schools  showed  that  from  15  to  20  per 
cent,  of  these  were  affected,  necessitating  isolation  and 
special  treatment.  Moreover,  it  was  proved  that  in 
these  great  schools  ringworm  was  often  both  prevalent 
and  persistent,  while  if  diphtheria  or  scarlet  fever  ever 
gained  admittance,  it  spread  amazingly,  owing  to  the 
-evil  system  of  massing  the  children  together,  and  of 
the  unfavourable  conditions  under  which  their  hapless 
lives  were  spent.  These  facts  in  themselves  would  be 
sufficient  to  condemn  the  Barrack  School  system,  but 
there  are  other  evils  of  which  it  is  the  source.  These 
relate  to  the  neglect  of  the  intellectual  and  moral  con- 
dition of  the  children,  concerning  which  the  Committee 
have  much  to  say  of  a  startling,  if  not  painful,  nature. 
The  Report  shows  that  there  b  an  entire  absence  of 
educational  provision  for  these  children,  and  in  those 
cases  where  it  was  provided,  it  was  perfectly  inade- 
quate ;  the  following  extract  from  the  Report  plainly 
indicates  the  position  of  affairs  in  this  regard  :  "  It  is 
impossible  without  seeing  them  to  realise  the  dulness 


430     Thk  Medical  Pbeps. 


LEADTNO  ARTICLFS. 


Apbil  22,  1896. 


of  the  lives  led  by  these  boys  and  girls,  and  the  very 
fact  that  they  have  no  employment,  no  teaching,  and 
no  interests  to  enliven  them  makes  it  additionally  im- 
portant that  they  should  be  placed  amid  wholesome 
surroundings,  or  at  any  rate,  apart  from  those 
whose  incapacity  or  misdeeds  have  brought  them 
to  dependence  on  the  rates."  Sir  John  Gorst 
and  Mrs.  S.  A.  Barnett,  two  members,  have 
added  a  special  memorandum  to  the  Eeport  em- 
bodying their  opinions  on  a  particularly  important 
point.  They  express  themselves  to  the  effect  that 
children  should  never  come  into  contact  with  the 
officials  and  methods  which  are  concerned  in  the 
repression  of  pauperism,  and  should,  therefore,  not  be 
under  a  Poor  law  authority.  They  consider  that  the 
supervision  of  the  Local  Government  Board  has  failed 
to  develop  proper  treatment  of  children,  or  to  stop 
scandals  in  the  institutions,  and  that  the  Board  might 
be  relieved  of  the  care  of  children,  which  is  foreign  to 
its  general  work.  They  recommend,  therefore,  that 
(a)  The  proposed  central  authority  for  looking  after  the 
children  should  not  be  a  Poor-law,  but  an  educational 
authority,  of  a  similar  nature  to  that  recommended  by 
the  Royal  Commission  on  Secondary  Education ; 
(6)  that  such  body  should  be  under  the  sole  super- 
vision of  the  Education  Department.  To  these  sugges- 
tions, we  believe,  full  concurrence  can  be  given,  and 
Sir  John  Gorst  has  lost  no  time  in  bringing  them  more 
prominently  forward,  inasmuch  as  he  has  incorporated 
them  in  his  Education  Bill,  which  was  recently  read 
before  the  House  of  Commons. 


THE  MIDWIFE  QUESTION  IN  LIVERPOOL. 
This  dispute  between  the  Board  of  Management  of 
the  Liverpool  Ladies'  Charity  and  Lying-in  Hospital, 
one  of  the  oldest  of  the  Liverpool  medical  charities, 
and  its  Medical  Staff  was  brought  before  the  subscribers 
on  the  15th  inst,  with  the  result  that  an  understand- 
ing was  arrived  at  that  will  permit  the  Medical  Staff 
continuing  to  hold  office.  It  will  be  remembered  that 
the  Board  of  Management  had  given  notice  of  a  pro- 
posed alteration  of  by-laws,  the  result  of  which,  if 
carried,  would  have  been  that  the  supreme  responsibi- 
lity for  the  proper  treatment  of  the  maternity  cases 
would  have  been  vested  in  the  matron  midwife,  and  the 
medical  officers  could  only  have  acted  under  her  direc- 
tion. She  would,  in  fact,  have  had  the  power  to 
prevent  the  medical  officer  entering  the  wards  at  any 
time  she  chose.  Such  a  condition  of  affairs  would 
have  rendered  it  impossible  for  a  medical  man  having 
any  sense  of  propriety  to  hold  office  any  longer  in  an 
institution  where  such  a  degrading  by-law  had  been 
passed.  This  was  felt  to  be  the  case,  and  failing  to 
move  the  Board  of  Management,  and  to  bring 
them  to  see  the  unfitness  of  the  proposed  change, 
the  staff  resigned  in  a  body.  A  meeting  of 
the  Governors  was  held  on  the  15th  as  already  stated, 
and  after  a  lengthened  discussion  in  which  a  good  deal 
of  irrevelant  matter  was  introduced,  the  following 
resolution  was  put  to  the  meeting  and  carried  :— "  That 
while  recognising  the  responsibility  of  the  Medical 
Board  through  the  Medical  Officer  on  daty  for  the 


general  supervision  of  all  medical  matters  in  connection 
with  the  hospital,  the  subscribers  regard  the  executive 
responsibility  for,  and  attendance  upon  normal  cases 
as  resting  with  the  Matron  Midwife."    The  proposer 
added  that  "  he  thought  as  common  sense  people  they 
might  accept  this  resolution  without  saying  whether  the 
Board  of  Management  or  the  Medical  Board  were 
right  in  their  interpretation  of  the  rules.''    The  resolu- 
tion was  put  to  the  meeting  and  carried  by  twenty-two 
votes  to  two.    At  first  sight,  it  is  difficult  to  see  in 
what  way  such  a  resolution  alters  matters  ;  the   pro- 
poser, evidently,  was   under  the   impression  that  it 
said    and    meant  very    little,    and  yet   the    mean- 
ing is   clear   that    no    obstacle,    not   even  that   of 
the  will     or    fancy   of   a  midwife,   can  prevent  a 
Medical   Officer    from    performing  his  duties  in   a 
conscientious   manner.     At  a  meeting  of  the  Board 
of  Management  held  later  in  the  day,  a  resolution 
explanatory  of  that  passed  at  the  meeting  of  subscribers 
was  adopted  and  forwarded  to  each  of  the  medical 
officers.     The  resolution  was  as  follows  :— ''  That  in 
the  opinion  of  the  Board  the  resolution  is  sufficient  to 
confer  upon  the  hospital  medical  officer  in  charge  the 
right  of  access  to  all  the  wards  for  the  purpose  of 
carrying  out  the  general  supervision  referred  to."    It 
was  also  decided  that  the  late  Medical  Staff  should  b  e 
invited    to    resume   their    posts    in    the    hospital 
and   districts.    It  may   also  be   mentioned  that  at 
the  meeting  of  the  Board  (on  the  7th   inst.,  a  reso 
lution  was  adopted  to  invite  the  Medical    Staff  of 
the  hospital  to  appoint  one  of  their  number  to  repre- 
sent them  at  the  Board  meetings.    There  has,  there- 
fore, been  a  climbing  down  on  the  part  of  the  Board  of 
Management  of  the  hospital,  but  we  do  not  think  il  has 
been  done    graciously    or    gracefully.     Instead   of 
recognising  the    valuable    services    of  its    medical 
staff    and    showing    gratification   at    their   evident 
desire  to  do  everything  in  their  power  for  their  poor 
patients,  the  Board  of  Management  grudgingly  grant 
them  by  resolution  a  **  right  of  access  "  to  their  patients, 
as  if  they  conceded  this  after  mature  deliberation  as  to 
whether  it  was  proper  to  do  so  or  not.    The  (Inspired  f) 
writer  of  a  leader  in  the  Liverpool  Conner  of  the  next 
day  evidently  thinks  such  ungracious  treatment  of  the 
doctors  is  good  enough.  "Will  the  Medical  Staff  of  the 
Ladies'  Charity  and  Lying-in  Hospital  be  content  with 
the  decision  reached  yesterday  at  the  special  meeting  of 
the  subscribers"  ?  he  asks,  and  goes  on  to  say  that  the 
resolution  establishes  the  right  of  free  access, ''  which 
was  never  disputed."    The  Medical  Staff  thought  this 
right  was  denied,  and  the  denial  of  the  right  as  set 
forth  in    the   resolution    proposed,  but    abandoned, 
was  the  cause  of  the  firm  stand  taken  by  them.    We 
consequently  fail  to  see  what  is  meant  by  the  asser- 
tion that  the  right  was  undisputed.    The  resolution 
passed  at  the  meeting  of  the  Liverpool  Medical  Institu- 
tion, on  the  other  hand,  shows  how  the  defeated  pro- 
ject was  looked  upon  by  the  medical  profession  gene- 
rally, and  will,  perhaps,  enable  the  Board  of  Manage- 
ment to  see  that  they  have  just  saved  themeelves  from 
a  very  awkward  predicament 


April  22,  1896. 


XOTES  ON  CUKRENT  TOPICS. 


The  Medtcal  Press.     431 


^0tc6  on  CTtttrcnt  %oipm. 

The  Midwives*  Begietration  Bill. 
A  WELL  attended  and  iDflutntial  meetiog  of  the 
profession  in  Sheffield  and  its  neighbourhood,  was  held 
at  the  Medical  School,  on  Thursday  last,  April  16th, 
Dr.  Dyson,  Senior  Physician  to  the  Sheffield  General 
Infirmary,  in  the  chair.  The  meeting  was  called  to 
consider  the  above  Bill,  and  what  steps  ought  to  be 
taken  with  regard  to  it.  A  large  number  of  the  gentle- 
men present  took  pait  in  the  discussion,  and  as  the 
outcome  of  the  meeting,  a  series  of  '^resolutions''  were 
unanimously  carried,  and  a  large  General  Committee, 
and  an  Executive  Committee  appointed  to  take  steps 
to  bring  them  to  the  notice  of  the  members  of  Parlia- 
ment for  the  city  and  'district,  and  to  as  many  other 
members  as  possible,  with  a  view  to  their  being  per- 
suaded to  take  action,  and  not  allow  any  hasty  or  ill- 
considered  legislation  to  take  place  in  connection  with 
a  question  of  such  vast  importance,  to. the  public  in 
the  first  place,  and  to  the  medical  profession  in  the 
second.  Copies  of  these  resolutions,  for  which  we  unfor- 
tunately have  not  space  in  detail,  but  which  we  give  en 
resumhyWQTe  also  to  be  circulated  as  widely  as  possible 
among  the  members  of  the  profession  in  Sheffield  and 
its  surrounding  neighbourhood.  These  resolutions  em- 
body the  leading  points  put  forward  from  the  first  by 
ourselves  and  other  opponents  of  this  Bill,  and  if  the 
profession  in  other  large  towns  would  bestir  themselves 
as  they  have  in  Sheffield,  there  would  be  little  chance 
of  this  obnoxious  measure  ever  becoming  law.  The 
objections  referred  to  in  the  resolutions  are  : — 1.  That 
the  General  Medical  Council  and  the  legalised  Medical 
Bodies  have  never  been  asked  to  institute  inquiries, 
nor  has  the  need  for  such  a  measure  on  public  grounds 
been  shown.  2.  That  every  bill  for  the  registration  of 
midwives  brought  forward  would  institute  a  new  and 
inferior  class  of  medical  practitioners.  3.  That  it 
would  consequently  be  dangerous  to  the  welfare  of  the 
public.  4.  That  the  medical  profession  is  now  open 
to  women  on  the  same  footing  as  to  men,  and  conse- 
quently they  have  the  same  opportunity  for  practising 
midwifery  as  men.  And,  lastly,  that  the  memorialists 
are  prepared  to  support  a  measure  for  the  registration 
of  midwifery  nurses  who  shall  attend  confinements  only 
under  the  control  of  qualified  medical  men  or  medical 
women,  but  never  be  entrusted  with  the  sole  charge 
and  responsibility. 


Cigarette  Smoking  among  the  Yonng. 
The  fragrant  weed  is  far  from  diminishing  in  favour. 
According  to  the  statement  of  the  Chancellor  of  the 
Exchequer,  the  net  revenue  yielded  in  the  course  of  the 
last  year  by  tobacco  in  its  various  forms  amounts  to 
more  than  ten  and  a  half  millions  of  pounds,  this  being 
£333,000  in  excess  of  the  sum  yielded  from  the  same 
source  during  the  preceding  year.  Sir  Michael  Hicks- 
Beach  believes  that  the  excess  is  mainly  due  to  an 
increase  in  the  consumption  of  cigarettes,  for  which,  as 
he  observes,  there  is  a  special,  and  it  may  be  added  a 
growing,  demand  among  the  more  youthful  members  of 


the  community.  This  is  hardly  a  matter  for  congra- 
tulation. Whatever  be  the  net  result  of  the  various 
benefits  and  disadvantages  that  attend  tobacco-smoking 
among  adults,  there  can  be  no  doubt  that  the  habit  as 
practised  by  those  of  a  more  tender  age  is  pro- 
ductive of  none  but  ill-effects.  The  great  danger 
of  smoking  in  the  young  lies  in  their  peculiar 
susceptibility  to  the  noxious  ingredients  of  tobacco 
fumes,  which  appear  to  exercise  a  baneful  influence 
over  the  development  of  mind  and  body  alike.  Even 
small  quantities  of  tobacco,  if  consumed  habitually, 
may  suffice  for  the  production  of  this  deleterious 
result.  At  our  great  public  schools  the  opportunities 
for  indulging  in  the  furtive  cigarette  are  so  few  and  far 
between,  and  discovery  involves,  as  a  rule,  such  sum- 
mary punishment,  that  no  great  evil  is  to  be  appre- 
hended from  smoking.  But  lads  of  the  lower  classes 
are  fettered  by  no  such  salutary  discipline.  There  is 
nothing  to  hinder  them  from  smoking  as  many  cigar- 
ettes as  they  can  afford  to  buy,  and  it  is  remarkable 
what  a  large  number  of  inferior  cigarettes  can  be  pur- 
chased for  a  comparatively  small  sum.  Among  these 
is  to  be  feared  that  the  habit  of  smoking  is  increasing,  to 
the  deterioration  of  mental  vigour,  and,  in  many  cases, 
to  the  hindrance  of  proper  physical  development.  The 
gain  to  the  Exchequer  is,  therefore,  not  an  uninixed 
advantage ;  indeed,  so.far  as  it  is  dependent  on  an  in- 
creased consumption  of  tobacco  by  those  who  are  of 
an  age  at  which  smoking  should  be  absolutely  pro- 
hibited, it  must  be  regarded  as  an  evil,  the  extent  of 
which  it  is  impossible  to  gauge,  but  which  it  may  be 
safely  asserted  by  far  outweighs  any  pecuniary  profit 
that  may  result  from  increased  revenue. 

The  Budget  and  the  National  Health. 
The  Budget  statement  of  the  Chancellor  of  the 
Exchequer  last  week  contained  several  interesting 
details.  The  first  had  regard  to  the  consumption  of 
tea.  It  now  appears  that  tea  is  driving  coffee  out  of 
the  market  in  this  country,  and  the  reasons  for  this  are 
unassailable.  Apparently,  therefore,  we  are  becoming 
a  nation  of  great  tea  drinkers,  ten  million  pounds  more 
tea  having  been  consumed  during  the  pasc  than  in  the 
previous  year.  This  is  certainly  a  matter  for  serious 
reflection.  Whether  the  national  health  is  likely  to 
benefit  to  the  same  extent  as  the  revenu  e  does  from  this 
enormous  indulgence  in  tea  is  undeniably  open  to 
question.  Tea  is  by  no  means  a  safe  commodity  of 
which  to  partake  indiscriminately,  and  in  this  respect 
it  is  certainly  more  harmful  than  coffee.  The  next 
point  of  importance  referred  to  in  the  Budget  was  that 
concerning  the  consumption  of  tobacco.  We  learn  that 
tobacco  was  responsible  for  a  remarkable  growth 
of  revenue,  mainly  due  to  the  ever-increasing  habit  of 
smoking  cigarettes.  In  this  connection  the  curious 
estimate  has  been  made  by  the  Customs  that  no  less 
than  £1,000,000  is  annually  thrown  into  the  gutter  in 
the  shape  of  cigar  and  cigarette  ends.  Judging,  how- 
ever, from  the  habits  of  the  waifs  and  strays,  and 
loafers,  of  the  streets  of  the  metropolis,  who  are  always 
ready  to  appropriate  the  remains  of  cigar  and  cigar 
ette  ends  cast  aside  by  smokers,  the  waste  canno  ^ 


432      The  Mbdioal  Prsss. 


NOTES  ON  CURRENT  TOPICS. 


APBIL22,  isoe. 


amount  to  very  much.  Lastly,  there  is  the  question  o^ 
the  consumptioD  of  wine,  referred  to  iu  the  Budget, 
and  here,  again,  the  figures  showed  a  remarkable 
increase  in  comparison  with  previous  years.  For 
example,  no  less  than  1,200,000  extra  bottles  of  cham- 
pagne were  drunk.  The  Chancellor  of  the  Exchequer 
appeared  to  be  disposed  to  attribute  this  increased 
consumption  to  the  London  Stock  Exchange,  whose 
members,  it  seems,  have  adopted  the  happy  custom  of 
pledging  their  congratulations  or  condolences,  arising 
out  of  their  speculations,  in  the  wine  of  the  champagne 
district.  In  reflecting  upon  all  these  facts,  however,  it 
will  be  conceded  that  the  increased  consumption  of  tea, 
tobacco,  and  wine  must,  to  a  greater  or  less  extent,  tell 
in  favour  of  or  against  the  national  health.  Upon  the 
whole,  we  should  be  disposed  to  believe  that  what  the 
revenue  gained  in  this  matter  the  national  health  lost, 
that  is  to  say,  that  while  there  was  an  increase  in  the 
one,  there  was  a  diminution  in  the  other. 

Medical  Aid  Societies  Abroad, 
The  tendency  to  cut  down  medical  fees  and  destroy 
the  independence  of  members  of  the  medical  profession 
by  making  them  assistants  in  medical  aid  societies  is 
not  confined  to  the  United  Kingdom.  From  an  adver- 
tisement in  a  Spanish  medical  journal  we  read  that  a 
Medico-Surgical  Service  has  been  established  in 
Madrid,  and  is  being  run  as  a  business  concern.  But 
though  conducted  in  Spain  there  is  a  flavour  of  the 
Connecticut  Yankee  in  the  advertisements  which  tell 
of  the  land  of  its  birth,  thus :  these  **  Services 
quite  new  in  Spain  and  in  Europe."  The 
staff  we  are  told  is  so  numerous  that  each 
Professor  is  strictly  confined  to  his  specialty. 
At  the  central  establishment,  a  specialist  of  standing 
in  his  profession  is  obtainable  for  visiting  at  any  hour 
of  the  day  or  night,  or  to  be  consulted  by  telephone. 
A  coach  awaits  his  orders  at  all  hours,  so  that  within  a 
few  minutes  of  being  summoned  he  is  at  the  patients 
bedside.  Electric  apparatus,  vapourisers,  inhalers, 
pulverisers,  and  all  the  instruments  known  to  medicine, 
are  kept  in  readiness.  The  customer  is  further  catered 
for  by  an  assortment  of  allopaths,  homoeopaths,  and 
dosimetric  practitioners.  Accoucheurs  and  certified 
midwives  are  also  kept  in  stock— the  mid- 
wife is  particularly  stated  to  have  a  Spanish 
certificate.  In  addition  to  the  numerous  specialists  on 
hand,  the  firm  keeps  four  supernumerary  physi- 
cians. The  most  flourishing  department  appears 
to  be  the  <' Odontological,''  in  which  the  pres- 
sure of  business  has  been  so  great  that  more 
hands  have  had  to  be  engaged  and  a  North-American 
dentist  is  added  to  the  staff.  The  Manchester  motto 
"Quick  Ketums  and  Small  Profits'*  is  that  of  the 
firm  ;  the  following  is  the  tariff:— First  visit  to  the 
patient's  house,  5  pesetas,  (44d.) ;  Each  succe^|ve 
visit,  2-5  peseta  (2Jd.) ;  A  night  visit,  10  pesetas  (9d.)  ; 
Consultation  with  the  staff  of  the  firm,  10  pesetas ; 
midwifery  fee  for  day  case,  20  pesetas  ;  midwifery  fee 
for  night  case,  40  pesetas ;  instrumental  midwifery  as 
may  be  agreed  upon.  Advice  in  the  firm,  from  morn- 
ing until  2  p.m.,  5  pesetrs  ;  from  2  p.m.,  to  6  p.m.,  10 


pesetas.  Dentistry  is  not  expensive— a  complete  set 
being  provided  for  100  pesetas.  Extractions  are  done 
without  pain  by  anaesthesia,  the  patient  being  free  to 
choose  chloroform,  ether,  nitrous-oxide,  cocaine,  chloride 
of  ethyl  and  so  forth.    Comment  is  unnecessary. 


A  Jenner  Society. 
Up  to  the  present  the  anti-vaccinationists  have  had  it 
all  their  own  way— that  is  to  say,  when  they  have  held 
meeting  after  meeting  in  the  various  villages  and 
towns  throughout  the  country,  no  one  has  raised  a 
voice  for  the  purpose  of  stemming  the  torrent  of  their 
garrulity,  and  of  enabling  their  deluded  victims  to 
reconsider  their  position.  But  there  is  now,  we  are 
happy  to  say,  a  chance  of  some  improvement  in  this 
respect.  A  society  has  been  formed  in  Gloucester 
called  ''  The  Jenner  Society,"  which  owes  its  initiation 
to  Dr.  Bond,  of  that  city,  who  has  undertaken  the 
duties  of  honorary  secretary.  The  laudable  objects  of 
the  society  will  be  to  check  the  dissemination  of  un- 
true statements  with  regard  to  vaccination,  and  to  the 
great  harm  which  is  apt  to  result  from  such  statements 
being  received  with  credence.  In  brief,  the  Jenner 
Society  will  combat  the  mischievous  work  of  the  Anti- 
vaccination  Society.  It  is  fitting,  in  some  sense,  that 
this  movement  should  have  been  started  in  the  centen- 
ary year  of  the  discovery  of  vaccination.  But,  on  the 
other  hand,  it  would  have  been  better  had  some  steps 
of  the  kind  been  taken  several  years  ago,  when  it  first 
became  evident  that  the  anti-vaccination  party 
were  beginning  successfully  to  disseminate  their 
pernicious  teaching.  No  doubt,  much  of  the  suc- 
cess of  the  anti-vaccinationists  has  been  due  to  the 
fact  that  within  recent  years,  owing  to  the  bene- 
ficent effect  of  vaccination,  small-pox  has  been 
robbed  of  most  of  its  horrors.  In  some  degree,  then, 
doubtless  many  persons  have  become  anti-vaccina- 
tionists upon  the  grounds  that  there  was  but  little  to 
fear  from  small-pox  because  it  was  seldom  met  with, 
and  that  under  these  circumstances  vaccination  was 
unnecessary.  Such  persons,  however,  living  in 
Gloucester,  have  had  a  rude  awakening  from  their 
condition  of  fatuous  lethargy,  and  it  may  be  trusted 
that  the  lesson  which  has  been  taught  them  will  not 
be  lost  upon  others  who  have  had  the  temerity  to  share 
their  opinions.  There  are  some  people  who  will  only  be 
taught  in  the  severe  school  of  experience,  and  among 
them  are  those  who  prate  about  the  uselessness  of 
vaccination.  Probably  more  by  good  luck  than  good 
management  the  unvaccinated  town  of  Leicester  has 
so  far  escaped  an  epidemic  of  small-pox.  But  were  an 
epidemic  to  occur  in  this  hitherto  favoured  town,  as 
one  day  may  be  the  case,  the  irresponsible  agitators 
who  have  converted  the  deluded  inhabitants  of  towns 
and  country  villages  into  anti-vaccinationists  will  have 
an  opportunity  of  gracefully  retiring  from  the  notorious 
position  into  which  they  have  thrust  themselves. 

The  Secretary  for  Scotland  has  appointed  Dr. 
Charles  Macpherson  to  be  a  Deputy  Commissioner 
in  Luqacy  for  Scotland,  vice  Dr.  Robert  I^iwson,  de- 
oease4 


April  22,  1896. 


NOTES  ON  CURRENT  TOPICS 


Thb  Mkdioal  Pbb88.     433 


Torture-Mongers. 
It  would  be  well  for  Miae  Frances  Power  Cobbe,  and 
others  of  her  persuasion,  to  divert  their  attention  from 
the  medical  profession,  which  they  accuse  of  all  kinds 
of  vivisecting  barbarity,  to  the  trainers  of  performing 
animals,  upon  which  terrible  tortures  are  in  some 
cases  undoubtedly  inflicted.  An  article  on  the  subject 
by  a  Mr.  S.  J.  Bensusan,  has  lately  appeared  in  the 
'*  English  Llustrated  Magazine/'  The  writer  states 
that  most  of  the  poor  brutes  in  question  are  trained  on 
the  Continent,  where  the  average  treatment  of  the 
brute  creation  is  notoriously  bad.  Trainers  and 
purchasers  of  monkeys  and  elephants  are  obliged,  so  it 
seems,  to  be  cautious,  as  those  animals  soon  die 
under  ill-treatment.  Dogs  are  blessed  with  most 
endurance,  and  accordingly  fall  in  for  the  greater 
part  of  the  cruelty.  Mr.  Bensusan  gives  a  number  of 
specific  instances  in  support  of  his  statements.  In  one 
passage  he  remarks  that  *'  many  an  animal  goes  through 
its  performance  in  a  state  bordering  upon  the  insane, 
with  such  an  obvious  terror  of  doing  the  wrong  thing 
that  it  is  really  surprising  how  an  intelligent  audience 
can  avoid  seeing  the  true  state  of  things."  Quite  so, 
any  amount  of  cruelty  to  dumb  animals  is  blinked  at 
by  the  antivivisectors  if  it  be  done  for  the  amusement 
of  mankind.  Pigeons  may  be  shot  out  of  traps,  tame 
deer  hunted  to  death,  dogs  tortured  into  acrobatic 
feats,  and  who  shall  say  them  nay  ?  Further,  how 
much  do  the  antivivisectors  concern  themselves  with 
the  sum  and  mass  of  human  suffering  at  their  gates  P 
It  would,  we  imagine,  furnish  some  instructive  reading 
were  it  possible  to  inspect  the  private  charity  lists  of 
some  of  the  leading  opponents  of  the  scientific  practice 
of  vivisection. 


Mrs.  Longshore  Potts. 
Some  two  years  since  a  lecturing  woman  of  this 
name,  who  signed  herself  M.D.,  and  professed  to  be  a 
Doctor  of  Medicine  of  an  American  University,  made 
a  tour  throughout  England  and  Ireland.  Some  of  her 
prelections  were  devoted  to  sexual  subjects,  and  were 
interlarded  with  all  the  prurient  suggestions  which  are 
the  stock-in-trade  of  such  lecturers.  Unfortunately, 
the  number  of  newspapers  whose  proprietors  can  with- 
stand the  temptation  of  making  money  out  of  adver- 
tisers—no matter  what  their  aims  and  pretensions— is 
terribly  small,  and  so  pretenders  of  this  class  are 
helped,  rather  than  opposed,  in  their  designs.  For  the 
honour  of  The  Press,  let  it  be  said  there  are  a  few 
exceptions,  and  Mrs.  Longshore  Potts  has  been  made 
to  feel  the  power  of  its  censorship,  and  has  been  de- 
nounced, not  only  by  the  Medical  Pbess  and  Cir- 
CULAB,  but  by  one  of  the  leading  Dublin  newspapers 
against  which  she  threatened  actions  for  damages.  In 
the  course  of  her  itinerancy,  she  reached  Belfast,  where 
she  applied  for  the  use  of  the  Town  Hall  for  her  lec- 
tures. The  proposal  to  grant  her  the  building  was 
resisted  by  one  of  the  Councillors,  Mr.  Curley,  a  draper, 
who  expressed  his  opinion  of  her  proceedings  pretty 
freely.  For  this  he  was  served  with  a  writ  for  damages, 
but,  like  the  previous  suite,  it  was  never  proceeded 
with,  and  we  note  that  it  has  now,  on  the  application 


of  Mr.  Curley,  been  dismissed  for  want  of  a  prose- 
cutor. 

A  Pioneer  in  Scientific  Education. 
The  development  of  scientific  teaching  in  our  pnbli® 
schools  has  been  so  rapid  that  one  is  apt  to  forget  tha 
its  introduction  is  of  comparatively  recent  date.  The 
death  of  Dr.  William  Sharp,  of  Eugby,  who  has  jmt 
died  in  his  ninety- first  year  at  Llandudno,  has  reminded 
the  world  of  the  youthfulness  of  the  natural  science 
curriculum.  Dr.  Sharp  settled  originally  in  Bradford* 
where  he  succeeded  his  father  and  became  senior  phys*" 
ician  to  the  Infirmary  in  1837.  He  afterwards  removed 
to  Rugby,  and  persuaded  Dr.  Tait  to  introduce  natural 
science  into  the  Rugby  teaching.  This  was  eventually 
done,  on  condition  that  Dr.  Sharp  would  become  the 
first  teacher,  under  the  title  of  "  Reader  in  Natural 
Philosophy."  Dr.  Sharp  came  of  a  North  Country  stock 
which  had  been  famous  for  its  scientific  attainments, 
and  Dr.  Sharp  himself  was  made  Fellow  of  the  Royal 
Society  in  1840.  His  Degree  of  Medicine  was  that  of 
Lambeth,  formerly  in  the  episcopal  gift,  but  now  in 
abeyance.  With  regard  to  the  public  school  science 
appointment,  the  late  Tom  Hughes  observed,  "  If 
Tait  had  done  nothing  else  at  Rugby  than  appointing 
Sharp,  not  without  difficulty,  as  Reader  in  Natural 
Philosophy,  he  would  have  deserved  the  gratitude  of 
every  Rugby  man." 

What  is  Swine  Fever? 
The  answer  to  the  question  *'  What  is  swine  fever  ? " 
is  one  which  the  Board  of  Agriculture  have  by  no 
means  answered  in  their  recent  report.  How  is  it  that 
the  bacteriology  of  this  infective  disease  has  not  been 
worked  out  ?  and,  why  is  it  that  the  travelling  inspec- 
tors appointed  to  investigate  the  various  outbreaks 
are  not  professional  men.  So  far  as  the  latter  ques- 
tion is  concerned  what  can  young  farm  students  know 
of  such  an  abstruse  matter  as  swine  fever,  and  yet  in  the 
majority  of  instances  the  travelling  inspectors  are 
young  men  of  this  class.  Until  the  etiology  and 
pathology  of  the  disease  has  been  thoroughly  worked 
out  it  would  be  much  more  expedient  to  place  the 
duty  of  investigating  its  outbreaks  in  the  hands  of 
those  who  are  accustomed  to  such  inquiries.  The 
report  says  that,  *^  the  bacillus  of  swine  fever  is  not 
sharply  distinguished  by  its  form,  size,  or  staining 
reaction  from  many  other  organisms  (harmless  or 
pathogenic)."  If  this  is  all  that  the  united  intelligence 
of  the  Board  of  Agriculture  can  say  upon  this  subject 
the  sooner  that  they  seek  elsewhere  for  enlightenment 
the  better.  Judging  from  *'  this  report  of  the  Depart- 
mental Committee  appointed  by  the  Board  to  inquire 
into  the  etiology,  pathology,  and  morbid  anatomy  (nc) 
of  swine  fever,'*  the  matter  will  remain  in  its  present 
chaotic  condition  until  doomsday. 


At  the  Gloucester  Quarter  Sessions,  held  last  week, 
the  grand  jury  referred  to  the  small-pox  epidemic  in 
the  town,  and  passed  a  resolution  requesting  Her 
Majesty's  ministers  to  take  the  Yacciuation  Acts  into 
their  serious  consideration. 


434     The  Mkdioal  Vkk^s. 


NOTES  ON  CURRENT  TOPICS. 


Af£il22,  1896. 


Adulteration  of  Butter  and  Milk. 
Thebe  can  be  no  doubt  that  the  inhabitants  of  the 
British  Islands  are  defrauded  annually  of  vast  sums  by 
food  adulterators.  It  is  therefore  somewhat  reassuring 
to  note  that  the  authorities  seem  to  be  bestirrinK 
themselves  in  the  protection  of  the  public  as  regards 
those  staple  articles  of  consumption,  butter  and  milk. 
Last  week,  two  most  salutary  prosecutions  were 
reported  in  London.  One  was  that  of  a  man  who 
traded  as  the  Danish  Dairy  Company,  but  whose 
"fresh  dairy  butter/'  although  guaranteed  absolutely 
pure,  was  shown  on  analysis  to  contain  from  75  to  80 
per  cent,  of  foreign  matter.  Defendant  was  fined  in 
two  sums  of  £10,  with  £5  and  £2  48.  6d.  costs.  In  the 
second  case  a  justice  of  the  peace  for  Wiltshire, 
trading  as  the  Frome  Dairy  Company,  was  con- 
victed of  selling  milk  from  which  20  per  cent,  of 
butter  fat  or  cream  had  been  abstracted,  and  7  per 
cent,  of  water  added.  The  fine  of  £10  in  this  case 
might  very  well  be  largely  increased,  as  the  sum  is  a 
trifling  one  to  a  man  who  is  selling  large  quantities  of 
diluted  skim  milk  as  fresh  milk.  The  authorities  have 
wisely  turned  their  attention  to  the  source  of  the 
milk  supply,  and,  as  in  this  case,  are  prosecuting  the 
middlemen  who  are  sending  the  milk  into  London. 
The  defendant  set  up  the  plea  that  he  merely  collected 
the  milk  and  sent  it  on  from  the  country  exactly  as  it 
had  been  delivered  to  him  by  the  farmers. 

The  Plumbers'  Registration  Bill. 
This  Bill  has  again  been  shelved  for  the  present 
session.  The  Government,  represented  by  Mr.  Hanbury, 
was  not  disposed  to  afford  the  Bill  any  facilities,  and 
moved  the  adjournment  of  the  House,  which  was  carried, 
and  the  Bill  was  accordingly  left  to  the  mercy  of  any 
blocker  who  pleases  to  stop  it.  We  do  not  regret  the 
result,  because  we  have  always  held  the  opinion  that  the 
measure  is  only  a  veiled  expedient  for  securing  a  mono- 
poly of  certain  work  for  a  special  class  of  plumbers.  It 
is,  of  course,  desirable  to  secure  that  a  water,  gas,  or 
sewer-pipe  shall  be  properly  repaired,  but  if  the  public 
is  not  to  be  trusted  to  take  care  of  itself  in  this  matter* 
we  do  not  see  where  the  grandmotherly  legislation  is 
to  stop.  Would  it  not  be  as  reasonable  to  enact  that 
every  horse-shoer  should  be  registered  lest  damage 
might  be  done  by  incompetent  blacksmiths,  or  that 
bricklayers  should  have  an  Act  of  Parliament  and  an 
official  record  of  their  own  lest  they  might  endanger 
the  life  of  the  citizen  by  building  a  crooked  wall  ?  The 
registration  hobby  is  being  done  to  death,  and  needs  to 
be  checked. 


Gun  Shot  Wounds. 
Dr.  D.  Carlos  Govea,  writing  in  the  Boletin  de 
Medidna  y  Cirugia^  gives  his  experience  of  the 
injuries  resulting  from  modern  gun-shot  wounds,  and 
as  he  is  resident  in  the  province  of  Tamanlipas,  Mexico, 
his  practice  in  such  cases  is  considerable.  His  rule  is 
to  give  chloroform,  and  carefully  examine  the  wound. 
Contrary  to  the  generally  received  idea,  he  finds  that 
the  modem  bullet  splits  and  splinters  the  wound.  He 
quotes     the     case     of    one    Dem^trio     Cruz,     in 


whom  a  bullet  comminuted  the  right  tibia  and 
fibula.  The  patient  did  not  come  under  notice 
until  six  hours  after  the  injury,  when  phleg- 
monous erysipelas  had  already  commenced.  In 
consultation  with  a  military  surgeon  it  was  deemed 
necessary  to  amputate  the  leg.  Whether  from  the 
insanitary  surroundings  or  the  mode  of  life  of  his 
patients,  he  finds  that  it  is  almost  useless  to  attempt 
to  save  a  limb  the  principal  bone  of  which  has  been 
comminuted.  In  some  of  the  cases,  as  in  Erichsen's, 
the  spicula  of  bone  remain  in  position  for  days  and 
then  becomes  loosened :  he  quotes  the  case  of  Maria 
Acuna,  in  whom,  ten  days  after  the  injury  a  spicula  of 
bone  became  detached  from  the  humerus,  wounded 
the  brachial  artery,  and  necessitated  the  vessel  being 
tied  near  its  origin.  In  this,  however,  efforts  to  save 
the  limb  were  crowned  with  success.  All  the  injuries 
were  treated  antiseptically. 

The  Mutilations  of  Soldiers  in  War. 
The  adverse  results  of  fighting  the  natives  in  Africa 
have  rendered  it  necessary  for  the  Italians  to  take  a 
somewhat  remarkable  step.  The  General  commanding 
the  Italian  troops  has  just  communicated  with  the 
home  authorities  to  the  effect  that  he  will  require  a 
large  number  of  artificial  limbs  for  his  mutilated  men. 
Accordingly,  three  experienced  mechanics  will  be  sent 
out  from  Italy  to  Massowah  for  the  purpose  of  apply> 
ing  artificial  legs  to  the  soldiers  and  friendly  natives 
who  have  undergone  amputation  of  their  lower 
extremities  during  the  war.  A  hundred  artificial  legs 
have  already  been  forwarded  to  Africa.  It  would 
appear  that  the  wounds  which  rendered  the  amputa- 
tions necessary  were,  in  the  majority  of  instances,  not 
received  in  the  ordinary  course  of  fighting,  but  were 
the  result  of  deliberate  mutilation  perpetrated  upon 
wounded  men  by  the  victorious  barbarians.  It  were 
well  to  bear  this  fact  in  mind  before  drawing  any  con- 
clusions as  to  the  predominance  of  the  mutilations 
which  occurred  among  the  wounded. 


Hydrophobia. 
A  LADY  residing  in  the  County  Limerick — Shaving 
seen  our  observations  on  this  subject— writes  to  inform 
us  that  she  possesses  a  remedy  for  hydrophobia,  which 
if  taken  within  nine  days,  prevents  or  cures  rabies  in 
the  human  subject.  The  evidence  presented  of  this 
fact  is  that  "  the  cure  was  given  to  a  gentleman  who 
was  badly  bitten  by  a  mad  dog  and  lived  until  he  was 
90  years  of  age  afterwards  without  showing  any  signs 
of  rabies.'*  This  proof  is,  no  doubt,  perfectly  conclu- 
sive to  the  mind  of  the  lady,  and  we  recommend  those 
who  are  bitten  to  use  the  cure  if  they  feel  so 
disposed,  but  by  no  means  in  substitution  for  the 
Pasteur  and  other  methods  of  treatment.  We 
do  so  because  we  are  aware  that  this  estimable  lady 
sells  the  cure  for  half-a-crown  a  dose,  and  applies  the 
proceeds  to  charity,  and  we  should  be  well  pleased  to 
see  every  bitten  patient  in  Ireland  assist  her  with  a 
contribution  of  2s.  6d.  Her  cure  would  do  no  harm, 
and  the  half-crown  would  do  good. 


Aphil  22,  1896. 


SCOTLAND. 


Tub  Midioal  Pbbss.     435 


A  Warning  from  Sonth  Australia. 
We  have  received  from  Mr.  Victor  Horaley,  Presi- 
dent of  the  Medical  Defence  Union,  a  copy  of  a  tele- 
gram which  he  received  on  April  15tb|  1896,  from  Dr. 
Lendon,  of  Adelaide,  stating  that  all  the  honorary 
medical  staff  of  the  General  Hospital,  Adelaide,  had 
resigned  under  protest  against  certain  proposals  of  the 
Government,  and  that  the  Government,  in  order  to 
fill  up  the  vacancies,  had  intimated  that  they  would 
import  other  practitioners  and  pay  them  for  their 
services.  Thus  it  would  appear  that  the  South 
Australian  Government,  finding  themselves  in  a  diffi- 
culty, have  decided  to  attract  more  medical  men  to 
the  colony  by  offering  them  a  paid  hospital  appoint- 
ment, despite  the  fact  that  the  honorary  staff,  who 
have  resigned  under  protest,  have  presumably  had  good 
reasons  for  their  action.  No  definite  information  has 
as  yet  reached  this  country  respecting  the  precise  con- 
ditions of  the  difficulty  which  has  arisen,  but  Mr. 
Horsley  has  promised  to  forward  to  us  the  facts  in 
connection  therewith  as  soon  as  they  reach  him.  Mean- 
while it  is  evident  that  no  medical  practitioner  should 
accept  any  appointment  at  the  Adelaide  Hospital  that 
may  be  offered  him  by  the  South  Australian  Govern- 
ment in  the  absence  of  further  information,  which  has 
been  promised.  The  following  is  the  list  of  the 
medical  staff  of  the  Hospital  in  question  :— Consulting 
Physicians  and  Surgeons  :  Drs.  G.  Mayo,  H.  T.  Whit- 
tell,  J.  Philips,  R.  T.  Wylde,  W.  T.  Clindening. 
Physicians ;  Drs.  J.  C.  Verco,  W.  T.  Hayward,  A.  A. 
Lendon.  Assistant  Physicians  :  Drs.  A.  A.  Hamilton, 
J.  Sprod,  H.  Swift.  Surgeons  :  Messrs.  E.  0.  Stirling, 
B.  Poulton,  W.  A.  Giles.  Assistant  Surgeons  :  Messrs. 
M.  A.  Jay,  R.  H.  Marten,  C.  E.  Todd.  Obstetrician  : 
Dr.  G.  W.  Way.  Ophchalmic  Surgeon  :  Mr.  M.  J. 
Symons.  Throat  Department :  Dr.  T.  K.  Hamilton. 
Skin  Department :  Dr.  Verco.  Ear  Department :  Mr. 
Giles.    Dentist :  Mr.  H.  Davies. 

The  Coming  Elections  at  the  Royal  College 
of  Surgeons  in  Ireland. 

The  approach  of  the  first  Monday  in  June,  when, 
according  to  Charter,  the  Council  and  officers  of  the 
College  are  elected,  is  creating  interest  in  the*occa- 
sion.  Sir  Thornley  Stoker  vacates  the  presidential 
chair  after  his  two  years  of  occupancy,  and  he  will  be 
succeeded  by  Mr.  William  Thomson,  of  the  Richmond 
Hospital,  the  newly-chosen  Direct  Representative  of 
the  profession  in  the  General  Medical  Council.  It  had 
been  understood  that  Mr.  R.  L.  Swan  would  have 
sought  the  vice-presidency  in  room  of  Mr.  Thomson, 
but  he  has  just  announced  that  he  will  withhold  his 
candidature  in  favour  of  that  of  Mr.  Kendal  Franks  of 
the  Adelaide  Hospital. 

Tho  annual  election  of  Examiners  is  announced  to 
take  place  on  the  5th  of  May.  It  is  not  as  yet 
known  who  the  competitors  will  be,  except  that  it  is 
assumed  that  almost  all  the  outgoing  examiners  will 
offer  themselves  for  re-election.  Professor  Eraser,  the 
chief  of  the  anatomical  department  in  the  College  has 
intimated  that  he  will  seek  an  examinership  in  that 
Bubject    Mr.  William  Stoker  has  resigned  his  office  as 


Councillor  in  order  that  he  may  seek  an  Examinership 
in  Surgery  or  Anatomy,  and,  upon  a  requbition  pre- 
sented to  them  by  six  Fellows,  in  accordance  with  the 
Charter,  the  President  and  Vice-President  have  ordered 
the  election  of  a  Councillor  in  Mr.  Stoker's  place.  We 
understand  that  Mr.  Cranny,  Gynaecologist  to  Jarvis 
Street  Hospital,  will  be  a  candidate. 

Adulterated  Linseed  MeaJ. 
A  Belfast  druggist,  having  been  fined  for  selling 
what  he  called  linseed  meal  adulterated  with  30  per 
cent,  of  starch,  appealed  to  the  higher  Court,  and  urged 
that  the  meal  which  he  sold  was  for  cattle  food,  and 
therefore,  not  liable  to  the  adulteration  law.  The 
Judge,  however,  said  that  from  the  small  quantity  sold 
and  other  circumstances,  he  thought  that  the  meal  had 
been  sold  for  medical  purposes,  and  he  therefore  con- 
firmed the  conviction. 

The  Qoeen  has  signified  her  intention  of  subscribing 
one  hundred  guineas  to  the  Fund  now  being  raised  fer 
the  re  endowment  of  Guy's  Hospital.  The  total 
amount  of  donations  will  be  announced  by  the  Prince 
of  Wales,  on  the  occasion  of  the  dinner  at  which  he 
will  preside  at  the  Imperial  Institute  on  June  10th. 


H.R  H.  The  Prince  of  Wales  will,  we  understand, 
present  Mr.  Hy.  C.  Burdett  with  an  address  and  album 
on  behalf  of  the  Council  of  the  Metropolitan  Hospital 
Sunday  Fund,  at  a  luncheon  given  in  the  Mansion 
House  in  June  next,  in  recognition  of  his  exertions  on 
behalf  of  and  interest  in  the  Hospital  Sunday  Move- 
ment for  years. 


[fSOM  OUB  OWN  COBBBSPONDINT.] 

Edinburgh  Univbbsity  Finances.  —  The  Business 
Committee  of  the  Goneral  Coancil  of  the  University  of 
Edinburgh,  in  their  report  to  the  half-yearly  meeting  to  be 
held  this  week,  tells  the  old  story  of  the  declining  number 
of  students  and  the  excessive  drain  on  the  University 
resources  by  reason  of  the  recently  instituted  laboratory 
and  extra-class  work.  The  £20,000  gifted  by  the  trustees 
of  the  late  Earl  of  Moray  to  the  University  aa  a  fund  for 
the  promotion  of  original  research,  is  received  in  rather 
a  cavilling  spirit,  the  Committee  saying  that  it  is  not 
nearly  enough  by  itself  to  serve  any  adequate  purpose, 
and  proposing  that  the  Royal  Colleges  might  unite  with 
the  University  for  this  object.  The  Colleffes  are  not  very 
likely  to  respond  this  offer  in  view  of  the  treatment 
generally  meted  out  to  them  by  the  University  Authori- 
ties. 

Glasgow  Tschnigal  Collegf.  Csntsnart.— A  meet- 
ting  of  the  Governors  of  the  Glasgow  and  West  of 
Scotland  Technical  College  was  held  on  the  I5th  inst., 
when  it  was  decided  to  postpone  till  October  the  celebration 
of  the  centenary  of  the  College,  which  was  founded  by  Pro- 
fessor Anderson  one  hnndrMl  years  ago,  in  order  that  it 
might  not  interfere  with  the  entertainments  which  are 
to  take  place  in  June  in  connection  with  Lord  Kelvin's 
jubilee  celebration.  The  present  Technical  College  is  the 
building  formerly  known  as  Anderson's  College  Medical 
School,  which  latter  migrated  westward  some  time  agr, 
as  it  was  thought  that  the  school  would  not  only  be  better 
placed,  but  would  increase  in  popularity.  This,  indeed, 
has  resulted  in  a  certain  sense,  but  not  to  the  extent  it 
was  hoped.  The  teachers  at  this  institution  cannot  be 
surpassed  in  certain  branches,  but,  unfortunately,  even 


4^6     Turn  Mbdioal  Pribs. 


C0RRB6P0NDENCK 


AraiL  22,  ISfte. 


although  the  lectures  entitle  her  stadente  to  qaalify  in  the 
University,  yet  it  is  a  notorious  fact  that  unless  a  student 
attends  certain  classes  in  the  University  he  would  have  a 
bad  quarter  of  an  hour  when  he  presented  himself  for 
examination.  Professor  Wenley,  who  has  recently  been 
appointed  Professor  of  Philosophy  in  the  University  of 
Michigan,  said,  at  a  complimenUry  dinner  a  few  evenmgs 
ago,  that  Glasgow  University  went  outside  for  its  professor^ 
bat  that  she  had  students  who  were  quite  competent  to 
become  profeesors.  No  doubt  the  statement  is  correct,  but 
in  the  medical  department,  at  least,  teachers  or  profesrors 
appointed  from  former  students  are  too  narrow-minded 
and  jealous  of  other  schools  of  the  same  kind ;  con- 
sequently all  those  who  attend  extramural  schools,  unless 
they  also  take  certain  classes  in  the  University,  stand  a 
very  poor  chance  [of  obtaining  the  degree.  This  is  not  as 
it  should  be. 

Th«  Rowdtish  of  Glasgow  University  Medical 
Students.— We  are  sorry  to  have  to  remark  upon  the  un- 
mistakable rowdy^behaviour  of  the  students  at  the  recent 
graduation  ceremony  ;  in  fact,  it  is  safe  to  say  that  never 
on  any  previous  occasion  have  they  behaved  so  out- 
rageously. It  may  have  been  their  own  little  way  of 
showing  their  pleasure  when  certain  candidates  were  pre- 
sented, but,  all  the  same,  the  din,  the  noise,  and  racket 
prevented  scarcely  a  word  being  heard ;  consequently, 
the  whole  ceremony  appeared  as  a  dumb  show.  Principal 
Gaird  was  unfortanately  (through  ill-health)  unable  to 
officiate,  Lord  Kelvin  acting  in  his  stead,  and  this  may 
have  been  one  reason  why  they  surpassed  themselves  in 
their  rowdyism. 


dorrtBponbjeitce. 


fWs  do  not  hold  ooiaelTM  rwpoDBible  for  the  opinions  of  ooi 
— Mpondmita.] 


jealousies.  The  right  path  of  individual  conduct  is  suely 
plain  enough  ;  whilst  in  matters  of  medical  policy  afifect- 
ing  the  relations  being  one  medical  man  and  another,  we 
should,  perhaps,  do  well,  until  debated  points  can  be 
settled  in  medical  conference,  to  show  in  the  presence  of 
the  outside  world  a  reasonable  measure  of  self-control  and 
toleration. 

I  am,  Sir,  yours,  &g., 

MaoSplint. 

Edinburgh,  April  16th,  1896. 

COCAINE    ANiESTHBTISATION. 

To  the  Editor  of  the  Midioal  Prbs  and  Oiboui.ab. 

giB,_Your  contemporaries  for  some  time  past  have 

noticed  the  value  of  painting  the  mucous  membrane  of 

the  nose  with  a  solution  of  cocaine  to  prevent  syncope 

during  aniesthetisation,  and  it  of  course  appears  as  a  new 

idea.  ,     , .  ,      .      ^ 

Turning  over  some  old  medical  joumalB  a  few  days  since 
I  came  on  the  following  in  La  Medieina  Cierhfica^  a 
Mexican  journal,  under  date  October  15th,  1894 :  - 

"Dr.  Casasovici,  of  Ronmania,  ansBsthetises  with 
cocaine  the  mucous  membrane  of  the  nose  of  patients  who 
he  intends  chloroforming.  By  this  means,  according  to 
the  author,  the  inhibitory  reflex  of  tho  heart  and  respira- 
tion, doe  to  the  irritation  of  the  mucous  membrane  en  the 
nose  by  the  chloroform  vapour,  is  prevented. 

<*  One  patient  who  had  presented  serious  symotoms  of 
chloroform  collapse  during  the  amputation  of  a  foot,  was 
able  to  bear  without  accident  a  similar  operation  on  the 
other  foot,  the  nose  having  been  cocaineeed  prior  to  the 
second  operation.'' 

My  object  in  writing  is  that  we  may  give  "honour  to 
whom  honour  is  due." 

I  am,  Sir,  yours/fta, 

Oboboi  Fot. 


THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 
To  the  Editor  of  Thb  Mbdioal  Prvss  and  Circular. 
Sib,— Like  many  others,  I  have  followed  with  much 
interest  the  correspondence  under  the  above  heading  in 
your  columns.  We  have  had  demonstrated  to  us  now 
great  is  the  solicitude  shown  by  many  of  our  profession  for 
the  "professional  honour"  and  dignity  of  their  brother 
doctors.  This  is,  of  course,  highly  gratifying.  Indeed, 
the  altruistic  spirit  has  so  far  prevailed  that  in  this  noble 
work  some  have  apparently  forgotten  to  keep  their  own 
honour  untamishea*  . 

The  result,  however,  is  unfortunate.  For  an  unchari- 
table public  sees  in  these  things  only  petty  jealousies  and 
spite,  and  hints  that  we  doctors  are  always  quarrelling. 
And  I  must  confess,  that  as  far  as  appearances  go,  the 
uncharitable  public  is  justified. 

Why  are  these  things  so  ?  Can  it  be  that  hfe's  competi- 
tion has  become  so  fierce  that  we  have  forgotten  to  act  as 
men  in  honourable  rivalry,  and  have  been  driven  to 
methods  which  a  schoolboy  would  despise  for  their  mean- 
ness? I  would  fain  hope,  however,  that  we  have  simply 
had  presented  to  us  an  exceptional  view  of  the  relations 
between  medical  men  ;  for  I  am  old-fashioned  enough  to 
cherish  the  ideal  that  medicine  is,  or  should  be,  "  a  noble 
profession."  But  if  such  an  ideal  is  to  be  successfully 
entertained,  it  will  apparently  beneceesary  that  we  should 
talk  lees  and  do  more ;  and  also  that  we  should  be  less 
anxious  about  tho  professional  conduct  ot  our  brother 
practitioners,  and  more  particular  about  our  own. 

A  word.  Sir,  in  this  connection,  about  special  hospitalp. 
I  must  confess  I  sympathise  with  Dr.  Brooke's  jX)sir.ion, 
which  seems  to  me  quite  clear  and  straightforward.  Your 
correspondent,  "  Antiquack,"  must  have  had  a  most  melan- 
choly experience,  ii  he  is  indeed  able  to  substantiate  his 
statement  that  "with  few  exceptions,  in  recent  years, 
special  hospitals  have  been  started  and  conducted  merely 
as  cloaks  under  which  to  advertise  at  the  public  expense 
medical  adventurers— men  greedy  of  gain,  or  incapable 
of  making  a  practice  by  legitimate  means."  I  need  not 
quote  the  remainder  of  his  denunciation,  which  appears 
to  the  casual  reader  slightly  tinged  with  onimtw. 

The  medical  profession  has,  in  the  main,  enjoyed  the 
confidence  and  esteem  of  the  non-medical  public ;  it  is  to 
be  hoped  that  we  shall  not  forfeit  that  esteem  and,  in , 
exchange,   incur    ridicule  by   the   exhibition  of   petty  ( 


THE  DEPUTY  COMMISSIONER  IN  LUNACY  FOR 
SCOTLAND. 

To  the  Editor  of  the  Medical  Prbss  \xj>  Circular. 

Sir,— Can  "  no  good  thing  come  out  of  Nazareth  "  ?  Is 
every  poet  as  it  becomes  vacant  to  be  filled  by  a  specialist, 
and  no  rewards  left  to  the  general  practitioner?  As  one 
who  certified  to  Dr.  Macpherson's  fitness  for  the  position 
he  has  so  honourably  secured,  I  ask  leave  to  point  outto 
your  readers  his  credentials  for  the  appointment.  Dr. 
Macpherson  was  perhaps  the  most  distinguished  medical 
man  in  the  whole  Scottish  Highlands,  distinguished  as  a 
man  of  strong  intellectual  power  as  well  as  of  great  force  of 
character.  Above  all  he  had,  from  long  and  varied  experi- 
ence, a  most  intimate  knowledge  both  of  the  oountry  and 
the  people.  He  hsd  also  been  a  meet  hard-working  and 
successful  practitioner.  He  possessed  too  the  unique 
advantage  of  having  been  put  to  the  proof  and  found 
competent,  having  done  the  late  Dr.  Lawsun's  work  in  his 
absence  from  ill-health  to  the  entire  satisfaction  of  the 
Scotch  Lunacy  Board.  .      ^     ^  ^         i...      < 

I  humbly  think  that  we  have  in  the  body  politic  of 
medicine  far  too  much  specialism  of  a  kind.  I  believe  in 
specialising  but  only  after  a  large  and  thorough  experi- 
ence of  medical,  surgical,  and  "alienist"  practice.  Are 
the  general  practitioners  of  Scotland  to  be  placed  undw 
the  heel  of  some  raw  youth,  whose  qualifications  begin  and 
end  in  lunatic  asylum  work  ?  The  visiting  officer  of  the 
Lunacy  Board  has  to  supervise  not  only  the  pauper  luna- 
tics and  their  guardians,  when  boarded  out,  but  has 
specially  to  ascertain  if  the  local  medical  officer  has  been 
regularly  and  honestly  doing  his  work  in  certifying  to  the 
due  and  proper  well-being  of  the  fatuous  poor.  Is  not  the 
best  man  for  this  purpose  one  who  will  take  a  broad  and 
liberal  view  of  the  whole  surroandings  of  the  poor  idiots 
and  deal  fairly,  not  only  with  hs  wants,  but  with  the  whole 
situation,  and  look  with  a  brotherly  eye  on  any  presumed 
failings  of  his  U9ual  medical  attendant  ?  To  inspect  is, 
too  often,  merely  made  the  occasion  to  find  fault,  which  is 

easy. 

I  am,  Sir,  yours,  &c  , 

W.  B. 

Gairloch,  April  17th. 

[We  are  quite  in  accord  with  the  views  of  the  writer  of 
the  foregoing.     We  think,  however,  that  he  has  mistaken 


Apsil  22,  1896. 


UTERATDBE. 


The  Medioal  Pews.     4S7 


the  ezpreasioDS  of  onr  Scotch  correepondent  for  those  of 
opinion  instead  of  inquiry. — Ed.] 


THE  SANITARY  SERVICE  OF  ENGLAND  AND 

WALES. 
To  the  Editor  of  the  Medical  Pbbss  and  Cibculak. 

Sib,— Yon  have  recently  devoted  a  good  deal  of  space  to 
a  comparison  of  the  various  examinations  for  the  Diploma 
in  Public  Health,  and  it  may  be  interesting  to  see  what 
inducements  men  have  for  making  a  special  study  of 
Public  Health.  With  Uiis  end  in  view,  I  have  made  some 
rouffh  calculations  from  the  particulars  given  under  the 
heading,  Sanitarv  Medical  Service  of  England  and  Wales, 
in  the  Medical  Directory.  It  appears  that  there  are  in 
London  41  sanitary  districts,  10  sub-districts,  and  8  minor 
districts.  The  salaries  of  the  Medical  Officers  of  Health 
attached  to  these  are  not  stated  ;  but  I  know  that  in  two 
of  them,  St.  Pancras  and  Kensington,  the  salary  is  £800, 
in  Lambeth  £700,  IsUngton  £654,  St.  Giles,  Battersea, 
and  Paddiogton  each  £600,  8t.  George's  the  Martyr, 
Fulham,  Sboreditch,  and  Hackney  £500,  and  we  may 
assume  that  the  average  of  the  41  larger  districts  is  at 
least  £400,  the  10  sub-districts  £200,  and  the  minor  dis- 
tricts nominal  salaries  only.  They  would  all  of  them  be 
very  desirable  posts,  and  much  sought  after. 

in  provincial  England  it  appears  there  are  about  1,100 
appointments  of  the  gross  value  of  about  £100,000,  or  an 
average  of  £86,  of  these 

351,  or  30  per  cent.,  are  from  £3  to  £25. 

354   „  30        „  „         £20  to  £50. 

279   „  24        „  „         £60  to  £100. 

101   „    tf        „  „  £100  to  £200. 

Leaving  only  76  appointments  (6*5  per  cent.)  above  the 
annual  value  of  £200.  Of  these  7  are  about  £250 ;  10, 
£300 ;  6,  £350  ;  15,  £400  :  13,  £500;  8,  £600  ;  4,  £700  j  8, 
£800 ;  3,  £900 ;  2,  £1,000.  In  some  instances  the  salary 
inelndes  a  small  payment;  as  public  analysts ;  in  others 
there  is  an  assistant  Medical  Officer  of  Health,  but  as 
these  particulars  are  not  always  given  in  the  list  referred 
to  I  have  not  attempted  to  separate  them. 

In  Wides  there  are  about  150  appointments  of  the  gross 
value  of  about  £8,000.  an  average  of  about  £50  per  appoint- 
ment. Of  these  about  75  are  £25  or  less,  40  are  over  £25, 
but  not  more  than  £50;  18  are  over  £50,  but  not  more 
than  £100  ;  9  over  £100,  not  more  than  £200  ;  2,  £250 ; 
2,  £300  ;  1,  £500  ;  1,  £670. 

For  the  purpose  of  comparison,  it  may  be  said  that, 
assuming  the  population  of  England  and  Wales  to  be 
26,500,000  in  1895  (without  London),  and  the  total  pay- 
ments £108,000,  then,  very  approximately,  tills  represents 
one  penny  per  unit  for  provincial  England  and  Wales.  The 
rate  per  unit  is  not  of  much  consequence  to  the  Medical 
Officer  of  Health. 

The  following  is  a  list  of  some  of  the  worse  and  best- 
paid  appointments  in  the  country,  toother  with  the  rate 
of  remuneration  per  unit  of  population  in  terms  of  pence 
and  tenths  of  a  plenny  :— 

SsDitary  IMstrict  Population.     Salary.    Per  unit. 


Kirltngton-cum-Upsland 
Bishop's  Castle,  Salop 
Broughton,  Lines. ... 
Ludgvan,  Cornwall 
Roxby-cum-Kisby,  Lines. 
Scholes,  Yorks 
Thurstonland,  Yorks 

Bala 

Menai  Bridge 
Montgomery 
Holbom.  London    ... 
Nottingham 

Portsmouth 

Newcastle 

Lambeth,  London  ... 

Leeds  

Brighton     

Bristol         

Manchester 

Liverpool     

In  Eogland  and  Wales 


258 

1,586 

1,257 

2.3.% 

392 

1,249 

933 

1,622 

825 

1,098 

32,690 

213,947 

159,251 

201.947 

280,284 

400,000 

11.5,873 

221.578 

515,.'>98 

517,980 


4 

5 

5 

5 

5 

5 

5 

5 

5 

30<) 

550 

550 

650 

700 

700 

800 

800 

850 

900 


d.  Pence. 

0  2-8 
0-6 
10 
05 
36 
10 
13 
0-7 
1-5 
11 
19 
06 
0-8 
08 
0-6 
0-4 
17 
0  9 
04 
0-4 


about  120  appointments  worth  over  £200  a  year  ;  to  com- 
pete for  these,  there  are  at  present  about  800  *'  Diplomates 
of  Public  Health,"  not  counting  those  who  hold  the  Scotch 
and  Irish  Qualifications.  But  the  time  cannot  be  far  dis- 
tant when  England  will  imitate  the  example  of  ScoUand 
and  combine  all  her  small  districts  into  larger  districts, 
and  so  be  able  to  command  the  services  of  men  specially 
trained  in  "  Public  Health"  for  all  of  them. 
I  am,  Sir,  vourr ,  &c., 

W.  H.  Symonds,  M  D.  (Brux.). 
60,  Holmdale  Road.  West  Hampstead, 
London,  N.W. 


©bituari). 


PROF.  MARIANO  SEMOLA,  OF  NAPLES. 
The  subject  of  this  notice  haf  just  died  ip  Naples  in  his 
65th  year.  He  was  much  esteemed  for  his  general  erudi- 
tion in  science  and  literature  Bis  study  of  Bright's 
disease  will  remain  as  a  d  -ssic  monument  of  his  memory 
His  "  Old  and  New  Medicine  "  has  already  been  translated 
into  several  languages.  He  was  a  well-known  figure  m 
Italian  society,  a  member  of  Parliametjr,  hijUcc  *«  polemic 
nature.  He  continued  a  warfare  against  Pasteur's  inocula- 
tion theory  during  four  consecutive  yearf. 


we  have,  including  LondoD, 


jfcitecatttrc 

THE  MEDIOAL  ANNUAL  FOR  1896.  (a) 

Thi  contributors  to  the  present  issue  of  the  "  Medioal 
Annual,"  number  twenty-four,  each  of  whom  is  well-known 
in  medical  literature. 

The  editors  include  some  of  the  beet-known  speotallato 
of  France  and  America,  and  we  need  do  no  more  than 
mention  that  the  Review  of  the  Therapeutics  of  the  Year 
is  from  the  pen  of  Professor  Hare,  whose  knowledge  of  the 
progress  of  therapeusis  is  perhaps  unequalled,  to  enow  the 
high  standard  of  excellence  of  the  book.  Not  satisfied 
with  the  best  obtainable  letterpress,  the  editors,  where 
necessary,  elucidate  the  articles  with  the  aid  of  illustra- 
tions, some  coloured,  and  some  in  black  anJ  white. 

Unfortunately,  the  work  does  not  reach  subscribers 
until  late  in  March,  and  the  delay  in  g^ettiog  the  volume 
out  creates  a  certain  amount  of  disappointment.  A  Year- 
Book  in  March  is  like  a  Christmas  card  in  January,  not 
very  welcome.  For  this  year,  however,  there  is  a  good 
excuse,  to  wit,  the  desire  to  give  an  account  of  Professor 
Rontgen's  discovery.  Indeed,  each  succeeding  volume  of 
the  "Annual"  bears  evidence  of  the  trouble  token  byaU 
concerned  in  its  production  to  give  the  very  latest  infor- 
mation. 

From  time  to  time  we  have  drawn  attention  to  the 
characteristic  excellencies  of  this  work  we  find  them  aU 
in  the  present  issue;  the  arrangement  is  alphabetical^ 
which  of  itself  is  convenient  for  a  Dusy  man,  besides,  there 
is  a  very  full  index.  Seventy-two  wood  engravings  and 
eighteen  plates,  all  well  selected  and  beautifully  finished, 
together  with  more  than  700  pages  of  letterpress  from 
well-known  specialists  on  articles  which  interest  the  prac- 
titioner almost  daily  in  his  practice,  and  all  this  for  a 
few  shillings  I  Of  course  the  annual  is  a  success  and  all 
who  know  it  recognise  that  the  success  is  well  deserved. 

YEARBOOK  OF  PHARMACY.  (5) 
Thv  present  volume  is  slightly  smaller  than  its  prede- 
cessor, with  whidi  we  find  no  fault ;  indeed,  as  we  turn 
to  the  contents  we  feel  inclined  to  ascribe  the  diminished 
bulk  to  good  editing. 

In  the  section  on  chemistry  we  have  a  brief  account  of 

the  liquefaction  of  hydrogen  ;  of  the  method  of  isolating 

argon  and  helium  and  the  spectroscopic  character  of  both 

argon  and  helium  are  described  by  Mr.  W.  Crooks. 

More  immediately  interesting  to  the  medical  profession 


(a)  "  The  Medical  Annual  and  Practitioner's  Index."  A  work  of 
Reference  for  Menical  Practitionerv.  1896.  Fourteenth  year.  Bristol: 
John  Wright  ft  Co..  Stone  Bridge. 

(»)  "  TeiUNBook  of  Pliarnuuqr.  with  the  TranaaotloBS  of  ths  9ritish 
ThMma/owMetA  Oonferenoe,  hdd  Jnlj,  1895."  London:  J.  A  A, 
Ohnrohill.    18Mk 


438     Thb  Midioal  Priss 


LABORATORY  NOTES. 


Apkil  22,  1896. 


ia  the  rasalts  obtained  by  Mr.  E.  Schmidt  from  his  exami- 
nation of  the  80-called  hyoecine  salts  of  commerce.  He 
found  them  to  be  salts  of  scopolanine,  associated  with 
very  small  qaantities  of  hyoscyanine  and*  atropine. 
Manacin,  a  principle  contained  in  manaca  roots,  has 
been  found  by  Mr.  Brandl  to  exercise  a  marked  stimula- 
ting effect  on  the  motor  end  plates  of  nerves  and  on  the 
secreting  glands.  We  shall  probably  soon  hear  further  of  it. 
Solactol,  formed  by  a  combination  of  the  sodium  salts  of 
salicylic  and  lactic  acids,  when  dissolved  in  a  one-per  cent, 
solution  of  hydrogen  peroxide,  is  recommended  as  a 
valuable  remedy  for  diphtheria.  The  solution  is  applied 
to  the  throat  with  a  brush  every  four  hours,  and  in  the 
intervals  the  solution  is  used  as  a  gargle.  According  to 
some  physicians  it  is  superior  to  serum  treatment  for 
diphtheria,  for  which  it  is  claimed  to  be  a  prophylactic. 
From  what  we  have  drawn  attention  to  in  this  excellent 
Year-Book  members  of  the  medical  profession  can  see  that 
it  would  form  a  uitefal  adHit.ion  to  any  medical  library. 

NEW  CLINICAL  CHART. 

Thb  insufficiency  of  the  ordinary  temperature  chart  in 
certain  diseases,  notably  those  of  a  pysemic  nature,  has 
induced  the  Richmond  Hospital,  Dublin,  to  provide  itself 
with  a  more  elaborate  sheet  on  which  the  temperature, 
pulse,  and  respiration  can  all  be  graphically  represented, 
so  that  instead  of  laboriously  interpreting  the  numbers 
and  estimating  their  significance  by  a  roundabout  mental 
process,  it  is  possible  to  see  by  a  glance  at  the  curves  the 
relation  subsisting  between  this  important  tiinity.  In 
many  such  cases,  significant  changes  occur  too  rapidly  for 
inclusion  in  observations  conducted  so  seldom  as  twice 
daily,  and  valuable  evidence  of  the  nature  of  the  affection 
is  in  this  wav  frequently  lost.  To  avoid  this  danger  the 
Chart  provides  for  four- hourly  records.  As  an  example  of 
this  we  have  before  us  two  charts  of  the  same  case  (of 
lateral  sinus  thrombosis  and  brain  abscess)  taken  by  two 
independent  observers,  one  twice  daily,  the  other  every 
fourth  hour.  There  is  the  same  difference  between  the 
two  as  between  illegible  writing  and  plain  prin<^.  The 
ordinary  chart  tells  one  nothing  except  that  the  patient's 
temperature  is  high  while  the  character  of  the  four-hourly 
curve  is  very  distinctlv  that  of  lateral  sinus  thrombosis. 
Again  the  four-hourly  cnart  shows  that  between  a  momiDg 
and  an  evening  observation  the  patient's  temperature  rose 
to  104'5°  F.,  and  subsided  again  to  normal,  thus  leaving 
no  trace  on  the  twice-daily  sheet.  Further,  if  one  took 
the  temperatures  marked  on  the  ordinary  chart  as  the 
maximum  and  minimum  for  the  day,  there  would  be  an 
average  mistake  of  over  three  degrees. 

The  want  of  the  new  chart  was  first  felt  in  cases  of  com- 
plicated middle-ear  disease,  and  in  these  it  is  indis- 
pensable. The  greatest  authority  on  the  subject,  Macewen, 
insists  on  this,  but  its  utility  is  not  limited  by  such  cases,  as 
it  will  certainly  be  required  wherever  accurate  observation 
and  record  are  desirable. 

The  chart  is  desiflrned  by  Dr.  R.  H.  Woods,  and  pub- 
lished by  Waller  and  Co. ,  Suffolk  Street,  Dublin.  Though 
intended  for  use  in  the  Richmond  Hospital,  Messrs. 
Waller  are  at  liberty  to  supply  copies  to  the  profession  at 
large  at  a  very  moderate  rate.  The  plate  is  copper 
engraved,  and  is  both  distinct  and  elegant. 

COUNTER-IRRITATION,  (a) 
Db.  Gillies  has  misled  a  good  opportunity.  There  is 
undoubtedly  no  book  in  our  language  which  treats  of  the 
wide  subject  of  counter-irritation  ^in  a  satisfactory  way. 
Dr.  Gillies  has,  however,  the  besetting  sin  of  diffuseness. 
Not  only  is  brevity  the  soul  of  wit,  but  it  is  the  acme  of 
scientific  writing  also.  In  the  preface,  the  author  states 
that  "he  Ukes  the  plan  of  the  essay  very  much  !"  We 
would  agree  if  we  could  understand  its  working  out.  In 
an  elaborate  history  of  the  subject  and  a  discussion  of  the 
different  theories  put  forward  to  account  for  the  action  of 
counter- irritation,  which  open  the  volume,  much  evidence 
of  research  is  given.  The  theories  are  so  confusedly 
stated,  however,  that  the  reader  is  left  to  imagine  most  of 
them.  In  Chapter  VII.,  the  author's  own  hvpothesis  is 
advanced,  and  after  some  careful  study,  we  at  length  were 
able  to  unravel  the  tanglc^d  pkein".     The  giot  of  it  con- 


(a)  *'  The   Theory  and   Practice   of  Ooanter-Initation." 
Cameron  GllUea,  M.D.    London;  Maomillan  &  Go.    189d. 


By   H 


sists  in  the  proposition  that  counter-irritation  causes  in- 
flammation of  the  part  to  which  it  is  applied.  Inflamma- 
tion is  Nature's  method  for  the  cure  of  disease.  Ergo^  the 
inflammation  induced  by  the  application  of  irritants  acts 
beneficially  on  the  adjacent  part  previously  diseased  by 
the  accompanying  stimulation  of  the  circulation. 
There  is  much  to  be  said  for  this  view,  and  there  i 


little  doubt  that  this  is  the  mode  of  action  in  many  o 
In  many  instances,  however,  the  result  cannot  be  thae 
explained,  especially  in  connection  with  the  remoter  effects 
of  counter-irritation. 

In  the  latter  part  of  the  book  there  is  a  very  good 
description  of  the  different  counter-irritants  used.  Paque- 
lin's  cautery  is,  curiously  enough,  not  mentioned.  Again, 
we  must  disagree  with  the  author  in  his  advocacy  of  the 
treatment  of  sprains  by  means  of  splints  and  blisters,  the 
results  of  early  passive  movements  and  massage  are 
infinitely  better.  It  is  very  unfortunate  that  Dr.  Gillies 
has  spoilt  what  is  really  a  good  piece  of  work  through  hie 
inability  to  express  his  meaning  in  brief  and  intelligible 
terms. 

A  FRESH  BATCH  OP  TABLOIDS. 
Ay.fiSTHKTio  Tabloids. 
The  restless  spirit  of  pharmaceutical  invention  which 
has  always  characterised  the  firm  of  Burroughs,  Wellcome 
and  Co.,  has  once  more  found  expression  in  further  addi- 
tions to  their  valuable  series  of  medicinal  tabloids.  The 
desirability  of  providing  additional  facilities  for  the  in- 
duction of  local  anaesthesia  has  prompted  the  manufacture 
of  three  sets  of  tabloids  to  be  used  with  that  object  in 
view.  They  are  of  three  strengths: — "Strong,**  "Nor- 
mal,** and  "Weak."  containing  respectively  a  fifth,  a 
tenth,  and  a  hundredth  of  a  grain  of  cocaine  hydrochlorate 
in  each,  in  association  with  hydrochlorate  of  morphine 
and  chloride  of  sodium.  These,  when  dissolved,  are  in- 
tended to  be  used  by  the  "  infiltration  method'*  intxodu(»d 
by  Dr.  Schleich,  of  Berlin.  This  comprises  the  injection, 
at  various  spots  just  beneath  the  skin,  of  the  solution  by 
which  complete  loss  of  sensation  is  obtained  over  an  area 
amply  sufficient  for  minor  surgical  purposes.  The  degree 
of  anieathesia  thus  obtained  is,  as  we  have  asoertaineo,  by 
personal  experiment,  quite  adequate,  and  the  after  effects 
— at  any  rate,  with  Nos.  2  and  3,  are  nil. 

OXALATB  OF  CeRIUM  TaBLOIDS. 

Oxalate  of  cerium  is  still  a  'popular  remedy  in  the 
treatment  of  sickness,  whether  associated  with  pregnancy, 
or  due  to  marine  disturbances.  The  drug,  moreover,  is 
extensivelv  prescribed  in  the  treatment  of  pyrosis,  gastro- 
dynia,  and  various  forms  of  dyspepsia.  Under  these  cir- 
cumstances, its  exhibition  in  tabloid  form 
obvious  advantages. 

CoMPorKD  Caffbikb  Tabloids, 

The  combination  of  caffeine,  gr.  j,  with  antipyrin, 
gr.  iij,  is  certainly  a  happy  one,  for  the  stimulating  effscts 
of  caffeine  on  the  cardiac  function,  minimise  one  of  the 
drawbacks  of  antipyrin.  On  the  other  hand,  the  analgesic 
effects  of  the  latter  drug  may  conceivably  prove  very 
serviceable  in  cases  in  which  caffeine  ia  employed  as  a 
cardiac  stimulant  and  diuretic.  These  tabloids  disinte- 
grate with  great  promptness  in  the  presence  of  moisture. 
Tabloids  of  Compound  Rhubabb  Powder. 

Each  tabloid  contains:  powdered  rhubarb,  2  parts: 
magnesia,  6  parts  :  ginger,  1  part.  Gregory's  powder  is 
still  extensively  used  and  as  it  is  not  very  agreable  to  take 
as  such,  the  advantages  of  the  compressed  form  wUl,  doubt- 
less, be  appreciated. 

KEILLBR'S  COCOA. 
CoooA  now  enters  so  largely  into  the  dietary  of  everyday 
life  that  we  are  glad  to  welcome  any  newoompetitor  in  the 
field  and  to  adjudicate  on  its  merits.  The  nutritive  and 
stimulating  qualities  of  the  Thtdbnyma  cacao  are  so  well 
known  and  appreciated  that  remarks  here  on  these  points 
would  be  superfluous.  We  will  content  ourselves,  there- 
fore, as  in  other  oases,  by  giving  the  result  of  analysis  by 
our  analytical  chemist,  Mr.  F.  Hudson  Cor,  pre&wsing  ths 
«ame  by  remarking  that  this  new  product  is  from  the 


ApBit  22^896.^ PASS  LISTS. 

factory  of  Meesra.  Keillor  &  Ca,  Daodoe,  of  marmalade 
fame,  as  a  gaarantee  to  coneumers  of  ezoellence  in  manu- 
faccnre. 

57  Chancery  Lane,  London, 
April  7th,  1S96. 
Sir,— I  have  analysed  the  sample  of  Keillor's  oocoa  sab- 
mittod  to  me  by  Tm  Mbdical  Press  and  Circular  and 
find  it  a  pare  oocoa,  freed  from  excess  of  far,  withoni 
added  su^jrar,  starch,  or  free  oanstio  alkali*    Analytical 
data:— 
Fat  ...  ...  ...    31-18  per  cent. 

Ash  ...  ...  ...      5*72 

Solableash  '[[  6-59       !! 

Alkalinity  of  ash  from  2  grm.  of  cocoa     7-1    cc.  J^  HCl. 

Fbedk.  Hudson  Cox. 


The  Medioal  Pbks.     439 


The  National  Consmnption  Hospital  for  Irtiand. 
At  the  ceremonial  opening  of  this  institution,  which 
we  reported  a  few  weeks  since,  the  absence  of  Miss 
Florence  Wynne,  the  originator  of  the  idea  and  the  first 
and  most  enthusiastic  organiser,  was  conspicuous,  and 
would  have  been  surprising,  were  it  not  already  known 
that,  foar  years  aj;o,  a  mosti  acrimonious  controversy  had 
arisen  between  Miss  Wynne  and  other  promotors  and  ad- 
ministrators of  the  Hospital,  and  that  the  dispute  bad 
resulted,  then,  in  the  resignation  of  her  office  of  Hon.  Sec. 
by  Mips  Wynne,  and  in  her  oetentatioasly  casting  off  the 
dust  from  her  feet  agamst  the  Executive  Committee,  and 
notably  against  its  Chairman,  the  Registrar-General.  On 
the  occasion  of  the  opening  of  the  Hospital,  a  thousand 
questions  were  asked  by  the  public  as  to  the  cause  of  this 
suspension  of  diplomatic  relations,  but  no  one  seemed  to 
have  the  information  or  were  willing  to  eive  an  answer  if 
they  had.  Miss  Wynne,  however,  is  not  disposed  to  allow 
the  points  of  the  dispute  to  remain  in  doubt,  for  she  has 
not  only  addressed  the  Dublin  papers  on  the  subject,  but 
has  published  and  circulated  a  voluminous  statement  of 
her  case  against  the  Committee,  and  we  imagine  that 
many  of  our  readers  will  be  curious  to  know  the  fatvi  et 
origo  malt.  It  will  be  admitted  that  Miss  Wvnne  merits 
the  honour  of  having  conceived  the  idea  of  the  Hospital, 
and  worked  it  np  with  that  enthusiasm  and  determination 
which  is  the  attribute  of  her  sex  whenever  they  acquire  a 
burning  interest  in  anything.  It  is  sufficient  to  say  that 
by  her  unaided  exertions  sne  gathered  round  the  scheme 
for  establishing  the  Hospital  a  number  of  wealthy  and 
fashionable  people,  and  got  together  several  thousand 
pounds.  The  chief  Patroness  was  the  Countess  of 
Zetland,  who,  at  the  time,  did  the  Viceregal  honours  at 
Dublin  Castle,  and  the  chief  benefactor  was  Earl 
Fitzwilliam,  who  ofifered  to  present  the  site  on  which  the 
Hospital  is  now  built,  and  a  donation  of  £500.  Unfor- 
tunately, as  we  think,  Miss  Wvne  fell  out  with  the  Com- 
mittee on  two  pointe.  First,  she  insisted  on  the  addition 
to  the  Hospital  of  two  chapels  for  the  Church  of  Ireland 
and  the  Mman  Catholic  Church  respectively,  but  she 
ofTered  to  collect  the  money  for  their  building  as  a  trans- 
action separate  from  the  Hospital.  The  Viceregal 
Patroness  and  the  Reeistrar-General,  who  represented 
her,  objected,  we  think  reasonably,  to  the  mixing  up  of 
the  Hospital  scheme  with  anything  which  might  give  rise 
to  religious  controversy  in  Ireland,  and  threatened  to 
withdraw  from  the  movement  if  Miss  Wynne  persisted. 
Secondly,  Miss  Wynne  differed  from  the  Committee,  as 
she  totally  objected  to  the  site  on  which  the  Hospital  is 
now  placed,  while  the  Committee,  apparently  preferring 
another  site,  desired  to  accept  this  one  because  they  got 
it  for  nothing,  and  g^t  with  it  a  large  donation  from  Lord 
Fitzwilliam  which  would  have  been  withdrawn  if  his  offer 
had  been  refused.  Upon  these  facts  there  is  no  occasion 
to  say  more  than  that  it  is  distressing  that  an  institution 
which  will  need  all  the  help  which  it  can  get  should  lose 
the  active  sympathy  and  the  invaluable  services  of  a  lady 
like  Miss  Wynne.  Such  devotion  to  her  object  as  she  has 
displayed  and  such  capacity  for  organisation  are  rare  and 
most  useful  qualities  which  ought  not  to  be  wasted.  But 
we  must  say  that  there  seems  to  have  been  a  characteristic 
want  of  discretion  on  her  part.  If  she  had  been  a  man,  at 
least,  ajwnsible  man,  she  would  probably  have  yielded  to 


the  judgment  of  the  large  majority  of  those  with  whom 
she  was  associated,  who,  we  are  convinced,  were  as  anxious 
as  possible  to  moot  any  reasonable  views  which  she  might 
express  We  do  not  recognise  in  either  of  the  points  upon 
which  she*differed  from  the  Committee  sufficient  cause  for 
waging  a  newspaper  war.  Considering  all  that  the  Hos- 
pitel  owes  to  Miss  Wynne,  we  think  the  Committe  mi^ht, 
even  now  invite  her  to  resume  her  place  in  the  organisa- 
tion and  give  her  co-operation  while,  however,  still  main- 
taining the  principle  for  which  they  have  contended — that 
there  is  no  occasion  for  embarassing  the  institution  with 
religious  controversies. 

The  Veterinary  College  for  Ireland. 
The  Chief  Secretory  for  Ireland  gave  the  assurance  in 
^he  House  of  Commons  last  week  that  he  hoped  to  be  able 
to  make  provision  in  the  present  session  for  the  grant  of 
£15,000  for  the  establishment  of  this  College,  but  he  de- 
clined to  pledge  himself  as  to  the  source  from  which  he 
would  toke  the  money.  It  is  said  that  the  Intermediate 
Education  Fund  will  be  bled  for  the  occasion. 


PASS    LISTS. 


University  of  Edinburgh -Second  Professional  Kramination. 
Thb  following  is  the  official  list  of  candidates  who  have 

completed  the   second  professional  examination  for  the 

degrees  of  M.B.  and  CM.  (old  ordinance)  ; — 
F.  T.  H.  Adamson,  H.  L.  Apthorp,  A.  B.  Blair,  £.  L.  Borthwiok,  C. 
W.  Breeks.  F.  W.  Broadbent,  b.  A.  Cameron,  M.  N.  CDoadborl,  A. 
W.<4.  Clark,  D.  E.  Dickson,  J.  H.  S.  B.  Douglas,  D.  L.  Flaber,  K. 
U,  Gibson,  W.  fl.  Oolille,  T.  F.  Greenwood,  James  Grieve,  F.  S 
Baiper,  A.  G.  Hayden,  Bobert  Irvine.  A.  L.  deJager,  Leslie 
KinKsford,  J.  9.  Lyle,  B.  A.  H'Oregor.  J.  M.  UMgr^or,  B.  F. 
Madie,  B.  N.  Mnllan.  Saiat  MuUick,  W.  D.  Osier.  D.  J.  Peirsoo, 
G.  M'O.  Pratt,  Oswald  Raitt,  C.  R.  Soott.  D.  C.  Sechna.  T.  R  ShooU 
Lrtad,  K  L,  Starmer,  J.  P.  Strickland.  J.  T.  Titterton,  W.  A.  G. 
Ussher,  Henry  «vaters,  G.  F.  Waterston,  and  M.  B.  Wrlsht. 
The  following  have  completed  the  second  professional 

examination  for  the  degrees  of  M.B.,  and  Ch.B.    (new 

ordinance) : — 
John  Alclndor,  A.  J.  T.  Allan,  James  Allison,  A.  S.  Allam,  J.  B. 
Anderson,  H.  L.  S.  D.  Belasco,  William  Bell,  J.  M.  Bowie,  Stanley 
Branch  (with  distinction),  0.  8.  Brebner.  B.  N.  Brebner,  H.  H. 
Broome,  James  Burnet  (.vf.A.).  John  Cameron  (with  distinction)  J. 
A.  Craig,  WilUam  Craig,  Robert  Camming,  J.  M.  Cuthbert,  L.  J. 
M.  Deas,  Oeoriie  Dick,  K.  J.  Dick,  W.  H.tuickinsnn,  J.  £.  Dods,  F. 
H.  Bommisse.  W.  S.  Katon,  liuncan  Forbes.  A.  D.  Fordyoe,  A.  T, 
Gailleton,  Robert  Gibson,  J.  D.  Uilfllian.  Andrew  Gilmoor,  Alex- 
ander Goodall.  A.  M.  Green,  W.  G.  He«th,  T.  K  Hlncks,  H.  T. 
HoUand  (with  distinction).  C.  A.  B.  Horsford,  B.  S.  Hyslop,  W.  J. 
Jones,  A.  H.  Keon.  G.  E.  J.  King,  G.  de  Labat,  B.  W.  Lewis, 
George  Lyon  (with  distinction),  J.  (/.  M'«jODaghey,  Edward 
M'OulIoch,  W.  C.  MDonald.  John  M'Gibbon,  J.  W.  M'intosh, 
D.  V.  M'lntyreQl.a  ),  W.  E.  MKechnie,  R.  w.  M'Kenna,  J.  W. 
Mackenzie,  T.  D.  M'Lsreo,  J.  W.  Mathewson.  J.  A.  Marray 
(d.s.c  X  J.  H.  P.  Paton,  W.  M.  Paol  (M.A.).  G.  M.  Pearson,  G.  B. 
Pemberton,  A.  H.  Pirie,  Robert  Pugh,  J.  A.  Raebom.  H.  H. 
Roberts,  A.  A.  Robinson,  A.  U.  Sandstein  (with  distiiiction), 
R.  F.  M'N.  Scott  (with  distinction),  J.  A.  C.  Bmith,  Ward  Smith. 
6.H.  Stewart,  Henry  Taylor,  David  WardiOp,  W.  C.  Wilson,  and 
G.J.Young.  '    -^     ' 

Third   Professional   Examination.  —  The  following 

have  passed  the  third  professional  examination  for  the  degrees 

of  M.B.andCh.B.:— 

B.  U.  Aldren,  V.  G.  Alexander,  T.  B.  W  Armoor,  E.  P.  Banmaan* 

Thomai   Biggam,   H    B.  Blaok,  H.  F.   Moland,  William  Boms 

(M  A  ).  R.  0.  OanninghaoB,  David  Glow,  C.  M.  Cooper  (disiinotloa), 

L.  W.  Davies,  James  Donaldson.  G    L.  Findiay,  James  Forrest, 

J  R.  ira»er.  Geonre  Gateubr.  Andrrw  Gibson.  William  nassilton 

(with  distiootion),  Rowland  Hill.  G.  B  HolUngs,  Patrick  Klnmont, 

A.  B.  MaoCarthT.  T.  J.  T.  M* flattie,  J  i<  M'lnnes,  John  Malcolm, 
William  Martin.  J.  D.  B.  Milln,  F.  W.  More,  B  G  Biddell,  J.  O. 
SUght  (M.  O.  W.  M.  A.  Smith,  W.  B.  Komirset.  J.  W.  Strnthers^ 
%x.  A.  Vincent,  W.  M.  Wilson,  and  A.  G.  Worr  UL 

Durham  Unlyersity  School  of  Medlcise. 

The  one  result  of  the  first  examination  for  the  degree  of 

Bachelor  of  Medicine  (new  regulations).     The  following 

candidates  satisfied  the  examiners : — 

All  subjects:  flrstH^lass  henours.  Richard  Henry  Dix;  seoond- 

clase  hooours^mest  F.  W.  Brwater,  Fred.  *tuart:  pass  list,  E. 

B.  Appleby,  M.  Armstrong,  Solomon  Armstrong,  Maarice  Jacobs, 
Edmand  Norman  Threlfall;  anatomy  and  biology,  Arthur 
Hu^h  Bunting,  Hubert  Wolstenholme  Hoian,  John  Bobert 
Mitchell,  Margaret  Joyce,  John  Ernest  Sidgwick,  Dayid  Hen- 
derson weir ;  chemistry  and  physics,  Percy  Francis  Alderson, 
Alan  Ajrre-Smith,  Arthur  Russell  Baker,  Edward  Hovendon 
Burleiffh  Barlow,  Clifford  Harold  Brookes,  Laurence  James 
Blandfbrd,  Edleston  Harvey  Cooke.  Sidney  John  Snow  Cooke, 
Selina  Fitzherbert  Fox,  Charles  Henry  Gibson,  Arthur  Hines. 
Hugh  Bobert  Kendal,  Bobert  James  Pearson.  Thomas  Basil 
Rhodes.  Claudia  Anita  Prout  Bowse.  Eliot  Swainston,  John 
Charles Telenski.  Bobert  Walker;  chemistry,  William  Henry 
Isaacs  Bathurst;  fuiatomy,  Harold  Bobert  Dacre  Spilta,  Frank 
Wheler  Sime. 


440    Tot  MiDioAL  Pr«8 


NOTICES  TO  CORRESPONDENTS. 


Afbil  22,  1896. 


(HontBpontmtB,  ^hcrt  f  ettttB,  *c. 

$9r  G0BBWP0in>SHT8  reqnlrtng  a  nply  in  tlili  oolumn  ure  par- 
ttcnlarly  reqaeited  to  make  naa  of  a  ditttnetive  tinntUwre  or  {nitfaitj 
and  aTold  tba  praoUoe  of  signing  themaelTaa  "Beader,"  "  Bnbacriber," 
"  OldSobicriber,"  dko.  Much  oonfnilon  wOl  ba  ipared  bj  attention 
to  this  rale. 

BEADING  CASES,  -aoth  board  cases,  gttt-lettered,  containing  twenty- 
six  strings  for  holding  the  nnmbers  of  The  Mbdioal  Press  ahd 
CiifcOULAR,  may  now  be  had  at  either  office  of  this  Journal,  price  2s.  6d. 
These  cases  will  be  f oond  very  useful  to  keep  each  weekly  number 
Intact,  eleaui  and  flat  after  it  has  passed  through  the  post. 

LooAL  Bepoets  AMD  NEWS— Correspondents  desirous  of  drawing 
attention  to  these  are  requested  kindly  to  mark  the  newspapers  when 
sending  them  to  the  Editor. 

OEi«niAL  ABnoLEB  or  LBXSEB8  Intended  for  pu  blioaHon  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated  with 
the  name  and  address  of  the  writer,  not  neoeHarily  for  publication, 
but  as  evidence  of  identity. 

BEPiii]rTS.--Authors  of  papers  requiring  reprints  in  pamphlet  form 
after  they  have  appeared  in  these  columns  can  have  them  at  half  the 
usual  cost,  on  application  to  the  printers  before  type  is  broken  up. 
BUTTEBMILK  FOB  COKSUafPTION. 
To  th4  Editor  oj  THE  Hedioal  Press  aed  Circular. 
Sir,— The  following  passage  occnrs  in  the  letter  of  Tab.  Bramble, 
dated  from  Bath,  May  19th,  to  her  friend  Dr.  Lews  :— '*  As  for  butter- 
milk, ne'er  apig  in  tbe  parish  shall  thrust  his  snout  in  It,  with  my 
good  wllL  Tnere  is  a  famous  physician  at  the  Hot  Well  tbat  pre- 
scribes it  to  his  natience  (sic),  when  the  case  is  consumptive."  I 
think  Smollett  oonld  mean  no  other  than  Lir.  Beddoea  by  the ''  famous 
phyrician,"  and  yet  I  cannot  find  in  Beddoes*  Pamphlets  on  Consump- 
tion any  mention  of  this  treatment.  My  edition  of  the  pamphlets  is 
ttie  second  ;  perhs ps  some  of  the  other  editions  contain  the  deiired 
Informati  on.  I  thall  be  very  grateful  to  any  of  your  readers  who  mav 
giye  me  information  on  the  subject.  Dr.  Neale,  in  bis  excellent 
'*  Digest,"  section  540,  gives  a  very  full  bibliography  on  "  Milk  Cure," 
and  although  he  mentions  Hippocrates  and  other  early  writers  he 
makes  no  mention  of  Beddoea. 

I  am  Sir,  yours,  Ac, 

George  Fot. 
De.  a.  smith  (Sheffield).  -The  latest  theory  as  to  the  cause  of  Icterus 
neotonorum  is  that  the  condition  is  chiefly  due  to  the  persistence  of 
the  canal  of  the  ductus  venosus. 

F.B.O.P.  LoEDOH.^An  article  on  the  subject  appeared  in  our 
columns  on  March  sath,  1896. 

Mb.  Gilbert  Gardeer.— Begret  we  were  unable  to  take  the  matter 
up  in  our  prf  sent  number. 
OPPOSITION  TO  THB  PB0P03ED  MIDWIVES'  BBGISTBATION 
BILL. 

THE  Profession  In  Shefileld  took  a  very  definite  and  dedded  step 
with  reference  to  this  objectionable  measure  last  week,  and  we 
heartily  Join  iu  the  wish  expressed  by  a  valued  and  energetic  Sheffield 
correspondent  who  sends  the  news  referred  to  in  anoiher  oolumn, 
that  '*  other  towns  would  move  in  the  matter.  The  >onnger  members 
of  the  profession  do  not  seem  to  me  to  realise  what  a  rod  they  are 
allowing  to  be  prepared  for  themselves  throngh  their  apathy.  They 
seem  to  think  that  it  is  possible  to  hold  these  mldwlves  in  control, 
once  they  are  registered,  though  giving  them  the  right  to  independent 
practice  ;  it  will  be  the  weakest  of  weak  paper  control,  and  about  as 
etfective  as  the  suzeraintyship  of  Sngland  over  the  TransvaaL  For 
touately,  I  am  now  independent  of  the  compel itioo  of  these  women, 
for  it  will  be  keen  Medicine  is  bad  enough  at  present,  but  it  will  be 
teufold  worse  in  the  days  to  come,  If  this  Bill  becomes  law." 

Mr.  Allen  Ieees  s  "  Unique  Complication  of  Bnteric  Fever,"  is 
marked  for  early  insertion. 

DR.  W.  B.  McDerMott.— We  hope  to  have  space  for  your  commu- 
nication in  our  next. 


jHcctinos  of  .^ntktics,  l^ccturca,  «c 

WSDNXsDAT,  April  izSD, 

DtRMATOLOGICAL    SOCIETY    OF    OKEaT    BRITAIN  AND    IRELAND.— 

6  pm.    Dr.  Abraham :  Case  of  Uchen  Buba  Acumlnatus.    Dr.  Bd- 
dowei :  Case  of  Xerodermia  Cured  by  Thyroid  Feeding.    And  other 


SociSTT  OF  ARTS.  -8  p.m.  Mr.  F.  E  Ives  :  The  Perfected  Phono- 
chromoftcope  and  its  Colour  Photographs. 

duNTBRlAN  SodBTT  (London  ibstitotion).— S.SO  p.m.  Discussion 
on  Joint  Affections  in  Nervous  Diseases.  Dr.  Beevor,  Dr.  Buzzard, 
Dr.  O.  d,  and  Dr.  A.  Turner  will  speak. 

FRIDAY,  April  24th. 

CLINIOAL  Society  or  London.— 8.80  p.m.  Clinical  Evening.  Mr. 
J.  Biaud  Button :  Excbion  of  the  Upper  Two- thirds  of  the  Fibula  for 
Sarcoma.  Mr.  Gordon  Brodie :  Deficient  Development  of  the  Lower 
End  of  Tibia  after  Transverse  Fracture,  Mr.  F.  C.  Wallis  :  Sequel  to 
Acute  Swellings  over  the  Cranium  in  an  Infant.  Mr.  R.  Stanley 
Thomaa  (introauced  by  Mr.  Pearoe  Gould) :  Deficiency  in  the  Lower 
Bibs. 

BoTAL  iNSttTUnoN.'Q  p.m.  Professor  G.  V.  Poore :  The  Clroula- 
tion  of  Organic  Matter. 


Catholic  University  Medical  School,  Dubliu.^Chair  of  Midwifery  and 
the  Lectureship  on  Ophthalmology.  Applications  for  these  offices 
must  leach  the  Be^istrar  before  May  16th.    (See  aiivt.X 

Huddersfleld  Infirmary  (100  beds).— Junior  House  Surgeon.  Salary 
£40  per  annum,  with  board,  lodging,  aud  washing.  The  appoint- 
ment will  be  for  one  year.  Applications,  stating  age,  with  copies  of 
testimonials,  to  be  sent  not  later  than  April  27th,  to  Mr.  J.  Bate, 
Secretary,  Infirmary,  Huddersfield. 

]forth-West  London  Hospltal.-Besident  Medical  Officer  and  Assistant 
Bfrsldent  Medical  Officer.  Salary  attached  to  the  senior  post  £60 
peranuum.  Further  pariiculais  to  be  obtained  from  the  Secre- 
tary, to  whom  also  applications,  with  copies  of  testimonials, 
should  be  sent  not  later  than  May  2ud.  Address,  Alfred  Craske, 
Kentish  Town  Bnad.  London,  N.W. 

Owens  College,  Manchester.— Senior  and  Junior  Dtmonstrator  in 
Physiology.  Also  Junior  Demonstrator  in  Anatomy.  FuH  parti- 
culars as  to  duties  and  emolumems  of  the  Beglstrar. 

Westmioster  Hospital,  London,  S.W. -Surgical  Beglstrar.  Salary 
£40  per  annum.  AppUcattons  to  be  sent  to  the  Secretary  not  later 
than  April  26th.    Sidney  M.  Quennell,  Secretary. 

West  Biding  of  Yorkshire.-  County  Medical  Officer  of  Health.  Salary 
£800  per  annum,  with  travelling  expenses,  and  a  suitable  staff  and 
laboratory  and  office  provided.  Applications,  stating  age,  exper- 
ience, Ac.,  with  not  more  than  three  recent  testimonials,  to  be 
sent  under  cover  marked  "County  Medical  Officer,"  on  or  before 
April  26th,  1896,  to  Trevor  Edwards,  West  Biding  Solicitor,  Wake- 
field. 

Wrexham  InflnnazT  and  Dispensary.— House  Surgeon.  Salary  £80 
per  annum,  with  furnished  rooms,  board,  gaa,  coal,  and  attend- 
ance. Applications  (on  forms  to  be  obtained  from  the  Secretaiy) 
to  be  sent  to  the  Secref  ary.  Geo.  Whltehouse,  27,  Begent  Street, 
Wrezhsm,  on  or  before  April  24th. 


S^ppoimmtntM 


Claytoh.  J.  H..  M.B.  Loud.,  M.B.C.S.,  Extra  Acting  Surgeon  to  the 

Birmingham  and  Midland  Hospital  for  Sick  Children. 
HANNAH,  W.,  M.B.,C.M.GUsg.,  DP.H.  Camb.,  Medical  Officer  for 

the  Buxton  l^iatrict,  Cbapel-en-le-Frith  (Jnion. 
Hbalby.  J.,  M.B.,  Cb.B.  Vict.,  Medical  Officer  of  Health,  Moseley, 

Lanes. 
Kenny,  M.  S.,  M.B.,  B.<%.,  Dubl.,  Medical  Officer  for  the  Carrick-on- 

Suir  Union  Infirmary. 
LlXTi-E,  £.  G.  GRAHAV,  B.  A.,  M.D.,  M.B  C.P.,  Assistant  Curator  of  the 

Museum  at  St.  George's  Hospital.  London. 
Macdonald,  W.,  L.B.aP.,  L.B.i;.S.  Edin.,  Junior  House  Surgeon  to 

the  Boyal  Albert  Edward  Infirmary,  Wigan. 
MiLROY,  W.  Cunniboham,  M.A.,  M.D.  Edln.,  Senior  House  Surgeon 

to  the  Bo>al  Albert  Edward  Infirmary,  Wigan. 
POLLOCK.  E.  S.,  M.B.,  B.<%.  Dubl.,  Medical  Officer  for  the  Sixth  Sani- 
tary District  of  the  South  Molton  Union. 
Beid,  Georqe  a.,  M.B.,  CM.  Aberd ,  Junior  Assistant  Medical  Officer 

to  the  Cumberland  and  Westmoreland  Co.  Asylum  at  Carlisle. 
SAVAaE  George  fl.,  M.D.  Loud ,  Physician  for  Mental  DiMases,  Guy's 

BospitaL 
BOURFIELD   HAROLD,  M.D.,    CM.  Idlu.,    D.P.H.   (^amb..  Medical 

Officer  of  Health  for  Sunderland. 


§it%\t». 


Barclay.— April  14th,  at  Fareham  House,  Norwich,  the  wife  of  the 

Bev.  L.  L.  Barclay,  B.D.,  of  a  son. 
CooK.^AprU  l4th,  at  Stewarton,  Ayrshire,  the  wife  of  James  Cook, 

M.  B..  CM  Glasg.,  of  a  son. 
Kma.  -  April  l4th.  at  Nicholas  Street,  Chester,  the  wife  of  Henry  W. 

King,  M.D.  Edin.,  M.B.C.S.,  of  a  son. 


c|a«t(iaj|jeB. 


Bristowe—Earslake.— April  16th,  at  St  Peter's.  Cranley  Gardens, 
London,  Hubert  Carpenter  Bristowe,  M.D.,  of  Wrinotun,  Somer- 
set, second  son  of  the  late  John  Syer  Bristowe,  M.Dm  LL.D., 
F.B.S.,  F.B.C.P.,  of  London,  toMaiy,  daughter  of  Lewis  Barslake, 
of  24,  Harcourt  Terrace. 

ElENDALL— CROSSE.— April  16th,  at  St  Clement's  Church,  Terrington, 
by  the  father  of  the  brtd^.  George  William  Kendall,  B.A.,  M.D., 
ol  Queensbury,  Yorks,  to  Phlllls,  youngest  daughter  of  the  Bev. 
Marlborough  Crosse,  vicar  of  Terrington  St.  Clement's,  Noriolk. 

MuiR- Taylor  -  April  2nd,  at  Colorado  Springs,  U.S.A.,  James  T. 
Muir,  M.A.,  M.D.,  youngest  son  of  Principal  Sir  Wm.  ttuir,  late 
Lieut-Goveinor  N.W.P.  India,  to  Hannah  L.  Taylor,  M.D. 

Nsvson-Pkootor.— April  14th,  at  St  Marylebone  Parish  Church, 
London,  W.,  ttoberc  William,  eldest  son  of  John  Newson,  Old 
Charlton,  Kent,  to  Katherioe  Annie,  eldest  daughter  of  James 
Cooptf  Proctor,  Suxgeon,  Lydd,  Kent 

Venablbs-Williajis— Parry. -April  i6th,  at  St  John's  (Hiurch, 
Chester,  Wm.  Montagu  Venabfes- Williams,  J.P.  (co.  of  Denbigh), 
L.B.C.P.  and  L.&.C.S.  Edin.,  Colwyn  Bay,  son  of  the  Bev.  W. 
y enables- Williams,  M.A.  Oxon.,  to  Sara  A.  A.  Parry,  second 
daughter  of  Albert  Parry,  Vicar's  Cross,  Chester. 

Craig.— April  16tb,  at  Waveriey  Bouse,  Worthing,  John  Craig, 
F.B.C  S.,  late  of  the  East  Inoia  Company's  Service. 

Gabon.— April  12,  at  Borne,  John  Oasoo,  M.D.,  T.C.D.,  F.F  CP.I., 
Physician  to  the  Anglo- Italian  Dispensary  in  Bonie.  aged  79  years. 

McNiooll  -Apnl  Uth,  at  16,  Manchester  Boad,  Southport,  Kdward 
Day  MdJiooU,  F.B.C.S.  Edin.,  L.B.CP.  Adin..  aged  61  >ears, 
second  son  of  the  late  David  Hudson  McMcoU,  M.D.   No  cards. 

BOPER.— April  18th,  at  Arundel  House,  London  Boad,  Croydon,  Alfred 
George  Boper,  F,B,C.S,  Eng.,  aged  77  yean. 


Mlt  ^dml  ^m$  mA  (immht. 


*«SALUS    POPULI    SUPREMA    LEX." 


Voucxn. 


WEDNESDAY,    APRIL    29,     1896. 


No.  18. 


"Bitxtm  Clinical  %tttV(XtB. 

THE  TREATMENT    OF    PROSTATIC 

HYPERTROPHY  BY  CASTRATION. 

By  Prof.  J.  ENGLISCH. 

[from  our  AUSTRIAN  CORRESPONDENT.] 

The  difficulty  of  treating  prostatic  hypertrophy  is 
generally  acknowledged  as  an  almost  insuperable  task. 
The  usual  methods  applied  are  at  best  only  palliative 
snd  of  very  short  duration.  Even  when  practising 
these  forms  of  relief,  we  are  exposed  to  considerable 
danger  of  inducing  new  troubles  higher  up  in  the 
urinary  organs,  and  thus  endangering  the  life  of  the 
patient.  At  an  early  period  in  the  treatment  of  this 
organ  the  surgical  operation  recommended  was  removal 
of  part  or  whole  of  the  prostatic  gland.  After  a  series 
of  operations  it  was  discovered  that  this  form  of  treat- 
ment was  fraught  with  fatal  consequences  in  a  large 
number  of  cases.  Attention  was  then  directed  to  other 
channels  with  the  view  of  overcoming  the  difficultv, 
and  the  causes  of  production  were  more  closely 
examined.    In  the  histology  of  hypertrophy  of    the 

Prostatic  gland  a  comparison  was  discovered  in  the 
evelopment  of  a  myoma  in  the  uterus,  which  appeared 
to  have  a  similar  growth.  This  opinion  was  recognised 
for  some  time,  but  it  has  now  been  abandoned.  The 
practice  of  looking  on  the  growth  of  the  hy^er- 
trophied  prostatic  gland  was  long  maintained  as  similar 
to  any  external  growths  which  increased  by 
a  super-abundance  of  nutrition.  Bier,  on  reason- 
ing from  these  premises,  advocated  a  similar 
treatment  to  that  practised  in  myoma  of  the 
uterus,  viz.,  the  tying  of  the  large  vessels  of  nutrition, 
and  he  recommended  tying  both  the  internal  iliac 
arteries  for  the  remedy  of  prostatic  hypertrophy.  This 
treatment  was  not  without  many  favourable  results 
and  gave  encouragement  to  other  surgeons  to  follow 
his  example.  After  an  accumulation  and  comparison 
of  many  operations  it  was  soon  discovered  that  this 
form  of  treatment  was  not  only  difficult  to  perform  but 
was  dangerous  in  its  consequences.  My  own  experience 
of  the  method  has  often  been  sadly  clouded  by  perito- 
nitis or  a  more  severe  recurrence  of  the  hypertrophy. 
Viewing  the  morbid  changes  from  another  stand- 
point I  am  convinced  by  long  observation  that  the  pro- 
static hypertrophy  is  closely  connected  in  some  form 
or  other  with  the  development  of  the  testicle.  This 
idea  was  suddenly  awakened  by  an  abnormal  condition 
of  a  prostate  after  removing  the  testicles.  From  this 
accident  it  occurred  to  me  that  hypertrophy  of  the 
prostatic  gland  might  be  influenced  by  a  similar  action 
on  the  testes.  The  importance  of  such  a  treatment, 
however,  must  be  seriously  considered  in  practice  from 
a  moral  point  of  view,  although  it  removes  in  a  great 
measure  many  of  the  dangers  of  its  predecessors.  The 
operation  is  simple,  and  the  patient  may  often  be 
allowed  to  leave  his  bed  on  the  third,  fourth,  or  even 
the  next  day  after  the  operation.  One  circumstance 
must  be  always  borne  in  mind,  viz.,  the  age  of  the 
patient.  Before  proceeding  further  to  consider  the 
operation  it  might  be  instructive  to  examine  the  several 


relations  between  the  prostate  and  the  testes  in  the 
normal  condition. 

Between  the  years  1879-1882 1  made  a  close  examina- 
tion of  the  disease,  with  the  object  of  obtaining  more 
accurate  statistics  on  the  subject  than  we  then  pos- 
sessed of  the  relationship  that  exists  between  the 
urinary  and  genital  organs,  more  especially  with  respect 
to  the  size  at  the  different  ages  of  the  individuals. 
During  this  time  all  the  males  that  visited  my  clinic 
were  examined  and  carefully  noted,  amounting  to 
2,000  in  all.  Everyone  of  these  cases  cannot  be  utDised 
for  the  present  object,  but  1,757  may  be  safely  applied. 
Other  deductions  may  be  considered  necessary  when 
we  reflect  on  the  genital  system  often  remaining  intact 
when  other  iMirts  of  the  whole  system  are  found  in  a 
morbid  condition.  It  is  matter  of  common  notoriety, 
however,  that  the  genital  and  urinary  ornins  are  often 
found  associated  m  morbid  changes.  It  frequently 
occurs  that  epididymitis  is  found  associated  with  affec- 
tions of  the  seminal  ducts  and  prostate.  Such  cases  of 
this  kind  must  also  be  excludea  for  our  present  object. 
After  excluding  all  allied  and  doubtful  cases,  we  still 
have  1,282  left  to  demonstrate  the  relation  of  con- 
current df^velopment  between  the  testes  and  prostate. 

In  the  first  class  of  cases,  which  are  taken  between 
ten  and  fifteen  years  of  age,  we  have  sixty  on  record. 
Making  a  closer  analysis  of  this  small  number  in  rela- 
tion to  age  and  size,  and  in  comparing  the  testes  with  the 
prostate,  two  groups  may  be  instructively  separated, 
viz.,  (a)  developed  and  undeveloped ;  (b)  where  the 
prostate  is  smaller  or  larger  than  the  testes,  and  vice 
versd. 

Out  of  the  sixty  cases,  only  five  could  be  said  to  be 
properly  developed ;  in  thirty-nine,  neither  testicle 
or  prostate  were  perfectly  developed.  In  the  second 
group,  the  numbers  were  respectively  nine  and 
seven.  We  may,  therefore,  briefly  conclude  from 
these  observations  that  neither  the  prostate  or 
testes  is  properly  developed  between  ten  and  fifteen 
years  of  ftge. 

In  the  next  class,  between  sixteen  and  twenty  vears 
of  age,  280  individuals  were  examined.  Out  of  this 
number,  eight]^-five  had  testes  and  prostate  properly 
developed,  while  fifty-one  had  neither  of  them  deve- 
loped. In  the  remaining  cases,  the  relationship  was  irregu- 
lar, although  the  preponderance  was  in  favour  of 
larger  testicles.  This  evidence  tends  to  show  that  the 
generative  organs  have  approached  the  period  of  de- 
velopment, though  the  testicle  is  still  in  the  ascendancy. 

Between  the  ages  of  twenty-one  and  twenty-five, 
237  observations  were  made,  and  of  these,  twenty-nine 
had  neither  the  internal  or  external  organs  fully  deve- 
loped ;  forty-nine  had  the  testes  relatively  larger  than 
the  prostate,  while  forty-six  were  smaller.  The  pros- 
tate at  this  age  has  overtaken  and  generally  is  found  to 
exceed  the  development  of  the  testes.  After  the  above 
ages  the  prostate  still  seems  to  increase  in  greater  pro- 
portion to  the  testes. 

From  this  overwhelming  evidence  of  statistical 
examinations,  we  can  scarcely  deny  the  fact  that  there 
is  some  constant  relationship  between  the  testes  and 
the  prostate,  and,  from  the  foregoing  figures,  it  would 
appear  that  the  development  of  the  prostate  commences 
at  the  age  of  puberty,  aud  reaches  its  completion  about 
I  the  twentieth  year  of  life.    To  this  general  rule  we 


442     Thb  Mbdical  Press. 


ORIGmAL  COMMUMCATIONS. 


April  29,  ISOA. 


must  add  a  large  number  of  exceptions,  which  is  the 
most  important  point  under  investigation  on  the  present 
subject,  as  it  bears  comprehensively  with  the  future 
rational  treatment.  To  sustain  this  view,  we  find  indi- 
vidual authors  (who  have  performed  castration  in  the 
fully  developed  scrotum  before  the  twentieth  year  had 
been  reached),  relating  in  the  history  of  the  patient  that 
the  prostate  was  below  the  normal  size.  We  can  easily 
conceive  this  to  be  one  of  the  exceptions  where 
the  prostate  and  testes  were  not  parallel  in  their 
relationship  at  this  period.  Another  point  clearly 
brought  out  in  the  examination  of  the  above 
cases  was  the  great  increase  that  took  place  in 
the  prostate  after  the  fiftieth^  year  of  life. 
We  have  seen  that  it  generally  increases  as  age 
advances,  and  becomes  more  susceptible  to  inflamma- 
tory processes  which  is  another  source  of  rapid 
augmentation.  The  importance  of  this  relationship 
between  prostate  and  testes  .is  forcibly  demonstrated 
in  the  fortv-four  cases  mentioned  of  undeveloped  testes 
all  of  which  had  the  prostate  arrested  apparently  about 
the  same  stage  of  growth.  There  were  nve  other  cases 
where  the  testes  were  no  larger  than  peas,  having  the 
prostate  reduced  in  a  parallel  manner  to  a  mere  rudi- 
mentary organ.  In  the  literature  on  the  subject  many 
other  cases  are  related  where  the  testicular  gland  and 
prostate  are  represented  as  mere  elementary  traces  of 
the  organs.  In  a  large  number  of  the  cases  recorded 
in  literature  of  defective  testes  no  parallel  observation 
has  been  made  with  respect  to  the  prostate  that  leaves 
us  ignorant  of  their  true  value,  but  in  the  eunuch  we 
have  strong  grounds  to  believe  that  the  theory  of 
castration  in  checking  prostatic  hypertrophy  is  well 
founded  and  worthy  oi  further  investigation.  Accord- 
ing; to  Linhart  and  others  who  have  examined 
this  class,  they  found  the  prostate  constantly 
undeveloped  or  small.  In  other  cases  where  the 
testes  had  been  destroyed  by  inflammatory  action 
or  other  circumstances  the  prostate  was  also  found 
diminished:  Another  danger  that  may  be  over- 
looked is  the  period  of  castration.  If  the  operation 
must  be  performed  young  to  arrest  the  growth  of 
the  prostate,  it  would  be  of  little  value  in  our  theory 
of  performing  it  in  advanced  years  with  the  object  of 
contracting  the  internal  organ.  It  has  been  demon- 
strated by  experimental  operations  on  animals  that 
this  theoretical  condition  is  actually  present  after  cas- 
tration of  dogs.  To  test  the  hypertrophied  condition 
where  l^e  prostate  of  the  dog  has  been  similarly  en- 
larged, as  frequently  found  in  man,  castration  had  also 
the  effect  of  reducing  the  gland  as  well  as  checkiog  its 
growth  in  the  former  cases. 

The  most  exact  of  these  experiments  were  conducted 
by  Lenoire  in  1882  to  1885.  which  have  been  more 
recently  confirmed  b^  Wight,  in  1893.  The  latter 
assures  us  that  castration  in  the  young  animal  immedi- 
ately checks  the  growth  of  the  internal  gland  which 
will  be  found  at  that  stage  of  development  at  any  later 
period  of  life.  On  the  other  hand,  the  perfectly  deve- 
loped gland  after  castration  undergoes  rapid  shrinkage, 
first  in  the  glandular  tissue,  and  later  in  the  muscular 
coverings.  The  fibrous  tissue  appears  first  to  increase 
which  subsequently  undergoes  retraction  and  contrac- 
tion of  the  gland.  These  experimental  results  conclu- 
sively prove  the  utili^  of  acting  on  the  prostate 
through  the  testes  at  dinerent  periods  of  life. 

WiUi  these  facts  before  us  we  are  prepared  to  place 
the  operation  of  castration  in  prostate  hypertrophy  as 
a  successful  method  recently  introduced  to  the  notice 
of  the  surgeon.  Hamon  appears  to  have  been  the  first 
to  notice  this  relation  between  the  testicle  and  prostate, 
but  he  viewed  it  at  first  as  only  a  means  of  arresting 
development,  and  on  April  3rd,  1893^  performed  the 
first  operation  with  this  object  in  view,  which  was 
succeeded  by  others,  and  confirmed  in  1895  by  Wight, 
who  performed  three  other  operations.  Subsequently 
the  interest   increased   till  Wight   contributed  111 


cases,  whose  results  he  offered  to  his  brother  operators 
for  their  freest  criticism.  In  addition  to  these,  cas- 
tration had  been  performed  in  several  other  cases  on 
account  of  tuberculosis  of  the  testes  and  prostate,  and 
in  every  one,  after  the  removal  of  the  tubercular  centre 
in  the  testes,  the  prostate  was  found  to  remain  station- 
ary or  undergo  reduction  of  the  morbid  process. 

Wight's  cases  comprise  102,  which  are  worthy  of 
careful  consideration  in  relation  to  the  disease  of 
hypertrophy  of  the  prostate,  and  more  particularly 
with  re^rd  to  the  secondary  phenomena,  such  as 
destruction  of  the  pelvis  of  the  kidney,  or  the  paren- 
chymatous structure  of  the  organ  itself.  The  opera- 
tion must,  therefore,  be  considered  in  a  double  sense, 
in  reducing  the  prostate  directly,  and,  secondly,  in 
alleviating  or  entirely  removing  the  subsequent  changes 
that  occur  in  the  urinary  tract  In  this  sense 
Wight  has  made  an  analysis  of  his  own 
cases,  in  which  he  classes  difficulty  of  urina- 
tion, cystitis,  &c,y  in  a  category  of  sixty-eight, 
all  of  which  were  attended  with  excellent  results  subse- 
quent to  the  operation,  the  organs  becoming  smaller, 
and  the  entire  morbid  condition  disappearing.  In 
thirty-two  other  cases  he  found  the  prostate  gland 
after  operation  remaining  about  the  same  in  dimen- 
sion, but  the  morbid  conditions  seemed  to  be  greatly 
relieved,  and  the  patient  improved  by  surgical  inter- 
ference. He  ccncludes  from  these  figures  that  100 
out  of  102  were  quite  restored  or  greatly  improved  hj 
the  operation.  It  is  also  worthy  of  note  that  this 
happy  result  takes  place  immediately  or  within  a  very 
short  time  after  the  operation  itself,  and  beneficially 
influences  the  health  of  the  patient  even  in  those  cases 
where  no  noticeable  reduction  is  observed  in  the  pros- 
tate. From  these  results,  however,  we  must  make  a 
distinction  in  the  point  oi  time  after  operation  which 
seems  to  alter  or  modify  these  results.  If  we  divide 
the  cases  into  cured,  improved,  or  unaffected  after  a 
reasonable  lapse  of  time,  thirty-nine  might  be  con- 
sidered cured,  and  fifty-seven  improved,  a  result  which 
is  not  to  be  discredited  in  such  an  important  subject 
These  facts  are  sufficient  to  justify  an  operation  m  a 
morbid  process  that  has  proved  so  obstinate  to  the 
surgeon,  even  if  it  were  only  to  relieve  the  dangerous 
retention  of  complete  or  incomplete  urination.  Accord- 
ing to  the  history  of  the  operations,  spontaneous  urina- 
tion will  take  place  on  the  same  or  following  day,  even 
immediately  after  as  is  sometimes  recorded,  which  is 
evidently  due  to  the  viration  or  stimulus  given  to  the 
bladder  by  surgical  interference.  These  are  the  excep- 
tions, however,  as  twenty-four  to  thirty-six  hours  are 
^ven  as  the  general  rule,  while  six  weeks  to  two  months 
IS  very  rare.  In  most  of  these  cases  before  operation 
the  catheter  had  to  be  used  every  two  or  eight  hours, 
which  of  itself  is  a  great  source  of  trouble  to  be 
relieved  of.  The  change  in  volume  of  the  gland  also 
varies  within  wide  limits,  commencing  on  the  third  or 
fourth  day,  up  to  the  ninetieth,  or  even  the  120th  day 
after  the  operation  before  the  diminution  of  the  pros- 
tate could  be  notably  observed.  From  Wiriit's 
tables,  it  is  surprising  to  notice  the  rapidity  which 
sixty-eight  of  his  cases  have  contracted.  As  noticed 
above,  no  proportion  seems  to  exist  between  the  reduc- 
tion of  the  prostate  and  the  suspension  of  the  morbid 
phenomena  that  produce  such  distressing  symptoms, 
although  a  parallelism  exists  between  the  pnmuryand 
secondary  lesions,  the  latter,  however,  depending  on 
the  condition  of  the  prostate  and  other  circumstances 
connected  with  the  bladder,  such  as  the  muscles,  &c. 

From  the  whole  of  the  evidence  now  before  us,  we 
are  forced  to  conclude  that  some  relationship  exists 
between  the  development,  or  arresting  of  the  develop- 
ment, and  the  testes,  and  that  bilatenJ  castration  is 
.  evidently  powerful  and  speedy  in  its  action  in  the 
I  above  gland.  We  must  admit,  however,  that  the  cases 
i  on  record  are  not  so  numerous  as  to  firmly  establish  a 
principle  although  the  theory  seems  to  be  feasible.    In 


IptuL.  29,  iHde. 


ORIGINAL  COMMtJKlCATIoifS. 


Thx  Mjbdioal  Pbh8.     443 


practice,  the  operation  cannot  be  thought  of,  unless 
the  symptoms  are  grave,  before  the  age  is  well  advanced. 
In  the  latter  cases  it  must  be  of  inestimable  value 
where  the  pain  is  very  great  and  the  circumstances 
usually  met  with  remain  without  much,  if  any,  ameliora- 
tion, owing  to  the  futility  of  every  method  hitherto 
adopted.  Another  advantage  in  this  operative  treat- 
ment is  the  immunity  from  danger  to  lite  as  no  single 
case  is  recorded  where  death  has  resulted.  There  are 
five  of  the  cases  at  a  later  period  who  died  with  lunacy 
s^ptoms,  who  had  hitherto  shown  signs  of  the 
disease,  two  cases  from  inanition,  two  from  pneumonia, 
but  none  of  them  had  any  connection  with  the  opera- 
tion itself.  We  may,  therefore,  conclude  that  this 
method  of  treatment  may  be  safely  undertaken  with- 
out any  risk  to  the  patient. 

The  greatest  difficulty  in  practice  will  be  the  con- 
senting of  the  patient  to  such  a  mutilation  of  the 
frenerative  organs  as  bi-lateral  extirpation  of  the  testes. 
Unilateral  castration  does  not  seem  to  satisfy  the  case, 
and  this  is  even  difficult  to  obtain  when  absolute 
necessity  arises.  With  a  view  to  modify  this  destruc- 
tion of  the  testes,  a  more  aesthetic  method  has  been 
suggested  in  the  form  of  tying  the  vas  deferens  which 
would  also  annihilate  the  function  of  the  testes  and 
thus  accomplish  the  same  end  as  if  they  had  been 
removed.  After  tying  the  seminal  ducts  the  same 
phenomena  in  the  prostate  as  observed  by  castration 
IS  established,  which  might  be  taken  advantage  of  in 
practice  in  future  from  the  moral  point  of  view,  as  it 
might  not  appear  so  destructive  as  castration. 


PROGNOSIS    IN    SYPHILIS. 

By  JOHN  A.  SHAW-MACKENZIE,  M.D.Lond. 
{Concluded  from  page  417). 

I  HAVE  endeavoured  in  the  preceding  cases,  as  well 
as  in  the  following,  to  present  a  simple  clinical  record 
of  manifestations  as  they  were  noted  in  patients  three 
to  forty  years  after  primary  disease. 

As  regards  any  time  limit  in  prognosis,  this  appears 
to  be  as  unsatisfactory  as  any  division  into  secondary 
and  tertiary  stages  of  syphilis.  It  is  evident  in  the 
large  msgority  of  cases  any  such  division  ia  lost  in  the 
similarity  of  later  manifestations  with  those  which 
mark  the  early.  Whether  the  less  severe  sequelae  of 
syphilis  are  to  be  attributed  to  more  successful  treat- 
ment or  to  the  attenuation  of  the  syphilitic  virus,  or  to 
the  fact  that  in  the  upper  classes,  circumstances  per- 
mit of  greater  care,  it  is  undoubted  that  gummata, 
nodes,  and  necrosis  of  bone  are  less  frequent,  and  the 
later  manifestations  of  syphilis  when  present  are  of  a 
more  superficial  character.  Twenty  years  a^  Mr.  Lee 
wrote  in  reference  to  the  stages  of  syphilis  :  **  I  am 
satisfied  no  such  classification  can  be  practically  relied 
upon  either  as  a  matter  of  pathology,  or  with  regard 
to  treatment.  The  morbid  processes  described  in  this, 
as  in  other  diseases,  without  reference  to  time  are  the 
most  true  to  nature,  and  furnish  the  most  reliable 
indications  for  practice  "  (a).  And  again,  forty  ^ears 
a^ :  *'  This  distinction  (into  secondary  and  tertiary) 
will  be  adopted  for  convenience  of  description,  but  it 
must  not  thence  be  inferred  th%t  there  is  any  well- 
marked  natural  division  "  (h). 

Eighteen  Yeaks.— 6  Cases. 

Hemiplegia.    Enlarged  glands. 
Induration  of  cellular  tissue  of  scrotum 
Node.    Irritable  spots  on  loin. 
Neurasthenia. 
Incontinence  of  urine. 

Rheumatism.  Throat,  old  evidence  of  ulceration. 
No  glands.    Suicide. 


Nineteen  Years.— 2  Cases. 
Eczema. 
Ulceration  of  tongue.    Spots  on  leg. 

Twenty  Yeabs.— 20  Cases. 

Deep  ulcer  of  throat    Eruption  on  head,  leg,  and 
back  of  arm. 

Loss  of  nasal  bone. 

Enlarged  testis.    Spots  on  leg.    Affection  of  tongue 

Eruption  of  back.    Loss  of  hair. 

Onychia.    Hypertrophied  nails. 

Eheumatism.    Psoriasis  palmaris.   Memory  affected. 
Pain  in  arms.    Obscure  abdominal  tumour. 

Ulceration  of  tongue  (2). 

Acidity  of  urine. 

Slight  eruption  on  penis. 

Disease  of  antrum. 

Necrosis  of  nasal  bones.    Paresis  of  4th  nerve. 
^  Ulceration  of  tongue.    Rupia  of  scalp. 

Three  circular  patches  on  arms. 

Want  of  power  in  right  leg  and  arm. 

Psoriasis  palmaris. 

Dyspepsia. 

Locomotor  ataxy. 

Psoriasis,  sore  throat,  rash  on  side  of  nose. 

Gumma  of  penis  after  intercourse. 


-1  Case. 

tonffue.    Riffht  in- 
gland    enlarged. 


Twenty-one  Yeaes.- 
Ulceration  of  whole  dorsum  of 
uinal   g^lands   and    sub-maxillary 
tomatitis.    Debility. 

Twenty-two  years.— 1  Case. 

A  few  spots  on  cheeks. 

Twenty-thbeb  Years.— 7  Cases. 

Ulceration  of  nose.    Subcutaneous  tubercle  of  skin. 

Loss  of  hair.    Ulceration  of  alas  nasi. 

Nasal  bones  affected.    Neuralgia  of  head. 

Lepra  of  body. 

Affection  of  tongue.  Has  had  dysentery,  fever,  and 
liver  trouble. 

Tubercular  eruption  of  hands.  Inguinal  glands 
slightly  enlarged.    Expresses  himself  in  perfect  health. 

Gumma  of  mid  sternum.    Headache. 

Twenty-five  Years.- 6  Cases. 
Sore  throat.    Swollen  testicles. 
Eruption  of  skin.    Re-infection. 
Mottled  skin  of  back.    Sore  tongue. 
Blood-stained  discharge  from  nostril ;  piece  of  spongy 
bone  came  away. 
Nodes  of  tibiae. 
Ulcer  of  throat. 

Twenty-seven  Years.— 1  Case. 
Pharyngitis.    Lichenous  eruption  on  stomach. 

Twenty-eight  Years. — 1  Case. 
Nil.    No  manifestations  of  syphilis. 

Thirty  Years.— 6  Cases. 
Eruption  on  arms.    Haemorrhoids. 
Phagedsenic  sore. 
Loss  of  smell. 

Hemiplegia.  Died  a  year  later  of  cerebral  haemor- 
rhage. 

Found  dead  in  bed.  Post-mortem,  mitral  calcareous 
vegetations.  Small  contracted  kidneys.  Slaty- coloured 
smidl  liver.    No  evidence  of  syphilis. 

Thirty-three  Years.— 3  Cases. 
Enlargement  of  right  tonsil. 
Nasal  bones  and  tongue  affected.    Node  (2). 

Thirty- FOUR  Years.— 2  Cases. 
Nil.    No  symptoms. 
Nil.    No  symptoms. 

Thirty-five  Years.— 2  Cases, 
Ulceration  of  tongue. 


444    Thb  Mbdioal  Pbbss. 


ORIGINAL  COMMUNIOATTONS. 


April  29,  1896. 


Throat  affected.  Aching  of  bones.  Pain  of  sacrum. 
Enlarged  inguinal  glands. 

Forty  Years.— 1  Casb. 

Induration  Ci)  prepuce.    No  other  manifestations. 

Dr.  MacLaren^s  hrst  classification,  viz.,  that  "if  a 
patient  has  been  properl>r  treated  the  probabilities  are 
that  he  will  go  through  life  with  scarcely  any  appreci- 
able ri^k/'  must  commend  itself  to  those  who  have  any 
experience  of  syphilis.  But  what  is  proper  treat- 
ment ?  •' 

John  Pearson,  in  1800  (c),  states  p.  96,  **that  mercury, 
conducted  by  men  of  such  endowments  should  often 
fail  of  doing  good,  nay,  that  it  should  frequently  inflict 
great  mischief  would  be  according  to  the  natural  order 
of  things." 

John  Bacot,  in  1829,  p.  259,  states  :— *'  I  am  fully 
prepared  on  this  occasion  to  join  Mr.  Abernethy  in 
extolling  the  advantages  of  these  fumigations  when 
employed  judiciously,  and  believe  with  him  that  they 
are  capable  alone  of  radically  curing  many  of  the  forms 
of  syphilis."  (d) 

Sir  Beojamin  Brodie,  p.  292  ;— ♦*  You  may  patch  up 
the  disease  by  giving  the  remedy  (mercury)  internally, 
but  it  will  return  over  and  over  again,  and  then  you 
may  cure  it  at  last  by  a  course  of  mercurial  ointment 
i^roperly  rubbed  in."  (e) 

LangstOQ  Parker  in  1860  states  in  his  work,  p.  322  : 
*^  I  have  very  rarely  seen  a  disease  that  has  not  been 
cured  "  (by  mercurial  baths  and  small  doses  of  mercury 
iaternally).  "  The  experience  derived  from  the  treat- 
ment of  manv  thousand  cases  warrants  me  in  speaking 
thus  positively  on  the  subject."  (/) 

Mr.  Jonathan  Hutchinson  states,  p.  511  :— '*  I  believe 
we  may  regard  the  modern  method  of  the  use  of 
mercurjr  in  syphilis  with  considerable  confidence  "  (t.f ., 
'*  one  simple  rule  appears  to  be  the  key  to  success.  It 
U  to  give  small  doses  more  or  less  frequently  re- 
peated, and  never  larger  ones,"  p.  51).  (g) 

In  1893,  in  a  contribution  to  the  Lancet,  on  the 
"Treatment  of  Oonstitutional  Syphilis  by  External 
Methods  of  Administration  of  Mercury,"  Mav  6th.  I 
stated  on  the  authority  of  Mr.  Henry  Lee  that  tne 
treatment  of  syphilis  by  small  repeated  doses  of  mer- 
cury internally,  was  tried  and  given  up  by  the  late 
Mr.  Briggs  at  tne  Lock  Hospital. 

In  the  Lancety  April  20th,  1895.  in  a  contribution  by 
Mr.  Henry  Lee  and  myself,  Mr.  Lee  states:— "he 
cannot  remember  a  single  case  of  gross  lesion  of  the 
nervous-  system  or  internal  organs  following  the 
c  ireful  and  detailed  primary  use  of  the  calomel 
bath."  (h) 

Cases  have  been  reported  in  which  an  inter- current 
attack  of  variola,  erysipelas,  and  enteric  has  apparently 
cut  short  sjrphilis. 

The  identity  of  the  streptococcus  pyogenes  with  that 
of  erysipelas  is  suggestive  that  the  virulence  of  syphilis 
may  be  increased  by  this  micro-organism  and  that 
its  antitoxin  may  be  found  to  be  of  serum-therapeutic 
value. 

I  am  well  aware  no  absolute  opinion  can  usually  be 
formed  as  to  proportion  of  relapses  under  different 
methods  of  treatment  Patients  if  well  do  not  often 
return,  others  pass  through  many  hands,  others  in  later 
life  do  not  refer  to  previous  syphilis,  unless  pressed, 
which  is  not  always  necessary  or  judicious,  whilst  a  few 
cases  run  a  malignant  or  severe  course,  apparently 
UD influenced  by  treatment. 

It  is  certain,  however,  that  "careful  and  detailed 
treatment  in  the  primary  stages  goes  far  to  eliminate 
disease,  and  at  a  time  when  disease  is  most  amenable 
to  eradication."  Such  treatment  includes  avoidance  of 
wet  and  cold,  stimulants,  or  anything  that  may  lower 
the  general  health,  while  hereditary  constitution, 
)•  ihit9,  and  occupation  are  important  factors.  Syphilis 
nf  the  brain  or  cord  are  chief  fantorn  in  unfavourable 
^irognosi^,  and  it  may  safely  be  said  that  lesions  of 


bones  or  superficial  gummata  are  indications  that  are 
unfavourable  to  life  assurance,  and  are  often  associated 
with  lesions  of  internal  organs,  and  vessels. 

While  undoubted  cases  of  re-infection  point  to  the 
curability  of  syphilis,  the  series  of  cases  I  have  brought 
forward  point  to  the  frequency  of  relapses.  Constitu- 
tional syphilis  is  a  disease  of  malnutrition.  Any  con- 
dition which  predisposes  to  debility,  hereditary  or 
otherwise,  makes  prognosis  unfavourable,  and  espe- 
cially Lb  this  seen  in  neuropathic  diatheses.  Of  special 
causes  of  relapse,  I  may  mention,  marriage,  child- 
bearing,  and  the  menopause.  In  men,  marriage  in 
many  cases  lights  up  latent  disease.  The  detaus  of 
sudb  cases  would  encroach  too  much  on  the  already 
length  of  this  paper.  But  perhaps  I  may  be  allowed 
to  quote  the  following  from  A.  Fournier,  p.  77-78  :— 

"  A  young  man  came  to  consult  me  for  various  sym- 
ptoms, the  result  of  neglected  syphilis.  I  treated  him, 
and  all  disappeared.  Some  months  later,  in  spite  of 
my  advice  ana  my  warnings,  he  married.  Twelve  days 
after  his  marriage,  during  his  wedding  tour,  he  was 
taken  with  a  violent  epileptic  fit,  the  first  symptom  of 
cerebral  syphilis,  which  soon  defined  itself  in  intellec- 
tual troubles  and  left  hemiplegia,  and  despite  all  my 
care  he  succumbed  a  few  months  later."  (t) 

"  A  young  clerk  contracted  syphilis  and  treated  him- 
self regularly  during  some  months.  Three  years  later, 
and  without  consulting  a  doctor,  he  married.  Hardly 
was  he  married  when  he  communicated  syphilis  to  his 
wife  by  a  renewal  of  a  secondary  symptom  which 
showed  itself  on  the  penis.  Then  symptoms  of  cerebral 
syphilis  set  in  and  a  recurrence  of  symptoms  carried 
off  the  patient  rapidly."  (t) 

In  married  women  syphilis  is  far  more  common  than 
is  generally  admitted,  either  due  to  primary  syphilis 
or  secondary  to  conception,  while  the  menopause  and 
prefpaancy  are  fertile  sources  of  relapse.  No  class  of 
patient  is  more  imperfectly  treated  because  manifesta- 
tions are  unsuspected  as  sequelse  of  syphilis. 

In  prognosis,  the  presence  of  enlarged  inguinal  or 
post-cervical  glands,  unless  natural  to  the  patient, 
point  to  the  probabilitv  of  relapse.  Another  fact  may 
be  mentioned— A  further  mercurial  course  will  often 
develop  manifestations  which  were  latent.  So  true  is 
this  that  some  observers  have  considered  treatment 
inadvisable  previous  to  contemplated  marriage.  It  is 
rather  an  indication  of  the  advisability  of  treatment  or 
postponement  of  marria^. 

Six  case  of  extra-genital  syphilis  have  come  under 
my  notice :  three  of  finger  of  medical  men ;  one  of 
finger  of  lady  ;  and  two  of  lip  in  lady  ;  one  from  kiss- 
ing a  8]^hilitic  grandchild,  the  other  direct  inoculation 
from  kissing.  They  have  not  appeared  to  present  a 
more  severe  course  than  syphilis  contracted  in  the  usual 
way.  One  of  the  ladies  presents  a  dean  circular  fora- 
men of  soft  palate,  from  sloughing  30  jrears  ago-  The 
second  lady  nad  two  severe  attacks  of  iritis,  while  the 
third  is  now  under  treatment  for  secondary  eruption, 
while  the  chancre  on  lip  is  healed  but  remains  the 
size  of  a  sixpenny  piece.  This  last  case  was  first  seen 
and  diagnosed  by  Dr.  Halley,  of  Fulham. 

Lectures  on  Fyphllis,"  p.  98. 

Syphilis."  p.  268. 

Obsenrations  on  Effects  of  Varions  Articles  of  Materia  Medica 
in  t^e  Core  of  Laes  Venerea." 
(d)  "  A  Trentlse  on  SyphilU." 
(«)  The  Worlu  of  Sir  a  Brodie. 
(/)  "  On  SyphiUtic  Disease." 
(p)  "Syphilis." 

ih)  On  Two  Cases  of  SyphiHs  with  Early  Nervons  Manifestations. 
<0  "  Syphilis  andManiage."    TransUted  by  Alfred  Lingard. 


(o) "  I 
(c)  "C 


The  Treasurer  of  Guy's  Hospital  acknowledges  with 
grateful  thanks  the  receipt  of  a  donation  of  100  guineas 
towards  the  special  re-endownment  fund  from  the 
Liebig's  Extract  of  Meat  Company,  Ltd. 


Apbil  29,  1896. 


ORIGINAL  COMMQNICATIONS. 


Thb  Midioal  PRCfrS.     445 


A  NOTE  ON 

THE  TREATMENT   OF  CARBUNCLE. 
By  J.  O.  CONOR,  MA.,  M.D  ,  B.Ch.,  T.C.D., 

Senior  Medical  Officer,  BritBb  HoBpltal,  Bucdob  Ayres. 

At  this  stage  in  the  progress  of  surgical  science,  one 
occasionally  is  struck  by  the  fact  that  there  are,  as  yet, 
some  medical  men  who  prefer  to  do  or  say  anything, 
rather  than  use  a  knife  freely.  I  confesR  I  was  deeply 
interested  in  a  memorandum,  in  the  Brit,  Med.  Jour., 
of  Jan.  25th,  written  by  Mr.  Timothy  Richardson,  re 
the  Local  Treatment  of  Carbuncle.  According:  to  this 
gentleman,  '*  moist  cane  sugar  (foots)  spread  over  a 
hot  linseed  poultice,"  is  guaranteed  to  kill  a  carbuncle. 
While  I  do  not  doubt  his  good  results,  nor  his  belief  in 
his  own  method,  yet  the  application  of  such  nobtrums 
appears  to  me  directly  opposed  to  scientific  treatment, 
and  the  appearance  of  sncn  doctrine,  in  a  journal  that 
is  supposed  to  be  an  up- to  date  tutor  for  practitioners, 
involves  such  a  considerable  risk  to  young  men  enter- 
ing practice,  that  I  have  no  hesitation  in  attempting 
to  detract  their  minds  from  such  folk  lore  to  a  much 
more  scientific  and  trustworthy  method,  viz.,  the 
removal  by  excision. 

During  the  past  three  years  it  has  fallen  to  my  lot 
to  treat  twelve  cases  of  carbuncle,  six  on  nape  of  neck, 
two  on  buttock,  two  on  back,  one  on  perineum,  and 
one  on  face ;  in  each  instance  the  treatment  ado]>ted 
was  excision,  supplemented  in  four  cases  by  erasion. 
The  ooeration  is  carried  out  in  the  following  manner  : 

I.  The  patient  having  been  placed  under  ether,  a 
deep  incision  is  mcule  round  the  whole  circumference  of 
carbuncle,  at  least  half  an  inch  outside  infected  area  ; 
luckily,  carbuncles,  as  a  rule,  do  not  occupy  parts  where 
there  are  any  large  blood  vessels,  therefore,  there  can 
be  no  excuse  for  stinting  the  depth  of  this  incision. 

II.  With  the  handle  of  a  scalpel  or  a  periosteal  ele- 
vator, the  carbuncular  mass  is  undermined,  elevated, 
and  removed,  in  the  same  manner  as  a  tumour  of 
breast. 

III.  Sometimes  it  happens  that  the  disease  has 
extended  too  deep  and  cannot  be  isolated  from  the 
surrounding  structures ;  in  such  a  case  I  always 
remove  all  I  can  with  the  knife,  then  a  strong  scissors 
is  brought  into  action,  and,  lastly,  the  business  is 
finished  with  a  sharp  Yolkmann's  spoon.  Not  a  trace 
of  the  disease  should  be  left. 

IV.  In  order  to  contend  with  any  microscopical 
particles  that  should  have  escaped  this  process  of 
eradication,  I  swab  the  whole  surface  with  a  solution 
of  40  grains  to  ounce  of  zinci  chloride.  Of  course, 
this  is  only  used  in  cases  that  do  not  admit  of  a  clean 
removal. 

v.  A  large  circular  wound  is  generally  left ;  this  is 
finally  painted  with  the  following  solution  :— Carbolic 
acid,  one  part ;  alcohol,  one  part ;  methyl  violet,  one 
part ;  water,  ten  parts  ;  dusted  with  iodoform  ;  packed 
with  iodoform  gauze  ;  and  bandaged. 

Vr.  When  the  gr<inulating  wound  comes  level  with 
surrounding  skin,  Thiersch's  grafts  are  applied,  which 
considerably  hasten  the  cure. 

Needless  to  say,  this  operation  is  not  by  any  means 
a  bloodless  one,  but  with  a  steady  assistant,  armed  with 
a  dozen  pressure  forceps,  there  is  no  need  of  alarm  ; 
any  vessels  that  merit  it  are  tied,  the  general  oozing 
soon  ceases  with  pressure  of  a  sponge  soaked  in  hot 
water. 

Oat  of  the  twelve  cases,  eight  were  excised,  the 
remaining  four  required  the  scissiors,  spoon,  kc.  In 
not  a  single  instance  did  the  disease  recur  in  the 
wound  ;  constitutional  symptoms,  in  some  oa^es  severe, 
vanished  in  twenty  four  hours.  In  fact,  it  is  hard  to 
realise  that  a  patient  ro  deep  in  the  throes  of  septi- 
csemia,  can  be  restored  to  his  normal  state  in  sucn  a 
short  space  of  time.  No  other  method  I  have  ever  tried 


or  heard  of,  equals  complete  excision  in  this  respect. 
To  show  this  I  shall  mention  one  case. 

A  ship's  officer,  fet.  36,  entered  the  British  Hospital, 
suffering  from  a  large  carbuncle  situated  below  spine 
of  left  scapula ;  on  evening  of  admission  his  tempera- 
ture was  104\  tongue  furred  and  dry,  pulse  110,  cold 
clammy  sweats,  anorexia,  with  an  anxious  face,  flying 
all  the  signals  of  surgical  distress.  On  the  following 
morning,  as  his  general  condition  was  worse,  notwith- 
standing the  frequent  application  of  warm  boracic 
fomentations  through  the  night,  be  was  placed  under 
chloroform,  and  an  incision  made  an  mud  whole  circum- 
ference of  carbuncle,  which  was  over  four  inches  in 
diameter  ;  the  whole  mass  was  lifted  up  from  the  con- 
nective tiasue  and  removed,  without  entering  the 
diseased  portion.  The  following  evening  the  tempera- 
ture wafl  norma],  **  He  felt  he  wanted  something  to 
eat.''  The  temperature  never  again  exceeded  99*" ;  he 
was  able  to  partake  of  full  diet  on  the  third  day,  and 
was  taking  exercise  in  the  garden  on  the  fourth.  My 
experience  in  the  other  cases  has  been  identical. 

There  was  no  trace  of  sugar  found  in  any  of  the 
urines ;  consequently,  I  cannot  say  how  a  diabetic 
patient  would  bear  the  operation.  It  practically  means 
for  him,  '*  is  the  cure  worse  than  the  disease  ? "  Per- 
sonally, I  doubt  it 

Having  obtained  such  remarkable  results  by  excision, 
I  reluctantly  feel  impelled  to  question  the  dictum  of  so 
good  an  authority  as  Mr.  Jonathan  Hutchinson,  junr., 
in  "  Treves's  System  of  Surgery,"  page  713.  This  gentle- 
man, writing  on  the  treatment  of  carbuncle,  states  : 
*'  An  ancient  plan  of  treatment  of  carbuncle  has,  how- 
ever, been  lately  revived,  consisting  in  cutting  with 
scissorR  and  scraping  away  all  the  slough,  in  the  belief 
that  this  shortens  the  healing  process ;  undoubtedly, 
some  time,  and,  perhaps,  considerable  pain,  are  occa- 
sionall  V  saved  by  this  plan,  but,  on  the  other  hand,  the 
risk  of  opening  up  veins  and  causing  pyaemia  appears 
to  be  distinctly  increased,  and  many  surgeons  have 
on  this  account  abandoned  it"  Well,  this  gentle- 
man's opinion  and  mine  are  far  from  coinciding.  I 
should  explain  the  occurrence  of  pyaemia  as  due  to 
halfhearted  operations,  where  the  disease  is  not 
thoroughly  cleared  away  ;  or  to  operations  undertaken 
too  late,  when  the  pyaemic  virus  had  already  entered 
the  blood  ;  so  far,  I  have  not  heard  of  pyaemia  follow- 
ing Barker's  operation  in  psoas  abscess,  scraping  away 
suppuratinir  inguinal  glands,  at  the  opening  up  and 
scraping  of  large  abscesses  on  the  thigh,  where  the  pro- 
cess is  somewhat  identical. 

My  apology  for  this  criticism  is— First,  that  I  do 
not  think  there  is  any  scientific  foundation  for  the 
remarks  just  quoted,  as  to  the  possible  dangers  ; 
secondly,  I  am  a  strong  believer  that  in  every  instance 
in  surgery,  where  there  is  grave  constitutional  depres- 
sion, prompt  measures  ought  to  be  taken,  and,  if 
possible,  a  "  clean  sweep  "  made,  not  only  of  the  micro- 
organisms, but  of  their  camp ;  to  dilly-dally  in  the 
hopes  that  painting  with  iodine,  injecting  limited 
quantities  of  carbolic  acid,  applying  dirty  linseed  meal, 
covered  with  '*  foots,"  will  bring  about  such  a  change, 
that  the  phagocytes  may  eventually  conquer,  is  a 
species  of  surgery  that- must  be  attended  with  disaster. 
As  Mr.  Hutchinsoii  does  not  mention  complete  excision 
in  the  treatment  of  carbuncle,  my  remarks  as  to  his 
theories  only  refer  to  operations  where  the  scissors  and 
spoon  are  used  as  supplementary  to  the  knife. 


At  the  last  meeting  of  the  Wycombe,  Bucks,  Board 
of  Guardians,  a  resolution  was  passed  rescinding  a 
previous  resolution  by  virtue  of  which  the  Vaccination 
Acts  have  been  a  dead  letter  locally  for  the  past  three 
years.  Vaccination  has,  therefore,  become  conipulsory 
in  the  district. 

1) 


^46     Thb  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


April  29,  1896. 


§paniBh  ^rtsmptixmB. 

Tramlattdfor  Thb  Mbdical  Priss  and  Circular 
By  GEORGE  FOY,  F.R.C.S., 

Surgeon  to  the  WhUworth  Hoapltal ;  Hon.  Fellow  of  the  Southern 
Surgical  and  Gynaeoological  Auoclatlon,  U.S.A. 

Bronchitis.— Dr.  R.  Rivas. 
Beechwood  creoeote,  8  decigrammee  ; 
Iodoform,  4  decigrammes ; 
Helanin,  2  decigrammee. 
Mix  and  make  twenty  pille.    Five  to  be  taken  daring 
the  day. 

Flatulent  Dyspepsia.— Dr.  Fernando  Munoz. 
Brucine,  10  centigrammes ; 
Qaassine  crystallised,  10  centigic  mmes ; 
Rhubarb,  3  grammes ; 
Essence  of  aniseed,  10  drops. 
To  be  made  into  sixty  pills.    One  to  be  taken  after  each 
meal.    Or 

Socotrine  aloes,  20  centigrammes  ; 
Extract  of  nux  vomica,  20  centigrammes ; 
Powdered  belladonna,  20  centigrammes. 
To  be  made  into  twenty  pills.    One  pill  after  each  meal. 

Epistaxis. 
The  following  solation  is  recommended  to  be  sniffed  ap 
the  nose  :— 

Trichloracetic  acid,  1  gramme ; 
Water,  30  grammes. 
Mix. 
When  the  bleeding  is  arrested  the  following  mixtare  is 
to  be  freely  applied  on  cotton  wool  :— 
Phenol,  15  grammes  ; 
Benzoic  acid,  15  grammes ; 
Tannic  acid,  15  grammes  ; 
Collodion,  100  grammes. 
And  in  every  case  it  is  recommended  to  plug  the  poste- 
rior nares  with  tampons  of  lint  wetted  with  the  above. 
Vomiting. 
Menthol,  4  grammes ; 
Olive  oil,  10  grammes. 
Mix. 
Six  or  ten  drops  to  be  taken  on  a  lump  of  loaf  sugar. — 
Gaceta  Medica  de  Cadiz. 


^SrAitBactumB  of  ^odetitB. 

CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  Fridat,  April  24th,  1896. 

The  President,  Dr.  Buzzard,  in  the  Chair. 

Clinical  Evening, 
excision  of  upper  two-thibds  of  fibula  for  sarcoma. 
Mr.  Bland  Sutton  showed  a  young  woman,  tet.  23, 
who  came  with  a  swelling  over  the  region  of  the  upper 
end  of  the  fibula.  This  he  cut  down  upon,  dividing  the 
musculo- cutaneous  nerve.  Ho  excised  the  tumour  with 
the  upper  two-thirds  of  the  fibula  dividing  at  the  same 
time  the  anterior  tibial  nerve  and  vessels.  He  then 
sutured  the  divided  ends  of  the  musculo-outaneous  nerve 
and  closed  the  wound.  She  developed  talipes  equinus 
which  had  been  remedied  by  means  of  a  suitable  boot  so 
that  she  could  walk  without  difiiculty.  The  growth  was 
of  the  nature  of  a  round-celled  sarcoma. 
deficient  development  of  the  lower  end  of  tibia 

after  transverse  fracture 
Mr.  Gordon  Bbodie  showed  a  lad  who  had  come  to  the 
Middlesex  Hospital  with  talipes  valgus  on  the  left  side. 
He  had  sustained  a  transverse  fracture  of  the  tibia  in  1S94 
and  this  had  been  followed  by  marked  curvation  outwards 
of  the  lower  part  of  the  tibia  thus  throwing  the  internal 
malleolus  into  undue  prominence.  The  lower  end  of  the 
fibula  was  much  hypertrophied  and  was  buttressed  up  by 
ridges  of  bone  to  compensate  the  strain  thrown  on  the 
outer  part  of  the  ankle-joint  by  the  obliquity  of  the 


articular  surfaces.  The  foot  had  assumed  the  position  of 
talipes  valgus.  He  brought  the  case  forward  because  it 
was  the  first  time  he  had  met  with  arrest  of  develop- 
ment as  the  result  of  transverse  fracture.  The  line  of 
fracture  was  far  away  from  the  epiphysis. 

Dr.  F.  DB  Havilland  Hall  suggested  that  it  was 
eminently  a  case  for  the  application  of  the  new  photo- 
graphy. 

sequel  to  acute  swellings  over  the  cranium  in  an 
infant. 
Mr.  Wallis  showed  a  child  already  brought  forward 
at  a  previous  meeting,  when  it  presented  a  Urge  diffuse 
swelling  over  the  forehead,  limited  by  the  saeittal  suture, 
the  nature  of  which  could  not  be  defined.  Nothing  waa 
done  in  the  way  of  treatment,  and  some  time  later  the 
child  contracted  measles,  after  which  the  tumour  cleared 
up,  and  now  not  a  trace  remained. 

SEQUEL  OF  A  CASE  OF  MULTIPLE  INFECTITE  NEURITIS. 

The  President  showed  a  patient  who  was  shown  by 
Dr.  Mott  in  February,  1894,  as  one  of  "multiple  infective 
neuritis."  He  was  then  brought  to  the  Society  on  a 
stretcher,  being  paralysed  in  alfhis'limbs.  He  had  been 
admitted  in  April,  1893,  with  severe  symptoms — hema- 
turia, mel»na,  high  temperature,  &c.,  symptoms,  in  fact, 
at  first  thought  to  point  to  typhoid  fever.  Gradually, 
however,  it  merged  mto  a  conaition  of  paralysis,  with 
marked  wasting  of  muscles,  and  it  was  noted  that  each 
exacerbation  of  temperature  was  followed  by  an  extension 
of  the  paralysis.  The  patient  passed  under  the  author's  care 
in  May,  1894.  Various  joints  had  at  different  times  to  be 
straightened  under  an  anaesthetic  to  break  down  adhesions. 
The  knee-jerks  were  exaggerated.  He  remained  in  the 
hospital  until  February,  1895,  by  which  time  he  had 
recovered  power  in  the  legs,  and  power  was  beginning  to 
return  in  tne  upper  extremities.  There  was,  however,  still 
some  loss  of  reaction  to  galvanic  and  faradic  stimulation 
in  the  arm  muscles.  He  was  treated  by  massage,  elec- 
tricity, and  hot-water  douches.  He  pointed  out  that 
although  the  symptoms  undoubtedly  pointed  to  multiple 
neuritis,  anterior  poliomyelitis  was  also  present,  as  shown 
by  the  spasticity  of  the  paralysed  muscles,  &c.  Cultures 
of  blood  from  the  finger,  taking  during  an  exacerbation, 
demonstrated  the  presence  of  a  coccus,  which  Dr.  Kanthack 
had  been  unable  to  identify. 

DEFICIENCY  OF  LOWER  RIBS. 

Mr.  J.  Murray  showed,  for  Mr.  Pearce  Gould,  a  small 
boy,  set.  5,  in  whom  the  8th,  9th,  and  10th  ribs  on 
the  left  side  were  completely  wanting,  leaving  a  gap  2^ 
inches  wide.  The  Uth  rib  was  smaUer  than  the  corres- 
ponding rib  on  the  other  side,  but  the  12th  was  larger. 
When  he  breathed  the  spleen  could  be  seen  moving  freely 
up  and  down  and  the  diaphragm  could  be  seen  rising  and 
falling.  There  was  nothing  of  interest  in  the  family  his- 
tory. There  was  no  history  of  any  disease  of  the  chest 
nor  of  maternal  impression. 

curious  defect  of  speech. 

Dr.  Herrinoham  showed  a  lad,  set.  13,  who  exhibited  a 
curious  defect  of  speech,  which  was  slow  and  markedly 
syllabic.  He  had  difficulty  in  beginning  words,  though 
in  other  respects  he  was  intelligent,  and  in  good  health. 
There  were,  however,  two  motor  symptoms,  viz.,  "jumps  " 
or  "  shakes,"  which  consisted  of  convulsive  movements  of 
the  hands  and  shoulders,  which  came  on  suddenly,  mostly 
in  the  morning.  He  also  had  twitchings  of  the  face 
muscles.  The  defect  of  speech  was  notic^  as  soon  as  he 
began  to  speak.  He  had  measles  at  four  years  of  age,  but 
the  parents  believed  that  even  before  that  attack  there 
was  something  abnormal  in  his  speech.  It  was  not  a  pro- 
gressive disease. 

Dr.  Ormerod  recalled  the  case  of  a  young  soldier  who  ex- 
hibited a* very  similar  defect  of  speech  which  came  on  after 
an  attack,  characterised  by  ataxia,  of  what  he  called  sun- 
stroke when  in  India.  He  was,  when  first  seen,  still  slightly 
ataxic,  and  his  speech  exhibited  the  same  syllabic  character 
as  this  lad's,  and  he  always  spoke  in  a  monotone.  He  had 
seen  the  man  from  time  to  time  since,  and  he  presented  no 
motor  symptoms,  and  could  walk  long  distances.  Dr. 
Hugblings  Jackson  suggested,  when  the  case  was  brought 
forward,  that  it  was  an  example  of  interference  with  speech 
associated  with  ataxy  supervening  after  some  acute  mfec« 
tive  disease, 


April  29,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Press.     447 


The  President  also  remembered  the  patient  alladed  to 
by  Dr.  Ormerod,  and  be,  too,  noticed  the  similarity  of  the 
defect.  He  suggested  that  it  would  be  a  good  thing  to 
record  these  defects  by  means  of  the  phonograph,  because 
defects  of  speech  really  could  never  be  adequately  described 
in  words. 

SAORO-COCCrOEAL  TUMOUR. 

Mr.  Clutton  showed  a  child,  sBt.  3,  with  an  enormous 
sacro- coccygeal  tumour.  It  had  not  increased  in  size 
since  he  first  came  under  observation,  but  he  had  post- 
poned interference  on  account  of  his  delicate  state  of 
health.  It  consisted  mainly  of  one  large  cyst  with  some 
solid  matter  round  the  base,  and,  per  rectum,  a  liquid 
tumour  could  be  felt  extending  up  the  rectum  rather 
beyond  the  reach  of  the  finger.  The  sacrum  and  coccyx 
could  be  felt  expanded  over  the  tumour,  showing  that  it 
commenced  between  the  rectum  and  the  coccyx.  He  pro- 
posed to  tap  the  cyst  at  the  outer  part,  reserving  the 
question  of  dealing  with  the  internal  cyst.  Mr.  Clutton 
also  showed  a  woman,  sat.  26,  with  spina  bifida,  the  posi- 
tion of  which  was,  of  course,  outside  the  sacrum,  thus  con- 
trasting with  the  previous  case.  He  also  referred  to  the 
case  of  a  young  woman  similarly  affected  who  had  insisted 
on  the  removal  of  the  tumour  because  she  wanted  to  get 
married,  and  she  regarded  the  position  of  the  tumour  as 
an  obstacle  thereto.    The  operation  had  proved  successf  uL 

Mr.  Bland  Sutton  observed  that  the  result  of  interven- 
tion in  pre-antiseptic  days  had  been  invariably  fatal,  but 
since  that  time  several  successes  had  been  recorded.  He 
added  that  possibly  the  tumour,  felt  per  rectum,  might  not 
extend  as  far  as  would  seem.  The  fatality  of  the  earlier 
operations  was  due  to  intervention  having  been  resorted 
to  at  too  early  an  age. 

Mr.  Clement  Lucas  said  he  had  operated  some  time 
since  on  a  tumour  of  this  kind  consisting  mainly  of  two 
cysts.  He  first  tapped  the  most  external  cyst,  carefully 
eealing  the  wound  to  prevent  infection,  and  later  repeated 
the  operation  for  the  other,  and  the  result  was  satisfactory. 
In  another  case  in  which  the  tumour  sprang  from  the 
front  of  the  sacrum,  pushing  up  the  bladder  and  rectum 
and  giving  rise  to  troublesome  symptoms,  he  made  a 
horse- shoe  incision  round  the  anus  and  cut  away  the  solid 
tissue  in  pieces,  and  that  case  also  recovered. 

pseudo-rickets  in  an  adult. 
Mr.  Salter  showed  a  girl,  sat.  14,  who  exhibited  in  a 
marked  degree  the  lesions  usually  associated  with  rickets. 
She  had  been  under  observation  for  two  years  and  the 
joints  had  been  skiographed  showing  the  exact  patho- 
logical condition.  Shewas  admitted  in  January,  1894,  for 
li^enu  valgum  which  had  commenced  in  September,  1893. 
^Double  osteotomy  was  performed  and  she  was  discharged 
in  March,  1894.  Since  the  operation  she  has  never  been 
able  to  walk  on  account  of  the  pain  in  her  ankles.  In 
December,  1894,  she  fell  and  fractured  her  left  thigh, 
apparently  with  very  slight  violence.  There  was  marked 
atrophy  of  both  vasti  intern!  and  general  muscular  weak- 
ness. The  bony  lesions  were  not  accompanied  by  the 
Bweating,  painful  sensations,  or  restlessness,  usually  met 
with  in  association  with  rickets  in  infants,  nor  did  she 
appear  to  have  had  rickets  when  a  child. 

ACROMEOALY. 

Dr.  Henrt  Campbell  showed  a  woman,  aet.  41,  exhibit- 
ing the  characteristic  features  of  acromegaly  in  a  marked 
degree. 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  April  9th,  1896. 


The  President,  Clement  Godson,  M.D.,  in  the  Chair 


specimen. 
Dr.  Winson  Ramsay,  of  Bournemouth,  showed  a  speci- 
men of  a  pedunculated  myoma  of  the  uterus,  which  had 
filled  the  pelvis  and  given  rise  to  intestinal  obstruction. 
The  intestmes  were  aotierent  to  it  over  a  large  area,  and 
in  the  jejunum  there  was  a  sharp  kink,  the  immediate 
cause  of  the  obstruction,  The  pati^qt  made  a  good 
reoovery. 


ADJOURNED   discussion    ON    \'ENTRO FIXATION  AND  SUSPEN- 
SION  OF  THE  UTERUS,  AND  ALLIED  OPERATIONS. 

This  was  opened  by  a  communication  from  Dr.  Bantock, 
which  was  reiad  in  his  absence.  He  claimed  the  right  to 
discuss  these  operations  on  the  ground  that  he  had  not 
done  them  in  a  single  instance.  When  Dr.  Alexander's 
book  was  published  he  studied  the  question,  and  came  to 
the  conclusion  that  the  principle  was  entirely  wrong  ;  for 
it  seemed  to  him  that  the  failure,  in  cases  of  procidentia, 
lay,  not  in  the  suspensory,  but  in  the  supporting,  structures. 
He  had  been  able  to  afibrd  complete  support  Sy  means  of  a 
diaphragm  pessary,  either  with  or  without  a  plastic  opera- 
tion. On  the  latter  depended  also  the  success  of 
Alexander's  operation,  for  this  alone  never  succeeded 
unless  a  plastic  operation  was  also  done.  He  had  never 
found  it  necessary  to  operate  on  account  of  retroflexion  ; 
and  when  he  bad  operated,  it  was  not  because  of  the 
retroflexion,  but  because  of  the  far  more  serious  condition 
of  the  appendages. 

Professor  Mayo  Robson  read  a  communication  by  Dr. 
O.  Conor,  of  Buenos  Ay  res,  received  through  Mr.  Reginald 
Harrison,  giving  his  experience  of  ventrofixation  of  the 
uterus,  which  he  had  performed  eight  times  with  very 
satisfactory  results. 

Dr.  Elder  (Nottingham)  said  he  had  performed  Alex- 
ander's operation  in  several  cases  many  years  ago,  but 
gave  it  up  for  three  reasons :  (I)  the  uncertainty  of 
finding  the  round  ligament ;  (2)  the  results  did  not  seem 
to  be  permanent ;  (3)  it  seemed  to  him  not  devoid  of  risk. 
In  uncomplicated  cases  he  had  found  curetting,  plastic 
operations,  and  pessaries  sufficient ;  in  cases  of  lulhesions, 
when  he  had  opened  the  abdomen,  he  did  it,  like  Dr. 
Bantock,  not  because  of  the  displacement,  but  because  of 
the  condition  of  the  appendages.  He  had  seen  many 
fashions  in  gynsscology,  and  he  thought  ventrofixation 
was  one  of  them,  which  would  not  last. 

Dr.  Alexander  (Liverpool)  thought  his  operation  had 
not  been  quite  fairly  represented  by  some  of  the  speakers 
at  the  last  meeting,  and  he  wished  especially  to  correct 
two  impressions :  (1)  that  it  was  a  double  abdominal 
section;  (2)  that  the  results  were  not  permanent.  The 
operation  i»as  as  follows  : — An  incision,  1^  inches  long,  was 
made  over  the  external  abdominal  ring.  A  few  touches 
with  the  knife  exposed  the  aponeurosis  of  the  external 
oblique,  and  the  round  ligament  was  at  once  found.  It 
was  pulled  up  with  forceps,  and  then  fixed  by  three  catgut 
sutures  to  the  pillars  of  the  ring.  One  suture  was  put  in 
the  skin  wound,  through  which  he  left  the  ligament 
projecting,  to  act  as  a  drain.  The  procedure  was 
then  repeated  on  the  other  side.  It  was  in  no 
sense  an  abdominal  section,  and  entailed  no  risk 
at  all.  Some  of  the  modifications  which  had  been 
introduced  were  both  dangerous  and  unnecessary.  Indi- 
cations:  (a)  Prolapse, — He  could  not  agree  with  Dr. 
Bantock's  pathology  of  the  condition.  The  first  trouble 
in  prolapse  was  not  cystocele,  but  retroversion  ;  and  the 
shortening  of  the  round  ligaments  cured  the  prolapse,  not 
by  drawing  up  the  uterus,  but  by  anteverting  it.  Peri- 
neorrhaphy alone  was  not,  as  Dr.  Bantock  maintained,  a 
permanent  operation,  (h)  If etrovernon,— "He  performed  the 
same  operation  in  these  cases,  but  introduced  at  the  same 
time  a  Hodge  pessary,  to  keep  the  fundus  up  and  prevent 
traction  on  the  round  ligaments.  In  cases  of  retroflexion, 
he  also  inserted  an  intra-uterine  stem  ;  this  was  kept  in 
for  three  weeks,  with  the  patient  in  bed  ;  and  the  Hodge 
for  three  weeks  longer.  Many  cases,  like  some  of  his 
earlier  ones,  failed  for  want  of  these  precautions.  It  was 
easy  to  tell  when  the  round  ligaments  bad  united, 
for  then  pressure  on  the^extemal  abdominal  ring  caused 
traction  on  the  cicatrix. '  Results, — Since  he  introduced 
the  operation  fourteen  years  ago,  he  bad  done  several 
hundred  cases,  and  he  had  always  found  it  fulfil  all  the 
conditions  he  required.  He  had  lately  been  looking  up 
the  after-histories  of  many  of  them.  Dr.  Alexander 
then  related  in  detail  the  later  results  of  a  number  of 
cases,  and  said  he  felt  justified  in  contending  that  the 
results  were  permanent.  Drawlxichs. — He  admitted  that 
there  was  sometimes  a  tendency  to  hernia,  but  this 
could  always  be  controlled  by  a  truss.  The  cases  in  which 
there  bad  been  failure  were  due  in  every  case  to  the  want 
of  the  above-mentioned  precautions. 

Dr.  WiNSON  Ramsay  (Bournemouth)  showed  a  uterus 
illustrating  an  effect  of  v^ntro^atiop  pot  touched  upon  by 


448     Thi  Mxdioal  Priss. 


TRANSACTIONS  OP  SOCIETIES. 


April  29,  1896. 


previoQB  spaakera.  The  patient,  nt.55,  bad  saffered  from 
prolapee  for  yearp.  In  Febmary,  1894,  he  perfoimed 
ventrofixafcion,  and  beard  nothing  more  from  her  for  twelve 
months,  when  sheoame  back  to  him  complaining  of  recur- 
renoe.  He  foand  the  oervix  protruding  from  the  vulva, 
and  concluded  that  the  stitchea  had  given  way.  He  there- 
fore performed  vaginal  hysterectomy,  and  then  found 
that  the  fundus  was  still  firmly  attached  to  the  abdominal 
wall,  and  that  the  protrusion  of  the  oervix  was  due  to 
great  hypertrophy.    She  made  a  good  recovery. 

Dr.  WiLUAM  DuNOAN,  who  spoke  in  response  to  an 
invitation  from  the  President,  said  the  specimen  they  had 
just  seen  was  very  interesting,  as  it  was  an  example  of 
supra -vaginal  elongation  of  the  cervix ;  but  be  presumed 
that  the  condition  existed  at  the  time  of  the  first  opera- 
tion ;  and  so,  though  the  actual  operation  was  suooesrful, 
it  was  hardly  a  case  where  they  could  expect  a  good 
result.  He  was  very  interested  in  Dr.  Alexander's 
remarks,  because  his  own  experience  of  the  operation  of 
shortening  the  round  ligaments  had  been  entirely  different. 
Seven  or  eight  years  ago,  be  performed  the  operation 
eleven  times ;  he  found  it  quite  simple,  and  did  not  agree 
with  Dr.  Elder  as  to  the  uncertainty  of  finding  the  round 
ligaments,  but  all  the  eleven  cases  reverted  within  four 
months  to  their  original  condition.  Be  did  not  use  a 
stem  pessary  because  he  regarded  it  as  a  dangerous  instru- 
ment. Ventrofixation, — He  would  consider  tiiis  under  the 
four  heads  adopted  by  Professor  Mayo  Robson.  (1 )  Safety. 
He  bad  done  five  casee,  all  successful,  but  the  number  was 
of  course  too  small  to  draw  general  conclusions  from, 
because  there  was  always  a  certain  risk  in  opening  the 
abdomen.  For  this  reason  also  the  operation  should  not 
be  undertaken  unless  other  moans  had  been  tried 
without  suocesB.  But  in  cases  of  old-standing  pro- 
lapse or  retroversion,  disabling  the  patient,  when 
instruments  failed  to  relieve  or  could  not  be  borne,  he 
thought  they  were  justified  in  advising  operation.  (2)  Per- 
manence. This  depended  largely  on  the  method  adopted 
One  or  two  sutures  were  not-  much  good  ;  he  always  used 
five  or  six,  passing  one,  a  double  one,  thiouirh  the  fundus, 
and  the  rest  through  the  anterior  surface  of  the  body,  so 
as  to  bring  this  well  into  contact  with  the  abdominal 
wall.  The  sutures  should  pass  through  a  small  portion  of 
the  muscular  tissue  of  the  uterus.  It  was  too  soon  for 
him  to  speak  of  the  permanent  results  in  his.cases,  as  the 
oldest  was  thirteen  months  ;  but,  so  far,  all  of  them  were 
cured,  both  as  to  the  position  of  the  uterus  and  as  to 
symptoms.  (3)  Indications.  The  best  results  followed  in 
cases  of  prolapse  or  retroversion,  without  adhesions,  when 
peesaries  had  failed.  When  there  were  adhesions  he 
doubted  whether  venotrfixation  alone  was  of  much  use  ; 
for  when  the  appendages  had  been  bound  down  for  some 
time,  they  were  generally  so  diseased  as  to  require  re- 
moval. This  he  had  done  several  times,  fixing  Uie  stump 
to  the  abdominal  wall.  Some  years  ago  he  htul  a  case  in 
which,  after  freeing  adhesions,  he  removed  only  the  right 
appendages,  fixing  the  stump  to  the  wound  ;  »ome  months 
later  she  returnea  with  extrauterine  gestation  on  the  left 
side,  and  so  he  thought  it  was  wise,  when  the  tubes  and 
ovaries  were  bound  down,  and  the  abdominal  ostia  of  the 
tubes  were  dosed,  to  remove  the  appendages  of  both  sides. 
(4)  Complications.  The  principal  one  was  ventral  hernia, 
but  there  was  not  much  risk  of  its  occurring  if  the  sheath 
of  the  rectus  were  well  brought  together  by  a  separate 
layer  of  sutures.  His  belief  was,  thac  ventrofixation  had 
a  place  in  gyniecology,  but  that  its  sphere  of  application 
was  a  limited  one ;  that  Alexander's  operation  would 
never  prove  satisfactory ;  and  that  vaginonxation  was  not 
destined  to  attain  any  important  position. 

Dr.  LviTH  Napikb  wished  to  add  a  clinical  detail  to  his 
previous  remarks.  The  firdt  case  he  operated  on  was  now 
pregnant  for  the  third  time,  and  the  uterus  maintained 
its  good  position.  He  would  like  to  ask  Dr.  Alexander 
whether  he  found  his  operation  practicable  when  there 
were  adhesions.  It  seemed  to  him  that  the  complication 
might  arise  spoken  of  bv  Edebohls,  of  New  York,  who  two 
or  three  timed  ruptured  the  round  ligament  in  trying  to 
draw  up  a  fixed  uterus.  Dr.  Duncan  had  dwelt  on  some 
important  points  in  the  Uchniqut  of  ventrofixation  ;  but 
he  did  not  think  that  more  than  three  sutures  were 
needed.  In  all  the  cases  in  which  trouble  during  preg- 
nancy had  followed  the  operation,  it  was  because  the 
adhesions  were  too  firm.  He  also  differed  from  Dr.  Duncan 


as  to  the  necessity  of  removing  the  appendages  when  they 
were  adherent ;  in  one  such  case  a  patient  of  his  had 
become  pregnant  after  the  operation. 

Dr.  HiYwooD  Smith  said  that  in  his  fir^t  case  he  u  sed 
only  one  suture,  and  it  was  entirely  successful.  The  dis- 
cussion well  illustrated  the  progress  of  public  opinion. 
Twenty-two  years  ago,  he  performed  the  first  case  of 
deliberate  ventrofixation,  and  the  Lancet,  in  commenting 
on  the  case,  said  that  as  it  was  the  first,  they  hoped  it 
would  be  the  last. 

Dr.  Alsxandxb,  in  answer  to  Dr.  Napier,  said  that  if 
the  uterus  could  be  put  into  position,  with  the  sound  or 
with  the  finger,  it  was  his  practice  to  operate.  When 
there  were  adhesions,  he  put  the  patient  to  bed,  and 
ordered  douches  and  glycerine  tampons,  and  after  such 
treatment,  he  always  found  that  the  uterus  could  eventu- 
ally be  restored  to  its  position.  He  did  not  consider  there 
was  an^  danger  in  the  stem-pessary  as  he  used  it ;  he 
kept  it  m  only  while  the  patient  was  in  bed. 

The  Pbbsidbnt  said  they  must  all  feel  indebted  to 
Professor  Mayo  Robson  for  coming  up  again  that  evening, 
at  considerable  personal  inconvenience,  to  join  in  the 
discussion.  It  had  been  a  most  interesting  and  instruc- 
tive debate,  and  showed  that  the  operation  of  ventro- 
fixation was  not  one  to  be  put  aside,  but  to  be  used,  with 
proper  limitations. 

Professor  Mayo  Robson,  in  reply,  thanked  the  Fellows 
for  the  interest  shown  in  the  discussion,  which  showed 
that  they  were  in  the  main  agreed  upon  essential  points. 
He  would  sum  up  on  the  lines  laid  down  in  his  opening 
remarks :— 1.  Safety.  If  these  operations  were  not  hafe, 
they  should  not  be  done.  But  the  discussion  had  gone  to 
show  that  they  were  safe,  except  for  the  small  risk  which 
attended  all  operations.  He  considered  Alexander's  opera- 
tion quite  safe,  and  had  nevtr  heard  of  any  bad  results 
from  it.  2.  Necessity.  It  seemed  to  him  that  Dr.  Edge 
operated  more  often  than  most  of  them  would  deem 
necessary,  having  done  twenty  cases  of  vaginofixation,  for 
instance,  within  a  short  time.  He  thought  the  maj<  rity 
of  cases  could  be  relieved  by  less  severe  measures  ;  and  in 
ten  years  he  had  only  found  it  necessary  to  do  under 
twenty  ca^es  of  venti  ofixa^^ion.  He  felt  strongly  that 
when  they  could  cure  a  patient  without  operation  they 
should  do  so.  3.  Efficiency.  All  were  agreed  as  to  the 
immediate  efficiency  of  these  operations,  and  their  ultimate 
efficiency  was  shown  by  the  evidence  of  Drs.  Napier, 
Tay!or,  Alexander,  Duncan,  and  others.  In  a  large 
number  of  cases  pregnancy  had  followed,  without  return 
of  the  displacement ;  and  many  other  patients  had  been  able 
to  resume  their  work  and  their  social  and  maritfJ  relations. 
And  so  he  thought  that  if  they  allowed  the  patient  to  judge 
for  herself,  and  she  chose  to  run  the  small  risk 
for  the  cake  of  the  possibility  of  cure,  they  were  justi- 
fied in  operating.  4.  Complications.  As  Dr.  Duncan  bad 
pointed  out,  the  prevention  of  hernia  lay  in  their  own 
nands.  Since  he  had  adopted  the  plan  of  suturing  the 
abdominal  wall  in  three  layers,  hernia  was  with  him  a 
thing  of  the  past.  He  had  no  wish  to  disparage 
Alexander's  operation  ;  and  he  was  glad  Dr.  Alexander 
was  present  to  give  them  his  results.  No  doubt  puch  an 
operation  was  TOtter  done  and  more  successful  in  the 
hands  of  its  inventor.  But  he  still  thought  the  scope  of 
the  operation  was  limited,  especially  when  there  were 
adhesions,  for  when  these  were  old  they  did  not  readily 
yield  to  douching  snd  tampons.  If  the  ovaries  were 
unhealthy  or  damaged  in  separating  adhesions,  they 
should  be  removed  ;  otherwise,  he  thonght  they  should  b  s 
left.  In  this  respect  he  was  getting  more  and  more  con- 
servative year  by  year,  and  he  thought  Or  Duncan's  case 
of  extra-uterine  gestation  must  be  ex cept  ional .  He-agreed 
with  Dr.  Alexander's  pathology  of  procidentia  rather  than 
with  Dr.  Bantock's  ;  the  essential  point  in  the  prevention 
of  this  displacement  was  rhat  the  uterus  should  be  ante- 
vented  ;  in  this  position  the  intestines  occupied  the  pouch  of 
Douglas,  and  helped  to  keep  the  uterus  in  proper  position. 
He  quite  agreed  with  Dr.  Duncan  in  objecting  to  the  stem 
pessary. 

♦ 

Dr.  Wiomore,  of  Qreen  Park,  Bath,  was  presented 
on  March  26* h  with  two  handsome  volumes  of  the  Poet 
Laureate's  works,  by  the  Members  of  the  Nursing 
Class  held  by  him  at  Englishcombe,  Batb. 


April  2d.  18ii6 


TRASfSACnONS  OF  SOCIETIES. 


The  Mbdioal  Prbsb.     44d 


ROV^AL  ACADEMY    OF    MEDICINE  IN  IRELAND 
SscnoN  OF  Surgery. 

MSBTINO  HELD  FRIDAY,  MaROH  20tH,    1896. 


The  President,  Sib  W.  Thornlby  Stoker,  in  the  Chair. 

THE  RADICAL  CURB  OF  INGUINAL  HERNIA. 

Mr.  Aeuston  in  this  paper,  which  appeared  in  oar  issne 
for  April  15th,  first  described  the  anatomical  straobures 
and  relations  of  the  internal  abdominal  rinj;  and  the 
posterior  wall  of  the  inguinal  canal  in  connection  with 
hernisB,  mentioned  some  of  the  operations  now  generally 
recommended,  and  then  proceeded  to  describe  an  0{)era- 
tion  which  he  himself  performed  on  thirty-two  occasions, 
the  patients  varying  in  age  between  eighteen  months  and 
fifty-two  years ;  all  of  his  patients  recovered,  and,  as  far  as 
be  could  ascertain,  the  hernia  has  not  recurred  in  any. 

The  President  said  that  operations  rec^uiring  great  ela- 
boration of  detail  did  not  contain  the  princiftle  of  success. 
He  had  long  been  of  opinion  that  the  one  thing  necessary 
to  ensure  success  is  not  any  particular  method,  but  the 
performance  of  the  operation  in  such  a  way  that,  while 
temporary  closure  of  the  inguinal  canal  during  healing  is 
afibraed,  a  copious  lymph  exudation  is  produced.  He 
rf'garded  the  sutures  as  serving  two  purposes — one  the 
temporary  closure  of  the  part  during  convalescence,  and 
the  other  the  provocation  of  a  copious  lymph  exudation, 
which  is  the  real  means  of  producing  contraction  and  per- 
manently drawing  the  parts  toother. 

Mr.  Croly  had  tried  nearly  aU  the  methods  mentioned, 
but  within  the  last  fortnight  he  had  performed  two  opera- 
tions by  the  displacement  methoa  of  Kocber.  Mr. 
Houston  had  quoted  Kocher  as  twisting  the  sac,  but 
Kocher  had  now  given  up  this  practice.  If  the  sac  was 
twisted  freely,  besides  causing  necrosis,  a  bit  of  the  gut 
was  very  apt  to  be  nipped.  He  avoided  scrotal  wounds 
when  possible,  as  asepsis  was  very  difficult  there. 

Mr.  Bennett  said  that  in  the  present  day  there  was  a 
tendency  to  the  indiscriminate  adoption  of  cutting  opera- 
tions for  the  radical  core  of  hernia.  In  children  with 
congenital  inguinal  hernia,  with  proper  attention  the  use 
of  a  truss  will,  in  70  per  cent,  of  the  cases,  bring  about  a 
cure.  In  operating  he  followed  Mr.  Ball's  methoid,  which 
was  very  successful.  He  had  seen  no  bad  results  follow 
f.om  twisting  the  sac.  The  twisting  was  done  sufficiently 
but  not  to  strangle 

Mr.  FiTZGiBBON,  since  be  first  used  Ball's  method,  had 
never  performed  a  radical  core  without  trying  to  do  it. 
Twisting  the  sac  was  most  dangerous  if  it  was  not  isolated 
from  everything  else.  If  the  sac  could  be  perfectly 
isolated,  he  considered  twisting  as  the  ideal  method  of 
doling  it. 

Mr.  M'Ardle  said  that  the  shortening  of  the  trans- 
versalis  fascia  and  the  cutting  away  of  the  sac  entirely 
was  the  proper  operation.  If  one  tried  to  close  the 
internal  abdominal  ring  it  should  be  done  by  transversalis 
fascia.  The  peritoneum  had  no  influence  in  preventing  a 
hernia. 

Mr,  Lbntaiunk  had  passed  from  one  operation  to 
another.  He  took  some  trouble  to  follow  up  his  cases, 
and  found  that  a  good  many  of  the  earlier  ones  had 
recurred.  About  two  years  ago  he  had  adopted  Mr. 
Halstead's  operation.  He  found  it  so  satisfactory  that  he 
has  performed  it  frequently  since.  Not  one  of  these 
capes  had  recurred  so  far. 

Mr.  Wheeler  said  that  after  the  radical  cure  of  hernia 
it  was  not  advisable  to  apply  any  pressure  over  the  part, 
as  pressure  tends  to  cause  absorption  of  the  material 
thrown  out,  and  so  tended  to  produce  a  return  of  hernia. 
Young  children  did  not  bear  the  operation  welL  He  agreed 
with  Mr.  Bennett  that  many  could  be  cured  by  a  truss. 
He  had  a  patient  over  forty  years  of  age  who  declined 
operation,  and  who  wore  a  truss  for  two  and  a-half  years 
and  WBH  cured. 

Mr.  Heuston,  replying,  said  he  agreed  with  the  President 
that  the  cure  did  not  depend  on  the  sutures,  but  on  the 
plastic  inflammation  set  up.  That  is  why  he  recommended 
the  twisted  sac  to  be  left  through  all  the  length  of  the 
canal.  The  weak  point  of  BalVs  operation  was  that  the 
sac  was  cut  off  too  close.  Otherwfad  it  was  an  excellent 
operation.  He  objected  to  silver  and  pilk  sutures,  as 
months  afterwards  they  might  set  up  inflammation  and 


suppurate  out.  He  did  not  agree  with  Mr.  M'Ardle  in 
leaving  the  sac  below,  after  Barker's  (?)  method.  Coiley, 
of  New  York,  had  reported  168  cases  without  one  failure, 
operated  on  by  Bassini's  method.  He  recommended  kan- 
garoo tendon. 

INDIAN  operation  FOR  RESTORATION  OF  THE  NOSE 
MODIFIED. 

Mr.  Robert  H.  Woods  read  a  psper  on  the  above  sub- 
ject. The  patient,  a  female,  set.  29,  had  had  the  cartila- 
ginous nose,  destroved  by  lupus.  The  forehead  flap  was 
cut  according  to  Dieffenbacn's  pattern.  The  skin  from 
the  nose  was  detached  and  reflected  downwards,  so  that 
the  raw  surface  looked  forwards  and  the  skin  backwards 
towards  the  nasal  cavitv,  the  raw  surface  of  this  triangle 
was  adapted  to  that  of  the  forehead  flap,  and  so  formed  a 
portion  of  the  skin  lining  the  new  nose.  The  lining  was 
completed  by  the  flaps  inverted  from  the  al».  Thus  the 
whole  new  nose  was  lined  with  skin,  and  the  tendency  to 
contraction  which  is  always  present  where  a  surface  is  l^t 
to  granulate  and  cicatrise  obviated.  The  forehead  surface 
instead  of  being  sutured  was  covered  by  a  flap  of  skin 
transplanted  from  the  arm  as  in  Wolfe's  method.  This 
completely  healed  and  perfectly  covered  the  deficiency. 
The  advantages  of  transplantation  were  that  it  avoided 
the  unsightliness  of  a  scar,  and  by  doing  away  with  the 
necessity  for  economy  in  the  forehead  flap,  allowed  a  suffi- 
cient quantity  of  skin  to  be  taken  away  to  completely  line 
the  nose  and  so  avoid  contraction  of  the  nostrils  from  cica- 
trisation of  raw  surfaces. 

The  President  said  that  the  patient  was  originally 
cured  by  him  of  lupus.  She  pressed  him  on  severad  occa- 
sions to  perform  a  plastic  operation,  but  he  declined  as 
lupus  had  not  cicatrised  sufficiently.  The  chief  interest 
he  thought  was  not  the  mere  reproduction  of  the  nose, 
as  the  large  transplantation  of  the  skin  from  the  arm.  He 
thought  it  was  too  soon  to  be  sure  that  there  would  bono 
contraction  of  the  nostrils. 

The  Section  then  adjourned. 


LIVERPOOL    MEDICAL    SOCIETY. 
Meeting  held  Thursday,  April  16th,  1896. 


Dr.  Macfie  Campbell,  Vice-President,  in  the  Chair. 


the  MIDWIVES  question  at  the  LIVERPOOL  LTINO-IN 
HOSPITAL. 

The  following  resolution,  proposed  by  Mr.  Banks, 
seconded  by  Dr.  Cameron,  was  c  arried  unanimously  :— 
**  The  Members  of  the  Liyerpool  Medical  Institution  de- 
sire to  place  on  record  their  firm  and  unanimous  protest 
against  the  course  recently  adopted  by  the  Managing 
Committee  of  the  Ladies'  Charity  and  Lying-in  Hospitid 
in  endeavouring  to  place  the  Matron  Midwife  in  a  position 
which  practicsUy  would  have  vested  in  her  the  medical 
controlof  all  the  patients.  They  consider  that,  however 
efficient  ehe  may  be  as  a  midwife,  her  want  of  knowledge 
in  other  respects  might  have  caused  her  to  overlook,  or 
fail  to  recognise  dangerous  incidental  complications, 
occurring  in  the  course  even  of  a  so-called  natural  labour, 
the  timely  treatment  of  which  by  a  member  of  the  medical 
stafi*  might  have  averted  serious  consequences  .to  the 
patient.  They  wi»h  at  the  same  time  to  convey  to  the 
Members  of  the  Medical  Staff  their  high  appreciation  of 
the  sense  of  dutjr  and  professional  honour  which  actuated 
them  in  declining  to  retain  office  under  conditions  to 
which  they  themselves  could  not  possibly  submit,  and 
which  they  believed  to  be  detrimental  to  the  best  interests 
of  the  Charity." 

Mr.  Banks  then  proposed  that  the  resolution  be  sent  to 
the  public  papeis,  the  medical  journals,  and  the  Members 
of  the  Committee. 

Dr.  Waters  seconded,  it  was  agreed  unanimously. 

CASE  of  MULTIPLE  WOUND  OF  SMALL  INTESTINE,  AND  PENE- 
TRATION OF  ORAVID  UTERUS,  BY  STAB  WITH  SHOE- 
MAKER'S  KNIFE.— RECOVERY. 

Mr.  PuzEY  relate  the  case.  The  patient,  nt.  28,  was 
admitted  into  the  Northern  Hospital,  under  his  care,  on 
the  14th  October  last.  A  loop  of  bowel  was  protruding 
from  a  small  wound  in  the  abdomen  about  half-way 
between  umbilicus  and  pubis ;  this  presented  two  incised 


450     Thb  Mboioal  Pbess. 


TRANSACTIONS  OF  SOCIETrES. 


Apbil  29,  1896. 


woandfl,  one  completely  dividing  the  bowel,  the  other 
cutting  half  throagh  the  diameter.  These  wounds  were 
closed  by  continuous  Czerny-Lembert  suture.  On  en- 
larging the  abdominal  wound  downwards,  there  was  a 
gush  of  arterial  blood  and  clots,  and  another  piece  of 
bowel  came  out ;  this  loop  had  been  transfixed  by  the 
weapon,  and  presented  three  wounds,  two  in  the  outer 
circumference  of  the  bowel,  the  other,  between  them  in  its 
attachment  to  the  mesentery,  which  was  extensively 
wounded,  and  bleeding  profusely.  The  bleeding  arteries 
having  been  secured,  the  intestine  was  clamped  above  and 
below  the  wounded  portion,  with  Lane's  intestinal 
clamp,  and  the  intervening  nine  or  ten  inches  was  cut 
away.  The  divided  ends  were  then  fixed  by  Murphy's 
button  (No.  2),  and  the  rent  in  the  mesentery  repaired. 
The  intestine  having  been  replaced,  and  the  abdomen 
irrigated  with  hot  boracic  acid  solution,  dark  blood  was 
seen  welling  up  from  the  pelvis,  which  was  filled  with 
black  clot.  The  abdominal  incision  was  enlarged  down 
towards  pelvis,  and  the  clots  scooped  out  with  the  hand ; 
then  a  stab  wound  of  the  anterior  portion  of  the  fundus 
uteri,  which  admitted  two  fingers,  was  found.  Out  of  this 
hung  three  or  four  inches  of  what  proved  to  be  umbilical 
cord,  which  had  been  divided.  This  was  pulled  out,  cut 
away,  and  the  wound  of  the  uterus,  which  had  contracted 
under  exposure  and  handling,  was  closed  by  one  thick 
chromic  catgut  suture.  The  pelvis  having  been  thoroughly 
fiushed,  the  abdominal  wound  was  closed,  except  at  its 
lower  part,  where  a  large  drainage-tube  was  inserted  for 
pelvic  drainage.  Four  days  after  the  patient  miscarried, 
but  only  placenta  and  membrane  were  removed  although 
the  uterus  was  flushed  out,  the  probability  being  that  the 
foetus  (three  or  four  months)  had  escaped  through  the 
uterine  wound  and  been  swept  away  with  the  clots  from 
the  pelvis.  The  woman  had  a  hard  struggle  for  a  fort- 
night, and  then  made  a  capital  recovery.  But  the 
Murphy's  button  has  not  appeared  though  sharply  lo  ked 
for.  Nevertheless,  she  has  had  no  bowel  trouble,  and  has 
been  up  and  about  for  the  last  three  or  four  months.  Two 
days  ago,  by  vaginal  examination,  the  button  was  felt 
apparently  in  the  sigmoid  flexure,  so  an  effort  can  now  be 
made  to  extras  it. 

Dr.  Macfie  Campbbll  congratulated  Mr.  Puzey  on  his 
sncoeesful  treatment  of  an  almost  unique  case.  He  had 
been  asked  to  see  the  patient  on  the  fourth  day  after  the 
operation  as  there  had  been  signs  of  uterine  action.  Ht 
found  the  woman  in  a  collapsed  condition  with  a  very 
offensive  vaginal  discharge,  but  no  labour  pains.  Onexam> 
ination,  the  os  was  patulous,  and  a  portion  of  placenta  pre- 
sented. This  was  cleared  away  with  the  finger,  was  very 
friable,  and  as  no  counter-pressure  over  the  womb  was 
possible  owing  to  the  abdominal  wound,  a  flushing  curette 
with  an  antisept  ic  solution  was  used  to  complete  its  removal. 
No  fcetus  was  discovered,  and  from  the  fact  that  the  por- 
tion of  umbilical  cord  presenting  through  the  wound  was 
single,  the  foetus  must  have  been  hooked  out  of  the  uterus 
by  the  assaulting  knife,  and  was  probably  in  the  blood 
and  dote  remov^  by  Mr.  Puzey.  He  had  to-day  seen  the 
patient,  and  agreed  with  Mr.  Puzey  that  the  Murphy's 
button  is  probably  in  a  pouch  in  the  sigmoid  flexure. 

Mr.  Paitl  thought  Mr.  Puzay  had  adopted  the  best 
methods  for  approximating  the  numerous  intestinal 
injuries  in  his  case,  every  such  injury  must  be  dealt  with 
in  accordance  with  the  special  conditions  of  the  case,  and 
the  chief  lesion  here  was  best  repaired  with  the  help  of 
Murphy's  button.  Mr.  Puzey's  fear  that  harm  might 
result  in  the  use  of  this  appliance  owing  to  its  retention 
in  the  body  was  hardly  justified  by  experience.  No  doubt 
it  was  not  rare  for  buttons  to  be  retained,  but  they  usually 
set  up  no  symptoms,  for  in  most  cases  they  were  in  a  part 
of  the  alimentary  canal  which  by  the  operation  had  been 
cut  off  from  the  functional  track.  The  real  danger  in  the 
use  of  the  button  was  the  tendency  it  sometimes  showed 
to  cause  perforation  at  the  seat  of  operation.  Mr.  Paul 
had  used  the  button  in  seven  cases,  four  recovered,  includ- 
ing an  extensive  pylorectomy,  and  three  died,  but  in  only 
one  of  the  three  could  the  button  be  blamed  in  the  least 
deerree. 
Mr.  Thewlall  Thomas  read  a  paper  on 

THE    OPBBATIVE    TREATMENT    OF    VAHIOOSE    VEINS  OF  THE 
LOWER  EXTREMITY  (SHOWING  LANTERN  ILLUSTRATIONS). 

He  advocated  a  method  of  ligature  and  division  of  the 
internal  saphena  just  below  the  saphenous  opening  as  an 


improvement  on  the  operation  of  Trendelenburg.  In  soma 
cases  where  a  large  bunch  of  varices  existed  at  the  inner 
side  of  the  knee  he  noticed  that  there  was  nearly  always  a 
deep  communication  which  necessitated  excision  of  a 
small  bunch.  Other  cases  could  be  cured  by  tying  and 
cutting  the  external  saphena  at  the  lower  end  of  the 
popliteal  space.  He  reaa  notes  of  seventeen  ca^es,  in  all 
of  which  union  occurred  by  first  intention,  When  the 
limb  is  carefully  bandaged  after  the  operation,  thrombosis 
does  not  appear  to  occur.  In  two  of  the  cases  a  large 
varix  was  present  at  the  saphenous  opening,  the  liga'-ure 
and  division  was  performea  immediately  oelow  this.  It 
was  astonishing  to  see  old  ulcers  of  the  leg  heal  up  so 
rapidly  after  the  operation  and  not  recur  even  in  cases 
where  the  ulceration  had  lasted  for  many  y^ftrs. 

Mr.  Robert  Jones  had  performed  Trendelenburg's 
operation  altogether  fifteen  times ;  in  some  instances, 
excising  both  the  internal  saphena  vein  and  the  external 
saphena.  In  those  cases  where  there  was  considerable 
ulceration  the  operation  helped  materially  the  healing 
process.  The  general  results  of  the  operation  were  most 
favourable.  Mr.  Jones  laid  much  stress  upon  the  after- 
treatment,  more  especially  the  employment  of  massage  in 
those  cases  of  brawny  swelling  due  to  lymphatic  obstruc- 
tion. 

Messrs.  Rush  ton  Parker  and  Lark  in  also  took  part  in 
the  discussion. 

Mr.  Thomas  replied. 


SHEFFIELD    MEDICO-CHIRURGICAL   SOCIETY. 
Meeting  held  Thursday,  April  9th,  1896. 


The  President,  Dr.  Porter,  in  the  Chair. 

Dr.  Keelinq  showed  a  '*  Solid  Ovarian  Tumour,  pro- 
bably of  a  Fibroid  Nature,"  which  had  been  removed 
from  a  patient,  set.  45,  at  the  Jessop  Hospital.  Firm 
adhesions  to  the  bowel  existed  at  two  points,  render- 
ing necessary  the  leaving  of  Fmall  portions  uf 
the  tumour  adherent  to  the  gut,  otherwise  the 
operation  presented  no  difficulty.  The  patient  made  a 
good  recovery. 

Mr.  Pye-Smith  read  notes  of  a  case  of  '<  Acute  Intestinal 
Obstruction  due  to  a  mass  of  Currants."  The  patient  w;s 
a  young  man,  set.  20.  Constipation  was  absolute,  and 
vomiting  frequent  for  sixty-eight  hours.  Severe  oolicy 
pain  and  slight  abdominal  distension  were  also  present. 
Relief  was  obtained  after  a  turpentine  enema.  Mr.  Pye- 
Smith  also  showed  a  "  Photograph  of  a  case  of  Malforma- 
tion of  the  Penis." 

Mr.  Baldwin  (Rotherham)  showed  a  case  of  '*  Sacro- 
iliac Excision,  and  gave  a  report  with  comments." 

Dr.  Arthur  Hall  showed,  and  made  remarks  upon, 
"  Four  capes  of  Muscular  Atrophy,"  and  a  case  of  "  Lead 
Paralysis." 

The  President,  Mr.  Cuff,  Mr.  Pye-Smith,  Dr.  Keeling, 
Mr.  Makeig  Jones,  Mr.  Atkin.  Dr.  Arthur  Hall,  Dr.  Sin- 
clair White,  Dr.  Hargeaves,  Mr.  Sidney  Barber,  and  Dr. 
Sweeten,  discussed  the  cases. 


WEST  KENT  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  Friday,  April  10th. 


The  President,  Mr.  Ernest  Clarke,  in  the  Chair. 

Mr.  Howard  Marsh  read  a  paper  on 
regent  progress  in  pathology  and  treatment  of 

diseases  of  joints, 
illustrated  by  specimens.  He  discussed — (1)  Syphilis  as 
affecting  joints :  first  in  children,  secondly  in  adults.  As 
to  children,  he  pointed  out  that  two  forms  of  syphilitic 
disease  occur,  viz.,  a  destructive  lesion  of  the  growing 
part  of  the  bone,  especially  common  in  early  infancy,  and 
a  gummatous  infiltration  of  the  synovial  membrane, 
affecting  children  most  commonly  between  three  and  nine 
years,  frequently  multiple  and  often  symmetrical ;  the  joint 
is  swollen,  but  it  is  freely  movable,  which  is  not  the  cfl»e  in 
tubercular  disease.  In  adults,  syphilis  produces  (1)  a 
simple  synovitis  with  effusion,  readily  mistaken  jfor 
sabaoute  rheumatism,  sprain,  or  oommenoing  tnberale ; 


Afbil  29, 18d6. 


GEEMAlf  ^. 


Thb  Mbdioal  Pbbss.     45 1 


bat  yielding  readily  as  a  rule  to  potaesic  iodide; 
(2)  a  gummatous  infiltration  of  the  subsynovial  tissue, 
often  very  similar  to  Brodie's  ''  pulpy  degeneration  "  ; 
and  (3)  a  deep  serpiginous  ulceration  of  the  articular 
cartila^  and  subjacent  bone,  similar  to  and  simultaneous 
with  ulceration  of  soft  parts  and  of  the  shafts  of  the 
long  bones.  The  treatment  of  the  two  latter  groups  is 
necessarily  prolonged,  and  it  is  especially  unsatisfactory 
in  gouty  and  rheumatic  subjects.  (1)  The  joint  lesions  of 
syringo-myelia  were  then  described  and  specimens  shown 
of  both  the  atrophic  and  hypertrophic  formr.  (2)  Senile 
tuberculosis  of  joints  was  next  discussed,  and  its  compara- 
tive  frequency  insisted  on ;  the  prognosis  of  these  cases  is 
invariably  bad,  and  the  older  the  subject  the  more  rapid  is 
thedownward  course.  (3)  A  very  rare  specimen  of  the  effeots 
of  repeated  hemorrhages  into  the  joints  in  hasmophilia  was 
shown.  (4)  Finally,  Mr.  Marsh  showed  the  practical  import- 
ance, as  regards  treatment,of  the  fact,  recen'ly  ascertained, 
that  the  seat  of  active  tubercular  disease  in  the  joints  of 
children  is  often  the  growing  tissue  at  the  end  of  the  dia- 
physis.  He  urged  that  in  cnildren  under  twelve,  excision 
IS  radically  wrong,  not  touching  the  seat  of  the  disease.  In 
these  cases,  rest  begun  early  and  maintained  for  a  prolonged 
period  gives  the  best  results.  It  is  difficult  to  persuade 
parents  to  continue  the  treatment  long  enough  to  ensure 
death  of  the  tubercle-bacillus,  and  the  removal  of  its  pro- 
ducts by  absorption.  Both  these  processes  must  obviously 
occupy  considerable  time.  But  until  they  are  both  com- 
pleted, the  use  of  the  joint  will  be  followed  by  a  relapse. 
To  maintain  rest  for  three  months,  and  then  allow  the 
patient  to  resume  exercise  ie,  considering  the  conditions 
present,  scarcely  less  than  a  farce.  Twelve  months  is 
sometimes,  in  early  cases,  sufficient,  but  two  or  three  years 
may  be  indispensable,  and  Mr.  Marsh  mentioned  two 
cases — examples  of  what  he  had  many  times  observed— in 
one  of  which  a  child  recovered  with  absolutely  free  move- 
ment in  the  knee-joint,  who,  at  two-and-a-hsdf,  had  acute 
tuberculous  disease  attended  with  deformity,  but  who 
wore  leather  splints  uninterruptedly  for  six  and  a  half 
years.  The  limb  now  bears  no  trace  of  the  disease,  except 
slieht  muscular  wasting.  In  the  other  case,  a  child  with 
old-standing  tubercular  disease  of  the  elbow,  threatening 
suppuration,  wore  splints  for  four  and  a  half  years,  with 
the  result  that  complete  free  movement  of  the  joint  was 
preserved  and  that  every  trace  of  disease,  except  some, 
but  not  marked,  muscular  wasting,  absolutely  disappeared. 
He  knew  no  other  method  by  which  such  results  could  be 
secured.  The  principle  of  forcibly  straightening  joints 
that  are  actually  diseased,  e.g.,  straightening  a  diseased 
knee  by  the  use  of  Mclntyre's  splint,  is  objectionable,  for 
as  the  force  employed  is  leucrage,  interarticular  pressure 
is  produced.  Weight  extension  in  the  line  of  deformity 
should  be  used  for  tne  hip,  and  for  the  knee  leather  splints 
should  be  fitted  to  the  limb  as  it  is,  and  altered  as  the 
limb  gradually  straightens  itself,  as  it  will  do  when  the 
muscular  spasm  is  relieved. 

The  President  showed  a  case  of  optic  neuritis  following 
influenza  in  a  girl  whose  vision  was  reduced  to  6/60,  but 
under  potassic  iodide  had  again  become  normal  (both  eyes 
6/6),  while  the  pearly  whiteness  of  .the  discs  originally  ob- 
served, still  continued. 


^ctmaitB. 


[rSOM  OUR  OWN  00BRE8P0NDENT.] 


BlRLIN .  April  24th. 

Kbport  on  Diphthbria  Cubativb  Serum. 
The  Keport  of  the  Kaiser  and  Kaiserin  Friedrich  Hospi- 
tal shows  that  a  considerable  diminution  has  taken  place  in 
the  mortality  from  diphtheria  in  that  institution  since  the 
introduction  of  the  curative  serum  treatment.  Whilst 
during  the  earlier  years  of  the  hospital's  existence  the 
average  mortality  from  the  disease  was  37*63  per  cent., 
it  fell  in  1894  to  27*80  per  cent.,  and  last  year  it  fell  fur- 
ther  to  11 '2  per  cent.  Besides  those  treated  in  the  hospi- 
tal, 460  children  were  treated  by  immunising  serum,  and 
of  t^es©i  18  only  contracted  the  disease  later.    Nearly  all 


the  cases  were  mild,  and  no  death  took  place  amongst  the 
number. 

In  the  introductory  address  at  the  Congress  for  Medi- 
cine on  the  8th  inst..  Dr.  Bailmler  speaks  of  the  serum 
treatment  of  diphtheria  as  the  most  important  acquisition 
of  modern  therapeutics,  that  it  has  been  admitted  as  a 
sure  constituent  of  our  armamentarium,  and  that  used 
with  caution  we  need  fear  no  ill-effects  from  its  use. 
For  the  first  time  in  the  history  of  medicine  we  have 
by  purely  scientific  methods,  discovered  in  it  a  new 
principle  for  the  treatment  of  infective  diseases,  and  one 
that  has  been  proved  in  practice.  It  consists  in  introduct 
ing  into  the  system  from  without  the  same  material  that 
in  favourable  cases  is  elaborated  in  the  body  itself  as  an 
antidote  to  the  disease.  We  had  obtained  an  insight  in 
the  way  in  which  recovery  was  brought  about.  The 
immunity  that  was  acquired  by  passing  through  a  disease 
depended  probably  on  the  fact  that  in  the  patient's  body 
protective  material  accumulated  and  remained  perma- 
nently. This  formation  did  not  take  place  in  the  juices, 
but  in  the  cells,  and  this  was  a  new  discovery  as  regarded 
cell  activity. 

Thb  Jenner  Celebration. 

In  connection  with  this  a  commemorative  address  was 
delivered  before  the  Medical  Congress  at  Wiesbaden  by 
Prof.  V.  Leyden.  He  said  that  the  14th  of  May  next  was 
the  100th  anniversary  of  the  first  vaccination  with  intent, 
in  which  Dr.  Edward  Jenner  vaccinated  a  boy  with  the 
contents  of  a  cow-pox  pustule  from  a  dairymaid,  and  that 
on  the  later  inoculation  of  the  boy  with  small-pox,  the 
disease  failed  to  make  its  appearance. 

This  important  inoculation  was  to  be  regarded  as  the 
birthday  of  vaccination,  and  indicated  the  completion  of  a 
great  work  that  freed  humanity  from  the  fearful  plague  of 
small-pox.  The  work,  like  Athene,  did  not  spring  per- 
fected out  of  the  head  of  Zeus,  but  was  the  result  of  years 
of  thought  and  work.  The  speaker  then  went  on  to  give  a 
history  of  the  various  steps  that  led  up  to  the  completed 
work,  and  related  how  on  the  presentation  of  his  work  the 
"Inquiry  into  the  Causes  and  Effects  of  the  Variola  Vac- 
cinae, or  Cow-Pox,"  to  the  Royal  Society,  it  was  rejected 
by  that  distinguished  body.  But  Jenner's  work  was  not 
completed  by  Jenner  himself,  the  most  important  improve- 
ment being  the  practice  of  re- vaccination. 

Re-vaccination  appeared  to  be  necessary  and  efficacious. 
It  was  introduced  into  (Germany  in  1819,  but  was  not 
made  compulsory  for  many  years.  In  the  year  1874 
it  began  to  be  regularly  carried  out  in  the  German 
army,  and  during  the  same  year  was  made  compulsory 
for  the  civil  population.  Another  advance  had  been  the 
introduction  (d  animal  lymph,  and  this  advance  was 
directly  attributable  to  the  opposition  of  the  anti-vac- 
cinators.  The  number  of  anti-vaccinators  had  been  gain- 
ing ground,  they  carried  on  a  lively  agitation  during  the 
present  session  of  the  Reichstag.  They  were  very  quickly 
dismissed,  however,  the  clear  and  comprehensive  report  of 
the  Reichsgeeundheitsamt  for  the  year  1896  contributing 
materially  to  their  overthrow.  Whoever,  without  pre- 
judice and  with  a  clear  mind,  read  over  the  explanation 
and  figures  could  have  no  manner  of  doubt  as  to  the 
blessings  that  vaccination  had  brought  us.  As  frequently 
happened,  the  opposition  had  done  good.  It  had  led  the 
way  in  avoidance  of  the  defects  of  Jenner's  system, 
instead  of  overlooking  them.  The  result  was  retro- 
vaccination,  t.e.,  the  inoculation  of  human  protective  vac- 
cination upon  the  calf  and  vaccination  with  this  humanised 


452     Thb  SdEDicAL  Pbess. 


AUSTRIA. 


Apbil  29,  1896. 


cow-pox  lymph.  In  Germany  animal  lymph  had  almost 
displaced  human  lymph.  Since  1884  a  Commission  had 
been  in  existence  in  the  Imperial  Health  Office  and  State 
Vaccination  Institute  for  the  production  and  preserva- 
tion of  calf  lymph,  and  for  its  free  distribution.  By  this 
procedure,  which  must  be  looked  upon  as  decided, 
advance  chances  of  doing  in*ury  by  inooulatin^i;  disease 
material  along  with  the  lymph  were  done  away  with,  and 
the  more  certainly  so  as  the  animal  from  which  the  lymph 
is  taken  had  to  be  killed  and  examined  as  to  its  healthi- 
ness at  the  time  of  killing. 

Indisputably,  since  the  introduction  of  this  method  of 
vaccination  and  compulsory  re-vaccination,  Germany  had 
obtained  the  best  results  of  all  the  States.  Even  the  last 
?mall-pox  epidemic  that  broke  out  last  winter  in  Berlin 
n  consequence  of  its  introduction  from  Poland,  and  which 
comprised  only  fifteen  oases,  showed  the  exceeding  good 
effect  of  vaccination.  On  a  careful  analysis  of  the  cases 
it  was  found  that  all  the  victims  to  this  epidemic,  three  in 
number,  were  unvaccinated,  the  disease  running  a  milder 
eourse  in  those  who  were  vaccinated.  The  speaker  then 
went  on  to  give  a  short  review  of  the  labours  and  dis- 
coveries of  German  and  French  investigators  into  bacteria 
toxines  and  antitoxines  and  immunity  that  were  allied  to 
Jenner's  protective  inoculation  and  that  had  already 
borne  fruit.  '*  We  now  stand  in  the  midst  of  a  great 
movement  in  the  domain  of  this  inquiry,  and  may  with 
certainty  hope  for  further  important  results  in  the  near 
future  to  the  glory  of  science  and  the  well-being  of 
humanity." 

Friedreich's  Ataxy. 

At  the  meeting  of  the  Society  for  Innere  Medizin,  Hr 
Lewy  showed  a  young  girl  with  marked  kyphosis  and 
well-marked  ataxic  gait.  There  was  weakness  of  the  right 
arm  and  right  leg.  There  was  no  evidence  of  nystagmus 
and  changed  speech,  but  intentional  hesitancy  and  changes 
in  the  fundus  of  the  eye.  The  brothers  and  sisters  were 
healthy.  Suspicion  as  to  multiple  sclerosis  was  to  be  ex 
eluded  as  no  symptoms  pointed  to  it,  whilst  they  did  so 
to  hereditary  ataxy.  The  absence  of  nystagmus  could  not 
be  counted  as  an  objection  to  the  diagnosis,  as  it  was  a 
later  manifestation,  and  had  not  yet  developed. 

Hr.  G.  Rosenbaum  showed  two  sisters,  aged  13  and  10, 
of  healthy  parentage  who  in  their  seventh  and  fourth  year 
respectively  passed  through  a  severe  attack  of  whooping- 
cough  fktber  which  the  ataxic  symptoms  developed. 


^n<5fni 


[tBOM  OUB  OWN    OOBBUPOirDBirV.] 

VIEHNA,  April  24th,  18M. 

Hypnotism  and  Death. 
The  case  of  Ella  Salomon  was  again  heard  in  the  Court 
of  Appeal,  and  the  judgment  of  the  lower  court  con- 
firmed. These  proceedings,  in  the  first  instance,  arose  out 
of  her  death  ;  she  was  the  daughter  of  Herr  Salomon, 
one  of  the  accused,  and  a  man  of  considerable  wealth 
and  property  in  Hungary.  The  hypnotiser  was  Frank 
Neukomm,  **  Master  of  Wells,"  as  he  is  designated  in  the 
charge,  although  commonly  known  in  the  district  as  pro- 
fessor of  this  department.  The  father  and  the  professor 
it  appears  decided  on  curing  Ella  Salomon  by  hypnotism, 
which  they  considered  the  proper  treatment.  After  an 
exhausting     strain,    continued     without     intermission 


for  a  long  time,  the  girl  died.  At  the  inquest 
the  jury  returned  a  verdict  of  culpable  homicide  against 
the  father  and  Prof.  Neukomm.  for  which  the  authorities 
prosecuted  in  the  lower  court,  but  the  culprits  having  the 
right  of  appeal  the  case  was  taken  to  a  higher  court,  which 
now  upholds  the  sentence  passed  in  the  lower  court. 
Opbrativk  Trsatmbnt  07  Myopia. 

In  young  people  where  a  high  degree  of  myopia  exists 
the  application  of  lenses,  even  when  the  retina  and  choroid 
are  sound,  has  proved  a  practical  failure. 

Prof.  Fuchs  brought  this  subject  before  the  Gesellschaf t 
some  years  ago,  and  suggested  the  removal  of  the  lens  as 
a  '*  radical  cure."  Since  that  time  he  has  shown  many 
excellent  results,  which  have  convinced  oculists  of  its 
utility. 

Prof.  Szili  showed  to  the  members  of  the  BudaPest 
medical  meeting  a  boy,  »t.  12,  who  had  myopia  in  both 
eyes  to  the  extent  of  14  D.,  and  vision  of  ^s.  Six  weeks 
after  the  operation  it  improved  to  1*5  D. ,  and  y=^i*  The 
reduction  of  the  error  of  refraction  and  the  improvement 
in  vision  is  the  common  result  of  all  such  operations,  a 
form  of  correction  that  cannot  be  obtained  by  any  kind  of 
lens  at  our  disposal.  If  the  ocular  structures  were  in  a 
morbid  condition  before  operation  it  can  be  easily  conceived 
how  the  function  of  an  eye  would  be  impaired  by  the  rapid 
accumulation  of  fluid  in  the  chambers,  and  thus  paralysing 
the  accommodation.  With  this  precaution,  Szili  thinks 
the  operation  well  adapted  for  young  patients  with  high 
myopia. 

Siklossy  brought  before  the  same  meeting  another  case 
that  ot  a  girl,  aet.  16,  whom  he  had  operated  on  for  myopia, 
which  was  22  D.  in  one  eye  and  24  D.  in  the  other,  with 
y  of  a  i  and  I  respectively.  He  first  performed  discission, 
owing  to  the  enormously  swollen  lens ;  absorption  rapidly 
took  place,  leaving  only  a  small  residue  of  lens  matter  to  be 
extracted  later.  The  power  of  vision  is  now  i,  with 
2  D.  This  was  a  favourable  result,  and  the  common 
experience  of  every  case  he  had  operated  on. 

Goldzieher  said  the  operation  was  a  wondrous  advance 
in  ophthalmology.  In  one  case  where  he  had  operated,  in 
which  the  myopia  was  14  D.,  the  girl  was  restored  to  almost 
perfect  vision  without  any  glasses  being  necessary.  In 
another  cas<*,  where  there  was  traumatic  cataract,  there 
was  better  vision  after  its  removal,  without  correction, 
than  was  present  in  the  healthy  eye. 

Grosz  thought  that  this  operation  should  still  be  held  in 
reserve.  It  is  not  many  years  since  Fuchs  introduced 
this  method  of  treatment  for  a  high  degree,  and  as 
far  as  he  knew,  there  would  only  be  about  200  cases 
operated  on,  which  were  distributed  very  sporadi- 
cally over  Germany  and  Austria,  but  as  yet  we  had  no 
exact  history  of  any  of  the  oases  beyond  the  first  year  or 
so  after  the  operation.  His  own  experience  was  that  we 
were  not  justified  in  operating  in  every  case  with  the  con- 
fident hope  of  uninterrupted  success.  The  dangers  were 
many,  and  the  success  sometimes  disappointing.  When 
the  myopia  reached  14  or  15  D.,  with  a  healthy  choroid, 
he  quite  agreed  with  his  colleagues  that  the  operation 
might  be  undertaken  with  benefit  to  the  patient,  but  the 
risks  were  always  great. 

Cancbr  of  the  Uterus. 

Backer  next  gave  an  analytical  account  of  the  two 
Clinics  of  Buda-Pest,  viz.,  (1)  midwifery  or  lying-in,  and 
(2)  gynecology  and  diseases  of  women.  Since  1882, 
11,093  new  cases  were  admitted  to  the  institutions  ;  and 
out  of  this  number  705  were  afflicted  with  oanceir  ==  6*35 


April  29,  1896. 


THE  OPlfiRATING  THEATRES. 


Thb  Midical  PajftSd.     453 


per  cent,  of  the  total.  From  a  further  analyeis  he  con- 
cluded (a)  that  carcinoma  waa  more  common  in  the  child- 
bearing  ;  (h)  that  the  birth  of  the  child  did  not  stand  in 
any  relation  to  the  outbreak  or  declaration  of  the  diseaee, 
as  85  per  cent,  of  the  casee  showed  no  symptoms  of  cancer 
until  three  years  after  confinement ;  (c)  that  carcinoma 
is  a  common  result  of  endometritis ;  {d)  and  that  the 
position  of  the  cancer  is  usually  found  to  commence  in  the 
original  site  of  the  endometritis.  From  thef e  statistics  he 
formulated  the  hypothesis  that  endometritis  was  the 
proximate  cause  of  cancer  in  the  uterus,  and  should  receive 
early  attention. 

In  the  diagnosis  it  is  difficult  to  determine  with 
accuracy  when  the  carcinomatous  character  has  com- 
menced, as  it  may  not  be  actually  demonstrated  in  the 
mucous  membrane  excochleated  from  a  uterus  sufifering 
from  metritis  chronica.  Yet,  after  a  short  time,  a  large 
cancerous  mass  may  be  removed  by  the  forceps. 

In  the  treatment  of  cancer  early  operation  is  necessary, 
but  it  need  not  be  abdominal  if  recognised  sufficiently  early. 

It  is  only  when  the  growth  has  exceeded  the  size  of 
the  fist  that  this  major  operation  need  be  resorted 
to,  as  the  vaginal  extirpation  abdomino-vaginal  or 
sacral  are  quite  ample  for  ordinary  purposes.  Sinc% 
1885  he  has  performed  70  operations  for  extirpation 
of  cancerous  uteri,  69  of  these  being  vai^inal,  and  1  after 
Freund-Rydigier'^  recommendation,  which  recovered. 

The  mortality  of  the  69  cases  was  11*6  per  cent.,  and  o{ 
the  recovery  cases,  33*33  per  cent,  continued  three  years 
without  recurrence.  Cure  can  only  be  expected  where  the 
disease  is  recognised  very  early. 

Tauffer  said  the  etiology  of  cancer  was  still  obscure, 
notwithstanding  Backer's  eloquence  on  the  subject.  It 
was  not  yet  demonstrated  whether  t^e  endometritis  was 
the  cause  of  the  carcinoma,  or  the  carcinoma  the  cause  of 
the  endometritis  !  His  personal  experience  of  the  sacral 
operation  was  that  it  was  not  a  minor  undertaking.  On 
reaching  the  uterus,  he  found  parametria,  infiltration,  and 
fistula  of  bladder  that  led  to  a  larger  operation  than 
possibly  would  have  been  required  by  an  abdominal 
section. 

^ke  derating  ^ktatrtB. 

ROYAL  FREE  HOSPITAL. 
Two  Joint  Gik 8is.  I.  Removal  of  Loose  Bodies 
FBOM  THE  Kneb-Joint.— The  patient,  a  big  well-built 
heavy  man,  applied  at  the  hospital  on  account  of  a  weak- 
ness of  the  right  knee-joint  of  some  months'  duration,  with 
occasional  attacks  of  pain.  The  knee  was  slightly  dis- 
tended with  fluid,  and  on  <  xamination  in  certain  positions 
of  the  joint  a  loose  body  about  the  size  of  a  shilling 
was  found  to  the  upper  and  outer  part ;  it  slipped 
away  again  immediately  when  touched ;  it  could  not 
always  be  found,  but  by  certain  movements  of  the  joint  the 
patient  could  make  the  body  appear  at  the  point  men- 
tioned. After  the  careful  cleansing  of  the  surface  of  the 
joint  and  shaving  of  the  limb,  Mr.  Battle  made  an 
incision  over  the  outer  part  of  the  joint  where  the  loose 
body  could  usually  be  felt,  and  on  presBure  it  was  easily 
brought  to  the  surface  and  removed  ;  the  finger  was  then 
introduced  to  examine  the  condition  of  the  interior  of  the 
joint,  and  detected  another  and  much  smaller  body  lying 
near  the  lower  margin  of  the  wound  ;  this  was  easily 
taken  away.  The  synovial  membrane  appeared  thickened 
and  ooDgeeted,  and  a  small  quantity  of  synovial  fluid  of 


very  thick  consistency  escaped  from  the  joint.  A? 
nothing  further  in  the  shape  of  loose  bodies  could  be  felt 
the  wound  wm  washed  out  with  perchloride  solution,  the 
synovial  membrane  sutured  with  silk  sutures,  and  the 
external  wound  closed  with  other  sutures,  the  usual 
dressings  being  applied.  The  limb  was  then  put  up  in  a 
plaster  of  Paris  splint.  The  larger  of  the  foreign  bodies 
removed  was  disc  shaped,  slightly  irregular  of  margin 
and  very  hard ;  the  smaller  was  flat  and  apparently 
fibrous.  Mr.  Battle  considered  that  the  separate  suturing 
of  the  synovial  membrane  was  an  important  thing  in  the 
treatment  of  these  cases,  for  should  suppuration  occur  in  the 
other  parts  of  the  wound  it  was  thus  rendered  less  likely  to 
spread  to  the  joint.  In  dealing  with  such  a  large  synovial 
membrane,  it  was  best,  he  thought,  to  treat  it  with  the 
same  respect  that  one  paid  to  the  peritoneum,  for  if  sup- 
puration occurred  in  the  knee-joint,  it  might  ultimately 
prove  as  fatal  to  the  patient  as  a  suppuration  in  the  peri- 
toneum. Another  point  on  which  he  insisted  was  the 
neoeesicy  of  immobilising  the  joint,  that  is,  of  applying 
splints  of  such  a  length  as  to  render  futile  any  attempt  of 
the  patient  to  move  the  joint ;  as  a  rule,  when  splints 
were  applied  to  the  knee,  they  were  rarely  of  sufficient 
length  to  attain  this  object,  and  experience  of  several  years 
in  out-patient  practice  had  shown  him  that  whilst  splints 
were  put  on  extending  far  enough  towards  the  foot,  they 
did  not  extend  sufficiently  high  up  the  thigh,  and  time 
after  time  he  had  seen  splints  which  apparently  gave  the 
patient  power  over  the  knee,  possibly  because  they 
had  slipped  down,  but  certainly  because  they  were  not  of 
sufficient  length.  The  treatment  by  splint  was  said  to 
have  been  ineffectual,  but.  this  was  because  the  method  of 
applying  the  splint  was  faulty,  not  because  the  treatment 
by  splints  was  in  itself  ill-advised. 

II.  Monarticular  Rheumatoid  Arthritis  of  Meta- 
cabpo-Phalangeal  Joint  of  the  Middle  Finger. —The 
patient,  a  woman,  sot.  about  45,  was  sent  to  the  hospital 
on  account  of  a  swelling  on  the  back  of  the  hand,  which 
she  had  noticed  for  five  years ;  she  had  consulted  a  medical 
man  for  pain  in  the  joint  a£fecte3  five  years  previously,  and 
the  swelling  had  gradually  formed  since.  Over  the  joint, 
and  extending  on  to  the  dorsum  of  the  hand  was  a  swell- 
ing about  the  size  of  half -a-crown  spreading  more  to  the 
radial  side  of  the  extensor  tendon  than  to  the  inner  side  ; 
its  outline  was  well  defined  and  gave  the  sensation  of  flue* 
tuation.  In  the  palm  of  the  hand  there  was  decided 
fulness  of  the  joint.  On  pressing  the  joint  surfaces 
together,  a  creaking  sensation  was  elicited,  and  the 
pavient  complained  of  some  pain  ;  she  could  not 
flex  the  fioger  fully,  and  waa,  therefore,  unable 
to  do  her  work,  that  of  a  laundress,  on  which 
her  livelihood  depended  (she  was  a  widow  and  had  to 
support  two  children).  Mr.  Battle  made  an  incision  to  the 
outside  of  the  extensor  tendon,  and  the  capsule  of  the 
joint,  which  waa  irregularly  distended,  was  opened  ;  it  waa 
found  that  the  greater  part  of  the  swelling  consisted  of  a 
lowly-organised  solid  material  with  some  cystic  dilatations 
in  its  substance  continuous  with  the  joint ;  this  was  dis- 
sected away,  being  closely  attached  to  the  extensor  tendon. 
There  was  a  groove  in  the  upper  part  of  the  head  of  the 
metacarpal  bone,  where  the  cartilage  had  been  partially 
worn  away.  The  small  end  of  a  Volkmann's  spoon  was 
passed  between  the  joint  surfaces  and  the  synovial  mem- 
brane on  the  anterior  aspect  scraped  as  thoroughly  as 
po8%ible  ;  many  polypoid  fringes  weie  thus  removed  ;  the 
joint  was  then  washed  out  with  perchloride  lotion  and 


464     Thi  Medical  Pbxbs. 


LEAl)ING  ARTICLE!^. 


*     April  29,  1896. 


the  wound  closed  without  drainage.  Eemarch's  bandage 
was  need  during  the  operation,  and  removed  after  the 
application  of  the  dresainga.  An  anterior  splint  was 
applied.  Mr.  Battle  remarked  that  snch  an  affection  of 
a  single  joint  of  the  hand  was  a  very  unasual  occurrence. 
When  a  single  joint  was  affected  in  the  hand  he  had 
generally  seen  the  metacarpal  joint  of  the  thumb  invaded. 
Operations  in  cases  of  rheumatoid  arthritis  were  seldom 
performed,  but  he  considered  that  there  were  many  cases 
where  snch  joints  as  the  shoulder  were  diseased  in  which 
operation  would  be  of  great  benefit  to  the  patient,  for  even 
if  a  movable  joint  was  not  obtained  much  relief  might  be 
afforded  from  the  pain,  and  the  patient's  condition  corre- 
spondingly improved  ;  he  thought  that  in  the  present 
position  of  surgery  much  more  might  be  undertaken  than 
formerly  to  the  great  advantage  of  some  of  the  sufferers 
with  this  painful  disease. 

LONDON    HOSPITAL. 

With  regard  to  the  tumour  of  the  palate  removed  by 
Mr,  Dean  (the  operation  was  reported  in  ''Operating 
Theatres"  on  the  15th  inst),  a  microscopical  examina- 
tion of  a  section  of  the  palate  growth  showed  it  to  be  a 
round-celled  sarcoma.  The  deposit  in  the  lymphatic 
glands  was  of  the  same  nature.  A  section  of  the  portion 
of  the  thyroid  gland  removed  did  not  show  any  sarcoma- 
tous change  under  the  microscope,  but  had  the  ordinary 
appearances  of  chronic  goitre.  The  case,  therefore,  was 
one  of  primary  sarcoma  of  the  palate  with  metastatic 
deposits  in  the  lymphatic  glands. 

It  is  satisfactory  to  state  that  the  patient  was  quite 
well  at  the  end  of  a  fortnight,  and  returned  home  promis- 
ing to  come  back  to  the  hospital  later  to  have  the  glands 
removed  from  the  right  side  of  the  neck. 


Dr.  Farquharson,  M.P.  for  AberdeeDshire,  has 
extracted  from  Sir  M.  W.  Ridley,  the  Home  Secretary, 
the  admiasion  that  the  scale  of  fees  for  witnesses,  medi- 
cal and  other,  which  is  now  operative,  is  obsolete,  it 
having  been  made  in  1858,  and  that  it  must  be  recon- 
structed.  We  trust  that  the  process  of  revision  will 
not  be  long  delayed,  for  at  present  the  fees  allowed  are 
preposterously  unjust. 


ff  Despite  statements  to  the  contrary  which  have 
appeared  in  certain  journals,  thePlayfair  v.  Eitson  case 
has  not  been  settled  out  of  court.  The  appeal  will  in 
due  course  come  on  for  hearing,  when,  of  course,  all 
the  old  evidence  will  have  to  be  repeated.  The 
damages  may  appear  to  be  excessive,  but  it  must  be 
remembered  that  the  amount  was  clearly  calculated  as 
sufficient  to  yield  to  Mrs.  Kitson  an  income  equivalent 
to  that  which,  through  the  representations  of  Dr.  Play- 
fair,  she  had  lost 

The  Board  of  Agriculture  have  had  their  attention 
drawn  to  a  serious  outbreak  of  swine  fever  in  Lanca- 
shire. 

At  Portsmouth  last  week  a  local  anti- vaccinationist 
was  fined  twenty  shillings  for  refusing  to  conform  with 
the  Vaccination  Act. 


Professor  Sapfet,  the  well-known  anatomist,  died 
recently  in  Paris  at  the  age  of  eighty-six. 


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%)lt  ^chM  f  nsa  ^  €muht. 


*8ALU8  POPULI  SUPRKMA  LEX.* 


WEDNESDAY,  APRIL  29,  1896. 


THE  PREVENTION  OF  MEDICAL  ADVER. 
TISIXG.  — IL 
Before  any  serious  endeavoar  is  made  to  purge  the 
profession  of  the  evils  to  which  we  have  referred  in  a 
previous  article  (see  The  Medical  Press  and 
Circular,  April  22nd)  it  is  necessary  to  obtain  a  clear 
idea  of  the  extent  to  which  existing  disciplinary 
powers  can  be  effectually  brought  to  bear.  Most  forms 
of  medical  advertising,  as  at  present  practised,  are  not, 
and  cannot  be  made,  amenable  to  the  disciplinary 
action  of  such  a  body  as  the  General  Medical  Council. 
That  body  will  certainly  never  consent  to  declare  that  it 
is  "infamous  in  a  professional  respect "  to  found  a  hos- 
pital, be  it  ever  so  private,  and  that  being  conceded  it 
is  dilEcult  to  see  how  the  founders  can  be  prevented 
from  using  their  connection  with  the  institution  for 
advertising  purposes.  It  is  possible  that  the  Colleges 
might  be  induced  to  formally  prohibit  the  advertising 
of  medical  works  in  the  lay  press,  but  such  drastic 
measures  would  if  insisted  upon  fall  upon  men  whose 
position  virtually  places  them  beyond  the  reach  of  colle- 
giate censure,  seeing  that  they  are  not  unfrequently 
presidents  or  censors  of  the  very  body  whose  duty  it  is  to 
take  cognisance  thereof.  As  we  have  repeatedly  pointed 
out  there  can  be  no  hard  and  fast  line.  Each  case  must 
be  judged  upon  its  merits.  It  is  not,  as  has  been  so  often 
asserted,  a  question  of  free  trade  in  advertisement 
or  its  entire  prevention.    Entire  prevention,  indeed. 


Apbil 


129,  1896. 


LEADING  ARTICLES. 


The  Mxdical  Prhs.     456 


is  altogether  out  of  the  question,  but  Qod  forbid 
that,  for  this  reason,  we  should  ever  come  to  free 
trade  in  medical  advertising,  if  only  on  the  ground 
that  the  cost  of  advertising,  if  it  became  general,  would 
absorb  a  large  proportion  of  one's  income  to  no  useful 
purpose  except  that  of  degrading  the  moral  and  social 
tone  of  the  profession.    Just  as  there  are  persons  too 
high-placed  to  be  amenable  to  any  impeachment,  so 
there  are  others,  and  their  name  is  legion,  who  are 
driven  by  the  struggle  for  existence  to  disregard  con- 
ventional  amenities  as  between  fellow  practitioners. 
In     a     sense     they     are    beneath     contempt    and 
beyond  the  reach  of   censure,   but   the  remedy  lies 
probably   in    measures    which   would    restrict    the 
number  of  competing  practitioners  and  thus  render 
it  possible  for  men  to  gain  a  livelihood  without  resort- 
ing to  unbecoming  practices.     Medical  societies  and 
associations  might  do  much  to  combat  the  evils  com- 
plained of  by  placing  a  ban  on  those  who  wantonly 
and  systematically  violate  the  code.    Their  action,  how- 
ever, would  be  more  likely  to  reach  those  in  the  higher 
walks  of  the  profession  than  delinquents  lower  down 
in  the  scale.    If  consultants  are  once  made  to  under- 
stand that  covert  advertising  excites  a  hostile  feeling 
among  "the  geese  who  lay  the  golden  eggs''  they 
will  be  more  chary  of  indulging  therein,  but  after  all 
the  consultantpits  himself  against  his  brother  consultant 
andtnot  against  the  general  practitioner,  who  has  con- 
sequently little  to  fear  from  his  self-assertiveness.    In 
spite  of  the  flood  of  eloquence  that  has  been  let  loose 
by  a  recent  law  suit,  we  really  doubt  if  there  is  serious 
ground  for  complaint  in  the  ranks  of  the  average  general 
practitioner.  He,  poor  man,  plods  his  melancholy  way, 
for  the   most  part    without    any  overt  attempt  to 
aggrandise  his  person  or  his  practice  by  illegitimate 
means.    As  a  matter  of  fact,  an  unexpected  puff  by  an 
injudicious  journalistic  friend  usually  gives  him  more 
pain  than  pleasure.     The  General  Medical  Council 
might,  as  matters  stand,  do  much  to  check  the  broad- 
cast distribution  of  quasi-anonymous  handbills  by  out- 
at-elbow  practitioners  who  make  a  bid  for  custom  by 
underselling  their  fellows,  but  this  the  Council  will 
probably  not  do  until  it  is  goaded  on   by  outside 
pressure.    If  the  medical  societies  and  associations 
would  declare  once  and  for  all  that  the  advertising  of 
medical  books  in  the  lay  press  was  unbecoming  and 
inadmissible  conduct  involving  exclusion  from  profes- 
sional fellowship,  the  practice  would  cease  to  exist  with 
a  few  insignificant  exceptions.    The  anti-fat  men  and 
specialists  in  sexual  disorders  might,  it  is  true,  set  all 
such  edicts  at  defiance,  but  as  far  as  the  profession  at 
large  is  concerned  their  blatant  self-advertisement  can 
safely  be  treated  with  contempt. 


FADS  AND  "ADS." 
With  the  alliterative  title  of  *'  Fads  and  *  Ads,  "  an 
American  practitioner  recently  read  a  paper  before  the 
Missouri  Medical  Association,  drawing  attention  to 
many  of  the  little  weaknesses  of  his  professional 
brethren.  In  the  first  place,  however,  his  remarks 
would  seem  to  show  that  in  many  respects  in  America 


practitioners  are  a  great  deal  more  disposed  to  indulge 
in  fads  than  is  the  case  in  this  country.    In  this  con- 
nection mention  is  made  of  the  peculiarities  of  several 
of  his  personal  friends.    For  example,  one  practitioner 
devoted  himself  to  fine  horses,  another  prided  himself 
on  keeping  his   *' office'*   clean,  a  third,  with  some 
perverseness,  made  a  particular  point  of  having  hie 
"  office  "  in  such  a  dirty  and  untidy  condition  as  to 
disgust  everyone  who  entered  it,  his  explanation  being 
that  the  adoption  of  this  policy  could  be  taken  to  indi- 
cate that  he  never  had  any  time,  owing  to  pressure  of 
work,  to  enforce  a  more  cleanly  state  of  affairs.    A 
further  example  is  given  of  a  practitioner  whose  "  fad  " 
is  always  to  indulge  in  "loud  talking,"  whenever  he 
sees  or  meets  a  friend  in  the  streets,  and  who  takes  the 
opportunity  to  say  that  he  is  too  busy  to  stop  and 
speak.    All  these  fads  and  '*  ads  "  the  author  believes 
are  in  themselves  harmless,  and  to  some  extent  excus- 
able, but  the  same  he  asserts  is  not  the  case  in  regard 
to  a  more  pressing  fad  which  everyday  is  becoming 
more  and  more  pronounced.    The  allusion  is  to  the 
use  of  proprietary  compounds.    Here  the  author's  lash 
is  fully  laid  about,  and  with  no  uncertain  hand  he 
makes  it  felt.    The  reasons  given  for  prescribing  these 
compounds  are  :    (1)     They  are  generally  palatable, 
some  of  them  are  trustworthy ;  (2)  Time  and  trouble 
is  saved  in  prescribing.    *^  For  instance,  I  believe  that 
quinine  and  iron  are  indicated  in  a  certain  case,  accord- 
ingly I  prescribe  someone's  elixir  of  quinine  and  iron 
already  made.    The  dose  and  proportion  may  not  be 
exactly  what  I  want,  but  through  laziness  or  careless- 
ness I  fall  into  the  trap  set  for  me.    These  compounds, 
as  arule,  are  labelled  andindicationgiven,  and  somehave 
an  extra  wrapper  on  which  are  printed  reports  of  cases 
treated  and  results.  These  wedo  notorder,  but  the  smooth 
manufacturer  saw  the  point    He  knew  if  the  doctor 
prescribed  the  compound  the  curiosity  of  the  patient 
would  lead  him  to  read  all  about  it,  after  which  the 
patient  gets  a  fad  of  his  own,  and  that  fad  consists  in 
buying   these    compounds   without    consulting    the 
doctor."    Another  point  of  which  this  critic  complains 
is  the  exorbitant  prices  which  are  charged  by  the 
manufacturers  for  these  compounds.    The  high  prices, 
it  is  stated,  are  charged  because  the  compounds  are 
recommended  by  medical  men.  Again,  a  manufacturer 
introduces  a  new  remedy  which  he  claims  as  a  specific 
for,  say,  influenza.    Forthwith,  says  the  author,  the 
word  of  the  manufacturer  is  taken,  and  the  remedy  is 
prescribed  broadcast.    *'  This,"  it  is  added,  ''  is  a  nice 
way  to  learn  and  practise  medicine,  a  nice  way  to 
study  our  cases  and  to  learn  what  is  the  real  lesion  in 
la  grippe.    Let  us  make  out  our  own  prescriptions 
and  study  medicine  and  pharmacy  for  ourselves.    In 
fact,  let  us  do  our  duty  as  physicians  and  cease  patron- 
ising ready-remedy-makers.    We  can  never   restore 
medicine  to  its  proper  sphere  by  connivance  with  drug 
manufacturers.    We  ought  to  be  teachers  of  pharmacy 
instead  of  its  dupes."    There  is  undeniably  some  truth 
in  these  remarks.  But  we  think  that  the  author  is  some- 
what hard  on  the  manufacturers  to  whom  he  refers.  In 
thefirst  place,  the  ordinary  busy  practitioner  has  no  time 
to  devote  to  the  investigation  of  new  pharmaceatical 


456     Thb  Mbdioal  P&vss. 


LEAPING  ARTI0L£«». 


Apul  2d,  1896. 


compoands.  For  the  most  part  all  that  he  has  time 
for  is  merely  to  prescribe  those  which  his  knowledge 
and  experience  have  taught  him  are  usefal.  On  the 
other  hand,  it  is  the  business  of  the  manufacturer  to 
spend  time  and  capital  upon  researches  in  this  direc- 
tion. Unless  praieeworthy  enterprise  had  been  shown 
in  the  pursuit  of  such  objects,  it  is  undeniable  that 
many  new  compounds,  the  value  of  which  has  been 
repeatedly  proved,  would  never  have  been  available 
for  practitioners  with  which  to  cure  or  relieve  their 
patients.  While,  therefore,  the  manufacturers  devote 
their  energies  towards  the  attainment  of  such  laudable 
objects,  it  seems  rather  unjust  to  quarrel  with  them 
for  the  profits  they  make,  and  to  decline  to  give  them 
support  in  consequence.  The  improvements  in  phar- 
macy have  been  entirely  due  to  the  modern  industry  of 
manufacturing  pharmaceutical  chemists,  and  it  would 
be  a  bad  day  for  the  public,  no  less  than  for  medical 
practitioners,  if  this  industry  were  suddenly  to  cease. 


THE  METROPOLITAN  DEATH-RATE. 

The  belief  that  London  is  the  healthiest  of  the  great 
cities  of  the  world  has  long  since  become  an  article  of 
faith  among  the  inhabitants  of  the  United  Kingdom. 
Nor  is  the  theory  devoid  of  a  solid  basis  of  fact,  for  the 
death-rate  of  20*5  for  the  decennium  1881-90  fell  to 
177  in  1894,  and  to  197  during  last  year.  The  figures 
of  the  death-rate  for  the  whole  metropolis,  however, 
although  in  themselves  of  a  satisfactory  nature,  will 
nevertheless  be  found  on  analysis  to  point  to  internal 
conditions  that  are  far  from  reassuring.  If,  for 
instance,  we  compare  together  the  mortality  returns  of 
the  various  districts  included  in  Greater  London  we 
see  that  the  mean  of  197  is  made  up  from  widely- 
varying  results.  Two  Southwark  parishes,  St  Saviour 
and  St.  Olave,  head  the  list  with  25*6  and  241  per 
1,000,  while  the  remaining  forty-three  sanitary  areas 
follow  in  diminishing  ratio  until  they  reach  Wands- 
worth, Lee,  and  Lewisham,  with  14*8,  14*5,  and  14'4 
respectively,  and  the  lowest  points  of  13'4  in  Stoke 
Newington,  and  12  0  in  Hampstead.  Southwark  has 
for  a  long  time,  in  one  or  other  of  its  parishes,  achieved 
the  unenviable  position  of  heading  the  death-rates  of 
the  Metropolis.  In  1894  the  parish  of  St.  George- 
the-Martyr,  Southwark,  came  first  with  237, 
but  last  year  a  fall  of  *2  placed  it  fourth  among  the 
London  sanitary  areas.  Its  Medical  Officer  of  Health« 
Dr.  Waldo,  in  his  recently  issued  annual  report  for 
1895,  has  gone  into  the  matter  in  a  way  that  is  both 
suggestive  and  instructive.  His  parish  is  the  poorest 
and  most  crowded  in  London,  and  a  comparatively 
high  death-rate,  under  such  circumstances,  might  be 
safely  predicted.  On  inquiry,  however,  the  striking 
fact  becomes  evident  that  the  excessive  mortality  is 
mainly  confined  to  a  single  one  of  the  three  sub-districts 
into  which  the  area  in  question  is  divided.  More  pre- 
cisely, the  1895  death-rate  for  the  Borough  Road  sub- 
district  was  330  per  1,000,  as  against  19*8  for  the 
London  Road,  and  191  for  the  Kent  Road  sub-dis- 
tricts. The  average  for  the  four  years  immediately 
preceding  was  33*9  for  the  Borough  Road,  as  against 


20  4  for  the  London  Road,  and  20*6  for  the  Kent  Road 
sub  districts.    Ic  other  words,  the  relative  number  of 
deaths  in  the  first-named  portion  of  the  parish  has 
been,  roughly  speaking,  almost  double  that  of  either 
of  the  two  remaining  portions.    As  Dr.  Waldo  points 
out,  the  period  over  which  these  figures  extend,  foar 
years,  and  the  actual  number  of  deaths  are  both  too  small 
to  allow  of  drawing  absolutely  sound  conclusions.    At 
the  same  time  he  calls  attention  to  the  following  facts 
in  connection  with  the  1895  Report    "  1.  The  mor- 
tality of  the  Borough  Road  sub-district  is  4'2  higher 
than  that  of  Liverpool  for  the  year  1895.    The  latter 
place  had  the  highest  death-rate  of  the  thirty-three 
large  English  towns.    2.  That  of  the  London  Road 
sub- district  is  almost  the  same  as  that  for  the  thirty- 
three  large  provincial  towns,  and  only  slightly  higher 
than  that  of  the  whole  of  London.    3.  That  of  the 
Kent  Road  sub -district  is  below  the  figure  returned 
for  the  whole  of  London,  and  for  the  thirty-three  great 
towns.''    These  statements  can  bear  but  one  interpreta 
tion,  namely,  that  the  Borough  Road  sub-district  is  0!:>e 
of  London's  plague  spots,  and  that  to  its  influence  is 
attributable  the  high  collective  death-rate  of  the  whole 
parish  of  St.  George-the- Martyr.    The  bane  of  exces- 
sive infantile  mortality  has  brought  about,  in  no  small 
degree,  this  evil  condition.    Thus  we  find  that  "  dur- 
ing 1895,  the  number  of  infants  who  died  within  the 
first  year  of  life  was  4'52.    These  figures  give  the  high 
rate  of  208  deaths  to  every  1,000  births  in  St.  George's 
as  compared  with  165  deaths    per  1,000  births  for 
London.  The  average  rate  for  the  four  years  1892-3-45, 
for  St.  George's,  was  206,  and  for  the  Borough  Road 
sub-district,    235 ;    as    against    155    for     London.'' 
Then  the   zymotic  rate   is    high ;   indeed,  for   the 
whole  parish,  it  heads  the  list  so  far  as  the  London 
sanitary  areas  are  concerned.    From  this  analysis  the 
valuable  lesson  may,  we  think,  be  gathered  that  the 
death-rate  of  Greater  London,  favourable  though  it  may 
seem,  attains  that  standard  only  through  the  dilution, 
so  to  speak,  of  the  returns  of  the  bad  districts  by  those 
of  the  good.    If  London  were  to  purge  its  vast  area  of 
plague  spots  its  death-rate  would  rapidly  sink  below 
17 per  1,000,  which  the  late  Dr.  Parkes  fixed  as  "the 
mortality  incident  to  human  nature."    Now  that  the 
principle  of  community  of  interest  in  metropolitan 
health  matters  has  been  accepted  it  would  be  well  if 
some  central  authority  were  to  search  out  and  purify 
such  plague  spots  as  those  of  the  Southwark  Borough 
Road  sub-district.    Dr.  Waldo's  report  contains  many 
other  interesting  features,  with  some  of  which  we  hope 
to  deal  at  a  future  time.    For  the  present  we  will  be 
content  with  the  solid  fact  that  the  death-rate  for  1895 
touched  the  lowest  point  recorded  for  the  last  half  cen- 
tury, *'  Moreover,  if  we  take  the  recorded  rate  for  the  past 
fifty  years  we  find  that  there  has  been  a  decrease  from 
30  in  the  decade  1841-50  to  237  in  1895."    These 
results,  both  the  general  and  the  particular,  are  encour- 
aging in  the  highest  degree,  and  most  people  will 
emphatically  endorse  the  modest  claim  of  the  author 
of  the  report  that   they  "  certainly  appear,   on  the 
face  of  them,  to  furnish  proof  of  the  value  of  sani- 
tary progress  to  the  community." 


April  20,  1896. 


NOTES  ON  CTJBKENT  TOPICS 


The  Mkdical  Press.     457 


<^0tc0  on  €utrent  ^opkB. 

The  Mauser  Rifle. 
From  medical  papers  to  haDcl,  it  appears  that  the 
Maiiser  rifle,  as  modified   by   the  Spanish  military 
authorities  and  used  in  the  Cuban  war  by  the  Eoyai 
troops,  is  a  weapon  better  adapted  for  wounding  tban 
for  killing,  especially  at  short  range.    The  bullet  is  one 
third  of  an  inch  in  calibre,  conico-cylindrical  in  shape* 
wrapped  in  five  coverings,  the  outer  of  which  is  made 
of  nickel-plated  steel.    With  a  charge  of  twenty-eight 
grammes  of    smokeless  powder,  the  range  is  2,000 
metres,  and  at  100  metres  the  bullet  can  pierce  a  metie 
of  pine  wood.    Dr.  J.  Santos  Fernandez  describes  a 
case  of  Maiiser  gun-shot  wound  in  a  recent  number 
of    La    Crontca     Medico- Quvrurgica    of    Havanna. 
The    patient,    set*  41,    was   wounded     in    the    left 
temple,   the    bullet   traversed    the    frontal  lobe  of 
the   brain    obliquely,    and  escaped  just  above  the 
inner    canthus  of   the  left   eye.     Immediately   on 
receiving  the  injury,  the   man  fell   to   the   ground, 
but  after  recovering  from  the  shock  he  did  not  com- 
plain of    pain.     The   eyelids    became    swollen  and 
pressed  down  on  the  eyes,   excluding  light.    After 
eight  days  the  swelling  diminished,  and  then  it  was 
noticed  that  the  globe  of  the  left  eye  had  become  much 
smaller  and  that  the  sight  of  that  eye  was  lost.  Neither 
pain  nor  suppuration  had  followed  the  injury,  and  the 
sole  leaion  discernible  was  atrophy.    Dr.  Fernandez,  in 
referring  to  the  great  velocity  of  the  bullet,  considers 
that  in  its  passage  through  the  tissues  it  cauterises 
those  with  which   it  comes  in  contact ;  hence,  the 
primary  haemorrhage  is  slight,  but  secondary  haemor- 
rhage frequently  occurs,  probably  from  slight  slougbs 
from  the  cauterised  walls  of  the  injured  blood  vessels. 
The  destructive  power  of  the  weapon  is  well  shown  by 
Dr.   Antonio   Canello   y   Peirole's    case    (El   Siglo 
Medico)  of  a   soldier  who  was   cleaning  the  barrel 
of  his  loaded  rifle.     He  had  placed  his  left  wrist 
on  the  muzzle  and  by  some  accident  the  rifle  went  off ; 
the  bullet  entered  the  anterior  surface  of  the  wrist  and 
passed  out  at  the  posterior  surface   at   the   carpo- 
metacarpal articulations.    It  blew  away  the  carpal 
extremities  of  the  radius  and  ulna  ;  the  whole  of  the 
08  magnum,  semilunar  and  unciform  bones,  and  the 
carpal  ends  of  all  the  metacarpal  bones.  On  examining 
the  wound  with  the  finger  it  was  found  to  contain  a 
large  number  of  spiculae  of  bone,  some  loose  and  some 
only  partly  detached.    The  haemorrhage  was  slight. 
Under  strict  aseptic  dressing  the  hand  was  saved,  but 
not  without  much  trouble.    On  the  fourth  and  fifth 
days  the  patient  complained  of  much  pain,  had  a  high 
temperature,  and  was  restless.  On  the  tenth  day  there 
came  a  copious  discharge  of  pus,  and  on  the  twelfth 
day  the  temperature  was  normal,  the  pus  lessened, 
and  the  patient  made  an  uninterrupted  recovery. 

The  Capacity  of  Women  for  Bearing  Pain. 

It  is  obviously  a  somewhat  difficult  matter  to  estimate 

the  degree  of  resistance  to  painful  impressions  in  man 

and  woman  respectively,  or  even  as  between  individuals 

of  the  same  sex.    Some  measure  of  success  has,  it  is 


true,  attended  attempts  to  express  in  figures  compara- 
tive sensitiveness  to  tactile  impression  and  in  respect 
of  the  auditory  and  olfactory  functions.  There,  how- 
ever, we  are  dealing  with  tangible  stimuli,  which  can 
themselves  be  titrated,  so  to  speak,  before  being 
employed.  It  is  quite  otherwise  with  the  subjective 
phenomenon  which  we  call  pain.  Fain,  indeed,  is  a 
reaction  which  varies  more  with  the  idiosyncrasy  of  the 
individual  than  with  the  nature  or  intensity  of  the 
excitant.  The  sensations  associated  with  the  violent 
abduction  of  a  tooth  are  always  disagreeable,  but  it  is 
diflicult  to  resist  the  conclusion  that,  other  things 
being  the  same,  the  intensity  of  the  pain  varies  within 
very  wide  limits.  For  purposes  of  comparison  we  are 
obliged  to  assume  what  we  may  call  a  standard  inten- 
sity of  pain,  and,  proceeding  on  that  basis,  M.  J.  Finot 
feels  justified  in  asserting  that  women  are  more 
resistant  than  men.  When  under  the  stimulus 
of  emulation  women,  he  tells  us,  are  capable 
of  developing  a  will  power  far  in  excess  of 
that  attainable  by  her  hardier  partner  in  the 
'*  struggle  for  life.*'  For  instance,  in  experiments 
with  the  electric  current,  the  female  subjects  were  able 
to  bear  as  much  as  230  volts,  compared  with  40  or  50 
volts,  which  was  all  the  men  would  put  up  with. 
According  to  this  observer,  this  capacity  of  resistance 
to  pain  constitutes  a  valuable  attribute  in  the 
struggle  for  life.  Woman's  intelligence  being  approxi- 
mately equal  to  that  of  man  this  extraordinary  will- 
power confers  an  indisputable  superiority  over  man. 
The  author  clinches  his  argument  by  pointing  out, 
on  biological  data,  that  femininity  of  sex  is  the  result 
of  a  superabundance  of  vitality,  of  a  richness  of 
nutrition,  rather  than  of  any  arrest  of  development,  as 
we  have  hitherto  complacently  supposed.  The  cater- 
pillars of  moths  and  butterflies  become  of  the  male 
sex  when  subjected  to  Ptarvation  regime,  and  in  poor 
and  miserable  countries,  the  preponderance  of  boys 
over  girls  is  very  marked,  just  as  twins,  who  have  to 
compete  for  the  maternal  nourishment,  and  are  com- 
paratively less  favourably  situated  from  a  nutritive 
point  of  view,  are,  he  states,  usually  of  the  male  sex. 
Everywhere  and  always,  concludes  M.  Finot,  nature 
sho^s  a  preference  for  the  female  sex,  a  preference,  it 
may  be  added,  which  men  have  universally  endorsed. 
The  ladies  ought  to  vote  a  medal  to  M.  Finot  for  his 
contribution  to  the  emancipation  of  women  on  logical 
and  biological  grounds. 

A  "  Penny -in-the-Slot"  Doctor. 
To  the  uses  to  which  the  **  penny -in -the  slot "  system 
can  be  put  there  seem  to  be  no  end.  The  public  have 
become  familiar  with  the  contrivances  of  this  kind, 
which  enable  them  to  test  their  own  vision  and  ascer- 
tain the  strength  of  the  lenses  required  to  correct  the 
refraction  defect  from  which  they  may  be  suffering. 
Presumably,  these  machines  are  patronised  by  some 
persons,  otherwise  it  is  certain  that  the  railway 
stations  and  other  places  where  they  are  placed  would 
know  them  no  more.  But  the  difficulty  is  to  under- 
stand what  manner  of  person  he  or  she  would  be  who 
could  seriously  make  use  of  any  information  derived 


458     Thb  Mbdioal  Prks. 


NOTES  ON  CURRENT  TOPICS. 


Apeil29,  1896. 


from  Buch  a  source.  However,  this  matter  aside,  there 
is  soon  to  be  a  new  development  in  the  "  penny-in-the- 
slot  **  business.  A  Dutchman,  it  is  reported,  has  in- 
vented un  automatic  doctor,  we  suppose,  upon  the 
general  practitioner  principle.  In  appearance,  the 
machine  is  a  dignified  metal  presentment  of  a  man,  the 
front  of  whose  waistcoat  is  pierced  with  a  number  of 
openings,  over  each  of  which  is  described  the  name  of 
one  of  the  common  ailments  to  which  humanity  is  sub- 
ject. A  penny  is  dropped  into  the  slot  corresponding 
with  the  disease  from  which  the  customer  is  sup- 
posed to  be  suffering,  and  out  pops  a  small 
packet  of  medicine  "suitable  for  the  case." 
But,  however  advantageous  this  arrangement 
might  prove  it  obviously  involves  a  question  of  eti- 
quette. For  example  it  would  be  difficult  to  proceed 
against  the  metal  practitioner  for  divulging  profes- 
sional secrets,  but  clearly  whenever  he  happened  to  be 
consulted  by  one  of  the  public,  say  at  a  railway  station, 
all  the  little  boys  and  other  persons  standing  near 
would  know  at  once,  from  the  particular  slot  operated 
upon,  what  the  complaint  happened  to  be  for  'which 
assistance  was  required.  An  engaging  young  lady 
might  covertly  drop  a  penny  in  one  of  the  slots,  but 
before  she  would  be  able  to  push  the  drawer  back,  a 
casual  passer  by  might  see  that  she  wanted  something 
for  the  toothache.  Again,  an  elderly  female  taking 
the  opportunity  when  nobody  was  looking  might 
manipulate  another  well-worn  slot,  but  an  inquisitive 
little  boy  might  pop  round  the  comer  and  just  be  in 
time  to  see  that  she  had  taken  something  for  the 
"spasms."  Of  course  the  metal  practitioner  would 
reveal  all  the  secrets  of  which  he  was  capable,  corres- 
ponding with  the  number  of  slots  which  entered  into 
his  construction.  This  unethical  character  of  his 
might,  or  might  not,  interfere  with  his  practice ;  never- 
theless it  is  certain  that  no  matter  what  he  divulged,  he 
could  never  be  proceeded  against. 


Dublin  Sanitation. 
Some  time  ago  we  noticed  the  promulgation  by  the 
Dublin  Sanitary  Association  of  a  Report  on  Typl^oid  in 
Dublin,  containing  a  number  of  recommendations  for 
change  in  the  sanitary  system  now  in  force.  Most  of 
these  recommendations  had  reference  to  matters  of 
detail  which  had  previously,  or  have  been  since, 
attended  to  by  the  Public  Health  Committee  of  the 
Corporation.  The  salient  points  of  the  report,  how- 
ever, were  proposals  that  a  complete  system  of  subsoil 
drainage  of  the  city  should  be  undertaken,  and  also 
that  a  map  should  be  prepared  and  kept  open  for 
inspection  of  all-comers,  in  which  would  be  indicated 
every  house  in  which  a  typhoid  case  had  occurred.  As 
regards  the  proposal  for  subsoil  drainage  the  Public 
Health  Committee,  in  its  report  to  the  Town  Council, 
attempts  and  seems  to  succeed  in  showing  that  no 
subsoil  drainage  is  needed,  because  no  water -logging  of 
the  soil  exists.  It  caused  wells  to  be  sunk  in  various 
parts  of  the  city,  [and  thereby  has  established  that 
the  districts  supposed  by  the  Sanitary  Association 
to  be  waterlogged  are,  in  fact,  the  driest  in 
the    entire    area-— for    geological    reasons,     The 


Committee  also  very  reasonably  objects  to  gibbet 
householders  who  are  so  unfortunate  as  to 
have  typhoid  in  their  houses  by  marking  them  on  a 
map,  to  which  all  the  world  might  have  access. 
Finally,  the  Public  Health  Committee  controverts  the 
assertion  that  typhoid  is  unduly  prevalent  in  Dublin, 
and  states  that  the  zymotic  rate  is  below  that  of  33  of 
the  largest  English  towns.  For  the  purpose  of  assert- 
ing an  empty  principle  the  Sanitary  Association  may, 
perhaps,  consider  it  necessary  to  declare  in  favour  of 
complete  subsoil  drainage  and  the  mapping  of  infective 
disease,  but  if  the  Association  means  business,  as  dis- 
tinguished from  dogma,  it  goes  a  very  bad  way  about 
improving  Dublin  sanitation.  Surely  the  Association 
must  know  that  it  might  as  well  recommend  the  paving 
of  the  streets  with  half-crowns  as  ask  the  citizens  to 
spend  another  £200,000  or  £300  000  on  subsoil  drainage 
after  they  shall  have  outlaid  £600,000  on  main 
drainage  and,  possibly,  £480,000  on  sewer  reconstruc- 
tion. Such  a  suggestion,  even  if  the  necessity  for  sub- 
soil drainage  were  admitted,  is  enough  to  choke  off  all 
attempts  at  sanitary  reform  and  to  extinguish  all 
chance  of  realising  the  praiseworthy  objects  to  which 
the  Association  is  devoted. 


The  MedioaJ  Aid  Sooietiee. 
The  speculators  known  by  this  name  have  held  a 
conference  at  Wednesbury,  at  which  they  discussed  the 
course  to  be  adopted  to  combat  the  agitation  against 
them  on  the  part  of  the  medical  profession.  We  notice 
the  pronouncements  of  delegates  at  this  conference  for 
the  purpose  of  pointing  out  that  this  sort  of  contract 
doctoring  has  now  put  forth  pretensions  which  it  would 
not  have  thought  of  advancing  ten  years  ago.  At  that 
time  these  Friendly  Societies  pleaded  to  be  allowed  to 
live  because  they  provided  medical  care  for  a  neglected 
class  who  were  too  good  for  hospitals  and  not  good 
enough  for  private  practitioners,  and  the  profession 
willingly  conceded  that  such  class  had  a  claim,  and 
might  be  catered  for  on  specially  easy  terms.  Now 
these  Societies,  as  represented  at  this  conference, 
assume  a  commanding  tone  and  avow  their  determina- 
tion to  admit  to  their  benefits  all  classes,  however 
wealthy.  One  of  the  spokesmen  made  the  following 
declaration :  ^  We  shall  have  welcomed  and  shall 
continue  to  welcome  the  entrance  of  persons  of  all 
grades  to  our  ranks,  whether  rich  or  poor,  and  we 
claim  for  the  welHo-do  the  right  to  make  what  pro- 
vision in  the  future  in  our  Society  they  may  desire.'' 
All  right  The  profession  has  no  power  to  effectually 
contest  this  proposition,  but  it  has  ample  power,  if  it 
pleases  to  avail  of  it,  to  checkmake  this  nice  little 
speculation  upon  the  necessities  of  the  doctors  by 
leaving  without  medical  attendance  any  Society  which 
adopts  the  policy  thus  stated.  If  the  Friendly  Societies 
have  perfect  freedom  of  action,  so  have  the  doctors, 
and  if  it  Lb  right  for  the  Societies  to  sponge  well-to-do 
people  upon  the  doctors  at  pauper  rates  it  is  also  right 
for  the  doctors  to  refuse  to  attend  such  people  and 
mercilessly  to  boycott  any  practitioner  who  does 
attend.  If  there  is  any  impropriety  in  the  tr^nsactiou 
it  is  on  the  part  of  the  Societies, 


April  29,  1896. 


NOTES  ON  ClJKRENT  TOPICS. 


Thi  Mkdioal  Prsbs     ^59 


Drug  Traps  for  Fools. 

The  Chemist  and  Druggist  favoars  us  with  an 
exposure  of  some  of  the  proprietary  ''springes  to 
catch  woodcocks"  from  which,  when  lavishly  adver- 
tised, piles  of  money  are  made  out  of  the  gullibility 
of  the  public,  especially  the  feminine  public.  It  is  as 
far  back  as  thirty  years  ago  that  our  contemporary 
showed  that  the  hair  restorers,  sold  at  6s.  a  bottle, 
consisted  of  nofhing  more  .than  a  little  sugar  of  lead 
and  sulphur,  aud  some  coloured  water.  Yet  these 
restorers  are  as  vigorous  in  their  sales  now  as  they 
were  then.  The  same  journal  has  found  that  an 
infallible  liquid  for  curling  the  hair  is  nothing  but 
common  lime  water,  and  a  powder  for  the  same  pur- 
pose comprises  a  little  washing  soda  mixed  with  gum 
powder.  Again,  a  lotion  to  clear  off  wrinkles  and 
freckles,  sold  at  half  a  guinea  a  bottle,  consists  of  a 
few  teaspoonfuls  of  glycerine  and  tinct  benz.;  one  for 
keeping  the  skin  safe  against  sea  breezes,  sold  at  16s.  a 
pint,  is  nothing  but  dilute  glycerine,  and  other  skin 
lotions  consist  of  a  pinch  of  corrosive  sublimate  dis- 
solved in  one  or  other  nice'smelling  menstruum.  These 
are  toilet  preparations,  but  the  same  tricks  of  trade  are 
found  as  frequently  in  proprietary  medical  preparations. 
Feverish  babies  are  calmed  and  cooled  with  a  grain  or 
two  of  potassium  chlorate,  mixed  with  a  little  liquorice- 
powder  ;  the  popular  pink  powder  owes  its  efficacy  to 
its  grain  of  calomel ;  headache-snuff  is  carbonate  of 
soda  with  a  pinch  of  salt;  and  the  "  nit-powder ''  is 
more  often  than  not  borax  pure  and  simple.  Higher 
flights  are  coloured  carbolic  oil  for  the  last-mentioned 
purpose,  and  solution  of  sal-ammoniac  with  a  bitter  for 
neuralgia.  It  would  be  ridiculous  to  expect  trade 
morality  so  Quixotic  as  to  refuse  to  make  money  by 
selling  to  the  public  what  they  ask  for,  and  are  willing 
to  pay  for,  and  what,  in  some  cases,  may  produce  the 
results  claimed  for  it,  nor  can  traders  be  reasonably 
condemned  for  charging  any  price  they  please  for  a 
nostrum,  if  they  find  buyers  ready  to  pay  such  price, 
and,  indeed,  unwilling  to  buy  at  all  if  they  are  not  over 
charged.  It  is,  however,  to  be  regretted  Uiat  ignorance 
and  stupidity  should  be  so  universal  amongst  the  buy- 
ing public,  and  we  can  only  hope  that  the  continual 
publication  of  the  tricks  of  trade  may  educate  them,  or 
some  of  them,  so  that  they  shall  be  less  credulous  than 
they  are.  

The    Loc€l1    Government    Bocurd    and  the 

Gloucester  Epidemic. 
The  Local  Government  Board,  somewhat  tardily  we 
think,  have  issued  an  important  statement  with 
regard  to  the  statistics  of  the  small-pox  epidemic  at 
Willenhall  in  1894.  It  will  be  remembered  that  since 
the  outbreak  at  Gloucester,  the  anti-vaccinationist 
agitators  have  repeatedly  referred  to  the  Willenhall 
epidemic,  and  have  issued  statements  respecting  it 
which  the  Local  Government  Board  have  only  now 
shown  to  be  absolutely  false.  The  attempt  of  the 
agitators  was  to  prove  that  Willenhall  was  a  fully 
vaccinated  district,  and  that  despite  this  fact  small-pox 
occurred  with  a  high  death-rate.  The  real  figures, 
however,  are  these,  quoting  from  the  official  communi- 
Pfition  ;— 


**  Having  regard  to  misstatements  that  have  been 
frequently  made  in  connection  with  the  epidemic  of 
small-pox  at  Willenhall  in  1894,  full  inquiries  have  been 
made  by  the  Local  Government  Board  as  to  the  facts 
of  that  epidemic  in  its  bearing  on  the  preventive  influ- 
ence or  otherwise  of  vaccination.  It  nas  been  found 
that  the  report  of  the  local  medical  officer  of  health  of 
Willenhall  gives  the  following  facts :— 842  cases  of  small- 
pox were  notified  :  of  these,  830  were  traced,  and  it  is 
known  that  no  death  occurred  among  the  remaining  12. 
Of  the  830  attacked,  89  occurred  in  persons  who  had 
never  been  vaccinated ;  of  these,  30  died — namely, 
337  per  cent.  The  remaining  739  persons  had  been 
vaccinated  at  some  or  other  time  of  tneir  lives,  and  of 
these  only  17,  or  2'3  per  cent,  died.  '  The  death-rate,' 
says  the  local  medical  officer  of  health,  'was  more 
than  14i  times  greater  among  the  former  than  the 
latter.'  Other  data  given  show  that,  accordingly,  as 
the  vaccinated  had  one  to  four  prominent  vaccination 
scars,  the  death-rate  ranged  from  4*1  per  cent,  among 
those  with  one  scar  to  1*1  per  cent,  to  those  with  four 
scars.  No  death  occurred  among  any  of  the  revac- 
cinated  persons." 

It  is  too  much  to  hope  that  the  logic  of  these  facts 
will  have  any  effect  upon  the  perverse  anti-vaccina- 
tionists,  for,  hydra-like,  they  become  assertive  with  a 
new  set  of  perverted  figures  when  their  cherished  mis- 
statements have  been  effectually  disposed  of  by  official 
records. 


The  Payment  of  MedioaJ  Bills. 
A  COBRESPOKDENT  in  Tit  Bits  raises  a  question 
which  might  certainly  with  advantage  be  considered 
by  the  public.  He  asks,  **  Is  medical  etiquette  bad  for 
the  public?"  and  then  relates,  in  illustration,  a  per- 
sonal experience  of  his  own.  He  lately  paid  his 
doctor's  bill  for  1895,  and  states  that  the  amount  rather 
startled  him.  "  There  was  no  possible  way  of  checking 
the  items,''  he  adds,  "  and  as  my  doctor  is  also  my 
friend,  I,  like  many  of  your  readers*  lacked  the  moral 
courage  to  ask  for  a  detailed  account,  and  so  wrote  a 
cheque  for  the  total,  feeling  dissatisfied,  and  wishing 
that  medical  etiquette  provided  the  ordinary  means  of 
gauging  one's  expenditure  on  any  particidar  item  of 
the  year's  outlay."  This  correspondent  then  proceeds 
to  argue  that  the  yearly  bills  sent  in  by  doctors  are  a 
mistake,  and  this  custom  of  rendering  accounts  can 
only  be  due  to  an  erroneous  sense  of  medical  etiquette. 
We  hasten  to  inform  this  critic  that  he  is  quite  in 
error.  Medical  men  prefer  cash  payments  just  as 
much  as  other  persons,  whether  professional  or  other- 
wise. It  is  merely  out  of  deference  to  their  patients 
that  such  payments  have  not  been  the  rule  among 
general  practitioners.  If  this  system  were  in  vogue  it 
is  certain  that  medical  men  would  find  that  their 
unremunerated  work  would  greatly  diminish.  Persons 
frequently  incur  the  costs  of  medical  attendance 
which  their  means  do  not  warrant,  and  in  these  cases 
it  often  happens  that  the  practitioner  has  to  suffer  for 
their  incapacity  to  pay.  Were  cash  payments  to  be  the 
rule  such  contingencies  could  not  arise. 


''Model"  Dwellings,  Indeed! 
Of  late  years  it  has  been  more  and  more  the  fashion 
to  build  huge  blocks  of  dwellings  for  the  artisans  of  our 
large  towps.    The  massing  together  of  so  many  people 


460     Thb  Mbdioal  Pans. 


NOTES  ON  CURRENT  TOPICS. 


Apbil  29.  1896. 


tinder  these  new  conditions  has  already  led  to  many 
unpleasant  complications.  One  of  the  latest  is  that  the 
police  decline  to  interfere  with  the  control  of  the  stairs 
and  passages  of  the  '*  models/'  because  they  are  private 
property.  The  result  of  this  attitude  may  be  gathered 
from  the  following  passage  which  appeared  lately  in  a 
letter  addressed  to  the  Daily  Chronicle :  "  The  stair- 
cases, as  a  rule,  are  open  to  the  street,  and  are  used  for 
sleeping,  and  often  for  worse  purposes  ;  the  yards  are 
infested  by  young  gamblers  throughout  the  greater 
part  of  Sunday,  and  whenever  daylight  allows.  The 
police  say  they  have  no  right  to  interfere,  because  both 
yards  and  staircases  are  private  property.  But  to  all 
intents  and  purposes  they  are  public  thoroughfares ; 
the  gates  are  open  all  night,  and  women  who  have  to 
go  office-cleaning  in  the  early  morning  not  infrequently 
go  in  fear  of  personal  violence."  In  view  of  these  and 
many  other  abuses  reported  under  the  present  system 
it  is  clear  that  the  interests  of  the  public  demand  a 
better  control  over  these  huge  hives  of  population. 


A  "Snap-shot"  Diagnosis. 
There  is  no  more  difficult  task,  at  times,  than  to 
decide  whether  a  particular  person  is  or  is  not  under 
the  influence  of  drink.  Various  tests  of  the  co-ordina- 
tion of  muscles  and  nerve-centres  have  been  devised 
from  time  to  time,  but  none  of  them  are  infallible.  It 
is  quite  conceivable,  for  instance,  that  a  sober  man 
would  slip  over  the  mystic  sentence,  *'  she  stood  at  the 
door  of  Burgess's  fish-sauce  shop,  beckoning  him  in," 
and  in  the  same  way  the  inability  to  walk  along  a  line 
chalked  on  the  floor  might  be  due  to  non-alcohelic 
causes.  It  behoves  the  medical  man  who  is  called  by  the 
police  to  pronounce  as  to  the  sobriety  or  otherwise  of 
a  prisoner  to  be  specially  guarded  in  his  diagnosis. 
During  the  past  week,  from  the  evidence  given  before 
a  London  magistrate,  it  appeared  that  a  doctor,  sum- 
moned to  a  police- cell,  gave  one  look  at  its  inmate, 
pronounced  the  word  *' drunk"  and  departed.  It  is 
not  surprising  that  the  magistrates  marked  his  sense 
of  the  worthlessness  of  such  evidence  by  discharging 
the  prisoner  and  disallowing  the  doctor's  fee.  With 
that  decision  we  are  in  full  accord,  as  we  hold  a  fixed 
opinion  that  the  diagnosis  of  drunkenness,  especially 
in  police  cases,  should  be  arrived  at  only  after  patient 
and  exhaustive  examination. 

The  Perils  of  Petroleum. 
The  increased  popularity  of  petroleum  lamps  for  the 
purposes  of  household  lighting  has  been  attended  with 
an  alarming  number  of  fatal  explosions.  Hence,  any 
attempt  to  control  these  accidental  occurrences  be- 
comes a  matter  of  national  importance,  and  on  that 
ground  we  welcome  the  inquiry  now  being  conducted 
by  a  Select  Committee  of  the  House  of  Commons, 
Last  week  some  important  evidence  was  tendered  by 
an  official  of  the  London  County  Council.  He  made 
the  remarkable  statement  that  the  lamp  accidents  in 
the  Metropolis  had  increased  from  sixteen  in  the  year 
1866  to  473  in  1895  Heating  of  the  burners  was  the 
main  cause  of  these  explosions,  and  it  was  the  opinion 
of  the  Council  that  the  sale  of  dangerous  lamps  ought 


to  be  entirely  prohibited.  Even  in  some  of  che  expen- 
sive lamps  a  channel  of  communication  was  sometimes 
left  open  between  the  flame  and  the  reservoir.  All  the 
oils  causing  accidents  were  found  to  be  above  73  de- 
grees flash-point,  which  was  the  "  Abel "  test  In  ono 
instance,  the  flash-point  was  as  high  as  110  degrees. 
The  witness  expressed  his  belief  that  it  would  be  wise 
to  raise  the  flash-point  from  73  to  120  degrees,  in  which 
case  it  would  not  matter  very  much  what  sort  of  oil 
was  used.  It  is  to  be  hoped  that  the  Qovernmental 
inquiry  will  speedily  lead  to  practical  results.  We 
know  of  no  piece  of  domestic  legislation  that  is  more 
needed  than  a  measure  to  control  the  makers  of  defec- 
tive lamps. 

Antl- Vaccinationists  Tactics. 
The  unscrupulous  statements  made  by  rabid  anti- 
vaccinationists  have  been  particularly  obtrusive  of  late. 
Perhaps  the  most  outrageous  one  of  this  description 
which  has  come  under  our  notice  is  that  of  a  corres- 
pondent, named  J.  R  Williamson,  who  frequently 
adorns  the  columns  of  the  Echo,  and  other  newspapers 
of  that  ilk.  His  latest  contribution  to  the  subject  is  that 
'*  although  it  is  no  longer  a  matter  of  speculation  that 
deaths  from  vaccination  are  of  constant  occurrence,  yet 
it  is  extremely  difficult  to  obtain  a  public  inquiry  into 
fatal  cases,  especially  in  Scotland."  He  also  asserts 
that  **  Mr.  A.  R.  Wallace  has  computed  that  10,000 
children  are  destroyed  yearly  in  England  and  Wales 
by  five  maladies  induced  by  vaccination."  How  is  it 
to  be  wondered  at  that  the  poor  and  uneducated  should 
be  induced  to  disobey  the  law,  when  such  mendacious 
statements  as  these  are  issued  broadcast  over  the 
country.  Can,  under  these  circumstances,  surprise  be 
felt  that  two  brothers  who  died  of  small-pox  last  week 
at  Qloucester  should  have  stated  that  they  preferred 
death  to  vaccination.  Verily,  the  anti-vaccinationists 
have  much  to  answer  for,  since  out  of  their  pernicious 
teaching,  death,  untold  misery,  hideous  deformities, 
and  many  other  evils  have  held  sway  during  the  course 
of  the  epidemic  of  small-pox  in  Gloucester. 


The  Importation  of  Invalids  into  the 
Colonies. 
Evil  days  are  in  store  for  phthisical  persona  in  this 
country  who  are  desirous  of  trying  the  effects  of  the 
climate  of  New  Zealand.  At  the  present  moment  the 
Government  of  this  Colony  are  considering  a  draft 
for  a  Bill  prohibiting  those  suffering  from  phthisis  from 
landing,  the  intention  being  to  pass  an  Act  similar 
to  that  in  force  against  the  importation  of  lepers,  suf- 
ferers from  small-pox,  and  others  afflicted  with  con- 
tagious disease.  A  clause  will  be  inserted  in  the 
proposed  Bill  exacting  heavy  penalties  from  ship 
captains  who  bring  consumptives  to  the  Colony.  One 
of  the  effects  of  this  will  be  that  the  owners  of  the 
passenger  lines  wiU  have  to  demand  clean  bills  of 
health  from  their  passengers  before  taking  them  on 
board.  We  doubt  the  necessity  or  the  expediency  of 
the  step  proposed  to  be  taken  by  the  New  Zealand 
Government  in  this  regard.  The  tubercle  bacillus  can 
only  flourish  when  the  conditions  are  favourable  to  its 


April  2d,  18^. 


NOTES  ON  CURRENT  TOPICS.  The  Medical  Peess.     461 


development.  Its  iDfectiveness  is  not  by  any  means 
comparable  to  that  of  the  zymotic  and  other  contagious 
diseases,  despite  the  opinion  of  German  professors 
upon  this  point ;  it  is  many  degrees  less  infective  than 
the  latter,  and  among  healthy  persons  not  predisposed 
to  the  disease,  the  risk  of  its  dissemination  is  niL 

The  Transvaal  Government  and  Foreign 
Medical  Practitioners. 
In  view  of  the  attention  which  is  now  being  centred 
in  the  South  African  Republic,  it  may  be  of  use 
to  point  out  the  conditions  under  which  the  holders  of 
foreign  medical  degrees  and  diplomas  are  permitted  to 
practice  in  that  country.  The  business  in  connection 
with  the  regulation  of  these  conditions  is  placed  in  the 
hands  of  a  Board,  called  the  Transvaal  Government 
Medical  Board.  The  Board  does  not  examine  the  can- 
didates applying  for  permission,  nor  does  it  grant  dip- 
lomas in  medicine  or  surgery,  but  it  only  supervises 
and  decides  on  the  merits  of  the  diplomas  of  such 
medical  men  who  desire  to  be  registered  in  the  State 
for  the  purpose  of  practising  their  profession.  The 
rule  followed  is  to  accept  and  admit  all  diplomas 
which  entitle  the  legitimate  holders  to  practice  in  the 
country  in  which  such  diploma  has  been  granted,  and 
for  which  a  minimum  of  four  years'  purely  professional 
study  is  required.  These  are  not  severe  restrictions, 
nevertheless,  if  carried  out,  they  would  be  quite  suffi- 
cient to  exclude  the  peripatetic,  uneducated  followers  of 
^sculapius,  who  might  be  disposed  to  make  a  raid 
upon  the  Transvaal  with  their  diplomas  obtained  from 
the  bogus  colleges  in  America  and  other  places. 


The  Late  Baoron  Hirsch  and  Medical 
Charities. 
The  death  of  Baron  Hirsch  will  make  a  great  differ- 
ence to  many  charities  which  in  this  country  have  to 
depend  for  their  existence  upon  voluntary  contributions. 
Especially  so  will  this  be  the  case  in  London.  The 
Charity  Record  points  out  that  in  1893  the  late  Baron 
gave,  to  metropolitan  hospital  charities  alone,  a  sum  of 
£40,000.  As  is  well  known  it  was  his  custom  to  devote 
most  of  his  winnings  on  the  turf  to  this  purpose. 
Truly  it  may  be  said  that  he  was  a  great  philanthro- 
pist, for  who  has  ever  given  as  much  as  £3,000,000,  as 
he  is  reported  to  have  done,  to  charitable  and  philan- 
thropic work,  within  the  space  of  a  few  years  ?  The 
late  Baron,  in  common' with  many  of  his  co-religionists, 
possessed  a  remarkable  faculty  for  making  money,  but 
the  unstinted  way  in  which  he  gave  of  his  great 
wealth  to  charitable  objects  will  long  survive  as  a  grate- 
ful reminiscence  among  those  who  were  the  recipients 
of  his  bounty. 

The  Matabele  Rebellion. 
The  daOy  press  have  been  keeping  the  public  well 
informed  with  regard  to  the  anxious  times  through 
which  the  inhabitants  of  Bulawayo  are  at  present  pass- 
ing in  consequence  of  the  revolt  of  the  Matabele.  But 
there  is  one  point  in  connection  with  the  unfortunate 
position  of  the  beleaguered  inhabitants  to  which  but 
little  attention  has  been  drawn,  and  that  is  the  absence 


among  the  Chartered  Company's  forces  of  skilled  sur- 
geons. A  few  young  surgeons,  thoroughly  versed  in 
all  the  modern  methods  of  operating  would  be,  at  the 
present  moment,  of  the  greatest  possible  use  in  Bula- 
wayo. Apparently  wounds  of  limbs  associated  with 
fractured  bones,  are  now  generally  treated  by  amputa- 
tion, and  the  cases  of  amputation  so  far  have  shown  a 
deplorable  rate  of  mortality.  The  overcrowding,  also, 
of  the  wounded  in  the  event  of  the  town  being  be- 
sieged, will  be  certain  to  prevail  to  a  large  extent, 
as  the  result  of  which  hospital  gangrene  or  other 
forms  of  blood  poisoning  cannot  fail  to  occur.  The 
only  remedy  for  this  state  of  things  is  to  have 
thoroughly  skilled  surgeons  on  the  spot,  who  would  be 
able  to  prevent  these  untoward  complications,  by  the 
adoption  of  the  modern  hygienic  and  antiseptic 
methods  of  wound  treatment. 

Abortion  Medicine-mongering. 
A  correspondent  of  a  medical  contemporary  again 
calls  attention  to  the  extensive  and  lucrative  trade  in 
emmenagogues,  which  are  largely  advertised  and 
recommended  to  married  women  and  to  young  women 
who  *'  have  got  themselves  into  trouble/'  the  palpable 
suggestion  put  forward  in  the  advertisement  being  that 
these  medicines  will,  when  desired,  cause  abortion. 
The  correspondent  knows  a  man,  and  believes  that 
there  are  many  such,  who  makes  £20  a  week  by  pur- 
chasing the  pil.  aloes  et  ferri  for  threepence  a  box, 
and  selling  them  under  a  another  name  at  six  shillings. 
Much  of  the  enormous  marginal  profit  is  expended  in 
advertising,  usually  in  the  religious  papers,  special 
prominence  being  given  to  the  statement  that  these 
pills  must "  on  no  account  be  taken  by  anyone  who 
expects  to  become  a  mother.'*  Of  course  they  have  no 
efficacy  as  abortives,  and,  therefore,  the  police  cannot 
prosecute  the  vendors,  but  the  women  buy  them  to  any 
extent  for  that  purpose,  and  the  trader  makes  a  for- 
tune out  of  their  vicious  and  immoral  propensities. 


Chloroforming  by  an  Unregistered  Dentist. 
An  inquest  was  held  last  week  at  Idle,  near  Bradford, 
which  brought  to  light  some  allegations  of  a  serious 
and  remarkable  nature.  The  inquiry  was  held  to 
investigate  the  cause  of  death  of  a  servant  girl,  set. 
fifteen.  The  deceased  had  suffered  from  toothache 
and  went  to  an  unregistered  dentist,  named  Priestley, 
who  is  alleged  to  have  administered  two  doses  of 
chloroform  for  the  purpose  of  extracting  a  tooth. 
During  the  operation  the  patient's  heart  ceased  beat- 
ing, and  a  doctor  who  was  summoned  pronounced  life 
extinct.  The  operator  is  now  under  arrest  on  a 
charge  oi  manslaughter.  It  seems  hardly  credible 
that  anyone,  without  full  medical  training,  should 
venture  upon  the  administration  of  chloroform  single- 
handed.  Moreover,  anyone  who  is  conversant  with  the 
subject  of  chloroform  and  its  dangers  knows  that  not 
a  few  of  the  fatal  cases  occur  in  the  practice  of  dentis- 
try and  of  minor  surgery.  We  shall  await  the  result 
of  this  trial  with  a  good  deal  of  interest. 


m      l^HB  AIbDIOAL  PR10S. 


SCOTLAliD. 


April  29,  lSd6. 


The  Metric  System. 
Wb  regret  to  note  that  the  reply  of  the  First  Lord 
of  the  Treasury  to  the  question  of  Mr.  Arnold  Foster, 
as  to  the  adoption  of  the  metric  system  in  Great 
Britain  was  discouraging  in  its  tone.  Mr.  Balfour 
said  that  the  imposition  of  such  a  system  by  law  has 
not  yet  come  within  the  scope  of  practical  politics. 
No  one,  however,  has  asked  for  any  revulsive  legisla- 
tion of  the  sort,  but  rather  for  some  alteration  of  the 
law  and  regulations  which  may  eventually  lead  up  to  the 
adoption  of  the  system.  It  is  satisfactory  to  the  pro- 
moters of  any  scheme  when  the  Minister  declines  on 
the  ground  that  it  is  not  "  within  the  scope  of  practi- 
cal politics."  It  means  that  if  enough  pressure  is  put 
on,  and  enough  noise  is  made,  the  subject  will  be 
brought  within  that  range,  and  the  desired  object 
gained.  We  are  glad  to  observe  that  three  other 
M.P.'s  have  given  notice  of  further  questions  in  order 
to  keep  the  matter  in  the  minds  of  parliamentarians. 

Climbed  Down. 
Thb  leader  of  the  anti-vaccination  agitation  at 
Gloucester,  seeing  his  neighbours  dying  of  the  murrain 
which  he  and  his  group  of  sympathetic  lunatics  have 
brought  upon  the  city,  has  announced  that  he  has 
"  submitted  to  vaccination,  against  his  convictions,  but 
for  the  public  good."  Let  there  be  no  mistake.  He 
submitted,  not  that  he  cared  one  straw  about  the 
public  good,  but  because  he  was  in  terror  lest  the 
falsity  of  the  doctrines  which  he  had  preached  might 
be  proved  upon  his  own  person.  People  of  this 
sort,  who  are  wont  to  disregard  human  life  when- 
ever the  fad  seizes  them,  cannot  be  allowed  credit  for 
magnanimity  when,  to  save  their  own  skins,  they  do 
what  they  have  spent  their  lives  in  persuading  other 
people  not  to  do. 

Euoaine. 
Uin)BB  this  name  a  new  substitute  for  cucaine  has 
been  brought  out  by  a  Berlin  dentist  named  Kiesel. 
It  isprepared  synthetically,  and  the  chemists  describe 
it  as  "  a  methyl  ester  of  benzo-yloxypiporidine  carbo- 
lozylic  acid."  It  is  claimed  for  it  that  it  does  not 
affect  the  heart,  produces  more  extensive  aneesthesia 
than  cocaine,  and  is  non-poisonous.  Probably,  it  will 
also  be  much  cheaper. 


[VBOM  OUB  OWN  OOBBISPONDIKT.] 

Thb  Late  Db.  A.  Flbmixo  Wood.— The  members  of 
the  professiOD  in  Edinburgh  were  ehocked  to  hear  of  the 
death  of  Dr.  A.  F.  Wood,  on  Tuesday  of  last  week,  from 
pneumonia,  contracted  in  the  discharge  of  his  duties  as 
Reeident  Medical  Superintendent  of  the  City  Fever 
Hospital.  Dr.  Wood  graduated  at  the  University  of  Edin- 
burgh in  1880,  and  shortly  afterwards  became  an  assistant 
in  the  fever  wards  of  the  Old  Infirmary.  When  the  New 
Infirmary  was  opened  the  old  buildings  were  reserved  for 
fever  casee  alone,  and  Dr.  Wood  was  given  the  resident 
appointment,  a  post  which  he  held  up  to  the  time  of  his 
death.  His  life  has  been  a  curious  one.  Exceedingly  shy 
by  nature,  and  seemingly  devoid  of  all  ambition,  be  was 
content  to  devote  all  his  time  and  his  by  no  means  incon- 


siderable talents  to  the  service  of  the  town.  From  his 
long  acquaintance  with  the  symptoms  and  course  of  infec- 
tious diseases,  obtained  at  first  hand,  his  opinion  as  to 
doubtful  and  isolation  cases  was  always  of  the  greatest 
value,  and  many  a  practitioner  in  the  city  has  cause  to 
thank  him  for  invaluable  help  in  difficult  casee.  From  his 
long  experience  his  powers  of  prognosis  in  fever  cases  waa 
marvellous,  and  his  opinion  was,  therefore,  relied  on  with 
much  confidence  by  the  ordinary  medical  attendants  of 
patients  in  the  hospital.  The  funeral  from  the  hospital  to 
the  Waverley  Station  en  route  for  Dundee,  was  attended 
by  a  number  ot  the  Edinburgh  Town  Council,  and  by  a 
large  representation  of  the  profession  in  Edinburgh. 

Medical  Dkgbees  at  the  Univbrsitt  of  EDiNBURtiH. 
— The  University  Court  Lave  agreed  to  make  the  following 
subjects  compulsory  for  the  degrees  of  Bachelor  of  Medi- 
cine and  Bachelor  of  Surgery  :  -1.  A  course  of  instruction 
in  Mental  Diseases,  given  by  the  University  Lecturer  or 
by  a  recognised  teacher,  consisting  of  not  lees  than  six 
class-room  meetings  for  lectures  and  demonstrations,  and 
ten  meetings  in  the  wards  ef  a  recognised  asylum  for  the 
insane.  2.  Post-mortem  examinations  in  a  recoenised 
hospital  for  a  period  of  at  least  three  months,  durin(|r 
which  practical  instruction  is  given  in  the  methods  of 
making  post-mortem  examinations,  and  in  framing  reports. 
3.  A  course  of  clinical  instruction  in  infective  fevers,  given 
at  not  less  than  twelve  meetings  in  the  wards  of  a  recog- 
nised hospital  where  clinical  instruction  is  ^ven  on  cases 
of  infectious  diseases.  4.  Instruction  in  Diseases  of  the 
Eye,  given  by  the  University  Lecturer,  or  by  a  recognised 
teacher,  at  not  less  than  tweWe  class-room  meetings  and 
twelve  meetings  for  clinical  instruction  in  the  wards  of  a 
recognised  hot>pital  or  in  the  wards  of  a  hospitid  and  in 
a  dispensary  both  recognised  for  the  purpose.  The  course 
to  include  efficient  practical  instruction  in  the  methods  of 
examining  the  eye.  5.  A  course  of  Operative  Surgery, 
conducted  by  the  Professor  of  Surgery  in  the  University 
or  by  a  recognised  teacher.  6.  E  veryjcandidate  shall  also  be 
required  to  attend  any  one  of  the  two  following  courses : — 
1.  Clinical  instruction  ia  children's  diseases,  given  by 
the  University  Lecturers  on  this  subject,  or  by  a  recog- 
nised teacher  or  teachers  in  a  hospital  recognisea  for  the 
purpose,  at  not  less  than  four  lectures  and  ten  meeting^  for 
clinical  instruction  in  the  wards,  together  with  four  meet- 
ings in  the  out-patient  department  of  the  hospital,  with 
attendance  at  post-mortem  examinations.  2.  Instruction 
in  diseases  of  the  larynx,  ear,  and  nose,  given  by  a 
University  Lecturer,  or  by  a  recognised  teacher,  at  not 
less  than  six  class-room  meetings,  and  twelve  meetings 
for  clinical  instruction  in  the  wards  of  a  recog- 
nised hospital,  or  in  the  wards  of  a  hospital 
and  in  a  dispensary  both  recognised  for  the  purpose. 
By  the  above  resolution  the  long-suffering  student  of 
ordinary  capacity  will  have  to  attend  classes  which  up  to 
the  present  only  those  of  greater  assimilative  power  or  of 
greater  ambition  have  thought  fit  to  patronise.  The 
result,  however,  must  be  that  all  the  graduates  of  the 
University  will  henceforth  enter  on  the  duties  of  their 
profession  better  equipped  for  their  manifold  duties  than 
hitherto,  a  thing  of  some  importance  for  the  laity,  especi- 
ally for  those  in  country  districts. 

Thb  Scottish  Ppblio  Health  Bill  in  thb  Lord!j.  — 
The  Select  Committee  of  the  House  of  Lords  have  been 
making  some  drastic  changes  in  this  Bill.  They  have 
thought  fit  to  strike  out  the  word  *'  dangerous  "  before 
*' infectious  diseases"  in  the  clause  relating  to  them, 
leaving  the  recognition  of  infectious  diseases  requiring 
supervision  presumably  to  the  local  authorities.  A  new 
clause  has  been  added  to  authorise  a  great  increase  in  the 
powers  of  the  mediual  officers  of  be^th,  which  runs  as 
follows: — *'A  medical  officer  may  at  reasonable  times 
enter  and  inspect  any  house  or  premises  in  the  district  in 
which  he  has  reason  to  believe  that  any  infectious  disease 
exists,  and  the  medical  officer  may  examine  any  person 
found  on  such  premises  with  the  view  of  ascertaining 
whether  such  person  is  suflering  from  any  infectious 
disease,  and,  in  the  event  of  access  being  refused,  the 
Sheriff  or  Magistrate  or  Justice  may,  on  reasonable  cause 
shown,  authorise  such  inspection  and  examination,  and^ 
on  such  warrant  being  obtained  and  exhibited,  any  person 
refusing  to  admit  the  medical  officer  to  such  house  or  pre- 
mises, or  obstructing  him  in  making  the  inspection 
or  examination  aforesaid,  shall  be  liable  to   a   penalty 


April  2d,  18M. 


COtolSPONbENOfe 


f  HB  Mbdioal  Pans.  -  46^ 


not  exoeediog  forty  shillings  for  every  such  offence." 
Provision  is  also  reoommended  to  enable  the  local 
authority  to  compel  the  removal  of  any  resident,  not 
themselves  sick,  from  a  house  in  which  infections  disease 
exists,  and  to  provide  accommodation  for  them  free  of 
charge.  The  hours  during  which  the  authorities  may 
enter  a  house  have  been  very  properly  changed  from  6  a.m. 
to  9  p.m.,  to  from  9  a.m.  to  6  p.m.  Some  other  altera- 
tions are  suggested  on  the  same  lines,  largely  also  in  the 
way  of  increasing  the  maximum  fines  imposable,  and  if 
the  recommendations  of  the  Ck)mmittee  are  adopted  in 
their  entirety,  if  Scotland  is  not  healthy  and  free  from 
any  excess  of  infections  disease,  it  ought  to  be. 

GlasooVs  Latsst  Hospital  fob  Ikfbotious  Disbasbs. 
— A  very  complete  disinfecting  system  has  been  intro- 
duced at  Lightbum  HospitaL  The  apparatus  used  is  the 
Alliot-Faton  Patent  Lyon's  Steam  Disinfector.  Without 
giving  minute  details  of  the  system,  it  may  be  stated  that 
the  apparatus  is  provided  with  a  door  at  each  end,  and  a 
cross  wall  built  so  as  to  prevent  goods  entering  through 
the  infected  chambers.  This  system  has  also  Men  intro- 
duced at  the  Ruchhill  HospitaL  This  new  hospital  (Light- 
bum)  was  opened  on  the  23rd  inst.,  and  is  mtenaeafor 
infectious  diseases,  is  beautifully  situated  a  few  miles  out 
of  Glasgow  in  Shettleetin  district,  north-east  of  the  city. 
The  buuding  consists  of  four  pavilions,  two  observation 
wards,  and  an  administrative  block  with  workehopSi  The 
ward  pavilions  are  one-storey  high,  and  so  arranged 
as  to  secure  the  fullest  exposure  to  the  sun. 
Two  of  the  pavilions,  with  eleven  beds  each,  are 
to  be  devoted  to  scarlet  fever  cases,  the  third 
pavilion  has  17  beds,  which  are  intended  for  typhoid 
lever,  and  the  fourth  also  with  17  I>ed8,  for  cases  of  diph- 
theria. The  two  observation  wards  have  two  l>eds 
each.  Altogether  there  is  a  total  l>ed  accommodation  for 
60  patients.  It  may  be  stated  that  in  each  pavilion  there 
is  the  necessary  accommodation  for  the  nursing  staff. 

Gkbbetock.— Claim  Against  thb  Military  Authob- 
rriBS. — Dr.  Wallace,  medical  officer,  Greenock,  has 
reported  that  three  cases  of  diphtheria  occurred  recently 
at  Fort  Matilda,  and  that  the  patients  were  removed  to 
the  infirmary.  He  considered  that  a  charge  should  be 
made  against  the  military  authoritiee  for  the  maintenance 
and  treatment  of  the  cases  referred  to.  The  Town 
Clerk  and  Sanitary  Inspector  of  Greenock  have  been 
instructed  to  forward  this  claim  to  the  proper  quarter. 

Dbath  or  A  Notablb  Sootoh  Cuabactbb. — There  has 
Just  died  at  Hawick,  Mrs.  Mitchell,  aged  76  years,  the  last 
surviving  daughter  of  a  well-known  Boraer  celebrity 
— ^Tibbie  Shiel,  who  for  many  years  kept  the  small  inn  at 
the  head  of  St.  MaiVs  Loch.  This  inn  was  frequented  by 
Hog^,  the  Ettrick  shepherd ;  Professor  John  Wilson 
(Christopher  North),  and' others  alluded  to  in  the  "  Noctes 
AmbrosianSB.''  The  deceased,  Mrs.  Mitchell,  up  to  the 
time  of  her  death  possessed  a  good  memory,  and  could 
give  many  interesting  reminiscences  of  the  famous  men 
who  used  in  bygone  days  to  visit  her  mother's  housoi 


MEDICAL  SOCIETY  OF  LONDON. 
Thb  meeting  on  Monday  evening  last  (April  27th)  was 
devoted  to  the  subject  of  mammary  abscess.  The  subject 
was  brought  before  the  Society  by  Mr.  Marmaduke  Sheild 
in  a  very  elaborate  paper,  in  which  he  discussed  the  fre- 
quency, causation,  ana  treatment  of  these  abscesses.  He 
pointed  out  that  by  far  the  greater  number  of  these 
absceepeo  oocnr  in  association  with  lactation,  and  are  due 
to  infection  from  excoriated  or  fissured  nipples.  Maminary 
absceoo  is,  therefore,  evidently  a  preventible  affection, 
and  the  results  of  antiseptic  treatment  of  the  nipples  in 
lying-in  hospitals  proves  the  correctness  of  this  view.  His 
plan  of  opmting  comprises  a  primary  incision,  into 
which  the  finger  is  passed  nntii  it  reaches  the  most 
dependent  part,  where  a  second  incision  is  made  and  the 
cavity  farther   explored.    After   thorouffhly  evacuating 


nsing  the  abeoess  cavity,  the  onginal  incision  is 
dosed  with  horsehair  sutores,  and  coUixUon  is  applied 
over  it  in  order  to  secore  healing  with  a  minimum  of  soar- 
ring.  In  the  even^  of  a  sinos  pcovin|^  intractable  after 
seraping,  Ac,  he  advocated  the  excision  of  a  wedge- 
shaped  piece  of  gland  tissoe,  including  the  sinos  and  its 
enviraonient  of  wise  fibrous  tiasoa 
Dr.  Grifliths  approached  the  question  from  tfar' Aetet- 


rician's  point  of  view,  and  insisted  on  the  facilitv  with 
which  abscesses  of  the  breast  can  be  prevented  oy  due 
attention  to  cleanliness  and  antisepsis. 

Mr.  Wallis  pointed  out  that  the  tendency  of  these 
abscesses  to  develop  in  the  shape  of  an  hour-glass  was  not 
sufficiently  recognised.  It  is  often  only  on  fequeecing  the 
breast  that  the  minute  orifice  of  communication  through 
which  the  superficial  collection  of  pus  communicates  wiUi 
the  deeper  abscess  can  be  renderea  visible. 

Dr.  Eocles  asked  the  author  what  his  experience  had 
been  in  respect  of  abscesses  of  gummatous  origin,  and 
alluded  to  a  case  of  his  own  which  appeared  to  ^ve  had 
that  origin.  He  urged  that  these  operations  should 
always  m  one  under  an  antesthetic  general  because  it  was 
impossible  otherwise  to  treat  the  abscess  effectually. 

Dr.  A.  Routh  alluded  to  the  success  which  had  attended 
antiseptic  treiatment  in  an  institution  where  previously 
inflammation  of  the  breast  was  common,  and  mentioned 
that  not  only  mi^ht  the  passage  of  pus  into  the  milk  ducts 
give  rise  to  vomiting  and  diarrhoea  in  the  infant,  but  the 
presence  of  micro-organisms  in  the  first  portion  of  milk 
might  determine  the  same  symptoms.  In  these  caees  all 
that  was  necessary  was  to  draw  off  the  first  portion  of  milk 
before  putting  the  child  to  the  breast. 


tWe  do  not  hold  oonelvet  rMponBible  for  the  oplDlont  of  our 
ooRetpondenti.]  

THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 

To  the  Editor  of  Thb  Mbdioal  Prbss  and  Ciboular. 

Si  A,— Your  correspondent  "MacSplint"  who  writes 
from  Edinburgh  may  have  full  warrant  to  speak  as  to  the 
institutions  of  that  city,  but  he  is  quite  mistaken  if  he 
imagines  my  statements — strong  as  they  may  be— will  be 
challenged  by  any  specialist  consultant  or  practitioner  of 
sufficient  experience  who  has  had  the  opportunity  of 
viewing  the  seamy  side  of  the  profession  in  tne  metropolis. 
Every  member  of  the  profession  in  London  entitled  to 
express  an  opinion,  and  not  being  a  member  of  the  staff  of  a 
sham  special  hospital,  will  endorse  the  words  of  your  leader 
of  this  date  (April  22nd)  that  "  the  most  rampant  form  of 
medical  advertising  is  without  doubt  that  which  is  daily 
practised  in  connection  with  new  hospitals,  special  or 
otherwise."  The  public  do  not  know  that  ample  provision 
is  made  for  treatment  of  all  so-called  special  diseases 
at  all  general  hospitals,  and  when  they  see  advertised  the 
names  of  individuals  in  connection  with  sham  special  hos- 
pitals, rectum,  throat,  ear,  skin,  deformities,  nose,  or  what 
not,  a  large  number  of  patients  are  attracted  to  the 
private  consulting  rooms  of  the  staff  under  the  impre9sion 
that  these  men  are,  in  fact,  the  elected  representatives  of 
the  profession  in  the  special  departments  in  question. 
Every  member  of  the  profession  in  London  knows  the 
equivocal  character  of  many  specialists — some  of  them  are 
constantly  denounced  openly  as  infamous — and  it  is,  I 
repeat,  a  demoralising  spectacle  to  see  these  ellows 
rolling  in  riches,  the  reward  of  pure  impudence 
and  ignorance,  whilst  honest  men,  as  superior  in  attain- 
ments as  in  moral  worth,  are  straggling  on  in  poverty,  or 
even  in  want. 

'*MacSplint"  seems  to  think  the  best  way  is 
to  cover  up  this  foul  sore,  and  make  the  public 
believe  all  Ib  well  within  the  profession  ;  but  many 
of  us,  and  I  among  them,  take  an  opposite 
view,  and  oonstantlv  act  upon  it.  On  everv  oppor- 
tunity we  inform  the  public  that,  on  the  whole,  no 
more  honourable  profession  exists  than  the  medical ;  that 
there  are  in  every  department  a  vast  number  of  men  in 
whom  absolute  confidence  may  be  reposed— men  steeped 
in  pfofessional  knowledge,  certain  to  bring  to  bear  the 
highest  practical  skill,  and  equally  certain  to  guard  evei^ 
interest  of  the  patient  with,  if  necessary,  self-sacn- 
ficing  devotion.  On  the  other  hand — we  explain — 
there  are  a  minority  in  every  department-  a 
minority  well  known  to  their  brethren— whose  sole 
aim  is  plunder ;  men  in  whom  the  pormiit  of  wealth  has 
deadwM¥<  human  feeling,  who  fouow  their  aim  with 
perfect  callousness  and  show  themselves  completely  in- 
digent to  the  injnzy  they  deliberately  inflict  upon  the 


464     Thb  Mbdigal  Pbkss 


Medical  news. 


Apul  29,  1896. 


victims  canningly  lured  by  this  sham  special  hospital 
advertising  dodge,  to  place  themselves  with  confidence  in 
their  hands. 

I  believe  it  is  better  the  public  should  be  frankly  made 
aware  of  these  facts  rather  than  be  allowed  to  learn  them 
for  themselves  at  cost  of  bitter  experience  and  with  the 
effect  (as  I  explained  in  my  last  letter)  of  damaging  the 
reputation  of  the  whole  profession. 

I  am,  Sir,  yours  &c., 

Anti-Quack. 


%xUvdt\xxt 

MURRELL'S  PHARMACOLOGY,  {a) 
We  are  informed  in  the  preface  that  "  pharmacology  has 
of  late  attained  such  importance  in  the  medical  curriculum 
that  a  c'tudent's  text- book  on  the  subject  is  urgently 
needed."  This  statement  is  somewhat  discounted  by  the 
fact  that  81  nee  this  work  left  the  press  the  Conjoint 
Examining  Board  for  England  has  thought  fit  to  remove 
pharmacology  from  the  position  it  then  occupied.  Although 
this  circumstance  detracts  from  the  importance  of  phar- 
macology to  the  London  student,  it  doen  not  in  the  least 
militate  against  its  intrinsic  and  undeniable  value  to  the 
practitioner.  A  knowledge  of  the  physiological  action  of 
drugs  is  vastly  moreefsentialtothe  physician  thanisa  know, 
ledge  of  anatomy  to  the  surgeon,  and  if  the  exclusion  of 
pharmacology  from  the  curriculum  be  maintained,  we  are 
within  measurable  distance  of  the  time  when  the  physician 
may  truthfully  be  described  as  pouring  into  bodies,  of 
which  he  knows  nothing,  drugs  of  which  he  knows  less. 
Fortunately,  the  last  word  rests  with  the  General  Medical 
Council,  where  the  art  of  prescribing  still  reckons  several 
devoted  admirers.  If  medical  men  are  to  continue  to 
prescribe  they  must  e*en  learn  the  rudiments,  of  which 
pharmacology  is  the  Alpha  and  the  Omega. 

Turning,  however,  to  the  work  before  us,  we  at  once  re- 
cognise the  author's  genial  conversational  style,  which 
divests  therapeutics  of  its  usual  aridity  and  confers  a 
glamour  even  on  the  dry  details  of  pharmacology.  After 
an  interojting  chapter  on  "Old-fashioned  Remedies," 
which  points  tbe  maxim  that  history  repeats  itself,  we  are 
given  a  brief  but  virtually  exhaustive  account  of  that 
branch  of  curative  medicine  now  known  collectively  as 
"  Serum  Therapeutics"  which,  in  the  author's  opinion, 
*'  holds  an  established  position,"  still  greater  developments 
in  this  direction  being  confidently  predicted.  In  deference 
to  a  growing  distaste  for  the  unpalatable  mixtures  dear 
to  our  ancestors,  the  author  discourses  of  **  palatable 
medicines,"  a  detail  contumaciously  ignored  by  previous 
writers  on  the  subject;  The  British  Pharmacopoeia  is 
lamentably  deficient  in  flavouring  agents  and  we 
are  fain  to  draw,  on  unofficial  formula)  to  remedy 
the  deficiency.  Diet  is  an  important  factor  in  any 
therapeutical  method,  and  the  author,  leaving  the 
beaten  track,  lays  down  the  principles  underlying 
"  the  art  of  self-nutrition,"  even  to  the  extent  of  giving  a 
choice  of  menus  calculated  to  make  the  reader  long  for  an 
invitation  to  partake  thereof  at  the  author's  expense. 
Among  the  other  topics  dealt  with  by  the  author,  not 
usually  met  with  in  therapeutical  text-books,  we  have 
exercise,  clothing,  massage,  climatology  and  bacteriology, 
and  special  '*  cures,"  such  as  the  grape  cure,  &c. 

We  now  come  to  the  modes  of  administering  medicines, 
special  attention  bein^  paid  to  the  hypodermic  and  ender- 
mic  methods,  and  to  the  exhibition  of  the  active  principles 
of  plants.  The  use  of  the  last-mentioned  is  rapidly  gain- 
ing in  popularity  since  practitioners  have  come  to 
recognise  that  the  exhibition  of  a  crude  drug  containing 
numerous  conflicting^  principles  is  polypharmacy  of  the 
worst  description.  Finally,  we  reach  the  chapters  dealing 
with  the  pharmacology  of  the  various  drugs  in  particular, 
regarding  which  little  need  be  said,  beyond  remarking 
that  the  main  properties  oi  each  are  tersely,  but  com- 
prehensively, described,  all  prescriptions  being  given  in 
plain  English. 

(d)  "  A  Manual  of  PharinacoloBy  and  Therapeutics."  liy  ^'illlam 
Munu^*,  M.D..  F.R.C.P.,i'h7Biciaiiand  Lecturer  on  FharmacoloKy  and 
Tlu'ruiientics  at  the  Westminiter  Hospital,  4c.  London:  BailUire, 
liiidall  and  Oox     1898.  Price  10s.  6d. 


Lastly,  we  have  a  chapter  on  what  oar  American 
cousins  would  call  '*  elegant  "  prescriptions,  which  will 
well  repay  attentive  perusaL 

The  work  is  indisputably  an  excellent  and  oompreheDsive 
manual,  though  pertiaps  better  suited  for  practitioners  than 
students.  It  is  a  practical  treatise  for  practical  men,  and  for 
it  deals  with  a  branch  of  our  art  which  of  late  years  has 
fallen  more  or  less  into  abeyance  The  text  has  evidently 
been  revised  with  the  utmost  care,  and  the  excellence  6l 
the  publishers'  work  leaves  nothing  to  be  desired. 


BEITRAGE  ZUR  KENNTNISS  EINIGER  PRACTISCH 
WICHTIGER   FRACTURFORMEN.  (a) 

This  volume  may  be  termed  a  specialist's  production, 
forming  one  of  the  series  of  the  Aimalea  Suisse  that  is  being 
so  ably  published  by  Sallmann,  of  Basle. 

The  whole  book  deals  with  the  fracture  of  the  ends  of 
two  bones,  viz.,  the  humerus  and  femur,  and  is  divided 
into  three  parts.  The  first  part  is  [devoted  to  the  consi- 
deration of  the  upper  part  of  the  humerus,  not  commonly 
described  or  observed  in  the  ordinary  literature  of  surgery. 
Under  the  head  of  the  humerus  alone  the  author  describes 
upwards  of  30  dififerent  fractures  occurring  within  the 
region  of  the  ^^supratuberculares"  and  '*  infratuberculares," 
the  former  terminating  with  the  coUium  anatomicnm 
humeri,  while  the  latter  incudes  fractura  pertubercularis, 
or  those  through  the  epiphysial  union  and  fractura  colli 
chirurgica  or  the  surgical  neck  of  the  humerus. 

The  probable  causes,  diagnosis,  and  treatment  are 
lucidly  discussed  and  clearly  illuBtrated  with  a  profusion  of 
diagrams,  which  enhance  the  value  of  the  work  in  correctly 
exhibiting  the  meaning  of  the  author.  He  considers  these 
fractures  in  the  head  of  humerus,  to  be  more  common  than 
those  of  the  lower  end  of  humerus,or  head  of  femur. 

In  the  second  part  the  lower  end  of  the  humerus  is 
treated  as  exhaustively  as  the  upper  end  was  treated  in 
the  firkt  part.  The  fractures  are  divided  into  seven 
simple  forms  :  (1)  supra-condylica,  (2)  condylus  extemus, 
(3)  epicondylus  internus,  (4)  dia-condvlica  (5)  fract.  con- 
dyliinterni,  (6)  epicondyli  externi,  (7)  and  partial  frac- 
ture of  the  condylus  externus.  The  other  compound  f 
and  Y  forms  make  the  whole  work  a  pleasant  study. 

The  third  part,  on  the  femur,  is  still  more  extensively 
worked  out  as  the  area  described  is  wider.  The  first 
difficulty  to  the  author  is  the  partition  of  the  space  into 
divisions  suitable  for  terminology,  as  the  capsule  of  the 
joint  is  not  coterminous  with  any  scientific  line  of  demarca- 
tion, although  it  is  not  uncommon  in  surgical  works  to  spoak 
of  intra-  or  extra-capsular  fractures.  Kocher  divides  them 
in  accordance  with  his  classification  of  the  humerus,  and 
adopts  the  terminology  of  : — 

(a)  Fracture  colli  femoris  supratrochantericfle,  which 
include  sub-divisions  of — (1)  Fractura  colli  femoris  sub- 
capitalis  ;  (2)  Fractura  colli  femoris  intertrochanterica. 
The  former  is  intra-capsular,  corresponding  with  the  '*epi- 
physaria,"  while  the  latter  is  extra-capsuUu'. 

(6)  Fractura  infratrochantericse.  Under  this  head  are 
arranged  fractura  pertrochanterica  and  fractura  sub- 
trochanterica. 

The  work  is  the  result  of  23  years'  experience  in  this 
department  of  surgery,  and  deserves  careful  perusal. 


"The  Arema"  Vaporiser. 

Tuis  vaporiser  is  an  entirely  new  and  improved  form  of 
appliance.  It  has  been  designed  for  the  purpose  of  treat- 
ing the  local  conditions  in  phthisis  and  other  diseases  of 
the  lungs  by  means  of  air,  charged  with  the  antiseptic 
vapour  from  volatile  oils  and  volatile  therapeutic  agents 
dissolved  in  them.  The  appliance  consists  of  a  stout  wire 
frame  attached  to  a  firm  wooden  stand.  Two  pans  are 
suspended  on  the  frame  over  the  source  of  heat  which  is 
supplied  from  an  oil-lamp,  fitted  with  a  float  and  wick, 
and  placed  in  the  centre  of  the  wooden  stand.  A  neat  and 
cleanly  arrangement  is  also  provided  for  the  use  of  a  night 
light.    Of  the  two  pans  one  is  the  evaporating  pan,  into 

(a)  "  Beitrfige  zor  KeobtnUs  einiKer  Practisch  wichtiger  FracUir* 
f ormen."    By  Theodor  Kooher,  Professor  of  Suigeiy.  Berne. 


^psiL  29,  1896. 


PASS  LISTS. 


Thb  Medical  Pbess.     465 


which  the  liquid  to  be  vaporised  is  placed  ;  this  pan  fits 
into  a  larger  and  outer  one,  in  which  water  is  placed  ;  thus 
the  evaporating  pan  is  placed  in  a  water-bath.  There  are 
three  pairs  of  notches  in  the  wire  frame,  by  which  the 
distance  of  the  pans  from  the  flame  can  be  regulated,  and 
according  to  the  distance  so  is  it  possible  to  control  the 
rapidity  of  the  evaporation.  We  have  no  hesitation  in 
B&ying  that  the  "Arema"  vaporiser  is  one  of  the  most 
perfect  appliances  of  its  kind  in  the  market ;  it  is  not  only 
cleanly,  handy,  portable,  but  the  ingenuity  of  its  design  is 
such  as  to  ensure  for  it  a  high  degree  of  usefulness.  The 
makers  are  the  **Arema"  Manufacturing  Company,  27 
High  Holborn,  London. 

The  Army  Medical  Dinner. 

It  has  been  arranged  that  the  dinner  of  the  Army 
Medical  Staff  shall  take  place  on  the  15th  of  June,  at  the 
Whitehall  Rooms,  and  that  the  Director-General  of  the 
Army  Medical  Department  shall  occupy  the  chair. 
French  Ophthalmological  Congress. 

The  Ophthalmological  Society  of  France  will  hold  its 
annual  meeting  in  Paris  for  three  days  commencing  on  the 
4th  of  May. 

Indian  Medical  Service. 

The  following  appointments  and  promotions  were 
officially  gazetted  ou  BViday  last,  April  24th  :— To  be  Sur- 
geon Colonel. — Brigade  Surgeon  Lieut. -Colonel  T.  J. 
M'Gann,  Madras  Establishment.  Surgeon-Lieutenants  to 
be  Surgeon- Captains  -  C.  Milne.  V.  G.  Drake-Brockman, 
W.  Young,  J.  J.  Bourke,G.  Y.  C.  Hunter,  B.  R.  Chatter- 
ton,  C.  B.  Prall,  C.  E.  Williams,  J.  N.  MacLeod,  W.  H. 
Ogilvie,  T.  A.  O.  Langeton,  R.  Heard,  E.  R.  Parry,  W.  H. 
Orr,  and  P.  St.  Clair  More,  Bengal  Establishment ;  and 
G.  Bidie  and  J.  P.  Morton,  Madras  Eatablishment.  Sur- 
geon Major  General  P.  S.  Turnbull,  M.D.,  Bombay  Estab- 
lishment ;  BrigadeSurgeon  Lieut.  Colonel  C.  W.  MacRury, 
Bombay  Establishment ;  Surgeon  Lieut. -Colonel  B.  Eveis, 
M.D.,  Bengal  Establishment ;  and  Surgeon  Lieut. -Colonel 
J.  O'Neill,  M.D.,  Bengal  Establishment. 

Tlie  "Policeman"  at  tlie  Dinner  Table. 

Thi  fact  that  at  all  our  formal  dinner  parties  it  is  essen- 
tially necessary  to  employ  ihe  "policeman  "  is  a  decided 
reflection  upon  our  culinary  knowledge.  If  stated  in  a 
bold,  matter  of  fact  way,  it  would  cause  quite  a  shock  to 
most  people  to  be  told  that  in  consequence  of  what  they 
had  eaten  they  must  take  a  dose  of  medicine  (in  the  form 
of  a  liqueur  or  a  **  policeman  ")  to  prevent  their  being  ill. 
The  fact  is,  that  all  our  dishes  are  much  too  heavy,  and 
this  is  the  more  to  be  regretted,  as  a  very  little  study 
would  lead  to  our  substituting  light  and  digestible  little 
entires  for  the  heavier  dishes  that  are  so  constantly  served 
up  to  us.  These  remarks  are  called  forth  by  the  presence 
on  our  table  of  a  little  book  on  cookery,  issued  by  the 
Liebig's  Extract  of  Meat  Co ,  which  will  be  sent  free  by 
post  lo  all  who  ask  for  it,  in  which  there  are  innumerable 
recipes  for  such  dishes,  which  are  a  pleasure  to  eat  and  no 
trouble  to  digest. 

THe  London  and  Counties  Medical  Protection  Boclety, 
Limited. 

The  Annual  Meeting  of  '*  The  London  and  Counties 
Medical  Protection  Society,  Limited,"  will  be  held  on 
Friday,  May  1st,  1896,  at  "The  Restaurant  Frascati," 
Oxford  Street,  London,  at  5  p.m.  The  Annual  Dinner  of 
the  Society  will  tike  place  after  the  meeting  at  7  p.m., 
under  the  presidency  of  Mr.  Johnathan  Hutchinson,  F.R.S. 
Medical  men  not  members  of  the  Society,  but  interested 
in  its  work,  are  cordially  invited  to  attend  the  Dinner. 
Tickets,  price  7s.  6d.  each  (exclusive  of  wine)  may  be  had 
on  application  to  the  Secretary,  11  Archway  Road,  -High- 
gate,  London, N. 

PASS    LISTS. 


Royal  College  of  Pliysiciaiis  of  Edinburgh,  Royal  College  of 
Surgeons  of  Ediuburgn,  and  Faculty  uf  PHytidans  and 
Stirgeuns  of  Glasgow. 
At  the  quarterly  Examinations  for  the  Triple  Qualifica- 
tion in  Edinburgh,  held  in  April,  the  following  were  the 
results  : — 

First  Examination.— Four  Years*  Course. 
Of  16  candidates  entered,  the  following  8  passed  the 
Examination  : —  ^  ^.„ 

Froderio  LiUey,  Louiae  Blanche  Smith,  William  JoMph  O'FarreU, 


Jamea  Dodwell  Richey,  Wesley  John  Jenner,  Walter  Latham, 
William  £dward  Wallen  Strickland,  and  John  Krtiest  Broadbent; 
and  3  passed  in  Elementary  Anatomy,  1  in  Histology,  and  1  in 
Chemistry. 

First  Examination.— Five  Years'  Course. 
Of  39  candidates  entered,  the  following  14  passed  the 
Examination  : — 

William  Thomas  Finlayson.  William  Henry  Eden  Brind,  WiHiani 
Lock,  James  Alexander  Chisholm,  WJiiam  ^itcht-li  Browne, 
Harold  Emery  Joues  (with  distinction).  William  Maxwell  Mather, 
Kraoc's  Wilfred  Harlin,  Alice  Muriel  MoFarlane,  Charles  Stephen- 
son Oliver.  Francis  E«lw<ird  Woodrotte,  Robert  McLaren,  Roger 
Shotton  Milburn,  and  Francis  Peake  Maitland  ;  and  2  passed  in 
Physics.  3  in  Biology,  ai.d  9  in  Chemistry. 

Second  Examination. — Four  Years'  Course. 
Of  18  candidates  the  following  7  parsed  the  examina- 
tion : — 
John  Harris.  Frederick  Ernest  Shawe,  Joseph  Stani  aii»  Gnbblns, 
Theodore  Alexander  Wiliiara  Og:^,  Joseph  Kennish,  John  Critchley 
Pemberton,  and  Frank  Parr  Mouckton;  and  1  passed  in  Anatomy 
and  3  in  Materia  Medlca. 

Second  Examination. — Five  Years'  Course. 
Of  16  candidates  the  following  11  passed  the  examina- 
tion : — 
Patrick  Coffey,  Henry  James  Clarke  (with  distinction),  Cecil  Charles 
Murison,    George    William    Hardie   (with   distinction),    Michael 
Sullivan,  Frederick  Patrick  Walsh,  John  Arnold  Petavel,  Kdith 
Neild  (with  distioction),  Hermaon  Aspinall,  John  Heihert  Gibbs, 
and  Katharine  Constance  Sampson  ;  and  2  passed  In  Elementary 
Anatomy. 

Third  Examination. — Five  Years'  Course. 
Of  15  candidates  the  following  6  passed  the  examina- 
tion : — 
Richard  James  Isaac,  Gilbert  Jamieson  Meikle,  William  Laldlaw 
Ctibbes,   Montague  Rast,  Edith  Mary  Paton,  and   Marcus  Hill 
BahiDgton ;  and  2  passed  in  Anatomy,  2  in  Pathology,  and  1  in 
Matsrii  Medics. 

Finfld  Examination, 
Of  105  candidates  entered,  the  following  42  parsed  the 

examination  and  were  admitted  L.R.C.P.E.,  L.R.C.S.E., 

andL.F.P.  andS.G:— 
Frederick  George  Haywood,  Frederick  Herbert  Perry,  Matthew 
Caldwell.  John  Bernard  Voortman,  Frederic  Victor  Elkington, 
Henrick  Otto  Kellner.  JamesWilson  McBrearty,  William  Chapman, 
John  Stott,  Gustave  Lewis,  Hubert  Hope  Thomas.  George  broad- 
bent,  Edward  Bernard  Levy,  Co'relli  Collard  Field,  Kilshnaji 
Annaji  Dodihalkar.  Herr>ert  Maun^ell  Hewlett  (with  honours) 
James  Jeffares,  Frank  Wiseiian  Doak,  Alfred  Whitehead,  George 
Patrck  O'Connor,  Allan  Forde,  Cecil  Ridge  Batchellor,  J.bn 
Simeon  Colebrook  Elkington,  Reginald  Bryson.  Edward  Robertson, 
•Samuei  Nicolson,  Arda^hir  Sorabsha  Paymaster,  >^illiam  Henry 
Drury,  Stanley  Foster,  James  George  Mackay,  John  Jsmes 
Sylvester  Healy,'  RobertI  Smyth  (with  honours),  Edward  Biythe 
Hurst  Hughes,  Arthur  holmes  Fieln,  Thomaa  George  S.anton 
Crouch,  William  Gladstone-Cook,  Kaval  Vittal  Rao,  thailes 
Edward  Proctor,  Edmund  Joseph  Cummins,  John  ^ewcombe 
Coul,  George  Percival  Searle,  and  ijeorge  Gr^int  Stewart. 

Ten  passed  in  Medicine  and  Therapeutics,  1  in  Sur- 
gery and  Surgical  Anatomy,  and  5  in  Midwifery  and 
Medical  Junsprudence. 

Unlyerslty  of  Dnrham. 

In  addition  to  the  list  published  in  our  last  issue,  of 

candidates  who  passed  the   recent  examination  for  the 

Degree  of  Bachelor  in  Medicine,  the  following  have  passed 

the  First  Examination  : — 

1.— Chemistry  with  Chemical  Physics,  and  Botany  with 

Medical  Botany. 
Alfred  Thomhill  Greenhill. 

2. — Chemistry  with  Chemical  Physics. 
John  Harris,  B.A.,  Herbert  Robert  Cambridge  Xewman,  George 
Norman,    M.R.U.S..    L.R.C.P.,    Vaughan    Pondred,     M.R.C.8., 
L.RC.P..  George  Woodyatt  Proctor,  Maurice  Frederick  Squirt;, 
M.R.C.8.,  L.R.C.P.,  Robert  Alfred  Wilson. 

3. — Elementary  Anatomy  and  Physiology. 
John  Henry  Martin,  Fred  button. 

The  following  passed  |the  Second  Examination  for  the 
Degree  of  Bachelor  in  Medicine  : — 

Anatomy,  Physiology,  Materia  Medica. 
Honours—Second  Class. 
Maurice  Frederick  Squire,   M.R.C.S.,  L.R.C.P'    Herbert  Robert 
Cambridge  Newman,  Rooert  Lowis  Routledge,  vaughan  Pendred, 
M.R.C.S.,    L.R.C.P.;    James     McConnell,     Lawrence     Fielder 
Hemmans. 

Pass  List. 
John  Thomson  Bell,  Wm.  Henry  Isaacs  Bathurst,  Ernest  Castleigh 
Biiley,  Wiilam  James  Codrlngton,  Thomas. Ponsford  Cann,  Francis 
Gerratd  Hamilton  Cooke,  Leopold  Stanley  Davisi.n,  Henry 
Kdwaid  Davison.  Thomaa  Stokoe  Elliot,  Henry  Adamson  Fielden, 
Thomas  Harold  Gibbs,  Douglas  Hethcote,  Samuel  Percy  Johnson 
Robert  Atkinson  Morland,  George  Norman.  M.R.C.S.,  L.R.C.P.; 
Harold  Turner  Newton,  Claud  Maxwell  Pennefather,  Maurice 
Dale  Wood,  Allan  Mackie  Garnock  Walker,  Thomas  Blandford 
Watflon. 


466    Thb  MiDioAL  Pbbss 


NOTICES  TO  COfiEESPONDENTS. 


AmL  29»  1896« 


c^tiajof  to 
CorrcspanbentB,  ^kort  Jlttterjs,  *jc. 

i^  COBBBSPOMDiiTB  roqnlring  «  ntHj  In  this  oolniiiii  tM  pw- 
Monlarly  roqoMted  to  make  me  of  « cKtMnoeif*  ffgiMtiirf  or  inMoli, 
and  avoid  the  praotloe  of  ilgnlng  theniaelTw  "  Beader,"  **  Subaeriber," 
"  Old  SnbMsriber,"  Ao.  Hnch  oonfiulon  will  be  ipared  bj  attention 
tothlanle. 

Mb.  8.  T.  O.— Onr  eorretpondent  hai  good  cause  of  complaint,  bat 
the  matter  is  entirely  an  ethical  one  which  had  better  be  referred  to 
the  president  and  oonnoU  of  the  medical  so^ety  of  which  onr  corre- 
spondent and  his  opponent  are  both  members. 

TO  ABOLISH  THE  BREAST. 

AT  a  recent  meeting  of  the  Serman  Social  Democratic  party  it  was 
proposed  by  an  enthnsiastlc  reformer  that  the  State  Bhonld  prohibit 
wet-nurses  on  the  (i^and  that  sterilised  milk  was  preferable  to  Nature's 
article.  Better  itlll.  we  sbonld  substitute  for  the  pregnant  woman  a 
sterilised  ovum  incaoator. 

PnrsATOR.— We  shall  be  much  obliged  if  our  correspondent  will 
forward  all  the  documents  besring  upon  the  subject,  so  that  we  may 
deal  with  it  in  an  early  number. 

SUBQIOH  LiauTl]lAHT-Ck)LOHXL  E.  LilTBlB  (Bombay). —Your  paper 
on  **The  Cause  and  Treatment  of  Malaria,^'  with  photographs  of 
blood-ceUs,  has  been  reoelTed. 

Dr.  a.  G.  Phiab  (Oxford)  will  recdve  a  prlTate  note  in  answer  to 
his  inquiry. 

IIR.  E.  J.  Price  Is  thanked  for  his  raggestion,  which  shall  have  the 
consideration  It  deeerres. 

Dr.  Julius  Althaus'  paper  on  "  Impotency  and  its  Treatment  by 
Electricity  "  is  marked  for  early  insertion. 

Dr.  Karl  Oktkrr  (Oeynhanseo).— Your  letter  has  reached  us,  but 
not  the  hrochun  to  which  you  ask  us  to  call  attention. 

O.  E.  Harrison,  M.D.  (Press  Club.  New  York,  and  of  8  Duke  Street, 
Bath).  -  Such  inTcciive  from  men  of  your  stamp  is  the  best  evidence  we 
can  reoelTe  that  we  have  touched  a  weak  spot.  Your  adyocacy  of  II  rs. 
Longshore  Potts,  and  your  polite  ezpressioiis  of  wrath  concemlog 
ourselyes,  will  not  prevent  our  keeping  that  lady  in  view. 

Dr.  ToHKnr.— Gnaiacol  is  regarded  as  a  safe  remedy  in  typhoid 
fever,  its  action  being,  so  it  Is  supposed,  that  of  preventing  the  toxin 
poisoning  of  the  later  stages  of  the  dlMsse,  due  to  the  badllus  ooU  and 
other  putrefactive  organisms  in  the  intestines. 


JOeetingB  of  tht  gjoctettefc 

WBBinsDAT,  April  29th. 

SooBTT  OF  ARTS. -8  p.m.  Mr.  E.  W.  Badger:  Fruit  Drying  or 
Evaporation. 

Fridat,  Mat  ist. 

WifT  LOHDOV  Mmco-CHiRURaiCAL  SooiiTT  (West  London  Hoipital, 
W  ).-  8.90  p.m.  Dr.  S.  Bontor :  The  Treatment  of  Whooping  Coagh. 
—Mr.  Mayo  Collier :  Some  Effects  of  Chronic  Nasal  Obetruotion.— 
Clinical  Case- Mr.  Keetley :  Temporary  Colotomy. 

WIST  Kent  Medioo-Cbiruroical  Sooistt  (Royal  Kent  Dispensary, 
Greenwich  Boad,  S.  E .).— 7. 46  p.m.  Messrs.  Maw,  Son,  and  Thompson 
will  exhibit  come  New  Surgical  Instruments.— Meiers.  Johnson  and 
Johnson  will  show  Surgical  Dressings,  &c  8.15  p.m.  The  President 
(Mr.  E.  Clarke) :  Becent  Progress  in  the  Treatment  of  Diseases  of  the 
Eye.— Mr.  T.  Moore  :  Demonstration  of  the  Boentgen  Bays. 

MOITDAT,  MAT  4TH. 

Odortological  Sooirtt  of  Great  Britaih.— 8  p.m.  A  discussion 
will  be  opened  bv  Mr.  J.  F.  Colver  on  "The  Early  Treatment  of 
Crowded  Mouthf.^'  Mr.  G.  Bmnton  will  read  a  paper  on  '*Some 
Experiments  in  Colouring  Porcelain  for  Teeth  and  Oum  Body." 

Thursday,  mat  7th. 
Haryeiae  Sooirtt  of  Londov  (Stafford  Booms.  Tichbome  Street, 
Edgware  BoadX— &80  p.m.  Dr.  A.  T.  Schofleld :  Mental  Therapeutics. 


BajcatiJCltB. 

Borough  of  Portsmouth.— Medical  Offloer  of  Health,  Port  Sanitary 

Medical  Officer,  and  Medical  Offloer.     Salary  £460  per  annum. 

rising  to  £650.    Applications  and  testimonials  endorsed  "  Medical 

Officer's  Application  "  to  the  Town  Hall,  Portsmouth,  by  May  2nd. 
Burgh  of  Leith.— Public  Health  Hospital.— Kesident  Fhyslnian.  Salary 

60  guineas.    Further  particulars  may  be  had  from  Uie  Subscriber. 

wiUi  whom  applications  and  testimonials  (17  copies)  to  be  lodged 

not  later  than  May  9th. 
Credlton  Union.— Medii-al  Officer.    Salanr  £86  16s.  per  annum,  wHh 

fees.    Further  Information  from  the  deik,  2  Market  Street, 

Credlton. 
Government  of  South  Australia.— Senior  Besident  Surgeon  and  Senior 

Besident  Physician  to  the  Adelaide  Hospital.    Surgeon's  salary 

£400,  Physician's  salary  £80o,  e«ch  with  apartments  and  board. 

Applications  to  tbe  Agent-General,  1  Crosby  Square,  Bishopagate 

Street  Within,  E.C.  by  May  1st. 
Hospital  for  Sick  Children,  JNewcasUe-on-Tyne.— Besident  Medical 

Officer.    Salary  £60,  with  board,  lodging,  and  laundry.    Applica- 
tions to  the  Secretary  by  4th  May. 
Metropolitan  Asylums  Board. -Medical  Superintendent  of  the  South 

Eastern  Hospital,  Old  Kent  Boad,  London,  S.E.    Salary  £400, 
w     rising  to  £600,  per  annum,  with  house,  attendance,  washing,  Ac. 
r*  Appucations  before  May  7th  (see  advert.) 
Korth-West  London  HcapitaL— Besident  Medical  Offloer  and  Assistant 

Besident  Medkal  Offloer.   Salary  attached  to  the  senior  post  £50 


per  annum.    Further  particulars  to  be  obtained  from  ttie  Secre- 
tary, to  whom  also  applications,  with  copies   of  testimonials, 
should  be  sent  not  later  than  2na  May.    Address,  Alfred  Craske, 
Kentish  Town  Boad.  London,  N.W. 
St.  Marylebone  General  Dispenssry,  77  Welbeck  Street,  Cavendish 


Square.— Assistant  Besident  Medical  Offlcer.  Salaiy  £50  per 
annum,  with  furnished  UMtrtments  attendance,  ftc.  Applications 
and  testimonials  to  the  Secretary  by  4th  May. 
University  Court  of  St  Andrew's.— The  Court  propose  to  appoint  the 
following  Leotnrers,  vis. :  CI)  on  Anatomy,  with  a  saliur  of  £800 
per  annum :  (tS  on  Materia  Medica,  with  a  salary  of  £800  per 
annum  i  and  (8)  on  History,  with  a  salary  of  £200  per  aonum. 
Applications  with  twenty  copies  of  testimonials  wiU  be  reoelvnd  by 
the  Secretary  until  1st  June. 


S^ppaintmtnt* 

DAHIBLL,  G.  H.  S.,  M.B.,  ac.Camb.,  Medloal  Offloer  for  the  First  Banl- 
tary  District  of  the  Blandford  Union. 

Eyabs,  J.  J.,  M.B.,  M.S.Edin.,  Senior  House  Surgeon  to  the  Birming- 
ham and  Midland  Kye  Hospital,  Birmingham. 

GAILOWAT,  W.,  L.B.aP.,  L.B.C.SJtdin.,  Medical  Offlcer  for  the  South 
Gateshead  Saultanr  District  of  tbe  Gateshead  Union. 

Graham.  J.,  M.B.,  CiLEdln.,  Medical  Offlcer  for  the  Orton  Sanitary 
District  of  the  East  Wsrd  Union. 

HiSLOP,  J.  A..  L&.C.P.,L.B.C.8.Edin.,  L.F.P.S.GIasg.,  Medloal  Offlcer 
for  the  district  oi  Glenely. 

KiLLEN,  S.,  LB.C.P.,  L.B.C.S.Edin.,  Medical  Superintendent  of  Shiels 
Institute,  Carrickfennis. 

LAMPLOUOH,  C^L.B.C.P.Lond.,  M.E.C.S.,  House  Physician  to  the  City 
of  London  Hospital  for  Diseases  of  the  Chest 

Long.  F..  L.B.C.P.Lond.,  M.B.C.S.,  Medical  Officer  for  the  Wells  Sani- 
tary District  of  the  walsingham  Union. 

MaOAN,  a.  v..  M.B,  MCb.DubL.F.B.C.P.IreL,  re-appolnted  King'a 
Professor  of  Midwifery  in  the  Boyal  College  of  Physlclana  of 
Ireland. 

MiREBs,  B.  S..  M.D..  M.B.CS.,  Besident  Surgical  Officer  to  the 
Birmingham  and  Midland  Eye  Hcapital,  Birmingham. 

Moore,  E.  D.,  U.B.,  M.8.Edin.,  Junior  Bouse  Surgeon  to  the  Birming- 
ham and  Midland  Eye  Hospitid,  Birmingham. 

MORTOE.  B.  B ,  M.B.,  C.M.Glasg.,  Besident  Dispensary  Surge<m  to  the 
Bradford  Infirmary. 

MUHRO,  H.,  M.B.,  C.M.Aberd.,  Besident  Dlspeosary  Surgeon  to  the 
Bradford  Infirmary. 

PAOE,  G.  &,  L.&.C.P.,  L.B^C.S.Edin..  PubUc  Vaccinator  for  BristoL 

Paxtoe,  F.  v.,  M.B.Ozon.,  M.B.C.P.Lond.,  Consulting  Physician  to 
the  Chichester  Infirmary. 

BoBBRTS,  J.  L.,  M.D.,  B.a,  a  A.,  B.Sc.Lond.,  F.B.C.S.,  Honorary 
Assistant  Pliyrician  to  the  Stanley  Hospital,  LiverpooL 

Sadler,  F.,  M.B.,  B.Ch.Ozon.,  Honorary  Surgeon  to  the  Beckett  Hca- 
pital and  IMspensaiy,  Bamsley. 

Smith,  a.  G.  L..  M.B.CJB.Bog.,  L.B.C.P.Lond.,  Medical  Officer  to  the 
Crick  District  of  the  Bugby  Union. 

SDfXOES,  G.  A.,  MD.Lond.,  as..  M.B.C.S..L.B.C.P.,  Medical  Officer 
for  the  Fairfield  House  Workhouse,  Chelsea. 

Thoree,  B.  a  T.,  M.D.Durh.,  L.B.G.P,Lood.,  M.B.C.6.,  Honorary 
Physician  to  St  Peter's  Convalescent  Home,  Woking. 


ftriks. 


CORNER.— April  26th,  at  Earbwood  Asylum,  Bedhill,  the  wife  of  Harry 

Comer,  M.D.Lond.,  of  a  son. 
HAEi>8.^April  2Qth,  at  Totland  Bay,  Isle  of  Wight,  the  wlfS  of  C.  H 

Hands,  M.B.Ozon.,  of  a  son. 
Sauedbt.— April  26th,  at  83  Edmund  Street,  Birmingham,  the  wife  of 

Bobert  Saundby,  M.D.,  of  a  son. 
Whitaker.— April  2ist  at  WUloufthby  Boad,  Homsey,  N.,  the  wife 

of  George  Herbert  Whitaker,  M.B.C.S.,  of  a  daughter. 


Jflstriftsts. 


Groves— Anderson.— April  21st,  at  the  church  of  St  Nicholas.  Cole 
Abbey,  Emeft  W.  Bey  Groves,  M.B.Cja.,  L.B.aP.,  to  Frederica 
Margaret  Louise  Anderson,  second  daughter  of  the  Bev.  E. 
Anderson. 

Tate— DalzelIi.— April  21st,  at  St  Benets  and  All  Saints',  London, 
E.C.,  Walter  William  Hunt  Tate,  M.D..  son  of  the  late  George 
Tate,  to  Flora,  widow  of  the  late  Dr.  Anthony  Dalxea 

Turnet-Ferouson.  -April  22nd,  at  St  James  Bpisoopal  Church, 
Inverleith  Bow,  Edinburgb.  Horace  Geoige  Turney,  M.B., 
M.aCPM  of  28  Wimpole  Street,  London,  to  Margaret,  daughter  of 
the  late  William  Ferguson,  Writer  to  the  Signet,  Edtaiburgh. 


9t«tli0. 


CLARK.-ApiU  23rd,  at  20  Oatestone  Boad,  Korwood,  WiUington 
Clark,  F.aCS..  L.S.A.,  formerly  of  Sutton,  Surrev.  aged  91, 

HEEPER90N. -April  lOtb  (suddenly),  at  his  residenoe,  Stanhope 
Terrace,  Begent's  Park,  Wm.  Henderson,  M.D.01aag.,  aged  61. 

HlOHETT.— April  20th,  Charles  Highett  M.B.aP.Ed.7of  Field  House, 
MontpeUier.  Bristol,  aged  84. 

HOLTTUX.— April  21st,  at  Latchmere  House,  WatUng  Street,  Canter- 
bury, Charles  Holttnm,  F.aca,  aged78. 

MBiOALrB.— April  18th,  at  Massoogex,  Vahtis,  Swltierland,  John 
William  Metcalfe,  M.D.Brlaog.,  MJt.C.&Bng.,  aged  77. 

Eattrat.— AprU  24th,  at  EstviUe,  Cheltenham,  Eiiza,  daughter  of 
Chas.  Battray,  M.D.,  of  Daventry. 

Square.— April  18th,  at  14  Portland  Square,  Plymouth,  of  pneumonia, 
William  (Square,  F.B.C.S.,  aged  61. 

yoTIC^—Annowteevtenuf  oj  hirihs^  MarriagUt  and  DuUki  in  the 
fmmUst  <{f  Subterib&n  to  thit  Journal  an  inmrttd  frm,  tmd  nmit 
ftttk  t»s  pfMSthtn  ns<  fgtsr  tktm  tht  Mvndtf  pr$^img  yw6liaaKsi» 


ibie  ^dimi  ^xt$i  mA  ^tmht 


«'SALnS    POPUU    SUPREMA    LEX." 


V01.OXIL 


WEDNESDAY,    MAY    6,     1896. 


No.  19. 


<Dn9mai  QIommtinicauon& 
lEITIS: 

ITS 

PATHOLOGY  AND  TREATMENT,  (a) 

By  HENRY  JULER,  F.R.C.S., 

Buseon  tn  the  Boysl  Westmliuter  Ophthalmic  Hoepltal,  Ophthalmic 

Surgeon  to  the  St  Mary's  Hospital,  Conaolting  Ophthalxnlc 

SaiKeon  to  the  London  Lock  HofpitaL 

In  bringing  before  you  the  sabject  of  iritis,  its 
pathology  and  treatment,  I  desire  to  confine  my  remarks 
to  non-traumatic  cases.  The  introduction  of  local 
injuries,  local  sepsis,  and  sympathetic  troubles  would 
occupy  too  much  of  the  time  at  our  disposal. 

I  will,  in  the  first  place,  offer  a  few  remarks  upon 
the  anatomy  of  the  iris ;  secondly,  upon  the  pathology 
of  iritis  ;  thirdly,  upon  its  clinical  varieties ;  and 
lastly,  upon  the  treatment  which  I  consider  to  be  most 
indicated  and  most  successful  in  each  form. 

1.  The  Anatomy  of  the  Ibis. 

This  is  a  vascular  and  contractile  membrane  which 
is  suspended  in  the  aqueous  chamber.  By  its  circum- 
ference it  is  attached  to  the  ciliary  body  and  the  liga- 
mentum  pectinatum.  Its  anterior  surface  is  free, 
whilst  its  posterior  surface  rests  by  its  pupillary  edge 
against  the  anterior  capsule  of  the  crystaUine  lens,  its 
substance  consists  of  a  loose  connective  tissue  stroma, 
in  which  are  found  two  sets  of  involuntary  muscular 
fibres,  copious  blood-vessels,  lymph  spaces,  pigment, 
and  nerves. 

The  sphincter  pujnllce  is  a  flattened  ring  of  fibres 
around  the  pupil,  situated  nearer  the  posterior  than 
the  anterior  sunace.  Its  existence  is  universally  ad- 
mitted. 

The  dilator  pupillas  consists  of  a  uniform  stratum  of 
fibres,  two  or  three  deep,  placed  immediately  in  front 
of  the  posterior  epithelium  of  the  iris.  Its  existence 
is  denied  by  some  observers.  In  unbleached  specimens 
it  is  so  hidden  from  view  by  the  uveal  pigment  that  it 
is  only  seen  with  difficulty.  Thanks  to  the  excellent 
method  of  bleaching  introduced  by  mv  colleague,  Mr. 
John  Griffith,  I  have  been  able  to  demonstrate  its 
existence  in  the  human  eye,  and  so  to  confirm  the 
opinion  of  those  who  had  previously  asserted  its  pre- 
sence (6).  The  anterior  surface  of  the  iris  is  lined  by  a 
very  delicate  endothelium,  continuous  with  that  on 
Descemef  s  membrane.  It  contains  certain  openings, 
or  stomata,  which  brin^  into  communication  the 
aqueous  fluid  of  the  anterior  chamber  with  the  lymph- 
spaces  and  lymph-channels  in  the  stroma  of  the  iris. 
Ijie  posterior  surface  is  covered  by  a  double  row  of 
deeply  pigmented  epithelium— the  uvea.  The  ^terior 
of  the  two  layers,  consisting  of  cubical  cells,  with  larg[e 
spherical  nuclei ;  it  is  thrown  into  folds  when  the  pupil 
is  dilated. 

2.  The  Pathology  of  Iritis. 

Two  chief  forms  of  iritis  are  recognised  by  patholo- 
gists :  the  serous  and  the  plastic. 

8erom  iritis  is  indicated  by  a  sluggish  action  of  the 

(a)  DeUyered  before  the  Haryeian  Society  of  London, 
(b)  Trans.  Tntematlonal  Ophthalmic  Oongreai,  1884,  p.  67. 


pupil,  which  is  somewhat  dilated ;  by  a  slightly  in- 
creased tension  of  the  globe,  and  by  a  somewhatr 
deepened  anterior  chamber.  The  iris  is  lustreless  and 
rather  muddy  in  appearance  ;  it  evinces,  however,  little 
tendency  to  the  formation  of  plastic  exudations. 
There  is  congestion  of  the  pericorneal  zone.  The 
aqueous  humour  is  turbid  and  distends  the  anterior 
chamber ;  the  cornea  often  presents  a  hazv  appearance 
at  the  lower  part.  Upon  examining  the  latter  by 
obliaue  focal  illumination,  or  with  the  ophthalmoscope, 
small  dots  of  opacity  are  seen  on  the  back  of  Descemef  s 
membrane.  These  dots  may  be  irregularly  scattered, 
or,  as  is  more  often  the  case,  may  occupy  a  triangular 
area  below,  the  apex  of  which  is  opposite  the  pupil  and 
the  base  at  the  periphery  of  the  cornea. 

Mr.  Treacher  Collins  considers  that  these  cells 
aggregated  on  the  back  of  the  cornea  are  derived  from 
the  cuiary  glands,  the  cells  of  which  have  proliferated 
from  catarrhal  inflammation,  and  being  thrown  off,  are 
carried  by  the  lymph-stream  through  the  pupil  to  the 
back  of  the  cornea.  If  such  be  the  case,  and  I  see  no 
reason  to  doubt  it,  this  affection  can  be  no  longer  con- 
sidered an  iritis  per  se,  but  rather  an  inflammation  of 
the  ciliary  body — a  cyclitis.  In  Plastic  iritis^  on 
the  other  hand,  we  find  a  tendency  to  plastic  exuda- 
tion, to  contraction  and  sluggish  action  of  the  pupil, 
and  to  irregular  dilatation  under  a  mydriatic.  The 
change  in  colour  of  the  iris  is  often  very  marked,  espe- 
cially if  the  natural  colour  be  blue ;  and  from  the  tur- 
bidity of  the  agtueous  humour  and  the  exudation 
within  and  upon  its  surface,  the  iris  loses  its  natural 
brilliancy  and  assumes  a  lustreless  and  so-called 
"  muddy ''  appearance.  The  exudation  of  lymph  occurs 
on  the  back  as  well  as  on  the  front  of  Uie  iris,  and 
occasionally  fills  the  area  of  the  pupil,  hence  it  is  only 
to  be  expected  that  the  iris  becomes  attached  by  its 

EupOlary  margin  to  the  anterior  capsule  of  the  crystal- 
ne  lens,  forming  more  or  less  complete  lymph  adhe- 
sions, which,  unless  they  can  be  broken  down  or  pre- 
vented altogether  by  the  early  use  of  mydriatics,  are 
likely  to  become  organised  into  fibrous  tissue  and 
cause  permanent  trouble  to  the  eye  and  to  the  vision. 
The  extent  of  the  mischief  will  of  course  vary  with 
the  severity  of  the  inflammation,  the  period  of  its 
duration,  and  the  number  and  permanency  of  the 
adhesions  formed.  We  know  that  the  nutrition  of  the 
eye,  and  the  clearness  and  fitness  of  its  transparent 
media,  are  kept  up  by  the  free  circulation  of  Ivmph 
within  its  cavity.  It  is  secreted  by  the  ciliary  oody, 
either  directly  by  the  ciliary  processes,  or  indirectly  by 
the  ciliary  glands  from  whence  it  permeates  the  vitreous 
humour,  nourishes  the  lens  and  passes  forwards  through 
the  posterior  chamber  into  the  anterior  chamber  by 
way  of  the  pupil  and  out  of  the  eyeball  by  the  spaces 
of  Fontana  and  canal  of  Schlemm,  being  carried  away 
in  the  blood  stream  of  the  venous  plexus  of  Leber. 

Thus,  the  sole  communication  between  the  anterior 
and  posterior  chambers  is  throueh  the  pupil,  if,  there- 
fore, the  whole  circumference  of  the  pupillarv  margin 
of  the  iris  became  glued  to  the  anterior  capsule  of  the 
lens  by  plastic  exudation,  and,  eventuallv,  if  not  broken 
down,  by  fibrous  tissue  what  irreparable  damage  is 
done  to  the  eye.  The  lymph  circulation  is  arrested 
and  secondary  glaucoma  inevitable.  Adhesion  of  the 
iris  at  one  point  of  its  pupiUary  margin  is  not  to  be 


468    Thx  Mbdical  Pubs. 


OBIOINAL  COMMUMGATIONS. 


Mat6»  laM. 


looked  upon  lightly.  It  creates  a  local  irritatioo, 
for  the  iris  is  a  most  active  membrane  as  shown 
by  the  rapid  chan^^es  in  size  of  the  pupil.  Every  time 
the  pupil  dilates  Uiere  must  be  a  drag  on  its  structure 
at  the  point  of  attachment.  In  subjects  prone  to 
recurrent  attacks  of  iritis  this  slight  local  disturbance 
may  precipitate  an  attack  with  an  extension  in  the 
amount  of  adhesion,  and  so  on,  till  a  time  comes  when 
the  whole  pupil  is  excluded,  and  possibly  occluded  as 
well.  Whether  the  total  posterior  synechia  is  the 
result  of  one  attack  or  several,  the  disastrous  effects 
are  the  same,  viz..  secondary  glaucoma  which,  if  not 
relieved  will  most  assuredly  result  in  permanent  blind- 
ness. Hence  any  adhesion,  however  slight,  must  be 
regarded  as  antaf;onistic  to  the  welfare  of  the  eye. 
When  total  postenor  synechia  exists  the  iris  throu£[h- 
out  its  circumference  bulges  forwards  between  its 
natural  ciliary  attachment  and  its  abnormal  lenticular 
attachment,  a  condition  known  as  iris  6om6^  and  which 
is  due  to  the  aqueous  humour  being  put  up  behind  and 
distending  the  posterior  chamber.  The  tissues  of  the 
eye  consequently  lose  their  nourishment  and  degener- 
ate, Uie  media,  vitreous,  and  lens,  become  cloudy,  in 
fact,  the  latter  may  become  wholly  cataractous,  and 
finally  undergo  calcareous  degeneration.  The  iris, 
ciliary  processes,  retina,  <fe3.,  show  microscopically 
atrophic  changes. 

These  facts  oring  home  to  us  the  importance  of  early 
diagnosis  and  early  treatment  in  all  cases  of  iritis  so 
that  the  pupil  may  be  well  dilated  at  onset  of  the 
disease,  and  that  these  adhesions  while  plastic  may  be 
broken  down  or  prevented  altogether. 

Working  as  I  have  done  for  many  years  in  the  eye 
departments  of  several  large  hoBpitals,  I  have  seen 
much  of  the  bad  results  of  ill-advised  treatment. 

Only  the  other  day  a  poor  woman  came  to  St.  Mary's 
Hospital  with  iritis.  She  remarked  that  it  had  become 
worse  since  she  worked  at  a  public-house  and  used  the 
eye- water  they  kept  for  their  customers.  It  seems  to 
be  a  very  common  practice  for  publicans  to  keep  a 
strong  lotion  of  sulpnate  of  zinc  on  the  premises  so 
that  persona  who  have  bad  eyes  can  bathe  them  with 
the  lotion  at  the  same  time  that  they  take  a  drink. 
This  may  be  an  excellent  remedy  for  conjunctivitis, 
but  when  applied  to  a  cass  of  iritis  it  cannot  fail  to 
aggravate  its  intensity  in  a  marked  degree.  Druggists 
a^n  are  very  fond  of  supplying  both  zinc  and  atro- 
pine for  eyes  which  look  red  and  uncomfortable,  little 
knowing  the  harm  they  may  be  inflicting  upon  the 
person  using  the  one  or  the  other. 

It  is  remarkable,  however,  what  a  large  number  of 
cases  one  sees  which  come  from  the  immediate  care  of 
members  of  our  profession  in  which,  either  from  ignor- 
ance or  culpable  neglect,  cases  of  iritis  on  the  one 
hand  have  been  treated  with  sulphate  of  zinc,  alum,  or 
other  equally  irritable  lotion,  and  cases  of  subacute 
glaucoma  on  the  other  hand  have  been  flooded  with 
atropine  until  the  patient  has  become  hopelessly  blind. 
It  would  seem  that  catarrhal  coniunctivitis,  plastic 
iritis,  and  subacute  glaucoma  must  have  some  outward 
resemblance  which  renders  them  mistakeable  the  one 
for  the  other.  It  is  more  difficult  for  me  to  bring 
forward  points  of  similarity  than  it  must  be  to  a  care- 
ful observer,  points  of  distinction.  The  only  common 
feature  is  ocular  conjunctival  redness,  and  yet  this  in 
itself  is  a  gruide  to  the  diagnosis.  In  catarrhal  con- 
junctivitis the  superficial  or  conjunctival  vessels  are 
injected^  there  is  a  bright  florid  redness,  and  the  vessels 
move  with  gentle  pressure  over  the  subadjacent  white 
sclera.  The  ocular  redness  in  glaucoma  is  chiefly  due 
to  distension  of  the  anterior  ciliary  veins,  the  venous 
blood  leaving  the  interior  of  the  eyeball  by  this  exit 
since  the  increased  tension  closes  the  oblique,  and 
hence  valvular  passages  in  the  sclera  which  transmit 
the  ven»  vorticose.  These  anterior  ciliary  veins  are 
distended  and  tortuous,  few  in  number,  and  dark  in 
colour.    The  redness  in  cases  of  iritis  is  more  deeply 


seated,  and  thoujsh  the  conjunctival  vesseLs  will  be 
injected  the  subiaoent  episcleral  vessels  will  also  be 
visible,  giving  the  circumcomeal  zone  of  sclera  a 
uniform  miyenta  colour.  Other  points,  perhaps  more 
valuable  to  the  general  practitioner,  are  the  follow- 
ing :— The  visual  acuitv,  the  state  of  the  pupil,  the 
presence  or  absence  of  discharge,  the  tension  of  the 
eyeball,  and  the  ophthalmoscopic  condition.  If  the 
visual  activitv  is  normal,  by  which  I  mean  not  only 
direct  vision,  but  also  the  visual  field,  iritis  and  glau- 
coma can  be  excluded.  If  the  pupil  is  contracted  and 
inactive  to  light  iritis  may  be  suspected,  but  if  dilated, 
oval,  and  inactive,  glaucoma.  A  pupil  of  natural  size 
and  active^  associated  with  normal  vision,  points  to 
conjunctivitis,  if  some  flakes  of  lymph  or  mucopuru- 
lent discharge  are  present,  the  diagnosis  is  substantiated. 
A  pupil  which  dilates  irregularly  under  the  influence 
of  a  mydriatic  is  strong  evidence  of  existing  iritis  if 
associated  with  collatend  signs  and  symptoms.  If 
the  recognition  of  changes  in  the  intraocular  tension, 
and  disturbances  in  the  fundus  oculi  can  be  made, 
the  diagnosis  of  these  three  complaints  would  not  be 
difficult  to  a  su^eon  so  efficient  in  ophthalmic  work. 

The  eye  is  a  lantern  ordained  by  Nature  to  guide  the 
physician  ;  it  is  the  organ,  par  excellence^  which  assists 
the  neurologist  in  determining  the  cause  of  nervous 
affections ;  he  mav  look  upon  it  as  his  compass,  the 
clerk  of  the  weather-storm,  the  scout  on  the  field  of 
battle.  Few,  if  any,  ocular  complaints  are  diseases, 
per  se,  they  are  symptomatic  only.  The  eye  is  an 
organ  of  signs  and  symptoma  "  The  light  of  the  body 
is  the  eye**  says  the  learned  apostle,  and  we  may 
rightly  add  that  the  body  provides  the  oil  for  this  lamp, 
the  purity  of  which  determines  the  brilliancy  of  the 
illumination.  The  iris,  as  we  have  already  said,  is  a 
vascular  and  contractile  brilliant-looking  membrane, 
which  is  completely  shut  up  in  a  closed  cavity,  and 
were  it  not  for  the  existence  of  the  natural  window — 
the  cornea — we  should  not  know  or  appreciate  the 
disturbances  to  which  it  is  liable.  Again,  it  is  sus- 
pended in  a  chamber  of  warm  water— a  direct  secre- 
tion from  the  blood,  the  temperature  of  which  is  the 
same  as,  and  only  varies  with,  that  of  the  blood. 
Besides  thb,  the  eye  is  amply  protected  by  the  eyelids, 
which  are  copiously  supplied  with  bloodvessels,  and 
are  ever  closing  as  protecting  organs  upon  the  eye. 
Before  any  heat  can  elevate  the  temperature  of  the 
aqueous  humour  the  corneal  surface  must  become  dry, 
and  before  the  cold  blast  can  lower  its  temperature 
dessication  of  the  corneal  epithelium  must  equally 
take  place,  but  the  secretion  of  the  tears  and  the 
closure  of  the  eyelids  prevent  any  such  mishap.  The 
only  cause  for  alteration  of  the  temperature  of  the 
aqueous  humour  is  a  disturbance  of  the  thermogenic 
centres  which  control  the  heat  of  the  blood. 

It  seems  to  me,  therefore,  unlikely  that  mere  alter- 
nations of  heat  or  cold,  such  as  a  draught  or  any  expo- 
sure, can  bring  about  an  attack  of  iritis,  except  in  a 
person  who  is  predisposed  to  this  by  some  constitu- 
tional dyscrapia. 

Passing  before  one's  mind's  eye  the  different  known 
causes  of  iritis,  we  are  at  once  struck  by  the  fact  that 
they  are  for  the  most  part  diseases  attended  witii  joint 
complaint.  In  syphilis,  rheumatism,  gout,  gonorrhoea, 
and  tuberculosis— the  beet  known  causes  of  iritis — 
joint  disease  is  a  prominent  feature.  I  do  not  wish  for 
a  moment  to  imply  that  arthritic  disease  is  always 
found  in  those  complaints.  In  gonorrhoea,  for  instance, 
joint  trouble  is  more  the  exception  than  the  rule,  as 
also  in  syphilis,  but  still  it  presents  itself  sufficiently 
often  to  incur  the  names  *'  gonorrhoeal  rheumatism " 
and  *'  syphilitic  rheumatism." 

Pyaemia,  another  well-known  blood  disorder,  and 
one  attended  with  joint  disease,  is  liable  to  be  com- 
plicated with  iritis  of  a  suppurative  form  terminating 
in  panophthalmitis. 

The  actual  cause  of  any  case  of  iritis  must  be  the 


Mat  6.  1896. 


OEIGINAL  COMMtTNIOATIOBrS. 


Ths  Mv>ioal  Pb»s.     ^69 


eame  as  that  which  originates  the  constitutional  com- 
plaint If  it  be  gottt,  the  excess  of  uric  acid  in  the 
blood  lithiemia.  If  rheamatism—the  circulating  poison 
whatever  it  may  be,  whether  originating  from  perverted 
metabolism  of  the  tissues,  or  whether  entering  the 
blood  from  without  in  the  form  of  a  parasite  analogous 
to  the  hsematozoa  malarisa.  If  syphilid— the  poison  of 
that  complaint,  be  it  a  micro-organism  or  not.  If 
gonorrhoea—the  poison  of  rheumatum,  for  gouor- 
rhceal  iritis  is  onljr  seen  in  association  with  gonorrhoeal 
rheumatism,  and  it  is  the  subject  who  is  predisposed 
to  rheumatism  who  suffers  from  gonorrhoeal  arthritis, 
and  iritis  when  the  victim  of  specific  urethritis.  Ii 
diabetes—grape  sugar  would  presumably  be  the  cause. 
It  is  not  my  intention  to  deal  with  the  actual  causes 
of  these  constitutional  complaints,  but  rather  to 
attempt  a  differentiation  in  these  forms  of  iritis 
originated  by  them. 

(To  he  continued.) 


A  UNIQUE   COMPLICATION  OF 

ENTERIC  FEVER— ENTEEO-VESICAL 

FISTULA. 

By  ALEXANDER  INNES,  M.B. 

M.  W.,  set  21,  single,  became  ailing  in  August,  1894, 
and  had  to  take  to  bed.  She  had  diarrhoea  and  fever- 
ishness,  and  from  her  temperature  I  was  able  to  dia- 
gnose enteric  fever  in  six  days'  time.  During  this 
attack  and  the  subsequent  relapse  there  was  an  entire 
absence  of  roseola,  although  looked  for  with  care  about 
every  second  day.  The  attack  proved  one  of  moderate 
severity,  with  persistent  diarrhoea  and  typical  typhoid 
dejecta,  and  abdominal  distension  was  present  in  the 
later  part  of  the  attack.  The  only  complication  was 
an  attack  of  bronchitis  which  did  not  distress  her  much. 
The  temperature  was  taken  by  myself  daily,  and  in  the 
third  ana  fourth  weeks  of  illness,  I  took  it  twice  daily. 
The  temperature  was  typical  of  the  disease.  In  the 
third  and  fourth  week,  evening  temperature  was  102*6'' 
to  104°,  and  on  one  evening,  105*2°,  but  reduced  by 
quinine  and  cold  sponging. 

Treatment— She  was  fed  on  milk,  three  parts,  and 
lime  water,  one  part,  varied  at  times  with  beef  tea  and 
soups.  She  took  ^j  of  whisky  (Scotch)  daily  from  the 
middle  of  third  week  with  benefit.  It  was  given  in 
•early  morning  and  forenoon.  She  was  given  $mall 
doses  of  Beta  naphthol,  which  she  took  with  some  dis- 
like. The  bronchitis  was  treated  with  spt.  ammon. 
arom.  and  spirit  chloroformi.  Sleeplessness  was  some- 
times complained  of,  but  5j  of  pot.  orom.  was  sufficient 
to  relieve  this.  Mind  was  clear,  except  for  a  slight 
wandering  on  some  nights. 

By  the  twenty- ninth  day,  temperature  was  normal 
at  night,  and  she  seemed  to  improve.  For  five  days, 
iiie  temperature  remained  normal  and  subnormal,  and 
no  change  was  made  in  diet,  medicine,  or  stimulant. 
The  urine  was  examined  from  time  to  time  and  no 
«um  or  albumen  was  found. 

Jtelap$e,-^Alter  these  five  days  of  apyrexia  the  tem- 
|)erature  be^an  to  rise,  and  the  diarrhoea  returned.  By 
the  end  of  the  week  the  evening  temperature  was  103° 
and  continued  during  the  rest  of  the  illness  rather 
variable  from  102^  to  105*6°.  In  the  mornings  it  was 
about  the  same  or  sometimes  lower,  never  higher  than 
at  ni^ht.  She  took  her  nourishment  badly,  and  whisky 
"Was  increased  to  §iij  a  day  with  benefit. 

She  took  the  Beta  naphthol  still,  but  in  smaller  doses. 
About  eight  days  after  this  relapse  she  had  left-sided 
pleurisj  with  moderate  effusion,  but  subsided  under 
•digitalis,  strychnine,  spt  ammon.  arom.  with  blisters 
to  chest.  The  pulse  after  this  became  very  small  and 
at  times  kregnlar,  and  now  a  mitral  systolic  murmur 


was  first  heard  with  siffns  of  dilatation  of  heart  This 
was  treated  with  beef  tea  in  addition  to  milk,  and 
whisky  was  raised  to  ^iv  daily.  Digitalis  and  strych- 
nine (the  latter  in  large  doses)  seemed  to  improve  the 
heart  to  a  slight  extent  She  had  now  become  greatly 
emaciated.  Tubercle  of  the  lungs  was  never  present 
although  carefully  looked  for  on  many  occasions.  She 
had  now  alwavs  delirium  at  night  which  was  combated 
by  partial  cold  sponging  and  ^  of  bromide  of  potass,  at 
night  She  took  nourishment  very  badly.  When  the 
diarrhoea  was  present  to  an  unnecessary  extent  she 
had  bismuth  ana  opium.  Her  general  state  was  now 
far  from  promising,  and  in  the  third  week  she  had  a 
slight  haemorrhage  from  bowels. 

But  just  before  this  the  left  foot  and  leg  became 
swollen  from  femorse  thrombosis  (which  was  easily 
felt).  With  bandaging  and  elevating  limbs  this  sub- 
sided slightly.  The  right  leg  in  three  da^s  after  was 
affected  in  a  similar  way.  YHiisky  was  raised  to  5^  a 
day  and  usual  heart  stimulants  given,  but  heart  now 
seemed  to  get  more  dilated.  On  the  22nd  day  of 
relapse  I  was  hurriedly  sent  for  and  found  her  nearly 
moribund.  She  was  in  a  state  of  collapse,  almost 
pulseless,  with  temperature  subnormal.  She  had  been 
seized  with  sudden  acute  pain  in  the  belly,  vomited, 
and  became  quite  faint  We  got  her  round  a  little  and 
then  a  smdl  dose  of  morphine  was  given.  She  was  in 
great  pain  and  in  a  few  hours  the  abdomen  became 
much  distended  and  tender.  She  lay  with  her  knees 
drawn  up.  Ice  was  given  by  mouth  and  she  was  fed 
by  enema.  To  my  surprise  the  issue  was  not  immedi- 
ately fatal,  for  she  rallied  a  bit  and  for  three  days  was 
between  life  and  death.  By  this  time  she  was  so  thin 
that  bed-sores  formed  on  the  sacrum.  She  was  in  a 
half  delirious  state  day  and  night  She  had  morphine 
in  small  repeated  doses.  She  still  lived  in  this  state 
for  some  three  more  days,  and  was  now  allowed  tea- 
nfuls  of  milk  and  whisky  by  the  mouth.    And  at 


this  time  her  mother  told  me  that  the  urine  contained 
faecal  matter,  which  I  saw.  Micturition  caused  extreme 
pain  and  she  passed  faeces  and  flatus  in  considerable 
quantity  by  the  urethra.  This  went  on  for  ^ve  days 
until  she  died  exhausted,  eleven  days  after  the  perfora- 
tion. I  washed  out  the  bladder  repeatedly  with  boric 
acid  with  little  benefit.  For  the  last  few  days  all  the 
faeces  came  by  the  urethra.  A  necropsy  was  refused, 
which  was  a  disappointing  end  to  such  an  interesting 
case. 

Eemarka.— Features  of  Interest— (I.)  Temporary 
recovery  from  intestinal  perforation.  (2.)  The  free 
communication  between  bowel  and  bladder.  This  was 
caused  probably  (a)  perforation  and  partial  peritonitis, 
forming  adhesions  to  bladder  and  so  shut  off  from 
general  peritoneal  cavity.  There  was  thus  formed  a 
cavity  into  which  the  bowel  (probably  ileum)  freely 
opened.  This  at  a  later  date  opened  into  the  bladder, 
and  so  a  free  communication  was  formed  between 
intestine  and  bladder. 

N.B.— I  have  been  unable  to  find  a  similar  case 
recorded. 

641  Fulham  Road,  S.W. 


Dr.  a.  Wynter  Blyth,  Medical  Officer  of  Health 
for  Marylebone,  in  his  report  on  the  health  of  that 
pariah,  records  the  fact  of  the  death  of  119  children 
from  measles  in  the  last  quarter,  and  says  the  main 
factor  of  the  spread  of  this  disease  was  undoubtedly 
crowding  in  the  schools. 

Trade  has  been  stagnant  in  Gloucester  during  the 
fear  and  glbom  occasioned  by  the  epidemic  of  small- 
pox, and  the  cost  itself  of  the  outbreak  has  been  esti- 
mated at  £12,000. 


470    Thi  Midioal  Pbiss. 


ORIGINAL  COMMUNIOATIONS. 


*Mat  6,  KffiL 


NOTE  ON  THE 
RONTGEN   KAYS  IN  LARYNGEAL 

SURGERY,  (a) 
By  JOHN   MACINTYRE.   MB.,  CM,   F.RS.E., 

Surgeon  to  the  Throat  and  Nose  Department,  Glaagow  R'lyiil 

ibermary  ;  Lecturer  on  Dlseatee  of  the  Throat  and  Noie 

in  Andenon  ■  College,  Glasgow. 

That  Rootgen's  brilliaDt  discovery  will  prove  use- 
ful in  general  surn^ery  is  no  longer  a  matter  of  doubt. 
Only  a  few  weeks  ago  photographs  of  the  bones  of  the 
hand  and  foot  were  looked  upon  with  curiosity  mixed 
with  speculative  interest,  and  now  the  greater  portion 
of  the  human  skeleton,  including  the  vertebral  column 
and  the  extremities,  have  been  photographed.  The 
question  naturally  arise?,  however,  will  this  important 
discovery  be  of  use  in  our  special  department  ?  and  as 
I  have  been  making  a  number  of  experiments  in  this 
direction,  the  following  preliminary  notes  may  be  of 
some  interest : — 

Apjxiratus. —For  cryptoscopic  purposes—- and  this 
must  in  the  end  be  of  more  importance  than  photo- 
graphy—more expensive  and  powerful  apparatus  must 
oe  at  the  surgeon's  disposal.  For  this  work  a  current 
of  something  like  ten  volts  and  twelve  to  sixteen  am- 
peres is  required  at  least,  and  a  good  coil,  with  a  well- 
made  interrupter,  having  a  spark  of  from  six  to  eight 
inches,  and  a  Crooke's  tube  at  the  proper  vacuum.  For 
photographic  purposes  the  current  need  not  be  so 
powerful,  and  even  a  two  to  four  inch  spark  coil  may 
be  used  for  most  practical  purposes.  During  my 
experiments  I  have  been  fortunate  in  having  currents 
and  coils  of  much  greater  strength  than  the  above- 
mentioned  ;  my  work  has  been  mainly  done  with  an 
Apps  coil,  and  the  best  results  have  been  obtained 
with  Newton's  tubes.  I  have  tried  a  number  of  fluor- 
escent screens  for  the  cryptoscope,  but  find  the  potas- 
sium platino-cyanide  ana  barium  platino-cyanide  the 
best.  Calcium  tungstate  in  its  crystalline  form,  as  recom- 
mended by  Mr.  Edison,  is  also  good.  With  tnis  appar- 
atus I  have  been  able  to  see  shadows  of  the  different 
bones  of  the  extremities,  and  the  vertebral  column, 
ribs,  clavicle,  and  scapula,  as  will  be  seen  further  on. 

In  the  present  state  of  our  knowledge  it  may  at  once 
be  stated  that  photography  by  means  of  Eontgen  ra^s, 
is  in  a  more  advanced  state  than  cryptoscopy.  With 
re^rd  to  the  former,!  may  say  that  I  have  on  the 
living  subject  photographed  the  vertebral  column  in  the 
chest  and  neck  (above  and  below  the  lower  maxilla) 
with  such  definition  that  destruction  of  bone  will  be 
easily  detected.  I  have  also  photographed  the  chest 
for  the  presence  of  foreign  bodies,  as  will  be  mentioned 
further  on ;  and  I  have  been  able  to  photograph  the 
larynx  in  the  human  subject,  the  picture  obtained 
showing  the  base  of  the  ton^e,  hyoid  bone,  thyroid 
and  cricoid  cartilages  with  epiglottis  ;  the  opening  at 
the  upper  part  of  the  oesophagus  is  also  seen,  and  the 
spine  is  indicated  behind.  I  have  also  photographed 
the  bones  of  the  face  in  health  and  disease,  in  the  latter 
case  showing  destruction  of  the  upper  jaw,  the  result  of 
malignant  disease.  Experimenting  on  the  dead  sub- 
ject, I  have  also  been  able  to  obtain  excellent  photo- 
graphs of  the  presence  of  foreign  bodies  in  and  around 
the  region  of  the  larynx,  as  well  as  ossification  in  the 
cartilages. 

With  regard  to  the  cryptoscope,  the  light  easily 
penetrates  the  tissues  of  tike  neck  and  chest,  and  I 
nave  seen  sufficient  of  the  former  to  enable  me  to  say 
that  many  foreign  bodies  might  be  detected  with  the 
eye  without  photography  at  all.  In  this  depart- 
ment I  have  to  record  an  interesting  case  sent  to  me 
by  Dr.  Rutherfurd  and  Professor  Henry  E.  Clark.  The 
patient  had  swallowed  a  halfpenny  six  months  ago, 

(a)  Raad  before  the  British  Laryogologlcal  AaeoclatlOn  Apr.l  19th, 
18V6. 


and  on  examining  him  by  means  of  the  fluoresooDt 
screen  I  could  easily  see  the  round  black  shadow  of 
the  coin  at  the  level  of  the  third  dorsal  vertebra.  This 
is  important  and  interesting,  because  the  boy  referred 
his  pain  to  the  cardiac  orifice  of  the  stomach.  I  after- 
wards photographed  the  case,  but  the  foreign  body 
could  as  easily  be  seen  by  the  eye. 

For  the  examination  of  the  antrum  of  Highmore,  I 
made  a  number  of  experiments  in  the  way  of  obtaining 
small  tubes  to  go  into  the  moutL  These  are  not  bo 
easily  obtained,  nor,  as  yet,  as  satisfactonr  as  the  large 
tubes.  I  therefore  fell  back  upon  another  plan,  viz., 
placing  the  Crooke's  tube  outside.  I  made  a  small 
laryngo-cryptoscopic  mirror  and  a  cryptoscopic  tongue 
depressor,  the  salt  being  placed  on  one  side  of  the  glaBS^ 
cut  to  the  proper  size  and  shape  and  covered  in  with 
aluminium.  In  this  case  the  X  rays  are  generated 
outside  of  the  mouth.  For  tho  antrum,  where  difference 
of  density  is  to  be  detected,  the  tube  is,  of  course,  to 
be  placed  above  the  level  of  the  face  and  the  mirror 
inside  of  the  mouth  with  the  platinum  surface  towards 
the  palate.  In  the  case  of  foreign  bodies  or  for  viewing 
other  parts  of  the  mouth,  the  Crooke's  tube  will  be 
placed  below  the  lower  maxilla.  The  instrument  I 
described  at  the  meeting  of  the  Royal  Society  in  Edin- 
burgh on  the  6thinst.  I  hope  at  the  next  meeting  of 
the  British  Larvngological  Association  to  place  the 
photographs  ana  appliances  before  the  Fellows.  As 
far  as  I  have  been  able  to  judge,  the  X  rays  are  going 
to  be  much  more  useful  in  our  special  department  than 
we  had  at  first  anticipated. 


ON  COMPLETE 
EKTIRPATION    OF   TUMOURS 

AND  THE  IMPOBTANCB  OF 

RAPID    CICATRISATION    OF    THE 

WOUND,  (a) 

By  F.  HOLME  WIGGIN,  M.D.. 

Surgeon  (Oyniecological  Department)  to  the  New  York  City  HoapitftL 

Neoplasms  occur  with  greater  frequency  in  the 
female  than  in  the  male  subject.  Statistics  show  that 
the  breast,  next  to  the  uterus,  is  the  most  usual  site  of 
these  morbid  changes— 17  per  cent,  of  all  cases  occur- 
ring in  the  former,  and  19  per  cent,  in  the  latter. 
Williams  found  in  a  collection  of  13,824  primary  neo- 
plasms 2,397  cases  in  which  the  female  breast  was 
affected,  while  only  25  similar  cases  were  found  to  exist 
in  males.  We  may,  therefore,  with  i)ropriety  limit 
ourselves  in  considering  and  answering  the  ques- 
tions of  the  necessity  of  complete  extirpation  of 
tumours  and  the  importance  of  the  rapid  cicatrisation- 
of  the  wound  to  the  neoplasms  of  this  region  in  the 
female.  It  may  be  well  once  more  to  call  attention  to- 
the  fact  that  malignant  growths  occur  in  all  pjarts  of 
the  body  more  frequently  than  do  those  wnich  are 
more  benign.  According  to  Williams,  95  per  cent  of 
all  breast  neoplasms  are  malignant.  The  preponder- 
ance of  malignant  tumours,  coupled  with  the  fact  that 
at  times  benign  neoplasms  take  on  malignant  charac> 
teristics,  proves  at  once  the  fallacy  of  the  widespread 
belief  which,  contrary  to  the  teaching  of  Gouley  and 
others,  still  continues  to  exist  in  the  minds  of  many 
general  practitioners,  that  as  long  as  a  tumour  remains- 
quiescent  it  is  unwise  to  remove  it.  This  idea  undoubt- 
edly originated  in  the  dread  which  surgical  procedures, 
undertaken  for  the  relief  of  these  morbid  conditions, 
inspired  in  the  minds  of  both  patient  and  physician, 
partly  on  account  of  the  high  rate  of  mortality  which 
formerly  followed  them,  and  partly  because  they  seldom 

(a)  Read  at  the  Twelfth  Annnal  Meeting  of  the  New  York  Stake. 
Medical  Aasodatlon. 


3Iat  6  I8te. 


ORIGIKAL  CdMlftTNIOATIONS. 


1^  BlKDIGAL  ISUBS.       4/1 


afforded  even  temporary  relief  to  the  sufferer.  We  can 
hardly  wonder  that  these  patients,  failing  to  receive 
enconragement  that  their  condition  could  be  materially 
benefited  by  drugs  or  operative  measures,  should  either 
do  nothing  or  should,  in  their  despair,  turn  towards  the 
charlatan  in  the  vain  hope  that  possibly  he  could  in 
some  degree  make  good  his  promises  of  cure. 

While,  undoubtedly,  this  was  a  true  statement  of  the 
results  of  the  treatment  employed  by  physicians  a  few 
years  since,  it  is  by  no  means  a  fair  representation  of 
the  case  to*day,  and  it  is  the  purpose  of  this  {Miper  to 
show  why  the  older  surgeons  so  often  faUed  in  their 
treatment  of  this  class  of  cases  and  the  methods  by 
means  of  which  so  much  better  results  are  obtained 
with  certainty  to-day  and  the  sur^^eons  enabled  to  hold 
out  hope,  if  not  cure,  of  long  penods  of  freedom  from 
the  disease.  The  most  frequent  cause  of  death  follow- 
ing these  operations  in  the  past  was  septic  infection ; 
but  thanks  to  the  discovenes  of  Pasteur,  and  their 
adaptation  to  surgical  practice  by  Lister,  and  the 
changes  which  have  finally  ended  in  the  aseptic  technique 
of  the  present  day,  the  mortality  following  these  opera- 
tions has  been  reduced  from  25  per  cent,  to  practically 
none. 

It  is  a  well-established  fact  that  after  three  years 
have  elapsed,  the  tendency  to  recurrence  ia  slight,  and 
for  my  present  purpose  this  period  of  immunity  will 
be  considered  as  the  test  of  success  of  the  methods 
employed  by  the  surgeon.  Formerly,  when  it  was  cus- 
tomary to  remove  only  the  tumour,  the  results  were 
unsatisfactory,  and  few  surgeons  succeeded  in  giving 
their  patients  this  period  of  immunity.  If  we  accept 
the  cellular  theory  of  the  genesis  of  neoplasms,  it  can 
be  readily  understood,  as  has  been  pointed  out  by 
li^^lliams,  that  these  lesions  are  seldom  limited  to  their 
starting  point.  Sir  Astley  Ck>oper,  in  the  course  of  his 
lectures  on  surgery,  pubUshed  m  1839,  page  386,  said, 
**  1  would  observe  that  the  scirrhous  tumour  is  not  all 
the  disease ;  there  are  roots  which  extend  to  a 
considerable  distance,  and  if  you  would  remove 
the  tumour  only  and  not  the  roots,  there 
will  be  little  advanta^^e  from  the  operation." 
Aeain  the  same  author  m  his  lectures  on  surgery 
published  in  1821,  in  describing  the  technique  of  the 
operation  of  excision  of  a  mamma  containing  a 
malignant  tumour,  said,  "  Let  both  the  incisions  be 
carried  down  to  the  pectoral  muscles  and  dissect  out 
the  tumour  close  to  the  latter,  so  as  to  lay  it  com- 
pletely bare,  removing  even  the  fascial  covering,  for  if 
this  be  not  minutely  attended  to,  there  will  be  a  very 
great  probability  of  the  disease  returning,  or  I  mav  say 
with  propriety,  remaining."  Again,  ''The  glands  in 
the  axilla,  if  enlarged,  are  now  to  be  cautiously 
removed,  together  with  the  intervening  substance,  as 
leaving  the  latter  would  be  the  future  cause  of  a 
similar  disease  being  produced."  In  1866,  Charles  H. 
Moore,  F.R.C.S.,  in  his  paper  entitled.  ''On  the  Influence 
of  Inadequate  Operations  on  the  Theorv  of  Cancer,' 
'^  Medico-Chirurgical  Transactions,  London,"  voL  L, 
pa^  245,  said,  "When  any  texture  adjoining  the  breast 
18  involved  in,  or  even  approached  by  the  disease,  that 
texture  should  be  removed  with  the  breast  This 
observation  relates  especially  to  skin,  to  lymphatics,  to 
much  fat  and  to  pectoral  muscles.  The  attempt  to 
save  the  skin  which  is  in  any  degree  unsound  is,  of  all 
errors,  the  most  pernicious,  and  whenever  its  condition 
is  doubtful,  that  texture  should  be  freely  removed.  In 
the  performance  of  the  operation,  it  is  desirable  to 
avoia  not  onlv  cutting  into  the  tumour,  but  also  seeing 
it ;  no  actually  morbid  texture  should  be  exposed, 
lest  the  active  microscopic  element  in  it  be  set  free 
and  lodge  in  the  wound.  Diseased  axillary  glands 
should  be  taken  away  by  the  same  dissection  as  the 
breast  itself,  without  dividing  the  intervening 
Ivmphatics  ;  and  the  practice  of  first  roughly  excising 
the  central  mass  of  the  breast  and  afterwards  removing 


successive  portions  which  may  be  of  doubtful  sound- 
ness, should  be  abandoned.  Onlv  by  deliberately 
reflecting  the  flaps  from  the  whole  mamma  and 
detaching  it  first  at  its  edge,  can  the  various  undetected 
prolongations  of  the  tumour  and  outlying  nodules  be 
included  in  the  operation.  To  parts  not  capable  of 
removal,  it  is  desirable  to  apply  chloride  of  zinc." 

It  would  appear  that  Sir  Astlejr  Cooper  was  the 
first  to  recognise  the  fact  that  the  disease  was  not  con- 
fined wholly  to  the  mamma  where  it  originated^  that 
in  cases  of  scirrhous  tumours  of  this  region,  the  axillary, 
infra  and  supra,  clavicular  gland  early  become  infected 
and  enlarged  and  should  be  removed,  that  the  incision 
should  be  made  wide  of  the  disease  and  down  to  the 
pectoral  muscle  ;  and  he  advocated  the  removal  in  all 
cases  of  the  pectoral  fascia.  He  called  attention  to 
the  fact  that  the  reappearance  of  the  disease  is  often 
not  a  true  recurrence  but  a  "remaining"  or  con- 
tinuance of  the  disease.  In  other  words,  the  opera- 
tion has  been  an  incomplete  and,  therefore,  unsuccess- 
ful one  when,  after  a  short  interviJ,  the  disease 
reappears  locally  and  cannot  be  considered  a  reinfec- 
tion. Had  he  left  out  the  words  "  if  enlarged  "  in  his 
advice  to  clear  out  the  axilla,  little  would  have  been 
left  for  the  so-called  originators  of  the  modem  com- 
plete operation  to  discover.  In  these  views,  Moore 
coincided,  reiterating  the  importance  (1)  of  the  com- 
plete removal  of  the  diseased  organ,  (2)  of  the  necessity 
of  cutting  so  wide  of  the  disease  that  none  of  it  should 
appear  in  the  course  of  operation  and  (3)  the  removal 
in  one  mass  of  all  the  tissues  (including  a  libend 
margin  of  apparently  healthy  skin). 

Notwithstanding  this  sound  and  brilliant  teaching, 
surgeons  continued  to  perform  partial  operations  only. 
Dr.  Curtiss  in  the  course  of  his  article  entitled  "  The 
Cure  of  Cancer  hy  Operation,"  (a)  said,  "  Gross  found 
in  those  cases  subjected  to  operation  in  which  the  site 
of  recurrence  is  noted  that  in  96  cases  operated  upon 
without  touching  the  ^nds,  the  disease  reappeared 
in  the  cicatrice  or  vicinity  alone  in  48  per  cent,  in  the 
axillary  glands  alone  in  20  per  cent.,  and  in  both  in  32 
per  cent,  retuminff  in  the  glands  in  52  per  cent,  of  the 
cases.  On  the  other  hand,  in  313  cases  in  which  the 
axilla  was  cleared,  the  percentage  of  recurrences  was 
75  locally,  twelve  in  the  glands,  and  thirteen  in  both  ; 
a  reduction  of  the  glandular  recurrences  from  52  per 
cent  to  25  per  cent."  These  statistics  showed  the 
importance  of  including  the  axillary  glands  in  the 
tissues  to  be  removed.  But  Eiister  was  probably  the 
first  to  prove  that  the  glands  may  be  infected  and, 
therefore,  a  source  of  continuation  of  the  disease  before 
they  begin  to  enlarge.  Volkman  called  attention  to 
the  fact  that  the  loose  areolar  tissue  between  the 
glands  and  the  pectoralis  major  muscle  contains 
glandular  offshoots  and  lymphatics  which,  in  malignant 
cases,  are  diseased.  Heidenhain  proved  that  these 
lymphatics  may  adhere  to  the  fascia  without 
penetrating  it  and  that  there  is  not  free 
communication  between  them  and  the  lymphatics  of 
the  muscle.  With  the  recognition  of  Yolkmann, 
Banks,  Gross,  Bull,  Dennis  and  others  of  the  impor- 
tance of  these  views  and  their  practical  adoption,  came 
a  marked  diminution  in  the  percentage  of  recurrences 
or,  more  properly  speaking,  continuance  of  the  disease, 
the  cures  amounting  to  about  20  per  cent. 

Volkman,  in  a  few  of  his  worst  cases,  excised  the 
pectoral  muscles,  as  well  as  the  other  tissues  ordinarily 
removed  by  him.  This  addition  to  his  technic  was 
followed  by  results  more  satisfactory  than  his  previous 
ones,  the  disease  reappearing  in  only  35  per  cent  of 
these  cases  against  60  per  cent  in  those  cases  in  which 
the  muscles  were  left  intact  Halsted,  acting  on  this 
suggestion,  has  for  some  time  included  this  procedure 
in  his  operations  for  the  removal  of  carcinomatous 
mamm»  with  apparently  wonderful  results,  he  stating 

(a)  Mtdkal  B^oord,  rth.  Mth,  1804. 


472    Tn  Mbdioal  Prws. 


TRAN8ACTIOK8  OF  SOCIETIES, 


Mat  6,  I^INL 


the  ao-called  recurrences  to  be  only  6  per  cent  in  the 
casea  operated  on  by  him  from  June,  1889,  to  January. 
1894,  but  in  many  of  these  cases  sufficient  time  had 
not  elapsed  when  his  paper  was  written,  to  make  the 
test  either  a  fair  or  satisfactory  one. 

Prof.  W.  H.  Welch,  subsequently  confirmed  the 
necessity  of  this  addition  to  tec/inique^  for  he  says,  "that 
frequently  microscopical  examinations  of  the  pectoral 
muscles  in  cases  in  wliich  there  was  no  appearance  of 
cancerous  deposit  showed  a  plugging  up  of  a  lympha- 
tic by  a  group  of  seTeral  cancer  cells ;  therefore,  he 
said,  '*  the  rule  for  cutting  wide  of  the  disease  has  the 
very  best  foundation  in  microscopical  examination." 
He  also  added  that  *'  a  carcinoma  was  always  unques- 
tionably a  malignant  tumour,  but  microscopical  exam- 
inations of  sarcomata  did  not  allow  one  to  speak  with 
the  same  assurance  as  to  the  malignancy  of  these 
tumours.  Thus,  sarcomata  which  were  made  up  of 
small,  round  cells  with  very  little  basement  substance, 
were  most  malignant  tumours ;  on  the  other  hand,  the 
spindle-cell  sarcomata  might  be  localised  and  never 
give  rise  to  metastasis. 

By  a  complete  operation,  then,  is  meant  one  that  not 
only  removes  the  entire  mamma  and  all  the  skin  that 
surrounds  it,  but  the  axillary  glands  and  those  con- 
tained in  the  infra  and  supra  clavicular  space  as  well 
as  those  that  lie  between  the  edges  of  the  pectoralis 
major  and  deltoid  muscles,  the  loose  areolar  tissue 
underlying  the  gland,  and  the  fascia  covering  the 
great  pectoral  muscle ;  and  if  more  than  six  months 
has  elapsed  since  the  detection  of  the  iprimary  neoplasm, 
the  pectoral  muscle  as  well,  the  incisions  being  carried 
wide  of  the  diseased  tissues,  which  are  removed  in  one 
mass,  thus  avoiding  the  danger  ef  dissemination  of 
cancerous  fragments  in  the  wound,  the  smallest  parti- 
cle of  which,  is  sufficient  to  form  a  nucleus  for  recur- 
rence or  continuation  of  the  disease. 

Halsted,  Mayer,  and  Curtiss  report  that  but  little  of 
deformity  and  functional  disturbance  follows  the  extir- 
pation of  the  pectoral  muscles,  major  and  minor. 

There  can  be  at  this  time  little  doubt  that  the 
reason  of  the  failure  of  the  older  surgeons  to  obtain 
satisfactory  results  was  due,  in  the  first  place,  to 
septic  infection,  and  in  the  second  place,  to  late  and 
incomplete  operation.  The  remedy  seems  at  present 
to  be  largely  m  the  hands  of  the  general  practitioner, 
as  well  as  those  of  the  surgeon,  for,  as  we  have  seen, 
much  depends  on  the  promptness  with  which  the 
operation  is  advised  and  performed.  Too  much  stress 
cannot  be  laid  on  the  importance  of  the  complete 
extirpation  of  neoplasms,  for  upon  the  thoroughness 
with  which  this  is  accomplished,  depends  the  cure  or 
intervid  of  immunity  from  the  disease.  To  the 
question  of  what  importance  is  the  rapid  cicatrisa- 
tion of  the  wound,  it  may  be  answered  that  while 
it  is  of  consequence  that  every  wound  should 
heal  as  rapidly  as  possible,  in  the  cases  we 
have  been  considering,  it  should  be  deemed  a 
matter  of  secondary  importance  to  the  free  removal  of 
the  tissues  adjacent  to  the  diseased  structures.  The 
rapid  healing  of  the  wound  may  be  promoted  by  skin 
grafting  according  to  the  method  of  Thiersch,  or  by 
Schede's  method  of  the  organisation  of  the  blood  clot 

With  a  better  understanding  on  the  part  of  the 
general  practitioner  of  the  necessity  for  the  early 
extirpation  of  all  neoplasms,  especially  of  those  of  the 
mammarv  region,  and  on  the  part  of  the  sur^n  of 
the  vital  importance  of  the  complete  operation,  it 
seems  reasonable  to  expect  that  in  the  near  future  the 
surgeon's  art  will  triumph  over  this  mortal  foe  of 
womankind,  and  that  a  reasonable  hope  of  cure  can 
be  confidently  offered  those  afflicted  with  this  most 
malignant  of  diseases. 


Translated/or  Thb  Medical  Prsss  aw  Cibculab 
By  GEORGE  FOY,  F.R.C.S., 

Bnigeon  to  the  Whitworth  Hospital ;  Hon.  Felloir  of  the  Southern 
Sviglcel  end  OyniBCologicel  AeeocUtion,  U.8.A. 

The  following  preacriptioDS  are  from  the  collection  of 
Drd.  Manzano  and  Moseti  {Oaceta  MSdica). 

Ch&onio  Cystitis. 
Iodoform,  50  grammes  ; 
Glycerine,  40  grammes ; 
DietiUed  water,  10  grammes  ; 
Gam,  0*25  grammes. 
Make  an  emulsion. 
One  tableepoonful  of  the  emalsion  added  to  a  litre  of 
tepid  water  to  be  need  daily  to  wash  the  bladder. 

Night  Swxats. 
Ergotica,  3  grammes ; 
Alcohol,  5  grammes ; 
Glycerine,  o  grammes ; 
Distilled  water,  6  grammes. 
Mix.  ^ 

The  full  of  a  Pravaz  syringe  to  be  injected  at  night. 

Dtspspsu  or  Phthisis. 
Pepsine,  1  gramme ; 
Hydrochlorio  acid,  1  gramme  : 
Hydrochlorate  of  quinine,  0 10 gramme ; 
Distilled  water,  180  mmmos  ; 
Syrup  of  orange  peel,  20  grammes  ; 
Mix. 
One  tablespoonf  ul  every  three  hours. 

Chronio  Eczbma  akd  Psoriasis. 
Papain,  10  grammes ; 
Salicylic  acid,  5  grammes ; 
Glycerine,  150  grammes ; 
Castor  oil,  150  grammes. 
Mix. 

To  be  well  rubbed  on  the  rash,  the  part  having  been 
previously  washed. 

Hbrpbs  op  thb  Vulva. 
Dr.  Lntand  (Gaceta  Medico)  prescribes  the  following  for 
herpes  of  the  vulva  : — 

Reeorcin,  2  grammes  ; 
Cocaine,  1  gramme ; 
Alcohol,  15  grammes. 
Make  a  solution. 
Wet  a  compress  with  the  solution,  and  apply  it  to  the 
rash  three  or  tour  times  daily,  covering  the  compress  with 
oiled  silk.    Or 

Phenol,  25  centigrammes ; 
Cocaine,  1  gramme ; 
Alcohol,  100  grammes. 
Make  a  solution.    To  be  used  as  above. 

Asthma. 
To  ahrest  the  spasm  of  bronchial  asthma  nothing  {BolHin 
dt  SftdroterapBia)  is  better  than  the  application  of  ioe  to 
the  umbilicus. 


ROf  AL  academy   of  medicine  in  IRELAND. 

SscTioN  OP  Mbdioinb. 

Mbetinq  hbld  Friday,  March  27th,  1896. 


The  President,  Dr.  Thos.  W.  Grimshaw,  in  the  Chair. 

DBFBCnVB  MBTABOLISM  IN  ITS  RBLATION  TO  GOUT. 

Dr.  M.  a.  Botd  read  a  paper  "  on  Defective  Metabolism 
in  its  Relation  to  Gout,"  and  pointed  out  the  interdepend- 
ence of  the  great  physiolo^csd  systems  on  each  other,  and 
how  defective  metabolism  m  any  one  of  these  systems  was 
likely  to  be  followed  by  derangements  of  the  others.  The 
defective  metabolism  that  1m  to  the  formation  oi  uric 


iiiAf  6,  1890: 


f  RAWSACTlOltS  OF  SOCIETIES.  Thb  Mbdioal  Pbiss.     47 3 


a^  in  6X0000  wao  not  oonfined  to  the  digMtive  oystem 
aloodf  bntoonld  ntiae  from  thi'0  defect  in  any  of  the  other 
great  eyotemo,  either  the  ciroulatory,  the  nervouo,  or  the 
lymphatio  onee.  Hi0  oommunication  ranged  over  the 
entire  field  of  their  individual  contribatory  aid  ;  and  after 
nviewing  the  evidence  of  thie  contribation  from  the 
nervone  and  digestive  0ide,  which  he  considered  the  meet 
ttecioent  factors*  he  dwelt  on  the  conclneions  of  Barbae- 
xwoki  a0  to  the  circnlatoi^  system  contributing  the  chief 
share  of  this  excess.  This  latter  observer  has  come  to  the 
cenelttsion  that  uric  acid  was  the  metabolic  product  of 
ilnclein  derived  from  leneocytes,  and  grounds  nis  conclu- 
noB  on  the  increase  of  this  acid  in  the  blood  and  urine  in 
WtikaBmia  and  pernicious  aneemia.  If  this  observer's  con- 
dvsions  be  correct,  Dr.  Boyd  considered  the  formation  of 
i|rie  aeid  must  be  intimately  associated  with  both  blood 
destpTdction  and  formation,  and  if  uric  acid  is  due  to  a 
lenoolysis,  it  must  materially  interfere  with  the  oontribu- 
toty  aid  of  the  leucocytes  in  blood  formation,  and  so 
aecount  for  the  annmia  present  in  many  of  the  forms  of 
atonic  gout.  As  to  uratic  precipitation  in  the  joints,  he 
eimsidered  if  the  nervous  system  was  to  be  invoked  in  this 
preeess(asit  was  by  every  writer  since  Sydenham's  time), 
n  was  in  this  aspect  of  uricacidsemia  that  it  principally 
Miplied,  as  an  interference  with  the  nutrition  of  joints 
torougb  their  trophic  nerves  rendered  them  more  vulner- 
able to  its  invasion,  as  Charcot  pointed  out. 

AK  O0TB&aAK  OT  A0X7TX  DTSBNTIBT  IK  FTVB    MAMBBBS  OF 
A  VAUILT. 

Dh  FiVNT  submitted  the  clinical  notes  of  acute  dysen* 
tDfr  which  broke  out  in  September,  1889,  among  the 
tliembers  of  a  family  consisting  of  seven  persons.  Five 
#drd  attacked,  and  two  died.  The  deaths  occurred  in 
otl^  old  lady  at  70  years,  and  an  infant  of  11  months.  The 
ages  of  the  others  were  37,  49,  and  12  years  respectively. 
Ae  first  case  began  on  September  12  th,  lasted  fifteen 
dkys,  and  ended  fatally.  The  second  case  occurred  two 
^ys  a^ter  the  first,  and  laeted  fourteen  days  (recovery). 
Tbd  third  began  on  19th.  and,  after  four  days,  aied.  The 
fourth  began  also  on  19th,  and  after  nine  days  recovered  ; 
tthd  the  fifth  also  recovered  after  seven  days,  and  began 
(HI  2t8t.  No  other  inmate  of  the  house  (and  there  were 
several)  was  ill  before,  during,  or  after  the  outbreak,  and 
no  cause  could  be  suspected  except  that  for  two  days 
before  the  outbreak  milk  was  used  which  had  been 
supplied  by  a  friend,  whose  child  was  reported  to  have 
died  on  September  14th  of  intestinal  disease.  The  family 
had  jilst  returned  in  perfect  health  from  spending  the 
summer  at  the  seaside  in  Go.  Wicklow.  It  is  probable 
that  the  latter  cases  contracted  the  disease  by  contagion. 
The  features  of  the  disease  were  almost  identical  in  all, 
viz.: — (a)  sudden  onset,  without  diarrhoea;  (b)  frequent 
oallB  to  stool,  12  20  in  24  hours  ;  (c)  immediate  and  com- 
plete absence  of  fasces  and  of  f»cd[  odour  from  the  stools 
fbr  several  days  (4  7)  (verifying  Stott's  definition  of 
dysentery — Morbus  cUvum  occhidius)  ;  (d)  the  motions 
itM  tery  seanty,  the  total  not  exceeding  1  os.-5  os.  in  24 
htMlfi ;  (s)  they  consisted  of  mucus,  glairy,  blood-stained 
olr  Moedjr,  and  shreds ;  (/)  considerable  pain  above  pubes, 
oftMr  rtfuuiuid,  and  In  epicpastrinm ;  [g)  oliguria  to  almost 
Mnplete  Anuria  ;  {h)  Alight  febrile  reaetion  in  two  cases  $ 
ittfiimu0  and  straining  were  notably  absent.  The  treat- 
Mnt  eonsisted  of  brMd  or  arrowroot  in  boiled  milk, 
emdk,  ittd  opium,  and  fo»  the  painp,  laudanum  enenata. 
Ifl^Tstte.  hi  90  gr.  doses  was  given  in  two  oases,  but  seemed 
to  bate  fK>  controlling  effect,  abd  the  same  may  be  said 
stf  dtery  kind  of  astringent  used.  Recovery  coincided  with 
tlMMbnage  of  a  form^  fsdoal  motion. 

Dr.  FALKimeR  said  he  had  a  friend  who  suffored  from 
JMMtifi  dysentery.  He  found  the  liquid  extract  of  Indian 
MM  dk  no  use,  but  a  preparation  made  bv  Squire^  of 
piMm^  from  the  freeh  fruit  was  the  only  thing  that  did 
htm  BXUf  gtvid. 

Dr.  8.  M.  THOMPsair,  from  his  experience  in  South 
ildMrica,  said  that  the  hippo  treatment  had  failed.  Sue- 
tfitii  of  Btard)  and  opium  hastened  death  by  blocking  up 
tiM  lowet*  bowel.  It  was  very  contagious.  Patients  in  the 
itigB  Ward  got  it,  although  fed  on  a  diifereiit  dies. 

ut.  Dawsoiv  sAid,  that  In  Aeute  dysentery  an  amoeba 
MA  hmH  discovered  by  Losoh.  It  had  been  found  by 
MBit  bl^sbrvdre  sincb.    It  gr«w  very  freely  in  ail  infusion 


Dr.  Lrma  said  there  must  be  two  or  three  different 

Sathological  changes  which  give  rise  to  the  symptoms  of 
ysentery.  He  saw  a  great  many  cases  in  India.  The 
astringent  treatment  was  not  useful  in  India,  but  quite 
the  reverse—  such  as  calomel  and  caster  oil.  When  he  was 
there,  the  ipecac,  treatment  was  revived.  In  virulent 
acute  dysentery  it  produced  results  unattainable  by  any 
other  treatment.  Vomiting  following  20  gr.  doses  was 
very  rare,  unless  in  the  first  done,  or  unless  mixed  with 
opium,  as  in  pulv.  ipecac,  co.  When  pure,  and  given  in  a 
little  arrowroot,  it  very  seldom  sickened.  After  the 
patient  had  an  evacuation,  20  minims  of  liq.  opii.  sed.,  in 
about  2  drachms  of  warm  milk,  was  injected  with  a  small 
glass  syringe  into  the  rectum.  If  the  patient  had  not  a 
motion,  he  was  first  given  a  warm  water  enema,  and  sub- 
sequently the  opium.  It  was  generally  followed  by  a  few 
hours  of  quiet,  which  was  a  matter  of  considerable  import- 
ance. In  chronic  dysentery  he  gives  1  ^rain  dose  each  of 
il)ecac.  and  extract  of  hyoscyamus  in  pill— 3  to  12  being 
given  in  the  day,  and  patient  put  on  a  milk  diet.  At 
about  the  same  time  as  Dr.  Finny 'p  cases  occurred  there 
were  several  cases  in  the  Adelaide  Hospital  which  pre- 
sented all  the  symptoms  of  tropical  dysentery,  and  which 
were  confirmed  by  post-mortem. 

Dr.  BuBGBSs  said,  when  crossing  the  Atlantic,  the  tem- 
perature suddenly  changed  from  being  very  cold  to  very 
not.  A  great  many  of  the  passengers  got  symptoms  of 
dysentery.  Astringent  and  sedative  remedies  failed,  and 
large  doses  of  ipecac,  caused  vomiting.  On  the  advice  of 
one  of  the  passengers,  he  tried  a  large  teaspoonfolof  pulv. 
ipecac,  co.  They  all  rapidly  got  well  under  this  treat- 
ment. 

Dr.  Finny,  replying,  said  that  when  he  stated  that 
ipecac,  had  failed  in  the  cases  he  mentioned,  be  did  not 
wish  to  condemn  it  generally,  as  he  had  found  it  useful  be- 
fore. Osier  had  mentioned  several  cases  in  which  an  amoeba 
was  found,  and  called  it  amoebic  dyeentery,  thus  separat- 
ing it  from  other  forms  of  dysentery.  He  tliought  his  own 
cases  were  probably  more  catarrhal  than  true  tropical 
dysentery. 
The  Section  then  adjourned. 


HARVEIAN  SOCIETY. 
Muting  hbld  Thubsdat,  Apbil  16th,  1896. 

Mr.  J.  H.  Dbiw,  in  the  Chair. 

MM8B8.  J.  T.  Lbon  and  R.  W.  Dodoson,  of  St.  Mary's 
Hospital,  gave  a  demonstration  of  the  Rontgen  ray  process 
of  photography.  A  vote  of  thanks  was  carried  by 
aeclaim. 

Mr.  Ratmond  Johnson  read  a  short  paper  on  some 

UNUSUAL  OA<«KS  OF  SWKLUNO  OF  THB  PAROTID  GLAND. 

Short  details  of  five  cases — two  adults  and  three 
children — were  given,  in  each  of  which  the  essential 
ff^ature  was  swelling  and  induration  of  one  parotid  gland. 
The  onset  of  the  swelling  was  invariably  rapid,  often 
oecurrinff  during  a  meal,  and  in  every  instance  the  swelling 
persisted  for  at  least  several  weeks.  Pain  during  masti- 
cation was  considerable,  and  in  one  case  suppuration  was 
wrongly  thought  to  have  occurred  on  account  of  redness 
and  oedema  ofthe  skin  in  the  parotid  region.  In  one  case 
recurrent  attacks  of  the  affection  took  place  during  two  or 
three  years,  in  each  attack  the  swelling  beginning  in  the 
sociaparotidis.  The  view  was  expressed  that  the  parotitis 
was  caused  by  retention  of  saliva  resulting  from  blockage 
of  Stensen's  duct  by  inflammation  of  its  lining.  In  two 
of  the  five  cases  this  was  evidenced  by  the  fact  that  pres- 
sure on  the  swollen  gland  caused  the  escape  of  a  string  of 
ropy  mucus  from  the  orifice  of  the  duct  followed  by  a  free 
fiow  of  clear  saliva,  whilst  in  the  cose  in  which  the  swelling 
always  began  in  the  sociaparotidis  it  was  easy  to  under- 
stand that  gradually  increasing  obstruction  would  affect 
first  this  part  of  the  gland,  which  has  small  ducts  of  its 
own  openinsT  into  the  main  one.  Reference  was  made  to 
somewhat  similar  cases  published  in  Germany  several 
years  ago  by  Kussmaul  and  others.  The  practical  impor- 
tance of  th»  affection  consisted  in  its  resemblance  to 
mumpsi  for  which,  indeed,  several  of  the  cases  were  at 
first  1 


4^4    Tmi  BIbdigal  PrbB. 


TRANSACT^IONS  0^  SOCIETIES. 


Mat  6, 18^6. 


Dr.  DuNDAS  Gbant  remarked  that  one  of  Mr.  Raymond 
Johnson's  cases  seemed  to  have  improved  very  rapidly 
after  the  application  of  liniment  of  iodide  of  potassiam. 
This  recalled  to  his  recollection  a  case  of  suppurative  paro- 
titis under  his  own  care  when  in  general  practice  in  East 
London,  in  which  no  benefit  ensued  from  even  a  consider- 
able number  of  incisions.  The  late  Mr.  Chance  was  called 
in  consultation,  and  he  recommended  abstention  from 
all  instrumental  interference,  predicting  that  under  the 
use  of  iodide  of  potassium  ointment  the  condition  would 
speedily  come  to  a  favourable  termination.  This  predic- 
tion was  amply  verified,  and  Dr.  Grant  thought  the  thera- 
peutic hinti  miffht  be  found  of  value  by  those  who  met 
with  these  decidedly  rare  cases. 

Dr.  CooDE  Adams  said  that  the  subject  of  parotid 
BwelHngs  was  one  of  extreme  interest  to  those  who  like 
himself  were  engaged  in  general  practice.  He  was  struck 
bjr  the  unsatisractory  state  of  our  knowledge  as  to  the 
etiology  of  such  conditions,  and  as  a  result  he  felt  himself 
frequently  compelled  to  enforce  all  the  annoying  conditions 
of  isolation  and  quarantine  where  he  had  doubts  as  to 
whether  the  case  was  really  one  of  mumps  at  alL  This 
indeed  had  been  done  in  the  majority  of  the  cases  just 
described  by  Mr.  Raymond  Johnson,  and  which  were  both 
interesting  and  instructive.  Mr.  Johnson,  however,  had 
not  made  reference  to  the  possibility  that  such  swelling 
might  be  caused  by  reflex  action.  It  had  been  noted  that 
arrest  of  salivary  secretion  always  took  place  in  the  dcg  if 
the  intestines  were  handled.  Mr.  Stephen  Paget  had 
published  in  the  "  Transactions  of  the  Clinical  Society  " 
an  interesting  account  of  a  case  of  parotid  swelling  occur- 
ring in  connection  with,  and  apparently  as  a  result  of 
severe  faecal  accumulation  in  the  intestine.  Mr.  Paget 
had  also  published  a  record  of  no  less  than  102  cases  of 
parotitis  associated  with  operative  interference  with  the 
abdominal  organs.  The  speaker  had  no  very  defined  ideas 
to  lay  before  the  meeting,  but  he  would  like  to  suggest 
the  possibility  that  many  cases  of  so-called  mumps  might 
really  be  instances  of  reflex  hyperemia  resulting  from 
intestinal  indigestion.  At  all  events,  he  hoped  his 
remarks  might  assist  criticism  and  discussion. 

Dr.  William  Hill  made  a  short  communication  on 

PB0OK06IS  IN  OHBOMIO  NON-SUPFURATIVE   CATARBH  OF  THE 
MIDDLE  BAK. 

The  author  excluded  from  the  purview  of  the  paper 
cases  onlv  of  a  few  months'  standing,  and  also  more  or  less 
chronic  deafness  in  children  and  young  persons,  because 
these  are  admittedly  the  most  favourable  classes  of 
patients  the  otologist  has  to  deal  with,  and  the  results  of 
treatment  are  often  brilliant,  and  nearly  always  encourag- 
ing ;  with  adults,  however,  it  is  frequently  quite  otherwise. 
On  account  of  the  anatomical  conformation  of  the  tym- 
panum and  its  delicate  structure,  it  was  obvious  that 
when  catarrhal  changes  went  on  for  even  only  six  months, 
permanent  damage  was  likely  to  result,  so  that  an  absolute 
cure  could  rarely  be  looked  for,  and  we  were  fortunate 
when  we  could  promise  and  obtain  a  moderate  improve- 
ment in  condition,  or  even  arrest  the  disease,  which  is 
usually  progressive.  After  alluding  to  the  forms  of 
middle  ear  catarrh  and  to  the  diaenoeis,  the  author  only 
briefly  discussed  the  more  obvious  uctors  which  influence 
pro^oeis,  such  as  the  age  and  general  health  of  the 
patient,  the  duration  and  degree  of  the  deafness,  the 
amount  of  damage  done  to  the  membrane  ossicular  appa- 
ratus and  Eustachian  tube;  more  consideration  was, 
however,  devoted  to  "  certain  points  which  are  often  of 
distinct  aid  in  forming  a  prognostic  opinion  which  is  more 
than  a  mere  guess."  Mode  ^  on^et  was  instanced  ;  deaf- 
ness coming  on  gradually  and  almost  imperceptibly,  and 
resulting  in  marked  dulness  of  hearing  in  the  course  of  a 
year  or  two,  was  usually  due  to  sclerosis  and  incurable  ;  a 
history  of  sudden  onset,  was  as  a  rule,  more  favourable, 
especially  when  due  to  a  definite  cause  such  as 
nsksal  and  pharyngeal  catarrhs  and  hypertrophies  ;  amongst 
exceptions  to  this  rule  were  noted  tympanic  disease  in 
acquired  syphilis  and  cases  of  extensive  destruction  pro- 
duced by  scarlet  fever  and  other  exanthemata.  From  this 
statement  it  was  seen  that  prognosis  was  influenced  by  the 
cause  ;  when  the  deafness  is  due  to  throat  and  nose  lesions, 
provided  the  damase  to  the  tympanum  is  not  great,  the 
outlook  is  good  if  the  cause  can  b«  remedied,  even  when, 
on  account  of  want  of  ventilation  from  the  blocked  tube. 


the  impairment  to  audition  may  be  considerable,  and  even 
as  lon^-standing  cases  the  result  is  occasionally  gratifying, 
Chronic  cases  of  rheumatic  gouty  of  malarial  origin 
usually  resist  treatment  especially  when  quinine,  salicine, 
and  alcohol  have  been  taken  in  excess.  E^afness  of  dental 
origin  requires  early  treatment.  When  no  extensive 
cause  is  ascertainable  as  in  tympanic  sclerosis  the  otologist 
is  usually  powerless,  even  when  the  disease  has  only  lasted 
a  few  months.  Variability  in  the  amount  of  deafness  is 
nearly  always  an  encouraging  sign  ;  it  may  depend  on  the 
general  health,  on  locality,  atmospheric  conditions,  occupa- 
tion, Ac. ;  in  women  pregnancy,  lactation,  menstruation  and 
the  menopause  often  act  adversely.  A  very  hopeful  form 
of  variation  in  hearing  power  is  improvement  as  the  result 
of  the  air  douche  applied  by  the  catheter  or  otherwise, 
and  is  also  relief  afforded  by  the  production  of  positive 
and  negative  air  pressures  on  the  meatus  by  Siegle's  or 
Delstanche's  methods.  Some  patients  were  better 
immediately  after  the  introduction  of  a  tympanic  boogie, 
and  others  after  tympanic  fluid  injections;  when  such 
exceptional  results  are  obtained  there  is  always  great  hope 
of  some  permanent  relief :  and  the  same  holds  good  for 
pressure  applied  to  some  part  of  the  membrane  by  probes 
or  supports.  Tinnitus,  Paracusis  Willisii,  and  vertigo  are 
generally  held  to  be  of  unfavourable  import,  but  the 
prognostic  value  of  these  symptoms  has  probably  been 
over-estimated. 

Dr.  DuNDAs  Grant  expressed  his  accordance  with  the 
views  set  forth  in  Dr.  Hill's  paper  on  chronic  catarrh  of 
the  middle  ear.  He  thought  that  it  was  most  essential  to 
difi'erentiate  between  the  two  classes  of  cases,  the  exu- 
dative in  which  the  Eustachian  tube  was  narrowed,  and 
the  sclerotic  in  which  this  was  not  the  case,  the  disease 
being  mainly  centred  in  the  articulation  between  the 
stapes  and  the  vestibule.  He  attached  great  value  to  the 
use  of  Eustachian  bougies,  and  he  had  &und  that  Weber- 
Liel's  fine  gum-elastic  intra-tympanio  catheter  was  the 
most  convenient  form  of  instrument  to  use  for  the  purpose. 
It  is  smooth  and  flexible,  and  being  hollow,  the  fact  that 
it  was  in  the  right  position  could  be  determined  by 
auscultation.  He  presumed  that  Dr.  Hill  would  not 
continue  the  use  of  the  bougie  in  cases  in  which  the 
Eustachian  tube  was  quite  free.  The  prognosis,  in  his 
experience  was  much  more  unfavourable  in  the  case  of 
females  than  that  of  males. 


LARYNGOLOGICAL  SOCIETY  OP   LONDON. 
Mbbtiko  bxld  Afbil  IfiTH,  1896. 

The  President,  Db.  Felix  Sbmon,  M.D.,  F.R.C.P.,  in  the 
Chair. 

ADJOUBNBD  DISCUSSION   ON  rORSION  BODIES  IN  THE  UPPEB 
AIR  AND  FOOD  PABSAOES. 

Dr.  SoANBB  Spigek  remarked  that  in  children  for  remov- 
ing foreign  bodies  impacted  in  these  passages  a  general 
ansestheuc  should  be  given  at  once  unless  asphyxiation  is 
imminent,  in  which  case  tracheotomy  should  be  done,  and 
then  annsthetisation.  The  distress  and  terror  of  the 
little  patient  is  thus  allayed,  calm  and  ^ntle  procedure 
on  part  of  the  surgeon  is  facilitated,  the  nsk  of  increasing 
impaction  is  lessened,  and  chances  of  removal  improved. 
Foreign  bodies  in  the  nose  in  children,  from  the  smallness 
of  the  channels  and  from  the  swelling  ^usually  secondary 
to  previous  attempts  at  removal  or  to  consecutive  rhinitis, 
—are  not  usually  to  be  detected  even  by  skilled  rhinoscopy, 
and  the  diagnosis  must  depend  on  the  probe.  This  must 
be  used  witu  caution  in  the  right  direction,  and  the  finger 
inserted  in  the  nasopharynx  to  guard  against  backward 
dislodorment  of  the  intruder  into  the  larynx  or  oesophagus. 
Forcible  injection  of  water  is  undoubtwily  attended  with 
risk  to  the  ears,  especially  if  practised  through  the  per- 
vious nostril  with  the  other  one  blocked.  It  is  not  impro- 
bable in  the  case  of  certain  metallic  foreign  bodies,  e.g., 
needles  and  pins  which  had  perforated  the  wall  of  the 
oesophagus  and  were  lying  more  or  less  parallel  to  its  axis 
(sucn  bodies  as  it  is  most  important  to  remove  forthwith), 
that  assistance  would  be  given  by  a  strongly  magnetised 
bougie  of  flexible  steel  shaped  like  an  ordinary  sum 
oesophageal   bougie    but    fluted   longitudinally.      With 


Mat  6,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Tmi  Mbdical  Pbbss.     475 


reference  to  the  use  of  emeticB  for  dislod^ng  impacted 
bodies,  be  would  fear  to  initiate  the  action  of  a  powerful 
f^is-aterffo  which  could  not  be  regulated  or  controlled. 
Emetis  appeared  just  as  likely  to  increase  impaction 
and  damage  surrounding  structures  as  the  vM-a/ronU  of 
the  surgeon  acting  with  undue  violence  at  the  end  of  an 
QBSophageal  ramr^ — a  method  now  so  generally  depre- 
cated. 

Mr.  Laubsnck  related  the  case  of  a  lady  who  had  a 
whiting  bone  in  the  epiglottis  low  down  close  to  the  left 
pyriform  sinus.  The  bone  caused  no  symptoms,  except  an 
occasional  prick.  He  drew  attention  to  the  difficulty  of 
localising  throat  impressions  generally. 

Dr.  A.  A.  Kanthack  gave  the  following  account  of  a 
specimen  of  impacted  piece  of  meat  in  the  larynx,  which 
he  showed,  A  piece  of  meat,  during  hasty  swallowing, 
had  become  lodged  in  the  aditus  laryn^is,  and  had  there 
been  firmly  impacted.  A  sagittal  section  had  been  made, 
which  showed  the  relation  of  the  parts  to  the  foreign  body. 
The  epiglottis  had  been  pushea  forwards  agamst  the 
tongue,  and  the  piece  of  meat  had  been  firmly  moulded 
into  the  upper  part  of  the  larynx.  The  specimen  afforded 
a  good  example  of  what  happens  when  the  epiglottis  does 
not  act  and  becomes  pushea  forward,  and  refutes  the  view, 
expressed  by  Prof.  Anderson  Stuart  that  the  epiglottis 
during  deglutition  becomes  applied  against  the  basis  lin- 
guie,  and  acts  as  an  inclined  plane  for  the  bolus  to  slide 
along  into  the  OBSophagus  beyond  the  larynx.  Experiment- 
ally this  view  had  alr^dy  been  disproved  by  the  speaker  in 
conjunction  with  Mr.  H.  K.  Ander>on,  of  Cambridge. 

Dr.  Lambirt  Lack  entirely  disagreed  with  Mr.  Symonds 
with  regard  to  the  absence  of  ^our  with  a  unilateral 
purulent  discharge  from  the  nose  in  children  as  diagnostic 
of  the  presence  m  a  foreign  body.  In  a  large  number  of 
cases  he  had,  the  fcebor  of  the  discharge  was  expressly 
noted.  In  one  case,  an  intensely  horrible  smell  pervading 
a  whole  ward  was  traced  to  a  foreign  body  (a  piece  of 
string)  in  the  nostril.  He  had  always  considered  that  a 
unilateral  fceiid  and  purulent,  and  often  irritating  dis- 
charge from  the  nose  of  a  child  indicated  a  foreign  body, 
had  usually  administered  an  anaesthetic,  and  only  once 
failed  to  find  the  foreign  bodv.  Dr.  Lack  entirely  agreed 
with  Mr.  Symonds's  remarks  about  the  real  danger  of 
foreign  bodies  entering  the  wind-pipe  during  cbloroformiss- 
tion.  A  patient  -  with  post-nasal  adenoids  under  his  care 
owed  her  life  entirely  to  the  fact  that  tracheotomy  instru- 
ments were  at  hand  auring  the  operation.  He  a^so  pointed 
out  that  in  some  cases  of  foreign  bodies  in  the  larynx 
breathing  may  not  be  restored,  even  after  tracheotomy, 
until  the  foreign  body  is  removed,  apparently  because  of 
the  FpMm  ts  presence  excites. 

Mr.  Cress  WELL  Babeb  showed  three  rhinoliths  to  illus- 
trate the  subject  under  discussion.  The  first  came  from 
the  left  nasal  cavity  of  a  medical  man.  He  applied  with  a 
history  of  discharge  from  that  nostril  for  two  or  three 
months,  having  had  no  inconvenience  at  all  before  that. 
On  inquiry  he  remembered  when  three  or  four  years  old 
putting  a  boot-button  into  his  nose.  Examination  showed 
the  rhinolith  to  contain  so  much  iron  (over  30  per  cent.) 
that  it  was  evidently  the  boot-button,  which  must  have 
been  there  for  twenty-five  years.  The  case  was  interesting 
as  showing  that  a  foreign  body  may  lodge  in  the  nose  for 
over  twenty  years  without  attracting  even  an  intelligent 
patient's  attention.  Mr.  Baber  remarked  on  the  necessity 
of  examining  the  naso-pharynx  in  cases  in  which  a  foreign 
body  is  felt  by  the  patient  in  the  larynx,  as  sensations  in 
the  naso-pharynx  are  often  referred  to  that  region. 

Dr.  Clifford  Beale  referred  to  the  possibility  of  sudden 
obstruction  of  the  larynx  during  meals,  by  means  of  scraps 
of  meat,  and  related  a  case  in  which  by  instant  inversion 
of  the  body  and  a  deep  inspiration,  followed  by  a  forcible 
expiration,  the  foreign  body  was  ejected.  The  necessity 
for  a  very  deep  expansion  of  the  lungs  under  such  circum- 
stances was  insisted  upon. 

Dr.  Herbert  Tilley  mentioned  a  case  in  which  a  child, 
set.  4,  swallowed  an  intubation  tube,  which  was  removed 
from  the  rectum  two  days  later  by  means  of  a  nasal  poly- 
pus forceps.  He  also  mentioned  a  case  of  almost  fatal 
asphyxia  during  operation  fur  adenoid  overgrowths,  the 
portion  of  growth  which  had  slipped  into  the  glottis, 
however,  was  looeened  by  forcible  pushing  upwards  of 
the  larynx.    He  pointed  out  the  advantage  of  having  the 


patient's  head  well  hanging  over  in  this  operation,  and 
obviating  the  accident  mentioned. 

Dr.  W.  Hill  remarked  that  one  of  the  commonest  forms 
of  foreign  body  which  he  had  been  called  upon  to  deal 
with  had  been  pledgets  of  wool  and  lint  which  had  been 
inserted  into  the  nose  after  operative  measures  for  the 
suppression  of  hasmorrhage ;  from  the  fact  that  several 
plea&rete  or  pieces  of  lint  are  often  inserted,  one  such  body 
is  liable  to  be  overlooked,  and  great  discomfort  and  stench 
results  from  its  rentention  for  more  than  two  or  three 
days.  Such  an  accident  had  unfortunately  happened  in  a 
case  under  his  care  in  conjunction  with  a  general  practi- 
tioner, and  undoubtedly  one  or  other  of  them  was  respon- 
sible for  leaving  a  piece  of  blue  gauze  in  the  nose. 

Dr.  Grant  recommended  the  use  of  the  air-bag  by  the 
opposite  nostril  instead  of  fluid  syringing,  docain 
should  first  be  applied,  then  an  oily  spray  should  be  used, 
and  Dr.  Spicer's  advice  to  dilate  tne  orifice  should  be 
carried  out.  During  the  use  of  the  bag,  both  ears  should 
be  plugged  by  means  of  pushing  in  the  tragus,  and  the 
patient  directed  to  blow  out  the  cheeks  forcibly.  Dr. 
Grant  had  found  an  instrument  like  a  sharp  recurved 
crochet-hook  of  considerable  value.  He,  on  one  occasion, 
used  the  pan-endoscope  for  the  oesophagus,  and  found  no 
difficulty  in  introducmg  the  instrument,  but  the  amount 
of  light  was  small,  although  sufficient  to  make  it  certain 
that  no  foreign  body  was  present. 

Dr.  Adolph  Bronner  had  seen  numerous  oases  of 
foreign  bodies  in  the  nose.  These  had  in  nearly  every  case 
been  easily  removed  by  the  use  of  Politzer's  bag  or  by  a 
stream  of  water  applied  to  the  opposite  nostril  (not  the 
douche).  In  cases  of  foreign  bodies  in  the  trachea  it  was 
always  best  to  perform  tracheotomy,  as  the  bodv  might  at 
any  time  become  loose  and  get  impacted  in  the  glottis, 
with  fatal  results.  Kirstein's  antoscope  was  ofcen  of 
great  use  in  nervous  patients  or  in  children,  who  would 
not  allow  the  laryngoscopic  mirror  to  be  introduced.  Dr. 
Bronner  asked  Mr.  Symonds  why  cases  of  oesophagotomy 
for  removal  of  foreign  bodies  were  so  fatal.  Dr.  Bronner 
was  of  opinion  that  the  use  of  the  continuous  nasal  douche 
was  very  dangerous,  but  that  the  use  of  Higginson's 
syringe  was  not  attended  by  any  bad  after-eflecos. 

Mr.  W.  R.  H.  Stewart  wished  to  draw  attention  to  the 
difference  between  forcible  syringing  up  the  healthy  side 
of  the  nose  to  remove  a  foreign  body,  and  the  ordinary  use 
of  the  Higginson  douche.  Speaking  as  an  otologist  he 
strongly  objected  to  the  forcing  of  a  stteam  of  water  up 
one  nostril  if  the  other  was  blocked,  owing  to  the  damage 
that  might  be  done  to  the  ears.  The  ordinary  use  of  the 
Higginson's  douche  was  one  of  the  beet  ways  of  employing 
nasal  irrigation,  but  he  doubted  its  efficacy  in  removing  a 
foreign  body  unless  force  was  applied.  He  disagreed  with 
Mr.  Symonds  with  regard  to  the  absence  of  fcetor  when 
foreign  bodies  were  in  the  nose.  He  had  frequently  met 
with  cases  in  which  a  very  foetid  smell  was  present.  With 
regard  to  rare  foreign  bodies,  he  had  that  day  on  removing 
a  pair  of  tonsils  lost  one,  and  after  a  long  hunt  had  found 
it  squeezed  into  the  posterior  nares. 

Dr.  Sherman  asked  if  stiffness  of  the  neck  had  been 
noticed  as  a  symptom  of  a  foreign  body  in  the  oesophagus. 
He  had  seen  a  child  at  the  Throat  Hospital,  that  had 
swallowed  a  halfpenny  three  weeks  before  admission.  The 
only  symptom  was  stifiness  of  the  neck,  the  child  would 
not  put  its  head  either  towards  one  shoulder  or  the  other, 
almost  as  if  disease  of  the  cervical  spine  were  present. 
Nothing  could  be  seen  with  the  laryngoscope.  Use  of 
the  coin-catcher  immediately  brought  up  the  halfpenny. 

Mr.  Jessop  inquired  from  Mr.  Symonds  as  to  any  practi- 
cal method  of  getting  rid  of  very  viscid  mucus  occurring 
after  repeated  examination  of  the  throat  for  foreign  bodies. 
The  umbrella  probang  was  useful  in  satisfying  the  feeling 
of  patients  after  assuring  them  that  there  is  really  no 
foreign  body  present.  Patients  frequently  confess  to  feel- 
ing much  relieved  after  this  operation. 

Mr.  Waooett  said  that  he  had  been  working  with  Mr. 
Sydney  Rowland  to  prove  the  use  which  could  be  made  of 
the  Rontgen  rays  in  the  diagnosis  and  treatment  of  foreign 
bodies  in  and  about  the  larynx.  Employing  a  "focus" 
Crooke's  tube  transmitting  X  rays  transversely  through 
the  neck,  they  had  been  able  to  obtain,  with  an  exposure 
of  five  minutes,  clear  shadow  pictures  of  coins  and  fish- 
bones attached  to  the  surface.  As  the  cartilages  of  the 
larynx  were  transparent,  and  gave  no  land-marks  on  the 


47S    Tm  MbdioaIi  Pbbss. 


TRAK8ACTI0NS  OF  SOCIETIES. 


Mat  VWg. 


picture,  projection  charts  represeotiofif  the  dittorfcad 
image  of  tne  dtruotures  of  the  neck  had  been  made,  refer- 
ende  to  which  permitted  of  localisation  of  any  given  point. 
Farther  help  in  this  direction  was  to  be  obtamed  by  taking 
more  than  one  position,  and  no  difficnlty  was  to  be  ex- 
pected in  obtaining  a  stereoscopic  effect.  In  order  to 
make  ezdaeion  possible,  the  relative  opacities  of  a  variety 
of  bodies  likely  to  obtain  accidental  entrance  had  been 
determined.  The  cryptoscope,  essentially  a  screen  of 
cardboard  coated  with  potassio-barinm  cyanide,  proved 
somewhat  lees  sensitive  than  the  photographic  plate,  bat 
has  the  advantage  of  permitting  of  contemporaneoas 
observation.  In  a  darkened  room  the  front  portion  of  the 
neck  appeared  in  half  shadow,  bounded  above  and  behind 
by  the  black  shadow  cf  the  jaw  and  spinal  column.  A 
defined  shadow  was  cast  by  the  hyuid  bone,  and  on  intro- 
duction of  a  probe  into  the  larynx  or  cesophagus,  the  move- 
ments of  the  instrument  could  be  followed  without  diffi- 
culty on  the  luminous  screen.  The  oryptoeoope  should 
afford  a  valuable  aid  in  the  guidance  of  the  forceps  in  the 
removal  of  foreign  bodies. 

[Owing  to  the  kindness  of  Mr.  Rowland,  who  had  brought 
his  apparatus,  photographs  were  shown,  and  the  crypto- 
scope demonstrated  to  the  members.] 

The  President,  before  calling  upon  Mr.  Charters  Symonds 
to  reply,  thaoked  Mr.  Waggett  and  Mr.  Rowland  for 
their  most  interesting  demonstration,  which  in  connection 
with  the  subject  under  discussion  opened  new  and  most 
important  poesibilities  for  the  dia^^nosis  and  removal  of 
foreign  bodies  from  the  upper  air  passages.  He  then 
briefly  summarised  the  more  important  points  touched 
upon  in  the  discussion,  and  instanced  as  such  (1)  the 
question  of  danger  to  the  ear  by  forcible  injection  of  water 
into  the  nose  for  the  removal  of  foreign  bodies  from  the 
nasal  cavity.  This  danger  he  thought  was  greater  when 
a  continuous  than  when  an  interrupted  current,  such  as 
produced  by  Higginson's  syringe,  was  used;  (2)  the 
danger  of  pieces  of  adenoid  vegetations  penetrating  into 
the  lower  air-passages  when  the  operation  was  performed 
with  the  patient  sitting  up ;  he  warmly  advocated  the 
position  with  pendiog  head  ;  (3)  the  deficient  power  of 
localisation  in  the  upper  air-passages ;  sensations,  even 
when  originating  in  the  naso-pharyngeal  cavity,  frequently 
being  referred  to  the  larynffo-tracbeal  region;  (4)  the 
desirability  of  any  digital  ezp&ration  being  preceded  by 
careful  inspection  of  the  parts  ;  (5)  the  persistence  of  sen- 
sations long  after  the  removal  of  the  foreign  body.  In 
conclnsioD,  he  thanked  Mr.  Symonds  in  the  name  of  the 
Society  for  having  by  his  careful  introduction  given  rise 
to  so  interesting  and  important  a  discussion. 

Mr.  Symonds,  in  reply  to  Dr.  Spicer,  said  he  recognised 
the  unilateral  discharge  from  the  nose  in  young  children 
with  adenoids,  where  the  other  side  was  obstructed,  but 
he  had  referred  to  a  purulent  discharge  without  any  such 
cause.  The  different  opinioos  expressed  by  the  speakers 
as  to  the  danger  of  syringing  the  nose,  showed  toat  the 
method  might  be  employed  with  little  risk  of  injury  to  the 
ear.  The  fatalities  after  oesophagostomy  were  due  to 
septic  cellulitis.  He  suggested  that  this  might  be  avoided 
with  certainty  by  operating  in  two  stagei*,  or  again  by 
plugging  the  wound  with  gauze  after  suturing  the  gullet. 


BRITISH  BALNEOLOGICAL  AND   CLIMATOLOGL 

CAL  SOCIETY. 

Meeting  held  Wednesday,  April  15th. 

The  President,  Dr.  Henbt  Lewis  (Folkestone),  in  the 
Chair. 

Dr.  R.  Fortescue  Fox  read  a  paper  on  '<  Articular 
Gout  and  its  Treatment  by  Natural  Sulphur  Waters."  By 
aid  of  cases  he  first  described  the  acquired  variety  of  gout, 
now  less  common  than  formerly,  and  generally  seen  in 
men  of  a  ttout  and  plethoric  habit.  There  is  not  infre- 
quently a  history  of  antecedent  rheumatism  or  rheumatic 
tever  ;  urate  deposits  are  not  a  marked  feature  excepting 
in  the  *'  occupation  gout  "  of  coachmen  and  others,  and 
the  disease  either  tends  to  visceral  degeneration,  or,  under 
favourable  circumstances,  to  gradual  extinction  of  sym- 
ptoms and  a  healthy  old  age.  On  the  other  hand,  the 
hereditary  gout  is  of  tenest  seen  in  spare,  active,  energetic 


men,  and,  not  being  a  *<diet  disease"  is  not  to  be  eiire4 
by  dieting.  The  author  found  in  his  e^parienee  i|i 
Strathpemr  Spa  that  both  forms  of  gont  were  favonrablj 
influenced  by  conrsee  of  sulphuretted  waters,  but  He 
strongly  deprecated  the  endeavour  to  apply  aoythuig  lik| 
a  routine  treatment  or  fixed  **  cure,'^  which  genenllj 
ends  in  disaster.  Baths  are  often  altogether  oontM- 
indicated  ;  and  in  determining  the  diet  and  fpmp^ 
treatment  it  is  important  to  ascertain  in  eeA  ^Afie 
whether  the  disease  is  acquired  and  dietetic,  or  due  to  » 
hereditary  perversion  of  tissue  change*  In  the  latter  oUal 
of  caMS,  as  much  as  in  the  first,  sulphur  in  the  form  dl 
sulphur  waters  is  an  effectual  alterative,  and  prodnoA 
excellent  results  when  taken  anonaUy  for  tome  yean.  At 
the  same  time,  in  the  debility  of  hereditary  gout  norvmif 
repose,  varied  and  nourishing  diet,  and  sometimea  wino  »■• 
indicated.  Gout  in  women  is  nearly  always  hereditary,  aMi 
exemplifies  the  infiuenoe  of  «6«  on  disease.  The  articnlMr 
symptoms  are  less  acute,  and  present  a  wide  range,  %mtm 
recurrent  attaeks  resembling  thoee  met  with  in  mMi«  M 
the  gradual  ehronio  enlargement  of  the  terminal  p)ui» 
langes,  known  as  Heberden's  nodes.  The  oUmaoterki 
period  in  women  unmasks  the  hereditary  tendency  to 
gont  unless  it  has  already  been  manifested.  Goat  Ui 
younger  women  is  sometimes  met  with  in  the  articolatiop«» 
as  recurrent  attacks  of  synovitis  in  knee  or  sbonlder* 
and  may  simulate  **  rheumatoid  "  arthritis.  Arikriii9^  i^ 
the  author's  view,  is  a  term  that  should  be  reserved  fo» 
degenerative  disease  of  the  joints.  In  this  sense  there  ie  4 
form  of  gouty  arthritis,  met  with  in  later  life,  in  whieb 
one  or  more  joints  (shoulder,  knee,  or  thumb)  become 
affected  with  degeneration  as  a  result  of  slight  injury. 
This  form  of  "local  arthritis "  must  be  carefully  distin- 
guished from  the  generalised  disease. 
Dr.  Edvv  ard  Gilbert  (Tunbridge  Wells)  said  his exp«ri- 
enoe  in  a  considerable  middle-class  practice  in  London  fa^ 
twenty  years  was  strongly  confirmatory  of  Dr.  Fox's  as  tp 
a  very  large  proportion  of  those  who  had  suffered  acoto 
gout  having  also  had  at  some  time  acute  rbenmatisn) ; 
be  had  not  found  that  those  who  inherited  gout  wer* 
usually  spare,  more  than  those  who  aoquired  it,  bnt 
that  in  ntarly  all  cases  there  was  some  history  of  gouty 
ancestry.  In  some  oases,  especially  in  women,  g^nt  waf 
associated,  apparently  intimately,  with  serious  disord^ri 
of  the  nervous  system,  especially  asthma  and  neuralgl^i 
both  in  the  individual  and  in  the  family. 

Dr.  Walter  Blakbr  (Bognor)  said  he  personally  mf 
the  subject  of  acquired  and  hereditary  gout.  He  lea  t 
steady,  healthy,  active,  outdoor  life,  was  a  moderate  bufir 
drinker  and  meat  eater.  Bhe^matie  patss  oommenoefi  a^ 
21,  never  acute  rheumatism.  Branchiiis at  3i,  ooqftantfY 
recurring  until  1893,  three  vears  ago.  Benefit  attribntea 
to  dry  air  of  Bognor,  where  ne  had  taken  up  his  resideqof. 
Goutf  chiefly  affecting  feet  and  knees,  appeared  at  4&  aftw 
first  attack  of  influenza,  succeeded  shortly  by  almOf( 
weekly  attacks  of  asthma,  of  which  he  had  had  nonfi 
whilst  livins  in  Bognor.  He  coneidered  diet  an  important 
factor  in  keeping  symptoms  in  check,  three  aays  oi 
butcher's  meat  producing  gravel  He  had  suffered 
much  from  headaches  since  residing  at  Bognor,  and  foui^a 
these  and  other  gouty  troubles  were  worse  when  ther4 
was  an  excess  of  ozone  in  the  air.  He  deduced  thoM 
facts  frcm  many  experiments  on  himself  and  patients.  H^ 
had  derived  much  benefit  for  the  gouty  joints  from  wat^ 
of  Llanffammarch  in  Wales. 

Dr.  Oliver  (Harrogate)  said  the  paper  oontained  sp 
many  points  of  interest  that  it  was  somewhat  difficult  lo 
single  out  those  most  deserving  of  discussion.  He  thought 
he  had  observed  some  signs  ol  change  of  type  iu  reeent 
years  towards  the  asthenic  and  neurotic  manifestations 
of  gout,  particularly  in  women  and  especially  since  influ- 
enza began  to  prevail  seven  years  ago.  He  referred  to  the 
possible  centric  origin  of  gout  with  which  the  hereditari- 
ness  of  the  disease  was  closely  associated.  He  had  noticed 
that  the  attacks  of  soot  occurring  during  the  couree  of 
»pa-treatment,  had  become  in  his  experience  much  lees 
frequent  since  the  warm  immersion  bath  had  been  largely 
replaced  by  douche  and  spray  baths  combined  with  vibra- 
tory  massage,  and  that  he  believed  a  course  of  hot  baths 
was  a  powerful  means  of  bringing  on  acute  attacks.  In 
diet  he  regarded  first  the  patient  and  then  the  disease, 
and  he  belieyed  that  no  uniformly  restricted  system  of 
diet  should  be  strictly  adhered  to  if  it  impoverlthod'tk^ 


Mat  6, 1806. 


FEAITCE. 


TqB  MHDIOOi  FbIS8.      477 


blood  or  the  nerve  oentree.  He  was,  however,  strongly  in 
favour  of  largely  increasing  the  fluids  and  the  yegetable- 
derived  elements,  and  of  redacing  the  proportion  of  the 
animal  food  to  a  minimum,  so  long  as  the  testing  of  the 
blood,  by  a  new  method  of  his  own,  showed  benefieial 
resaltSb 

Dr.  MoscAN  DooKBBix  said  it  was  rare  to  see  oases  o| 
eczema  or  psoriasis  in  which  some  previous  diagnosis  of 
§^ut  had  not  been  made  on  account  of  the  skin  disease 
present.  Dr.  Fox  only  mentioned  two  cases  in  which 
eczema  had  appeared.  He  hoped  it  was  now  the  settled 
opinion  that  gout  had  no  more  to  do  with  the  production 
of  either  eczema  or  psoriasis  or  other  skin  diseases  than 
any  other  condition  which  caused  a  general  deterioration 
of  the  health,  and  in  that  way  predisposed  to  the  produc- 
tion of  certain  skin  diseases.  He  pleaded  for  the  aban- 
donment of  the  habit  of  qualifying  these  different  skin 
affections  by  the  term  "gouty,"  which  was  quite  an  unne- 
cessary addition  and  often  too  loosely  used. 

Dr.  Alexander  Haig  was  interested  in  the  patient  who 
drank  mach  whisky,  but  Dr.  Fox  also  mentioned  that  he 
was  fond  of  good  hving,  and  his  goat  was  probably  due 
rather  to  his  meat  than  his  drink.  As  to  gout  in  abstemi- 
ous persons,  he  had  seen  it  in  some  who  thought  themselves 
very  abstemious,  but  on  writing  out  their  diet  it  was  often 
found  to  be  nearly  all  meat.  He  could  not  agree  as  to  the 
great  inflaenoe  of  inheritance  in  gout,  believing  that  this 
was  often  merelv  the  inheritance  of  the  money  necessary 
to  buy  meat  and  wine. 

6.  H.  Wabd-Huhphbbts  (Cheltenham),  from  a  clinical 
point  of  view,  could  not  accept  Dr.  Haig's  theory  that 
hereditary  eout  was  so  often  due  to  hereditary  dollars  and 
excess  of  diet.  He  had  often  seen  it  in  hard-living 
hunting  men,  and  in  those  who  were  careful  in  their  diet. 
Patients  with  a  gouty  tendency  who  lived  inland  often 
suffered,  on  going  to  the  sea,  from  constipation,  inactivity 
of  the  liver,  headache,  and  gouty  svmptoms.  He  con- 
nected as  cause  and  effect  the  sluggish  liver  and  the  gout. 
That  certain  mineral  waters  precipitated  a  gouty  attack 
had  been  pointed  out  sixty  years  ago  by  Jameson,  but  this 
could  be  prevented  by  proper  doses  of  the  waters  after 
suitable  preliminary  treatment. 

Dr.  Febgusson  (Great  Malvern)  thought  the  disease 
primarilv  due  to  errors  in  diet.  Dr.  Fox's  cases  proved 
this,  ana  showed  that  where  the  high  living  is  associated 
with  the  free  use  of  alcohol,  the  diseai>e  comes  on  earlier. 
Dr.  Fox  thought  gout  in  women  is  always  hereditary,  but 
even  this  was  on  account  of  errors  in  diet  in  their  progeni- 
tors. He  was  in  favour  of  reduced  diet,  increased  con- 
sumption of  fluids,  and  hot  baths. 

The  President  also  considered  it  a  '<  diet  disease,"  and 
advocated  brown  meat  once  only,  in  the  middle  of  the  day, 
a  liberal  administration  of  fluids,  total  abstinence  from 
alcohol,  and  plenty  of  walking  or  riding  exercise  daily. 
Himself  the  victim  of  hereditary  gout,  he  managed  by  this 
regimen  to  keep  the  enemy  at  bay. 

Dr.GnFrE(WoodhallSpa)  bad  often  noticed  that  gout  fol- 
lowed rheumatism,  and  rheumatism  had  followed  affections 
of  the  throat,  which  mi^ht  point  to  some  microbic  ioflaenoe 
affecting  the  system.  He  had  seen  very  hot  baths  produce 
gout  at  Woodball  Spa  though  there  was  no  sulphate  in  the 
water.  He  mostly  met  with  the  asthenic  form  of  gout, 
and  observed  that  many  of  his  gouty  patients  ate  enor- 
mously of  meat.  He  quite  agre^  with  a  diet  containing 
little  meat  and  very  little  alcohol.  He  strongly  advocated 
the  use  of  the  cold  spray  and  douche. 

Dr.  Htde  (Buxton)  agreed  with  Dr.  Oliver's  remarks  as 
to  the  apparent  alteration  of  type  which  had  taken  place 
in  gout.  He  had  been  much  impressed  in  late  years  by 
the  gradual  but  marked  diminution  in  the  proportion  of 
cases  showing  those  uratic  deposits  commonly  spoken  of 
as  "  chalky."  He  had  also  observed  a  great  falling  off  in 
cases  of  the  more  acute  forms  of  gout.  In  his  opinion, 
these  changes  of  type  necessarily  involved  departures 
from  the  older  forms  of  treatment. 

Dr.  FoBTESGiTE  Fox  bavin  AT  replied  to  the  views  and 
criticisms  of  the  various  speakers, 

The  discussion  on  the  necessity  of  producing  increased 
railway  facilities  to  the  British  health  resorts  was  postponed 
to  the  next  meeting^on  May  20th. 


BRITISH    LARYNOOLOGICAL,   BHXNOLOGICAL 
AND  OTOLOGICAL  SOCIETY. 

Meeting  held  Friday,  April  17th. 
The  President,  G.  Stokes,  M.R.G.P.,  in  the  Chair. 

Dr.  Macnaughton- Jones  showed  a  case  of  *<  Gouty 
Tumour  of  the  Auricle  "  and  an  improved  throat  lamp  and 
Eustachian  electrode. 

Dr.  £.  Law  a  case  of  <*  Hyperostosis  of  the  External 
Auditory  Meatus." 

Dr.  Pegler,  sections  : — Vegetation  from  Frontal  Sinus, 
Epithelioma  of  Pharynx  (dog).  Tuberculous  Disease  of 
Middle  Turbinated. 

Dr.  HiLL«  *'  Tuberculoma  of  Vestibule." 

Dr.  A.  Bronnsr  opened  a  discussion  on  '<  Disease  of  th^ 
Attic."  His  main  points  being— (1)  That  localised 
disease  of  the  attic  is  very  common,  and  that  perfora- 
tion is  not  necessary.  (2)  That  the  attic  is  affected  in 
long-standinfl:  middle-ear  disease  and  in  mastoid  disease 
in  adults.  (3)  Pain  in  this  affection  radiates  upwards 
and  forwards.  (4)  Ordinary  surgical  means  should  have 
failed  before  the  ossicles  are  removed.  (5)  In  external 
operation  the  wound  should  be  above  the  ear. 

Drs.  Dundas  Grant,  Hill,  Law,  Mr.  Waggett,  and  Dr. 
Satliff  took  part  in  the  discussion. 

Dr.  Maointtrx,  F.B.S.E.  (Glasgow),  read  a  Note  on 
the  subject  of 

RONTGBN  RATS  IN  LARYNGEAL  SFBGERT, 

which  will  be  found  under  the   heading  of   '*  Original 
Communications." 


J^tSXttZ. 


[from  our  own  0ORBB8PONPKNT.] 


PABI8,  May  2nd,  1896. 
Appendicitis 

Professor  Pozzi  related,  at  the  Medical  Society,  the 
cases  of  two  patients  on  whom  he  had  operated  success- 
fully for  append 'oitis.  The  first,  a  man,  »t.  40,  had 
suffered  since  his  childhood  from  gastro-inteetinal  trouble, 
and  at  the  beginning  of  the  present  month  he  was  seized 
with  a  sharp  pain  in  the  right  iliac  fossa.  Appendicitis 
was  diagnosed  and  the  operation  practised  the  following 
day.  When  the  appendix  was  brought  to  view,  it  was 
found  to  be  enlarged,  indurated,  and  adherent ;  it  con- 
tained neither  pus  nor  liquid,  but  on  one  side  was  a  small 
perforation. 

The  second  patient  was  a  young  man,  est.  18,  subject  for 
several  months  to  colics  in  the  iliac  fossa.  When  the  cavity 
was  opened  an  abscess  was  found  in  the  neighbourhood  of 
the  appendix,  while  this  organ  was  bent  so  as  to  oppose  the 
free  circulation  of  the  contents.  In  both  cases  the  appen- 
dix was  removed.  The  speaker  considered  that  the  flexion 
of  the  appendix  played  an  important  r6le  in  the  cause  of 
the  accidents,  and  whenever  a  correct  diagnosis  could  be 
arrived  at,  it  was  neoessary  to  operate  as  early  as  possible, 
for  although  medical  treatment  might  succeed  apparently 
in  calming  the  most  prominent  symptoms,  the  trouble 
was  sure  to  return,  and  perforation  would  be  the  ultimate 
result. 

M.  Dieulafoy  described  another  case  of  appendicitis 
which  confirmed  in  every  point  the  conclusions  of  the 
first  speaker,  A  young  man  entered  the  hospital  with 
symptoms  of  the  affection  in  question.  Medical  treatment, 
consisting  in  applications  of  ice,  laxatives,  &c.,  was  tried, 
and  apparently  with  success,  but  a  fortnight  afterwards 
a  relapse  took  place,  and  this  time  it  was  decided  to 
operate.    The  appendix, (which  was  removed,  was  found 


478    Thb  Msdical  Puss. 


GERMANY. 


Hat  6,  1896. 


to  be  inflAmed  and  filled  with  pui,  and  on  one  side  was  a 
small  perforation.    The  man  recovered. 

AXMMIA. 

At  the  meeting^  of  the  Obstetrical  Society  M.  Maygrier 
spoke  on  the  treatment  of  cases  of  anemia  by  injections 
of  salt  water.  He  said  that  among  the  means  at  our  dis- 
posal to  struggle  against  hsBmorrhage  of  a  grave  character 
we  have  added,  within  the  last  two  or  three  years,  injec- 
tions of  artificial  serum  into  the  cellular  tissue,  or  even 
into  the  veins  directly.  Lately,  he  had  witnessed  in  his 
own  practice  most  astonishing  results  from  this 
method,  and  he  would  add,  with  other  clinicians, 
(Thomson,  H.  Spencer,  Smith,  Horrocks,  &c.)  that  there 
should  be  no  fear  of  injecting  strong  doses  or  of  renewing 
them  frequently.  The  patient  who  furnished  him  with 
the  opportunity  of  trying  the  method  was  a  woman,  who 
was  brought  to  the  hospital  in  a  dying  state  from  placenta 
previa.  The  first  attempts  at  provoking  a  delivery  were 
accompanied  by  such  grave  attacks  of  syncope  that 
death  seemed  to  be  imminent.  He  injected  immediately 
two  quarts  of  salt  water  directly  into  the  vein  of  the  arm 
at  an  interval  of  twenty  minutes.  The  effect  was  magic, 
the  woman  who  was  apparently  dead  seemed  to  come 
back  by  a  kind  of  resurrection.  Shortly  afterwards,  par- 
turient pains  came  on,  and  the  child  was  expelled.  The 
consequent  loss  of  blood  brought  on  the  fainting,  and 
two  more  quarts  were  injected  with  similar  good  effect. 
But  towards  evening  the  patient  showed  again  signs  of 
sinking,  and  the  injections  were  repeated,  and  this  time 
with  permanent'  effect,  so  that  in  the  one  day  six  quarts  of 
artificial  serum  had  been  injected.  If  women,  the  speaker 
added,  are  brought  to  us  in  a  lamentable  state  of  anemia, 
their  condition  ought  to  be  improved  by  injections  of 
serum  before  proceeding  to  deliver  them.  Certain  acoou- 
cheurs  have  a  great  dread  of  intravenous  injections,  but 
their  fears  were,  in  his  mind,  exaggerated. 

The  mode  of  operating  is  of  the  simplest.  The  vein  is 
laid  bare  and  an  opening  made  in  it  for  the  point  of  the 
canula.  This  canula  is  connected  with  the  reservoir  con- 
taining the  serum  by  means  of  a  tube.  Care  should  be 
taken  to  exclude  all  air  and  to  properly  sterilise  the  instru- 
ments. If  at  any  moment  blood  flowed  back  into  the 
canula,  because  the  reservoir  was  not  held  suflSciently  high 
(three  feet),  it  might  coagulate,  and  the  danger  of  inject- 
ing a  clot  would  be  very  great.  In  such  a  case  the  instru- 
ment should  be  withdrawn  and  all  the  blood  emptied  and 
then  replaced. 

A  Lemon  as  a  Pbssaby  ! 

At  the  Medical  Society  of  Lyons  a  member  produced  a 
lemon  which  a  woman  had  employed  as  a  pessary  for 
prolapse  of  che  womb.  This  enterprising  lady  had  been  in 
the  habit  of  utilising  this  fruit  for  this  purpose  for  many 
years,  alleging  that  she  preferred  it  to  every  kind  of 
pessary. 


(SermattB. 


[from  our  own  oorbbspondsnt.] 


Bkrlih,  May  Ut 
Thx  Sebum  Poisoning  Case. 
The  details  of  the  unfortunate  issue  from  injecting  diph- 
theria curative  serum  for  prophylactic  purposes  by  Prof. 
Langerhans  have  now  been  made  the  subject  of   legal 
inquiry.    It  will  be  remembered  that  Prof.  Langerhans 


injected  the  serum  into  his  own  child,  a  boy  a  year  and 
nine  months  old,  and  the  child  died  immediately.  The 
announcement  of  the  death  was  made  by  the  profeeaor 
himself,  and  was  to  the  effect  that  the  child  who  was  in  the 
"most  blooming  health  'died'  in  consequence  of  the 
injection  of  Behring's  curative  serum  for  immunisation.' 
Prof.  Langerhans  is  a  pathological  anatomist  of  note.  He 
was  assistant  to  Prof.  Virchow  for  years,  and  is  now  Pro- 
sector at  the  Moabit  City  Hospital  He  comes  from  a 
family  of  medical  men,  and  is  married  to  a  daughter  of 
Prof,  (rerhardt.  A  year  ago  he  had  the  misfortune  to  lose 
two  children  from  diphtheria.  This  Easter  a  servant  maid 
suffered  from  a  dubious  kind  of  sore  throat,  which  he 
thought  was  diphtheria,  and  the  girl  was  sent 
to  hospital.  There  his  colleagues.  Prof.  Benvers 
and  Prof.  Ooldscheider  advised  him  to  inject  his 
remaining  child  with  immunising  serum  for  the 
sake  of  protecting  hinL  He  procured  a  flask  of  the  serum 
from  the  dispensary  of  the  hospital  and  gave  the  injection, 
notwithstanding  the  objections  of  his  wife.  Within  five 
minutes  the  child  was  a  corpse.  The  father  sealed  up  the 
flask  and  forwarded  it  along  with  an  announcement  of 
the  disaster  to  the  authorities.  The  obduction  took  place 
in  due  course  in  the  presence  of  the  father  and  of  a 
ministerialrath  from  the  medioal  department  of  Cultus- 
ministerium.  Nothing  was  discovered  to  indicate  the 
cause  of  death,  but  the  chemical  examination  is  not  yet 
completed.  A  special  examination  of  the  blood  and  of 
the  individual  parts  as  well  as  of  the  serum  employed  has 
yet  to  be  made.  The  obduction  showed,  however,  that 
the  child  was  perfectly  healthy.  It  also  showed  that  the 
injection  was  properly  performed,  and  that  the  perforation 
of  the  needle  did  not  pass  into  the  abdominal  cavity  and 
that  neither  veins  nor  lymph  vessels  were  injured.  Neither 
was  there  any  embolism  nor  air  in  the  chambers  of  the 
heart.  The  only  possible  cause  of  death  then  was  the 
serum  itself.  In  regard  to  this  certain  possibilities 
present  themselves.  The  serum  may  have  been  impure 
originally,  or  decomposition  may  have  set  in,  and  a 
further  examination  may  throw  some  light  on  these 
points.  The  facts  show  that  the  serum  is  not  the  harm- 
less material  it  has  been  said  to  be,  but,  at  the  same  time, 
the  overwhelming  clinical  evidence  in  its  favour  shows 
that  its  usefulness  far  outweighs  the  dangers  that  may  lie 
in  it.  When  used  for  preventive  [purposes,  at  least,  it 
appears  highly  desirable  that  we  should  have  some  means 
of  testing  the  harmlessness  of  any  particular  sample 
before  employing  it  on  the  human  subject. 

At  the  Congress  of  Innere  Medizin  a  discussion  took 
place  on 

The  Value  op  the  Medicinal  Antiptbetics. 

The  discussion  was  introduced  by  Prof.  Kast,  of  Bros- 
lau,  and  Prof.  Bins,  of  Bonn.  The  conclusions  reached  by 
Prof.  Kast  were  that  in  infective  fevers  the  essential 
dangers  did  not  lie  in  the  pyrexia.  In  rare  cases  life 
might  be  threatened  by  high  temperature.  A  certain 
degree  of  febrile  consumption  was  induced  by  increased 
tissue  change,  combined  with  the  dyspepsia  associated 
with  it. 

In  functional  disturbances,  especially  those  of  the  ner- 
vous system,  which  were  heightened  by  high  temperatures, 
cool  bathing  was  by  far  the  beet  means  of  relief.  In  cer- 
tain cases  the  effect  of  the  bath  might  be  increased  by  a 
dose  of  quinine.  Except  this  drug,  which  occupied  a 
place  by  itself,  the  medicinal  antipyretics  simply  possessed 
the  value  of  symptomatic  nervines,  which  from  time  to 


Mat  6,  1896. 


AUSTRIA. 


Tmi  Mkdioal  Pbiss    479 


time,  given  in  moderate  doses,  removed  symptoms.  The 
older  remedies,  aDtipyrin  and  phenacetin,  in  this  respect, 
had  not  undergone  any  improvement  through  modem 
combinations. 

Prof.  Binz  then  discussed  the  individual  antipyretics, 
quinia,  salicylic  acid,  antipyrin,  antifebrin,  phenacetin, 
thiUine,  and  alcohol.  In  his  opinion,  quinine  still  con- 
tinued to  be  the  most  important  antipyretic.  Experiment 
and  observation  had  shown  that  antipyrin  produced  its 
effect  by  its  action  on  the  heat -regulating  centre,  on  the 
brain,  that  it  was,  therefore,  a  symptomatic  antipyretic, 
thus  acting  differently  from  quinine,  and,  to  some  extent, 
from  salicylic  acid. 

Antifebrin  and  phenacetin  acted  in  the  same  way.  In 
them  also  the  soothing  influence  on  the  nerves  was 
marked.  With  thallin  it  was  different.  It  had  a  para- 
lysing effect  on  the  various  micro  organisms.  It  was  but 
little  used  however. 

As  regards  alcohol,  up  to  1869,  it  was  generally  believed 
to  raise  temperatura    It  was  therefore  discountenanced 
in  fevers,  and  on  the  Rhine  a  physician  was  denounced  to 
the  authorities  because  he  had  given  champagne  to  a 
typhoid  patient.    He  had  succeeded  in  showing  that  any 
temperature  change  produced  in  warm-blooded  animals 
by  alcohol  was  in  the  reduction  of  temperature.    Kow-a- 
days,  there  was  no  longer  any  doubt  as  to  the  correctness 
of  this  view.    He  showed  the  temperature  chart  of  two 
dogs  of  the  same  litter  that  had  been  inoculated  with 
typhoid  fever.    Absolu^^e  alcohol  diluted  with  water  had 
several  times  been  injected  into  the  stomach  of  the  one, 
but  not  of  the  other.    The  one  that  received  the  injection 
recovered,  the  other  died.    He  had  received  further  con- 
firmation   of    this   temperature-reducing    property    in 
puerperal  fever,    when  large  doses  of  alcohol    reduced 
the    fever.     Runge,    of   Gdttingen,    said  the  resisting 
power    of     the     organism    was    immensely    increased 
by     alcohol     associated     with     baths,     and     Ahlfeld, 
of    Marburg,    also     recommended    wine    in    puerperal 
fever.    The  quantity  given,  however,  must  be  large.  The 
quantity  required  for  a  woman  when  reckoned  in  propor- 
tion to  the  body  weight,  as  when  given  to  the  dog,  would 
be  50  grms.  per  dose  or  a  little  over  12  drachms.    Alcohol 
could  act  as  an  antipyretic  without,  under  certain  circum- 
stances, the  heart  or  brain  taking  part  in  the  action. 
Cardiac  stimulation  might,  however,  contribute  to  the 
fall  of  the    temperature.     In  putrid  fevers  the  heart's 
action  was  scarcely  perceptible  ;  the  pulse  was  thin  and 
thready,  the  blood  remained  in  the  deeper  seated  organs 
and  did  not  get  to  the  periphery  to  be  cooled.    As  soon, 
however,  as  the  cardiac  activity  was  increased,  the  peri- 
pheral circulation  improved  and  the  blood  was  unburdened 
of  some  of  its  heat.    This,  however,  was  not  sufficient  to 
explain  such  a  sudden  fall  as  was  sometimes  seen.    Then 
the  antiseptic  property  of  alcohol  per  m  was  to  be  con- 
sidered  as  seen  in  the  preservation  of  anatomical  prepara- 
tions. It  did  not  act  by  withdrawal  of  water  as  some  thought, 
but  simply  through  its  germicidal  properties.    In  putrid 
fevers  such  a  direct  germicidal  action  might  be  assumed, 
and  so  much  the  more  as  when  dogs  had  been  brought 
into  a  febrile  state  artificially  the  post-mortem  rise  of 
temperature  that  came  on  after  the  heart  and  nerves  bad 
long  ceased  to  act,  could  be  completely  prevented  by 
alcohol  and  quinine.    It  might  finally  be  accepted  as  clear 
that  fever-exciting  tozines  could  be  more  quickly  got  rid 
of  by  exciting  diuresis.    By  experiment  on  an  iadividnal 


it  was  found  that  after  taking  a  litre  of  water  385  ccm.  of 
urine  were  passed  in  five  hours,  but  after  drinking  a  litre 
of  Hungarian  wine,  1,600  ccm.  were  passed.  It  was 
shown  farther  that  the  diuresis  was  excited  to  the  highest 
degree  when  large  quantities  of  water  were  taken  along 
with  the  alcohol. 


[fbom  cub  owk  oobbbspondbvv.] 

VnVHA,  April  80th,  IBM. 
Pbbisinus  Absoess  with  Ptjemia. 
Ds.  Kaufman N  exhibited  a  girl,  set.  12,  who  had  suffered 
from  pain  in  the  ears  for  a  year.  On  January  22nd  she 
had  a  rigor  which  lasted  half  an  hour,  and  was  repeated 
several  times  during  the  next  two  days,  when  she  began 
to  vomit,  and  rapidly  became  insensible. 

On  the  25th  she  was.  brought  to  Prof.  Politsser's  clinic 
complaining  of  great  pain  in  head,  vertigo,  and  vomiting, 
with  intervals  of  somnolence  and  a  temperature  of  38 '5" 
(  =  101  '3^  Fahr.).  All  the  internal  organs  were  healthy  ; 
right  ear  sound.  The  left  ear  was  filled  with  a  thick 
offensive-smelling,  purulent  discharge.  The  state  of  the 
middle  ear  could  not  be  determined.  The  soft  parts 
around  the  mastoid  process  were  normal,  although  there 
was  tenderness  on  pressure. 

The  radical  operation  was  at  once  decided  upon,  and 
the  mastoid  process  opened.  Not  far  from  the  surface 
dark  coloured  gangrenous  masses  of  cholesteatoma  were 
met  with,  but  no  ossicule  were  to  be  seen.  The  lateral 
sin  as  was  next  laid  open,  from  which  thick  bloody 
purulent  matter  escaped.  The  whole  was  cleansed  and 
dressed  with  iodoform  gauze.  The  next  day  the  tem- 
perature was  37'9°c ,  and  no  rigors,  after  which  the  patient 
speedily  recovered. 

Abnormal  Position  op  Eustachian  Orificis. 
Gonprez  showed  a  patient,  et.  23,  with  a  congenita 
abnormality  in  the  position  of  the  orifices  of  the  Eustachian 
tubes  which  were  placed  in  the  upper  part  of  the  pharynx, 
and  rising  in  a  round  swelling  from  the  surface  of  the 
mucous  membrane  about  3  or  4  millimetres.  There  was  no 
history  of  syphilis. 
Dkfbots  in  the  Outer  Wall  of  thb  Middle  Ear. 
Politzer  read  a  paper  on  the  total  destruction  of  the 
membranee  shrapnelli  which  led  to  inflammation  of  the 
middle  ear,  and  consequently  denudation  of  the  bony 
structure  by  the  deprivation  of  nutrition  in  the  periosteum. 
This  mischievous  result  produced  a  thinning  of  the  margo- 
tympanum,  although  the  upper  parts  of  the  attic  wall  were 
often  found  thickened,  with  the  vessels  enlarged  and  the 
hearing  preserved.  Walb  is  inclined  to  believe  that  the  pri- 
mary cause  is  a  purulent  ostitis  of  the  margo-tympanum, 
which  causes  inflammation  of  the  attic,  and  subsequent 
caries  of  the  bony  structure.  Politzer  is  in  favour  of  the 
view  of  the  denudation  commencing  in  the  incisura  rivini 
with  a  purulent  discharge,  from  which  the  saprophytic  cocci 
pass  into  the  bony  structure,  and  ultimately  destroy  the 
tissue.  The  longer  this  discharge  continues  the  more 
bone  is  destroyed  and  the  osseous  defect  made  the 
greater  in  the  wall  of  the  attic.  At  this  point  he  showed 
a  large  number  of  preparations  to  demonstrate  his  own 
views.  In  the  discussion  that  followed  Prof.  Gruber 
expressed  a  similar  opinion  of  the  ectasia  prodnoed  in  the 
temporal  bone. 


Mat»  6  1896. 


THE  OPERATINO  THEATRES. 


Tmi  Mbdioal 


480 


Pbostatio  Hypkbtbofht. 
At  the  GeselliichAft  der  Aerzte,  Prof.  FriBoh  ihowed  a 
man,  set.  68,  who  had  formerly  complained  of  proatatic 
hypertrophy  and  extenaive  dilatation  of  the  bladder.  On 
reflecting  over  the  sacceas  of  Profa.  Eni^liaoh  and  Leittel 
on  the  removal  of  the  teetea  or  the  tying  of  the  vaa 
deferena  in  the  treatment  of  hypertrophy  of  the  proatate 
Friach  reaolved  on  the  tying  of  vaa  deferena,  and  haa  ao  aac- 
ueeded  in  improving  hia  patient,  that  inatead  of  nrinating 
forty  timea  in  the  day,  and  aa  often  daring  the  night,  he  ia 
now  able  to  retain  that  accretion  for  two  hoara  or  even 
more  at  a  time.  The  total  amount  of  urine  paaaed  daring 
the  twenty-four  houra  before  the  operation  waa  2,400  grma. , 
which  haa  now  aunk  aince  the  operation  to  the  normal 
amount.  Friach  conaidera  the  reault  of  the  operation  a 
perfect  eucceaa  in  the  treatment  of  proatatic  enlargement. 


[from  an  occasional  oobbvbpondknt.] 

ST.  PXTlBSBUaO,  April  80th,  1806. 

Malabia  in  Man  and  Animals. 

Danilbwski,  who  haa  recently  been  engaged  in  the 
microacopic  examination  of  the  cytozoa,  endeavoura  to 
eatablieh  an  identity  between  the  malaria  of  man  and  a 
aimilar  affection  met  with  in  animala.  Theae  cytozoa 
belong  to  a  group  of  faaemoapoaidia,  and  are  ana- 
logoua  to  hflsmatozoa  aporozoica  of  the  fiah,  amphibia 
and  reptile.  The  cytozoa  ia  pathogenic  of  malaria 
in  birda  and  oorreaponda  in  every  detail  to  that  met 
with  in  man.  The  acute  febrile  atage  ia  aaaociated 
with  aporulating  intercellular  microbee  or  *'  cytoaporon  " 
aa  he  prefera  to  deeignate  the  morbid  organiam.  In  the 
chronic  atage  of  the  diaeaae  the  bird  aeema  perfectly 
healthy,  but  if  the  blood  be  examined  the  vermiculate 
parasite  will  be  found  analogoua  to  Lareran'a  creacentic  or 
half-moon  bodiea  met  with  in  man  during  the  interval  of 
malarial  fever.  Again,  if  a  amall  quantity  of  the  blood  be 
examined  after  it  haa  been  drawn  a  few  minutea,  a  long 
whipcord-like  body  will  be  obaerved  withdrawing  itaelf 
from  the  hsemocytea  in  what  he  terma  the  "polimitua." 
After  ita  extrusion  from  the  hsamatic  cell  the  cord-like 
body  burat  the  polimitua  and  darta  about  in  the  plaema 
for  20  or  30  minutea  more  aa  paendo-oapirilla  while  the 
polimitua  degeneratea.  He  finda  aU  theae  cytozoa  aaaoci- 
ated with  a  retrogreaaive  and  melanic  condition  of  the 
hemoglobin.  Although  theae  metamorphoaea  are  con- 
atantly  accompanied  with  Laveran'a  creacentic  or  half- 
moon  bodiea,  the  polimitua  and  paeudoaporon  are  not  ao 
conatantly  met  with.  In  the  blood  of  birda  auffering 
from  the  chronic  form  of  infection  "  leacooy tozoa "  are 
frequently  preaent  in  which  to  the  naked  eye,  the  moving 
polimitua  may  be  noticed. 

In  the  apleen,  liver,  and  bonea,  a  great  number  of 
miorobia  and  melanophagia  may  be  obaerved.  Rapid 
aporalution  of  the  cyatoapora  proportionately  afTect  the 
health  and  periodicity  in  the  eourae  of  the  diaeaae, 
although  the  biological  property  of  the  paraaite  muat  be 
an  active  factor  to  calculate. 

Amyloid  Dxgenebation  op  Livxb. 
Maximow,  in  hia  experimental  biatogeneaea,  finda  that 
doga  and  hena  fed  on  oulturea  of  ataphylocoeoaa  pyogenea 
aureaa  will  produce  amyloid  liver.    Thia  morbid  oonditioii 


ia  produced  by  a  depoaition  of  pathological  albiuoan  in 
the  interatioee  of  the  fibroaa  tiaaae.  Neither  the  liv«r 
cella  nor  fibrona  cella  in  the  amyloid  maaa  are  in  any  wi^ 
changed  or  altered  in  atructure.  The  whole  transfonna* 
tion  ia  confined  to  the  inteatinal  tiaaae,  not  even  affectin|^ 
the  membrana  propria. 


Wxt  (Dptrating  WxtxixtB. 

KING'S  COLLEGE  HOSPITAL. 

NlUBIOTOMT    OP    THl    TbIBD    DIVISION  OP    TRB  FlPTH 

NfeBVB.— Mr.  W.  RoBB  operated  on  a  man,  st.  about  42 
who  had  aafiered  for  many  yeara  from  aevere  paroxysmal 
tic,  for  which  he  had  previooaly  undergone  aeven  opera- 
tiona,  moat  of  them  on  the  peripheral  portiooa  of  Mie  nerve. 
At  the  laat  operation  performed  nearly  two  yeara  ago  Hr. 
Oarleaa  had  divided  the  aeoond  diviaion  of  tbe  nerve  at  the 
foramen  rotundum  ;  from  thia  operation  the  patient  gained 
ten  montha  immunity  from  pain,  which,  however,  baa 
aince  recurred  with  all  ita  old  aeverity,  apeoially  along  the 
auricnlo-temporal  branch.  The  movementa  of  the  jaw 
have  alao  remained  oonaiderably  impaired.  Mr.  Roee 
therefore  determined  to  divide  the  third  diviaion  of  the 
fifth  at  ita  exit  from  the  foramen  ovale.  An  inoiaion  was 
made  according  to  hia  uaual  plan,  elliptical  in  ahape, 
atarting  from  a  little  in  front  of  the  tragua,  and  paaeing 
downwarda  and  backwarda  to  the  angle  of  the  jaw,  and  then 
forwarda  along  the  maxillary  border  for  about  two  inohee- 
The  flap  thoa  marked  oat  waa  diaaeoted  forwarda  and  tem* 
porarily  atitched  to  the  cheek  doae  to  the  noae,  the  raw 
aurface  being  protected  by  a  piece  of  wet  cyanide  gaaie. 
The  outer  aurface  of  the  lower  jaw  waa  next  exposed  by  a 
tranaverae  inciaion  through  the  maaaeter  just  below  the 
aocia  parotidia.  Inatead  of  deepening  the  aigmoid 
notch,  aa  nauaUy  done  by  Mr.  Victor  Horaley,  Mr. 
Roae  aawed  completely  through  the  bone  on  a  level 
with  the  dental  foramen  and  removed  the  upper  portion 
including  the  condyle,  the  coronoid  proceaa  having  been 
removed  at  the  laat  operation.  By  thia  meana  it  was 
hoped  that  the  ankyloaed  condition  of  the  jaw  would  be 
remedied.  A  good  deal  of  hemorrhage  followed,  but  wae 
commanded  to  a  large  extent  by  the  application  of  a  liga- 
ture to  the  internal  maxillary  artery,  which  at  thia  point 
waa  diatinctly  aeen.  Some  of  the  fibrea  of  the  external 
pterygoid  muacle  were  now  taken  away,  and  the  lingual 
and  dental  nervea  aought  for  between  it  and  the  internal 
pterygoid.  Having  found  the  nervea,  he  twisted  them 
from  their  diatal  connectiona  by  what  ia  known 
aa  Thierach'a  method,  removing,  in  the  caae  of 
the  lingnal,  a  length  of  not  leaa  than  two  and 
a  quarter  inchea.  The  proximal  enda  of  the  nerves 
were  traoed  down  to  the  base  of  the  akull 
and  divided.  The  wound  waa  then  doaed  by  the 
flap  being  atitched  down  in  poaition.  Mr.  Rose  remarked 
that  he  thought  it  only  right  before  prooeeding  to  the 
major  operation  of  removal  of  the  Gaeaerian  ganglion  to 
aee  what  efiect  would  be  produced  by  a  thorough  neurec- 
tomy of  the  third  diviaion.  Should  the  pain  recur,  no 
other  eourae  would  be  open  but  removal  of  the  ganglion. 

It  ia  aatiafactory  to  atate  that  the  patient  haa  made  an 
excellent  recovery,  the  wound  healing  by  firat  intention  ; 
the  pain  haa  quite  diaappeared,  and  the  movements  of  the 
jaw  are  much  improved. 

MIDDLESEX  HOSPITAL. 

NBPHBO-LnHovoMT^nf  ▲  supposBD  Hbbmaphbodrb.— 


Mat  6,  1890. 


LEADIUa  ARTICLES. 


Thb  Mbdioal  Pbibs.     481 


Mr.  Andbbw  Glabk  operated  on  an  individual,  wfc.  26, 
who  bad  been  admitted  into  hia  female  ward  baTing  had 
•qppreiaion  of  urine  for  forty-eight  hours.    The  history 
the  patient  (^ave  was  that  two  years  before  an  operation 
h^  been  performed  on  the  right  kidney  and  a  stone 
removed  by  the  late  Mr.  J.  W.  Hulke,  and  the  patient 
stated  that  from  that  time  she  was  informed  that  the  right 
kidney  would  be  subsequently  useless;  she  then  bad  a 
tedious  convalescence,  but  went  out  of  the  hospital  prac- 
tically well,  and  remained  so,  working  as  a  laundress  until 
a  short  time  before  the  present  admission,    when  she 
began  to  feel  ill,  had  a  good  deal  of  pain  in  her  left  side, 
and   passed    several  fragments  of   calculus  ;   the   sym- 
ptoms  got   worse  and    worse,  and  the  urine  suddenly 
ceased  to  flow  ;  none  having  passed  for  forty-eight  hours, 
ahe  deemed  it  advisable  to  return  to  the  hospital.    On  ad- 
miesion,  Mr.  Clark,  finding  the  case  urgent,  there  being 
t«i|demess  and  swelling  in  the  left  loin  with  the  history  of 
complete  suppression,  determined  at  once  to  explore  the 
kidney.    The  patient  being  perfectly  willing,  an  anasi- 
tbetio  was  given,  she  was  placed  on  her  right  side  and  the 
nenal  incision  made  in  the  loin  to  expose  the  kidney  ;   it 
was  found  to  be  enlarged  but  beyond  this  nothing  abnor- 
mal could  be  detected.    An  incision  was,  therefore,  made 
in  the  convex  border,  the  left  forefinger  introduced,  and 
several  pieces  of  calculous  material  extracted  ;  on  further 
exploration,  which  was  then  deemed   necessary   as   the 
amount  removed  was  not  sufficient  to  account  for  the  block- 
ing of  the  ureter,  a  calculus  about  the  size  of  the  top  of  the 
finger  was  found  in  the  pelvis  blocking  up  the  ureter ; 
this  stone  was  removed  and  proved  to  be  uric  acid.    The 
kidney  was  then  thoroughly  flushed,  and  several  small 
fragments  came  away.     The  wound  in  the  organ   was 
dosed  by  two  catgut  sutures,  these  effectually  stopped  the 
bleeding,  which  had    been   considerable.    The  external 
wound  was  then  closed  in  the  ordinary  way,  a  drainage 
tube  being  employed. 

It  is  reported  that  the  next  morning  the  patient  was  in 
a  fairly  comfortable  condition,  having  passed  a  fair  nig^t, 
but  was  troubled  with  frequent  attacks  of  sickness  ;  she 
had  passed  since  the  operation  a  considerable  amount  of 
bloody  urine  by  the  urethra.  The  wound  looked  healthy, 
and  there  being  no  discharge  from  it,  the  drainage-tube 
was  removed.  The  next  day  the  urine  was  free  from 
blood,  and  with  the  exception  of  the  continued  sickness  the 
patient  was  in  a  satisfactory  state.  Subsequently,  she,  how- 
ever, succumbed  to  exhaustion,  the  result  of  the  continuous 
and  intractable  sickness,  a  result  the  more  to  be  deplored 
as  the  operation  had  been  evidently  successful  in  relieving 
the  condition  which  was  the  cause  of  her  illness. 

It  is  remarkable  about  this  case  that  although  brought  up 
as  a  woman  the  individual  was  discovered  after  death  to  be 
without  doubt  a  male  with  very  marked  hypospadias.  The 
penis  was  very  rudimentary,  the  right  testicle  was  in 
what  appeared  to  be  the  right  labium,  and  bad  been 
believed  by  the  patient  to  be  a  hernia,  the  left  testicle  was 
in  the  inguinal  canal,  there  was  a  rudimentary  prostate, 
and  no  sign  of  a  uterus.  There  was  no  hair  on  the  face, 
but  the  breasts  were  those  of  a  male. 


JUeUEUUn)  FOB  TSAaSMIBSIOfl  ABBOAO. 

%ht  JRebkal  fxzBB  anb  Cirrttlar. 

Pobllihad  every  Wednesday  moming,  Frioe  6d.    Post  tree,  ft^d. 
ADVEBTISBMSHTS. 

f  OB  OBB IBBBBXIOB :— Wbole  Pase,  A6  Oi.  Od. ;  Balf  Page,  M  10s.  Od. 
Qaarter  Page,  £1  6s. ;  One-elghtti,  Its.  Sd. 

FOB  A  Bbbibs  or  Ibbbbiiovs  :— whole  Page,  thirteen  Insertloni 
(weekly,  fortnightly,  or  monthly)  at  «S  lOi.  Od. ;  twenty-iiz  laser* 
tlona  (weekly  or  fortnightly)  at  «S  M.  Od. ;  flfty-two  Ineertlons 
(weekly)  at  £8  each.  Half-page,  thirteen  Ineertloiif  at  86e.; 
twenty-slz  at  8Se. ;  flfty-two  taiaertloiif  at  SOt.  each.  Qaartei^page, 
thirteen  Insertions  at  Ui. ;  twenty-ilx  IneertloDS  at  lOe. ;  fltty-elz 
Iniertlone  at  Ifie.  eaoh 

Small  Annonncementi  of  Praotlees,  AMleUnolet.  VeoaDdee,  Bc(k 
Ac.— Seven  Unee  or  under,  4e  per  Insertion ;  6d.  per  line  beyood 

tettere  In  this  department  ehonld  be  addreeied  to  the  Pnbllahet* 

SUBSOBIPTIOVB. 

PO0f  Tan  TO  ABBUAL  SUBBOBXBBBS       .         .  41    1    0 

,,         abboad.  withib  tbb  Posxal  Ubiob      Ml  Z  9 

„  IBDIA,  CHIBA,  ABD  JAPAB  .  .      Al    f    6 

Foet-oiloe  Orders  and  Oheqnee  to  be  drawn  In  favour  of— 

A.  A.  TIBDALL,  20-21  King  William  Street,  Strand,  London. 
A.  H.  JACOB,  80  Molenrorth  Street,  Dublin. 

BirBSOBiPTiOBS  BOB  Fbabob  are  received  by  Meeers.  BAniLTBBB,  Bae 
Hantef enllle,  Parle— post  free  In  advance,  £1  M.  Od.  per  annum. 

SUBSOBiPTiOBS  BOB  THB  Ubitbd  Statbb,  post  free  In  advance 
(£1  8l  6d.  per  annum),  should  be  eent  direct  to  the  Offlcee  In 
this  countey  by  International  Post  Office  Order. 

8oU  AgwUi  for  Oermtmy  and  Auitro-Hungmry— 
W.  A  S.  LOWBBTHAL  (Office  of  the  BerHner  Aoretilmck), 
i,  Berlin. 


%llt  P^Mal  §n88  ^  ^ittixhx. 


The  Mortality  of  Foreign  Cities. 
Thb  annual  death-rate  per  1,000  m  the  principal  foreign 
eities  according  to  the  weekly  returns  communicated  to 
the  Registrar-Goneral,  is  as  follows : —  Bombay  39,  Madras 
32,  Paris  21,  Brussels  19,  Amsterdam  20,  Rotterdam  19, 
The  Hague  16,  Ck}penhagen  15,  Stockholm  19.  Ghristiania 
19,  St.  Petersburg  37,  Mosoow  39,  BerllQ  16,  Hambnsg  18. 


*8ALU8  POPULI  8UPREMA  LEX.'' 


WEDNESDAY,  MAY  6,  1896. 


LADY    DOCTORS    AND    PROFESSIONAL 
ETIQUETTE. 

Of  late  years,  a  large  number  of  legally  qualified 
women  have  been  added  to  the  already  crowded  ranks 
of  the  army  of  medical  practitioners.  About  their 
presence  we  make  no  complaint,  for  the  invasion  is 
part  of  a  new  departure  that  appears  to  be  the  inevi- 
table outcome  of  a  progressive  social  evolution. 
Among  the  determining  forces  that  are  so  busily  at 
work  in  sweeping  away  the  sexual  disabilities  under 
which  women  have  laboured  in  the  past  are  the  general 
spread  of  education,  the  normal  excess  of  the  female 
population ;  the  rising  proportionate  value  ot  brain 
over  muscle,  and  the  ever  increasing  hurry  and  stress 
demanded  in  the  struggle  for  existence.  To  examine 
the  problem  fully,  however,  would  require  the  analyti- 
cal methods  and  training  of  a  Herbert  Spencer,  and 
would,  after  all,  in  no  wise  affect  the  result  which  is 
before  our  eyes.  The  problem  of  the  moment  is,  now  that 
the  lady  doctors  have  entered  the  lists  of  professional 
competition,  how  are  they  going  to  behave  themselves. 
A  correspondent  suggested  this  question  in  a  letter 
published  some  weeks  since  in  Thb  Medical  Pbess 
AND  CiBCULAB.  In  that  communication  he  drew 
attention  to  some  flagrant  instances  of  personal  touting 
on  the  part  of  medical  women.    One  definite  statement 


^2     Ths  Medioal  Pbi86. 


•LEADING  ARTICLES. 


Mat  6, 1896. 


was  that  a  stranger  called  on  one  of  his  own  patients 
and  tendered  her  services  as  medical  attendant.  Oar 
correspondent  has  since  assured  us  that  he  is  prepared 
to  furnish  definite  proofs  of  the  occurrence  as  reported, 
and,  that  being  so,  it  is  at  once  evident  that  such  a  state 
of  affairs  cannot  be  for  a  moment  tolerated.  Other 
instances  of  gross  neglect  of  the  ordinary  rules  that 
guide  professional  life  are  not  wanting  on  the  part  of 
female  practitioners,  and  in  at  least  one  case  the  name 
of  the  offender  has  been  erased  from  the  Register.  Now, 
we  have  not  the  least  wish  or  intention  to  be  severe  in  our 
censures  upon  the  "  lady  medicals."  On  the  contrary, 
we  have  always  consistently  championed  their  cause 
from  a  time  when  their  friends  were  few  and  far 
between.  At  the  same  time,  we  think  it  best  to  speak 
out  plainly  on  the  point,  and  to  give  this  newly  fledged 
class  of  practitioners  to  understand  once  and  for  all 
that  they  will  have  to  submit  to  the  same  rules,  written 
and  unwritten,  that  have  hitherto  guided  the  profes- 
sion whose  portals  they  have  been  permitted  to  enter. 
As  everyone  knows,  there  are,  unfortunately,  plenty 
of  black  sheep  among  the  men,  but  the  danger  they 
incur  in  transgressing  professional  rules  is  writ  large  in 
the  annals  of  the  General  Medical  Council.  Such 
lapses,  however,  it  is  hardly  necessary  to  point  out,  do 
not  in  the  least  justify  the  offences  of  others.  It  would 
be  a  thousand  pities  if  women  who  have  gained  the 
right  to  a  place  in  the  medical  world  after  a  long  and 
arduous  struggle  were  to  sully  their  laurels  by  stooping 
to  such  dishonourable  methods  as,  say,  the  door-to- 
door  touting  for  practice  mentioned  by  our  corre- 
spondent. If  such  a  step  has  been  adopted  under  the 
pressure  of  absolute  penury,  then  it  may  be  concluded 
that  a  mistake  has  been  made  in  such  instances  in 
entering  the  medical  profession.  It  seems  a  fairly  self- 
evident  fact,  and  one  that  cannot  be  too  strongly  im- 
pressed on  parents  and  guardians,  that  it  is  inad- 
visable for  anyone  to  hope  to  gain  a  living  by 
medicine  who  cannot  command  the  necessary 
means  either  to  purchase  a  practice  or  to  tide 
over  the  first  years  of  waiting.  In  offering 
these  remarks  we  hope  that  they  will  not  be  misunder- 
stood by  those  to  whom  they  are  addressed.  In  their 
own  interests  it  will  be  wise  for  medical  women  to 
formulate  and  insist  upon  a  code  of  rules  for  their  own 
guidance.  It  may  be  well  to  remind  them  that  although 
they  have  stormed  many  medical  strongholds,  yet  other 
important  conquests  still  await  their  energies,  and  the 
day  of  success  will  not  be  hastened  by  affording  the 
enemy  a  vantage  ground  of  attack. 


IS  BICYCLIxVG  HARMFUL  FOR  GIRLS  ? 
Whenever  any  pastime  reaches  the  stage  of  an 
infatuation,  as  it  were,  among  the  community,  there 
are  always  some  persons  to  be  found  who  make  it 
their  business  to  issue  solemn  warnings  respecting  the 
harm  which  will  certainly  arise  therefrom.  This  fact 
has  been  abundantly  proved  in  the  present  craze  of 
bicycling,  especially  so  far  as  women  are  concerned. 
At  first  the  most  direful  evils  were  prognosticated, 


relating  to  the  unnatural  sexual  gratification,  with 
which,  it  was  pointed  out,  cycling  among  women  could 
only  result.  The  more  timid  advisers  to  whom  the 
question  was  referred  were  doubtless  disposed  to 
admit  the  possibility  of  such  a  contingency,  and  thus 
joined  in  the  opposition  against  sanctioning  the 
pastime  for  girls  and  women.  But  fortunately  this 
myth  was  soon  dispelled,  not  the  slightest  evidence 
could  be  produced  favouring  any  such  suggestion.  The 
physical  impossibility  of  it  became  at  once  apparent  to 
anyone  who  took  the  trouble  to  reflect  upon  the  matter, 
and  thus  nothing  is  ever  said  now  in  respect  to  it  But 
a  new  objection  has  been  raised.  At  first  it  was  the 
clitoris  which  was  in  danger,  but  now  the  warning  baa 
been  issued  in  regard  to  the  pelvis.  According  to  an 
American  obstetrician,  the  plastic  pelvis  of  the  growing 
girl  runs  a  considerable  risk  of  becoming  flattened  by 
bicycle  riding.  This  pelvic  deformity,  he  asserts,  is 
more  common  than  any  other  in  Europe  and  America, 
and  young  girls  by  poising  themselves  upon  the  narrow 
saddles  of  their  machines  so'  press  upon  the  ischial 
tuberosities  upwards  and  inwards,  that  the  deformity 
is  increased.  The  main  features,  however,  of  the 
attack  upon  bicycling  are  included  in  the  following 
quotation  :— '*  As  in  our  climate  the  bicycle  is  used 
nine  months  in  the  year,  and  as  the  modern  girl  walks 
less  and  less,  while  more  abundant  nutrition,  both 
intellectual  and  animal,  is  supplied,  increasing  the  size 
of  the  foetal  skull,her  prospects  for  instrumental  delivery, 
symphysiotomy  and  celiotomy  increase.  It  is  yet  too 
early  to  verify  this  prediction,  but  for  years  the  very  large 
increase  in  the  number  of  cases  in  which  the  forceps  has 
been  used  by  the  masters  in  obstetrics  demonstrates 
the  evil  effects  of  the  lack  of  walking.  When  Nature 
increases  the  size  of  the  foetal  head  it  increases  the 
capacity  of  the  mother's  pelvis,  but  such  increase  may 
be  frustrated  by  art.  Through  laziness  man  is  said  to 
have  worn  his  tail  off  by  much  sitting,  and  through 
the  fashion  of  not  walking  woman  will  add  to  the 
inconveniences,  if  not  the  impossibilities,  of  natural 
labour.  For  centuries  the  horse  has  been  utUised,  but 
both  the  teaching  of  anatomy  and  of  propriety  has 
prohibited  the  woman  from  bestriding  his  soft  back. 
The  fact  is  that  the  straddling  attitude  is  unnatural  in 
man  and  only  became  popular  through  the  chase  and 
through  war,  and  surgical  injuries  are  sufficiently 
common  on  account  of  such  attitude.  The  parts 
traversing  the  male  perinseum  are  sensitive  and  im- 
portant and  lie  superficially.  But  they  are  slightly 
protected  from  pressure  by  broad  and  comparatively 
long  ischial  tuberosities  which  are  near  togeth&r.  In 
addition  the  perinseum  of  the  male  is  moderately  pro- 
tected by  hair.  In  the  female  perinseum  the  tuberosi- 
ties are  smaller,  sharper,  and  under  apart,  and  it  is 
comparatively  without  hair.  As  shown  by  its  tissue, 
physiology  and  function,  the  perinseum  of  woman  is  a 
kind  of  supplemental  uterus.  It  is  padded  with  connec- 
tive tissue,  prolonged  pressure  upon  which  must  cause 
condensation  and  atrophy,  thus  adding  'atrocious' 
pains  to  the  second  stage  of  labour  and  much  liability 
to  rupture."  We  are  disposed  to  regard  the  author  as 
somewhat  transcendental  in    his    ideas ;   moreover. 


Mat  6, 1896. 


^OTES  ON  CUKRENl  tOPICS. 


'twrn  Mbdioal  Prkss.     48o 


much  doubt  may  be  felt  whether  he  is  in  a  position  to 
prove  from  his  own  experience  or  that  of  others  the 
truth  of  the  allegations  which  he  makes.  But  even  if 
it  can  be  substantiated  that  women  add  to  the  penalty 
of  labour  by  indulging  in  cycling,  this,  after  all,  is  a 
small  matter  in  comparison  with  the  health,  enjoy- 
ment and  exercise  which  they  derive  from  the  attractive 
pastime.  It  is  certain  that  thousands  and  thousands 
of  girls  and  women  are  now  in  the  enjoyment  of  better 
health,  in  consequence  of  bicycle  riding,  than  they  have 
ever  known  before  in  their  lives,  and,  so  far,  there  is 
practically  no  direct  or  indirect  evidence  to  show  that 
this  benefit  has  been  obtained  at  any  sacrifice  to  their 
well  being. 


THE  MIDWIVES  REGISTRATION  BILL. 

The  movement  in  opposition  to  this  ill-cooaidered 
measure  is  steadily  gaining  in  scope  and  intensity,  and 
if,  as  prombes  to  be  the  case,  the  stalwart  example  of 
the  Sheffield  practitioners  is  followed  io  other  large 
towns,  its  fate  will  be  sealed.  It  is  indispensable  that 
no  opportunity  be  lost  of  impressing  upon  memb  ers  of 
Parliament  and  upon  the  Government  the  dislike  and 
apprehension  which  this  Bill  excites  among  the  large 
majority  of  practitioners.  The  present  state  of  parlia- 
mentary business  is  such  as  to  render  it  extremely 
improbable  that  the  measure  will  arrive  at  the  stage  of 
discussion,  but  it  would  be  highly  impolitic  on  that 
account  to  allow  silence  to  be  construed  as  acquies- 
cence. Those  members  of  the  profession  who  are  allied 
with  outsiders  in  the  attempt  to  force  this  precious 
legislation  upon  us,  if  numerically  inconsiderablei  are 
influentially  powerful.  They  have,  moreover,  the  advan- 
tage of  unanimity  and  parliamentary  experience,  so 
that  only  the  most  strenuous  and  persistent 
opposition  can  be  relied  upon  to  thwart  their 
aims.  At  the  same  time  the  campaign  is 
one  which  ought  to  be  carried  on  with 
courtesy  and  forbearance.  However  strongly  we  feel 
on  the  subject,  and  however  clearly  we  realise  the 
lasting  and  irremediable  injury  to  professional  interests 
which  must  accrue  from  the  legitimisation  of  a  new 
order  of  unskilled  practitioners  in  midwifery,  we  can- 
not but  recognise  that  the  partizans  of  the  measure 
are  actuated  by  conscientious  motives  and  have  at 
heart  the  best  interests  of  the  parturient  women  of 
this  country.  We  must  admit  our  inability  to  under- 
stand how  trained  minds  can  ignore  the  flagrant  incon- 
sistency of  authorising  unskilled  persons  attending 
women  at  such  a  critical  time,  while  the  practice  of 
dentistry,  for  example,  is  hedged  in  by  numerous 
restrictions,  nor  how  they  get  over  the  fundamental 
difficulty  of  defining  a  natural  labour,  seeing  that  no 
labour  can  be  said  to  be  natural  until  it  has  reached  a 
natural  termination.  It  is  for  the  opposition  to  bring 
forward  an  alternative  measure  which  shall  attain  the 
objects  which  the  others  have  in  view  without  jeopard- 
ising professional  interests,  and  this  is  now  about  to  be 
done. 


^jQtcB  on  Cutrent  ^apkB. 

The  Liverpool  Lying-in  Hospital  Deadlock. 
The  affairs  of  this  institution  appear  to  be  coming 
to  a  crisis.  It  will  be  remembered  that  the  medical 
staff  agreed  to  continue  in  office  under  certain  con- 
ditions, the  most  important  being  that  in  all  things 
medical  the  staff  were  to  be  the  supreme  authority 
The  Committee  replied  to  this  saying  they  were  wish- 
ful to  retain  the  services  of  the  staff  and  that  they 
were  willing  to  make  certain  concessions,  that  the 
medical  officer  in  charge  '*may  pay  occasional  visits 
to  one  or  more  normal  patients  and  make  such 
examinations  as  he  may  consider  necessary  in  order  to 
ascertain  that  his  general  rules  are  thoroughly  under- 
stood and  are  being  efficiently  carried  out ;  but  no  such 
visit  is  to  be  regarded  as  relieving  the  matron-midwife 
from  her  responsibility  or  charge  of  the  case."  '^  That 
under  no  circumstances  are  the  normal  cases  in  the 
hospital  to  be  treated  as  subjects  for  general  observa- 
tion, for  the  purpose  of  compiling  statistics  or  literary 
articles  or  for  instruction  to  students."  To  this  extra- 
ordinary letter  the  medical  staff  made  the  following 
reply,  which  by-the-bye,  is  neither  wanting  in  dignity 
nor  firmness  : — 

To  the  President  of  the  Board  of  Management  Ladies' 
Chanty  and  Lying-in  HoepitaL 

12  Rodney  Street,  Liverpool, 
April  dOth,  1896. 
DxAB  Sib,— A  meeting  of  the  late  medical  staff  was  held 
here  to-day,  and  I  am  instructed  to  send  you  the  following 
unanimous  opinion. 

The  medical  staff  regret  that  they  cannot  accept  any 
other  conditions  than  those  definitely  stated  in  their  letter 
of  April  24th,  to  which  they  must  again  refer  the  Board  of 
Management. 
The  opinions  stated  in  the  letter  of  April  24th  are  final 
Yonrs  faithfully, 

J.  E.  Gemmxll, 

Hon.  Sec.  Med.  Staff. 
Wm.  Bartlett,  Esq. 

After  this  ultimatum  the  Committee  have  one  of 
several  courses  open  to  them.  *  1.  They  may  give  in 
to  the  staff  and  reinstate  them  as  medical  officers 
acting  without  conditions.  2.  They  may  work  the 
institution  without  a  medical  staff,  paying  for  such 
services  as  they  may  require.  3.  They  may  engage  a 
qualified  lady  doctor  who  cannot  any  more  than  the 
others  work  under  the  midwife.  4.  They  may  resign 
in  a  body,  and  hand  over  the  management  of  the  Charity 
to  a  new  Committee,  pledged  to  run  the  institution 
on  common  sense  and  practicable  lines.  We  strongly 
urge  them  to  accept  the  fourth  alternative,  and  if  they 
will  not  do  this  voluntarily,  we  as  strongly  urge  the 
medical  staff  to  compel  Uiem  to  do  it  A  special 
general  meeting  of  the  Liverpool  Medical  Institu- 
tion is  to  be  held  on  Monday  week  in  support  of  the 
medical  staff. 


Medicine  in  Mexico 
Senor  Dr.  Miguel  Mendoza  Lopez,  Professor  of 
GynaBCology  in  the  Medical  School  of  Jalisco,  Guada- 
lajara, Mexico,  has  published  (Boletin  de  Medicina  y 
Cirugia)  a  very  interesting  account  of  the  late  epidemic 
of  influenza  in  his  district    He  kept  notes  of  95  cases, 


4d4     Thb  Medical  Pbmb. 


NOtES  ON  CURRENT  TOPICS. 


Mat  6,  ISH. 


of  which  21  patients  were  men,  39  were  women,  and 
35  were  children  under  seven  years  of  age.  Of  the 
whole  number  treated  27  patients  had  complications 
more  or  less  grave,  and  of  these  6  died,  (a)  The  com- 
plications were  broncho  pneumonia  ;  3  of  these  cases 
occurred  in  men,  with  2  deaths ;  4  cases  in  women, 
with  1  death.  (6)  Pleuro-pneumonia ;  1  case  occurring 
in  a  male  patient,  who  recovered  ;  5  in  women  patients, 
with  2  deaths  ;  and  10  cases  in  children,  with  1  death. 
(Edema  of  the  glottis  attacked  3  patients,  2  men  and  1 
woman,  all  recovered.  The  greatest  difference  of  tem- 
perature, pain,  and  headache  was  found  in  cases  during 
the  epidemic.  In  many  of  the  cases  the  disease  took  on 
an  intermittent  character,  a  marked  access  of  fever  occur- 
ring in  the  evening,  the  temperature  sometimes  rising 
to  40'5^  C.  In  the  morning  the  fever  disappeared  and  the 
patient  felt  free  of  all  pain  and  suffering  until  evening. 
The  usual  symptoms  were  an  intense  frontal  headache 
and  the  dreadful  '*  break-bone"  pain  ;  most  cases  com- 
menced with  a  well-marked  rigor.  When  the  fever 
had  established  itself  it  was  marked  by  profuse  sweat- 
ing, but  in  none  of  the  cases  did  any  sudamina  appear. 
Four  cases  were  ushered  in  by  severe  vomiting.  The 
treatment  consisted  in  giving  two  grammes  of  the 
salicylate  of  soda  every  hour  or  two  hours  until  the 
temperature  fell  and  the  skin  began  to  act,  when 
quinine  in  doses  of  60  centigrammes  was  given.  Some 
cases,  especially  those  who  suffered  from  complications, 
continued  fifteen  days ;  the  milder  attacks  passed  off 
in  eight  to  ten  hours. 

Mr.  Mundella  and  the  Midwives'  Registration 
Bill. 
Ths  members  of  the  profession  of  the  city  and 
district  of  Sheffield  appointed  last  week  a  deputation 
to  wait  upon  Mr.  Mundella  upon  the  subject  of  the 
Midwives'  Registration  Bill,  and  the  conference  took 
place  in  the  Sheffield  School  of  Medicine.  The  depu- 
tation asked  Mr.  Mundella  to  use  his  efforts  against 
allowing  any  hasty  or  ill-considered  legislation  to  take 
place  in  connection  with  such  an  important  subject. 
The  objections  against  the  Bill  were  stated  to  be  (1) 
that  there  was  no  need  for  such  a  measure  on  public 
grounds;  (2)  that  it  would  lead  to  the  r^stra- 
tion  of  a  new  and  inferior  class  of  medical 
practitioners,  and  consequently  be  dangerons  to  the 
welfare  of  the  public ;  (3)  that  the  medical  profession 
being  now  open  to  women  on  the  same  footing  as  to 
men,  they  had  the  same  opportunity  of  practising 
midwifery  as  the  latter.  In  the  course  of  the  proceed- 
ings it  transpired  that  the  deputation  were  prepared 
to  support  a  measure  for  the  registration  of  midwives 
who  should  attend  cases  only  under  the  control  of 
qualified  medical  men  or  medical  women.  Mr.  Mun- 
della, in  reply,  observed  that  he  would  ascertain  the 
position  of  the  Bill,  consult  the  General  Medical 
Council,  and  report  the  result  of  his  inquiries.  He 
however,  expressed  his  conviction  that  the  Bill  had 
practically  no  chance  of  being  proceeded  with  this 
session.  Nevertheless,  although  there  may  be  reasons 
for  believing  that  this  is  the  case,  we  must  urge  upon 
those  who  have  undertaken  to  represent  the  minority 


of  the  profession  against  the  Bill  not  to  relax  their 
efforts  in  carrying  on  the  crusade. 

Dublin  Sanitation. 
Following  the  remarks  which  we  made  last  week 
as  to  the  demands  of  the  Dublin  Sanitary  Association 
for  the  expenditure  of  a  quarter  of  a  million  on  subsoil 
drainage  (which,  it  appears,  is  not  wanted)  and  the 
imposition  of  a  sort  of  sanitary  inquisition  into  the 
condition  of  the  citizen's  house  (which  used  to  be  his 
castle,  but  would  be  so  no  longer),  we  note  that,  so 
far  as  can  be  judged  from  the  mont  recent  return  of 
the  Executive  Medical  Officer  of  Health,  that  for  the 
month  of  March,  Dublin  is  in  a  condition  of  pheno- 
menally robust  health.  The  zymotic  death-rate  was, 
in  that  month,  only  1*1  per  1,000,  which  is  pretty  good 
for  a  large  city,  considering  that  Kingstown,  the 
salubrious  suburb,  is  publicly  boasting  of  10.  The 
total  mortality  for  Dublin  was  the  lowest  on  record  for 
this  quarter.  No  general  conclusion  can  be  derived 
from  the  report  for  one  month,  but,  so  far  as  it  goes,  it 
suggests  that  there  is  no  sufficient  reason  for  spending 
a  quarter  of  a  mQlion  of  money  on  main-drainage, 
subsoil-drainage,  and  private  sewer  drainage. 

The  Motor  Car. 
Membebs  of  the  medical  profession  are  perforce 
obliged  to  spend  much  of  their  time  in  active  locomo- 
tion. It  follows,  therefore,  that  they  are  interested  in 
any  movement  which  is  likely  to  forward  the  resources 
of  civilisation  as  to  the  particular  means  by  which  free 
locomotion  is  effected.  Among  the  greatest  of  modem 
movements  in  this  direction  there  can  be  no  doubt 
that  the  motor  car  will  play  a  prominent  part.  Indeed, 
judging  from  the  signs  of  the  times,  it  seems  probable 
that  in  a  near  future  the  horse  will  be  ousted  to  a  great 
extent  by  mechanical  agencies  for  the  propulsion  of 
vehicles.  At  the  present  moment  the  regulations 
existing  in  this  country  practically  forbid  the  intro- 
duction of  motor  vehicles.  However,  there  is  every 
prospect  that  Parliament  will  shortly  revise  these 
absurd  and  out-of-date  lawp.  Meanwhile,  the  medical 
profession  will  watch  with  interest  the  scientific 
development  of  this  important  industry,  which  at  some 
future  period  seems  likely  to  affect  so  important  a 
portion  of  their  lives  as  the  speedy  performance  of 
the  daily  round. 

The  Value  of  Oxygen  Inhalation. 
A  NOTSWOBTHY  instance  of  the  value  of  the  inhala- 
tion of  oxygen  has  just  been  afforded  in  connection 
with  the  sad  catastrophe  last  week  at  the  Peckfield 
Colliery,  near  Leeds.  An  explosion  took  place,  as  the 
result  of  which  many  of  the  miners  were  exposed  to  the 
fatal  effects  of  the  after-damp,  or  carbonic  acid  gas. 
However,  on  the  relief  parties  having  descended  the 
pit  shaft,  and  sent  to  the  surface  severalof  the  victims, 
who  were  just  alive,  means  were  at  once  taken  to 
restore  them.  Among  the  measures  in  this  direction, 
the  well-known  firm  of  Messrs.  Keynolds  and  Branson, 
of  Leeds,  were  applied  to,  by  whom  cylinders  of  com- 
pressed oxygen  were  furnished.    The  use  of  this  gas 


Mat  6|  1896. 


NOTES  ON  CUlaita^T  TOPICS 


Thx  Msdigal  Pbbss.     485 


proved  inTalaable  in  restoring  those  men  who  were 
sufiering  from  the  asphyxiation  caused  by  the  inhala- 
tion of  the  carbonic  acid  gas.  This  point  is  really  one 
of  considerable  moment,  and  it  would  be  well  that 
eollieiy  owners  and  managers  should  bear  it  in  mind. 
In  ^  fiery  "  pits  especially,  the  plan  would  be  a  good  one 
to  store  cylinders  of  compressed  oxygen  in  some  con- 
venient spot  in  the  pit  itself.  By  this  means  lives 
might  be  saved  in  the  event  of  catastrophes  of  the 
nature  to  which  attention  is  here  drawn.  At  all  events 
it  would  seem  advisable  that  in  the  manager's  office  or 
somewhere  upon  the  premises  of  the  colliery,  cylinders 
of  oxygen  should  be  kept  in  case  of  eventualities.  We 
strongly  commend  this  suggestion  to  colliery  managers. 

The  Decline  in  the  Use  of  Leeches. 
As  showing,  in  one  sense,  the  change  which  time  has 
effected  in  the  treatment  of  disease,  mention  may  be 
made  of  the  fact  that  the  trade  in  leeches  is  becoming 
extinct  Before  long,  therefore,  these  creatures  will  no 
more  be  known  in  medical  practice.  It  does  not 
follow,  however,  because  this  is  the  case  that  the 
''occupation"  of  leeches  in  the  practice  of  medicine 
and  surgery  is  entirely  gone.  On  the  contrary,  there 
are  still  some  diseases  left  the  treatment  of  which  is 
greatly  assisted  by  the  application  of  the  familiar 
"hirundo."  We  more  especially  allude  to  cases  of 
acute  iritis,  in  certain  of  which  the  rapid  local  abstrac- 
tion of  blood  by  leeches  is  followed  by  most  beneficial 
effects.  Nevertheless,  it  should  be  borne  in  mind  that 
even  in  these  instances  an  *'  artificial  leech  "  is  able  to 
perform  the  same  service,  with  practically  as  good 
results.  Thus  it  will  come  to  pass  that  leeches  will  be 
very  difficult  to  obtain,  simply  on  the  grounds  that  the 
few  occasions  on  which  they  may  be  required  will  not 
afford  sufficient  remuneration  for  maintaining  them. 

The  New  Fellows  of  the  Boyal  College  of 
Physicians,  London. 

Thb  ordinary  comitia  of  the  Royal  College  of  Physi- 
cians was  held  on  the  30th  ult.,  the  President,  Dr. 
Samuel  Wilks,  F.RS.,  in  the  chair.  Among  the  busi- 
ness transacted  was  the  election  to  the  coveted  honour 
of  the  Fellowship  the  following  Members  of  the 
College  :— Dr.  Charles  Montague  Chadwick,  Dr.  Harry 
Campbell,  Dr.  Arthur  Gamgee,  Dr.  John  Anderson, 
Dr.  John  Michell  Clarke,  Sir  Hugh  Beevor,  Dr.  Ernest 
Septimus  Keynolds,  Dr.  WOliam  Hunter,  Dr.  William 
Aldren  Turner,  and  Dr.  Arthur  Pearson  Luff. 


The  Petroleum  Lamp  Again. 
Thb  news  of  a  fatal  lamp  accident  has  just  come  to 
hand  from  Munich.  The  victim  was  the  well-known 
Privy  Councillor,  Professor  Friedrich  Geffeken,  who 
was  suffocated  by  a  fire  kindled  in  his  room  by  the 
explosion  of  a  petroleum  lamp.  Such  are  the  bare 
facts,  as  communicated  by  telegram,  but  there  is  no 
diffieolty  in  filling  in  the  details  of  the  picture  from 
eocperiences  ihat  are  only  too  common  in  our  own 
country.  It  is  to  be  hoped  that  this  unfortunate 
oeeorteoce  will  direct  the  attention  of  Europe  afresh 
to  tiie  appalling  nature  of  the  scourge  that  nineteenth 


century  civilisation  has  lately  manufactured  for  her 
own  back.  Inquiry  has  shown  pretty  conclusively  that 
by  proper  apparatus  and  the  use  of  oil  of  low  combus- 
tion point  the  danger  of  petroleum  as  an  artificial 
illuminant  would  be  reduced  to  a  minimum.  The 
late  Professor  was  a  violent  Anglo-phobe,  and  was 
notorious  as  the  editor  of  the  late  Emperor  Frederick's 
Diary  of  the  Franco-Prussian  War,  for  which  work  he 
was  imprisoned  by  Bismarck. 


The  End  of  the  Kitson  v.  Playfair  Case. 

It  has  been  well  doubtless  for  all  concerned  in  this 
cattse  cklebrey  that  the  end  has  come  by  a  mutual 
arrangement  To  have  reopened  the  case  and  discussed 
anew  all  its  many  points  of  professional  difficulties 
and  differences,  would  have  been  in  the  highest  degree 
a  matter  to  be  avoided  if  possible.  The  appeal  case 
was  set  down  for  hearing  on  the  30 uh  ulc,  but  it  was 
announced  by  the  counsel  for  the  defeDdant  that  the 
case  had  been  settled  on  terms  which  had  been  agreed 
upon  between  the  parties,  and  that,  therefore,  the 
Court  would  not  be  troubled  in  the  matter.  The 
Court  assented  to  this  course  being  taken,  and,  thus,  the 
Kitson  V,  Playfair  case  reached  its  termination.  No 
details  were  divulged  respecting  the  terms  of  the 
settlement,  and,  consequently,  upon  this  subject  the 
natural  curiosity  of  the  public  will  have  to  remain 
unsatisfied.  We  are,  however,  in  a  position  to  state 
that  the  amount  of  the  settlement  agreed  to  was  £9,200, 
to  include  costs,  incurred  by  Mrs.  Kitson,  and  that  of 
this  sum  £8,000  were  to  be  invested  for  the  benefit  of 
Mrs.  Kitson  and  her  children. 


The  Release  of  Dr.  Herz. 
Fob  two  years  the  case  of  Dr.  Herz  has  figured  in 
the  public  press,  by  reason  of  the  demand  of  the 
French  Government  for  his  extradition.  Repeatedly, 
however,  consultations  have  been  held  regarding  his 
health  by  English  and  French  physicians,  and  upon 
every  occasion  the  combined  opinion  was  that  Dr. 
Herz  was  too  ill  to  be  handed  over  to  the  French  Autho- 
rities. It  will  be  remembered  that  the  charge  against 
him  was  that  of  being  associated  in  fraudulently 
obtaining  from  the  French  Government,  with  the 
late  Baron  Reinach,  a  sanction  for  the  issue 
of  a  lottery  loan  to  raise  720  million  francs 
for  the  Panama  scheme.  The  Baron's  share  for 
successfully  negotiating  this  matter  is  stated  to  have 
been  six  million  francs,  and  that  of  Dr.  Herz,  ten  millions. 
But  delay  arose  in  the  payment,  and  Dr.  Herz  accord- 
ingly claimed  his  millions  and  enforced  his  claims  in 
somewhat  threatening  language.  In  accordance  with 
the  new  extradition  law,  a  prisoner  in  England  charged 
by  a  foreign  government  may  be  tried  elsewhere  than 
at  Bow  Street,  and  the  inquiry  which  was  undertaken 
by  Sir  John  Bridge,  at  Bournemouth,  where  Dr.  Herz 
has  been  living  since  his  arrival  in  this  country,  was 
concluded  at  Bow  Street  on  the  2nd  inst.  Sir  John 
Bridge  expressed  the  opinion  that  a  man  was  justified 
in  enforcing  his  claim  with  a  certain  amount  of  threats, 
and  that  Dr.  Herz  had  not  exceeded  the  limit.  Thus 
Dr.  Herz  is  now  free,  and  will  be  relieved  of  the  police 


486     Thi  Mbdigjll  Pb188. 


NOTES  Otf  CUR&ElJt  TOPICS. 


May  5.  1896 


guard  which  has  been  on  duty  in  his  residence  from 
the  time  of  the  extradition  proceedings,  two  years  ago. 

The  Boyal  College  of  Physicians,  London, 

and  the  Question  of  Privilege. 
It  will  be  remembered  that  at  the  Kit^on  v.  Play- 
fair  trial  Sir  John  Williams  sUted  that  the  Royal 
College  of  Physicians,  London,  had  published  their 
opinion  on  the  question  of  privilege  in  regard  to  the 
divulging  of  professional  confidences.  But  it  is  only 
right  to  add  that  nothing  appears  to  be  known  of  the 
circumstances  under  which  the  publication  of  this 
opinion  took  place.  Indeed,  considerable  doubt 
seems  to  prevail  as  to  the  correctness  of  Sir 
John  Williams'  statement  In  view,  however, 
of  the  importance  of  the  subject  it  is  only  fair, 
supposing  that  the  College  has  made  a  special 
pronouncement  thereupon,  that  the  profession  and 
the  public  should  be  informed  of  the  views  enter- 
tained and  the  resolutions  agreed  to  by  the  College  on 
this  question.  Expediency,  moreover,  indicates  that 
there  should  be  no  concealment  or  secrecy  regarding 
the  ruling  of  the  College  in  connection  therewith,  so 
that  the  great  body  of  the  Licentiates  of  the  College 
should  have  something  to  guide  them  when  confronted 
with  problems  of  the  kind.  If,  however,  the  College 
refuse  to  divulge  their  ruling,  it  might  be  worth  while 
to  raise  the  question  of  appealing  to  the  Privy  Council 
with  a  view  of  compelling  them  to  make  an  authorita- 
tive statement  Perhaps,  however,  it  may  ultimately 
transpire  that  Sir  John  Williams  was  not  correct  in 
the  statement  that  he  made,  and  that  his  opinion,  as 
expressed,  was  not  that  of  the  College  on  the  subject 

The  Elections  at  the   Boyal   CoUe^e  of 

Surgeons  of  Ireland. 
The  election  of  a  Councillor,  in  room  of  Mr.  William 
Stoker, resigned,  took  placeon  Monday  last.  The  meeting 
of  the  Fellows  for  the  CounciUorship  election  was  held 
at  one  o'clock,  and,  for  Mr.  Stoker's  vacant  seat,  four 
candidates  offered,  viz.,  Mr.  Cranny,  of  Jervis  Street 
Hospital,  Mr.  Harrison  Scott,  of  the  Adelaide  Hospital, 
and  Messrs.  Sherlock  and  Q.  O.  Murray,  both  Fellows 
practising  dentistry,  and  no  doubt,  aspiring  to  repre- 
sent that  speciality.  Upon  the  counting  of  the  ballot 
papers  the  result  of  the  election  was  declared  as 
follows : — 

Mr.  Cranny 79  votes. 

Mr.  G.  P.  Murray    . .  37  votes. 

Mr.  H.  G.  Sherlock. .  27  votes. 

Mr.  Harrison  Scott  . .        . .        16  votes. 

Totel  Votes      159 
The  election  of  examiners  to  serve  for  the  ensuing 
year  took  place  yesterday  (Tuesday),  but  terminated  at 
so  late  an  hour  that  it  is  impossible  for  us  to  publish 

the  result  

Petroleum  as  a  Hair-Wash. 
Of  late  there  has  been  an  increasing  fashion — both 
among  dermatologists  and  on  the  part  of  the  public— 
to  use  petroleum  as  an  application  to  the  scalp.    It 


goes  without  saying  that  the  use  of  so  inflammatory 
a  material  must  be  attended  with  some  amount  of 
danger,  and,  as  a  matter  of  fact,  several  instances 
have  been  reported  of  fatal  injury  from  the  ignition  of 
the  oil.  A  few  days  since  an  English  lady  of  title  had 
a  narrow  escape  of  the  kind  at  Monte  Carlo.  After 
using  a  petroleum  wash  she  accidentally  set  fire  to  her 
hair,  but  fortunately  did  not  sustain  any  serious 
personal  disfigurement.  It  is  certainly  the  duty  of  any 
medical  man  who  orders  a  remedy  of  this  sort  to  warn 
his  patient  not  to  approach  a  naked  light  after  making 
the  application.  This  is  all  the  more  necessary, 
because,  for  obvious  reasons,  the  stuff,  in  nine  cases 
out  of  ten,  will  be  applied  at  night,  and  often  by  the 
light  of  a  candle  or  lamp. 

Poor-law  Officers'  Superannuation  BilL 
This  Bill  which  was  designed  to  apply  to  the  Eng- 
lish Poor-law  Service  only,  was  most  unexpectedly 
called  on  last  Friday,  in  consequence  of  the  sudden 
collapse  of  the  Benefices  Bill,  which  had  occupied  the 
Grand  Committee  on  Law  for  the  last  three  weeks. 
The  Bill  got  through  the  Committee  stage  satis- 
factorily, and  only  occupied  a  few  hours,  but  an 
amendment  was  carried  by  the  Radical  party  which 
is  likely  to  give  trouble  at  a  future  stage.  As  to  the  ex- 
tension of  the  Bill  to  Ireland,  Sir  Walter  Foster  elicited 
the  statement  from  Mr.  T.  W.  Eussell,  who  was 
watching  the  Bill  for  the  Government,  that  an  opportu- 
nity would  be  afforded  for  moving  the  extension  clause  at 
the  next  stage,  and  that  he  thought  the  extension  might 
be  approved  if  it  did  not  involve  opposition  from  Irish 
members.  The  outcome  of  the  whole  transaction  is 
that,  if  the  Bill  passes  at  all  it  will  probably  carry  with 
it  the  extension  of  its  provisions  to  Ireland,  but  as  the 
Government  have  taken  all  the  private  members  time, 
it  can  make  no  progress  unless  the  Government  assents, 
which  we  earnestly  hope  they  will  do. 


The  annual  conversazione  of  the  Medical  Society  of 
London  wiU  be  held  in  the  Society's  rooms  on  Monday 
evening,  the  18th  inst,  at  8'30  p.m.  Dr.  Allchin  will 
deliver  an  oration  on  *'The  Breaking  Strain,"  after 
which  there  will  be  a  reception  by  tne  President, 
smoking,  and  music  by  the  "  Bijou  "  Orchestra. 


Dr.  W.  H.  Symons,  D.P.H.Oxon,  whose  papers  on 
Pablic  Health  Examinations  have  been  appearing  n 
this  journal  lately,  has  been  appointed  Medical  Officer 
of  Health  for  Bath.  We  understand  there  were  nearly 
forty  candidates  for  the  post 


[vbom  oub  own  oobbwpovdbmt.] 

Tub  Monbtart  D^fhculty  with  Gohvalbscbnt 
Homes. — It  has  come  to  our  knowledge  that  the  Directora 
of  the  Glaegow  Royal  Infirmary  are  greatly  and  very 
serioasly  exercised  respecting  the  cost  of  maintenance  of 
the  Schaw  Convaleeoent  Home  at  Bearaden,  near  Glasgow. 


Mat  6.  189(5. 


CORftHSPONDENCE. 


The  Mbdical  Pbxss.     487 


It  may  be  ramembered  that  Mira  Hchaw  gave  the  sam  of 
£40.000,  iD  memory  of  her  brother,  for  charitable  pari)08e8, 
and  the  CDnvaleeoent  home  was  bnilt  from  the  funds. 
The  present  endowment,  however,  has  been  found  to  be 
insufficient  to  maintain  the  full  complement  of  convales- 
centB  the  institution  is  capable  of  accommodating,  and, 
as  a  consequence,  the  Directors  will,  therefore,  through 
force  of  circumstances,  have  to  decide  either  to  admit  only 
a  limited  number  in  order  to  make  ends  meet  and  not  over- 
step the  endowment,  or  to  fill  the  home  to  its  normal 
capacity  and  throw  the  additional  expenditure  required 
on  the  ordinary  income  of  the  infirmary.  The  latter  alter- 
native would  appear  to  be  verging  on  the  ridiculous, 
inasmuch  as  the  ordinary  income  of  the  infirmary  falls  a 
long  way  short  of  meeting  the  ordinary  expenditure.  It 
may  be  stated  that  convalescent  homes,  in  connection  at 
least  with  Scottish  institutions,  are  looked  upon  by  the 
artisan  class  in  the  same  light  as  hydropathic  establish- 
ments are  in  the  eyes  of  the  well-to-do,  simply  places  where 
a  certain  time  can  bo  spent  in  ease  and  comfort— of  course, 
with  this  great  difference,  that  in  the  hydro,  the  inmates 
have  to  pay,  but  in  the  convalescent  homes  there  is  nothing 
to  pay,  but  a  great  deal  to  do  in  finding  fault  with 
the  food  and  everything  else,  although  those  seeking  its 
advantages  have  been  strangers  to  such  luxuries  previous 
to  their  admission  to  the^e  homes. 

DuNDBE  AND  THE  PuBLio  HEALTH  BiLLS.— The  Sanitary 
Committee  of  Dundee  Town  Council  met  last  night  to 
consider  the  Public  Health  Amendment  Bill  and  the 
Public  Health  Conbolidation  Bill,  in  reference  to  their 
bearing  upon  Dundee.  Notes  upon  the  Bills  by  the 
Medical  Ofiicer  and  the  Chief  Constable,  as  well  as  suggee- 
tions  by  the  Glaegow  Police  Commissioners,  were  produced 
and  considered.  The  Committee  made  suggestions  for 
additional  amendments  on  the  Bills,  but  in  view  of  the 
fact  that  the  Committee  of  the  House  of  Lords  had 
amended  the  proposed  measures  in  a  variety  of  respects, 
it  was  decided  to  delay  further  procedure  until  copies  of 
the  amended  Bills  had  been  received.  On  receipt  of  these, 
instructions  were  given  to  the  Convener,  the  Clerk,  the 
Medical  Officer,  and  the  Sanitary  Inspector  to  formulate 
and  circulate  among  the  members  of  the  Council  any 
amendments  and  suggestions  which  they  considered  were 
still  required  for  the  final  revisal  of  the  Bills.  The  Com- 
mittee will  then  meet  for  further  consideration. 


(!t(mrejBponbtnce. 

(We  do  not  hold  oonelves  responsible  for  the  opinions  of  our 
ooaespondeDts.]  

THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 

To  the  Editor  ofTuE  Medioal  Press  and  Ciroulab. 

Sib, — The  complacent  arrogance  with  which  your  corre- 
spondent, **  Anti-Quack,"  sits  in  the  seat  of  judgment 
upon  the  difficult  and  debatable  question  of  i  he  special  ' 
hospitals  invites  a  candid  criticism.    His  letter  is  not  dis-  ' 
tinguished  for  its  logical  method.     He  speaks  of  *'  sham  "  , 
special  hospitals,  but  does  not  define  the  term.    By  using 
the  epithet  he  is  begging  the  question,  for  no  decent  man  ' 
would  want  to  support  a  '*  sham  "  special  hospital.  I 

It  is,  no  doubt,  true  that  a  certain  number  of  special 
hospitals  would  not  be  able  to  come  clean  out  of  the  ordeal  | 
of  a  searching  inquiry  into  their  accounts  snd  manage- 
ment. Precisely  the  same  thing  may  be  asserted  of  the  ' 
large  hospitals.  At  the  present  moment  they  are,  for  the 
most  part,  resisting  with  might  and  main  the  proposal  to 
put  all  hospitals  under  the  control  of  a  central  board. 
Why    Some  folks  do  not  hesitate  to  answer,  becauee 


reform  of  management  would  be  against  their  interests. 
Bat  it  would  be  unfair  to  condemn  all  general  hoepital» 
because  some  are  badly  managed.  A  precisely  similar 
argument  applies  to  the  special  institutions.  Some  are* 
bad,  while  others  are  good.  At  any  rate,  they  were  the 
pioneers  who  set  the  example  of  special  work  which  haa 
since  been  followed  by  the  genend  hospitals.  Where 
would  your  correspondent  draw  the  line?  Who  is  to* 
settle  what  is  or  wnat  is  not  a  hospital  deserving  con- 
fidence ?  Certainly  not  any  man  who  displays  the  narrow 
prejudices  that  are  written  larp^  between  the  lines  of  your 
correspondent's  letter.  Certamly  not  the  hospital  funds, 
for  the  present  writer  knows  of  a  special  hospital,  managed 
economically,  doing  an  immense  amount  of  good  work, 
both  scientific  and  charitable,  controlled  by  a  committee 
whose  names  are  a  guarantee  of  absolute  integrity,  but 
which  is  practically  boy-cotted  by  both  funds.  Your 
correspondent  can  have  chapter  and  verse  for  these  state^ 
ments.     Let  him  digest  them  at  leisure. 

Again,  the  genend  hospitals  in  London  are  in  the  hand» 
of  a  close  corporation.  Is  a  man  who  does  not  happen  ta 
be  within  that  ring,  but  who  at  the  same  timei  is  conscious 
of  his  own  integrity  and  abilities,  to  throw  away  hie 
chances  of  success  in  this  short  life  for  want  of  making  an 
opportunity  ?  If  he  '*  throw  up  the  sponge  "  in  this  way 
and  take  a  back  seat — to  use  somewhat  sporting  language 
— he  certainly  deserves  no  sympathy.  No — it  certainly 
seems  to  me  that  medicine  is  the  only  profession  that  seeke 
absolutely  to  bar  the  rise  of  a  man  from  the  ranks  to  the 
higher  places 

Let  **  Anti-Quack  "  ponder  well  before  he  presents  hie 
one-sided  and  narrow  views  to  the  medical  public. 
I  am.  Sir,  yours,  kc , 

Anti-Quack  the  IIni> 

Cambridge. 


PRESCRIBING  PHARMACEUTICAL  CHEMISTS. 
To  the  Editor  of  The  Medical  Press  and  Ciroulab. 

Sir, — 1  have  read  with  interest  the  letters  about  phar- 
maceutical chemists  prescribing  in  your  journal  of  the  8tb 
and  15th  ult. 

I  am  one  of  those  who  have  no  sympathy  with  chemists 
prescribing,  but  I  must  candidiy  confess  that  I  think 
*'  X  "  goes  too  far  when  his  accusations  are  equivalent  to 
charging  pharmaceutical  chemists  with  wholeeale  murder. 

Any  unqualified  person,  chemist  or  otherwise,  visiting 
and  prescribing  as  stated,  are  highly  culpable,  or,  ta 
quote  from  the  report  of  a  speech  of  so  high  an  authority 
as  Sir  Richard  Quain,  who  said,  referring  to  this  subject 
in  1894,  he  did  not  call  the  man  who  gave  a  simple  remedy 
or  application  a  prescribing  chemist,  but  the  man  who 
visited  and  prescribed  for  the  sick,  and  became  guilty  of 
crimes  next  to  murder  by  doing  that  which  he  knew 
nothing  about. 

Evidently,  the  correct  moral  to  be  drawn  from  "  X's  *' 
letter  is  that  had  he  (Dr.  *'X")  been  called  in,  all  the 
cases  mentioned  would  have  at  once  reooven  d. 

As  to  giving  a  mixture  for  a  cough,  in  reply  to  Mr. 
Downes,  tbe  Editor  ''unhesitatingly"  answers  that  it 
should  not  be  given,  *'  especially  if  the  advice  id  to  be  given 
in  cUfeentid  of  the  patient." 

In  my  opinion,  it  makes  no  matter  whether  the  patient 
is  pref^ent  or  absent,  no  chemist  ought  to  pose  as  a  doctor, 
but  all  apothecaries  and  pharmaceutical  chemists  who 
keep  **  open  shop  "  always  keep  cough  bottles,  lozenges, 
&c.,  for  sale,  and  anyone  asking  for  such  receives  them, 
nor  could  they  do  otherwise.  If,  on  the  contrary,  as  sug- 
gested by  the  Editor,  the  chemist  were  to  sav  he  could 
not  supply  them  without  the  purchaser  first  calling  on  a 
medical  man,  paying  his  guinea,  and  bringing  a  preecrip- 
tion,  can  any  sane  man  think  the  advice  woula  be  fol- 
lowed ?  The  poor  chemist  would  be  regarded  as  an  idiot, 
and,  in  place  of  thanks,  would  receive  advice  in  return, 
often  in  language  more  forcible  than  polite. 

In  order  to  hinder  a  cough  bottle  being  sold,  or  a  bunion 
or  corn-plaster  prescribed,  nothing  less  than  an  Act  of 
Parliament  making  it  penal  to  do  so,  without  the  verbal  or 
written  instructions  of  a  medical  man,  will  have  any 
effect. 

Dr.  Foy,  in  his  communication  of  the  15th  ult.,  4ays : — 


488    Tn  MsDioAi.  Pucn. 


LTTEBATURE. 


May  6.  18IW> 


*'Tbe  pharmaceatioal  chemist  considered  he  had  com- 
pletely exonerated  himself  when  he  confessed  total 
lenoranoe  of  the  dni|^  ordered."  This  is  a  very  sweeping 
•cmarge  affainst  chemists  in  generaL 

I  would  reepectfally  suggest  to  this  chemist  that  he 
ought  to  follow  the  custom  adopted  by  a  large  number  of 
mMical  men  of  always  keeping  the  iateet  edition  of  Mr. 
Martindale's  Extra-pharmacopoeia  at  hand  for  reference. 

No  one  doubts  Uiat  there  are  some  ver^  ignorant 
•chemists,  but  having  taken  an  interest  in  examinations  for 
many  vears,  I  think  any  man  with  a  fair  and  candid  mind 
will  admit  if  they  take  the  trouble  to  read  the  examina- 
tion papers  of  the  Pharmaceutical  Society  that  the  candi- 
dates who  pass  successfully  cannot  be  men  who  are  grossly 
ignorant  of  chemistry  and  pharmacy. 

Sir  Dominic  Corrigan  was  the  first  President  of  the 
Pharmaceutical  Society,  and  I  understand  that  the 
majority  of  the  examiners  have  been  medical  men,  and 
the  Government  Inspector  is  a  Fellow  of  the  Royal  College 
of  Physicians. 

Why  does  Dr.  Foy  allow  his  patients  to  go  to  such 
ignorant  men  ?  No  chemist  is  justified  in  substituting 
one  drug  or  chemical  for  another  unless  by  permission  of 
the  preecriber. 

Would  it  be  fair  towards  the  large  body  of  highly- 
odocated  medical  men  we  have  in  Ireland  to  accuse  them 
all  of  gross  ignoraooe,  because  I  have  seen  practitioners 
order  tablespoonful  doses  of  Easton's  syrup,  tablespoonful 
doses  of  cherrylaurel  water,  ever^  three  hours ;  grain 
doses  of  iodide  of  arsenic,  2  grain  doses  of  morphia, 
i  grain  doses  of  gelsemina  (when  the  dose  of  the  latter  is 
from  1-60  to  1-20  of  a  grain),  and  probably  no  one  ever  saw 
1-20  of  a  grain  given,  not  to  speak  of  a  prescription  I  saw 
lately,  where  strong  pills  were  ordered,  with  the  aston- 
ishing directions  **  semi  unciam  ter  in  die."  In  such  cases, 
the  patients'  lives  are  saved  by  the  dispenser,  and  from  my 
•experience,  it  would  be,  in  my  humble  judgment,  an  ad- 
vantage to  medicine  and  pharmacy  generally,  if  the  medi- 
cal men  of  Ireland  would  take  pattern  by  their  English 
■cot^rires  in  the  relation  they  hold  to  pharmacy. 

Mr.  Downes  asks  a  question  as  to  the  difference  between 
"  prescribing  "  and  "  advising."  This  is  naturally  the 
great  difficulty,  and  in  my  estimation,  the  chief  error 
made  in  establishing  a  Pharmaceutical  Society  in  Ireland, 
where  the  people  had  become  accustomed  to  the  apothe- 
cary who  slways  had  the  right  of  prescribing  as  well  as 
^e  supplying  of  medicine. 

I  write  thus  to  elicit  a  further  expression  of  opinion,  as 
it  is  a  question  of  difficulty  to  decide  where  the  line  ought 
to  be  drawn,  having  regard  to  the  welfare  and  safety  of  the 
public. 

In  concluding,  I  must  apologise  for  trespassing  so  much 
on  your  valuable  space. 

I  am.  Sir,  yours,  &c., 

Faib  Play. 


THE  CHALYBEATE  WATERS  OF  GOREY. 
To  the  Editor  oj  Tbb  Medical  Prkss  and  Ciboulab 

Sib,— Can  any  of  your  readers  inform  me  if  the  Cbaly- 
l)eate  Clogh  waters  of  Gorey,  in  the  co.  Wexford,  are  still 
4being  used.  Dr.  Rulty  thought  very  bighlv  of  them,  and 
JUS  an  evidence  of  their  efficacy  gives  thelollowing  case  : — 

"  Thomas  Gowan,  est.  22,  was  weak  and  emaciated  to 
the  last  degree,  with  a  severe  cough  and  withal  an  hssmi- 
plegia ;  in  this  state  he  went  to  these  waters,  even  in  the 
autumnal  season,  viz ,  in  October  1731,  and  bleeding,  and 
eome  other  evacuations,  having  been  premised  in  regard 
to  his  paralytic  disorder,  he  drank  them  for  six  weeks, 
and  recovered  the  use  of  his  limbs  so  far  as  to  have  had 
only  now  and  then  some  slight  returns  of  that  disorder  unto 
this  presentyear  1751, and  hid  flesh  and  strength  so  fares  to 
contract  matrimony  the  March  following  ;  and  which  was 
remarkable,  he  married  a  widow  who  was  drinking  the 
waters  at  the  same  time,  and  had  borne  no  children  to  her 
former  husband,  though  a  promising  person,  but  soon 
proved  fruitful  with  her  new  husband  and  consort  in  drink- 
mg  the  waters,  which,  among  other  things,  gave  rise  to 
a  certain  song,  of  which  the  following  lines  were  a  part : — 
L  **  Consumptive  lad,  with  asthma  Imd,  grew  rampant  and 
piqueering ; 
And  widow  pale,  from  head  to  tail,  was  cured  at 
Tobbemeermg." 


The  well  is  called  in  Irish,  Tobbemeering,  t.e.,  the  Iran 
Well  ^ 

I  am.  Sir,  yours,  &c, 

GlOBOK  FOT. 

♦ 

PAVY  ON  THE  CARBOHYDRATES,  (a) 
These  volumes  are  intended  to  promulgate  the  author's 
hypothesis  concerning  the  rdle  of  carbohydrates  in  the 
metamorphoses  of  the  albuminous  substances  in  the  body, 
and  his  aidoption  (we  cannot  admit  it  to  be  his  discovery) 
of  the  construction  of  the  albuminous  moledes  on  a  carbo- 
hydrate frame  or  pattern,,  and  to  defend  that  hvpothesui 
against  the  objections  raised  by  the  supporters  of  the  doc- 
trine of  Bernard.  We  are  of  his  opinion  as  regards  the 
fact  that  many  of  these  objections  are  mere  subtletiea 
which  do  not  touch  the  main  issues  ;  also  that  many  are 
the  result  of  mere  blundering  of  inexperienced  persons, 
whose  "  juniority  is  associatMl  with  a  belief  in  personal 
supremacy  entiuing  them  to  authoritatively  set  other 
people  right "  (p.  128).  This  is  only  too  true,  partionlarly 
as  concerns  work  done  by  students  of  different  nation- 
alities in  most  German  physiological,  and  chemical- 
physiological  laboratories,  and  those  operations  which  the 
Russians,  who  formerly  travelled  to  Germany,  now  per^ 
form  at  home.  Pavy's  Epicriticism  is  directed  mainly 
against  an  essay  of  Dr.  Noel  Paton,  bearing  the  title  On 
Sepatie  Olffcokenssis,  published  in  the  Philosophical  Tran- 
eactions,  1893,  and  against  a  paper  by  the  same  author, 
entitled  TAc  Physiology  of  the  GatiwhydrcUes  ;  our  Present 
Knowledge  of  their  Relations  to  the  Animal  Ecmwmy, 
printed  in  the  Edinburgh  Medical  Journal^  for  December, 
1894.  To  the  paper  in  the  Philosophical  Transactions 
Paton  had  attached  a  foot-note,  printed  on  the  first  or 
opening  page,  which  offended  Pavy.  He  addressed  the 
GDuncilof  the  Royal  Society  in  a  letter,  of  which  he  gives 
an  abstract,  showing  that  the  paper  was  inserted  irregu- 
larly as  not  having  heen  previously  communicated  to  the 
Society,  and  in  coneequence  had  no  right  of  being  in  the 
Transactions  at  all.  In  reply,  the  President  and  Council 
expressed  their  regret  that  the  paper  should  have  been 
published,  but  dioT  nothing  to  expunge  its  existence  or 
effect. 

Having  disposed  of  these  important  ethical  matters, 
Pavy  commences  his  reply.  He  nrst  refutes  the  assertion 
of  Paton  that  the  teaching  of  Bernard  concerning  hepatic 
glycogenosis  had  directed  the  practice  of  phyaicians  in  the 
treatment  of  diabetes  during  the  last  thirty  years.  This 
is  indeed  completely  unfounded,  for  the  treatment  of 
diabetes  during  the  last  thirty  years  has  been  and  is  now 
the  same  as  that  which  was  practised  and  taught  before 
Bernard's  interesting  discoveries — it  is  merely  empirical 
and  merely  palliative,  but  has  no  curative  element  to  boast 
of.  To  the  objection  that  he  gave  hardly  any  considera- 
tion to  the  work  of  others,  Pavy  replies  with  a  general 
indictment  of  these  others,  repeated  on  several  pages,  e,^., 
pp.  3  and  15,  to  the  efiect  that  the  literature  of  the  subject 
was  loaded  with  contradictory  statements,  that  in  no 
other  physiological  subject  perhaps  was  there  po  much 
conflicting  material.  Pavy  here  falls  into  the  very  error 
of  omission,  with  which  he  properly  loads  Paton,  namely, 
that  of  condemning  without  argument  or  proof  work 
which  has  the  same  good  claim  to  consideration  as  his 
own.  The  reliance  upon  his  own  work  is  therefore  rather 
too  exclusive,  and  as  such  only  could  it  have  enabled  him 
to  set  up  a  claim  to  diecovery  in  matters  which  have  been 
discovered  and  brosdly  stated  in  publications  long  before 
he  ever  imagined  *'the  new  departure."  which  he  himself 
describes  sa  the  result  of  an  accidental  find  of  his 
assistant.  Up  to  that  he  had  mistaken  his  cleavage 
product  from  albumin  for  glycogen  of  hepatic  notoriety  or 
origin.  Coming  to  the  carbohydrates  obtained  by  cleavage 
from  albuminous  matters,  Pavy  proves  by  elementary 
analysis   of  phenyl-hydraztn    compounds   of  his  carbo- 

(o)  '*  The  Physiology  of  the  Carbohydratec :  their  Application  ai 
Food  EDd  in  BeUtion  to  Diabetei."  By  F.  W.  Pavy,  M.D.,  LL.D., 
F.B.8.,  Ac.    8to.,  pp.  280.    LondoD,  1894. 

*'  The  Phyiiol  )gy  of  the  Carbohydrates :  An  Eploriticisai."  By  the 
•ame  Author.  Bin.  8va,  xix,  td.  141  pp.  I.ondoB,  189K.  London :  J. 
and  A.  ChnnshiU. 


Mat  6.  IH^ 


LITEEATURE. 


Tbs  Medioal  Press.     489 


hydrate  from  white  of  egg,  that  he  had  really  pro- 
dooed  an  oaazone,  or  compoond  of  a  sugar,  the  name  of 
which  ends  in  om,  with  this  phenyl-hydrazine,  of  the 
iKHnpoeition  ezpreesed  by  tbe  formala  G^  Hjo  O4  (N*  H  Gq 
Hq)!  ;  thuB  tbe  reaction  oonsists  in  a  suoBtitution  of  two 
moledee  of  hydrozyl  by  two  moledee  of  phenyl- bydrazin. 
The  reUtive  analyses  were  made  by  Mr.  A.  B.  Linf<.  Gon- 
trary  to  previous  resolataons,  Pavy  seeks  to  derive  support 
from  statements  made  by  others.  But  this  support,  if  any, 
IB  really  of  the  weakest  kind,  and  we  believe  that  the 
author  could  have  found  much  more  telling  research 
work  and  argument,  much  better  "  nudein,"  round  which 
to  synthetise  his  new  ideal,  had  he  made  more  extensive 
studies  nearer  home.  The  cleavage  of  carbohydrates  from 
albuminous  matters,  and  from  matters  not  being  albu- 
minous by  chemical  agency,  has  been  effected  and  proved 
incontrovertibly  during  thelast  twenty  years,  and  the  claim 
to  the  discovery,  which  the  author  here  again  asserts  for  him- 
aelf  of  the  glucoside  constitution  of  proteid  matter  cannot  for 
a  moment  be  admitted.  Moreover,  from  the  finding  of 
glueoee  as  a  product  of  cleavage  to  the  proof  of  the 
oonstitution  of  the  bodies  from  which  it  is  obtained  is  a 
great  distance  which  Pavy  does  rothing  to  help  us  across. 
AgalD,  glucose  is  not  the  only  product  of  the  process,  but 
other  carbohydrates  occur  along  with  it,  some  forming 
oopper  compounds,  and  benzoyl  chloride  esters.  There- 
fore, while  there  are  true  glucosides  of  relatively  simple 
oonstitution  in  the  animal  nody,  to  which  Pavy  does  not 
refer,  the  proteid  compoundshave  amuch  more  complicated 
oonetitntion  than  he  imagines,  and  should,  therefore,  not 
be  vainly  dubbed  with  a  name  derived  from  a  single  pro- 
duct equivocally  selected  out  of  a  (rreat  number  of  equally 
characteristic  ones  formed  by  the  side  of  them*  On  the  more 
physiological  side  of  the  question  the  author  presents  a 
more  ample  case  for  judgment  than  on  the  more  chemical 
one.  If  all  the  authors  whom  he  criticises  out  of  court  are 
ozperimentally  wrong  there  is  an  end  of  glycogenosis 
from  hepatic  glycogen. 

On  page  66  the  author  of  the  epicriticism  passes  from 
defenoe  to  attack,  and  gives  a  focussed  view  of  his  conten- 
tions, but  even  this  is  too  long  to  be  quoted  in  this  place. 
Oarbohydrates  and  albuminous  matters  are  supposed  to 
undergo  repeated  chemical  alliances,  and  as  frequent 
prooesses  of  divorce.  Peptones  are  presented  as  albumens 
which  have  lost  the  constituent  carbohydrate,  and  here 
is  at  once  a  great  difficulty  left  undiscovered,  namely,  the 
^ueation  of  what  holds  them  together,  when  the  consti- 
tuent frame,  tbe  alleged  typical  constituting  glucose  is 
removed.  This  is  apart  from  the  fact  that  many  analyses 
of  peptones  show  no  such  differences  of  their  composition 
■from  the  elementary  ingredients  of  the  original  albuminous 
enbstanoes,  as  would  necessarily  be  effected  by  the  removal 
of  each  one  group  of  a  carbohydrate  the  name  of  which 
«Dds  in — ose.  But  we  will  allow  the  occurrence  of  the 
cleavage  in  order  to  let  the  hypothesis  progress.  Pep- 
tone and  carbohydrate  arrive  at  the  villi,  and  there  they 
are  at  once  to  be  reoombined  to  form  albumen.  There  is 
difficulty  the  second,  namely,  the  question,  after  the  use 
of  the  peptonisation,  which  is  an  expenditure  of  energy,  if 
the  produced  peptone  has  to  be  recombined  with  the  car- 
ibohydrate  to  become  albumin  in  the  villi,  a  process  which 
■also  cannot  be  effected  without  tho  expenditure  of  energy. 
The  consideration  of  equivalent  leaves  no  peptone  for  the 
•carbohydrate  which  is  consumed,  and  this  latter  arrives  at 
•the  villi  without  peptone  available  for  union.  We  are 
liere  in  fact  again  before  an  old  problem,  namely, 
the  question  in  what  shape  carbohydrates  pass  into 
Iblood  and  lymph,  and  in  what  manner  they  reach  the 
places  where  they  are  used  up,  i.e ,  burnt  for  the 
production  of  heat,  power,  or  other  animal  energy. 
^e  author  discovered  in  1860  that  when  animals  were 
ied  upon  much  carbohydrate,  glycogen,  or  hepatic  amy- 
lose  accumulated  in  the  liver.  He  now  seems  to  impair  his 
latest  argument  a  little  by  proposing  that  the  glycogen 
iound  in  the  liver  of  animal  feeders  was  derived  from 
carbohydrate  already  contained  in  flesh,  and  consequently 
all  glycogen  in  the  liver  might  be  derived  from  carbo- 
liydrate,  and  none  need  be  the  produce  of  cleavage  of 
iJbuminous  matter.  The  author  thinks  that  the  glycogen 
onoe  in  the  liver  is  disposed  of  in  that  organ  by  the  agency 
^  the  hepatic  cells.  But  the  manner  in  which  this  is 
effected  we  cannot  find  to  be  elucidated.  He  teaches  us 
4hat  the  Uver  contains  no  more  sugar  than  other  parts,  and 


frequently  not  so  much;  moreover,  the  sugar  is  not 
glucose,  and  the  sugar  in  the  other  structures  of  the  body 
IS  also  not  glucose.  The  liver  manufactures  su^r  imme' 
diately  after  death  by  means  of  a  ferment,  which  death 
lets  loose  while  life  inhibits  it.  Here  the  discussion 
becomes  mixed  up  with  the  pla^  of  words  entitled  zymo- 
gens and  enzymes,  and  arrived  at  this  point  the 
author  breaks  off  with  a  cautious  reservation  and 
prudent  pause.  On  page  129  the  hypothesis  of  the 
transformation  of  starch  into  fat  in  the  cells  of 
tbe  villi  is  defended  against  Paton's  observations.  The 
microscopic  aspect  of  a  few  villi  can  furnish  no  measure 
for  the  amount  of  fat  contained  in  them,  and  tbe  presence 
of  fat  alone  is  no  proof  of  a  transformation  effected  upon  a 
material  which  contains  five  per  cent  of  fat  already.  The 
hypothesis  of  this  metamorphosis  in  this  place  has  no 
actual  proof  in  its  favour,  but  this  want  of  proof  is  of  not 
much  importance  for  the  main  question,  for  the  transform- 
ation takes  place  somewhere,  and  there  is  no  reason  why 
tbe  protoplasm  of  the  villi  should  be  less  potent  in  this 
respect  than  other  protoplasm.  Pavy's  volume,  of  1894, 
is  well  illustrated  by  many  reproductions  of  the  microscopic 
aspects  of  crystallised  and  crystalline  opazones.  If  all  the 
cleavage  products  of  albuminous  matter  were  thus 
depicted,  ten  thousand  folios  would  hardly  suffice  for 
their  representation.  Dr.  Pavy's  work  on  this  subject  is 
somewhat  bewildering,  particularly,  because  like  Father 
GhronoB,  he  has  repeatedly  either  consumed  hii  own 
children,  or  transformed  them  by  spiritual  protoplasmic 
power  into  new  combinations  adapted  to  new  conditions, 
just  as  he  now  transposes  his  former  glycogen  finds  into 
the  rariation  of  gluoosides.  In  any  case  these  works  will 
stimulate  research,  advance  the  chemical  side  of  physio- 
logy, and  moderate  that  professional  presumption  which 
hu  done  so  much  harm  during  the  last  thirty  years.  We 
cordially  recommend  Dr.  Pavy's  works  to  tbe  study  and 
attention  of  all  our  readers. 


INDEX  GATALOGUE    OF    THE    UNITED   STATES 
SURGEON-GENERAL'S    OFFIGE.  (a) 

Thts  volume  includes  12,759  author-titles,  representing 
4,857  volumes  and  11,613  pamphlets.  It  also  contains 
8.312  subject- titles  of  separate  books  and  pamphlets,  and 
13,280  titles  of  articles  in  periodicals. 

The  great  value  of  this  series  may  be  estimated  from  tbe 
following  tables,  showing  the  number  of  titles  in  the 
Intlex-Gatalogue : 

Author-titles  176,364,  volumes  85,663,  pamphlets  161,504. 
Under  subject-titles,  we  find  book-titles  168,557,  and 
Journal  articles  511.112. 

This  volume  completes  the  alphabet,  and  is,  therefore, 
the  final  volume  of  the  first  series  of  the  Index- Gatalogue. 
The  manuscript  of  the  second  series,  including  all  the 
titles  of  books  and  articles  received  too  late  for  msertion 
in  the  first  series,  has  been  prepared,  and  will  probably 
make  five  printed  volumes  of  the  same  size  and  style  as 
those  constituting  the  first  series. 

With  the  comfSetion  of  Volume  XVI,  Dr.  John  S.  Bil- 
lings retiree  from  the  personal  supervision  of  the  great 
work  with  which  his  name  will  be  indissolubly  connected 
— a  work  which  has  laid  the  medical  profession  under  a 
deep  debt  of  gratitude  to  him. 

With  the  last  volume  of  the  first  series  of  the  Indez- 
Gatalogue  Dr.  Billing  has  published  an  Appendix,  which 
fives  an  alphabetical  list  ot  tbe  abbreviations  of  titles  of 
medical  periodicals  employed  in  the  Index-Gatalogue. 

The  aobreviations  (a)  follow  the  exact  order  of  the 
words  of  the  title;  (6)  are  as  brief  as  is  consistent  with 
clearness ;  (e)  follow  the  orthographical  usage  of  each 
language  ;  {d)  and,  as  a  rule,  are  uniform  ;  (e)  the  artide 
with  which  a  title  commences  is  omitted. 

The  book  is  a  very  welcome  addition  to  the  series,  and 
we  are  sorry  that  with  it  was  not  printed  the  '<  Gorrigenda  " ; 
as  it  is,  the  rCNader  must,  in  consulting  the  Index-Gata- 
logue,  keep  this  and  the  i6th  volume  iMside  him  ;  withal 
we  make  no  complaint.  Dr.  Billings  has  completed  a 
herculean  task,  which  could  not  have  been  accomplished 

(a)  '*  Index-Catalogue  of  tbe  Library  of  the  Panreon  Oeneral's  Ollce' 
United  States  AnDy."  Antbon  and  Snbjects.  Vol.  XVX.  W.  Lythni, 
Washington:  Govemment Printing Offlce.    1895. 


490    Thb  Mbdigal  Pans 


LITERARY  NOTES  AND  GOSSIP. 


Mat  6,  1896. 


hy  other  than  an  enthatiastic  bibliophile,  and  he  haa  done 
it  in  a  manner  which  has  elicited  the  spontaneoiu  admira- 
tion of  hie  profeeaional  brethren. 


Ititerarg  #oteB  aiib  <S00«ip. 

Thx  Editor  of  Nature  announces  that  to-morrow's 
issue  (May  7th)  will  contain,  as  an  addition  to  the  "  Science 
Worthies  Series,'*  a  Life  and  Appreciation  of  Sir  Joseph 
Lister,  F.R.S.  The  latter  will  be  by  Prof.  Tillmanns,  of 
Leipzig.  A  photogravure  portrait  of  Sir  Joseph  Lister 
will  accompany  the  articles  as  a  supplement. 
« 

A  SUGGK8TIVS  set  of  "  Diet  Charts  "  and  tables  for  the 
use  of  physicians  for  handinsto  patients  after  consultation, 
has  just  Deen  issued  by  Mr.  H.  K.  Lewis.  These  we  think 
will  be  appreciated  as  they  will  save  the  consultant  con- 
siderable time  and  trouble  in  writing  out  instructions  for 
diet  to  suit  individual  requirements.  They  are  published 
at  the  moderate  charge  of  59.  per  100  charts. 

V 

Our  monthly  contemporary,  The  Pretctitianer,  for  May, 
is  a  *'  vaccination  number  "  pure  and  simple.  It  contains 
a  portrait  of  Jenner ;  its  editorial  references  are  to  Jenner  . 
and  his  connection  with  vaccination,  the  vaccination  j 
commission,  the  Gloucester  small  .pox  epidemic,  &c.,  whilst 
the  five  "  original  contributions  "  are  entirely  devoted  to 
small-pox,  vaccination,  and  vaccine.  This  should  prove 
amply  sufficient  for  the  most  ardent  of  Jenner 's  disciples. 
•  • 

Onb  of  the  best  and  most  popular  of  American  works  on 
Therapeutics  is  that  of  Professor  Wood,  of  the  University 
of  Pennsylvania  (London  :  Smith,  Elder  &  Co.).  The 
work,  which  has  reached  its  ninth  edition,  is  characterised 
by  breadth  and  thoroughness,  while  it  shows  an  immense  | 
amount  of  research  and  practical  grasp  of  details.  It 
seems  to  us  that  the  book  is  well  nigh  inaispensable  to  all 
engaged  in  the  etudy  and  teaching  of  the  important 
subject  of  materia  medica.  Farther,  it  contains  a  min^  of 
accurate  information  that  could  not  fail  to  be  of  the 
utmost  value  to  writers  upon  medicaJ  subjects. 
• 

Hblbii'o's  **  Modem  Materia  Medioa  "  (London  :  H.  K. 
Lewis)  contains  information  that  is  certain  to  be  of  the 
utmost  value  to  all  who  are  interested  in  the  scientific 
aspects  of  modern  materia  Imedica.  Its  aim,  the  author 
tells  us,  is  to  supply  the  want  of  fall  and  comprehensive 
details  as  to  the  constitution,  methods  of  preparation, 
tests,  and  medicinal  applications,  of  new  remMies.  It 
includes,  in  fact,  a  series  of  monographs,  and  represents  a 
great  deal  of  careful  and  conscientious  work.  The  neces- 
sity of  some  such  book  of  reference  is  every  day  made 
evident  by  the  advances  of  scientific  investigators  in 
transcendental  pharmacy. 

We  have  received  amongst  other  medical  journals  copies 
of  Boletin  de  Medkind  y  Cirurgia,  a  journal  started  by  Dr. 
Teodoro  Nunez,  of  Guadalajara,  Mexico.  The  name 
Nunez  is  well  known  in  Spanish  medical  literature. 
Joannes  Zwelfer,  writing  in  Vienna  in  1672,  quotes  Nunez 
fUi  Clarissimi  and  Acutisimi  Hiapanorum  ScriptorU  who 
had  recommended  a  wine  of  acaros  larieis  and  ginger,  for 
night  sweats  in  phthisis,  and  in  some  cases  he  advised 
that  the  wine  be  evaporated  and  the  inspissated  mixed 
extracts,  agaracine  and  giogerine,  be  made  into  lozenges, 
with  or  without  opium,  for  he  remarks  that  agaric  some- 
times gripes  and  is  best  corrected  with  opium.  The  book 
acquiied  great  celebrity.  It  was  dedicated  to  the 
Emperor  of  the  Holy  Roman  Empire,  Ferdinand  the  III, 
in  1661,  but  did  not  appear  for  21  years  afterwards. 

We  have  received  the  quarterly  number  of  the  "  Oxford 
English  Dictionary."  The  section  contains  766  main 
wordf),  533  combinations  explained  under  these,  and  97 
subordinate  entries,  1,416  in  all.  The  obvious  combina- 
tions, recorded  and  illustrated  by  quotations,  without 
individual  definition,  number  569  more.  Of  the  main 
words  586  are  current  and  nati^re,  or  fully  naturalised,  161 
are  obsolete,  and  19  alien  or  not  fully  naturalised.    The 


present  section  is  concerned  with  words  that  are  amongeb 
the  oldest  and  meet  frequently  used  in  the  language.  As 
might  be  expected,  very  many  of  these  words,  on  acooont 
of  the  mnltiplicitv  of  their  senses  and  applications,  have 
required  to  be  illustrated  at  much  more  than  average 
length.  The  illustrative  quotations  in  this  section  *'  Field- 
Fish  "  in  the  following  Dictionaries— (Johnson,  556 ; 
Gaeeell's  Encydopndia,  584;  Centuary,  1,138;  French's 
Standard,  278 ;  The  Oxford  English  Dictionary,  8526.) — 
show  the  value  of  this  work  in  throwing  new  and  unex- 
pected light  on  the  origin  of  the  senses  of  the  words  now 
current,  and  of  the  interpretation  of  many  passages  in 
our  older  literature. 

•  • 

• 

Wb  have  received  a  very  interesting  reprint  from  the 
New  Orleans  Medical  Journal  of  Dr.  Edmond  Souchon's 
article: — "Places  rendered  famous  by  the  late  Dr.  J. 
Marion  Sims  in  Montgomery,  Alabama."  It  contains  five 
beautiful  photogravures  illustrating  the  scenes  of  Marion 
Sims'  early  triumphs  in  gynaecology.  It  is  a  pity  that  the 
scenes  of  Simr'  labours  in  Richmond,  Virginia,  were  notr 
also  included  ;  they  would  have  been  appropiate,  for  it 
was  in  the  Richmond  School  of  Anatomy  that  he,  whilst 
lecturing  on  topographical  anatomy,  acquired  the  dexterity 
in  dissection  which  long  afterwards  gave  him  such  a 
world-wide  reputation  as  a  surgeon.  Very  few  recognise 
how  much  gynaecology  owes  to  Virginian  surgeons.  Its 
very  existence  is  due  to  McDowell's  ovariotomy,  then 
followed  Sims,  whose  works  made  two  hemispheres  his 
debtors,  and,  lastly.  Batty,  whose  operation  was  described 
in  1876,  and  whose  death  has  only  recently  been  recorded. 
The  house  Sims  occupied  before  leaving  Montgomery, 
Alabama,  was  afterwards  occupied  by  Confederate  officialfl 
prior  to  the  removal  of  the  capital  to  Richmond,  and  Sime 
lived  to  see  the  fall  of  the  Confederacy  whose  welfare  he 
had  so  deeply  at  heart. 

•* 

Vbbt  few  new  books  of  importance  have  reached  ns  so 
far  for  the  spring  publishing  season,  but  several  new 
editions  of  well-known  books  have  come  to  hand,  among 
which  may  be  mentioned  :  — the  sixth  edition  of  Ailing- 
ham's  '*  Diseases  of  the  Rectum  "  (Bailli^re,  Tindall,  & 
Cox)  ;  the  ninth  edition  of  Tyson's  '*  Practical  Examina- 
tion of  Urine  "  (same  publishers)  ;  the  fourth  edition  of 
Blyth's  ''Foods  and  their  Analysis"  (Griffin)  ;  the  second 
edition  of  Kennard's  **  Public  Health  Laboratory  Work  " 
(Lewis)  ;  and  the  second  edition  of  Halliburton's  **  Essen- 
tials of  Chemical  Physiolc^"  (Longmans).  The  latter 
publishers  have  also  issued  the  Appendix  to  Qoain's  "Ele- 
ments of  Anatomy,"  tenth  edition,  and  a  volume  of  **  Ocoa* 
sional  Papers  "  by  Dr.  Howship  Dickinson.  A  new  work  on 
**  Surgical  Diseases  of  the  Ovaries  "  has  been  published  by 
Messrs.  Caraell  &  Co.,  and  Messrs.  Smith  Elder  &  Co.  one  on 
"  The  Treatment  of  Ph<  hisis,"  by  Dr.  Arthur  Ransome.  The 
Rebman  Company  have  in  the  press  a  serial  work  exempli- 
fying the  Uses  of  the  New  Photography  in  Medical  and 
Surgical  Diagnosis,  by  Sydney  Rowland,  B.  A. 

•% 

New  Books  and  New  Editions.— The  following  have 
been  received  for  review  since  the  publication  of  our  last 
monthly  list :— The  Diagnosis  and  Treatment  of  Diseases 
of  the  Rectum  (6th  Edition),  by  W.  Allingham,  F  R.CS^ 
and  Herbert  W.  Allingham,  F.R  C.S.  Manual  of  Practical 
Anatomy,  by  D.  J.  Cunningham.  M.D.,  F.R.S.,  Vol.  L 
St.  Thomas's  Hospital  Reports,  Vol  XXIIL,  edited  bv 
Dr.  Adand  and  Mr.  Bernard  Pitts.  St.  Bartholomew'fr 
HospiUl  Reports,  Vol.  XXXI.,  edited  by  Dr.  Samuel 
West  and  Mr.  Walsbam.  Biolosrical  Experimentation  ^ 
Its  Fanctions  and  Limits,  by  Sir  B.  W.  Richardson,  M.D., 
F.R.S.  Quain's  Elements  of  Anatomy.  Appendix  on 
Superficial  and  Surgical  Anatomy,  by  Professors  Thane 
ana  Godlee.  Foods,  Their  Composition  and  Analysie 
(4th  Edition),  by  A.  Wynter  Blyth,  M.R.C.S.  Surgical 
Diseases  of  the  Falopian  Tubes,  by  J.  Bland  Sutton^. 
F.R.C.S.  The  Essentials  of  Chemical  Physiology  (2nd 
Edition),  by  W.  D.  HaUiburton,  M.D.,  FRS.  Hand* 
book  for  Hospitals,  by  A.  H.  Woolray.  A  Few  Medical 
and  Surgical  Reminiscences,  by  Augustin  Pritchard.  On 
Extraction  of  the  Teeth,  by  W.  D.  Woodbum,  L.D.S« 
Sterility,  by  Robert  Bell,  M.D.  The  Practical  Examina- 
tion of  Urine  (9th  Edition),    by  James  Tyson,   M.D.^ 


Mat  6,  1896. 


PASS  LISTS. 


Thb  Mbdigal  Pbiss.     491 


Public  Health  Laboratory  Work,  by  H.  R.  Ken- 
wood, M.B.  (2nd  EHition).  THa  Treatmenb  of  Phthiaip, 
by  Aitbur  Raneome.  M.D.,  F.K.S.  Diseases  of  the 
iSectQm  and  Anus,  by  S.  G.  Gant,  M.D.  Occasional 
Paperfk  on  Medical  Subjects,  by  W.  Howship  Dickinson, 
M.D.,  F.BC.P.  Memorials  of  the  Faculty  of  Physicians 
and  Surgeons,  Glasgow,  by  Alex.  Duncan,  BALond., 
Medical  and  Surgical  Report  of  the  Presbyterian  Hos- 
pital, New  York,  1896  Examination  Papers,  1895, 
Royal  University  of  Ireland. 


Liverpool  Post-Gradnate  Course. 
LivfifiPOOL,  like  most  of  the  large  centres  of  medical 
enterpripe  is  now  to  have  its  Post-Graduate  Course,  and 
mn  announcement  which  appears  in  our  advertisement 
columns  states,  that  a  series  of  thirty  Lectures  and 
Demonstrations  will  be  given  at  University  College,  Royal 
Infirmary,  Royal  Southern,  Northern,  Children's  Eye  and 
Kar,  Lock,  and  Shaw  Street  Women's  Hospital,  on  Tues- 
days and  Fridays,  commencing  May  12cn,  and  ending 
June  30th.  Lectures  2  to  3  p.m.  ;  Hospital  Demonstra- 
tions 3.30  to  5  p.m.  Fee  for  the  whole  course,  £3  3s. ; 
for  Clinical  Lectures  and  Demonstrations,  £2  26. ;  for 
Anatomy,  Physiology,  and  Bacteriology  Lectures,  £1  Is. 
The  Hon.  Sec.  of  the  Post  Graduate  Committee,  Professor 
Boyce,  University  College,  Liverpool,  will  be  glad  to 
f arnish  further  particulars  where  required. 

The  London  and  Counties  Medical  Protection  Soeiety. 

Ths  annual  dinner  of  the  London  and  Counties  Medical 
Protection  Society  was  held  in  London  at  Frascati's  Res- 
taurant on  the  Ist  May.  The  chair  was  taken  by  the 
President,  Mr.  Jonathan  Hutchinson,  who  reviewed  the 
progress  and  present  position  of  the  Society  in  an  excellent 
speech.  The  toast  of  the  guests  was  proposed  by  Mr. 
Druce  Clarke,  and  respond^  to  by  Dr.  Glover.  Several 
eongs  were  admirably  rendered  by  Dr.  Foulerton  and  some 
of  uie  ladies  present,  and  contributed  to  the  success  of  a 
most  enjoyable  evening.  At  an  early  period  we  hope  to 
give  some  details  of  the  work  of  the  society. 

Vital  Statistics. 

Thb  deaths  registered  last  week  in  thirtv-three  great 
towns  of  England  and  Wales  oorrespondea  to  an  annual 
rate  of  19*5  per  1,000  of  their  aggregate  population,  which 
is  estimated  at  10,860,971  persons  in  the  middle  of  this 
vear.  ^  The  deaths  registered  in  each  of  the  last  four  weeks 
in  the  several  towns,  alphabetically  arranged,  corres 
ponded  to  the  following  annual  rates  pec  l,OW  :— 

Birkenhead  21,  Birmingham  19.  Blackburn  19,  Bolton 
21,  Bradford  16,  Brighton  13,  Bnstol  17,  Burnley  22, 
CardifT  13,  Croydon  15,  Derby  19.  Dublin  23,  Edinburgh 
90,  Glasgow  20,  Gateshead  19,  Halifax  17,  Huddersfield 
13,  Hull  16,  Leeds  17,  Leioeeter  13,  Liverpool  22,  London 
19,  Manchester  27,  Newcastle-onTyne  17,  Norwich  15, 
Nottingham  17,  Oldham  24,  Plymouth  15,  Portsmouth  16, 
Preston  25,  Salford  26,  Sheffield  21,  Sunderland  23, 
Swansea  11,  West  Ham  16,  Wolverhampton  21.  The 
highest  annual  death-rates  per  1,000  living,  as  measured 
by  last  week's  mortality,  were:— From  measles,  3*1  in 
Manchester,  4  3  in  Birkenhead,  and  4*8  in  Sunderland  ; 
from  whooping-cough,  1  2  in  Newcastle-on-Tync^  1*3  in 
Croydon  and  m  Liverpool,  1  6  in  London,  1*8  in  Man- 
chester, and  2  2  in  Bolton  ;  from  fever,  1*6  in  Swansea ; 
and  from  diarrhoea,  1  2  in  Blackburn.  In  no  case  did  the 
death-rate  from  scarlet  fever  reach  10  per  1000  in  any  of 
the  lam  towns.  The  64  deaths  from  diphtheria  included 
41  in  London,  5  in  Birmingham,  3  in  Liverpool,  3  in 
Manchester,  and  3  in  Leeds.  One  death  from  small-pox 
was  registerod  in  Bristol,  but  not  one  in  any  other  of  the 
lu|re  towns. 

ITiines'  BzbiUtton. 
An  entirely  novel  Exhibition  is  to  be  held  at  St. 
Martin's  Town  Hall,  London,  from  June  1st  to  June  13th, 
ftt  which  it  is  proposed  to  show  the  many  useful  and 
ingenious  instruments  and  dresnngs  by  means  of  which 
the  modem  trained  nurse  is  enabled  to  carry  out  medical 
directions  for  the  alleviation  and  cure  of  ilmess  or  injury. 


There  will  be  nursing  appliances  as  employed  io  the  chief 
general  and  special  hospitals  of  the  United  Kingdom  ; 
model  beds  and  other  furniture  for  the  sick  room  and  the 
hospital  ward  ;  nursing  uniforms  and  dress  ;  hospital  cer- 
tificates, medaJs,  and  badges  for  nurses.  The  methods  in 
use  at  the  hundreds  of  hospitals  in  the  United  Kingdom 
differ  so  greatly  that  such  an  Exhibition  should  not  only 
be  of  much  interest,  but  also  of  much  educational  value  to 
the  large  numbers  of  women  now  engaged  in  nursing. 


PASS    LISTS. 


University  of  Durham. 
At  the  Convocation  holden  on  April  25th,  the  Degree  of 
Doctor  in  Medicine   for    practitioners  of  fifteen  years' 
standing  was  granted  to  the  following  candidates  :«- 

Blacker,  Krnest,  M.R.C  S.,  t.R.0  P. 

Brown,  Francis  Wh-  elcr.  M .  R.r.8  ,  L.  8.  A . 

Davies.  John.  M  B.o.8  ,  L.8  a. 

Lowne,  Benjamin  Tnorapeon.  *  B^^.ft,  L.fi.  *. 

Mackinlay.  Hobert,  UB  C  P.Ed.   L.F.P.8.GIa«. 

Matthews.  Chsrles  Edwin,  M  B.O.^..  L.R.C  P. 

Mavor.  Wtiliam  Samnel,  M.B  G  8..  L.B  C.F. 

And  the  following  received  the  ordinary  Deg^ree  of 
Doctor  in  Medicine  : — 

Cox,  Birtfon,  If  B..  B.S.Dorh. 
D-twsoa  H-nry  King,  M  B.,  H.8.Darh. 
Diver.  Ebenezer  William,  M.B.    urh. 
Hawthorn.  »rank,  M.B.,  B.8  Durh. 
Leech.  Joseph  WlllU'a.  M.B..  B  h  Darh. 
Lovely,  Obarles  Newt  n.  M  B.,  B8.Darh. 
Matthews,  Penry  John,  M.B  Durh. 
Morgan,  Eobert  William  M.B.,  b.M.Darh. 
Orfden,  Ogden  Wat«>n.  M  B..  B.8.Darh. 
WhlllU,  Samuel  Short,  M.B.,  B.S  Dorh. 

The  following  obtained  the  degree  of  Bachelor  in  Medi- 
cine (M.B.)  :- 

Honours— Second  Class. 
Burrow,  Vincent,  M.E.C.«>.,  L.E.C.P.,  St  Mary's  Hospital. 
SutdUr,  Edward  Harvey,  Pt  Thomas'^  H'  spital. 
Streatfleld.  •  homaa.  M.R.C  8.,  L.  a.C.P  ,  Ui.lversity  Colleee  HotpttaL 
TomllnaoD,  0«k).  H.,  M.B.C.8  ,  LB.G.P..  Mason  College.  Ittrmlngbam. 
Lauffhton-Smith.  F.,  M.R.o.S..,  L  B.O.P.  Maaon  College,  Birmingham. 
Poolei  Ihomaa  Brioe,  M.E.<\8  ,  L.E  C.P.,  Goya  Hoeprial. 
BowUnd,  Frederick  W.,  M.E  C.^.,  L.E.C  P.,  Gny's  HoepltaL 

PaPS   List. . 
Armstrong  Percy  Luke,  College  of  M»'d«cloe.  Newcastle-upon-Tyne. 
Davirtson,  Leslie,  College  «»f  Medici-  e.  NewcasUe-upon-Tyne. 
Dickens.  Charles  Henry  Bt  Tnoniaa'*  Hospital. 
Harkness.  William  T.,  College  of  Medttine,  Newcaatle-upon  Tyne. 
joeoebne,  Edward  Walw.  L  8. A.,  St.  M-ry's  Hospital. 
Jov  Charles  HolroM>.  Mason  Collect,  Birmingham. 
Mevrlck-Jores,  H.  M.,  M.E.C.a,  L.B.C.P..  Col .  of  Med  .  Newcastle. 
Newson,  Herbert, «  olleg^nf  Medicine,  NewcasUe-npon-Tyn^ 
Eichards,  Lewis  WUIlam,  M.a.C.d.,  L  E.O.P.,  St.  Thomas*  HoepltaL 
Elchards!  William  fl..  College  of  Medicioe,  Newca*tl«^u  lon-Tvne. 
Shapland.  John  Dee,  B.A.Ciuiab.,  University  CoUege  Hosnital. 
Whitehooae,  William  Henry,  Mason  CoUege,  Birmingham. 

The  following  obtained  the  Degree  of  Bachelor  in  Snr 

gery  (B.S.)  : — 

Armstrong.  Percy  Luke,  College  of  Medicine,  Nowcastie. 
Bm^ Vincent,  M.E.fc.8..  UEC  P., St,  Mary's  HospitaL 
DaTldaon   Leslie,  College  of  Medicine,  Newcastle. 
Harkness^  WillUun  Thomas,  College  of  Medicine,  Newcastle. 
Joy.  Charles  Holitoea,  Maaon  Collet,  Wnningham. 
LMighton.Smith.F..  M.E.C.8.,  L.Lc.P.,  Mason  CoUege,  Birminghsm 
SSSlckSones,    H.  M.,  M.E.fc.&,  L.E.aP,.  College  of   M^dldne, 

Newcastle^ 
Newtome,  Beibait,  College  of  Medlclno,  Newct^le- 
pSle  Thomas  J^rtce,M.lLa3..L  R.a  P.,  Gay's  Hwplt^l    ,    „      ,    , 
SSiards,  Lewis  WiUltm,  M.KC8  ,  L.R.C.P.  St  jUma^v  HoipiUl 
Eowland  Frtdt^rick  wmtam,  M.R.t.S.,  L.R.C,P.,  Gu/a  Hofpltaf. 
Eichards,  WJlimm  Saiitpr,  CijIlegB  of  Medicine   Seweaitle 
8trwilfl3d.T.,  M,R.C,S„  L.R.C.P..  UnlvonUy  College  H  cm  pi  ttl 
Shanland.JohTi  Ut^,  B.A.t€*iit*b,.  Unlvarslty  iioll^ge  n-wpltal. 
Tomttoson.O.  H.    M.R.f'.B,  L.E.Cl  P.,  SI  moh  College,  BLirolngh    m. 
Whitehoose,  WiUlam  Beary,  Mwoti  Collegfl^  Blrmiiiijliftm.    ,  ^    ^  ^ 

A.  E.  Iboiipatm.  MB.,  lia..  Diirh..rc«?fllTftd  the  T>egT*e  of  Bich*l0T 
in  irglene :  and  w.  b.  Umutou,  M.&.  M.R.as.,  LR,aP.  Iho 
Diploma  in  Public  Health. 

In  the  Third  Ezaminatioii  (New  Begnlatioiis)  for  the 
Degree  of  Bachelor  in  Medidne,  the  following  passed  :— 

Second  Class  Honours. 
Petfwn,  Alhert,  O.  W.,  CoUege  of  Medidne,  Newctstie-apon-TJme. 

Pass  List. 
Bolgate.  Pewsy.  College  of  Medicine,  Newcaitje-iipon.Tyne. 
UsteTwalter  Herbert.  College  of  Medicine,  Newcastle-apon-Tyne 
Lowiy,  John,  CoUege  of  Medicine,  Newcastte-upon-Tyoe. 
Simpson,  WiUiam,  CoUege  of  Medieine,  Newcattte-npon-Tyne, 


492     Tni  Mn>iGAL  Pbws 


NOTICES  TO  CORRESPONDENTS. 


Mat  6.  1890. 


e^ouad  to 
CorrtBponbetttB,  l^hort  JUtttxB,  ice 

C^  OonsBPOHDnnB  rtqsMiiff  a  n^  to  Ikli  oolamii  an  par- 
tfculatlj  laqnartad  to  maka  naa  oC  a  dl$Um§tim  §ifrnahMre  «r  UMab, 
aiMl  arold  tha  praotloa  of  ilgBlni  tiMBBidYW  <*  lUadflr,' 
'•QldBDliaarlbar,"  Ao.  Mvoli  oonfodon  wfll  ba  ipaiad  bf 
lotbiirDla. 

Ob.  Oovtts  la  tliankad  foe  hia  nota,  and  tha  pronnlaa  oootalnad 
thaieia. 

H.  T.  win  fled,  on  rafaranoa  to  anotlur  oolamo,  that  hit  raquaat  has 
baan  oompUad  with. 

BoOK-WoBM.—We  avdaiatandtha  book  refarrad  to  haaffona  through 
■Iz  or  MTan  edlttoDS  In  Amarica,  bat  it  la  Uttla  known  In  thii  oonntry, 
and  la  nnaaitable  for  atndabta  hero,  baing  arraoged  on  tha  baola  of  tha 
U.S.  FliamiaoopQela. 

Mr.  ]UHBOia.^Toar  lint  qnaatton  mnat  ba  anawarad  In  tha  nega- 
tlTo.  Yonr  aooond  rappoattlon  la  oorraot.  Dr.  Sharp,  whoaa  daath 
waa  annonnoad  a  faw  dsyi  ilnoa.  waa  ninaty  jaara  of  aga,  and  waa  a 
homoaopathic  practitlonar,  altbongh  not  an  enttra  battarar  in 
Hahnemann'a  thaorlea.  He  wai  a  man  oC  oonaidaraUa  power,  and 
healtated  not  to  oritldaa  HahnemanD'a  efaaraotar.  and  the  prinelple 
of  similia  BinUUbua  curantwr,  on  which  tha  mla  of  drag  seleetlon 
reotad.  For  the  laat  flftr  7Mn  he  baa  realdad  at  Eagby,  where  he 
waa  engaged  In  a  moat  extenalTe  praotioa,  thoagh,  io  later  year*, 
almoat  parely  aa  a  oonaaltant. 

ADCJIiTBBATIOK  TN  SX0EL$I3, 

Thk  latett  high  art  ■ophietlraMon  introdnoed  to  medicine  la  the 
mixing  of  cryatau  of  aoaar  eandj  wiih  codeine.  The  frand  cannot  be 
detected  except  bj  FehUng'a  aolotlon  and  the  apectroacope. 

(lOeettttgs  of  the  ^ooetiea 

WiDHBaPAT,  Hat  oth. 
Obstrrioal  Soozsn  o?  howwm,  -  8  p.m.  Spedmeot  will  be  ahown 
by  Dr.  Iiewen,  Mr.  Doran,  Dr.  Haodflald-^onea,  and  othera.  Adjourned 


Diacnaalon  on  Mr.  Morlaon'a.  Dr.  Spenoar^a,  and  Dr.  ISden'a  papara  on 
Dedduoma  Malignam.  Papera :— Mr.  A.  Doran :  Oaaaa  of  Fibroma  of 
the  Ovary  and  Orarl«n  Ligament  Bemored  br  Operation:  with  a 


aeiiea  of  After-Biatoriee  of  Oaaea  reported  In  tha  Itanaactlona  aince 
187».    Dr.  J.  PhiUipa  :  Anterior  Oolpotomy. 
TBUBgDAT,  Mat  7th. 

Ophtbalxoumioal  Soodrt  o¥  tbb  UimsD  KnioDOM  (ti  Chandoa 
Street,  OaTcndiah  Sqoara,  W.).>8  p.m.  CUnloal  Braning.  Mr.  A. 
Critohett:  (1) Aeatotatien  to  Mormal  Vlakm after  armpatSatlc Oph- 
thalmltlat  (i)  Kxtraction  of  a  Dldocatad  Uoa  with  Good  Beanlt.  Dr. 
|L  D.  Batten  lOplcNenreDlaeaaa  In  a  Mother  and  Three  Children. 
Mr.  H.  Bpioer :  Oaae  of  Sparioaa  Optic  Neorltia.  Mr.  B.  Power:  Cmc 
of  Ughtning  Stroke  of  Face  without  Permanent  Laalon  of  the  Byea. 
Dr.  D.  Mowat :  lormphaogiactaab  of  Eyellda.  Mr.  Madehoee  :  One- 
aided  Sixth  Kerre  Paialyria,  BeCraotioa  of  Globe  and  Oontractkm  of 
Orbicularii  on  Botation  Inwarda.  Mr.  B.  Taykv :  Ttanq^lantation  of 
SklntothaSuifaoaoftheByeballfortheCuraofSymblepharon.  Mr. 
Cart wright :  Poaterior  Leutal  Opacity.  Bemama  of  ttyaldd  Artery  and 
Colombo  Iientia.  Mr.  F.  Bra :  Gaae  of  Detachment  of  Bettaa  treated 
by  Drainage. 

Habveiam  SooiiTT  OF  LovDOV  ffltaffoid  Booma.  Tltchboma  Street, 
Bdgware  Boad).>&80  p.m.  Dr.  A.  T.  Schofleld :  Mental  TharM«tttl«. 
FBIDAT,  Mat  8TH. 

CUBICAL  SoonrT  OF  L0BiKni.-8JK)  p.m.  Mr.  L.  Hndaou:  A  Omc 
of  Malingering  In  a  Boy       '  "  "* 

Laryngectomy.    M 

PaitialCoafanltal  _     _       

wanta.  Mr.  Baymond  Johnaon :  Fracture  of  the  Neck  cC  the  Femor 
In  a  Yoong  Subject  retalting  from  Dry  Gariaa  of  tha  Bone.  Mr. 
Makina  :  A  Oaae  of  Divlalon  and  Immediate  Sntoie  of  the  Left  Vagna. 

BOTAL  lB8n!nmoN.-9  p.m.  Prot  S.  P.  Thoapaon:  Blaotric 
Shadowa  and  Lumlneaoenoe. 

Satvbpat.  Mat  vte. 

BOTAL  lB8nTunoH.-gp.ni.  Mr.  F.  Coid«:  Three  Bmotional 
Oompoaara— Berlles.' 


nrr  or  unnxm,'-i5Mt  p.m.    Mr.  JU.  BOdaon:  A  Omu 

In  a  Boy  aged  Kleren.    Mr.  B.  Ward :  Three  Oaaea  of 

Mr.  W.  ATLana:  A Omo  lUaatrattaig  a  Condition  cC 

Ud  DIalocatlon  of  both  Hip  Jolnta  fbtward  and  Up- 


Barbadoea  General  HoopltaL— Janior  Bealdant  Surgaon.  Salary  £S0O 
per  annum,  with  anfnralahed  apartmenta.  Applicationa  and 
teatimonlala  to  the  Secretary  not  later  than  July  8th. 

Bolawayo  BoopitaL-Bealdeat  Houae  Suigeon  (unmarried).  Salary 
A¥»  pet  annum,  with  board  and  lodging.  Applicationa  and  tea- 
tlmonlala  to  the  Chairman,  Hoapltal  Board,  Bulawayo.  Bhodetla. 

Bor^h  of  Leith.-PubUc  UeUth  HoapltaL-Beaident  lliyalcian.  Satary 
60  sulneaB.  Further  particuhva  may  be  had  from  the  Subacriber, 
with  whom  applicationa  and  teatimonlala  (17  copiea)  to  be  lodged 
not  later  than  May  9tiL 

Glamorgan  lOounty  Aaylnm,  Bridgend. -Junior  AadaUnt  Madi- 
^  ??*?•.  '^•'^  *^  '*^n»  *1®  ■  y«*  *o  ^160,  with 
board,  lodidng,  and  waahing.  Applicatloaa  and  teatimonlala  to 
tha  Medical  Snperlntendeni  not  later  than  May  ISth. 

Kent  County  Ophthalmic  Hoapltal. -Houae  Suigeon.  Salary,  with 
fumi«hed  wartmeota  and  attendance  in  the  OMpttaL  but  without 
board,  for  the  flrtt  year  £125,  and  £15  j  after.  Applicationa  and 
teatimonlala  to  Matthew  A.  Adama,  Sorgeon  to  the  Hoanital. 
Trinity  Houae,  Maldatone. 

Metropolitan  Aayluma  Board. -Medical  Superlatendent  of  the  South 
Baatem  Uoapital,  Old  Kent  Boad,  London,  8.B.  Salanr  £400. 
riaiiw  to  £600,  per  annum,  with  houae,  attendance,  waahing,  ±c 
Applicationa  before  May  7th  (ace  advert.) 


Bangoon  Municipality.— Health  Officer.  Hilary  ta.SiiO  per  nuaaeaa, 
rlaing  to  Ba.1 000  per  menaam  by  annual  iocrementi  of  BfJSO  per 
menaem.  Aopllcatloni  to  Meaara^  Ogdry,  Qfllandera,  and  Co., 
Sun  Court,  07  Comhill,  K.C.,  not  later  than  May  rOth. 

Stamford.  Builand.  and  General  Infirmary. -Houae  Sorgeon  (on-' 
mairlad).  Kalarr  £100  per  annum,  with  board,  lodging,  aod 
waahing.  Applicationa  and  taatlmoniala  to  the  Beoretary  on  o€^ 
beforaMay  UCh. 


S^ppaintmtnxM 


BBAUMOBT.  J.  C.  H.,  L.B.aP.,  L.B.C.8.«d.,  Medical  Officer  for  the 
Inflnnary  and  Ckxrdna  Boad  Workbooaa,  Camberwell 

Burt,  D.  J.  Sw,  M.  &,  C.M.Bdln.,  Houae  Suraeon  to  the  Brighton,  Hore 
and  Suaaax  Throat  and  Bar  Hoapltal,  fiilghton. 

Cbaoo,  W.  H..  L  B.C.P.Lond^  M.B.C  S.,  Honorary  Aaaiatant  SoigaoD 
to  tha  Sydney  HoanitaL  New  South  ffalea. 

Dalb,  F.,  M.D.CaDUb.,  F.R.C.8.Eng..   Honorary  Ophthalmic  and 
Aural  Surgeon  to  the  Scarborough  Uoapital  and  Dfapenaaiy. 

FLTBB.  B.  A.,  F.B.C.P.IreL,  L.B.G.S.IrBl.,  0>naKologlat  to  the  Dmm« 
condra  HonltaL 

l^BTBSCDB,  W.  A.  J.,  M.Bw,  CMJlhard.,  Medloal  OOoar,  Boyal  Infir- 
mary,^ Aberdeen. 

OILL.  S.  B.,  M.aLond.,  L  B.C.P..  M.B.O.8.,  Bfildent  Medical  Officer 
to  the  Bo}  al  Hoapltal  for  DIaaaara  of  the  Cheat,  London. 

GOBDOB,  J.  L.,  M.B.,  O.M.Aberd.,  Medical  Ofllcar,  Boyat  Infitmarr. 
Aberdeen. 

JoBBS,  H.  T.,  UB.C.P.Lond.,  M.B.C.S.,  Medical  Officer  far  the  Second 
Sanitary  DiBtrlct  of  the  Pembroke  Union. 

LOTBOBOYB,  J.  F.,  M.B.C.S.,  GoTcmment  Medical  Ofllcw  and  Yao- 
dnator  for  the  dlatr!ct  of  Pioton.  New  South  Walea. 

CMBBHAB,  J.  A.,  L.B.C.S.lTe].,  Bealdant  Medical  Officer  and  PabUo 
Vaccinator  for  the  dlatrlcta  of  KalgoorUe,  Weatem  Auatralla. 

PBAR80B.  B.  B.,  L.B.C.P.Lond.,  M.B.as.,  Medical  Officer  of  Healtb 
for  the  Winn  Bat  alSanitary  DIatrlct. 

PUBSBB,  C,  mIb.,  Ch.M.C>yd.,  Uonoraiy  AaaiaUnt  Phyalelan  to  th« 
Prince  Aifted  Hoapltal.  Sydney.  New  Sootii  Walea. 

STBWABT,  C.  A.,  L.B.aP.,  LB.C.8.Bdln.,  Acttrg  Officer  cC  Health  for 
Blchmond  Citr ,  Victoria,  Auatndte. 

STBWAkT,  G.  J.  T.,  M.B.,  O.M.Aberd.,  Medical  Ofllcar.  Boyal  Infir- 
mary, Aberdeen. 

STMOB8,  W.  H.,  D.P.aOxim.  and  Durh.,  Medieal  Officer  of  Health  bF 
theBath  Urban  Sanitanr  Authority. 

THOMflOB,  A.G.  A..  M.a,O.M.Abetd.,  Medical  Ofllcar.  Boyal  Infir- 
mary, Aberdeen. 


WAI8HAM,  H.,M.A.,  M.B.Gantob.,  M.BuaP.Lond.,  Aaaiatant  Phyal- 
to  the  City  of  London  Boqrttal  for  D  aeaaaa  cC  the  Cheat. 


dant 


firtlia. 


BBBBT.-^ApHl  28th,  at  Wanaford  Houae,  Watford,  the  wife  of  F« 

Hajcraft  Berry.  M.D.Lood.,  of  a  aoo. 
Blaoklook.— May  let,  at  Delay  Bank,  Piaatwich,  the  wlf^  cC  Joho 

Biocklock,  M  D.,  cC  twin  aona. 
ORABT.- Anril  aotb,  at  8  Upper  fHrnpole  Street,  London.  W.,  the  wile 

of  Dnndaa  Grant,  M.D..  F.B.C.S  ,  of  a  aon. 
HURRT.— April  SOth,  at  Abbdabrook,  Beading,  tha  wile  of  Jamlaaoa 

a  Huny.  M.A.,  M.D.  of  a  daughter. 
Martib.— April  S7th,  at-  88  Bermondfey  Bqnara,  London,  8.B.,  th» 

wife  of  V,  G.  CUfton  Martin.  L  B.aP.,  M. LOA,  oC  a  ^ 


BOPBBBR- WARnLAW.—April  tSth,  a*  the  Pariah  Ghnroh  of  81  Mary, 

8traiinrd-le-Bow,  Ueniy  Albert  Bodeker,  M.a  and  aM.,  of  Meal* 

main,  firitlah  Bnrm«h,  to  Helen,  youngeat  da^phter  of  Sir  Haniv 

Wardlaw,  Bart.,  of  PItrearle,  Soothuid. 
DATIP -WnxiABS.— April  88th.  at  LlanwooDO  Pariah  Church,  W» 

Waahingtoa    David,   MJLC.&.Tonypa»dy.    to  Anne    Wllliamt,. 

daughter  of  the  late  Thomaa  WOUama.  Y  Glog,  UaawonnOb 
Jabbsob-Skifworth.— April  SSth,  at  St  Geor8a*B,  Graveaand,  Geoigr 

Bernard  Jameaon.  M.D.,  ion  of  Brigade-Surgeon  G.  W.  Jamaaon, 

to  Blla  Marion,  elder  dani^ter  of  the  late  Bct.  Gray  SUpworth. 
LAFTHORir-LBB.  -  April  SBth.  at  Union  Chapel,  lalingtim,  Chaa.  Albert - 

Lapthon.  F.B.C.<<JB..  of  littlehampton.  to  Agnea  Maiy,  daughter 

of  Henry  Lee,  J.P.,  of  Bartham,  Hfghbary. 
Lbiqbtob—Batbiiab.— April  SMh,  at  St  GOaa'a 

Bobert  Leighton,  of  Streatham.  to  Florence  Bthelind,  < 

Sir  Flmderic  Bataman.  M.a,  lLd.,  d  Norwich. 
MiOHBiL-BoBiBSOif.- April  80th, at  TMnlty  Ghnroh,Soath  Hamp- 

btead.  J.*hn  C.  Ulcheli;  M.B.CA,  aon  of  the  BetTw.  F.  MicheO,. 

Vicar  cCOarhamnton,  to  Helena  &.,  foarth  danghtar  of  tha  late 

John  Robtnaon,  Backwell  Hooae.  Someraet. 
NAnBR-JoiB8:-BU8SBL.— May    Ut,  at  St   Mary  and  Bt  HeleD'iW- 


Chardh.  Nonrioh. 
heUndTdaaghterol' 


Jonea,  M.B.aS.Bng.,  LJtCP. 

Jonea,  tOth  BegiaMnt,  to  Annie 
McLeod,  }OQi«cat  danghtar  of  the  Ute  David  Bmaell,  MJX,  of 
Neaton. 


Neaton.  Cheahire,  PhiUp  NapleivJ< 
Lend.,  aon  of  the  late  Major  KM.  J 
McLeod,  soongcat  danghtar  of  the 


SVTBBRLABP  -BARWBLib^Aprfl  80th,  at  St  John'a,  Hollington,  St 
Leonard'a,  Henry  Sutheriand,  M.D.,  of  Blchmond  Tacxace,  White- 
~  ",  London,  to  Meta  Praecott  aecond  daughter  of  Captahi  W.. 


B  BarwaU,  formerly  lOth  Bengal  Uncera. 


MttikB. 


ABUBB80B.— Aprfl  fOth,  at  Pitlochry.  N  a,  Arthnr  Anderwm,  M.D., . 

aa,  retired  Inapeotor-Geoeral  of  H.M.  ^MBitala,agad  81. 
Flabaoab.— April  80th,  at  Portamouth,  Jamaa  JUaagan,  L.aC.S.L,. 

aN.,  Deputy  Inapector-General oCHoapitab  andF1eeta<rotlrad),. 

agedOL 
HBALD.-April  86th,  at  HIngham,  Norfolk,  Bobert  Heald,  M.aC.%, 

L.S.A.,  aged  46. 
L00KHART.-April  29th,  at  GimnviUe  Park,    Blackhenlh,   WiUiam 

Lockhart,  F.aas.,  ved  8t 
MAHOBT.^April  SSth,  at  Beat  Grinatead,   Arthur  John  Mahony». 

L.S.A.,  aged  70. 


ib  ^dmi  ^m$  mA  ^irotkt 


"SALUS    POPUM    SUPRBMA    LEX." 


YouGXIL 


WEDNESDAY,    MAY    13,     1896. 


No.  20. 


lEITIS: 

ITS 

PATHOLOGY  AND  TREATMENT,  (a) 

By  HENRY  JULER,  F.RC.S., 

Snigeon  to  the  Boyal  Weatminster  Ophthalmic  Hospital,  Ophthalmic 

Surgeon  to  the  St  Mary's  Hospital,  Consnltiiig  Ophthalmic 

Suigeon  to  the  London  Lock  Hospitiu. 

(Concluded  from  page  469.) 

3.  Its  Clinical  Yabietiss.— Among  the  different 
forms  may  be  mentioned  the  followinj;  :— 
1.     Intra-nterine  irituu 
8.    Tubercular       „ 
3*     Syphilitic         ^ 

Rheumatic       „ 

Gonorrhoeal     „ 

Gouty  „ 

( Idiopathic  „ 
By  idiopathic  iritis  I  mean  those  cases  in  which 
no  (^use  is  discoverable.  !niey  seem  to  occur  in  those 
subjects  which  miicht  be  classed  in  the  uric  acid 
diathesis,  in  sjpte  of  no  evidence  of  gout,  either  here- 
ditary or  acquired. 

Intra-vterine  iriHs  is  rather  an  assumption  than  a 
proved  fact,  but  the  appearance  of  the  eyes  of  certain 
infants  is  highly  suggestive  that  such  an  inflammation 
does  take  place  m  utero.  Babies  are  occasionally  seen 
with  posterior  synechia  without  any  evidence  of  recent 
inflammation,  and  no  history  of  redness  of  the  eye. 
In  these  cases  it  is  not  unusual  to  find  a  smaU  white 
opacity  of  the  lens-capsule  at  the  site  of  the  adhesion, 
and  sometimes  four  or  five  such  opacities, 
simulating  anterior  polar  cataract,  but  differ- 
ing in  not  being  central,  but  corresponding  in 
their  position  to  the  natural  ring  of  the  pupil. 
To  some  the  iris  may  be  adherent,  to  others  no  such 
adhesion.  Presuming  that  they  are  evidences  of  inflam- 
mation, no  treatment  is  called  for,  as  the  inflammatory 
storm  is  past.  The  condition  is  merely  an  interesting 
pathological  curiosity.  Certainly  the  cause  must  be, 
m  such  a  case,  a  constitutional  one,  and  through  tiie 
mother. 

^  Tubercular  iritis  is  a  chronic  inflammation  of  the 
iris  characterised  by  the  formation  of  grey  nodules  in 
its  stroma.  One  or  two  nodules  are  seen  at  first,  then 
they  coalesce  and  form  a  thick  mass  of  chronic  inflam- 
matory tissue.  There  is  some  fibrinous  exudation,  and 
the  pupil  is  small  and  inactive.  Mydriatics  may  at 
first  dilate  it,  but  it  soon  contracts  again  as  the  stroma 
becomes  invaded  hj  the  new  growth.  The  vessels  of 
the  iris  become  visible  and  are  seen  between  the 
nodules  if  carefully  examined ;  they  give  the  iris 
a  brick-red  appearance.  It  develops  slowly  with  at 
times  temporary  improvement,  and  according  to  some 
authorities  may  clear  up  altogether.  There  is  not  much  * 
pain  in  the  early  stage.  Sometimes  an  acute  attack 
of  plastic  iritis  may  subside  into  a  chronic  form,  and 
after  a  time  prove  to  be  tuberculous.  > 

The  pathology  of  this  disease  differs  in  no  way  from 

(a)  Deltrered  before  the  Harrvian  Society  of  London. 


tuberculous  deposits  elsewhere.  The  tubercle  bacillus 
has  been  sufficiently  often  demonstrated  to  leave  no 
doubt  as  to  its  true  nature.  Why  these  or^^isms 
should  choose  this  membrane  for  their  habitat  is  some- 
what strange.  There  can  hardlv  be  any  doubt  that 
they  find  their  way  there  by  the  bloodstream,  and  that 
they  are,  in  some  instances,  carried  there  from  some 
focal  disease  elsewhere,  such  as  tuberculous  glands  in 
the  neck.  There  are  many  cases,  however,  in  which 
it  is  Quite  impossible  to  find  any  evidence  of  tubercu- 
lous oisease  other  than  that  in  the  iris  which  tends  to 
the  belief  that  the  iris  may  be  the  sole  seat  of  the  mor- 
bid deposit,  and  why  should  it  not  be  so  ?  We  find 
that  certain  tissues  are  prone,  either  from  hereditary 
or  acquired  weakness,  to  suffer  from  certain  ills,  and 
we  are  aware  that  the  tubercle  bacillus  may  enter  the 
blood  either  by  the  lungs  or  alimentary  canal  without 
infecting  them,  and  that  it  may  be  carried  by  the 
bloodstream  to  a  remote  part  of  the  body  and  may  find 
a  suitable  nidus  and  grow,  or  not  do  so  and  die.  It  is 
the  bacillus  of  all  others  to  take  its  choice  in  the  matter, 
what  other  organism  is  more  prone  to  start  a  local 
inflammation,  and  a  chronic  one  ?  It  is  very  true  that 
a  local  outbreak  of  tubercle  in  the  body  may  at  any 
moment  ^vq  rise  to  a  general  tuberculosis,  especially, 
if  the  primary  focal  lesion  undergoes  caseation.  It 
would  merely  demonstrate  the  constitutional  suscepti- 
bility of  che  individual.  The  lesion  in  the  iris  usually 
starts  near  the  iritic  angle  and  early  invades  the  ciliary 
body  and  later  the  cornea  in  front  and  the  choroid 
behind.  Eyes  have  been  excised  not  infrequently  for 
suspected  sarcoma  of  the  iris  which  tumour  has  been 
found  to  be  tubercle  of  tiiat  membrane  upon  examina- 
tion. 

This  pathological  Question  is  a  matter  of  considerable 
importance  from  a  clinical  standpoint  Here  we  have 
a  cusease  of  tiie  ins  which  we  know  from  its  appear- 
ance and  clinical  course  to  be  tuberculous,  and  we  are 
unable  to  find  any  tubercle  elsewhere  in  the  body ; 
ought  we  to  excise  the  eye  at  once  to  remove  the 
danger  of  generahsation,  or  not  f  We  are  aware  that 
certain  cases  have  been  cured  leaving  an  organ  practi- 
cally undamaged.  Iridectomy  has  not  proved  suc- 
cessful Many  cases  progress  slowly  till  secondary 
glaucoma  and  the  aocompanyinf^pain  demand  excision. 
In  my  own  mind,  I  feel  convinoad  that  an  attempt 
should  be  made  to  save  the  organ,  because  I  consider, 
if  this  is  the  sole  focus  of  the  tubercle  the  danger  of 
dissemination  is  very  slijght,  indeed,  on  the  ground  that, 
in  the  first  place,  tiiere  is  no  tendency  for  caseation  to 
take  place  here ;  and,  secondly,  that  the  growth  of  the 
organism  in  this  remote  region  must  be  accidental, 
rawer  than  due  to  a  constitutional  predisposition.  If 
the  disease  progresses,  and  secondary  slaucoma 
threatens,  then  enucleation  should  be  advised,  but  not 
otherwise. 

Syphilitic  vritis  presents  itself  in  three  chief 
varieties  :  (a)  that  which  appears  as  a  sub-acute 
plastic  iritis  m  the  early  sta^  of  secondary  syphilis  ; 
(b)  a  gummatous  iritis  in  which  gummata  are  formed 
on  the  surface  and  in  the  stroma  of  the  iris  at  a  later 
stage  in  secondary  syphilis ;  and  (c)  plastic  iritis 
which  is  due  to  the  taint  of  inherited  syphilis. 
[Syphilis  is  undoubtedly  the  most  common  cause  of 


494      Thx  iilDlOAL  PrB88. 


dRioiifAL  cokMu^iCATtoNs. 


Mat  13,  Idte. 


iritis,  at  least  half  the  cases  that  occur  being  referable 
to  that  disease  alone.] 

The  first  is  the  most  common  form ;  it  generally 
apiiearfl  in  the  early  period  of  secondary  syphilis 
daring  the  stage  of  eruptions,  macoos  patches,  &c.  It 
is  characterised  by  a  copious  exudation  of  lymph  into 
the  substance  of  the  iris,  especially  around  its  pupillary 
border,  sometimes  orange-coloured  nodules  appear  at 
this  site.  The  pupil  is  contracted,  and  its  outline  is  no 
lodger  weli'defined,  but  blurred,  the  whole  membrane 
is  discoloured,  and  its  spon^  network  of  fibres  masked 
by  lymph  deposit.  The  circumcorneal  zone  is  some- ' 
what  injected  out  not  intensely  so.  There  is  sometimes 
but  little  pain ;  indeed,  patients  will  often  come  for 
advice  on  account  of  failure  of  vision  only,  and  make 
no  reference  to  pain,  photophobia  or  lachrymation  ;  in 
severer  cases  the  pain  may  be  agonising.  The  diagnosis 
is  readily  made  by  collateral  evidence  of  acquired 
syphilis,  the  raw  ha[m  rash,  mucous  patches  in  mouth 
and  on  the  fauces,  laryngitis,  enlarged  lymphatic 
f^lands,  loss  of  hair,  and  sometimes  synovitis  in  several 
joints.  * 

In  the  second  form-^gummatous  iritis— fawn,  or 
dirty  orange-coloured  elevations  appear  in  the  tissues 
and  on  the  surface  of  the  inflamed  ins,  much  larger 
than  the  smaller  nodules  of  lymph  already  referred  to 
in  the  former  varietur.  They  are  generally  multiple,  and 
are  seen  in  the  iritis  which  occurs  towards  the  end  of 
the  second  year.  Their  size  appears  to  be  from  2  to 
5  mm.  in  diameter,  but  may  oecome  larger  and  reach 
the  posterior  surface  of  the  cornea  and  contract  adhe- 
sions to  that  membrane.  The  gummata  are,  perhaps, 
prone  to  start  near  the  pupillary  margin,  though  they 
may  appear  anywhere  in  the  iris. 

The  diagnosis  between  gumtnatotu  iritis  and  tuber- 
culotis  iritis  is  not  difficult,  even  apart  from  collateral 
evidence  and  the  history  of  the  case.  In  the  former 
the  nodules  are  always  more  or  less  tinged  with  yellow, 
the  circumcorneal  redness  is  always  present  and  usually 
well  marked,  anti-syphilitic  treatment  is  readily  re- 
sponded to.  and  the  fear  of  secondary  glaucoma 
averted.  Tne  latter  almost  invariably  progresses  to 
secondary  glaucoma  in  spite  of  treatment,  no  circum- 
corneal redness  is  seen  in  the  early  stage  unless  an 
acute  iritis  precedes  the  tuberculous  infection,  the 
nodules  are  grey  in  colour,  never  yellow,  sometimes 
reddish-grey.  If  in  doubt,  mercury  ana  iodide  of 
potassium  will  give  you  friendly  advice. 

Iritis  also  occurs  in  subjects  of  hereditary  syphilis. 
It  presents  itself  in  association  with  interstitial  keratitis, 
possibly  by  extension  of  inflammation  from  the  cornea, 
and  80  appears  usually  about  the  period  of  puberty. 
As  a  manifestation  of  the  secondary  stage  of  congenital 
syphilis,  it  is  most  rare,  but  cases  have  been  recorded, 
and  the  intra-uterine  attacks  are  probably  all  due  to 
the  same  poison.  It  appears  from  the  second  to  the 
fifteen  month,  while  the  child  is  suffering  from  rash, 
even  pemphigus,  mucous  patches,  and  condylomata  at 
angles  of  mouth,  and  around  the  anus,  kc.  The  his- 
tory of  miscarriages  is  another  guide  to  the  diagnosis. 

Rheumatic  iritis  does  not  occur  as  a  complication  of 
rheumatic  fever  ;  it  is  essentially  a  disease  occurring 
in  association  with  subacute  or  chronic  rheumatism. 
It  is  always  an  acute  iritis  attended  with  greiftt  (Nun 
and  tenderness,  with  photophobia  and  lachrymation, 
intense  circumcorneal  redness,  but  less  exudation, 
there  is  consequently  less  change  in  colour,  the  pupil- 
lary margin  more  clearly  defined  than  in  syphilitic, 
and  the  tendency  to  adhesions  less.  It  has  a  remark- 
able feature  of  distinction— that  of  relapsing,  and  the 
attacks  of  iritis  alternate  with  the  joint  lesions,  mus- 
cular and  fascial  'pains,  and  rheumatic  nerve-disturb- 
ances. If  adhesions  form,  recurrences  increase  the 
synechia  until  a  total  posterior  synechia,  or  exclusion 
of  the  pupil,  is  the  result.  The  inflammatory  attacks 
seem  then  to  subside,  as  if  satisfied  with  its  ruinous 
work.    Secondary  glaucoma  is  then  inevitable. 


Gouty  iritis  resembles  rheumatic  more  than  second- 
ary syphilitic,  differing  only  in  severity  and  persistency. 
It  is,  as  a  rule,  more  difficult  to  treat  than  any  form, 
and  the  pain  is  most  difficult  to  assuage.  The  whole 
ocular  conjunctiva  is  intense,  congested,  the  vessels 
are  large  and  tortuous.  The  symptoms  are  severe. 
It  is  prone  to  recur. 

Idiopathic  is  a  term  applied  to  those  cases  of  plastic 
iritis  in  which  no  coUatend  evidence  of  any  constitu- 
tional disease  ctfn  be  found.  All  the  symptoms  of  local 
inflammation  exist,  but  no  sign  of  syphilis,  rheumatism, 
gout,  or  other  systemic  disease,  can  be  discovered  or 
elicited  from  the  i>atient.  I  feel  convinced,  however, 
that  all  cases  of  iritis,  apart  from  local  injury  and  local 
sepsis,  are  caused  by  some  constitutional  dyscrasia. 
These  indefinite  forms  of  iritis  are  most  common  in 
middle  life ;  they  are  in  my  experience  more  frequent 
in  persons  who  lead  unhealthy  lives,  who  are  exposed 
to  the  vicissitudes  of  weather,  and  to  the  temptation  of 
eating  and  drinking  more  than  they  require  for  daily 
use. 

The  urine  of  such  persons  is  frequently  of  high 
specific  gravity,  and  is  found  to  contain  an  increased 
amount  of  uric  acid.  Very  often  a  faint  trace  of 
albumen  may  be  present. 

Such  persons  it  not  gouty,  come  within  the  category 
of  the  lithsemic  diathesis.  They  frequently  present  an 
unhealthy,  heavy,  and  wretched  countenance.  They 
complain  of  headache,  feel  bad-tempered,  and  possess 
the  nervous  depression  of  persons  whose  income  in 
nitrogenous  food  stuffs  exceeds  the  expenditure  of 
physical  and  mental  force. 

4.  The  Treatment.— TA^  treatment  of  iritis  is,  to 
my  mind,  of  the  greatest  importance,  and  so  I  wish  to 
dwell  somewhat  m  detail  upon  what  I  have  found,  and 
what  no  doubt  others  have  found  out  lon^  ago,  to 
be  the  most  successful  way  of  overcoming  this  embar- 
rassing, painful,  and  sometimes  tedious,  disease. 

It  is  chiefly  from  the  point  of  view  of  treatment  that 
I  have  endeavoured  to  classify  cases  as  far  as  possible 
into  clinical  groups  so  that  we  may  not  only  see  the 
local  trouble  but  may  recognise  the  general  dyscrasia 
by  which  it  is  caused. 

The  first  canon  in  the  treatment  of  iritis  from  what- 
ever cause  arising  is  a  negative  one — to  do  no  harm — 
by  the  use  of  astringents.  If  there  be  any  doubt  about 
the  diagnosis,  the  proper  course  is  to  let  the  astringent 
wait  and  to  prescribe  a  mydriatic  for  a  few  days  until 
the  truth  declares  itself.  As  I  have  said,  many  eyes 
are  irreparably  injured  by  the  neglect  of  this  simple 
precaution. 

The  second  step  in  treatment  of  any  case  of  plastic 
iritis  is  to  aim  at  the  complete  dilatation  of  the  pupil. 
This  is  of  paramount  importance  and  should  be  done 
immediately  the  condition  is  recognised.  The  object 
of  this  has  already  been  indicated  in  my  remarks  upon 
the  pathology,  viz.,  either  to  prevent  the  formation  of 
plastic  adhesions  to  the  lens  capsule,  or  endeavour  to 
break  them  down  if  recently  formed,  to  keep  the  in- 
flamed iritis  at  rest  by  paralysing  the  sphincter,  and  to 
diminish  the  amount  of  the  plastic  exudation  by  con- 
tracting the  blood-vessels  of  the  iris. 

The  best  mydriatic  is  undoubtedly  atropine  sulphate. 
It  should  be  used  in  the  form  of  drops  (1  per  cent, 
solution)  instilled  into  the  palpebral  sac  every  three  or 
four  hours,  or  as  an  ointment  of  the  ssme  strengtii.  If 
adhesions  have  already  formed  and  are  recent  it  is  well 
to  use  the  mydriatic  every  hour  for  six  consecutive 
hours ;  this  treatment  is  likely  to  break  them  down, 
leaving  a  few  dots  or  a  ring  of  pigmented  lymph  upon 
the  capsule  which,  however,  may  partially  or  entirely 
disappear.  If  the  adhesions  are  of  sufficient  a^  to 
have  become  firmly  organised  the  atropine  will  not 
break  them  down,  but  it  will  still  cause  dilatation  of 
the  unattached  portions  of  the  pupil  and  so  prevent 
further  <»>mp]ications.  This  free  use  of  atropine  may 
give  rise  to  local  irritation  in  the  form  of  irritahie  oon- 


Mat  Id,  1806. 


ORIGINAL  C0MMCJNICATI0K8. 


Thb  Mbdioal  Pr»s.     495 


junotmtis,  swelling,  and  erythema  of  the  eyelids  and 
ftnrrounding  region.  In  some  cases  this  is  very  severe. 
When  this  complication  arises  the  atropine  may  be 
chanf^d  for  sulphate  of  duboisine,  0  5  per  cent.»  or  a 
solution  of  scopolamine,  of  similar  strength.  These 
drugs  sometimes  exert  a  lees  irritating  effect. 

Systemic  poisoning  may  also  occur  from  the  use  of 
atropine,  and  is  recognised  b^^  heat  and  dryness  in  the 
mouth  and  throat,  difficulty  in  swallowing,  thirst,  loss 
of  appetite,  f aintness,  and  even  diarrhcea  and  delirium. 

An  efficient  way  of  preventing  this  is  to  let  the 
patient  press  the  puncta  lachrymalia  at  the  inner 
canthus  with  his  finger  for  a  few  minutes  after  each 
instillation,  so  as  to  prevent  the  drug  from  passing 
down  the  najsal  duct 

The  next  indication  in  treatment  is  to  relieve  local 
pain  and  congestion.  One  of  the  best  drugs  for  this 
purpose  is  cocaine  hydrochlorate.  It  may  be  used  in 
conjunction  with  the  atropine  just  mentioned  in  the 
strength  of  2  per  cent,  solution.  It  not  only  assists 
the  atropine  in  dilating  the  pupil,  but  is  a  powerful 
local  sedative.  Those  who  suffer  from  the  agonising 
pain  of  rheumatic  and  gouty  iritis  know  too  well  the 
value  of  this  precious  addition  to  our  pharmacopoeia. 
It  is  of  all  things  most  important  in  iritis  that  the 
patient  should  be  enabled  to  get  sound  sleep. 

Hot  fomentations  come  next  as  valuable  adjuncts  to 
these  drugs.  Large  pads  of  cotton  wool  saturated 
with  water  as  hot  as  it  can  be  borne  are  to  be  placed 
over  the  closed  eyelids,  covered  with  oiled  silk,  and 
then  with  several  layers  of  warm  dry  Gamgee  tissue 
lightly  bandaged  on  so  as  to  keep  up  the  warmth  of  the 
fomentation. 

If  pain  still  persists  and  redness  shows  no  siim  of 
abatement,  we  now  resort  to  local  blood-lettinff.  Three 
or  four  leeches  should  be  applied  to  the  temple  of  the 
affected  eye  as  near  to  the  outer  canthus  as  they  will 
allow,  or  an  equal  withdrawal  of  blood  by  means  of 
the  artificial  Heurteloup  leech,  is  one  of  the  most 
marvellous  aids  we  possess  in  the  relief  of  pain  and 
the  control  of  inflammation. 

In  persistent  cades  wh^re  the  paii^  continues,  and 
particularly  when  the  tension  of  the  globe  seems  to 
De  rather  increased,  the  operation  of  paracentesis 
of  the  anterior  chamber  often  causes  immediate 
relief.  The  operation  is  very  easily  performed, 
and  that  without  danger  of  wounding  the  iris 
or  lens  by  using  the  paracentesis  needle.  By  thus 
relieving  the  tension  of  the  eye  the  globe  seems  to  be 
enabled  to  better  absorb  the  atropine  and  cocaine,  and 
so  dilatation  of  the  pupil  and  cessation  of  pain  and 
redness  is  often  a  marked  result. 

The  relief  of  pain,  in  all  cases,  is  so  very  important, 
inasmuch,  as  without  it  the  patient  is  unable  to  sleep, 
at  least,  for  any  length  of  time,  and  prolonged  healthy 
sleep  is  most  essential  because  it  gives  rest  to  the  eye. 
If,  therefore,  the  pain  is  not  subdued  by  the  aforesaid 
remedies,  we  must  at  once  resort  to  sedatives,  in  the 
form  of  a  hypodermic  injection  of  morphia,  bromide  of 
potassium,  and  chloral  hydrate  by  mouth,  or  some 
oth«r  and  ei^nally  efficient  remedy. 

The  third  important  point  is  the  treatment  of  any 
constitutional  ayscrasia  that  may  be  found  associated 
with  the  iritis. 

In  the  iritis  just  described  as  occurring  in  the  early 
stages  of  secondary  syphilis  there  is  no  remedy  so 
efficient  as  the  internal  administration  of  mercury. 
This  is  the  most  common  form  of  syphilitic  iritis  and 
one  in  which  the  beneficial  effects  of  this  dru^  are  most 
marked.  I  usually  begin  the  treatment  by  giving  two 
grains  and  a  half  of  blue  pill  night  and  morning.  Any 
other  form  of  administration  such  as  the  hypodermic 
injection,  the  mercurial  vapour  bath,  or  the  inunction 
by  the  skin,  may  be  equally  efficient,  or  even  better 
than  this,  but  I  have,  from  old  Lock  Hospital  experi- 
ence, become  partial  to  the  old  blue  pill.  The  drug 
muBt  be  continued  day  by  day  and  week  by  week,  until 


the  iritis  and  all  the  collateral  si^ns  of  syphilis  have 
disappeared,  The  only  sign  for  its  temporary  cessa- 
tion is  that  of  commencing  ptyalism.  If  the  gums 
become  spongy  or  sore  the  mercury  must  be  stopped 
for  a  time  and  a  mouth  wash  of  chlorate  of  potash 
used  until  the  soreness  has  disappeared.  Certain 
important  points  in  the  administration  of  mercury  are 
to  keep  the  gums  as  healthy  as  possible,  to  avoid  taking 
a  chill,  and  not  to  take  fruit  or  alcohol  in  any  form. 
If  the  iritis  is  of  an  acute  character,  indeed  in  any 
form,  it  is  well  to  keep  the  patient  in  bed,  and  to  give 
him  warm  baths  so  as  to  promote  the  action  of  the 
skin. 

In  the  second  or  gummatous  form  of  iritis  which  has 
been  described  as  occurring  in  the  later  secondary 
stages  of  syphilis  the  administration  of  mercury  is  still 
indicated.  These  cases  are  more  rare  and  generally 
confined  to  one  eye.  I  alwa^rs  give  iodide  of  potassium 
and  decoction  of  sarsaparilla  in  addition  to  the  mercury, 
and  the  symptoms  rapidly  subside. 

In  the  inherited  form  of  syphilitic  iritis  as  I  have 
said  we  seldom  find  the  iris  suffering  alone,  it  is 
usually  sharing  the  burden  with  the  cornea,  the  ciliary 
body,  or  the  choroid  The  iritis  is  more  of  a  chronic 
variety.  Mercury  is  well  received  by  the  patient  and 
very  efficient  in  its  action.  The  patient  need  not 
generally  be  kept  in  bed  but  should  be  well  nourished, 
encouraged  to  take  exercise  in  the  open  air,  and  to 
avoid  alcoholic  drinks  of  all  kinds. 

In  the  rheumatic  and  in  the  ^uty  forms  of  iritis  the 
constitutional  conditions  are  still  of  paramount  impor- 
tance. The  pain  in  these  cases  is  usually  very  intense, 
and  requires  all  the  local  aid  which  has  just  been' 
referred  to,  but  the  general  condition  of  the  system 
must  not  be  neglected.  The  patient  should,  if  possible, 
be  kept  in  bed.  A  brisk  purge  of  calomel  and  rhubarb 
followed  by  a  saline  aperient  administered. 

Then  the  salicylate  of  soda  in  doses  of  ten  grains 
administered  every  three  or  four  hours  will  be  found 
to  have  a  marvellous  effect  in  reducing  the  severity  of 
the  attack.  This  may  be  continued  for  two  or  three 
days  according  to  the  degree  of  abatement. 

The  free  action  of  the  skin  should  be  promoted  by 
hot  air  baths  once  at  least  in  twenty-four  hours.  A 
capital  hot  air  bath  can  be  obtained  at  the  bedside  bv 
means  of  a  lamp  placed  beneath  a  chair  and  a  thick 
flannel  cloak  fastened  round  the  patients  neck.  He 
can  sit  and  simmer  for  half  an  hour  with  the  greatest 
ease  and  perspire  copiously.  Great  care  should  be 
taken  to  prevent  a  chin,  and  it  is  better  to  sleep  between 
the  blankets  so  as  to  encourage  perspiration  after  the 
batb.  I  feel  that  the  importance  of  keeping  patients 
warm  and  in  bed  and  the  promotion  of  skin  action  by 
hot  air  baths  is  considerably  overlooked  in  this  country  ; 
indeed,  patients  are  often  allowed  to  get  up  and  go 
about  as  if  they  were  only  suffering  from  a  toothache: 
When  only  one  eye  happens  to  be  affected  the  other 
eye  is  allowed  to  go  unshaded  so  that  the  affected  eye 
is  irritated  by  the  influx  of  light  to  the  sound  eye. 
Both  eyes  should  be  shaded,  both  atropised,  and  the 
disease  should  be  treated  as  one  of  the  greatest  impor- 
tance, and  requiring  the  greatest  promptness  and  acti- 
vitv  on  the  part  of  the  medical  attendant. 

In  the  chronic  rheumatism  cases  I  find  the  iodide  of 
potassium  and  bark  a  good  successor  to  the  salicylate. 

In  goutv  cases  I  attach  more  importance  to  the 
patient's  dietary  and  mode  of  life  than  to  any  medicines 
he  may  take  into  his  alimentary  canal.  As  I  have  said, 
I  believe  many  of  the  cases  of  iritis  which  we  now 
describe  as  idiopathic  are  in  reality  due  to  a  gouty  con- 
dition of  the  blood,  and  should  be  placed  on  a  diet 
which  reduces  as  far  as  possible  the  uric  acid  directly 
introduced,  and  at  the  same  time  reduces  as  fur  as  is 
compatible  with  healthy  nutrition  the  formation  of 
uric  acid  within  their  bodies.  The  iritis  of  these  cases 
is  always  liable  to  recur  unless  the  habits  of  the 
patient  are  bo  altered  as  to  improve  his  blood  condition. 


496    Thb  Mbdhul  Pbmb. 


ORIODTAL  COMMUNIOATIOlfS. 


Mat  is,  1890. 


Healthy  exercise  in  the  open  air,  a  very  moderate  nee 
of  meat,  white  meats  in  preference  to  red,  abstinence 
from  all  food  stnfis  which  give  rise  to  dyspepsia,  the 
avoidance  of  ail  alcoholic  drinks  while  the  eye  is 
inflamed,  and  extreme  moderation  afterwards.  R^lar 
habits,  t.e.,  meals  at  regular  honrs,  not  to  have  late 
suppers,  daily  evacuation  of  the  bowels,  not  to  take 
anything  to  eat  or  drink  between  meal  times,  and 
always  to  secure  a  good  night's  rest. 
In  conclusion,  let  me  advise  yon  to  know  your 

Ktient,  his  habits,  and  his  idiosyncrasies,  for  though 
rd  and  fast  rules  are  often  laid  down  in  the  treat- 
ment of  iritis  I  wam^rou  that  if  anv  one  disease  is 
more  prone  to  peculiarities  than  all  others  in  respond- 
ing to  the  influences  of  drugs  iritis  might  well  be  said 
to  DO  that  disease.  You  must  be  guided  by  all  you  see 
and  know  of  your  patient  and  his  environments. 


TUBERCULOUS  DISEASES  OF    THE 
HIP -JOINT. 

By  R.  L.  SWAN,  F.RC.S.L, 

Sugwm  to  Dr.  Btaeruu'  ud  the  OrthopiBdlo  Hoqpllals,  DnbUn. 


With  the  exception  of  those  rare  cases  already 
alluded  to,  where  there  is  a  tuberculous  deposit  at  or 
outside  the  epiphysial  line,  and  where,  after  a  careful 
selection,  tunnelling;  the  bone  may  be  employed,  the 
treatment  of  hip-jomt  disease  in  the  early  stage  must 
be  non-operative.  There  are  two  distinct  non-opera- 
tive metnods :  the  ambulatory,  and  the  recumbent ; 
each  of  which  have  their  advocates. 

The  ambulatory,  in  which  an  attempt  is  made  at  an 
early  period  to  ootain  the  advantagies  of  fresh  air  and 
freedom,  and  to  avoid  the  enervatin|;  effects  of  con- 
tinuous confinement  to  bed,  by  permitting  the  patient 
to  go  about,  without  a  fixation  or  traction  apparatus. 
The  instruments  which  appear  to  be  the  best  adapted 
fortius  purpose  are,  for  nxatioo,  Thomas's  splint ;  and 
for  traction,  those  deviMd  by  Davis,  Taylor,  and  Sayer. 
American  surgeons  have  wntten  forcibly  in  favour  of 
this  method,  particularly  Sayer,  Scaffer,  and  Taylor. 
The  instruments  deviMd  by  each  of  these  gentlemen 
are  dei>icted  in  the  **  American  Armamentarium 
Chirumcum,"  (Qeo.  Tiemann  Je  Co.,  187  F^k  Row. 
New  York),  but  that  of  Sayer  had  been  largely  used 
in  this  country,  and  may  be  had  at  most  instrument 
makers.  Sayer^s  splint  consists  of  a  pelvic  band,  pass- 
ing under  the  crest  of  the  ilium,  to  wnich  two  perineal 
straps  are  fastened  for  counter  extension.  Its  outer 
surface  holds  a  ball  and  socket-joint,  from  which  a 
steel  bar  runs  down  the  outer  side  of  the  thigh  to 
within  two  inches  of  the  lower  end  of  the  femur.  This 
outer  bar  is  divided  into  two  sections,  one  running 
within  the  other,  and  controlled  by  a  rachet  and  key 
which  can  make  it  longer  or  shorter.  At  the  lower 
end  IS  a  projecting  branch  which  receives  the  attach- 
ment of  plaster  which  causes  traction  by  adhering  to 
the  integuments  of  the  thigh. 

From  the  results  gained  by  observation,  and  the 
records  of  a  great  number  of  tuberculous  diseases  of 
the  hip  and  other  joints,  which  I  have  collected  for  the 
past  twenty  vears,  I  have  arrived  at  the  conclusion 
that  the  ambcdatory  treatment  in  an  early  stage  is 
extremely  unsatisfactory,  and  I  am  satisfied  that  in 
discarding  it  and  adopting  the  system  of  recumbency 
and  complete  rest,  I  have  obtained  better  results  than 
I  should  nave  done  had  I  acted  otherwin.  There  is 
no  one  who  would  more  willingly  advocate  judicious 
exercise  and  fresh  air  if  the  case  were  suitable  for  such 
concession,  but  the  following  reasons  have  decided  my 
course  of  action.  I  do  not  now  confine  myself  to  the 
Mp-joint,  but  apply  the  same  deductions  to  all  joint 
anectionB  of  a  tuoerculous  character,  and  select  for  illus- 
tration those  of  the  spine,  hip.  and  knee.  I  have,  in 
common  with  all  surgeons  who  nave  seen  many  of  those 


cases,  observed  a  condition  which  Ib  invariable,  and  to 
whid^  the  vague  term  dyscrasia  has  been  applied. 
Take,  for  example,  a  child  affected  with  a  tuberculous 
focus  in  the  booies  of  two,  three,  or  more  dorsal  verte- 
brie.  There  is  no  pain^  as  we  know  that  in  children 
the  deposit  is,  as  a  rule,  intraosseous.  There  is  a  feel- 
ing of  fatigue.  The  child  exhibits  lassitude,  and  dis- 
likes play.  He  looks  badly ;  gets  thin,  not  a  healthy 
leanness,  but  a  fragility.  He  has  dyscrasia.  Take 
a  diseased  hip  wiUi  a  deposit  at  or  external  to  the 
epiphysial  line  i  there  is  slight  flexion  and  abduction, 
but  no  acute  pain  ;  no  night  cries.  He  has  dyscrasia. 
Take  a  knee ;  there  are  deposits  in  the  bone,  slight 
flexion,  which  relieves  the  intra-articular  pressure,  no 

Sin  to  speak  of,  but  there  is  a  dyscrasia.  This  con- 
tion,  manifestly  the  outcome  of  some  enervating 
influence,  is  seen  in  children  who  are  not  at  resL 
coming,  perhaps,  as  out-patients  to  the  hospital,  or  if 
in-door  natients,  who  are  stUl  permitted  to  go  about 
with  a  fixation  apparatus,  such  as  a  Saver's  jacket,  an 
immobilinng  sphnt  for  the  knee,  or  a  Thomas's  splint 
for  thehip.  Now  I  wish  to  observe  that  this  constitu- 
tional state  in  patients  who  are  undergoing  the  so-called 
ambdatoiv  treatment  is  invariably  accompanied  by  an 
elevated  afternoon  or  evening  temperature  during  the 
continuanceof  movement ;  and  unless  from  some  spedai 
reason,  such  as  the  commencement  of  abscess,  the 
severi^  of  the  case  as  indicated  by  its  rapid  progress, 
and  otherwise  this  temperature  subsides  on  the  enforce- 
ment of  rest.  From  tne  records  of  a  large  number  of 
cases,  all  in  the  above  category,  (that  is,  in  the  pre- 
caseating  stage,  and  without  acute  symptoms,)  I  sdect 
six,  in  whom  the  temperatures  were  recorded  while 
going  about,  and  who  were  subsequently  treated  by 
enforced  recumbency  :— 

M^Ttm.   Ir.Teai, 

5  boy,  10,  inTolving  foar  dorsal 
vertebra     ..!       ^V     101' 
boy,  6,  two  dorsal,  two  lambar       100*'       102* 

^*P      [b^,7     9r       101- 

Kn-    Jb<V»12 W-y     100- 

^•*    {boy,U W       lOr 

These  are  illustrations  of  temperatures  which  are 
usually,  I  believe,  entirely  unsuspected  and  unlooked 
for  in  consequence;  and  accompanying  the  malaise  re- 
ferred ta  Such  a  temperature  as  any  one  of  those 
cases  exhibits,  is  not  necessarily  followed  by  suppunh- 
tion.  The  cases  quoted  all  terminated  in  reooverjr 
without  such  an  event,  and  the  temperature  in  each 
instance  became  normal  when  rest  in  bed  was  enforced. 
If  such  a  case,  at  too  early  a  period  be  again  submitted 
to  the  ambulatorv  treatment,  even  with  every  precau- 
tion for  the  local  fixation  of  the  diseased  joint  or 
joints,  an  accession  of  elevated  evening  temperature 
IS  again  perceived,  and  a  return  of  the  haggard  and 
worn  aspect  indicative  of  the  induced  dyscrasia.  What 
is  the  significance  of  this  oft-repeated  term  9  Does  it 
mean  that  exennse  creates  a  disposition  to  dissemina- 
tion of  the  bacilli  t  Does  it  inmcate  an  absorption  of 
toxic  material  into  the  blood  from  the  focus  of  disease  f 
Does  it  signify  that  increased  rapidity  of  circulation 
renders  more  potential  or  increases  the  number  of 
the  third  blood  corpuscle,  the  so-called  tine  qua  non  of 
the  tubercle  bacillus  f  We  are  aware  that  lai^ity 
of  the  circulation  increases  absorption,  and  that  tiie 
subject  of  erysipelas,  typhoid,  or  septic  infection  will 
not  go  about,  but  remain  quiet  We  also  know  that  in 
such  cases,  so  far  as  clinical  evidence  can  give  us  infor- 
mation, the  increase  in  temperature,  ana  malaise,  do 
not  appear  to  be  due  to  any  alteration  at  the  site  of  the 
deposit 

If  we  contrast  the  appearance  of  those  patients— 

their  improved  diction,  cheerfulness,  ana  visour— 

who  have  been  subjected  for  a  \^me  to  enforced  rest, 

and  the  similar  conditions  of  those  who  have  been 

I  undergoing  ambulatory  treatment,  we  cannot  fail  to  be 


ifAT  Id,   I8d6. 


O&IGIKAt  COMMUNICATIONS. 


Thb  Medioal  Pbisb,     497 


struck  with  the  contrast,  the  state  of  the  disease  being 
tolerably  similar. 

These  observations  must  not  be  held  to  imply  a  dis- 
regard of  the  advantages  of  fresh  air  and  exercise  if 
the  case  be  in  a  suitable  condition  for  such  indulgence, 
but  if  there  be  an  evening  temperature  of  even  99** 
during  the  treatment  by  a  traction  spiint—or  a 
Thomas's— with  patten  and  crutches  comoined  with 
daily  exercise,  I  snould  at  once  forbid  movement  and 
place  the  patient  in  bed. 

An  interesting  paper  appeared  in  the  Boston  Medical 
and  Surgical  Journal,  April  17th,  1890,  by  Dr.  R.  W. 
Lovettj  on  the  diagnostic  value  of  high  temperature  in 
joint  disease.  It  has  been  demonstrated  that  elevation 
of  temperature  is  present  in  connection  with  the 
earliest  symptoms  of  hip  disease.  It  is  valuable  as  a 
diagnostic  sign  in  those  cases  of  a  slightly  stiff  and 
painful  hip,  where  there  may  be  no  history  of  a  fall, 
and  where  the  signs  are  not  sufficient  to  warrant  a  posi- 
tive diagnosis  of  hip  disease.  The  presence  of  an 
evening  temperature  of  100°,  under  those  circumstances, 
Kreatly  increases  the  probability  of  tuberculous  disease. 
In  the  same  way  oWure  affections  of  the  vertebrse, 
such  as  slight  immobility  with  a  little  lateral  deviation 
of  the  column  may  be  considered  more  or  less  suspicious 
according  to  the  presence  or  absence  of  high  evening 
temperature.  The  temperature  in  those  early  cases 
must  be  looked  on  as  a  symptom  in  quite  a  distinct 
way  from  that  which  accompanies  more  advanced 
conditions. 

The  temperature  does  not  invariably  rise  during  the 
formation  of  pus,  or  in  eases  of  unopened  abscess,  and 
when  it  does  so  it  appears  to  bear  a  proportion  to  the 
severity  of  the  case  rather  than  to  the  occurrence  of 
suppuration.  Temperature  will  alway[s  exist  in  the 
late  stage  where  rapid  disintegration  is  going  on  and 
the  discharge  is  also  profuse.  Also  where  there  are 
numerous  discharging  sinuses.  It  is  obviously  very 
difficult  to  keep  such  channels  aseptic, 

A  persistent  nigh  temperature,  with  no  obvious  cause 
in  the  early  stages  of  hip-joint  disease,  will  indicate 
that  the  disease  will  run  a  rapid  and  destructive  course, 
and  is  ominous  of  an  unfavourable  termination. 

Under  recumbency  and  fixation  the  temperature 
becomes,  if  not  quite  normal,  at  least  constant.  Any 
sudden  elevation  will  indicate  trouble,  either  joint 
implication,  or  some  remote  tuberculous  deposit.  I 
have  seen  tuberculous  meningitis  heralded  by  a  tem- 
perature of  103«>  to  104^  in  the  progress  of  hip  or  spine 
dLsease. 

From  a  consideration  of  the  foregoing  circumstance, 
I  am  forced  to  the  belief  that  the  ambulatory  treatment 
in  tuberculous  diseases  of  joints  is  unsatisfactory,  and 
especially  in  the  case  of  hip-joint  disease,  as  it  is 
manifestly  impossible  to  so  fix  the  articulation  that  no 
possibility  of  movement  can  exist,  but  the  general 
reasons  that  I  have  advanced  bear  even  greater  weight, 
as  while  even  a  very  grave  state  of  malaise  may,  for  a 
long  period,  be  permitted  to  exist,  the  local  conditions 
if  acute  imperiously  demand  recumbency,  fixation  and 
traction. 


CASE  OF 

CEREBELLAR   TUMOUR 

WITH  SECONDARY   HYDROCEPHALUS,  (a) 

By  ARTHUR  J.  HALL,  B.A..  M.B.,  M.RC.R, 

Hon.  Physician,  Sheffield  Royal  HngpitRl ;  Lecturer  on  Physiology, 
School  of  >Iedlcine. 

The  patient,  F.  H.,  boy,  set.  4,  came  under  my  obser- 
vation in  February,  1895,  with  the  following  history  :— 

In  Junp,  1894,  he  had  whooping  cough.  In  August, 
1894,  he  began  tn  walk  unsteadily,  his  head  pushed 

(a)  Bead  before  the  Sheffield  Medico-Chirnrgical  Society,  odarch  26th, 
1S06. 


forward,  eyes  staring.  This  continued  until  December 
when  two  or  three  times  a  week  he  had  severe  occipital 
headache  with  bilious  vomitinj^,  this  coming  on 
suddenly.  During  this  autumn  his  head  was  noticed 
to  have  enlarged.  He  was  admitted  into  the  Royal 
Hospital  in  February,  1895,  and  the  following  notes 
were  made  of  his  then  condition  :  Unable  to  walk  or 
stand  by  himself^  complete  loss  of  control  over  his  legs, 
no  loss  of  sensation,  head  measures  22^  ins.  in  fronto- 
occipital  circumference,  14|  ins.  in  antero-posterior 
f  ronto-occipitaJ  line,l  3  ins.  from  mastoid  processes  across. 
Pupils  react  normally.  Both  discs  swollen  and  vessels 
indistinct.  No  discharge  from  ears  or  deafness. 
Reflexes  normal.  No  ankleclonus.  He  is  clumsy  in 
feeding  himself  but  can  pick  up  pins  quite  easily.  He 
remained  in  hospital  until  May  1st,  1895,  during 
which  time  he  had  no  headache  or  vomiting  and  his 
condition  remained  unchanged.  The  diagnosis  made 
at  that  time  was  cerebellar  tumour.  I  then  lost  sight 
of  the  boj^  until  six  months  later  when  he  was  re- 
admitted into  hospital,  October  1895.  He  was  then 
distinctly  worse,  had  been  suffering  from  attacks  of 
headache  and  vomiting  frequently,  and  had  several 
''fits.''  He  was  now  much  weaker,  unable  to  feed 
himself,  could  hardly  use  his  legs.  Often  very  drowsy 
and  irritable.  Pupils  widely  dilated,  equal,  react  to 
light.  No  ocular  paralysis,  or  nystagmus.  Distinct 
optic  neuritis  right  eye.  Head  measurements,  coronal 
circumference  23  inches,  transverse  intermastoid  13i 
inches.  No  separation  of  cranial .  bones  at  sutures. 
Patellar  reflexes  exaggerated.  Complete  incontinence 
of  urine  and  fseces.  During  November  and  December 
he  got  gradually  worse,  the  circumference  of  the  head 
increased  by  a  quarter  of  an  inch,  and  at  one  time  on 
percussing  the  nead  a  distinct  crack-pot  sound  was 
evinced.  He  also  gradually  lost  his  vision  almost 
completely.  Violent  attacks  of  occipital  headache 
and  vomiting,  also  *'  fits  "  occurred  at  intervals.  The 
diagnosis  at  this  time  was  hydrocephalus,  possibly 
secondary  to  cerebellar  tumour,  and  on  January  24th, 
1896,  my  colleague,  Mr.  Pye-Smith,  made  a  puncture 
in  the  lumbar  vertebral  canal,  to  ascertain  if  there  was 
any  increased  pressure  of  cerebro-spinal  fluid,  and  if  so, 
to  relieve  it.  About  two  drachms  of  fluid  were 
removed,  but  the  pressure  did  not  appear  to  be  much 
increased ;  the  boy  complained  of  much  headache 
during  and  after  the  slight  operation  and  died  the 
following  day.  At  the  autopsy  the  cranial  bones  were 
found  to  be  very  much  thinned  out  and  cardboard-like, 
the  brain  greatly  enlarged,  and  the  two  cerebral  hemi- 
spheres like  bags  of  fluid.  The  enormous  distension 
of  the  lateral  ventricles  with  fluid  had  caused  con- 
siderable Winning  of  the  substance  of  the  hemispheres. 
On  opening  the  brain  all  the  cavities  of  the  central 
canal  above  the  fourth  ventricle  were  found  to  be  very 
greatly  distended  with  clear  cerebro-spinal  fluid.  A 
tumour  the  size  of  a  hen's  egg  was  found  occupying 
the  middle  lobe  of  the  cerebellum  arising  apparently 
from  the  left  side  of  the  middle  line.  It  was  distinctly 
encapsuled  and  quite  separate  at  its  margin  from  the 
remainder  of  the  cerebellum.  The  pressure  of  this 
had  flattened  out  parts  of  the  cerebeUum,  and  pushed 
the  medulla  and  pons  out  of  shape.  It  seemed  to  com- 
pletely obstruct  tne  fourth  ventricle,  and  this  mechani- 
cal obstruction  between  the  ventricles  of  the  brain  and 
the  foramen  of  Majendie  in  the  root  of  the  fourth 
ventricle  would  appear  to  have  been  an  important 
factor  in  producing  the  gradual  distension  of  the  ven- 
tricles with  fluid.  Another  impediment  to  the  cere- 
bral circulation  due  to  the  pressure  of  the  tumour  must 
have  been  some  obstruction  to  the  exit  of  blood  from 
the  deeper  parts  of  the  brain  through  the  vein  of  Qalen. 
Thn  nature  of  the  tumour  was  a  round- celled  sarcoma. 
The  case  presents  some  features  of  interest,  in  the 
first  place  it  was  under  observation  for  a  long  period 
prior  to  the  head  being  very  much  enlarged,  and  during 

C 


4^8 


Ths  Msdical  Press 


TRAHSACTtONS  OF  SOClfeXlfeS. 


May  13,  1896. 


several  weeks  in  hospital  the  headache  and  vomiting 
were  entirely  absent,  although  at  home  they  had  been 
marked  symptoms.  This  absence  of  heaaache  and 
vomiting  durms  a  long  period  in  hospital  and  under 
observation,  I  have  seen  before  in  a  case  of  cerebellar 
tumour,  and  it  is  worthv  of  remembrance  for  it  tends 
to  make  one  doubt  whether  the  friend's  history  of  the 
case  was  correct,  and  whether  the  headache  and  sick- 
ness had  been  more  than  slight  before  admission. 
Possibly  the  complete  rest  in  bed  and  judicious  feeding 
of  hospital  routine  may  have  something  to  do  with  it. 
A  distinct  **  crack-pot "  sound  was  elicited  on  percus- 
sion of  the  head  towards  the  end  of  the  illness,  this 
has  been  noticed  before  in  cases  of  hydrocephalus  by 
German  observers,  (a)  During  the  last  few  weeks  of 
life  the  child  varied  in  temper  greatly  from  da^  to  dav, 
sometimes  happy  and  smiling  at  others  very  irritable 
and  peevish.  Convulsive  attacks  were  frequent,  and 
intense  headaches  with  vomiting.  As  regards  the 
adoption  of  lumbar  puncture  it  was  performed  with 
the  idea  that  we  migntget  some  information  as  to  the 
hydrocephalus  whether  internal  or  external  or  both, 
and  as  being  in  itself  a  very  simple  procedure.  As 
things  turned  out  it  could  not  have  Deen  the  least 
benefit,  and  even  the  removal  of  the  very  small  quan- 
tity of  fluid  caused  severe  headache  and  seemed  to 
precipitate  the  child's  death. 


(iUtniad  JBittmb». 


BRITISH    HOSPITAL,    BUENOS    AYRES, 

ARGENTINA. 

Case  of  Displacement  of  Scapula  from  Clavicle, 

Under  the  care   of   J.  O'Ognob,   M.A.,   M.D.,  T.C.D. 
Senior  Medical  Officer. 
A.  E.  T ,  »t.  41,  sailor,  admitted  into  British 


Hoepital  on  January  7bb,  1896,  saffering  from  an  accident, 
which  occarred  fourteen  days  prior  to  admission,  caused 
by  his  having  been  *'  thrown  over  the  wheel." 

On  admission  he  oomplained  of  pain  in  left  shoulder, 
and  inability  to  raise  his  arm  ;  the  objective  symptoms 
were,  a  distinct  prominence  of  acromial  end  of  clavicle, 
with  depression  of  shoulder ;  the  arm  hung  by  the  side. 
When  moving  about  he  supported  the  left  forearm  like  one 
suffering  from  fractured  clavicle. 

A  futue  attempt  was  made  to  reduce  the  dislocation  by 
forcibly  pressing  downwards  and  forwards  the  displaced 
end  of  clavicle,  while  an  assistant  dragged  the  shoulder 
outwards. 

Tne  nature  of  the  injury  and  the  probable  diminution  in 
utility  of  limb  having  been  explained  to  him  he  consented 
to  have  an  operation  performed. 

On  Jan.  lOch,  the  patient  having  been  chloroformed,  a 
curved  incision,  4  inches  in  length  was  made,  commencing 
about  junction  of  middle  and  outer  thirds  of  clavicle, 
passing  directly  outwards  over  displaced  end  of  this  bone, 
and  endmg  about  1  inch  external  to  articular  surface  of 
acromion  ;  by  this  means  the  end  of  collar  bone  and  clavi- 
cular acromial  articulation  were  readily  exposed. 

The  next  step  was,  to  free  the  outer  end  of  clavicle  from 
surrounding  integuments,  in  order  to  obtain  sufficient 
room  for  its  articular  surface  to  be  removed  with  a  chisel 
and  mallet ;  care  was  taken  to  place  a  broad  copper  re- 
tractor beneath,  in  case  the  chisel  should  slip ;  the  arti- 
cular end  was  sliced  away  for  l-3rd  of  an  inch.  The 
acromial  portion  of  joint  was  next  attended  to,  with  a 
Lister's  bone  scoop,  the  cartilage  was  removed  and  the 
bone  freely  scraped. 

Two  holes  were  then  drilled  through  acromion,  about 
half  an  inch  apart,  and  through  corresponding  portion  of 
clavicle.  Some  trouble  was  experienced  in  passing  wires 
through  acromion,  on  account  of  the  inability  of  tilting 
the  shoulder  sufficiently  outwards  and  downwards,  so  as  to 
expose  its  under  surface,  but  this  was  as  nothing  compared 
to  the  next  difficulty,  viz.,  the  drawing  down  of  clavicle 


into  its  normal  position.  However,  by  the  persistent 
efforts  of  one  assistant  drawing  the  shoulder  outwards, 
and  another  pushing  the  displaced  end  of  the  clavicle 
downwards,  the  bones  were  eventually  approximated 
eufficiently  for  me  to  twist  tight  the  wire  sutures,  and 
when  thus  fixed,  there  did  not  seem  any  further  tendency 
to  displacement. 

The  wound  was  brought  together  by  interrupted  silk- 
worm gut  sutures,  a  small  opening  was  left  in  centre  into 
which  a  small  roll  of  iodoform  gauze  was  inserted  a**  a 
drain.  Iodoform  gauze  dressing  naving  been  applied,  the 
limb  was  bandagM  up  in  same  position  as  for  fractured 
clavicle. 

On  the  third  day  the  dressings  were  removed  and  gauz  ) 
drain  taken  out;  it  was  thoroughly  soaked  with  blood. 
As  the  oozing  did  not  appear  to  have  quite  ceased  in  depth 
of  wound,  another  roll  was  inserted. 

On  the  seventh  day  the  wound  was  dressed  for  the 
second  time  ;  the  gauze  was  again  found  saturated  with 
blood,  but  as  the  bleeding  seemed  to  have  stopped  the 
gauze  was  dispensed  with  and  iodoform  dusted  in. 

On  the  eleventh  day  it  was  dressed  again.  Union  by 
first  intention  having  taken  place,  the  sutures  were 
removed,  and  he  was  allowed  out  of  bed.  The  temperature 
did  not  once  exceed  99°  since  operation.  All  dressings 
and  bandages  were  left  off  on  the  twenty-first  day» 
excepting  patient  was  made  to  carry  his  arm  in  a  sling. 
On  the  twenty-fourth  day  he  was  permitted  to  commence 
moving  the  shoulder,  and  was  discharged  on  the  thirty- 
first  day,  sound  union  without  the  least  deformity  having 
taken  place. 

He  could  raise  his  arm  from  his  side  to  an  angle  of  75^ 
and,  to  use  his  own  words,  '*  I  am  getting  it  up  more  each 
day." 

The  question  now  arises :  Will  the  commercial  value  of 
the  limb  be  more,  minus  a  clavicular  acromial  joint,  than 
with  the  dislocation  unreduced  ?  I  regret  that  his  occu- 
pation did  not  admit  of  his  making  a  longer  stay  in 
Buenos  Ayres^  in  order  that  I  might  see  the  ultimate 
result.  Anyhow  I  feel  satisfied  that  the  operation  is  a 
rational  surgical  procedure,  yet  by  no  means  so  easy  in 
exf^cution  as  one  might  expect. 

I  wish  to  acknowledge  the  kind  assistance  of  Drs. 
Shadbolt  and  Cruickshank. 


^^xsriButionB  td  ^odctttfi. 


CLINICAL  SOCIETY 
Mbbtino    hbld    Friday, 


OF  LONDON. 
May    8th,     1896. 


(a)  Fkgge,  "  PUndpleB  of  Medldne,"  vol.  1,  p.  SM. 


The  President,  Dr.  Buzzard,  in  the  Chair. 

A  CASK  OF  MALINGERING  IV  A  BOY,   AGKD   11. 

Mr.  Leopold  Hudson  showed  a  specimen  of  urine, 
coloured  to  imitate  h»maturia,  which  was  brought  to  the 
Hospital  for  Sick  Children,  Great  Ormond  Street,  on 
February  17th,  1896,  together  with  the  boy  who  was  said 
to  have  passed  it.  The  patient  was  »t.  ll,  and  had  been 
sent  home  from  a  boarding  school  on  account  of  hiematuria. 
He  remained  at  home  for  seven  weeks,  jjAMeiDg  normal 
urine,  but  for  the  week  previous  to  examination  he  was 
said  to  have  passed  blood  in  his  urine  three  times  daily. 
Examination  of  the  urine  showed  absence  of  blood  and 
albumen,  it  was  acid  and  of  normal  specific  gravity.  Dr. 
Archibald  Garrod  made  a  spectroscopic  examination, 
which  revealed  absence  of  haemoglobin  band.  Urine 
drawn  off  by  catheter  presented  normal  properties.  Upon 
being  pressed,  the  boy  confessed  that  he  had  added  red 
sweets  (jargonelle  pear  drops)  to  his  urine.  He  had  done 
this  in  order  to  be  sent  home  from  school,  where  he  said 
he  had  been  made  to  clean  steps  in  cold  weather  without 
shoes  or  stockings.  Afterwards,  his  aunt  brought  to  the 
Hospital  a  piece  of  rag  dyed  with  Turkey  red  dye,  which 
had  evidently  been  used  to  produce  the  colouration. 

TGTREE  CASES  OF  LARYNGECTOMY. 

Mr.  E.  Ward,  of  Leeds,  read  notes  of  three 
cases  in  which  he  had  performed  laryngectomy.  The 
main  feature  of  the  operation,  was  the  complete 
shutting    off  of    the    wound   from  the  mncons 


^r  1^  1896. 


tBANSACrriONS  OF  SOClETliS. 


Tub  Medical  Pbsbf.     499 


which  open  into  it.    This  method,  in  favoarable  caaes, 
reenlted  in  anion  by  first  intention  throoghoat  the  whole 
extent  of  the  wound.    No  preliminary  tracheotomy  wae 
required  where  it  had  not  already  been  rendered  necessary 
by  argent  dyspnoaa.    The  first  part  of  the  operation  was 
carried  oat  on  the  ordinary  Unes,  the  larynx  being,  in 
preference,  separated  bv  division  of  the  crico-tracheal  mem- 
brane and  dissection  from  below  upwards,  enucleation  of 
the  upper  part  being  thus  facilitated.    In  cases  of  intrinsic 
disease  the  opening  into  the  pharynx  need  not  be  more 
than  a  small  vertical  slit.    After  the  larynx  had  been 
removed  a  large  tube  was  passed  from  the  month  into  the 
stomach,  and  the  cut  edges  of  the  pharynx  were  carefully 
brought  together  over  it  by  closely-set  sutures  of  fine  silk, 
the  pharyngeal  wound  being  entirely  closed.    Then  two 
half-discs  oiskin  were  cut  out  of  the  edge  of  the  flaps 
opposite  to  the  tradieal  apertare,  which  is  closely  stitehed 
to  the  circular  opening  thus  made,  and  the  skin  wound  is 
closed  by  suture  throughout.  Drainage-tubes  are  inserted 
at  each  end  of  the  cross  incision  at  the  upper  part.    By 
this  method  of  closing  the  wound  the  trachea  and  pharynx 
are  completoW  shut  out  from  it,  and  the  trachea  is  so 
held    open     that    no    tracheotomy   tube   is   required. 
The    OBSophageal   tube    is   removed,    or    It  ft    %»    ntu 
for    feeding,    according    to    the   requirements   of   the 
case    and     the    difficiuty    with    which    it   is    passed. 
Com  1. — A  man,  »t.  64,  came  with  extensive  disease  of 
the  larynx  causing  great  suffering,  dyspooda,  kc,  and  he 
was  operated  on  on  June  26th,  1893.     He  has  remained 
well  up  to  the  present  time  and  has  never  worn  a  tracheo- 
tomy tube.    The  ^wth  proved  to  be  a  squamonp-celled 
epithelioma.    He  is  able  to  speak  in  a  whieper.    Case  2. — 
A  female  child,  8Bt.  2«  was   admitted  on  June  2nd,  1894, 
with  argent  dyspnoea  for  which  tracheotomy  was  at  onoe 
performed  with  great  relief.    The  tube  was  removed  on 
July  3rd,  but  had  to  be  replaced  on  the  10th.    In  October 
thyrotomy    was   performed,  and  the  larynx   was  found 
stuffed  with  a  soft  papillomatous  growth  destroying  a]l 
its  anatomical  features.    This  was  scraped  and  dissected 
out.    She  remained  in  a  very  critical  state  for  some  time, 
bnt  the  tube  remained  absolutely  necessary,  though  in 
November  she  had  much  Improved.     On   January  9th, 
1895,  she  was  resdmitted,  extremely  ill,  the  growth  fun- 
gating  so  luxuriantly  that  it  was  ppronting  through  the 
tube  and  blocking  it.  He  performed  laryngectomy  on  Jan. 
25th.    There  was  some  difiicnlty  in  closing  the  upper  part 
of  the  pharyngeal  wound  owing  to  the  smallness  of  the 
parte  and  their  deep  recession  under  the  chin.    The  child 
was  quite  intracteole  and  refused  food,  and  she  rejected 
what  food  was  introduced  by  means  of  the  oasophageal 
tube.    She   died   in   a   steto   of    collapse    sixty   hours 
after  the  operation.    Post-mortem,  the  operation  wound 
was   found  in   an   entirely   satisfactory   condition   and 
the  larynx  was  again  crammed   with  papilloma.     Ccute 
3.  A  man,  SBt.  42,    was   admitted  on   August   8,   1895, 
with  dyppnosa  and  dysphagia,  of  five  months'  stending. 
He  was  extremely  ill,  with  orthopooea  and  marked  stridor 
and  Itvidity.    There  was  much  swelling  of  the  ventricular 
bands,  with  general  tumefaction  of  the  whole  of  the  parts, 
including  the  epiglottis,  the  vocal    cords    being   quite 
hidden.    No  growth  or  ulceration  could  be  seen  anywhere. 
On  January  21st,  tracheotomy  had  to  be  performed.    On 
September  Ist,  he  was  unable  to  breathe,  the  tracheotomy 
opening  being  plugged.    The  diagnosis  was  confirmed  by 
a  preliminary  thyrotomy,  and  he  then  performed  laryngec- 
tomy.   On  the  17th,  it  became  evident  that  one  or  two  of 
the  sutures  at  the  lower  part  of  the  pharynx  had  given 
way,  but  by  the  21st,  the  regurgitotion  of  food  had  cMsed. 
His  recoveiy  was  subeequently  uneventful.  He  claimed  for 
this  operation  (1)  that  it  will  reduce  the  mortelity  of  the 
<^ration  itself ;  (2)  that  it  will  considerably  shorten  the 
period  of  healing  and  convalescence ;  (3)  that  it  will  add 
immeasureably  to  the  comfort  of  patiente,  both  during 
convalescence  and  after  recovery ;  (4)  that  it  will  justify 
attempte  at  radical  treatment  in  some  cases  in  which  this 
is  at  present  considered  inadmissible. 

Mr.  A&BtTTRNOT  Lanb  said  he  had  adopted  a  similar 
course  in  a  case  of  his  own,  dividing  the  trachea  and 
drawing  it  forward  out  of  communication  with  the 
pharynx,  and  the  result  had  proved  very  satisfactory. 
He  mentioned  that  in  a  similar  case  of  papilloma  of  the 
larynx  in  which  recurrence  took  place  after  removal  of 
tbegrowths  he  had  tried  arsenic,  which  was  a  reoogniBed 


remedy  for  warte  elsewhere,  and  the  patient  got  com- 
pletely well  very  quickly.  By  the  time  the  dose  of 
Fowlers  solution  had  been  carried  to  seven  minims  three 
times  a  day  the  obstruction  had  altogether  disappeared. 

Dr.  F.  SxMON  said  he  had  hoped  to  hear  of  some  new 
operative  procedure  or  at  any  rate  of  some  fresh  reasons 
for  underteking  this  very  formidable  operation.  In  these 
respecto  he  had  been  disappointed.  There  were  two 
observations  made  by  the  author  from  which  he  must 
dissent.  He  would  not  go  so  far  as  to  affirm  that  totel 
laryngectomy  was  always  unjustifiable.  That  was  a  ques- 
tion which,  in  spite  of  the  risks  it  enteiled,  ought  to  be 
decided  by  the  patient,  but  be  could  not  agree  that  the 
question  of  the  patient's  subsequent  comfort  was  a  matter 
about  which  the  surgeon  need  not  concern  himself.  He 
protested  strongly  against  performing  an  operation  as 
grave  as  totel  laryngectomy  in  a  child  for  papillomatous 
disease  of  the  larynx,  a  condition  which  had  been  shown  to 
be  amenable  to  milder  forms  of  treatment.  Even  if  the 
author's  little  patient  had  survived,  he  asked  what  sort  of 
life  such  a  person  could  have  led.  A  simple  prophylactic 
tracheotomy,  with  the  removal  of  exuberant  massee,  would 
certainly  have  sufficed  to  prolong  life  until  the  age  when 
endolaryngeal  methods  might  have  been  adopted.  Indeed, 
by  a  combination  of  chloroform  narcosis  ana  local  cocaine 
ansBSthesia,  by  the  method  suggested  by  Mr.  Scenes  Spicer, 
it  was  possible  even  at  this  tender  age  to  remove  the 
gprowths.  He  urged  that*under  no  circumstenoes  could 
such  a  terrible  operation  be  justified  for  mere  papillomatous 
degeneration  of  the  mucous  membrane  of  the  larynx,  and 
he  protested,  if  only  to  prevent  the  practice  becoming 
general. 

Mr.  E.  Wakd,  in  reply,  admitted  that  he  would  not  be 
disposed  to  resort  to  laryngectomy  again  in  a  similar  case 
as  that  of  the  child  with  papilloma  of  the  larynx.  At  the 
same  time,  he  knew  of  three  cases  in  which  the  papilloma- 
tous growths  recurred  after  removal,  and  ultimately  com- 
pletely obstructed  the  larynx,  and  the  condition  of  these 
patiente  was  no  better  than  after  this  operation.  He  ad- 
mitted that  children  were  not  fit  subjecte  for  laryngec- 
tomy. He  had  not  been  aware  that  his  procedure  had 
already  been  practised. 

Mr.  Arbuthkot  Lake  showed  a  child  on  whom  he  had 
operated  successfully  for  a  deformity  with  wbich  he  was 
familiar  in  a  much  slighter  degree  and  often  as  a  unilateral 
condition,  but  he  had  never  before  seen  it  in  the  same 
marked  degree  as  presented  by  this  patient.  The  de- 
formity consists  in  a  varying  degree  of  outward  rotation 
of  the  legs,  due,  apparently,  to  a  slight  forward  and  up- 
ward displacement  of  hip-joint  from  its  normal  position. 
In  this  case,  when  the  child  lay  on  its  back  the  feet  rested 
by  their  outer  margins  on  the  fioor.  On  attempting  to 
rotete  the  thighs  inwards,  it  was  only  possible  to  do  so 
till  the  inner  margins  of  the  feo!)  became  parallel  to  one 
another.  The  same  was  true  of  the  child  in  the  erect 
posture.  During  walking,  the  legs  were  fiung  outwards 
and  only  very  slightly  forwards,  so  that  progress  was  very 
slow  and  ungainly.  Mr.  Lane  divided  each  femur  at  the 
junction  of  the  middle  and  lower  third  and  niter  roteting 
the  lower  fragment  inwards  in  the  upper  through  an  angle 
of  90*"  or  more  he  secured  them  togetiher  with  wire.  The 
result,  as  exhibited  by  the  patient,  both  as  regarded  loco- 
motion and  appearance,  was  very  good.  Mr.  Lane  pointed 
out  that  this  partial  displacement  of  the  acetabulum, 
though  produced  during  intra-uterinelife,  differs  clinically 
from  the  cases  of  congenitel  displacement  of  the  hip  up- 
wards and  forwards  where  the  head  of  the  femur  articu- 
lates with  a  new  acetebulum  cavity,  the  old  one  losing  its 
form  rapidly.  He  ascribed  the  cause  in  both  conditions 
to  pressure,  in  one  case  resulting  in  a  displaoement  of  the 
head,  in  the  other  to  a  displacement  of  tne  hip-joint  to  a 
slight  degree. 

Mr.  Makins  recorded  a  case  of 

REMOVAL  or  A  8E00NDART  EPITHELIOHATOnS  TUMOUR  FROM 
THE  NECK,  IN  WHICH  OPERATION  THE  LEFT  VAdUS  NERVE 
WAS  DIVIDED. 

The  nerve   was  divided  just  above    the    centre    of 


nerve 
ite  cervical  portion  and  immediately  sutured.  No 
obvious  resulto  either  immediate  or  i-emote,  beyond 
the  paralysis  of  the  muscles  supplied  by  the  recurrent 
laryngeal  branch  were  observed.  With  legard  to  the 
larjmgeal  paralysis,  the  quality  of  the  voice  rapidly  im« 


500     The  Mbdical  Phiss. 


TRANSACTIONS  01*  SOCTETTES. 


JAay  18,  18B6. 


proved,  and  two  months  later  the  following  report  wae 
made  by  Dr.  Semon.  The  left  vocal  cord  now  stands  quite 
fixed  near  the  middle  line  and  the  ri^bt  joins  it  in  phona- 
tion  and  the  voice  is  almost  normal,  occasionally  slightly 
hoarse  and  a  little  high  pitched.  Apparently  after  suture 
of  the  nerve  the  adductor  fibres  have  partially  recovered 
but  not  the  adductor.  After  the  partial  reooverv  the 
conducting  fibres  have  on  phonation  moved  the  vocal  cord 
into  the  phonatory  position,  and  in  this  position  a  gradual 
paralytic  contraction  of  the  adductors  has  taken  place, 
fixine  the  cord  where  it  is  now  seen.  It  was  allowed  that 
the  functional  activity  of  the  vagus  in  this  case  might 
have  been  lowered  by  continuous  pressure  by  the  tumour, 
but  it  was  claimed  that  the  case  supported  the  opinion 
lately  expressed  by  Bos  well  Park  as  to  the  comparative 
safety  of  dividing  one  vagus  if  necessary,  and  also  oflered 
some  evidence  as  to  the  possible  recovery  of  function  if 
immediate  suture  be  performed. 

Dr.  Semon  said  it  was  now  generally  admitted  that  in 
progressive  lesions  which  involved  any  of  the  laryngeal 
nerves  the  abductor  fibres  were  always  first  attocked,  and 
when  the  adductors  were  also  involved  they  (the 
adductors)  were  the  first  to  recover.  He  referred  to  the 
case  of  a  well-known  tenor  who,  having  contracted 
syphilis,  developed  a  tumour  pressing  on  the  pneumo- 
gastric  nerve,  causing  loss  of  speaking,  as  well  as  singine 
voice.  He  underwent  an  [active  course  of  treatment,  and 
the  adductors  gradually  recovered,  the  cords  returning 
to  the  phonatiog  position  with  complete  recovery  of 
singing  voice,  in  spite  of  some  weakness  of  the  abductors. 

Mr.  Raymond  Johnson  brought  forward  a  case  of 

FRACTURK  OF  THE  NECK   OF  THE     FEMUR  IN  A  YOUNO  SUB- 
JECT RESULTING    FROM   DRY  CARIES  OF  THE  BONE. 

The  patient,  a  boy,  aet.  17,  fell  whilst  skating,  and  pre- 
sented all  the  signs  of  a  fracture  of  the  neck  of  the  left 
femur.  It  was  noticeable  that  during  several  weeks  be- 
fore the  accident  the  boy  had  limped  slightly,  and  that  his 
}  ounger  sister  was  the  subject  of  early  hip- joint  disease. 
After  a  period  of  nearly  four  months'  fixation,  there  was 
no  evidence  of  repair.  Operation  was  therefore  under- 
taken with  the  object  of  either  pegging  the  fracture  or 
excising  the  separated  head  according  to  circumstances. 
After  opening  the  upper  and  posterior  part  of  the 
capsule  a  transverse  fracture  through  the  middle  of 
the  neck  of  the  bone  was  diiiplayed,  and  the 
bone  showed  evidence  of  somewhat  extensive  super- 
ficial caries  the  head  was  removed.  Two  and  a  half 
years  after  the  operation  the  patient  was  walking  fairly 
satisfactorily ;  the  shortening  of  the  limb  amounted  to 
two  inches  and  a  half.  After  describing  the  naked-eye 
and  microscopic  appearances  of  the  bone  it  was  concluded 
that  these  were  antecedent  to  and  not  the  result  of  the 
fracture,  and  that  they  were  of^the  nature  of  dry  tubercu- 
lous caries.  The  chief  interest  of  the  case  lay  in  the  fact 
that  such  a  degree  of  bone  destruction  should  occur  with 
so  little  impairment  of  function,  that  the  boy  wae  able  to 
skate  without  discomfort,  although  the  nock  of  his  left 
femur  was  extensively  carious.  It  was  insisted  that,  if  in 
a  young  subject  after  an  injury  to  the  hip,  and  the  sym- 
ptoms suggest  intracapsular  fracture  of  the  neck  of  the 
femur,  the  possibility  of  pre-existing  pathological  changes 
in  the  bone  must  carefully  be  borne  in  mind,  even  though 
the  clinical  evidence  of  such  may  be  very  imperfect. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  Wednesday,  Mat  6th. 


The  President,  Dr.  Argyll  Robertson,  in  the  Chair. 

Patients. 
Mr.  Alexis  Thomson  showed  two  male  patients  with 
perforating  ulcer  of  the  foot  In  the  first  case  no  cause  for 
the  ulcer  could  be  found,  unless  that  the  patient  had  some 
slight  degree  of  alcoholic  neuritis.  Of  this,  however  there 
were  no  symptoms  other  than  marked  anaesthesia  of  the 
affected  leg.  He  proposed  to  stretch  the  nerve  in  thid 
case,  as  the  same  procedure  had  been  productive  of  much 
benefit  in  the  other.  In  this  the  ulcer  wae  an  accompani- 
ment of  spinal  sclerosis.  He  also  showed  a  man  on  whom 
he  had  operated  for  perforated  gastric  ulcer.    There  had 


been  no  precedent  history  of  disease.  The  patient  was 
suddenly  attacked  when  out  walking,  having  had  no  sym- 
ptoms before.  He  managed  to  get  home,  was  taken  up  to 
the  infirmary,  but  was  not  operated  on  until  about  twelve 
hours  after  the  accident.  With  no  history  to  act  as  a 
guide,  the  diagnosis  presented  some  difficulty,  and  lay 
between  a  perforated  gastric  ulcer  and  a  ruptured  appen- 
dix. On  cutting  down  on  the  stomach  a  small  circular  aloer 
was  foun  J  to  have  perforated  the  anterior  wall  of  that  organ 
close  to  the  smaller  curvature.  The  rent  was  treated 
secuTidum  artem,  the  peritoneal  cavity  swabbed  out,  and, 
notwithstanding  the  delay  in  the  operation,  the  patient 
had  done  excellently. 

Dr.  James  Carmichabl  showed  a  girl,  act.  7,  who  could 
not  walk,  but  who  presented  none  of  the  signs  of  any 
known  systemic  disease.  All  the  muscles  were  weak, 
and  the  ligaments  very  lax.  He  thoaght  that  it  was 
simply  a  case  of  abnormal  debility  of  the  muscles. 

Mr.  David  Wallace  exhibited  a  man  to  the  Society, 
St.  23,  who  had  had  tuberculous  disease  of  the  tarsus, 
requiring  amputation  at  the  ankle,  and  again  in  the  little 
finger.  Some  time  after  it  was  noticed  that  his  face 
seemed  to  have  become  asymmetrical  He  had  had  no 
pain.  On  examination  a  puffy  swelling  could  be  made  oat 
over  one  side  of  the  head,  fluctuation  was  present.  On 
opening  the  abscess  a  sequestrum  about  the  size  of  a 
shilling  and  comprising  the  whole  thickness  of  the  skull 
was  found  and  removed.  The  dura  was  separated  from 
the  bone  for  about  2  in.  b^  2  in.  round  the  aperture,  the 
cavity  being  nearly  one  inch  deep  in  the  centre.  That 
there  were  no  symptoms  arising  from  such  a  large  abscees 
might  be  explained  by  the  fact  that  it  lay  over  the  right 
frontal  lobe.  It  was  a  case  of  osteitis  perforans  ( Volkmann) 

Mr.  Wallace's  second  case  was  that  of  a  man  who,  in 
falling,  had  struck  his  head  against  a  stone.  There  waa 
a  lacerated  wound  in  the  left  parietal  region,  and  the 
patient  became  diowsy,  but  with  no  paralysis.  Next  day 
his  temperature  rose  to  102<^,  twitcbings  were  observed  in 
his  right  hand,  and  over  the  right  side  of  his  face,  and  he 
was  rather  more  drowsy.  On  the  third  day  the  skull  waa 
trephined,  and  a  fissured  fracture  found  in  the  left  parietal 
bone.  The  coronal  suture  was  loosened ,  especially  towards 
the  right,  where  another  circle  of  bone  was  removed.  On 
this  side  the  parietal  bone  was  distinctly  separated  from 
the  frontal.  A  small,  subdural  hasmorrhage  was  found  on 
the  right  side.  The  man  did  well,  but  it  was  a  question 
whether  the  operation  was  necessary,  or  if  it  had  caused 
his  recovery. 

Dr.  Norman  Walker  showed  a  man  with  a  curious  line 
of  warts  on  his  chin,  which  had  been  also  communicated 
to  his  scalp. 

Specimens. 

Dr.  Norman  Walker  also  exhibited  three  microscopic 
slides,  one  illustrating  his  last  case  ;  another  of  ringworm 
of  the  scalp  in  an  adult ;  and  a  third  showing  the  germ  of 
eczema. 

Mr.  Caihd  gave  a  lantern  demonstration  of  a  number  of 
microscopic  slides  illustrating  the  pathology  of  the  appen- 
dix vermiformis. 

Dr.  G.  W.  Balfour  read  a  paper  entitled 

A   FEW  MORE  WORDS  ON  STROPHANTHUS. 

Dr.  Balfour  commenced  by  summarising  the  beneficial 
action  of  digitalis  in  heart  disease.  The  chief  thing  neces- 
sary in  such  cases  was  to  increase  the  power  and  elasticity  of 
the  heart  muecle.  Digitalis  had  the  property  of  stimulat- 
ing the  muscular  fibres,  not  onlv  of  the  neart,  but  also  of 
all  the  arteries  in  the  body.  The  heart  beat  slower,  bub 
more  powerfully,  more  blood  was  sent  through  the  vessels, 
and  as  they  were  the  first  to  benefit,  along  with  the  heart, 
from  incroEised  blood  supply,  their  metabolism  wae  in- 
creased, synchronously  with  the  heightened  blood  pressure. 
Digitalis  was  therefore  a  stimulant  to  the  circulation  and  a 
help  to  the  weary  heart.  Strophanthus,  on  the  other 
hand,  acted  as  a  direct  poison  on  the  heart, 
acting  3,000  times  more  powerfully  than  digi- 
talis. The  heart  beat  more  powerfully,  but  as 
the  diastole  was  much  prolonged,  the  condition 
resembled  brachycardia  and  was  not  wholesome.  As  it  had 
no  stimulating  action  on  the  muscular  fibres  of  the  heart, 
or  the  blood  vessels,  the  increased  force  of  the  beat  of  the 
heart  wae  supplied  by  the  reserve  energy  of  the  organ. 
If  a  large  dose  was  given  the  heart  stopped  in  systole  due 


Mat  13,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Thk  Mkdioal  Pbbss.     501 


to  the  energetic  oontrantion  induced  by  the  poison.  Stiro- 
phanthas  acted  one  hundred  times  less  powerfully  on  the 
vessels  than  digitalis,  consequently  the  blood  presnure  did 
not  rise  under  its  use,  and  the  vessels  were  insufficiently 
nourished  as  well  as  the  other  tissues.  Logically  digitalis 
was  immeasurably  better  than  strophanthus  which  he 
regarded  as  a  virulent  poison,  and  a  drug  which  should  be 
struck  out  of  the  pharmacopoeia.  DigitsJis,  on  the  other 
hand,  was  one  of  the  most  useful  drugs,  perhaps  the  most 
useful,  in  the  pharmacopoeia. 

Dr.  Graham  Brown  saidjthat  the  society  were  much 
indebted  to  Dr.  Balfour  for  his  contribution  on  such  an 
important  question. 

Dr.  Ja3£BS  Ritchib  thought  that  Dr.  Balfour  had  gone 
t  CO  far  in  his  condemnation  of  strophanthus.  He  had 
found  that  drug  of  the  greatest  service  in  the  treatment  of 
angina,  when  digitalis  was  of  no  service  or  contri-indi- 
cated.  It  was  also  of  much  use  in  emergencies  when 
rapid  action  was  required,  as  the  action  of  digitalis  was 
too  slow. 

Dr.  LooKHART  Gillespie  said  that  Dr.  Balfour  had  not 
mentioned  anything  about  the  comparative  merits  ol  stro- 
phanthus and  digiuJis  as  diuretics.  According  to  Prof. 
Fraser,  strophanthus  was  a  powerful  diuretic,  without 
increasing  the  blood-pressure.  Digitalis,  on  the  other 
hand,  probably  acted  in  this  way  by  increasing  the  pres- 
sure. In  many  cases  it  was  important  to  increase  the  flow 
of  urine  without  a  high  blood- pressure.  Was  not  digitalis 
a  cumulative  drug  ?  He  had  often  seen  sickness  produced 
by  strophanthus,  especially  in  cases  of  senile  weak  heart, 
when,  however,  digitalis  was  tolerated. 

Dr.  Leith  spoke,  and 

Dr.  Balfour  replied.  He  did  not  believe  in  the  diuretic 
action  of  strophanthus,  and,  as  for  the  cumulative  action 
of  digitalis,  it  depended  on  the  dose.  He  confessed  that 
some  patients  showed  an  idiosyncrasy  as  regards  the 
effects  of  digitalis.  On  the  whole,  it  was  about  the  most 
useful  drug  we  had. 


WEST-LONDON  MEDICO-CHIRURGICAL  SOCIETY. 
Meetiko  held  Friday,  May  1st,  1896. 

A.  Symons  Eoclbs,  M.B.,  President,  in  the  Chair. 


THE  TREATMENT  OF  WHOOPINO-CJOUOH. 

Dr.  Bontor  read  a  paper  on  this  subject.  He  drew 
attention  to  the  great  annual  mortality  from  the  disease, 
and  pointed  out  that  the  death-rate  is  nearly  as  great  now 
as  it  was  thirty  years  ago,  so  that  the  question  is  one  of 
importance.  He  reviewed  the  bacteriology,  and  concluded 
that  no  organism  has  yet  been  isolatea  which  may  be 
regarded  as  specific.  He  then  drew  a  parallel  between  the 
clinical  history  of  whooping-cough  and  that  of  a  microbic 
disease,  and  showed  their  similarity.  He  criticised  the 
usual  line  of  treatment  adopted,  and  pointed  out  that 
although  the  disease  was  looked  upon  as  having  a  microbic 
origin,  the  treatment  was  not  based  upon  this  conclusion, 
and  he  suggested  that  a  more  consistent  mode  of  treatment 
would  be  to  use  antiseptics  freely,  both  internally  and 
locally,  during  the  firat  stage,  which  was  the  period  of 
bacterial  activity,  but  that  during  the  second  or  paroxys- 
mal they  are  no  longer  indicated,  since  the  paroxysms  are 
probably  due  to  a  neurosis  produced  by  their  products  and 
not  by  their  own  action.  He  thought  that  when  the 
second  stage  was  reached  the  most  that  treatment  could 
do  was  to  reduce  the  number  and  severity  of  the  spasms, 
and  the  usual  method  of  treatment  was  hardly  calculated 
to  do  this  without  at  the  same  time  impairing  the  general 
health.  He  had  come  to  the  conclusion  that  the  actual 
excitant  of  the  spasms  of  coughing  was  the  mucus  in  the 
larynx  and  trachea,  and  he  thought  the  treatment  of  the 
second  stage  should  be  directed  to  building  up  the  general 
health,  promoting  the  separation  of  the  mucus,  and 
deadening  the  reflex  nervous  apparatus,  and  to  meet  these 
indications  he  has  eschewed  nerve  sedatives  (except  in 
oases  of  severe  nervous  disturbance)  and  antiseptics,  and 
had  given  tonics,  combined  with  stimulating  expectorants 
i  ntemally,  and  accompanied  with  them  as  a  local  applica- 
tion a  solution  of  menthol  in  liquid  vaseline,  which  was 
calculated  to  both  deaden  the  sensibility  of  the  mucous 


membrane,  and  at  the  same  time  to  assirit  in  the  separation 
of  the  mucus.  He  has  treated  forty  cases — mostly  severe 
— by  this  method,  and  read  notes  of  several  of  them.  One 
died,  and  one  with  acute  bronchitis  was  not  benefited ; 
the  others  made  good  recoveries,  and  none  were  followed 
by  any  of  the  usual  sequeUe. 

Mr.  Mayo  Collier  congratulated  the  author  on  his  able 
and  instructive  paper.  The  examination  of  the  larynx 
during  an  attack  of  whooping-cough  was  difficult  unlesa 
the  irritability  of  the  parte  was  soothed  by  a  spray  of 
menthol  in  paroUeum,  with  10  grains  of  cocaine  to  the 
ounce.  This  should  be  sprayed  into  the  nose  with  an 
ointment  atomiser,  and  the  patient  instructed  to  draw  in 
the  breath  during  the  application.  This  was  not  only  a  really 
certain  and  eflScient  method  of  examining  the  larynx, 
but  the  application  invariably  stopped  the  troublesome 
and  disturbing  cough,  and  assisted  materially  in  expe- 
diting a  cure.  The  local  appearances  in  the  larynx  were 
simply  those  of  intense  vascularity  and  congestion,  with 
accompanying  increase  of  glairy  secretion. 

Dr.  Campbell  Poi'E  agreed  entirely  with  Dr.  Bontor's 
recommendation  of  antiseptic  treatment  in  the  first  stacre, 
but  would  advocate  a  thorough  application  of  menthol 
spray  to  the  nasal  fosse  by  tne  pnysician  himself.  He 
considered  the  menthol  not  merely  a  sedative,  but  a 
powerful  antiseptic.  He  agreed,  too,  that  mucus  was  the 
existing  cause  of  a  spasm,  but  this  was  formed  not  in  the 
larynx,  but  in  the  nasal  cavities,  and  dripped  down  into 
the  laiynx. 

Dr.  0.  W.  Chapman  remarked  on  the  use  of  the  inhala- 
tion of  a  few  drops  of  chloroform  in  checking  the  spasm 
of  whooping-cougn.    The  good  effects  lasted  some  time. 

Dr.  BuRRBLL  had  used  small  doses  of  morphia  and  anti- 
mony both  for  ordinary  catarrh  and  for  whooping-cough. 
He  had  found  it  very  succe<«sfQl. 

Dr.  AcHARD  had  found  great  benefit  by  keeping  the 
room  in  which  the  child  liv^,  constantly  fumigated  with 
tar  vapour ;  this  was  produced  by  introducing  a  red  hot 
poker  into  liquid  tar.  He  considered  that  the  operation  of 
the  disease  was  shortened  under  this  treatment. 

Dr.  DoBSON  considered  that  the  use  of  menthol  and 
cocaine  spray  was  very  satisfactory  in  the  second  stage ; 
but  he  had  great  difficulty  in  diagnosing  the  first  stage 
from  catarrhal  conditions  of  the  larynx. 

Dr.  BoNTOR,  in  reply,  admitted  that  he  could  not  recog- 
nise the  first  stage  of  the  disease.  He  used  menthol  spray 
not  so  much  for  its  antiseptic  as  for  its  sedative  properties. 
He  had  found  no  benefit  from  the  tar  treatment. 

Mr.  Mayo  Collier  read  a  paper  on 

SOME  EFFECTS  OF  CHRONIC  NASAL  OBSTRUCTION, 

and  showed  several  casts  illustrating  the  serious  effects 
of  chronic  nasal  obstruction  on  th**  growing  skull,  and  more 
especially  on  the  upper  jaw.  The  inevitable  effect  of 
chronic  obstruction  was  a  partial  vacuum  in  the  nasal 
chambers' whose  walls  in  the  young  and  growing  were 
unable  to  support  or  resent  the  consequent  increase  of 
atmospheric  pressure,  and  consequently  collapsed.  Hence 
the  high,  almost  in  some  cases,  vertical,  palates,  the 
crowded  and  irregular  teeth,  and  approximated  dental 
arch,  the  pinched  and  approximated  upper  maxillary  bones 
and  the  secondary  and  almost  complete  obliteration  of  the 
nasal  cavities. 

Dr.  Campbell  Pope  considered  that  it  was  almost  as 
important  to  exhale  as  to  inhale  through  the  nose.  If  the 
air  be  exhaled  through  the  mouth  the  mucous  membrane 
of  the  nose  get  chilled  by  losing  the  warm  return  current 
from  the  lungs  and  so  a  catarrh  was  started. 

Mr.  Batten  had  noticed  that  numerous  cases  of  myopia 
arose  as  a  result  of  nasal  obstruction. 

Mr.  McAdam  Ecclbs  inquired  why,  if  these  bony  changes 
were  due  to  partial  obstruction  so  few  cases  are  the  subject 
of  changes  in  the  bones,  when  adenoid  vegetations  and  other 
obstructions  are  so  common  in  quite  young  subjects  in 
which  the  jaws  and  palate  are  developing  ? 

Mr.  Y PARSLEY  believed  that  the  distortion  of  the  upper 
jaw  was  more  frequent  in  hospital  than  in  private  practice. 

Dr.  Thudichum  did  not  think  that  the  mechanical  pres- 
sure of  air  within  the  nasal  cavities  was  sufficient  to 
explain  such  cases  as  these,  of  which  casts  had  been  shown. 
These  he  considered  to  be  congenital  in  origin,  and  he 
should  think  that  the  patients  had  only  just  escaped  the 
fate  of  being  idiots.    He  considered  that  the  bony  part  of 


502     Thb  Midioal  Pbiss. 


TRANSACTIONS  OP  SOCIETIES. 


May  13, 1996. 


the  sept  am  was  bard  and  stiff  and  would  ratber  break 
than  bend,  and  neither  this  nor  the  maxillary  bones  wonld 
be  distorted  by  pressure  of  air  from  the  outside.  Heidso 
pointed  out  that  the  moet  common  form  of  nasal  obstruc- 
tion was  hypertrophy  of  the  turbinated  bones,  and  advised 
their  removal  as  the  only  means  of  effecting  a  cure. 

Mr.  Mato-Collikr,  in  reply,  stated  that  the  easts 
exhibited  were  taken  from  persons  in  no  way  mentaUy 
deficient.  The  distortion  had  commenced  just  before 
puberty  in  each  case  and  had  steadily  advanced.  He  did 
not  agree  with  the  operation  of  cutting  away  the  lower 
turbinated  bone,  since,  in  his  opinion,  the  use  of  the 
galvano-cautery  was  sufficient.  He  did  not  consider  that 
post-nasal  growths  would  or  could  produce  any  distortion 
of  the  upper  jaw. 

CLINIGAL  CASB. 

Mr.  Kextlby  showed  a  girl  on  whom  he  had  performed 
a  Temporaby  Colotomy  jfor  tuberculous  ulceration  of  the 
rectum,  and  described  the  method  by  which  he  bad  closed 
the  artificial  anus. 


LIVERPOOL    MEDICAL    SOCIETY. 
Mbxtutg  hbld  Thursday,  Afbil  30th. 

Mr.  C.  H.  Sheabs,  Vice-President,  in  the  Chair. 


Mr.  Thblwall  Thomas  read  notes  of 

TWO  OASES  OF  BXCIRION  OF  SPINA  BIFIDIA — CURB. 

(1  )  M.  A — ,  woman,  »t.  37,  with  a  very  large  lumbo- 
sacral sac  20  inches  in  circumference  which  had  ourst.  In 
it  were  two  nerve-like  strnctnres  which  were  excised  and 
proved  to  be  simple  fibrous  cords,  no  nerve  elements 
therein.  The  neck  of  the  sac  was  sutured  with  a  Saddler's 
suture  reef-knotted  each  time  the  needles  crossed,  and  a 
catgut  ligature  tied  around.  She  made  an  uninterrupted 
recovery.  (2.)  Child,  aet.  6.  Sacral  spina  bifida,  globular, 
three  inches  in  diameter,  the  whole  of  the  posterior  wall 
of  the  sacral  canal  was  missing.  Excision  was  performed 
and  the  redundant  dura  mater  and  the  arachnoia  removed. 
(Jontinnous  sutures  united  the  (arachnoid  and  then  the 
dura,  and  over  the  new  canal  were  folded  two  flaps  of 
fascia  from  the  gluteus  maximus  as  additional  protection. 
Leakage  occurred,  so  the  wound  was  reopened  and  a  small 
orifice  closed  by  buried  silk  sutures.  The  wound  then 
healed  slowly,  notwithstanding  an  attack  of  measles.  The 
author  had  found  46  recent. case^  on  record  of  treatment  by 
excision  with  a  death-rate  of  17*4  per  cent.  The  Clinical 
Society's  Committee  Report  in  1885,  gave  Morton's  own 
statistics  as  50  case^  nine  unsuccessful  (!)  =  18  ner*cent. 
failures.  Clinical  Society's,  71  cases  treated  by  Morton's 
fluid  with  27  deaths  =  38  per  cent,  and  they  condemn 
excision  on  a  published  table  of  23  with  seven  deaths  = 
30-4  per  cent.,  apparently  paying  no  heed  to  the  cases 
treated  before  and  those  after  the  antiseptic  era  ;  if  such 
had  been  done,  the  result  would  have  read  16  cases  before 
1870,  six  deaths,  37*5  per  cent.,  seven  cases  afcer  1880,  one 
death,  14  2  per  cent.,  and  their  pronouncement  might  have 
been  less  decidedly  adverse  to  excision. 

Mr.  R.  N.  MuRBAY  drew  attention  to  the  fact  that 
hydrocephalus  frequently  followed  upon  the  cure  of  spina 
bifida  during  infancy. 

Dr.  E.  T.  Davibs  related  a  case  of  "  Strangulated  0%'ar- 
ian  Tumour,"  in  which  grave  symptoms  of  strangulation 
abruptly  set  in,  diffuse  peritonitis,  stoppage  of  bowels,  and 
at  end  of  a  fortnight,  with  patient  in  a  collapsed  condition 
— apparently  moribund— laparotomy  was  performed.  The 

eitient  made  a  rapid  recovery,  without  a  bad  symptom, 
e  also  related  a  case  of  "  Pyosalpin  and  Blood-cyst  of 
Ovary,"  in  which,  after  operation,  sepsis  followed  with 
peritonitis.  Pus  escaped  from  pelvis  by  lower  angle  of 
wound.  How  became  infected  ?  (1)  Through  wound  ; 
(2)  by  stump  of  tube,  or  by  (3)  bacterial  invasion  through 
gut  in  czecal  region  ?  The|patient  made  a  tedious  re- 
covery. 
Dr.  Stanley  Gill  read  a  paper  on  the 

INSANITY  OF  CONDUCT  AND  THB  TESTS  OF  INSANITY. 

In  the  course  of  his  remarks  he  pointed  out  that  conduct 
was  evolved  from  certain  primitive  movements,  that  is  to 
say,  from  random  automatic  movements  or  movements 
not  physically  initiated,  or  rather  those  which  seem  to  be 


independent  of  sensory  stimulation,  alao  from  aensori 
motor  or  leflex  movements  which  are  conscious  or  onoon- 
scious  according  as  to  whether  they  involve  the  higher 
cerebral  cortex  or  oo,  and  lastly  from  instinctive  movements. 
He  pointed  out  that  these  unacquired  movements  anffice 
to  bring  into  play  the  motor  mechanism  of  volitioii,  awi 
thus  supply  experience  of  active  movement.  He  said  that 
it  was  from  experience  so  gained  that  we  are  enabled  to 
direct  our  thoughts,  feelings,  and  actions  into  the  proper 
channels,  and  thus  to  adapt  ourselves  to  the  particmar 
environment  in  which  we  may  happen  to  be  plaoed,  and 
he  defined  conduct  to  be  the  *'  adjustment  of  the  organism 
to  its  environment."  He  then  pointed  out  that,  acmding 
to  Herbert  Spencer,  we  adjust  ourselves  to  sarronoding 
circumstances,  which  are  classified  as  follows,  viz. : — by 
acts  which  minister  directly  to  self-preservation,  by  acts 
which  are  involved  in  the  production,  maintenance,  and 
rearing  of  children,  by  acts  which  are  displayed  in  the 
maintenance  of  proper  social  and  political  reli^ons,  and, 
lastly,  by  religions,  aesthetic,  ana  recreative  activities. 
The  next  portion  of  the  paper  was  devoted  to  the  insanity 
of  conduct,  in  which  he  showed  the  difiSlculties  of  exactly 
defining  insanity.  He  said  that  it  was  in  view  of  these 
difficulties  that  the  law  has  laid  down  three  ** teste" 
for  its  detection,  viz.  :  testamentary  capacity,  that  is  to 
say,  had  the  testator  a  disposing  mind  ?  Crinunal  reipon- 
sibility,  or  a  knowledge  of  right  and  wrong.  A  oommissioD 
of  inquiry  into  the  capability  of  a  person  to  manage  him- 
self and  his  affairs.  He  did  not  believe  in  the  tests  for 
criminal  responsibility,  as  it  is  well  known  that  some 
persons  commit  crime  with  a  perfect  knowledge  of  what 
they  are  doing,  being  impelled  to  commit  the  act  by  a 
sadden  impulse.  Lastly,  he  showed,  by  quoting  several 
cases,  that  insanity  meant  something  more  than  disorder 
of  mind,  viz.,  '*  disorder  of  conduct." 

Drs.  Permewan,  Stansfield,  Imlach,  and  Ross  took  part 
in  the  discussion  which  followed.  Dr.  Stanley  Oilf  re- 
plied,  and   this  closed   the   meetings  for   the  preseot 


THE  HUNTERIAN  SOCIETY. 
Mbbtino  held  Wednesday,  Apbil  22kd,  1896. 

The  President,  Dr.  Hebman,  in  the  Chair. 

Mb.  Taboett  gave  a  lantem^lide  demonstration  of  th® 
changes  which  occar  in  the  joints  in  Charcot's  disease  and 
syringomyelia,  and  pointed  out  that  the  lower  extremity 
was  chiefly  affected  in  the  former  disease,  and  the  upper 
extremity  in  the  latter. 

Mr.  EvB  showed  a  specimen  of  distortion  of  the  foot 
with  trophic  changes  in  the  joint  and  hands  from 
peripheral  neuritis. 

Dr.  CoTMAN  brought  forward  a  patient,  who  bad  an 
unusual  condition  of  the  ankle-joint  following  a  sprain  of 
a  year  ago,  there  was  an  increase  in  the  swelling. 

Mr.  Chaktebs  J.  Symonds  mentionedthecase  of  a  patient 
who,  with  distinct  symptoms  of  loco  motor  ataxy,  had  four 
perforating  ulcers  on  his  feet,  in  one  of  which  he  had 
removed  the  carious  head  of  the  meta-tarsal  bone,  with 
successful  healing  of  ulcer  in  a  fortnight.  Cuzetting  of 
another  ulcer  had  failed,  the  tomb  not  having  been  entered. 
In  another  patient,  he  removed  the  head  of  a  carious 
metatarsal  bone,  with  success.  He  does  not  consider  it 
always  necessary  to  amputate,  the  cases  may  be  left  alone 
for  long  periods. 

Dr.  FoBTBScuE  Fox  attributed  difference  of  joints 
affected  in  Charcot's  disease  and  in  syringo-myelia  to  the 
pressure  of  body-weight  in  the  former,  and  to  the  liability 
to  injury,  and  to  degenerate  changes  of  shoulder-joint,  in 
the  latter,  sup^gesting  thus  a  certain  parallelism  between 
syringo-myelia  and  traumatic  or  local  arthritis. 

Dr.  HoBBoCKs  referred  to  a  case  where  Uie  removal  of  a 
band  pressing  on  the  Cauda  equina  in  a  case  of  spina 
bifida  occulta  had  removed  nervous  symptoms  in  feet. 


Typhoid  fever  caused  thirty-six  per  cent,  of  the 
deaths  among  the  British  troops  in  India  during  the 
year,  1894, 


Mat  13,  lg96. 


GERMANY. 


Trb  Mbdioal  Press.     503 


JtelKC- 


[from  our  own  00RRI8P0NDBNT.] 

PAKIS,  May  9th,  1899. 

Dermoid  Ctst. 
At  the  Acaddmie  de  M^ecine  M.  Levy  related  a 
remarkable  case  of  a  well-developed  fcebae  found  in  the 
abdomen  of  a  young  man.  The  man  had  suffered  it  seems 
for  two  years  from  an  abdominal  tumour,  which  gradually 
attained  a  considerable  size.  In  the  course  of  the  laparo- 
tomy performed,  this  tumour  was  found  to  be  situated 
between  the  mesenteric  folds.  It  contained  a  yellowish 
gelatinous  liquid  and  a  well- developed  foetus  of  about  &ye 
months.  The  patient  succumbed  twenty-four  hours  after 
the  operation.  The  speaker  considered  that  the  cyst 
should  be  classed  among  those  called  "dermoid,"  not 
intrequently  met  with  in  young  girls. 

Tapping  in  TuBBRCCLors  Meningitis. 
M.  Colin,  at  the  Medical  Society,  spoke  on  tapping  the 
thoracic  canal  in  the  lumbar  region  as  a  diagnostic  sign  in 
tuberculous  meningitis.  He  said  a  young  man'recently 
entered  the  hospital  with  moderate  fever,  diarrhcea,  head- 
ache, and  gastric  disturbance.  The  symptoms  simulated 
those  of  typhoid  fever,  but  after  the  expulsion  of  a  tape- 
worm the  patient  seemed  to  get  better.  However,  he  re- 
tained the  fever  and  the  headache.  Although  exploration 
of  the  ears  and  eyes  gave  negative  results,  M.  Colin  inclined 
to  the  idea  of  the  case  being  one  of  meningitis.  Con- 
sequently, in  order  to  clear  up  the  point,  he  tapped  in  the 
lumbar  region  and  drew  off  two  ounces  of  liquid  in  which 
he  found  numerous  tubercle  bacilli.  The  patient 
seemed  to  be  relieved  by  the  operation  but  died  a  few 
weeks  afterwards.  The  autopsy  confirmed  in  all  points 
the  diagnosis,  and  the  origin  of  the  tuberculous  lesion 
seemed  to  have  been  in  the  thoracic  canal. 

M.  Fraenkel  said  that  to  diagnose  meningitis  was  very 
frequently  difficult.  He  had  seen  patients  who  had  pre- 
sented no  symptoms  of  the  malady  in  their  lifetime  and 
yet  the  autopsy  revealed  vast  purulent  effusions  at  the 
base  of  the  brain.  Last  year  a  man  entered  his  service 
with  fever  and  some  brain  disturbance,  but  without  any  of 
the  usual  symptoms  of  meningitis  or  typhoid  fever.  The 
canal  was  tapped,  and  in  the  liquid  were  found  numerous 
bacilli  indicating  tuberculous  meningitis. 
Traumatic  Pleurisy. 
Dr.  Cbauffard  gave  recently  a  clinical  lecture  on  the 
frequency  of  pleurisy  succeeding  traumatism  of  the  thorax, 
and  gave  the  history  of  three  cases  brought  successively 
into  his  ward. 

A  man  of  52,  in  good  health,  but  slightly  alcoholic  fell 
from  the  car  he  was  driving,  and  one  of  the  wheels  passed 
over  his  right  shoulder  and  the  half  of  the  thorax.  He  was 
brought  to  the  hospital,  where  it  was  found  that  the  seventh 
rib  was  fractured.  A  week  subsequently,  the  patient  had 
slight  rigors,  followed  by  dyspnoea.  Examination  of  the 
chest  widl  revealed  pleural  effusion,  which  required  four 
tappings.    The  man  made  a  good  recovery. 

The  second  patient  was  an  alcoholic,  who  got  hurt  under 
a  barrel  of  wine ;  several  ribs  were  broken.  He  took 
three  months  to  recover  from  this  accident.  About  six 
months  afterwards  this  patient  was  again  crushed  between 
two  wine  vats,  and  ten  days  after,  rigors  and  dyspnoea  set 
in,  indicating  pleurisy,  which  was  promptly  relieved  by 
thoracentesis. 
The  iMt  patient  wim  a  woman  o  ^i  who  fell  from  a 


certain  height,  and  fractured  two  ribs.  An  abundant 
hemoptysis  followed.  Ten  days  afterwards,  the  pleura  con- 
tained a  quart  of  serosity,  which  was  drawn  off.  The 
woman  was  well  in  a  few  weeks. 


(SermaitQ. 

[from  our  own  CX)RRB8P0NDBNT.] 

BlBLlii.  May  Sth. 
The  Fatal  Serum-Injkction  Case. 

V'brt  little  further  progress  has  been  made  in  determin- 
ing the  cause  of  death  in  this  case,  and  that  little  has  been 
of  a  negative  character.  It  was  not  the  contained  carbolic 
acid  that  caused  the  death,  and  a  large  portion  of  the 
special  brew,  of  which  the  fatal  flask  formed  a  part,  has 
been  traced  and  found  to  have  been  used  without  any 
evil  result.  One  child,  of  a  year  and  a  half,  received  an 
injection  of  10  times  the  quantity  given  to  Prof.  Langer- 
han's  child,  and  without  any  injurious  consequences.  The 
case  has,  however,  given  support  to  the  opponents  of  the 
serum  method  of  treatment,  for  a  time  at  any  rate,  until 
the  true  cause  of  the  death  is  known. 

During  the  present  week,  the  Friedrichshain  Hospital 
has  published  its  Annual  Report,  in  which  the  results  of 
serum  treatment  as  carried  out  there  are  embodied. 
Sixty-three  cases  of  diphtheria  in  the  adult  were  treated, 
twenty-seven  of  them  with  serum.  Only  one  died,  and 
of  the  thirty-six  treated  without  serum,  all  recovered.  No 
ill-effects  were  observed  from  its  use.  In  the  Surgical 
Klinik  of  Prof.  Hahn',  581  cases  of  diphtheria  in  children 
were  treated,  with  175  deaths,  making  a  mortality  of  30*7 
per  cent.  In  1894,  with  a  grave  diphtheria  epidemic,  the 
mortality  was  35*2  per  cent.  ;  293  children  vere  treated 
with  serum,  of  which  69,  or  23*5  per  cent,  died  ;  165  had 
tracheotomy  performed  for  dyspnoea.  Of  these,  45*1  per 
cent,  recovered,  against  37*9  the  preceding  year.  Of  tho«e 
that  had  tracheotomy  performed,  78  were  treated  with 
serum,  and  86  without.  Of  the  former,  61*5  per  cent,  re- 
covered ;  of  the  latter,  only  29*1  per  cent.  The  reporters 
are  of  opinion  that  no  far-reaching  conclusion  should  be 
drawn  from  the  above  figures.  The  total  mortality  is  not 
much  below  that  of  the  previous  year. 

At  the  Fourteenth  Congress  for  Medicine,  Hr.  Gruber 
opened  a  discussion  on 

Immunity  Against  Cholera  and  Typhoid. 

The  speaker  said  he  had  previously  shown  that  rabbits 
and  guinea-pigs  could  be  infected  with  cholera,  and  unim- 
munisedby  introducing  living  or  dead  cultures  under  certain 
precautionary  measures.  The  blood  serum  of  these  animals 
protected  others  on  being  injected  into  the  peritoneal 
cavity.  On  the  basis  of  microscopical  observation,  the  ex- 
planation of  this  was  that  vibirios  or  bacteria  became 
sticky  on  their  surface  under  the  influence  of  their  own 
immune  sera,  in  consequence  of  which  they  clung  together, 
so  that  their  movement  was  interfered  with.  They  became 
collected  into  flocks  that,  on  account  of  their  specific 
gravity,  fell  to  the  bottom. 

The  reaction  of  cholera  bacteria  to  cholera  serum  was  not 
sharply  defined,  as  little  so  as  any  other  reaction.  But  in 
spite  of  this  absence  of  specificity  a  high  diagnostic  value 
could  not  be  denied. 

In  guinea-pigs  the  protective  power  went  parallel  with 
the  agglutination,  and  he  did  not  doubt  the  same  occurred 
in  the  humsn  subject.    Fresh  immunising  serum  exercised 


604    Ths  Mbdical  P&iss. 


ATJSTEIA. 


Mat  13,  1806. 


a  bactericide  action,  but  there  was  no  special  bactericide 
material ;  the  process  was  a  very  complicated  one.  On 
heating  to  60  C.  the  bactericide  action  was  lost,  and  the 
serum  became  a  good  nutrient  soil  for  the  bacteria.  If 
some  of  this  heated  serum  was  introduced  into  the  animal 
along  with  a  quantity  of  the  particular  species  of  bac- 
terium the  reaction  took  place,  but  in  the  reagent  glass 
nothing  was  seen  but  the  agglutination.  It  was  probable 
that  the  agglutinine  were  the  material  that  rendered  the 
bacteria  accessible  to  the  alexinee. 

Dr.  Durham,  London,  also  spoke  to  the  effect  that  the 
action  was  not  a  specific  one. 

Hr.  Pfeifler,  Berlin,  declared  .that  most  of  whatHr. 
Gruber  had  stated  had  been  made  known  by  himself  years 
before  the  agglutination  for  example.  Only  the  theory 
that  this  was  the  protective  mechanism  was  his  property. 
This  was  very  difficult  of  proof.  The  matter  was  a  very 
complicated  one.  Proskaner  and  himself  had  shown"  by 
experiments  lasting  over  months  that  the  chemical  nature 
of  the  anti-bodies  present  in  the  immunised  serum  agreed 
with  the  behaviour  of  the  ferments.  Still  they  could  not 
decide  whether  they  really  were  ferments.  He  thought 
there  was  a  strong  specific  action.  He  conceded  a  bye 
action  on  allied  bacteria.  All  cholera  cultures  from  what- 
ever epidemics  they  may  be  taken  provided  the  viru- 
lences are  equal,  behave  exactly  alike  as  regards  cholera 
serum. 

Hr.  Stem,  Breslau,  said  it  had  been  shown  repeatedly 
that  after  months  and  sometimes  even  after  years  material 
was  present  in  serum  that  protected  animals  from  the 
disease  that  the  human  subject  had  gone  through  from 
whom  it  had  been  taken.  He  had  shown  that  serum  from 
a  man  who  had  had  typhoid  fever,  even  in  the  smallest 
quantities,  had  the  power  of  protecting  guinea-pigs  from 
fatal  doses  of  typhoid,  but  that  at  the  same  time  the 
serum  had  no  increased  bactericide  action.  He  further 
calculated  the  protecting  dose,  mixed  this  with  a  fatal 
dose  of  typhoid  culture  in  a  reagent  glass,  and  observed 
that  the  animal  into  which  they  were  injected  did  not  die. 
If  he  allowed  the  bacilli  to  grow  in  serum,  they  were  as 
virulent  as  others.  From  this  he  concluded  that  the  action 
was  indirect,  viz.,  that  the  serum  produced  changes  in 
the  system,  and  that  they  cause  the  destruction  of  the 
bacteria,  and  this  assumption  was  confirmed  by  Pfeiffer. 

Hr.  Poehl,  St.  Petersburg,  said  that  one  of  the  most 
important  factors  by  which  immunity  was  weakened  was 
auto-intoxication, and  especially  reduced  tissue  respiration. 
Cholera  showed  itself  in  low  temperature  cyanosis,  &c. 
That  immunity  was  increased  by  alkalinity  of  the  blood 
had  been  shown  by  the  experiments  in  Senator's  Klinik. 
He  pointed  out  that  Asiatic  cholera  in  cultures,  when  the 
process  of  oxydation  was  limited  gave  the  iodol  reaction 

the  cholera  red.    In  cultures  in  favourable  media  the 

cholera  red  reaction  was  not  present,  and  he  associated  this 
circumstance  with  the  appearance  of  swollen  membranes 
and  agglutination.  He  believed  there  was  no  speci6c 
action,  but  we  had  to  deal  with  general  symptoms  of  auto- 
intoxication that  predisposed  to  certain  infections. 
Thb  Jenneb  Celebration. 
The  celebration  will  take  place  in  the  Eathbaus,  and 
the  address,  as  already  announced,  will  be  delivered  by 
Prof.  Gerhardt.  The  Imperial,  State,  and  City  authorities 
are  invited  to  be  present,  as  well  as  the  medical  profession 
and  deputations  from  foreign  and  other  societies.  In  con- 
nection with  the  celebration  there  will  be  an  exhibition  of 


objects  having  a  relation  to  vaccination.  A  fairly  com- 
plete collection  of  83  medals  struck  in  commemoration  of 
Jenner  and  vaccination  will  be  shown  by  Geh.  Bat.  Dr. 
Pfeiffer,  and  further  objects  for  exhibition  are  asked  for, 
and  will  no  doubt  be  forthcoming. 


cflusUnH. 


[f  BOM  OUB  OWN   OOBBBSPONDBNT.] 

VIBHNA,  Msy  !ith.  1896. 

Acromegaly  ? 

At  the  Gesellechaft  der  Aerzte^  Lamberg  showed  a  case 
which  he  considered  was  one  of  true  acromegaly.  The 
patient  was  an  American,  from  Missouri,  set.  22,  was  8 
feet  3  inches  in  height,  and  is  known  here  as  the  giant. 
The  clinical  history  is  good  ;  he  never  had  any  illness ; 
his  parents  and  five  sisters  are  all  alive  and  well.  His 
size  is  proportionate  in  every  part  except  the  face  which  is 
asymmetrical,  the  left  side  being  greatly  hypertrophied 
in  the  bony  structure  and  presumed  to  be  due  to  acrome- 
galy. When  the  case  is  carefully  examined  a  tumour  in  the 
hard  bony  structure  may  be  discovered  in  the  canine  fossa. 

In  the  discussion  Sternberg  criticised  the  giant  growth 
of  the  patient  and  disputed  the  conclusion  of  this  being  a 
case  of  acromegaly  as  all  the  other  parte  of  the  bony 
structure  were  so  proportionate,  although  gigantic,  that  it 
seemed  to  him  to  be  one  of  hemihypertrophiafacicUijr, 
or  an  exostosis  of  the  bones  in  the  lef c  side  of  the  face. 

BioLooT  or  Trichophyton  Tonsitrans. 
UUmann  showed  a  preparation  taken  from  a  case  of 
sycosis  parasititaria  barbae  where  the  protozoa  could  be 
seen  lying  in  jits  follicle  far  removed  from  the  point  of 
suppuration.  He  concluded  from  these  facts  that  the 
parasite  made  its  way  into  the  surrounding  tissues  where 
its  virulence  was  first  established  in  the  form  of  a 
perifollicular  inflammation,  which  ultimately  led  to 
exfoliation  and  complete  dissolution  of  the  surrounding 
coverings.  He  considers  the  parasite  closely  resembles 
the  streptococci  of  actinomycosis,  &c.,  in  their  habitat 
and  pathology. 

Paralysis  op  the  Spinal  Accbssoy  Nerve. 
Sternberg  invited  the  attention  of  the  meeting  to  con- 
sider a  few  cases  of  paralysis  that  more  exactly  defined 
the  function  of  this  nerve  than  those  descriptions  met 
with  in  text- books.  Classic  information  teaches  us  that 
the  external  portion  of  the  accessorius  passing  through  the 
foramen  jugulare  supplies  the  stemo- mastoid  and  trapezius 
without  noting  a  branch  to  the  levator  scapulae  which 
the  preparations  shown  seemed  to  prove.  In  two  groups 
of  cases  the  nerve  was  paralysed  by  the  invasion  of  spinal 
disease  in  the  one  and  injury  in  the  other.  He  had  other 
testimony  in  support  of  his  argument  in  cases  of  extirpa- 
tion of  tuberculous  glands  in  the  neck  where  the  nerve 
had  been  divided.  In  one  of  these  cases  the  deformity 
was  so  obvious  that  surgical  interference  was  afterwards 
solicited.  In  appearance,  the  upper  part  of  the  thorax  is 
narrow,  the  superior  angle  of  the  scapula  rides  up  above 
the  level  of  the  shoulder.  Viewed  from  behind  the 
characteristic  symptoms  of  paralysis  of  the  trapezius  is 
invariably  present  where  the  internal  margrin  of  the  scapula 
appears  sinking  or  as  if  the  entire  shoulder  wen  twisted 
round  and  the  scapula  supported  by  ite  upper  angle.    On 


Mat.  13,  1896. 


THE  OPERATING  THEATRES. 


ThB  MeDIOAL  PRM8S.       505 


minute  ineipection  one  of  the  levator  scapuIsB  that  opposes 
a  part  of  the  trapezius  that  is  attached  to  the  acromion 
will  be  found  intact,  whose  nerve  supply  is  derived  from 
the  brachial  plexus. 

Occlusion  of  Vena  Cava  Inferior. 

At  the  Medical  Club,  Schlesinger  drew  attention  to  a  few 
peculiarities  in  the  diagnosis  of  closure  of  the  inferior  vena 
cava.  The  typical  symptoms  are  oedema  of  both  extremi- 
ties, with  cyanosis  and  collateral  venous  delatation  in  the 
cutaneous  surface  of  the  abdomen.  The  exceptions  to  this 
general  rule  are  so  common  that  the  accurate  diagnosis 
becomes  a  difficult  task  to  the  clinician.  In  some  cases 
none  of  the  typical  symptoms  are  present,  but  a  more 
common  except/ion  is  the  oedema  of  one  leg  only.  It  is 
now  several  years  ago  sines  this  [symptom  was  clearly 
demonstrated  in  a  case  where  one  leg  only  was  oedema- 
tous,  while  the  abdomen  was  greatly  distended  with 
water.  The  po^t-mortem  in  this  case  revealed  an  occlu- 
sion of  the  vena  civa.  In  the  bibliography  of  the  subject 
IS  cases  are  now  recorded.  This  unilateral  phenomenon 
seems  to  depend  on  a  greater  development  of  one  side  over 
the  other  in  its  collateral  circulation  which  would)  expose 
it  to  earUer  congestion  than  the  other. 

The  origin  ol  the  thrombus  in  one  of  the  iliac  veins  from 
any  phlegmonous  change  may  also  have  some  share  in 
determining  the  resulting  symptoms. 
Ojcychography. 

Herz  introduced  the  subject  of  the  Nail-pulse  which  has 
recently  been  advocated  in  many  quarters  as  a  more  deli- 
cate method  of  diagnosing  morbid  conditions  of  the  circu- 
lation. For  a  long  time  the  sphygmograph  was  the  only 
instrument  on  which  we  trusted  for  haematic  information. 
This  was  succeeded  by  the  plethismograph  ;  later,  Ruedl 
of  Bern,  introduced  the  flammentachygraph,  and  now  we 
are  confronted  with  the  onychograph  as  the  most  delicate 
instrument  for  hematic  curves,  as  it  faithfully  exhibits  the 
movements  in  the  capillary  vessels.  When  the  capillary 
arteries  and  veins  contract,  the  instrument  shows  a  low 
curve  ;  when  dilated,  the  pulse  curve  is  high.  From  this 
curve,  with  the  assistance  of  the  respirations,  the  condi- 
tion of  the  brain  can  be  presumed.  In  the  case  of  icterus 
the  capillaries  are  dilated.  This  state  is  also  present 
during  the  rigors  of  malaria,  as  well  as  in  aortic  insuffi- 
ciency. In  mitral  defects  he  could  not  obtain  a  nail-palse. 
The  instrument  can  unhappily  only  determine  the  condi- 
tion of  the  capillaries  in  the  digits. 


^ke  ©peratittg  theatres. 

LONDON  HOSPITAL. 
ScpFURATivB  Salpingitis.— AoDTB  General  Peritoni- 
Tis. — Removal  of  the  Uterine  Appendages.— Mr.  Dean 
operated  on  a  woman,  aet.  40,  who  had  always  enjoyed 
good  health  until  four  days  before  admission  to  the  hos- 
pital, when  on  going  upstairs  she  was  suddenly  seized 
with  acute  pain  in  the  abdomen  which  was  so  severe  that 
she  lay  on  the  floor  for  some  minutes  before  she  could 
move;  she  went  to  bed  feeling  very  ill,  "cold  and  shiver- 
ing," and  slept  very  little  during  the  night.  The  next 
morning  she  tried  to  get  up  but  could  scarcely  raise  her- 
self in  bed  ;  during  the  day  she  vomited  several  times  and 
the  bowels  were  opened  once.  The  next  day  she  vomited 
and  suffered  from  slight  diarrhcea;  on  the  following  day  she 
was  brought  to  the  hospital  and  admitted.    The  abdomen 


was  found  to  be  much  distended,  and  the  abdominal 
muscles  were  quite  inactive  during  respiration  :  she  com- 
plained of  pain  chiefly  in  the  right  and  left  lumbar  and 
hypochondriac  regions.  On  gently  palpating  the  abdomen 
there  was  considerable  tenderness  over  the  whole  of  it  but 
no  localired  spot  where  the  tenderness  was  greater.  The 
patient's  condition  was  evidently  serious ;  the  pulse  was 
rather  wjak  (120  per  minute),  she  felt  very  ill  and  could 
scarcely  move  in  bed ;  there  was  evidence  of  slight 
discharge  from  the  vagina  but  the  nature  of  this  could  not 
be  determined.  A  diagnosis  was  made  of  acute  septic  peri- 
tonitis, the  exciting  cause  being  considered  to  be  either  in 
the  vermiform  appendix  or  in  the  Fallopian  tube?.  The 
abdomen  was  opened  in  the  middle  line  below  the  um- 
bilicus and  a  quantity  of  thin  cafe  aulait  coloured  pus 
esciped.  Trie  right  iliac  fossa  was  carefully  explored,  and 
the  vermiform  appendix  was  found  to  be  free  from  any 
disease  excepting  that  the  peritoneum  over  it  shared  in 
the  general  peritonitis.  The  pelvis  was  then  explored, 
and  both  Fallopian  tubes  were  discovered  to  be  consider- 
ably distended  and  of  a  dark  purple  colour.  Borh  ovaries 
were  slightly  enlarged  and  contained  numerous  cysts. 
The  uterus  was  enlarged  to  about  the  size  of  a  ten  weeks 
pregnancy,  and  felt  firm ;  there  was  no  evidence  of  fluc- 
tuation in  it.  Between  the  tubes  and  the  neighbouring 
coils  of  intestine  a  good  deal  of  greenish  lymph  had  been 
thrown  out.  A  ligature  was  placed  round  the  broad  liga- 
ment of  each  side,  and  the  Fallopian  tubes,  together  with 
the  ovaries,  removed.  The  whole  of  the  peritoneal  cavity 
was  carefully  sponged  dry,  some  iodoform  dusted  on  to  the 
ligatured  ends  of  the  tubes,  and  the  abdominal  wound  sewn 
upcompletely  without  drainage.  Mr.  Dean  remarked  that  on 
admission  the  patient  was  evidently  suffering  from  acute 
inflammation  of  the  peritoneum,  and  the  sudden  onset 
pointed  to  the  invasion  of  the  serous  membrane  from 
some  septic  focus  ;  indeed,  he  added,  so  sadden  was  the 
onset  that  some  perforation  of  the  alimentary  canal  natur- 
ally suggested  itself,  but  the  fact  of  the  bowels  having 
been  well  opened  rather  negatived  this  diagnosis  ;  there 
was  no  history  of  any  previous  abdominal  trouble  which 
might  throw  light  on  the  nature  of  the  existing  lesion,  so 
that  it  was  thought  probable  that  the  septic  focus  would  be 
found  either  in  the  vermiform  appendix  or  in  the  Fallopian 
tubes.  The  enlarged  condition  of  the  uterus  was,  he 
thought,  rather  difficult  to  explain,  but  later  on  the  matter 
could  be  more  thoroughly  investigated.  He  mentioned 
that  the  woman  had  always  menstruated  regularly,  in  fact, 
her  period  had  just  commenced  on  her  admission  to  the 
hospital. 

A  week  after  the  operation  the  patient  was,  compara- 
tively speaking,  well ;  no  bad  symptoms  had  supervened  ; 
the  bowels  had  been  opened  spontaneously,  and  she  was 
quite  cheerful  and  happy. 

KING'S  COLLEGE  HOSPITAL. 

Cystic  Goitre.  -Mr.  Carless  operated  on  a  woman, 
set.  26,  who  had  been  the  subject  of  a  goitre  for  some 
years.  Recently  it  had  increased  in  size  rather  rapidly 
and  had  given  rise  to  symptoms  of  obstructed  respiration, 
especially  at  night.  The  voice  also  was  somewhat  hoarse, 
and  ^be  heart's  action  a  little  irregular.  The  tumour  was 
situateu  in  the  middle  line,  and  was  about  the  size  of  a 
small  orange.  An  indistinct  sense  of  fluctuation  could  be 
detected  here  and  there.  The  patient  was  ansesthetieed, 
with  chloroform,  and  an  incision  made  in  the  middle  line 
extending  down  to  the  growth,  which  was  readily  freed 
from  its   connections,  except  posteriorly.    During   thia 


506     Thb  Mbdioal  Pbiss. 


'LEADING  ARTICLES. 


B4ay  13,1896. 


manipnlation  the  respiration  became  more  and  more 
impaired,  and  finally,  when  the  tumoar,  which  was  now 
definitely  made  oat  to  be  a  tense  cyst,  was  protruded 
throagh  the  skin  the  traction  apon  the  trachea  became  so 
great  that  respiration  ceased  entirely,  the  face 
becoming  of  a  ghastly  livid  colour.  The  head 
was  at  ODoe  lowered  and  the  cyst  punctured. 
The  traction  on  the  trachea  being  thus  relieved, 
respiration  at  once  recommenced  and  the  operation  was 
satisfactorily  completed  by  the  enucleation  of  the  cyst. 
The  fiuid  in  the  cyst  was  of  a  serous  nature  and  the  sudden 
relief  of  tension  after  puocturing  wa?  not  followed  by  any 
haemorrhage,  in  fact,  there  was  but  little  bleeding  during 
the  whole  operation.  The  wound  was  stitched  up,  care 
being  exercised  to  approximate  the  different  muscular  and 
fascial  planes  by  deep  sutures  ;  no  drainage  was  employed. 
Mr.  Carless  remarked  that  the  position  of  this  tense  cyst 
beneath  the  deep  cervical  fascia  and  in  front  of  the 
trachea  sufficed  to  explain  the  respiratory  embarrassment 
from  which  the  patient  had  suffered  before  the  operation, 
and  also  the  serious  condition  through  which  she  passed 
when  sufficient  traction  was  put  upon  the  mass  to  oauM 
it  to  project  from  the  wound.  In  all  probability  the 
trachea  was  more  or  less  fiattened  by  the  frrowth.  It  was, 
he  thought  fortunate  for  the  patient  that  the  tumour  was 
cystic  in  nature  as  otherwise  the  relief  could  not  so  readily 
have  been  afforded  had  a  solid  mass  required  to  have  been 
dissected  out. 


EMUnUD  FOE  T&AVBMIBSIOV  ABBOAD. 


^he  JHebkal  ^xzm  atib 


QLxxtvihv. 

Pott  free,  S^d. 


Pabliihad  emj  Wsilnaidaj  morning,  Prios  6<1. 

ADYBBTIBBMBHTS. 

FOE  QSB  iBSUno :— Wliole  Pifs,  iB6  Ok  Od. ;  Bsif  Psfs,  £f  lOi.  Od. 
QaartorPags,ill6s.;  Ons-olghtti,  lla  Sd. 

Foe  a  Snns  or  Ivsibtioiis  .'—Whole  Pifs,  tblrtMn  InMrtlons 
(waskly,  fortnightly,  or  monthly)  at  £8  lOi.  Od. ;  twsoty-ilx  liuer- 
ttoDi  (weekly  or  fortnlfl^tly)  al  iBS  8i.  Od. ;  flfty-two  Insertloiu 
(weekly)  at  MB  each.  Hsif-page,  thirteen  inaertloiu  at  86e.; 
twentj-ilxat  saa  ;  llfty-two  Insertions  at  Ms.  each.  Quarter-page 
thirteen  luerUona  at  18t. ;  twenty-ilz  Insertions  at  16s. ;  flfty-iix 
Insertlonf  at  16s.  esoh 

Small  Anaoiinoemente  of  Preotlcea,  AMtftsnelM.  Vtosncte*.  Prrk 
*o.— Seven  lines  or  under,  4s  per  Insertion  ;  ad.  per  line  bcyrod 

Letters  In  this  department  should  be  addressed  to  the  Pnbllaber. 

IVBBOSIPnONi. 

POST  FRU  XO  AVnVAL  SUBBORIBBBS  £110 

„  ABBOAI>,WITBIBKHB  P08SALUBI0B  ill    t    6 

„  IBDIA,  CSHIBA,  ABX>  JAPAB  .  .  Al    fi    0 

Post-ofllce  Orders  and  Cheques  to  be  drawn  In  favour  of ~ 

A.  A.  TIBDALL,  SO-Sl  King  William  Street,  Strsnd,  London. 

A.  H.  JACOB,  88  Moleaworth  Street,  Dublin. 
SUBSOBIPTIOBS  BOB  FBABOB  are  received  by  Messrs.  Bahubbb,  Kaa 

HautefeniUe,  Paris— poet  free  in  advanoe,  ill  8b.  6d.  per  annum. 
SVBSOBIPTIOBS  BOB  KHB  Ubitbd  Scaxbs,    post  free  in  sdvaDca 

(£1  88.  ad.  per  annum),  should  be  aent  direot  to  the  Offlcea  Id 

this  country  by  International  Post  Oflloe  Order. 


^t  S^^Mral  f  ns8  ^  €itm\m. 


*BALUB  POPULI  BUPRKMA  LEX. 


WEDNESDAY,  MAT  13,  1896. 


OF 


THE  ROYAL  COLLEGE  OF  PHYSICIANS 
LONDON  AND  PHARMACOLOGY. 
It  is  satisfactory  to  find   that   the   curious,  and, 
indeed   inexplicable   action  of  the  Royal  College  of 


Physicians  of  London,   in   expunging  phannacology 
from  the  list  of  subjects'.for  examination,  has  not  been 
allowed  to  pass  without  protests  on  the  part  of  various 
eminent  therapeutists.    We  learn  on  the  one  hand  that 
Dr.  Lauder  Brunton  has  decided  to  resign  his  poet  as 
Examiner  in  Materia  Medica  at  the  College,  and  it 
must  be  admitted  on  all  hands  that  the  loss  of  the 
services  of  so  distinguished  an  authority  is  of  itself  no 
light  matter,  especially  as  it  is  rumoured  that  other 
resignations  are  not  unlikely  to  follow.    Dr.  Murrell 
and  Dr.  MacAlister,  of  Cambridge,  have  each  entered 
their  individual  protests  against  this  retrograde  step, 
and  matters  have  assumed  such  a  serious  aspect  that 
Dr.  Clifford  Allbutt   and   Dr.  Bradbury  have   also 
publicly  formulated  their  views  on  the  subject.    The 
process  of  '*  climbing  down  "  is  never  an  agreeable  or 
graceful  proceeding,  and  it  must  be  peculiarly  repug- 
nant to  the  haughty  directors  of  this  venerable,  but  not 
always  venerated,  institution.   That  some  such  process 
will  have  to  be  gone  through  is  probable,  even  if  to 
bring  it  about  the  supreme  powers  of  the   General 
Medical  Council  have  to  be  invoked.    The  matter  is 
eminently  one  as  to  which  the  opinion  of  the  Council 
ought  to  be  solicited,  and  as  the  Spring  meeting  will 
shortly  be  summoned,  advantage  will  doubtless  be 
taken  of  the  opportunity  to  ventilate  the  general  ques- 
tion.   The  issues  at  stake  are  considerable,  for  the 
example,  if  unchallenged,  is  certain  to  be  followed  by 
other  bodies,  with  results  that  cannot  fail  to  be  disas- 
trous to  the  cause  of  medical  education  generally.    The 
Royal  College  of  Physicians  is  not  a  private  body  which 
is  at  liberty  to  fashion  the  curriculum  at  its  will,  but 
a  body  which  is  entrusted  with  public  functions  for 
the  due  fulfilment  of  which  it  is  answerable  to  the  pro- 
fession, and,  viA  the  General  Medical  Council,  to  the 
Government.    It  is  not  as  if  there  were  any  special 
reason  just  now  for  lightening  the  curriculum.    On 
the  contrary,  the  ever  increasing  number  of  candidates 
for  admission  to  the  profession  renders  it  more  than  ever 
desirable  to  reinforce  the  standard  of  requirements  all 
along  the  line  in  order  to  secure  that  only  those  whose 
intelligence  and  special  attainments    are  above  the 
average  shall  be  admitted  to  the  privileges  of  medical 
practice.    It    is,    however,    not   so    much  on    this 
general  principle  that  we  take  our  stand  in  urging 
the  abrogation  of  this  ill-timed  resolution,  but  upon 
the  intrinsic  importance  of  the  branch  of  study  so 
summarily  eliminated  from  the  schedule  of  require- 
ments. Pharmacology,  fis  we  have  already  had  occasion 
to  remark,  is  even  more  indispensable  to  the  education 
of  the  medical  practitioner  than  is  anatomy  to  the 
surgeon,  yet  none  has  so  far  had  the  courage  to  suggest 
that  anatomy  should  be  discarded  from  the  curriculum. 
One's  surprise  is  enhanced  by  the  flagrant  inconsis- 
tency of  the  move.    While  on  the  one  hand  those  who 
are  supposed  to  watch  over  the  interests  of  medical 
education  and  practice  make  the  welkin  echo  with 
their  lamentations  over  the  empire  in  medicine  which 
the  use  of  ready-made   combinations  of  drugs  have 
obtained,  these  very  persons  have  done  all  that  lies  in 
their    power   to  place    the   neo-practitioner  at   the 
ercy  of  the  prescribing  chemist,  taking  this  tern 


Mat  13,  1896. 


LEADING  ARTICLES. 


Thi  Mbdioal  Pbiss.     507 


for  our  purpose  to  mean  the  prescribing  chemist 
in  high  quarters,  the  wholesale  manufacturer 
who  prepares  in  pills,  tablets,  or  mixtures,  such 
combinations  of  drugs  as  they  judge  to  be  likely  to 
commend  themselves  to  the  uninformed  and  submis- 
sive practitioner.  It  can  be  no  matter  for  surprise  to 
learn  that  considerable  difficulty  has  already  been 
experienced  at  the  various  medical  schools,  both  in 
London  and  in  the  provinces,  where  the  Deans,  to  their 
credit  be  it  recorded,  have  almost  unanimously 
declined  to  assume  the  responsibility  of  advising  stu- 
dents that  attendance  on  lectures  in  pharmacology  and 
therapeutics  is  no  longer  necessary.  The  matter  is 
not  finally  settled,  and  we  are  pleased  to  hear  that 
there  is  every  probability  that  collective  action  will  be 
taken  ere  long  with  the  view  of  having  the  question 
reconsidered. 


IRISH  WORKHOUSE  REFORM. 
Some  of  the  local  newspapers  in  Ireland,  which 
naturally  take  the  side  of  the  local  guardians,  are  in- 
dignant that  the  unattractive  nakedness  of  the  Irish 
workhouse  system  should  have  been  exposed  to 
public  view  at  the  Conference  recently  held  in  St. 
Martin's  Hall,  London.  These  journals,  as  a  rule,  deny 
that  there  is  any  occasion  for  general  reform,  and  insist 
that  their  own  local  workhouse  is  as  nearly  perfect  as 
may  be.  They  do  not,  however,  seem  to  be  aware  that 
the  speakers  at  the  meeting  in  question,  who  con- 
demned the  existing  system,  spoke  from  book,  and  with 
the  most  convincing  evidence  before  them.  They  held 
in  their  hands,  first,  the  reports  of  the  Medical  Officers 
of  seventy  Irish  workhouse  infirmaries,  who,  almost 
all,  agreed  that  a  root-and-branch  reform  was 
needed,  and  who  supported  their  opinions  by 
the  facts  relative  to  their  own  workhouses. 
Second,  they  argued  from  the  reports  of  the  Commis- 
sioner deputed  by  the  British  Medical  Journal  to  visit 
and  inspect  Irish  workhouses,  who  revealed  a  state  of 
things  which  could  scarcely  be  believed,  or  apologised 
for  even  by  the  editors  of  papers  which  reflect  guar- 
dians' opinions.  It  is  complained  by  them  that  one  of 
the  speakers  said  that  it  was  useless  to  order  better 
class  food  because  "  often  there  was  no  one  to  cook  it, 
nothing  to  cook  it  with,  no  plates  to  serve  it  on,  and  no 
knives  or  forks  to  eat  it  with.''  The  statement  is 
strong,  but  it  is  true.  From  the  returns  of  the  70  medical 
officers  it  appears  that  in  32  of  the  unions  there  were 
no  cooking  stoves,  in  43  no  plates,  knives,  forks,  cups, 
or  saucers,  and  in  50  no  hot  water  available  save  what 
could  be  boiled  in  a  kettle.  Another  speaker  is 
abused  because  he  said  that  ''the  sanitation 
of  many  of  the  workhouses  was  filthy  and  dis- 
gusting beyond  measure."  So  it  is.  In  59, 
out  of  the  70  workhouse  infirmaries,  the  only 
available  receptacles  for  nastinesses  of  all  sorts  were 
pails— kept  usually  in  the  wards— and  left  to  diffuse 
all  night  their  nauseous  effiuvia  amongst  the  patients. 
In  only  twelve  of  the  seventy  were  there  any  sort  of 
water-closets.  If  these  arrangements  are  not ''  filthy 
and  disgusting,"  we  do  not  know  how  to  describe  them. 
The  same  speaker  said  that "  the  whole  system  of  work- 


house administration  is  corrupt  from  beginning  to 
end."  So  it  is.  Every  one  knows,  and  none  better 
than  the  editors  of  these  papers,  that  many  Irish 
Boards  of  Guardians  are  little  better  than  manu- 
factories of  personal,  political,  and  religions  jobs ; 
that  appointments  are  uniformly  made— often  of  per- 
sons totally  unfit— for  reasons  entirely  apart  from  the 
capacity  of  the  candidate ;  that  the  contracts  for  every 
article  supplied  to  the  Union  are  jobbed  amongst  per- 
sonal friends;  that  outdoor  relief  is  similarly  dispensed 
to  the  great  loss  of  the  ratepayer ;  and  that  the 
interests  of  the  sick  poor  are  often  totally  neglected 
in  order  that  the  Board-room  may  be  turned  into  a 
political  debating  club.  Are  such  proceedings  corrupt, 
or  are  they  not  P  It  is  of  course  true,  and  no  one  has 
ever  denied  it,  that  there  are  many  Unions  to  which 
these  statements  do  not  apply,  and  which  are  worked 
honestly  and  carefully  for  the  good  of  the  poor  ;  but 
the  fact  that  some  Unions  are  so  worked  makes  the 
indictment  stronger  against  those  which  are  not  so 
worked. 


MEDICAL  AGENTS  AND  COMMISSIONS. 
A  CASE  of  great  importance  to  the  medical  profession 
has  just  been  decided  at  the  Westminster  County 
Court.  Dr.  Blyth,  of  Victoria  Park,  N.E.,  some  time 
ago  desired  to  sell  his  practice,  and  entered  into 
negotiations  with  Mr.  Perceval  Turner,  a  medical  agent, 
for  its  sale.  Several  clients  were  introduced,  and  finally 
a  medical  man  was  brought  forward  as  a  prospective 
partner.  Several  interviews  took  place,  and  the  usual 
examination  of  the  books  of  the  practice  was  noade.  A 
draft  agreement  was  prepared,  but  for  reasons  into 
which  it  is  not  necessary  to  enter  Dr.  Blyth  broke  off 
the  negotiations  and  withdrew  the  practice 
from  Mr.  Turner's  hands.  Mr.  Turner  thereupon 
demanded  the  full  commission  of  £27  10s.  This 
amount  Dr.  Blyth  declined  to  pay,  as  the  contract  was 
not  completed,  although  he  was  quite  willing  to  pay  a 
reasonable  fee  for  work  done.  Proceedings  in  the 
High  Court  were  subsequently  taken  against  him  for 
the  full  sum,  and  summary  judgment  was  applied  for 
on  the  ground  that  there  was  no  defence  to  the  action, 
such  application  being  supported  by  an  affidavit  of  the 
plaintiff.  The  defendant  being  a  member  of  the  Medi- 
cal Defence  Union,  applied  to  that  association  for 
assistance.  The  Council  of  the  Union  being  of  opinion 
that  a  very  serious  professional  principle  was  involved, 
instructed  their  solicitor  to  take  the  necessary  proceed- 
ings to  defend  the  action.  Application  was  immediately 
made  to  the  EUgh  Court  for  leave  to  defend  the  action, 
this  being  obtained ;  an  order  was  also  made,  removing 
the  case  to  the  Westminster  County  Court  The  action 
was  heard  on  the  17th  ult  before  His  Honour  Judge 
Lumley  Smith.  Both  parties  were  represented  by 
counsel.  The  sum  of  £4  4s.  had  been  paid  into  court 
by  the  defendant  as  a  matter  of  grace,  but  without 
acknowledging  any  liability.  Several  witnesses  were 
heard  for  the  plaintiff,  but  for  the  defendant  Dr. 
Blyth's  evidence  alone  was  taken.  The  learned  judge 
gave  judgment  for  the  defendant  with  costs,  and 
ordered  the  amount  paid  in  to  be  restored  to  him,  as 


^08     Thb  Mxdioal  Prbw. 


NOTES  ON  CUBRENT  TOPICS. 


Mat  13,  lg96. 


he  considered  that  the  contract  and  negotiations  were 
never  completed,  and  therefore  the  commission  claimed 
was  not  earned.  In  the  coarse  of  his  judgment  he 
remarked  that  it  was  quite  clear  that  Dr.  Blyth  had 
reasons  for  not  taking  the  partner  in  question,  and 
that  partnerships,  like  marriage,  could  only  be  carried 
on  successfully  when  both  parties  were  thoroughly  in 
accord.  Dr.  Blyth  had  a  perfect  right  to  withdraw 
from  the  negotiations  even  at  the  last  moment, 
and  until  the  agreement  was  signed  by  both  contract- 
ing persons  nothing  valid  had  been  accomplished.  With 
this  decision  all  medical  men  will  agree  :  it  would  be 
monstrous  to  mulct  a  would-be  vendor  of  a  practice  in 
the  full  commission  alleged  to  be  payable  to  an  agent 
because  the  said  vendor  objects  to  the  prospective 
partner  introduced,  or  because  of  other  legitimate 
reason,  the  matter  is  not  brought  to  a  successful  issue. 
It  would  be  well  for  medical  agents  to  reconsider  their 
position  in  this  respect ;  to  attempt  to  claim  a  sum  of 
money  which  can  only  in  justice  be  considered  due 
when  the  purchase  or  other  contract  is  completed, 
appears  to  us  to  be  outside  the  bounds  of  reason,  and 
we  hope  the  decision  in  this  case  will  settle  the  point. 
Dr.  Blyth  was  undoubtedly  fortunate  in  being  a 
member  of  the  Medical  Defence  Union. 


^oits  on  (Jtutrent  ^ofxcB. 

The  Members'  Question  at  the  Boyal  College 
of  Surgeons,  England. 
The  members'  question,  that  is  to  say,  the  (|uestion 
of  the  direct  representation  of  the  members  of  the 
Koyal  College  of  Surgeons  on  the  Council  of  their  Col- 
lege will  again  come  before  the  Council  at  their  meet- 
ing to-morrow  (Thursday).  There  was  every  appearance 
a  short  time  ago  that  the  Council  had  definitely  deter- 
mined, by  resolution,  to  have  nothing  more  to  do  with 
the  matter.  But,  fortunately,  this  policy  did  not  com- 
mend itself  to  those  members  of  the  Council  who  do 
not  happen  to  have  allied  themselves  with  the  conser- 
vative majority.  Consequently,  the  somewhat  bold 
procedure  has  been  adopted  of  taking  steps  to  rescind 
the  resolution  passed  at  the  March  meeting  of  the 
Council  by  which  the  members'  question  was  tem- 
porarily shelved.  Mr.  Rivington  will  bring  forward 
to-morrow  a  motion  to  this  effect,  and  it  is  more  than 
likely  that  the  voting  thereon  will  be  very  close.  It  is 
to  be  hoped  that  this  attempt  to  re-open  this  much 
debated  question  will  be  successful.  For  various 
reasons,  it  must  be  obvious,  save  to  the  most  unyield- 
ing conservative  members  of  the  Council,  that  the  re- 
sponsibility of  deciding  against  the  expressed 
wishes  of  a  large  section  of  the  ''body  cor- 
porate'' should  not  lightly  be  assumed.  In  these 
forward  days  any  policy  of  a  hole-and-corner 
nature  upon  matters  of  public  interest,  carried 
out  by  the  ''  powers  that  be,"  is  destined  in  the  long 
run  to  prove  inexpedient  The  wisdom,  therefore,  of 
the  Council  in  this  respect  does  not  appear  to  be  plain. 
It  cannot  be  said  that  they  have  been  wise  in  the 
measures  which  they  have  taken  to  deal  with  the 
members'  question.    Up  to  a  certain  point  they  cer- 


tainly acquitted  themselves  well  in  this  connection, 
that  is  to  say,  they  referred  the  claim  of  the  members 
to  be  directly  represented  on  the  Council  to  the  meet- 
ing of  Fellows  in  January  last.  No  one  could  poeaibly 
do  less  than  commend  them  for  this  wise  political  act. 
It  was  clear  by  this  that  they  were  wishful  to  share 
the  responsibility  of  deciding  upon  so  important  a 
matter.  The  Fellows  replied  to  the  appeal  made  to 
them  in  no  uncertain  terms.  By  a  large  majority  in 
an  unprecedently  large  meeting,  a  resolution  was 
passed  endorsing  the  members'  claim.  This  resolution 
was  referred  to  the  Deputation  Committee  of  the 
Council,  a  Committee,  the  majority  of  the  members  of 
which,  unfortunately,  belonged  to  the  conservative 
party  in  the  Council,  as  the  result  of  which  a  report 
adverse  to  the  proposed  reform  was  drawn  up  and 
presented.  But  even  at  this  juncture  the  Council 
had  an  opportunity  of  taking  a  course  which 
would  only  have  been  wise.  Clearly,  the  next 
step  to  have  taken  was  to  have  submitted  the 
question  of  the  members'  claim  to  the  body  of 
Fellows.  A  resolution,  in  favour  of  the  adoption 
of  this  course  was  actually  brought  forward  by  Mr. 
Tweedy,  at  the  February  meeting  of  the  Council,  and 
was  just  lost,  and  from  that  moment  the  policy  of  the 
Council  upon  this  question  was  distinctly  retrograde, 
and  unwise.  The  suggestion  of  polling  the  Fellows 
was  shelved,  and  a  resolution  was  agreed  to  in  which 
the  conservatism  of  the  narrow  mtgority  on  the 
Council,  which  is  opposed  to  reform,  was  fully  dis- 
played. However,  it  is  of  interest  to  note  that 
at  the  meeting  to-morrow  Mr.  Tweedy  will  be  per- 
mitted to  bring  forward,  for  the  second  time,  his  resolu 
tion  with  regard  to  polling  the  Fellows.  The  importance 
of  this  fact  cannot  be  gainsaid.  All  that  is  now  wanted, 
for  the  members'  question  to  enter  upon  a  new  phase, 
is  the  passing  of  the  resolutions  standing  in  the  names 
of  Mr.  Rivington  and  Mr.  Tweedy.  By  the  one,  the 
barrier  to  the  further  discussion  of  the  subject  will  be 
removed,  by  the  other,  a  definite  pronouncement  will 
be  obtained  in  regard  thereto  from  a  large  number  of 
the  FeUows  whose  opinion  at  this  juncture  would  be 
most  valuable. 


A  ''  Chiel "  on  London  Medical  Students. 

It  lis  sometimes  interesting  to  learn  what  others 
think  of  us  ;  more  often  it  is  amusing,  and  the  latter 
feeling  will  be  the  predominant  one  among  medical 
students  in  London  who  have  been  made  the  subject 
of  a  critical  description  by  the  London  correspondent 
of  the  New  York  Sun,  Everyone  on  this  side  of  the 
Atlantic  knows  that  America  out-distances  everybody 
and  everything  in  "  this  best  of  all  possible  worlds  " ; 
at  least,  it  is  customary  to  believe  that  this  is  the  case 
because  we  are  told  so — by  Americans.  Hence  it  is  not 
surprising  to  learn  that,  in  common  with  everything 
else  in  this  country,  the  London  medical  students 
hopelessly  and  deplorably  form  one  more  illustration 
of  the  incapacity  of  all  things  English.  The  choice 
criticism  to  which  we  refer  is  as  follows  :—'*  The 
ignorance  and  unekilfulness  of  the  average  English 
practitioner  as  turned  out  of  the  Medical  Colleges  are 


texT  13,  18d6. 


NOTES  ON  CtTRRENT  TOPICS 


Ths  kxDicAL  Pbbm.     b09 


Bomething  appaUing.  I  have  attended  two  or  three 
cliniqaes  in  the  principal  London  hospitals  for  the 
purpose  of  comparing  them,  from  a  layman's  point  of 
view»  with  Belle vae,  the  Massachusetts  General,  and 
other  American  institutions.  The  methods  of 
instructing  the  students  are,  of  course,  practi- 
cally the  same  in  both  countries.  What  most 
impressed  me  was  the  low  grade  of  intelligence, 
the  dense  stupidity,  in  fact,  of  many  of  the  young  men 
to  whose  care  the  ills  of  humanity  in  these  islands 
were  about  to  be  confided.  I  have  in  mind,  particu- 
larly, a  class  of  young  men  about  to  pass  their  final 
examinations  previous  to  beginning  practice.  I 
watched  them  undertake,  one  by  one,  to  diagnose  a 
long  series  of  cases  in  the  outpatient  department  of  a 
great  hospital.  It  is  no  self-conceit  to  say  that  with  only 
a  layman's  knowledge  I  should  have  come  nearer  the 
mark  in  half  the  cascs.  Their  book  knowledge  may  be 
complete  as  their  diplomas  will  certify,  but  the  prac- 
tical application  of  it,  the  native  intelligence  which 
makes  it  invaluable,  was  sadly  deficient."  This  is  all 
very  sad—for  the  London  medical  student,  but  he 
must  not  be  downhearted.  All  his  fellow  countrymen 
are  in  the  ''same  box"  with  himself.  It  is  quite 
evident  that  the  native  intelligence  of  English 
people  departed  with  the  English  emigrants  who  went 
to  colonise  America.  Somehow,  however,  an  English 
nation  has  still  had  the  audacity  to  exist,  and,  among 
other  things,  with  considerable  presumption,  young 
Englishmen  are  taught  to  be  practitioners  of  medicine 
and  surgery.  But  in  view  of  the  criticism  above 
quoted,  the  sooner  that  this  system  is  put  a  stop  to  the 
better.  One  Englishman,  it  used  to  be  said,  was 
a  match  for  three  Frenchmen— in  battle ;  this  saying 
may  be  varied.  It  will  now  have  to  be  said,  that  one 
American  layman  knows  as  much  as  a  class  of  English 

students— in  medicine. 

The  Elections  at  the  Royal  College  of 
Surgeons,  Ireland. 
On  the  first  Monday  in  June,  the  President,  Vice- 
President,  and  Councillors  will  vacate  their  offices,  but, 
no  doubt,  will  almost  all  be  re-elected.  Sir  Thornley 
Stoker,  having  completed  his  two  years  of  office  as 
President,  will  retire  from  the  chair,  but,  it  is 
expected,  will  re-enter  the  Council  as  one  of  its 
.  members.  The  Vice-President,  Mr.  William  Thomson, 
Surgeon  to  the  Eichmond  Hospital,  and  Direct  Repre- 
sentative of  the  profession  in  Ireland  on  the  General 
Medical  Council,  will  become  President.  For  succes- 
sion to  the  Vice-Chair,  Mr.  R.  L.  Swan,  of  Steevens's 
Hospital,  had  long  since  announced  his  candidature, 
but  he  has,  within  the  past  fortnight,  intimated  that 
he  will  not  seek  the  position  just  now,  but  withdraws 
his  candidature  in  favour  of  Mr.  Kendal  Franks,  of  the 
Adelaide  Hospital.  It  is  reported,  however,  in  well 
informed  professional  circles,  that  Mr.  Franks  has 
determined  to  give  up,  in  a  few  months,  his  practice  in 
Dublin,  and  to  commence  afresh  in  Johannesburg, 
South  Africa,  the  reason  assigned  being  that  the 
delicate  health  of  his  famUy  compels  them  to  reside 
in  a  tropical  climate,  and  preferably  in  Johannesburg 
where  they  have  inherited  large  property. 


For  the  position  of  Councillor,  Mr.  Henry  Gregg 
Sherlock,  a  Fellow  in  large  practice  in  the  dental 
speciality,  has  offered  himself.  Though  unsuccessful 
at  the  recent  bye-election  of  a  Councillor,  in  which  Dr. 
Cranny  headed  the  poll,  Mr.  Sherlock  has  many  friends 
and  may  be  more  fortunate  at  the  general  election. 
The  election  of  Examiners  to  serve  for  the  ensuing 
year  took  place  on  Tuesday,  the  5th  inst,  and  there 
was  an  active  competition  on  the  part  of  numerous 
candidates.  For  the  two  Examinerships  in  Anatomy, 
heretofore  held  by  Messrs.  J.  Barton  and  Myles, 
there  also  competed  Professor  Alec  Fraser,  Mr.  W. 
Stoker,  and  Mr.  Pat.  J.  Fagan,  Demonstrator  in 
the  Catholic  University  School.  In  the  result 
Messrs.  Barton  and  Fraser  were  elected.  For  the 
Surgery  Examinerships  the  out-going  examiners 
—  Messrs.  Chance  and  Sir  William  Stokes  had  to  con- 
tend with  Messrs.  Dallas  Pratt  and  William  Stoker. 
For  the  Examinerships  in  Physiology,  Histology,  Bio- 
logy, and  Pathology,  there  were  also  many  candidates, 
including  those  out-going,  and  a  competitor  not  here- 
tofore in  the  field,  presented  himself,  to  wit,  Mr.  Ed. 
H.  Taylor,  Examiner  in  Anatomy  in  the  University  of 
Dublin.  Mr.  Myles,  who  has  hitherto  examined  in 
Anatomy,  has  been  transferred  to  the  Pathological 
Examinership.  The  result  of  the  count  showed  that 
Messrs.  Chance  and  W.  Stoker  were  elected  to 
the  Surgery  Examinerships.  The  following  is  the 
complete  list  for  the  year  1896-97  :— 

Anatomy  :  Messrs.  J.  Barton  and  Alec  Fraser. 

Surgery:  Messrs.  Arthur  Chance  and  William 
Stoker. 

Physiology  and  Histology :  Messrs.  J.  A.  Scott  and 
Coppinger. 

Biology :  Messrs.  J.  A.  Scott  and  G.  Burbidge  White. 

Pathology  :  Mr.  Myles  and  Mr.  Taylor. 

Midwifery  and  Gynaecology :  Miss  Winifred  Dickson. 

Ophthalmology :  Messrs.  Maxwell  and  Story. 

Dental  Surgery  :  Messrs.  Baker  and  Stack. 

Dental  Mechanics  :  Messrs.  Bishop  and  Wall. 

Dental  Physics  and  Chemistry :  Dr.  Edgar  Fiinn, 
Dallas  Pratt,  and  Capper. 

Bacteriology  :  Mr.  J.  A.  Scott. 

Sanitary  Engineering :  Mr.  Chas.  J.  Wilmot. 

Prelimiaary  Court :  Messrs.  R.  J.  Montgomery  and 
Morton. 

Medical  Certifloation 
The  Kitson  and  Playfair  case  is  not  the  only  one 
which  has  recently  cropped  up  of  interest  to  the  pro- 
fession. The  case  of  Dwyer  v,  Russell,  recently  tried 
in  the  Queen's  Bench,*.Dublin,  is  full  of  warning  to 
medical  men,  for  the  jury  gave  £40  damages  for 
what  they  termed  an  incomplete  certificate,  drawn  up 
and  signed  by  the  defendant.  The  facts,  which  are 
uncontroverted,  are  as  follows ;— (We,  of  course,  avoid 
the  controverted  ones.)  The  plaintiff's  husband  alleged 
that  she  was  malformed,  and,  desiring  to  put  her  away, 
employed  the  defendant  to  examine  her.  He  gave  a 
certificate  that,  from  the  statements  made  by  both 
parties,  they  could  not  have  connection,  and  that  there 
I  existed  a  bar  to  same.    Legal  proceedings  were  then 


Mo 


ThI  MiDICUL  PRB88. 


iTOTfeS  ON  CUkbfiNt  TOPldS. 


Mat  13.  IfM 


taken  in  Jndge  Warren's  coart.  Dr.  Laffan  was  called 
in  and  certified  that  there  was  nothing  wrong.  Sub- 
sequently, Judge  Warren  ordered  Dr.  Home,  of  Dublin, 
to  examine  her,  and  he  also  certifying  that  there  was 
nothing  wrong,  the  husband  withdrew  his  applica- 
tion for  a  divorce,  but  a  separation  with  alimony  was 
granted  to  the  wife.  Next,  the  wife  sued  the  doctor 
for  damages,  and  this  has  just  been  heard,  as  already 
stated.  The  jury,  after  a  lengthened  consideration, 
during  which  they  were  called  out  several  times  by  the 
judge,  found  that  the  certificate  was  a  libel,  but  written 
without  malice,  and  found  £40  damages  for  plaintiff ; 
they  found  for  the  defendant  that  the  examination  was 
skilfully  made  ;  that  he  certified  to  the  best  of  his  skill 
and  knowledge,  and  that  the  statement  in  the  certificate 
was  true,  so  far  as  it  went.  The  damages  are  contin- 
gent on  judgment  being  given  for  the  plaintiff  by 
the  Queen's  Bench  after  reviewing  the  case  and  the 
course  of  the  trial.  Drs.  McCann  and  Flynn  were 
examined  for  the  defence,  and  expressed  the  opinion 
that  vaginismus  existed  when  defendant  was  ex- 
amined. The  defendant  himself,  however,  swore  that 
he  believed  it  to  be  organic  narrowing,  but  added  that 
he  told  the  husband  that  it  was  curable,  and  in  a  short 
time,  by  incision  or  by  dilatation,  but  this  he  did  not 
embody  in  the  certificate,  and,  though  the  jury  exoner- 
ated him  from  the  charge  of  unskilfulness  and  negligence, 
they  mulcted  him  accordingly.  A  curious  feature  in 
it  was  the  direct  conflict  of  medical  testimony.  No 
evidence  was  offered  that  any  operation  had  been  per- 
formed in  the  interval  between  the  first  and  second 
medical  examinations.  The  lesson  is  obvious,  and, 
coming  as  a  complement  to  the  more  celebrated  case, 
will  add  its  note  of  warning  to  medical  practitioners. 

CoBt  of  Diploma  Begifitration. 

A  coBRESPONDENT  complains  to  us  that,  whereas  he 
can  have  a  Diploma  in  Dentistry  or  in  Midwifery, 
or  of  Fellowship— registered  in  the  Medical  Register 
as  an  ''additional  qualification  " — ^for  a  fee  of  5s.,  he  is  for 
no  apparent  reason,  charged  £2  for  registering  a  State 
medicine  qualification.  He  remonstrated  with  the 
General  Medical  Council,  but  received  the  following 
reply : — 

"I  have  to  inform  you  that  the  question  of  the 
amount  of  the  fee  to  be  charged  for  the  registration  of 
Diplomas  in  Public  Health  has  received  the  special 
attention  of  this  Council,  and  that  it  has  been  definitely 
ruled  that  the  registration  of  each  such  Diploma  shall  be 
accompanied  with  the  payment  of  a  fee  of  £2'' 

The  fact  is  that  the  Council  had  no  power  to  register 
a  State  medicine  diploma  until  the  Medical  Actof  1886, 
and  the  21st  Section  of  that  Act  gave  power  to  do  so 
"on  payment  of  such  fee  as  the  General  Medical 
Council  may  appoint"  Under  this  authority  £100  or 
£500  might  legally  be  charged  for  the  registration 
and,  as  the  Council  has  always  an  eye  to  the  main 
chance,  it  thought  that  a  trifling  inconsistency  need 
not  stand  in  the  way  of  a  lucrative  tax.  It  certainly 
is  difficult  to  gauge  the  principles  which  guide  the 
General  Medical  Council  in  the  matter.  Why  the 
unfortunate  holder  of  the  Public  Health  Diploma  should 
be  fined  £2  for  registering  his  diploma— for  that  is  what 


the  proceeding  virtually  means— is  a  mystery,  indeed, 
when  a  registration  fee  of  five  shillings  is  considered 
adequate  for  other  kinds  of  additional  qualifications. 
Arbitrary  decisions  of  this  sort  simply  emphasise  the 
necessity  of  making  the  Council  more  direcUy  repre- 
sentative of  the  interests  of  the  main  body  of  general 
practitioners  of  medicine. 

Profeesional  Confidences. 
Thb  Journal  of  the  British  Medical  Association  for- 
mulates the  rule  of  professional  confidences,  as  settled 
by  the  Kitson-Playfair  case,  in  the  following  terms  : — 

"The  knowledge  which  a  doctor  obtains,  whether 
voluntarily  or  involuntarily,  from  his  patient  is  the 
patient's  secret  and  not  the  doctor's.  It  must  be  taken 
to  have  been  obtained  on  an  absolute  understanding 
that  it  will  not  be  used  without  the  patient's  consent. 
By  this  understanding  the  doctor  is  bound,  however 
hard  upon  himself  the  circumstances  may  be,  except  in 
one  class  of  cases,  where  the  law,  reinforced,  in  fact,  by 
the  widest  principles  of  morality,  lays  upon  him  the 
duty  to  break  the  seal,  t.^.,  the  case  in  which  the 
doctor's  continued  silence  would  make  him  practically 
the  accomplice  in  a  crime  which  would  be  prevented, 
and  only  be  prevented,  by  revealing  the  secret  of  his 
patient." 

This  seems  to  us  to  be  a  well-expressed  and  sound 
conclusion,  and,  if  it  be  strictly  followed,  a  charge  of 
breach  of  professional  confidence  can  scarcely  ever  be 
brought  against  any  doctor.  There  is,  of  course,  a 
latitude  of  interpretation  left  to  each  practitioner  as  to 
what  circumstances  constitute  a  crime  which  justifies 
the  revelation  of  a  professional  secret,  but  we  are  con- 
vinced that  there  is  little  danger  that  such  latitude  will 
ever  be  used  for  the  purpose  of  making  public  facts 
which  it  is  not  absolutely  necessary  should  be  known. 

The  Metric  System. 
The  adoption  of  the  decimal  system  of  weightc, 
measures  and  coinage  meets  still  with  serious  resist- 
ance amongst  English-speaking  communities,  although 
it  has  been  approved  by  every  important  nation  except 
Britain  and  Russia.  The  answer  given  by  Mr.  Han- 
bury  in  the  House  of  Commons  last  week  was  dis- 
couraging for  those  who  advocate  the  change,  and  it 
is  worthy  of  note  that  the  American  Senate,  which 
legalised  the  adoption  of  the  metric  system  thirty  years 
ago,  during  which  period  it  has  been  scarcely  used  at  all, 
recently  passed  the  Bill  to  make  it  compulsory  by  only 
two  votes.  An  unexpected  and  influential  opponent  to 
decimalism  has  turned  up  in  the  person  of  Mr.  Herbert 
Spencer,  who,  under  a  nam  de  plume^  contributed  re- 
cently to  the  Times  three  letters  hostOe  to  the  prin- 
ciple. It  would  be  reasonable  to  expect  a  great  un- 
willingness on  the  part  of  traders  to  abandon 
the  code  of  weights  and  measures,  and  coinage 
to  which  they  and  their  ancestors  were  trained, 
and  it  could  not  be  expected  that  any  government 
would  precipitately  force  the  changes  upon  commercial- 
Lsts.  But  no  one  who  has  lived  in  France,  or  other 
continental  country  where  decimalism  obtains,  can  have 
failed  to  be  convinced  of  its  many  advantages  over  the 
duodecimal  system,  and  it  is  difficult  to  understand 
why  anyone  should  hesitate  to  make  it  gradnaUy  the 


Mat  13, 1806. 


NOTftS  ON  CUKitENl  f  OPICS. 


Th>  Mbdical  Vmmsa. 


Ml 


aystem  of  the  nation,  by  increasing  the  teaching  of  it 
in  public  schools,  and  by  adopting  it,  at  least,  as  an 
alternative  in  all  Qovemment  contracts  and  other 
public  commercial  dealings.  If  public  bodies  would 
make  it  a  rule  to  give  their  orders  to  tradesmen  in 
decimals  the  change  would  be  insensibly  effected  in 
a  comparatively  short  time.  In  no  department  would 
a  beginning  be  more  readily  made  than  in  the  com- 
pounding of  medicines,  and  we  do  not  anticipate  that 
anyone  would  object  if  the  Oeneral  Medical  Council 
turned  the  old  drachms  and  scruples  of  the  British 
Pharmacopoeia  into  grammes  and  litres. 

Army  Medical  Concessions. 
It  18  rumoured  that  the  Army  authorities  are 
about  to  promise  a  number  of  concessions  to  the 
members  of  the  Medical  Staff.  We  trust  that  the 
promise  will  be  fully  redeemed,  but  at  the 
same  time  we  must  remind  possible  competitors 
for  commissions  that  the  promises  of  ^*my  military 
advisers  "  have  been  proved  by  past  experience  to  be 
somewhat  fragile  and  unreliable.  It  is  not  the  first 
time  that  visions  of  peace  and  plenty  have  been  held 
out  to  candidates  when  an  examination  was  in  view 
and  when  the  supply  of  candidates  was  insufficient,  bat 
that  when  a  rush  of  expectant  candidates  was  attracted 
and  the  vacancies  were  filled  the  visions  proved  to  be 
nothing  but  mist.  If  candidates  for  the  Service 
do  noc  listen  to  the  warning  given  to  them 
by  those  who  know  the  prospects  of  the  Service 
they  need  not  complain  when  they  find  that  faith  has 
been  broken  with  them  by  the  combatant  authorities. 
They  should  recollect  that  they  are  dealing  with 
enemies,  and  with  unscrupulous  ones,  and  should  act 
accordingly  for  their  own  protection.  If  young  prac- 
titioners who  think  of  entering  the  Army  Medical 
Service  want  to  know  the  sort  of  treatment  which  they 
have  to  expect  from  Sir  Redvers  Buller  and  the  rest 
of  '*my  military  advisers,"  we  invite  them  to  post 
themselves  up  in  the  case  of  Army  Doctors  Briggs, 
Smith,  Fowler,  Qardener,  and  Walsh,  all  occurring 
within  a  couple  of  years,  and  all  redolent  of  a  vin- 
dictive determination  to  keep  the  doctors  under  foot. 
If  any  young  practitioner,  after  such  perusal,  likes  to 
become  a  "  civilian,"  and  to  take  rank  as  such  amongst 
his  military  brethren,  he  is  quite  at  liberty  to  do  so. 

A  Surgeon  and  his  Papils. 
Well-known  and  popular  members  of  the  teaching 
Btaffd  of  large  medical  schools  have  not  infrequently 
pleasant  experiences  when  travelling  abroad  and 
meeting  their  former  pupils.  An  experience  of  this 
kind,  which  is  likely  to  be  memorable,  has  recently 
occurred  to  Professor  Annandale,  of  Edinburgh. 
While  on  a  visit  to  the  Cape  in  March  last,  the  old 
students  there  of  the  University  of  Edinburgh  and 
Edinburgh  School  of  Medicine  entertained  him  at  a 
dinner,  as  already  mentioned  in  these  columns.  From 
fuller  accounts  to  hand  from  the  Cape,  we  learn  that 
the  warmth  of  his  reception  was  most  conspicuous ; 
and  in  relying  to  the  toast  of  his  health,  he  had  some 
amnsing   experiences   to   relate.    Among  others  he 


stated  that  notwithstanding  the  uncomfortable 
experiences  of  the  examination-room,  it  was 
wonderful  how  soon  these  were  forgotten  and  how 
long  the  good  outcome  of  them  was  remembered. 
One  surgeon— up  country— told  him  that  he  had  re- 
proved him  for  making  flaps  too  short,  and  from  that 
day  to  this  he  had  always  been  on  the  safe  side  by 
having  them  long  enough.  But,  perhaps,  the  most 
paralysing  evidence  of  goodwill  Prof.  Annandale  said 
that  he  had  ever  had  was  at  the  dinner  given  in  his 
honour  in  Johannesburg,  when  he  heard  a  voice  from 
somewhere  down  the  table  saying,  '*  Thomas,  yon 
plucked  me,  but  I  forgive  you."  This  was  convincing 
proof  of  the  good  feeling  which,  despite  misfortune, 
often  prevails  between  examiner  and  candidate 
Doubtless,  this  forgiving  practitioner  has  had  ample 
time  to  reflect  upon  the  justness  of  the  rejection  of 
which  he  reminded  his  examiner  at  the  dinatr  in  ques- 
tion. But  for  an  examiner  to  have  had  hid  atteution 
called  in  so  startling  a  manner  to  one  of  the  exigencies 
of  his  duties  was  an  episode  well  calculated  to  produce 
an  impression  upon  his  mind. 


Strophanthus  v.  Digitalis. 
Dr.  G.  W.  Balfour's  attack  on  strophanthus  at  last 
week's  meeting  of  the  Edinburgh  Medico-Chirurgical 
Society  savours  somewhat  of  Don  Quixote's  tilt  at  the 
windmill.  Dr.  Balfour  is  a  well-known  authority  on 
heart  disease,  and  it  was  not  very  creditable  to  the 
senior  physicians  of  the  city  that  not  one  of  them 
should  have  thought  it  worth  while  to  put  in  an 
appearance.  Dr.  Balfour  blessed  digitalis,  but  cursed 
strophanthus  almost  as  vehemently  as  the  archbishop 
cursed  the  jackdaw  of  Rheims.  It  remains  to  be  seen 
if  the  curse  will  have  any  effect.  There  is  no  doubt, 
however,  that  digitalis  is  much  superior  for  most  cases 
of  heart  disease,  and  has  often  a  wonderful  effect  in 
stimulating  the  whole  circulatory  metabolism,  as  Dr. 
Balfour  put  it.  That  the  action  of  strophanthus  on  the 
heart  is  3,000  times  more  powerful,  and  even  then  only 
acts  as  an  irritating  poison  on  its  muscular  mechanism, 
should  teach  the  value  of  caution  in  its  administration. 
Perhaps  it  is  going  a  little  too  far  to  say  that  it  should 
never  be  given,  for  in  many  cases  of  emergency  its 
exhibition  is  followed  by  rapid  and  satisfactory  amelio- 
ration of  the  symptoms.  One  other  note  we  would  like 
to  make  is  that  the  different  preparations  of  strophan- 
thus in  the  market  vary  very  much  in  strength  and 
purity,  entailing  increased  care  in  its  use. 


The  Representative  of  the  London  College  of  Physi- 
cians in  the  General  Medical  Council,  Dr.  Wilks,  has 
resigned  his  seat  on  the  General  Medical  Council  in 
consequence  of  his  election  to  the  Presidency  of  the 
College,  and  it  has  been  filled  by  the  appointment  of 
Sir  William  Roberts,  r.R.S. 


The  British  Association  for  the  Advancement  of 
Science  will  commence  its  meetings  at  Toronto  on 
August  18th.  It  met  in  Canada  last,  in  the  year  1884 
at  Montreal. 


61 2     Thb  Mbdioal  Prbbs. 


NOTER  ON  CUBRRNT  TOPICS. 


Mat  18,  1996. 


Sunday  Closure  of  Public  Houses. 
A  NOTABLE  incident  has  been  recorded  in  the  parlia- 
mentary history  of  the  temperance  movement.  Last 
Wednesday  there  was  a  lapse  of  five  minutes  between 
the  adjournment  of  the  Education  debate  and  the  time 
fixed  for  the  cessation  of  contentious  business.  This 
opportunity  was  seized  upon  by  the  member  in  charge 
of  the  Bill  for  the  Sunday  closing  of  public-houses  in 
England)  who  quietly  moved  a  second  reading  of  his 
measure.  Before  the  House  Lad  realised  what  was 
going  on,  the  Speaker  put  the  question  and  a  division 
followed  aa  a  matter  of  necessity.  The  result  of  this 
manosuvre  in  a  partially  emptied  House  was  the 
carrying  of  the  second  reading  by  113  to  105.  There 
can  bd  no  doubt  that  the  Bill  will  be  thrown  out  at  a 

later  8tage,but  for  all  that  the  friends  of  temperance 
will  find  their  hands  strengthened  by  this  unexpected 
triumph.  Speaking  from  a  medical  point  of  view, 
anything  that  tends  to  restrict  the  curse  of  immoder- 
ate drinking  must  be  approved  by  members  of  our 
profession.  If  Sunday  opening  can  be  shown  to  be 
unnecessary  and  hurtful,  then  let  it  cease  to  exist. 
Certainly,  Sunday  closing  must  curtail  the  opportuni- 
ties for  over-indulgence.  If  the  principle,  however,  is 
to  be  enforced  in  other  parts  of  the  United  Kingdom 

it  is  hard  to  see  why  it  should  not  be  applied  imparti- 
ally to  all,  also  ;  what  is  sauce  for;  the  goose  should  be 
sauce  for  the  gander. 

The  Hours  of  the  Joumeymeui  BaJ^er. 
After  many  years  of  waiting,  the  journeyman  baker 
appears  to  be  gaining  some  scant  measure  of  long 
needed  reform.  The  late  Government,  in  the  Bill 
introduced  by  Mr.  Asquith,  decreed  that  from  the 
first  day  of  the  year  1896,  no  more  bakeries  were  to  be 
constructed  underground.  The  latest  important 
change  in  the  conditions  of  the  baking  trade,  we  are 
glad  to  see,  has  resulted  from  the  united  action  of  the 
men  themselves.  As  the  result  of  forcible  protests  by 
their  operative  union,  their  grievances  were  referred 
to  a  Committee  appointed  by  the  London  Labour  Con- 
ciliation and  Arbitration  Board.  The  award  of  this 
body  has  now  been  issued.  It  decides  that  the  men  are 
to  work  a  maximum  of  sixty-bix  hours  a  week,  or 
eleven  hours  a  day,  with  half  an  hour  off  for  meal,  and 
overtime  beyond  the  first  hour^is  to  be  paid  for  as  time 
and  a  half.  Saturday  labour  for  Jews,  and  Sunday 
labour  for  Gentiles  is  to  be  abolished  as  far  as  possible. 
Men  under  the  factory  system  are  to  work  ten  hours 
a  day.  These  resolutions  constitute  a  step  in  the  right 
direction,  but  they  are  pithed  by  the  fatal  weapon  of 
permissiveness.  An  absolute,  all-round  limit  of  ten 
hours  and  no  Sunday  labour  would  be  a  perfectly  reason- 
able demand.  It  has  been  shown  over  and  over  sigain 
that  bakers  need  not  work  longer  than  workmen  in 
other  trades,  and  Sunday  labour  can  be  dispensed  with 
altogether,  if  only  the  trade  show^  a  united  front  on 
the  matter. 


Owing  to  an  outbreak  of  diphtheria,  the  public 
schools  at  Eainham,  Kent,  have  been  closed  by  order 
of  the  sanitary  authorities. 


The  London  and  Counties  Medical  Protec- 
tion Society. 
If  the  future  prosperity  of  the  medical  profession  ia 
to  be  ensured  by  organisation  nothing  can  be  more 
promising  than  the  financial  and  social  position  of 
modern  defence  societies.  One  of  these  bodies,  the 
**  London  and  Counties/'  has  entered  upon  the  third 
year  of  its  existence  under  circumstances  that  point  to 
a  strong  vitality  of  constitution.  At  the  annual 
meeting  last  week  the  President,  Mr.  Jonathan 
Hutchinson,  announced  that  although  the  year  1895 
began  with  a  deficit,  yet  the  end  of  the  twelve  months 
showed  a  cash  surplus  of  £125  17s.  9d.  He  also  made 
the  statement  that  the  negotiations  which  have  been 
going  on  for  some  time  with  a  view  of  amalgamation  with 
the  Medical  Defence  Union  have  now  been  definitely 
abandoned.  During  the  past  year  the  report  showed  that 
much  valuable  aid  was  granted  to  members.  We  note  that 
the  Council  of  the  Society  has  adopted  the  cautious 
course  of  taking  no  account  in  their  balance-sheet  of 
subscriptions  in  arrears.  As  the  Committee  remark, 
it  would  be  extremely  unwise  to  count  upon  such 
arrears  (the  annual  subscription  is  lOs.)  as  forming  an 
available  asset  in  case  of  emergency,  owing  to  the  cost 
of  compelling  payment  The  strong  list  of  official 
members,  both  Metropolitan  and  local,  leads  to  the 
belief  that  a  prosperous  career  awaits  this  Society. 


The  Civil  Bights  Defence  Committee. 
Ak  important  meeting  of  the  Civil  Rights  Defence 
Committee  will  be  held  at  the  house  of  Mr.  Victor 
Horsley,  25  Cavendish  Square,  W.,  on  the  15th  inst. 
The  main  business  to  be  transacted  will  be  to  consider 
and  report  on  the  relation  of  the  General  Medical 
Council,  andlof  the  bodies  corporate  of  the  profession, 
to  the  rights  of  medical  men  for  the  defence  of  which 
the  Committee  was  constituted,  and  on  the  most 
proper  and  suitable  way  of  obtaining  the  oo-operation 
of  the  General  Medical  Council,  University  of  London, 
Royal  College  of  Physicians  of  London,  and  Worship- 
ful Society  of  Apothecaries,  and  other  public  bodies 
in  defence  of  those  rights.  The  Royal  College  of 
Surgeons,  England,  took  the  llead  some  months  ago  of 
appointing  representatives  on  this  Committee,  and  it  is 
difficult  to  understand  why  the  other  Corpoiations  do 
not  follow  suit. 


Pocket  Soda  Water. 
An  invention  has  been  perfected  which  professes  to 
enable  any  one  to  carry  about  a  dozen  bottles  of  soda 
water  or  other  ^  mineral "  in  his  waistcoat  pocket  It 
consists  in  a  special  stopper  to  an  ordinary  soda-water 
bottle  and  a  small  steel  capsule  into  which  ia  com- 
pressed about  a  drachm  of  solid  carbonic  acid  gas 
The  bottle  is  filled  with  drinking  water,  either  fiavonred 
to  taste  or  not ;  the  capsule  is  placed  in  position  in  the 
stopper,  and  the  bottle  is  closed.  By  the  act  of  closing, 
the  capsule  is  penetrated  by  a  pin  which  is  in  the 
stopper,  and  the  C  Og  is  thus  set  free.  A  few  shakes 
of  the  bottle  and  the  soda  water  is  fit  for  drinking, 
but  the  longer  it  is  kept  the  better.  Messrs.  Read,  of 
Broad  Street  Avenue,  London,  are  the  patentees. 


Hat  13,  1896. 


trOTfeS  Oif  CURRENT  TOPICS. 


Thi  ttiDioAL  Pubs    513 


The  Protection  of  Infemt  lafe. 

Thkrx  are  now  two  Bills  before  the  House  of  Lords 
dealing  with  the  protection  of  infant  life.  One  is  pro- 
moted by  the  London  County  Council,  and  designed 
to  amend  the  present  Act  known  under  this  name, 
and  the  other  is  called  the  ^  Safely  of  Nurse  Children 
Bill*"  for  which  the  Society  for  the  Prevention  of 
Cruelty  to  Children  have  made  themselves  responsible. 
Both  Bills  have  been  referred  to  a  Select  Committee 
of  the  House,  which  for  the  past  few  weeks  have 
been  taking  evidence  upon  the  subject.  With  the 
hideous  revelations  of  the  Reading  case  before  them, 
pointmg  to  the  absolute  inefficacy  of  the  present 
Infant  life  Protection  Act,  it  may  be  trusted  that  the 
Committee  will  report  in  favour  of  the  valuable  amend- 
ments suggested  in  the  Bill  promoted  by  the  London 
County  CoundL  The  most  important  amendment 
proposed  is  that  which  provides  for  the  registration 
and  inspection  of  houses  in  which  a  child,  or  children, 
are  received  for  hire  or  payment  under  the  age  of 
five  years.  This  undeniably,  to  a  large  extent,  touches 
the  root  of  the  evils  associated  with  the  baby-farming 
syatem.  Buttheinterestaof  Medical  Officers  of  Health 
are,  to  some  extent,  touched  by  this  Bill,  as  one  of 
its  clauses  provides  that  the  Sanitary  Authority  shall 
keep  a  register  of  all  local  baby-farmers,  and  it  shall 
be  the  duty  of  the  Medical  Officer  of  Health  to  inspect 
and  report  from  time  to  time  as  to  the  fitness  of  the 
registered  abode  for  the  accommodation  of  the  children, 
and  as  to  the  condition  of  children  themselves.  For 
this  onerous  and  responsible  function,  no  specific  pay- 
ment is  provided  by  the  Bill ;  but  the  9th  Clause  says 
that,  for  the  purposes  of  the  Bill,  the  Sanitary 
Authority  may  appoint  and  pay  such  officers  as  they 
please.  This  sort  of  discretionary  power  to  such 
authorities  has  always  proved  unsatisfactory,  and  no 
doubt  we  shall  see,  in  many  cases,  the  effort  made  to 
impose  these  new  duties  without  adequate  remunera- 
tion.   

The  HlnesB  of  Sir  Bussell  Beynolds. 

Ws  regret  to  hear  that  the  indisposition  of  Sir 
Bussell  Reynolds,  lately  President  of  the  Royal  Col- 
lege of  Physicians  of  London,  has  taken  a  serious  turn. 
Hitherto,  although  great  weakness  has  occasionally 
given  cause  for  uneasiness,  the  absence  of  symptoms 
pointing  to  any  organic  disease  has  encouraged  his 
friends  and  medical  advisers  to  hope  that  with  rest 
from  work,  whether  of  a  public  or  private  nature,  a 
turn  towards  new  strength  would  be  taken.  But  on 
Saturday  morning  last  certain  pulmonary  symptoms 
manifested  themselves,  the  importance  of  which, 
occurring  in  an  ahready  enfeebled  subject,  cannot  be 
disguised,  and  Sir  Russell  Reynold's  present  state  is 
one  of  extreme  gravity.  Sir  Russell,  who  is  President 
of  the  British  Medical  Association,  was  the  President 
of  the  Royal  College  of  Physicians  of  London  until 
Mardi  last,  when  he  did  not  offer  himself  for  re-elec- 
tion. There  can  be  no  doubt  that  he  was  during  the 
whole  of  last  year  under  a  burden  of  official  duty  too 
heavy  for  him  to  carry,  to  the  labours  of  which  he 
added  those  incident  to  the  life  of  a  physician  at  the 
head  of  his  profession. 


The  South  AfHcan  Horse  Sickness. 
This  disease,  which  is  one  of  the  chief  obstacles  to  the 
development  of  large  tracts  of  South-Central  Africa, 
has  been  the  subject  of  close  bacteriological  investiga- 
tion by  Br.  Erdington,  the  Director  of  the  Bacterio- 
logical Institute  at  Cape  Town.  He  has  had  no 
difficulty  in  identifying  the  mycelium  which  causes  the 
disease,  but  great  difficulty  in  growing  it,  as  it  failed 
to  develop  in  any  of  the  usual  media  for  bacillus  culti- 
vation. He  has,  however,  found,  strange  to  say,  that 
the  natural  gam  which  exudes  from  the  wild  mimosa, 
growing  in  the  district,  is  laden  with  the  mycelia, 
which  seem  to  thrive  and  propagate  on  it,  and  his 
conclusion  at  present  is  that  the  only  effectual  remedy 
for  the  disease  is  to  destroy  the  mimoss.  There  is  an 
analogy  for  this  in  a  sort  of  ''rust"  that  has  been 
found  to  have  its  habitat  on  the  leaf  of  the  barberry 
tree,  which  affects  com,  and  which  has  been  got  rid  of 
by  destroying  those  trees  wherever  the  "rust '  appeared. 


Mectrio  Belta 
The  trade  in  these  appliances  which  were  so  well 
ad vertLsed,  and  freely  bought,  by  the  public  a  few  years 
ago  seems  to  have  receded  to  a  very  low  ebb,  probably 
owbg  to  the  exposure  of  the  Harness  Belt  frauds  and 
the  collapse  of  that  company.  We  note  that  the  busi- 
ness of  Mr.  Palvermacher,  whose  electric  belts  at  one 
time  had  undisputed  possession  of  the  field,  and  had 
certainly  more  pretension  to  efficiency  than  any  other 
appliances  of  the  sort,  has  been  converted  into  a 
limited  liability  company.  As  the  promoters  are  all 
clerks,  and  the  total  nominal  capital  is  dlfiOO^  it  does 
not  look  as  if  a  large  trade  is  expected. 


Health  of  the  Rand. 
A  JoHAKNSSBUBO  correspondent  writes  to  us  that 
the  last  annual  report  of  Dr.  Yisser,  Health  Officer,  on 
the  general  health  and  sanitation  of  the  town,  just 
issued,  gives  the  percentage  of  deaths  from  typhoid  as 
very  great  in  that  town  due  to  bad  water  and  adultera- 
tion ;  the  deaths  from  these  causes  during  1895,  are 
given  as  upwards  of  one  thousand.  Pneumonia,  also, 
he  states,  was  very  prevalent  during  the  winter  months. 
He  IB  decidedly  of  opinion  that  a  repetition  of  this  can 
only  be  obviated  by  the  sufficient  and  effectual  water- 
ing of  the  streets  as  to  completely  lay  the  dust,  which  is 
the  chief  cause  of  the  annual  epidemic.  The  sanita- 
tion of  Johannesburg  is  altogether  in  the  most  primi- 
tive  state,  the  disposal  of  its  sewage  being  at  the 
present  time  but  little  in  advance  of  that  which  obtains 
in  semi-barbarous  states  and  a  fod  of  filth-producing 
diseases. 

nie^timacj^in  Ghreat  Britain. 
In  his  evidence  given  before  the  Lords'  Committee 
on  baby  farming,  Dr.  Tatham,  head  of  the  statistica 
department  at  Somerset  House,  said  that  the  number 
of  children  bom  out  of  wedlock  in  England  was  4*3 
per  cent  of  the  entire  births.  Forty  years  ago  the  per- 
centage was  7.  The  available  figures  must,  however, 
be  received  with  caution  because  women,  while  their 
child  lived,  were  usually  ready  to  swear  that  it 


^^^'  Tn  MsDioAL  PsaoB. 


MEDICAL  sociferr  Olf  LOlcbON. 


Mat  is.  I^. 


legitimatet  but  when  it  died  had  no  hesitation  in  con- 
f  easing  that  it  was  illegitimate. 


Wb  regret  to  learn  that  there  has  been  a  slight 
recrudescence  of  small-poz  at  Gloncester  daring  the 
last  few  days.  The  number  of  fresh  cases  had  been 
steadily  declining  day  by  day,  but  on  Friday  and 
Saturday  last  the  number  increased  somewhat,  giving 
rise  to  a  little  uneasiness  among  the  authorities. 

Thv  Treasury  have  appointed  Dr.  G.  H.  Savage,  the 
expert  in  mental  diseases,  to  examine  Mrs.  Dyer's 
mental  condition  on  behalf  of  the  Public  Prosecutor. 
Mrs.  Dyer  is  already  under  the  observation  of  Dr. 
Scott,  at  Holloway  Prison. 


A  MEDICAL  officer  of  health  is  to  be  appointed  by 
the  Shropshire  County  Council  at  a  remuneration  ci 
£500  per  annum. 

The  students  of  the  University  of  Wurzburg  have 
organised  a  torch-light  procession  in  honour  of  Prof. 
Bontgen. 

♦ 

[iBOlf  OVB  OWN  OOBBBBPOKDBirT.] 

The  Edinbubgh  and  St.  Andrews  Ukfvebsities  Elec- 
tion.— Owing  to  the  elevation  of  Sir  Charlee  Pearson  to 
the  Bench,  a  vacancy  is  created  in  the  repre«entation  of 
these  Universities.  The  Committee  of  the  (conservative 
Association  for  the  oonstittfenev  have  unanimonsly 
adopted  Sir  W.  flrieetley,  of  London,  as  their  candidate. 
This  resolution  will  give  great  pleasure  to  all  the  medical 
graduates,  probably  of  both  sides  in  politics,  although 
many  felt  tlubt  if  a  local  mduate  could  nave  been  induced 
to  stand  it  would  have  Been  more  appropriate.  Sir  W. 
PriesUey  is  an  Unionist  in  politics,  and  there  does  not 
seem  to  be  any  chance  of  opposition.  The  prospective 
new  member  is  an  Edinburgh  M.D.  and  a  Hon.  LL.D.  of 
the  same  University. 

Uniyeksitt  07  Glasgow. — Lacblan  McPherson,  the 
worthy  Bedellus  off  the  University,  on  the  6th  inst., 
entered  upon  his  eightieth  year,  and  was  the  object  of 
quite  an  ovation  and  many  oonffratulations.  His  father 
was  a  soldier  in  the  famous  42ad  Highlanders,  and  fought 
throughout  the  Peninsular  War  and  at  Waterloo,  obtain- 
ing miedals  (the  Peninsular  with  three  clasps  for  each  of 
these  campaigns).  When  three  days  old  our  subject 
(Lachlan)  started  atop  of  a  baggage  waggon  for  Port- 
Patrick,  en  route  for  Ireland,  to  which  place  the  regiment 
had  been  ordered.  His  boyhood  was  spent  with  his  erand- 
mother  in  Aberdeenshire,  his  parents  being  abroad  with 
the  42nd  reeiment.  After  a  period  of  service  as  footman 
and  butler  In  various  county  families,  he  obtained  in 
1863  his  present  poet  of  Bedellus  to  the  University,  which 
he  has  held  with  so  much  dignity  and  ielat  ever  since. 
Our  friend  has  lived  under  four  sovereigns,  served  under 
three  Principals,  and  officiated  at  the  " cappine"  of  more 
than  seven  thousand  graduates,  including  His  Royal 
Highness  the  Prince  of  Wales, -Lord  Beaoonsfield,  and 
Mr.  Oladstone.  No  University  function  is  complete  or 
considered  complete  unless  the  portly  Bedellus  is  in  pre- 
sence. All  through  the  long  years  of  his  connection  with 
the  University  he  has  endea^  himself  to  all  sections  of 
students,  which  must  be  set  down  to  his  8uavUer  in  modo, 
fortiter  in  re.  We  wish  the  venerable  old  man  many,  many 
happy  days  to  come. 

The  late  Dr.  John  Grieve  has  bequeathed  £8,000  to  the 
Universitv  of  Glasgow  for  the  endowment  of  a  lectureship 
or  fellowship  or  a  scholarship  to  which  orphans  or  the  sons 
of  widows  shall  have  the  preference. 

The   Dundee    Royal    Intiemabt.— Some 


dence  has  been  taking  place  with  regard  to  the  admission 
of  patients  to  this  hospital  in  the  lay  papers.  The  rules 
which  govern  the  admission  of  patients  seem  unfortunately 
to  depend  on  the  difficulty  of  getting;  Dnndonians  to  sub- 
scribe to  the  funds  of  the  hospital  unless  they  get  a  quid  ■ 
pro  qw}.  The  people  of  Dundee  are  canny  Scots  and  like 
to  get  a  return  for  their  money  in  the  ^hape  of  subscri- 
bers' lines.  Is  this  true  charity  ?  225  patients  are 
admitted  without  lines  each  year,  and  all  urgent  or  acci- 
dent cases.  We  think  that  the  manu^ers  would  do  well 
to  admit  all  cases  requiring  hospital  treatment  with  or 
without  lines,  giving  those  who  have  the  preference  if 
empty  beds  are  few.  There  are  many  who  subsoribe  a 
small  sum  to  a  hospital,  not  as  a  charity,  but  as  an  eco- 
nomy, whereby  they  can  eet  their  dependents  treated 
free  oif  charge,  and  with  no  bother  to  themselves. 

MuNmciBNT  Bequest*!  to  Glasgow  Chabities. — At 
the  Town  Council  meeting  on  the  7th  inst.  the  Lord 
Provost,  Sir  James  Bell,  intimated  that  he  had  just 
received  a  letter  from  the  London  and  Westminster  Bank 
wit»h  reference  to  the  division  of  the  estate  of  the  late  Mr. 
William  Andrew  Guepdon,  who  made  a  number  of  large 
bequests  to  Scottish  funds.  The  bequests  were  as  follows  : 
Hospital  Sunday  Fund  for  Royal,  Western,  and  Victoria 
Infirmaries,  ^05,000 ;  Hospital  for  Sick  Children,  £1,500  ; 
Institute  for  Orphan  and  Destitute  Girl«,  £2,000  ;  Sick 
Poor  and  Private  Nursing  Association,  £1.000  ;  Glasgow 
Industrial  Schools  at  Mossbank  and  Maryhill,  £500 ;  and 
a  further  sum  of  £5,000  as  a  bequest  to  Mr.  Quarner's 
Homes.  We  are  pleased  to  note  the  fact  "  The  Qnarrier's 
Homes  "  have  come  in  for  a  portion  of  the  good  things, 
for  we  have  no  hesitation  in  saying  that  of  all  charitable 
institutions  *'  Quarher's  Homes "  approach  more  closely 
the  type  in  our  minds  than  do  other  institutions  of  the 
same  class. 

Glasgow  MedicoChiruboical  Societt. — The  following 
is  a  list  of  the  offices  to  be  filled  at  annual  meeting. 
May  8th,  1896.  Of  course  it  is  superfluous  even  to  imagine 
that  any  one  of  the  following  names  will  be  depleted  by  the 
proposal  of  others  not  in  the  "  know  "  of  the  clique  which 
srovems  the  management  of  this  societv  : — Section  of 
Medicine :  Dr.  Alexander  Napier,  Vice-President  ;  Dr. 
Maitland  Ramsay,  Councillor ;  Dr.  Jus.  Hinseelwood, 
Secretary.  Section  of  Surgery:  Dr.  Newman,  Vice- 
President  ;  Dr.  J.  H.  Nicoll,  Councillor  ;  Drs.  Jno.  Barlow 
and  J.  H.  Nioolls,  Secretaries.  Section  of  Pathology  :  Dr. 
Henry  Rutherford,  Councillor ;  Dr.  R.  M.  Buchanan, 
Secrefarv.  Section  of  Obstetrics  :  Dr.  Edgar,  Councillor  ; 
Dr.  Oliphant,  Secretary ;  Mr.  Henry  K  Clark,  Treasurer ; 
Di.  C.  O.  Hawthorne,  General  Secretary. 

The  Sebum  Tkbatment  of  Diphtheria.— In  the 
statistics  of  theBelvidere  Hospital,  Glasgow,  for  1895,  we 
note  that  while  the  annual  mortality  in  cases  of  diphtheria 
during  the  previous  five  years  averaged  38  3,  in  1895,  with 
the  use  of  the  serum,  it  only  reached  14  0  per  cent. 

Dr.  Wright  has  been  recommended  bv  the  Glasgow 
Corporation  Committee  to  succeed  Dr.  Boyd  in  the  casualty 
surgeonehip  of  the  western  district  of  the  city. 


MEDICAL  SOCIETY  OF  LONDON. 
The  meeting  on  Monday  evening  last  (May  II th)  com- 
menced with  the  election  of  officers,  &o.,  after  which  Dr. 
Hamilton,  of  New  York,  read  a  paper  on  "  The  Connection 
of  Autotozis  with  Certain  Forms  of  Insanity,"  of  which 
the  following  are  the  conclusions: — (1)  Urines  rich  in 
indican  contain  very  little  or  no  preformed  sulphuric  acid 
and  are  toxic.  ^2)  When  the  sulphate  ratio  is  materially 
changed  it  probably  indicates  autotoxis  in  connection 
with  an  increase  in  tne  amount  of  combined  or  ethereal 
sulphates.  (3)  Such  indications  are  generally  found  with 
acute  insanities  in  which  rapidly  developing  symptoms 
occur.  (4)  Fngaeeons  and  cnanging  illusions  and  hallu- 
cinations, unsystematised  delusions,  confusion,  and  verbi- 
geration in  connection  with  insomnia,  pallor,  intestinal 
indigestion,  constipation  and  rapid  exhaustion,  are  due  to 
autotoxis.  (5)  Paranoic  states,  or  those  in  which  concepts 
are  the  main  feature,  chronic  stuporous  conditions,  and 
certain  forms  of  dementia,  have  little  to  do  with  the 
formation  of  intestinal  products  of  putrefaction.  (6) 
Various  post-febrile,  traumatic,  alcoholic,  or  drug  insani- 
ties are  those  in  which  aatotoxis  is  most  constant.    (7) 


MAt  18»  18M. 


COKRHSPOlfDENCE. 


Thb  Mbdioal  Phbbs. 


Md 


The  varlfttknia  in  the  excretion  of  oombined  aalphatea 
keep  pace  in  the  cbftngei  in  the  progrefls  of  an  ettabltsbed 
ineanitY,  ace^n  and  epileptiform  attacks  beins  directly 
eonnectod  with  pntrelaotiTe  procenee.  (8)  The  moet 
enecemful  treatment  consists  in  lavage,  intestinal  doaches, 
{^tric  and  intestinal  antisepsis  by  means  of  hydrochloric 
acid,  borax,  salicylate  of  soda,  charcoal,  gnaiacol,  or 
naphthaUn,  in  small  and  repeated  doses,  along  with  the 
administration  of  a  combination  of  the  red  marrow  from 
the  small  bones,  blood  and  glycerine. 

Sir  J.  Crichton  Browne  ealog^^ed  the  author's  work  in 
this  department  of  medicine  and  said  his  own  attention 
had  often  been  directed  to  the  interdependence  of  certoin 
forma  of  mental  derangement  with  defective  intestinal 
digestion  or  a  diseased  fiver  which  was  no  longer  able  to 
prevent  ptomaines  formed  in  the  intestines  from  entering 
the  circnlation. 

Dr.  Haig  claimed  that  the  phenomena  described  by  the 
author  were  mainly,  if  not  exclusively,  attributable  to  the 
presence  of  an  excess  of  uric  acid  in  the  blood,  and  he 
reproached  him  with  attributing  to  the  action  of  intestinal 
antiseptics,  effects  which  were  really  to  be  credited  to  the 
influence  of  the  treatment  in  faciliteting  the  elimination, 
or  hindering  the  production,  of  uric  add. 

Dr.  Hare,  Dr.  Theodore  Williams,  and  Dr.  Forbes 
Win^low  continued  the  discussion  and  Dr.  Hamilton 
briefly  replied. 


(Wsdo  nol  hold  onnelfet  respoiuible  for  the  opinions  of  om 

SIR  JOHN  WILLIAMS  AND  THE  QUESTION   OF 
PRIVILEGE. 

To  the  Editor  (/Thb  Msdioal  Press  aud  Oiscttlar. 

Sis,— In  an  article  on  '*The  Royal  College  of 
Physicians,  London,  and  the  Question  of  Privilege," 
which  appealed  in  your  issue  of  last  week,  you  state, 
'*  It  will  be  remembered  that  at  the  Kitsoo  v.  Play  fair 
triad  Sir  John  Williams  stated  that  the  Royal  College  of 
Physicians,  London,  had  published  their  opinion  on  the 
qnestion  of  privilege  in  regard  to  the  divulging  of  pro- 
Mssional  confidences." 

Your  statement  is  incorrect,  as  the  following  letter 
which  appeared  in  the  Time^  of  March  28th  will  show — 

"  To  the  Editor  of  the  Times, 

"  Sir, — Will  you  permit  me  to  correct  an  error  in  your 
report  of  my  evidence  in  the  above  ease  to  which  my 
attention  has  been  called  ? 

*•  Your  r^rt : — 

"  Mr*  Justice  Hawkins  :  Suppose  a  medical  man  were 
called  in  to  attend  a  woman,  ana  in  the  course  of  his  pro- 
f  eesional  attendance  he  discovered  that  the  lady  attempted 
tojprocure  abortion.  That  being  a  crime  under  law,  would 
it  be  his  duty  to  go  and  tell  the  Public  Prosecutor  ? 

"  Witness  :  The  answer  of  .the  College  of  Physicians  to 
that  very  question  was  '  yes/  " 

My  answer  wae :  *'  The  last  legal  opinion  upon  that 
question  obtained  by  the  College  «  Physicians  is  '  yes.' " 

The  snbject  has  not  been  considered  by  the  College  of 
PhysioiaoSy  and  the  College  haa  given  no  opinion  upon 
it. 

I  am  yours,  &c.. 

John  Williams. 

63  Brook  Street^  London. 
AprU  10th,  1896. 

LADY  DOCTORS  AND  PROFESSIONAL  ETIQUETTE. 

To  the  Editor  of  Tn  Medical  Pans  akd  CnionLAB. 

Sis, — My  attention  has  been  drawn  to  a  leading  article 
nnder  the  above  heading  in  your  issue  of  Kav  6th,  in  which 
you  say  that  "  the  problem  of  the  moment  is  how  medical 
women  are  going  to  behave  themselves."  After  this  some- 
what alarmine  exordium,  I  was  glad  to  find  that  the 
diarges  brought  against  medical  women  scarcely  matched 
in  gravity  the  argument  based  upon  them.  In  a  letter 
signed  "Central,  London,"  in  the  Msdioal  Pbbss  and 
CiBCULAB  of  April  Ist,  we  are  told  that  a  patient  of  the 
writer's  had  had  in  a  few  months  two  or  three  calls  from 
<'soi-disant"  medical  women,  offering  their  professional 
eenrioee.    Such  a  statement  requlree  oarefol  investigation 


before  it  ean  be  accepted.  The  *'  soi-diaant "  is  probably 
a  well-applied  limitation,  and  I  should  be  much  surprised 
to  learn  tnat  the  officious  ladies  were  medical  in  any  one's 
judgment  but  their  own.  Possibly  they  were  district 
visitors  with  a  turn  for  quackery.  If  sncb  a  charge  is  to 
be  seriously  considered,  *'  Central,  London,"  must  give  his 
authority,  and  the  '*  soi-disant "  medical  women  must  be 
identified.  In  the  second  case  mentioned  by  "Central, 
London,"  an  ophthalmic  patient  was  advised  to  go  to  an 
eye  hospitel  in  Oxford  Street.  Possibly  the  adviser  was 
a  medical  student  with  morezoal  than  discretion  ;  but  even 
if  she  was  a  medical  woman,  she  was  not  touting  for  herself. 
There  is  no  eye  hospital  or  dispensary  in  Onord  Street 
officered  by  medical  women.  In  your  article  it  is  said 
"  that  other  instences  of  gross  neglect  of  the  ordinary 
rules  that  guide  professional  life  are  not  wanting  on  the 
part  of  femiale  practitioners,  and  that  in  at  least  one  case  the 
name  of  the  offender  has  been  erased  from  tbe  Register."  I 
am  w^  acquainted  with  the  case  to  which  reference  is  here 
made.  The  practitioner,  who,  as  the  daughter  of  a  doctor,- 
ought  certamly  to  have  known  better,  was  tempted  to 
follow  some  baa  Colonial  precedento,  and  while  practising 
in  New  South  Wales,  she  puffed  herself  in  an  unpardonable 
manner.  The  Association  of  Registered  Medical  Women, 
of  which  she  had  been  a  member  for  some  je%r«,  procurea 
evidence  of  her  offence,  erased  her  name  from  nheir  list  of 
members,  and  placed  the  matter  before  the  General 
Medical  Council,  with  the  result  you  have  named.  It  is 
difficult  to  see  what  more  the  Association  of  Registered 
Medical  Women  could  have  done  in  defence  of  sound  pro- 
fessional conduct. 

Your  correspondent  seems  to  forget  that  qualified 
medical  women  are  subject  to  the  disciplinary  powers  of 
the  General  Medical  Council  in  precisely  the  same  way  as 
qualified  medical  men,  and  there  need,  therefore,  be  no 
more  anxiety  as  to  the  punishment  of  improper  profes-' 
sional  conduct  in  the  one  ca^e  than  in  the  other.  The 
difficulty  of  dealing  with  unqualified  practice,  is,  in  the 
present  ptite  of  the  law,  equally  great,  whether  the  offend- 
ing quack  be  man  or  woman. 

The  above  is,  so  far  as  I  know,  the  only  case  in  which  a 
medical  woman  has  been  found  guilty  of  unprofessional 
conduct. 

Of  the  people  who  give  themselves  out  as  doctors,  and 
are  not  such,  and  who  trade  upon  the  liking  of  the  publio- 
for  impostors,  it  does  not  concern  me  to  speak. 

Considering  that  there  have  been  medieval  women  In 
England  for  more  than  thirty  years,  and  that  they  are 
now  too  numerous  to  be  counted,  even  by  their  friends, 
and  that  they  hail  from  manv  schools  and  many  examin- 
ing bodies,  we  may,  I  think,  congratulate  ourselves  on 
only  knowing  of  one  of  our  number  of  whose  professional 
conduct  we  have  had  reason  to  be  ashamed.  Want  of  con- 
sideration for  the  feelings  and  interests  of  others,  and 
greed  for  selfish  advantage,  are  faulte  which  are  not 
hkely  to  be  confined  to  one  sex ;  medical  women 
will,  no  doubt,  from  time  to  time,  show  these 
unlovely  qualities,  and  will,  I  hope,  as  individuals, 
be  promptly  and  appropriately  punished. 

But  to  indict  a  large  body  of  highly  respecUble  prac- 
titioners in  consequence  of  one  woman  having  misbehaved, 
and  of  their  having  brought  her  to  justice,  does  not  appear 
to  me  equiteble.  In  any  ease,  the  leading  wonien  in  the 
medical  profession  are  not  forgetful  of  the  duty  incumbent 
on  them  to  maintain  within  their  body  the  laws  of  pro* 
fessional  courtesy,  justice,  and  right  feeling  for  interests 
other  than  their  own,  which  have  been  accepted  by  men, 
and  are  shortly  known  nnder  the  name  of  "  medical  eti- 
quette." 

Tnis  was  one  of  the  main  objecto  of  those  who  founded 
the  Association  of  Regbterect  Medical  Women  many 
years  before  any  medical  association  saw  fit  to  admit 
women  as  members,  for  it  was  felt  that  professional  isola- 
tion was  not  calculated  to  foster  those  high  ideals  of  con- 
duct which  belong  to  the  worthiest  traditions  of  medics! 
practice.  They  will  best  be  aided  in  their  endeavours  by 
everything  which  encourages  medical  women  to  recogniee 
that  they  are  no  longer  a  class  apart,  and  out  of  toueh 
with  the  ffeneral  interesto  of  the  profession  to  which  they 
belong.  The  fact  that  they  are  now  admitted  as  membere 
of  the  British  Medioal  Association  will  have  an  important 
influebce  in  this  direction,  and  when  in  due  oourse  of  time 
th^  are  alao  admitted  to  the  great -medioal  seoietieB  we 


5lS    Ths  Mvdioal  PwMbs. 


CORRESPONDENCE. 


IIat  li  1880. 


may  exp«ot  the  tenie  of  profewioDal  tolidarity  to  becomo 
more  active  than  oiicnmstaQoee  have  hitherto  permitted  it 
tobei 

I  am  Sir,  yours,  &o., 

Elizabrh  Oakritt  ANDiBsoy,  M.D^ 
(President    of  the   Association  of  Registered   Medical 
Women,  4  Upitor  Berkeley  Street) 

May  9th,  1896. 

•        — 
TQE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 
T7'ihe  Editor  of  Thm    Medical  Pbsss  and  Ciroulab. 

Sir,— Having  taken  a  considerable  part  in  this  discus- 
sion, will  you  Slow  me  to  say  that  I  entirely  agree  with 
*'  Anti-Quack  the  2nd  "  in  the  view  that  he  Ukes  of  the 
perfect  right  of  every  member  of  the  profession  to  avail 
himself  of  the  flotsam  and  ietsam  of  society  which  goes  to 
form  clinical  material,  and  which  is  thus  utiliMd  by 
members  of  the  profession  in  the  interests  of  science  and 
for  the  advancement  of  their  own  ends.  StiU,  where  is  the 
'.'  charity "  of  founding  a  special  or  a  general  hospital 
apart  from  th«t  to  the  founder  or  founders  ?  It  is  the 
pretence  of  veiling  under  the  cloak  of  charity  what  is  a 
nisre  matter  of  business  that  is  to  me  so  detestable  and 
reprehensible.  On  the  other  hand,  if  the  founding  of  a 
special  or  a  general  hospital  be  benevolence,  then  why 
should  there  m  any  monopoly  in  public  benevolence  ?  That 
In  the  metropolis,  in  Glasgow,  and  other  large  cities 
"hosi>itals  are  in  the  hands  of  close  corporations"  is 
undeniable,  and  that  if  \  man,  no  matter  what  his  character 
and  abilitv,  is  not  within  the  charmed  circle,  he  is  cer- 
tainly prafeseionally  compelled  to  "  throw  up  the  sponge," 
or  fight  the  world  and  the  profession  with  Uie  weapons 
used  against  him.  For  example,  here  in  Glasgow  all  the 
hospitS  appointments  worth  having  are  in  the  hands  of  a 
clique  of  eighteen  or  twenty  men,  and  at  the  Weetem 
Infirmary  the  full  physicians  and  suigeons  hold  oflSce  for 
lifOi  It  would  be  absurd  to  maintain  that  this  is  either 
for  the  public  good,  or  fair  to  the  profession, 
yet  there  is  no  prospect  of  change.  Further 
appointments  are  multiphed  to  the  extent  of  three 
or  four  in  the  hands  of  almost  every  member  of  this  clkiue. 
Again,  strange  to  say  when  a  Glasgow  graduate  applies 
for  a  hospttalappointment  in  Glasgow  there  seems  a  pre- 
judice against  him  as  compared  with  the  Edinburgh 
graduate.  The  scandalous  condition  of  hospital  appoint- 
ments in  Glasgow  oflers  the  meet  ample  justification  lor 
competing  institutions  on  the  part  of  the  men  unfairly 
brnsned  aside.  Will  you  allow  me  to  say  that  my  views 
on  this  and  kindred  questions  will  be  found  at  length  in 
the  8calpd  for  April,  May,  and  succeeding  numbers  ! 
lam.  Sir,  yours,  &c., 

D.  Campbili  Black. 

Glasgow,  May  7th,  1898. 

To  the  JBdtior  of  Thi  Mrdioal  Prbbs  and  Ciboular. 

SiR,~The  argument  in  support  of  the  preeent  situation 
is  not  to  be  strengthened  by  personalities  or  by  imputa- 
tion of  motives  to  individnsl  writers  about  whom  not 
enough  can  be  known  on  which  to  form  an  opinion.  There 
are  reasons  sufficient  why  one  should  prefer  to  remain 
anooymons  in  this  disoossion,  but  as  vou.  Sir,  are  well 
aware,  if  my  name  were  revealed,  it  would  be  evident  I  am 
oneof  those  who  personallvcan  neither  be  injured  nor  bene- 
fited by  speeiaURn,  or  by  the  existing  special  hospital 
system.  <*Anti  Quack  the  2nd"  asks  for  a  more  exact 
definition  of  "  sham  "  special  hospital.  Sham  special  hos- 
pital is  synonymous  with  unnecessary  special  hosmtal,and 
this  term  applies  to  most  of  these  institutions.  They  are 
not  needed  in  the  service  of  the  suffering  poor ;  they 
are  not  needed  for  clinical  observation  or  scientific  research, 
and  most  of  them  are  maintained  for  the  purpoee  for  which 
they  were  founded,  namely,  as  cloaks  under  which,  at  the 
expense  of  the  public,  medical  adventurers  may  advertise 
themselves  as  distingnished  spedaliste.  Such  a  system 
oould  only  be  justified  if  the  practice  of  medicine  were  a 
trade  in  which  like  soap,  mustard,  or  cocoa  mongering, 
no  stigma  need  attach  to  the  puffing  of  common  wares 
as  '*  ^  best."  The  great  bulk  of  medical  men  are 
almost  eaual  in  professional  worth.  The  profession  is 
too  crowoed  for  toe  mass  to  make  an  income  beyond  a 
bare  livelihood.  Fortune,  as  it  often  is,  ought  to  be 
always  reserved  for  the  men  who  by  tnperioril^  of  talent 


or  acquirements,  or  the  value  of  their  edentifio  achieve- 
ments really  deserve  success.  There  exists  no  obetade  (as 
**  Anti-Quack  the  2nd  "  suggests)  to  the  rise  of  men  of  this 
stamp  "  from  the  ranks  to  the  higher  phwes."  What  should 
be  prevented  is  the  capture  of  the  prises  of  worldly  success 
hj  men  utterly  undeserving  ;  and  this  I  maintain  is  one 
of  the  results  of  the  present  state  of  things,  under  which 
any  one  ma^r  start  and  carry  on  an  unnecessary  or  sham 
special  hospitaL 

I  am.  Sir,  yours  fta, 

AVTI-QUAOK. 

May  8th,  1896. 

» 

PRESCRIBING  PHARMACEUTICAL  CHEMISTS. 
To  the  Editor  of  Thb  Mxdioal  Prrss  and  Ciroui.ab. 
Sir, — I  am  very  sorry  that  my  X  ray  on  the  preecribing  of 
pharmaceutical  chemists  has  offended  that  great  and  good 
authority  "Fair  Play."  What  a  wonderful  man  he  is  I  He 
grives  us  a  history  of  the  Irish  Pharmaceutical  Society,  and 
then  speaks  of  his  own  excellences.  Day  after  day  he  sits 
correcting  ph^rsicians'  and  surgeons'  prescriptions,  and 
what  astounding  errors  he  has  detected,  although  his 
patrons  are  of  the  most  aristocratic  group. 

I  must  say  he  draws  the  correct  mors!  from  my  letter. 
Had  I  or  any  other  ordinary  practitioner  been  called  in  the 
patients  would  have  recovered,  and  I  think  on  each  tomb- 
stone of  theirs  it  might  truthfully  be  said  **  killed  by  a 
pharmaceutical  chemist." 

I  am,  Sir,  yours,  &c, 
X. 
» 

GENERAL  MEDICAL  COUNCIL  AND   THE  REGIS- 
TRATION FEE  FOR  PUBLIC  HEALTH  QUAU- 
FICATIONS. 
To  the  Editor  qf  the  Mbdigal  Prbbs  avd  Ciroulax. 
Sir,— May  I  call  vonr  attention  to  the  markedly  unfair 
regulations  of  the  General  Medical  Council  regarding  fees 
for  registering  Diplomas  in  Public  Health.    In  general 
medicine,  having  once  been  registered  as  a  medicid  prac- 
titioner, each  suoseqnent  additional  qualification  is  regis- 
tered for  a  fee  of  5s.    In  Public  Health  a  fee  of  £2  is 
levied  on  the  initial  diploma,  and  a  like  sum  on  every  sub- 
sequent diploma,  such  as  the  M.D.  State  Medicine.  Surely 
such  an  arrangement  is  unnecessarv  and  vexations,  uid 
can  serve  no  other  purpose  than  that  of  adding  to  the 
funds  of  the  Council.    I  wrote  to  Dr.  Wilks  as  represent- 
ing London  University  on  the  Council  and  reoeivea  areply 
from  the  Registrar,  which  I  enclose  for  your  information. 
I  am.  Sir,  yours,  truly, 

J.  0.  Stmons. 
We  have  referred  to  this  subject  in  another  oolnmh.  Ed.] 


OUR  DIRECT  REPRESENTATIVES  AND  THE  SO- 
CALLED  MIDWIVES'  BILL. 

To  the  Editor  ofTBM  Mrdioal  Prrbs  and  Circular. 

Sir,— As  the  next  election  of  Direct  Representatives  to 
theMedical  Council  takes  place  not  later  than  January,  1897, 
and  more  especially  as  it  is  absolutely  necessary  that  each 
candidate  should  before  this  date,  speak  out  in  no  tone  of 
hesitancy  or  duplicity,  I  write  to  suggest  tlmt  this  quee- 
tion  of  a  proposed  formation  of  an  inferior  order  of  mid- 
wifery practitioners  should  be  made  a  test  Question  in  the 
coming  election.  To  oppose  these  Midwiver  Bills,  a  great 
amount  of  valuable  time— almost  six  years— has  been 
wasted.  No  doubt  the  Bills  would  not  have  lived  so  long 
had  all  our  five  Direct  Representatives  oppoeed  the  Bills. 
While  Mr.  Whedhouse,  Sir  W.  Foster,  and  Mr.  W. 
Thomson  have  opposed  these  Bills,  I  regret  to  say  that 
Dr.  G.  G.  Glover,  one  of  the  representatives  of  the  pro- 
fession in  England  on  the  Council,  and  Dr.  Bond,  the  re- 
presentative of  the  profession  in  Scotland,  have  favoured 
this  proposal  to  establish  an  inferior  order  of  obstetric 
practitioners.  In  order,  therefore,  that  the  real  feeling 
of  the  profession  may  be  tested  upon  thie,  and  other 
momentous  questions,  I  write  to  suggest  that  the  election 
of  Drs.  Bruce  and  Glover  be  opposed.  To  oppose  the 
former  I  can  make  no  better  suggestion  than  that  the  pro- 
fession in  Scotland  should  invite  Dr.  J.  Campbell  BUdE 
to  stand  as  their  osndidate.    He  has  shown  himself  to  be 


Mat  l^  18M. 


PASS  LISTS. 


well  acquainted  with  the  real  aimB  and  wants  of  the  great 
bodjT  of  onr  profeeaion,  and  to  have  the  courage  (»  hia 
opiniona,  and  I  feel  sure,  that  if  he  be  elected,  he  will  not 
f  omt  that  his  first  duties  on  the  Medical  Council  are  due 
to  his  constituents. 

I  am  always  sorry  when  I  see  an  election  of  Direct 
Representatives  pass  by  uncontested.  It  displays  a 
lamentable  want  of  public  spirit  on  the  part  of  medical 
practitioners. 

I  am  Sir,  yours,  &c.. 
A  SuppoBTBB  OF  Db.  J.  Gampbbll  Bulok. 


Thi  MipioAL  Pbibs.     517 


(Dbttttats. 

JOSEF  SPATH,  OF  VIENNA. 
Anothib  pillar  of  the  Vienna  School  has  passed  away 
in  the  person  of  Dr.  Josef  Sp&th,  late  Professor  of  Gynn- 
ooloey.  He  was  bom  in  Bozen,  73  years  ago,  in  very 
humble  circumstances  and  with  very  gloomy  prospects  of 
life,  as  he  suffered  from  a  pulmonary  affection,  his  mother 
having  died  shortly  after  bis  birth  from  a  lung  disease. 
He  was  educated  for  the  church,  but  in  1844  came  to 
Vienna  as  a  tutor  and  commenced  the  study  of  medicine. 
In  1849  he  qualified  ;  in  1854  he  waa  appointed  assistant 
obstetrician  under  Prof.  Barisch ;  in  the  following  year 
he  entered  on  private  practice  as  an  assistant,  but  un- 
happily was  soon  invalided  through  syphilitic  poisoning 
after  an  instrumental  delivery.  At  this  time  his  guardian, 
Prof.  Ghiari,  died,  to  whose  o£5ce  in  the  Joeef- Academy, 
as  Professor  in  obstetrics  he  succeeded.  In  1876  a  second 
chair  of  gynncology  was  established,  to  which  Sp&th  was 
appoint^,  and  which  he  retained  till  he  retired  in  1886. 
His  literary  works  are  numerous  and  his  social  honours 
many,  as  he  was  highly  esteemed  by  all  with  whom  he 
came  in  contact. 


DEPUTY  SURGEON-GENERAL  G.  SCOTT  DAVIE. 
This  gentleman  died  last  week  at  Upper  Norwood,  in 
his  siztv-first  year.  Bom  in  June,  1836,  he  took  the  de- 
grees of  M.D.  and  L  R  C  S.  at  Edinburgh,  and  during  the 
war  with  Russia  served  as  Acting  Assistant  Surgeon  with 
the  Artillery  of  the  Turkish  Contingent  from  May,  1855, 
to  June  of  the  following  year,  in  Turkey  and  at  iKertch, 
for  which  he  had  the  Turkish  medaL  Appointed  an  Assis- 
tant Surgeon  in  the  Army  in  November,  1858,  he  was 
advanced  to  the  rank  of  Surgeon  in  March,  and  to  that  of 
Surgeon- Major  in  September,  1873.  Two  years  later  he 
was  actively  engaged  throughout  the  operations  in  Perak, 
in  the  Malay  States,  as  Senior  Medical  Officer,  for  which 
he  received  the  medal  with  clai^p;  and  in  1878-9  served 
with  the  Peshawur  Valley  Field  Force  in  the  Afchw  War, 
for  which  he  was  mentioned  in  despatches,  and  received 
his  third  medal.  In  1882  he  served  in  the  Egyptian  War, 
and  was  present  at  the  battle  of  Tel-el-Kebir,  again  ob- 
taining mention  in  despatches  and  receiving  the  medal 
with  clasp,  the  third  clasp  of  the  Medjidie,  and  the 
Khedive's  star.  In  January,  1885,  he  was  advanced  to  the 
rank  of  Brigade-Surgeon,  and  in  May,  1886,  to  that  of 
Deputy  Surgeon-General,  when  he  was  placed  on  the 
retirea  list. 


<^9[dktotl  JtclD& 


NEW  CLINICAL  CHARTS. 
Ik  our  issue  of  Aoril  22nd  we  called  attenMon  to  a  new 
chart  designed  by  Dr.  Woods,  of  the  Richmond  Hospital, 
Dublin,  the  object  ef  which  was  to  provide  for  records  of 
temperature,  pulse,  and  respiration  every  four  hours 
instead  of  twice  daily,  in  certain  cases  in  which  the  fluc- 
tuations are  rapid  and  frequent.  Mr.  Lewis,  publisher, 
of  Gower  Street,  London,  has  called  our  attention  to  the 
fact  that  a  somewhat  similar  chart  was  published  by  him 
two  years  ago,  which,  he  says,  has  met  with  a  ready  sale. 
Mr.  Lewis's  chart  appears  to  have  anticipated  that  of  Dr. 
Woods'  as  far  as  temperature  record  is  concerned,  but  it 
does  not  provide  for  four  hour  registry  of  pulse  and 
respiration  as  Dr.  Woods*  does,  and  is,  therefore,  not  so 
perfect.  Mr.  Lewi8,|however,  deserves  the  credit  of  having 
first  recognised  the  advantage  of  a  more  frequent  record 
than  that  presented  by  the  ordinary  Clinical  Chart. 


West  London  Medlco-CblniTglcal  Sooietgr. 
Ths  annual  dinner  of  this  popular  society  will  be  held 
at  the  Caf^  Monico,  Piccadilly,  on  Wednesday  next,  May 
20th,  at  7.30  p.m.  The  President,  Dr.  Symons  Eodes, 
will  take  the  chair,  and  a  distinguished  number  of  guests 
are  expected,  including  the  Cavendish  Lecturer  (Mr. 
Bryant),  and  the  Presidents  of  the  Royal  Medico-Chirur- 
gieal  and  other  societies. 

The  Health  of  Irsland. 

In  his  official  return  for  the  past  quarter,  the  Reeistrar- 

General  for  Ireland  says  that  a  review  of  the  Registrars' 

returns  shows  that,  measured  by  the  statistics  of  mortality, 

the  state  of  the  i>ublic  health  in  Ireland  during  that 

Eeriod  was  veiy  satisfactory.  The  death-rate  represented 
y  the  deaths  from  all  causes  is  the  lowest  for  any  March 
quarter  since  the  establishment  of  registration  in  the  year 
1864,  except  the  rate  for  the  first  quarter  of  1868,  which  it 
very  dightly  exceeds,  and  shows  a  decline  equivalent  to 
17  per  cent.,  as  compared  with  the  average  rate  for 
the  first  quarter  of  the  last  ten  years.  Scarlatina  and 
whooping-cough  proved  very  fatal  in  a  few  localities,  but 
there  was  no  extended  prevalence  of  the  severe  t^rpe  of 
any  zymotic  disease,  and  the  deaths  from  the  prmdpal 
diseases  of  that  class,  taken  collectively,  were  much  below 
the  average  for  the  first  quarter  of  the  year. 

Free  Course  of  Lectures  at  the  Victoria  Hospital  for 
Sick  Children. 

The  Medical  and  Surgical  Staff  of  the  Victoria  Hospital 
for  Children,  Chelsea,  propose  to  give  a  course  of  lectures 
during  the  summer  session  upon  the  diseases  of  children. 
The  lectures  will  bedeliveredin  the  Board  Room  of  the  Hos- 
pital every  Thursday  afternoon,  at  four  o'clock,  and  eadi 
will  be  foUowed  by  a  demonstration  of  cases  in  the  wards. 
Practitioners  ana  students  of  medicine  are  invited  to 
attend.  The  Hospital  is  easily  accessible  from  all  parte 
of  the  metropolis  by  steamboat  and  omnibus.  The  follow- 
ing is  the  syllabus  with  dates  and  names  of  Lecturers  :— 

May  14,  *'  Meningitis  in  its  Surgical  Aspects,"  by  Mr. 
ITArcy  Power,  F.RC.S.  May  21,  "The  Invasion  of 
Tubercle,"  by  Dr.  Dawtrey  Drewitt.  M*y  28,  "On 
Operative  Interference  in  Morbus  Coxsb,"  by  Mr.  T. 
Pickering  Pick,  F.R.C.S.  June  4,  •*  Selected  Medical 
Cases,"  by  Dr.  Montague  Murray.  June  11.  **  The  Trsat- 
ment  of  Hernia,"  by  Mr.  Raymond  Johnson,  F.R.CS. 
June  18,  "  PneumoniaM  in  Children  and  their  Sequels," 
by  Dr.  Walter  Carr.  June  25,  "  Adenoid  Vegetations  in 
the  Naso-Pha^nx  and  their  Treatment,"  by  Mr.  H.  F. 
Waterhouse,  F.R.CS.  July  2,  •'Infantile  Scurvy,"  by 
Dr.  Wallis  Ord.  July  9.  "Some  Forms  of  Keratitis  in 
Childhood,"  by  Mr.  W.  T.  Holmes  Spioer,  F.R.CS.  July 
16,  "  Hepatic  Disease  in  Children,"  by  Dr.  Rolleeton. 


PASS    LISTS. 


Royal  College  of  Physicians  and  Surgeons  of  Edin- 
burgh and  Faculty  of  Physicians  and  Surgeons  of 
Gls«gow. 
At  the  April  sittings  of  the  examiners  held  in  Glas^w 
the  following  oandi£tes  passed  the  respective  examma- 
tion9,  those  marked  with  an  asterisk  (*)  paasing  "with 
distinction  " : — 

First  Examination— Five  Years'  Course. 
*John  Campbell  Douglas,  Greenock ;  John  B.  Oonner,  Oreenook ; 
WUlkm  A.  Oglvv,  Cambnalang ;  Charlee  M'Donell,  Lfanerlek ; 
irdward  Michael  M'Swlney,  Limerlek;  John  Thooma  Bradley, 
Clare ;  Percy  J.  Batemao,  Cork ;  Oer«ld  8.  Oogfalan,  Loogton ; 
John  G^rge  Grant,  London  ;  *Danlel  Michael  Donovan,  Cdn. 

First  Examination — Four  Years'  Course* 
Vrederiek  George    Henderson.   Dinapore,  India;   Louis    R.    St. 
Bomalne,  Oalontta ;  Alexander  B.  Crabbe,  Aberdeen ;  John  B. 
&.  Dodds,  Dariington ;  Charles  K.  Darnell,  Bngby. 

Second  Examination— Five  Years'  Course. 
*Henry  Btewart  Anderson,  Danmury ;  Alexander  Maogregor.  Glas- 

Kw ;  William  Hntton,  Greenock ;  *Biohard  Staward,  Nortnfield ; 
mes  M.  Inveraiity,  Dundee ;  James  Danlop,  Glasgow ;  William 
Carey.  Gbbuow;  Thomas  D.  Bird,  Woodlotd:  Harry  O.  Ogltvle, 
Jamaica ;  William  J.  Aiken,  I>rone ;  James  T.  O'Connor,  Cork : 
Bdward  H.  Harrison,  Glasgow  i  John  Dick,  areenock ;  W.  Judd, 
Lowestoft. 


518    Ths  Mxdioal  Pbbss 


NOTICES  TO  OORRESPONDENTS. 


Mat  13»  199S. 


(Eorrcsponbcntfi,  §liort  JcttttB,  See. 

1^  GouMBFOVDiirTS  raqoliliig  »  reply  In  fhlf  oolunii  fve  par- 
ftoaUily  requested  to  nuke  nee  of  •  fiiiUnetiw  iiqntshin  or  inMob, 
and  »Told  the  pnotloe  of  ilgntng  thefttNlTee  "  Seeder,"  "  Sabeorlber," 
"  Old  Snbeerlber, '  Ae.  Mnob  oonfniioo  will  be  ipwed  hj  attention 
tothbrale. 

NOT  CAUGHT ! 

Thi  Cardiff  dootort  have  been  making  efforti,  ears  T?ie  Western  Mail, 
to  put  an  end  to  the  operations  of  the  local  qaackfl.  Bec«ntly  tber 
detuatched  a  tpy  to  the  abode  of  an  noqoaiifled  practltlotierwith 
inttmotions  to  secure  a  written  p.  escriptlon- Important  evidence  for 
the  iLtended  proMcntion.  The  Stijr  called  and  decailed  his  i  ymptoms. 
"You  are  very  ill/'  said  the  quack  after  sounding  him,  'but  take 
heart ;  your  case  is  not  beyond  the  reach  of  medical  skill ;  aud  if  you  will 
place  yourself  in  my  hands  I  will  cure  you."  The  spy  was  profuse  In 
nis  thanks  and  asked  for  a  written  prescription.  The  quaok  immedi* 
ately  "  smelt  a  rat,"  but  he  unhesitatingly  consented,  addin/,  how- 
ever, "  My  terms  tor  a  written  prescription  are  two  guineas."  1  he  spy. 
though  somewhat  reluctantly,  then  paid  the  two  guineas,  and  secured 
the  presciptlon  wbich,  when  the  envelope  was  sabteqoently  opened, 
ran  thus  :— 

"  I  hereby  certify  that  the  bearer  is  a  well-dressed  man,  and  appears 
flush  of  money.' 

Mb.  B.  H  Wooi>9.~Yonr  drawings  are  In  the  hands  of  engi«ver, 
who  has  instructions  to  send  you  early  proofs. 

PHOTOGRAPBY  IN  EX0BLSI8. 
Thi  acme  of  perfection  in  photography,  so  far  as  speed  Is  ooncemed, 
seems  to  bave  been  at  last  attained.  At  the  reoent  convenasntne  ox 
the  Boyal  Society,  Piofessors  WortUngton  and  Cole  exhibited  photo- 
graphs of  the  splash  of  a  drop  when  falilog  on  water.  To  Illustrate 
this  abouc  100  exposures  were  required,  and  each  picture  was  taken 
by  nn  exposore  of  lets  than  three  Midi/LnthM  of  a  second. 

Db.  Saxukl  Kbithbdt.— Your  letter  adduces  nothing  that  is  not 
already  known  in  connection  with  the  Mattel  controversy,  and  we 
must  decline  to  pobllsh  it. 

SCENE  IN  THE  8UBGE&T. 
DRBSsn  (loq.) :  Well,  my  good  woman,  what  can  I  do  for  you  t 
Bibulous  Old  Pabtt  :  Just  run  and  fetch  ns  a  doctor,  there's  a  good 
boy.    Cartoon,  ^t.  BarthoUm'Vf's  Hasp,  JcurwA. 

Dr.  Sansox's  paper  un  "  Influenzal  Arthritis  "  is  marked  for  early 
Insertiou. 

SuBOioir  LiRXTT.-CoLOirxL  LAUBn.~Your  paper  on  "  The  Cause 
and  Treatment  of  MaUrla  "  shall  appear  when  the  necessary  lllnstra- 
tions  are  completed. 

Dr.  a.  O.  p.— We  do  not  agree  with  the  views  propounded,  and 
cannot,  therefore,  accept  them  as  an  editorial  expression  of  opinion. 
We  shall,  however,  be  nappy  to  publish  a  letter  containing  your  views 
on  the  subject 

TflS  ANTI.VACCINATIONISTS  NOT  BEATEN. 
Thb  antt-vaccinatlonists  have  not  been  routed  by  the  epidemic  that 
has  caused  such  havoc  in  Gloucester,  and  the  last  number  of  the 
journal  devoted  to  their  views  contains  the  following  remarkable 
challenge  i—"  There  is  nothing  that  educates  the  laity  so  fast  and  so 
pleasantly  as  public  debate  of  a  question.  So  let  the  Jenner  Society 
select  a  chaoDpton,  and  we  on  our  side  will  do  the  same,  and  let  us 
hold  aseiies  of  debates,  the  expenses  to  be  shared  between  ns,  and 
the  terms  of  the  contests  to  be  mutually  agreed  upon. ' 


4EteetmgB  of  the  §0netie& 

WlDRSeDAT,  MAT  13TH. 

LabtnoolooiojlL  Socictt  of  Lovdom  (20  Hanover  Square,  W.X— 
6  p.m.  Bepon  of  the  Morbid  Growths  Committee  on  (•)  Myxoma  of 
Vocal  Cord  shown  by  Dr.  fiond  ;  (2)  Myxoma  of  Vocal  Cord  shown  by 
Dr.  St.  Clair  Thompson :  (8)  Tubercnloais  of  the  Septum  shown  by  Dr. 
W.  HilU  Caves  and  Specimens  :~Dr.  B.  Baron  :  Obstruotion  of 
Larynx  due  to  a  W«b.  Dr.  F.  Semon :  Q)  Case  of  Thyrotomy  for  Epi- 
thelioma of  the  Larynx :  (2)  Case  of  Periodic  «1  Tracheal  Bleedit  g. 
Dr.  Bond :  (1)  Boy  with  UnuomroUable,  lotermittent,  Larynseal  Cry; 
(2)  Man,  aged  forty-five,  with  Tubercle  of  Urynx.  Dr.  H.  L.  Lack: 
(1)  Case  and  MicroBcoiM  Spec  .men  of  Healed  Tuberculous  Lanmgltis 
in  a  Female ;  (2)  Case  and  Microscope  dpecimen  of  Lupus  aixectlng 
Doly  the  Pharynx  in  a  Man  aged  thirty-four ;  (8)  Case  of  Healed  Sop- 
Duration  of  the  Left  Frontal  and  Maxillary  Sinuses  In  a  Female.  Dr. 
H.  TiUey :  Case  and  Specimens  of  Cured  Polvpi  of  Frontal  Sinuses. 
Dr.  8.  Spicer :  Case.  Dr.  Brady  (Sydney):  Instrument 
Thurbdat,  Mat  14Th. 

Britibh  OTNiBOOLOOlCAL  SociSTT  (20  Banover  Square,  W.).-8.80 
p.m.  Speclmeii :— Dr.  bchacht:  Unruptured  Tubal  Gestation  con- 
taining FoBins.  Papers:— Dr.  Bell  (OUakOw):  The  Treatment  of  Car- 
cinoma of  the  Uterus,  Certain  Forms  of  Ovarian  Disease,  and  Fibroids 
of  the  Uterus  by  means  of  Thyroid,  Parotid,  and  Mammary  Gland 
Therapeutics.  Mr.  B.  Jessett:  The  Karly  Diagnosis  of  Malignant 
Disease  of  the  Body  of  the  Uterns,  illustrated  by  Museum  Specimens. 

VICTORIA  Hospital  for  Childrbn  (ChelseaX  -4  p.m.  Air.  I/Arcy 
Power :  Meningitis  In  its  Surgical  Aspects. 

FniDAT,  Mat  i&th. 

Epidsmiolooioal  Sooibtt  of  Lobdoh  (11  ChandoB  Street,  Cavendish 
Square).- 8  p.m.  Dr.  O,  Held:  Ipfeotiona  Sore-throat  and  Diph- 
theria. 


Bucks  County  Lunatic  AiylunL—AMlstant  Medloal  Officer.  Salary 
£100  per  annum,  with  board  and  furnished  apsrtmenta.  Testi- 
monials, on  or  before  May  16th,  to  Wm.  Croaoh,  Clerk  to  the 
Visiting  Committee. 

Coonty  Borough  of  Oateshead.— Medical  Officer  of  Health.  Salary 
£800  per  annum.  Applications,  with  teefelmoniala,  not  laAer  fcban 
May  leth,  to  W.  Swinburne.  Town  Clerk. 

Chichester  Infirmary.— Bouse  Surgeon.  Salary  480  per  ammm,  wtyi 
board,  lodging,  and  washiug.  Applications,  with  teetimonlali,  lo 
the  decretory,  on  or  before  the  IMU  Inst. 

Glamorgan  County  Asylum,  Krldgend.— Junior  Assistant  Medical 
Offic  r.  Salary  £lSu.  with  board  (no  beer  or  wine),  lodghag,  and 
washing;  Apply  with  testimonials  to  the  Medical  Snpertntendent 
not  Uter  than  May  18th. 


Horton  Infirmary,  Banbury.— House  Sturgeon  and  Diapetner.  Salary 
80  per  annum,  with  board  and  lodging.  Applications,  with  taatl- 
moulals,  on  ur  before  May  28rd,  to  Mr.  C.  H.  Davids,  Hon.  Bee, 


21  Marlborough  Boad,  Banbuzy. 

Kent  County  Ophihalmlc  Hospital. -House  Surgeon.  Salary,  with 
fumiihed  apartments  and  attendance  In  the  HospltaL  bat  without 
beard,  for  the  flr*t  ye«r  £125,  and  £16j  after.  Applications  and 
testimonials  to  Matthew  A.  Adams,  Surgeon  to  the  Boapital, 
Trinity  House,  Maidstone. 

St.  Andrew's  tioepltol  for  Mental  Diseases,  Northampton.— Junior 
Assistaht  Medical  OOlcer.  Salary  £U0  per  annum,  with  bosod, 
furi'ished  aparunenta,  and  washing.  Applications,  with  taatt- 
monlals,  to  the  Medical  Superintendent  on  or  before  May  18th. 

Stamford,  Butland.  and  General  Inflrmary.— House  Surgeon  (un- 
married), balary  £100  per  annum,  with  board,  lodging,  and 
washug.  Applications  and  testimonials  to  the  Seeretory  on  or 
bef orelCay  18th. 

University  Court  of  SI  Andrew's.~The  Court  propose  to  appoint  the 
following  Lecturers,  via  :  (1)  on  Anatomy,  with  a  salary  of  £800 
per  annum  *  (8)  on  Materia  Medloa,  with  a  salary  of  £200  per 
annum ,  and  (^  on  History,  with  a  salary  of  £800  per  aonuoa. 
Applications  with  twenty  copies  of  testimonials  will  be  received  by 
the  Secretary  until  ist  June. 


DA^unr.  A.  B..  M.D.,  B.Ch.Dub.,  L.M.K.C.P.IreL,  Medical  Officer  of 
Health  for  the  Daventry  Bural  Sanitary  District. 

Evans,  ARTHUR  H.,  L.B.C.P.Lond.,  M.B.C.S.,  denior  Hooae  Physician 
to  Westminster  Hospital. 

GRIFFITH,  Wm.,  M.B.,C.M.Bdin.,  Consulting  Phyaiolan  to  the  Pem- 
brokeshire (Toonty  Infirmary. 

Haroriavis,  W.  H.,  M.R.G.S.,  L.R.C.P.,  Obstetric  House  Physiclau 
to  Uidfilesez  Hospital. 

1UTAR1>,  D.,  M.U.St  And.,  L.B.C.P.Lond.,  M.1LC.8.,  D.P.H.ftig., 
t  onsoltlna  Physician  to  the  Pembroke  County  Infirmary. 

JOLLT,  R.  A.,  L  B.C.P.,  L.B.C.8.l£d.,  L.F.P.3.GlaaflN,  Medlcsl  Offioer  for 
tbe  Acton  Sanitary  District  of  the  Brentford  Union. 

LARKlva.  A.  S.,  M.D.Darh..  M.B.C.S.,  Medical  Offioer  of  Health  for 
the  Chesham  Irban  Sanitary  District. 

Mackinzis,  J..  L.R.C.P.,  L.R.C.S.Ed.,  L.F.P  S.Glasg.,  Medical  Officer 
for  the  Klrby  Sanitory  nistriot  of  the  Basford  Union. 

MacHaLB,  p.  J.,  L.R.C.P.,  L.R.C.S.Irel..  Medloal  Oflloer  for  the  Lahar- 
dane  Dispensary  District,  Mayo. 

Papillok.  T.  a.,  F.R.O.S.Bdln  ,  O^thalmic  Surgeon  to  the  Hastings, 
St.  Leonards,  and  East  Sussex  BospttaL 

PLUMMnt.  SlLBf  W.,  M.B.,  B.S.Durh.,  Honorary  Surgeon  to  the 
Durham  County  Hoepltal. 

Prior,  H.  p.  J..  M  E.C.8.,  Consulting  Physician  to  the  Pembrokeahire 
County  Infirmary. 

BUD,  D.  A.,  M.D.Bdin.,  U  E.C.8.,  Consulting  Physician  to  the  Pem- 
brokeshire County  Inflirmary. 

BowiLL,  GiOROi,  F.B.C.S.(  Senior  Anssthetist  to  Guy's  Hospital  and 
Demonstrator  of  AuflBsthetics  in  the  Medical  Bobool. 

SAUNDERS,  B.  A.,  M.B.C.S.,  Consulting  Physician  to  the  Pembroke- 
shire County  Infirmary. 

SimoAR.  H.,  M.&Lond..  M.B.aS.,  L.B.C.P.,  Assistant  Medical  Offioer 
to  the  Birmingham  Workhouse  Infiriuary. 

Starlet,  Arthur,  M.D.Lond.,  M.b.O  S.,  Assistant  Medical  Officer  to 
the  North- Wtstera  HosjpitHl  of  the  Metropolitan  Asylums  Board. 

Williams,  «^m.,  M.B.Lond.,  M.B.O.S.,  Consulting  Physician  to  the 
Pembrokeshire  County  Infirmary. 


firihs. 


Edob.— May  8nd,  at  Tudor  House,  Maidenhead,  the  wife  of  Arthur 

Kdge,  M  B.Lond.,  of  a  daughter. 
Harris.— VI ay  4th,  at  Sussex  Place.  Southampton,  the  wife  of  A. 

WtUesley  Bairia,  M  tt.CS.,  L.S.A.,  D.P.H..  of  a  son. 
HlT.'May  4th,  the  wife  of  H.  Darwin  Hey,  M.B.C.S.,  L.B.C.P., 

of  Eastfield,  Faringdon,  Berks,  of  a  daughter. 
MUbSEti.-May  6th,  at  Welford   Boad,  Leicester,   the  wife  of  W 

Mussen,  L.B.C.P.  K.,  of  a  daughter. 
WATT.    May  2nd,  at  MiUbrook,  Pi)  mouth,  the  wife  of  J.  LesUe  Watts, 

M.B.Aberd.,  of  a  son. 

MiCHELS— ScHOELL.-May  6th.  at  St.  Mary*s  (Hrman  Lutheran 
church,  London,  Ernst  Michels,  M.D.,  F.B.G.8.Bng..  to  Hildrgard 
Maria,  younger  daughter  of  the  E«v.  C.  Schoell,  D.O. 

DARiiiNO.— May  Itt,  at  The  Hawthorns,  18  Merohiston  Place,  Edin- 
burgh, Janet  A.  Walker,  wife  of  T.  Brown  Darting,  M.D. 

DAVIE.— May  7th,  at  Upper  Iforwood,  Georae  Beott  Davie,  HJ)., 
Depu^oripeonMitoperal,  Ui|e  Medlqa  mS^  In  hli  (Ast  year, 


%h  ^dmi  ^t0fi  mA  €itmhx. 


-SALUS  POPULI  8UPRKMA  LEX." 


VouOXIL 


WSDKESDAY,    MAY    20,     1896. 


Ko.  21. 


(Sta:i9ttml  (JTotttmunicHtioitfli. 


THE  BREAKING  STRAIN : 

Being  an  Abstract  of  thi  Annctal  Oration  Dbliverbd 

AT  the   Medical  Sooistt  of  London, 

Monday,  May  18th,  1886. 

By  W.  H.  ALLCHIN,  M.D.,  F.RC.P.Lond., 

Physician  to  the  Westminstor  Hospital. 

It  occurs  to  me  that  it  may  not  be  disadyantaffeoufl 
to  spend  a  short  time  in  the  consideration  of  a  snbject, 
which,  though  not  of  immediate  practical  application, 
may  furnish  some  principles  of  general  application,  ana 
suggest  some  lines  of  conerence  among  the  many  scat- 
tered and  apparently  isolated  obeerTations  which  we 
are  so  constantly  recording.  It  will  be  well  at  the 
outset  to  obtain  as  clear  an  objective  conception  of  the 
phenomena  as  we  can,  to  ascertain  and  realise  as  far 
as  possible  the  facts  of  the  case.  To  begin  with,  it  is 
clear  that  we  mean  by  death  a  condition  of  matter 
when  it  has  ceased  to  exhibit  any  of  the  properties 
which  we  call  living.  For  a  thing  to  be  dead  implies, 
properly  speaking,  that  the  thing  has  lived,  ana  the 
term  is  inappicable,  or  should  be,  were  we  precise  in 
our  language,  to  material  that  has  not  been  just  pre- 
viously living.  It  will  be  impossible,  therefore,  to 
enter  on  the  consideration  of  death  without  some  pre- 
liminary agreement  in  notion  of  what  is  meant  by  life, 
which,  after  all,  is  only  another  aspect  of  the  same 
problem.  The  essentiu  facts  of  vitality  ascertained 
py  observation,  experiment,  or  experience  are :  (1)  the 
invariable  preeence  of  a  certain  material  of  very  easily 
recognised  physical  properties  but  of  a  highly  complex 
and,  as  yet,  undetermined  chemical  compositioB  and 
molecular  structure,  known  as  protoplasm,  which  recent 
investigation,  hus  tended  to  show,  too,  is  not  so  homo- 
geneous as  was  originally  thought,  though  the  details 
of  its  arrangement  the  microscope  has,  as  yet, 
imperfectly  revealed ;  (2)  such  material  occurs  in 
isolated  and  distinct  pturticles  of  exceeding  minute- 
ness, probably  always,  even  in  its  simplest 
form,  dmerentiated  into  cytoplasm  and  nucleus— the 
cell,  or  as  aggregations  of  sucii  particles,  frequently  in 
association  with  other  materiak  lees  complex  m  compo- 
sition and  not  possessing  the  properties  which  we  call 
life.  (3)  Given  this  substance,  we  call  it  living  when 
it  exhibits  certain  special  forms  of  energy  to  which 
the  collective  term  "  irritability  "  may  be  applied,  or 
more  specifically  ''contractility,"  nerve  power  or 
secretion.  They  are  accompanied  invariably  by  the 
liberation  of  heat  and  probably  always,  certainly  often, 
by  electrical  manifestations  both  of  which  are  identical 
in  nature  and  measurable  by  the  same  means  as  the 
heat  of  our  fires  or  the  electricity  produced  by  our 
batteries.  Further,  it  would  seem  that  for  their 
manifestations  there  must  be  some  immediately  ante- 
<^ent  existing  agent,  some  stimulus,  whether  extrinsic 
or  intrinsic.  For  the  display  of  these  properties,  and 
essentially  included  in  the  conception  of  life,  is  the 
presence  m  the  cell  of  an  adequate  supply  of  non-living 
materia,  fqod,  whereby  its  nutrition,  as  we  say,  is 
maintained.     NutriMea   and   life  may,   indeed,   be 


regarded  as  synonymous  terms.  Movement,  often 
apparently  purposeful,  is  another  characteristic^  and 
the  manifestation  of  life  is  subiect  to  certain  conditions 
of  environment  familiarly  known  as  temperature, 
moisture,  sunlight,  atmosphere,  including  a  due  supply 
of  oxvgen,  <kc.,  certain  degrees  of  which  are  favourable, 
as  others  are  fatal,  to  the  vitality  of  the  protopls 
We  have  further  to  recognise  that  the  range  of  ' 
tion  within  which  the  extrinsic  environment  is  o 
tent  with  life,  is  very  considerable,  and  that  the  living 

grotoplasm  has  a  considerable  range  of  adaptability 
y  which  it  adjusts  its^f  within  limits  to  altered 
conditions.  This  power  of  adaptation  is  the  inhereaS 
property  of  living  matter.  If  to  these  we  add  the 
tendency  to  death,  which  sooner  or  later  asserts  its^ 
we  have  a  summary  of  the  characters  by  which  we 
affirm  that  a  given  object  lives. 

Turning  to  the  processes  collectively  spoken  of  as 
nutrition,  it  may  be  affirmed  that  the  balance-sheet  of 
energy,  in  which  the  work  done  by  the  body  is  accounted 
for  by  the  food  stuffs  used,  has  now  been  prepared 
with  such  an  approach  to  accuracy  as  to  justify  the 
expectation  that  it  will  ultimately  be  capable  of  oeiag 
presented  in  such  a  form  as  to  satisfy  the  most  critical 
physiological  auditor.  There  remain,  however,  deepet 
aspects  of  the  problem  where  we  are  not  nearly  on  as 
firm  ground  and  where  conjecture  and  hypothesis  do 
duty  at  present  for  more  accurate  knowled^.  It  is  m 
respect  to  the  exact  relationship  which  exists  betweaii 
Uie  ingesta  and  the  living  elements  of  the  tissues  in  the 
course  of  these  changes  which  eventuate  in  the  libera- 
tion of  vital  energy,  that  conjecture  prevails,  and,  as 
may  be  supposed,  no  single  hypothesis  is  wholly 
accepted.  The  relationship  of  the  living  strueture 
(mechanism)  to  the  fuel  scarcely  appears  to  be  that  of 
the  fuel  to  the  machinery  in  the  case,  say,  of  a  steam 
engine.  Some  at  least  d  the  food  stoflb  wouldseeni  te 
be  incorporated  in  the  tissue  itself  and  to  form  an 
integral  part  of  it,  to  be  raised  up  to  that  hogbt  of 
molecular  complexity  and  oonresponding  instability 
whioh  pertains  to  the  living  particle.  This  ia  no 
sooner  reached  than  it  overtopples,  so  to  speak,  and 
passing  from  the  pinnacle  at  which  it  may  be  called 
living,  it  breaks  down  a^n  into  the  oeaditioB  of 
non-U  ving  matter  from  which  it  has  just  been  built  up^ 
constituting  "  a  cyclosis  in  which  the  organism  retoraa 
after  every  cycle  to  the  same  point  of  dqpartave,  evev 
changing,  yet  ever  the  same,"  in  fact,  life  itself. 

These  complex  interchanges  are  independent  of 
tiiose  undergone  by  the  mi^or  portion  of  the  ingesta- 
which  probiMy  never  become  actual  oonslitaeBta  of 
tissue,  but  consist  mainly  of  oxidation  ncooeass^ 
carried  out  within  the  range  of  inflnenee  of  the  piot»- 

glasmic  metabolism.  Given  the  lina^  protoplasoi, 
ow  has  it  come  into  being,  how  does  it  come  to  an 
end  ?  Science  is  not  concerned  vrith  the  **  why,"  but 
the  "how"  is  its  legitimate  field  of  inquiry. 

In  considering  tM  nature  of  death  we  ave  con- 
fronted by  the  fact  that  death  after  all  is  only 
a  relative  term.  Some  cells  do  not  die,  stricw 
sjpeaking,  for  they  multiply  by  fission  indefr 
nitely.  All  unicellular  organisms,  however,  do 
not  iH[>pear  capable  of  unlimited  propagatioa'  hf 
fission,  for  after  a  certain  number  of  such  molli]^ 
cafeioBs  the  pvoeese  slackens  and  can  only  be  set  gomg 


620    Tai  MiDioAL  Psns. 


ORIGINAL  COMMUKI0ATION8. 


Mat  ^,  1806. 


aRain  by  temporary  coAJugation  with  another  of  its 
land.  Death,  therefore,  is  only  known  in  the  higher 
diyisions  of  living  beings.  The  mass  of  the  body  dies  ; 
that  which  lives,  or  can  live,  constituting  bat  a  minute 
fragment  compared  thereto,  and  this  participates  in 
the  partner's  death  unless  removed  to  suitable  sur- 
roundings. I  am  obviously  not  alluding  to  death  by 
injury.  My  remarks  only  a^ply  to  death  as  a  natural 
phenomenon,  and  as  such  it  has  a  more  restricted 
scope  than  at  first  appears. 

We  are  accustomed  to  recognise  in  the  course  of 
existence  of  a  living  being  three  stages  :  one  of  growth 
and  development,  one  of  maintainedf  maturity,  and  the 
third  of  aecline  and  senility,  terminating  in  death. 
After  each  stage  has  lasted  a  certain  time,  more  or  less 
peculiar  to  each  sjpecies,  the  organism  begins  to  fail  in 
Its  activities,  to  live  less  perfectly,  and,  as  we  say,  to 
grow  old,  the  tissue  elements  are  no  longer,  or  but  im- 
perfectly, renewed,  those  that  remain  atrophy  and 
degenerate,  the  power  of  reproduction  has  departed, 
the  individual  has  fulfiUedits  destiny,  it  has  lived  and 
reproduced,  it  now  remains  for  it  but  to  die. 

Disease,  which  is  but  a  departure  from  normal  living, 
has,  like  death,  no  natural  connection  with  the  stages 
of  growth  and  maturity.  On  the  other  hand^  during  the 
decline  of  lif &  disease,  as  signifying  a  functional  short- 
comingf  rom  the  normal  standard  of  the  prime,  isanatural 
accident.  If  we  pass  from  the  soma  as  a  whole  to  consider 
the  various  constituent  tissues  as  they  exist  in  the  highest 
forms  of  life  we  are  struck  by  several  notable  circum- 
stances. Some  tissues  are  far  removed  from  the 
primary  embryonic  elements,  while  others  are  but 
slightiy  removed  apparently  from  their  embryonic 
ancestors.  The  former  do  not,  once  arrived  at  their 
full  development,  multiply  or  reproduce  their  kind, 
whereas  the  simpler  forms  of  tissue  are  constantly 
multiplying,  with  the  freedom,  indeed,  of  free  unicellular 
organisms.  It  will  be  seen,  therefore,  that  the  highly 
differentiated  tissue  elements,  like  the  more  complex 
individual,  invariably  die,  whilst  the  simpler  forms,  in 
proportion  as  they  approximate  to  the  germinal 
elements,  and,  as  such,  to  unicellular  organisms,  retain 
the  power  of  multiplication,  and  so  escape  from  death 
the  longest,  though  they  have  not  the  potentiality  of 
development  into  an  entire  individual  such  as  is 
possessed  by  the  germs.  It  follows  (1)  that  death  as 
an  incident  in  the  evolutionary  circle,  is  not  inevitable 
to  all  living  beings ;  (2)  that  whilst  unicellular  organ- 
isms are  immortal,  those  of  any  higher  grade  of 
structure  of  inherent  necessity  die ;  (3)  that  these 
latter  are,  given  favourable  conditions,  continuously  pro- 
pagated by  specialised  portions  of  their  own  substance, 
the  individual  itself,  apart  from  these  portions,  perish- 
ing ;  (4)  that  the  power  of  self -division,  and  hence  of 
perpetuation,  with  avoidance  of  death,  is  lost  by  cells 
which  have  advanced  beyond  the  most  rudimentary 
stage  of  differentiation,  such  power  being  restricted  to 
those  dements  which  retain  their  embryonic  character, 
and  most  completely  by  those  which  form  the  sexual 
elements. 

We  now  come  to  the  question,  how  is  it  that  the 
vital  processes  decline  and  cease  cdfter  a  manifestation 
over  a  definite  period  P  Whence  comes  and  what  is 
the  nature  of  the  breaking  strain  which  disrupts  the 
ceaseless  interchanges  which  constitute  life  ?  It  has 
been  shown  that  all  protoplasm,  as  living  matter,  is 
not  of  necessity  mortal,  but  only  certain  specialised 
forms  of  protoplasm  that  are  so  distiaguished 
The  difference  between  the  two  groups  of  living  matter, 
the  particles  that  under  favourable  circumstance  mul- 
tiply indefinitely,  and  the  more  highly  developed  cells 
which  die,  is  apparently  one  rather  of  degree  than  of  kind. 
In  proportion  as  the  tissues  become  more  highly  differen- 
tiated they  lose  their  power  of  self -division  possessed  in 
common  with  the  other  vital  powers  by  the  simplest 
form  of  protoplasm.  These  are  but  grades  and  all 
intervening  degrees  are  to  be  found  between  the  highest 


and  the  lowest  being.  Nor  is  the  difference  as  regards 
the  incidence  of  death  fundamental,  for  whilst  the 
one  individual  lives  wholly  in  his  immediate  descen- 
dants, the  other  livm  but  in  part,  his  own  identity  beioff 
lost  in  his  death.  There  still  remains  the  unsatisfied 
question,  how  is  it  that  the  organism  once  it  has 
reached  its  maturity,  gradually  comes  to  fail,  grow  old 
and  die  1  Is  the  explanation  to  be  sought  in  the  con- 
tinued effect  of  surrounding  circumstances  and  condi- 
tions the  adverse  influence  of  which  gradually  prevails, 
or  is  it  from  some  inherent  defect  in  the  vital  processes 
which  become  intensified  by  time  and  constant  repeti- 
tion F  Is  it  in  the  anabolic  stages  that  the  inherent 
antecedentthat  finally  arrests  themetabolism  and  with  it 
life,  is  to  be  found  ?  Or  is  it  that  in  the  catabolic  descent 
materials  are  formed  which  exert  a  slowly  increasing 
pernicious  influence  on  the  entire  process,  autogenetic 
poL^ns  in  fact,  that  are  invariable  accompaniments  of 
protoplasmic  changes?  Or,  lastly,  may  it  be  some 
failure  in  the  stimulus,  the  existence  of  which  is 
involved  in  our  conception  of  this  same  protoplasmic 
activity  ?  Comformably  with  our  fundamental  hypo- 
thesis of  the  nature  of  nutrition  it  is  difficult  to  see 
any  other  direction  in  which  to  look  for  our  desired 
antecedent. 

A  review  of  all  the  circumstances  would  seem  to 
show  that  failing  vitality  follows  the  cessation  of 
reproductive  capability  rather  than  that  this  latter 
fails  because  of  approaching  death,  and  it  looks  as  if 
the  lacking  stimulus  is  to  be  found  in  connection  with 
the  sexual  elements  themselves,  some  ferment,  it  may 
be,  such  as  we  assume  to  exist  in  those  lately  recog- 
nised internal  secretions,  the  potency  and  influence  of 
which  in  respect  to  mutative  processes  we  are  but  just 
gaining  a  glimpse  of.  Exhausted  by  their  efforts  to 
perpetuate  the  individual,  it  may  be  that  the  reproduc- 
tive organs  and  their  products  no  lon^r  liberate  that 
stimulus  which  is  needful  for  the  maintenance  of  the 
mutative  processes  of  maturity,  and  for  lack  of  which 
the  individual  deteriorates  and  dies.  May  it  be  that 
there  is  a  real  truth  embodied  in  the  experiments  of 
Brown  S^uard,  however  incomplete  they  have  hitherto 
been  in  results  ?  The  real  meaning  of  such  phrases  as 
cardiac  failure,  of  fatal  intoxication,  whether  from 
within  or  without,  or  arrested  nerve  influence,  and  the 
like,  must  be  somewhere  in  the  region  I  have  now  been 
groping  in.  The  very  foundations  of  prognosis,  if  not 
of  treatment,  so  far  as  this  ipay  attempt  to  modify 
nutritive  processes  by  dru^s  or  other  re-agents,  must 
be  built  on  an  understanding  of  the  intimate  nature  of 
life,  and  the  inherent  causes  of  its  failure  and  cessation. 


ON 

IMPOTENCY    AND  ITS  TREATMENT 
BY  ELECTRICITY. 

By  JULIUS  ALTHAUS,  M.D.,  M.R.C.P.  (Lend.), 

Consulting  Phy«ieUD  to  the  Hocpltal  for  S|>llep«7  and  Pisnlytto, 
Begent's  Ptfk. 

Some  forms  of  impotency  are  met  with  in  practice 
in  which  judicious  applications  of  electricity  may  be  of 
considerable  service  after  the  failure  of  other  modes 
of  treatment.  Impotency,  however,  is  not  a  disease, 
but  only  a  symptom,  which  may  have  a  very  different 
significance  according  to  the  cause  by  which  it  is  pro- 
duced, and  which  may  show  the  opposite  characters  of 
undue  excitability  or  paresis.  It  will  therefore  be 
readily  understood  that  a  close  analysis  of  the  charac- 
teristic features  of  each  case  is  of  the  first  importance 
in  treating  it,  and  that  the  electrical  treatment  must, 
if  it  is  to  be  of  use,  be  strictly  adapted  to  the  indivi- 
dual condition  with  which  we  have  to  deal.  A  mere 
application  of  Franklinic,  Galvanic,  or  Faradic  Elec- 
tricity to  the  sexual  organs  can  rarely  be  of  much 


Mat  20,  1896. 


ORIGINAL  COMMQNICATIOl^S. 


1?HB  Mkdigal  Prjbss.     521 


benefit  ia  impotency,  as  most  forms  of  this  affection 
have  either  a  cerebral  or  spinal  origin  ;  and  we  hava 
here,  as  elsewhere  in  electro-therapeutics,  to  follow  the 
role  that  the  principal  application  shoold  be  made  to 
the  seat  of  the  disease. 

It  is  hardly  necessary  to  state  that,  where  impotency 
arises  from  coarse  organic  disease  of  the  brain  or  spinal 
cord,  or  from  ezhaosting  acate  or  chronic  complaints, 
sach  as  diabetes,  phthins,  kidney  disease,  severe  forms 
of  irritative  dyspepsia,  <&c.,  or  where  it  is  owing  to 
physical  defects  m  the  generative  organs  themsdves, 
there  will  be  no  room  for  electrical  treatment.  This 
latter,  however,  finds  a  nsef ol  sphere  of  action  in  those 
very  numerous  functional  cases,  where  the  lack  of 
sexual  power  is  owing  either  to  cerebral  inhibition,  or 
to  undue  excitability  or  paresis  of  the  several  com- 
ponent parts  of  the  genital  centre  in  the  lumbar  en- 
largement  of  the  spinal  cord. 

I.  Cerebral,  mental,  imaginary,  psychical,  or  inhibi- 
tory impotency— all  these  terms  being  nearly  synony- 
mous— IS  apt  to  occur  in  persons  of  a  naturally  timid 
or  apprehensive  cast  of  mmd,  and  who  may  show  want 
of  self-confidence  in  other  respects.  It  lb  also  seen  in 
those  who  have,  during  adolescence,  suffered  from  un- 
duly frequent  nocturnal  emissions  of  sperma,  or  who 
have  been  addicted  to  excesses.  It  b  very  commonly 
observed  in  newly-married  men.  After  having  failed 
on  some  particular  occasion  to  accomplish  the  sexual 
act  satisuustorily,  they  readUy  apprehend  failure  on 
subsequent  occasions,  with  the  result  that  there  are 
further  disappointments.  In  such  cases  the  physiolo- 
gical condition  of  the  sexual  organs  is  usually  normal. 
There  is  generally  absence  of  erectile  power  at  the 
critical  moment  only,  while,  at  other  times,  more  espe- 
cially during  the  night  or  on  awakening  in  the  morning, 
good  erections  occur. 

This  form  of  impotency  may  be  relative,  inasmuch 
as  failure  may  only  happen  with  regard  to  particular 
persons  of  the  opposite  sex,  while  there  is  good  power 
with  regard  to  otherd  ;  or  it  may  be  temporary,  occur- 
ring only  at  certain  times,  while  on  other  occasions  the 
power  is  there.  The  affection  is  owing  to  inhibition  of 
the  sexual  impulses,  which  are  habitually  excited  by 
sight,  contact,  or  the  imagination,  and  which  travel 
from  the  mid-brain  and^the  occipital  lobes  to  the  genital 
centres  in  the  cord.  Timidity,  tear,'disgust,  and  other 
depressing  emotions  are  apt  to  inhibit  the  sexual  im- 
pulses by  producing  a  discurbance  in  that  highly  com- 
Slex  reflex  mechanism  which  extends  from  the  brain 
own  to  the  terminations  of  the  spermatic  nerves,  and 
a  perfectly  harmonious  action  of  which  in  all  its  parts, 
as  in  the  several  links  of  a  chain,  is  essential  for  the 
complete  and  satisfactory  performance  of  the  sexual 
act 

Habitual  Frigidity.  —In  some  persons  the  inhibitory 
centres  of  the  sexual  passion  predominate  over  the 
reflex  centres  from  the  first,  subduing  all  such  feelings 
and  impulses.  This  constitutes  congenital  or  habitual 
frigidity,  which  occurs  with  preference  in  men  of 
unusual  intellectual  vigour  and  self-control,  whose 
mind  is  constantly  fixed  on  work  of  an  absorbing 
character.  I  have  seen  it  in  great  legal  luminaries, 
and  in  authors  of  repute  who  have  written  on  abstruse 
subjects.  The  condition  may  be  accompanied  with 
arrested  development  of  the  penis  and  testicles,  but 
also  occurs  without  any  such  deficiency. 

Cerebral  impotence  may  occur  after  ir^ury  to  the 
heady  more  especially  the  occiput,  and  may  continue 
after  recovery  from  all  the  other  symptoms  produced 
by  the  concussion.  Such  injury  is  occasionally  followed 
by  wasting  of  the  penis  and  testicles. 

Where  impotency  is  purely  imaginary,  and  arises 
from  timidity,  especially  in  newly-married  men,  en- 
couraging 8af^;estions  on  the  part  of  the  medical 
attendant,  with  the  assurance  that  the  trouble  will 
shortly  yield^  and  the  prescription  of  a  tonic,  generally 
have  the  deoired  effect.    In  a  number  of  cases,  how- 


ever, suggestion  proves  ineffectual,  more  particularly 
where  there  is  want  of  a  proper  balance  of  nerve  force 
in  other  respects.  Such  persons  often  suffer  from 
undue  excitability  alternating  with  depression,  defi- 
cient power  of  fixing  the  attention  on  a  subject, 
exaggerated  tendon  reflexes,  and  phos]^haturia.  In 
such  cases  we  must  insist  upon  hygienic  conditions 
of  life  in  their  fuUest  sense  being  oraerved,  and  pre- 
scribe the  more  powerful  nervine  tonics,  such  as  arsenic, 
phosphorus^  ana  strychnine.  Should  such  measures, 
however,  fail  to  lead  to  the  desired  result,  then  a  care- 
ful application  of  the  constant  current  maj  stimulate 
the  reflex  centres  in  the  mid-brain  and  occipital  lobes, 
from  which  the  sexual  impulses  start,  and  tend  to 
reduce  the  undue  predominance  of  inhibition. 

Mode  of  application,— B.ound  electrodes  of  from  four 
to  five  cms.  diameter  should  be  placed  on  the  mastoid 
processes,  and  a  current  of  from  two  to  three  milU- 
amp^res  sent  through  for  five  minutes,  with  iJie  usual 
precaution  of  gradual  introduction  and  cessation.  After 
this,  an  oblong  anode  of  fifteen  by  nine  cms.  surface 
should  be  placed  on  the  occiput,  while  the  hand  of  the 
patient  should  rest  on  the  indifferent  cathode  of  about 
a  hundred  square  cms.  The  current  is  then  gradually 
brought  up  to  two  mUliampdres.  and  iJlowed  to  act  for 
three  minutes,  after  which  it  is  let  out  by  degrees,  and 
then  reversed  in  the  metallic  circuity  so  that  the 
cathode  now  acts  in  its  turn  on  the  occiput,  with  the 
same  strength  and  for  the  same  time  as  before.  In 
bald  patients  there  is  little  trouble  in  successfully  con- 
ducting this  application  to  the  end ;  but  where  the 
occiput  is  covered  with  hair,  the  galvanometer  must  be 
watched  throughout  with  the  greatest  possible  care,  on 
account  of  the  considerable  resistance  offered  by  the 
hairy  scalp.  At  first  the  needle  does  not  move  unless 
a  comparatively  strong  current  is  put  on ;  but  as  the 
resistance  is  gradually  being  overcome  by  the  action  of 
the  current,  we  must  be  careful  not  to  use  too  much 
force,  as  the  needle  may  suddenly  make  a  too  rapid 
excursion.  With  some  little  practice,  however,  and 
keeping  one's  eye  constantly  on  the  needle,  and  one's 
hand  on  the  screw  of  the  rheostat,  there  will  be  no 
difficultv  in  keeping  the  current-strength  just  at  the 
required  leveL  it  would,  however,  to  hazardous  to 
give  such  an  application  without  having  an  absolute 
galvanometer  and  an  efficient  rheostat  in  the  circuit. 

Some  may  think  the  effects  of  the  electricity  thus 
applied  to  be  owing  to  suggestion,  but  I  have  met  with 
cases  in  which  this  treatment  proved  successful,  and  in 
which  the  influence  of  suggestion  could  be  al:oolutely 
excluded. 

In  cases  of  habitual  frigidity  this  treatment  should, 
if  possible,  be  combined  with  some  change  in  the 
mode  of  life  adopted  by  the  patient  Incessant  appli- 
cation to  abstruse  intellectual  work  should  be  eschewed, 
and  the  airier  and  lifter  side  of  existence  cultivated. 
Where  there  is  deficient  development  of  the  penis  and 
testicles  a  local  application  to  these  organs  should  be 
combined  with  the  central  application.  This  is  done 
by  placing  the  anode  on  the  epi^trium  and  making 
cathodal  yasses  along  the  groin,  in  the  direction  of  the 
spermatic  nerves,  the  upper  and  lower  surface  of  the 
penis,  the  perinasom,  and  the  testicles.  The  current- 
strength  has  to  be  regulated  according  to  the  indivi- 
dual susceptibility  of  the  patient,  and  may  vary  from 
two  to  ten  milliamp^res. 

Where  impotency  is,  owing  to  injury  to  the  head, 
causing  concussion  of  the  occipital  lobes  and  mid- 
brain, a  number  of  other  symptoms  may  be  present, 
such  as  paralysis  of  the  bladder,  numbness,  and  loss  ot 
power  in  the  limbs,  impaired  vision  and  memory,  &e. 
There  is  usually  some  amount  of  meningeal  haemor- 
rhage in  such  cases,  and  as  the  effused  blood  is 
graduaUy  absorbed,  there  is  a  corresponding  improve- 
ment in  the  symptoms.  Sometimes  the  loss  of  sexual 
power  is  the  only  trouble  remaining  after  such  an 
injury,  and  where  this  is  the  case,  recovery  under  the 


522     Thb  Mbdical  Pbms, 


RlGllTAL  OOMMUMCATIONS. 


Mat  do,  18M. 


inflaence  of  electrical  treatment  may  be  expected.  In 
such  cases  there  appears  to  be  an  interraption  of  con- 
daction  between  tne  reflex  centres  in  the  occipital 
lobes  and  in  the  lumbar  portion  of  the  cord,  and  I  am, 
therefore,  in  the  habit  ot  conducting  the  current  from 
one  to  the  other  centre,  subjecting  each  part  alternately 
to  the  influence  of  the  anode  and  cathode,  three  minutes 
each  way,  with  about  five  milliamp^res  and  large  elec- 
trodes. The  application  of  electricity  in  this  form  of 
impotency  was  first  suggested  by  the  late  Mr.  Curling 
(a),  with  whom  I  have  treated  a  number  of  cases  of 
this  kind. 

II.  Spinal  Impotbncy. 

The  sexual  power  resides  in  the  lumbar  enlargement 
of  the  spinal  cord,  which  contains  two  separate, 
although  closely  connected,  genital  centres,  one  of 
which  presides  over  erection,  and  the  other  over  ejacu- 
lation. Loss  of  balance  in  these  centres  causes  that 
form  of  impotency  which  Gross  has  called  "  atonic  ''—a 
term  which  appears  to  me  inappropriate,  as  in  most 
such  cases  there  is,  more  especially  in  the  beginning  of 
the  affection,  undue  excitability  rather  than  atonj,  or,  in 
other  words,  over  action,  and  not  want  of  action.  I. 
therefore,  propose  substituting  the  term  '*  spinal  im- 
potency,'' which  includes  both  undue  excitability  and 
paresis,  and  which  draws  a  distinct  line  of  demarcation 
between  this  and  the  cerebral  or  inhibitory  form. 

Spinal  impotency  is  frequently  owing  to  excesses, 
and  may  be  complicated  with  prostatorrhoea,  sperma- 
torrhoea, irritability,  and  catarrh  of  the  bladder,  stric- 
ture, gleet,  and  other  allied  affections.  It  occurs, 
however,  likewise  without  any  such  complications  in 
persons  who  have  led  chaste  lives,  and  have  been 
addicted  to  studious  habits.  I  have  frequently  seen 
it  in  widowers  of  a  certain  age,  who  had  formed  new 
ties  after  prolonged  abstinence. 

A.  The  efactUatory  centre  is  commonly  the  first  to 
suffer.  There  is  unduly  rapid  discharge  of  the  seminal 
fluid,  owing  to  increased  excitability  of  this  centre, 
which  responds  too  quickly  to  a  comparatively  slight 
stimulus.  This  often  occurs  at  a  time  when  sexual 
desire  and  the  erectile  response  to  it  are  still  normal 
Premature  emission  renders  the  act  too  short,  and 
therefore,  incomplete  and  unsatisfactory,  for  the 
activity  of  the  ejaculatory  centre  should  only  come 
into  play  in  response  to  a  more  powerful  and  prolonged 
stimulation. 

ParedB  of  the  same  centre  may  become  developed  in 
the  further  course  of  these  cases,  or  may  be  the  initial 
symptom  of  spinal  impotency.  In  any  case  it  leads  to 
loss  of  contractile  power  in  the  muscular  coat  of  the 
vesicuiae  seminales,  the  ejaculatory  ducts,  the  prostate, 
and  the  urethra.  Erectile  power  may  still  be  there, 
but  the  act  is  unduly  prolonged,  and  the  erection 
generally  subsides  after  a  time  from  exhaustion, 
without  any  ejaculation  taking  place.  This  condition 
has  by  Gross  and  others  been  incorrectly  described  as 
*^ aspermia^  ot  ^ (ispermatism,'*  There  is  no  want  or 
absence  of  sperma  in  these  cases,  for  it  is  not  uncommon 
to  find  that,  although  no  ejaculation  takes  place  during 
coition,  emissions  of  seminal  fluid  still  occur  during 
sleep,  showing  that  the  testicles  continue  to  secrete. 
The  terms ''aspermia"  or  "aspermatism,"  as  applied 
to  the  condition  which  I  have  just  described,  is  there- 
fore a  misnomer,  and  has  evidently  arisen  from  an 
incorrect  appreciation  of  physiological  facts. 

B.  The  erectile  centre  may  suffer  either  in  the  com- 
mencement or  the  further  course  of  spinal  impotency, 
more  especially  the  latter.  The  erection  then  becomes 
imperfect,  or  is  no  longer  produced  at  all  in  response 
to  the  ordinary  physiological  stimulus.  In  such  cases 
desire  maj  still  be  present,  and  even  unduly  keen. 
Where  this  latter  state  obtains,  the  erectile  centre 
may  still  respond  to  stimulation  by  abnormal  irritants  ; 
and  it  is,  therefore,  a  somewhat  fruitful  source  of 

(a)  "  A  Praotioal  J  »MlM  od  tbe  Dlaea«M  of  \tk»  Xettiii,  «c."   TlUrd  | 


sexual  aberrations.  This  constitutes  an  additional 
reason  why  we  should  use  all  legitimate  means  at  our 
disposal  for  combating  the  condition,  if  we  are  con- 
sulted at  this  stage.  If  the  further  progress  of  the 
affection  is  not  arrested  by  treatment,  there  is  even- 
tually complete  loss  of  desire  as  well  as  paresis  of  both 
spinal  centres. 

A  good  deal  of  confusion  has  been  caused  in  what 
has  been  written  on  this  subject  by  authors  not  having 
traced  the  symptoms  of  impotency  to  affections  of  the 
several  centres  presiding  over  the  sexual  act ;  and  this 
has  naturally  prevented  any  definite  rules  being  laid 
down  for  treatment. 

Paresis  and  undue  excitability  require  different 
therapeutical  measures  for  their  removal,  more  especi- 
ally where  electricity  is  concerned ;  and  a  due  locali- 
sation of  the  trouble  is  absolutely  necessarv  for  its 
successful  treatment.  Where  over-action  in  the  ejacu- 
latory centre  is  treated  with  Faradisation  or  cathodal 
passes  over  the  penis  and  perinaaum,  we  cannot  be 
surprised  if  the  patient  should  get  worse  instead  of 
better.  By  closely  analysing  the  features  of  each 
individual  case,  however,  the  rules  to  be  acted  upon  in 
the  electrical  treatment,  follow  naturally  from  general 
principles ;  and  if  closely  adhered  to,  as  I  shall  now 
describe  them,  will  give  satisfactory  results  in  the  great 
majority  of  cases.  Indeed,  an  extensive  clinical  experi- 
ence has  shown  me  that  electricity,  when  used  with 
proper  discrimination,  is  a  most  effective  remedy  for 
spinal  impotency. 

I  now  proceed  to  detail  the  rules  which  I  am 
in  the  habit  of  following  in  the  treatment  of  these 
cases.  Where  we  find  evidence  of  undue  excit- 
ability of  the  ejaculatory  centre,  the  anode  should  be 
applied  to  the  lumbar  portion  of  the  spine,  by  an 
electrode  of  ten  by  six  cms.,  with  a  cathode  of  about 
a  hundred  square  cms.  on  the  epigastrium,  or  on  the 
patient's  hand.  According  to  individual  susceptibility, 
a  current  of  from  five  to  ten  milliamp&res  is  then 
gradually  put  on,  is  allowed  to  flow  from  five  to  seven 
minutes,  and  slowly  let  out.  In  many  cases,  especially 
where  the  affection  is  of  recent  ori|(in,  this  is  sufficient 
for  its  cure.  A  single  such  application  makes  some- 
times a  decided  difference  for  the  better,  but  in  general 
it  will  be  necessary  to  apply  the  current  from  ux  to 
twelve  times,  either  on  consecutive  or  on  alternate 
days. 

in  obstinate  cases,  and  where  the  affection  is  of  long 
standing,  or  complicated  with  urethral  or  prostatic 
troubles,  an  internal  application  of  the  anode  to  the 
prostatic  portion  of  the  urethra  by  an  insulated  con- 
ductor with  a  metallic  end  should  be  added  to  this,  with 
one  or  two  milliamp^res  for  from  two  to  five  minutes. 
Much  care  and  special  knowledge  is  required  for  the 
successful  use  of  tnis  proceeding.  A  metallic  anode  in 
contact  with  the  mucous  membrane,  causes  free  electro- 
lytic decomposition  of  the  urethral  mucus,  oxygen  and 
acids  being  developed  from  it.  The  metal  of  the  elec- 
trode is  therefore  oxydised,  and  glued  to  the  mucous 
membrane.  This  renders  the  removal  of  the  sound 
difficult  after  the  application  is  over  ;  and  as  no  force 
must  be  used  for  pulling  it  out,  I  have  been  led  to  over- 
come this  obstacle  bv  the  simple  expedient  of  revers- 
ing the  direction  of  the  current  in  the  metallic  circuit 
oi  the  battery,  after  the  anode  has  done  its  work  and 
the  current  has  ceased  to  act.  A  short  cathodal  influence 
is  then  substituted  for  the  previous  anodal  action.  This 
leads  to  the  opposite  electrolytic  effect,  hydrogen  and 
alkalies  being  now  developed  in  place  of  oxygen  and 
acids.  The  congealed  mucus  is  thus  fluidified,  and 
the  instrument  may  therefore  now  be  readily  removed. 

If  skilfully  performed,  this  somewhat  complicated 
proceeding  is  not  unpleasant,  and  highljr  effectual  The 
terminations  of  the  spermatic  nerves  m  the  vasicnlae, 
the  prostate,  and  the  urethraare  soothed  by  this  applica- 
tion ;  and  where  chronic  discharges,  owing  to  gonor^ 
rhoea,  dec.,  are  present,  a  healthy  modifioatioB  of  the 


Mat  20,  18M. 


OtUGIKAL  COMMUNICATIONS. 


Tai  MXDiGAL  Pbbm.     52Jt 


mncoas  membrane  b  brought  aboat.  I  believe  these 
latter  effects  to  be  owing  to  the  germicide  action  of 
the  anode,  as  oxygen  in  the  nascent  condition  has 
been  experimentally  shown  to  be  destructive  of 
microbes. 

For  paresis  of  the  ejaculatory  centre,  with  loss  of 
tone  in  the  muscular  coat  of  the  organs  under  its 
influence,  I  am  in  the  habit  of  usin^  the  opposite 
arrangement  of  the  poles.  Here  our  object  must  be  to 
stimulate  the  centr^  which  we  may  do  by  applying  the 
cathode  to  the  lumbar  spine ;  and  where  this  should 
not  be  sufficient  to  rouse  its  activity,  the  ejaculatory 
ducts  and  adjacent  parts  should  be  stimulated  by  the 
application  of  the  insulated  cathode  to  the  prostatic 
portion  of  the  urethra.  A  stabile  cathodal  application, 
with  the  anode  on  the  epigastrium,  for  two  minutes, 
with  one  or  two  milliamp^res,  should  be  followed  by 
from  twenty  to  forty  interruptions  in  the  metallic 
circuit,  whereby  the  stimulation  is  considerably 
increased.  There  is  never  any  difficulty  in  removing 
the  cathode  from  the  urethra. 

Paresis  of  the  erectile  centre  is  treated  by  the  cathode 
on  the  lumbar  spine,  as  before ;  and  as  the  nervous 
impulses  reaching  the  sexual  organs,  and  the  circulation 
of  blood  in  them,  are  generally  sluggish,  cathodal 
passes  over  the  external  surface  of  these  parts,  as  de- 
scribed above,  should  be  added. 

It  will  be  observed  that  I  have  said  nothing  in  this 
paper  on  the  use  of  Franklinic  and  Faradic  electricity 
in  the  treatment  of  imjpotency.  Their  applicabilitv  in 
this  affection  appears  indeed  to  be  very  limited.  Fara- 
dism  has  no  perceptible  influence  on  the  nervous 
centres,  and  would  therefore  be  useless  in  those  forms 
of  the  affection,  the  origin  of  which  has  to  be  sought 
in  the  brain  and  spinal  cord.  I  have  used  it  however 
with  good  results  m  cases  of  atony  after  long-continued 
gonorrhoea,  after  caustic  injections,  <&c.,  and  also  in 
place  of  cathodal  passes  over  the  penis  and  perinsBum 
m  the  paretic  form  of  spinal  impotency.  In  this  latter 
class  of  cases  however,  it  should  be  combined  with  the 
constant  current  applied  to  the  spine,  as  above  de- 
scribed. 

Franklinic  electricity  does  not  appear  to  have  been 
used  in  such  cases  of  late  years,  althou^  there  has 
recently  been  a  considerable  revival  of  its  use  in  other 
affections,  more  especially  in  the  United  States.  Cur- 
iously enough,  Bigelow's  **  International  System  of 
Electro-Therapeutics"  (Philadelphia.  1894),  a  bull^ 
and  prolix  work  of  nearly  1,700  closely-printed,  octavo 
pages,  the  editor  of  which  modestly  mentions  in  the 
preface  that  '*each  paper  in  the  book  is  a  classic  of 
itself  ''—does  not  contain  a  single  line  on  the  use  of 
electricity  in  impotency,  althougn  I  have  treated  of  the 
subject  as  early  as  1870,  in  the  second  edition  of  my 
•*  Treatise  on  Medical  Electricity,"  while  Erb  (1882) 
and  Lewandowski  (1887)  have  likewise  given  an  en- 
couraging account  of  their  experience  in  this  matter. 

In  conclusion,  I  will  say  that,  while  I  am  fully  im- 
pressed with  the  great  value  of  electrical  treatment  in 
the  cases  under  consideration,  this  is  no  more  infallible 
than  any  other  remedy  which  we  may  use  for  other 
disease&and  that  cases  are  occasionally  met  with  which, 
although  they  may  at  first  sight  appear  promising,  are 
not  benefited  by  this  line  of  treatment 


ON 

MENTAL  THERAPEUTICS  : 

SOME  RELATIONS  OF  MIND  AND  BODY,  (a) 

By  ALFRED  T.  SCHOFIELD,  M.D. 

The  subject  on  which  I  venture  to  offer  a  few 
remarks  is  not  only  one  of  great  interest  in  itself,  but 
it  has  the  special  character  of  being  a  subject  of  real 

(a)  Baad  before  (he  Herveian  BodMj,  Mej  Ith,  ISQfi. 


practical  value  in  the  rational  treatment  of  disease. 
Indeed,  the  whole  science  of  mental  therapeutics  is 
founded  on  an  intelligent  understanding  of  the  rela- 
tions of  the  mental  and  the  physical  in  man. 

There  can  be  no  doubt  in  the  minds  of  thoughtful 
men  as  to  the  fact  of  the  great  therapeutical  influence 
the  mind  has  on  the  bodjr.  But  Uiou^  some  mono- 
graphs may  have  been  written  from  time  to  time  on 
this  subject— and  it  is  incidentally  touched  upon  in 
various  works  on  the  brain  and  mind— its  practical 
application  is  of  the  most  fortuitous  and  casual  nature. 
It  IS  difficult  to  understand  whv  such  a  powerful  means 
of  cure  is  so  systematically  neglected,  and  even  ignored, 
by  the  profession.  I  suppose  it  is  because  mentfu 
therapeutics  have  been  practically  for  so  long  the  real 
modus  operandi  of  the  vast  army  of  chsurlatans,  that 
the  whole  subject  has  acquired  such  a  bad  name  that 
most  men  fear  for  their  reputation  if  they  touch  it. 
Indeed,  it  is  onl^  because  I  have  been  taught  practi- 
cally so  much  of  its  real  value,  and  feel  so  stron^^y  that 
its  continued  neglect  is  no  small  blot  on  the  present 
system  of  medicine,  that  I  shsdl  call  attention  to  the 
wide  powers  the  mind  has  over  the  body  in  relation  to 
disease.  My  remarks  will  therefore  fall  naturally 
under  two  heads  :  the  first  being  directed  to  what  we 
should  understand  by  the  word  *'  mind  "  and  what  is 
known  of  its  relations  to  the  body ;  the  second  pointing 
out  in  brief  the  practical  bearing  of  this  knowledge  on 
disease. 

Our  ego^  or  personality,  as  defined  by  Herbert 
Spencer,  is  '*  the  permanent  nexus,  which  is  never  itself 
in  a  state  of  consciousness,  but  which  holds  states  of 
consciousness  together."  I  think,  however,  we  all  feel, 
that  though  the  conscious  mind  would  fain  arrogate 
the  personality  to  itself,  that  personality  holds  a  great 
deal  more  than  mere  "states  of  consciousness" 
together.  It  is  true  that  what  is  generally  called  Mind, 
has  hitherto  been  limited  to  conscious  mind.  All 
writers  on  psychology  take  the  ground  tiiat  mind 
is  co-extensive  with  consciousness.  To  talk  of  un- 
conscious mind  is  said  to  be  a  contradiction  in 
terms,  and  even  the  unconscious  action  of  the 
brain,  which  is  now  universally  acknowledged,  was 
considered,  as  late  as  1876,  a  most  objectionable  doc- 
trine. Why  the  whole  region  of  mind  should  be 
limited  to  consciousness  I  could  never  myself  under- 
stand, and  to  grasp,  the  scope  of  mental  therapeutics  it 
is  necessary  to  take  a  wider  view — one,  indeed,  which 
has  long  been  before  me,  but  which  I  have  not  hitherto 
ventured  to  formulate,  until  I  recently  came  across 
some  thoughts,  on  entirely  original  lines,  ably  ex- 
pressed by  the  learned  professor  of  Physics  in  Dublin, 
which  seemed  to  endorse  those  suggestions  which  1 
am  about  to  lay  before  this  society.  It  is  abundantly 
evident  that  most  psychologists  feel  there  are  psychical 
actions  on  a  sub-conscious  plane ;  some  get  rid  of  the 
difficulty  by  including  all  these  under  consciousness ; 
others  use  such  terms  as  unconscious  cerebrative  nerve 
action,  <kc.  I  do  not  strive  for  terminology,  but  for  the 
clear  recognition  of  sub-conscious  psychic  action.  It 
appears  to  me,  therefore,  that  the  conscious  mind  is 
a  very  small  part  of  the  whole  range  of  psychic 
action.  A  coral  island  in  the  South  Pacific  is  a  mere 
ring  of  rock  in  the  water,  of  insignificant  size  to  the 
sailor;  but  to  the  biologist  or  geologist,  it  is  the 
highest  peak  of  a  stupendous  structure  that  rises  from 
the  bottom  of  the  ocean  as  a  mountain,  miles  high.  In 
the  same  way,  it  seems  to  me  the  conscious  is  but  a 
ver^  small  part  of  the  vast  sub-conscious  mind,  on 
which  it  rests. 

The  conscious  mind  has  its  seat,  as  we  know,  in  the 
cortex,  or  surface,  of  the  brain  only  :  the  unconscious 
mind  is  connected  with — or  may  we  not  say  is  the 
source  of  P— all  life  that  lies  below. 

Consciousness  is  not,  as  far  as  we  know,  an  inherent 
quality  of  the  cortex  nor  of  the  mind  by  itself,  but  is  the 
result  of  the  interaction  of  Uie  two ;  for  when  the 


624     The  Medical  t>EB98.  OftlGlNAL  CO^iMUNICATIONS. 


Mat  20,  1896. 


working  of  the  cortex,  and  hence  the  harmony  of  the 
two,  is  diaturbed,  as  by  narcotics  or  a  violent  blow,  it 
ifl  lost.  We  are  also  by  no  means  conscious  of  all  that 
takes  place  even  in  the  cortex,  for  innumerable  sensa- 
tions may,  and  do,  continually  reach  it,  of  which  we 
are  wholly  or  partially  unconscious.  On  the  other 
hand,  it  would  appear  from  recent  researches  that  it  is 
not  possible  to  be  conscious  of  any  sensations  that  do 
not  reach  the  surface  of  the  brain. 

The  conscious  mind  has  reason,  feeling,  and  volition. 
By  it,  and  by  it  alone,  we  direct  and  control  the  main 
expenditure  of  life  and  force.  This,  however,  is  not 
done  80  much  by  reason  as  by  feeling— it  is  in  the 
heart,  not  in  the  head,  as  Dr.  Maudsley  points  out, 
that  our  deepest  feelings  are  rooted,  and  ne  does  ill 
service  to  the  religious  faiths  who  strive  to  baae  them 
on  the  feeble  apprehensions  of  human  reason ;  the 
driving  impulse  by  which  men  are  moved  to  act  comes 
from  feeling  rather  than  reason. 

The  sub-conscious  mind  is  on  a  lower  plane,  and 
runs  largely  in  grooves  of  habit,  and  follows  closely 
change  of  association  and  sensation  :  but  its  powers  far 
exceed  in  the  body  those  of  conscious  mind.  The 
unconscious  powers  of  life  can  make  egRs  and  feathers 
out  of  Indian  corn ;  and  milk  and  b^  out  of  ^rass. 
The  new  science  relating  to  our  protective  organisms, 
so  brilliantly  worked  out  by  Metschnikoff  and  others, 
shows  that  they  can  carry  on,  without  erring,  a  thou- 
sand complicated  and  purposive  operations  and  form 
chemical  combinations  that  no  chemist  can  compas-* ; 
work  with  ease  and  without  fatigue,  and  are  only 
hampered  when  interfered  with  by  the  conscious  mind. 
This  is  seen  when  the  sub  conscious  mind  takes  up 
conscious  acts,  and  transforms  them  into  unconscious 
or  sub-conscious  habits.  It  is  ever  doing  this  through 
life ;  and  ease  and  perfection  in  any  pursuit  entirely 
depend  upon  the  degree  in  which  it  ceases  to  be  con- 
nected with  consciousness  and  is  carried  on  sub-con- 
sciously. Playing  the  piano,  skating,  bicycling,  skilled 
trades,  and,  indeed,  almost  everything,  depend  for  their 
perfect  execution  on  the  power  of  the  subconscious 
mind. 

It  is  likely  that  when  habits,  or  artificial  reflexes, 
are  established  in  the  brain,  that  the  current  of  sensa- 
tion and  ensuing  motion  never  goes  up  to  the  cortex 
at  all  for  orders  from  the  conscious  mmd,  the  action 
being  short-circuited  in  the  middle  brain,  and  it  is  not 
only  actions  that  are  ** short-circuited"  by  habits. 
Sights  and  sounds  frequently  repeated  are  arrested  in 
our  unconscious  brain,  and  not  allowed  to  rise  to  the 
level  of  consciousness.  If  we  live  near  a  boiler  factory, 
we  soon  cease  to  hear  it ;  or  if,  as  in  a  friend's  case,  we 
live  near  a  large  dairy,  where  milk  cans  are  washed  at 
night,  it  soon  fails  to  wake  us.  There  appears  to  be  in 
the  sub-conscious  mind  some  power  of  choice  as  to 
whether  an  impulse  shall  be  short-circuited  or  sent  on 
up  to  the  cortex.  By  experiment,  I  find  that  if  a  man 
moves  about  the  room  in  the  morning  when  hii  wife  is 
fast  asleep,  and  makes  loud  noises  of  various  kinds, 
they  do  not  wake  her ;  though  it  cannot  be  exactly 
from  habit,  for  probably  the  exact  noise  has  not  been 
heard  before,  but  rather  from  an  unconscious  know- 
ledge of  who  makes  it.  On  the  other  hand  the  faintest 
noise  in  opening  the  door— often  heard  before — wakes 
her  up,  because  it  sug^ts  someone  else  entering.  The 
lower  mind  seems  to  think  it  is  the  only  sound-message 
requiring  the  attention  of  the  cortex,  and  so  sends  it 
up.  It  LB  almost  like  the  action  of  a  private  secretary 
opening;  all  letters  and  placing  a  few  before  his  chief, 
answenng  the  rest  himself.  The  unconscious  mind, 
we  must  remember,  is  not  only  the  active  agent  in  all 
habits,  but  in  all  voluntary  conscious  actions  as  well. 
It  is  often  forgotten  that  we  cannot  wUl  the  contrac- 
tions of  any  muscles  ;  we  can  only  will  the  moving  of 
leg  or  arm,  and  are  quite  unconscious  of  the  process 
by  which  the  act  is  carried  out. 

But  the  sub-conscious  mind  can  do  greater  wonders 


than  these.  It  not  only  carries  on  all  the  work  of  the 
body  from  the  action  of  the  lowest  cell,  but  it  can  use 
unconsciously  the  highest  cortical  centres  of  thought 
that  are  ordinarily  worked  by  the  conscious  mind.  If 
the  conscious  mind  gives  the  cortex  some  work  to  do, 
such  as  solving  a  problem,  recalling  a  sound,  a  name, 
or  a  place,  meanwhile  occupying  itself  completely 
in  some  other  way,  the  sub-conscious  mind  will 
step  in  and  do  tne  work  and  give  the  answer 
in  a  surprising  way— as  O.  W.  Holmes  says,  **Our 
unconscious  mmd  delivers  the  result  at  the  doors  of 
our  consciousness  just  like  a  prepaid  parcel " ;  or,  on 
the  other  hand,  it  will  work  alone  in  forming  impulses 
and  recalling  memories.  This,  however,  requires  time : 
for  a  man  may  try  to  recall  a  name  and  look  in  a  direc- 
tory for  it;  but  though  under  his  eye  he  fails  to 
recognise  it,  for  his  unconscious  mind  has  not  yet  had 
time  to  find  it  in  his  brain.  Five  minutes  after  he  has 
closed  the  book  he  remembers  the  name,  which  he 
could  not  do  though  he  actually  saw  it  with  his  eye. 
(Carpenter.)  That  is  to  say,  the  visual  impression  on 
the  brain,  though  conscious,  fails  to  recall  the  mental 
record  of  the  name,  which  the  unconscious  mind 
succeeds  in  a  few  minutes  in  doing.  The  other  day, 
leaving  home  for  Brighton,  I  was  stopped  at  the  door 
by  a  suggestion  from  my  unconscious  mind  that  I  had 
not  much  money  in  my  purse  :  I  looked  and  found  only 
a  few  shillings.  I  had  previously  opened  my  purse 
'  often  that  day,  and  the  sight  of  these  shillings  was  un- 
consciously registered  in  my  cortex,  and  somehow  this 
fact  was  presented  by  my  lower  to  my  higher  or 
conscious  mind  at  the  door.  How  often  in  a  similar 
way  impulses  and  fancies  of  unconscious  origin  direct 
our  steps  and  even  save  our  lives.  It  is  pro&ble  that 
the  sub-conscious  mind  is  ever  working  m  the  cortical 
region  in  the  way  of  deepening  impressions  and 
memories. 

But  it  will  do  more  than  this.  Of  all  the  thousands 
of  impressions  that  are  being  received  in  the  cortex, 
from  various  parts  of  the  body,  and  from  our  special 
senses,  but  very  few  are  even  noticed  by  the  conscious 
mind,  though  all  are  registered  sub-consciously.  We 
hear  a  slang  expression,  or  a  new  song ;  we  do  not 
notice  it  particularly,  but  the  sub-conscious  mind  does, 
and  the  result  is  that  we  find  ourselves  unconsciously 
repeating  the  words,  or  humming  the  tune  ;  and  the 
curious  part  is,  that  we  can  often  hum  the  air  perfectly 
if  we  will  do  it  with  the  sub-conscious  mind,  whereas, 
if  we  try  to  hum  it  consciously  it  goes  from  us.  After 
a  time,  however,  when  its  impression  has  had  time  to 
deepen,  we  can  hum  it  at  will.  For  the  same  reason 
we  can  often  remember  things  better  when  we  cease 
to  try  to  do  so  with  our  conscious  mind. 

During  sleep,  for  instance,  thoughts  range  themselves 
anew.  The  powers  of  the  unconscious  mind  can  do 
more  in  this  way  than  the  most  arduous  effort,  in 
arranging  facts  and  ideas  in  due  proportions.  Hence 
we  like  to  sleep  over  a  thing  before  deddinj^,  and 
Judges  in  a  difficult  case  always  like  to  take  time  to 
deliver  judgment— often  on  the  morrow. 

Our  conscious  mind,  as  compared  with  the  uncon- 
scious mind,  has  been  likened  to  the  visible  spectrum 
of  the  sun's  ra^s,  as  compared  to  the  invisible  part 
which  stretches  indefinitely  on  either  side.  We  know 
now  that  the  chief  part  or  heat  comes  from  the  ultra- 
red  rays  that  show  no  light,  and  the  main  part  of  the 
chemical  changes  in  the  vegetable  world  are  f^e  result 
of  the  ultra-violet  rays,  at  the  other  end  of  the  spec- 
trum, which  are  equally  invisible  to  the  eye,  and  are 
only  recoe[nised  by  their  ^tent  effects.  Indeed,  as 
these  invisible  rays  extend  indefinitely  on  both  sides 
of  the  visible  spectrum,  so  we  may  say  that  the  mind 
includes  not  only  the  visible  or  conscious  part,  and 
what  we  have  termed  the  sub-conscious,  that  lies  be- 
low or  at  the  red  end,  but  the  supra-conscious  mind, 
that  lies  beyond  at  the  other  end— ail  the  regions  of 
higher  life,  of  which  we  are  only  at  times  vaguely 


i^AT  20,  1896 


ORIGINAL  COMMlTllflCAriONS. 


The  Mboiual  Pbbss. 


625 


conscious,  bat  which  always  exist,  aad  link  us  on  to 
abstract  and  spiritual  thoughts,  on  the  one  side,  as 
surely  as  the  sub-conscious  mina  links  us  to  the  body 
on  the  other. 

The  powers  of  the  unconscious  mind  are  seen  in  a 
remarkable  way  in  insanity.  The  sane  man  is  one  in 
whom  the  conscious  mind— the  middle  part  of  the 
spectrum — rules.  In  an  unsound  mind,  the  supra, 
or  sub-conscious,  steps  in,  and,  overpowering  the  con- 
scious mind,  oroduces  ecstatic  visions  and  phantasms, 
or  coarse  ana  sensual  conduct  It  is  remarkable  to 
note  in  this  connection  that  when  reason  is  even  par- 
tially dethroned  how  the  whole  unconscious  mind  can 
unite  in  coupling  the  highest  spiritual  ideas  with  the 
lowest  sensuality,  as  in  some  recent  heresies.  In  de- 
fective intellects,  where  the  conscious  mind  is  weak, 
the  power  of  the  sub-conscious  mind  is  remarkably 
seen.  Miss  Martineau  tells  of  an  idiot  who  had  his 
hands  washed  and  nails  cut  at  11.10,  and  who  came  of 
his  own  accord  exactly  at  the  same  hour  each  day  to 
have  the  operation  repeated,  though  he  knew  nothing 
consciously  of  time. 

Our  conscious  mind  is  like  the  yellow  spot  in  the  eye, 
which  is  practically  the  conscious  centre  of  vision,  the 
images  falling  as  a  rule  unnoticed  on  all  the  rest  of  the 
retina,  and  making  an  unconscious  record  in  the  brain. 
When  the  conscious  mind  is  in  abeyance,  as  in  a  dream 
or  reverie,  or  artificially,  as  in  hypnotism  or  narcotism, 
the  unconscious  mind  emerges  from  its  obscurity,  and 
these  and  other  impressions  unconsciously  formed 
upon  the  brain  are  seen  and  noticed  for  the  first  time, 
just  as  a  receding  tide  lays  bare  the  hidden  parts  of 
the  coral  mountain,  e.^.,  a  servant  in  delirium  spoke 
Latin  and  Greek  words  which  she  had  absorbed  un- 
consciously from  her  master  years  before. 

If  the  unconscious  mind  be  stimulated  at  such  times 
it  can  exert  extraordinary  and  apparently  unlimited 
powers  over  the  body.  An  actual  blister  can  thus  be 
produced  upon  the  forehead  by  its  powers,  without 
any  external  application.  Reveries  and  dreams, 
unconsciously  fixmg  this  mind  on  any  part  of  the  body, 
have  produced  the  forms  of  letters  ana  other  marks. 

The  bearing  of  all  this  on  mental  therapeutics  is 
sufficiently  obvious.  Our  field  of  action  while  embracing 
the  whole  mind  is  mainly  the  sub-conscious  region, 
which  not  only  can  be  treated  without  knowledge  of 
the  ego^  but  which  can  e£Fect  through  its  wonderful 
powers  of  nutrition  and  health  of  the  body  to  an  illimit- 
able extent^  and  indeed  i&  the  real  agent  in  most  cures. 
Bearing  this  somewhat  lengthy  preface  therefore  in 
mind,  which  will  throw  a  light  on  all  we  yet  have  to 
say,  let  us  proceed  to  consider  longo  intervallo^  how  the 
body  afifects  the  mind. 

Mental  therapeutics  can  be 'applied  to  the  body  in 
one  of  three  ways  :— 

1.  By  the  unconscious  mind  directly— in  spiritual  or 
physic^  influences  and  surroundinirs. 

2.  By  the  tmconsdotis  mind  acted  on  by  the  con- 
scums  indirectly— in  rousing  faith  in  persons,  remedies 
or  places,  &c. 

3.  By  the  unconscious  mind  acted  on  by  the  conscious 
by  direct  effort-^iu  determination  to  get  well,  to  shake 
off  illness,  ignore  pain,  <bc. 

With  regard  to  the  ailments  for  which  mental  thera- 
peutics is  useful,  it  is  a  powerful  means  of  cure  in  all 
organic  and  inorganic  diseases  ;  while  in  hysteria  and 
allied  neuroses  it  is  the  only  reliable  means  of  per- 
manent efficacy.  Let  us,  then,  first  consider  the 
influence  of  the  mind  in  ordinarv  diseases.  Putting 
aside  all  those  cases  which  get  well  without  any  means 
(the  cure  of  which  we  maintain  is  solely  effected  by  the 
action  of  our  sub-conscious  mind),  we  will  give  just 
one  or  two  special  illustrations  of  this  influence. 

At  the  siege  ^of  Breda^  in  1625,  the  whole  garrison 
was  down  with  scurvy  ;  the  l^rince  of  Orange  smuggled 
into  the  town  three  small  phials  of  essence  of  camphor, 
and  his  physician  put  three  or  four  drops  into  a  gallon 


of  water,  and  the  men  recovered  and  saved  the  town. 
As  to  this  we  may  remark  that  it  is  a  matter  for 
curious  conjecture  as  to  how  far  generally  the  cureA 
we  now  attribute  to  drugs  in  homoeopatmc  or  other 
doses  will  be  considered  in  the  future  to  be  the  results 
of  the  powers  of  our  unconscious  minds. 

A  patient,  suffering  agonies  with  toothache,  was 
told  by  a  medical  man  to  apply  to  the  tooth  a  silver 
coin  wrapped  in  silver  paper.  Believing  it  to  be 
infallible,  she  did  so  several  times  and  was  relieved. 
One  day,  however,  she  was  told  the  remedy  was  wholly 
mental,  and  at  once  it  was  powerless.  Here  is  an  in- 
stance of  the  pernicious  effects  of  the  conscious  mind 
inhibiting  after  first  aiding  the  sub-conscious. 

Unzer,  in  1771,  says :  '*  The  expectation  of  the 
action  of  a  remedy  often  causes  us  to  experience  its 
operation  beforehand."  I  have  j  ust  received  a  remark- 
aole  illustration  of  this  that,  however,  goes  beyond  this 
statement.  A  colleague  of  mine  gave  a  patient  the 
other  day  some  opium  pills  to  produce  sleep,  but  for^^t 
to  mention  their  object  Last  week  he  found  the  pills 
had  not  acted  as  hypnotics,  but  in  a  totally  different 
manner,  though  the  patient  had  had  no  better  sleep. 
Another  patient  thought  she  had  taken  a  large  dose  of 
rhubarb,  which  was  effectual ;  she  discovered  after- 
wards that  she  had  forgotten  to  take  the  medicine. 

Hunter  sa^,  "  By  my  will  I  can  fix  my  attention  on 
anv  part  until  I  have  a  sensation  in  that  part "  ;  while 
Miiller  affirms  that  it  may  be  stated  as  a  general  fact, 
that  any  state  of  the  body  which  is  expected  with 
certain  confidence  will  be  very  prone  to  occur  as  the 
result  of  that  idea.  It  is  easy  to  produce  symptoms 
by  suggestions.  If,  for  instance,  you  press  some  par- 
ticular part  of  the  spine  of  a  neurasthenic,  and  say, 
**Do  vou  feel  any  pain  here?''  he  may  say  "No." 
But  if  you  persist  in  your  suggestion  for  half-a-dozen 
times,  and  tuB  nervous  centres  are  at  all  susceptible, 
he  will  say ''  Yes,"  and  the  pain  suggested  by  you  will 
be  felt.  Now  this  is  true  with  regard  to  producing 
cures  as  well  as  in  producing  diseases. 

It  has  been  well  said,"  We  think  as  we  feel,  or  think 
we  feel,  and  we  feel  as  we  think.  If  we  f del  a  pain,  we 
think  we  are  ill ;  and  if  we  think  we  are  ill  we  feel 
ill.*'  If  my  ideal  centre  vibrates  with  the  thought  of 
crossing  the  Channel  in  rough  weather,  and  pictures 
the  nausea  that  would  then  be  felt,  these  vibrations 
are  transmitted  to  the  terminal  centres  of  the  sensory 
nerves  running  from  the  stomach,  and  I  actually  feel 
sick  from  communication  with  a  sensory  centre,  and 
possibly,  if  of  a  highly  nervous  organisation,  maj  actu- 
ally be  so  from  transference  to  a  motor  centre. 

Becdjeelvngs  and  real  acts  can  be  stcurted  in  entirely 
ideal  centres.  If  we  think  intensely  of  any  part  of  the 
body  long  enough,  we/eel  sensations  in  that  part.  If 
we  think  of  a  good  dinner  our  mouths  may  water.  We 
shiver  whether  we  only  think  of  cold  or  actually  feel 
cold.  The  sensation  of  pain  can  be  produced  as  really 
and  vividly  by  thoujfhts  or  ideas  alone,  as  light  in 
the  eye  by  stnking  it  in  the  dark.  In  short,  every 
sensation  of  the  body  ordinarily  produced  from  with- 
out can  also  be  produced  from  within. 

These  ideal  vibrations,  acting  on  motor  and  other 
centres,  are  quite  different  from  the  action  of  a  motor 
centre  by  the  direct  impulse  of  the  will;  the  action 
being  in  the  latter  case  voluntary  and  in  Uie  former 
involuntary.  So  far  we  have  only  spoken  of  ideas 
of  which  we  are  conscious,  so  that  although  the  modes 
of  exciting  these  motor  and  sensory  centres  are  abnor- 
mal, we  know  them  to  be  so,  and  hence  are  not  deceived, 
and  do  not  deceive  others,  into  believing  them  to  be 
Batural. 

Thus,  when  our  teeth  are  on  edge  from  sounds,  we 
do  not  go  to  a  dentist ;  if  we  are  sick  from  ideas,  we  do 
not  think  we  are  dyspentic ;  if  we  hear  noises  in  the 
ear,  we  dq  not  look  for  tnem  externally  ;  if  we  shiver 
from  thinking  of  cold,  we  do  not  put  on  more  clothing. 
But  now  let  us  go  one  step  further,  into  the  region  of 


526     Ths  Midioal  Pbiss. 


Spanish  PRESCBipnoifs. 


Mat  20,  I90i. 


the  aab-ooQficioas  mind,  and  of  memoriea  and  habits  : 
and  the  theory  I  wish  to  present  as  to  the  mental 
causation  of  these  nerve  troubles  we  group  under  the 
word  '* hysteria"  will  be  made  plain. 

Our  brain  not  only  acts  by  the  will  and  the  ideas  of 
the  conscious  mind,  as  we  have  seen,  but  is  continu- 
ously vibrating  with  ideas,  memories,  and  trains  of 
thought  of  the  sub-conscious.  It  is  so  even  with  regard 
to  common  sensation.  If  vou  concentrate  your  atten- 
tion on  any  ]^rt  of  your  body,  you  become  aware  of 
sensations  in  it  that  escaped  vour  attention  before,  but 
were  eoually  there  then.  If  with  a  feather  I  lightly 
tickle  tne  back  of  your  neck,  and  at  the  time  ^ou  are 
engaged  in  very  earnest  conversation,  the  vibration 
aroused  in  the  Drain  sensory  centre  is  unnoticed  by 
you  ;  and  yet  if  I  call  jour  attention  to  the  part  it  is 
noticed  at  once.  B^  increasing  the  stimulus  I  can 
make  the  waves  of  vibration  set  m  action  other  centres; 
involuntary  ones,  such  as  cause  a  shaking  or  shudder- 
ing of  the  neck ;  or  voluntary,  such  as  turning  the  head 
round  or  moving  away.  If  vou  are  asleep  I  may  tickle 
your  foot  so  that  you  draw  the  leg  away  and  you  wake 
up.  In  this  case  you  are  probably  conscious  of  moving 
your  leg ;  but  the  stimulus  that  made  you  do  it  was 
too  slight  to  reach  your  consciousness.  We  maj  thus 
be  conscious  of  a  transferred  vibration  leading  to 
action  or  sensation,  and  yet  be  ignorant  of  the  cause 
that  set  it  going.  Memories  again  will  involuntarily, 
and  it  may  be  unconsciously,  arouse  both  feelings  and 
actions.  Observe  in  all  these  cases  we  are  not  con- 
sidering vibrations  deliberately  set  up  by  the  will  in 
an  unusual  way. 

Let  us  now  sum  up  our  results,  taking  a  definite 
case,  say,  of  a  pain  in  the  little  finger.  This  pain  is 
felt  in  the  little  finger,  we  say,  thon^gh  we  realljr  know 
that  the  only  seat  of  any  sensation  is  in  the  brain.  It 
is  there  at  the  central  termination  of  the  ulnar  nerve 
which  leads  from  the  little  finger  that  all  the  vibrations 
take  place,  of  which  the  mind  becomes  conscious  and 
calls  pain.  Whenever  these  vibrations  take  place,  in 
the  nerve  centre  belonging  to  the  little  finger,  in  the 
brain,  the  mind  always  refers  the  sensation  to  the 
commencement  of  the  nerve  in  the  little  finger,  what- 
ever may  be  its  real  origin. 

We  may  add  that  while  in  health  it  is  generally  easy  to 
discriminate  between  pain  in  the  little  finger  caused 
by  injury  to  the  little  finger  from  that  set  up  in 
other  ways,  in  nerve  disease,  where  the  subconscious 
mind  has  gpreater  sway,  it  is  not  Nay,  it  is  sometimes 
impossible  not  only  to  the  sufferer,  but  to  the  doctor 
who  attends  him. 

We  have  dwelt  upon  mimetic,  or  imitative,  hysteria, 
because  it  shows  the  wonderful  Dowers  of  the  sub-con- 
scious mind  over  the  body  for  evil,  as  nothing  else  does, 
simulating  every  known  disease,  including  tumours, 
deafness,  blindness,  dumbness,  paral;f8is,  St.  Yitus's 
dance,  &c.,  and  is  capable  of  producing  the  highest 
temperatures  of  fevers.  Now  if  the  range  of  psycho- 
physical ailments  is  large,  the  power  of  mental  thera- 
peutics to  cure  them  is  equally  great,  though  much  less 
known.  The  same  sub-conscious  mind  that  produces 
the  disease  can  be  used  to  cure  it  If  the  person  is  in 
other  ways  in  good  health,  and  has  not  entered  the 
vicious  circle  of  dyspepsia  and  debility^  he  can  prob- 
ably be  cured  in  a  snort  time,  without  isolation,  going 
to  bed,  or  any  form  of  long  treatment  Anyhow  the 
cure  must  be  effected  in  one  of  the  three  ways  already 
indicated.  Perhaps  he  may  be  cured  instantaneously 
by  applying  to  the  irritated  ideal  centres,  that  keep  up 
the  (usease,  i;:ood  suggestions  consciously  or  sub-con- 
sciously sufficiently  {powerful  to  overcome  the  bad  ones. 
We  have  no  belief  in  their  application  by  means  of 
hypnotism  which  often  in  the  end  aggravates  the  con- 
dition which  it  is  meant  to  relieve ;  for  suggestions  are 
thoroughly  effectual  without  it,  if  you  have  confidence 
and  have  gained  the  respect  and  trust  of  your  patient 
The  cure  of  warts  by  faith  is  well  known,  and  in 


spite  of  the  imposture  that  has  lately  been  exposed 
at  Lourdes,  there  is  great  difficulbr  in  believing  that 
the  cures  effected  there  and  elsewhere  are  limited  to 
what  we  call  functional  diseases.  It  is  perhaps  the 
connection  of  mental  therapeutics  directly  with  faith 
healing.  Christian  science  h^ing,  and  hypnotism  ;  and 
indirectly  with  certain  liquid  electricities,  billionth 
dilutions,  and  quack  remedies  of  all  sorts,  that  has  so 
far  deterred  the  profession  from  examining  very  closely 
its  wonderful  powers. 

This  disgust  is  natural  if  we  consider,  for  instancy 
one  or  two  sentences  from  a  recent  work  on  mind 
healing  :— 

*'  If  the  disease  is  consumption,  begin  your  ai^niment 
by  taking  up  the  leading  point ;  showing  that  it  is  not 
inherited ;  and  that  inflammation,  tubercles,  haemor- 
rhage are  but  thoughts,  beliefs,  and  nientai  images 
before  mortal  minds,  not  the  immortal  mind." 

And  again  :— 

^  Ossification,  or  any  abnormal  condition  of  the 
bones,  is  the  action  of  the  mind  as  directly  as  insanity. 
Bones  have  no  more  substance  than  thoughts ;  what 
we  call  matter  was  primitively  error  in  solution" 

Small  wonder,  in  the  face  of  such  remarkable  state 
ments,  if  one  is  tempted  to  turn  away  from  the  whole 
subject  of  mental  therapeutics. 

The  relations  of  the  mind  consciously  or  uncon- 
sciously with  the  body  are,  however,  far  too  interesting, 
and  t^e  issues  of  such  study  in  its  application  to 
disease  far  too  important  to  be  neglectea  on  account 
of  any  misuse  of  these  powers  by  quacks  and  others. 
The  subject  is  ripe  for  further  investigation,  which 
can  be  carried  on  quite  apart  from  hypnotism,  mes- 
merism, and  kindred  methods ;  and  we  have  little 
doubt  that,  on  the  one  hand,  ere  long  the  vast  range 
of  mental  action  in  connection  with  the  body  will  be 
recognised  and  scientifioEdly  classified ;  whUe,  on  the 
other,  mental  therapeutics  will  be  rescued  from  the 
cold  nefflect  with  which  it  has  so  long  been  treated  by 
the  profession,  and  take  its  proper  and  important  pUce 
in  clinical  teaching  and  in  our  medical  works,  trom 
both  of  which  it  is,  as  yet,  conspicuously  absent  These 
few  words  may  at  any  rate  serve  to  call  some  attention 
to  these  important  subjects. 


§immBk  Jr£8mpti0tt0. 

TranslcUed/or  The  Medical  Press  and  Ciboulab 
By  GEORGE  FOY,  F.RC.S., 

Surgeon  to  the  WUtworth  HotplUl,  Dramoondn,  Hon.  FeUow  of  the 
BouUie;n  Surgical  and  OjniBCologloal  AnocUtion,  U.8.A. 

One  of  the  deficiencies  of  the  British  Pharmacopoeia  is 
the  few  flavouring  syrnps  it  contaios.  In  the  present  aee 
patients  require  palatable  medicines,  and  all  patients  do 
not  like  tbe  same  flavouring  agent  Referring  to  the 
Spanish  Pharmacopceia  we  find  the  following  formula  for 
syrups,  besides  which  they  have  the  syrups  of  the  British 
one: — 

Stbup  of  Chioobt. 
Dry  chicory  leaves,  116  grammes  ; 
Water,  500  grammes ; 
White  Sugar,  690  grammes. 
Infuse  the  dry  leaves  of  the  chicory  in  tbe  water ;  strain 
the  fluid  through  serge  with  strong  pressure ;  add  the 
sugar  and  make  a  syrup  by  beating  and  clarifying.  Syrup 
of  Ohioory  and  Rhubarb  made  in  a  similar  way  is  a  very 
pleasant  aperient  for  children. 

Stbup  of  Absikthe. 
Absinthe,  30  grammes ; 
Water,  345  grammes ; 
Loaf  sugar,  620  grammes. 
Make  an  infusion ;  strain  the  liquor  through  serge ; 
allow  it  to  clear  bv  standing ;  add  the  sugar  and  produce 
the  syrup  by  simple  solution. 


Mat  20,  1896. 


TRANSACTIONS  OF  SOCIETIES.         The  Medical  Pbebs,     527 


Stbup  of  Vebjuiob. 
Juice  of  nnripe  grapee,  345  grammes ; 
Pure  sa^ar,  620  grammes. 
Dissolve  the  sugar  in  the  juice  by  the  heat  of  a  salt- 
water bath. 

Sybup  of  Mabshmallow. 
Marshmallow  root,  scraped  and  cut,  26  grammes  ; 
Water,  145  grammes ; 
Simple  syrup,  690  grammes. 
Cut  the  marshmallow  root  in  small  pieces ;  infuse  them 
in  water  for  twelve  hours  ;  strain  the  liquid  without  pres- 
sure ;  add  the  syrup ;  concentrate  by  boiling  until  the 
proper  consistency  is  acquired,  and  then  strain  through 
serge. 

Stbup  of  Obakok  Flowbbs. 
Orange  flower  water,  345  grammes  ; 
Loaf  sugar,  620  grammes. 
Make  a  syrup  by  simple  solution  of  the  sugar  without 
heat. 

Stbup  of  Tab. 
Tar  water  of  the  silver  pine,  345  grammes ; 
Loaf  suear,  620  grammes. 
Make  a  syrup  oy  simple  solution. 

Stbup  of  Citbon. 
Prepared  with  the  distilled  water  of  citron  peel  as  syrup 
of  orange  flowers. 

Sybuf  of  Obakob  Pijbl. 
Prepared  with  water  distilled  from  orange  peel  in  the 
same  way  as  syrup  of  orange  flowers. 


OBSTETRICAL  SOCIETY  OF  LONDON. 
Mbetiko  Hbld  Wednesdat,  Mat  6tu. 

The  President,  Dr.  Champnets,  in  the  Chair. 

AIXFOUBKED  DISCUSSION  ON  DEOIDUOMA  MALIGNUM. 

Mb.  Kanthaok  said  that  in  the  main  he  agreed  with 
what  Dr.  Eden  had  said  last  time  (see  MedioalPbbss  and 
CiBCULAB,  April  8th,  1896)  on  this  subject.  He  remarked 
that  the  descriptions  eivon  by  the  various  observers 
differed  very  greatly,  anathe  histological  origin  assigned 
also  varied  very  much.  From  these  descriptions  one  might 
classify  them  under  three  heads,  viz ,  (1)  from  decidual 
cells,  (2)  from  decidual  masses,  and  (3)  from  mesoblastic 
tissue  of  the  chorionic  villi.  The  cases  might  also  be 
classified  under  two  chief  headings,  viz.,  sarcomata  and 
carcinomata.  If  the  large  cells  described  were  really 
connective  tissue  cells,  growths  springing  from  them  must 
necessarily  be  sarcomata,  while  if  the  growth  started  from 
decidual  cells  they  must  belong  to  the  carcinomata.  If, 
therefore,  a  term  were  required  to  designate  these  growths 
the  first  variety  ought  to  be  called  sarcoma  deciduale  and 
the  other  decidual  carcinoma.  With  respect  to  the  case 
described  by  Dr.  Williamson  in  the  Johns  Hopkins  Hospi- 
tal Reports  both  the  description  given  and  the  drawings 
§Tovea  the  growth  to  be  a  sarcoma.  In  reference  to  Dr, 
pencer's  case  he  observed  that  it  was  often  very  difficult 
to  make  out  the  nature  of  a  primary  sarcomatous  growth, 
but  in  secondary  growths  the  character  usually  comes  out 
clearly.  It  followed  that  as  the  secondary  growth  in  the 
lungs  was  evidently  sarcomatous  the  primary  growth  was 
also  sarcomatous.  If  this  were  so  the  growth  presented 
nothing  remarkable.  It  would  seem,  therefore,  that  sar- 
coma might  develop  primarily  in  the  decidua.  Dr. 
Morison's  specimen,  which  he  had  examined  very 
carefully  under  the  microscope,  appeared  to  be  an 
ordinary  sarcoma,  and  the  same  remark  applied  to 
Dr.  Hebb's  specimen.  Although  in  the  last  case  the 
secondary  growths  were  striking  they  did  not  prove 
anything  in  particular.  The  plasmodial  masses  lound 
in  decidua  were  often  met  with  in  certain  sarcomata, 
while  in  the  syncytium  the  cells  were  epithelial,  and 
growths  springing  therefrom  must  be  carcinomatous  It 
was  necessary  to  Dear  in  mind  that  decidual  cells,  which 
were  connective  tissue  cells,  were  not  necessarily  charac- 


teristic of  pr^nancy,  in  fact,  they  were  often  met  with  in 
diseased  conditions  of  the  uterus  quite  apart  from  preg- 
nancy,  as,  for  instance,  in  uterine  sarcomata.  In  these 
cases  it  must  be  proved  first  that  pregnancy  existed,  for  if 
there  was  no  pregnancy  then  the  question  of  a  decidual 
origin  could  not  come  in.  Dr.  Eden  had  pointed  out  that 
in  some  of  the  cases  on  record  the  existence  of  pregnancy 
was  not  proved.  Then  too  the  pregnane;  must  have 
existed  before  the  commencement  of  the  malignant 
growth,  and  he  did  not  see  what  evidence  there  was  of  the 
pregnancy  having  antedated  the  growth.  He  thought 
the  evidence  was  conclusive  that  such  growths  could  not 
arise  from  chorionic  villi.  In  short,  in  sal  the  observations 
of  alleged  deciduoma  malignum  there  was  a  petitio  a 
principii.  First  it  had  to  be  proved  that  the  malignant 
growth  was  the  result  of  pregnancy  or  abortion,  and  it 
must  be  excluded  that  the  malignant  growth  preceded  the 
pregnancy.  Dr.  Spencer  described  the  fiprowth  in  the 
fundus  as  primary,  and  the  cervical  growth  as  secondary, 
on  what  appeared  to  be  inadequate  evidence.  It  was  quite 
possible  that  the  cervical  growth  was  the  primary  growth, 
and  if  so  it  would  be  beyond  the  sphere  of  influence  of  the 
decidua.  Sarcoma  and  pregnancy  were  both  common 
enough,  and  an  occasional  coincidence  need  not  excite 
surprise.  If  it  were  proved  that  a  sarcoma  could  spring 
from  the  foetal  ectoderm  it  would  be  something  at  present 
unknown  in  pathology. 

Dr.  Clabkncb  Websteb,  of  Edinburgh,  said  that  he, 
too,  had  been  struck  by  the  marke*!  indefiniteness  of  the 
descriptions  given  by  the  various  observers,  and  there  did 
not  appf'ar  to  be  anything  in  the  clinical  histories  to 
throw  any  light  on  the  subject.  The  growths  were 
described  variously  as  occurring  during  pregnancy,  im- 
mediately after  labour,  or  at  some  indefinite  period  there- 
after. The  growths,  moreover,  had  been  described  some- 
times as  sarcomata,  and  at  others  as  carcinomata, 
sometimes,  indeed,  as  a  mixture  of  the  two.  The  origin  of 
the  growths  was  given  in  some  instances  as  from  the 
maternal  portion,  the  epithelium,  or  connective  tissue  and 
even  from  muscle ;  in  others,  as  of  fcetal  origin,  either 
epithelium  or  connective  tissue,  while  others,  again,  called 
them  mixed  maternal  and  foetal.  Evidently,  more  had 
been  comprised  under  this  term  of  deciduoma  malignum 
than  was  ever  intended  by  the  inventors  of  the  term. 
Microscopically,  the  cafes  might  be  divided  into  two 
groups  :  first,  those  in  which  cells  are  found  without  syn- 
cytium, and  those  in  which  syncytium  was  found  without 
other  cells.  Virchow  and  Klebs  had  asserted  that  the 
uterine  mucous  membrane  was  more  frequently  the  seat 
of  mixed  sarcomatous  and  carcinomatous  growths  than 
any  other  tissue  in  the  body,  and  this  added  to  the  diffi- 
culty of  the  question.  It  was  not  strange  that  there 
should  be  a  tendency  to  large-cell  formation  in  growths 
connected  with  pregnancy,  for,  obviously,  the  existence  of 
these  large  cells  m  the  uterus  might  influence  the 
characteristics  of  the  new  growth.  The  question 
of  the  existence  of  such  large  cells  in  the  uterus, 
apart  from  pregnancy,  was  a  difficult  one,  and 
could  not  be  regarded  as  settled,  but  it  had  been 
shown  to  be  impossible  to  exclude  the  possible  influence 
of  a  past  abortion  in  these  cases.  The  existence  of  large- 
cellea  sarcomata  in  relation  to  pregnancy  either  recent  or 
at  some  previous  time  was  not  in  itself  remarkable. 
Class  II  was  the  most  difficult  and  delicate  to  decide. 
If  there  were  a  tumour  and  metastatic  growths  in  which 
plasmodial  or  syncytium  were  present  in  both  primary  and 
secondary  growths,  either  it  was  purely  maternal,  or  from 
intercellular  tissue,  or  it  was  fcetal  alone,  i.e.,  from  the 
epiblast  or  mesoblast,  or  from  the  epiblast  entirely ;  or  it 
might  be  maternal  and  fcptal  mixed.  He  opined  that  the 
syncytium  had  been  proved  to  be  the  outermost  layer  of 
the  foetal  epiblast,  formed  very  early  in  embryonic  life. 
If  one  compared  the  decidua  vera  and  serotina  up  to  the 
sixth  or  eighth  week  it  would  be  seen  that  syncytium  was 
found  in  relation  to  the  serotina  alone,  and  not  in  relation 
to  the  vera  until  the  foetal  envelopes  in  the  course  of 
development  come  into  contact  witn  the  latter.  Other- 
wise the  changes  in  the  mucosa  were  the  same. 

Dr.  FoTUEBOiLL,  of  Manchester,  observed  that  the 
origin  might  he  referred  to  four  tissues,  two  maternal  and 
two  fcetal,  viz.,  the  maternal  connective  tissue  and  the 
maternal  epiblast,  the  foetal  epiblast  and  the  foetal  connec- 
tive tissue.    A  tumour  derived  from  the  maternal  connec- 


528     Tm  Mbdioal  Pbiss. 


TRANSACTIONS  OF  SO(3TETIE8. 


Mat  20,  1896. 


tive  tissue  noifi^hfc  fairly  be  cftllec}  i^  sarcoma,  and  if  from 
the  epiblast  a  carcinoma,  but  there  was  abnolately  no 
reaRon  why  Buch  growths  shoald  receive  a  special  name. 
It  might  nob  have  been  previously  understood  that  preg- 
nancy could  act  as  an  irritant  or  stimulant  of  these 
pathological  changes,  and  in  future  this  source  might  be 
incTuded  to  their  list  of  causes,  but  that  was  not  a  reason 
for  giving  the  growths  themselves  a  fresh  name.  The 
descriptions  and  the  nomenclature  given  in  the  recorded 
cases  varied  very  much,  indeed  many  of  them  left  it 
quite  uncertain  whether  the  origin  was  in  maternal  or 
foetal  tissues.  He  thought  syncytium  might  safely  be 
regarded  as  a  foetal  structure,  and  the  tumours  described 
as  deciduoma  malignum  might  be  tiJcen  as  springing  from 
the  foetal  epiblast.  If,  however,  that  were  so,  it  was  a  new 
discovery,  for  there  was  no  reliable  evidence  of  growth  of 
the  connective  tissue  after  the  death  of  the  foetus. 

Dr.  Lewebs  brought  a  specimen  from  a  case  which  he 
had  shown  before  the  Society  some  years  ago,  the  clinical 
features  of  which  resembled  those  of  Dr.  Spencer's  case- 
There  were  sarcomatous  masses  in  both  the  cervix  and  the 
b"dy  of  the  uterus,  and  there  were  also  secondary  growths 
in  the  lungs  and  vagina. 

Mr.  Bland  Sotton  said  that  when  he  read  Sanger's  and 
Pfeiffer'fl  cases  it  at  once  occurred  to  him  that  they  were 
tumours  of  the  connective  tissue  type  probably  arising  in 
thedecidua.andhehadthoughtthereforethat  they  oaghtto 
be  included  in  a  freeh  group.  He  pointed  out  that  although 
connective  tissue  was  ubiquitous  it  varied  greatly  in 
different  parts  of  the  body,  and  the  nature  of  the  connec- 
tive tissue  from  which  a  tumour  sprang  could  influence  its 
characteristics  very  greatly.  Every  tissue  in  a  malignant 
growth  had  its  physiological  prototype  and  it  was  possible 
to  define  what  kind  of  growth  would  be  likely  to  occur  in 
particular  parts,  from  a  study  of  the  particular  formation 
of  the  connective  tissue  in  that  situation.  In  respect  of 
uterine  growths  he  observed  that  among  others  they  might 
have  two  kinds  of  sarcoma,  the  common  spindle-celled 
sarcoma  from  the  connective  tissue,  and  another  kind  from 
the  mucous  membrane.  If  this  arises  within  two  or  three 
months  of  pregnancy  he  would  expect  to  find  decidual 
cells  in  great  quantity.  He  believed  that  very  few  of  them 
were  really  familiar  with  the  appearances  of  normal  decidua, 
to  say  nothing  of  diseased  conditions,  and  this  fact  might 
account  for  much  of  the  confusion  that  had  arisen.  The 
discussion  might  serve  the  useful  purpose  of  stimulating 
men  to  make  routine  examinations  of  the  cases  which  came 
under  their  notice.  His  own  view  of  the  so-called  deci- 
duoma malignum  was  to  regard  it  as  a  sarcoma  arising  in 
decidual  tissue.  With  regard  to  the  other  varieties  described 
by  German  and  other  observers,  it  would  be  prudent  to 
preserve  an  attitude  of  active  scepticism,  their  occurrence 
being  at  any  rate  not  probable,  and  their  existence  not 
having  so  far  been  demonstrated. 

Mr.  Alban  Doran  said  he  was  driven  to  the  conclusion 
that  these  growths  did  not  exist,  or  that  their  nature  and 
origin  had  been  overlooked.  The  great  objection  was 
that  though  millions  of  women  became  pregnant,  very  few 
had  sarcoma  of  the  uterus  in  connection  with  pregnancy. 
As  sarcoma  of  the  uterus  was  a  recognised  disease,  the 
chances  of  coincidence  were  in  any  ca^e  very  great. 

The  President  admitted  that  the  question  was  one  of 
very  great  difficulty,  and  he  feared  that  Mr.  Sutton's  re- 
proach was  more  or  less  justified.  If  it  existed,  it  would 
hardly  be  a  new  disease,  and  one  would  like  to  know  what 
it  wa«  called  before  this  term  was  applied  to  it.  He 
thought  the  general  sense  of  the  meeting  was  that  they 
were  not  as  yet  prepared  to  accord  to  these  growths  a 
separate  place  in  the  catalogue  of  diseases. 

Dr.  Spbnckb  pointed  out  that  while  in  his  specimen  the 
cervical  growth  appeared  as  large  as  that  in  the  fundus, 
large  masses  had  been  removed  during  life  from  the  latter, 
and  it  was  obviously  the  earlier  growth.  It  had  been 
urged  that  there  was  no  evidence  of  pregnancy  not  having 
preceded  the  growth,  but  he  argued  that  it  must  be  rare  to 
meet  with  pregnancy  in  a  uterus  with  a  malignant  growth 
of  the  fundus.  He  expressed  the  opinion  that  all  growths 
containing  large  masses  of  syncytium  must  be  taken  as 
arising  from  foetal  structures. 

Dr.  Eden  observed  that  if  they  admitted  certain  of  the 
recorded  cases,  they  would  be  obliged  to  face  the  pos- 
sibility of  there  being  uterine  growths  which  could  not  be 
classified  Ai^  sarcomata  or  carcinomata.  He  raised  the  ques- 


tion whether  the  syncytium  posaessed  any  distinctive 
features  which  enabled  them  to  distinguish  it  from  plae- 
medial  masses  from  any  othw  soured.  It  was  evident  that 
if  they  admitted  the  presence  in  such  growths  of  chorionic 
villi,  there  was  no  term  by  which  to  describe  them,  bat 
if  this  were  not  conceded,  then  sach  growths  eould  be  de- 
teribed  as  either  saroomata  or  carcinomata. 


HARVBIAN  SOCIETY. 
MiBTiNo  HSLD  Thubsdat,  Mat  7th,  1896. 


The  Vice-President,  Wm.  Hill,  M.D.,  in  the  Chair. 


Db.  a.  T.  Schofibld  read  a  paper  on  "  Mental  Thera- 
peutics,** which  will  be  found  in  another  column. 

In  the  discussion  which  followed,  after  a  few  remarks 
from  the  Chairman, 

Dr.  Sansom  said  that  Dr.  Schofield's  paper  contained 
many  observations  of  interest  and  value,  bat  it  was  diffi- 
cult to  seize  upon  sach  points  for  discassicn  as  shoald  be 
of  practical  usefulness  to  the  physiologist  and  physician. 
The  scope  of  mental  therapeatics  included  hypnotism  and 
mesmerism,  and  these  subjects  presented  points  of  interest, 
theoretical  and  practical.  In  the  production  of  states  of 
onoonsoioosness  (sleep  and  trance)  or  of  sub-consciousnees 
(unconsoious  cerebration)  it  would  seem  that  the  first 
agency  proceeding  from  the  hypnotiet  or  mesmerist  was 
upon  the  visual  centre  of  the  subject,  and  that  there  fol- 
lowed a  modificati'>n  of  the  conditions  of  nutrition  of  the 
cerebral  hemispheres— slowing  of  heart,  contraction 
of  arterioles,  arreet  of  nutritive  supply,  disturbance  of 
lymphatic  circnlation,  accumulation  of  products  of  retro- 
grade  metamorphosee.  A  word  of  protest  ought  to  be 
entered  against  the  senseless  exhibitions  of  hypnotic  trance 
which  have  been  in  vogue  lately.  The  condition  of  trance 
is  one  of  danger,  slight  causes  may  turn  the  scale  to 
death.  It  should  be  realised  that  Colonel  Townsend  died 
in  the  course  of  a  self-induced  trance.  In  the  abnormal 
states  of  thought  and  action  involved  by  the  hypnotist  it 
will  seem  that  the  arterioles  permit  vascular  supply  to  some 
areas  of  cerebral  matter  whilst  cutting  it  ofl*  from  others. 
These  perverted  mental  states  are  nothing  less  than  an 
artificially  induced  insanity.  The  protraction  by  the 
hypnotist  of  abnormal  states,  whether  of  trance  or  of  uncon- 
scious cerebation  in  the  healthy  subject  ought  to  be  depre- 
cated as  outrages  on  the  sanctity  of  bodily  and  mental  health. 
The  methods  may  be  legitimate  enough  in  disease,  but 
they  should  be  undertaken  only  by  duly  qualified  persons, 
ana  with  a  due  sense  of  responsibility.  An  illustration 
was  given  of  the  possibly  beneficial  induction  of  hypnotic 
sleep  in  disease.  As  to  the  value  of  suggestion  in  morbid 
states— of  wishing,  hope,  and  cheerfulness — there  could  be 
no  doubt.  Dr.  Sansom  could  not  follow  the  author  in 
speculations  as  to  the  supra-conscious  state.  For  the 
scientific  observer  thought  is  the  outcome  of  the  reaction 
of  force  and  matter.  It  follows  that  any  hypothesis  ot 
force  without  matter  is  unintelligible  to  the  human  mind. 
Then  comes  in  authority.  Far  be  it  from  the  imperfect 
human  mind  to  decry  the  authority  that  is  Divine.  In- 
stances of  the  influence  of  the  noble  and  religious  thoughts 
of  an  elder  person  upon  the  yet  unformed  cerebral 
mechanism  of  the  young  are  manifold.  And  in  the  case 
of  the  aged  the  consolations  of  spiritual  things  in  over- 
coming the  sufierings  and  miseries  of  the  body  are  in  like 
manner  proved  by  experience. 

Dr.  Francis  Warkbb  remarked  that  the  influence  of 
the  body  over  the  mental  condition  of  the  brain  was  more 
likely  to  prove  a  fruitful  subject  of  scientific  study  than 
following  questions  of  metaphysical  psychology.  He 
narratea  cases  of  weak-brainea  patients  who  readily  fell 
into  a  hypnotic  condition  if  looking  fixedly  towards  a 
bright  obiect ;  or  even,  when  looking  for  many  moments 
at  a  teacher  performing  physical  exercises  for  imitation. 
He  then  referred  to  the  objective  phenomena  observed  in 
sleep — physiological  unconsciousness — and  remarked  on 
the  contracted  pupil  in  sleep  in  contrast  with  the  dilated 
pupils  seen  in  mental  excitement  as  a  point  observable  by 
those  in  charge  of  children,  and  an  indication  of  the  need 
of  mental  root. 

Mr.  Parker  Young,  after  alluding  to  the  remarks  of 
the  two  previous  speakers  on  hypnotism,  related  his  own 


Mat  20,  1896. 


GERMANY. 


Thb  Mbdioal  Pbxss.     529 


personal  experience  as  an  hypnotist,  and  then  gave  as  his 
opinion  that  if  the  profession  were  to  pay  more  attention 
to  the  sugf^eetions  of  Dr.  Scbofield  more  cures  woald  result 
in  practioe,  and  he  believed,  further,  that  if  less  value 
were  placed  on  the  innumerable  drugs  now  prescribed, 
and  the  mind  more  influenced  in  the  right  direction,  we 
should  get  better  results.  He  thought  the  so-called  case 
of  cure  mentioned  by  Dr.  Warner,  in  which  Dr.  Savage 
(after  making  a  minute  examination  of  the  head  of  a 
lunatic,  and  then  ordering  the  head  to  be  blistered) 
proved  the  efficacy  of  the  Author's  recommendations.  He 
Delieved  the  reason  why  so  many  men  in  our  profession 
did  not  succeed  was  because  they  neglected  the  mental 
condition  of  their  patients  altogether.  The  terms  used  in 
the  paper  were  new,  they  required  to  be  well  considered, 
and  thought  over,  and  he  expressed  a  hope  that  the 
Society  might  do  this  by  the  Author  printing  his  paper, 
which  was  most  important  and  interesting,  and,  he 
believed,  would  result  in  advancing  the  science  of  medicine 
considerably. 
Dr.  ScHOFiBLD  replied,  and  the  meeting  adjourned. 


Jcanrc. 


[PBOM  OUR  OWN  CORBESPONDBNT.j 

PAKI8,  Maj  16th,  1896. 
TCBBRCULOUS  MeNINOITIS. 

Db.  Lazard  relates  a  case  of  tuberculous  meningitis 
treated  by  him  by  the  operation  of  Quincke — tapping  the 
spine  in  the  lumbar  region.  The  patient,  aged  thirteen 
months,  was  brought  to  him  by  its  mother  in  the  first 
week  of  April.  Up  to  that  time  the  child  was  in  the  best 
of  health,  but  for  two  or  three  days  it  had  a  slight  cough, 
with  a  little  fever,  and  slept  almost  continually.  There 
was  neither  vomiting  nor  intestinal  trouble.  A  few  days 
afterwards,  the  cough  got  better,  but  the  somnolence 
continued,  and  the  child  was  peevish.  On  closer  examina- 
tion M.  Lazard  remarked  that  the  anterior  fontanelle,  which 
was  still  patent,  was  slightly  prominent.  The  next  day 
convulsions  set  in,  followed  by  contractions  and  paralysis, 
while  through  the  fontanelle  a  certain  amount  of  liquid 
could  be  felt.  Believing  that  the  substraction  of  some  of 
the  cephalo-rachidian  liquid  might  give  relief,  he  called 
in  his  colleague,  Dr.  Variol,  who  consented  to  operate.  At 
the  time  of  the  operation  and  for  some  time  previously 
the  infant  was  in  profound  coma. 

M.  Variol  inserted  the  needle  of  the  aspirator  between 
the  sacrum  and  the  lumbar  vertebra  about  half  an  inch 
from  the  median  line  and  a  little  obliquely  for  about  an 
inch.  After  a  few  minutes  the  liquid  began  to  ooze  drop 
by  drop,  so  that  at  the  end  of  an  hour  nearly  an  ounce  and 
a  half  was  drawn  off.  The  effect  on  the  patient  was  not 
very  considerable^  it  seemed,  however,  to  have  regained 
consciousness  to  some  extent  so  that  the  mother  thought 
that  her  child  would  recover,  but  the  following  day  it  died. 
In  commenting  on  the  case  Dr.  Lazard  said  that,  the 
operation,  which  is  quite  simple  when  done  between  the 
sacrum  and  the  last  lumbar  vertebra  or  between  the  two 
last  vertebrse,  can  only  be  considered  as  palliative,  and 
in  his  hands  at  least  did  not  affect  the  results  claimed  for 
it  by  Quincke. 

Artificial  Serum. 

At  the  Soci6t6  de  Biologic,  M.  Legais  presented  a  young 
man  on  whom  he  had  practised  laparotomy  and  sutured 
a  ruptured  intestine  which  had  provoked  acute  peritonitis. 
The  patient  recovered  after  having  received  26  litres  of 
serum  by  intravenous  injections.  He  furnished  also  to 
his  colleagues  the  following  list  of  equally  successful  cases 
treated  by  the  above  method  ;— 


A  lad,  ret.  17,  suffering  from  acute  osteo-myelibis  of  the 
left  femur,  fell  into  an  alarming  Btate  after  operation  ;  the 
fever  ran  high,  and  the  pulse  flickered.  Fourteen  litres 
of  serum  were  injected  in  five  days  with  excellent  effect. 
The  fever  fell,  and  the  general  symptoms  improved,  and 
at  the  moment  of  speaking,  the  patient  was  making  a  good 
recovery. 

A  man,  ret.  52,  knocked  down  by  a  train,  had  his  foot 
and  arm  crushed,  and  other  parte  of  his  body  more  or  less 
bruised.  A  double  amputat'on  had  to  be  performed  ;  the 
patient  was  much  agitated  by  fever,  rigors,  and  delirium. 
Fifteen  litres  of  serum  were  injected  into  the  veins  in  the 
space  of  four  or  five  days,  producing  a  rapid  improvement 
in  the  general  condition ;  he  was  now  entirely  convales- 
cent. 

A  young  woman,  ret.  21,  pale  and  emaciated,  entered 
the  hospital  for  an  ovarian  kyst.  The  day  following  the 
ablation  she  was  seized  with  vomiting,  the  hands  were 
cold,  and  the  wrists  pulseless ;  death  was  imminent. 
Three  litres  and  a  half  were  injected  at  once,  and  two 
more,  three  hours  afterwards.  The  patient  quickly  rallied, 
and  has  since  gone  on  welL 

In  concluding,  M.  Legais  said  that  even  in  the  most 
desperate  cases  injections  of  serum  always  produced  a 
certain  improvement,  retarding  the  fatal  termination 
several  hours,  if  not  days,  and  even  when  given  in  massive 
doses  were  inoffensive. 

In  infectious  maladies,  where  the  kidneys  act  well,  they 
frequently  attenuate  the  virulence  and  produce  most 
unhoped-for  results,  on  the  condition  that  they  are  given 
every  day  for  some  time,  and  that  large  quantities  are 
used  (two  or  three  litres)  at  each  stance. 


[from  our  own  oorrxspondbkt.] 

BIBLIN,  May  16th. 

A  New  Method  of  Inducing  Aboution. 

Dr  a.  Duhrssbn,  in  the  Sambral  Klin.  Vorw ,  No.  131 
describes  a  new  method  of  fnducing  abortion,  as  practiced 
by  himself  in  19  cases.  In  all  cases  under  seven  months, 
whether  he  wishes  to  empty  the  uterus  of  all  its  contents, 
whether  of  the  entire  ovum  or  of  the  placenta  alone,  or 
whether  the  os  uteri  is  partly  open  or  entirely  closed,  he 
packs  the  uterine  cavity  with  as  much  iodoform  gauze  as 
it  will  contain,  and  then  fills  the  vagina  with  salicylate 
wadding. 

In  a  few  hours  the  pains  begin,  and  then  cease  in  a  few 
hours  more,  and  at  this  time  any  bleeding  present  will 
also  have  ceased.  When  the  pains  have  ceased  it  will  be 
time  to  remove  the  tampons,  and  on  doing  so  it  will 
generally  be  found  that  the  foetus  and  placenta  are  already 
in  the  vagina,  or  when  the  ovum  is  small  in  the  balloon- 
shaped  cervix,  the  internal  os  and  fundus  uteri  being  well 
contracted.  In  some  cases  the  strength  of  the  pains  will 
have  expelled  the  uterine  contents  and  also  the  tampons 
through  the  vulva.  The  further  advanced  the  pregnancy 
is  the  more  certain  is  the  activity  of  the  tampons  on  the 
uterus.  He  thinks  that  for  the  cautious  practitioner  this 
will  prove  to  be  an  excellent  and  safe  method  of  emptying 
the  uterus. 

At  the  Congress  for  Medicine  a  discussion,  introduced 
by  Hr.  Ewald,  Berlin,  and  Bruns,  Tubingen,  took  place  on 
The  Therapeutical  Emflotmekt  of  Thtroid  Prepara- 
tions. 

The  first  speaker  began  by  saying  that  Baumann's  dis- 


530    Thb  Medical  Pbbm. 


AUSTRIA. 


Mat  20,  1896. 


oovery  had  eDiiched  our  Annamentarium,  but  that  it 
would  not  revolntioniee  our  knowledge  and  activity. 
Thyreoidine  contained  nearly  all  the  active  constituents 
of  the  gland,  and  might  replace  the  various  extracts  and 
dry  preparations.  It  was  a  distinct  advance  that  we  were 
now  acquainted  with  a  comprehensible  and  dearly  recog- 
nisable constituent  of  the  gland,  and  were  possessed  of  a 
measure  of  the  capabilities  of  a  given  quantity  of  gland 
substance.  By  means  of  his  thyreo-antitozine  Fraenkel 
had  succeeded  in  curing  animals  that  were  in  a  condition 
of  tetanus  resulting  from  thyreodectomy.  Observations  as 
to  the  iodine  contained  in  the  gland  were  not  reliable* 
The  substance  used  by  Kocher,  jun.,  and  Fraenkel  must 
have  been  different  from  that  employed  by  Banmann, 
and  until  quite  lately  it  was  not  at  all  quite  clear  how 
these  inquirers  could  obtain  specific  results  with  these 
preparations.  Baumann  had,  however,  furnished  an 
explanation.  This  was  to  the  effect  that  thyroidine  is  pre- 
sent in  the  gland  as  such  only  in  minute  quantities,  but  that 
there  is  much  more  thyro-iodine  albumen  and  thyro-iodine 
globnline.  Both  bodies  were  extracted  by  water  ;  they 
were  then  precipitated,  the  precipitate  was  then  decom- 
posed by  boiling  in  sulphuric  acid  and  alcohol,  when  thyro- 
iodine  was  obtained.  As  regarded  the  action  of  thyroid 
extracts,  two  components  were  to  be  distinguished  ;  one 
was  the  objective  demonstrable,  tissue  changes,  the  other 
the  subjective  symptoms,  which  ranged  from  slight  de- 
rangement to  the  most  pronounced  appearance  of  illness — 
thyroidism.  There  was  no  doubt  that  thyroid  prepara- 
tions, both  in  the  healthy  and  the  sick,  might  increase  the 
tissue  changes  to  an  extreme  degree.  They  might  set  up 
anorexia,  increased  pulse  frequency,  giddiness,  and  palpi- 
tation, stenocardiao  attacks,  &c.,  such  as  were  met  with, 
with  rapid  melting  away  of  the  albumen  and  fat  as  in 
the  Banburg  and  Schweninger  treatment.  These  might 
be  avoided  with  caution.  There  was  no  special  poisonous 
action.  A  Marienbad  *'  cure  "  sometimes  produced  a  similar 
condition.  But  all  the  symptoms  could  not  be  attributed  to 
increased  tissue  changes  any  more  than  in  Basedow's  disease. 
Some  of  the  symptoms  might  be  due  to  bye  or  poisonous 
action,  for  instance,  those  first  described  by  Mackenzie, 
and  bacilli  had  been  found  in  some  of  tbe  English  tablets. 
In  a  large  series  of  cases  no  variation  in  the  tissue  change 
could  be  discovered.  Whence  this  variability  arose  was 
unknown.  Sometimes  an  improvement  in  the  condition 
of  a  myxoedema  was  seen  after  one  gramme,  often  after 
ten,  and  often  not  at  all. 

He  grouped  tbe  physiological  and  pathological  observs- 
tion  toge^her.  A  specific  secretion  was  produced  in  the 
thyroid,  an  organic  iodine  compound,  in  which  the 
iodine  was  in  firm  combination.  The  iodine  might 
amount  to  10  per  cent,  of  the  whole.  This  secretion  was 
being  constantly  distributed  into  the  circulation,  where  it 
served  for  the  destruction  of  certain  poisons  of  an 
unknown  nature,  the  existence  of  which  was  demonstrated 
by  toxic  symptoms,  and  which  appeared  after  the  loss  of 
the  gland  or  of  its  function  (athyreosis  or  ekthyreosis). 
The  secretion  acted  as  an  antitoxine.  If  it  were  absent 
these  toxines  accumulated,  and  tissue  changes  were 
retarded.  If  secreted  too  copiously,  or  introduced  from 
without,  beyond  the  point  of  neutralisation,  the  specific 
action  of  thyreoidin  book  place.  It  might  be  compared 
to  tbe  stomach.  As  in  the  one  we  had  the  condition  of 
hyperchlorhydria,  encblorhydria,  and  hypochlorhydria,  so 
in  the  thyroid  gland  we  had  hyperthyreoeiF,  enthyreosis, 
and  hypothyreoeis. 


The  treatment  had  to  be  lifelong,  as  the  disease  returned 
as  soon  as  it  was  omitted.  Animal  diet  retarded  the 
action  of  thyroidine  and  vegetable  diet  was  to  be  pre- 
ferred. It  was  the  same  with  sporadic  cretinism  and 
infantile  myxoedema.  Endemic  cases  of  cretinism  should 
be  removed  from  the  surroundings  and  treated  with 
thyroidine  as  speedily  as  possible.  Endemic  cretinism 
was  the  resultant  of  two  factors,  local  infection,  and  the 
thereby  induced  degeneration  of  the  thyroid  gland.  The 
action  of  the  extract  on  certain  skin  affections,  particu- 
larly psoriasis,  had  been  made  known  by  English  and 
American  writers.  Its  action  in  obesity  was  beyond 
doubt.  An  exaggerated  tissue  change  and  melting  away 
of  fat  were  to  be  assumed.  Why  certain  fat  people  were 
refractory  he  oonld  not  say.  At  any  rate,  we  had  in  the 
thyroidine  prepckration  a  remarkable  remedy  for  obesity, 
and  the  injurious  bye  effects  would  in  time  be  avoided 
more  and  more. 

Its  usefulness  in  tetanus  was  doubtful.  Some  observers 
had  spoken  well  of  it,  others  had  seen  no  goodresnlte. 
Bat  tetanus  and  tetanus  were  very  different  things.  In 
epilepsy,  psychosis,  acromegaly,  and  rickets,  the  results 
were  doubtful,  and  were  worse  with  Basedow's  disease. 
He  had  seen  no  good  results  in  this  disease,  but  had  seen 
it  rendered  transiently  worse.  How  far  reported  successes 
were  reliable  he  could  not  say.  In  re^urd  to  gottre  he 
agreed  with  other  observers. 

He  concluded  :  In  thyroid  treatment  we  have  an  agent 
in  our  hands  as  powerful  as  it  is  often  enigmatical. 
The  practical  perspicacity  of  Anglo-Saxon  neighbours 
first  of  all  led  the  way  rather  empirically  to  this  treatment. 
We,  as  Germans,  may  be  proud  that  it  has  fallen  to  two 
of  our  oountrymen  to  furnish  the  scientific  basis  for  it. 
Scbiff  first  furnished  the  physiological  basis,  Baumann  by 
his  epoch  making  discovery  of  thyroidine  then  cast  a  new 
light  on  these  so-  called  dark  regions. 

The  Jbkner  Cbntbnaby. 

The  Centenary  Exhibition  in  Berlin,  in  honour  of  the 
discovery  of  vaccination,  contains  an  interesting  collection 
of  the  most  various  objects  illustrative  of  the  history  of 
vaccination,  together  with  the  literatare  of  the  subject- 
but  it  cannot  boast  a  copy  of  the  first  edition  of  Jenner's 
Treatise  of  1798.  The  Municipal  Authorities  of  Biickeberg 
— where  the  anniversary  of  the  first  inoculation  is  cele- 
brated annually  as  a  children's  fete  —  have  lent  the 
Exhibition  various  objects,  including  an  old  portrait  of 
Dr.  Jenner  which  belonged  to  Dr.  Faust,  a  contemporary 
of  Jenner,  and  the  first  German  doctor  who  performed 
vaccination.  Dr.  Pfeiffer,  of  Weimar,  has  also  contributed 
bis  collection  of  eighty-three  medals  struck  in  honour  of 
Dr.  Jenner  and  his  discovery. 


cJlUBtm. 


[f  BUM  OUR  OWN   OOBBBSPONDBVT.] 

ViSirVA,  Mft7 15th,  1896. 

Coxa  Vaba. 
Frey  showed  to  the  members  of  the  Medical  Club  a 
patient  suffering  from  static  fiexure  in  the  neck  of  the  right 
femur.  In  walking  he  falls  to  the  one  side ;  on  sitting 
down  he  mast  have  one  leg  folded  over  the  other.  The 
right,  or  affected  leg,  is  undeveloped  muscularly.  The 
head  of  the  femur  can  be  felt  moving  in  the  joint,  while 
the  movements  of  the  limb  are  greatly  impeded  on  rotation 


May,  20,  1896. 


THE  OPERATING  THEATRES. 


Thb  Mkdioal  Pr^ss.     531 


inwATcb  or  outwards,  and  abduction  is  impossible.  The 
top  of  the  trochanter  is  two  and  a  half  centimetres 
above  the  line  of  N^laton.  According  to  his  own  statement, 
he  had  suffered  two  years  ago  from  a  weak,  weary  feeling, 
followed  by  pain  in  the  hip,  which  radiated  down  the  leg 
to  the  knee,  which  justified  the  diagnosis  of  coxa  vara. 

The  first  of  these  cases  seem  to  have  been  recognised  by 
Ernest  Muller  whodemonstratedapathological  preparation 
showing  a  simple  bending  in  the  neck  of  the  femur.  One 
of  the  prominent  features  in  the  specimen  is  the  measure- 
ment from  the  anterior  superior  spinous  process  to  the 
malleolus  ezternus  which  is  shorter  in  the  affected  leg,  but 
when  measured  from  the  trochanter  to  the  malleolus  both 
legs  are  found  to  be  equal  in  length. 

The  angle  between  the  shaft  and  the  head  is  usually  less 
than  normal  as  the  neck  is  found  to  be  bent  forwards  and 
upwards.  Before  Muller's  demonstration  this  affliction 
was  classed  among  those  of  coxitis,  from  which  it  materi- 
ally differs  by  the  easy  flexion  of  the  leg. 

The  treatment  first  adopted  in  these  malformations  was 
resectto  subtrochanterica,  but  Kraske  has  somewhat  modi- 
fled  this  operation  by  an  osteotomy,  whereby  a  wedge  of 
bone  is  removed  whose  base  is  forwards  and  upwards  ;  a 
line  of  treatment  he  purposed  following  in  this  case. 
Paralysis  or  thb  Spinal  Aooessory. 

Eisenschiitz  presented  a  young  man  to  the  meeting  with 
paralysis  of  the  external  branch  of  the  accessory  after  an 
operation  for  tuberculous  glands  of  the  neck.  The  right 
shoulder  appeared  to  the  observer  raised  and  drawn 
forward  from  the  paralysis  of  the  trapezius  and  stemc- 
deido  mastoideus.  The  internal  margin  of  the  scapula 
was  lowered  and  almost  horizontal  owing  to  one  part  of 
trapezius  (anterior  of  which  is  supplied  by  the  cervical 
nerve)  being  intact  from  another  nerve  source. 
Typhoid  Diagnosis. 

Singer  brought  forward  a  case  of  typhoid  which  possesed 
considerable  interest  from  the  complicated  clinical  history. 
The  patient  was  ro**.  21,  of  a  tuberculous  diathesis.  When 
six  years  of  age  she  suffered  from  measles,  which  left  a 
discharge  from  the  left  ear.  In  1889  an  operation  was 
performed  by  Politzer  for  chronic  inflammation  of  the 
mastoid,  and  was  afterwards  repeated  so  often  that  the 
result  was  an  atresia  of  the  outer  ear.  About  January 
2l8t  of  the  present  year  the  patient  felt  weary  and  fatigued, 
with^beidache  and  exhaustion.  The  cephalalgia  increased 
till  the  28th,  when  she  had  a  rigor,  when  she  was  at  once 
conveyed  to  PM's  ward,  with  a  temperature  of  39*3^  (== 
102*7''  Fahr.),  which  subsequently  continued  for  some  time. 
Along  with  this  headache  there  was  persistent  and 
obstinate  vomiting ;  enlargement  of  the  spleen,  and  the 
abdomen  was  flat.  The  pain,  though  slight,  in  the  head 
was  somewhat  local  at  first,  but  ultimately  became 
general,  causing  stiffening  of  the  neck,  with  hyperies- 
thesia. 

From  these  observations  and  recorded  facts  in  the  his- 
tory, meningitis  was  the  first  morbid  condition  that  was 
apprehended,  for  which  an  operation  was  presumptively 
anticipated  as  the  formation  of  an  abscess  was  highly  pro- 
bable. Typhoid  fever  was  also  suggestive  from  many  of 
the  symptoms,  and  to  eliminate  this  a  preparation  of  the 
blood  was  made  for  microscopic  examination,  when  the 
pathognomonic  symptom  was  discovered,  y\z.^  Hypoleucocy- 
ion4.  This  discovery  led  to  a  closer  scrutiny  of  the  clinical 
history  of  the  patient  before  admission  to  hospital.  It 
was  then  discovered  for  the  first  time  that  she  had 
attended  typhoid  patients,  and  in  the  performance  of  her 


duty  had  used  some  of  the  utensils  in  the  cooking  of  her 
own  meals.  A  further  bacteriological  examination  was  made 
of  the  urine  at  two  different  times  and  on  both  occasions 
typhoid  bacilli  were  present  A  few  days  later  the  rose- 
olear  rash  was  quite  distinct,  which  left  no  doubt  of  the 
true  diagnosis  of  the  case  and  destroyed  all  thought  of 
any  operative  interference. 

Children's  Hospital  Report. 
From  the  report  of  the  Leopold  Stadter  Hospital  we 
learn  that  1,02  children  have  been  treated,  of  whom  714 
were  cured,  or  73*98  per  cent ;  39,  or  4  per  cent,  have  been 
improved  ;  202,  or  21  97  per  cent,  have  died.  Among  the 
special  diseases  were  217  caees  of  diphtheria,  of  which  43 
died,  or  19*8  per  cent,  against  34*9  in  the  previous  year. 
Two  hundred  and  five  of  these  cases  were  treated  with 
serum,  of  which  40  died,  making  19*5  per  cent.  Of  measles 
there  were  172  treated,  and  40*1  per  cent,  died ;  of  scarlet 
fever  235,  of  which  20*1  per  cent.  died.  The  large  number 
of  deaths  from  measles  is  noteworthy. 


ROYAL  FREE  HOSPITAL. 

Radical  Cijrb. — IJNusaAL  Anatomical  Arranobment 
OF  Ring. — Mr.  Battle  operated  on  a  young  man,  set.  24, 
who  had  suffered  from  inguinal  hernia  on  the  right  side  for 
some  months  previously ;  the  hernia  was  of  small  size,  but 
came  through  an  opening  which  was  peculiarly  quadri- 
lateral in  shape  with  very  sharply- defined  edges.  After 
incision  of  the  skin  and  subcutaneous  tissue,  a  very  thick 
well-developed  muscular  layer  was  found  enveloping  the 
cord  ;  search  beneath  this  showed  a  thin  sac,  the  lower  part 
of  which  extended  into  the  upper  part  of  the  scrotum  ;  this 
was  separated  from  the  surrounding  structures  liga- 
tured at  the  neck,  and  then  cut  off  below  the  ligature. 
The  neck  was  curiously  hidden  by  the  external  pillar  of 
the  external  ring.  The  conjoint  tendon  was  then  sutured 
with  silk  sutures  to  Poupart's  ligament  and  the  external 
pillar  of  the  ring.  The  external  ring  was  next  sewn  up, 
and  required  four  silk  sutu^^es  to  effectually  close  it.  The 
external  wound  was  brought  together  with  silk  and  dressed 
with  cyanide  gauze.  Mr.  Battle  remarked  on  the  somewhat 
unusual  disposition  of  the  parts  ;  the  large  square-shaped 
external  ring  would  have  given  passage  to  a  hernia  far 
larger  than  the  one  from  which  this  patient  suffered,  and 
whilst  the  external  pillar  was  normally  inserted,  the  in- 
ternal pillar  was  attached  much  to  the  inner  side  of 
its  usual  point.  The  conjoint  tendon  extended  further  out 
than  in  general  so  that  that  the  internal  ring  was  below 
and  external  to  its  usual  point,  and  when  the  neck  of  the 
sac  was  ligatured,  it  was  secured  well  under  the  cover  of 
the  external  pillar  of  the  ring.  The  muscular  tissue  was 
well  developed,  and  the  muscles  large,  the  cremaster  being, 
as  noted  during  the  operation,  especially  thick. 

Operation  for  Ruptured  Psrin^um.— Mr.  Battle 
operated  on  a  woman,  set.  40,  a  multipara  ;  she  was  torn  at 
last  confinement  some  years  ago,  but  had  always  refused  to 
have  anything  done  to  close  the  wound  until  la*>terly  when 
there  had  been  tendency  to  prolapse  of  the  uteru^y 
a  feeling  of  weakness,  and  dragging  pains.  She  had  a 
rupture  of  the  perinteum,  stopping  short  at  the  sphincter 
ani,  but  the  muscle  was  evidently  weakened.  The  uterus 
came  low  down,  and  the  cervix  was  slightly  enlarged,  there 
beingalsosome  endometritis.  The  operation  was  performed 
after  the  method  of  Lawson  Tait»  but  no  transverse  outs 


S<^2    Tn  Mebioal  Pu08. 


rLEADTNG  ARTICLES. 


Mat  20, 1896. 


were  made  at  the  extremities  of  the  lon(jr  inci«ton.  The 
loDg  incision  was  made  with  a  knife  from  side  to  side 
about  half  an  inch  from  the  lower  border  of  the  scar,  and 
continued  upwards  into  the  labium  on  each  side  for  what 
wae  considered  a  sufficient  distance ;  a  flap  was  then 
carried  forward  for  about  half  an  inch  in  the  middle  line, 
sloping  gradually  outwards  to  the  extremity  of  the  in- 
cision ;  this  had  to  be  done  somewhat  carefully,  on 
account  of  the  thinness  of  the  partition  be*/ween  the  vagina 
and  rectum  ;  a  posterior  flap  wa^  then  lifted  in  a  similar 
manner  for  about  half  an  inch.  There  was  a  little  trouble- 
some hsemorrhage  from  some  dilated  veins  which  had  to 
be  arrested  by  ligature,  but  otherwise  the  bleeding  was 
unimportant.  The  wound  was  douched  with  1  in  1,000 
hot  perchloride  of  mercury  solution  and  fish  gut  sutures 
inserted  from  behind  forwards.  The  first  three  or  four 
were  carried  through  tissues  in  the  septum  so  that  they 
were  hidden  throughout  the  whole  of  their  course.  The 
others  were  inserted  so  as  to  include  the  flap  on  each  side 
and  the  central  part  of  the  flap  which  had  been  dissected 
forwards.  Finally,  the  central  point  of  the  anterior  flap 
wM  sutured  to  the  ends  of  the  long  incision  which 
joined  accurately  in  the  middle  line.  The  perinsBum  thus 
formed  was  a  good  one,  having  the  normal  shape  and  depth. 
Iodoform  dressing  was  used,  and  a  morphia  suppository 
introduced  into  the  rectum.  No  catheter  was  left  in  the 
bladder,  but  directions  were  given  that  one  should  be 
passed  every  four  hours.  Mr.  Battle  said  he  considered 
this  method  of  operation  was  easier  to  perform  than  many 
of  those  described  ;  it  took  less  time  than  most,  and  the 
result  was  extremely  good.  He  did  not  make  transverse 
cuts,  as  already  pointed  out,  because  the  incision  of  itself 
opened  so  readily  that  a  good  broad  surface  showed  iteelf 
quite  wide  enough  to  ensure  strong  and  good  union.  He 
idso  pointed  out  that  it  was  fortunate  this  patient  had  not 
Buffered  as  much  as  many  from  the  consequences  of  a 
ruptured  perinseum,  although  the  cervix  uteri  was  en- 
larged and  there  was  some  endocervicitis,  the  whole  uterus 
was  not  affected,  and  the  slight  scraping  of  the  cervix 
done  at  the  operation  would  probably  suflice  to  effect  the 
cure.  One  cause  of  the  comparative  failure  of  an  opera- 
tion for  this  condition  was,  he  considered,  due  to  the  fact 
that  a  large  heavy  uterus  pressed  on  the  newly  formed 
tissue  and  caused  it  to  yield ;  this  was  chiefly  the  case 
where  the  operation  had  been  performed  after  many  years, 
the  uterine  disease  not  having  been  corrected  beforehand 
and  the  patient  had  been  allowed  to  get  up  too  soon. 

It  is  satisfactory  to  state  that  the  wound  healed  with- 
out suppuration,  and  that  the  patient  has  experienced  but 
little  discomfort. 


aianmun>  vok  Tbavskissiov  abtoat  . 


As  an  outcome  of  last  year's  grave  outbreaks  of 
cholera  and  enteric  fever,  the  authorities  in  India 
have  now  issued  orders  that  the  *'  mussuek  **  (sheep- 
skin) is  no  longer  to  be  used  for  water  carrying  pur- 
poses, at  least,  where  drinking  water  is  concerned. 
Metal  buckets  are  to  be  issued  as  substitutes,  and 
drinking  water  is  to  be  boiled  before  use,  and  issue  of 
fuel  being  provided  to  facilitate  the  precaution. 

The  Islington  Guardians  have  agreed  to  purchase 
from  the  Metropolitan  Asylums  Board  the  small-pox 
hospital,  at  Highgate  Hill  for  £52,500.  The  hospital, 
which  stands  on  nine  acres  of  ground,  is  to  be  converted 
into  an  infirmary. 


Pnbllahed  every  Wednesday  momlng,  Price  6d.    Poet  free,  S^d. 

ADYBRTUBinVTB. 

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A.  H.  JAOOB.  80  Moleaworth  Street,  Dnblln. 
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SUBSOBIPTIOBS  FOB  THB   Ubftbd  Statbb,    poat  free  In  adTaaoe 

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"8ALU8  POPULI  8UPREMA  LEX." 


WEDNESDAY,  MAY  20,  1896. 


FINGERS  VERSUS  BUTTONS  IN  INTESTINAL 
SURGERY. 
Success  in  abdominal  surgery  has  been  truthfolly 
said  to  be  the  reward  of  attention  to  details,  and  the 
various  improvements,  real  or  fancied,  which  are  con- 
tinually being  made  in  this  department  bear  on  points 
of  technique  which,  if  small  in  themselves,  not  unfre- 
quently  prove  of  capital  importance  in  determining 
the  ultimate  result  of  the  operation.  Not  many  years 
ago,  Senn  of  Chicago,  startled  the  surgical  world  and 
won  for  himself  a  European  reputation,  by  introducing 
the  use  of  decalcified  bone  plates  for  the  purpose  of  secur- 
ing close  and  firm  apposition  of  the  apertures  of  commu- 
nication between  the  hollow  viscera.  His  results  were 
so  remarkable  that  it  seemed  for  a  time  as  if  in  future 
their  use  would  be  virtually  compulsory.  His  idea 
was  soon  followed  up  by  other  surgeons,  one  American 
and  one  English,  Dr.  Murphy  of  Chigago,  and  Mr. 
Mayo  Robson  of  Leeds,  of  whom  the  former  introduced 
the  button,  which  bears  his  name,  and  the  other 
a  bobbin,  or  reel,  which  is  also  known  by  the 
name  of  its  inventor.  These  mechanical  contrivances 
have  now  been  long  enough  before  the  surgical  world 
for  sufficient  material  to  have  accumulated  to  enable 
us  to  form  an  approximate  opinion  as  to  their  merits, 
and  this  was  done  in  a  singularly  able  and  lucid  paper 
read  by  Messrs.  Ballance  and  Edmunds  at  the  last 
meeting  of  the  Royal  Medical  and  Chirurgical  Society. 
The  result  is  somewhat  unexpected,  for  in  this  paper 
is  read  the  condemnation  of  all  such  contrivances,  the 
use  of  which,  in  the  authors'  opinion,  and  their  opinion 
is  based  on  an  elaborate  aeries  of  experiments  and 


Mat  20,  1896. 


LEADING  ARTICLES. 


Ths  Mbdioal  Pbsbs.     533 


observatioDB,  ought  to  be  restricted  to  special  cases. 
Speaking  generally  they  are  of  opinion  that,  in  the 
language  of  Mr.  Harrison  Cripps,  a  staunch  adversary 
of  mechanical  aids  to  intestinal  anaatomosis,  the  sur- 
geon's fingers  are  the  most  efficient  apparatus  for  the  pur- 
pose. This  is  rather  a  blow  for  Dr.  Murphy,  whose  button 
has  been  lauded  as  a  triumph  of  mechanical  ingenuity 
and  surgical  skill,  but  the  decision  has  evidently  been 
arrived  at  after  full  consideration  of  the  statistics  and 
of  the  results  obtained  in  experimental  operations  in 
animals.    Another  curious  fact  is  that  not  a  surgeon 
was  found  to  take  up  the  brief  for  the  defence.    Mr. 
Bryant,  it  is  true,  reserved  the  right  of  employing  one 
or  other  of  the  devices  in  exceptional  circumstances, 
of  which  he  gave  a  very  apposite  instance,  but  this  is 
a  singular  contrast  to  -the  enthusiasm  with  which  Mr. 
Herbert  Allingham,  for  example,  among  other  sur- 
geons, holds  them.    The  main  objection  to  Murphy's 
button  is  that  so  long  as  it  is  inside  the  intestine  it  is 
necessarily  a  source  of  grave  danger  to  the  patient,  and 
instances  are  tolerably  abundant  in  which  its  presence, 
before,  as  well  as  after,  breaking  loose,  has  determined 
serious  and  even  fatal  lesions.    Mr.  Cripps,  indeed, 
went  so  far  as  to  say  that,  acting  on  strictly  surgical 
principles,  his  first  impulse  on  hearing  that  such  a 
body  was  lying  in  the  intestine  would  be  to  reopen 
the  wound  and  remove  it.  Nor  is  it  the  only  objection. 
The  size  of  the  bobbin  employed  is  necessarily  limited 
by  the  calibre  of  the  intestine,  and  the  result  is  that 
even  with  the  largest  size  that  can  be  utilised  the 
passage  left  for  the  passage  of  faeces  is  comparatively 
small.      Then,  too,  the  pressure  of  faeces  along  the 
intestine  is  very  liable  to  be  prevented  by  the  pressure 
of  the  bobbin  on  a  neighbouring  coil   of   intestine, 
instances  of  which  were  furnished  by  Mr.  Bidwell  and 
confirmed  by  the  authors.    Incidentally  the  effects  of 
the    various   sutures    was  discussed.      Against   the 
Lembert  suture  it  was  shown  that  when  employed  in 
dogs,  and  also  in  man,  there  results  an  infolding  of  the 
intestinal   wall,  which  practically  constitutes  a  dia- 
phragm, the  effect  of  which  must  be  to  hinder  the 
passage  of  faeces  along  the  intestinal   tract  at  the 
point  of  anastomosis.    This  objection  does  not  apply  to 
Halstead's  method,  nor,  as  far  as  we  could  gather,  to 
Maunseli's   method.    These   conclusions   may   bring 
comfort  to  the  minds  of  surgeons  who  pride  themselves 
on  having  acquired  special  dexterity  in  the  application 
of  the  complicated  sutures  which  are  to  render  the 
patient  secure  against  the  formidable  consequences  of 
faecal  extravasation.    These,  moreover,  contumaciously 
deny  the  one  remaining  advantage  claimed  for  such 
contrivances,  viz. :  that  their  use  materially  shortens 
the  duration  of  the  operation,  which,  if  true,  would  be 
a  point  of  considerable  importance.    Their  contention 
is  certainly  correct  if  surgeons  follow  the  practice 
introduced  by  American  surgeons   of   putting   in  a 
second  row  of  Lembert  suture  in  order  the  more  cer- 
tainly to  Safeguard  the  patient  against  leakage  of 
intestinal  content^.    To  sum  up  the  question,  it  would 
appear  that  no  plate  or  button  or  bobbin  affords  as 
great  protection  against  faecal  extravasation  as  is  pro- 
vided by  the  skilful  surgeon  with  bis  fingers  in  the 


application  of  sutures,  and  unless  very  cogent  argu- 
ments are  brought  forward  on  the  other  side,  for  we 
have  so  far  only  heard  one  side  of  the  problem,  their 
uses  will  in  future  be  restricted  to  special  cases  in  which 
the  ordinary  sutures  for  some  reason  cannot  be 
employed.  It  is  perhaps  to  be  regretted  that  the  parti- 
sans of  these  contrivances  abstained  from  joining  in 
the  discussion.  We  get  a  discussion  at  one  society  at 
which  the  bobbin  surgeons  have  it  all  their  own  way, 
and  then  within  a  few  weeks  or  months  we  are  treated 
to  another  discussion  at  another  society  where  the 
iconoclasts  carry  all  before  them.  Under  these  cir- 
cumstances the  battle  has  ultimately  to  be  fought  out  in 
the  medical  journals,  which,  after  all,  possibly  offer  a 
better  field  for  arguments  largely  based  on  statistical 

results. 

♦ 

THE  BKEAKING  STRAIN. 
The  old  problem  of  the  reason  for  the  mortality 
which  is  the  inherent  characteristic  of  differentiated 
protoplasm  still  possesses  the  invincible  attraction 
which  it  has  exercised  over  countless  generations  of 
our  predecessors,  themselves  subject  to  the  inexorable 
law  which  decrees  and  carries  into  execution  the  dis- 
appearance of  the  individual  and  the  perpetuation  of 
the  species.  The  brightest  intellects  have  scrutinised 
in  vain  the  processes  of  nature  as  exemplified  in  the 
phenomena  of  biology,  in  search  of  a  clue  which 
should  enable  them  to  understand  the  immutable  pro- 
vision in  virtue  of  which  the  tissues  which  are 
the  seat  of  the  complex  interchanges  which 
constitute  life  at  last  undergo  deterioration, 
decay,  and  die.  Anatomists  have  teased  out  the 
tissues  to  their  ultimate  ramifications,  and  physiologists 
have  thrown  the  light  of  the  microscope  and  the  test- 
tube  on  the  metabolic  processes  which,  during  life, 
provide  for  the  nutrition  of  the  organism  ;  but  the 
"  unsolved  supreme  attraction ''  remains  unsolved,  and 
we  are  still  profoundly— pitiably—ignorant  of  the 
reason  why  the  vital  processes  undergo  retrogression 
and  ultimate  death.  There  is  no  answer  from  the 
tissues  '*  telling  us  where  life  has  been,  whence  it 
issues.'*  The  subject,  in  spite  of  the  sterility  of  all 
attempts  to  elucidate  it,  is,  nevertheless,  well  worthy 
the  consideration  of  the  philosophical  physician,  using 
this  designation  in  its  wider  acceptation,  and  for  this 
reason  the  scholarly  discourse  of  Dr.  AUchin,  of  which 
we  publish  an  abstract  elsewhere,  is  sure  to  command 
respectful  attention.  Not,  indeed,  that  he  claims  to  have 
succeeded  where  so  many  other  intellects  of  the  highest 
order  have  failed.  He  does,  however,  throw  a  glimmer 
of  hypothesis  in  regions  hardly  accessible  even  to  the 
boldest  flights  of  human  speculation.  The  problem  is 
one  which  had  for  years  enthralled  the  genius  of  Brown- 
S6quard,  indeed,  his  ideas  on  the  subject,  being  so 
startlingly  in  advance,  or  shall  we  say  at  variance,  with 
our  present  ideas,  well  nigh  brought  into  possibly 
unmerited  contempt  a  reputation  established  on  a  life 
time  of  solid  and  conscientious  observation.  Is  it 
possible,  as  suggested  by  the  orator,  that  there  is  a 
substratum  of  truth  underlying  the  hypothesis  which  it 
is  the  present  custom  to  allude  to  only  to  deride  1    Our 


534     Thm  Mbdioal  Puns. 


NOTES  ON  CURRENT  TOPICS. 


Mat  20, 1896. 


reprodactive  cells  represent  the  only  physiologically 
immortal  parts  of  as,  oar  whole  life  is  apparently 
centred  roand  them,  oar  growth,  oar  development,  oar 
very  existence,  have  apparently  bat  one  object— their 
prodaction,  and  when  this  fanction  ceases  oar 
physiological  existence  is  virtaally  at  an  end  and  there 
remains  for  as  bat  to  die.  Is  it,  as  Dr.  Allchin 
saggests,  that  the  abrogation  of  this  fanction  deprives 
the  organism  and  the  protoplasm  of  which  it  is  bailt, 
of  the  stimalas  necessary  to  the  metabolic  changes 
apon  which  depend  the  maintenance  of  the  tiasaes  ? 
Even  if  we  concede  this  bold  hypothesis  we  are  fain  to 
admit  that  the  qaestion  is  bat  shifted.  Why  does  the 
stimulas  cease?  The  activity  of  the  reprodactive 
processes  is  more  or  less  an  indication,  if  not  a  corollary, 
of  the  vitality  of  the  particalar  organism,  and  economy 
in  this  direction  is  no  gaarantee,  even  remote,  of 
longevity.  If  reprodactive  fatigae  be  the  antecedent 
of  mortality  then  the  anmarried,  or  at  any  rate  the 
continent,  ought  to  gain  a  prolongation  of  life,  bat  this 
we  hasten  to  affirm  is  contrary  to  observation  and 
experience.  While,  therefore,  we  are  gratefal  to  Dr. 
Allchin  for  having  led  as  into  pastures,  which,  if  not 
new,  are  comparatively  anfreqaented,  we  feel  some- 
what despondingly  that  he  has  bat  stirred  the  embers 
of  a  fire,  a  desire  for  a  knowledge  of  the  unknowable, 
which  has  burned  within  the  bosoms  of  humanity  ever 
since  the  dawn  of  reason. 


SIR  JOHN  WILLUMS  AND  THE  QUESTION 
OF  PRIVILEGE. 
Fob  many  reasons,  we  should  be  glad  to  avoid  any 
reference  to  the  recent  case  of  "  Kitson  v.  Playfair," 
for  we  cannot  but  think  that  both  parties  were 
greatly  to  be  pitied  for  the  misunderstanding  that 
arose  between  them.  There  is  one  question,  however, 
which  was  introduced  in  the  course  of  the  action,  of 
serious  importance  to  the  public  and  the  profession  at 
large,  thoogh  it  had  really  little  or  nothing  to  do 
with  the  case  itself,  namely,  the  question  of  *'  privi- 
lege.'*  In  an  annotation  on  the  5th  inst.,  we  remarked 
that  in  the  trial  in  question  Sir  John  Williams  had 
stated  that  the  Royal  College  of  Physicians  had  pub- 
lished their  opinion  on  the  question  of  privilege  in 
regard  to  the  divulging  of  professional  confidences. 
In  reply  to  this,  Sir  John  stated  in  our  last  issue 
that  this  was  not  so.  It  is  in  consequence  of  this 
letter  that  we  feel  compelled  to  deal  rather  fully 
with  this  subject  This  letter  was  dated  April  10th, 
although  we  received  it  on  May  11th.  W,e  draw  atten- 
tion to  this  little  inaccuracy  as  an  indication  of  want  of 
care  on  Sir  John  Williams'  part,  which  makes  us  hesitate 
in  accepting  very  readily  his  correction  of  the  report  in 
the  Times  of  the  answer  which  he  gave  to  Mr.  Justice 
Hawkins,  relating  to  the  Royal  College  of  Physicians 
of  London.  If  the  Times  was  incorrect  in  its  report,  the 
same  must  be  said  of  other  leading  journals,  but  what- 
ever Sir  John  Williams  may  think  he  said  in  court,  or 
meant  to  say,  it  is  far  more  likely  that  the  Times  was 
correct  than  otherwise.  We  now  proceed  to  ask  some 
questions  as  to  what  really  has  occurred  at  the  Royal 
College  of  Physicians.    We  cannot  understand  what  Sir 


John  Williams  means  by  saying  that  "  the  subject  has 
not  been  considered  by  the  College  of  Physicians,"  and 
yet  that  ^  the  last  legal  opinion  upon  that  question 
obtained  by  the  College  of  Physicians  is  *  yes.'  "  It 
looks  as  if  the  College  must  have  had  the  subject 
under  consideration,  for  their  subcommittee  was 
appointed  on  November  22nd,  and  we  believe 
that  Sir  John  Williams  was  a  member  of  it. 
We  think  that  the  College  of  Physicians  ought  now  to 
make  known  to  the  profession  and  the  public  what  the 
legal  opinion  was  to  which  he  refers.  It  was 
quite  clear  that  Mr.  Justice  Hawkins  took  a  veiy 
different  view  from  that  expressed  in  this  ''legal 
opinion  "  if  Sir  J.  Williams  stated  it  fairly  in  Court 
It  would  be  well  for  the  College  to  have  another 
opinion  from  counsel  if  this  is  the  case,  for  the 
view  taken  generally,  as  expressed  by  Mr.  Justice 
Hawkins,  of  what  ought  to  be  the  conduct  of  medical 
practitioners  in  cases  like  that  of  Kitson  v.  Playfair 
does  not  agree  with  that  now  advanced,  we  presume, 
by  the  College  of  Physicans.  It  is  very  likely 
from  the  way  in  which  Sir  J.  Williams  has  acted  that 
he  has  not  stated  quite  correctly  what  the  legal  opinion  is 
which  the  College  of  Physicians  has  received  from  its 
learned  counsel,  for  whose  reputation  and  character 
we  think  the  College  ought  to  be  careful.  We  can  well 
understand  Mr,  Justice  Hawkins  saying,  ^  Well,  it  will 
make  me  chary  in  selecting  my  medical  man.**  If  the 
College  of  Physicians  thinks  that  it  is  quite  superior 
to  public  opinion  and  to  that  of  the  great  body  of  the 
profession,  we  predict  for  it  consequences  sooner  or 
later  of  no  pleasant  character.  The  Fellows  of  the 
Royal  College  probably  feel  but  little  interest  in  such 
a  case  as  that  of  Kitson  v.  Playfair,  but  they  ought  to 
be  careful  how  they  allow  the  name  of  their  College  to 
be  mentioned  in  Court,  and  their  Senior  Censor  to  give 
evidence  which  brings  them  into  a  position  not  con- 
sistent with  that  high  character  which  ought  never  to 
be  assailed  without  notice.  Apart  from  the  honour  of 
the  College  of  Physicians  itself,  and  quite  apart  from 
professional  advantage,  it  is  of  serious  import  to  pre- 
serve that  confidence  which  patients  have  felt  would 
never  be  abused,  and  in  which  it  was  such  a  relief  to 
the  sufferer  to  indulge. 


^0tc0  on  dtttrent  ^opicB. 

The  Apothecaries'  Hall  of  Ireland  and  the 

Privy  Council. 
The  appeal  of  the  *'  Hall "  from  the  decision  of  the 
General  Medical  Council  was  heard  by  the  Privy 
Council  on  the  11th  inst  It  will  be  recollected  that 
after  the  conjunction  between  the  "Hall"  and  the  Irish 
College  of  Surgeons  had  been  dissolved  the  ''  Hall " 
applied  to  the  Medical  Council  for  power  to  appoint 
surgical  examiners,  as  indicated  by  the  Medical  Act,  to 
enable  it  to  carry  on  its  examinations.  The  Medical 
Council  refused  this  application,  and  the'*  Hall "  had, 
therefore,  no  alternative  but  to  availitself  of  the  appeal 
to  the  Privy  Council  provided  by  the  Act,  for  bodies 
which  feel  themselves  aggrieved  by  the  decisions  of  the 
Medical  Council    The  ''Hall"  enforced  its  appeal  by 


ilAT  20,  1806. 


l^OTES  Oil  CtJRRElrtf  TOt>lCS 


Tn  iixDiGAL  Pbbm.     ^35 


representing  that  it  had  been  disfranchised  because  one 
single  candidate  had  been,  against  the  judgment  of  the 
inspectors,  passed  through  one  single  subject  of  an 
examination  of  which  the  inspectors  approved,  and, 
furthermore,  by  the  suggestion  that  the  "  Hall "  had 
been  prevented  from  carrying  on  its  examinations 
to  perfection  by  reason  of  the  persistent  hos- 
tility of  the  Irish  College  of  Physicians,  which 
ia  really  the  accusing  party  in  the  dispute. 
The  Medical  Council  answered  that,  on  several 
occasions  the  examinations  in  medicine  of  the  **  Hall's  " 
conjunction  were  reported  by  the  Councirs  Inspectors 
to  be  defective  and  insufficient,  and,  as  a  matter  of 
course,  it  disclaimed  all  hostility  or  partiality  against 
the  "Hall."  The  hearing  of  the  case  by  the  Privy 
Council  has,  so  far,  resulted  in  a  score  for  the  "  Hall." 
The  Privy  Council  did  not  see  its  way  to  grant  Exam- 
iners in  Surgery  only,  inasmuch  as  it  was  not  in  that 
subject  that  the  tests  were  declared  to  be  defective, 
but  it  seemed  to  consider  it  reasonable  that  the  Medical 
Council  should  enable  the  ''  Hall "  to  carry  on  by 
granting  Examiners  in  both  Surgery  and  Medicine,  and 
it  adjourned  the  further  hearing  of  the  matter  to  allow 
of  the  ''  Hair*  making  such  application  to  the  Medical 
Council.  That  application  will  be  heard  by  the  Medi- 
cal Council  at  its  meetiog  in  June,  and  it  remains  to 
be  seen  whether  the  combined  forces  of  the  English  and 
Irish  Colleges  of  Physicians  will  be  strong  enough  to 
defeat  the ''  Hall"  and  the  considerable  section  of  the 
Council  which  desires  to  give  fair  play  to  it.  If  they 
are  sufficiently  influential  to  do  so,  it  will  be  necessary 
for  the  **  Hall "  to  go  back  again,  on  appeal,  to  the 
Privy  Council,  and,  as  far  as  any  one  can  see  at  present, 
it  seems  likely  that  the  Privy  Council  will  give  the  addi- 
tional Examiners  whether  the  Medical  Council  likes 
it  or  not. 


The  Chelsea  Hospital  for  Women  and  its 
Honorary  Medical  Staff. 
The  annual  meeting  of  the  Governors  of  the  Chelsea 
Hospital  for  Women  will  take  place  to-day  (Wednesday), 
with  Lord  Glenesk,  the  Chairman  of  the  Council,  in 
the  chair,  and  in  respect  of  this  meeting  a  correspon- 
dent has  been  good  enough  to  forward  us  a  copy  of  the 
agenda  paper.  This  latter,  it  cannot  be  disputed,  is  a 
remarkable  document,  and  is  probably  unprecedented 
in  the  history  of  any  medical  charity,  either  in  this 
great  Metropolis  or  elsewhere.  The  Governors  of  the 
Hospital,  we  learn,  will  be  called  upon  to  adopt  the 
following  laws  relating  to  the  appointments  of  the  Hon- 
orary Medical  Staff : — 

"  (1)  Svspermon :  A  member  of  the  Honorary  Medi- 
cal Staff  may  be  suspended  from  duty  for  not  longer 
than  one  calendar  month  by  resolution  of  the  weeklv 
Board,  and  notice  of  a  special  Council  meeting  shall 
be  immediately  given  to  consider  the  case. 

*'  (2)  BemovcU :  A  member  of  the  Honorary  Medical 
Staff,  whether  previously  suspended  or  otherwise,  may 
be  removed  by  a  majority  of  not  less  than  three-fourths 
of  the  members  present  at  a  Council  meeting  speciallv 
convened,  by  not  less  than  seven  days'  notice,  which 
notice  shall  state  that  the  meeting  is  to  consider  a 
matter  concerning  a  member  of  the  staff.  The  member 
of  the  staff  in  question  shall  have  an  opportunity  of 


appearing  before  the  Council  to  give  explanations.  A 
member  so  removed  shall  ipso  facto  cease  to  be  a  mem- 
ber of  the  Honorary  Medical  Staff." 

These,  then,  are  the  new  regulations  to  which  the 
Governors  are  to  be  asked  to  give  their  consent  at  the 
meeting  to-day.  The  only  reason  that  we  can  see  for 
these  proposals  on  the  part  of  the  Weekly  Board  is, 
that  they  see  rocks  ahead,  and  are  wishful  to  be  well 
prepared  for  all  emergencies.  Of  course,  if  the  new 
rules  are  adopted,  the  whole  control  of  the  medical 
staff  will  be  placed  in  the  hands  of  that  individual 
member  of  the  Board  who  is  able  to  pull  the  most 
wires,  and  no  one  will  be  prepared  to  dispute  that  in 
the  management  of  the  Chelsea  Hospital  for  Women, 
the  wire-pulling  has  not  latterly  been  "  immense."  Thus, 
we  hold  strongly  to  the  opinion  that  the  new  rules, 
above  suggested,  are  derogatory  in  character,  unworthy 
iu  motive,  and  emphatically  in  this  instance,  opposed 
to  the  well-being  of  the  institution.  When  Mr. 
O'Callaghan  was  thrown  over  board  by  the  Weekly 
Board,  the  incident  reminded  us  of  the  story  of  Jonah 
who  was  kindly  provided  with  a  saloon  passage  by  a 
sagacious  whale,  and  landed  without  any  mishap  on  a 
lee  shore.  Jonah  thus  was  none  the  worse,  and  the 
ship  from  which  he  was  cast  successfully  weathered 
the  storm.  But  there  is  great  doubt  whether  the  pros- 
pects of  the  Chelsea  Hospital  for  Women  are  any 
brighter  by  the  policy  which  has  recently  been  pur- 

su^.  

The  Place  of  Science  in  Education. 

It  is  somewhat  of  a  surprise  at  this  end  of  the 
nineteenth  century  to  be  told  on  the  authority  of  no 
less  a  personage  than  the  Bishop  of  London  that  the 
teaching  of  science  in  elementary  schools  is  ^'  a  very 
great  evil "  which  might  advantageously  be  got  rid  of 
entirely.  It  has  always  appeared  to  us  a  desirable  thing 
that  people  should  know  that  the  liver  is  not  in  the 
right  groin,  and  that  the  heart  occupies  a  position 
somewhere  below  the  left  nipple,  but  his  lordship  thinks 
otherwise,  and  he  resents  the  idea  that  little  children 
should  be  taught  to  regard  the  thunder  as  a  natural 
phenomenon  due  to  perfectly  understandable  causes. 
If  our  system  of  education  is  open  to  criticism  as 
compared  with  that  of  other  European  countries  it  is 
precisely  by  reason  of  the  scant  attention  devoted  to 
scientific  matters,  a  neglect  which,  if  persisted  in,  will 
ere  long  place  the  nation  in  a  position  of  hopeless 
inferiority.  Go  where  we  will  through  the  world  we 
find  German  chemists  at  the  head  of  every  industry 
into  which  science  enters.  Even  in  our  own  land 
German  analysts  hold  the  field,  and  some  of  the  most 
important  posts  under  the  Government  are  in  their 
possession,  and  rightly  so,  for  our  system  of  education 
does  not  provide  an  adequate  supply  of  the  native 

article.  

The  West  London  HospitcJ. 

The  immense  district,  containing  a  population  of 
upwards  of  600,000,  to  the  sick  poor  of  which,  the  West 
London  is  the  nearest  general  Hospital,  has  impelled 
the  Board  of  Managers  to  provide  an  additional  ser- 
vice of  beds.  As  part  of  the  scheme  of  enlargement  a 
new  east  wing  has  just  been  built,  with  corridors  on  each 
floor  uniting  it  with  the  main  building.   So  far,  some 


586     TBI  tdiDioAL  Press. 


HOTEH  ON  CURRENT  TOPICS. 


Mat  20.  1896 


seyenty-three  more  beds  will  be  available  in  conse- 
quence of  the  present  enlargement.  With  a  view  to 
raising  fands  to  meet  this  new  expenditure  a  grand 
bazaar  and  f^te  will  be  opened  to-morrow  (Thursday) 
at  3.30  p.m  ,  in  the  new  wing  by  H.R.H.  the  Princess 
of  Wales.  It  is  expected  that  His  Royal  Highness 
the  Prince  of  Wales  will  also  be  present  together 
with  the  Princesses  Victoria  and  Maud.  The 
Countess  of  Ilchester  will  perform  the  opening 
ceremony  on  the  second  day.  A  feature  of  the  occasion 
will  be  a  series  of  entertainments  given  by  members  of 
the ''  Savage  Club  "  during  the  afternoons  and  evenings 
in  which  the  bazaar  is  open.  Moreover,  variety  enter- 
tainments, in  which  eminent  artists  from  nearly  all  the 
London  theatres  and  a  few  distinguished  amateurs 
will  assist,  have  been  arranged  for.  In  every 
way  the  bazaar  and  fite  should  attract  crowds 
to  spend  their  money  for  the  benefit  of  this 
deserving  institution,  and  we  trust  that  the  financial 
result  will  exceed  all  expectations. 


Health  BoBorte  and  Oonsumptives. 

Thb  following  instructive  note  appeared  in  a  recent 
number  of  the  Journal  of  Hygiene ;— "  Forty  years 
ago  Mentone  was  a  happy  village  in  France,  where 
lived  peasantry  happy  in  their  farms  and  in  their 
superb  physical  state,  conditioned  by  the  climate.  It 
was  discovered  that  the  region  was  a  most  healing  one 
for  consumptives,  and  it  became  the  Mecca  for  the 
unfortunates  of  Europe  so  stricken.  The  inhabitants 
abandoned  their  farms  to  wait  upon  the  strangers. 
The  strong  healthy  women  forsook  their  dairies  and 
became  the  washerwomen  of  the  consumptives'  clothes. 
No  precautions  were  taken  ;  the  disease  was  not  then 
understood  as  now,  the  theory  of  the  tubercle  bacillus 
not  having  been  discovered.  The  place  to-day  is 
bacillus-ridden,  a  pest  hole,  death  itself.  The  hitherto 
strong  inhabitants  are  emaciated,  a  coughing,  bleeding 
people,  filled  with  the  germs  of  consumption.  The  soil 
and  air  are  both  contaminated  with  the  tubercle  bacilli. 
It  is  no  longer  a  health  resort.''  The  same  fate,  it  is  be- 
lieved, awaits  many  other  similar  localities  unless  active 
measures  are  taken  to  destroy  all  germs.  This  will  be 
a  most  difficult  task,  because  consumptives  themselves, 
as  a  rule,  are  not  thoughtful  of  the  danger  they  spread, 
or  of  the  rights  of  others.  They  should  bear  in  mind 
that  if  all  others  had  been  careful  they,  too,  might 

have  escaped.  

The  Death  of  a  Medical  Centenarian. 

Mb.  William  Reynold  Salmon,  whose  death 
occurred  last  week,  had  reached  the  extraordinary  age 
of  106  years,  having  been  born  on  March  16th,  1790,  a 
fact  of  which  ample  documentary  evidence  exists.  He 
was  admitted  a  Member  of  the  Royal  College  of  Sur- 
geons, England,  as  long  ago  as  the  year  1812.  He  was, 
therefore,  by  far  the  oldest  member  of  that  body. 
His  death  has  certainly  severed  a  wonderful 
link  with  the  past.  For  example,  when  he  was 
about  twenty-four  years  of  age  the  battle  of 
Trafalgar  was  fought,  and  he  remembered  well 
the  profound  sensation  caused  in  this  country  by 
Nelson's  death.    Again,  he  was  one  of  the  earliest 


arrivals  in  Paris  after  the  news  had  been  received  there 
of  Well  ington's  crowning  achievement  at  Waterloa  But 
the  battlefield  had  more  attractions  for  him  than  the 
fascinations  of  the  capital.  He  at  once  made  his  way  to 
Brussels  to  find  one  half  of  the  city  a  hospital ;  after- 
wards he  explored  the  scene  of  the  great  encounter 
while  there  were  yet  bodies  unburied  and  survivors  of 
the  conflict  to  tell  from  their  own  knowledge  how  the 
field  was  fought.  Another  point  of  interest  in  his  life 
was  that  he  was  the  oldest  Freemason  in  the  country, 
having  been  one  of  the  original  members  of  the 
*' Jerusalem  Lodge,"  in  London.  But  it  has  not  been 
possible  to  ascertain  the  exact  date  of  his  initiation, 
although  there  are  records  showing  his  membership  of 
the  lodge.  Curiously  enough  at  the  age  of  ninety,  he 
took  to  smoking,  but  the  habit  disagreed  with  him,  and 
he  soon  gave  it  up,  and  ever  afterwards  he  could  scarcely 
tolerate  even  the  smell  of  tobacco  smoke.  In  1816  he 
married  an  heiress  under  romantic  circumstances,  and 
from  that  time  he  had  no  need  to  continue  practising 
his  profession.  Thenceforward  for  many  years  his 
chief  pastime  was  travelling ;  most  of  his  time  was 
spent  in  London,  or  on  the  Continent,  while  he  paid 
only  occasional  visits  to  his  Glamorganshire  estate,  to 
which  he  finally  retired  at  the  age  of  seventy.  His  wife 
died  many  years  ago.  He  has  left  an  invalid  daughter 
whose  son  will  inherit  the  property. 

Lead  Poisoning. 
The  results  of  notification  of  cases  of  lead-poisoning 
during  the  last  two  months  prove  the  extent  of  the 
mischief  among  our  labour  poptdation.  During  the 
month  of  February  63  cases  were  formally  reported  to 
the  Factory  Department  under  Section  29  of  the  1895 
Act.  In  March  the  number  was  65,  of  whom  38  were 
adult  males  and  21  females,  4  male  young  persona,  and 
2  female  young  persons.  There  can  be  no  doubt  that 
many  cases  of  obscure  nervous  and  chronic  wasting 
disease,  as  well  as  much  rapid  and  acute  illness,  are  due 
to  poisoning  by  the  metal  in  question.  Indeed,  it  is 
impossible  to  surmise  the  extent  of  the  ravages  effected 
by  this  most  insidious  poison  among  the  population  of 
any  large  manufacturing  town.  Recent  factory  legisla- 
tion can  hardly  fail  to  be  beneficial,  if  only  by  calling 
general  attention  to  the  existence  of  the  evil  and  by 
furnishing  data  for  future  action.  One  thing  is  certain, 
namely,  that  an  insoluble  and  comparatively  inert  lead 
salt  could  be  substituted  for  the  dangerous  "  white  " 
lead  now  in  common  use.  It  is  likely  that  the  com- 
pulsory substitution,  now  mainly  avoided  on  the  score 
of  cost,  will  forma  main  feature  of  future  reform.  The 
principle  involved  is  a  cardinal  one,  namely,  that  the 
pocket  of  the  employer  must  not  be  saved  at  the 
expense  of  the  health  of  the  workman. 

The  Midwives'  Be^tration  Bill. 
This  measure  has,  in  all  probability, been  effectually 
shelved  for  the  present  year.  It  stands  on  the  Notice 
Paper  of  the  House  of  Commons  for  June  10th,  but, 
before  that  time  arrives,  it  is  almost  certain  that  the 
Government  will  have  taken  the  entire  time  of  the 
House,  and  shut  out  all  private  bills. 


Mat  20,  ISM. 


>tOTES  ON  CUKRENT  TOMCJS. 


'fmi  Mbdioal  Pr«8.     53? 


The  Deadlock  at  the  Liverpool  Lying-in 
Hospital. 
On  the  11th  inst.,  a  very  largely  attended  meeting 
of  medical  men  and  medical  leaders  of  Liverpool  and 
district,  was  held  at  the  Medical  Institution,  Dr. 
Macfie  Campbell  in  the  chair.  A  resolution  was 
almost  unanimously  passed  to  the  effect  that  the  medi- 
cal profession  of  Liverpool  and  neighbourhood  viewed 
the  action  of  the  Board  of  Management  of  the  Ladies 
Charity  and  Lying-in  Hospital  with  much  indignation, 
and  that  it  was  the  wish  of  the  meeting  that  no  one 
should  fill  the  offices  of  those  excluded,  and  that  from 
the  19th  inst,  no  medical  man  should  attend  patients 
of  the  Charity  for  gain  or  otherwise,  except  at  the 
express  wish  of  the  patient  or  her  friends,  i.e.,  that 
from  that  date  the  Charity,  its  Board  of  Manage- 
ment and  Officers  should  be  completely  ignored. 
It  is  generally  believed  that  the  action  of  the  Board  of 
Management  has  in  some  way  been  motived  by  a  desire 
to  further  the  cause  of  education  and  registration  of 
midwives.  If  this  be  so,  the  Board  have  completely 
failed  to  take  in  the  situation.  There  is  no  chance  of 
a  Registration  Bill  passing  so  long  as  the  whole  medical 
profession  is  united  in  opposing  it,  and  here  we  have 
a  body  doing  its  very  utmost  to  set  the  whole  profes- 
sion against  them,  and  consequently  rendering  unattain- 
able the  object  at  which  it  is  aiming.  We  understand 
that  a  medical  woman  from  Stockport  is  acting  as  in- 
structor to  the  present  class  of  pupil  midwives. 

A  Novel  Clcum  for  Compensation. 
The  Corporation  of  Yarmouth  have  just  had  to 
consider  a  claim  made  upon  them  for  compensation 
by  the  executors  of  a  flourishing  tradesman  whose 
death  is  alleged  to  have  resulted  from  their  negligence. 
In  carrying  out,  some  time  ago,  certain  drainage  works 
in  one  of  the  streets  in  the  town  the  workmen  un- 
happily perforated  the  well  from  which  the  tradesman 
obtained  his  water  supply.  The  result  was  that  the 
well-water  became  contaminated  with  sewage,  render- 
ing it  entirely  unfit  either  for  drinking  or  domestic 
purposes.  No  intimation  was  given,  so  it  is  stated,  of 
what  had  occurred  to  the  unfortunate  owner  of  the 
well,  who  continued  as  before  to  use  the  water,  and 
the  consequence  was  that  he  contracted  typhoid,  and 
after  a  short  illness  died.  Up  to  the  time  of  his 
seizure  the  deceased  had  always  ei^oyed,  it  is  con- 
tended, perfect  health,  while  his  business  was  in  a 
flourishing  condition  and  rapidly  increasing.  By  his 
death  his  wife  and  two  children  have  been  left  almost 
unprovided  for.  In  view  of  all  these  facts,  a  claim  of 
£3,000  has  been  made  for  compensation,  but  the  claim- 
ant's solicitor  has  considerately  intimated  that  £1,500 
would  be  accepted  in  lieu  of  the  larger  sum  if  paid  imme- 
diately. The  Corporation  have  dispassionately  dis- 
coBsed  the  matter,  and  have  arrived  at  the  conclusion 
to  repudiate  all  liability,  while,  at  the  same  time,  they 
have  deputed  their  town  clerk  to  defend  any  action 
brought  against  them.  The  features  of  this  claim  are 
not  without  interest,  and  if  the  case  be  proceeded  with 
probably  a  good  many  corporations  will  await  the 
result  with  more  than  ordinary  curiosity. 


The  Fatal  Chloroform  Administration  by  an 
Unqualified  Dentist. 
A  FEW  weeks  since  we  reported  a  case  in  which 
death  followed  the  administration  of  chloroform  to  a 
servant  girl  by  an  unqualified  dentist.  With  remark- 
able dispatch,  the  case  has  been  tried  at  Leedp,  where 
the  prisoner,  described  as  a  herbalist,  was  charged 
with  manslaughter.  The  evidence  showed  that  half  an 
ounce  of  chloroform  was  given  to  the  patient  shortly 
after  she  had  eaten  a  hearty  meal,  and  that  no  one  was 
present  in  the  room  other  than  the  administrator  ai  d 
the  patient.  Mr.  Justice  Wright  said  the  question  was 
whether  the  accused  had  taken  proper  precautions. 
It  was  said  the  dress  and  stays  ought  to  have  been 
loosened ;  the  chloroform  ought  not  to  have  been 
administered  after  a  heavy  meal ;  and  there  ought  to 
have  been  remedies  ready  at  hand,  and  some  person  to 
watch  and  apply  the  remedies  if  anything  went  wrong. 
It  really  came  to  this  :  Was  he  guilty  of  criminal  neg- 
ligence in  using  chloroform  when  he  did  not  know 
more  about  it  ?  The  jury,  after  prolonged  consideration, 
returned  a  verdict  of  not  guilty.  This  merciful  view  of 
the  case  is  a  fortunate  one  for  the  unqualified  dentist, 
and  it  is  to  be  hoped  that  his  experience  will  act  as  a 
warning  to  others  who  may  feel  inclined  to  undertake 
the  administration  of  anaesthetics  without  a  full  know- 
ledge of  the  subject.  For  a  fully-qualified  and  presum- 
ably competent  practitioner  to  administer  an  anaesthe- 
tic alone,  and  for  his  own  operation,  would  be  grossly 
indiscreet,  and  it  cannot  be  tolerated  that  ignorant 
persons  shall  be  permitted  to  risk  life  in  such  way. 

Sir  Joseph  Lister. 

Sir  Joseph  Listbb,  as  has  already  been  announced, 
is  the  President  of  the  British  Association  this  year, 
and,  doubtless,  partly  in  consequence  of  this,  our  con- 
temporary. Nature^  has  published  in  its  columns  a  sym- 
pathetic biographical  account  of  the  great  surgeon,  con- 
tributed by  Professor  H.  Tillmanns.  In  addition,  an 
excellent  photogravure  of  Sir  Joseph  accompanies  the 
paper.  *'  As  long  as  there  is  an  earthly  immortality  it 
must  be  his,  for  as  long  as  ever  surgery  is  scientifically 
discussed  his  name  cannot  fail  to  be  mentioned."  Such 
are  the  closing  words  with  which  Professor  Tillmanns 
feelingly  shows  his  admiration  for  our  countryman. 
Apart,  however,  from  the  interest  which  must  natur- 
ally be  felt  in  a  description  of  Sir  Joseph  Lister's  work, 
the  sketch  is  worthy  of  note  as  emphasising  the  praise- 
worthy way  in  which  German  surgeons  from  the  first 

adopts  d  his  teaching.      

Congress  of  German  Surgeons. 

The  twenty-fifth  Congress  of  German  Surgeons  will 
be  held  on  May  27th,  and  the  following  days.  Among 
the  more  important  subjects  arranged  for  discussion 
are  the  following :  The  Treatment  of  Goitre,  by  Professor 
Brnns,  of  Tubingen  ;  the  History  of  a  case  of  Local 
Tuberculosis  of  twenty-five  years  duration,  by  Professor 
Koenig,  of  Berlin ;  the  Surgery  of  the  Stomach  and 
Intestines,  by  Professor  W.  Wolfler,  of  Prague ;  the 
Surgical  Treatment  of  Appendicitis,  by  Dr.  Sonnen- 
burg,  of  Berlin  ;  SurgicaJ  Interference  in  cases  of 
Diseases  of  the  Biliary  Passages,  by  Professor  Langen- 
beok,  of  Berlin. 


538     Ths  Mbdigal  Pbiss. 


IfOTfcS  OK  CUkRENt  TOPieS. 


Mat  20,  IdM 


How  Scarlet  Fever  is  Spread. 

Thebe  can  be  little  hope  of  effectually  checking  the 
spread  of  scarlet  fever  until  the  public  at  large  becomes 
educated  to  a  proper  sense  of  responsibility  in  the 
matter.  This  general  proposition  is  suggested  by  a 
prosecution  for  neglecting  to  report  scarlet  fever,  the 
news  of  which  comes  from  Yorkshire.  From  the  news- 
paper report  it  appears  that  a  county-inspector  visited 
the  house  of  a  milk-seller,  and  found  a  child  suffering 
from  scarlet  fever.  The  defendant  admitted  that  the 
girl  had  been  ill  for  a  fortnight  during  which  time  he 
had  g3t  her  medicine  from  a  chemist  in  Wakefield. 
At  the  same  time  he  stated  that  she  was  kept 
in  a  room  by  herself;  disinfectants  were  used; 
and  neither  the  milk  nor  the  milk  cans  went  near  the 
house.  A  moderate  fine  was  imposed,  as  the  prosecu- 
tion did  not  press  for  a  heavy  penalty.  This  case 
brings  forward  a  number  of  points  of  great  interest. 
Here  we  have  a  dairyman  in  a  fairly  large  way  of 
business— he  kept  seven  cows  of  his  own— wilfully 
concealing  from  the  authorities  the  fact  of  the  exist- 
ence of  an  infectious  disease  in  his  family.  To  make 
matters  worse,  he  had  five  other  children,  one  of  whom 
was  actually  attending  school  during  the  illness  of  her 
sister.  From  these  statements  it  appears  that  the 
reckless  dairyman  may  have  spread  scarlet  fever 
through  the  county  wholesale,  and  we  altogether  fail 
to  see  why  he  should  escape  severe  and  summary 
punishment.  The  fact  that  dairymen  suffer  loss  by  the 
temporary  closing  of  their  shutters,  no  doubt,  affords 
the  key  to  criminal  recklessness  of  the  kind  in  question. 
It  is  likely  that  the  evil  will  continue  until  the  sani- 
tary authority  is  empowered  to  compensate  milksellers 
during  compulsory  closure.  Such  a  step,  in  the  long 
run,  would  probably  cost  ratepayers  less  than  they 
have  to  pay  for  infectious  diseases  under  the  present 

system.  

Blood  Brotherhood. 

Blood  brotherhood,  as  practised  in  Central  Africa,  is 
a  formality  which  consists  in  making  an  incision  on 
the  right  wrists  of  the  two  persons  desirous  of  acquiring 
this  relationship,  just  sufficient  to  draw  blood,  a  little 
of  which  is  seraph  off  and  smeared  on  the  other's  cut. 
It  appears  that  European  travellers  do  not  often 
favour  the  rite,  indeed,  according  to  a  correspondent 
of  Nature,  only  Mr.  Stanley  is  known  to  have  gone 
through  the  process.  It  happens  that  Mr.  Stanley  was 
singularly  exempt  from  malarial  disease,  and  on  this 
slender  foundation  the  correspondent  in  question 
ventures  to  formulate  a  plan  by  which  travellers  in 
malarial  districts  are  to  be  protected  against  the 
malarial  parasite,  assuming  that  there  is  such  an  one, 
for  its  existence  has  been  denied  on  high  authority.  As 
no  kind  of  treatment  has  much  chance  of  success  in 
these  days  which  is  not  more  or  less  remotely  based 
on  Pasteurian  methods,  he  explains  that  the  probable 
effect  of  the  inoculation  is  to  confer  on  the  blood- 
brother  the  immunity  which  he  assumed  to  be  possessed 
by  the  natives  of  malarious  regions.  He  opines  that 
no  larger  quantity  of  blood  would  be  required  than  is 
used  as  lymph  in  ordinary  vaccination,  and  he  is  careful 
to  add  that  there  would  be  no  difficulty  in  obtaining 


an  adequate  supply  of  healthy  natives  who  would  be 
ready  and  willing,  for  a  consideration,  to  impart  their 
protection.  This  gentleman  evidently  does  not  con- 
sider the  matter  ripe  for  immediate  application,  but  he 
makes  bold  to  say  that  experiments  conducted  on 
these  lines  would,  in  all  probability,  result  in  the 
acquisition  of  much  useful  and  valuable  information. 
We  note  that  he  dates  his  communication  from 
Greenock,  which  is  not  a  part  of  the  world,  if  we  are 
correctly  informed,  where  malaria  is  rampant,  and  this 
may  account  for  his  childlike  faith  in  the  efficacy  of 
this  simple  procees,  a  faith  which  is  of  the  theological 
variety,  since  it  is  not  based  on  facts  which  admit  of 
scientific  demonstration.. 

Eczema  Mistaken  for  Small-pox. 
The  history  of  a  most  undesirable  mistake  in  dia- 
gnosis comes  from  a  borough  in  the  North  of  England. 
The  attention  of  the  Council  of  the  town  in  question 
was  called  to  the  fact  that  last  October  a  patient,  re- 
ported to  be  suffering  from  small-pox,  was  admitted  to 
hospital,  but  it  was  afterwards  found  that  his  disease 
was  eczema.  The  Town  Clerk  confirmed  this  state- 
ment, and  added  that  the  Medical  Officer  of  Health 
certified  the  case  to  be  small-pox.  This  unfortunate 
incident  opens  up  various  issues  of  interest  to  the 
medical  profession.  So  far  as  the  error  goes,  it  may 
have  happened  to  anyone  in  the  press  and  hurry  of 
professional  life,  although  the  use  of  a  clinical  thermo- 
meter would  probably  have  revealed  the  real  nature  of 
the  case.  Every  dermatologist  of  experience  knows  of 
a  case  or  two  of  small-pox  sent  to  a  skin  hospital  for 
treatment,  and  vice  vend,  of  skin  diseases  transmitted 
to  small-pox  hospitals.  Come  what  will  we  must 
expect  a  certain  margin  of  error  in  the  diagnosis  of 
affections  which  have  multif6rm,  variable,  and  over- 
lapping objective  signs.  Some  folks  have  always  main- 
tained, however,  that  the  average  Medical  Officer  of 
Health  is  not  the  best  judge  of  the  nature  of  specific 
febrile  eruptions.  By  the  nature  of  his  work  he  is 
carried  away  from  the  sphere  of  active  medic^  pract'c?, 
and,  unless  he  has  had  long  special  experience  of  fever 
hospitals,  he  is  tolerably  certain  to  be  caught  tripping 
now  and  then  over  atypical  forms.  In  deciding  as  to 
the  nature  of  obscure  cases  the  Medical  Officer  will 
do  well  to  give  way  to  the  general  practitioner,  pro- 
vided he  be  a  man  of  average  abilities  and  experience. 


Mr,  Pridoin  Tkale,  M.B.,  F.R.C.S.,  of  Leeds,  has 
been  elected  for  a  further  five  years  from  the  23rd 
inst.  to  serve  as  Member  of  the  General  Medical 
Council  on  Crown  nomination. 


Sir  William  M*Cormac,  F.R.C.S.,  and  Mr.  Samuel 
Osborn,  F.R.C.S.,  have  been  appointed  Knights  of 
Grace  to  the  Order  of  the  Hospital  of  St.  John  of 
Jerusalem  in  England. 


A  CORRESPONDENT  writes  US,  that  the  British  Asso- 
ciation for  the  Advancement  of  Science  will  meet  this 
year  in  Liverpool,  and  not  in  Toronto,  the  latter  city 
having  been  selected  for  next  year's  meeting. 


Uay  20, 1896. 


jNroTia  ON  current  topics 


Thb  Mbdioal  Peks.     539 


Sir  John  Millais. 
A  GOOD  deal  of  unDecessary  mystery  has  sarrounded 
the  case  of  Sir  John  Millais.  It  is  at  least  fifteen 
months  ago  that  we  heard  of  an  affection  of  the  larynx 
which  had  deprived  him  of  his  voice,  and  it  will  be  in 
the  recollection  of  all  how  painf ally  this  disability  was 
evident  at  the  Royal  Academy  Banquet  of  1895,  when 
Sir  John  took  the  chair  in  the  absence  of  the  late 
President.  Rumours  were  even  then  rife  that  the  opera- 
tion of  thyrotomy  was  advised,  but  as  the  hoarse 
ness  was,  at  that  time,  the  only  symptom  present, 
more  moderate  counsels  prevailed,  and  we  were  later 
assured  of  a  great  improvement  in  general  health  and 
body  weight.  Since,  however,  his  election  as  Presi- 
dent of  the  Royal  Academy  on  the  death  of  Lord 
Leighton,  an  exacerbation  has  occurred,  and,  as  we  are 
nf ormed,  "  warty  growths "  became  manifest.  From 
this  date,  to  the  voice-failure  must  be  added  distress 
in  breathing.  Relief  by  the  tracheotomy  which  was 
performed  at  midnight  last  Saturday  week,  on  appar- 
ently a  sudden  emergency,  had  been  long  urged  as 
necessary,  and  the  advisability  of  its  being  performed 
deliberately  had  been  insisted  on.  Happily,  no  injury 
has  been  done  by  the  delay,  and  the  distinguished 
patient  is  making  a  good  recovery.  Nevertheless,  the 
profession  will  understand  both  the  import  and  the 
importance  of  the  statement  that  the  constitutional 
state  of  affairs  remains  unchanged.  The  illness  of  Sir 
John  Millais  has  been  conspicuously  remarkable  for 
one  most  noticeable  detail.  Despite  the  distinguished 
position  of  the  patient  and  the  public  interest  from 
Royalty  downwards,  which  has  been  taken  in  his  wel- 
fare, no  bulletins  concerning  the  operation  were  issued 
to  which  the  signatures  of  the  medical  men 
in  attendance  were  attached.  We  must  here 
express  our  conviction  that  so  praiseworthy  an  instance 
of  a  new  departure  in  medical  ethics  is  deserving  of  the 
highest  recognition  and  commendation  of  the  pro- 
fession. The  name  of  the  surgeon  who  performed  the 
operation  of  tracheotomy  upon  his  illustrious  patient 
has  never  once  been  referred  to  in  our  lay  contempor- 
aries, and  yet  here  was  an  opportunity  for  having  his 
achievement  blazoned  forth  in  all  the  quarters  of  the 
globe.  Let  honour  be  given  to  whom  honour  is  due. 
It  gives  us  much  pleasure  to  accord  our  hearty  con- 
gratulations to  the  well-known  surgeon  in  question 
whose  dignified  attitude  upon  this  occasion  will,  we 
trust,  be  a  lesson  to  those  both  above  and  below  him 
in  position,  who  profess  much,  but  accomplish  little  in 
their  practice  of  medical  etiquette  and  advertising. 


"Made  in  Germany." 
Undeb  this  title  a  series  of  articles  has  been  pub- 
lished in  the  New  Beview,  the  purpose  of  which  has 
been  to  show  that  the  commerce  of  England  is  being 
rapidly  carried  off,  for  one  cause  or  other,  by  Continen- 
tal nations.  As  far  as  the  chemical  industry  is  con- 
cerned, .the  facts  extracted  from  the  official  returns  of 
exporta/and  imports,  appear  to  prove  beyond  a  doubt 
that  Of  eat  Britain  has  been  for  several  years  entirely 
undersold  out  of  the  market,  and  that  the  industry  is 


practically  lost  to  our  country.  No  one  who  has  studied 
the  events  of  the  past  twenty  years  can  feel  snrpriae. 
The  British  artisan  seems  to  have  made  up  his  mind 
not  to  give  more  than  14s.  for  ^1  worth  of  labour,  an4 
he  refuses  to  work  at  all  if  he  is  asked  to  give  better 
value.  The  Oerman  or  other  Continental  artisan,  beinic 
prepared  to  live  more  economically,  is  willing  to  give 
say  18s.  worth.  Naturally  the  foreign  manufacturer 
is  in  a  position  to  undersell  the  British  maker.  It 
does  not  seem  possible  to  suggest  a  remedy  until  the 
petted  British  artisan  has  been  starved  into  realisation 
of  the  fact  that  he  must  work  at  the  same  rate  of 
labour  and  remuneration  as  his  Continental  brethren. 


Where  Our  Old  Horses  Go  To. 
The  Society  for  the  Prevention  of  Cruelty  to  Animals 
prosecuted  recently  certain  persons  who  were  driving 
two  worn-out  horses  to  the  docks  for  shipment  to 
Rotterdam,  and  last  week  Mr.  Wootton  Isaacson  asked 
the  Home  Secretary  whether  he  knew  the  ultimate 
destination  of  these  animals.  Sir  Matthew  White 
Ridley  admitted  that  these  animals  were  being  con- 
veyed to  Holland,  probably  to  be  sold  as  food  and 
returned  to  England  as  sausages  or  tinned  meat,  but 
he  did  not  see  that  such  a  transaction  was  part  of  hi« 
business  to  inquire  into. 


Dispensers  for  Naval  Hospitala 
Neably  a  year  ago  we  called  attention  to  the  fact 
that  certificates  issued  by  the  Irish  Pharmaceutical 
Society  were  not  received  as  qualification  for  the  posi- 
tion of  dispensers  by  the  Naval  Medical  Department, 
although  similar  certificates  granted  by  the  London 
Society  were  recognised.  We  note  that  a  change  has 
been  made  in  the  regulations  by  which  the  Irish 
Society  is  admitted  to  equal  privileges  with  its  English 
sister.  A  further  new  rule  declares  that  the  admiwioa 
to  the  Service  as  dispenser  shall,  in  future,  be  by  com- 
petition, it  having  been,  heretc^ore,  by  selection. 

The  Registration  Craze  Agfti> 
The  vendors  of  spectacles  propose  to  follow  the 
example  of  the  plumbers,  nurses,  midwives,  and, 
perhaps,  the  chimney  sweeps  and  pork  butchers,  and  to 
get  themselves  recognised  and  registered  by  law.  At 
least,  a  Bill  with  that  object  has  been  introduced  into 
the  New  York  legislature,  which  provides  for  a  State 
Board  composed  of  spectacle  sellers,  with  a  corps  of 
examiners,  and  all  sorts  of  penalties  for  anyone  who 
sells  a  pair  of  goggles  without  a  license.  Can  trades 
unionism  go  further  ? 


London  University  Beconstruotion. 
It  was  stated  last  week  in  the  House  of  Commons 
by  Sir  John  Gorst  that  the  Privy  Council  Ofllce  is 
engaged  upon  the  compilation  of  a  Bill  for  the  reorgani- 
sation of  the  London  University  in  accordance  with 
the  recommendations  of  the  Gresham  Commission. 
The  Bill  would  probably  be  introduced  in  the  Lords, 
but  it  had  not  yet  received  the  consideration  or 
approval  of  the  Government 


540      The  Midioal  Priss. 


SCOTLAND. 


Mat  20,  189^. 


Sir  Ruasell  Beynolds. 
As  we  go  to  press  the  gravest  news  reaches  as  of  the 
illDess  of  Sir  Russell  Reynolds.  For  the  past  few 
days  his  condition  has  caased  the  greatest  anxiety  to 
his  friends  and  medical  attendants,  and  his  strength 
has  perceptibly  declined.  This  news  will  be  received, 
w  e  are  certain,  with  sincere  regret  by  all  our  readers. 

The  Preaidenoy  of  the  RO.S.  Bnglaad. 
Wb  hear  that  the  mantle  of  Mr.  Christopher  Heath 
as  President  of  the  Royal  College  of  Surgeons  of 
England  is  likely  to  fall  upon  the  shoulders  of  Sir 
William  MacCormac,  late  of  St.  Thomas's  Hospital. 
No  exception  can  be  taken  to  the  choice  of  Sir  William 
on  snrgical  grounds,  but  it  is  not  impossible  that  his 
staunch  conservatism  in  matters  concerning  collegiate 
reform  has  had  at  least  as  much  to  do  with  it  as  a  long 
and  honourable  career  in  surgery. 

Sir  William  Priestley,  M.P. 
Thb  unopposed  election  of  Sir  William  Priestley  for 
the  Universities  of  St  Andrews  and  Edinburgh  is 
satisfactory,  by  reason  of  the  fact  that  one  more 
member  of  the  medical  profession  is  added  to  the 
present  House  of  Commons.  In  politics  Sir  William  is 
a  supporter  of  the  Government.  The  last  contest 
for  the  seat  was  in  1885,  when  Sir  J.  Eric  Erichsen 
was  defeated  by  400  votes  by  Sir  C.  J.  Pearson,  Q.C. 


Dk.  W.  R.  Qowebs,  of  London,  has  been  elected  a 
foreign  correspondent  of  the  Medical  and  Surgical 
Society  of  Bologna. 

Thb  meeting  of  the  German  Ophthalmological 
Society  will  be  held  at  H:)idelburg  on  August  5th  and 
following  days. 


Board  of  Ck>ntrol,  Irish  Lunatic  Asylums. 
This  B^ard,  which  has  been  hitherto  somewhat  of  a 
namints  umbra^  has  been  constituted  for  the  ensuing 
year  by  the  appointment  of  the  two  Commissioners  of 
Asylums,  Drs.  OTarrell  and  Courtenay,  Judge 
Holmes,  Mr.  Robertson  (the  new  Chairman  of  the 
Public  Works  Board),  Dr.  Cruise,  Mr.  Drummond,  and 
Mr.  Charles  Kennedy. 

Oarbolic  Aoid  Poisonings. 
The  number  of  hum^n  lives  sacrificed  by  the  drink- 
*  ing  of  carbolic  acid,  either  accidentally  or  intention- 
ally, is  becoming  so  great  that  it  will  evidently  be 
impossible  to  allow  the  free  sale  of  it  to  continue.  Last 
week  no  fewer  than  nine  persons  met  their  death  from 
this  agent. 

Thi  Eton  Union  Guardians  have  placarded  the  town 
and  parishes  of  Eton  with  offers  to  vaccinate  and  re- 
vaccinate  gratuitously  any  person  against  small-pox. 
They  have  also  instituted  a  batch  of  prosecutions 
against  defaulters,  and  urged  the  Great  Western  Rul- 
way  to  assist  them  in  precautions  against  the  intro- 
duction of  small-pox. 

Db.  John  Andkbson,  CLE.,  F.RC.P.,  Physician  to 
the  Seamen's  "  Dreadnought  *'  Hospital,  has  been 
appointed  Lecturer  on  Diseases  of  Tropical  Climates 
at  St  Mary's  Hospital  Medical  School. 


Mr.  a.  PaARCB  Gould,  F.RCS.,  late  Assistant 
Surgeon  to  the  Middlesex  Hospital,  has  been  appointed 
Surgeon  to  that  institution. 


[raOM  0I7B  own  09BB14POerDlVf.] 

Cl(7b  Peaitiok  and  QaAOKs. — At  a  meetiiie  of  the 
Daniee  and  DlBtrict  Branch  of  the  BriUah  Medical  As- 
eociation  recently  held.  Dr.  MacEwan  gave  an  address,  in 
which,  inter  alia,  he  tpcke  of  clab  practice  and  quackery. 
Tne  romaaeration  given  to  the  medical  officers  of  soeietie* 
was  DOtorioasly  inadequate,  and  a  considerable  nnmber  of 
their  mimbers  acted  in  a  professional  capacity  to  these 
societies.  Negotiations  were  still  in  progress  between  the 
CoanCil  of  the  Branch  and  the  societies,  and  he  hoped  that 
they  would  have  the  desired  result.  At  the  last  annual 
meeting  of  the  Association  in  London  a  resolution  was 
parsed  asking  the  Council  to  take  means  to  protect  the 
individual  and  collective  interests  of  the  profession.  Tne 
most  important  part  which  the  Association  would  have  to 
do  if  the  resolution  were  agreed  to,  was  the  suppreeeion  of 
illegil  praccioe.  For  this,  however,  amendment  of 
the  Medical  Acts  was  necessary.  In  spite  of  the 
much  vaunted  increase  of  learning,  impostors  were  as 
numerous  as  ever,  and  not  onlv  the  partially  educated 
but  the  so-called  highly  eduoatea,  had  recourse  to  them. 
The  advertisement  columns  of  the  daily  papers  were 
sufficient  evidence  that  this  was  so.  Not  long  ago  it 
had  been  stated  that  15,000  children  perished  annually 
from  the  administration  of  soothing  svrups.  That  such  a 
terrible  sacrifice  of  Infant  life  to  the  Moloch  of  quackery 
should  pass  unnoticed  in  the  19th  century  was  a  blot  on 
their  civilisation.  Remonstrances  by  individual  members 
of  the  profession  were  apt  to  be  looked  on  as  induced  by 
personal  Interest.  In  this  way  combined  action  was  more 
judicious. 

Nbw  Medical  Chairs  at  St.  ANoaBWd  UwivEBsrrr. 
— Undeterred  by  ordinances  in  suspense,  impending  pro- 
ceedings before  the  Privy  Council,  or  of  the  prolongation  of 
the  Universities'  Commission,  in  the  hope  that  Sc  An- 
drews and  Dundee  might  yet  be  brought  together,  the  Uni- 
versity Court  of  St.  Andrews  has  advertised  for  candidates 
for  Ldctnreships  in  Anatomy  and  Materia  Medioa.  The  first 
carries  with  it  a  salary  of  £300,  the  second  one  of  £203. 
This  action  of  the  Court  is  the  more  incomprehensible  a^  a 
larg^  number  of  its  members  are  supposed  to  be  working 
for  reconciliation  with  Dundee,  a  reconciliation  which  will 
be  impossible  if  further  Chairs  are  established  in  the  small 
but  historic  town.  It  is  difficult  to  tee  how  far  the  Univer- 
sity can  go  in  providing  a  full  medical  curriculum,  for  it 
seems  absurd  that  so  small  a  town  should  imagine  that  it 
will  be  able  to  supply  sufficient  material  for  the  later  years 
of  study.  It  stancu  to  reason  that  at  some  stage  or  other 
of  their  course  students  will  have  to  seek  instruction  on 
the  final  subjects  at  other  schools,  and  this  being  so,  it  is 
extraordi  lary  that  the  University  Authorities  are  unable 
to  see  that  it  must  be  to  their  ultimate  advantage  to  have 
a  Medical  School  affiliated  to  them  where  their  students 
can  obtain  the  neoesaary  instruction  under  their  own  ae^ 
as  it  were,  instead  of  having  to  disperse  throughout  &e 
country  in  search  of  educative  facilities.  For  our  own 
part,  as  we  have  stated  before,  we  think  that  the  Medical 
Schools  in  Great  Britain  are  already  sufficiently  numerous 
for  the  requirements  of  the  country,  and  we  would  like  to 
see  Sq.  Aadrews  devoting  her  substance  to  thf^  advance- 
ment of  Art  and  Science  rather  than  throwing  ini  away  in 
a  vain  comiiOtition  with  Universities  and  Schi ' 
mn«^  advantageously  placed  for  teachinir  medicii 

Tm  PuBLio  Hsalth  (S03TLahd)  Bill  — ThisBi! 
through  the  Conmiittee  stage  in  the  Lords  on 
weeky  May  12th.    Daring  ite  progreos  through  thj 
House  it  has  been  oonsiaered  by  a  Select  Commit^ 
by  the  House  in  Committee,  and  several  alterati< 


Mat  20,  18M. 


OBITUARlf. 


Thi  Mxdioal  Pbxbs.     541 


been  made  ia  it.  The  first  of  these  makes  it  obligatory 
for  the  local  authorities  to  appoint  medical  officers,  who 
mast  possess  degrees  indicative  of  their  fitaesa  for  the  post. 
An  attempt  wrs  made  by  the  Earl  of  Rosslyn  to  invest 
a  chief  County  Medical  Officer  with  aathority  over  the 
lo<»l  officers  and  the  sanitary  inspectors,  and  throagb 
whose  bands  all  reports  on  public  health  would  pass.  The 
clause  (No.  15)  enables  the  local  authority  to  make  bye- 
laws  regulating  the  respective  duties  of  the  medical 
officers  and  the  sanitary  inspectors.  The  change  proposed 
by  the  Earl  of  Rosslyn  would  have  been,  in  all  probability, 
a  salutanr  one,  as  in  health  matters  one  head,  especially  if 
trained  ror  the  purpose,  is  better  than  many,  the  many 
being  under  the  beck  and  call  of  a  lay  committee.  The 
Oovemment,  however,  would  not  accept  the  amend- 
ment, and  it  was  withdrawn.  On  the  other  hand, 
ae  Lord  Camperdown  said  at  a  meeting  of  the 
Forfar  County  CDuncil,  the  locil  authorities  are  glad 
enough  to  be  toe  masters  of  their  officials,  not  their  servants. 
One  of  the  provisions  of  the  Bill,  which  was  attempted  to 
be  altered,  is  a  very  ridiculous  one,  and  one  which  will 
impose  considerable  hardship  on  many  farmers.  A 
clause  forbids  the  laying  down  of  manure  heaps  within  50 
yards  of  a  public  road.  If  it  forbade  their  formation  any- 
where near  dwelling-houses,  streams,  and  wells,  or  on 
ground  draining  towards  houses  or  sorings,  it  would  be 
more  sensible.  It  will  be  very  difficult  to  gauge  the 
exact  nature  of  many  of  the  provisions  of  the  measure 
antil  a  Consolidation  Bill  is  passed  to  homologate  the 
different  Bills  on  Public  Health,  which  are  not  repealed 
with  the  proposed  new  statute. 


CtorreBponiitncc. 

fW*  do  not  hold  oonelTM  respoii«ible  for  ths  opinions  of  ou 
oonrespondsntt.]  

THE  ETHICS  OP  PROFESSIONAL  ADVERTISING. 

To  O^t  Editor  of  Trk  Medical  Press  and  Cibculab. 

SuL, — There  is  an  old  saying,  **  That  one  man  may  steal 
a  horse  and  another  may  not  look  over  the  hedge/'  This 
is  easilv  realised,  if  one  takes  the  trouble  to  watch  the 
coarse  followed  by  the  London  College  of  Physicians,  its 
Fellows,  and  some  of  its  Members,  who  appear  to  advertise 
themselves  with  an  audacity  and  impunity  that  no  mere 
licentiate  had  dare  to  hope  for. 

Not  long  ago,  in  a  city  not  a  hundred  miles  from 
Birmingham,  a  friend  called  mv  attention  to  a  placard 

posted  on  the  wall  of  a  bookseller'^  shop :  '*The of 

Disease,  by ,  M.D.,  F.R.C.P.,  &c."  The  gentleman 

in  question  being  a  phvsician,  practising  in  the  city.  It 
is  bad  enough  to  see  shilling  books  on  medical  subjects, 
written  by  K»oal  men,  in  conspicuous  positions  in  the  shop 
windows,  but  when  it  comes  to  posters  outside  the  shop,  I 
think  you  will  agree  with  me  that  it  is  going  a  little  bit 
too  far,  even  for  a  F.Ii,G.P,t  Lond,  When  one  asks  why 
no  notice  is  taken  of  such  conduct,  a  shrug  of  the  shoulders 
is  the  only  answer.  Had  '*  A  General  Practitioner  in  a 
Small  Way  "  attempted  one-half  the  self-advertising 
practised  by  these  so-called  leaders  of  the  profession,  the 
Lancet  and  Jowrmal  would  wax  terrible  over  such  gross 
indecency.  The  longer  one  lives,  the  more  one  realises, 
that  all  is  vanity.  Except  the  '*  bawbees." 
I  am,  Sir,  yours,  &c., 

Okb  Cbtinq  in  the  Wilderness. 


To  the  JSditor  oj  The  Medical  Press  and  Ciroitlar 
Sir, — Your  correspondent  '*  Anti-Quack  "  appears  to  be 
somewhat  hurt  by  what  he  calls  «  personauties "  and 
"imputation  of  motives."  I  mav  point  out  to  him,  how- 
ever, that  any  mw  who  writes  letters  of  the  kind  with 
which  he  opened  up  the  question  of  special  hospitals, 
mast  expect  to  have  his  opinions  analysed  and  his  argu- 


In  my  answer  I  said  that  all  decent  men  must  condemn 
*'sham''   hospitals,   and  asked  for  his   definition    of   a 
*' sham"  hospital.    In  answer  he  tells  me  that  a  sham 
special    hospital    is   an    unnecessary   hospitaL     *'Anti-^ 
Quack"  is  plainly  unversed   in  the  elements  of   logical  | 


definition,  for  he  omits  to  say  what  he  means  by  unneces- 
sary. Until  we  have  a  clear  de6nition,  short,  and  covering 
the  whole  of  the  ground,  of  the  phrase  "  sham  hospi- 
tal"  it  is  evident  *<  Anti-Quack,"  and  I  may  go  on  arguing 
indefinitely  without  advancing  a  step  towaras  any  trust- 
worthy conclusions. 

The  simple  assertion  of  "  Anti-Quack  "  that  there  exists 
no  obstacle  to  the  rise  of  men  from  the  lower  ranks  to  the 
higher  places  of  the  medical  profession  does  not  dispose  of 
the  subject.  To  say  that  is  simply  to  adopt  the  tone  of 
''complacent  arrogance"  of  which  I  complained  in  my 
first  letter. 

I  am,  Sir,  yours,  ^., 

Anti-Quaok  the  Second. 

THE  METRIC  SYSTEM. 
To  the  Editor  of  the  Medical  Press  and  Circular. 

Sir, — In  an  annotation  on  this  subject  in  your  issue 
of  this  week  ^ou  say  :^"The  adoption  of  the  decimal 
system  of  weights,  measures,  and  coinage  meets  still 
with  serious  resistance  amongst  English-speaking  com- 
munities, although  it  has  been  approved  by  every  im- 
portant nation  except  Britain  and  Russia,"  and  you  go  on 
to  remark  that  the  Bill,  to  make  it  compulsory  in  America, 
was  only  carried  by  the  bare  majority  of  two.  Now  there 
is,  I  beUeve,  a  reason  for  this,  though  it  is  not  generally 
acknowledged.  The  Anglo-Saxon  or  English  speaking 
race  is,  without  doubt,  of  Jtsraelitish  origin  ;  that  is.  they 
are  the  descendants  of  the  lost  Ten  Tribes  of  Israel,  and 
thus  they  adhere  to  their  tribal  duodecimal  notation  ; 
whereas,  the  other  nations,  having  no  sacred  tradition 
regarding  the  number  twelve,  use  the  method  that  is. 
perhape,  more  scientifically  convenient. 

I  am.  Sir,  yours,  &c, 

Heywood  Smith. 

Barley  Street,  May  16th. 


©bltuari). 

DR.  GERMAIN  S^E,  OP  PARIS. 
Bt  the  death  last  week  of  Dr.  Germain  S^e,  at  the  age  of 
78,  a  pathologist  of  world  wide  celebrity  is  lost  to  science. 
The  deceased  physician,  who  was  of  Jewish  extraction,  was 
bom  in  1818,  and  was  admitted  to  practice  by  the  Paris 
medical  faculty  in  1846.  He  had  suffered  for  several  years 
from  nephritic  colic,  but  he  succumbed  eventually  to  slow 
cerebral  anaemia,  caused  by  excess  of  work,  for  this  extra- 
ordinary man  carried  on  the  largest  practice  in  France  and 
at  the  same  time  almost  superhuman  scientific  labours, 
almost  to  the  day  of  his  death.  His  great  intellect  shone 
brightly  to  the  last,  in  spite  of  the  disease  which  was 
undermining  him,  and  of  the  unjust  calumny  and  envy  to 
which  he  had  been  long  subject.  After  acquiring  celebrity 
by  his  pathological  lectures  at  the  hospitiJs.  he  succeeded 
Professor  Trousseau  in  1»66  in  the  Chair  of  Therapeutics  at 
the  Faculty  of  Medicine.  His  lectures  in  this  capacity 
were  noted  for  their  brilliancy,  and  attracted  unexpected 
attention  owing  to  the  charges  of  materialism  brought 
against  M.  S^e  ny  some  (i  his  colleagues  in  a  petition 
addressed  to  the  Senate,  the  debate  upon  which  in  May, 
1868,  created  considerable  sensation.  In  1869  M.  S6e  was 
appointed  to  the  clinical  chair  at  the  Charity  Hospital,  and 
in  the  same  year  was  elected  a  member  of  the  Academy  of 
Medicine.  In  1870  he  was  summoned  to  attend  theEmperor 
Napoleon  in.,  and  drew  upareporton  the  malady  from  which 
his  Imperial  Majesty  was  suffering,  which  was  included 
among  the  State  papers  afterwards  found  at  the  Tuileries. 
He  was  made  an  officer  of  the  Legion  of  Honour  in  1876,  and 
promoted  to  the  Commanderahip  of  the  same  Order  in 
1880.  Professor  S^  was  a  voluminous  writer  on  medical 
subjects,  and  made  many  valuable  discoveries  of  new 
drugs.  His  lectures  on  heart  disease  delivered  at  the 
Charity  in  1874-76  were  translated  into  several  foreign 
Unguals  He  also  wrote  a  monograph  on  the  diagnosis 
of  phthisis  from  the  bacilli  in  the  sputa,  and  a  whole  series 
of  studies  of  the  physiological  action  of  vanooa  drugs, 
including  tobacco,  digitalis,  chloral,  and  opium.  Valuable 
contributions  were  also  made  by  him  on  the  modem  treat- 
ment of  heart  affections. 


542        ThI  MlDIOiL  ?B198. 


LITEllATTTRE. 


Mat  do,  1881. 


DR.  MOXEY,  OF  EDINBURGH. 
Dr.  Moxit  who  died  io  Paris  on  the  8th  inst.,  was  a 
g^raduate  of  the  University  of  Edinburgh,  M.R.C.P.  Lond., 
and  was  in  practice  for  some  time  in  the  South  of  England. 
He  early  developed  great  talents  as  an  elocutionist,  and 
became  connected  with  the  dramatic  profession.  About 
eighteen  years  ago  his  tbouflrhts  were  directed  towards 
religion,  and  from  that  time  devoted  himself  to  Christian 
effort.  He  preached  in  many  ports  of  this  country  and 
also  in  America  with  great  success.  Settling  down  in 
Edinburgh,  he  became  professor  of  elocution  to  the  students 
of  the  Free  Church  and  U.  P.  Colleges. 


DR.  DON  VICENTE  MARTIN  DE  ARGENTA,  OF 
MADRID. 
In  the  death  of  Dr.  Argenta,  Madrid  has  lost  one  of  the 
best-known  members  of  the  medical  profession  in  Spain. 
The  Royal  Academy  of  Medicine  sent  a  wreath  to  his 
funeral,  and  suspended  its  sittings  until  afcer  his  burial. 
A  sympathetic  and  eloquent  obit^iary  notice  of  Dr.  Arg^^nta 
appears  in  El  Siglo  Medico  from  his  friend  Dr.  Don  Decio 
Carlan  :  '*  Good,  affable,  modest,  hardworking  .  .  . 
one  of  those  persons  who  conquer  by  loving  and  secure  the 
esteem  of  all  honourably-minded  persons."  He  belonged 
to  a  type  which  is  now  almost  gone,  to  which  Donovan, 
Moore,  and  Charles  Butter  belonged,  men  who  lifted 
pharmacy  to  the  dienity  of  a  science.  His  house  in 
Hortaleza  Street,  Madrid,  was  the  resort  of  the  majority 
of  the  scientific  physicians  of  the  city. 


ICiterature. 

HARRIS  AND  BEALK  ON  PULMONARY  CONSUMP- 
TION, (a) 
This  book  comes  out  as  one  of  Lewis's  Practical  Series, 
and  as  a  manual  for  the  guidanee  of  all  who  are  concerned 
in  the  management  of  consumptive  invalids,  according  to 
the  best  m<Klern  notions,  it  will  prove  most  useful.  The 
history  of  phthisis  from  the  earliest  age^  is  succinctly 
given  in  the  first  chapter,  and  also  the  views  of  the  ancients 
as  to  treatment.  Arytseus  insisted  much  on  the  value  of 
milk  diet  for  consumptives  and  on  the  effect  of  sea  air  in 
drying  up  the  ulcers  on  the  lungs  by  means  of  the  saline 
particles  with  which  such  air  is  loaded.  The  excellent 
results  that  often  follow  a  residence  in  the  strongly 
marine  climate  of  St.  Leonards  prove  the  correctness  of 
the  views  of  Arytaeus.  Pliny  wm  of  opinion  that  the 
bcdsamic  exhalations  from  pine  forests  were  conducive  to 
the  cure  of  consumption. 

In  following  the  history  of  the  propess  in  knowledge  of 
the  nature  of  tuberculous  disease,  it  is  interesting  to  note 
that  the  idea  of  a  foreign  paraeite  appears  in  1733  in  the 
works  of  a  French  writer,  who  thought  that  both  scrofula 
and  consumption  werecontagious,  '*  the  putrefaction  breed- 
ing worms,  which  propagate  the  disease  and  cause  it  to 
spread.'* 

In  Chapter  II  we  have  the  pathological  history  of  the 
disease  traced  as  far  as  Koeh  and  his  bacillus  with  its 
active  products  called  "  toxinee." 

The  pathological  processes  set  up  in  the  lung  tissue  by 
the  tubercle  bacilli,  and  the  several  ways  in  which  this 
process  may  come  to  arrest,  are  described  in  a  way  that  is 
full  of  interest.  A  remarkable  instance  is  given  of  the 
arrest  and  cure  of  the  tuberculous  process  by  the  advent  of 
an  acute  disease. 

Two  young  men  in  the  last  stage  of  pulmonary  consump- 
tion were  attacked  with  virulent  small-pox ;  both  recovered, 
and  at  once  the  pulmonary  symptoms  disappeared.  The 
patients  laid  on  flesh,  and  are  now  the  living  images  of 
health.  In  another  case  an  attack  of  acute  rheumatism 
was  followed  by  disappearance  of  the  symptoms  and  signs 
of  advanced  phthisis. 

The  observations  on  affections  of  the  bronchial  glands 
are  good  and  practical.    In  130  post-mortem  examinations 


(a)  "  The  TreMtmant  of  PulmooAry  Cousumptiou :  A  Prac.ical 
Maaiul."  By  Vincent  Dormer  Harris,  M.D.,  F.R.C.P.,  and  Edwin 
Clifford  Beale,  M.A.,  M.B.,  F.a.C.P^I^lclana  to  tbe  City  of  London 
Hospital  for  Diseaaee  of  the  Gliest,  vMtU  Park,  Ao.    ~ 


8to     London]  H.  K.  Lowla.    I8M. 


Pp.  488,  orown 


only  six  cases  are  reported  of  normal  brooohial  glands. 
A  single  caseous  gland  in  a  child  may  be  the  starting 
point  of  acute  tuberculosis. 

This  we  believe  firmly,  and  hence  the  grevt  impocfcanoe 
after  an  attack  of  measles  or  whoopingp^oug^  to  get  rid 
of  all  traces  of  bronchial  catarrh.  Various  complicatiODS 
of  phthisis  such  as  emphysema,  pneumothorax,  and  eeped- 
ally  larjrngeal  affections  are  treated.  We  eannot  entiiely 
agree  with  the  remarks  on  page  225.  The  aothor  seems 
to  think  that  obliteration  of  enlarged  veins  is  a  proceeding 
of  little  benefit.  That  the  operation  will  cure  hmnorrha^ 
we  quite  agree  is  very  doubtful  indeed,  but  in  fibroid 
phthisis  with  much  cough  and  pharyngo-laryngeal  irri^ 
tion,  we  certainly  have  seen  much  good  done  by  the 
judicious  application  of  the  galvanic  cautery  to  enlarged 
veins  in  the  pharynx. 

After  speaking  of  the  general  treatment  of  phthieis  the 
authors  proceed  in  chapter  X  to  speak  of  special  modes  d 
treatment.  Nearly  every  one  of  the  most  recently  inven- 
tive methods  of  treatment  come  in  for  more  or  lees  notioe. 
Some  to  be  condemned  at  once  after  trial  as  useless  or 
worse  than  useless,  others  have  undoubtedly  made  good 
their  claim  to  rank  among  very  valuable  therapeutic  aids. 
The  treatment  of  chronic  phthisis  by  the  inhaler  reepirap 
tor,  first  devised  by  Dr.  Sinclair  Cogbill,  of  Ventnor,  is 
one  that  has  found  favour  it  appears  with  Dr.  Bumey 
Yeo,  Dr.  J.  Thorowgood,  and  others.  The  gradual  and 
prolonged  medication  of  the  throat  and  bronchial  tubes 
by  breathing  through  the  respirator  various  inhalants  or 
instillations  is  now  proved  by  experience  to  be  an  excellent 
way  often  to  soothe  cough  and  pulmonary  spasm  and  cheek 
excessive  secretion  from  the  bronchi.  Formule  are  given 
for  the  instillations  most  in  favour  with  Dr.  Harris,  at 
Victoria  Park  Hospitol. 

Dr.  Heron's  carlK>lic  acid  chamber  treatment  is  reported 
as  sound  in  theory,  but  not  so  beneficial  in  practice  as 
miflrht  at  first  have  been  thought. 

The  creasote  chamber  of  Dr.  Arnold  Chaplin,  of  which  a 
notice  recently  appeared  in  the  British  Medical  Jowmal^ 
seems  of  decided  efficacy  in  relieving  dyspnoea  and  pro- 
moting expectoration.  Some  troublesome  cases  of  dilated 
bronchial  tubes  have  found  more  relief  from  a  sitting  in 
this  chamber  than  from  any  other  mode  of  treatment. 

Dr.  Kingston  Fyffe  has  endeavoured  to  show  th«t  the 
administration  of  creasote  by  the  mouth  has  a  dietinot 
effect  in  diminishing  the  virulence  of  the  bacilli  in  the 
sputum.  A  similar  result  follows  the  inhalation  of  creasote 
vapour,  but  more  actual  demonstration  of  this  is  yefr 
needed.  Creasote  in  full  dose  seems  in  greater  favour  at 
Victoria  Park  Hospital  than  guaiaool  or  its  derivativee* 
and  experiments  on  animals  appear  to  bear  out  the  corveci- 
ness  of  this. 

The  concluding  chapters  of  the  book  treat  of  thd<k6tetie 
and  climatic  treatment  of  consumption.  Thoy  fti«  abort, 
but  abound  in  good  practical  advice  for  the  guidMioe  ol 
physician  and  patient.  The  high  altitude  plaoes,  saeh  ae 
Davos  and  St.  Moritz,  are  recommended  in  early  phthisis 
of  young  people,  and  experience  will  bear  out  the  soand- 
ness  of  this  advice  ;  some  cases  of  early  {>hthisis  have  been 
arrested  or  cured  at  Davos  and  such-like  places. 
Elderly  people  are  wisely  counselled  to  avoid  Davos. 
Those  who  nave  fever  with  high  temperature  are  most 
wisely  recommended  to  stay  at  home.  If  invalids  attended 
to  this  we  should  hear  fewer  stories  of  those  who  have 
managed  to  reach  a  foreign  health  resort  to  die  after  but 
a  brief  stay  there. 

The  book  is  thoroughly  practical  throughout  and  well 
sustains  its  claim  to  rank  as  a  useful  manual  on  the  treat- 
ment of  consumption. 

HUTCHINSON'S  SMALLER  ATLAS,  (a) 
This  book  contains  136  plates  illustrative  of  cases  of 
interest  in  clinical  surgery,  together  with  descriptive 
letter- press.  It  is  a  continuation  in  smaller  form  ox  Mr. 
Johnathan  Hutchfnson's  former  illustrated  work,  which 
appeared  in  two  volumes,  and  was  finished  in  1882.  Its 
contents  form  a  further  embodied  testimony  of  the  mar- 
vellous wealth  of  clinical  material  amassed  by  this  most 
original,    painstaking,    and     philosophical    of    modern 


%{a)  "A  Sin*ltec  AJaa  of  CUnlcal  dugeiy,"  Joju^i^mi  Eatchia- 
soo.  LL.D.,  F.R.S.,  CSoDsoltiog  surgeon  to  the  London  ffospltij,  Sko 
London:  west,  Newman,  and  Co.    1806. 


UAt  20,  1891. 


FA88  LISTS. 


ThB  MlDIOAL  PBI 


543 


oibtlSt^ert.  The  pl&tl»,  which  are  admirably  executed, 
inclyde  a  coneiderable  number  of  the  rarer  skin  conditions, 
which  afford  a  valuable  means  of  education  to  the  derma- 
t6to|ti»t.  Fdr  instance,  a  study  of  the  pictures  of  iodide 
raeh  (pUite  iv.),  chloral  rash  (pi.  v. ),  of  lupus  mareinatus 
(pL  ziii.),  ctnd  of  Bxzin's  malady  (pi.  cix.)  could  nardly 
fail  to  impress  the  appearhnces  of  those  conditions  on 
tBe  memtMry  in  a  pett(kaneiit  forra.  The  bdly  oritioism  we 
have  to  offer  is  thiLb  there  is  no  attempt  at  arranfirement  of 
the  Tarled  materials  presented  to  the  reader.  However, 
w«  IHi!  hOp«  with  the  author  thai  the  *'  Index  will  prevent 
any  real  inconvenience  bh  this  scor^" 

COATS*  PATHOLOGY  (a). 
This  well-knowli  text-bo6k  on  pathologv  has  arrived  at 
the  iperited  digni^ly  of  a  third  edition.  The  populaHt;^  of 
thd  bpbk  is  Sufficient  evidenc^e  of  its  worth,  and  the  tima 
for  .detailed  ertticism  of  its  contents  has  gone  by.  The 
text  ha4  been  carefully  revised,  and  a»  many  as  185  new 
illustrations  added.  The  volume  is,  therefore,  bulkier 
than  before,  but  the  text  is  only  sliehtly  increased.  Or 
Coats  apologises  for  the  inclusion  of  so  many  new  repro- 
dnbttens  of  photographs  on  the  ((found  that  most  of  them 
wer^  taken  by  himself.  And  that  he  is  only  a  be^hnet  in 
the  att.  Despite  the  fact  that  onb  or  two  of  the  photo- 
mlerographs  are  somewhat  haxy,  we  may  congratulate  the 
author  on  the  snooMs  whioh  has  attended  his  first  attempts 
in  k  difficult  sphere. 

BIBLIOTHEK;    DBR    GE8AMMTEN    MEDICI- 

NISCHEN  WISSENSCHAFTBN. 
Tfits  Bhe^doptBdia  of  Medicine  is  now  well  advanced 
and  continues  to  maintain  the  high  standard  promised  by 
Prof.  Drasbhe  at  it  inauguration.  Vierodt  contributes 
an  interesting  paper  on  Mensuration,  in  which  he  deals 
with  every  part  of  the  body  setting  down  normal  dimen- 
siohs  for  diagnosis.  Af^er  giving  a  "  Normal  Ideal  Type" 
he  teUs  us  that  if  the  "Xiphoidal— UmbUioal  line"  depart 
from  this  standkrd^  we  6an  diagnose  "enlarged  liver, 
spleen,  or  distended  ven&  cava  inferior."  For  the  treiit- 
ment  of  measles.  Pott  advocates  the  cold  water  bath 
which  should  be  guided  by  watching  the  thermometer. 
Steinbrugge  is  of  opinion  that  M^ai^re's  disease  may  be 
combated  by  the  use  of  quinine  whe^e  the  central  disturb- 
ance depends  on  an  altered  condition  of  the  vaso-motor 
centres.  Bruhner  thinks  that  the  drug  produces  ah 
isohtemia  in  the  labyrinth  as  in  the  retinal  vessels.  Ac- 
commodation, asMgtii^tism,  and  cataract,  abe  exhaustively 
treated  by  Hdrrnheiser,  Salzmand,  and  Bernhe'imer. 


The  Mortality  of  Foreign  Cities. 
Thi  annual  death-rate  per  1,000  in  the  principal  foreign 
cities  according  to  tbe  weekly  returns  communicated  to 
the  Registrar-General,  is  as  follows :— Calcutta  47,  Bombay 
41,  Paris  21,  Brussels  18,  Amstehlate  19,  Rotterdam  15, 
The  Hacue  17,  Copenhagen  15,  Stockholm  21.  Christiania 
15,  St.  F^raburg  37,  Moscow  38,  Berlin  17,  Hamburg  17, 
DreMen  21,  Breslau  25,  Munich  23,  Vienna  28,  Prague  26 
Boda-Peeth  34,  Trieste  25,  Rome  21,  Turin  22,  Venice  3l! 
Cairo  47,  Alexandria  37,  New  York  25,  Brooklyn  21, 
PhilUdelphia  23. 

The  Medico-Psychological  Association. 

The  next  examination  for  the  Certificate  in  Psychologi- 
eal  Medicine  will  be  held  in  July.  Candidates  intending 
to  present  themselves  should  give  at  least  fourteen  day? 
istitiee  id  writing  to  the  Registrar  of  the  Association,  Dr. 
Spenoe,  Bumtwood  Asvlum,  near  Lichfield.  Tbe  exami- 
nation for  the  Gaskell  Priae,  in  oonnection  with  this  Asso- 
ciation will  also  be  held  in  July  ;  the  exact  dates  for  these 
Examinations  have  not  yet  been  definitely  fixed,  but  they 
will  be  notifled  in  this  journal  early  in  June,  meanwhile, 
further  particulars  will  be  found  on  reference  to  our  ad- 
vertisement ooluoms. 

Vital  SUtistics. 

Thx  deaths  registered  last  week  in  thirty-three  great 

/•2:lt.\^'^^  ^*'&*?*'^"    By  JoM^h  GMito,  1I.D.,  Pi^4 


towns  of  England  and  Wales  corresponded  to  an  annual 
rate  of  18*5  per  1,000  of  their  aggregate  population,  which 
is  estimated  at  10,860,971  persons  in  the  middle  of  this 
year.  The  deaths  registerea  in  each  of  the  last  four  weeks 
in  the  several  towns,  alphabetically  arranged,  corres- 
ponded to  the  following  annual  rates  per  1,0(Sj  :~ 

Burkenbead  18,  Birmingham  22,  Blackburn  16,  Bolton 
19,  Bradford  16,  Brighton  16,  Bristol  18,  Burnley  25, 
Cardiff  15.  Croydon  13,  Derby  14,  Dublin  21,  Edinburgh 
17,  Gateshead  12,  Glasgow  21,  Halifax  14,  Huddersfield 
19.  Hull  19,  Leeds  19,  Leicester  14,  Liverpool  20,  London 
17,  Manchester  23,  Newcastle-on-Tyne  17,  Norwich  13, 
Nottingham  13,  Oldham  19,  Plymouth  23,  Portsmouth  12, 
Preston  28,  Balford  31,  Sheffield  19,  Sunderland  23, 
Swansea  12,  West  Ham  14,  Wolverhampton  18.  The 
highest  annual  death-rates  per  1,000  living,  as  measured 
by  last  week's  mortality,  were: — From  measles,  2  2  in 
Sunderland  and  2  9  in  Birkenhead ;  from  scarlet  fever, 
1*0  in  Huddersfield  ;  from  whooping-coueh,  1*7  in  Halifax, 
1.9  in  Manchester,  and  2*2  in  Salford ;  from  fever,  1*1  in 
Halifax  ;  and  from  diarrhoea,  1*0  in  Norwich  and  in  Sal- 
ford.  The  77  deaths  from  diphtheria  included  41  in 
London,  6  in  West  Ham,  6  in  Birmingham,  5  in  Man* 
Chester,  and  3  in  Burnley.  No  death  from  small-pox  was 
registered  in  any  of  the  large  towns.  In  the  registration 
district  of  Gloucester,  25  deaths  from  smalUpox  were 
registered  last  week,  24  of  the  deceased  persons  having 
beisn  residents  of  Gloucester  municipal  borough. 

The  Sanitary  Institute. 
Thk  Council  have  acoepted  an  invitation  from  the  city 
and  county  of  Newcastle-upon-Tyne  to  hold  a  Sanitary 
Congress  and  Health  Exhibition  in  that  city  in  the  autumn 
of  this  year. 

PASS    LISTS. 

Royal  Navy  Medical  Service. 
The  undermentioned  gentlemen  who  coinpeted  on  the 
4th  inst.,  and  following  days  at  Examination  Hall,  Victoria 
Embankment,  London,  for  appointment  as  surgeon  in  the 
Royal  Navy  have  been  granted  commissions. 

Name  ICaito  Name 

A.  E.  MerewetbMr.  M.B.  ..    2,712    W.  E.  Matthew 
W.  E.  Geriter.  M.B.  ..    2,680   IC  L.  M.  Vaadin,  M.B. 

C.  M.  Beadnefl        ..        ..    2,081    W.  iL  lliomBon 


W.  ^.  U.  Sequeira,  M.B.  ..  2,006 

J.  G.  Fowler 2.494 

J.  G  Q.  Ried 2.446 

E.  GB.  0'Leai7      ..        ..  2.898 

W.  II.  Keith,  M.B.  ..        ..  2,866 

B  Satton       2,818 


J.  W. '  laig,  M.B. 
W.  L.  Martin 
A.  T.  Wygttd 
W.  J.  Stltt 


Mark! 

2,807 
2,2'>0 
2.181 
2.176 
2,171 
2,161 
2,109 


B.  Croneen 2,056 


a,  Cheshire ;  Eibert  M.  Qnin.  Portsdown  i  Tom  J. 
bhamberland:  JUchard  E.  Boberte,  Camarvonahfre ; 
ley.  Belfast  I  Jamet  H.  Stuart,  county  Antrim  ;  Mary 
n,  Uncolnahire;    John   Boyd,  KUrea ;    Michael  U 


Bditloa 


Royal  College  pf  Phjvlcians  and  Surgeons  of  Edin- 
burgh  and  Faculty  of  Physicians  and  Surgeous  of 
Gliwgow. 

At  the  April  sittings  of  the  examiners  held  in  Glasgow 
the  following  candidates  passed  the  respective  examina- 
tions, those  markied  with  an  asterisk  (*)  passing  *'with 
distinction  " : — 

Second  Examination— Four  Years'  Course. 

Charles  ¥.  Splnkea,  Cheshire ;  Eibert  M.  Qoln.  Portsdown  i  Tom  J. 
Lamley,  Northnmberland:  —— — ^  -    ~  '     -     - 
Fredenok  Laiey.  ~  -        ^ 

Ann  Handson,  I  ,     -w-, «..—  .« 

Keylon,  YlctwU,  AnstraHa;  F4rrlB  N.  Jaboor,  Syria:  John  G. 
Gibsot.  NewOamnock;  liontagae  V.  M'Keohnle,  Witton  Park; 
SUli  Owen  Jones,  OanMrronshire ;  James  H.  heming  Avon- 
dale  ;  Christopher  B.  White,  Jamaica ;  John  L.  M.  Govan,  Wool- 
wich. 

Third  Examination. 

Andrew  M'Credie,  Stranraer;  James  M*OIynn,  Tyrone. 

Final  Examination,  and  Admitted  Licentiate  of  the  Three 
Co-operating  Colleges. 

George  Henderson,  Coatbridge ;  Ernest  Bdward  Crowther,  Lodden- 
den;  David  Smith  Henderson.  Coatbridge;  James  Morrison.  Bel- 
fast;  Patrick  James  Calnan,  Cork;  Mark  O'Brien,  BallinacoUlir. 
county  Cork ;  WiUiam  Herbert  Richardson,  Manoheeter  •  AnSe 
Christina  Satherland.  Bo'Dess ;  Charles  Ayton  Manett,  London  ; 
Daniel  vniesM,  Belfast ;  Daniel  Morrisy.  Passage  West,  Cork; 
Arthur  John  PoUsrd,  fleadlngley,  Leeds ;  Alfred  Hamman,  Knuts- 
ford,  Cheshire. 

The  following  oandidates,  having  completed  both  the 
first  and  second  examination,  were  admitted  Diplomatee 
in  Public  Health  at  the  May  sittings  of  the  Board  of  Ex- 
'    ITS  : — 

Heut  Loraaa,  M.a.  CJf .  Bdla.,  Mauritius. 
llarkaiannan.lL«.  CM.,  Olasg..  lUokmaosworth. 
John  Liesching  Sahidga,  M,  a,  C.  M.  Edin..  Cape  Colony. 
James  Stavemon,  M,B.,  C,M,  Qla«„  Oj^HImSu 


544    Thb  Mkdioal  Pbxbs 


NOTICES  TO  COKRESPONDENTS. 


Mat  20,  lg96. 


c^t^otictB  to 
Corrcsponbcnts.  i^hort  fetters,  &c. 

C^  CORRHFOVDiiiTB  requiring  a  reply  la  this  column  ire  par- 
ticularly reqneated  to  make  lue  of  a  dittinoUwe  tignmtwre  or  imitkUt, 
and  avoid  the  praoUoe  of  signing  themeeWea  "  Reader,"  *'  Sabeorlher/' 
"OldSobwriber,*  Ac.  Mnch  oonfnaloo  wlU  be  epared  by  attention 
tothlamle. 

THE  COST  OF  ANri.V\CCI5rATlO?f. 

Wb  understand  that  the  cost  of  combating  the  small -pox  epidemic 
at  Oloncester  has  been  so  great  as  to  necessitate  the  levrlng  of  a 
special  rate  of  9d.  In  the  £1  for  twMTC  months.  Beyond  this,  a  per- 
manent hospital  costing  £11,000  will  be  bnllt,  and  mnst  InTolTO  an 
ontlsy  of  £1,800  or  £1,800  a  } ear  in  s«larles  and  maintenance.  That 
was  in  any  ca»e  a  necessary  proviaioa.  The  epidemic  bat,  howeyer, 
taught  a  useful,  although  an  expensive,  leison  it  life  and  money. 

Dr.  T.  H.  —The  subject  wilt  b»  referred  to  in  our  next 

TBS  VABTiya  STBEirOTHS  OF  STBOPHAyTHUS. 
To  tha  Kditor  of  THI  MIDIOAL  FfLESa  aHD  CIRCULAR. 

BlK.— In  connection  with  the  subject  of  the  variation  In  the  strength 
rf  preparations  of  ttropbanthus,  noted  by  you  In  referring  to  Dr.  M. 
W.  Balfour  s  oondeainatlon  ot  tbe  drug,  I  beg  to  say  that  in  conjunc- 
tion with  my  friend,  Mr.  K.  H.  Farr,  I  have  been  at  wor^  upon  the 
subject  for  some  months  pait  We  hope  shortly  to  publUn  one  or 
more  notes  on  tbe  subject,  embrscintr  processes  for  the  determloaiion 
of  the  active  principio,  a  report  upon  commercial  tinctures,  and  also 
a  method  lor  standatdising  the  pbermacopceial  tincture. 

I  am,  Sir,  yours,  ko.. 

H.  WriobT. 

Boxton,  May  16th,  1899. 

PROVivaAL  PRAcnrioiriR.— Ton  can  legally  demand  the  customary 
fee  for  attending  the  Inquest. 

SKIJf  DISCOLOUR  iTIOy. 

A  LIYBRPOOL  correspondent  asks  advice  under  the  following  cir- 
cumstances. He  says:— I  had  the  misfortune  some  months  since  to 
fall  face  downwards  on  a  cinder  pxth,  and  made  a  nasty  jagged  out  on 
the  bridge  of  the  noee.  The  wound  was  washed  at  the  time,  and  Is 
now  pertectlv  heeled,  and  though  there  Is  no  tear,  and  the  surface  Is 
oQlte  smooth,  there  remains  a  blue  discolouration  in  or  under  the 
skin.  I  presume  it  mav  either  be  the  bruised  tissues,  or  the  presence 
of  fine  coal  dust  or  saod.  such  as  Is  seen  In  the  faces  of  eosl  miners 
who  have  met  with  acddente,  or  in  the  f  aeee  of  sportsmen  who  have 
been  marked  by  gunpowder.  I  should  be  obliged  for  any  suggestions 
as  to  the  best  way  of  restoring  the  skin  to  Its  original  colour. 

Dr.  J.  M.  will  find  that  his  question  has  been  answered  on  reference 
to  our  "  Notes  on  Current  Topics." 

TBE  SALUBRITY  OF  MINER  HL  WATER  MiKINO. 

A  DEPARTMBHTAL  Inquirv  Into  the  circumstancee  affecting  the 
health  and  safety  o(  mineral  water  makers  has  been  ordered  by  the 
Home  Secretary,  and  wUl  be  held  in  Belfast. 

4EteetmgB  of  the  ^odxtitB. 

WBDRBBDAT,  MAT  SOTH. 
DBRMATOLOOIOAL  SOOIBTT  0¥  GRBAT  BRFFaIN  AHD  IRBLAND  (20 
Hiinover  Square,  <^.)-4.46  p.m.  Annual  Meeting  aud  Conference. 
Election  oC  Ofllcers.  Introductory  Addrees  by  Preeldent.  Paper  :— 
Dr.  W.  Q  Smith  (Dublin) :  Notee  upon  Chrysorobhi  and  Chrysophanlc 
Add.    5.45  p.m.  Cases. 

THUB8DAT,  Mat  SlST. 

Harybiam  SoorvTT  07  LOUDON,  (Stafford  Rooms,  Titchbome  Street. 
Bdgware  tioad,  W.)    <'  CUoical  Evenins." 

ViOTORiA  Uo<>prTAL  F0»  CHILDREN,  (Cholsea)  —4  P.m.  Dr.  Montague 
Murray ;  Demonstration  of  *'  Seldcted  Medical  Cases." 
Friday,  Mat  SSnd. 

Clinical  Sooibtt  or  London.— 8.80  n-m.  Annual  General  Meet- 
ln«  Election  of  Officers  for  1896-1807.  Dr.  Olemow:  A  Case  of 
Typhoid  Fever  with  H«perpyrexla  and  Cardiac  Dilatation ;  Veneeec- 
tlon  ;  Recovery.  Dr.  R  »lieston  and  Mr.  Haward :  A  Case  of  Chroni  j 
Dilatation  of  the  Colon.  Mr.  W.  G.  Spencer :  Punctured  Wound  of 
Right  Ventricle  of  Heart  through  Seoond  Left  laterooetal  Space,  severe 
Primary  and  three  Secondary  BsBmorrhages,  Healing  of  the  ^onnd, 
subsequent  Post-mortem  Examination  after  Death  from  Disease.  Mr. 
O.  R.  Baldwin :  A  Case  of  Central  Sarcoma  of  the  Femur  with  Esrly 
Dissemination. 

Monday,  Junb  Ist. 

Odontolooical  Sooibty  of  Great  Britain.— 8  D.m.  Annual 
General  Me  -ting  Paper  by  Dr.  WMhboume :  '*  Some  roints  in  Con- 
nection with  the  Bacteria  of  the  Mouth,"  illustrated  with  Lantera 
SUdee. 


IBajcaitJCUB. 


Abingdon  Union.— Medical  Officer.  Salary  £100  per  annum.  AppUca^ 
tlons  with  testimonials,  on  or  before  Mav  28rd. 

Bridrwater  Infirmary.— Bouse  Surgeon.  Salary  £80  per  annum,  with 
board  and  residence.  Applications  with  testimonials,  to  Mr.  John 
Coombs,  Hoa  Secretary,  Bridgwater  Infirmary,  Bridgwater,  on  or 
before  May  29th. 

City  of  Birmingham.— Medical  Superintendent,  (unmarried),  for  the 
City  Hospital  for  Infectloni  Diseases.  Salary.  £200  per  annum, 
(rising  by  £20  per  annum  to  £800  per  annum)  with  board,  lodging, 
and  attendance.  Applications,  with  testimonials,  to  Mr.  J.  Keyte, 
Clerk  to  the  Health  Committee,  Council  House,  Blrmlngbam,  on 
or  before  May  29th. 


Horton  Infirmary,  Banbury.— House  Surgeon  and  Dispenser.  Salaiy 
00  per  annum,  with  board  and  lodgioic.  Applications,  with  testi- 
monials, on  or  before  May  28rd,  to  Mr.  C.  H.  Davids,  Hoe.  See., 
21  Marlborough  Road,  Banbury. 

Poplar  Hospital  for  Accldente,  Blackwall,  S.— Amistant  RMid«it 
House  iiurgeon.  Salary  £80  per  annum,  with  board,  lodging,  and 
washing.  Applications,  wlu  three  recent  testimonials,  to  the 
Secretary  on  or  before  May  22od.  The  Second  Assistant  ReeidenC 
It  a  candidate  for  the  post.  Should  he  be  elected,  eandidatee 
will  please  sUte  if  they  are  wttling  to  take  his  poet.  Salary  £50 
per  annum,  with  board,  lodging  and  washing. 

Royal  College  of  Surgeons  nf  England. —Professorships  and  Lecturer 
ships,  open  to  Feuows  and  Members  of  the  College.  Applications, 
with  particulars  of  tbe  subject  on  which  they  propose  to  lecture, 
to  the  Secretary,  before  June  2nd.    (See  advert.) 

University  Caurt  of  St.  Andrews.— Toe  Court  propoeee  to  appoint  this 
following  Lecterers,  viz  :  (1)  on  Anatomy,  with  a  saUun*  of  £800 
per  annum ;  (2)  on  Materia  Medica,  with  a  salary  of  gSOO  per 
annum ,  and  (8)  on  History,  with  a  salary  d  £900  per  annum. 
Applications  with  twenty  copies  of  testimonials  will  be  received  bj 
the  Secretary  until  1st  June. 

Westoo-eaper-  «are  Hospital  and  Dispensary.— Medical  Officer.  Salary 
£80  per  annum,  with  hoard,  lodging,  and  washing.  AppllcatloQs, 
with  testimonials,  to  the  Hon.  Secretary,  on  or  before  May  28th* 


^ppointmtnim 


CLBOO,  J.  Gray,  M.D  ,  B.S.Lond..  F.R.C.S.Sng.,  Senior  House  Surgeon 

to  the  Manchester  Royal  Eve  Hospital. 
Edwards,  Arnold,  J.,  M.D.Vict ,  B  Ch..  Honorary  Surgeon  to  the 

Chorlton-upon-Medlock  Dispensary,  Manchester. 
Findlay,  Gbo.,  M  D.,  C.M.Aberd.,  Medical  Officer  of  Health  for  the 

Campden  Urban  Sanitary  District. 
(Griffith,  W.  s.,  M.B.Camb.,  L.R.C.P.Lond.,  F.R.C.8.,  Medical  Officer 

of  Hoalth  by  the  Mllford  Haven  Urban  DUtrict  OouncO. 
JipaoN,  B.,  M.D.Dnrh  ,  M.R.C.S..  Honorary  Physician  to  tbe  Durham 

County  Hoapital. 
Marshall,  W.  L.  W.,  M.R.C.S.,  Surgeon   to  the   Hnddenflald 

Inflrmary. 
Martin,  Sidnby.  M.D.,  F.R.S.,  Professor  of  Pathology  In  University 

College,  London. 
Mbnzibs,  J.  AOWORTH,  M.D.,  C.M.Bdin.,  Junior  Honie  Surgeon  to  the 

Manchester  Bojral  Bye  Hospital. 
Morrison,  CS.,  Lr.c.p.,  L.R.C.S.Edin.,  L.F.P.8.01a8g.,  Medical 

Superintendent  of  the  <*ounty  and  City  Asylum,  Hereford. 
Paton,  E.  Pbroy,  M.D.,  M.S.Lond.,  F.R.C.S.,  Surgical  Registrar  to 

the  Westminster  HospiC4l. 
SBLLBR8,  A.  B.,  LR.C.P.Lond.,  M.R.C.P.,  Medical  Officer  of  Health 

for  tbe  Thomhill  Urban  Sanit«ry  District. 
THOMPSON,  Prbr,  M.B.,  Ch.aVict..  Senior  Demonstrator  In  the 

Department  of  Anatomy  at  Owens  College,  Mancheeter. 
VOUNO,  ROBT.,  M.B.,  CM.Aberd.,  Medical  Officer  of  Health  for  the 

Rochford  Rural  Sanitary  District 

firtltB. 

Martyn.— May  15th,  at  8  The  Beacon.  Ezmouth,  the  wife  of  Reginald 

Martyn,  M.R.C.S.,  of  a  daughter. 
Robinson.— May  leih,  at  l  Upper  Wimp:>le  Street,  London,  the  wife 

of  H.  Batham  koblnson,  M.S.Lond..  r.R.C.8.,  of  a  son. 
Shadwbll.— Mav  11th,  at  Lynhurst.  Walthamstow,  the  wife  of  St. 

Clrr  B.  Shsdwell,  M.D.8t  And.,  of  a  daughter. 
Smart.— May  I2th,  at  Needham  Place,  Newry,  the  wife  of  Henry  W. 

Smart,  L.R.C.S.I.,  of  a  daughter. 
STBPHBHSON.-May  8th.  at  Welbeck  Street,  London,  the  wife  of  Sidney 

Stephenson,  M.B.Edin.,  of  a  daughter. 
UeHH— May  14th   at  Laurel  Lodge,  Dundrum,  County  Dublin,  the 

wife  of  Isaac  William  Usher,  L.E.C.S.I ,  of  a  son. 
Vachbll.- M«y  nth,  at  Charles  Street,  Cardllf,  the  wife  of  Charles 

Taotleld  Vachell,  M  D  ,  of  a  dau^ter. 
Ward.— May  Uth.  at  Wokingham,  Berks,  the  wife  of  Ernest  Ward, 

M.R.C.S.,  L.R.C.P.,  of  a  son. 


^MtinqtB. 


BLABB— Harris.  -M«y  nth,  at  the  City  re  aple,  Victor  John  Blake, 
M.a,  as.  Loud..  M.RC.S.Eng.,  L.R.C.P.  Loud.,  of  Eldnorv, 
Yentnor,  L  of  W..  to  Amy  Katharine  Harris,  eldeet  daughter  of 
B.  Harris,  of  Wreihsm. 

COLBMAN— Soott.— Mav  UthjitSt  Jamse's  Church,  Gravesend,  Percy 
Coleman,  M.B.,  B.8..  of  Glacton-on-Sea,  son  of  S.  H.  Coleman,  of 
Treveaa,  Forest  Hill,  to  Florrie,  youngest  daughter  of  the  late 
James  W.  Scott,  of  Poons. 

Crambr  —  Maonauqhton-Jonbs.  —  May  ISth,  at  St.  Marylebone 
Chnrch,  London,  by  the  Very  Rev.  the  Dean  of  Norwich,  assisted 
by  the  Rev.  W:  H.  MacnauKhton-Jones,  M.A..  brother  of  the 
bride,  Captain  Jocelyn  Henry  Cramer,  son  of  the  late  John  Cramer, 
Esq..  of  Ballindlnisk  House,  Klnsale,  formerly  of  the  7th  Dragoon 
Guards,  to  Edith  May,  only  daughter  of  H.  Maonaughton-Jonee 
Esq.,  M  D.,  F.R.C.S.I.  and  E.,  of  London. 


itathB* 


Ball.— May  10th,  at  Crosby  House,  Houndow,  WiHIam  Montague 

BaU.  M.B.Aberd..  aged  41. 
Gardnbr.— May  lOtb,  at   Mustapha  Sup^rieure,   Algiers    RIcfaar 

C.  Gardner,  M.D.,  late  of  Paioswick,  Gloucester,  aged  68. 
M0XBK-M«y  Pth,  In  Paris,  David  A.  Mozey,  M.D.rM.R.C.P.Lo 

Fulton  Lecturer,  New  College,  Edinburgh. 
STATTBR.-May  Othl  at  Snapethorpe  Hall,  near  Wakefle  d,  WQ  lav 

Statter,  jTp.,  FJI.C.S.,  In  his  90th  year. 

NOTICB—Aniwuno-tnentM  v/  Birffu,  Marrioffett  and  DmUIu  im  tke 
familieM  of  Subteriben  to  this  Journal  art  in»erUd  frw,  mnd  mitsf 
rcLch  the  publuJufrt  not  laUr  than  the  Monday  prectdhng  ynWieafien. 


Mt  ^dial  ^vts$  mH  (Mvmht 


«^gALnS    POPUU    SUFRBMA    LSX." 


V0L.OXIL 


WEDNESDAY,    MAY    87,    1896. 


No.  22. 


THE    VARIOUS 

MANIFESTATIONS   OF    EYE-STRAIN 

UPON  THE  EYE  ITSELF 

AND    THE    BEARING  THIS   HAS   UPON 

TREATMENT,  (a) 

By  ERNEST  CLARKE,  M.D.,  F.R.C.S., 

BwgeoD  to  the  Ceotnl  Loodoa  Ophthalmlo  Hospltol,  Ao. 

I  SHALL  not  refer  here  to  ocular  pein,  headache,  and 
the  remoter  effects  of  eyorstrain.  These  I  and  others 
have  dealt  with  elsewhere,  and  they  are  more  or 
less  known  to  all  of  you.  In  passing  I  would  brieflv 
call  four  attention  to  a  paper  I  read  before  the  British 
Medical  Association  two  years  ago,  (b)  in  which  I 
showed  that  hUpharitis  was  invariably  associated  with 
an  error  of  refraction,  and  that  66  per  cent,  of  the 
oases  were  astigmatic.  A  longer  experience  has  only 
served  to  confirm  the  views  expressed  in  that  paper, 
and  I  consider  that  the  treatment  (although  not  the 
only  treatment)  for  blepharitis  is  the  proper  correction 
of  the  error  of  refraction  and  the  wearing  of  glasses. 
Now  here,  as  all  through  my  paper,  I  do  not  want  you 
to  understand  that  I  consider  eye-strain  to  be  the  only 
cause  of  blepharitis.  A  strumous  diathesis,  dirt,  and 
many  other  causes  mav  exist,  but  the  eye-strain,  I 
maintain,  is  the  cause  that  determines  the  attack  on 
the  eye  or  on  the  eyelid.  You  may  cure  the  disease 
for  a  time,  by  active  local  and  general  treatmept,  but 
if  the  strain  is  not  removed,  you  will  sooner  or  later 
have  a  recurrence. 

Conjtu%ct%vitU,—yf^  may  divide  this  disease  into 
five  groups  :— 

1.  Furident  Conjunctivitis  (gonorrhoeal  or  oph- 
thalmia neanatorum. 

2.  Afuco-purulent  (catarrhal  ophthalmia,  spring 
catarrh,  &e.). 

3.  Oranular  (trachoma,  follicular  coi^.,  granular 
ophthalmia). 

4.  Phlyctenida/r. 

5.  Diphtheritic, 

Only  in  the  phlyctenular  variety  do  I  sugj^t  that 
there  is  any  marked  association  with  ametropia,  but  in 
other  forms,  which  have  become  chronic  and  resist 
treatment,  I  strongly  advocate  that  the  refraction 
should  be  tested,  and  if  any  refractive  error  be  dis- 
eovered,  it  should  be  corrected.  I  am  confident  that 
you  will  then  find  the  disease  much  more  amenable 
to  local  and  general  treatment 

Keratitis. — ^You  know  how  frequently  children 
suffer  from  phlvctenular  keratitis.  A  phlyctenule 
forms  in  the  middle  of  the  cornea,  more  often  than  not 
aver  the  pupil ;  this  breaks  down,  and  an  ulcer  results, 
photophobia  is  intense,  the  ulcer  is  neglected,  and  a 
funeral  keratitis  ensues,  and  when,  finally,  the  disease 
IS  cured  ( P)  a  dense  corneal  opacity  is  left  as  a  scar  that 
interferes  with  vision  for  ever  afterwards.    Tou  know 

(«)  The  Presidential  AddreM  dellTered  before  the  Wert  Kent 
Meoioo-Gbimrgloal  Society,  Mi^  1st,  1806L 
(»)  Ophthalmolofiodl  Hcvtov,  NoTember,  18M. 


how  useful  atropine  is  in  such  cases,  and  how,  if  properly 
put  into  the  eye,  the  child  will,  in  a  few  days,  be  able 
to  open  its  ^e,  and  in  a  very  short  time  be  well.  Why 
is  atropine  such  a  useful  agent  P  because  it  puts  the  eye 
at  rest.  Follow  the  history  of  that  child,  the  eye  gets 
well,  you  cease  using  the  atropine,  and  all  goes  on  wdl 
for  some  time ;  in  the  course  of,  say,  a  year  or  longer  it 
has  an  attack  of  measles,  or  in  some  way  the  sjrstem 

Sts  lowered,  and  the  child  is  brought  to  you  again.  I 
ve  scores  and  scores  of  old  hospital  letters  with  the 
records  of  such  cases.  A  year's  interval  and  then  the 
word  relapse  occurs  on  the  patient's  letter  ;  a  few  weeks 
of  treatment  and  well,  another,  or,  perhaps,  two  years, 
and  another  relapse,  and  so  on.  When  the  child  is  well, 
and  before  ceasing  theatropine,te8t  the  refraction  ;  you 
will  find  an  error,  and,  in  most  cases,  a  considerable 
amount  of  astigmatism.  Put  that  child  into  glasses 
and  you  prevent  the  relapse.  I  think  the  eye-strain 
determines  the  attack  on  the  eye.  say,  in  a  strumous 
child,  and  one  recoverv  from  an  illness  in  exactly  the 
same  way  that  an  unhealthy  joint  will  determine  an 
attack  of  gout  in  it.  When  we  realise  the  enormous 
number  of  people  whose- vision  is  permanently  lowered 
through  these  scars,  the  result  of,  in  many  cases,  recur- 
rent corneal  ulcers,  we  cannot  help  feeling  that  the  old 
adage,  "Prevention  is  better  than  cure,"  was  never 
better  applied. 

^c/^rttM.— Inflammation  of  the  sclerotic  is  in  many 
cases  a  very  painful  complaint,  it  is  exceedingly 
obstinate,  and  sometimes  appears  quite  unamenable 
to  treatment  It  is  associated  very  often  with  the 
rheumatic  diathesis.  Leeches,  blisters,  atropine,  fomen- 
tationsandinternal  exhibition  of  salicinemayameliorate 
matters  and  the  disease  settles  down  into  a  chronic  or 
subacute  state,  or  may  get  well  only  to  reappear  again 
some  time  later.  In  a  lar^e  percentsge  of  cases  that 
have  been  under  my  care  during  the  last  few  years  I  have 
found  a  marked  error  of  refraction,  and  on  correcting 
this  with  glasses  the  various  remedies  have  acted  like 
a  charm.  Some  cases  that  have  resisted  treatment 
for  months  have  been  cured  in  a  week  or  ten  days. 

Iritis.— 'The  intimate  association  of  the  ins  with 
the  ciliary  body  and  muscle  would  lead  us  to  expect 
that  strain  would  have  a  perceptible  effect  on  the 
causation  or  aggravation  of  this  disease,  and  so  it  has. 
It  is  in  recurrent  iritis  that  I  would  specially  diaw 
your  attention  to  this  association.  You  know  what  an 
annoying  disease  recurrent  iritis  is,  how  it  recurs  in 
one  or  both  eyes,  or  alternately  year  after  year,  or 
with  longer  or  shorter  intervals,  and  how,  from  the 
deposit  of  lymph  and  pigment  on  the  antenor 
capsule,  or  from  the  delay  of  treatment  with  atro- 
pine, from  the  adhesions  formed,  the  eye  is  left  worse 
off  after  each  attack.  You  know  that  the  treatment 
has  been  iridectomy^  but  an  operation  is  always  looked 
upon  as  a  very  serious  thing,  and  it  is,  in  fact,  a  serious 
matter,  but  the  worst  is  that  iridectomy  does  not 
always  prevent  a  recurrence.  During  the  last  three 
years  I  have  attempted  to  determine  the  refraction  of 
any  iritis,  and  where  I  succeeded  I  have  found  in 
every  case  a  serious  error,  and  I  believe  the  first,  if  not 
the  best  treatment  for  recurrent  iritis,  is  the  correc- 
tion of  refractive  errors.  In  this  way  I  have,  in  many 
instances,  prevented  a  relapse  in  patients  wh'> 
constantly  suffering 


^A    Thi  Ubdkul  PiMfe. 


OBIOINAL  GOMMITNIOATTONS. 


Mat  87,  ISM. 


Olattcoma,^Yon  know  that  die  fluid  secreted  by 
the  glands  of  the  ciliary  body  nonriehes  the  yarioiis 
structures  in  the  ey^i  notably  the  yitreoos  and  lens, 
and  that  the  greater  part  of  the  fluid  passes  from  the 
posterior  chamber  through  the  pupil  into  the  anterior 
chamber,  and  thence  out  at  the  nitration  angle  into  the 
choroidal  veins.  The  tension  of  the  eye  is  raised  by 
this  increase  of  fluid  in  the  eye.  either  (1)  by  its  hyi>er- 
aecretionf  or  (2)  its  obstructed  exit  at  the  filtration 
angle  due  to  its  increased  viscidity  or  to  actual  obstruc- 
tion at  this  spot,  or  both,  and  we  get  ([lauooma.  Now 
irritation  of  the  fifth  nerve  and  dictation  of  the  ciliary 
vessels  will  cause  hypersecretion,  and  although  Priest- 
ley Smith  savs  '*  the  hypothesis  that  glaucoma  is  the 
expression  of  a  persistent  hypersecretion  remains  a 
hypothesis  "  (a),  stUl  I  want  vou  to  bear  in  mind  that 
it  IS  a  hypothesis,  and  withal  a  very  reasonable  one. 

But  let  us  pass  on  to  the  real  cause  of  ptimsay  glau- 
coma—obstructed excretion.  We  find,  according  to 
Priestley  Smith,  three  important  facts  (6)  :— 

1.  The  size  of  the  lens  increases  throughout  life,  and 
the  liability  to  glaucoma  increases  throughout  life. 

2.  The  liability  to  primary  glaucoma  is  greatest  in 
exceptionally  small  e^es. 

3.  Hypermetropia  is  the  commonest  refractive  state 
in  eyes  affected  with  primary  glaucoma. 

All  these  three  factors  tend  to  block  the  filtration 
angle. 

Now  with  reference  to  hypermetropia,  I  want  you 
to  recognise  three  important  facts  :~ 

1.  The  ciliary  muscle  is  always  enlarged  in  hyperme- 
tropia,  and  with  it  very  often  the  ciliary  body  is  also 
hypertrophied ;  this  tends,  of  course,  to  obstruct  the 
filtration  angle,  and  might  also  lead  to  hypersecretion. 

2.  Hypermetropia  uncorrected  always  means  con- 
eiderable  eje-strain,  because  the  eye  is  never  at  rest, 
except  during  sleep. 

3.  Hypermetropia  in  a  large  number  of  cases  is 
associated  with  astigmatism,  which  would,  of  course, 
increase  the  strain. 

Walker  (''Trans,  of  Int  Med.  Congress,  1881 ")  and 
Shoen  C' Trans.  Int  Oph.  Conffress,  1888'')  both  put 
forth  the  contention,  that  hypermetropia  might 
probably  start  glaucoma  through  the  excessive  strain 
in  the  accommodation,  but  Priestley  Smith  answered 
Ahis  by  asserting  that^  according  to  his  tables,  the 
liability  to  glaucoma  is  ^eatest  at  a  time  of  life 
when  me  accommodation  is  in  abeyance.  My  answer 
to  this  is  that  by  his  own  tables  he  shows  that,  although 
the  liability  reaches  its  maximum  at  60,  it  begins  to 
rise  rapidly  after  30,  and  that  its  most  rapid  rise  is 
about  40,  just  at  the  period  when  the  accommodation 
may  be  taxed  to  its  utmost,  and  certainly  is  not  in 
abeyance.  Again,  as  I  have  said,  astigmatism  is  in  a 
large  number  of  cases  associated  with  hypermetropia, 
and  this  of  itself  must,  if  uncorrected,  cause  strain. 

I  have  several  patients  under  mv  care  who  have  had 
one  sli^t  attack  of  primary  glaucoma,  and  who, 
by  wearing  correcting  lenses,  have  succeeded  in  ward- 
ing off  another  attack  ;  this  may  be  a  coincidence,  but 
if  it  is,  it  appears  to  me  to  be  a  very  remarkable  one. 
Please  quite  understand  me.  I  do  not  suggest  for  a 
moment  that  every  case  of  glaucoma  is  due  to  eye- 
strain, but  I  do  maintain  that,  from  what  we  know  of 
eye-strain,  it  is  highly  probable  that,  given  other  con- 
ditions, it  may  start  an  attack,  and  thus  form  an  im- 
portant factor  in  the  causation  of  this  dire  disease. 

Catoroc^— Although  for  some  time  past  I  have  fully 
recognised  the  important  part  that  astigmatigm  plays 
in  the  causation  of  cataract,  I  confess  I  was  very  sur- 
prised at  the  result  of  the  investigation  I  made  for  this 
paper.  I  have  taken  200  cases  of  cataract  eyes 
from  my  private  case-books,  beginning  with  my  last 
cataract  patient  and  ceasing  when  I  reached  the  two- 

(a)  "OUnooma,"  1891,  iMgeSO. 

(b)  Ibid,  p.  84. 


hundredth.  In  a  large  number  of  these  cases  the 
cataract  was  incipient  and  often  only  discovered  when 
the  pupil  was  dilated,  and  oonsequentiy  the  patient 
had  no  idea  of  the  presence  of  the  disease. 

I  have  only  consioered  such  cases  as  cataract  when 
the  lens  showed  opaque  striae  or  patches  in  its  substance, 
and  have  excluded  all  cases  of  opacities  on  the  capsule 
the  result  of  inflammation.  In  almost  all  the  cases  the 
examination  was  made,  and  the  refraction  worked  out 
under  homatropine.  Those  cases  in  which  the  density 
of  the  cataract  prevented  the  estimation  of  the  refrac- 
tion were  excluded.  Counting  an  error  of  refraction 
to  be  any  astigmatism  over  "25  D.,  any  hypermetropia 
over  1  D,  and  any  myopia,  I  found  ametropia  present 
in  every  case,  and  astigmatism  present  in  150,  ie.,  75 
percent 

The  refraction  of  200  cataracts. 
Astigmatism. 

Hypermetropia... 

c.  presbyopia 


Myopia 
Mi^ed 


Hypermetropia. 
Simple 


Myopia. 

Simple 


Presbyopia. 
Simple 


c.  presbyopia 
c.  presbyopia 

c.  presbyopia 

c  presbyopia 


48 
17 
64 
15 
3 


150 


4 
16 


20 


14 
13 


27 


200 


Astigmatism  present  in  75  per  cent 

What  is  the  percentage  of  astigmatism  present  in  all 
ejres  ?  Work  Dodd  (a)  found  on  examining  50  people 
with  apparently  normal  sight,  that  9  of  them,  t.e.,  18 
per  cent  were  astigmatic.  Contrast  this  18  per  cent 
with  75  per  cent  shown  in  the  above  table  and  surely 
these  figures  indicate  a  distinct  association  between 
astigmatism  and  cataract 

If  astigmatism  may  lead  to  cataract  you  may  very 
naturally  ask,  what  is  the  modus  operandi  f 

With  few  exceptions,  the  seat  of  regular  astigmatism 
is  in  the  cornea,  due  to  a  difference  in  the  curvature  of 
the  different  meridians  ;  added  to  this  there  is  some- 
times found  a  "static  crystalline  astigmatism," due  to 
a  difference  in  the  curvature  of  the  diiBPerent  meridians 
of  the  lens,  and  the  two  together  make  up  the  total 
astigmatism  of  the  e^e  which  is  revealed  under 
an  ordinarjr  examination,  fint  most  frequently, 
although  astigmatism  of  the  eye  is  suspected,  where  it 
is  of  low  degree  it  may  be  impossible  to  detect  it  with- 
out resorting  to  a  mydriatic.  Bonders,  in  1864,  first 
drew  attention  to  this,  and  he  pointed  out  that  the 
corneal  astigmatism  was  masked  and  corrected  by  an 
inverse  astigmatism  of  the  lens.  Dobrowalsky,  in  1868, 
asserted  that  this  crystalline  astigmatism  was  produced 
by  an  unequal  contraction  of  the  ciliary  muscle  ;  and 
Hensen  and  Yoelckers  later  have  shown  by  experi- 
ments upon  animals  that  this  unequal  contraction  is 
I)06sible.  They  showed  that  when  a  filament  of  the 
cUiar;^  nerve  was  divided  the  portion  of  the  muscle 
supplied  by  it  was  relaxed,  and  that  on  stimulating  the 
cut  end  a  local  contraction  took  place. 

But  quite  apart  from  the  physiological  proof,  the 
clinical  proofs  are,  to  my  mind,  so  perfectlv  conclusive 
that,  in  spite  of  the  fact  that  many  ophthalmologists 
decline  to  accept  this  theory,  I  myself  thoroughly 
believe  it 

(a)  "  Ttani.  Oph.  8o«.,"  roL  zill,  p.  80S. 


Mat  27,  1896. 


OKIOIlliAL  GOMMUNIGATIONa 


Thi  Msdioal  Pb»8.     547 


Let  me  take  a  typical  case.  A  patient  complains  of 
headache  accentuated  by  near  work.  £b[amination 
revealfl  no  refractive  error.  The  ciliary  maecle  ia  para- 
lysed by  a  mydriatic,  and  astigmatism  is  discovered. 
This  is  corrected  by  cylinders,  the  glasses  are  ordered 
to  be  worn  always,  and  in  a  short  time  the  patient  is 
cared. 

Again,  very  often  when  the  ejSect  of  the  mydriatic 
has  passed  off  the  patient  refuses  the  cylinder  that 
improved  his  vision  under  atropine.  He  tells  you  that 
it  makes  his  vision  worse.  In  spite  of  this  you  pre- 
scribe it,  and — ^this  is  a  very  important  point — ^you 
insist  on  the  glasses  being  worn  always.  He  returns 
in  a  month  or  two,  assuring  you  that  his  headaches 
have  entirely  disappeared,  that  he  has  become  accus- 
tomed to  the  glasses,  but  that  he  cannot  now  see  as 
well  without  them  as  he  could  before  using  them.- 

What  has  happened  ?  At  first,  when  the  effect  of  the 
mydriatic  has  passed  off,  the  ciliary  muscle  returns  to 
its  old  habit  of  unequal  contraction,  and  consequently 
the  correcting  glasses,  instead  of  helping,  make  matters 
worse  ;  but  by  constantly  wearing  them  the  necessity 
for  this  unequal  contraction  disappears,  the  muscle 
resumes  the  normal  condition  and  allows  the  glasses  to 
do  the  work.  Vision  is  apparentlv  worse  without 
the  glasses  because  the  muscle  has  for^^tten  its  bad 
habit ;  but,  of  course,  like  all  bad  habits,  it  can  be 
easily  re-acquired.  The  patient  has  lost  nothing  but 
his  headache.  What  stronger  proofs  could  one  have 
that  this  unequal  contraction  does  occur? 

What  is  more  likely  to  inteif  ere  with  the  nutrition 
of  the  lens  than  this  unequal  contraction'of  the  cUiary 
muscle,  producing  an  artificial  lenticular  astigmatism, 
and  constantly  taking  place  ? 

It  is  interesting  to  note  that  in  the  cases  I  examined 
where  the  strain  was  more  in  one  eye  than  the  other, 
that  eye  showed  greater  changes,  and  in  some  cases 
was  the  only  one  affected  by  cataract. 

The  practical  deduction  from  all  this  is  that  by  cor- 
recting the  error  of  refraction  and  so  removing  the 
strain  we  ought  to  be  able  to  arrest  or  retard  the 
development  of  cataract,  and  I  fully  believe  that  this 
is  the  case.  The  patients  I  have  under  treatment  at 
present  most  certainly  illustrate  this,  but  as  the  longest 
period  of  observation  is  only  four  years  the  time  is  at 
present  too  short  to  enable  me  to  use  them  as  convinc- 
ing proofs  of  the  above  theory,  time  alone  will  show 
this,  and  I  shall  hope  at  some  future  period  to  bring 
the  subject  before  you  again. 


ABDOMINAL   SUKGERY— NOTES  OF 
CASES. 

By  RUTHERFORD  MORISON,  M.B..  F.R.C.S., 

Senior  Assistant  Surgeon,  Royal  InflmnAry,  Newcastle-on-I>ne  ; 
Consulting  Surgeon,  Newcastle  Dental  Hospital. 

(Continued  from  page  420.) 

In  the  previous  portions  of  this  paper  the  deaths 
that  occurred  after  my  abdominal  operations  during 
1895  have  been  recordea  in  detail.  It  now  remains  for 
me  to  fulfil  the  rest  of  my  promise,  and  to  report  such 
cases  of  special  interest  as  were  operated  upon  by  me 
during  the  same  period. 

Perhaps  the  suoject  most  engaging  at  present  the 
attention  of  abdommal  surgeons  is  the  surgical  treat- 
ment of  appendicitis,  and  it  is  one  well  worthy  of 
stud}r.  Knowledge  of  it  is  only  to  be  added  to  by  the 
making  of  accurate  clinical  and  pathological  records. 
Symptoms  and  siji^ns  should  be  carefully  observed, 
llien  the  pathological  conditions  found  should  be  care- 
fully noted.  The  present  prognostic  uncertainties,  on 
which  depend  the  differences  of  oi)inon  as  to  treat- 
ment, are  the  result  of  insufficient  pathologfieal , 
information,  and  will  be  overcome.    It  is  impossible  ] 


for  me  to  deal  in  the  space  at  my  command  with  so 
large  and  important  a  subject,  even  if  it  were  useful 
that  I  should  do  so,  but  there  are  one  or  two  points  I 
would  like  to  emphasise. 

The  first  is  one  on  diagnosis.  It  is  safe  to  say  that 
appendicitis  is  by  far  the  most  common  cause  of  acute 
abdominal  pain  accompanied  by  rise  in  temperature, 
and  that  the  appendix  should  first  be  excluded  in 
dealing  with  such  case?. 

The  next,  also  on  diagnosis :— A  considerable  tender 
swelling  round  the  appendix,  not  diminishing  under  care- 
ful treatment,  and  of  over  four  days'  duration,  contains 
pus,  even  though  the  temperature  and  pulse  be  normal, 
and  other  symp»toms  are  not  aggressive.  The  diagnosis 
of  pus  carries  with  it,  of  course,  the  recommendation  for 
operation. 

The  third  :— -That  a  case  with  a  history  of  two  or 
three  days  of  abdominal  uneasiness,  followed  hj  a 
sudden  attack  of  *'  agonising  pain,"  is  one  demanding 
operation,  at  the  earliest  convenient  time,  for  there  is 
a  large  perforation  in  the  appendix,  and  the  grave  risk 
of  diffuse  peritonitis,  should  be  anticipated. 

The  last  on  treatment  That  repeated  doses  of  opium 
may  be  relied  on  to  relieve  all  the  svmptoms  to  such  an 
extent  as  to  mislead  the  most  watchful  practitioner.  Pos- 
sibly  it  would  be  well  to  add  my  belief  that  the  opera- 
tion for  removal  of  the  appendix  by  a  comi>etent  sur- 
geon is  one  involving  so  small  a  risk,  that  if  there  is 
doubt  as  to  whether  it  should  be  undertaken  in  any 
particular  case,  the  benefit  of  the  doubt  should  be  given 
in  favour  of  operation. 

Casb  L— Severe  Belapsing  and  Recurrent  Appendi 
citis — Large  Mass  Remained  in  Right  Iliac  iosm — 
Operation  After  Fourth  Attack— Cavity  Outside  of 
Ccecum  packed  unth  Gauze  and  Drained, 

Mrs.  D.,  8et.  54,  sent  to  me  by  Dr.  Thompson,  Gates- 
head. During  the  last  eleven  months  the  patient  has 
had  four  attacks  of  severe  abdominal  pain,  terminating 
in  an  illness  of  some  days'  duration. 

The  first  attack  began  on  a  Wednesday  evening,  in 
April  of  last  year  (1894),  while  the  patient  was  in 
church,  with  pain  chiefly  round  the  navel.  She  was 
able  to  sit  out  the  service,  and  walk  home  alone,  though 
with  difficulty.  Soon  after  getting  home  she  went 
to  bed;  and  vomited,  was  in  pain,  and  slept 
very  little  all  night.  The  matter  vomited  was 
dark-coloured,  and  the  doctor  said  it  was  blood. 
The  pain  increased  during  the  next  day,  and 
lasted  for  a  week,  after  which  it  ^dually  sub- 
sided. During  the  first  few  days  the  pain  was  all  over 
the  bowels,  after  which  it  settled  in  the  right  side. 
The  bowels  were  much  constipated,  but  no  swelling 
was  noticed  till  Dr.  Thompson  discovered  it  last 
December.  The  second  attack  began  in  July,  the 
third  in  November,  and  the  fourth  in  December,  1894. 
Each  was  similar  to  the  first,  with  the  exception  that 
the  vomited  matter  was  never  dark  except  the  first  time. 

After  the  last  attack  in  December  the  patient  did 
not  regain  her  strength,  and  never  became  entirely  free 
from  pain,  as  she  had  usually  done.  After  six  weeks' 
rest  m  bed  she  still  continued  ill,  and  the  lump 
remained  tender.  On  February  5th  her  condition 
was  as  follows  : — ^The  abdomen  was  not  dbtended.  In 
the  right  iliac  fossa  there  was  a  distinct  feeling  of  re- 
sistance. 

One-third  of  the  distance  between  the  anterior 
superior  spine  of  the  ileum  and  the  umbilicus  a  hard 
rounded  tender  mass  the  size  of  a  large  filbert  was 
felt.  Extending  upward  from  it  there  was  a  less  firm, 
less  tender  mass  for  two  inches^  the  upper  end  of  wliich 
was  gradually  lost  above.  The  harder  nodule  seemed 
to  be  fixed  on  a  less-defined  underlying  mass,  the  lower 
end  of  which  ended  abruptly  opposite  the  centre  of 
Pouparf s  ligament. 

Operation,  6rh  Feb.,  1895.— An  incision  was  made  in 
the  right  linea  semilunaris,  extending  from  the  right 

0 


548     Trs  MiDiOAL  Press. 


ORIGINAL  C0MMUMCATI0N8. 


Mat  27.  1898. 


umbilical  level  to  immediately  above  Poupart's  liga- 
ment The  cecam  was  adherent  to  the  parietal  peri- 
toneum and  omentum,  and  a  doubled-up  influned 
portion  of  the  omentum  had  caused  the  knob  felt 
before  operation.  A  second  incision  was  now  made 
commencing  at  the  centre  of  the  first  and  running 
obliquely  back  in  the  middle  of  the  iliocostal  space. 
The  abdominal  cavity  was  packed  with  sponges,  and 
the  outer  side  of  the  cecum  stripped  from  the  parietal 
peritoneum.  A  small  quantity  of  purulent  fluid  and  a 
considerable  quantity  or  dirty  granulation  tissue  was 
found  locked  up  between  the  two,  and  at  the  bottom 
of  the  cavity  the  appendix  firmly  bound  down  by 
adhesions.  It  was  separated  up  to  its  ciBcal  attach- 
ment, when  a  small  perforation  was  exposed  at  the 
junction  of  the  cecum  and  the  appendix.  The  latter 
was  ligatured  and  cat  off,  and  the  stump  burned  with 
the  thermo-cautery.  The  former  was  carefully  sutured 
with  silk,  after  tucking  into  it  the  charred  and  li^- 
tured  stump  of  the  appendix.  After  draining  the  cavity 
it  was  packed  with  iodoform  gauze,  and  a  full-sized 
india-rubber  drainage-tube  inserted.  The  abdominal 
wound  was  closed  with  three  layers  of  specially  pre- 
pared cat-gut  sutures,  except  at  the  posterior  and 
dependent  end  of  the  oblique  incision,  where  the  ends 
of  the  ffauze  and  drainage-tube  projected  into  the  loin. 
Here  uie  wound  was  temporarily  closed  by  two  silk- 
worm-gut sutures  tied  m  a  bow  knot,  to  be  untied  for 
the  removal  of  the  sauze  plug,  and  permanently  tied 
afterwards,  as  described  in  a  paper  of  mine  on  *'The 
Use  of  the  Tampon  and  Temporary  Suture  in 
Abdominal  Surgery,"  published  in  Northumberland 
and  Durham  Medical  Journal^  January,  1893.  The 
operation  lasted  one  hour  and  a  quarter,  and  the  patient 
was  put  to  bed  in  good  condition. 

Patholoay. — The  appendix  removed  was  two  inches 
long  and  thickened,  fifear  the  centre,  where  it  had  been 
specially  adherent,  the  thickening  was  most  marked. 
Ijiere  was  a  small  perforation.  On  slitting  it  up,  the 
mucous  membrane  liuing  it  nearly  filled  the  lumen  in 
which  was  some  mucus.  Two  perforations  had  occurred, 
one  at  the  junction  of  appencux  and  caecum,  the  second 
in  the  midclle  of  the  appendix. 

After  Progress.— On  February  8th,  forty-eight  hours 
after  operation,  the  gauze  strip  was  removeoT  and  the 
eilkworm  gut  sutures  were  permanentljr  tied.  February 
10th. — ^Wound  dressed  Uie  second  time  and  tube  re- 
moved. February  16feh.— Wound  dressed  for  third 
time  and  was  healed,  except  where  drainage-tube  had 
been,  and  the  silkworm-gut  sutures  were  removed. 
Four  days  later  she  went  home  healed.  There  is  no 
weakness,  and  no  bulging  of  the  scar,  though  a  segment 
of  the  lower  end  of  the  rectus  muscle  is  paralysed. 

Cass  II. — Appendicitis  in  Female  with  Pelvic  Peri- 
tonitis—Dermoid  Ovarian  and  Parovarian  Cyst — 
Appendix  Abscess  drained  through  Loin —Ovariotomy 
— Pelvis  drained  per  Vaginam. 

Mrs.  M.  P.,  et.  31,  patient  of  Dr.  Davies,  of  Sunder- 
land. On  April  4th,  1895,  felt  a  pain  in  abdomen  but 
not  severe.  She  took  a  purgative  pill,  and  at  2.30 
a.m.  was  wakened  with  severe  pain.  A  aose  of  saline 
aperient  and  hot  flannels  relieved  her.  In  the  morning 
ehe  took  a  cup  of  tea  which  she  vomited.  She  had 
hiccough.  Her  bowels  were  not  moved.  On  April 
5th,  at  10  o'clock  a.m.  she  was  seen  by  Dr.  Davies,  who 
found  her  with  a  pulse  of  80  and  temperature  100°, 
complaining  of  general  abdominal  pain.  Her  cheeks 
were  flusheo,  feet  cold,  knees  drawn  up,  mouth  dry 
and  she  had  thirst.  Abdomen  generally  tender,  but 
mostly  in  the  hypogastriura.  £nema  given  in  the 
evening  had  no  apparent  effect,  but  was  followed  by 
intense  pain,  and  feeUiig  of  faintness,  vomited  once. 
Temperature  101*2°,  pulse  90,  feels  occasional  chills.  On 
April  6th  pain  became  more  distinctly  referred  to  right 
side  of  the  abdomen,  which  was  swollen.  On  April 
14th  Dr.  Davis  found  a  lump  in  the  right  Oiac  fossa 


On  April  18(h  a  oonaultation  with  Dr.  Drummond  ' 
held,  and  a  pelvic  swelling  was  found  in  addition  to 
the  tumour  m  right  iliac  fossa,  I  saw  the  patient  first 
on  April  19th  (fifteen  davs  after  illness  commenced). 
Previous  to  her  present  illness  she  had  always  been  in 
good  health.  Sne  was  now  pale  and  ill-looking,  her 
tongue  was  red  and  moist,  pulse  100  temperature  100", 
In  uie  right  lumbar  region  and  extending  into  the  right 
iliac  fossa,  a  tender  resisting  ill-defined  swelline  was  felt 

Per  vaginam.— The  pelvu  was  filled  with  nrm  exu- 
date, fixing  the  uterus.  Her  temnerature  chart,  kept 
since  the  commencement  of  her  ulness,  was  strongly 
suggestive  of  the  presence  of  pua. 

Operation,  April  20th.~The  abdomen  was  opened 
by  an  oblique  incision  in  the  direction  of  the  external 
oblique  fibres  over  the  caecum.  The  caecum  was  found 
glued  down  over  a  mass  in  the  right  iliac  fossa.  In 
the  pelvis,  and  filling  the  pouch  of  Douglas,  and  covered 
by  adherent  intestines,  a  fluctuating  swelling  was  felt 
The  intestines  above  the  pelvis,  with  the  exception  ol 
the  caecum,  were  free  from  adhesions.  The  abdominal 
wound  was  packed  with  sponges,  and  covered  with  an 
antiseptic  towel,  and  the  patient  was  placed  in  the 
lithotomy  position.  After  vigorous  cleaning  of  vulva 
and  vagina,  an  incision  was  made  in  the  posterior 
vaginal  fornix,  close  behind  the  cervix  uteri.  About 
3j  of  purulent  fluid  escaped.  A  pair  of  forceps  pushed 
close  into  the  opening  and  drawn  out  open  led  to  no 
further  result  between  one  hand  in  the  abdomen 
above,  and  finger  in  the  vaginal  opening  below,  a  cystic 
swelling  could  be  distinctly  felt  The  patient  was  now 
placed  on  her  back,  with  an  antiseptic  towel  over  tiie 
vulva,  and  tiiie  abdominal  wound  was  prolonged  back- 
wi^s  to  the  loin,  and  forwards  to  the  middle  line,  the 
deep  epigastric  artery  being  secured  before  its  division. 
After  separating  the  adherent  intestine,  the  cystic 
swelling  m  the  pelvis  was  now  seen  to  be  ovarian. 
The  tumour  was  turned  out  whole,  and  the  oozing  bed 
in  which  it  had  been  adherent,  was  immediately 
packed  with  sponges.  The  remainder  of  the  abdomf  nu 
cavity  was  also  packed  off  with  sponges,  and  the  sepa- 
ration of  the  caecum  from  the  parietes  on  the  outer 
side  undertaken.  On  separating  the  outer  layer  of  the 
meso-colon,  an  abscess  containing  at  least  two  ounces 
of  stinking  pus  was  evacuated.  The  appendix  was 
searched  for  by  raising  the  whole  caecum  from  the 
outer  side.  It  was  seen  and  felt  firmly  adherent  to, 
and  flattened  on,  the  under  surface  of  the  exposed 
caecum,  where  it  was  left  after  an  attempt  to  separate 
it  had  shown  that  this  could  not  be  done  without 
tearing  the  intestine.  The  abscess  was  sponged  dry 
and  carefully  packed  with  iodoform  gauze  strips, 
the  ends  of  which  were  left  hanging  out  from 
the  loin  end  of  the  wound  behind.  The  abdo- 
minal and  pelvic  sponges  were  next  removed, 
and  all  oozing  found  to  have  ceased.  A  second  cyst, 
the  size  of  a  turkey's  egg,  was  now  found  in  the  pelvisu 
and  was  removed.  The  left  ovary  and  tube  were  found 
in  their  normal  position,  and  seemed  healthy,  though 
adherent,  they  were  left  A  pair  of  long  clamp  forceps 
were  introduced  from  the  abdominal  wound  down  to 
the  opening  in  the  upper  part  of  the  vagina,  and 
guidea  by  Dr.  Davies' finger  in  the  vagina  were  led 
outside  of  the  vulva,  when  they  were  opened,  and  made 
to  seize  a  thick  strand  of  iodoform  gauze,  the  upper 
end  of  which  was  drawn  on  so  as  to  just  reach  into  the 
pelvis,  tiie  lower  lying  within  the  vulva.  The  entire 
abdominsi  wound  was  closed  with  silk,  except  where 
the  gauze  drain  and  an  india-rubber  drain  were  left 

S rejecting  at  ite  loin.    The  vulva  and  the  wound  were 
ressed  with  antiseptic  dressings. 
The  first  cyst  removed  was  an  ovarian  dermoid,  the 
size  of  a  cocoanut ;  the  second  a  parovarian  cyst,  the 
size  of  a  turkey's  egg. 

After  Progress,— April  24th,  1895  (ninety-six  hours 
after  operation),  the  gauze  was  removed  from  both 


Mat  27,  1896 


ORIGINAL  COMMUNICATIONS. 


Thb  MfloioAL  Pbsss.     549 


▼ai^nal  and  lambar  wounds.  April  26th,  the  vaginal 
discharge  was  noticed  to  be  offensive,  and  irrigation 
with  iodine  water  brought  away  a  quantity  of  foetid 
matter.  All  the  stitches  were  removed  on  the  fifteenth 
day  ;  the  wounds  were  entirely  healed  in  the  early  part 
of  June.  Convalescence  was  uninterrupted,  and  the 
immense  cicatrix  has  been  so  carefully  looked  after 
that  it  has  shown  no  tendency  to  bulge. 

Case  III. — Acute  Appendicitis— Large  Localised 
Collection  of  Fluid  in  Peritoneal  Cavity  SimuUUing 
Diffuse  Peritonitis  ^Drainage — Recovery. 

Miss  G.  M.  C,  8bL  11,  a  patient  of  Dr.  Macaulay's. 
On  Thursday  morning,  Feb.  2l8t,  1895  (six  days  before 
operation),  the  patient  was  slightly  sick  after  taking 
some  tea.  Again  on  the  following  morning  (Friday) 
ehe  was  sick,  but  got  up,  and  then  complained  of  some 
pain  atfd  feeling  sick.  A  little  brandjr  was  adminis- 
tered, but  she  vomited  it,  and  complained  of  feeling 
alternately  cold  and  hot  On  Saturday  morning  an 
aperient  was  given,  which  she  vomited  two  hours  after- 
wards. At  2  o'clock  p.m.  some  senna  was  administered, 
after  which  she  slept  for  two  hours,  but  woke  scream- 
ing with  pain  in  her  bowels,  which  was  so  acute  that 
ehe  became  unconscious  for  five  minutes.  For  the  first 
time  her  illness  was  now  recognised  as  serious,  and  the 
doctor  sent  for.  At  6  p.m.  she  vomited.  She  passed  a 
restless  night,  and  on  Sunday  morning  her  abdomen 
was  swollen  and  tender.  She  had  an  easy  day  after 
5  p.m.,  when  she  vomited  and  complaineid  of  pain. 
Another  restless  night  was  followed  by  no  improve- 
ment. On  Monday  afternoon  I  saw  the  patient  with  Dr. 
Macaulay.  She  was  the  most  philosophical  young  person 
I  have  ever  known,  for  though  desperately  ill  she 
made  no  complaint,  and  took  everything  as  it  came. 
Her  face  was  pinched  and  gray,  with  large  black  rings 
round  her  eyes.  Temperature  100**,  pulse  128.  Abdo- 
men considerably  distended,  and  there  was  some 
tenderness,  best  marked  on  the  right  side,  and  in  the 
right  iliac  fossa.  Both  flanks  were  dull  on  percussion, 
especially  the  right  The  dulness  of  the  left  side 
receded  with  change  of  posture,  but  not  so  that  on  the 
right.  Dr.  Macaulay  and  myself  took  the  most 
unfavourable  view  of  the  case,  for  we  made  a  dia- 
gnosis of  acute  perforating  appendicitis  with  general 
peritonitis,  and  thought  an  operation  might 
only  hasten  the  end.  The  measurement  of  the  abdo- 
men round  the  umbilicus  was  23i  inches,  and  the 
following  morning,  February  26th,  1895,  we  met  again, 
and  the  only  change  recognisable  was  that  the  abdo- 
minal girth  bad  now  increased  to  25  inches.  In  a  few 
hours  \\  inches  of  increase  was  recorded.  The  same 
afternoon  we  had  the  advantage  of  a  consultation 
with  Dr.  Drummond,  who  urged  operation,  as  offering 
the  only  chance,  though  a  very  poor  one.  At  3.15 
p.m.,  operation.  An  incision  was  made  in  the  right  linea 
semilunaris,  opening  the  abdomen,  and  about  half  a 
pint  of  stinking  purulent  fluid  gushed  out,  My  finger 
introduced  into  the  cavity,  and  gently  run  round,  led 
me  to  believe  that  the  cavity  might  be  shut  off  from 
the  general  peritoneum  by  surrounding  soft  intestinal 
adhesions.  From  the  upper  end  of  the  first  incision  a 
second  was  made  back  into  the  ileocostal  space  to  the 
loin.  The  cavity  was  sponged  dry,  and  the  appendix 
looked  for,  but  without  disturbing  any  adhesions.  It 
was  not  seen.  The  dry  cavity  was  lightly  dusted  with 
iodoform,  and  drained  by  ^l^rS®  india-rubber  drainage- 
tube,  coming  out  at  the  loin  end  of  the  wound.  The 
remainder  of  the  wound  was  closed  in  three  layers 
with  specially  prepared  catgut. 

After  Progress,— With,  the  exception  of  some  suppura- 
tion in,  and  faecal  discharge  from,  the  wound,  which 
caused  an  occasional  rise  of  temperature,  recovery  was 
uninterrupted,  and  the  wound  healed  entirely  by  April 
11th.    No  yielding  of  scar  or  hernia. 

{To  he  continued.) 


NOTES  OF  A  CASE  OF 

PULMONARY      EMBOLISM; 

RECOVERY 

WITH  SOME  REMARKS  UPON 

PERIPHERAL     VENOUS    THROM- 

BOSIS,  (a) 

By   JOHN    H.   GLENN,   M.D., 

Bz-AHiitant  Physician,  Rotanda  Hotpital,  Dablia. 

Mrs.  J.,  was  delivered  of  her  second  child,  a  large, 
healthy  bojr,  on  December  9,  1896.  The  patient  was  a 
tall,  exceedingly  stout,  younff  woman  ;  the  labour  was 
natural  and  not  prolonged.  When  I  arrived  the  head 
was  born  and  the  perineum  required  two  sutures, 
which  were  of  silk.  She  had  both  before  and  since 
her  marriage  sufiEered  from  varicose  veins  of  both  legs, 
and  these  caused  her  considerable  pain  after  her  first 
child  and  also  when  carrying  the  second.  Her  tem- 
perature remained  normal,  and  the  perineal  wound 
healed  kindly,  but  on  the  third  day  my  attention 
was  called  to  the  left  leg,  where  I  found  the  in- 
ternal saphenous  vein  thickened  and  inflamed,  with  a 
distinct  area  of  redness  about  the  size  of  a  florin.  The 
usual  treatment  was  resorted  to,  namely,  elevation 
of  the  limb,  suitable  posture,  lotion  of  lead  and  opium, 
covering  with  cotton  wool,  and  even  bandaging. 

The  case  for  three  weeks  displayed  some  unusual 
features,  as  the  temperature  in  the  evening  remained 
below  100^  F.,  and  the  leg  displayed  none  of  the  usual 
hard  oedema  met  with  in  the  so-called  '*  white  leg."  At 
this  time  I  felt  justified  in  regarding  the  case  as  one  of 
simple  venous  thrombo6is,my  onlyanxiety  being  presence 
of  obstinate  constipation  with  ^hite  -  furred  tongue, 
the  well-known  recognised  prodromata  of  phlegmasia 
alba  dolens.  With  this  in  mind  careful  abdominal 
palpation  was  practised,  but  no  ejBTusion  was  to  be  de- 
tected on  either  side.  During  the  fourth  week  the 
vein  was  to  be  felt  as  a  distinct,  hard  cord,  but  the  leg, 
though  painful  at  night  and  feeling  heavy  to  the 
patient,  was  still  quite  soft,  it  was  slightly  larger  than 
the  ri^ht  on  measurement 

Patient  and  her  friends  were  warned  as  to  the  grave 
dangers  incurred  by  sudden  movements,  and  she  was 
progressing  well,  if  slowly,  up  to  the  17th  of  January, 
1896,  or  thirty-nine  days  after  her  delivery.  On  the 
18th  of  January  she  had  some  visitors,  and,  feeling  so 
much  better,  probably  rather  over-exerted  herself,  for 
immediately  after,  when  having  her  leg  dressed,  she  sud- 
denly became  faint  and  breathless,  and  I  was  sent  for 
in  a  hurry.  My  friend  Dr.  Flynn,  who  was  kindly 
doing  duty  for  me,  saw  her  at  9.30  p.m..  and  found  her 
lying  with  anxious  aspect,  rapid  breathing,  and 
tumultuously  beating  heart.  Her  brother,  who  is  a 
senior  medical  student,  had.  on  auscultating  before 
Dr.  Flynn's  arrival,  distinctly  heard  a  systolic  murmur, 
but  this  disappeared,  only,  however,  to  return  again 
with  increasea  volume  on  her  second  attack,  which 
took  place  at  5  a  m.  So  serious  had  the  case  become 
that  Dr,  Flynn  sent  for  Dr.  Parsons  at  6  a.m.  Dr. 
Parsons  has  very  kindly  furnished  me  with  the  follow- 
ing notes:— "I  saw  Mrs.  J.  about  six  o'clock,  she 
was  then  rather  pale  and  anxious  looking  |  there  was 
no  distinct  cyanosis,  or  marked  distension  of  the 
jugular  veins ;  her  temperature  was  slightly  elevated  ; 
pulse  about  110;  respiration  somewhat  increased  in 
frequency,  but  there  was  at  the  time  of  m^  visit  cer- 
tainly no  dyspnoea.  So  far  as  an  examination  of  the 
front  and  sides  of  the  chest  was  concerned,  I  could 
detect  nothing  abnormal  In  her  lungs.  I  did  not  care 
to  move  her  as  I  thought  doing  so  might  be  attended 
with  some  danger.  As  regards  her  heart,  there  was  no 
thrill  or  friction  palpable,  nor  was  there  any  marked 

(a)  Bead  before  the  Royal  Aoademy  of  liedicliie,  Ireland,  April  10th, 


550     Thb  Mbdiqal  P£K3s. 


ORIGINAL  COMMUNICATIONS 


Mat  27,  18B6. 


displacement  of  the  apex  beat.  A  rather  rough 
murmur,  apparently  aystolic  in  time,  was  audible  over 
the  mitral  area,  out  was  heard  with  the  greatest 
intensity  in  the  third  left  intercostal  space,  about  an 
inch  from  the  left  margin  of  the  sternum,  and  could  be 
traced  downwards  and  inwards  towards  the  end  of  the 
sternum.  The  murmur  was  loud,  single,  and  had  not 
any  of  the  characteristics  of  a  pericardial  friction 
sound.  I  recommended  digitalis  and  diffusible  stimu- 
lants, so  as  to  keep  the  blood  flowing  actively,  and 
thereby  diminish  the  tendency  of  a  clot  to  increase  in 
size." 

I  myself  saw  the  case  at  eleven,  and  found  her  with 
a  full  pulse,  beating  at  140.  temperature  101*  respira- 
tions 40  I  made  a  careful  examination  of  ner  chest 
and  found  a  well-marked  systolic  murmur,  with  its 

Eoint  of  greatest  intensity  over  the  tricuspid  area.  The 
eart  beats  were  regular,  but  afterwards  oecame  inter- 
mittent. She  was  slightly  cyanosed  when  I  saw  her. 
but  not  the  livid  purple  considered  as  a  proof  or 
spontaneous  coagulation  rather  than  embolism.  The 
air  was  entering  the  lungs,  but  not  easily,  as  her  atten- 
tion was  concentrated  upon  the  act.  She  was  in  a 
most  highly  nervous  state,  and  had  quite  made  up  her 
mind  to  die.  There  was  no  bronchitis  nor  pneumonia. 
I  quite  agreed  with  the  diagnosis  arrived  at  that  it  was 
a  case  of  pulmonary  embolism.  I  have  twice  before 
met  with  it  after  coeliotomies  during  my  service  in  the 
Rotunda  Hospital. 

The  treatment  was  spts.  amm.  arom.  and  spts.  sBtheris 
CO.,  with  hypodermic  injections  of  morphia  to  allay  her 
restlessness,  which  was  extreme.  Digitalis  was  ex- 
hibited later,  and  the  morphia  was  changed  first  to 
paraldehyde  and  then  to  sulphonal,  which  proved  the 
most  serviceable.  The  murmur  persisted  for  four  days, 
and  gradually  diminished,  while  the  temperature  rose 
until,  on  the  22nd,  it  was  103*4^  Now  occurred  the 
most  interesting  feature  of  the  case  ;  as  the  murmur 
ptassed  away  a  localised  area  of  pneumonic  consolida- 
tion appeared  at  the  back  of  the  right  lung,  corres- 
ponding to  the  middle  lobe,  while  at  the  same  time  she 
began  to  expectorate  rusty-coloured  sputum.  I  submit 
a  chart  of  this  local  pneumonia,  oy  which  nature 
expelled  this  embolus ;  the  amount  in  the  twenty- four 
hours  never  exceeded  half  a  spitting-cup.  Care  was 
taken  to  keep  her  off  her  back,  and  the  case  went  on 
from  this  time  favourably ;  It  is  interesting  to  note 
that  the  right  leg  became  affected  after  this  attack,  but 
in  merely  a  slight  degree.  Dr.  Parsons  saw  her  on 
February  20th,  1896,  and  writes :— "  Her  heart  seems 
perfectly  normal,  but  there  is  still  some  dulness  over 
the  lower  portion  of  the  right  lung  at  the  back."  This 
dulness  has  since  cleared  up,  but  I  believe  the  pleura  is 
still  thickened. 

I  have  brought  the  above  case  before  the  Obstetrical 
Section,  not  only  on  account  of  the  interest  which  must 
necessarily  attach  to  a  recovery  from  pulmonary 
embolism,  but  also  because  I  regard  it  as  an  example 
of  thrombosis  apart  from  sepsis.  As  long  ago  as  1877, 
Spiegelberg  stated  *'  that  puerperal  thrombosis  has 
been  far  too  much  mixed  up  with  those  complications, 
and  it  is  desirable  that  we  should  study  simple  uncom- 
plicated thrombosis."  An  interesting  discussion  on 
this  point  is  published  in  the  last  volume  of  the 
Obstetrical  Society  of  London's  Transactions,  and  the 
bulk  of  opinion  favoured  the  non-septicitv  of  peripheral 
venous  thrombosis.  In  the  case  here  before  you  I  fail 
to  see  how  it  could  be  included  under  septic,  but 
should  like  to  hear  the  opinions  of  those  better  quali- 
fied to  judge. 

It  must,  I  think,  be  allowed  to  be  one  of  two  con- 
ditions—K^ither  spontaneous  coagulation  in  the  right 
heart,  and  extending  into  the  pulmona^  artery,  or  an 
embolus  detached  from  a  peripheral  urombus,  pro- 
bably floating  out  of  the  femoral  vein  into  the  vena 
cava.    I  have  already  mentioned  why  it  is  not  likely  to 


have  been  spontaneous  coafful&tion.  The  great  majori^ 
of  emboli  found  after  death  come  from  the  systemic 
veins,  and  notably  from  the  internal  saphenous  and 
femoral  veins.  The  reason  of  coagula  forming  most 
commonly  in  these  situation  being— first,  that  the 
action  of  the  vis  a  tergo  and  thoracic  asj^iration  is 
scarcely  at  all  felt ;  and,  second,  the  lying-in  state  is 
exceedingly  favourable  to  this  condition  on  account  of 
the  state  of  the  blood,  the  dilated  pelvic  4ind  femoral 
veins,  and  the  diminution  of  the  heart's  action ;  while, 
if  we  consider  these  same  causes  as  provocative  of 
varices  before  delivery,  we  must  add  the  general  rise 
of  abdominal  pressure  consequent  upon  the  increased 
dimensions  of  the  uterus.  In  this  puerperal  complica- 
tion it  is  satisfactory  to  note  that  many  more  recoveries 
are  reported  than  perhaps  is  generally  recognised,  and 
it  is  a  great  satisfaction  to  me  to  be  able  to  add  yet 
another. 


NOTES  ON  A  CASE  OF 

CHRONIC  ULCER  TREATED  BY 
OXYGEN. 

By  ROBT.  J.  HARVEY,  L.R.C.S.I., 

AHistant  SorgeoD,  Eichmond  HotpiUL 

The  patient,  a  woman,  set.  58,  was  sent  up  from  the 
country  about  two-and-a-half  years  ago  for  treatment 
of  an  ulcer  on  her  leg.  The  ulcer,  situated  on  the 
outer  surface  of  the  lower  third  of  the  left  leg  was  of 
some  months'  duration,  ovoid  in  shape  and  measured 
two-and-a-half  inches  in  the  long  diameter,  by  two 
inches  transversely,  the  edges  were  rounded  and  eleva- 
ted, the  base  quite  insensitive  and  devoid  of  granula- 
tions, the  surrounding  skin  was  pigmented  and 
infiltrated  and  in  an  eczematous  condition.  Active 
treatment  for  chronic  ulcer  was  adopted^  rest  and 
elevation  of  the  limb  with  pressure  applied  by  an 
ordinary  wet  bandage  The  eczema,  which  was  very 
troublesome,  was  treated  with  lead  and  tar  lotion. 
The  ulcer  healed  in  three  months  time.  A  great  deal 
of  infiltration  and  solid  cedema  persisted  in  spite  of 
the  rest  and  bandaging.  The  eczema  had  subsided 
but  was  not  completely  cured  when  the  patient  was 
allowed  to  go  home. 

On  September  25th,  1895,  patient  was  readmitted  to 
the  Richmond  Hospital.  An  ulcer  had  formed  near, 
but  not  in  exactly  the  same  situation  as  the  one  pre- 
viously mentioned.  Measurements,  2  2-5th  by  2  l-5th 
inches.  The  limb  was  greatly  congested  and  infiltrated, 
the  skin  in  an  acute  eczematous  condition  from  the 
ankle  to  the  tubercle  of  the  tibia,  some  varicosity  of  the 
internal  saphenous  vein  existed,  but  not  to  a  marked 
extent. 

The  circumferential  measurements  of  the  diseased 
limb  as  compared  with  the  sound  one  may  be  of  in- 
terest 

Diseased.  Sound. 

Round  calf         ...      17}  inches.  14}  inches. 

„      level  of  ulcer  132       »  11       „ 

„      ankle      ...      12i       „  10       „ 

Dr.  George  Stoker^s  oxygen  treatment  was  adopted. 
A  50  per  cent,  oxygen  was  kept  constantly  applied  to 
the  limb  for  nearly  eight  weeks.  At  the  end  of  the 
second  week  the  ulcer  was  looking;  healthy,  firm,  and 
florid  granulations  covered  the  surface,  the  thickened 
and  elevated  edges  seemed  to  have  melted  away,  and 
ike  eczema  had  completely  subsided. 

October  14th,  viz.,  about  a  fortnight  under  the 
oxygen  treatment,  nine  skin-grafte  taken  off  the  same 
limb  above  the  knee  were  put  on,  only  five  of  these 
were  visible  on  the  sixth  day ;  they  made  very  little 
progress  during  the  treatment  and  showed  no  sign  of 
spr«idinff  and  coalescing. 

The  mcer  gradually  diminished  in  size  from  day  to 


Mat  27,  1896. 


TRANSACTIONS  OF  SOCEETHS. 


Tbs  Mbdioil  Prms.     &51 


day,  though  to^wards  the  end  of  the  healing  process  the 
diminution  became  less  marked,  and,  finally,  appeared 
to  be  at  a  standstill,  when  the  ulcer  was  only  two- 
fifths  of  an  inch  in  diameter. 

November  22nd.— Oxygen  treatment  was  discon- 
tinued, a  dry  pad  of  boric  Tint  and  bandages  applied. 

On  December  1st  the  ulcer  was  completely  healed. 

What  can  be  claimed  for  the  oxygen  treatment  in 
this  case  is  :— 

1.  The  good  firm  cicatrix  that  resulted,  and  which 
showed  no  tendency  to  break  down. 

2.  The  improvement  that  had  taken  place  in  the 
skin  and  infiltrated  tissues  :  the  eczema  had  completely 
subsided  in  less  than  a  fortnight,  the  skin  had  r^;ained 
in  most  places  its  normal  appearance,  though  pigmen- 
tation still  persisted  in  the  immediate  vicinity  of  the 
cicatrix. 

3.  The  marked  diminution  in  the  size  of  the  limb 
speaks  for  the  absorption  that  had  taken  place  from 
the  infiltrated  tissues.  The  measurements  of  the  limb 
now  are,  round  calf,  16  inches ;  round  level  of  cicatrix, 
11}  inches  ;  round  ankle,  11  inches. 

4.  The  length  of  time  under  treatment  was  shorter 
than  before,  when  the  ulcer  was  treated  on  ordinary 
principles,  though  the  ulcers  were  practically  the  same 
size. 

The  patient  now  (six  months  after)  writes  to  say  she 
is  in  excellent  health ;  the  ulcer  has  not  broken  down, 
and  the  eczema  which  she  dreads  most  has  not  made 
any  appearance. 

I  am  gratefully  indebted  to  Sir  Thornley  Stoker  for 
allowing  me  to  publish  these  notep. 


Trarulated/or  Thi  Mbdioal  Puns  and  Cibculab 
By  GEORGE  FOY,  F.R.C.S., 

Soxgeon  to  the  Whifvrorth  Hoapital,  Drumoondra ;  Hon.  Fellow  of  the 
Boafchern  Surgical  and  Gyniecologloal  Aaiooiation,  U.S.  A. 

PflABTNOSAL  SpBAT. 

Iodine,  25  centigrammes ; 
Carbolic  add,  25  centigprammes  ; 
Potaaaium  iodid.,  25  centigrammes  ; 
Glycerine,  5  grammes ; 
Distilled  water,  30  grammes. 
Mix.  ^ 

To  be  Rprayed  on  the  inflamed  tissues  occasionally.  ^El 
Eeo  del  Consultorio, 

MocTTH  Wash. 
Saccharine,  1  gramme ; 
Soda  bicarbonate,  1  gramme  ; 
SalicvHc  acid,  4  grammes  ; 
Alcohol,  200  grammes. 
Make  a  solation. 
A  few  drops  in  water  to  be  need  as  a  gargle. 
Anodyne  Ointment. 
Hydrochlorate  of  cocaine,  30  centigrammes  ; 
Eacalyptol,  20 drops; 
Lanoline,  30  grammes. 
Make  an  ointment. 
Recommended  for  a  nose  pigment  in  bay  fever  and 
before  minor  operations  in  the  nose. 

Nasal  Ointment. 
Eacalyptol,  1  to  4  grammes  ; 
lAnoUne,  SO  grammes. 
Mix. 
A  asef  al  application  in  rhinitis  sicca. 
Sybup  of  Eucalyptus. 
Dried  leaves  of  eucalyptus,  30  grammes  ; 
Water,  690  gprammes ; 
Loaf  sagar,  1,240  gprammes. 
Make  an  infasion ;  strain  it  through  serge  with  slight 
pressure ;  allow  the  sediment  to  subside ;  add  the  sugar 
And  dissolve  by  heat  of  a  water  bath. 


Sybup  of  Rhatany. 
Extract  of  rhatany,  12  grammes  ; 
Water,  116  ^in^mmes  ; 
Loaf  sugar,  220  gprammes. 
Dissolve  the  extract  in  water  ;  filter  the  liquid  ;  add  the 
sugar,  and  make  the  syrup  without  heat. 
Sybup  of  Comfbsy. 
Prepared  from  the  root  of  the  oomfrey  in  the  same  iyrup 
of  marsh  mallow. 

Sybup  of  Coltsfoot. 
Prepared  with  the  dried  leaves  of  the  plant. 
Sybup  of  Raspbebbibs. 
White  sugar,  1,000  grammes  ; 
Raspberries,  520  grammes ; 
Water,  345  grammes. 
Dissolve  the  sugar  in  the  water  with  a  gentle  beat ;  add 
the  raspberries  ;  and  after  a  slight  simmer,  strain,  with- 
out prepsur^,  through  serge. 
Syrup  of  Strawberry  is  prepared  in  the  same  way. 
Sypup  of  Gum. 
White  gum  arable,  90  grammes  ; 
Water,  90  grammes ; 
Simple  syrup,  600  grammes. 
Dissolve  the  gum  in  water  ;  strain  through  serge  ;  mix 
with .  boiling  syrup. 

Sybup  of  Cinchona. 
Cinchona  loja  in  powder,  115  grammes  ; 
White  wine,  1,035  grammes  ; 
Alcohol,  90  per  cent.,  85  grammes  ; 
Loaf  sugar,  1,550  grammes. 
Macerate  the  quinine  for   twenty-four  hours,  in  the 
mixture  of  wine  and  alcohol ;  filter  ;  add  the  sugar,  and 
dissolve  without  heat. 

Syrups  of  gooseberry,  lemon,  quince,  mulberry,  and 
pomegranate  are  prepared  with  juice  of  the  fruit  as 
verjuice  syrup. 

Syrup  of  the  blue  violet,  syrup  of  heartsease,  syrup  of 
ground  ivy,  and  syrup  of  sarsaparilla,  all  find  a  place  in 
the  Pharmacopoeia. 

These  syrups  are  stocked  by  Messrs.  Hamilton,  Long  & 
Co.,  Dublin.— Ed.] 

^ranBaaioriB   at  f^ocxttith. 

CLINICAL  SOCIETY  OF  LONDON. 
Mbbtinu    hild    Fbiday,   May   22nd,    1896. 


The  President,  Dr.  Buzzabd,  in  the  Chair. 

TYPHOID  FBVBB  WITH  HYPRBPYBEXIA  ;  AOUTB  CABDIAO 

dilatation  ;  vbnbsbotion  ;  and  bbgovbby. 
Dr.  A.  H.  Wbiss  Clxmow  read  notes  of  the  case  of  a 
patient,  Mr.  A.  H.  A.,  set.  25,  who  became  ill  on  Wednes- 
day. Nov.  Idch,  1895,  and  when  first  seen  on  the  18th 
his  temperature  was  104"  F.  (although  he  had  been  taking 
antipyretics  for  two  days  or  more),  and  fine  crepitations 
were  audible  at  the  base  of  the  right  lung.  On  the  19th 
epistaxis  occurred,  and  the  following  day  after  a  dose  of 
calomel  (gr.  iii)  typhoid  stools  wore  passed.  He  was 
placed  upon  an  appropriate  dietary  of  muk  (two  and  a  half 
pints  per  diem)  and  beef  tea  (one  and  a  half  pints)  and 
brandy,  and  ordered  cold  or  tepid  sponging  at  frequent 
intervals  as  the  temperature  might  indicate.  During 
the  next  four  days  the  temperature  ranged  between 
102*^  and  104*.  Retention  of  urine  occurred  during 
the  night  of  the  25th,  and  was  relieved  by 
a  gum  elastic  catheter  on  the  morning  of  the  26th,  and 
again  at  9  p^m.  His  condition  at  the  time  was  otherwise 
satisfactory,  pulse  90,  tongue  moist  and  not  excessively 
furred,  and  no  abdominal  distension.  At  10  and  11.45 
p.m. ,  epistaxis  recurred.  Temperature  at  midnight  103*4*. 
Two  hours  later  there  was  a  severe  rigor,  he  became  wildly 
delirious,  and  the  axillary  temperature  rose  to  106*7  • 
Vigorous  iced  sponging  reduced  this  to  103^,  and  he 
became  quiet,  tnough  he  continued  unconscious.  At 
7  a.  m.  his  temperature  was  normal,  but  at  7-30.  there  was 
another  rigor  with  delirium,  and  the  axillary  temperature 
,  rose  to  107^.    Iced  sponging  again  lowered  the  tempera- 


552     Thi  Mbdigal  Pbus. 


TRANSACTIONS  OF  SOCTETrES. 


Mat  27,  ISIPb. 


tare  and  quieted  the  delirium.  At  9.30  a.m.  be  was 
seen  in  consultation  by  Sir  William  Broadbent,  who 
advised  the  snbcutaneons  injection  of  l-3rd  grain  of 
morphia.  Between  11  and  11.30  a.m.  a  rapid 
change  for  the  worse  ooourred,  and  Dr.  Clemow  was 
requested  by  the  nurse  to  come  at  onoe,  as  Mr.  A., 
was  sinking  rapidly.  On  hisarrival  the  patient  was  found 
to  be  apparently  in  arUculo  mortis,  the  face  deeply 
cyanoeeo,  the  jaw  dropped,  conjunctival  reflex  abeent, 
and  respiration  consisting  of  almost  futile  inspiratory 
efforts.  Examination  of  the  heart  revealed  a  very  con- 
siderable distension  of  the  right  side  of  acute  onset. 
Venesection  from  the  left  median  basilic  vein  was  at  once 
resorted  to,  eight  ounces  of  blood  being  removed,  and 
subcutaneous  injections  of  digitalin  (gr.  ^^)  and  strych- 
nia (gr.  ^S  and  brandy  administered.  The  cvanoses 
then  gradually  diminished,  the  pulse,  althongn  very 
feeble  and  irregular  for  a  few  minutes,  became  fuller 
and  less  rapid,  and  shortlv  the  respiratory  movements 
improved,  air  entering  the  cnest  more  readily.  An  hour 
later,  and  subsequently  every  three  hours  for  the  next 
twenty-four  hours,  the  injection  of  digitalin  and  strychnia 
were  repeated,  and  were  supplemented  by  enemata  of 

Kptonised  milk,  beef  tea  ana  brandy.  AI>out  5  o'clock 
regained  consciousness  and  was  able  to  take  some 
nourishment.  The  next  day  considerable  hypostatic  con- 
gestion of  the  lungs  manifested  itself,  but  passed  off  under 
appropriate  treatment.  During  the  remainder  of  his 
iliness,  rigors  threatened  on  two  or  three  occasions,  the 
temperature  rising  to  103"*  or  104%  but  the  patient  ulti- 
mately made  a  complete  and  perfect  recovery. 

Dr.  Chapman  said  it  was  worthy  of  note  that  the  vene- 
section was  not  only  successful  in  reducing  the  temperature 
but  that  this  effect  was  brought  about  after  the  usual 
Antipyretics  had  failed. 

Dr.  F.  L.  Bbnham  said  it  was  an  open  question  how  far 
the  reduction  in  the  temperature  was  due  to  the  venesec- 
tion per  M,  for  this  conceivably  might  have  produced  its 
beneficial  effect  by  its  influence  on  the  pulmonary  compli- 
cation. He  recalled  a  case  of  rheumatic  hyperpyrexia 
which  proved  refractory  to  ordinary  antipyretic  measures 
such  as  cold,  &c.,  in  which  he  employed  venesection  as  a 
last  resort,  but  without  any  benefit. 

Dr.  8.  Wist  pointed  out  that  rigors  not  nnf requently 
followed  hyperpyrexia.  Bleeding  was  a  great  relief  to 
the  overdistended  right  ventricle,  acting  in  a  mechanicid 
way.  The  amount  of  blood  to  be  let  would  be  dependent 
on  the  size  of  the  individnaL  He  did  not  think  as  a  rule 
that  it  would  of  itself  reduce  pyrexia.  There  were  com- 
paratively few  cases  in  which  blood  letting  was  admissible, 
out  in  these  it  was  often  not  performed  when  it  ought 
to  be. 

Dr.  Clbhow,  in  reply,  said  he  regarded  the  rigors  as 
consequent  on  the  intensity  of  the  fever.  The  venesec- 
tion was  done  solely  to  relieve  the  over-distension  of  the 
right  heart  He  recalled  the  case  of  a  lady  suffering  from 
uraemia  within  a  few  weeks  of  delivery.  She  had  marked 
orthopnaea,  and  was  deeply  cyanosed.  Venesection  to  the 
amount  of  12  oe.  was  practised,  and  was  followed  by 
ru>id  and  complete  reuof,  delivery  being  afterwards 
effected,  and  the  patient  recovered. 

Dr.  H.  D.  RoLLBSTON  and  Mr.  Warbinoton  Hawabd 
on  a  case  of 

CHBONIO  DILATATION  OT  THB  OOLON. 

A  boy,  set.  12.  had  been  subject  to  constipation  since 
six  months  of  sffe.  He  came  from  Inverness,  and  por- 
ridge had  formea  a  considerable  part  of  his  diet.  From 
time  to  time  he  had  attacks  of  vomitine  and  complete 
inactivity  of  the  bowels  ;  on  one  occasion  having  gone  for 
nine  weeks  without  an  evacuation.  On  admission  to  St. 
George's  Hospital,  he  was  seen  to  be  emaciated,  the 
eyes  sunken,  and  the  complexion  of  a  bistre  tint.  The 
abdomen  was  enormously  distended,  and  through  the 
stretched  abdominal  wall  peristaltic  contractions  of  the 
intestine  could  be  seen.  The  front  and  upper  part  of  the 
abdomen  were  resonant,  no  faecal  masses  could  be  felt. 
Palpation  of  the  abdomen  usually  gave  no  pain,  but 
sometimes,  on  deep  pressure,  he  complained  of  tenderness, 
the  situation  of  which  varied.  The  rectum  was  natural, 
and  there  was  no  spasm  of  the  sphincter.  During 
the  three  months  that  he  was  under  observation 
his  condition  varied,  often  very   suddenly.    |He   would 


improve  for  a  time,  the  bowels  acting  daUy  and  the 
abdomen  becoming  soft.  Then  suddenly  constipation  and 
vomiting  would  come  on  without  manifest  cause.  These 
attacks  usnaJly  subsided  in  a  day  or  two,  but  in  one  of 
them  he  died.  There  was  never  any  obstruction,  the 
bowels  acting  nearly  every  day.  The  treatment  was 
varied,  but,  with  the  exception  of  calomel,  nothing  seemed 
to  do  any  material  good.  PoH'-marfem, — Great  dilata^on  of 
the  colon  was  found  ;  the  ascending  colon  parsed  up  to 
the  hepatic  flexure,  from  whidi  point  the  transverse  colon 
descended  to  the  neighbourhood  of  the  caecum ;  the 
descending  colon  occupied  the  greater  part  of  the  right 
half  and  upper  portion  of  the  abdomen,  it  passed  out  of 
sight  in  the  left  lumbar  reffion,  and  then  joined  the 
dilated  sigmoid  flexure.  No  stricture  or  cause  for 
obstruction  could  be  found  anywhere.  There  were 
numerous  ulcers  in  the  colon,  due,  presumably,  to  disten- 
sion. The  muscular  coats  were  hyper trophied,  Gases  of 
dilatation  of  the  colon  were  divided  into  acquired  and 
congenital,  and  reference  was  made  to  nine  esses,  eight  of 
which  were  fatal.  The  etiology  and  patholof^  of  the 
condition  were  discussed,  and  it  was  shown  that  neither 
mechanical  cause  nor  an  inflammatory  origin  was  borne 
out  by  facts.  The  high  mortality  and  the  unsuoeessful 
results  of  treatment  were  pointed  out,  and  the  danger  of 
>ge  insisted  upon.    The  question  of  colotomy  or  of 


opening  the  small  intestine  was  considered,  and  it 
advised  that,  having  regard  to  the  abnormal  mobility  and 
change  in  the  position  of  the  bowel,  any  operation  should 
include  as  its  first  step  the  ascertainment  of  the  anatomical 
relations  of  the  parts  involved. 

Dr.  Halb  Wbitb  observed  that  the  acquired  fonn  doe 
to  constipation  was  well  known,  and  did  not  possess  much 
importance.  Several  cases  of  the  congenital  form  were 
found  scattered  throughout  medical  utereture,  and  of 
these  no  satisfaotory  explanation  had,  as  yet,  been  offered, 
the  constipation  bmnff  the  result  rather  than  the  cause. 
Some  of  toe  cases  of  dilatation  of  the  colon,  particularly 
of  the  sigmoid,  occurring  in  adults,  were  not  associated 
with  sufScient  constipation  to  aocount  for  the  dilatation. 
These  cases  appeared  to  be  comparable  to  cases  of  para- 
lytic distension  of  the  stomach.  The  cases  were  equally 
distributed  between  males  and  females.  Treatment  by 
opening  the  large  bowel  above  the  distended  part  had 
been  practised,  so  as  to  allow  any  faeces  to  pass,  the 
affected  portion  of  bowel  being  regularly  washea  out  and 
left  at  rest. 

Mr.  Bbucb  Glabxb  said  that,  in  addition  to  the  case 
recorded  by  Dr.  Herringham,  he  was  enabled  to  ^ve  a 
further  example  of  one  which  he  regarded  as  bdoneins  to 
the  same  category.  It  was  that  of  a  man  who  had 
obstruction  of  the  large  intestine  which  was  thought  to 
k>e  due  to  careinoma.  Colotomy  was  performed,  and  the 
patient  improved  and  lived  for  four  years,  dying  ulti- 
mately of  a  condition  not  connected  with  the  boweL 

Dr.  RoLLXSTON  said  the  case  recorded  by  Osier  appeared 
to  be  the  only  one  which  had  not  proved  fatal.  As  m  thia 
case  the  colon  was  so  movable,  it  was  suggested  that  an 
exploratory  laparotomy  should  be  first  done,  as  otherwise, 
when  lumbar  colotomy  was  performed,  the  surgeon  might 
fail  to  find  the  bowel. 

OBNTBAL  SABOOBfA  OF  FBMOB. 

Mr.  Baldwin  read  a  paper  on  a  case  of  central  sarcoma 
of  the  femur  with  early  dissemination.  The  patient  was 
a  man,  aet.  35,  admitted  into  St.  George's  Hospital  on 
Septembsr  3rd,  1895,  with  a  central  sarcoma  of  the  femur. 
The  thigh  was  amputated,  and  the  man  discharged  on 
October  2nd.  Soon  after  leaving  the  hospital  he  suffered 
from  pain  in  the  right  arm  which  subsequently  became 
stiff  and  weak.  On  November  1st  he  found  on  wakine 
that  he  was  paralysed  over  the  lower  part  of  the  trunk 
and  lower  limbs.  He  was  readmitted  on  November  8th 
the  trunk,  left  lower  limb,  and  stump  being  para- 
lysed and  devoid  of  sensation.  He  was  suffering  from 
incontinence  of  urine  and  faeces.  The  rieht  arm 
was  completely  paralysed  and  the  left  partially,  both 
upper  extremities  were  without  sensation,  save  over 
the  deltoid  muscles.  He  died  two  days  after  admission. 
A  post-mortem  examination  was  made,  and  widely  diB« 
seminated  growths  were  found.  Ot  these,  the  largest  waa 
one  growing  from  the  7th  cervical  vertebra,  and  extending 
upwards  and  downwards  in  front  of  the  lower  cervical  ana 


Mat  27,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Trs  Mbdioal  Pubs.     553 


upper  doraal  vertebm,  the  lower  cervical  nerves  being 
embedded  in  its  snbstanoe.  Other  nowths  were  present 
in  both  langs  and  in  the  risht  kidney.  Both  primary 
and  secondary  growths  were  mixed-celled  in  natore.  The 
reader  of  the  paper  also  referred  to  a  second  case  in  which 
a  central  sarcoma  of  the  femur  became  disseminated.  Un- 
fortnnately  there  was  no  record  of  the  nature  of  the 
growth,  and  no  post-mortem  examination  was  made. 


OPHTHALMOLOGIOAL   SOCIETY   OF    GREAT 

BRITAIN. 

Mbring  hbld  Thubsdat,  Mat  7th,  1896. 

The  President,  Mr.NBTTLiSHiP,  in  the  Chair. 

ClJNIOAL  EVSNINO. 
KKOOVKBT  FROM    BTMPATHBTIO  OPHTHALMIA. 

Mr.  Andebson  Critchett  showed  a  man,  set.  55,  who 
received  an  injury  to  the  right  eye  on  Jan.  90th,  when  he 
was  struck  with  an  iron  nail,  no  part  of  which  remained 
inside  the  organ.  Two  days  later  the  lens  was  seen  to  be 
swollen  and  opaque,  and  secondary  glaucoma  resulted. 
The  lens  was,  therefore,  removed,  a  small  amount  of 
vitreous  escaping.  The  case  progressed  favourablv  uhtil 
Feb.  20th,  when  the  eye  became  painful  and  inflamed. 
Vision  was  lost,  and  the  eye  was  excised  five  weeks  after  the 
accident  and  two  weeks  after  the  sudden  return  of  the  pain. 
On  March  22od  he  was  brought  to  the  hospital  practically 
blind.  The  left  eye  was  red,  the  affection  having  come  on 
two  days  previously,  twelve  days  after  the  excision  of  the 
right  eye.  The  pupil  was  contracted  and  motionless,  and 
the  tension  was  notably  increased.  Under  atropine  most 
of  the  adhesions  gave  way.  He  was  ordered  mercurial 
inunctions  daily.  On  April  2Qd  the  ^inunctions  were 
discontinued  for  awhile  on  account  of  stomatitis.  He  com- 
plained of  severe  pain  in  the  head  relieved  by  phenacetine. 
T%e  details  of  the  fundus  could  not  be  made  out.  On 
April  15th  the  inunctions  were  resumed,  V  =  6/36.  The 
patient  denied  having  had  syphilis,  and  there  was  no  signs 
of  his  having  had  it.    Vision  with  weak  convex  spherical 

glasses  was  now  6/6  J.  I.  The  fundus  appeared  healthy, 
[e  pointed  out  that  the  injury  was  cortical  and  did  not 
directly  involve  the  usual  tract.  The  supervention  of 
inflammation  twenty-two  days  after,  when  the  eye  was 
apparently  doing  well  was  suggestive  of  the  influence  of 
some  micro-organism.  He  remarked,  also,  that  excision 
of  the  disease-injared  eye  did  not  avert  sympathetic 
ophthalmia,  and  the  restoration  ot  vision  showed  that 
sympathetic  ophthalmia  might  be  recovered  from,  it  al«o 
showed  that  in  sympathetic  ophthalmia  subsequently 
to  excision  of  the  injured  eye  the  prognosis  is  less  grave. 

Mr.  Critohbtt  also  showed  a  woman,  sat.  42,  who  came 
to  St.  Mary's  Hospital  with  almost  complete  loss  of  sight 
in  September  last.  She  stated  that  twenty-three  years 
previously  she  had  received  an  injury  to  the  left  eve  from 
an  umbrella,  and  iridectomy  was  subsequently  done  on 
that  eye.  Vision  was  much  impaired  and  had  been  getting 
worse  ever  since.  The  right  eye  became  inflamed  shortly 
liter  the  accident  (?  sympathetic  ophthalmia),  but  vision 
was  not  impaired  until  twelve  years  ago,  when  it  became 
suddenly  worse.  He  performed  iridectomy.  Last  summer 
the  sight  of  the  right  eye  was  much  worse,  and  when  seen, 
the  patient  could  only  count  fingers  with  difficulty.  He 
removed  the  cataract  in  the  left  eye,  and  in  January  this 
year,  she  was  discharged,  vision  in  the  left  eye  with  I  D 
spherical  being  6/60.  He  was  careful  to  make  his  incision 
within  the  coroea,  being  anxious  not  to  lose  any  vitreous, 
and  none  escaped.  He  did  not  lacerate  the  capsule,  but 
used  a  vectis.  He  made  the  incision  with  a  Graefe  knife 
set  at  an  angle  of  45  degrees. 

The  PRBSiDBNT  observed  that  the  second  case,  as  well 
as  the  first,  would  seem  to  be  an  instance  of  recovery  from 
sympathetic  ophthalmia,  for  the  patient  seemed  to  have 
had  an  attack  of  iritis  shortly  after  the  injury  to  the  first 
eye.  The  question  before  them  was,  had  the  removal  of 
the  injured  eye  any  influence  upon  the  degree  and  dura- 
tion of  the  sympathetic  ophthalmia.  He  would  like  to 
hear  of  any  cases  within  the  knowledge  of  Fellows  in 
which  recovery  has  followed  without  Uie  offending  eye 
having  been  removed. 


Mr.  Bpincmr  Watson  said  that  in  a  case  on  which  he 
had  operated  some  years  ago,  the  lens  was  either  dislocated 
or  there  was  a  very  weak  suspensory  ligament.  He  got 
the  lens  with  its  capsule  away  without  any  difficulty.  Ae  . 
patient  before  operation  was  highly  myopic,  and  aftdr 
removal  of  the  lens  she  had  good  vision  without  the  aid  of 
glasses. 

OPTIO  KSaVB  DI8RA8B  IN  A  MOTHBB  AND  THBUB  OHILDBIN. 

Dt,  A.  D.  bATTKN  showed  a  patient,  with  her  three 
children,  whopresented  herself  with  them  the  same  day  com- 
plaining of  their  failin^r  sight.  She  was  anxious,  she  said, 
because  the  failure  of  sight  had  come  on  at  about  the  same 
age  as  in  herself.  Her  own  parents  appeared  to  have  bad 
good  eyesight,  but  the  patient  herself  had  begun  to  lose 
sight  at  12  years  of  a^,  the  affection  rapidly  increasing 
to  its  present  condition,  when  it  remained  stationary. 
She  had  one  sister,  »t.  33,  with  worse  vision,  which  also 
commenced  in  late  childhood.  She  also  had  a  brother, 
now  51  years  of  age,  whose  sight  had  undergone  rapid 
failure  at  the  age  of  11.  The  boy,  tot,  12,  showed  a 
certain  amount  of  optic  neuritis,  the  girl,  nt.  10,  had 
distinct  optic  atrophy,  and  the  youngest,  set.  8,  had  some 
hypermetropic  astigmatism,  and  the  discs  were  hyper- 
semio  and  congestM  with,  possibly,  commencing  optic 
neuritis.  There  was  no  constitutional  taint  or  nistorv 
of  other  nervous  disease  in  the  family.  The  mothers 
vision  was  R  1/60,  left  2^60,  not  improved  by  glasses.  The 
discs  were  pale,  atrophic,  the  marine  hazy,  and  marked 
central  cupping,  the  outline  being  irregular. 

The  Pbb^idknt  asked  if  there  was  a  historv  of  anything 
of  the  kind  in  members  of  the  family  further  back  than  the 
mother's  own  generation. 

Dr.  Habbbshon  observed  that  the  interest  of  these  cases 
lay  in  the  early  age  at  which  the  vieuiJ  failure  began. 
Most  of  the  recoraed  cares  of  Leber's  disease  had  com- 
menced between  14  and  16  years  of  sge,  and  in  the  female 
subjects  puberty  and  the  menopause  seemed  to  have  been 
the  commonest  periods.  He  asked  whether  anything  was 
known  as  to  the  children  of  the  uncles  and  aunts  ? 

Dr.  Battbn  replied  that  there  were  no  cousins. 

CA8B  OF   SPUBIOUS  OPTIC  NBUBITIS. 

Mr.  HoLMBS  Spicbb  showed  a  patient,  let.  9,  who  waa 
seen  in  April,  1893,  when  he  complained  of  pain  in  theeyee 
with  blinking,  of  six  weeks'  duration.  Both  eyes  were 
emmetropic,  vision  being  6/6.  Both  optic  discs  were  pale, 
swollen,  and  indistinct  at  the  edges.  In  November,  1893, 
vision  was  still  6/6  in  each  eye.  He  was  seen  at  intervale 
ever  since.  In  February  last  he  still  complained  of  head- 
ache and  pain  in  the  eyes,  but  he  went  to  school  He  has 
had  one  or  two  attacks  of  coloured  vision.  There  was  no 
contraction  of  the  visual  fields.  The  appearances  were 
those  of  optic  neuritis  in  the  early  subsidence  stage.  The 
interest  of  the  case  lay  in  the  long  period  during  which 
the  patient  had  been  under  observation,  the  persistence  of 
the  appearances  without  visible  change,  and  the  oocnr- 
renoe  of  optic  neuritis  apart  from  hyper metropia. 

Mr.  Habteidob  saia  the  case  ought  really  to  be 
described  as  persistent  optic  neuritis,  and  not  as  **  spuri- 
ous." Most  of  them  had  seen  such  cases  lasting  long 
periods  of  time  with  tolerably  good  vision. 

Dr.  Battbn,  in  reply,  said  the  appearances  suggested 
that  the  retina  had  been  pushed  through  too  small  a  hole» 
and  this  might  explain  the  constriction  of  the  vessels  and 
the  swelling.  These  cases  had  some  resemblance  with  the 
hypermetropic  cases,  except  that  they  lacked  the  fine 
striation. 

Mr.  Marous  G(7NK  asked  whether  anyone  had  seen  such 
a  case  as  this  get  all  right  agein  ?  He  had  watched  one  in  a 
boy  of  this  age  for  four  or  five  years,  when  unfortunately 
he  lost  sight  of  him.  During  this  period,  at  any  rate, 
his  sight  remained  unaffected.  He  was  hypermetropic  4  or 
5  D.  Correction  of  this  had  no  influence  on  the  condition 
of  the  discs. 

Mr.  QuARHT  SiLCOGK  pointed  out  that  in  this  particular 
case  there  had  never  been  any  signs  of  coarse  inflammatory 
exudation,  nor  any  bsBmorrhages.  He  remembered  the 
case  of  a  young  woman  whom  ne  had  under  observation 
for  two  years.  She  suffered  from  headache,  vomiting,  and 
other  obscure  symptoms,  and  trephining  had  even  been 
proposed  on  the  assumption  of  her  having  a  cerebral 
tumour.    Ultimately,  however,  they  came  to  the  conolu" 


554    Thb  Mbdioal  Pbhs. 


TRAKSACTIONS  OP  SOCIETIES. 


May  27,  1896. 


uon  bhat  she  was  vafferine  from  f anctional  diMaae.  These 
cases  sometimes  preaentecT  oonsiderable  difficulties  of  dia- 
gnosis. 

Mr.  Adams  Fbost  said  he  could  certainly  call  to  mind 
several  cases  of  optic  neuritis  which  had  undergone  subsi- 
dence as  in  this  case.  The  fact  that  the  discs  had  re- 
mained unchanged  was  not  per  ae  evidence  of  the  condition 
not  being  really  one  of  optic  neuritis. 

Mr.  M0LMS8  Spiobb,  in  reply,  said  he  had  called  the 
case  one  of  '*  spurious"  optic  neuritis  because  he  looked 
upon  it  as  a  physiological  condition.  Optic  neuritis  of  this 
apparent  degree  of  severity  and  lasting  so  long  would  have 
led  to  some  impairment  of  vision  whereas  by  all  the  tests 
he  could  apply  the  visual  function  was  normal. 

LTMPHANOIABOTASIS  OF  BTKLID8. 

Dr.  D.  MowAT  showed  a  lad  who  presented  a  swelling 
of  the  lower  lid  of  the  right  eye.  When  pressure  was 
applied  to  the  lower  lid  the  fluid  passed  into  the  upper 
lid,  and  when  the  pressure  was  applied  to  both  lids  at  the 
same  time  the  fluid  passed  across  the  right  side  of  the  face, 
through  several  ducts,  into  a  swelling  behind  the  right 
ear,  and  vice  versd.  The  lid  was  flrst  affected  three  years 
ago,  and  the  swelling  behind  the  ear  since  18  months. 
The  swelling  of  the  udd  had  sbeadilv  increased,  and  at 
times  was  so  pronounced  as  to  completely  hide  the  globe 
of  the  eye. 

0NB-8IDBD  SIXTH  NBBVB  PARALYSIS,  BBTBACTIOK  OF  GLOBB 
AND  OOMTBAOTION  OF  THB  OBBIOULABIS  ON  ROTATION  IN- 
WABDS. 

Mr.  Maclbhosb  showed  an  example  of  an  interesting 
group  of  cases  showing  associated  movements  to  which, 
be  believed,  attention  had  not  hitherto  been  drawn  before 
the  Society.  The  essential  points  were  paralysis  of  one 
sixth  nerve,  or,  at  any  rate,  inability  to  move  the  eve 
outwards.  There  was  pronounced  narrowing  of  the 
palpebral  fissure  on  the  same  side  when  the  eye  was  moved 
inwards  as  well  as  defective  retraction  of  the  eyelids.  The 
temporal  retraction  was  so  great  that  one  could  see  a 
definite  space  between  the  inferior  surface  of  the  globe 
and  the  lower  eyelid.  In  a  private  case  of  his  own  with 
the  same  symptoms  there  was,  as  well,  a  permanent  degree 
of  exophthalmos.  In  some  of  the  recorded  cases  there 
appealed  to  have  been  weakness  of  the  internal  rectus. 

The  Pbbsidbnt  asked  whether  there  was  any  peculiarity 
of  vision  in  the  affected  eye,  such  as  diplopia  ? 

Mr.  HoLMBS  Spigbb  said  he  had  recently  had  a  case 
which  mieht  throw  some  light  on  this  one.  A  lad  came 
to  him  whose  eyes  were  on  a  different  level  causing  very 
troublesome  diplopia.  This  he  attempted  to  remedy  by 
division  of  the  superior  rectus  which  he  only  made  out 
with  difficulty,  and  it  was  found  far  to  the  outer  side  near 
to  the  external  rectus.  If  the  same  condition  of  obliquity 
existed  in  the  inferior  rectus  the  effect  would  be  to  pull 
the  eye  backwards.  The  diplopia  was  not  improved  by 
the  operation. 

HJEMOBRHAGB  INTO  THB  ORBIT. 

Mr.  Mabous  Ounn  showed  a  woman,  aet.  67,  who  came 
to  him  a  week  since  with  the  eyelids  swollen  and  oBdema- 
tons,  the  risht  eyeball  being  proptosed.  Ocular  move- 
ments were  limited  in  all  directions,  the  pupil  was  dilated 
and  inseneible  to  light.  Tension  normal.  Eight  weeks 
ago  the  right  eye  and  right  side  of  face  became  suddenly 
greatly  swollen,  the  eyelids  being  clo'^ed  so  firmly  at  first 
that  even  with  force  they  could  not  be  separated.  Her 
doctor  described  it  as  a  haemorrhage.  The  disc  was 
atrophied,  and  on  gently  pressing  the  globe  distinct 
pulsation  was  perceived.  There  was  no  paralysis  of  the 
fifth  nerve,  but  the  third  was  affected  as  also  the  fourth 
and  sixth  to  some  extent.  He  thought  at  first  it  might  be 
thrombosis,  but  with  the  history  of  hemorrhage  and  the 
pulsation  it  occurred  to  him  that  it  might  be  aneurism  of 
the  ophthalmic  artery.  It  might,  however,  be  a  malig- 
nant growth  which  had  given  way. 

The  Pbbsidbnt  observed  that  the  blood  effused  into  the 
orbit  might  perhaps  explain  the  limitation  of  the  muscular 
movements.  He  asked  how  the  author  accounted  for  the 
involvement  of  the  optic  nerve  ? 

Mr.  EvB  recalled  the  case  of  a  girl  who  came  to  him 

with  proptosis  and  immobility  of  the  orbit  which  had 

1  existed  for  a  considerable  time.    There  was  atrophy  of  the 

optic  nerve.    On  removing  the  eye  he  found  a  sarcoma  at 


the  back  of  the  orbit,  which  contained  a  cavity  filled  witii 
blood.  If  this  had  given  way,  the  result  might  have  beeo 
as  in  the  author's  case. 

Mr.  Mabous  Gunn  replied  that  possibly  the  sheath  at 
the  optic  nerve  had  been  involved  by  the  hemorrhage. 
He  could  not  imagine  that  the  mere  pressure  of  the  blood 
would  be  sufficient  to  determine  atrophy. 

DBTAOHMBNT  of  BBTINA  TBBATBD  by   DttAINAOB. 

Mr.  F.  EvB  showed  a  patient  whose  sight  was  first 
affected  just  before  Christmas.  He  saw  him  in  January 
when  there  were  numerous  opacities  in  the  vitreous  as 
evidence  of  the  past  choroiditis.  On  February  6th,  he 
suddenly  lost  the  siffht  of  the  left  eve.  There  was  ex- 
tensive detachment  <3  the  retina  involvingf  its  lower  half, 
and  an  obscured  optic  disc.  He  was  given  iodide  of  potas- 
sium, and  was  put  to  bed  for  a  fortnight,  during  which 
time  he  had  daily  injections  of  pilocarpin.  This  treat- 
ment had  no  effect  whatever.  On  March  3rd,  he  expooed 
the  sclerotic  and  made  an  incision  into  its  lower  part,  in- 
serting a  cannula  to  let  out  the  fluid,  and  then,  through  the 
cannula,  he  inserted  a  small  bundle  of  horse  hair.  The 
drain  was  removed  three  days  later,  rather  earlier  than  he 
had  intended,  on  account  of  the  conjunctivitis  to  which  it 
gave  rise.  A  few  days  later,  the  field  was  found  to  be 
normal,  but  opacities  were  still  present  as  bands  in  the 
vitreous.  On  April  20tb,  vision  was  6/24,  but  a  week  later 
it  had  declined  to  3/36,  on  account  of  an  increase  in  the 
opacities.  At  the  present  time,  the  field  was  normal.  He 
could  detect  no  detachment  of  the  retina,  but  above  the 
disc  was  a  fine  grey  fold  running  towards  the  yellow  spot, 
probably  connective  tissue  formation  lying  upon  or  just  in 
front  of  the  retina.  It  was  unfortunate  that  the  results 
of  the  treatment  were  obscured  bv  the  opacities  in  the 
vitreous,  but  these  existed  before  the  operation. 


ROTAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Seotion  of  Obstbtbics. 

Mbbtino  hbld  Fbidat,  Apbil  IOth,  1896. 


The  President,  Db.  Lombb  Atthill,  in  the  Chair. 

BXHIBIT3. 

Db.  Alfbbd  Smith  showed— (1)  A  hvdrosalpinx  of  the 
outer  third  of  the  Fallopian  tube,  which  he  removed  from 
a  young  married  woman  who  was  sterile.  She  had  oom- 
plained  of  constant  pain  in  the  left  side,  with  unbearable 
dyspareunia.  There  was  no  history  of  any  inflammatory 
trouble.  The  tube  was  embedded  in  adhesions.  Recovery 
rapid. 

(2)  Another  example  of  complete  hydrosalpinx,  which 
he  removed  from  a  married  woman,  set.  35.  The  history 
was  well-marked  of  inflammatory  trouble  following  the 
birth  of  a  premature  child  six  years  ago.  Since  that  time 
she  had  become  almost  a  permanent  invalid,  and  spent  her 
time  in  various  hospitals  without  benefit ;  dyspareunia 
intense.  On  examination  the  palpation  gave  uterus 
slightly  dextro-posed,  with  a  mass  which  gave  the  impree- 
sion  of  an  adherent  intestine  to  the  left  Fallopian  tubs,  ao 
soft  and  elastic  did  it  feel.  This,  on  operation,  proved  to 
be  the  distended  Fallopian  tube  embedded  in  adheeioDS. 
Recovery. 

(3)  A  solid  myoma  of  the  ovary  the  size  of  a  goose  eg^, 
which  he  removed  from  a  woman,  et.  45.  Her  climatenc 
was  passed,  having  seen  no  menstruation  for  twelve 
months.  She  had  a  fibro-myoma  of  the  uterus,  whidi 
never  gave  her  any  trouble  except  the  inconvenience  of 
getting  properlv-fitting  corsets.  For  the  past  year  a  lump 
on  the  left  side  became  very  painful.  She  could  not 
tighten  her  corset,  and  had  a  dread,  while  walking  the 
streets,  of  anyone  jolting  against  her,  so  painful  did  this 
lump  become.  Under  ether  the  tumour  was  dii^noeed 
solid  ovarian.  The  operation  proved  the  diagnosis  correct ; 
the  large  myoma,  which  was  giving  no  trouble,  was  not 
removed.    Recovery, 

Dr.  Glbnn  asked  whether  there  were  any  adhesions  in 
either  of  the  two  cases  of  hydrosalpinx  ?  Hydrosalpinx 
was  usually  painless. 

Dr.  Smith  replied  that  there  were  very  extensive  perito- 
nitic  adhesions  in  both  cases.  The  pain  was  probably  due 
to  the  local  peritonitis. 


JlAT  27,  18M. 


TRANSACTIONS  OF  SOCIETIES. 


TbB  lilDIGiL  PftlSB.      555 


Dr.  JoHK  H.  Glkkv  read  notee  of  a 

CASE  OF  PUUIONABT  XMB0LI8M, 

wifeh  remarks  on  Peripheral  Veaoae  Thromboeis ;  tbia 
«aae  will  be  found  in  another  column.  In  the  diacnarion 
that  followed:  — 

Dr.  Pabsoks  said  the  characters  of  the  friction  sound 
were  endocardial  and  not  pericardial.  Thromboeia  might 
have  occurred  in  the  rieht  auricular  appendix,  and  have 
produced  the  murmur.  He  thought  that  more  probably 
it  was  due  to  an  embolna.  It  was  very  remarkable  that 
in  a  month  afterwards  the  heart  sounds  were  perfectly 
normal.  He  saw  a  poet-mortem  on  a  woman  in  Vienna 
who  had  got  up  three  days  after  confinement.  A  large 
embolus  was  found  completely  obstructing  the  pulmonary 
vessels. 

Dr.  TwRDT  said  pulmonary  embolus  was  a  very  rare 
affection.  He  did  not  think  it  would  be  coounoner  if  women 
got  up  six  hours  after  confinement.  The  orthod'^x  treat- 
ment  was  to  give  plenty  of  stimulantu,  as  the  patients 
generally  died  of  shock.  In  this  case,  as  the  woman  was 
not  suffering  in  any  way,  large  doses  of  ammonia  and 
digitalis  might  have  done  harm  by  washing  away  the  clot 
into  some  more  dangerous  situation. 

Dr.  DoTLK  said  that  some  years  ago  he  had  brought  a 
patient  to  the  Obstetrical  Society  who  had  several  attacks 
of  severe  dyspncea  after  confinement.  She  was  treated 
with  carbonate  of  ammonia  and  ether,  from  which  she 
derived  the  greatest  benefit,  and  finally  made  a  good 
recovery. 

Dr.  KiDD  had  met  with  onlv  one  case  of  pulmonary  em- 
bolism. It  occurred  a  few  hours  after  (ulivery.  The 
patient  died  in  spite  of  treatment  by  stimulants.  Some 
time  ago  five  cases  of  pneumonia  occurred  in  the  Coombe 
Hosoitol;  three  of  them  died,  but  no  trace  of  septic 
trouble  or  of  embolism  could  be  found  as  the  cause  of  the 
pneumonia.  He  thought  one  of  the  cases  was  saved  by 
oxygen  inhalation. 

Dr.  WiKiFAXD  Dixon  thought  that  inhalations  of  oxygen 
would  be  ot  more  use  in  combating  shock  and  dyspncea 
than  stimulants.  It  could  be  given  more  quickly.  It 
was  very  good  for  relieving  dyspnoea  in  pneumonia  and 
heart  cases,  and  it  might  be  of  use  in  embolus. 

Dr.  Smith  said  the  chief  point  of  interest  was  whether 
this  phlebitis  was  septic  or  not.  He  classified  thrombosis 
under  two  forms.  First,  passive  thrombosis  ;  it  frequently 
<XHSurred  in  persons  of  feeble  circulation ;  the  temperature 
was  rather  subnormal.  Second,  where  a  local  inflamma- 
toiy  trouble  was  found,  there  was  a  rise  of  temperature. 
And  it  was  generally  associated  with  some  form  of  septic 
organism.  Dr.  Glenn's  case  was  not  one  of  passive  throm- 
bosis. The  septic  organisms,  however,  were  not  strepto- 
oooci,  or  staphylococci,  for  then  the  woman  would  never 
tiave  got  well. 

Dr.  Glbkn,  replying,  said  that  only  10  minim  do«o«  of 
digitalis  were  given  twice  a  day.  He  gave  diffusible 
stimulants,  especially  ammonia,  because  ammonia  was 
eupposed  to  have  some  efficacy  in  preventing  coagulation 
of  blood,  and  in  helping  the  resolution  of  hXoSa  clots 
•Ireadjr  formed.  Oxygen  would  act  quickly,  but  would 
not  assist  the  resolution  of  blood  clots.  The  temperature 
in  this  case  never  rose  above  100^  F. 

Dr.  Jbllst  read  notes  on  a 

mCBNT  METHOD  OF  PftSFAHIKQ  CATGUT  SUTUBBS. 

The  method  described  is  a  modification  of  Dr.  Fowler's 
method.  He  stores  lengths  of  catgut  in  glass  tubes  con- 
taining alcohol,  and  then  boils  them  in  water  or  places 
them  in  a  steriliser.  This  is  the  best  way  of  preparing 
gut,  but  cannot  be  carried  out  by  a  surgeon.  Catgut  is 
difficult  to  prepare  owing  to  its  nature,  and  must  be 
absolutely  aseptic  in  consequence  of  its  being  absorbed. 
Out  can  be  rendered  aseptic  by  means  of  antiseptics,  or  by 
heat.  The  former  are  difficalt  to  manage,  as  the  bacteria 
lie  encased  in  fat,  which  is  with  difficulty  penetrated  by 
«ny  antiseptic  Heat  is  more  certain,  but  is  difficult  to 
apply  without  spoiling  the  gut  Gut  can  be  boiled  in 
Aloohol,  which  boils  at  173°  F.  This  heat  is  not  sufficient, 
it  must  be  superheated.  This  is  Dr.  Fowler's  method. 
The  modification  consists  in  using  a  cvlindrical  brass  box 
with  a  screw  top  instead  of  a  glass  tube.  The  gut  is  im- 
mersed  in  alcohol  in  the  box  and  boiled  for  fi  fce^n 
cninntes.    It  is  e8sentia^  in  order  that  the  gut  may  be 


strong  that  it  should  be  absolutely  dehydrated,  and  that 
it  is  rolled  very  looeely  on  the  plates  on  which  it  is  kept. 

The  method  recommended  is  as  follows :— 1.  Roll  the 
gut  very  looeely  on  glass  plates.  2.  Place  it  in  a  jar  in 
absolute  alcohol,  and  let  it  lie  there  for  three  or  four  dajrs. 
3.  Place  the  plates  in  Uie  brass  steriliser  just  covered  with 
alcohol.  4.  Place  the  steriliser  in  a  saucepan  containing 
cold  water,  and  keep  it  in  for  fifteen  minutes  after  the 
water  begins  to  boil.  5.  Remove  the  gut  and  place  it  in 
a  mixture  of  glycerine  and  alcohol,  which  should  be 
changed  every  ten  days.  The  steriliser  can  also  be 
used  to  render  aseptic  any  substance  which  cannot  be 
exposed  to  boiling  water  as  tests  and  also  to  resterilise 
the  glycerine  and  alcohol  in  which  the  gut  is  stored. 

Dr.  TwBSDT  said  he  had  himself  been  working  by  different 
methods  at  sterilising  catgut.  Catgut  could  oe  boiled 
without  rotting,  p^'ovided  it  was  dehydrated.  It  was  very 
difficult  to  dehydrate  catgut  in  alcohol.  It  could  be  easily 
dehydrated  by  keeping  it  in  sand,  at  a  temperature  of  80% 
for  three  days.  He  had  had  a  tin  steriliser  made  ;  the 
top  of  it  screwed  on  and  had  a  cock  in  it.  A  little  alcohol 
was  first  put  in,  and  then  the  dehydrated  catgut ;  the  top 
was  screwed  on  and  it  was  boiled  in  boiling  water.  A 
coil  was  attached  to  the  cock,  which  was  tamed  on,  and 
the  alcohol  evaporated,  being  caught  in  the  coil,  and  the 
catgut  was  left  dry. 

Dr.  Olknn  congpratulated  Dr.  Jellett  on  the  simplicity 
of  the  apparatus.  He  wished  to  know  what  was  the 
advantage  of  it  over  sterilising  in  envelopes  by  dry  heat. 
He  found  Fowler's  tubes  very  good.  Had  the  catgut  been 
examined  bacteriologically  ?  Would  chloride  of  calcium 
dehydrate  catgut  ? 

Dr.  Smith  used  catgut  pretty  extensively  and  never  had 
any  trouble  with  it.  He  dehydrated  it  with  alcohol,  then 
boUed  it  in  alcohol,  and  left  it  in  oil  of  janiper.  Chloride 
of  calcium  had  been  used  for  dehydrating  catgut. 

Dr.  Jbllitt,  in  reply,  said  he  kept  the  steriliser 
separated  from  the  bottom  of  the  saucepan,  as  he  bad  once 
found  the  catgut  scorched.  A  drv  steriliser  had  always 
to  be  watched.  Dr.  0*Sullivan  haa  examined  the  catgut 
a  couple  of  times  and  had  been  unable  to  grow  any  cultiva- 
tions from  it.  Dr.  Smith  boiled  the  catgut  in  alcohol ;  but 
in  an  open  vessel  there  was  not  sufficient  heat.  Kylol 
and  cumol  had  not  the  same  germicidal  power  as  water 
or  other  substance  at  212^  which  penetrated  more. 


EDINBURGH  MEDICO  CHIRURGICAL  SOCIETY. 
Mkbtino  hbld  Wkdxksdat,  Mat  20th. 


The  President,  Dr.  Abotll  Robbbtsov,  in  the  Chair. 

dbmosstbations. 

Db.  Korman  Walker  demonstrated  a  handy  and  cheap 
method  of  using  the  flash-light  in  photography.  A  smaU 
quantity  of  a  powder  compoMd  of  magnesium  and  chlorate 
of  potassium  was  placed  on  a  small  bit  of  gun-cotton,  and 
ignited  with  a  match.  The  resulting  flash  was  uf  great 
brilliancy. 

Dr.  GiLis  also  showed  a  method  of  using  the  magneeium 
light  The  powder  was  placed  in  the  bowl  of  a  small  clay 
pipe  and  blown,  by  means  of  an  indiarubber  bidl  attached 
to  the  stem  of  the  pipe,  into  the  flame  of  a  spirit  lamp  in 
position  just  in  front  of  it. 

patients. 

Mr.  Joseph  Bell  brought  under  the  notice  of  the 
Society  a  young  man,  who  had  managed  to  discharge  a 
rook  rifle  close  to  his  wrist,  both  tho  powder  and  the 
bullet  entering  the  forearm.  The  radius  was  splintered 
near  its  lower  end,  and  several  bits  of  bone  bad  been 
removed.  Pare  of  the  bullet  had  also  been  recovered,  but 
part  could  not  be  found.  Two  skiagraphs  of  the  arm  were 
shown,  in  which  small  portions  of  tho  bullet  could  be  dis- 
cerned lying  in  close  proximity  to  the  radius,  while  the 
callus  thrown  out  round  the  splintered  part  was  readily 
visible. 

Dr  George  T.  Beatson  read  a  paper  entitled 

ON  the  treatment  of  inoperable  gases  of  cancer. 
Since  he  had  been  appointed  Surgeon  to  the  Glasgow 
Cancer  Hospital  he  had  seriously  endeavoured  to  ascertain 


656     Thi  Mbdigal  Priss. 


TRANSACTIONS  OF  SOCIETIES. 


Mat  27.  1896. 


if  there  was   no   cauae  for  oanoer  through  which  the 
dieeMe  might  be  attacked  when  operative  interference  was 
oat  of  the  qaettion.    Shortly  after  he  paaaed  he  had 
worked  up  the  subject  of  lactation  with  a  view  of  writing 
hii  thesis  on  it.    Ultimately,  however,  he  wrote  it  on 
another  subject,  but  the  facte  which  he  had  observed 
made  a  strong  impression  on  his  mind.    The  chief  point  to 
which  he  alluded  was  the  similarity  which  existed  between 
the  mamma  in  lactation,  and  that  organ  when  the  seat 
of  a  cancerous  affection.    In  both  the  epithelium  prolifer- 
ated, becoming  in  health  a  constituent  of  the  milk,  in 
disease  a  cancer  cell.    In   Australia  the   ovaries   were 
removed  from  cows  which  had  just  calved,  they  gave  after 
this  operation  a  continuous  supply  of  milk  for  an  indefinite 
period.    In  this  country  to  obtain  the  same  object  the 
cows  were  covered  soon  after  calving.    In  both  cases  the 
ovaries  were  rendered  inert.    He  had  removed  the  ovaries 
of  suckling  rabbits  and  they  continued  to  give  milk  until 
the  young  were  taken  from  them,    however  long  that 
might  have  been.    These  rabbits  got  very  fat,  perhaps 
from  the  mammse  continuing  to  secrete  milk  which  was 
used  up  in  the  body.    The   nervous  system  had  little 
influence  over  lactation,  the  organs  of  generation  had 
much.    Arrest  of  lactation  was   dangerous    and  might 
start    the    cancerous    process    in    the    mamma.     The 
opinions   at  present  held  concerning  cancer  might   be 
divided  into  two  classes,  the  first   on    which    all  were 
agreed,  the  sec3nd  on  which  there  was  some  dubiety. 
They  were  all  agreed  that :  (1)  it  was  epithelial  in  origin ; 
(2)  that  it  was  due  to  an  overgrowth  of  this  epithelium ; 
^3)  that  no  treatment  could  do  good,  short  of  the  knife  ; 
(4)  that  microscopically,  certain  cancer  bodies  could  be 
identified ;  (5)  that  the  younger  the  patient   the   more 
acute  was  the  disease ;  (6)  that  it  was  invariably  fatal ; 
(7)  and  that  the  only  hope  of  cure  was  a  clean  sweep  of 
the  surgeon's  knife.    The  origin  of  the  process,  however, 
was  ascribed  to  different  cauees :  (l)*from  nervous  causes, 
due  to  local  irritation  ;  (2)  from  the  blood ;  (3)  from  local 
injuries.      The   cancer    bodies   had  been    described   as 
coccidia  by  some.    Russell  had  found  that  they  stained 
well    with     fuchsine,    and    thought   them    nearly    re- 
lated   to   the   yeasts,  others  had  identified  them  with 
inactive  leucocytes.    He  was  opposed  to   the   parasitic 
theory,  and  inclined  to  regard  them  as  degenerated  cells. 
CcLse  1.  E.B.,  female  married,  ast.  33.    She  had  borne  two 
children  whom  she  nursed  herself  aJmost  entirely  on  the 
left  breast  owing  to  suppuration  in  the  right  one  during 
the  first  lactation.    During  the  second  period  she  noticed 
a  hard  lump  in  the  left  breast,  which,  however,  did  not 
increase  much  until  ten  mouths  after  she  had  weaned  the 
second  child.    She  went  into  hospital,  where  the  mamma 
was  excised,  together  with  the  axillary  glands  and  a  part 
of  the  pectoral  muscle.    Three  months  later  the  wound 
opened  and  the  scar  became  bard.    On  May  Uth,  1895,  he 
saw  her  for  the  first  time  ;  weight,  Qst.  91bs.  ;  when  the 
affected  area  proved  to  be  too  large  for  any  operation.    A 
small  portion  of  the  tumour  examined  proved  it  to  be 
undoubted  carcinoma.     Thyroid  tabloids  were  given  till 
their  full  physiological  effects  were  produced,  but  with  no 
benefit.    He  then  removed  the  ovaries  and  tubes,  recom- 
mencing the  thyroid  treatment  shortly  after.    No  local 
treatment  was  applied.    On  July  19(ii,  she  was  better, 
and  October  r2th,the  cancerous  tissue  was  yellow  and  fatty. 
At  the  present  time  there  were  no  traces  of  cancer  remaining. 
Ciiae  2.  M.  R ,  fem%le,  ast.  40,  with  a  large  tumour  of  the 
right  breast,  which  proved  to  be  cancerous.    Owing  to 
the  great  involvement  of  the  skin  and  glands  an  operation 
was  impossible.    As    the  disease  was  ^progressing   and 
cauding  much  pain  she  consented  to  have  her  ovaries  and 
tubes  removed.     This  was  done  on  October  3rd.     Three 
weeks'  after  the  skin  was  less  red,  and  the  nipple,  which 
had  been  retracted    and  fixed,    was    larger  and    more 
prominent.    Thyroid  treatment  was  also  begun,  and  now, 
although  not  so  well  as  the  first  cmo,  she  had  not  lost 
flesh,  and  the  tumour  was  not  nearly  so  prominent.   Gcue  3. 
A  woman,  set.   39,  whose  left  breast  had  been  entirely 
eaten  away  by  an  ulcerating  cancer,  which  had  lasted  for 
six  or  seven  years.    The  glands  were  not  involved,  nor 
was  there  any  evidence  of  secondary  disease  anywhere.     It 
was  not  tuberculous     The  thyroid  treatment  had  been 
begun  on  February  7th  and  fully  pressed,  but  with  no 
result.     As  she  had  passed   the  menopause,  it  was  a 
question  whether  he  should  attempt  the  same  operation 


as  in  the  other  two.  He  did  not  eare  to  attempt  removal, 
as  he  had  so  often  seen  the  disease  set  up  much  more 
acutely  in  a  case  like  this  by  operation.  The  first  eaee 
seemed  to  be  cured,  the  second  relieved,  while  the  third 
remained  for  treatment.  The  ovaries  and  testicles  exer- 
cised some  subtle  infiuenoe  over  nutrition.  He  believed 
that  the  special  cancer  oeUs  would  be  proved  to  be  ova,  the 
epithelium  taking  on  characters  like  the  germinal  epithe- 
lium of  the  ovaries  and  testicles.  Klebs  had  come  inde- 
pendently to  the  same  oonolnsion.  The  three  condnaione 
behadoometo  were:— (1)  The  ovaries  and  testicles  liad 
acme  influence  over  epithelial  cells  in  the  body.  (2) 
Their  removal  had  an  effect  on  epithelial  overgrowths. 
(3)  This  was  especially  the  case  in  nursing  mothers. 

The  Pbbbidbmt  oonveyed  the  thanks  of  the  Society  to 
Dr.  Beatson  for  his  remarkable  paper.  He  thought  that 
perhaps  the  theory  was  rather  a  big  one  to  swallow  all  at 
once. 

Prof.  Simpson  was  rather  inclined  to  think  that  diaeaae 
or  removal  of  the  ovaries  conduced  to  the  onset  of  canoer, 
such  at  least  had  been  his  experience.  That  the  ovariee 
had  some  potent  effect  was  shown  by  the  result  obtained 
by  giving  ovarian  extract  for  climateric  troubles. 

Prof.  Chixnb  said  that  the  theory  was  beyond  Lim,  but 
that  the  evidence  afforded  by  the  first  case  showed  them 
that  here  was  an  instance  in  which  canoer  had  been 
undoubtedly  cured,  a  fact  which  was  enough  for  him. 

Mr.  Bill  agreed  with  Mr.  Chiene  that  the  first  case  bad 
been  cured. 

Dr.  J.  RnoHU  said  that  oases  of  osteomalacia  had 
been  cured  by  removal  of  the  ovaries  even  after  the  climac- 
teric. 

Mr.  Stilbs  was  sure  that  all  traces  of  cancer  had  dis- 
appeared from  the  first  patient,  the  one  or  two  nodules 
remaining  he  looked  upon  as  of  the  nature  of  keloid.  He 
did  not  believe  in  the  parasitic  origin  of  cancer,  nor  in  the 
ovaries  having  anything  to  do  with  its  outbreak.  Ov» 
was  a  bad  word  to  use  m  this  connection,  embryonic  cell 
was  better.  In  all  cancers  the  rate  of  growth  depended 
on  the  birth  and  death-rate  of  the  cancer  cells,  removal  of 
the  ovaries  might  check  the  birth-rate  and  gradually 
lessen  the  process. 

Dr.  LuNDiB  spoke,  and  Dr.  N.  Walkib  said  that  he 
thought  the  thinl  case  to  be  one  of  rodent  ulcer  which 
might  safely  be  removed. 

Dr.  Bbatson  replied. 


WEST  KENT  MEDICO-CHIRUROICAL  SOCIETY. 

Thb  Last  Mbbting  of  thb  Sbssiok  was  bkld  at  tss 

MiLLBB  Hospital  on  Fkidat  Evening,  Mat  Ist. 


The  President,  Ernest  Clark,  M.D.,  F.R  O.S., 
Chair. 


in  the 


The  Pebsidbnt  delivered  his  Annual  Address  the  title 
of  which  was  *'  The  Various  Manifestations  of  Eye  Strain 
upon  the  Eye  itself,  and  the  bearing  this  has  upon  Treat- 
ment."    This  address  will  be  found  fully  reported  at 

^Mr.  Thos.  Moore,  and  Mr.  Webster  gave  a  demonstra- 
tion of  the  Rontgen  Rays. 

Messrs.  Johnson  and  Johnson  gave  an  exhibition  of 
Surgical  Dreesings,  Ac 

Messrs.  Maw,  Son  and  Thompson  exhibited  Surgical 
Instruments  and  Appliances. 

There  was  a  good  attendance  of  members  and  visitors^ 
nearly  forty  being  present  on  this  occasion. 


Thb  annaal  meeting  of  the  Irish  Medical  Asaociatioift 
will  take  place  on  Monday,  the  Ist  of  June,  and  it  is 
expected  that  it  will  be  largely  attended.  The  dinner 
on  the  same  evening,  ander  the  presidency  of  Dr. 
MeldoD,  is  also  likely  to  attract  a  large  number  of 
members  and  gaests,  among  whom  will  be  the  heads 
of  the  departments  which  are  associated  with  the 
medical  profession,  as  well  as  the  leaders  of  the  Pro^^a- 
sion  in  Ireland. 


Mat  27,  1896. 


GERMANY. 


Trs  Mbdioal  Pans.    557 


JItanrt. 


[from  OUB  own  0ORKX8POKP1NT.] 

PA1U8,  May  28rd,  1886. 
GOOAIKS. 

At  the  meeting  of  the  Acad^mie  de  M^decine,  M. 
ReduBmade  some  remarks  anent  oocaine.  He  said  that 
local  ansesthesia  by  injections  of  cocaine,  of  which  he  has 
been  a  strong  partisan  for  the  last  ten  years,  has  not  yet 
found  many  adherents.  He  thought  it  necessary,  conse- 
quently, to  recall  in  a  few  words  the  principles  to  be 
observed  in  its  employment,  and  to  explain  at  the  same 
time  the  reason  why  accidents  have  been  reported  from 
time  to  time  from  its  use.  At  first  he  would  affirm  once 
more  the  eminent  anesthetic  properties  of  cocaine,  which 
he  considered  to  be  superior  to  all  those  used  with  the 
same  therapeutic  object,  and  in  particular  to  guaicol,  that 
had  recently  been  warmly  recommended  by  one  of  his 
colleagues. 

He  (the  speaker)  had  made  a  comparative  study  of  both 
of  these  agents,  employing  them  in  the  jregion  he  was 
about  to  operate,  one  on  either  side ;  he  found  that  an»3- 
thesia  was  complete  in  the  part  which  had  received  the  injec- 
tion of  cocaine,  while  the  sensibility  was  not  entirely  abol- 
ished in  the  region  submitted  to  the  gnaicol  The  accidents 
attributed  no  cocaine  were  due  to  the  operator,  and  not 
to  the  drug,  and  could  have  been  easily  avoided  if  the  in- 
dications he  had  repeatedly  laid  down  had  been  foUowed, 
and  which  consisted  in  employing  only  1  per  cent,  solu- 
tions, and  never  to  exceed  the  total  dose  of  three  to  four 
grains  of  cocaine,  to  always  place  the  patient  in  a  recum- 
bent position,  and  to  avoid  penetrating  a  vein. 

It  was  by  observing  these  rules  that  he  was  able  to 
practise  3,500  operations  without  one  accident,  not  even 
did  he  once  observe  an  attack  of  syncope  or  vomiting. 

He  employed  cocaine  exclusively  in  cases  where  the 
field  of  operation  was  not  too  extensive.  That  was  to  say, 
he  did  not  use  it  in  abdominal  surgery  nor  in  amputations 
of  the  limbs.  However,  in  two  cases,  where  he  was  not 
able  to  give  chloroform  by  reason  of  cardiac  trouble,  he 
used  with  success  cocaine  in  amputating  the  arm. 

CkRIBBAL  TtJMOUB. 

M.  Broca  presented  to  the  Soci^t^  de  Chirurgie  a  man, 
»t.  31,  on  whom  he  operated  for  a  cerebral  tumour.  The 
patient  entered  the  hospital  in  March  last,  with  the 
fundamental  symptoms  of  a  tumour  in  the  brain  ;  violent 
headache  localised  in  the  left  parietal  region,  insomnia, 
vomiting,  pn^^ressive  amblyopia.  A  month  before  he  had 
had  an  attack  of  epilepsy.  This  fact  decided  M.  Broca 
to  operate,  and  applying  the  trepan  a  little  above  the 
mastoid  process,  he  removed  a  piece  of  bone,  and  subse- 
quently enlarged  the  opening  to  an  extent  of  three  inches, 
and  passing  in  the  finger  he  felt  in  the  temporal  lobe  a 
tumour  of  considerable  size,  apparently  situated  about 
half  an  inch  beneath  the  surface  of  the  brain.  The 
operator  cut  down  on  it,  and  removed  the  neoplasm  in 
pieces  with  the  curette.  The  loss  of  substance  was  filled 
with  iodoform  gauze»  and  the  scalp  wound  sutured,  except 
in  one  comer,  for  drainage.  All  the  former  symptoms 
rapidly  disappeared,  so  that  the  patient  was,  on  that  day, 
in  an  excellent  condition. 

Thyboid  Medication. 

Prof.  Lepine,  of  Lyons,  reports  a  case  of  progressive 
myopathy  treated  successfully  with  the  thyroid  gland.  A 
man,  set.  44,  suffering  from  the  above  affection  was  sub- 


mitted, without  result,  to  every  kind  of  treatment  recom^ 
mended  for  that  malady.  M.  Lepine,  as  a  last  resourcef 
prescribed  a  half  drachm  doses  of  the  fresh  thyroid 
gland  in  wafers.  In  this  way  the  patient  took  about  two- 
ounces  a  week.  At  the  end  of  a  month,  under  the  influence* 
of  this  treatment,  a  conaidorable  improvement  took  placer 
so  that  the  man  was  able  to  return  to  his  work. 


[raOM  OVB  OWN  00BBS8P0NDXNT.] 


BiBUH.  H«]r  22od. 
The  Value  of  the  Diphthebia  Bacillus. 

At  the  Medical  Congress  Hr.  Hennig,  Kon^berg,  reaJ 
a  paper  on  the  above  subject,  in  which  he  concluded  that 
the  diphtheria  bacillus  was  of  no  diagnostic  value,  as  it 
was  present  in  many  cases  where  there  was  no  diphtheria, 
and  absent  throughout  the  course  in  many  cases  followed 
by  paralysis.  In  Konigsberg  it  was  present  in  only  t5'5r 
per  cent,  of  the  cases,  and  in  the  remainder  streptococci, 
staphylococci,  and  diplococci  were  found.  This  being  the 
case,  any  treatment  based  on  the  specificity  of  the  diph- 
theria bacillus  must  fall  to  the  ground.  The  results  of 
serum  treatment  as  published  by  the  Imperial  Health 
Office  were  not  very  imposing.  Since  1868  he  had  treated 
1,970  cases  of  diphtheria  by  a  method  of  his  own,  viz.,  limer 
water  and  ice,  with  a  mortality  of  only  3*06  per  cent.  In 
Egypt  also,  where  the  mortality  from  the  disease  wa9 
from  80  to  90  per  cent.,  since  the  introduction  of  his 
method  of  treatment,  it  had  fallen  to  3  per  cent. 

At  the  same  meeting  Hr.  Mannaberg,  Vienna,  described 
A  New  Disoovebt  in  LEtJOJBMiA  Blood. 

In  a  typical  case  of  lymphatic  leuc»mia  in  the  plasma  of 
the  leucocytes  he  found  small  uncolonred  bodies  with  Sr 
sharp  outline  and  of  various  forms,  sometimes  roundish, 
sometimes  oval,  sometimes  forked.  In  an  nnheated 
object  glass  their  shape  changed  slowly  but  distinctly  in 
an  amsboid  manner.  When  the  glass  was  warmed  ther 
changes  took  place  somewhat  more  rapidly.  On  staining, 
he  could  exclude  the  usual  degeneration  form  of  the  cells« 
He  failed  to  find  the  form  in  all  casee  of  lymphocytosis, 
and  also  in  the  freshly  extirpated  lymph  glands  and  in  ther 
lymph  glands  of  animals  and  the  thymus  of  cats.  The 
body  was  either  a  known  cell  degeneration  or  a  probozoon. 
He  remarked  on  the  occasion  the  value  of  quinine  as  ar 
remedy  whilst  Liq.  Fowleri  had  failed. 

Hr.  Passler,  Leipsig,  read  a  paper  on 

The  Hbabt  and  Vaso-Motobs  in  Infeoiive  Diseases. 

The  speaker  had  studied  the  subject  along  with  Rom^ 
berg.  In  the  case  of  Fraenkel's  diplococcus  and  the 
bacillus  pyocyaneas  the  blood  pressure  fell  through  para^ 
lysis  of  the  vaso-motors.  It  could  be  determined,  how- 
ever,  that  the  vaso-motor  centre  in  the  oblongata  was 
principally  damaged  ;  the  peripheral  vascular  nerves  and 
Golfs  centres  in  the  spinal  column  preserved  their  normal 
function  up  to  death.  In  relation  to  the  heart,  the  two 
forms  of  bacteria  showed  a  noticeable  difference.  In 
Fraenkel's  diplococcus  the  vaso-motors  were  sooner  or  later 
affected  according  to  the  severity  of  the  infection.  But 
increased  activity  of  the  heart  for  a  time  kept  the  blood 
pressure  up  to  the  height  required  for  existence.  But  with 
further  advance  of  the  vaso-motor  paralysis,  the  blood 
pressure  sank.  But  even  now  the  power  of  the  heart  was 
not  diminished.  With  bacillus  pyocyaneus  there  was  no 
increased  cardiac  activity  but  rather  a  striking  disturbance 


558     Thi  MiDiCAL  PmisB. 


AUSTRIA. 


Mat  27i  1896. 


of  tke  rhythm,  slowing  and  irregularity,  without  any 
I088  of  power  however.  Only  in  individual  casea  were 
there  any  pronounced  eymptoms  of  cardiac  weakneee  in 
connection  with  numerous  emboli  in  the  endocardium 
after  intravenous  injections  of  bacteria.  But  even  here 
the  symptom?  were  dominated  by  the  vaso-motor  para^ 
lysis. 

Other  experiments  were  made  in  relation  to  Loffler's 
diphtheria  bacillus.  The  experiments  were  carried  out 
in  the  same  way  as  the  others.  Sixty-five  rabbits  were 
inoculated  and  the  blood  pressure  estimated  in  thirty-four. 
The  development  and  course  of  the  disease  were  thoroughly 
typical  in  all  the  animals.  The  symptoms  were  identical 
whether  the  infection  lasted  one,  two,  or  nine  days, 
whether  the  fever  rose  rapidly  and  fell  quickly,  or  oeclllated 
for  days  together.  The  blood  pressure  sank  in  proportion 
to  the  duration  of  the  illness  quicklj  or  more  slowly  to  the 
lower  level.  In  rapid  cases  the  pressure  fell  in  an  hour,  or 
even  less,  in  less  rapid  cases  its  fall  was  less  rapid.  There 
were  individual  differences  however.  The  lower  the  blood 
pressure  was  the  lees  it  rose  after  sensible  stimulation 
until  it  did  not  take  place  at  all.  The  cardiac  activity  was 
not  diminishe«i.  The  gradual  falling  off  and  final  dis- 
appearance of  the  normal  reaction  to  stimulation  showed 
that  the  cause  of  the  circulatory  disturbance  was  paralysis 
of  the  vaso-motors.  The  final  fatal  failure  of  the  ci'cala- 
tion  did  not,  therefore,  depend  on  injury  to  the  heart,  but 
to  paralysis  of  the  vaso-motors.  Injections  of  chloride  of 
barium  considerably  increased  the  blood  pressure.  The 
peripheral  vascular  nerves,  therefore,  and  the  vaso-motor 
muscles  were  intact.  The  power  of  the  heart  remained 
normal,  the  cardiac  rhythm,  however,  changed,  the  fre- 
quency sank  to  to  176, 150,  and  occasionally  as  low  as  120, 
and  then  irregularity  was  observed.  The  cause  of  the 
slowing  was  in  the  heart  itself,  a  vacuolary  degeneration 
of  the  muscular  substance  of  the  auricle  supported  the 
view  that  the  diphtheria  poison  affected  the  auricle  more 
than  the  ventricle.  The  fatty  degeneration  of  the  heart 
met  with  in  diphtheria,  was  of  surprisingly  less  import- 
ance as  regarded  functional  power.  It  was  not  to  be 
held  responsible  for  the  slowing.  It  did  not  lead  to  any 
determinable  injury  or  weakening  of  the  heart,  and  it 
appeared  to  develop  immediately  before  death. 

It  appeared  proper  to  apply  the  results  obtained  to 
human  pathology,  although  the  frequent  complication  of 
diphtheria  with  micro-organisms  rendered!  the  relation 
rather  mixed.  In  diphtheria  of  the  human  subject  also, 
a  gradual  fall  of  the  blood  pressure  had  been  noticed, 
slowing  of  the  pulse  had  been  frequently  hidden  by  mani- 
fold influences  on  the  heart.  But  in  spite  of  this  a  strik- 
ing slowing  of  the  pulse  had  been  noticed  now  and  then, 
and  a  moderate  slowing  of  the  pulse  in  about  one-third  of 
the  cases.  And  then  in  diphtheria  of  the  human  subject 
the  disturbance  of  circulation,  the  so-called  cardiac  weak- 
ness, could  be  traced  to  paralysis  of  the  vaso-motors.  At  its 
origin  the  heart  was  unaffected  so  long  as  the  right  ventricle 
was  not  injured  by  distension  through  extensive  disease 
of  the  respiratory  tract.  Post-diphtheritic  cardiac  death 
was  to  be  strongly  distinguished  from  disturbance  o' 
circulation  in  the  course  of  the  disease.  Two  conceptions 
stood  opposed  to  each  other.  The  one  condidered  the 
symptom  in  re-convalescence  as  directly  due  to  the  poison 
still  present  in  the  system,  the  other  attributed  it  to 
anatomical  changes  in  the  cardiac  musculature.  Against 
the  first  view  it  might  be  said  that  the  diphtheria 
poison  in  longer  or  shorter  durations  of  the  illness  alway^ 


damaged  the  dronlation  in  the  same  way,  and  the  anatomi- 
cal changes  were  the  same.  He  also  did  not  consider  it 
likely  that  the  diphtheria  poison  continued  to  drcnlate 
for  weeks,  that  could  cause  such  severe  disturbances.  It 
was  rather  to  be  assumed  that  it  passed  away  or  loet  its 
activity.  He  held  to. the  view  represented  by  Romberg, 
that  in  many  surviving  cases  the  heart  had  been  injured 
by  the  diphtheria  poison  in  such  a  way  that  a  diphtheritic 
myocarditis  was  set  up.  The  kind  of  injary  was  yet  to 
be  determined.  A  vaso-motor  stimulant  must  yet  be 
sought  after,  that  acted  with  more  certainty  and  greater 
safety  than  those  hitherto  known. 


c2lufitria. 

[f  KOM  OVB  OWV    OOBBMPOITDBKV.] 

VllHRA.  Ma7  S2Dd,  ISM. 

Lotflbb's  Bacillus. 

Bernhbim  exhibited  a  few  microscopical  preparations  to 
the  Gesellschaft  showing  Loffler-diphtheritic  bacilli  at 
different  stages  of  development  direct  from  the  membrane. 
He  distinguishes  two  distinct  species,  one  in  which  buds 
form  the  parent  cell,  thus  increasing  by  germination ;  the 
second  where  a  diohotomous  ramification  occurs.  The 
latter  not  infrequently  divides  into  three  branches,  making 
long  even  threads,  which  are  nevertheless  sometimes  pear- 
shaped.  This,  he  concluded,  was  at  variance  with  the 
received  opinion,  which  was  that  these  varieties  were 
obtained  only  by  cultivation,  and  were  thus  only  one  and 
the  same  family  of  bacteria,  whereas  it  would  appear  from 
these  facte,  that  we  can  hardly  place  them  in  the  same 
order,  as  the  one  resembles  the  Schizomycetes,  while  the 
other  evidently  belongs  to  the  Hyphomycetes. 

Fbagmbkt  of  Glass  passed  through  Bowel. 

Fein  brought  forward  a  piece  of  glass  measuring  3*5 
centimetres  by  1*5,  or  1*965  inch  long  by  0*585  inch  broad* 
which  a  soldier  had  passed  through  his  anus.  The  history 
was  that  the  soldier  had  got  up  during  the  night  and 
drank  beer  from  a  broken  glass  which  contained  the  frag- 
ment exhibited.  Immediately  it  got  beyond  the  faucea 
the  pain  commenced,  as  the  angles  and  sides  were  very 
sharp.  Large  quantities  of  potatoes  were  at  once  pre- 
scribed, with  the  happy  result  that  the  fragment  was 
pskssed  per  anum  within  forty  hours  after  deglutition. 
Dislocation  of  Elbow-Joikt. 

Albert  showed  a  case  of  incamplete  dislocation  of  the 
elbow-joint  which  had  every  appearance  of  fracture  of  the 
epiphysis  of  the  humerus. 

MOLLUSCUM  CONTAOIO8UM. 

K  aposi  showed  a  child  at  the  breast  with  an  accentuated 
form  of  this  affection,  which  he  was  inclined  to  designate 
moUnscum  contagiosum  gryanteum.  Both  cheeks  were 
covered  with  a  black  or  dark  brown  deposit,  two  to  three 
centimetres  thick.  The  head,  forehead,  shoulders,  and  upper 
arms  were  similarly  affected,  giving  the  peculiar  appear- 
ance of  a  hood  on  the  child.  The  first  thought  in  diagnosis 
was  bromide-acne,  which  is  often  caused  by  solicitous 
nurses  giving  this  drug  to  restless  children.  Closer  exam- 
ination of  the  morbid  deposit  revealed  a  palatinoid  forma- 
tion of  the  growth  with  sharp  edges,  which  had  an  opaque 
lustre.  In  the  region  of  the  throat,  neck,  &o,,  there  were 
many  isolated  parts  that  more  correctly  revealed  the 
schistic  nature  of  the  disease,  although  the  more  recent  of 
these  contained  a  clear  fluid  resembling  miliary  eruptions 
n  the  limbs  or  agg  ravated  pemphigus. 


Mat,  27,  1896. 


THE  OFERAHNO  THEATRES. 


Thi  Mbdioal  Pbims.     559 


The  mioroacopic  examinatioii  of  these  cuticalar  exoree- 
eences,  when  taken  in  section,  revealed  an  acinoee  arrange- 
ment of  the  sebaceous  glands  enormously  hypertrophied  ; 
thedissesjiments  extending  far  into  the  surrounding  tissue- 
At  an  early  stage  of  this  rare  affection  the  epithelium  of 
the  gland  begins  to  multiply  and  distend  the  fibrous  cap- 
sule till  it  appears  above  the  surface  of  the  cuticle,  when 
the  clear  glittering  margin  can  be  distinctly  seen,  and  is 
characteristic  of  the  disease.  Subsequently  the  epithelium 
contained  becomes  cloudy  and  degenerates  into  a  fatty 
granular  mass,  finally  forming  the  distinctive  qualities  of 
moUuscum  corpuscles.  This  latter  retrograde  property  is 
not  a  constant  factor  in  the  disea^.  Sometimes  acute 
inflammation  in  the  general  surroundings  occurs  when  pus 
is  formed  and  a  diffuse  discharge  is  the  result.  The 
rational  therapy  of  the  usual  form  would  be  an  early  open- 
ing and  cleansing  of  the  primary  nodules  to  check  the 
spread  of  the  infectious  matter. 

The  Obioin  of  Syphilis. 

Different  authors  have  attempted  to  solve  this  problem 
with  varying  success,  but  none  seem  to  establish  the  true 
source  of  the  evil,  though  the  presumption  may  be  strong 
in  the  various  arguments  adduced.  Italy,  Spain,  and 
America  have  alternately  been  blamed,  but  no  satisfactory 
testimony  is  yet  forthcoming  to  locate  it  anywhere  till  the 
pandemic  appeared  in  Europe. 

Puschmann  brought  the  question  before  the  Qesellschaf  t 
in  an  exhaustive  paper,  in  which  he  asserts  that  syphilis 
was  certainly  present  in  Europe  before  the  discovery  of 
America  in  the  Fifteenth  Century.  The  oldest  documents 
on  the  subject  that  we  possess  are  those  of  Petrus  Machir, 
a  practitioner  of  Salamanca,  written  in  the  year  1488. 
We  have  also  poetic  references  on  the  subject  even  earlier 
than  this,  which,  if  not  scientific,  go  far  to  prove  the 
presence  of  the  disease  prior  to  1492,  when  Columbus  set 
sail  from  Spain  on  his  first  expedition  of  discovery. 
Besides  this  proof,  we  have  chronicles  of  personages  in 
high  positions  dying  from  the  disease,  one  of  whom  was 
Ladislaus,  of  An jon,  who  died  of  syphilis  in  1414.  Thomas, 
of  Oxford,  relates  several  cases,  among  which  he  specifies 
the  Duke  of  Lancaster,  who  died  in  1399  from  ulcers  on  the 
genitals,  presumably  syphilitic  There  is  another  very 
probable  case  of  syphilis  recorded  of  Nicolaus,  Bishop  of 
Posen,  who  suffered  from  ulcers  on  the  genitals  and  tongue, 
and  who  died  in  1382. 

These  cases  must  all  be  received  with  a  certain  amount 
of  reserve,  as  the  chroniclers  were  not  medical  men,  but  in 
some  instances  only  local  historians,  probably  writing  from 
hearsay.  In  other  cases  the  ulcers  referred  to  may  have 
been  simple  phagedenic  venereal  sores  and  not  syphilis  at 
all,  although  at  the  time  it  appears  that  a  distinction 
seems  to  have  existed  for  the  secondary  development  of 
the  disease.  The  ulcers  on  the  genitals  arising  from 
female  contact  were  usually  designated  morbus  gallious, 
while  the  later  syphilitic  phenomena  on  the  skin^  &e., 
termed  **  Aussatz,"  or  rash  that  has  often  been  confounded 
with  lepra,  and  seems  to  have  yielded  readily  to  mercury, 
which  appears  to  have  favoured  the  too  general  use  of 
salivation  as  a  curative  agent  at  a  later  period  of  our 
history. 

Stxnosis  of  thb  Aobta. 

Schlesinger  showed  a  young  man,  set.  22,  to  the  Medical 

Club,  with  a  few  singular  phenomena  in  the  diagnosis  of 

•  aortic   stenosis.     The   patient    had   enjoyed    excellent 

health  till  he  was  eighteen  years  of  age,  but  after  this  time 


his  work  appears  to  have  been  laborious.  He  was  received 
into  hospital  on  account  of  hemoptysis,  &c.  On  examining 
the  lungs  nothing  could  be  found  to  account  for  the 
hemorrhage.  The  patient  said  that  he  had  periodicaDy 
suffered  for  two  years  past  with  palpitation  and  asthma 
after  any  great  effort.  The  apex  beat  lay  in  the  fifth 
intercostal  space  outside  of  the  median  line  ;  the  cardiac 
dulness  not  being  increased  outwards  nor  ascending  to 
the  margin  of  the  sternum  internally.  A  whirring  vibra- 
tion could  be  felt  with  the  hand  over  the  apex,  which 
increased  towards  the  base  and  could  also  be  felt  over  the 
jugular  at  every  systole;  its  greatest  intensity  was  heard 
in  the  second  right  intercostal  space  as  a  rough  protracted 
murmur,  ceasing  to  be  heard  during  diastole.  The  art«ria 
radialis  was  feeble  and  the  tension  low.  In  the  carotid, 
aorta  abdominalis,  and  femoral,  the  pulse  was  only  per« 
ceptible.  The  character  of  the  murmur  and  its  site 
pointed  to  the  diagnosis  of  aortic  stenosis.  Now  this  is 
a  general  term.  We  have  stenosis  of  the  aortic  isthmus, 
stenosis  of  the  conns  arteriosus,  stenosis  of  the  aortic 
valve,  as  well  as  a  general  stenosis  of  the  whole  curve. 
The  former  is  negatived  by  the  absence  of  any  col' 
lateral  circulation  which  would  be  present  if  the 
arch  alone  ^were  affected ;  the  latter  is  disproved 
by  the  absence  of  any  contractions  or  narrowing' 
of  the  peripheral  vessels  which  might  be  expected 
to  accompany  any  general  narrowing  of  the  ves- 
sels. We  are,  therefore,  left  to  decide  between  conus 
arteriosus  or  the  aortic  valve.  The  former  is  a  rare  lesion, 
and  would,  therefore,  point  to  stenosis  of  the  aortic  valve 
by  the  law  of  exclusion,  but  the  position  of  the  murmur  is 
rather  against  this  conclusion,  as  the  sound  is  usually 
loudest  at  the  lower  part  of  the  sternum,  which  was  not 
so  in  this  case.  Again,  if  the  lesion  were  in  the  aortic  valve 
we  would  expect  valvular  insufliciency,  but  this  was 
also  absent.  It  is,  therefore,  difficult  to  say  whether  the 
lesion  is  stenosis  of  the  conus,  or  aortic  valve. 

The  etiology  is  equally  obscure.    Whether  the  stenoeie 
be  congenital  or  acquired  cannot  easily  be  determined. 


MIDDLESEX  HOSPITAL. 
Cask  of  Aouts  Cabcinoha  bbgikviho  is  thb  UTSBUfr 
AND  Inyolying  many  OBOAKS.—This  interesting  ease, 
under  the  care  of  Mr.  Hbnbx^  Mobris,  was  one  in  which 
no  operative  interference  was  ever  possible.  The  patient, 
a  woman,  sbd.  34,  was  admitted  complaining  of  a  vaginal 
discharge,  a  lump  in  the  right  breast,  and  one  or  two- 
small,  but  excessively  painful,  lumps  in  the  neck  on  the 
right  side :  hitherto  she  always  had  enjoyed  good  health  f 
she  was  regular  till  the  present  illness ;  of  late  the  cata- 
menia  had  been  excessive ;  she  had  had  no  children,  but 
several  miscarriages.  There  was  no  family  history  of 
cancer.  About  two  months  before  her  admission  she  began 
to  have  aching  pains  in  the  loins,  which  she  ascribed  to  a 
chill,  but  shortly  afterwards,  however,  a  yellowish  vaginal 
discharge  appeared ;  soon  after  this,  she  noticed  a  lump  in 
the  right  breast ;  some  six  weeks  after,  the  right  side  of 
her  neck  began  to  swell,  and  she  found  she  had  one  or  two 
small  lumps  in  this  situation.  The  lump  in  the  right 
breast  had  been  steadily  growing  since  its  first  appearance. 
The  vaginal  discharge  continued  with  slight  remissions, 
but  the  patient  never  noticed  any  blood  in  it,  nor  was  it 
ever  noticeably  offensiva      On  admission  she  appeared 


A60     Tbm  Mbdioal  PSMi. 


THE  OPERATING  THEATRES. 


Mat  27,  1898. 


to  be  a  well  noarithed  wonwD,  in  very  fair  general 
health.  In  the  upper  part  of  the  right  breast  was  a 
tnmour  the  sise  of  a  wiJnat,  hard  and  irregular,  but  not 
painful  nor  markedly  tender ;  the  skin  overlaying  it  was 
natural  and  not  adherent  Lower  down  in  the  breast, 
■oear  its  lower  and  inner  margin,  was  a  hard  lump,  the  size 
•of  a  filbert,  the  skin  over  which  was  purple  in  colour, 
and  adherent  to  the  underlying  nodule.  Other  smaller 
lumps,  four  or  five  in  number,  were  found  in  the  breast. 
All  these,  apparently,  werein  the  subcutaneous  tissue.  Over 
vne  left  breast  were  one  or  two  small  similar  nodules.  The 
-glands  in  both  axilln  were  slightly  enlarged.  A  few 
smaller  lumps  could  be  felt  in  the  left  posterior  triangle. 
•Over  the  front  part  of  the  abdomen  were  about  a  dosen 
nodules  in  the  subcutaneous  tissue,  most  of  them  being 
about  the  size  of  a  hazel  nut ;  they  were  not  tender  nor 
.painful  and  did  not  involve  the  skin*  A  further  collection 
of  three  or  four  nodules  was  found  in  the  right  iliocostal 
.space,  these  were  more  painful  than  the  others,  and  pre- 
vented the  patient  from  lying  on  that  side.  Vaginal 
.examination  showed  the  cervix  to  be  hard,  but  freely 
movable,  its  lower  end  presenting  a  bard,  round-edged, 
excavated  ulcer,  which  apparently  affected  the  whole 
thickness  of  the  cervix  and  extended  in  its  substance  as 
•high  a^  the  finger  can  reach.  The  uterus  itself  was  freely 
movable,  and  examination  caused  no  bleeding ;  there  were 
no  glandular  enlargements  in  the  groin.  The  patient 
complained  of  a  good  deal  of  pain  in  the  lower  part  of  the 
.  abdomen.  The  vaginal  discharge  was  slight,  not  offensive 
and  free  from  blood.  During  the  first  six  days  in  the 
hospital  it  was  remarked  that  the  nodules  were  steadily 
getting  larger,  those  in  the  neck  being  very  painful. 
Nausea  was  first  complained  of  on  the  fourteenth  day,  when 
the  patient  actually  did  vomit  several  times  ;  about  this 
time,  too,  it  was  noticed  that  several  new  nodules  had 
appeared  in  the  breast,  and  on  the  front  of  the  abdomen. 
Thirteen  days  afterwards,  the  woman  in  the  interval 
having  had  a  great  deal  of  sickness,  she  was  seen  to 
"he  markedly  jaundiced  ;  this  went  on  increasing,  as  also 
the  growth  and  number  of  the  nodules  and  the  sickness. 
.A  vaginal  examination  made  seven  weeks  after  admission 
showed  a  large  succulent  growth  of  the  cervix  uteri  and 
some  enlargement  of  the  fundus.  The  cervix  projected  an 
inch  or  more  lower  than  normal ;  it  was  four  or  five  times 
its  normal  thickness,  and  was  ulcerated  at  the  posterior 
left  aspect,  so  that  there  was  a  V-shaped  notch  in  its 
margin  large  enough  to  lodge  the  tip  of  the  finger.  The 
fundus  was  considerably,  but  not  completely,  fixed.  A 
week  after  this  the  nodules  had  much  increased  in  number 
;  and  in  size,  those  in  the  right  breast  being  very  painful 
and  exquisitely  tender ;  the  patient  could  not  lie  in  any 
position  with  comfort.  A  week  later  the  nodules  had  still 
increased  ;  the  numerous  ones  in  the  right  breast  were  to 
.  a  large  extent  fixed  together  towards  the  central  part  of 
the  gland  into  a  large  irregularly-outlined  hard  <<  hob- 
nailed" mass.  The  general  distribution  of  the  nodules 
was :  Faee^  none.  Neck,  one  below  each  ear,  and  in  each 
submaxillary  region ;  several  in  each  supra-clavicular 
•fossa,  but  especially  in  the  right.  AxUUb,  numerous  in 
both,  but  most  in  the  right.  Brecuts,  very  numerous,  the 
•  right  being  most  affected  and  its  nodules  larger;  there 
were  several  between  the  breasts.  Abdomen,  20  or  30 
were  scattered  over  the  front  of  the  abdomen  ;  they  were 
covered  over  by  the  natural  skin  and  did  not  show  the 
dilated  capillaries  that  were  present  over  many  on 
.the     chest     and    back.     Back,    a     group     of     fifteen 


in  the  small  of  the  back  about  the  middle 
line  covering  an  area  about  4  inches  long  and  3  inchee 
wide.  Above  the  right  iliac  crest  was  a  group  of  eight 
smaller  than  the  foregoing.  None  in  the  same  region  on 
the  left  side.  Between  the  scapulas  there  were  twelve 
more  and  fonr  over  the  left  scapula.  Ten  days  after,  the 
sickness  having  continued,  the  patient  could  hardly  be 
induced  to  take  any  food ;  the  jaundice  became  deeper, 
and  the  nodules  continued  growing  steadily ;  any  move- 
ment caused  intense  pain.  The  woman  got  rapidly  weaker, 
this  being  largely  due  to  want  of  food  ;  the  symptoms  in- 
creased, and  she  died  a  fortnight  later,  eighty-three  days 
after  her  admission,  the  duration  of  the  disease  having 
been  about  four  months.  At  the  post-mortem  the  body 
was  not  found  very  much  emaciated  ;  of  the  subcutaneous 
nodules  in  only  one  near  the  umbilicus  did  the  growth 
extend  through  into  the  peritoneal  cavity.  In  the  thorax 
there  were  numerous  nodules  of  new  growth  in  both  the 
anterior  and  posterior  mediastina,  also  alongtbe  side  uf  the 
aorta,  and  in  front  of  the  base  of  the  pericardium^  which 
contained  about  two  ounces  of  bile-stained  serum  and 
numerous  nodules  of  new  growth  on  its  visceral  layer,  but 
there  were  no  adhesions.  Numerous  nodules  were  found 
scattered  over  the  heart.  Both  the  pleura  contained  a 
nodule  of  new  growth.  No  deposits  in  the  lungs  nor  in  the 
cesophagus.  The  peritoneum  showed  some  milky  patches  of 
new  growth  ;  the  omentum  and  mesentery  containing  many. 
No  new  growth  in  theatomeuh,  pylorus,  duodenum,intesiinee, 
or  rectum.  Liver  weighed  61  oz  No  new  growth  in  liver 
itself.  Gall  bladder  distended  by  black,  thick 
bile.  No  calculi.  One  nodule  on  its  serous  coat.  The 
glands  in  the  portal  fissure  were  invaded  by  new  growth. 
The  pancreas  was  matted  and  infiltrated  by  new  growth. 
The  supra-renal  capsules  oould  not  be  made  out  in  the 
infiltrated  masses  about  the  pancreas.  No  trace  of  new 
growth  in  the  spleen.  Bile  and  cystic  ducts  obstructed 
by  the  pressure  of  surrounding  new  growth.  Numerous 
nodules  in  each  kidney.  Bladder  not  affected.  The 
body  of  the  uterus  was  not  enlarged,  but  presented 
two  sessile  subserous  nodules ;  the  cervix  enlarged, 
the  margins  of  the  os  formed  of  softening,  mucoid, 
pale,  new  growth.  The  walls  of  the  Fallopian  tvbes 
were  infiltrated  by  new  growth.  Extensive  infiltra- 
tion of  the  riffht  broad  ligament  with  new  growth.  The 
breasts  were  so  thoroughly  infiltrated  that  no  breast 
tissue  could  be  made  out. 


The  Daily  Telegraph  in  a  recent  issue  stated  that 
Sir  William  Savory  was  present  at  a  special  gathering 
of  the  friends  of  the  National  Health  Societv.  Sir 
William  mav  have  been  present  in  the  spirit,  but  he 
could  scarcely  have  been  at  the  meeting  in  the  flesh,  for 
as  most  persons  know  the  distinguished  surgeon  died 
more  than  a  year  ago. 

The  post  of  Professional  Assistant  to  the  Director- 
General  of  the  Army  Medical  Department,  which 
SurgeoD-Major(}eneral  Jameson  vacates  on  his  ap- 

g ointment  as  Director  General,  is  to  be  conferred  on 
urgeon-Major-General  William  Taylor,  M.D.,  who 
was  principal  Medical  Officer  of  the  recent  Ashanti 
expedition. 

It  was  stated  in  the  House  of  Commons  last  week 
that  the  total  cost  ci  the  Vaccination  Commission  up  to 
March  aist  last  had  been  £16,792. 


Mat  27,  1806. 


LEADING  ARTICLES. 


Thi  Midical  Pb»8.     561 


FOm  TBimilBBIOB  ABBOAO. 


^ke  JRcbiorl  f  te0«  atib  Crrcdar. 

Pnbllahed  trery  WadneidAy  monlnc,  Priee  6d.   Poit  fret,  5|d. 
ABVBBTIfBMBHTB. 

ffOBOnUtanno*:— WtaoleF«g«,«6  0i.0d.;  Hidfl  Piff,  M  lOi.  Od. 
Qaai««Paie,A6L;  OnMlgbtli,  IftL  60. 

Vom  A  SmiB  ov  Innnon:— Wbola  Pift,  llditem  likwrtloni 
(weakly,  fortniglitly,  or  monthly)  At  £8  lOi.  Od. ;  iw«ity-«iz  Inaer- 
ttoni  (wMUy  or  fortnlsfatly)  at  £8  8i.  Od. ;  fifty-two  InaertloiM 
(weddy)  at  £8  Mtoh.  Halt-pi«o,  thbteen  tnwrttoiia  at  88t.; 
iwaoty-aizatSta.;  fifty-two  iDMrtloiia  at  80i.aaelL  Qaaitar-paga 
thlrteaiitiiMrttoiiaatUi.;  twoity-aiz  tmortloni  at  Ua. ;  flfty-ilz 
Iniartloni  at  16a.  aaoh 

flnall  Annonnoamoiita  of  Praotleea,  AMlttaneles,  Taeaoelea,  Book 
*e.— flarao  Unaa  or  iindar,  4a  par  Inaartloii ;  6d.  par  Itoa  bayond 

Lattara  In  thla  dapartmant  abonld  ba  addraaaad  to  tba  Pnbllabar. 
SUBSORIPnONI. 
Poet  Pun  vo  AnrvAL  Bubsgribbbs  Al  l  o 

„  ABBOAD.WIZHIB  THB  POSKALUBIOB        A1    8    6 

„  Ibdia,  CBOBA,  abd  Japab  .  .     A   ft   6 

Voat-odBoa  Ordan  and  Chaqnaa  to  ba  drawn  In  f  aTOor  of « 

A.  A.  TiBDALL,  80-81  King  William  Btraat,  Strand,  London. 
A.  H.  JAOOB,  89  Molaaworth  Btraat,  Dublin. 
«UB80BipnoB8  BOB  Pbabob  ara  raoalTad  by  Haaara.  Baiuubbb,  Bna 
Hantefanllla,  Parla— poat  trea  In  adranoa,  £1  8a.  6d.  par  annum. 

AlTBSaBIFTIOBS    BOB    THB    TJBRBD    BTATBS,     poat    ' 

(Al  81.  6d.  par  annum),  aliould  ba  aant  diract 
thla  oountry  by  Intamatlonal  Poat  Oflioa  Ordar. 


tn  adTanoa 
to  tha  Oflleaa  In 


%llt  H^MjceI  ^tm  i(  ^irmlsr. 


'SALUS  POPULI  BUPBBlfA  LEX.' 


WEDNESDAY,  MAY  27,  1896. 


THE  CENTRAL  CONTROL  OF  HOSPITALS. 

Thb  qnestion  of  the  advisability  of  some  system 
under  which  the  medical  charities  of  any  particular 
district  shoald  be  controlled  by  a  central  body  is  by  no 
means  new.  Eight  or  ten  years  ago,  for  instance,  it 
was  answered  in  the  affirmative  by  Birmingham, 
althongh,  as  yet,  there  appears  to  be  no  prospect  of 
ttheir  abstract  resolution  being  reduced  to  practice. 
A  short  while  since  the  subject  was  once  more  pro- 
minently brought  before  the  notice  of  the  public,  by 
ihe  Charity  Organisation  Society.  Its  subsequent  dis- 
<cussion  seems  to  have  left  matters  very  much  as  they 
were.  The  arguments  in  favour  of  centralisation,  as  we 
take  them,  appear  to  be  unanswerable.  As  things  stand 
the  interests  of  rival  institutions  are  conflicting,  and  the 
dresults  disastrous,  so  far  as  economy  is  concerned.  The 
latter  statement  can  be  verified  by  a  glance  at  the 
-comparative  cost  per  bed  of  the  various  charitable  hos- 
pitals throughout  the  country.  Indeed,  the  most  sue- 
•cessful  management  appears  to  be  the  one  that  has 
the  greatest  expenditure  and  the  largest  debt, 
which  is  wiped  off  or  reduced  from  time 
-to  time  by  an  ad  muericordiam  appeal  to  the  gener- 
osity of  the  public.  This  state  of  affairs  was  fully  com- 
mented upon  and  discussed  some  twelve  months  ago 
in  the  columns  of  the  Mbdigal  Pkbss  and  Cibculab, 
the  matter  having  been  initiated  by  the  vigorous  letters 
of  a  correspondent  who  wrote  under  the  title  of  ''  A 
Young  Man  from  the  Country."  What  we  then  chiefly 
insisted  upon  was   the  extravagance  and  selfishness 


directly  fostered  by  the  almost  absolute  isolation  which 
is  the  amazing  and  unfortunate  rule  among  institutions 
conducted  in  the  great  cause  of  humanity.    One  of  the 
most  deplorable  results  is  an  absence  of  due  regard  for 
the  interests  of  the  medical  profession,  upon  whose 
gratuitous  services  the  whole  charitable  edifice  is  erected. 
In  some  cases  wards  are  opened  for  paying  patients,  who 
are  thus  taken  away  from  their  outside  medical  atten- 
dants, and  nursed  out  of  funds  originally  subscribed 
for  the  use  of  the  sick  poor.    Yet  the  protests  of  medical 
practitioners  against  this  invasion  of  their  field  are 
disregarded.    One  notable  instance  of  the  kind,  which 
occurred   lately   in   the  North   of   London,  will  be 
fresh  in  the  minds  of  many  of  our  readers.    Then, 
again,  in    the   matter  of  the  indiscriminate   relief 
granted  to  hospital  applicants,  especially  in  the  out- 
patient departments,  there  can  be  no  reform  until  some 
common  plan  of  action  is  adopted  amongst  the  various 
charities.    Some  of  these  abuses,  it  has  been  suggested, 
might  be  checked  by  conferring   central   authority 
upon  the  Hospital  funds.    The  history  of  those  bodies, 
however,  excellent  as  it  has  been  in  many  respects, 
does  not  offer  any  very  hopeful  prospect  of  a  just  and 
final  settlement  of  the  vexed  question  of  centralisa- 
tion.    Hitherto   their   tendency   has  been  to   give 
money  to    the  institutions    that   show   the   largest 
debts  and  deficits  and  the  greatest  number  of  patients, 
without  regard  to  economy  of  management  or  to  the 
guidance  of  its  alms  to  worthy  recipients.    Nay,  more 
than  that,  the  fact  that  any  particular  institution  is 
labouring  under  unanswered  public  charges  of  dishonest 
management  does  not  debar  it  from   receiving  the 
grants  of  the  hospital  funds.    These  criticisms,  be  it 
noted,  we  offer  in  no  spirit  of  unfriendliness,  for  we 
fully  believe  that  a  field  of  vast  and  progressive  useful- 
ness  lies  before  both   bodies.    As   to   the  Charity 
Organisation  Society,  in  our  opinion  it  has  hardly 
justified   its   existence   sufficiently   to  warrant   any 
expectation  it  may  entertain  of  being  made  the  nucleus 
of  the  proposed  body  of  control.    This  Society  was 
originated  in  order  to  see  that  the  money  of  the  chari- 
table went  to  deserving  persons.    It  has  created  a  large 
organisation  of  its  own,  with  many  costly  offices  and 
officers.    Many  complaints  have  been  made  of  its  harsh 
treatment  of  the  deserving  poor,  although  on  the  other 
hand  there  can  be  no  doubt  that  it  has  done  much  excel- 
lent service  to  the  public  in  the  detection  and  exclusion 
of  rogues.    In  the  opinion  of  many  persons,  the  Society 
has  never  altogether  disproved  the  truth  of  the  old 
sarcasm,  that  it  spends  so  much  of  its  energy  in  organisa- 
tion that  there  is  little  or  none  left  for  charity.     While 
it  has  so  large  a  legitimate  field  of  its  own,  we  fail  to 
see  what  it  has  to  do  with  the  pay  system,  or  the 
central    control   of   hospitals.      That    some  central 
board  is  required  in  the  interests  alike  of  the  hospitals, 
of  the  medical  profession,  and  of  the  public,  seems  fairly 
evident.  The  task  before  such  a  body  is  simply  Oargan- 
tuan.    To  evolve  system  out  of  chaos ;  to  establish 
financial  unity  where  now  is   fantastic,   haphazard 
expenditure ;  to  minister  to  the  deserving  poor,  and  at 
the  same  time  to  exclude  the  well-do-to  parasite ;  to 
:.void  injury  to  the  medical  practitioner;  to  make 


562    Thb  Midioal  Pbvs. 


LEADING  ARTICL18. 


May  27, 1896. 


dishonest  management  impossible ;  in  short,  to  lay 
down  and  enforce  principles  in  a  region  that  knows  no 
written  laws  ;  such  are  a  few  of  the  knotty  problems 
awaiting  solution,  not  only  in  the  metropolis,  but  also 
throughout  the  length  and  breadth  of  the  United 
Kingdom. 

AUTOTOXIS    IN    THE    CAUSATION    OF 
INSANITY. 

We  are  so  much  accustomed  to  regard  insanity  in 
its  various  forms  as  the  outcome  of  hereditary  influ- 
ence plus  special  strain  that  it  is  useful  to  be  reminded 
occasionally  that  mental  disturbances  are  not  always 
so  strictly  constitutional,  and  that  mental  aberrations 
may,  in  a  certain  proportion  of  the  cases  at  any  rate, 
owe  their  origin  to  such  ephemeral  and  preventible 
causes  as  functional  disorder  of  the  intestinal  canal. 
A  paper  on  this  subject  was  read  by  Dr.  Hamilton,  of 
New  York,  at  the  last  meeting  of  the  Medical  Society 
of  London,  and  although  we  are  by  no  means  prepared 
to  admit  the  accuracy  of  all  hia  deductions,  it  may 
fairly  be  asserted  that  he  has  succeeded  in  demonstrat- 
ing that  certain  varieties  of  insanity  are  the  direct  out- 
come of  the  action  of  poisons  elaborated  in,  and 
absorbed  from,  the  intestinal  tract.  Years  ago.  Dr. 
Lauder  Brunton  directed  attention  to  the  phenomenal 
activity  of  the  toxic  products  elaborated  in  the  course 
of  an  ordinary  attack  of  indigestion,  and  although  he 
does  not  appear  to  have  included  the  production  of 
even  temporary  insanity  among  the  troubles  to  which 
they  may  give  rise,  he  established  a  striking  analogy 
between  their  action  and  that  of  curare.  The  intestinid 
tract  is  the  habitat  of  an  almost  incredible  number 
of  bacteria  and  fungi  which,  or  some  of  them,  assist  in 
the  process  of  food  disintegration,  preparatory  to 
assimilation,  and  under  normal  circumstances  they 
hold  each  other  in  check.  It  is  easily  conceivable  that 
under  altered  circumstances,  either  in  the  direction  of 
a  change  in  the  composition  of  the  fseces  or  an  altered 
environment  such  as  would  be  afforded  by  a  condi- 
tion of  chronic  catarrh,  the  balance  of  bacterial 
power  may  be  disturbed,  the  beneficent  microbes 
taking  a  back  seat  while  the  more  virulent  species, 
temporarily  at  any  rate,  gain  the  upper  hand. 
If  we  add  to  this  an  unduly  prolonged  retention 
of  the  abnormal  faoces  in  the  intestines,  we  have  all 
that  is  required  to  provide,  and  permit  of  the  absorp- 
tion of,  soluble  toxic  products  capable,  as  laboratory 
experiments  have  repeatedly  shown,  of  exerting 
marked  pathogenic  effects  on  the  nervous  system. 
Under  ordinary  circumstances,  in  the  healthy  animal 
organism,  the  liver  acts  the  part  of  a  chemical  filter, 
eliminating  from  the  blood  all  such  toxic  products 
which  are  thus  prevented  from  entering  the  general 
circulation.  When  the  liver  function,  for  any  reason, 
is  imperfectly  performed,  these  products  are  permitted 
to  pass,  and  are  left  free  to  work  their  effects  on  the 
delicate  tissues  of  the  central  nervous  system.  In 
persons  who  have  acquired  the  habit  of  periodical 
evacuation  of  the  intestines,  it  is  surprising  what  an 
amount  of  discomfort  and  inconvenience  is  entailed  by 
even  a  moderate  delay  in  the  accustomed  rite,  and  it 


cannot  excite  surprise  that  the  systematic  neglect  of 
the  intestinal  function  should  give  rise  to  more  per* 
manent  and  more  serious  manifestations.  According 
to  Dr.  Hamilton's  observations,  it  seems  that  a  fair 
indication  of  the  condition  of  the  intestinal  canal  can 
be  obtained  from  a  careful  examination  of  the  urine. 
He  confessed  that  he  had  been  unable  to  discover  any 
definite  standard  of  abnormal  urine  which  could  be 
held  to  be  characteristic  of  insanity,  or  of  any  particular 
form  of  insanity,  but  he  pointed  out  that  intestinal 
putrescence  determines  the  presence  in  the  urine  of  an 
appreciable  quantity  of  indican,  and  when  indican  is 
present  there  is  also  a  more  or  less  marked  alteration 
in  the  ratio  of  prssformed  sulphates.  These  indica- 
tions, he  stated,  are  generally  found  in  acute  insanities, 
especially  those  characterised  by  rapidly  developing 
symptoms.  Changing  illusions,  hallucinations  of 
unsystematised  delusions,  in  association  with  insomnia, 
pallor,  constipation,  and  rapid  exhaustion,  are,  in  hia 
opinion,  generally  due  to  autotoxis  of  alimentary  origin 
and  this  condition  is  also  responsible  for  various  post- 
febrile, traumatic,  alcoholic,  and  drug  insanities.  It  is 
worth  while  recalling,  while  dealing  with  this  subject, 
that  the  same  effects  have  been  attributed  by  various 
observers  to  the  presence  of  uric  acid  in  the  blood,  and 
as  the  effect  of  an  excess  of  uric  acid  in  the  production 
of  certain  forms  of  mental  disturbance  is  generally 
conceded,  it  is  a  difficult  and  a  delicate  task  to 
distinguish  which  is  primary  and  which  secondary. 
The  worst  of  the  "  professors  of  uric  acid,"  is  that  they 
ride  their  hobby  to  death  or  as  near  death  as  common 
sense  will  allow  of.  To  listen  to  them,  when  they 
condescend  to  impart  their  views,  uric  acid  is  the  font 
et  origo  malt  in  most  of  the  diseases,  apart  from  the 
specific  fevers,  to  which  human  flesh  is  heir.  If  the 
treatment  based  on  the  autotoxis  hypothesis  is  shown 
to  be  successful  in  [a  certain  class  of  cases  we  are 
assured  that  it  is  because  this  very  treatment  has 
incidentally  for  effect  to  favour  the  elimination  of  the 
surplus  acid,  and  so  on.  Another  class  of  critics  object 
that  the  intestinal  irregularity  is  the  result,  and  not 
the  cause,  of  the  central  nervous  trouble,  though,  if 
treatment  directed  to  the  supposed  intestinal  focus 
proves  successful  it  is  not  easy  to  understand  their  pro- 
cess of  reasoning.  Under  these  circumstances  it  is 
well  to  go  on  broad  general  principles.  We  may  take 
it  as  proved  that  a  certain  proportion  of  cases  of 
insanity  not  obviously  due  to  cerebral  degeneration  or 
other  toxic  influences  may  be  immensely  improved  and 
even  relieved,  by  measures  having  in  view  the  antisepsis 
of  the  intestinal  tract.  The  washing  out  of  the  large 
bowel  and  the  administration  of  antiseptics,  such  as 
naphthaline  or  salicylate  of  soda,  certainly  seem  to  be 
attended  by  marked  and  favourable  effects  in  these 
cases,  and  this  is  enough  for  the  practitioner  who  may 
not  have  leisure  to  enter  upon  the  judicial  considera- 
tion of  questions  of  etiology  and  proximal  therapeutics. 
The  success  of  the  treatment  shows  that,  contrary  to 
the  dictum  of  Shakesperian  sceptics,  medicine  can, 
under  certain  circumstances,  "minister  to  a  mind 
diseased."  It  may  lessen  the  anxiety  of  the  Govern- 
ment at  a  time  when  the  increase  of  insanity  is  exdt- 


Hat  27,  1990. 


NOTES  ON  CUBBINT  TOPICS 


Thi  Midioal 


56a 


ing  diBmay  to  be  told  that  one  of  the  moet  fertile 
•caases  ia  chronic  constipation  or  intestinal  catarrh.  In 
any  case  the  thonghtfol  and  suggestive  paper  which 
Dr.  Hamilton  brought  before  the  Medical  Society  of 
London  ought  to  have  for  effect  to  direct  the  attention 
of  those  in  charge  of  the  insane  to  an  important 
•department  of  clinical  observation  hitherto  compara- 
tively unexplored,  which  may  possibly  in  the  near 
future  give  a  rich  harvest  of  therapeutio^l  results  in  a 
whole  category  of  mental  diseases  usually  assumed,  on 
insufficient  data,  not  to  be  amenable  to  medicinal 

treatment 

♦ 

LADY    DOCTORS    AND    THE    MEDICAL 
SOCIETIES. 

Havino  cast  their  eyes  around  qucerena  devorent  the 
lady  doctors  recently  decided  to  try  their  luck  at  the 
Pathological  Society  with  a  view  to  breaking  down  the 
boycott  which  has  so  far  been  successfully  maintained 
in  respect  of  their  admission  as  Fellows  or  Members 
•of  the  medical  societies,  and  the  matter  came  forward 
on  a  motion  by  Mr.  Stanley  Boyd,  at  the  annual  meet- 
ing on  the  19th  instant  It  appears  that  an  appli- 
cation, or  applications,  for  admission  had  been  made 
in  the  usual  way,  but  in  the  absence  of  any  precise 
rule  bearing  on  the  subject,  the  President  (Mr.  Butlin) 
-oautiously  decided  that  silence  did  not  mean  consent, 
and  threw  the  responsibility  of  deciding  the  matter  on 
the  annual  meeting,  at  which  there  was  an  unusually 
large  attendance  in  consequence.  Mr.  Boyd  intro- 
duced the  subject  in  a  quiet,  argumentative  fashion, 
and  for  a  time  it  seemed  as  if  tiie  adversaries  of  the 
motion  were  not  going  to  place  their  archaic  views  on 
xeoord.  Before  the  discussion  closed,  however,  one  or 
two  of  them  plucked  up  courage  to  utter  the  tiresome 
old  platitudes  concerning  the  indelicacy  of  discussing 
'  certain  subjects  before  women,  launching  off  now  and 
again  into  diatribes  against  the  impious  trespass  of 
women  in  the  domain  of  medicine.  The  arguments 
were  all  on  the  side  of  the  innovators,  but  the  votes 
iTemaiued  with  the  conservatives,  and  the  proposal  was 
4iltimately  rejected  by  a  substantial  majority.  One 
would  have  thought  that  of  all  societies,  the  Patho- 
logical, which  deals  with  objective  specimens,  and 
euphemistically  described  as  '*  fresh,"  was  the  one  at 
which  the  least  inconvenience  could  result  from  the  pre- 
sence of  ladies.  But  the  bogey  of  feminine  indelicacy 
.proved  too  much  for  the  fellows  in  conclave  assembled, 
though  we  shrewdly  suspect  that  the  younger  men 
either  voted  with  the  majority,  or  abstained  from 
voting,  more  in  deference  to  the  bias  of  their  seniors 
than  to  their  own  views  on  the  matter.  How  anyone 
ean  maintain  that  it  is  indelicate  to  discuss  certain 
subjects  before  a  fellow-practitioner,  female  though 
ehe  be,  passes  our  comprehension,  bearing  in  mind 
that  all  sorts  of  operations  and  all  sorts  of  remarks 
and  directions  are  hourly  given  to  nurses  whose  sex 
exposes  them  to  the  same  objection.  He  must,  in  deed, 
be  supematurally  fastidious  who  could  not  discuss  a 
atrictly  medical,  or  surgical,  or  pathological  subject 
before  a  mixed  audience  of  duly  qualified  practitioners, 
«4ndeed,  there  is  a  certain  pruriency  in  the  very  sug- 


gestion of  an  inability  so  to  do.  It  cannot  be  hoped 
that  the  boycott  will  be  indefinitely  maintained,  for 
it  is  contrary  to  justice  and  common  sensa  There  was 
an  appearance  of  logic  in  refusing  women  admission  to 
the  profession,  but  once  that  line  of  defence  was 
abandoned  it  is  mere  professional  jealousy  and  petty 
rivalry  that  underlie  the  refusal  to  admit  our  female 
associates  to  the  privUege  of  availing  themselves  of 
the  knowledge  which  is  to  be  obtained  at  the  medical 
societies,  and  at  these  societies  only.  We  had  hoped 
that  the  Pathological  Society  would  rise  superior  to 
such  considerations,  but  the  sexual  hypersesthetics  had 
it  ail  their  own  way  and  as  they  are  impervious  to 
reason  and  argument  the  ladies  must  e*en  wait  until 
these  become  too  infirm  to  attend  the  meetings  or  until 
they  are  old  enough  to  be  superannuated.  It  is  worthy 
of  remark  that  Fellows  whose  voices  are  never  heard 
and  whose  forms  are  unknown  under  ordinary  circum- 
stances within  these  hallowed  precincts  invariably  turn 
up  to  defend  the  society  which  they  profess  to  cherish, 
but  which  they  never  frequent,  from  themoral  contamina- 
tion involved  by  the  presence  on  terms  of  scientific 
equality  of  the  new  order  of  practitioners.  Science  is 
asexual,  and  the  relief  of  human  suffering  knows  no 
distinction  of  persons.  Women,  as  practitioners  of 
medicine,  labour  under  many  inherent  disadvantages, 
but  this  is  not  a  sufficient  reason  for  refusing  to  the 
more  diligent  and  gifted  among  them  free  scope  for 
their  unemployed  energies.  Just  as  we  naturally 
respect  the  man  who  has  fought  his  way  to  the  front 
in  spite  of  opposition  and  difficulties,  so  we  ought  to 
regard  the  woman  who,  in  spite  of  physiological 
burdens  and  social  discouragement,  has  acquired  the 
right  to  be  enrolled  a  member  of  an  honourable  and 
humane  profession. 


^tzB  on  dtttrent  ^apka. 

A  Lady  Examiner  in  Qynsecology. 
The  Dublin  newspapers  state  that  a  meeting  of 
students  connected  with  the  Schools  of  the  Irish  Col- 
lege of  Surgeons  and  Catholic  University  has  been 
held  for  the  organisation  of  action  to  protest  against 
the  recent  appointment  by  the  College  of  Dr.  Winifred 
Dickson  as  Examiner  in  Midwifery  and  Gynsecology. 
It  is  stated  that  it  is  intended  that  a  petition  for  the 
appointment  of  a  male  examiner  shall  be  presented  to 
the  Council  of  the  College  with  the  threat  that,  if  Dr. 
Dickson  la  not  superseded,  they  (the  students)  will 
"go  elsewhere  for  their  lectures."  It  does  not 
publicly  appear  what  are  the  grounds  of  the  objection 
to  Miss  Dickson  as  an  examiner.  Incompetency  or 
want  of  knowledge  of  her  subject  cannot,  certainly, 
be  alleged,  considering  that  the  lady  is  Assistant  Phy- 
sician to  the  Coombe  Lying-in  Hospital  and  GynsBCO- 
logist  to  the  Richmond  Hospital,  and  has  had  a  most 
distinguished  career  during  the  studentship  which  has 
now  culminated  in  her  receiving  the  Fellowship  of  the 
College  of  Surgeons  and  the  M.D.  of  the  Boyal  Uni- 
versity with  highest  honours.  Nor  can  there  be  any 
complaint  of  partiality  or  of  her  method  of  examining 


664     Thi  UmowjLt  Pbus. 


K0TE8  OK  CUSBKIIT  T0FIG8. 


Mat  97,  mc 


because  ebe  has  not  yet  had  the  opportaaityof  show- 
ing her  capacity  for  the  doty.  In  any  case,  the 
Conncil  of  the  Ck>llege  has  simply  discharged  the 
oUigation  imposed  by  the  Charters  of  the  College  in 
electing  Dr.  Diekaon.  The  lady  is  duly  qnalified  by 
her  Fellolrship  for  election,  and,  on  the  occasion  when 
she  was  chosen,  each  member  of  the  Conncil  took  a 
declaration  that  he  wonld,  "without  hatred,  evil 
will,  partiality,  affection,  favour,  or  fear,"  elect  the 
candidate  who  had  shown  the  highest  attainments  in 
the  subject  in  which  he  (or  she)  wonld  be  called  upon 
to  examine.  It  will  be  obvious  that,  being  thus  bound, 
the  Council  could  not  allow  any  sentimental  considera- 
tion to  prevent  it  making  the  selection  dictated  by  its 
chartered  obligation.  As  we  can  conceive  no  objection 
against  Dr.  Dickson  on  these  merits,  we  have  difficulty 
in  imagining  what  the  ground  of  such  objection  may 
be.  To  say  that  the  sense  of  propriety  and  modesty  of 
the  medi<»l  students  of  Dublin  is  shocked  by  the 
appointment  of  a  lady  to  examine  on  obstetric  subjects 
sounds  more  like  a  joke  than  a  reasonable  objection. 
But  if  such  examination  involves  an  outrage  upon  the 
too  susceptible  feelings  of  our  student  friends  we 
would  suggest  that  they  have  not  found  it  necessary 
to  blush  or  to  hold  meetings  in  vindication  of  their 
religious  propriety,  for  all  these  years,  while  male 
examiners  were  engaged  in  examining  lady  candidates 
on  the  same  subjects.  In  any  case  we  venture  to 
observe  that  it  is  quite  a  new  departure  that  medical 
students  should  seek  to  exercise  a  selection  of  the 
examiners  who  are  to  test  them,  and  it  is  a  grave 
question  for  those  who  have  the  regulation  of  such 
examinations  whether  they  can  accept  dictation  from 
^e  students  on  such  a  matter. 

The  Deadlock  at  the  LiTerpool  Lying-in 
HoapitaL 

No  new  development  has  taken  place  in  the  matter 
of  the  above  institution  and  its  medical  officers.  A 
compromise  with  kindly  intent  was  proposed  by  Mr. 
W.  Rathbone  and  accepted  by  the  Board  of  Manage- 
ment, but  rejected  by  the  medical  staff.  The  com- 
promise proposed  was,  in  fact,  no  compromise  at  all, 
but  apparently  a  trap  to  catch  the  doctors.  The  first 
sentence  appeared  to  concede  something,  but  the  next 
took  it  completely  away,  still  leaving  the  matron  mid- 
wife master  or  mistress  of  the  situation.  A  number  of 
letters  have  appeared  in  the  daily  papers  on  the 
subject,  and  one  in  the  papers  of  the  23rd  inst.,  by  Mr. 
James  Lister,  a  member  of  the  Board  of  Maogement, 
or  rather  mismanagement,  put  the  matter  in  a  per- 
fectly clear  light,  and  show  that  the  Board  are  as  far 
off  making  concesBions  as  ever.  In  this  letter,  Mr. 
Lister,  amongst  other  things,  says  :— 

"The  doctors  claim  that  every  case  that  comes 
into  the  hospital  is  theirs  ab  initio^  and  that  it  lies 
with  them  to  decide  whether  it  is  for  them  or  for  the 
midwife.  This  we  resist,  as  it  places  the  institution 
absolutely  in  control  of  the  Medical  Staff,  and  the 
Board  would  be  false  to  their  duty,  and  to  sil  the  tra- 
ditions of  the  charity,  if  they  admitted  this  change  in 
its  working." 

This  makes  it  clear  that  all  so-called  concessions 
and  compromises  have  been  iUusory,  and  intended 


only  to  throw  dust  in  the  eyes  of  the  me&al  staff  and 
the  public,  and  that  the  Board  do  not  recede  frcnn 
their  poMtion  in  the  slightest  Such  being  the  casCr 
it  u  a  sathifaction  to  learn  that  not  only  the  late 
staff  of  the  Hoepital,  but  the  whole  profession  in 
Liverpool,  have  stood  firm,  and  that  not  a  single  doctor 
has  shown  himself  willing  to  take  office  under  the- 
conditions  imposed  by  the  Board  of  Management. 
This  is  as  it  should  be.  Wealso  understand  that  the 
lady  doctor,  whose  services  the  Board  had  obtained  ss 
lecturer  to  the  pupil  mid  wives,  withdrew  her  services  as 
soon  as  she  became  acquainted  with  the  position  of 
affairs.  It  is  clear  things  cannot  always  continoe  as 
they  are,  and  the  only  course  now  open,  as  far  as  we- 
can  see,  is  for  the  Board  to  resign  and  make  way  for 
one  endowed  with  a  clearer  perception  of  the  fitness  of 
things. 

Legialation  for  Barmaids. 
There  is  probably  no  class  of  workers  in  more- 
urgent  need  of  legislative  help  than  that  of  barmaidi. 
The  time  for  work,  as  a  rule,  is  outrageously  long, 
twelve  or  fourteen  hours,  or  even  longer,  being  a  com- 
mon daily  average.  So  far  as  one  can  see,  there  is  no- 
particular  reason  why  a  ten-hours  limit  should  not  be 
fixed  for  the  barmaid  as  readily  as  in  most  other 
occupations.  We  suspect,  however,  that  the  semi- 
domestic  naturo  of  her  position  offers  one  of  the  greatest 
difficulties  in  the  way  of  reform.  At  present,  the 
control  of  licensed  houses  is  in  the  hands  of  the 
police,  and  any  further  regulations  as  to  the  hoars- 
of  barmaids  would  probably  be  best  also  entrusted 
to  the  same  authorities.  It  seems  fairly  erident 
that  to  send  the  average  sanitary  inspectors  on  such 
a  mission  would  be  unwise  from  several  points 
of  view.  Meanwhile,  the  barmaid  waits.  Daring 
long  and  weary  hours  of  overwork  she  has  to 
stand  patiently  at  her  post ;  she  has  scant  time  for 
exercise,  sleep,  and  meals  ;  and  in  too  many  cases  she 
turns  to  alcohol  to  recruit  her  exhausted  physical 
energies.  Constant  standing  makes  her  prone  to  vari- 
cose veins  and  uterine  disorders,  and  her  constitution 
often  breaks  down  under  the  ordeal.  Moreover,  it  not 
infreqaently  happens  that  she  sleeps  in  unsuitable- 
and  insanitary  quarters.  We  are  glad  to  see  that  a 
Bill  has  been  introduced  into  Parliament  with  a  view 
of  emancipating  this  terribly  overworked  class  from  a 
portion,  at  least,  of  its  exacting  burden.  Why  do  not 
some  of  the  women's  societies  take  up  the  subject  t' 
They  would  find  it  hard  to  discover  any  of  their  sisters 
more  sorely  in  want  of  a  helping  hand. 

The  International  Congress  of  Derxnatolo^* 
As  already  announced,  the  third  IntematioDal  Oon- 
gress  of  Dermatology  will  this  year  be  held  in  London. 
Beginniag  on  August  the  4th,  it  will  last  five  dsys, 
each  of  which  presents  an  attractive  programme.  The 
chief  features  are  the  presidential  address  by  Mr. 
Jonathan  Hutchinson,  the  exhibition  of  clinical  cases, 
and  the  reading  of  various  papers.  There  will  be  also 
four  formal  discussions  on  the  following  subjects  :— 
** Prurigo";  "The  Etiology  and  Varietiee  of  Kef*^ 
toeis";    •'The   Connection    of    Tuberculosis    witli 


Mat  27, 1886. 


NOTES  ON  CURRENT  TOPICS 


TMI  liBMOU. 


M& 


Biaeaaee  of  the  Skia  other  than  Lnpds  Yalgaris"; 
'^The  Nature  and  Relatione  of  the  Erythema  Malti,- 
fonne  Gkoup."  Many  distinguished  foreigners  will 
take  part  in  the  proceedings.  Among  them  Dr. 
Besnier,  Profs.  Foamier,  and.Letoar,  from  Prance; 
Profs.  Lassar,  Unna^  and  Neisser,  from  Germany ; 
Prof.  Petersen,  from  Rossia;  Drs.  Dahring,  White 
Bolkley,  Keyes,  and  Fox,  from  America ;  and  Drs- 
Shepherd,  and  Qraham,  of  Canada.  There  are  special 
reception  Committees  for  reception,  museum,  and 
bacteriological  arrangements.  Altogether,  there  is 
every  prospect  of  an  important  and  brilliant  interna- 
tional meeting  of  medical  men  interested  in  this  pro- 
gressive specialty.  '  The  Secretary-General  is  Dr.  J.  J. 
Pringie,  from  whom  any  further  details  may  be  ob- 
tained. 

The  Medioal  Defbnoe  Union  and  the  Appeal 
in  the  CardiS  Case. 
It  will  be  remembered  that  the  Medical  Defence 
Union  prosecuted  at  Cardiff  a  person  named  Bridg- 
water, for  the  assumption  of  titles  implying  that  he  was 
a  registered  medical  practitioner.     The  magistrate^ 
however,  dismissed  the  case  on  the  ground  that  the 
defendant  held  himself  out  to  be  a  Doctor  of  Medi- 
cine of  the  United  States  of  America  only,  thus  imply- 
ing that  he  could  not  be  registered  under  the  Medical 
Act.    The  titles  assumed  were  the  now  familiar  ones 
of  "  M.D.,  UaA."*    The  Union,  dissatisfi^  with  this 
decision,  appealed  against  it,  and  the  case  was  heard 
last  week.    Mr.  Justice  Grantham  held  that  the  magi- 
strate had  found  that  there  was  no  intention  on  the 
part  of  the  defendant  to  deceive.    The  real  question 
involved  was  whether  the  fact  of  a  practitioner  using 
the  letters  "  M.D."  after  his  name  was  evidence  that  he 
intended  to  hold  himself  out  as  a  registered  doctor  of 
medicine.    No  case,  the  judge  contended,  went  so  far 
as  to  say  that  it  was,  and  that  although  the  letters 
U.S.  A.  were  added,  the  person  so  doing  was  neverthe- 
lees  guilty  of  a  false  pretence.    Mr.  Justice  CoIHqs  also 
held  that  the  magistrate  was  warranted  in  finding  that 
the  defendant  had  no  intention  to  deceive.     But  he 
admitted  that  although  it  was  impossible  to  say  m  the 
present  case  that  an  offence  had  been  committed,  yet 
the  law  on  the  subject  was  in  a  fog,  and  it  could  not 
be  determined  what  were  decisions  of  law  atid  what 
were  decisions  of  fact.    In  consequence  of  these  con- 
clusions, both  judges  agreed  that  the  rule  should  be 
discharged,  and  thus  the  Medical  Defence  Union  have 
failed  in  their  application.    We  shall  refer  to  this  case 
again  next  week. 

American  Dentists  in  England. 
Qualified  English  dentists  appear  to  want  just  as 
much  protection  as  the  medicxJ  profession  against 
unqualified  practice.  At  every  turn  they  find  them- 
adves  pitted  against  men  who  practice  dentistry 
without  the  desirable  authority  of  a  dental  diploma. 
In  many  cases  these  free  lances  are  ignorant  and 
unprincipled  adventurers  who  have  failed  in  other 
pursuits.  Of  late  years,  however,  the  United  Kingdom 
has  offered  an  attractive  hunting  ground  to  the  un- 
ualified  American  dentist.     This  class  of  practitioner 


invades  our  shore  and  advertises  hiMsalf  with  bta  e 
front  in  every  way  that  an  exuberant  ingenvity  cam 
suggest    He  is  by  no  means  backward  as  regards  the 
amount  of  his  fees,  and  in  some  instances  he  extorts- 
exeeesive  payment  from  his  victims.     At  times  he- 
takes  the  title  of  "  Dr.,"  a  fact  to  which  one  may  well 
draw  the  attention  of  the  medical  defence  societies. 
An  unqualified  dentist  assuming  a  false  title  and  sap- 
plying  materials  to  a  patient  under  th^t  cover  lays- 
himself  open  to  the  law  equally  with  the  medical  pre- 
tender.   At  any  rate,  it  is  doubtful  whether  victims- 
could  be  compelled  to  pay  for  his  services  by  legal 
process.    With  regard  to  the  question  of  unqualified 
dental  practice  generally  there  can  be  no  doubt  that- 
some  good  sweeping  legislation  is  needed  both  in  the 
interests  of  the  public  and  of  a  profession  that  within 
the  generation  has  shown    marvellous    powers   of 
development  and  consolidation.    The  dentists  will  do- 
well  to  join  one  or  other  of  the  qualified  medical 
defence  societies. 

The  Election  of  Counoillors  at  the  Irish 
College  of  Surgeona 

Thb  ballot  for  President,  Vice-President,  and  Council* 
of  the  College  will  take  place  on  Monday,  the  1st  of 
June.  The  list  of  candidates  for  Councillorship  closed 
last  Saturday,  and  in  addition  to  Mr.  Sherlock,  whoee- 
candidature  we  announced  the  week  before  last.  Sir 
William  Stokes,  Mr.  Broomfield,  a  former  Councillor, 
and  Mr.  Eburison  Scott  have  offered  themselves,, 
besides  the  whole  of  the  outgoing  members  of  the 
Council,  including  Sir  Thornley  Stoker,  who  now 
vacates  the  Presidential  chair  and  is  certain  to  resume 
his  seat  on  the  Council.  Thus  there  are  four  competi- 
tors and  no  voluntary  vacancy  in  the  ranks  of  the 
present  Council,  and,  obviously,  if  one  or  more  of  the 
new  aspirants  succeed  they  will  displace  one  or  more 
of  the  outgoing  Council.  On  Saturday  evening  last 
the  Councillors  entertained  the  President,  Sir  Thornley 
Stoker,  at  dinner  at  the  Shelbourne  Hotel,  Dublin,  on* 
his  retirement  from  the  Presidential  chair.  The 
banquet  was  presided  over  by  Mr.  Thomson,  the  Vice- 
President,  who  will  be  President  in  a  few  days. 


Army  Morality. 
Tab  lax  sexual  morality  of  military  men  is  more  or 
less  proverbial.  However,  lapses  of  the  kind  have  not 
hitherto  appeared  to  interfere  in  any  way  either  with 
the  social  position  of  an  officer  or  with  his  professional 
prospects,  that  Ib  to  say,  if  he  does  not  happen  ta 
belong  to  the  medical  branch  of  the  Service.  Withii^ 
the  last  year  or  two  we  have  the  amazing  instance  of 
an  Indian  Army  surgeon  actually  dismissed  the 
Service  for  offering  to  kiss  a  married  woman.  It  is  not 
even  asserted  that  he  attempted  to  carry  out  the  pro- 
posal. If  one  were  to  judge  from  the  cash- 
iering of  this  unfortunate  officer,  the  moral 
standards  enforced  in  the  British  Army  must 
be  exceedingly  high.  But  the  most  superficial  acquain- 
tance with  the  inner  conditions  of  army  life  will  speedily 
prove  the  exact  opposite.  Last  week,  in  the  divorce 
courts,  the  judge  made  some  strong  comments  upon  the 
conduct  of  a  respondent,  who  he   pointed  out  had 


966     Tn  liKuoAL  Fuw. 


NOTES  ON  GUBBENT  TOPIOS. 


Mat  27,  mm 


broken  up  the  home  of  a  brother  officer  and  made  hia 
life  miaerable.  Now,  the  point  ia  thiB.  wUl  the  authori- 
defl  who  punished  the  Indian  non-combatant  for  a 
oontemplated  assault  of  a  trivial  kind,  overlook  what 
«n  English  judge  has  pronounced  a  gross  moral  offence  ? 
We  are  strongly  of  opinion  that  the  private  morals  of 
A  paid  public  servant^  such  as  an  army  officer,  should 
have  little  concern  for  the  authorities.  But  if  the  lash 
is  to  be  applied  only  to  the  medical  branch  of  the 
^rvioe,  we  think  it  time  to  enter  a  vigorous  protest 

A  Midwifes  False  Oertifloate. 
.The  exact  position  of  the  midwife  in  relation  to  the 
public  and  the  medical  profession  has  of  late  attracted 
a  good  deal  of  attention.  The  interest  in  the  subject 
has  been  intensified  by  the  dramatic  disclosures  that 
have  recently  been  made  as  regards  the  systematic 
barbarity  to  which  many  infants,  especially  when 
illegitimate,  are  liable  to  be  exposed.  In  view  of  these 
facts  the  conviction  of  a  midwife  last  week  in  a  London 
police  court  of  making  a  false  statement  about  a 
child's  birth  has  more  than  an  ordinary  significance. 
From  the  evidence  it  appeared  that  the  prisoner 
signed  a  certificate  of  still-birth,  although  the  child 
lived  for  nine  hours.  The  only  defence  was  that 
the  parents  urged  her  to  give  a  false  certificate  so 
>as  to  save  the  cost  of  a  funeral.  The  Magbtrate  im- 
posed a  fine  of  40s.,  or  ten  days'  imprisonment,  which 
appears  to  be  a  light  punishment  for  so  grave  an 
x>ffence.  It  is  not  necessary  to  point  out  to  medical 
readers  that  in  the  absence  of  registration  for  still- 
births, an  evasion  of  the  kind  here  practised  might 
readily  be  made  the  cover  for  serious  crimes.  Such 
occurrences  emphasise  the  need  of  revising  the  powers 
of  the  midwife  in  granting  any  certificate  at  all  for 
purposes  of  burial 

A  Degrading  Exhibition. 
Thkbe  seems  to  be  no  limit  to  the  sensationalism 
sought  after  by  variety  show-mongers,  in  order  to  pro- 
duce something  which  will  be  calculated  to  attract  the 
public.  The  taste  of  the  public,  it  must  be  confessed, 
is  by  no  means  what  it  should  be  in  this  connection, 
and  thia  fact  has  just  been  amply  proved  by  the 
crowds  which  have  flocked  to  a  degrading  exhibition  in 
Paris.  A  man  undertook  to  hang  by  his  neck  for  the 
space  of  fourteen  days,  under  the  following  condi- 
tions :— He  was  to  be  allowed  every  hour  a  few 
minutes  rest,  to  be  obtained  by  standing  on  the  steps 
of  a  ladder,  holding  on  to  the  rope  above  the  latter  in 
order  to  relieve  the  swelling  of  his  hands.  Before  the 
ladder  is  taken  away  he  is  permitted  to  inhale  some 
^chloroform  or  ether.  While  he  is  hanging  he  is  prac- 
tically semi-conscious,  though  there  is  some 
twitching  of  the  feet  and  hands  and  some  move- 
ment of  the  lip3.  Throughout  the  whole  of  the 
period  during  which  he  has  undertaken  to  hang  he 
will  have  neither  food  nor  drink.  Such  is  the  exhibi- 
tion which  is  now  to  be  seen  in  Paris,  and  we  learn 
that  the  showroom  in  which  it  is  held  is  full  of  visitors 
nearly  all  day  and  night  It  is  difficult  to  speak  in 
Btrong  enough  terms  of  the  repulsive  nature  of  such  a 


sight  The  "  fasting"  man  has  now  been  eclipsed  hy 
the  ''hanging  man" ;  and  naturally  the  question  ariaee 
where  will  this  pandering  to  the  morbid  public  taate 
endt 


The  Dearth  of  Oandidates  for  the   Army 

Medical  Service. 
Ws  trust  that  the  rumour  is  not  true  that  the  War 
Office,  in  order  to  obtain  a  sufficient  number  of  candi- 
dates for  the  Army  Medical  Service,  has  decided  to 
lower  the  standard  of  examination.    No  policy  wonid 
be  fraught  with  greater  danger  to  the  well-being  of  the 
Service  than  the  adoption  of  this.    Perhaps  it  is  not 
generally  known  that  just  thirty-three  years  ago,  when 
the  Medical  Department  of  the  Army  had  fallen  into 
disrepute  in  the  Medical  Schools,  a  large  number  of 
insufficiently  qualified  medical  men   were   admitted 
into  the  Service  with  results  which  might  have  been 
anticipated.    Thus,  for  obvious  reasons,  to  meet  the 
difficulty  of  the  dearth  of  candidates  by  lowering  the 
standard  of  examination,  and  by  this  means  render  it 
possible  for  a  less  qualified  class  of  practitioners  to 
enter  the  Service,  is  the  worst  plan  to  adopt    As  soon 
as  the  grievances  of  ,the  Service  are  removed,  there 
will  be  no  lack  of  candidates  to  fill  the   vacancies. 
The    matter,    therefore,    rests     entirely    with    the 
War   Office.     Let   the   War  Office   take   measures 
to  concede  what  the   Officers  of  the   Medical  De- 
partment of   the    Army    demand,    and    do    their 
best  to  smooth  away  the  differences  which  have  arisen, 
and  then  they  will  find  that  some  of  the  best  young 
qualified  men  from  the  medical  schools  will  not  hesi- 
tate, as  the  occasion  arises,  to  join  the  Service. 


Workhouse  Children's  Teeth. 
Thb  state  of  the  teeth  of  the  children  in  the  work- 
house in  Beverley,  Yorks,  was  recently  the  subject  of 
a  special  report  of  the  Local  Government  Board 
Inspector  for  the  district,  and  the  recommendation  was 
made  that  a  dentist  should  be  instructed  to  attend  to 
the  children  and  examine  their  teeth.  The  Board  of 
Guardians  to  whom  the  matter  was  referred  adopted 
the  recommendation,  and  the  hope  was  expressed  that 
a  dentist  in  Baverley  would  perform  the  necessaiy 
duties  without  charga  It  is  impossible  to  dispute  the 
importance  of  supervising  the  teeth  of  children,  even 
of  those  in  workhouses,  but  it  is  difficult  to  conceive 
why  the  services  of  a  dentist  should  be  expected  to  be 
given  without  remuneration  under  the  latter  circum- 
stances. Perhaps,  however,  were  expense  to  be  incurred 
in  the  matter  the  alternative  would  be  adopted  of 
neglecting  the  children  in  this  respect,  a  policy  which 
would  be  quite  in  keeping  with  that  pursued  by  many 
boards  of  guardians. 

The  Meeting  of  the  Gteneral  Medical  GounolL 
The  Council  will  hold  its  spring  meeting,  commenc- 
ing on  the  2nd  of  June  next  Mr.  Pridgin  Teale  will 
present  to  the  Council  the  renewal  of  his  Commission 
as  Crown  Representative  for  England,  and  Mr.  Thom- 
son will  take  hia  seat,  for  the  first  time,  as  Direct 
Representative  for  Ireland,  vice  Dr.  G.  H.  Kidd.   The 


Mat  27.  18M. 


THE  POSTAL  MEDICAL  OFPfCERS.       Tbm  Mioioal  Pbm.     567 


aflhir  of  the  Iruh  ApoiheearieB'  Hall  and  its  appeal  to 
the  Privy  Coimeil  for  a  grant  of  additional  examiners 
to  permit  it  to  discharge  its  examining  and  diploma- 
granting  foQctions  will  occapy  mnch  of  the  time  of  the 
Council,  and  will,  in  fact,  be  the  most  important 
business  for  transaction. 

The  Ck>nT6r8asione  of  the  Medioal  Society, 

London. 
The  annual  converscmone  of  the  Medical  Society 
of  London,  was  held  on  the  18th  instant,  and  was 
attended  by  a  large  number  of  Fellows  and  guests. 
The  subject  of  the  aaaoal  oration  was  ''  The  Breaking 
Strain,"  of  which  an  abstract  appeared  in  our  columns 
last  week.  Dr.  W.  H.  Allchin  was  the  orator,  and 
much  hearty  applause  was  accorded  him  for  his 
address.  The  purely  bastness  part  of  the  evening 
having  been  disposed  of,  the  company  proceeded  to 
indulge  in  light  refreshments,  smoking,  and  social 
intercourse.  The  reunion  was  a  great  success,  and  the 
proceedings  were  prolonged  until  close  upon  midnight 


[VBOM  OUB  OWN  ooBBispoironn.] 

Hospital  Aooommodatioit  in  Bbbohin.— The  Direotora 
of  the  Brechin  Infirmary  at  a  meeting  last  week,  after  a 
protracted  discnasion,  aereed  to  appoint  a  committee  of 
their  members  to  oonmer  the  qnestioa  of  the  hospital 
aooommodation  for  inf eotioiis  cases.  Durms  the  disonasioQ 
it  was  stated  that  the  proposals  of  the  Medioal  Officers  of 
Health  were  too  magoifioeot  fo«*  the  f anda  available.  The 
Direotors  were  in  favour  of  amalframation  with  the  Burgh 
and  District  Committee  of  the  County  Goaocil.  In  view 
of  the  Pablic  Health  Bill  it  will  certainly  be  advisable  for 
the  hospital  authorities  in  all  places  each  as  Brechin  to 
continue  to  keep  up  the  Fever  Hospital  which  they  will  be 
compelled  to  erect,  with  the  Local  Anthoritiec,  so  that 
expense  may  be  saved,  and  efficiency  procured* 

PnBUO  HxALTH  Bill  fob  Sooklakd.— The  Corporation 
of  the  City  of  Glasgow  has  memorialised  for  alterations  in 
this  Bill,  which  have  aronsed  the  righteous  indignation  of 
the  Veterinary  Surgeons  in  Scotland.  The  object  of  the 
memorial  is  to  provide  for  the  determination  (d  diseai^  in 
animals  by  Medioal  Officers,  not  by  Veterinary  Surgeons. 
The  reasons  given  for  this  stepare  as  follows :  1.  That  there 
is  no  justification  either  in  necessity  or  expediency  for  the 
emplojrment  of  a  Veterinary  Surgeon.  2.  That  medioal 
men  fiurst  pointed  out  the  special  diseased  conditions  in 
cows  which  entail  grave  risk  to  the  consumers  of  their 
milk.  3.  That  it  would  be  difficult,  if  not  impossible,  to 
find  a  properly  qualified  Veterinary  Surgeon  in  many 
counties  in  Scotland.    It  seems  to  be  hardly  fair  to  so  dis- 


parage the  attainments  of  a  profession  which  is  nowhighly 
.  trained  for  its  duties.  The  House  of  Lords  in  Committee 
rejected  the  amendments  suggested,  and  it  is  not  likely 
that  in  the  Report  stage  any  such  alteration  will  be  made. 
Tbaokdt  at  Dttnobb  Lunatic  Astlum. — A  lunatic 
who  had  been  regarded  as  harmless,  when  working  out- 
side, suddenly,  one  day  last  week,  attacked  an  attendant 
with  a  spade,  infliotmff  severe  injuries,  while  with  the 
same  weapon  he  attacked  and  killed  an  old  patient,  who 
had  proceeded  to  the  attendant's  assistance.  An  inquiry 
is  bemg  held  into  all  the  circumstances  of  the  case. 


Journal  for  Ireland,  which  took  plaee  at  his  residenoe,  6G 
Dame  Street,  Dublin,  as  the  rssult  of  oardiae  disease,  from 
which  he  has  suflered  for  some  time.  Mr.  Stuart  was  well 
known  in  the  profession  in  Ireland,  with  whom  he  has  beso 
in  constant  communication  Tor  nearlv  a  Quarter  of  a  oen- 
tnry,  during  which  lengthened  period  he  nas  had  in  hand 
the  chief  business  management  of  the  Mbdioal  Puns  and* 
CiBOULAB,  as  far  as  Ireland  is  oonoemed.  His  kindliness 
of  disposition  and  unassuming  manners,  and  his  oonstant- 
snxiety  to  meet  the  wishes  of  both  subscribers  and  adver- 
tisers, earned  for  him  universal  popularity  and  produce 
a  wide-spread  regret  for  his  loss  on  tiie  part  of  all  who 
have  had  business  dealings  with  the  Irish  depsrtment  of 
the  Mbdigal  Pbbss.  To  ourselves  the  deprivation  of  his 
services,  and  of  his  personalitv.  is  a  serious  loss,  and  the 
occasion  of  deep  regret.  He  has  served  us  for  nearly  25 
years  with  unvarying  industry  and  with  anxiety  for  the 
good  of  the  journal  and  all  concerned  in  its  management, 
and  he  has  administered  the  finances  of  his  department 
with  scrupulously  honourable  integritjr.  He  was  a  gentle- 
man in  mind  and  a  true  friend  in  spirit,  and,  for  us,  his 
loss  involves  a  most  unwelcoms  change  in  onr  arrange- 
ments. 


MR.  ROBERT  STUART. 
It  is  with  deep  regret  that  we  record  the  death,  on  the 
21st  inst.,  of  Mr.  Robert  Stuart,  the  publisher  of  this 


THE  POSTAL  MEDICAL  OFFICERS* 

Thi  annual  meeting  of  the  Association  of  British  PostaT 
Medical  Officers  was  held  at  the  Hotel  Metropde,  in 
London,  on  the  19th  inst.  The  President  of  theAssooia* 
tion,  Dr.  Mathew  Halton,  of  Bamsley,  Yorks,  occupied 
the  chair.  There  were  present  a  considerable  number  of 
Provincial  Postal  Medical  Officers. 

Dr.  Hsnry  FitzGibbon,  of  Dublin,  was  elected  Presi* 
dent  of  the  Association,  for  the  ensuing  year,  and  Dr.  R. 
Ritchie  Geddings,  of  Nottingham,  was  re-elected  as  Hon. 
Secretary. 

After  the  conclusion  of  routine  business,  the  Secretary 
submitted  to  the  meeting  a  very  exhaustive  report  upon 
the  sanitary  condition  orthe  Post  Offices  of  the  country, 
which  he  had  prepared  at  the  request  of  Lord  Tweedmouthr 
President  of  the  Special  Onnmittee  upon  Postal  Estab- 
lishments. 

Subsequently,  questions  of  Interest  were  discussed  ;  Dr. 
Ritchie  Geddings  initiated  a  debate  as  to,  '•  How  far 
heredity  should  influence  meiical  examiners,  in  their  ex- 
amination of  candidates  for  Civil  Service  appointments." 

In  the  evening  the  annual  dinner  of  the  Association, 
took  place.  Dr.  Halton  occupied  the  chair.  Besides  a  large 
number  of  members  there  were  also  present,  Sir  Walter 
Foster  M.P.,  Sir  Dyce  Duckworth,  M.P.,  Sir  Robert 
Hunter  (Secretary  to  the  Post  Office),  Mr.  E.  B.  Lewin 
Hill  (Assistant-Secretary  Post  Office,)  Dr.  Farquharson 
M.P.,  Dr.  Thorn  Thorn,  Dr.  E.  West  Symes  (Halifax)^ 
Captain  Henry  Berkeley,  R.N.,  Surgeon- Major  Murray, 
Mr.  Thos.  Baillie  Gage,  Snrgeon-Lieutenant-Colonel 
Phillips,  and  about  forty  others. 

The  President  proposed  the  loyal  toasts,  which  were* 
duly  honoured. 

Sir  Dyce  Duckworth  proposed  the  toast  of  the  Houses 
of  Parliament.  Sir  Walter  Foster  in  replying  said.  Sir 
Dyce  Duckworth  had  thanked  Gkxl  we  have  a  House  of 
Lords.  His  feeling  would  have  been  considerably  more 
intense  if  we  haa  arrived  at  that  period  of  civilisation  in 
which  we  had  life  peerages  and  medioal  men,  on  account 
of  their  intellectual  and  social  qualifications,  and  their 
self-sacrifice  for  the  crood  of  humanity,  found  a  place- 
in  the  House  of  Lords.  The  medical  men  connected 
with  the  Postal  Service  had  done  wisely  and  well  in 
organising  themselves,  they  have  under  charge  in  various 
pi^  of  the  Kingdom  one  of  the  most  desendne  class  of 
public  servants,  they  had  grave  and  responsible  duties  to 
perform,  and  they  should  form  such  a  poUqy  for  themselves 
as  would  tend  to  the  better  performance  of  thehr  duties 
and  the  elevation  of  the  class  to  which  they  belonged, 
mear,  hear}.  They  could  then  raise  the  Postal  Memeal 
Officers  of  the  Kingdom  to  that  posidon  which  they  ousht 
to  enjoy  as  a  very  important  part  of  the  Civil  Servioe. 
(Cheers.)  No  men  in  the  Civu  Servioe  deserved  higher 
honours  than  medical  men  when  they  did  their  woric 
honestly  and  well. 

# 


56^    Tini  Mtoioal  Pum.  NOTICBS  10  CORBESPOMTDENTR 


Mat  87.  laos. 


Corrtspottbettte.  ^ott  fetters,  *c 


Mr  CoBiavoMDnn  rHiMnc  •  nply  In  lUs 
•ttenlaily  rtfnutod  to  mate  vm  of  a  dlttlmtt§9$  ifywlMrtf  or  fwliliiTi. 
and  avoid  the  praotiMof  rfgnliiff  thMualfw  "1— dar,"  "SutMomMr," 
"OldSobMrflMr,"  Ac.  Maoh  oonfwlon  wOl  b«  iptt^  hf  mmMum 
tottilinilo. 

XiADnro  048ML  •Cloth  board  omm,  gllt-letlerod,  ooBteinlDg  twentr 
«ilz  itringi  for  holding  the  nnmben  of  Thi  Hbdiojll  Puss  axd 
•OtxoirLiLS,  may  DOW  be  had  at  either  oflloe  of  thli  Jonmal,  price  •§.  «d. 
Theee  CMee  will  be  found  Tery  nsefol  to  keep  each  weekly  nmnber 
■Intaot,  clean,  and  flat  after  it  haa  paned  through  the  pott. 

LOOAL  BBPOBn  ASP  KBWg— Ooffieepondente  dMiioiii  of  drawing 
attention  to  theee  are  reqneetod  kindly  to  mark  the  newipapew  when 
oending  them  to  the  Idltor. 

OBianAL  ▲moLU  or  Lic^Bg  intended  for  pnblleatloo  rihoold  be 
written  on  one  ilde  of  the  peper  only,  and  mnit  be  anthentlceted  with 
the  name  and  eddreu  of  the  writer,  not  neoeaartty  for  imblloetlon, 
'  bnt  aa  erldenee  of  Identity. 

BiiPRmi.~Aathon  of  p«pen  reqolrlog  reprinti  In  pamphlet  form 
after  they  have  appeared  in  theee  oolamne  can  haTc  them  at  half  the 
nioal  coit,  on  application  to  the  printen  before  type  li  broken  np. 

Db.  SBSxm.— Your  letter  will  appear  in  our  nest. 

Sbo  Laxp.— There  can  be  no  donbt  whaterer  aa  to  the  beat  ooniae 
for  yon  to  poraae.  If  the  annoyance  be  repeated  lay  the  whole  of  the 
facta,  nropeely  anthentloated,  before  one  of  the  medical  defence  aocie- 
tlea  If  yon  do  not  belong  to  one,  the  aooner  yon  become  a  member 
'the  better.  We  conalder  it  the  dnty  of  erery  member  of  the  prof  aaaioo 
ito  take  ont  the  ioanrance  polioy  obtainable  by  paying  a  haU-gotnea 
•yearly  to  a  defence  aodety. 

▲  FiLU)W.~OertalDly;  aend  In  an  aeooont  at  onoe,  if,  aa  yon  aay, 
•the  attendance  haa  bean  going  on  for  twelTc  oaontha  and  payment  la 
.donbtfnL 

BXAKT.^CoDra)t  some  practitioner  of  good  ttaadiDg  and  long  expert- 
.  enoe  on  the  point.    There  la  no  definite  law  dealiog  with  the  aame. 

BK(N  BiaOOLOUaiTION. 
Bom  anthorltiea  atate  that  corroaiTC  anblimate  la  a  ▼alnable  meana 
-of  getting  nd  of  akin  diaoolonraUona.  It  ia  the  baata  of  the  nnmeroaa 
applicatlona  for  freoklea  and  other  aotface  macnlea.  It  ahonid,  how- 
erer,  be  need  with  caation.  Aa  to  the  bine  marking  mentioned  by 
onr  UTcrpool  oorreapondentin  onr  iaane  of  the  80th,  the  diacolooratlon 
la  probably  dne  to  foreign  matter  from  the  cinderpatto  on  which  he  fell. 
If  to,  there  ia  little  proq)eet>  of  improtement.  Howerer.  aa  the  injury 
la  on  the  face  an  attempt  might  be  male  by  meana  of  email  ineialona 
to  remoTetbe  deep-lying  particlea  by  degreea,  or  a  plMtic  operation 
mi^t  be  performed  if  the  enifaoe  be  of  moderate  aize  and  thedtaflgore- 
ment  great. 

J.  H.  Am>  J.  F.  B.— Your  letten  arennaToidably  held  OT«r  until  onr 
inezt 

la  nndergolDg 


DR.  P.  (?axlB).-The  MS.  haa  bee 
reriaion.  We  hope  to  pnbllih  it  at  an  early  date. 
P  'M.B.^We  have  acceded  to  your  req[UMt  though  we  do  not  conalder 
that  your  contention  ia  baaed  on  an  accurate  appreciation  of  the  Im- 
portanoe  of  your  particular  branch  of  atndy. 

Admibir.— The  teatimonial  buaineaa  la  really  oTerdone.  Everybody 
cdnnot  have  atatuea  erected  to  tbem,  nor  can  every  departed  worthy 
have  a  comer  in  Weatminiater  Abbey.  With  a  few  notable  exceptiona 
it  aeema  beatto  "let  the  dead  paat  bury  itadead." 

M.  K.— Tour  BUggeation  comea  at  an  inopportune  moment  aeeing 
that  moat  of  the  medical  looietlea  have  cloeed.  or  are  on  the  eve  of 
doatng,  their  aeaalonal  doora.    We  will,  however,  bear  it  in  mind. 

nOiDL—We  cannot  deal  editorially  with  aueh  a  matter,  but  if  yon 
.oare  to  embody  your  complaint  in  a  algned  letter  we  will  conalder  the 
l^ropriety  of  publlcat'on. 

4tlttttnQ0  of  the  !$0ctettt6 

LECTUBB4  AND  BBMONBTBATIONS. 
WIDRBSDAT,  MAT  S7TH. 
KATIOHAL  HOSPITAL  VOB  THB  PARALTSUD  AMD  EPILIPTIO  (Blooma- 
bnryX— 8  p.m.    Dr.  Beevor :  Paralyiia  of  the  Soft  Palate. 

Hospital  vob  GoNBOMPnoir,  «a,  (Brompton). -4  p.m.  Dr.  Biaa: 
Intra-Thoradc  Anenryam  of  the  Aorta. 

THUB8DAT,  MAT  28TH. 
BOTAL  THSllTUnoH.— S  p  m.    Dr.  E.  Munro :  Lake  Dwellinga. 
VioTOBiA  Hospital  vob  Childbbh,  Chbl8IA.-4  p.m.     Mr.  T. 
Pickering  Pick :  On  Operative  Interferenoe  in  Morbua  Coxn. 
FBn>AT,  Mat  29TH. 

BoTAL  Institution. -9  p.m.  Mr.  A.  Birrell :  John  Wealey  ;  aome 
Aipeota  of  the  Blghteenth  Century. 

Batubdat,  Mat  soth. 

BOTAL  IN8TITUTI0N.~8  p.m.  Dr.  E.  A.  WalUa  Bu(*ge :  The  Moral 
and  Beligiona  Liter «ture  of  Andect  Xygpt. 

THVBSPAT,  JVNB  4TH. 

YioiOBiA  HOSPITAL  VOB  Cbildbbn,  Cbblsia.— 4  p.m.  Dr.  BoUea- 
ion :  Hepatic  Dlaeaae  in  Children. 


^tttntUB. 


Bedford  Genanl  Infirmary  and  Fever  HospltaL— Honae  BargMNi. 
ppartmenk,  board,  lodging,  and 
Imoniala  to  the  Seotetary  net  later 


Salary  £100  per  annum,  with  appartmento,  board,  lodging,  and 
waahinfr  Applioatlona  and  teatbnonlala  to  the  Seotetary  net  later 
than  June  6tli. 

Bridgwater  Inflrmaiy.—Houae  Burgeon.  Salary  £30  per  ■nniim,  wtOi 
board  and  realdenoe.  AppUcationa  withteetlmoolalB,toMr.  Jolm 
Ooomba,  Hon.  Secretary,  Bridgwater  Infirmary,  Bridgwater,  on  or 


Ooomba,  Hon.  Secretary, 
before  May  SBUu 
mtyLanatIo 


Aaylnm.— Aariataat  Medical  Oflleer  (unmarried). 

'      ^  ■       •      ■  -     ilahedapart- 

totheaeak 


BnokaOoanty , 

Salary  £100  per  annum,  together  with  board  and  f  urniahed  i 
menti  In  the  aaytiun.  Appllcationa  and  teetlmoolala  to  the 
to  the  VlaitlngOommittee  on  or  before  Jnne  6th. 

Oovan  District  Lunacy  BoaML-Aaaiatant  Medical  Oflloer  for  tbe 
Aaylnm  at  Hawkhead,  near.Palaley  (unmarried).  Salary  AlOO 
with  board  and  apartmenu.  AppUcaUooa  and  teatimoBfala  to 
Andrew  Wallace,  ueik,  T  Cariton  Place,  COaagow,  on  or  belora 
June  10th. 

Lambeth  Workhouse.- Aaaiatant  Medtoal OOcer  and  Diapenaer  for  tlie 
~"  "  ■  r.  rlaingto£l25, 


Workhouae,  Kenn _    _       .      .      .      

with  board,  apartflaeota,  and  waahlng.  Printed  forma  of  appltca- 
tion  ia  to  be  obtained  at  the  Gnardiana'  OlBcea,  Brook  Street, 
Kennington  Bond,  B.E, 


Salary  £100  per  year. 


London  Hoepital,  WhIteohapeL-nMedioal  Beglatrarataip.  Salary  £100 
per  annum.  Applicatlona  and  teatlmonlala  to  the  Hoipital  not 
later  than  June  nth. 

look  Hom^ltal,  Harrow  Boad,  W.-Honae  Burgeon  to  tba 
le  HoapltaL  Balaty  £60  per  annum,  with  board,  lodging, 
'aahlng.  AppUcaUooa  and  teatlmonlala  to  the  Seerstaiy  not 
than  May  80th. 


London  Look  Hoq;»ital,  Hairow  Boad,  W.-Honae  Burgeon  to  tba 

Female  HoapltaL    Balaty  £60 

and  waahln 

later  than  1 

MetropoUtan  Aaylnma  Board.— Aariatant  Medical  Officer  at  the  Vaan- 

taln  Fever  Hoepital,  Lower  Tooting.    Salary  £160  during  the  flist 

year,  rlaing  to  £S00,  with  board,  ludgbig  attendance,  ana  « 

(See  advert  A 
Stamford  Hill,  Stoke  Newington,  Clapton,  Ac.,  Diapenaary,  180  High 

Street,  Stoke  Newlngton,  K.— Junior  Bealdent  Medical  Officer. 


Salary  £60  per  annum  during  the  flrat-quarter,  afterwarda  at  the 
rate  of  £76  per  annum,  wlui  board  and  lodging.  Applications 
and  teattmonlala  to  the  Senior  Bealdent  Medioal  Officer  on  or 

dtal,  Brighton.— Home  Phyridan  Otunairied). 
og  at  £60  per  annum,  with  board,  realdenoe,  and 
mriona  and  teatlmonlala  to  the  lieoretary  on  or 


before  June  8rd. 
Buaaex  Oounty  Hoapil 
8alary  commeudot 
waahug.    ApidioasionB 
belore  June  8rd. 


MaoObioob,  D.  a.,  M.B.,  G.  if.EdIn  ,  Medical  Officer  ol  Health  by  the 

Denby  and  Comberworth  Crban  Diatncc  Council. 
MSB80N,   A.   u.,    L.R.aP.,    L.il.C.8.1£d.,   L. K  P  S.Glaag.,  Parochial 

Medical  Officer  by  the  Aberdoar  Pailah  Coancil. 
Mbtib,  W.  B.,  UH.A.,  Medical  Officer  for  the  fourth  Sanitary  Diatrict 

of  theCuckfleld  Union. 
MoBOAN,  T ,  L.B..C.P.,  L.B.C.8.Ire1.,  Medical  Officer  for  the  Parithea 

of  FOrden,  l,Unriy«8il,  and  Llanmerewlg. 
II0BTI8,  H.B.,  LB-aP.Lond.,  L.S.A.,  MttUieal  Officer  for  tbe  Fifth 

Saultary  Diatrict  by  the  <>aw«atry  looorporatloD. 
N  [COLL,  J.  MacD..  M.B.  C.M.Kdlu.,  Medical  Officer  of  Health  by  the 

Jarrow  Town  CouncIL 
Pbidbauz,  C.  S.,  L.U.S,  B.C.S.,  Honorary  Surgeon  Dentiat  to  the 

DoraetCoUDdl  Hoepital. 
EOBBRTS,  L,  lifcD.Load.,  L.B.aP..  M.B.G.B.,  Medical  Officer  for  the 

OaoiBwa  Worichouae. 
Saundbb*,  A.  L.,  L.B.C.P.Lond.,  M.B.C.S.,  Medical  Officer  for  the 

Kirat  Soath-Kaatem  District  of  the  Freebridee  tynn  Uuioa 
STBRCB,  G.  B.   R.,  UB.C.P.,    L.R.C.S.Kd.,  L.F.PS.Qlaw..  Medical 

Officer  for  the  Tadhoe  Sanitary  Diatrict  of  the  Durham  Union. 
WoOLLOOMBB,   W.  L..  F.B.C.S.B,    M.K.GS.BoR.,    L.B.U.P.,  Senior 

Honorary  Surgeon  to  the  South  Devon  Hnapital,  I'ly mouth. 


ftrtba. 


HABBISOV.—Ilay  Slat,  at  North  Walaham,  Norfolk,  tbe  wife  of  Sidney 

H.  Harriaon,  L.B.C.P.,  M.B.C.R.,  of  a  aon. 
J  ORBS.  -  May  17th,  at  Aihton  Old  Ro»d,  Higher  Openahaw,  Mancfaeater, 

the  wife  of  Kdwin  K.  Jonea,  aurgeon,  of  a  eon. 
MILTON.    May  20tb,  at  Port  Said,  Egypt,  tbe  wUe  of  F.  B.  S.  MUton, 

M.B.O.S.,  of  aaoD. 


Babnabd  OBPOBD.~May  19th,  at  Si.  Peter'a,  Oranley  Oardeaa, 
London,  R  chard  Barnard,  M.B.C.8.,  yonngeat  aon  of  tbe  late 
William  Barnard,  of  Harlow,  Kuez,  to  Jane,  only  daughter  of  the 
late  John  Orfotd,  of  Brooke  Hall,  Ipawich. 

GLUTTON -YouNO.— May  Slit,  at  the  Pariah  Church.  Guildford.  H.  H. 
Ciutton.  F.B.C.S.,  of  8  Portland  Place,  London,  to  Margaret^ 
danghterof  tbe  late  Bev.  Canon  Toung,  Hector  of  Whitnaah, 
Warwick. 


9<«thB. 


G00DWl«.-May  20th,  at  6  Macaalay,  Bath,  very  anddenly,  J.  Medmer 

Goodwin,  M.B.C  8.,  late  of  Bamaate.  aged  80. 
GVPPir.  -  May  2Ut,  at  Ouy'a  Hoepital.  whiut  undergoing  an  operation, 

Mary  Annie,  wife  of  Hy.  B.  Gappy,  M.B.,  of  MaUodL 
BUXBOLL.— May  12th,  at  hia  realdence,  Sarrwy  Square,  London,  S.B., 

Walter  Bumboll,  M.B.C.S.,  L.H.A.,  aged  56. 
Staplbton.— May  utb,  at  Boaaye  Lodge,  Upper  Norwood,  Joeeph 

Whitaker  Buplatoo,  M.R.C.8^,  aged  81. 

NOTICE^AnnounetmenU  of  Bir!h$,  Marriagw^  and  Deaths  in  <Aa 
families  of  Subseriben  to  this  Journal  an  inserted  free^  and  mtcH 
rsaek  the  publishers  not  later  than  the  Monday  preceding  ptMicution 


Mh  ^dmi  ^m$  mA  €ttmht 


'SALUS    POPUU    SUPRElfA    LBZ.'' 


Vol.  CXII. 


WEDNESDAY,    JUNE    3,     1896. 


No.  23. 


ON 
INFLUENZAL  ARTHRITIS. 
By   A.   ERNEST   SANSOM,   M.D.,  F.RC.P., 

PhyBiolttD  to  tlie  London  Hoapltal,  Ae, 

I  DO  not  think  that  it  la  generally  admitted  that 
Arthritis  which  ma^  be  with  difficulty  differentiated 
from  the  rheumatic  form  is  sometimes  intrinsic  to 
influenza.  I  propose  briefly  to  review  the  evidence 
'which  has  come  before  me. 

L  Abthbitib  coincident  with  the  Acute  Stage  of 
Influenza. 

Case  1. — ^A  case  came  under  my  observation  in 
December,  1891,  in  which  a  young  man,  aged  20,  became 
suddenly  stricken  down  with  fever,  accompanied  by 
sweatings,  and  by  pains  referred  to  knees,  ankles  and 
other  larse  joints.  There  were  some,  but  not  consider- 
able, swellings  of  these  joints  and  a  little  evidence  of 
effusion.  Competent  observers  considered  the  case  to 
he  one  of  rheumatic  fever.  Complete  defervescence 
and  recovery  occured  at  the  end  of  a  fortnight.  There 
were  no  cardiac  nor  other  complications. 

During  the  profpress  of  this  case  the  question  occurred 
to  me.  is  the  diagnosis  of  acute  rheumatism  in  this 
case  correct  ?  The  fever,  the  sweatings,  and  the  quasi- 
rheumatic  arthritis  were  present.  On  the  other  nand 
the  patient  had  never  suffered  from  rheumatism  before, 
there  was  no  family  proclivity  to  rheumatism  on  the 
father's  side,  nor  on  the  mouier's.  Of  three  brothers 
and  three  sisters,  not  one  had  ever  presented  the  least 
trace  of  rheumatism.  To  my  own  knowledge  the  sub- 
ject has  never  manifested  any  signs  of  rheumatism 
during  the  five  years  subsequent  to  the  attack. 

Influenza  was  rife  at  the  time  of  onset  of  the  illness, 
and  there  was  a  very  near  chance  of  infection.  I  had 
not«  however,  any  precise  experience  of  a  form  of 
influenza  which  in  its  early  stages  was  so  intimately 
associated  with  pain  and  swellings  of  the  joints,  though 
pains  in  the  back  and  the  limbs  were  very  common. 
Severely  acute  articular  pains,  however,  constitute  an 
integral  part  of  an  analogous  affection— dengue. 
Many  cases  of  undoubted  influenza  have  been  recorded 
in  which  painful  affections  of  the  joints  coincide 
with  the  febrile  signs,  but  I  am  not  aware  that  ti^e 
difficulty  of  diagnosis  from  acute  rheumatism  has  been 
discussed. 

Case  2.— On  March  22nd,  1894, 1  had  the  opportunity 
of  seeing  at  one  of  the  chief  towns  in  the  Kiviera  a 
valued  friend,  himself  a  highly  esteemed  physician,  and 
to  watch  his  case  for  the  space  of  a  fortnight.  He  had 
been  stricken  some  weeks  previously  with  fever,  severe 
sweatings,  pains  in  the  joints,  and  pains  referred  to  the 
muscles.  The  diagnosis  made  by  himself  and  other 
physicians  was  '*rneumatic  fever."  I  found  the  lar^r 
joints,  esx)eciall^  the  knees,  swollen  and  acutely  pain- 
ful,  but  evidencing  little  or  no  intra-articular  effusion. 
Severe  pain  was  referred  to  the  axillary  portion  of  the 
left  chest.  There  was  quickened  breauiing,  but  the 
ordinary  signs  of  pneumonia  were  absent.  There  was 
neither  cough  nor  expectoration.  The  patient  knew 
that  his  condition  was  one  of  much  gravity,  but  he 


congratulated  himself  that  there  was  no  pneumonia. 
With  much  difficulty^  on  account  of  the  pain  on  move- 
ment, I  made  a  physical  examination  of  tne  back  of  the 
chest  and  founa  dulness  on  percussion,  the  extreme  of 
tubular  breathing  and  all  the  signs  of  consolidation  of 
the  basic  portion  of  the  left  Jung.  I  thought  it  best  to 
say  no  word  to  the  patient  of  the  existence  of  pneu- 
monia, though  of  course  it  was  a  subject  of  anxious 
considerationwith  those  physicians  who  were  in  assi- 
duous attendance  upon  him.  I  found  signs  of 
moderate  dilatation  ot  the  heart  but  none  of  pericatr- 
ditis  nor  of  valvular  disease.  The  urine  was  alkaline 
andphosphatic.  The  painful  conditionsof  the  joints  gra- 
duafiy  subsided,  and  there  was  a  gradual  improvement 
in  all  respects,  but  the  pulse  remained  quick  and  f  eebl& 
and  during  the  protracted  convalescence  the  rate  did 
not  become  reduced  below  100  per  minute.  Happily, 
recovery  was  ultimately  complete  and  permanent 
There  was  no  doubt  that  the  case  was  one  of  influenza, 
and  that  the  severe  pains  in  the  joints  as  well  as  those 
referred  to  the  muscles  were  in  direct  association 
therewith. 

Case  3,  was  that  of  a  gentleman,  aged  44,  who  was 
seized  in  February,  1896,  with  pain  in  the  back  followed 
by  extreme  pain  in  all  the  large  joints.  The  patient,  who 
was  himself  a  doctor,  thought  he  had  rheumatic  fever. 
It  was  his  first  attack.  I  found  some  enlargement  of 
the  joints  but  little  or  no  effusion,  the  suffering  was 
intense.  There  was  moderate  fever  and  some  sweatiuff. 
No  cardiac  nor  other  rheumatic  signs  were  manifested. 
The  case  was  very  protracted  and  was  followed  by  deep 
jaundice,  but  ultimately  a  good  recovery  occurred.  The 
evidence  left  no  doubt  on  my  mind  that  the  case  was 
one  of  influenza. 

Case  4— A  young  woman,  aged  22,  was  admitted  into 
the  London  Hospital  under  my  care  on  January  1st. 
1894,  complaining  of  difficulty  in  walking,  weakness  of 
the  arms  and  legs,  and  impairment  of  the  finer  move- 
ments of  the  fingers.  Previous  history  unimportant 
She  had  never  suffered  from  rheumatism.  The  illness 
for  which  she  was  admitted,  began  about  the  middle 
of  October,  1893,  with  shooting  pains  in  both  legs  from 
the  knees  to  the  ankles,  and  some  stiffness  in  the  ri^ht 
hand.  About  a  week  afterwards  she  was  seized  with 
influenza  when  she  had  mm  in  most  of  her  Joints;  the 
right  torist  and  both  ankles  were  swollen.  Four  or  five 
weeks  after  this  attack  she  began  to  have  a  sensation 
of  numbness  all  over  the  body,  but  more  markedly  on 
the  right  side.  She  then  lost  power  in  her  legs,  especi- 
ally the  right,  and  also  in  the  hands  and  arms,  so  that 
she  was  unable  to  write  or  sew.  Her  condition  on 
admission  was  that  of  a  fairly  well  nourished  young 
woman,  rather  anaemic,  pulse,  respiration,  temperature, 
special  senses,  abdominal  and  thoracic  conditions 
showin^f  no  abnormalities.  Her  walk  was  tottering, 
with  slight  tremor  of  the  legs ;  the  grasp  of  both 
hands  seemed  to  be  weak,  the  right  perhaps  weaker 
than  the  left ;  there  was  some  tremor  on  movement 
The  finer  movements  of  the  hands  were  much  impaired, 
so  that  she  was  unable  to  write  or  to  pick  up  a  pin. 
The  arms  showed  much  muscular  enfeeblement  and 
also  signs,  which  were  yet  more  marked,  of  inco-ordin- 
ation.  A  spot  was  attempted  to  be  touched,  with 
much  desultory  movement  of  the  muscles,  and  that 
attained  was  wide  of  the  mark.    The  interossei  and 


570    Thi  Mkdioal  Pbks. 


ORIOmAL  COMMXTNICATIONS, 


Juvs  3»  18M» 


thenar  eminences  of  both  hands  were  a  little  wasted, 
the  right  more  markedly  so  than  the  left.  The  lower 
limbs  showed  less  inco-ordinated  movements,  but 
greatly  exaggerated  deep  reflexes,  with  patellar  and 
ankle  clonus  and  muscular  enf eeblement.  The  wasted 
muscles  responded  fairly  well  to  the  faradaic  current, 
but  to  the  galvanic  the  reactions  were  not  well  marked. 
There  was  no  reaction  of  degeneration.  Muscular 
sense  was  good.  There  was  no  evidence  of  tenderness 
of  muscles  nor  hvpersdsthesia  over  the  nerves,  and  no 
rigidity  of  muscles.  Wrist  and  elbow-jerks  could  be 
easily  obtained.  Her  hands  and  feet  were  usually 
cold,  and  often  covered  with  a  clammy  sweat.  For 
about  three  weeks  she  remained  in  much  the  same 
condition. 

On  January  20th  it  was  noted  that  the  knee-jerks 
were  not  quite  so  exaggerated ;  her  walk  was  still 
weak  and  staggering.  On  February  Ist  her  gait  was 
much  better ;  she  was  able  to  walk  up  and  down  the 
ward  with  slight  support  On  February  5th  she 
could  get  along  by  herself :  the  knee-jerks  were  still 
exaggerated,  and  there  were  ankle  and  patellar  clonus 
on  both  sides.  On  the  17ih  she  was  able  to  walk 
fairly  well  by  herself  ;  the  hands  remained 
about  the  same.  She  had  complained  lately 
of  a  tingling  sensation  in  the  spine.  On 
March  19th  it  was  noted  that  the  grii>  of  the  hands  was 
much  stronger  with  more  co-ordination  of  movement. 
8he  continued  to  improve,  and  on  April  9th  the  clonus 
had  disappeared  though  the  knee-jerks  were  still  exces- 
sive. The  hands  were  much  improved,  she  was  able  to 
knit  and  do  needlework.  She  was  discharged  on  April 
23rd.  She  could  knit  and  sew  fsirly  well,  there  was 
DO  tremor,  co-ordination  was  much  better,  the  knee- 
jerks  were  somewhat  brisk,  but  there  was  no  clonus. 

The  treatment  consisted  of  rest,  the  administration 
of  bromide  and  iodide  of  potassium  and  liquor  arseni- 
calis.  Massage  of  all  the  weakened  muscles  was  care- 
fully carried  out. 

II.    Abthritis  aftbb  a  Thibd  Attack  of  Influ- 
enza, AND  IN  AN  Acute  Form  co-incidentally 

WITH  A  FOUBTH  ATTACK. 

Case  S.—A  man,  aged  40,  came  under  my  care  in 
October,  1894.  He  had  been  well  until  he  had  caught 
influenza.  There  was  no  rheumatic  proclivity.  He 
was  seized  with  influenza  at  the  end  of  1889.  He  had 
a  second  attack  in  January,  1892,  and  a  third  in  the 
spring  of  1893.  Four  months  afterwards  he  began  to 
suffer  from  pain  at  the  heart,  and  about  the  same  time 
from  swelling  and  pain  in  both  ankle-joints  and  in  the 
ball  of  the  rij^ht  thumb.  The  pain  at  the  heart  was 
of  a  dull  aching  character,  with  extension  down  the  left 
arm  to  the  hands  and  fingers.  There  was  a  recovery 
from  these  s;fmptoms.  Then  during  a  sojourn  in 
Cumberland,  in  September,  1895,  occurred  an  attack 
which  was  considered  to  be  one  of  acute  rheu- 
matism. There  were  swellings  and  intense  pains  in 
the  larger  joints  and  of  the  metatarso-phalangeal 
joints  of  the  left  hand.  I  saw  the  patient  on  his  return 
to  London.  He  was  then  in  mucn  suffering.  I  could 
detect  no  rheumatic  association,  and  from  all  the  evi- 
dence I  concluded  that  there  had  been  a  fourth  attack 
of  influenza  attended  by  acute  arthritis  which  was  not 
of  the  rheumatic  form.    He  made  a  good  recovery. 

III.  Abthbitis  subsequently  to  Influenza. 

Case  6.— A  woman,  aged  51,  was  admitted  into  the 
London  Hospital  under  my  care  in  April,  1894.  There 
had  been  an  attack  of  influenza  in  1892,  and  a  second 
attack  two  months  before  admission.  She  manifested 
rigors  and  erratic  temperatures,  tiie  latter  varying 
between  97^  and  102-5«  F.,  the  pulse-rate  having  a 
maximum  of  96,  a  minimum  of  72,  and  an  average  of 
86.  There  was  an  eruption  of  pemphigus.  Paralyses 
of  arms  and  legs  were  then  manifested  ;  the  deep 
reflexes  were  exaggerated.  Then  followed  paralysis  of 
the  thoracic  muscles,  the  breaUiing  beconung  wholly 


diaphragmatic.  Five  weeks  after  the  patient's  admis- 
sion marked  arthritis  oj  the  left  ankle  occurred ;  no- 
other  joint  was  affected. 

This  was  the  most  severe  case  of  disease  of  the  spinal 
cord  after  influenza  which  ever  came  under  my  notice.. 
The  lesions  must  have  been  profound  and  extensive. 
The  disease  commenced  in  a  gradual  manner  some^ 
weeks  after  the  attack,  which  I  could  not  doubt  was 
rightly  characterised  as  influenza.  At  first  the  signs- 
pointed  to  a  lesion  of  the  cervical  portion  of  the  cord. 
At  this  time  the  bulls  of  pemphigus  began  to  appear. 
I  have  had  several  examples  of  pemphigus  as  a  sequel 
of  influenza  (see  case  of  Purpura  Haemorrhagica  witb 
Acute  Pemphigus,  probably  induced  by  Influenza— 
Treatment  by  large  doses  of  Sodiam  Sulpho-carbolate  r- 
Recovery.  Transactions  of  the  Clinical  Society  of 
London,  1894,  p.  239).  There  soon  followed  signs  of 
commencing  double  optic  neuritiB.  Then  the  cord 
lesion  became  more  pronounced,  and  paralysis  of  limbs,, 
and  later,  of  thoracic  muscles  occurred.  The  patient 
died  three  months  after  admission.  The  case  is  re- 
corded in  detail  in  the  Liverpool  Medical  Journal,  1895i 

Case  1,— Severe  Oeteo-artkritis  after  In^uenxa, — ^A^ 
female  patient,  aged  37,  was  admitted,  under  my  care, 
into  the  London  Hospital  on  October  12th,  1895.  She 
had  had  excellent  health  until  an  attack  of  inflaenzaia* 
June,  1890.  There  was  no  hereditary  tendency  to* 
rheumatism.  Subsequently  to  the  acute  attack  of 
influenza,  there  occurred  progressive  loss  of  flesh.  In 
July,  1891,  she  experience  pain  and  swelling  in  the 
left  knee  ;  the  symptoms  subsided  in  a  couple  of  weeks ;. 
shortly  afterwards,  the  right  wrist,  and  subsequently 
the  right  shoulder  were  severely  dOfected,  and  gradu- 
ally other  joints  became  enlarged,  stiff,  and  painfuL 
In  April,  1895,  she  experienced  a  second  and  severe 
attack  of  influenza.  Then  all  the  joints  became  ex- 
tremely painful  and  enlarged,  and  weakness  and  wast- 
inf[  were  more  and  more  manifest.  The  hands  and 
wnsts  now  became  swollen  and  painful.  On  admission 
the  patient  was  observed  to  be  verjr  emaciated,  and* 
showing  signs  of  extreme  osteo-arthritis.  Both  wrist- 
joints,  the  metacarpo-phalangeal  and  the  inter-phcdan- 
geal  articulations  were  enlarged,  stiff,  painful,  and 
creaked  on  movement  The  interossei  and  the  muscles- 
of  the  left  thenar  eminences  were  wasted,  and  there 
was  deviation  of  both  hands  to  the  ulnar  side.  Tho 
elbow-joints,  the  shoulders,  and  knees  were  stiff  and 
painful.  The  enlargements  were  diiefly  shown  in  the- 
ends  of  the  bones ;  tiiere  was  little  or  no  effusion  into* 
the  joints.  The  left  ankle  presented  a  swelling  on  the 
inner  malleolus  and  internal  lateral  ligament  The- 
patient's  temperature  was  usually  sub- normal,  it  rose- 
to  100^  on  two  occasions  only,  and  the  pulse  varied 
between  76  and  88.  Yet  there  were  repeated  sweatings 
on  the  surface,  especially  that  of  the  palms  of  the  hands^ 
which  were  usually  pretematurallv  moist. 

The  medicinal  treatment  was  the  administration  of 
sodium!  iodide  (gr.  v)  and  arsenical  solution  (n\,ig)> 
three  times  a  day.  Scotf  s  dressing  was  applied  to  the 
knees,  and  massage  of  the  limbs  and  the  other  jointa 
was  practised  for  naif  an  hour  every  other  day.  There 
was  much  improvement  and  the  patient  went  out  after 
a  stay  of  two  months  in  the  hospital,  able  to  wcdk  a 
little,  though  she  had  been  perfectly  helpless  on  admis- 
sion. 

The  cases  I  have  cited  as  examples,  seem  to  me  to 
form  a  chain  of  evidence  to  demonstrate  that  the 
materies  morbi  of  influenza  may  produce  in  the  early 
periods  of  its  activitjr  symptoms  closely  resembling 
those  of  acute  rheumatism,  that  at  periods  remote  from- 
theori^nal  infection,  it  may  ^ive  rise  to  painful  lesions 
of  the  joints  and  that  a  new  infection  may  be  attended* 
with  an  acute  exacerbation  of  arthritis. 

The  cases  in  which  the  signs  closely  resemble  those 
of  acute  rheumatism  are  to  be  thus  differentiated  f rom^ 
the  latter.    1.  Examination  shows  little  or  no  evidenoft 


Juva  3,  iNM, 


ORIQIKAL  COMMUOTCATTONP. 


Thb  Mxdigal  Vrbr.     571 


of  effiuioii  within  the  joints.  The  maxima  of  pain  are 
in  the  ends  of  the  bones  and  these  are  enlai^ged  and 
tender.  2.  The  disease  is  manifested  in  those  who 
have  no  traceable  proclivity  to  rheumatism,  and  some- 
times at  an  age  when  a  first  attack  of  rhenmatic  fever 
is  rare.  3.  In  some  cases  the  manifestations  are  identi- 
cal with  those  of  a  very  acute  form  of  osteo-arthritis  (so- 
called  rheumatic  gout).  4.  The  morbid  associations 
differ  from  those  of  rheumatism.  These  may  be  con- 
sidered under  two  heads,  1,  nervous ;  2,  cardiac. 

In  the  influenzal  cases  the  direct  relation  with 
induced  disease  of  the  spinal  nervous  system  seems  to 
me  to  be  demonstrated  by  the  cases  I  have  recorded.  In 
the  early  manifestations  the  articular  inflammations 
ma^  be  considered  to  find  their  paraUel  with  those,  of 
limited  duration,  which  occur  in  some  cases  of  cerebro- 
spinal meningitis.  In  the  more  remote  periods,  and  after 
repeated  infections^  the  intense  and  protracted  morbid 
chan^  in  the  joints  resemble  those  of  rheumatoid 
arthritis  (osteo-arthritis,  arthritis  deformans),  and  have 
similar  nervous  associations.  Cases  of  disease  of  the 
spinal  cord  induced  by  influenza  have  been  recorded 
by  many  observers.  (Althaus  on  Influenza.  London  : 
Longmans.  1892.  rp,  147,  et  seq,)  I  have  met  with 
several  cases  other  than  those  I  have  mentioned. 

The  occurrence  of  peripheral  (multiple)  neuritis  in 
relation  with  influenza,  immediately  or  remotely,  has 
been  attested  by  a  host  of  observers.  In  a  case  of 
acute  arthritis  resemblinff  rheumatic  fever  the  mani- 
festation of  symptoms  indicating  an  unusual  invasion 
of  the  nervous  system,  central  or  peripheral,  is  primd 
facie  in  favour  of  an  influenzal  causation.  In  a  case 
with  undoubted  rheumatic  antecedents  influenza  may 
determine  an  arthritis  widely  differing  from  the 
rheumatic  form,  and  having  associations  with  profound 
changes  in  the  nervous  system.  I  have  recorded  such 
a  case  in  a  Clinical  Lecture,  published  in  the  Clinical 
Journal,  on  January  9th,  1895.  A  woman,  »t.  46,  was 
admitted  into  the  London  Hospital  under  my  care, 
after  a  febrile  attack  accompanied  by  arthritis,  which 
was  diagnosed  by  her  medical  attendant— I  have  no 
doubt  rightly— as  influenza.  She  had  suffered,  how- 
ever, since  the  age  of  16  from  two  well-marked  attacks 
of  rheumatic  fever  and  repeated  subacute  attacks. 
Closely  following  the  painful  affection  of  the  joints 
which  accompanied  the  late  febrile  outbreak  were  signs 
not  only  of  peripheral  neuritis  butof  diseaseof  thespinal 
cord.  There  were  paralyses  of  muscles  in  both  upper 
and  lower  extremities.  The  symptoms  indicated  widely- 
spread  lesions  of  the  spinal  cord-^of  the  antero-lateral 
columns,  for  there  were  muscular  spasms  and  contrac- 
tions, cramps  (reflexes  were  hindered  by  the  pre-exist- 
ing spasms,  but  clonic  spasms  of  the  muscles  were 
easily  provoked) :  the  grey  matter  of  the  anterior  horns 
was  probably  involved,  for  there  were  paralyses  and 
wastmgs  ;  the  posterior  comua,for  there  were  no  delay 
in  transmission  of  sensations  and  of  thermic  influences 
and  painful  impressions  with  various  interferences  with 
sensibility.  Perhaps  also  there  was  Interference  with 
the  posterior  columns,  because  there  were  inco-ordinate 
movements  as  well  as  interference  with  the  due  trans- 
missionof  sensibility  of  touch,  pressure,  and  temperature. 
The  case  was  one  of  influenza  in  a  rheumatic  subject, 
but  the  influenza  did  not  aggravate  the  rheumatism  in 
any  appreciable  way.  There  was  a  systolic  murmur 
at  the  apex  of  the  heart,  which  I  believed  to  be  due  to 
old-standing  endocarditis,  but  there  were  no  signs  of 
cardiac  dilatation. 

Two  months  after  her  discharge  from  hospital,  and 
six  months  from  the  commencement  of  her  attack  of 
influenza,  the  patient  was  again  admitted  into  the 
hospital  for  mono-arthritis  of  the  left  knee.  The  signs 
were  those  usual  in  osteo-arthritis. 

The  cardiac  associations  of  influenzal  arthritis  pre- 
sent questions  of  great  interest  and  importance. 
Organic  diseases  of  the  heart  and  pericardium  are 


conspicuous  by  their  absence,  the  only  exception  being 
cardiac  dilatation. 

^  In  none  of  the  cases  I  have  cited  in  this  communica- 
tion, except  the  one  in  which  there  was  undoubted 
evidence  of  the  pre-existing  rheumatism,  did  I  find 
signs  of  organic  valvular  disease  of  the  heart.  I  have 
never  met  with  a  case  of  influenza  in  whidi,  without 
co-operating  morbid  agencies,  pericarditis  or  endo- 
carditis of  the  ordinary  rheumatic  form  has  been 
manifested.  I  have  seen  many  cases,  however,  in 
which  the  disease  has  gravely  affected  the  conditions 
of  a  pre-existing  rheumatic  endocarditis.  A  well  com- 
pensated lesion  has  after  an  attack  of  influenza  shown 
all  the  usual  signs  of  increased  valvular  imperfection, 
and  in  some  cases  there  have  been  evidences  of 
dangerous  and  fatal  cardiac  failure.  I  have  also 
observed  some  cases  in  which  there  has  been  influenzal 
infection  in  the  course  of  acute  rheumatism;  then 
there  seemed  to  be  a  re-inforcement  of  all  adverse 
symptoms.  One  such  case  was  rapidly  fatal ;  another 
went  through  a  long  course  of  pericarditis  and  endo- 
carditis to  a  lethal  issue. 

It  has  been  a  general  experience  that  pericarditis 
and  endocarditis  are  rarely  met  with  in  influenza. 
Althaus  says  *'  Pericarditis  and  endocarditis  have  only 
rarely  occurred  as  complications  of  the  feverish  attack. 
In  the  German  Army  where  55,263  suffered,  altogetiier 
six  cases  of  pericarditis  and  four  of  endocarditis  have 
been  noticed.'' (a) 

In  regard  to  pericarditis,  however,  I  have  observed 
that  in  more  than  one  case  there  has  been  some  diffi- 
culty in  diagnosis.    The  following  is  an  instance : — 

Case  8.— T.  T.,  a  man,  aged  40,  was  admitted  into  the 
London  Hospital  under  my  care,  suffering  from  head- 
ache, abdominal  pains,  vomiting,  and  diarrhcBa.  He 
said  that  he  had  been  quite  well  until  three  days 
before  admission  ;  then  the  symptoms  above  men- 
tioned commenced  and  increased.  There  was  no  his- 
tory of  rheumatism.  Undoubtedly,  he  had  been 
accustomed  to  indulge  freely  in  alcohol,  especially  beer. 
He  said  that  during  the  past  five  years  he  had  had 
occasional  attacks  of  palpitation  of  the  heart,  and  in 
the  last  three  weeks  there  was  occasional  difficulty  of 
breathing  in  addition.  Yet  he  considered  himself  well 
till  the  commencement  of  this  acute  illness. 

On  admission,  the  patient  was  in  an  extremelv 
critical  condition.  There  were  intense  dyspnoea,  with 
cyanosis  and  dusky  pallor,  and  cough  with  blood- 
stained sputa.  The  pulse-rate  was  200.  The  area  of 
precordial  dulness  was  greatly  in  excess  of  the 
normal,  extending  about  half  an  inch  to  the  right  of 
the  right  sternal  border,  and  to  the  left  a  like  distance 
from  the  vertical  nipple  line.  The  upper  limit  of 
dulness  was  also  higher  than  the  normal.  My  house 
physician  heard  rough  sounds  over  the  lower  portion  of 
the  sternum,  which  he  thought  indicated  pericardial 
friction.  These  sounds,  however,  had  quite  disappeared 
when  I  came  to  examine  the  case  ;  they  were  probably 
extra-cardiac  in  causation  (Potain's  cardio-pulmonary 
murmurs).  There  was  no  doubt,  great  enlarjB^ment  of 
the  hearty  both  of  right  and  left  chambers.  This  enlarge- 
ment, as  indicated  by  the  dulness  on  percussion,  receaed 
gradually,  but  in  a  comparatively  brief  period  of  time. 
On  the  sixth  day  after  admission  the  left  limit  of 
dulness  intersected  the  nipple.  On  the  ninth  day  it 
was  well  within  the  nipple  line.  On  the  thirteenth 
the  area  of  heart-dulness  was  normal. 

The  pulse  rate  during  the  four  days  subsequent  to 
admission  was  200, 190, 180, 106,  on  the  sixth  day  it 
fell  suddenly  to  80,  then  72,  56,  58,  72,  74. 

The  respiration  rate  during  the  first  five  days  varied 
between  30  and  50.    On  the  sixth  day  it  was  34  (pulse 
80)  and  gradually  it  came  to  the  normal. 
I  regard  this  case  as  one  of  acute  dilatation  of  the 


(a)  AlthAHf 
I  p.  260. 


'  on  iDflaenu."     London :  LongnuuiB  and  Co.,  189S. 


572    Thb  Mkdical  Pwhs. 


ORIOIKAL  OOMMOMCATIONS. 


JnvBS,  ISM. 


heart  in  relation  with  inflnenza)  the  diaeaae  being  rife 
at  the  tinae  of  the  patient^s  adnuBeion),  and  the  tigns 
and  symptoma  conforming  to  those  of  agrave  typeof  the 
disease.  The  associated  tachycardiaandtachypnoea  sng- 
gestedaparalyticleeion  of  the  vagus.  Ihad  already  noted 
uie  symptoms  of  neuritis  of  the  vaflus  in  other  cases. 
It  is  probable  that  the  dilatation  of  the  heart  had  its 
cause  in  a  disturbance  of  the  trophic  nervous  mechan- 
ism. 

Subjective  pain  ascribed  to  the  heart  and  dis- 
turbances of  the  cardiac  rhythm,  are  very  common 
after  attacks  of  influenza,  whust  organic  diseases  of  the 
heart  are  comparatively  infrequent  I  noted  in  a  com- 
munication to  the  Boyal  Medical  and  Chirurgical 
Society,  onlJune  12th,  1894,  concerning  100  cases  under 
my  own  observation,  that  there  was  pain  referred  to 
the  heart  in  23  cases  ;  morbid  accelerations  of  the  heart's 
action  (tachycardia)  in  37  cases ;  pronounced  irregu- 
larity (arhythmia)  in  26  cases ;  aboormal  retardations, 


(braclj^cardia,)  in  5  cases,  and  organic  disease  of  the 
heart  in  10  cases,  (a)  It  cannot  be  doubted  that  disturb- 
ances of  the  nervous  mechanism  of  the  cardiac  reflex 
are  far  more  frequent  in  association  with  influenza  than 
organic  diseases  of  the  heart.  Dilatation  of  the 
heart,  however,  may  occur  in  an  acute  or  in 
a  chronic  form.  From  the  series  of  cases  which 
I  have  adduced  in  this  and  other  communications  as 
well  from  much  extant  evidence,  the  conclusion  seems 
to  be  justified  that  the  determining  cause  of  the 
symptoms  is  a  morbid  change  in  the  cervical  portion 
of  Uie  spinal  cord  or  in  the  vagi  nerves  at  their  origin 
or  in  various  parts  of  their  course. 

It  is  important  to  remember  that  in  an  influenzal 
arthritis  which  simulates  the.  rheumatic,  the  subjective 
signs  as  well  as  the  physical  evidences  of  dilatation  of  the 
heart  may  cause  much  difficulty  in  diagnosis.    The 
subsequent  history,  however,  of  the  cases  of  organic 
disease  of  the  heart  in  association  with  influenza  shows 
that  these  present  marked  differences  from  any  rheu- 
matic form  of  such  disease.    Excluding  cases  in  which 
there  was  anv  evidence  of  pre-existing  rheumatism  I 
have  notes  of  fourteen  cases  in  which  I  have  observed 
organic  heart  disease  in  clear  association  with  influ- 
enza.   These  cases  are  thus  distributed : — Dilatation 
of  the  heart,  six  cases.    Mitral  regurgitation  without 
detected  changes  in  the  chambers  of  the  heart,  five 
cases.    Aortic  valvular  disease,  two  cases.    Tricuspid 
r^urgitatioD,  one  case.    In  the  group  of  six  cases  of 
duated  heart,  three  were  unaccompamed  by  physical 
signs  of  valvular  imperfection.     In   one  there  was 
marked  cantering  rhythm  (bruit  de  galop) :  progressive 
heart  failure  ensued  and  death— (no  autopsy).    The 
other  two  were  accompanied  by  forcible  pulsations  and 
pain  at  heart,  but  not  by  serious  symptoms.    In  three 
cases  of  dilatation  of  the  heart  there  was  valvular 
imperfection.     In  one  of  them  a  musical   systolic 
murmur  of   mitral   regurgitation   was  found  at  the 
heart's  apex.    The  second  was  a  remarkable  case.    A 
lady,  aged  61,  suffered  from  an  attack,  which  was 
probably  influenzal,  in  October,  1890.    Severe  paroxys- 
mal pain  at  heart  followed.    In  October,  1891,  there 
was  a  second  attack  of  influenza,  with  pneumonia. 
Then  followed  dropsy  and  the  signs  of  failing  heart.  A 
murmur  of  mitral  regurgitation  was  heard,  but  this 
was  singularly  variable  and  sometimes  absent.    The 
signs  of  dilatation  of  the  heart  very  slowly  increased, 
and  the  patient  died  in  November,  1894.    The  autopsy 
was  made  by  my  friend.  Dr.  Basil  W.  Walker.    There 
was  no  notable  change  in  the  mitral  valve,  but  the 
aortic  segments  presented  smdl  nodules  of  atheroma 
on  their  edges,  and  the  aorta  near  the  [valves  showed 
patches   and   plaques  of   atheromatous   changes,  in 
various  stages,  some  of  them  being  calcareous.    I  con- 
sider this  to  have  been  a  case  of  subacute  and  chronic 


endarteritis  of  the  aorta  (aortitis)  having  influenza  as  a 
primary  cause.  I  have  considered  the  evidence  on 
which  this  view  is  based  in  my  article  on  ''Diseases  of 
the  Bloodvessels  in  the  Twentieth  Ouitury  of  Medi- 
cine," published  by  Messrs.  Wood  k  Co.,  of  New  Tork 
(VoLm 
The  third  was  also  a  remarkable  case  of  a  female 

Sbtient,  Sffed  26,  placed  under  my  care  at  the  London 
ospital  by  Dr.  Daljr,  of  Hackney,  as  a  well-marked 
example  of  Graves'  disease  initiated  by  influenza.  All 
the  usual  phenomena  of  Graves'  disease  were  present 
There  were  also  well-marked  signs  of  mitral  regurgita- 
tion with  dilatation  of  the  heart  About  three  weeks 
after  her  entrance  into  the  hospital  the  patient  mani- 
fested symptoms  of  ulcerative  endocarditis ;  the  case 
rapidly  proceeded  to  a  fatal  issue,  and  the  dlagnosia 
was  confirmed  at  the  autopsy. 

Several  cases  of  ulcerative  endocarditis  have  been 
recorded  as  following  influenza.  In  this  case  I  con- 
sidered that  there  was  a  secondary  cause  of  infection, 
for  the  patient  had  suffered  from  long-standing  disease 
in  the  left  ear.  Acute  disease  supervened  in  the  right 
ean  with  perforation  of  the  tympanuuL 

In  the  group  of  five  cases,  in  which  there  were  the 
systolic, apical  murmurs  of  mitral  regurgitation  with- 
out any  signs  of  dilated  heart,  there  is  little  to  be  said. 
except  that,  from  the  fact  that  the  pulmonic  second 
sound  was  not  accentuated,  it  is  probable  that  the 
vidvular  imperfection  was  very  slight  in  degree. 
There  were  many  associated  nervous  phenomena 
—vagus  storms— and  in  one  case  the  rate  of  cardiac 
pulsations  was  extremely  variable,  from  54  to  120  in 
brief  periods. 

In  one  case,  that  of  a  lady,  aged  30,  seen  with  Dr. 
Miller,  of  Amherst  Road^  Stoke  Newingtqn,  we 
observed  not  only  the  systolic  murmur  in  the  tricuspid 
area,  but  the  distinct  venous  pulsations  of  tricuspid 
regurgitation,  though  there  were  no  signs  of  mitral 
disease,  nor  any  to  be  detected  of  enlargement  of  the 
heart  The  tricuspid  imperfection  seemed  to  be  the 
direct  effect  of  influenzs^  for  the  case  was  observed 
eleven  days  from  the  original  disease. 

Of  the  two  cases  of  aortic  valvular  disease,  one  was 
in  the  case  of  an  athletic  young  man  of  22,  in  whom 
overstrain  was  probable.  There  were  systolic  and 
diastolic  murmurs  over  the  base  of  the  heart,  but  these 
were  singularly  variable  in  quality,  and  on  some 
occasions  were  quite  inaudible.  The  pulse  was 
irregular.    Vertigo  was  a  symptom. 

TuA  only  other  case  of  aortic  valvular  disease  was 
that  of  a  lady,  aged  21,  in  whom  a  typical  diastolic 
murmur  of  aortic  regurgitation  was  found  five  months 
after  an  attack  of  influenza.  There  were  none  of  the 
usually  associated  signs  of  aortic  valvular  disease,  but 
much  nervous  disturbance,  with  attacks  of  diarrhoea 
and  sickness. 

I  submit  this  brief  review  of  cases  manifesting 
organic  diseases  of  the  heart  in  association  with 
influenza,  and  presenting  no  rheumatic  antecedents, 
because,  though  the  nuoooer  observed  is  limited,  the 
conclusion  seems  to  be  justified  that  the  morbid 
phenomena  differ  widely  from  those  met  with  under 
other  circumstances. 

Arthritis,  which  in  some  points  resembles  that  of 
rheumatism,  may  occur  in  relation  with  influenza; 
there  may  be  signs  and  symptoms  of  organic  disease  of 
the  heart  in  cases  which  manifest  such  an  affection  of 
the  joints  ;  but  there  are  sufficient  data  to  completely 
differentiate  the  two  forms  of  disease. 


(a)  A  review  of  cm«6i  maolfeetlDg  pain  at  the  bean,  or  morbid 
acceleration  of  the  heart'a  contraoUooa  (Tachycardia)  ■ubuqnently 
to  loflnenza.    "  Medloo-Ghimrglcal  Tranaactlona,  1891,  p.  287."^ 


The  Canadian  Medical  Association  meets  in  Mon- 
treal on  August  26th  next,  and  the  two  following 
days.  

There  are  at  the  present  time  no  less  than  2,000 
inmates  in  the  asylum  at  Colney  Hatch. 


Juva  3.  1886. 


ORIGINAL  COMMUNICA'nONS. 


Thb  MaoioAL  PBXS8.     673 


ABDOMINAL   SUKGERY— NOTES  OF 
CASES. 

By  RUTHERFORD  MORISON,  M.B.,  F.RC.S., 

Senior  AMittant  Surgeon,  Boval  InflmiAry,  NewoMile<on-I^ne ; 
GonaoltiDg  Sargeon,  l«eircMtle  Dental  Hospital. 

{Continued  from  pdge  549.) 

Case  IN, --Acute  Perforating  Peritonitis — Removal 
of  Appendix  on  Third  2)ay— Femoral  Phlebitis  during 
Convalescence. 

A  MAN,  set  28,  over  six  feet  high,  and  broad  and 
strong  in  proportion,  seen  with  Dr.  Russell,  of 
Ueaton,  gave  the  following  history  of  his  illness.  On 
the  17th  and  18th  of  December,  1895,  he  was  tionbled 
by  diarrhoea  and  pain  in  his  abdomen  but  was  able  to 
attend  to  his  business.  He  went  to  bed  at  10  p.m.  on 
the  20th  December  and  slept  soundly  till  11  o'clock, 
when  he  was  awakened  by  a  severe  pain  on  the  right 
side  of  his  abdomen.  The  pain  was  so  acute,  that  he 
felt  faint  and  perspired  profusely,  and  for  the  remain- 
der of  the  night  got  no  rest.  Dr.  Russell  saw  him  on 
the  21st  and  diagnosed  acute  appendicitis.  A  hypo- 
dermic iigection  of  morphia  relieved  the  pain  for  that 
day.  It  commenced  again  towards  evening  and  he 
had  another  bad  night.  On  the  evening  of  the  22nd 
I  saw  him,  and  agreed  with  Dr.  Russell  that  the  case 
was  one  of  acute  perforation  of  the  appendix,  and 
required  immediate  operation.  The  muscles  on  the 
right  side  of  the  abdomen  were  markedly  rigid.  There 
was  great  tenderness  in  the  right  iliac  fossa,  with  a 
feeling  of  an  indefinite  mass  there.  His  temperature 
was  fluctuating  between  102°  and  104^  and  his  pale 
appearance,  with  profuse  sweating,  pointed  to  a  very 
serious  illness. 

Operation,  December  23rd,  1895.— The  abdomen  was 
opened  by  an  incision  in  the  right  linear  semilunaris 
and  the  outer  side  of  the  caecum  seen  to  be  adherent 
to  the  parietal  peritoneum.  The  general  abdominal 
cavity  was  packed  with  sponges,  and  a  second  incision 
started  from  the  centre  of  the  first  and  carried  well 
back  into  the  iliocostal  space.  The  friable  adhesions 
attaching  the  outer  side  of  the  caecum  to  the  parietal 
peritoneum  were  then  torn  through,  and  a  horribly 
foetid  dark  fluid  escaped.  The  appendix  was  lying 
pointing  upwards  between  the  caecum  and  ascending 
colon  on  the  inside,  and  the  parietal  peritoneum  on  the 
outside.  It  was  ligatured  at  its  base  and  excised.  The 
stump  was  seared  with  the  thermo-cautery  and 
inverted  into  the  caecum  bv  Lembert's  sutures.  The 
cavity  in  which  it  lay  was  cleansed,  dried,  packed  with 
iodoform  gauze,  and  drained.  The  wound  was  closed, 
except  at  the  back,  where  the  drainage-tube  and  gauze 
were  left  protruding. 

The  appendix  had  a  ganerenous  perforation  near  its 
centre  as  large  as  the  tip  of  my  little  finser,  and  in  the 
lumen  of  it  opposite  this  spot  an  enterouth  the  size  of 
a  cherry-stone. 

After  Progress  was  satisfactory  till  December  31st, 
when  the  patient  complained  of  severe  pain  in  his  left 
thigh.  A  severe  attack  of  phlebitis  in  bis  left  femoral 
vein  developed,  and  the  swelling  consequent  on  this 
had  not  subsided  when  he  went  to  the  bouth  of  Eng- 
land, six  weeks  after  the  operation. 

^  Of  all  abdominal  operations  the  one  which  has  so  far 

S'ven  me  the  greatest  satisfaction  is  that  introduced  by 
eincke  and  Mickulicz,  called  pyloroplasty.  My  first 
case  was  published  in  the  Lancet  last  year.  The 
patient,  who  when  operated  on  weighed  5st.  lib.,  and 
so  far  as  we  could  judge  had  only  a  few  days  to  live,  is 
now  in  perfect  health,  and  weighs  9st.  7lbs.  The 
second,  the  least  striking  of  the  series,  is  the  case  about 
to  be  recorded.  The  third  was  a  young  man  who  had 
postponed  the  operation  till  he  was  reduced  by  con- 
stant   vomiting   and  starvation  to   a  condition  of 


extreme  weakness  and  emaciation,  and  who  increased 
three  stones  in  weight  and  regained  perfect  health 
during  the  two  months  following  the  operation.  The 
fourth  case  was  only  operated  on  ten  days  ago,  and  has 
not  vet  been  allowed  full  diet  These  cases  aJmost 
justify  the  popular  belief  in  miracles,  for  they  are  veri- 
table resurrections.  The  operation  by  which  such 
results  may  be  achieved  is  theoretically  of  the  simplest 
character,  and  I  was  fortunate  in  having  as  my  first  case 
one  in  which  no  difficulties  were  encountered.  If,  how- 
ever, as  in  my  third  case,  dense  adhesions  have  oblite- 
rated all  anatomical  landmarks,  the  operation  is  one 
presenting  grave,  possibly  insurmountaole,  difficulties. 

Case  V.— M.  M.,  aet.  37,  a  patient  of  Dr.  Dickie, 
Morpeth,  who  had  consulted  Dr.  Drummond  about  her 
case,  was  sent  to  me  in  October,  1895. 

She  complained  of  vomiting  and  swelling  of  the 
stomach.  Her  trouble  commenced  between  seven  and 
eight  years  ago.  After  taking  food  she  had  a  swollen 
uneasy  feeling,  and  frequently  vomited.  Since  then  she 
has  never  been  well,  and  has  frequently  been  troubled 
with  sickness  thouj^h  better  at  times.  During  the  last 
seven  months  vomiting  has  been  nearly  constant,  and 
three  months  agjo  she  had  bad  pain  in  her  stomach  and 
it  swelled.  Owing  to  this  she  was  confined  to  bed  for 
three  weeks.  Both  pain  and  swelling  were  relieved  by 
vomiting.  Five  weeks  ago  her  stomach  was  washed 
out  daily,  but  this  she  thought  aggravated  all  her 
symptoms.  The  vomited  matter  was  sometimes  black, 
latterly  it  has  looked  yeasty,  and  had  a  bad  smell. 
There  was  nothing  of  importance  to  note  in  her  pre- 
vious health  or  family  history. 

The  patient  was  a  sallow  anxious-looking  woman, 
evidently  much  reduced  in  condition,  though  she  still 
weighed  8st  I2lb.  Percussion  and  auscultation 
showed  considerable  dilatation  of  the  stomach  which 
reached  downwards  as  far  as  the  umbilicus.  No 
tumour  or  thickening  could  be  felt 

Operation,  Oct.  1 7tn,  1895.— Theumbilicus  was  excised 
and  the  incision  extended  from  below  this  to  near  the 
ensiform  cartilage.  Onopeningthe  abdomen  the  stomach 
was  found  to  be  adherent  to  the  abdominal  parietes,  the 
most  dense  adhesion  being  towards  the  lesser  curva- 
ture. The  omentum  was  adherent  to  the  right,  and 
the  duodenum  bound  down  by  adhesions,  which 
blocked  the  foramen  of  Winslow.  The  walls  of  the 
duodenum  were  oedematous.  With  some  difficulty 
the  pylorus  was  discovered.  It  had  a  hard  nodule 
in  it,  and  was  adherent  everywhere.  After  separa- 
ting these  adhesions  the  pylorus  was  brought 
fairly  into  view,  the  abdomen  was  packed  wiUi 
sponffes,  and  the  stomach  opened  H  inches  above  the 
nodule  in  the  pylorus.  My  finger,  introduced  through 
the  opening  entered  a  conical  space,  to  the  right  of 
which  the  pyloric  opening  was  found.  It  was  repre- 
sented by  a  sharp  ring  just  lai^e  enough  to  engage  the 
tip  of  my  little  finger.  The  incision  in  the  stomach 
was  continued  through  the  middle  of  the  anterior  wall 
of  the  pylorus  for  one  inch  into  the  duodenum ,-  and 
the  nodule  situated  in  the  upper  and  posterior  wall  of 
the  pylorus  was  seen  to  be  due  to  cicatricial  tissue. 
The  cicatrix  was  adherent  to  the  head  of  the  pancreas, 
and  this  made  the  introduction  and  proper  arrange- 
ment of  the  sutures  somewhat  difficult.  The  vertical 
wound  was  converted  into  a  transverse  one  (see  Lancet, 
1895)  by  a  continuous  catgut  suture  through  all  the 
coats  of  the  stomach  and  duodenum,  which  effectually 
closed  the  opening  temporarily,  and  arrested  all  bleed- 
ing from  the  cut  edges.  A  second  row  of  interrupted 
Lembert's  sutures  of  silk  inverted  and  covered  up 
the  first,  and  outside  oi  this  a  Uiird  line  of  continuous 
Lemberf  s  sutures  of  silk  was  applied.  The  abdomen 
was  closed  without  drainage. 

After  Progress,— Dnnng  the  first  twenty-two  hours 
nothing  was  allowed  by  the  mouth,  but  nutrient 
enemata  were  ordered  every  two  hours.  During  the 
next  twelve  hours  §x\j  of  milk  and  soda  were  given 

C 


574     TBM  MbDIOAL  PBBSb. 


ORIGINAL  COMMUNICATIONS. 


JUNB  3,  1896. 


and  retained.  On  the  evening  of  the  third  day,  5  gra. 
of  calomel  were  given  by  the  month,  and  on  the  fourth 
day,  the  bowels  were  well  moved  after  an  enema.  On 
the  eleventh  day,  the  dressing  was  taken  off  for  the  first 
time,  and  the  wonnd  was  healed.  By  the  twelfth  day 
the  patient  was  taking  solid  food,  and  got  up  for  the 
first  time.  On  the  seventeenth  day  she  went  home. 
During  the  first  month  Jshe  was  frequently  troubled 
with  "water-brash,"  and  was  dyspeptic  and  low- 
spirited,  having  gained  no  weiffht  since  the  operation. 
A  fortnight  later  she  called  and  reported  that  she  had 
gained  16lbs.  in  weight  during  the  last  fourteen  days, 
and  felt  better  than  she  had  done  for  years. 

Dr.  Buncle,  under  whose  care  the  patient  is,  writes, 
May,  1896:  '*The  patient  was  well  until  Jan.  19th, 
when  she  was  under  treatment  for  twelve  days  with 
just  the  same  symptoms  as  she  had  before  the 
operation.  I  attributed  this  attack  to  indiscretion  in 
diet  She  was  well  for  five  weeks."  Now  ''she  has 
vomiting,  evidently  blood  somewhat  altered,  circum- 
embed  pain,  and  tenderness  over  the  stomacn,  and  is 
living  on  peptonised  milk."  It  looks  as  if  some  fresh 
ulceration  of  the  stomach  had  occurred,  but  this  is  not 
oow  likely  to  interfere  with  the  lumen  of  the  pylorus. 

During  last  year  I  read  articles  which  astonished  me 
not  a  little,  dealing  with  the  surgical  treatment  of 
ffall-stones  by  two  distinguished  London  surgeons. 
The  one  (Mr.  Treves)  advocated  in  difficult  cases  merely 
opening  the  gall-bladder,  and  stitching  it  to  the 
pArietes,  stating  that  stones  which  it  would  be  too 
risky^  to  remove  would  escape  in  time  by  the  artificial 
opening ;  the  other  (Dr.  Barker)  suggested  that  gall- 
stone operations  should  be  done  in  two  stages,  the  first 
consisting  of  suture  of  the  gall- bladder  to  the  abdominal 
wall,  the  second,  incision  of  the  gall-bladder  throug:h 
this  opening,  after  firm  union  had  made  incision  of  it 
safe,  and  removal  of  the  stones.  If  it  be  true  that  the 
cystic  and  the  common  ducts  will  themselves  evacuate 
stones  through  an  opened  gall-bladder,  the  operation 
for  impactea  gall-stones  is  at  once  reduced  m  most 
cases  (because  the  gall-bladder  can  usually  be  drawn 
forward  to  the  abdominal  wall)  to  one  of  extreme 
•simplicity  and  little  danger.  Tne  statement,  neglect- 
ing all  considerations  due  to  the  eminence  of  its  author, 
is,  therefore^  one  necessitating  the  very  cravest  study, 
for  operations  on  cases  of  impacted  ^1-stones 
are  often  difficult  and  consequently  serious.  The 
extrusion  of  them,t.e.,  the  stones,  after  the  gall-bladder 
has  been  opened  is  not  what  one  would  expect,  for  it 
«eems  hignly  probable  that  the  efforts  of  the  gall- 
bladder are  the  main  factors  in  their  expulsion  in  an 
ordinary  way,  and  a  gall-bladder  discharging  externally 
has  been  deprived  of  all  its  former  action  on  the  stone  or 
Atones.  The  hypertrophy  of  the  gall-bladder  present  in 
most  gall  stone  cases,  and  the  histological  structure  of 
the  bladder  as  compared  with  that  of  the  ducts,  are 
evidence  in  favour  of  this  view.  If  the  stones,  how- 
ever, are  discharged  externally  in  the  conditions 
described,  even  in  the  majority  of  cases,  no  reason, 
however  convincing,  as  to  why  tiiey  ought  not  to  be  so 
extruded,  should  or  could  have  any  weight.  It  has 
been  my  rule  for  some  years  to  get  out  ever^  stone,  so 
that  an  insufficient  number  of  cases,  in  which  stones 
were  left  in  one  or  other  duct,  have  been  observed 
by  me  to  allow  of  a  judgment  based  on  extensive 
experience.  Mv  own  cases  in  which  stones  were  left 
are  two  in  number.  The  first  was  a  woman  in  whose 
common  duct  I  left  a  stone  impacted.  When  her 
bOiary  fistula  closed,  she  had  recurring  attacks  of  gall- 
stone colic  which  were  only  relieved  by  the  re-opening 
of  the  biliary  fistula.  Five  years  after  my  operation, 
another  surgeon  removed  an  impacted  calculus  from 
her  common  duct,  resulting  in  complete  relief  of  her 
pains  and  cure  of  her  fistula.  The  second  was  a  young 
woman  with  a  single  small  stone  impacted  in  her  cystic  j 
duct.    More  than  three  years  ago  I  opened  her  gall- ' 


bladder  and  left  the  stone.  She  has  either  to  maintain 
the  patency  of  the  fistula  or  to  suffer  attacks  of  gall- 
stone colic,  and,  needless  to  say,  with  neither  is  she 
content,  nor  will  she  let  me  try  a  further  operation 
to  remove  the  stone,  which  lean  occasionally  feel  with 
a  probe  in  apparently  the  same  position  as  it  was 
three  vears  ago. 

With  regard  to  Mr.  Barker's  operation  (and  any 
suggestion  of  his  cannot  be  neglected)  I  tnink  hu 
method  can  only  be  applicable  to  stones  impacted  in 
the  neck  of  the  gall-blaader.  Through  an  indsion  a  foot 
long,  with  fingers  outside  of  the  duct,  and  forceps  and 
scoop  in  it,  I  have  more  than  once  failed  to  extract  a 
stone  impacted  in  one  of  the  ducts,  and  cannot  see  how, 
by  any  possibility,  stones  impacted  in  the  common 
duct  can  be  ordinanly  removea  through  a  small  open- 
ing in  the  gall-bladder. 

My  belief  is  that  a  complete  operation  can  be  safely 
performed  at  one  sitting,  if  the  principles  I  have  advo- 
cated elsewhere  (jSrtt^  Medical  Journal^  Nov.  3rd, 
1894),  and  of  which  the  following  case  will  serve  as  an 
example,  are  carried  out 

Case  YL— Gall  stone  Impacted  in  Cystic  Duet — 
Failure  to  Bemove  It  by  Ordinary  Means — Exdsio 
0/  Gall-Bladder,  Cystic  Duct^  and  Stone. 

W.  L,  set.  50, engineer,  a  patient  of  Dr.  Drummond, 
South  Shields,  had  his  first  attack  of  gall-stone  colic 
fourteen  years  ago.  It  was  a  severe  one,  and  was 
followed  by  five  weeks  of  illness  and  jaundice,  during 
which  the  patient  was  mostly  confined  to  bed.  About 
every  six  months  he  has  had  an  attack  more  or  less 
severe.  One  year  and  a  half  aeo,  he  had  a  worse  one 
than  usual,  and  was  confined  to  bed  for  a  month.  Ten 
days  ago  hia  last  severe  attack  came  on,  and  was 
attended  by  much  vomiting,  and  swelling  and  tender- 
ness of  the  bowels.  The  attacks  have  always  been  of 
the  same  character,  commencing  with  pain  over  the 
liver  and  stomach,  and  accompanied  by  vomiting, 
sweating,  and  shivering. 

There  was  nothing  worthy  of  note  in  his  family  his- 
tory. As  a  child  he  was  very  delicate,  and  had  been 
subject  frequently  to  bronchitis  until  quite  recently. 
The  patient  was  a  man  of  fair,  somewhat  sallow,  com- 
plexion, with  a  clean  tongue,  and  sound  except  for 
slight  bronchitis^  and  the  exception  noted  below. 

At  the  lower  right  costal  margin,  behind  the  edge  of 
the  rectus  muscle,  there  was  a  rounded,  resisting, 
tender  swelling,  which  moved,  but  not  freely,  down- 
wards, on  deep  inspiration. 

Operation,  June  18th,  1895.— The  abdomen  was 
opened  by  a  transverse  incision  below  the  right  costal 
margin,  extending  from  the  outer  edge  of  the  right 
rectus  muscle  in  front  to  the  outer  edge  of  the  ri^ht 
quadratus  lumborum  muscle  behind,  and  packed  with 
sponges.  The  omentum  and  the  pylorus  were  firmly 
aaherent  to  the  gall-bladder,  and  were  separated.  On 
exposing  the  gall-bladder  it  was  seen  to  be  thick  and 
contracted,  and  two  movable  stones  could  be  felt  near 
its  neck.  The  gall-bladder  was  opened,  and  these 
stones  extracted ;  a  third  stone  was  then  felt  in  the 
cystic  duct.  It  could  not  be  dislodged  either  by 
pressure  outside  of  the  duct,  or  forceps  or  scoop  inside 
of  the  duct,  or  by  combined  outside  and  inside  manipu- 
lations. The  gall-bladder  was  then  detached  along 
with  the  cystic  duct  from  the  under-surfaceof  the  liver, 
the  cystic  duct  tied  with  cat^t  beyond  the  stone,  and 
bladder,  duct,  and  stone  excised.  There  was  no  bleed- 
ing of  any  moment  The  raw  under-surface  of  the 
liver  was  packed  with  gauze,  and  a  drainage-tube  left 
in  the  liver  pouch,  both  protruding  from  the  wound 
behind.  The  remainder  of  the  wound  was  closed  with 
three  tiers  of  specially  prepared  catgut  sutures. 

After  ProgrcM, — Was  uneventful,  and  the  patient 
went  home  with  his  wound  healed  three  weeks  after  the 
operation. 

A  month  ago  he  called  to  report  progress.    He  looked 


JuOTB,  3,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Ths  Mbdical  Pb«b0;     575 


^ell  and  had  gained  flesh,  and  said  he  had  never  felt 
«o  well  in  his  life  as  he  had  since  the  operation.  There 
was  no  bnlging,  or  weakness  of  the  scar. 


EXCISION  OF  THE  CERVIX   UTERI. 
By  J.  O'CONOR,  M.A.,  M.D.,  B.Ch.,  T.C.D., 

Senior  Medical  Officer,  BriUih  Hoepital,  Baenoi  Ayrea. 

During  the  past  twelve  months  I  have  excised  the 
cervix  in  eight  cases,  for  hypertrophic  elongation  asso- 
ciated with  prolapse,  and  in  two  cases  for  most  intract- 
able dysmenorrhoB^. 

The  method  employed  was  original  as  far  as  I  am 
concerned,  though  probably  to  some  it  may  be  by  no 
means  new.  Yet,  as  it  is  not  mentioned  in  the  text- 
books at  my  command^  Pozzi  and  Hart  and  Barbour,  I 
venture  to  publish  it. 

Some  days  previous  to  undertaking  this  operation,  if 
there  should  be  any  endometritis  or  endocervicitis,  the 
uterus  is  curetted,  and  swabbed  with  pure  carbolic 
acid.  In  all  cases  the  vagina  is  irrigated  twice  daily 
for  four  davs  before  operation  with  warm  1  in  2,000 
corrosive  sublimate. 

On  the  day  previous  one  ounce  of  sulphate  of  mag- 
nesia is  given  and  followed  on  the  morning  of  opera- 
tion by  a  large  soap  and  water  enema ;  the  bowels 
having  been  thorougnly  cleared  out,  the  patient  has  a 
warm  sitz  bath  (1  in  5,000  corrosive  sublimate)  the 
arine  is  then  drawn  off,  vagina  irrigated,  and  extern^ 
f^itals  washed  with  1  in  2,000  corrosive  sublimate 
before  patient  is  brought  into  operating  room.  Chloro- 
form having  been  administered,  a  Simon's  speculum  is 
introduced,  and  anterior  lip  is  seized  with  a  vulsellum, 
and  the  cervix  drawn,  if  possible,  outside  vulva  ;  at  this 
6tage  irrigation  with  1  in  1,000  corrosive  sublimate  is 
fdvisable. 

One  blade  of  a  strong  angular  scissors  bent  on  flat  is 
introduced  into  cervical  canal  for  a  distance  of  a  half 
to  one  inch  (as  may  be  deemed  necessary),  with  one  or 
two  cuts  half  an  anterior  and  posterior  flap  is  formed, 
the  scissors  is  then  turned  on  itself,  and  a  correspond- 
ing cut  made  on  the  other  side.  The  cervix  is  thus 
sput  into  an  anterior  and  posterior  flap,  to  the  latter 
another  vulsellum  is  attached.  The  bleeding  from 
these  incisions  is  trifling,  and  does  not  interfere  with 
further  progress. 

At  a  point  about  one  quarter  of  an  inch  from  end  of 
first  incision,  one  blade  of  same  scissors  is  entered,  and 
pushed  obliquely  upwards  into  cervical  canal  to  a 
point  as  near  as  possible  to  anterior  fornix  without 
opening  it.  A  cut  is  then  made ;  on  the  opposite  side 
the  same  manoeuvre  is  carried  out  Thus  a  wedge  is 
removed  from  anterior  flap.  The  whole  thickness  of 
cut  edges  are  grasped  by  a  few  Muzeux's  forceps ;  there 
are  usually  two  or  three  spurting  vessels,  buttne  bleed- 
ing can  be  conveniently  arrested  by  applying  the 
forceps  just  mentioned  over  them  ;  with  an  ordinary 
curvM  needle  four  catgut  (No.  2)  sutures  are 
passed  from  below  upwards,  the  ends  of  which  are 
caught  in  torsion  forceps  and  handed  to  an  assistant 
to  hold ;  it  simplifies  the  procedure  to  pass  a  suture 
behind  a  forceps  controlling  any  bleeding  point,  so 
when  the  edges  are  approximated,  and  sutures  tied,  no 
haemorrhage  takes  place.  Out  of  the  posterior  flap  an 
identical  shaped  wedge  is  removed,  but  it  must  be  on 
a  smaller  scale  than  that  of  anterior  in  order  not  to 
open  posterior  fornix  or  Douglas'  pouch  ;  Muzeux's 
forceps  are  applied,  and  four  catgut  sutures  inserted ; 
these  latter  are  at  once  tied ;  thus  the  posterior  cut 
edges  are  drawn  into  apposition.  A  sound,  or  leaden 
probe,  is  next  passed  into  uterine  cavity  and  retained 
there,  while  the  anterior  cut  surfaces  are  approximated ; 
all  the  ends  of  sutures  are  then  cut  short. 

The  reason  why  the  Y-incisions  are  commenced  on 
each  side,  one  quarter  of  an  inch  from  ends  of  primary 


lateral  incisions,  is  at  once  obvious,  in  that  a  slit-like 
orifice  is  left,  thus  the  patency  of  the  caniU  is  secured. 
I  usually  make  the  opening  oval-shaped,  by  snipping 
off  with  a  scissors  the  corners  of  the  four  flaps ;  in 
order  to  be  able  to  do  this,  the  lowest  of  each  of  the 
anterior  and  posterior  sets  of  sutures  must  not  be 
inserted  too  close  to  margin  of  canal.  A  small  conical 
stump  is  left,  which  by  the  fifth  day  has  usually  dis- 
appeared, involution  having  taken  place ;  all  that 
remains  is  a  cicatrix  flush  with  vaginal  roof,  in  the 
centre  of  which  is  seen  the  patent  canal. 

Lastly,  the  vagina  is  again  irrigated  with  1  in  2,000 
corrosive  sublimate,  and  an  iodoform  and  glycerine 
plug  introduced,  this  is  withdrawn  by  the  nurse  in  the 
twenty-four  hours,  and  part  irrigated  twice  daily  with 
Condy's  lotion. 

By  the  eleventh  day  sound  union  has  taken  place, 
and  the  catgut  has  generally  disappeared. 

The  advantages  claimed  for  this  operation  are  :  — 

1.  The  ease  with  which  it  may  be  carried  out,  no 
special  needles,  no  special  anything  (except  cleanliness), 
are  required,  and  it  takes  a  shorter  time  to  perform 
than  any  other  method. 

2.  Haemorrhage  is  trifling,  the  few  spurting  vessels 
are  readily  secured. 

3.  Primary  union  always  takes  place. 

4.  No  danger  of  wounding  rectum  or  bladder. 

5.  No  subsequent  removal  of  sutures. 

6.  A  considerable  amount  of  involution  follows,  and 
the  primary  object, "  lightening  the  load,"  is  thoroughly 
earned  into  effect 

If  by  accident  the  fornices  or  Douglas's  pouch  are 
opened,  one  or  two  catgut  sutures  promptly  inserted 
make  up  for  the  mishap. 

In  operations  for  dysmenorrhoea,  it  must  be  remem- 
bered that  the  cervix  is  small  and  often  conical,  there- 
fore this  operation  must  be  carried  out  in  miniature, 
compared  with  that  for  hypertrophic  elongation. 

In  the  ten  operations  performed,  no  elevation  of 
temperature  or  suppuration  followed,  and  only  during 
the  first  twenty-four  hours  was  any  pain  complained 
of ;  all  the  wounds  united  by  first  intention,  and  no 
atresia  of  cervical  opening  supervened. 

In  the  eight  prolapse  cases  this  treatment  was  sup- 
plemented by  colpo-perineorrhaphy  and  ventro-hystero- 
pexy. 

In  the  two  cases  of  dysmenorrhoea,  the  patient's 
report  that  they  are  free  from  pain  at  menstrual 
period. 


BRITISH  OYNiECOLOGICAL  SOCIETY. 
Meeting  held  Mat  14th,  1896. 


0.  H.  F.  RouTH,  M.D.,  Vice-President,  in  the  Chair. 


UNKUPTCTBBD  TUBAL  GESTATION. 

Dr.  F.  F.  Schacht  showed  a  specimen  of  unniptured 
tubal  gestation  containinflr  foetus  of  about  six  weeks' 
development.  History. — Mrs.  K.,  set.  28,  married  three 
years,  had  bad  one  child,  now  two  years  old,  and  no  mis- 
carriages. She  went  to  join  her  husband,  who  was  staying 
in  Constantinople,  in  July,  1895.  In  August  following 
had  some  pain  in  left  inguinal  region  extending  down  to 
thigh.  In  October  had  first  bout  of  sharp  pain  in  mid- 
abdomen,  with  bearing  down,  necessitating  her  going  to 
bed  for  three  or  four  &y%.  Later  in  OctOMr  second  bout 
similar  to  preceding.  In  November  had  third  bout  simi- 
lar in  nature,  and  auo  requiring  her  to  stay  in  bed  for  four 
days  under  medical  supervision.  These  bouts  of  pain 
occurred  quite  irrespective  of  periods,  were  accompanied 
by  vomiting,  and  occasionally  with  pain  in  back  as  well  as 
in  localities  previously  mentioned.  She  was  brought  home 
to  England  m  December,  1895.  Oo  her  arrival  just  before 
Christmas  she  had  a  fourth  attack  of  pain  of  the  same 


576     Thb  Mbdioal  PBito. 


TRANSACnOWS  OF  SOCIETIES. 


Jvn  3,  1896. 


nfttare  as  the  others.  As  regards  the  oatamenia  she  was 
alvfays  regular,  every  four  weeks.  Period  lasted  eight 
days,  loss  was  free.  In  November,  1895,  that  is  aboot  the 
time  of  the  third  attack  of  pain,  there  was  a  modification, 
the  period  lasted  eleven  days,  bat  the  loss  was  less  than 
Qsnal  in  qoantity.  In  December,  1895,  there  was  no 
show  of  any  kind.  Never  missed  before  except  in  former 
pregnancy.  I  first  saw  her  on  January  8th.  Examination 
per  vaginam  discovered  general  tenderness  ;  uterus  small 
in  normal  direction  ;  right  fornix  free.  To  left  of  uterus 
was  felt  a  rounded  very  tender  mass  separable  from  uterus, 
while  a  much  smaller  mass  lay  in  Douglas'  pouch.  No 
pulsating  vessel  could  be  felt.  The  larger  mass  appeared 
to  be  about  the  size  of  a  bantam's  egg,  and  was  diagnosed 
as  a  dilated  tube ;  the  smaller  was  thought  to  be  the 
ovary.  Very  considerable  tenderness  and  thickening  pre- 
vented detailed  manipulation.  She  was  sent  home  to  oed 
at  once  and  watched.  On  Jan.  15th  (one  week  later)  period 
commenced,  the  loss  was  as  usual.  There  was  no  pain,  the 
loss  continued  till  the  22Qd  (eight  dayv).  During  this 
time,  as  all  through  the  illness,  the  temperature  was  normal. 
On  January  23rd,  1896.  Dr.  Travers  very  kindly  examined 
her  with  me.  The  tenderness  and  resistance  were  so  much 
less  that  bi-manual  examination  was  easy.  The  dilated 
tube  was  found  to  be  distinctly  larger  in  size  and  slightly 
mobile.  The  smaller  lump  was  as  before.  With  the 
assistance  of  Dr.  Travers  and  Dr.  Patterson  I  onerated 
six  days  later  and  removed  the  left  dilated  tube  ana  ovary 
as  seen  in  the  specimen.  The  operation  presented  no 
special  features  beyond  the  fact  that  there  were  somewhat 
extensive  but  recent  adhesions  to  be  torn  through.    The 

Satient  made  an  uninterrupted  recovery.  Mr.  Wood 
mith,  of  St.  Bartholomew's  Hospital,  has  reported  upon 
the  specimen,  and  Dr.  Kanthack  has  most  kindly  eiamined 
it  and  confirmed  the  report,  which  is  as  follows : — *'  The 
specimen  consieted  of  the  left  ovary  and  left  dilated  tube 
and  part  of  the  broad  ligament.  The  left  tube  was  dis- 
tended, forming  a  swelling  about  the  sise  of  a  hen's  egg. 
On  section  this  mass  was  found  to  consist  of  old  and  recent 
blood-dot,  in  the  centre  of  which  was  a  small  sac  which 
also  contained  a  blood-stained  fluid  and  a  foetus  (about 
the  sixth  week)  attached  towards  the  outer  part  of  the 
sac,  near  the  fimbriated  extremity.  Fimbrias  were  well 
seen.  Left  ovary  contained  a  cyst  on  its  posterior  surface, 
no  corpus  luteum  seen.  Microscopic  section  showed 
blood-clot  (mostly  degenerated)  and  traces  of  chorionic 
villi  undergoing  mucoid  degeneration."  It  is  interesting 
to  note  in  this  case  that  the  history  was  an  unusual  one 
for  an  extra-uterine  gestation.  There  was  no  modification 
of  the  oatamenia  tiU  November,  about  the  time  of  the 
third  sharp  attack  of  pain.  The  December  period  was 
missed,  but  in  January  the  usual  loss  occurred.  The 
pathologist's  report,  when  taken  in  conjunction  with  these 
facts,  would  seem  to  show  that  there  was  a  hemorrhage 
into  the  tube  on  each  occasion  that  there  was  an  attack  of 
pain.  But  these  hemorrhages  had  not  apparently 
obliterated  the  lumen  of  the  tube.  For  the  size  of  the 
foetus  corresponded  with  the  oatamenial  history  and  would 
suggest  that  the  patient  became  pregnant  of  this  foetus  in 
November,  \,e ,  after  her  third  attack  of  pain.  At  any 
rate,  from  a  surgical  point  of  view,  the  case  is  instructive 
as  showing  once  more  that  the  fact  of  a  patient's  having 
successfully  tided  over  several  suspicious  bouts  of  pain 
must  not  be  taken  as  presumptive  evidence  of  the  destruc- 
tion of  all  chances  of  lurther  developments  in  the  tube. 

Drs.  HiTwooD  Smith  and  Mahskll-Moullik  made  some 
observations  on  the  specimen  ;  and  a  Committee,  composed 
of  Drs.  Heywood  Smith,  Mansell-MoulUn  and  Schacht  was 
nominated,  to  further  examine  and  report  upon  it. 

Mr.  Frbd.  Bowsbman  Jsssbtt  showed  a 

MULTILOCULAB  0Y8T  OF  OBBAT  OMXMTUH. 

Mr.  Jessett  said  he  showed  this  specimen  as  he  thought 
it  was  of  some  clinical  interest.  The  case  before  operation 
was  thought  to  be  one  of  ovarian  cyst,  with  a  long  pedicle, 
but  on  opening  the  abdomen  and  clearing  out  the  cyst,  it 
was  found  to  te  attached  to  the  upper  part  of  the  great 
omentum  and  apparently  between  its  folds.  The  cyst  was 
enucleated,  and  the  pedicle  tied  close  to  the  transverse 
colon.  The  ovaries  were  examined,  and  found  to  be  quite 
normal.  The  contents  of  the  cvst  contained  a  quantity  of 
cholesterin  and  was  highly  albuminous,  becoming  quite 
solid  by  heat.  The  patient,  who  had  been  operated  on 
only  four  days  previously,  was  doing  well.    Mr.  Jessett 


said  he  thought,  perhaps  the  chief  interest  of  the 
consisted  in  its  rarity.  On  looking  up  the  English  litera- 
ture, he  could  only  find  ^v%  oases  recorded,  one  by  Dr. 
Oooding  in  Lancet,  Feb.,  1887.  In  this  case  Sir  WiUian* 
Jenner  and  Sir  Spencer  Wells  saw  the  patient,  and  thought 
it  was  ovarian  with  longjpedicle.  This  patient  was  sac- 
cessf  ully  operated  on  by  Dr.  Oooding.  Dr.  Groeby,  in  1889, 
records  another  case,  and  Dr.  Waldy  a  case  of  suppurating^ 
omental  cyst,  in  Lancet,  1889,  and  Sir  Spencer  Wells  also 
recorded  a  case.  The  question  had  passed  through  Mr. 
Jessett's  mind,  wliether  this  was  a  true  omentiu  cyst, 
or  a  vaginal  ovarian  cyst,  which  had  taken  root  at  the 
base  of  the  omentum.  The  argument  against  this  wae, 
that  the  large  vessels  passing  round  the  entire  cyst,  came 
direct  from  the  omental  vessels.  A  (Jommittee,  consisting^ 
of  Messrs.  Jessett  and  Piimmer,  and  Dr.  Heywood  Smith, 
was  appointed  to  report  upon  the  specimen. 
Dr.  RoBBRT  BsLL  (Glasgow)  on 

THB  TBBATMENT  OF  OABOINOMA  OF  THE  UTSBUS,  CERTAIN 
FOBBfS  OF  OVARIAN  DISEASE,  AND  FIBROIDS  OF  THB 
UTERUS,  BT  MEANS  OF  TBTROID,  PAROTID,  AND  MAMMARY 
OLAND  THEBAPEUnOS. 

Judging  from  the  beneficial  efiects  which  thyroid  extract 
exerts  upon  the  epithelium  of  the  skin  in  psoriasis,  the 
author  was  led  to  infer  that  epithelioma  of  the  cervix 
uteri  was  partly  due  to  the  absence  of  some  obscure  cata^- 
lytic  influence  of  this  gland ;  and  that  thyroid  extract 
might  consequently  be  useful  in  the  treatment  of  epithe- 
lioma, and  of  other  unhealthy  conditions  of  mucous 
surfaces.  True,  unhealthy  conditions  of  the  thyroid  did 
not  invariably  ^ive  rise  to  epithelioma,  but  they  were 
frequently  associated,  in  the  author's  experience,  with 
metrorrhagia.  Now,  it  would  seem  that  the  predisposing^ 
cause  of  epithelioma,  and  of  other  uterine  affections  of  a 
less  virulent  type,  was  the  presence  of  some  lesion,  sucb 
as  laceration  or  liypertrophy,  due  to  long-continued  endo- 
metritis ;  and  from  his  experiments,  the  author  concluded 
that  the  exciting  cause  existed  in  an  abnormal  conditioQ 
of  the  thyroid.  Then  it  would  appear  that  the  parotid 
gland  exerted  a  powerful  influence  upon  the  ovaries.  He 
was  not  able  to  judge  whether  ovarian  disease  was  super- 
induced by  any  lack  of  influence  of  the  parotid  ;  but  he 
was  able  to  vouch  for  the  fact  that  ovarian  disease  conld 
be  brought  under  subjection  by  the  administration  of 
parotid  glands  of  healthy  young  sheep,  calves,  and  pige. 
Again,  he  regarded  it  as  beyond  dispute  that  fibroid  of 
the  uterus,  as  well  as  hyperplasia  and  flaoddity  of  the 
organ,  could  be  most  ben^cially  affected  by  the  employ- 
ment of  mammary  glands  of  healthy  animals.  He  had 
also  ascertained  tlutt  ovarian  disease  was  beneficially 
influenced  by  the  administration  of  mammary  gland. 
Summary  of  Cases. 

Epithelioma  of  Cervix.—l.  Patient,  nt  48  ;  seen  first  in 
Summer  of  1895.  Cauliflower  excrescence.  Curetting: 
fuming  nitric  acid.  Put  on  thyroid  elixir.  SubsequenUy 
two  sloughs  came  away.  Symptoms  of  local  disease  sub- 
sided. 2,  Patient,  »t.  65 ;  seen  December,  1805.  Curet- 
ting :  Stick  of  chloride  of  zinc  inserted.  Put  on  thyroid 
elixir.  Her  doctor  (Dr.  Donald,  of  Paisley)  recently  re- 
ported that  the  discharge  had  ceased ;  she  was  free  from 
pain  and  discomfort,  had  gained  in  weight,  and  felt  per- 
fectly well.  3.  Patient,  »t.  31.  Under  treatment  by 
thyroid  elixir  two  months.  Local  treatment  by  ichthyol 
tampons.  All  symptoms  of  malignancy  now  disappeared, 
only  a  little  erosion  left. 

Fibroid  of  Uterus.— I.  Patient,  single,  »t.  48  ;  first  seen 
November,  1895.  Fibroid  of  uterus  size  of  seven  months' 
pregnancy.  Put  on  mammary  elixir.  April,  1896,  tumour 
found  not  more  than  quarter  original  size.  Feeling  well. 
2.  Patient,  nt.  33  ;  seen  January,  1896.  Small  fibroid  in 
anterior  wall.  Mammary  palatinoids.  May,  1896,  tumour 
small,  monorrhagia  less. 

MenorThagiek.—l.  First  seen  March,  1896.  AppUcationa 
of  iodised  phenol;  mammary  palatinoids.  Seen  again 
lately ;  discbarge  less  ;  no  pain.  2.  Patient,  nt.  34 ;  seen 
March,  1896.  Treatment  and  result  same  as  in  preceding 
case. 

Ovarian  Dweow.— Four  cases ;  treated  by  parotid  pala- 
tinoids ;  three  of  them  also  had  applications  of  iehthyol 
tampons.    In  all  four  eases,  great  improvement. 

The  Chaibmak  thanked  Dr.  Bell  for  his  paper,  which 
opened  up  new  views  of  treatment  for  these  cases.    The 


JuNB  3,  18M. 


TRANSACnOBTS  OF  SOCIETIES. 


ThS  MlDIOlL  Pbmb.      577 


«fieot  of  the  adminifltratioD  of  the  prodnete  of 
these  daotlees  glands  was  often  very  marked. 

Mr.  BowRXMAN  JassBTT  said  he  was  interested  in  the 
acooont  of  these  methods  of  treatment.  Bot  he  tfaoog^ht 
«ihe  oomparisoQ  of  epithelioma  with  psoriasis  and  with 
myzoedema  had  no  rational  basis.  He  noted  that  in  all 
the  cases  of  epithelioma  curetting  was  done,  followed  by 
the  application  of  such  sbrong  caustics  as  chromic  acid 
and  chloride  of  zinc  ;  and  he  was  inclined  to  attribute  the 
improvement  to  the  use  of  the  caustic.  If  Dr.  Bell  had 
recorded  cases  in  which  the  thvroid  extract,  and  nothing 
•else,  had  been  used,  they  would  have  been  more  convincing. 
As  regards  the  cases  of  fibre- myoma,  the  enlargement  was 
reduced  in  three  cases ;  but  he  would  like  to  ask  what  was 
the  age  of  tbe  patients,  and  what  other  treatment  was 
adopted.  It  was  well  known  that  fibroid  tumours  were 
apt  to  diminish  in  size*  especially  at  the  menopause,  if  the 
patient  could  be  kept  at  rest,  fiut  all  the  cases  were  too 
recent  for  the  deductions  to  be  considered  as  trustworthy. 
The  cases  of  ovarian  disease  were  also  treated  locally,  by 
applications  of  iodised  phenol  and  ichthyol  tampons ;  it 
was,  of  course,  not  uncommon  for  erosion  of  the  os  to  be 
associated  with  enlargement  of  the  ovaries  and  inflamma- 
tion of  the  tubes  ;  ana  these  conditions  were  always  found 
to  improve  under  local  treatment.  He  therefore  regarded 
the  local  treatment  as  the  more  important  factor  in  Dr. 
Bell's  cases.  No  doubt,  however*  many  would  give  these 
new  methods  a  trial. 

Dr.  LuTH  Napixb  said  he  had  had  no  ezperienoe  of  this 
treatment ;  but  he  had  recently  read  a  translation  of  a 
paper  by  Dr.  Jouin,  who  in  one  case  was  treating  a  patient 
for  obesity,  by  means  of  thyroid  extract.  She  happened 
to  have  a  fibroid,  and  was  under  observation  for  twelve 
months.  He  discovered  at  the  end  of  this  time  that  the 
tumour  had  shrunk  from  two  inches  above  the  umbilicus 
to  one  inch  above  the  pubes.  This  led  him  to  try  it  in 
other  cases.  The  second  was  a  soft  fibroid,  and  was  bene- 
fited ;  the  third  was  a  hard  fibroid,  and  no  improvement 
was  found.  Three  other  cases  were  too  recent  to  draw 
•conclusions  from.  The  recent  views  of  the  pathology  of 
•soft  fibroids  regarded  them  as  associated  with  morbid 
glandular  action,  so  it  was  quite  possible  that  thyroid 
extract  might  exert  an  influence  on  them.  He  would  ask 
Dr.  Bell  what  was  meant  by  mammary  and  parotid 
extracts ;  he  hoped  to  give  in  an  earlj^  number  of  the 
*"  Journal "  an  account  of  the  therapeutics  of  some  of  the 
animal  extracts  ;  but  he  did  not  know  the  composition  of 
these  two. 

Dr.  Hbtwood  Smith  observed  that  Dr.  Bell  did  not  tell 
ihem  what  was  the  condition  of  the  cervix  in  the  first  case, 
at  the  time  of  the  last  examination  ;  but  in  all  the  cases 
there  seemed  to  have  been  an  amelioration  of  symptoms  in 
a  much  shorter  time  than  they  were  accustomed  to.  As 
regards  the  cases  of  fibroid,  had  Dr.  Bell  tried  in  any  case 
a  change  of  treatment,  from  one  kind  of  extract  to  anotherl? 
In  a  paper  which  the  Chairman  read  before  the  Society 
some  time  ago  there  was  reference  to  a  substance  called 
spermine,  obtained  from  the  ovaries.  Had  Dr.  Bell  tried 
ovarian  extracts,  and  was  there  any  evidence  that  giving 
this  would  restore  the  action  of  diseased  ovaries?  It 
would  be  useful  also  to  know  whether  any  of  tbe  cases  were 
treated  by  animal  extracts  alone,  and  what  led  Dr.  Bell  to 
decide  which  extract  he  should  employ  in  any  given  case. 
In  view  of  Uie  results  recorded  in  tne  paper,  he  thought 
they  should  give  the  method  a  triaL 

Dr.  Maoan  observed  that  in  a  recent  paper  on  the  treat* 
ment  of  bronchocele  by  thyroid  preparations,  the  author 
etated  that  they  wereof  no  use  in  cystic  bronchocele ;  he  also 
-found  th^t  in  the  cases  where  a  good  result  was  obtained, 
the  English  preparations  were  much  more  active  than 
thyroidin. 

Dr.  Bill,  in  reply,  said  he  thought  Mr.  Jessett  was 
under  a  misapprehension  in  supposing  that  he  compared 
•epithelioma  to  psoriasis  and  myxoedema.  It  was  rather 
that  in  view  of  the  action  of  the  thyroid  extract  on  the 
epithelium  in  cases  of  psoriasis,  and  on  the  epithelium 
and  subjacent  tissues  in  cases  of  myicBdema,  it  seemed  to 
'him  that  it  might  have  an  action  on  the  epithelium  in 
carcinoma.  "For  probably  epithelioma  was  at  first  a 
benign  disease,  remediable  by  medical  measures,  if  the 
•cause  of  irritation  could  be  removed.  Mr.  Jessett  also 
thought  that  the  curetting  and  caustics  might  have 
eaused  an  improvement  wiUiout  the  thyroid  treatment, 


but  he  had  tried  both  of  these  in  many  oases,  and  had 
never  had  the  same  satisfactory  results  as  he  obtained 


from  the  thyroid  extract ;  and  since  he  began  the 
treatment  it  had  not  been  necessary  for  his  liospital 
patients  to  return  to  him  so  often.  He  had  often  been 
disappointed  in  the  eflect  of  the  menopause  upon  fibroids, 
indeed,  he  had  never  known  it  to  act  beneficialljr.  The 
reason  he  used  mammary  gland  extract  for  fibroids  was 
that  the  uterus  and  mammas  sympathise  with  each  other ; 
and  he  gave  parotid  extract  in  ovarian  disease  because 
physiologically  these  organs  were  related,  as  was  shown 
by  the  frequency  of  metastases  between  the  two.  Others 
had  now  been  using  this  treatment  for  some  time,  and 
had  been  very  pleased  with  the  results  ;  in  one  of  his  cases 
there  was  no  other  treatment  adopted.  He  had  not  tried 
ovarian  tissue.  He  felt  sure  that  those  who  tried  the 
method  would  be  satisfied  withjthe  results. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Sbotion  of  Statb  Mkdioikb. 

Mketino  held  Friday,  April  17th,  1896. 


The  President,  Dr.  J.  M.  Rbdmond,  in  the  Chair. 

Dr.  Waltbr  Bernard  submitted  models  of  portable 
apparatus  for  domestic  disinfection  of  articles  by  heat  and 
fumigation  ;  one  adapted  for  the  sick  room,  the  other  for 
the  doctor's  and  nurse's  overalls,  which  are  worn  while 
attending  the  sick.  He  remarked  that  in  our  daily  rounds 
we  could  in  this  way  do  battle  against  the  spread  of 
disease,  but  when  we  came  to  fight  against  other  evils, 
which  in  all  the  social  relations  of  life,  tend  to  lower  the 
workers  physically  and  mentally,  such  as  the  building  of 
houses  on  polluted  subsoil  raised  by  filthy  rubbish  and 
street  sweepings,  and  with  no  concrete  foundations,  then 
indeed  we  are  powerless. 

Dr.  Dotlb  wanted  to  know  the  disinfectants  Dr.  Ber- 
nard used,  and  how  long  the  procens  lasted. 

Dr.  Bswlbt  asked  whether  a  separate  apparatus  was 
supplied  to  each  family  where  there  was  scarlatina. 

Dr.  Bernard,  replyine,  said  the  antiseptic  he  used  was 
eucalyptus  oil  and  carbolic  acid.  This  was  heated,  and  the 
articles  were  fumigated  for  a  considerable  time.  The 
apparatus  was  6  feet  long  and  13  inches  wide,  and  13  inches 
wide,  and  could  be  carried  from  one  house  to  another  after 
being  rendered  aseptic. 

criminal  RB8P0N8IBILITT  IN  THS  INSANE 

Dr.  CoNOLLT  Norman  read  a  paper  on  the  above  sub- 
ject. He  reviewed  the  history  of  the  laW  on  this  subject, 
tracing  the  stages  by  which  it  arrived  at  its  present 
position.  He  pointed  out  that  the  dictum  of  the  judges  in 
the  MacNaughten  case,  which  had  often  since  been 
accepted  as  an  authoritative  statement  of  the  law,  had, 
properly  speaking,  no  such  character.  Neither  the  House 
of  Ix)rds  who  asked  the  questions,  nor  the  judges  who 
replied,  could  be  recognised  constitutionally  as  having  any 
power  to  make  laws,  and  tbe  opinion  of  a  judge  or  aB  the 
judges,  on  an  abstract  point,  nas  no  more  binding  value 
than  that  of  any  other  person,  and  does  not  constitute  a 
precedent  nor  an  authoritative  interpretation  of  the  law 
as  it  might  do  if  enunciated  from  the  bench  on  the  trial 
of  a  concrete  case.  Tbe  speaker  proceeded  to  point  out 
the  injustice  and  absurdity  of  the  supposed  legal  tests  of 
responsibility,  as  applied  to  tbe  insane,  since  a  strict  ap- 
plication of  the  criteria  of  knowledge  of  the  nature  of  the 
act  done  or  of  knowledge  of  right  from  wrong  would  lead 
to  all  the  insane  being  held  responsible,  with  the  excep- 
tion of  low-class  idiots  and  a  few  acute  cases.  At  the 
same  time.  Dr.  Norman  deprecated  anything  like  an 
attempt  at  present  to  substitute  medical  for  legal  defini- 
tions in  this  matter.  Our  knowledge  of  insanity  is  still 
so  limited  that  we  cannot  define  its  conditions,  and  to  en- 
deavour to  define  that  which  is  indefinable  is  to  risk 
repeating  the  mischief  already  done  and  laying  down 
criteria  uie  validity  of  which  will  soon  be  as  disputable  as 
that  of  the  former  ones.  Owing  to  a  variety  of  circum- 
stances with  which  the  speaker  dwelt  in  some  detail,  there 
is  not,  he  thought,  much,  if  any,  practical  injustice  done 
under  the  present  state  of  the  law,  however  unjustifiable 
it  may  theoretically  be. 

Dr.  Bewlet  was  glad  to  hear  that  Dr.  Norman  could 


578     Tm  MsDiGAL  Piums. 


FRANCE. 


JuvB  3,  1896. 


not  snggeBt  any  definite  line  npon  which  the  Uw  shonld 
be  amended,  and  that  it  was  a  mistake  to  define  insanity. 
Dr.  Norman  did  not  take  up  the  question  of  self-control. 
He  showed  most  persons  knew  whether  a  certain  act  was 
ri^ht  or  wrong.  There  were  two  other  sets  of  cironm- 
stances  to  take  into  consideration.  The  intensity  of  the 
desire  to  do  wrong,  and  the  power  or  want  of  power  to 
prevent  themselves  from  doioe  wron^.  There  is  no  way 
of  estimating  the  power  of  self-restraint.  If  a  man  wants 
to  do  right  and  his  power  of  self-control  is  diminished  or 
lost,  he  may  still  be  unable  to  resist  doing  things  which 
he  knows  perfectly  well  are  wrong.  Persons  have  ptft 
themselves  into  asylums  to  prevent  themselves  giving  way 
to  these  morbid  influences.  Criminals  who  are  not  insane 
often,  from  education  and  surroundings,  have  diminished 
power  of  self-control.  A  little  inoanity  and  a  great  deal 
of  wickedness,  and  a  little  wickedness  and  a  great  deal  of 
insanity  merge  very  much  ioto  one  another.  Medical  men 
are  not  always  the  best  judges  of  insanity.  They  are  too 
much  inclined  to  believe  that  criminals  are  to  be  treated 
and  not  punished.  An  ordinary  jury,  helped  by  a  judge 
who  is  not  influenced  by  the  absurd  statements  of  judges 
50  years  ago,  perhaps  would  come  to  the  right  conclusion. 
Dr.  MgWbenst  wished  to  know  in  what  position,  with 
regard  to  sanity  or  insanity.  Dr.  Norman  would  place 
habitual  criminals  who,  from  their  very  earliest  days,  have 
a  tendency  to  the  committal  of  crime. 

Dr.  DoTLi  said  that  in  the  life  of  every  individual  there 
was  a  time  in  which  he  was  insane.  He  often  regretted 
that  medical  men  went  into  the  witness-box,  in  a  case  of 
lunacy,  to  give  positive  evidence.  Thev  should  tell  the 
judge  that  they  could  not  define  a  case  of  lunacy.  At  one 
time  he  had  charge  of  the  criminals  at  Spike  Island.  He 
believed  that  one-third  of  them  suffered  from  different 
forms  of  lunacy. 

Dr.  Pabsons  said  there  was  one  point  on  which  Dr. 
Norman  did  not  touch,  namely,  how  far  a  person  could 
be  held  responsible  for  bringing  about  an  attack  of  acute 
mania.  A  short  time  ago  a  doctor  he  knew,  suffering  from 
ddirium  trement^  shot  a  near  relative.  He  barely  escaped 
being  hung.  If  insanity  was  pleaded  would  it  not  be 
better  to  have  the  person  examined  by  four  or  five  medical 
witnesses,  and  that  the  jury  should  be  guided  by  them 
and  not  by  the  judge. 

Dr.  Edgar  Flinf  said  he  heard  a  woman  appeal  to  a 
medical  man  to  send  her  to  an  asylum  to  prevent  her 
murdering  a  deformed  child,  for  whom  she  had  an  intense 
hatred.    She  was  subsequently  sent  to  an  asylum. 

Dr.  Norman,  replying,  said  he  did  not  dwell  on  the 
question  of  control  which  Dr.  Bewley  raised.  It  was  of 
immense  importance.  "  Irresistible  impulse ''  was  a  term 
too  freely  used  by  medical  men.  Nobody  doubted  that 
such  a  thing  existed.  But  the  word  impulse  was  rather 
vague ;  and  it  is  impossible  to  say  what  is  irresistible, 
because  that  was  only  known  to  the  man  to  whom  the 
impulse  occurred.  It  was  better  to  look  out  for  other 
signs  of  insanity  than  irresistible  impulse.  He  thought 
the  question  of  a  criminal  being  insane  should  be  left  to 
the  jury  to  decide.  A  question  of  life  or  death  should  not 
be  left  to  a  single  expert  or  body  of  experts.  The  chief 
cause  of  complaint  of  medical  witnesses  was  that  one  judge 
wanted  nothine  but  facts,  and  another  wanted  one's 
opinions  The  law  regarding  a  lunatic  giving  evidence 
was  much  the  same  as  that  of  a  lunatic  mMLing  a  wilL  He 
could  give  evidence  if  he  understood  the  nature  of  an  oath 
and  if  he  had  not  delusions  on  the  point  at  issue.  He  can 
make  a  will  if  his  memory  is  sound  and  in  case  he  has  not 
delusions  which  refer  to  his  relations  or  others  that  would 
be  benefited  by  the  will. 

TILLAOB  WATIR  8UPFUB8  IN  IRBLAND  ;  PABRNASILLA  AS  A 
WINTRR  AND  SPRING  HRAi;rH  RBSORT. 

Dr.  Edgar  Fijkn  read  two  papers— one  on  **  Village 
Water  Supplies  in  Ireland,''  and  the  second  on  '*  Park- 
nasilla  as  a  Winter  and  Spring  Health  Resort"  In  the 
former  paper  he  laid  stress  on  the  difficulty  there  existed 
in  procuring  a  really  pure  and  wholesome  drinking  water 
in  the  smaller  Irish  villages  and  towns,  most  of  the  wells 
being  of  aphallow  character  and  liable  to  pollution  from 
surface  and  drainage  percolation — the  contract  for  the 
sinking  of  wells  being  nearly  always  in  the  hands  of 
totally  inexperienced  and  incompetent  persons,  who  may 
happen  to  have  friends  on  the  ruriJ  sanitary  authority — 
no  account  apparently  being  ever  taken  of  tne  site  or  the 


configuration  and  condition  of  the  soil  in  the  immediate 
locality  whence  the  supplv  is  derived,  the  result  being' 
that  in  the  majority  of  tne  viliaees  the  quality  of  the 
water  supply  is  defective  and  below  the  standard,  and 
the  quantity  in  dry  seasons  scanty.  The  smaller  class  of 
hamlets  suffered  much  in  this  regard,  the  inhabitsntfr 
having  often  to  take  the  water  from  obviously  tainted 
sources.  Sanitary  reform  in  this  queetion  was  much 
needed. 


0§!tSXitt. 


[FROM  CUB  OWN  OORBRSPONDRVT.] 

PABIS,  May  80th,  1896. 
PROSTATIO  PaTIBNTS. 

At  the  Academic  de  M^d^ine  M.  Oruessin  spoke  on  the 
pain  experienced  by  patients  affected  with  enfanped  pros- 
tates, and  located  in  the  neck  of  the  blad£r.  Th«- 
character  of  the  pain  was  important  to  know,  as  an  ope^^- 
tion  is  frequently  reauired  to  give  relief.  At  the  end  ot  a. 
miction,  and  especially  a  nocturnal  miction,  or  under  the 
influence  of  congestion  provoked  by  cold,  retention  or 
imprudence  in  diet,  a  painful  contraction  of  the  urethra 
and  the  bladder  takes  place,  simulating  an  imperious- 
desire  to  expel  the  contents.  After  some  days  these 
painful  spasms  occur  during  the  whole  time  of  emission, 
and  do  not  immediately  cease  after  the  evacuation,  an<i^ 
finally  retention  results,  requiring  the  oonstant  use  of  the 
catheter.  But  this  latter  treatment  seems  to  diminish  the 
capacity  of  the  bladder,  and  renders  more  frequent  tho^ 
desire  to  micturate.  In  such  cases  he  found  that  placing^ 
of  a  catheter  d  demeurt  was  the  only  treatment  which  re- 
lieved these  painful  vesico- urethral  contractions.  H,. 
however,  and  the  cases  were  rare,  that  the  condition  of 
the  patient  had  not  improved,  a  unnary  fistula  as  a  last- 
resource  should  be  created. 

Trbatmbnt  of  Nburasthbnia. 

Whilb  the  term  "  neurasthenia "  is  a  comparativehr 
new  one,  and  while  the  morbid  entity  for  which  it  stanos- 
has  only  recently  found  its  place  in  pathological  nomen- 
clature  it  must  not  on  that  account  be  suppMed  that  the- 
malady  has  only  just  made  its  appearance.  Its  constitn- 
ent  symptoms — the  great  merit  of  grouping  them  into  an 
homogeneous  complaint  belongs  to  Dr.  Beard,  of  New- 
York-  had  been  recognised  by  our  masters  who,  for  lack 
of  a  better  classification,  placed  them  under  the  general' 
head  of  "  nervousness,"  one  of  those  expectant  diagnosis 
to  which  science  is  only  too  often  obliged  to  have  resorts 
But  while  recognising  that  neurasthenia  does  not  date 
from  yesterday,  it  must  be  confessed  that  for  some  time 
past  it  has  manifested  itself  so  frequently  that  it  may, 
perhaps,  be  regarded  as  the  medical  characteristic  of  our 
epoch.  It  is  easy  to  understand  the  reason  of  this  whe» 
we  remember  that  this  malady  is  principally  caused  hj- 
the  excess  of  intellectual  labour,  by  the  cerebral  overwork, 
that  result  from  the  intense  existence  of  our  daily  struggle 
for  life.  If  mental  fatigue  develops  neurasthenia  in  those 
who  are  free  from  all  hereditary  taint,  a  fortiori  it  will  do- 
so  when  the  soil  has  been  prepared  for  it,  either  by  heredi- 
tary neuro-arUiritis  or  by  infectious  disorders.  In  this 
respect  endemic  grippe  or  epidemic  influenza  has  obtained* 
a  baneful  reputation.  Nor  is  it  alone  in  the  intellectual 
sphere  that  the  morbid  action  of  cerebral  fatigue  mani- 
fests itself;  the  emotional  faculties  exercise  a  similar 
influence :  sorrow,  grief,  worry,  the  pre-occupations  of 
ambition,  reverses  of  fortune  are,  in  many  instances, 
causes  of  neurasthenia. 

The  treatment  of  this  malady  is  therefore  a  matter  of 
considerable  importance,  not  only  because  of  the  frequency 
of  the  complaint,  but  also  because  it  may  prove  the  origin 
of  a  morbia  degeneration,  which  sometimes  is  the  prelude- 
to  genera]  panSysis,  to  hysteria,  to  melancholia,  and  not 
I  infrequently  to  alcoholism  and  the  morphia  habit.     Neu- 
I  rasthenia,  in  spite  of  its  polymorphism,  is  always  charac- 
I  terised  by  a  certain  number  of  fundamental  symptoms, 
very  justly  and  aptly  called  by  the  late  Professor  Cbaroot» 
I  the  stigmata  of   neurasthenia.     These  symptoms  are  t 
cephalitis,  Insomnia,  cerebral  depression,  racbialgia,  neuro- 
muscular asthenia,  and  dyspepsia.    Cephalitis  consists  ii» 
a  sensation  of  constriction,  or  weight     It  may  be  called 


JuNB  3,  1896. 


G  E  B  M  A  N  Y. 


Tn  MiDioAt  Pbm.    579 


the  nenraetheDio  helmet.  The  pain  ia  not  always  general 
to  the  whole  head,  it  la  sometimes  localised  in  various 
regions  of  the  face  or  sknll.  It  is  on  awakening  from 
sImp  that  it  is  most  keenly  felt. 

Persons  troubled  with  neurasthenia  experienoe  great 
difficulty  in  falling  to  sleep ;  then,  after  a  doze  of  varying 
duration,  they  awake  in  an  excited  or  anxious  condition 
which  prevents  them  from  again  falling  to  sleep.  They 
turn  and  toss  in  their  beds ;  their  minds  are  harassed  by 
rapid  successions  of  quickly  associated  fancies,  ideas, 
and  memories  which  they  find  it  impossible  to  hold  in 
check.  Some  sufferers  are  frecjuently  startled  from  their 
sleep  by  terrifying  dreams  ending  in  abrupt  awakenings. 
The  insomnia  of  neurasthenia  is  rarely  complete,  but  it 
frequently  refuses  to  yield  to  treatment,  (a)  The  cerebral 
depression  seems  to  consist  essentially  in  a  weakening  of 
the  mental  faculties,  accompanied  by  a  propensity  to  hypo- 
chondriacal ideas.  Neurasthenic  rachialgia  consists  in 
sensations  of  pressure  and  compression  anuogous  to  those 
which  are  characteristic  of  cephalitis.  Neuro-muscular 
asthenia  betrays  itself  by  muscular  weakness,  experienced 
from  the  moment  of  awakening  in  the  momins.  Many  of 
those  thus  troubled  feel  as  exhausted  when  t£ev  arise  as 
though  thev  had  not  been  to  bed  at  all.  From  this  it  may 
be  deduced  that  neurasthenia  calls  for  a  two-fold  treat- 
ment :  a  general  hygienic  treatment  and  a  symptomatic 
pharmaceutical  treatment. 

The  general  treatment  demands  first  of  all  the  removal 
of  the  accidental  cause  of  all  the  neurasthenia.  Then  the 
patient  should  be  subjected  to  a  strict  course  of  hygiene  ; 
moderate  exercise,  massage,  and  even  hj^dropathy  are 
amonff  the  chief  elements.  At  the  same  time  the  physi- 
cian £ould  seek  to  exercise  a  suggestive  action  over  the 
mind  of  his  patient.  But  this  treatment,  in  spite  of  its 
efficacy,  is  far  from  sufficing  in  itself  and  unassisted,  to 
remove  all  the  symptoms  of  uie  malady,  and  this  is  parti- 
cularly when  we  are  dealing  with  the  insomnia  which  is  so 
wearying  to  the  patient  and  so  rebellious  to  the  remedies 
usually  employeo.  There  is,  however,  in  Bromidia,  (Battle 
and  Go.)  a  remedy  that  victoriously  combats  this  symptom 
which  is  so  disheartening  to  the  physician  and  to  the 
patient 

The  formula  of  this  preparation  is  no  mystery.    It  is  a 
successful  combination  of  well -known  hypnotics  and  anti- 
spasmodics, which  has  been  thoroughly  tested.     Each 
teaspoonf  ui  of  the  preparation  contains  : — 
Brom.  potas.,  15  grains  ; 
Pure  chloral,  15  grains ; 
Cannabis  ind«,  i  grain  ; 
Hyoscyam,  i  grain. 

Owing  to  the  purity  of  the  products  entering  into  its 
composition  this  remedy  may  oe  termed  the  hypnotic  par 
excellence.  It  produces  a  refreshing  sleep,  ana  succeiads 
where  opium  fails  to  ^ve  relief.  Its  success  in  nervous 
insomnia,  in  migraine,  m  hysteria,  in  all  forms  of  neuralgia, 
and  in  manias  allowed  us  to  forecast  the  value  of  the  remedy 
in  the  treatment  of  neurasthenia.  Subsequent  facts  have 
shown  how  well  founded  was  this  expectation,  and  it  may 
now  be  confidently  asserted  that  Bromidia  is  one  of  the 
most  powerful  medical  agents  which  we  have  at  our  dis- 
posal for  the  cure  of  neurasthenia. — From  the  Paris  BvlUUn 
Midical,  April  30th,  1896. 


dtttu^S. 


[FBOM  our  own  00BBS8F0VDBKT.] 

BxBLiir^lUySMh. 
The  Impbbial  Health  Omox. 
GoNSiDBRABLB  changcs  in  the  fferMcnnel  of  the  Institute 
have  recently  been  effected.  It  is  now  just  twenty  years 
since  the  Institute  was  opened  with  two  members — one  for 
the  medical  and  one  for  the  veterinary  department.  Since 
then  the  number  of  members  has  steadily  increased. 
There  are  now  eight  ordinary  members,  besides  a  number 
of  associates.  Another  member  is  provided  for,  however, 
in  next  year's  estimates,  as  the  present  staff  is  quite  inade- 
quate for  the  work  demanded.  The  new  member  will 
undertake  the  Department  of  Public  Health,  so  far  as  it 

(a)  **  DectU,  Keanwthenie.  Xntlte  do  Mededne,"  YoL  YI.,  p.  1,288. 


relates  to  injurious  callings  and  adnlteratioD  of  food  stufb 
prejudicial  to  health.  He  will  also  take  in  hand  the  test- 
ing of  drugs  in  the  interests  of  the  forthcoming  New 
PharmacopcBia.  Dr.  Josefo  Brandl,  Privat  Decent  in 
Munich  has  been  called  to  the  new  post  and  nominated  ao 
Imperial  Regierungsrath.  Dr.  Brandl  qualified  in  1800, 
has  studied  chemistry,  was  several  years  assistant  to  Prof. 
Tappeiner  at  the  Pharmacological  Institute,  Munich,  and 
is  author  of  several  contributions  in  bis  Department  of 
Science. 

At  the  Medical  Society's  meeting,  Hr.  Blaschko  read  a 
paper  on 

LlPBOST  IN  THE  KbUSB  MsMXU 

He  said  it  was  Fiirst,  then  of  Memel,  who  first  observed 
cases  of  leprosy  in  the  Memel  district  at  the  commence- 
ment of  the  eighties.  In  1S03  Bindikowsky  reported  nine 
cases,  of  which  four  had  since  died.  That  the  cause  wae 
an  autochthonic  was  shown  bv  the  fact  that  not  one  of  the 
patients  had  ever  been  outside  the  Memel  district,  whiNt 
an  official  report  has  been  received  that  fw  eighty  miles 
across  the  Russian  border  not  a  single  case  has  been  met 
with.  The  speaker  made  a  journey  to  Memel  for  the 
purpose  of  studying  the  question  '*  an  Ort  and  Stelle." 
His  investigation  embraced  three  points : — 1.  Whence  the 
disease  arose,  and  how  was  it  spread  ?  2.  Was  its  >praad 
beyond  the  Memel  district  to  be  feared?  3.  What 
measures  were  to  be  adopted  against  it  ?  He  found  that 
the  country  people  generally  liv«l  in  poverty,  their  income 
principally  coming  from  the  fishery  and  in  certain  distric^s 
from  smuggling.  Their  food  was  bad  and  insufficient, 
coarse  brmd  and  fish  were  the  principal  food,  meat  wae 
seldom  used,  alcohol  was  lareely  used,  amongst  the  women 
in  the  shape  of  Hoffmann's  drops,  the  houses  were  mean 
and  filthily  overcrowded,  in  some  parts  human  beinss  and 
cattle  housing  together.  The  air  in  the  over-heated 
rooms  was  horrible.  Tbe  nursing  and  treatment  of  the 
sick  were  neglected,  medical  men  were  consulted  only  in 
the  extremest  need.  Many  died  without  seeing  a  doctor 
at  all.  There  was  9carcely  any  dread  of  infectious  diseases* 
He  even  found  a  leper  living  in  a  room  along  with  six 
other  healthy  members  of  the  family.  It  was  clear  that 
under  such  conditions  disease  found  a  suitable  soil.  It 
was  here  that  leprosy  had  established  a  footing  for  the" 
first  time  for  three  hundred  years.  The  number  of  cases 
reported  by  F&rst  was  20, 13  others  had  since  died.  The 
speaker  had  found  two  other  cases.  All  the  patients  were 
Lithuanians,  and  not  Germans.  There  was  no  recent  case 
among  them,  and  ten  of  the  patients  were  married  ;  in  no 
case  was  the  disease  communicated  to  the  healthy 
husband  or  wife,  but  in  two  it  has  descended  to  the 
children.  There  could  be  no  question  of  hereditary  trans- 
mission, as  the  children  were  mostly  grown  up  before  the 
parent  acquired  the  disease.  Occurences  in  the 
same  family  were  frequent.  Only  one  had  a  sleeping-room 
to  himself ;  the  others  came  into  contact  with  the  healthy 
as  much  as  they  pleased.  Great  undeanliness  prevailed 
in  some  of  the  families.  In  one  case  the  sores  were 
wrapped  in  a  dirty  rag  that  was  also  used  for  other  pur- 
poses. The  disease  did  not  appear  to  be  infectious  there- 
fore, and  this  might  be  for  the  reason  that  most  people 
were  immune  ss  regarded  the  lepra  bacillus,  only  a  small 
minority  bein^  susceptible.  He  met  with  two  cases  of 
lepra  ansBsthetica  that  had  up  to  then  been  overlooked. 
As  regarded  origin,  all  authors  had  shown  that  lepra  arose 
independently  of  food  and  climate,  but  its  origin  wae 
exceedingly  difficult  to  trace.  It  had  been  in  a  state  of 
steady  progression  in  Russia,  and  there  was  a  good  deal  of 
intercommunication  between  Memel  and  the  neighbour- 
ing Russian  provinces,  Tilsit,  Raenit,  and  Heydekrag, 
and  Memel  must  be  considered  as  uie  last  offshoot  of  the 
Russian  disease.  As  regarded  further  spread,  it  was  to  be 
noted  that  the  disease  was  actually  diminishing, 
no  new  cases  were  arising.  A  possible  spread 
into  our  midst  must  be  borne  in  mind,  as  daughters  of 
leprous  families  were  servants  in  K6nigsberg.  One  man 
was  a  soldier  at  Spandau,  and  there  were  several  in  other 
garrisons,  and  a  short  time  ago  a  soldier  who  had  served 
two  and  a  half  years  was  discovered  to  be  a  leper.  Gzemy'e 
case  from  Heidelbttre  also  belonged  here.  Although  no 
consequences  followed  these  cases,  measures  were  neoMsary 
to  prevent  a  spread  of  the  disease.  The  spsaker  proposed 
an  inquiry  into  the  extent  of  the  epidemic.    The  whole 


580    Trb  MaMoukt  Fbibb. 


THE  OPERAXmO  THEATRES. 


JuKs  3,  1886. 


popaUtioD  of  the  diatriot  aboald  be  ezftmined  by  skilled 
exfrnrts.  Penons  oomioji^  in  from  Ronia  ahoald  be  ex- 
amined, and  suspected  tndivldaals  should  be  detained.  He 
considered  lepra  anasthesia  as  less  dangerous  than  the 
tuberose  form,  cleanliness  tended  to  prevent  tbesDread 
of  the  infection.  Leper  houses  such  as  those  of  the  Middle 
Ages  were  useless  horrors.  It  seemed  unsuitable  to  bring 
Urge  numbers  together,  as  the  plan  would  be  costly  and  the 
sick  could  not  be  permanently  oetained  in  them.  It  would 
be  better  to  form  colonies,  and  employ  the  colonists  with 
agriculture,  and  for  those  who  were  bedridden,  to  institute 
special  hospitals.  The  matter  was  of  great  importanoe, 
as  the  example  of  the  Russian  Baltic  province  taught.  If 
the  proper  steps  had  been  taken  sixty  years  ago,  the 
disease  would  not  have  spread  as  in  Livonia  where  there 
were  800  cases  alone.  It  was  the  more  imporrant  to  adopt 
proper  measures  as  the  epidemic  was  restricted,  as  other- 
wise a  condition  similar  to  that  prevailing  in  Russia  might 
arise. 

He  then  showed  a  patient  with  lepra  anasthetica  with 
commencing  clawing  of  the  fingers,  muscular  atrophy  of 
the  hands,  and  gangrene  cicatrices  on  the  elbows,  and 
inflammation  of  both  great  toes.  He  further  showed  and 
explained  microscopical  preparations,  showing  the  inter- 
cellular position  of  the  lepra  bacillus  lately  denied  by 
Unna,  as  well  as  a  section  of  lepra  from  the  scalp,  lepra 
nodules  of  the  palm  of  the  band,  and  a  drawing  of  a  large 
leprous  artery. 

Hr.  Brasch  was  in  a  position  to  show  the  difficulties 
of  diagnosis  in  cases  of  anassthetica  lepra. 

Hr.  Wassermann  had  had  several  cases  of  lepra  in  the 
Infectious  Institute.  The  ministry  were  quite  aware  of 
the  importance  of  the  subject,  and  were  willing  to  give  all 
the  support  in  their  power  to  combat  the  disease,  and  had 
directea  that  all  cases  should,  as  far  as  possible,  be  trans- 
ferred to  the  university  clinics,  or  to  infectious  institutes. 
These  regulations  should  be  received  with  the  greatest 
thankfulness. 


[FBOM  OUB  OWH   OOBBBBPOlTDBirV.] 

YimiA,  May  29tb,  18M. 
BiSLOCATIOK  OF  THI  FXBONBUS  LoNGUS  MUSCLB. 

PoROBS  showed  to  the  "  Gesellschaft "  a  patient  in  whom 
the  peroneus  longus  had  been  luxated.  When  the  foot  was 
at  rest  nothing  abnormal  about  it  could  be  observed,  but 
immediately  toe  patient  attempted  to  walk  a  large  swelling 
formed  on  the  outside  of  the  external  malleolus. 

In  the  didcuesion  that  followed  Kraske  and  Schreiber 
concarred  in  the  pathology  of  this  rare  lesion  being  due  to 
a  sudden  contraction  or  jerk  of  the  peroneus  when  the  foot 
was  flexed,  thus  allowing  the  tendon  to  glide  easily 
forward. 

Different  modes  of  treatment  were  suggested.  The 
classic  admonition  is  to  fix  the  foot  in  a  plaster  of 
Paris  bandage.  Thiff  treatment  had  been  applied  in  this 
case  for  a  month  without  the  slightest  benefit.  Moli^re 
recommended  subcutaneous  section  of  the  tendon,  while 
Albert  advocated  operating  on  the  bone  by  deepening  the 

groove  through  which  toe  tendon  passes.  The  only 
anger  was  the  fear  of  adhesions,  which  had  never  occurred 
in  any  of  his  own  cases.  Kraske  was  of  opinion  that  the 
most  rational  form  of  treatment  would  be  lifting  a  section 
of  periosteum  3  centimetres  by  1  broad,  and  bringing  it 
over  the  tendon,  so  that  it  might  finally  form  a  sheath. 

A  SUBSTITUTB  FOB  PhOSPHOBUS  ON  MATCHES. 

From  the  large  number  of  accidents  that  have  recently 
occurred  in  Austria,  as  well  as  the  adverse  reports  on  the 
health  of  the  operatives  of  those  factories  where  matches 
are  made,  the  Imperial  Sanitary  advisers  have  passed  a 
resolution  prohibiting  the  use  of  yellow  phosphorus  in  the 
production  of  matches,  and  recommended  the  Swedish 
form  of  manufacture. 

Gurowitz  exhibited  a  substance  to  the  meeting  which 
was  free  from  poison  and  was  admirably  fitted  to  take  the 
place  of  phosphorus.  It  is  non-explosive  and  free  from 
narmful  effects.  It  is  made  by  msltmg  sulphur  and  amor- 
phous phosphorus,  which  forms  a  mass  very  different  from 
their  mechanical  mixture.    To  this  may  be  added  potas- 


sium chlorate  and  hypoenlpbate  of  lead,  which  formsa  safe 
compound.  It  requires  a  temperature  of  150"*  to  160** 
Cent,  before  it  can  be  kindled,  and  it  is,  therefore,  safe 
against  fire. 

Thb  Obioin  of  Stphius. 
Prof.  Puschman  resumed  his  paper  on  the  origin  d 
syphilis,  and  quoted  largely  from  heathen  writers  as  well 
as  those  during  the  Middle  Ages  to  show  that  the  disease 
presumably  existed  long  before  the  time  that  medical 
nistory  credits  it  with.  Celsus  records  a  large  number  of 
genital  diseases,  among  which  are  phimosis,  pharaphimosis, 
condyloma,  uloers,  ana  hard  spots  on  the  penis,  presnmablv 
syphilis,  which  he  treated  by  excision  and  caustics.  Pal- 
laaius  describes  phagedenic  chancre  while  informing  us 
that  ^ngrene  oi  the  penis  was  not  uncommon.  The 
bubo  IS  also  diagnosed  at  this  early  period,  according  to 
Hippocrates,  for  he  tells  us  that  it  appears  regularly 
on  both  sides  of  the  body  with  ulcers  on  the  mouth  and 
genitals.  The  condylomata  are  forcibly  described  in 
epigrams  by  Martisd.  The  skin  eruptions  described 
by  these  writers  are  doubtless  of  a  syphilitic  nature. 
In  Plinv  and  Seneca  indubitable  testimony  is  conveyed 
by  the  hoarse  voice,  ozaena  and  nodes,  which,  according  to 
Andron,  were  treated  successfully  with  ointments  of 
cinnabar.  The  f oesile  bones  have  many  points  of  evidence 
that  lead  to  the  belief  that  they  were  the  seat  of  syphilitic 
lesions,  although  this  point  has  not  been  fully  worked  out. 

OSTBOMALAOIA. 

Latxko  again  Advocated  the  use  of  chloroform  in 
the  treatment  of  osteomalacia.  The  patient  he  exhi- 
bited had  suffered  from  this  disease  for  three  months. 
During  the  illness  the  patient  was  unable  to  move 
about  without  the  use  of  crutches  and  suffering  great 
pain,  but  since  the  treatment  all  pain  has  gone  with 
the  crutches,  and  she  now  walks  as  easily  and  comfortably 
as  ever  she  did.  Latako  particularly  drew  attention 
to  the  fact  that  pre^ancy  could  not  enter  into  the 
estimate  of  recovery  m  thu  case,  as  it  was  now  over 
two  years  ago  since  we  last  gravid  condition,  which  ter- 
minated in  an  abortion  ;  therefore  he  concluded  the 
present   case   can  have  no  affinity  to  puerperal   osteo- 


EBTTHUfA  EXSUDATTVA    MULTIFOBHA. 

Ulmann  recorded  the  case  of  a  female,  »t.  50,  with  a 
diffuse  p  ustular  rash  over  face,  neck,  and  mucous  mem- 
brane of  the  mouth.  In  her  youth  she  had  suffered  from 
repeated  pulmonary  catarrhs,  at  16  had  typhoid,  but  never 
rheumatism.  Six  weeks  ago  she  had  a  rigor  with 
general  constitutional  disturbance.  On  the  forearme 
were  extensive  pigmentations.  Blood  and  urine  were 
both  normal,  except  in  the  salts,  which  were  increased. 
Singer  thought  this  discovery  pointed  to  an  increased 
decomposition  product,  which  might  be  symptomatically 
revealed  in  the  form  of  erythema.  iUi  opinion  was 
expressed  that  the  source  was  obscure  and  might  yet  be 
found  in  a  purulent  formation  somewhere  in  the  abdomen, 
if  not  in  the  bowel  or  reproductive  organs. 


KING'S  COLLEGE  HOSPITAL. 
Sabooma  of  FxMUBr— Amputation  ik  thb  Middlb  of 
THB  Thigh— Rb-Amputatiok  at  thb  Hip-Joint. — Mb. 
RosB  operated  on  a  young  man,  est.  27,  who  was  admitted 
with  an  ill-defined  enlargement  of  the  lower  end  of  the 
femur  similating  disease  of  the  knee-joint.  The  patient 
had  noticed  a  swelling  about  six  months  previously,  which 
was  occasionally  painful,  but  had^only  lately  oaused  him 
to  walk  lame,  owing  to  the  knee  becoming  semi-flexed. 
The  first  operation  took  place  about  two  months  ago ;  an 
incision  was  made  across  the  front  of  the  joint,  which  was 
found  to  be  free  from  disease,  but  the  synovial  membrane 
was  thick,  the  lower  end  of  the  femur  was  foundto  be 
greatly  enlarged,  and  there  was  a  cavity  leading 
into  the  interior  of  the  bone  which  last  was  converted 


Jror»  3,  1818. 


THE  OPERATING  THEATRES. 


Thb  Msmoal  Pbiss.     '"^^l 


into  ft  00ft  and  aemiHUtrtOaginona  materiftl,  this  was 
«vid«ntl7  of  &  saroomatoiu  natare.  Amputation  was  there- 
fore performed  throogh  the  middle  of  the  femar,  by  antero- 
ftDdpoetero-lateral  flaps.  The  meduUa  at  the  point  of  section 
«howed  evidence  of  the  same  disease,  consequently  another 
inch  or  so  of  the  femur  was  removed,  and  although  the 
parts  looked  now  more  satisfactory,  their  appearance  was 
atill  suspicious  ;  pending  microscopic  investigation,  Mr. 
Rose  thought  it  wiser  not  to  expose  the  patient  on 
this  occasion  to  the  immediate  risk  of  disarticu- 
lation at  the  hip  joint.  The  man  made  a  good  recovery 
from  this  operation,  and  was  sent  away  for  change 
of  air  for  a  fortnight.  On  his  return  a  skiograph  of 
the  stump  was  taken,  and  the  negative  revealed 
that  the  upper  part  of  the  femur  was  distinctly  enlarged 
a£  compared  with  that  on  the  opposite  side,  and  that 
there  was  an  irregular  outgrowth  from  the  lower  end  of  the 
bone.  Under  theeecircumstanoes  the  only  course  left  was  to 
disarticulate  the  limb  at  the  hip- joint.  This  was  under- 
taken by  the  anterior  racket  operation,  the  incision  com- 
mencing over  the  femoral  vessels  and  passing  down  on 
either  side  for  about  four  inches.  The  flaps  of  skin  thus 
marked  out  were  dissected  up  for  an  inch  or  two,  and 
then  the  femoral  vessels  were  exposed  and  tied  a  little 
below  the  bifurcation,  which  was  here  rather  high,  the 
internal  and  external  circumflex  vessels  being  secured  at 
the  same  time.  The  soft  parts  were  now  rapidly  divided 
on  either  side,  very  little  blood  being  lost ;  the  capsule  of 
the  joint  was  opened,  the  limb  diearticulated,  and  the  few 
remaining  posterior  structures  severed.  An  examination 
of  the  femur  by  longitudinal  section  showed  disseminated 
sarcomatous  nodules  extending  the  whole  length,  one 
even  being  present,in  the  head.  Mr.  Hose  remarked  that 
although  the  local  disease  had  been  eradicated  there  still 
remained  the  possibility  of  deposits  in  other  parts  of  the 
body.  He  considered  the  anterior  racket  operation  one  of 
the  best  methods  he  had  ever  tried,  inasmuch  as  it  enabled 
the  hemorrhage  to  be  reduced  to  a  minimum,  rendering 
quite  unnecessary  any  mechanical  compression. 

The  patient  has  made  good  progress  since  the  operation. 
ROYAL  FREE  HOSPITAL. 

Examination  of  Tumoub  op  Os  Innominatum.— Mr. 
Battue  examined  arare  case  of  tumour  of  the  ilium  in  aboy, 
«t.  about  16,  who  had  been  sent  to  the  hospital  from  Luton. 
The  patient  stated  that  he  had  had  pain  about  his  right 
hip  for  three  months,  and  that  a  swelling  had  been  noticed 
for  five  or  six  weeks.  He  walked  very  well  and  did  not 
appear  emaciated.  There  was  a  large  swelling  situated 
on  the  dorsum  ilii  above  the  great  trochanter,  hard,  firm, 
and  immovably  fixed  to  bone,  about  the  size  of  a  large 
orange,  but  its  outline  could  not  be  distinctly  defined 
below  nor  posteriorly.  Another  swelling  apparently  of 
similar  extent  could  be  felt  in  the  yenter  ilii,  the  outiine 
of  which  was  obscured  owing  to  rigidity  of  the  abdominal 
muscles.  Both  tumours  extended  forwards  towards  the 
anterior  superior  spine,  but  did  not  involve  it.  Flexion 
and  other  movements  of  the  hip-joint  were  performed 
without  pain,  but  abduction  was  limited  by  the  mechani- 
cal resistance  offered  by  the  tumour.  There  were  no  signs 
of  secondary  growth  in  other  parts  of  the  body  nor  signs  of 
any  visceral  disease,  so  with  the  consent  of  the  patient's 
friends  it  was  decided  to  make  an  examination  under  an 
anaesthetic  to  see  if  it  were  possible  to  get  beyond  the  limits 
of  the  growth  and  remove  it  successfully.  Under  the 
aniBsthetic  it  was  found  that  the  internid  aspect  of  the 
ilium  was  filled  to  a  great  extent  with  a  tumour  mass  that 


extended  towards  the  brim  of  the  true  pelvis.  An  incision 
was  made  over  the  external  aspect  of  the  tumour  through 
the  muscles,  so  that  its  extension  towards  the  hip- joint 
and  anteriorly  might  be  defined ;  the  finger  could  be 
passed  downwards  under  the  muscles,  and  although  the 
edge  of  the  growth  was  definite  and  firm,  it  extended  close 
to  the  acetabulum,  so  that  any  attempt  at  removal  would 
have  implied  removal  not  simply  of  part  of  the  ilium  but 
of  nearly  the  whole  of  it,  and  this  was  considered  unjustifi* 
able  as  the  growth  on  the  inner  aspect  of  the  bone  appeared 
to  exceed  that  outside.  A  trochar  with  a  cannula  was  intro- 
duced into  the  tumour  from  the  incision  already  made  and 
a  small  amount  of  serous  fluid  exuded ;  the  cannula  was 
then  pushed  in  different  directions  so  as  to  cut  out  a  small 
piece  of  the  growth  which  might  be  utilised  for  micro- 
scopical examination.  Mr.  Battle  considered  that  the 
growth  was  of  the  nature  of  chondro-sarcoma,  its 
rapid  growth  and  fine  consistency  rendering  this 
most  probable.  The  portion  removed  was  kept  for 
microscopical  examination,  so  the  diagnosis  will  be 
definitely  ascertained  later.  An  interesting  feature  in  the 
case  was  the  family  history  of  cancer,  no  fewer  than 
three  close  relations  of  the  patient  having  died  from  some 
form  of  the  disease.  Tumours  of  the  os  innominatum, 
Mr.  Battle  thoaght,  rarely  presented  themselves 
at  a  stage  suflSciently  early  to  permit  the  idea  of 
removal  to  be  entertained,  and  out  of  a  considerable 
number  that  he  had  seen,  no  attempt  at  excision  appeared 
justifiable.  There  were,  however,  some  cases  on  record  of 
successful  excision  in  patients  suffering  from  sarcoma  of 
this  region,  and  he  had  hoped  from  examination  of  this 
boy  before  the  anesthetic  was  administered,  more  especi- 
ally taking  into  account  the  patient's  history  and  general 
good  condition,  that  removal  was  feasible. 


British  Medical  Temperance  Association. 
The  twentieth  annual  meeting  of  the  British  Medical 
Temperance  Association  was  held  on  Thursday,  May  21st, 
at  the  Wilfrid  Lawson  Temperance  Hotel,  Woodford 
Green,  Essex.  Several  members  and  friends  enjoyed  a 
drive  through  Epping  Forest  before  the  meeting.  Sir  B. 
W.  Richardson  presided,  and  the  report  was  read  by  the 
Honorary  Secretary,  Dr.  S.  J.  Ridge.  This  showed  that 
24  new  members  and  41  new  student  associatcH  had  been 
enrolled  during  the  year,  making  a  total  of  430  members, 
96  student  associates,  and  2  (Lay)  associates.  The  official 
organ  of  the  Association,  the  MediccU  Pioneer,  had  been 
sent  to  every  member  and  associate  and  to  a  laree  number 
of  subscribers,  and  upwards  of  15,000  had  been  sent 
gratuitously  to  medical  men  and  to  medical  libraries  and 
schools.  It  was  mentioned  that  a  Continental  Medical 
Temperance  Association  had  been  formed  on  similar  lines. 
A  prize  of  £3  offered  to  medical  students  for  an  essay  on 
the  action  of  alcohol  on  the  nervous  and  circulatory 
vvstems  had  been  awarded  to  Mr.  J.  Phillips,  jun.,  of  the 
Bristol  Medical  School.  The  usual  Temperance  Breakfast 
will  be  given  at  the  annual  meeting  of  the  British  Medical 
Association  in  Carlisle.  It  has  been  arranged  for  on  Thurs- 
day, July  30th,  at  the  Central  Hotel. 


Thb  Lewisbam  District  Board  of  Works,  as  the  local 
sanitary  authority,  recently  directed  the  attention  of  tlie 
Local  Government  Board  to  the  fact  that  the  Guardians 
were  rather  lax  in  the  matter  of  enforcing  the  Vaccination 
Laws,  and,  in  reply,  the  Local  Government  Board  pointed 
out  that  the  Board  of  Guardians  had  no  discretion  in 
carrying  out  the  Act.  As  the  Guardians  still  decline  to 
enforce  vaccination  when  an  excuse  was  urged  against  it, 
the  Board  of  Works  has  taken  counsel's  opinion,  and  is 
about  to  apply  to  the  Court  of  Queen's  Bench  for  a  rule 
nisi  tor  A  mandamus  caXiing  upon  the  Guardians  to  show 
cause  why  they  should  not  be  ordered  to  carry  out  the 
law. 


_^^    Ths  Medical  Psmb. 


LEADING  ABnCLES. 


Juki  3^  18B>. 


VOB  TlAMmiMOM  AJUMAD 


^he  ^BLtbkal  fxtBB  mt  (BModax. 


,PriMf4.    POStflM  5^4. 
IDVBBTIIBIIBMTS. 

fOBOnisoBDoa:— W]M>laP»tt,il6  0k0d.;  HiOf  Pi«t,  4S  lOk  Od. 
QnarlMPMtiiBlto.;  OM.«lglith,  IIl  6d. 

fOB  A  SnnB  Of  Iimsiovfl:— Wliolt  Puft,  ihlrtMB  toMrtloDi 
(WMkly,  torlnlfl^tlj,  or  mootblsr)  at  Jt  lOi.  Od. ;  twratjr-dz  tmer- 
tloDi  (WMkly  or  f oitnli^tly)  at  Jt  H.  Od. ;  llflf -two  liiMrtloiii 
(wMkiT)  At  Jt  Moh.  HiOf .pi«0,  thlrtom  liiMrtloiu  at  88t. ; 
ftw«itgr-dzat81k;llf|f.twoliiMrtloiiiafel0i.Moh.  <|iiail«wpi«0 
thlrtMD  laMrttou  at  Ul  ;  fewwly-dz  laaartioM  at  Ma. ;  fllty-dx 
Imartlona  at  lit.  oaflh 

BmaU  Annonnoomanti  of  PraottoM,  AailitoDolM,  Taeaoelai,  Book 
*o.^8«T«B  Uiiai  or  ondar,  ta  par  taiartloii ;  6d.  par  Una  bajrond 

LatUn  IB  tlila  dapartmant  ahonld  ba  addiaaaad  to  tba  PnbUabar. 

IVBlOBimon. 
FOff  JWMM  TO  AmrvAL  avBaaRiBBis  Al    1   0 

„        AMMOA3>.wnaa  TBM  ronAhVnom      «i  t  • 
I,         In>iA,  OHiaA,  An>  Jafav  .  .    Ai  •  • 

Foat-^iaoa  Ordan  and  Chaqnai  to  ba  drawn  In  tavow  of — 

A.  A.  TDTOALL.  80-21  King  William  Straat,  Strand,  London. 
A.  H.  JAOOB«  n  Molaaworth  Straat,  Dublin. 
BVBSOBiPTiOHfl  VOB  I'SABOB  ara  raoalTad  by  Maaira.  Bailubbb,  Boa 

Hantafanllla,  Parto-poattna  in  adTanoa,  Al  la.  6d.  parannnm. 
BUB80BIPTIOB8  fOB  ffHB  Ubrbd  Btatbb,    poat  fToa  in  advaaoa 
(Al  la.  6d.  par  annum),  ahonld  ba  aant  diraot  to  tha  OOcaa  In 
thia  oonntry  bj  Intamatlonal  Poat  Ottoa  Ordar. 


%  ^tbm\  f  was  ^  Ctelar. 


'8ALUS  POPULI  SUPBKMA  LBXj 


WEDNESDAY,  JUNE  8,  1896. 


GENERAL  MEDICAL  COUNCIL 
Thi  Conocil  entered  upon  its  Spring  meeting  yester- 
day (Tuesday),  when  Mr.  Thomson  was  sworn  in  as 
Direct  RepresentatiTe  for  Ireland  vice  Dr.  Eidd,  and 
Mr.  Teale  presented  Her  Majesty's  Commission  as  one 
of  the  Crown  BepresentatiTes  for  the  next  five  years. 
We  understand  that  the  Bev.  Dr.  fiaughton  has  re- 
signed his  seat  as  Representatiye  of  the  University  of 
Dublin,  and  it  is  most  probable  that  he  will  be 
succeeded  by  Mr.  Bennett,  Professor  of  Surgery  in  the 
University  School,  whose  long  services  in  that  capacity 
to  the  University,  should  mark  him  for  such  honour  as 
is  open  to  the  Board  of  Trinity  College  to  confer.  We 
also  learn  that  Dr.  C.  F.  Moore,  Bepresentative  of  the 
Apothecaries'  Hall  of  Ireland,  has  resigned  his  seat, 
and  will  be  succeeded  in  the  appointment  by  Pro- 
fessor Tichbome,  Governor  of  the  Hall.  A  chief 
item  in  the  programme  of  the  Council  is  the 
ooDFideration  of  the  demand  of  the  Irish  "  Hall "  for 
additional  examiners  to  be  nominated  by  the 
Council  to  enable  it  to  carry  on  its  examinations, 
now  that  it  has  ceased  to  work  in  combination  with  the 
Irish  College  of  Surgeons.  In  renewing  that  demand, 
which  was  rejected  at  the  last  meeting  of  the  Council, 
the  '^  HaU  "  is  placed  in  a  favourable  position  by  the 
action  of  the  Privy  Council,  to  which  it  had  appealed  i 
against  such  rejection.  The  Privy  Council  broadly  i 
hinted  that  it  would  be  disposed  to  give  the  examiners  | 
asked  for,  if  the  "Hall"  would  take  examiners  in  : 
medicine  as  well  as  in  surgery,  for  the  consideration  I 
of  which  proposal  it  referred  back  the  subject  to 


the  General  Medical  GounciL  To  ensure  the  ngectioiff 
of  the  re  appeal  of  the  ''HalP  the  utmost  eiEortB 
of  the  Irish  College  of  Physicians  and  its  ooad^ 
jutors  in  the  Council  have  been  put  forth.  So  far, 
indeed,  has  this  hostUity  to  the  ''Hall"  been  pressed 
that  the  Bepresentative  of  the  Chief  London  license 
ing  Corporation  has  considered  it  not  inconsistent  with 
his  position  to  write  letters  to  personages  in  Dublin 
whom  he  thought  might  help  him,  begging  them  ta 
exercise  every  influence  to  get  instructions  issued  ta 
Bepresentatives  from  Ireland  that  they  shall  vote 
against  the  ''Hall."  The  attempt  thus  to  prepare  a 
verdict  in  advance  totally  faUed,  but  that  fact  does  not 
mitigate  the  indecency  of  the  proceeding.  That  a 
gentleman,  bound  alike  by  his  official  position  and  by 
the  trust  confided  to  him  by  the  Council,  should,  in  the 
exercise  of  his  function  as  Inspector,  depreciate  the 
body  upon  which  he  was  commissioned  to  pass  judg- 
ment, and  then  should  forthwith  constitute  himself 
a  tout  of  the  party  devoted  to  the  destruction  of  the 
body  which  he  had  judged,  is,  we  think,  scarcely  con- 
sistent with  his  dignity,  or  that  of  either  the  College 
which  he  represents,  or  of  the  General  Medical  Council 
of  which  he  is  a  member.  The  Apothecaries'  Hall  of 
Ireland  approaches  the  trial  of  the  issue  in  the  General 
Medical  Council  under  very  adverse  circumstances.  Its 
former  Bepresentative  has,  in  consequence  of  domestic 
affliction,  resigned  his  seat  The  places  of  Dr.  Kidd 
and  Dr.  Haughton,  both  of  whom  had  taken  a  wide 
view  of  the  question  apart  from  Corporation 
interests,  will  be  filled  by  gentlemen  who 
are  currently  believed  not  to  be  fond  of  the 
Irish  Apothecaries'  ElaU.  It  is  to  be  assumed 
that  the  Direct  Bepresentative  for  Ireland  will 
feel  bound  to  give  weight  rather  to  the  question.  What 
is  best  for  the  profession  and  public  in  Ireland  f  rather 
than,  What  is  best  for  the  Corporations  and  Colleges  f 
If  he  thinks  it  a  good  arrangement  to  leave  medical 
qualification  in  Ireland  to  a  single  Corporate  monopoly 
he  will,  no  doubt,  vote  against  the  grant  of  the  addi- 
tional examiners  to  the  Irish '' Hall."  It  is  greatly  to 
be  regretted  that  the  dispute  should  be  narrowed  down 
to  this,  but  the  blame  for  that  fact  lies  at  the  door  of 
the  Boyal  College  of  Physicians  of  Ireland,  which  haa 
been  prevented  by  its  impenetrable  and  impractical 
omotir  proprefromentertainingaproposalforatripartite 
examination  such  as  is  worked  in  Scotland,  and  which 
would,  at  any  moment,  settle  the  controversy  to  every- 
one's satisfaction. 


THE  FBIENDLY   SOCIETIES    QUESTION. 

Thb  contest  which  for  the  past  few  weeks  has  been 
in  progress  between  the  United  Friendly  Societies  in 
Lincoln  and  the  medical  men  of  the  town  has  now 
reached  a  stage  the  proceedings  of  which  should  claim 
the  attention  of  the  whole  of  the  profession.  In  brief 
the  causes  of  the  contest  were  that  the  old  policy  of 
sweating  the  Medical  Officers  was  resorted  to,  that 
the  appointments  became  too  derogatory  for  any  self- 
respecting  medical  man  to  hold,  and  that  the  commer- 
cial element  was  the  only  one  to  which  the  promoters 
seemed  anxious  to  devote  any  special  attention.    Bat 


JuNS  3,  1896. 


LEADING  AETICLE8. 


Ths  Midioal  Pbm8.     583 


because  the  officers  of  the  societies  failed  to  secure  the 
services  of  any  medical  men  in  Lincoln,  the  result 
proved  that  they  had  no  reason  for  feeling  anxious  as 
to  candidates  for  the  appointments.  Ab  a  matter  of 
fact,  this  was  a  difficulty  which  was  easily  surmounted. 
In  drawing  attention  to  this  matter  it  is  sad 
to  reflect  that  medical  men  can  be  found  who  are 
prepared  to  play  into  the  hands  of  the  tradesmen  who 
conduct  these  associations.  How  can  the  honour  and 
respectful  integrity  of  the  profession  be  upheld  when 
audi  derelictions  of  duty  are  committed  by  practi- 
tioners, as  in  the  Lincoln  case.  We  must  here  repeat, 
as  we  have  said  over  and  over  again,  that  the  responsi- 
bility of  dealing  with  these  cases  imperatively  falls  upon 
the  General  Medical  Council.  The  Council  have  by  an 
inane  and  feeble  resolution  shirked  their  responsibility. 
But  this  is  no  reason  why  the  question  should  not  be 
reopened.  Under  present  drcumstanoes  the  difficult 
position  of  maintaining  the  honour  of  the  profession 
falls  upon  the  shoulders  of  those  practitioners  who 
honourably  refuse  to  be  allied  to  these  societies.  No 
assistance  in  these  contests  is  derived  from  the  '^  Parlia- 
ment "  of  the  profession,  the  General  Medical  Council. 
The  Council  have  emphatically  declined  to  interfere, 
and  thus  the  evil  of  these  societies  continues  to  prevail, 
despite  remonstrances,  dignified  protests,  and  refusals 
to  compromise  themselves  by  the  self-respecting  mem- 
bers of  the  profession  concerned.  The  time  has  really 
arrived  when,  in  our  opinion,  very  strong  action 
should  be  taken  to  compel  the  General  Medical  Council 
to  do  their  duty  in  regard  to  the  deroga- 
tory appointments  filled  by  medical  men  asssociated 
with  medical  aid  societies.  So  long  as  the  Coun- 
cil in  no  way  interfere  with  the  practitioners  holding 
such  appointments,  so  long  will  the  abases  exist.  On 
the  other  hand,  were  a  ukase  to  be  issued  exacting 
certain  conditions  from  the  holders  of  such  appoint- 
ments on  pain  of  being  indicted  on  a  charge  of 
*' infamous  conduct  in  a  professional  respect,'^  the 
societies  would  be  compelled  to  conform  to  the 
demands,  or  cease  work  by  reason  of  their  failure  to 
secure  medical  officers.  The  practitioners  in  the  town, 
with  the  object  of  circumventing  the  influence  of  the 
Lincoln  Medical  Aid  Association,  have  just  inaugu- 
rated the  "Lincoln  Provident  Medical  Associatioo," 
with  the  view  to  benefiting  the  wage-earning  classes, 
which  are  unable  to  pay  the  usual  medical  fees.  The 
undertaking  is  in  no  sense  a  commercial  one.  The  Com- 
mittee of  Management  is  an  honorary  one,  the  medical 
officers  are  appointed  by  the  practitioners  of  the  city, 
who  will  also  elect  annually  the  Committee  of  Manage- 
ment, which  is  chiefly  composed  of  medical  men.  It  is 
further  stated  that  no  private  practitioner  will  derive 
any  pecuniary  benefit  from  the  Association,  and  that 
the  Association  was  founded  in  order  to  obviate  any 
hardship  which  misht  fall  upon  the  wage-earning 
classes  owing  to  the  combination  of  the  Lincoln 
medical  men  in  regard  to  the  existing  medical  aid 
societies  in  the  town.  There  is  much  reason  for  believ- 
ing that  were  this  course  to  be  adoi>ted  in  other  locaJi- 
ties  in  which  medical  aid  societies  exist,  and  the  example 
of  the  Lincoln  medical  men  followed,  much  good  would 
result  in  the  direction  of  the  suppression  of  these  trade 
concerns. 


HORSEFLESH  AS  FOOD. 
It  is  probable  that  in  no  part  of  his  life-habits  is 
mankind  more  hopelessly  the  slave  of  prejudice  than  in 
the  matter  of  food.  The  Chinaman  feasts  gleefully 
upon  swallows'  nests,  sharks,  puppy  dogs,  and  other 
delicacies  that  would  savour  of  deep  abomination  to 
Europeans,  while  he  agrees  with  Jews  and  Mahome- 
dans  in  cursing  pork.  But,  if  we  take  our  own  country 
as  a  western  type,  we  find  that  wide  differences  exist 
among  our  kith  and  kin  as  to  what  they  eat  and  what 
they'eschew  in^the'shape  of  solid  food.  Some  are  vegeta^ 
rians  and  flout  the  contention  that  the  human  mammal 
is  anatomically  meant  to  be  a  mixed  feeder.  Some 
form  societies  to  investigate  and  consume  harm- 
less wild  fungi  in  general,  whereas  the  average 
man  in  the  street  is  sufficiently  content  with  the 
single  toothsome  variety,  the  agarictu  campestns,  or 
meadow  mushroom.  Others  of  our  countrymen  are 
hippophagists,  that  is  to  say,  eaters  of  horseflesh.  Id 
this  matter  they  have  followed  the  example  set  by 
various  continental  countries,  notably  France  and 
Belgium.  Nor  is  it  easy  to  imagine  any  scientific 
objection  to  the  use  of  horseflesh  as  food  for  mankind 
if  animals  are  to  be  used  at  all  as  an  article  of  diet. 
Horses  are  clean  feeders ;  for  that  matter,  they  are 
just  as  dainty  as  cattle  and  sheep,  and  infinitely 
superior  to  pigs.  Then,  again,  they  are  far  less  subject 
to  disease,  such  as  tuberculosis  and  trichinosis,  which 
may  be  transmitted  to  the  human  consumer,  than  are 
animals  now  slaughtered  daily  in  enormous 
hecatombs  for  human  food.  Such  being  the 
facts  of  the  case,  it  is  hardly  possible  to  avoid 
the  conclusion  that  the  objection  to  hippophagy, 
to  dignify  the  practice  by  its  full  and  formal  title,  is 
founded  on  sentiment  rather  than  on  reason.  When, 
therefore,  a  leading  London  newspaper  bursts  out  into 
a  blaze  of  indignation  because  the  Belgians  choose  to 
import  our  worn  out  horses  as  an  article  of  food,  we 
think  it  time  to  utter  a  mild  but  firm  protest.  Last 
week,  the  Daily  Chronicle  opened  its  leaderette  column 
by  a  paragraph  which  began  thus  :—^' Every  now  and 
then  one  is  deeply  shocked  by  the  sudden  revelation  of 
some  unsuspected  horror  in  our  midst.  We  print  one 
to-day  from  Belgium.  The  Minister  of  Agriculture  in 
Brussels  has  admitted  that  4,000  old  horses  are  exported 
yearly  from  England  to  Belgium  to  be  made  into 
tinned  meat."  Where  the  "horror'*  of  the  affiedr  comes 
in  will  hardly  be  apparent  to  the  readers  of  a  scientific 
journal.  It  has  a  very  real  existence,  however,  in  the 
case  of  the  sentimental  Daily  Chronicle  writer,  for  he 
dismisses  the  suggestion  of  the  Belgian  Minister  that 
all  ''horses  imported  for  food  should  be  specially 
branded''  with  the  sapient  and  judicial  remark, 
"  For  our  own  part  we  should  prefer  to  see  the  branding 
done  upon  the  backs  of  the  people  engaged  in  this 
sickening  traffic."  Let  English  voluntary  eaters  of 
horseflesh,  therefore,  beware  of  this  journalistic  fire- 
eater.  We  wonder  if  he  is  ready  to  settle  other  matters 
of  gastronomic  taste  in  an  equally  high-handed 
manner.  A  good  number  of  our  countrymen,  for 
instance,  eat  snails :  would  he  have  all  such  offenders 
pilloried  because  they  avail  themselves  of  a  clean-feeding 


684    Tn  Mbdioal  Pbbm. 


NOTES  ON  CTJREENT  TOPICS 


JuiTB  3,  1896. 


«iid  QutritiouB  moUiuc  which  Ib  to  be  obtained  all  over 
the  Uaited  Kingdom  for  the  asking?  Does  he  think 
that  all  Frenchmen  who  eat  frogs  should  be  whipped? 
What  would  he  suggest  should  be  done  to  the  China- 
men who  indulge  in  all  kinds  of,  to  him,  unhallowed 
food?  That  his  line  of  reasoning  in  condemning 
Belgium  for  its  hippophagy  is  mainly  sentimental  may 
be  gathered  from  the  foUowinginspired passage  :— ''The 
kindly*  willing,  plucky,  spirited,  silent  horse,  who  flings 
up  his  heels  as  a  foal,  gallops  in  his  prime  as  a  racer 
or  hunter,  or  steps  out  proudly  with  his  heavy  load, 
drags  first  a  day  hansom  and  then  a  night  hansom, 
and  ends  his  working  days  as  a  sprung  and  spavined 
bag  of  bones  in  a  'growler,'  is  not  even  allowed  to 
die  in  peace,  but  is  sold  again,  and  sent  suffering  agony 
over  sea,  to  be  knifed  in  a  foreign  slaughter  house,  and 
eaten  as  tinned  beef  by  the  descendants  of  the  men  who 
ran  away  at  Waterloo."  This  tearful  sub-editor  has 
allowed  his  pity  to  blind  the  dear  and  lucid  style 
which  usually  stamps  the  first  page  utterances  of  a 
London  "daUy."  Has  he  never  seen  lambs  afrolic  in 
the  fields,  or  the  shapely  comeliness  of  well-bred  cattle 
at  a  show,  and  does  he  still  partake  of  lamb  or  beef  ? 
Does  he  think  that  the  fact  of  the  imported  horses 
being  destined  to  lie  in  ''tins"  is  an  added  indignity 
to  the  equine  race  ?  Does  it  not  strike  him  that  the 
state  of  the  horses  in  the  United  Kingdom  which  he 
describes  points  to  a  mote  in  our  own  eye  ?  We  should 
feel  inclined  to  condemn  the  owner  of  a  fine  horse  who 
«old  him  for  cab  purposes  much  more  than  the  man 
who  exported  him  to  be  "  knifed  '*  and  to  be  eaten  by 
Belgians  rather  than  by  cats  and  dogs.  And  what. 
Oh !  what,  has  the  fact  that  a  man's  ancestors  once 
turned  tail  in  a  great  battle  to  do  with  his  choice  of 
food,  whether  that  be  cattle,  fish,  or  horses,  or  slate- 
pencils,  or  slugs,  or  any  other  living  or  dead  thing  what- 
so-ever,  even  mares'  nests  ?  But  the  Daily  Chronicle 
man  need  not  go  so  far  afield  as  Belgium  to  find  his  emo- 
tional "  copy."  In  London,  unless  we  are  misinformed, 
there  is  an  immense  surreptitious  traffic  in  horsefiesh, 
especially  among  the  poor.  In  many  foreign  restaur- 
ants in  the  metropolis  we  believe  it  is  a  common 
practice  to  serve  up  horse-beef  in  lieu  of  beef -steak.  At 
any  rate,  from  time  to  time  cases  crop  up  in  the  police 
courts  where  knackers  are  convicted  of  disposing  of 
horseflesh  to  butchers.  Here,  then,  is  a  legitimate 
outlet  for  the  young  man  of  feverish  sentiment  who 
writes  the  Chronicle  leaderettes,  namely,  to  inquire  into 
the  systematic  fraud  alleged  to  be  practised  largely 
opon  Londoners  by  the  sale  of  horseflesh  in  place  of 
what  is  commonly  known  as  "  butcher's  "  meat  As  to 
whether  the  objections  to  horseflesh  as  an  article  of 
food  is  not  purely  SBSthetic,  and  whether  our  own 
countrymen  by  abstaining  from  horseflesh  are  not 
denying  themselves  a  valuable  food-stuff*,  we  offer 
no  opinion. 


JtottB  on  (Etttrent  ^oficB. 

The  Legal  Aspeots  of  Obecene  Advertisizi^. 
OuB  attention  was  recently  called  to  two  advertise- 
ments in  an  Irish  provincial  paper,  one  of  a  book  by 
the  notorious  "  Dr.  "  Allinson  who  was  expunged  some 
time  since  by  the  General  Medical  CouncU  for  ^  infa- 
mous conduct  in  a  professional  respect,"  and  the  other 
by  a  person  who  calls  herself  Madame  Frain.  Allinson 
advertises  a  shilling  catchpenny  book  ''for  ladies" 
married  and  unmarried,  and  sets  forth,  in  terms  sug- 
gestively prurient,  the  sexual  information  which  such 
authors  think  likely  to  prove  attractive  to  the  readers 
whose  patronage  they  want  Madame  Frain  advertises 
an  abortion  medicine  at  4s.  6d.  a  bottle,  with  the  usual 
encomiums.  As  it  seemed  to  us  that  both  the  adver- 
tisements were  calculated  to  corrupt  public  morality 
and  to  debauch  the  minds  of  readers,  we  thought  it 
well  to  call  the  attention  of  the  Public  Prosecutor  to 
them  with  the  object  of  ascertaining  whether  they  come 
within  reach  of  the  law  as  indecent  publications.  We 
have   received  the  following  letter  in  reply  to  our 

queries  :— 

Treasury,  Whitehall,  S.W., 

May  2l8t,  1896. 

SiK, — lo  reply  to  your  letter  of  the  18th  May,  we  have 
often  had  occasion  to  consider  advertisements  of  this 
nature.  The  principles  on  which  the  qaesbion  of  obscenity 
is  to  be  determined  have  been  much  discussed  in  the  well- 
known  casesof  R.  v.  Hicklin,  3  2  B  360,  and  Steele  v.  Brannan 
(arising  out  of  the  publication  of  "The  Confessional 
Unmasked"  )  L  K.  7  C  P  261,  but  it  is  one  of  fact  which 
must  be  decided  by  the  opinion  of  the  particular  tribunal 
before  which  proceedings  may  be  taken  in  respect  of  such 
publication,  and  it  might  be  considered  that  advertise- 
ments of  the  nature  yon  enclose,  although  most  undesir- 
able and  improper,  are  not  obsoene  publications. 

The  conclusion  arrived  at  in  respect  of  prosecutions  of 
this  nature  has  been  generally  afsrainst  the  expediency  of 
prosecuting,  both  as  a  matter  of  public  policy,  prosecu- 
tion resulting  in  {^vine  a  wide  publicity  to  the  publication 
and  on  account  of  the  difficulty  of  determining  toe  question 
of  fact. 

The  prooeedines  in  respect  of  the  advertisements  would 
be  a^inst  the  Printer  and  Publisher  of  the  newspaper 
containing  tiie  advertisements,  and  the  matter,  so  far  as 
the  advertisements  are  concerned  would  be  for  the  con- 
sideration of  the  authorities  in  Ireland. 

As  regards  Mr.  Allinson's  book,  I  think  it  may  be  assumed 
that  the  advertisement  sufficiently  indicates  its  nature  and 
that  if  the  one  is  obscene  the  other  is  also. 

Any  prosecution  of  Mr.  Allinson  for  publication  of  an 
obsoene  libel  would  be  within  the  jurisdiction  of  the 
Metropolitan  Police  Courts.  I  have  not  seen  the  book, 
but  unless  it  is  something  more  than  a  popularised  medi- 
cal work  and  contains  matter  which  is  on  the  faoe  of  it 
obscene  for  the  sake  of  obsoenity  and  intended  to  gratify 
base  passions,  a  prosecution  in  respect  of  the  publication  of 
such  a  work  would  be  neither  expedient  nor  successful,  but 
as  to  the  latter,  this,  as  I  have  explained,  would  b^  for  the 
determination  of  the  tribunal  dealing  with  the 


A  COMPETITIVB  examination  for  twenty-five  commis- 
sions in  the  Army  Medical  Staff  will  be  held  on 
August  7th  next  and  following  day.  Particulars 
thereof  will  be  found  in  our  advertisment  columns. 


whether  magistrate  or  jury. 

I  may  point  out  that  Mjadame  Frain's  advertisement  is 
a  fraudulent  one,  as  from  analyses  we  had  made  of  the 
articles  mentioned  in  her  advertisements  it  appeared  that 
they  were  comprised  of  such  ingredients  as  water  tinged 
with  aloes,  bread  and  bicarbonate  of  soda,  and  the  like, 
the  sale  of  such  articles  really  amounts  to  obtaining 
money  by  false  pretences.  1  return  the  advertisements 
in  case  you  may  require  them. 
I  am.  Sir, 

Your  obedient  Servant, 

Baknabd  Thomas, 
AssistflUQt  Director. 

This  enunciation  of  the  law  bearing  upon  obscene  ad- 


JuNX  3, 1896. 


NOTES  ON  CTJKRENT  TOPICS. 


TSI  MlDIQAL  PBI88.      685 


▼ertising  is  interesting.  As  legards  Madame  Frain,  it 
appears  that  a  prosecution  for  obtaining  money  under 
false  pretences  would  lie,  but  it  should  be  maintained 
not  by  the  Public  Prosecutor  but  by  some  individual 
whoyhavingpurchased  the  fraudulent  concoction,  should 
prove  by  competent  analyst's  evidence  that  it  is  not 
what  it  professes  to  be.  Ab  regard  Allinson's  book,  it 
is  declared  that  an  author  cannot  be  prosecuted  unless 
his  book  *^  contains  matter  which,  on  the  face  of  it,  is 
obscene,  for  the  sake  of  obscenity,  and  intended  to 
gratify  base  passions."  This  appears  to  represent  a 
very  unsatisfactory  state  of  the  law,  because  it 
bears  upon  the  intention  of  the  advertiser  rather  than 
upon  the  demoralising  effect  of  the  advertisement  A 
rabid  Malthusian  might,  in  perfect  good  faith,  and  in 
furtherance  of  his  craze,  publish  matter  which  would 
be  in  the  highest  degree  demoralising,  but  which  would 
not  be  "  obscene  for  the  sake  of  obscenity  or  intended 
to  gratify  base  passions."  In  short  if  the  law  permits 
the  publication  of  obscene  matter,  provided  that  it  is 
not  published  "for  the  sake  of  obscenity,"  it  seems 
obvious  that  the  law  needs,  like  many  other  laws,  to 
be  amended. 


The  Belatioii  of  Tabes  Dorsalis  to  Syphilis. 
Many  authorities  hold  that,  in  most  cases,  tabes  dor- 
salis is  of  syphilitic  origin,  but  the  recent  researches  of 
Storbeck  into  this  subject  by  no  means  confirm  this 
opinion.  The  case  books  in  the  hospital  and  private 
practice  of  Professor  Leyden  showed  108  cases  of 
tabes,  and  among  these,  in  22,  there  was  a  history  of 
syphilis  ;  in  23  a  syphilitic  history  was  doubtful,  while 
in  63  syphilis  could  be  excluded.  If  one-hcdf  the 
doubtful  cases  were  really  syphilitic  the  result 
would  be  30*6  per  cent,  which  Storbeck, 
from  the  frequency  of  syphilis,  thinks  is  not 
higher  than  could  be  expected,  so  that  the 
relation  of  the  two  diseases  does  not  seem  to  him  to 
be  established.  The  percentage,  on  the  other  hand, 
of  syphilitic  cases  in  tabes  according  to  D^j^rine  is  97 
per  cent.,  while  Mayer  believes  that  syphilis  has 
nothing  to  do  with  the  disease.  Between  these  two 
extremes  many  observers  have  recorded  their  experience 
on  the  subject,  and  the  varying  percentages  which  they 
have  given  tell  greatly  in  favour  of  the  view  that  tabes 
dorsalis  is  unquestionably  a  disease  of  syphilitic  origin, 
but  by  no  means  to  the  extent  which  is  commonly 
supposed. 

Hypnotism  for  the  Core  of  Insanity. 
Ws  thought  we  had  good  reason  to  suppose  that 
this  craze  had  died  out,  and  on  receiving  a  cutting 
from  the  New  York  World  we  still  believed  that  it 
would  only  find  favour  in  sensational  papers  of  that 
description,  but  we  regret  to  say  that  we  are  dis- 
appointed. From  our  own  country,  from  Hoxton 
House  Asylum,  Shoreditch,  comes  the  latest  develop- 
ment of  this  advertising  craze.  The  29 ew  York  World 
gives  a  graphic  picture  of  a  female  patient  having  a 
new  device  in  the  form  of  a  head  apparatus  applied  for 
the  purpose  of  inducing  hypnotic  effects.  The  doctor 
of  the  Asylum  is  interviewed,  and  his  statements  are 


accepted  as  having  all  the  air  of  authority.  He 
is  said  to  have  showed  the  head-gear  already  men- 
tioned, which  is  a  metal  piece,  and  he  is  also  said  to  have 
explained  its  action  as  follows  :— "  By  fastening  it  on^ 
the  head  like  a  night  cap,  and  by  pressing  a  screw  on 
any  part  of  the  cranium  you  can  act  on  the  brain  ceUs^ 
and  the  patient  will  do  your  bidding."  We  are  not 
surprised  that  the  interviewer  adds  :— "  It  gave  me  a 
creepy  sensation  to  think  that  it  was  in  the  power  of 
anotiier  human  being  to  render  me  perhaps  an  auto- 
maton at  will."  There  can  be  no  doubt  that  this 
savours  somewhat  of  quackery.  It  is  not  necessary  to 
invent  any  device  to  hypnotise  or  render  amenable  to 
suggestions  certain  subjects,  and  when  a  member  of 
the  medical  profession  deliberately  talks  of  acting  upon 
certain  brain  cells  by  pressing  a  screw,  and  thereby 
controlling  the  patient's  will,  he  is  talking  utter 
rubbish,  and  if  he  is  not  knowingly  making  a  fool  of 
his  auditors,  his  ignorance  of  cerebral  structure  and 
cerebral  function  is  as  undoubted  as  it  is  incompre- 
hensible. The  interests  of  medical  science  are  not 
furthered  by  this  kind  of  advertisement. 


The  Death  of  Sir  Bussell  Be3rnolds. 
Ths  long  and  anxious  illness  of  Sir  J.  Russell 
Reynolds  has  terminated,  as  for  some  time  had  been 
anticipated,  fatally.  Late  in  the  afternoon  of  the  29\ik 
ult  our  distinguished  eonfrh't  passed  away,  to  the- 
general  regret  of  the  profession,  and  to  the  great 
sorrow  of  a  wide  circle  of  patients  and  friends.  It  is- 
asserted,  undeniably  with  a  large  measure  of  truth,, 
that  the  arduous  duties  of  the  appointments  which  Sir 
Russell  Reynolds  held  last  year  have  had  much  to  do 
with  the  onset  of  the  illness  to  which  he  has  just  suc- 
cumbed. To  the  responsible  official  work  in  connection 
with  his  Presidency  of  the  Royal  College  of  Physicians 
he  was  called  upon  to  discharge  the  exceedingly 
laborious  engagements  associated  with  the  Presidency 
of  the  British  Medical  Association,  the  annual  meet- 
ing of  which  was  held  in  London  last  year.  Few  who 
saw  him  after  the  labours  of  the  meeting  were  over 
could  fail  to  have  been  struck  with  the  terribly 
''fagged"  appearance  which  he  then  presented. 
Punctiliously,  conscientiously,  and  unremittingly  as  he 
discharged  those  duties,  from  the  first  it  was  clear  that 
he  never  spared  himself,  and  to  his  arduous  exertions 
a  large  measure  of  the  success  of  the  meeting  was 
due.  The  British  Medical  Association  are  now  without 
a  president,  and  the  duties,  therefore,  which  would 
otherwise  have  devolved  upon  Sir  Russell  Reynolds- 
will  have  to  be  undertaken  by  some  other  officer  of  the 
Association  at  the  annual  meeting  in  Carlisle  in 
August  A  full  obituary  notice,  with  portrait,  of  the- 
late  distinguished ;  physician  appears  in  another 
column. 


Snt  William  H.  Bboadbsnt  will  take  the  chair  at 
St  Mary's  Hospital  Festival  Dinner,  at  the  Whitehall 
Rooms,  on  June  17th.  The  object  of  the  dinner  is  to 
raise  a  good  portion  of  the  £12,376  required  to  com* 
plete  the  new  out-patients'  department  cd^the  Clarence 
Memorial  Wing. 


686     Ths  Mvdjoal  Pr»8. 


NOTES  ON  CURRENT  TOPICS. 


Juke  3.  1896. 


The  Deadlock  at  the  Liverpool  Lying-in 
Hospital 

Thb  Board  of  Management  appear  to  be  slowly 

Awakening  to  the  awkward  position  in  which  they  have 

succeeded  in  placing  themselves.    This  is  shown  by  the 

resolutions  passed  at  a  meeting  held  on  the  28th  alt., 

There  was  a  full  attendance  of  members  and   the 

following  were  passed  unanimously  :— 

Differences  of  opinion  having  arisen  between  the 
Board  of  Management  and  the  late  medical  staff  of  the 
Ladies'  Charity  and  Lying-in  Hospital  as  to  the  proper 
construction  of  the  rule* ,  and  sach  differences  having 
resulted  in  the  Medical  Institnbion  passing  a  resolution 
intended  to  preclude  the  charity  from  obtaining  direct 
medical  aid,  either  voluntary  or  paid,  and  it  being  recog- 
nised that  notwithntAuding  these  differences,  the  Board  of 
Management,  the  late  medical  staff,  and  the  Medical 
Institution  have  the  welfare  of  the  charity  at  heart,  it  is 
resolved  that  an  offer  be  made  to  the  late  medical  staff  and 
the  Medical  Institution  to  lay  the  whole  matter  before  the 
jLord  Mayor,  as  arbitrator,  the  following  being  suggested 
j»  the  terms  of  such  reference : — 

1.  That  the  arbitrator  decide  whether  the  reading  of  the 
rules  by  the  Board  of  Management  or  ^e  medical  staff  ia 
the  correct  one. 

2.  That  the  arbitrator  be  asked  to  give  his  opinion  as  to 
the  advisability  of  any  modification  of  such  rules. 

3.  That  the  arbitrator  be  asked  to  state  his  opinion  for 
what  purposes  the  hospital  is  intended  to  be  used  accord- 
ing to  the  objects  contemplated  by  the  charity. 

4.  That  the  arbitrator  decide  what,  if  any,  representa- 
tion the  medical  board  ought  to  have  on  Uie  Board  of 
Management. 

5.  That  all  the  parties  ame  to  abide  by  the  dedaion, 
and  act  upon  the  recommendations  of  the  arbitrator. 

It  is  quite  clear  from  the  foregoing  that  the  Board 
has  given  in,  but  instead  of  surrendering  their  weapons 
to  the  conquering  party  they  offer  them  to  the  Earl  of 
Derby  as  Lord  Mayor  of  the  city.  This  may  be  con- 
sidered adroit,  but  it  is  not  ingenuous,  and  the  offer  in 
no  way  alters  the  situation.  The  Board  has  still  to 
learn  that  none  but  medical  men  can  settle  the  dispute, 
and  that  on  their  part  the  last  word  has  been  said. 
'They  must  be  first  or  nowhere.  It  is  idle  to  say  that 
the  present  state  of  affairs  has  been  in  existence  for  ten 
years.  If  it  had  the  then  staff  did  not  know  it,  and  the 
Tales  did  not  show  it,  otherwise  they  must  have  resigned 
as  the  late  one  did.  Mr.  Bartlett,  as  a  lawyer,  may 
.decide  that  normal  labour  ia  not  a  medical  matter,  but 
every  medical  student  knows  that  obstetrics  is  an 
important  branch  of  medicine,  and  that  obstetrics 
•indudee  natural  labour.  Dr.  Bentoul  in  a  recent 
letter  in  the  papers,  makes  the  sensible  suggestion 
that  the  dedsion  should  be  left  to  the  General  Medical 
-Council.  Why  does  not  the  Board  resign?  Every 
day  makes  it  more  difficult  for  any  medical  staff  to 
work  with  them,  there  is  no  longer  a  question  of  work- 
ing under  them. 

The  Bzpiring  Anti- Vaccination  dry  in 
Gloucester. 
It  is  highly  amusing  to  read  in  some  of  the  local 
journals  of  the  West  Country  district  of  the  efforts 
made  by  the  anti-vaccination  party  to  bolster  up 
their  discredited  cause.  But  it  is  quite  impossible 
for  those  who  write  in  favour  of  vaccination 
to  silence  their  bleatings.  The  irrepressible 
young   medical   man,   Mr.    Hadwen.  was  indiscreet 


enough  last  week  to  send  a  further  communication  to 
a  local  journal,  but  his  letter  was  so  unmercifully  dealt 
with  by  Dr.  Davies,  the  Medical  Officer  of  Health  for 
Bristol,  that  probably  most  persons  in  the  district  had 
begun  to  congratulate  .themselves  that  they  had  heard 
the  last  of  him.  But  no  such  thing.  A  few  days 
afterwards  another  effusion  of  Mr.  Hadwen's  was  pub- 
lished, and  so  the  farce  continues.  Another  arch  anti- 
vacdnationiBt  in  Bristol  was  also  skilfully  disposed  of 
by  Dr.  Davies  in  the  same  reply.  In  the  course  of  a 
further  communication  this  anti-vacdnationist  makes 
the  astounding  and  untruthful  assertion  that  the  Royal 
Commission  on  Vaodnation  does  not  contain  a  single 
anti-vaccinationist  among  its  members.  This  is  a  good 
example  of  the  tactics  to  which  the  anti-vaccinationista 
are  now  compelled  to  resort.  It  is  of  interest  to  note, 
also,  that  they  are  endeavouring  to  create  a  sensation 
by  challenging  Dr.  Davies  to  take  part  in  a  public 
discussion,  himself  to  represent  vaccination,  and  an 
opponent  to  support  the  anti- vaccination  craze.  The 
Bristol  Anti-Compulsory  Vaccination  Society  have 
undertaken  to  provide  a  room  and  pay  all  expenses 
inddental  to  the  contest  The  artfulness  of  this  chal- 
lenge is  that,  of  course,  the  anti- vaccinationists  intend 
to  make  the  most  of  it  if  it  be  not  accepted,  as  we  trust 
that  it  will  not 

Diarrhoea  Mortality. 
Thb  enormous  death-rate  from  diarrhoea,  especially 
among  children,  is  attracting  the  general  attention 
of  sanitarians.  Thus  far,  it  seems  clear  that  scientific 
medicine  has  little  real  knowledge  with  regard  to  the 
etiology  of  this  fatal  condition.  As  a  symptomatic 
affection,  there  can  be  no  doubt  that  it  is  due  to  causes 
of  multiple  origin.  The  subject  has  of  late  figured  in 
the  writings  of  many  medical  officers  of  health,  and 
the  following  passage,  taken  from  the  annual  report  of 
Dr.  Robertson,  the  Medical  Officer  of  St.  Helens,  may 
be  taken  as  a  type  of  the  general  attitude  of  public 
health  officers :— "  The  great  majority  of  deaths  from 
diarrhoea  are  due  to  preventible  causes.  Investigation 
shows  in  a  most  pointed  manner  that  the  three  main 
factors  to  be  dealt  with  are  :— 1.  The  ignorance  dis- 
played by  mothers  of  the  most  elementary  principles 
in  the  rearing  of  young  infants,  especially  as  regards 
their  food.  2.  Among  the  lower  classes  there  is  a 
certain  amount  of  carelessness,  which,  although  not 
culpable,  is  most  productive  of  harm.  3.  Insanitary 
surroundings,  although  probably  influencing  the  mor- 
tality of  children  suffering  from  marasmus,  debility, 
diarrhoea,  and  some  other  diseases,  do  not  play  in  St. 
Helens  such  an  important  part  as  the  first  two  factors." 
A  most  promising  field  of  inquiry,  likely  to  be  fraught 
with  scientific  and  practical  results  of  the  utmost 
value  to  the  community,  awaits  the  investigator  who 
will  work  out  the  history  of  infantile  diarrhoea.  There 
can  be  no  doubt  that  the  bacteriology  of  dairy  milk 
under  varying  conditions  of  environment  will  form  an 
important  step  of  the  advance  towards  a  more  perfect 
understanding  of  the  matter. 


JuNS  3,  1896. 


NOTES  ON  CURBENT  TOPICS. 


The  Medical 


587 


A    Notable    Instanoe    of  the  Value    of 
PflBBtenrisxxL 

Thb  valae  of  a  Pasteur  Institute  has,  according  to 
the  British  Oonsnl  at  Fineus,  been  remarkably  shown 
in  Athens.  The  Institute  was  opened  in  August,  1894, 
by  Dr.  Pampoukis,  and  during  the  first  sixteen  months 
of  its  existence  201  cases  were  treated,  of  which  176 
were  from  Qreece,  21  from  Egypt,  and  4  from  Asia 
Minor.  There  was  only  one  death,  and  in  this  case  the 
patient  had  delayed  applying  for  treatment  until  fif- 
teen days  after  having  been  bitten.  The  Consul  also 
adds:  "It  is  practically  impossible  to  over-estimate 
the  value  of  such  an  establi^ment  in  the  Levant,  and 
its  existence  should  be  made  widely  known.  Not  only 
does  the  curse  of  masterless  dogs  exist  in  Greece,  but 
even  more  so  in  the  neighbouring  countries.  A  muzz- 
ling order  does  exist  in  Attica,  but  it  is  not  enforced, 
^nd  the  strewing  of  poisoned  meat  in  the  streets  of 
Athens  and  Piraeus  is  apparently  the  only  attempt 
made  by  the  authorities  to  deal  with  an  increasing 
amount  of  rabies."  These  facts  afford  a  strong 
argument  in  favour  of  the  utility  of  the  muzzling  order 
as  a  preventive  of  hydrophobia.  The  testimony;  of 
this  observer  may  be  safely  regarded  as  unprejudiced, 
and  the  facts  to  which  he  draws  attention  are  those  of 
which  he  has  personal  knowledge. 

"Ethios"  at  the  British  Medical  Associatioii. 
The  youthful  Section  of  *'  Ethics  "  lately  introduced 
into  the  programme  of  the  meeting  of  the  British 
Medical  Association  gives  promise  of  a  vigorous  and 
productive  future.  The  President  of  the  Section, 
which  comes  first  on  the  list,  has  issued  a  notice  of 
subjects  to  be  dealt  with  during  the  three  days  at  his 
disposal.  Among  the  papers  may  be  noted  many  of 
extreme  interest  to  the  profession  generally,  such  as 
'*The  Abuse  of  the  Out-patient  Departments  of  Hos- 
pitals,*' "Provident  Dispensaries,"  "Chemists  and 
Counter-prescribing,"  "The  Overcrowding  of  the 
Profession,"  "The  Ethics  of  Advertising,"  ''Medical 
Aid  Associations,"  and  others.  The  dis  ussion  of 
these  and  kindred  topics  can  hardly  fail  to  throw 
valuable  light  on  many  obscure  points  that  intimately 
concern  the  inner  life  of  the  profession.  In  these  days 
of  struggle  and  competition,  it  is  somewhat  reassuring 
to  find  that  medical  men  are  taking  steps  to  ascertain 
for  themselves  the  exact  nature  of  the  evils  that  lie  at 
the  root  of  the  matter.  It  is  to  be  sincerely  hoped 
that  around  such  inquiries  a  system  of  protection  and 
mutual  aid  may  slowly  gather. 

The  Twenty-fifth  Annual  Congress  of  the  German 
Surgical  Society  was  held  in  Berlin  last  week.  Among 
English  surgeons  present  were  Sir  Spencer  Wells,  Mr. 
John  Langton,  and  Mr.  Reginald  Harrison,  while  Pro- 
fessor Habstedt,  of  Baltimore,  and  Dr.  Lange,  of  New 
York,  were  present  from  the  United  States.  Wreaths 
were  placed  on  the  graves  of  the  German  savants, 
Langenbeck  and  von  Bardeleben,  on  behalf  of  the 
English  representatives  of  the  Congress. 


Medioal  Aid  Sooieties  and  the  Profsesion. 
Tfls  Oddfellows  have  just  held  their  Annual  Con- 
gress at  Bristol,  and,  as  might  be  expected,  had  a  good 
deal  to  say  on  the  subject  of  the  attitude  of  the  medical 
profession  towards  the  medical  aid  societies.  One  of 
their  delegates  who  opened  the  discussion  invoked  the 
aid  of  Parliament  to  put  a  special  clause  into  operation 
enabling  doctors  to  become  the  servants  of  friendly 
societies  without  let  or  hindrance.  This  is  an  extra- 
ordinary position  for  a  trades-unionist  to  assume.  The 
class  which  this  individual  represents  owes  the  security 
of  its  income  and  its  various  labour  rights  almost  solely  to 
trade  organisations.  In  the  course  of  its  operations  the 
particular  society  to  which  the  speaker  belongs  has 
found  that  a  handsome  profit  is  to  be  made  by  sweat- 
ing the  medical  profession.  Naturally,  doctors  as  a 
body  object  to  this  inroad  upon  their  field  of  labour, 
coupled  as  it  is  with  a  mean  foisting  of  monied  patients 
upon  medical  clubs  at  starvation  rates.  We  are  glad 
to  find  that  one  'delegate  had  the  courage  to  remark 
that  doctors  were  as  much  justified  in  combining 
together  to  obtain  the  best  remuneration  for  their  ser- 
vices as  a  body  of  trade-unionists.  Now  is  the  time, 
if  ever,  for  members  of  the  medical  profession  to  unite. 
A  long  pull,  a  strong  pull,  and  a  pull  all  together,  and 
not  only  may  a  rock  ahead  be  avoided,  but  the  dis- 
tance between  present  disunion  and  future  consolida- 
tion be  sensibly  diminished.  We  understand  that  the 
Council  of  the  Royal  College  of  Surgeons  in  Ireland, 
at  its  last  meeting,  adopted,  unanimously,  an  emphatic 
resolution  in  condemnation  of  those  Medical  Aid 
Associations,  in  which  a  profit  is  made  by  individuals 
out  of  the  services  of  a  medical  practitioner,  and  also 
disapproved  of  the  conduct  of  practitioners  who  accept 
appointments  to  such  societies. 


The  OfBicers  of  the  Army  Medical  Depart- 
ment. 
Wb  understand  that  the  officers  of  the  Army 
Medical  Department  are  becoming  so  dissatisfied  with 
the  conditions  of  their  service  that  many  of  them  have 
made  up  their  minds  to  resign  at  the  first  available 
opportunity.  Almost  every  month,  then,  the  difficul- 
ties in  this  regard  are  increasing  bo  far  as  the  War 
Office  are  concerned.  What  with  unsuitable  candi- 
dates who  cannot  qualify  to  fill  vacancies,  and  aug* 
menting  resignations,  the  time  seems  to  be  coming 
when  the  Medical  Department  of  the  Army  will  reach 
a  most  deplorable  position  of  inefficiency  and  short- 
handedness.  Even  under  present  circumstances 
the  under-manning  of  the  department  is  such  that 
the  officers  are  loudly  complaining  of  the  '*  sweating' 
to  which  they  are  being  subjected.  Of  course  the  work 
of  the  department  hss  to  be  carried  on  all  the  same, 
whatever  the  numberof  the  officers  may  be,  upon  whom 
the  duties  fall.  Thus  the  work,  owing  to  lack  of 
candidates  to  fill  vacancies,  is  becoming  every  day 
harder,  and  more  arduous  for  the  officers  who  at  pre- 
sent belong  to  the  department.  Verily  **  my  military 
advisers,"  as  the  late  Mr.  Stanhope  described  the  War 
Office  authorities,  are  reaping  a  rich  reward  for  their 
persistent  policy  of  "snubbing"  the  Army  Medical 


588    Tmi  MiDio^L  FkMS. 


NOTES  ON  CUBRENT  TOPICS. 


JuxiJB  Sy  180d« 


Department.  The  only  way,  eyen  now,  out  of  the 
difficulty,  is  for  Fftrliament  to  intervene,  and  compel 
the  War  Office  to  concede  the  just  demands,  and  satisfy 
the  grievances,  of  our  confreres  in  the  service. 


The  Demonstration  against  a  Lady  Examiner 
in  Dublin. 
The  memorial  supposed  to  emanate  from  the  meet- 
ing of  students,  referred  to  in  our  last  issue,  was  pre- 
sented to  the  Council  of  the  Royal  College  of  Surgeons 
of  Ireland,  on  the  28th  ultimo,  and  was  referred  for 
further  consideration  to  the  first  meeting  of  the  new 
Council  in  June.  The  memorial,  we  understand,  states 
the  objection  of  the  students  to  be  examined  by  any 
one  but  a  gentleman,  but  it  does  not  offer  any  reason 
whatever  for  such  objection.  If  the  Council  of  the 
College  could  entertain,  under  any  circumstances,  the 
claim  of  the  students  to  dictate  their  own  examiners, 
the  memorial  put  forward  by  them  would  be  entitled 
to  every  consideration  if  it  would  bear  scrutiny  and  be 
found  to  be  perfectly  bona  fide.  But  experience  of 
several  such  manifestoeslsuggests  that  careful  scrutiny 
of  the  signatures  is  necessary  just  as  it  is  necessary 
in  the  case  of  Parliamentary  petitions.  We  have,  ere 
this,  seen  students'  memorials  signed,  obviously,  to  the 
extent  of  dozens  of  signatures,  by  one  and  the  same 
hand,  signed  in  the  name  of  persons  who  did  not 
exist,  signed  with  incorrect  designations  such  as  LL.D., 
J.P.,  <fec.,  and  signed,  in  great  minority,  by  persons  who 
never  attended  any  meeting  on  the  subject  and  who, 
no  doubt,  cheerfully  attached  their  signs-manual  with- 
out caring  in  the  least  for  what  the  prayer  of  the 
petition  might  be.  If  students  really  have  a  grievance 
and  will  give  expression  to  it  in  a  business-like  manner 
and  in  good  faith  we  believe  that  they  will  always  find 
the  powers-that  be  willing  to  consider  the  representa- 
tions made  with  a  desire  to  meet  their  views. 


Opening  of  the  General  Medical  OounciL 
Thb  General  Medical  Council  opened  its  session 
yesterday  in  the  new  Council  chamber,  which  has  been 
in  course  of  construction  for  the  past  twelve  months. 
It  is  built  on  an  extension  of  the  former  premises  at 
299  Oxford  Street,  where  the  Council  has  heretofore 
assembled  in  a  sort  of  bear-pit  placed  on  the  basement 
level  and  entered  by  a  winding  staircase.  Proper  pro- 
vision for  the  Press,  which  did  not  previously  exist,  has 
been  made  by  the  erection  of  a  reporters'  gallery  on 
the  same  level  as  the  chamber,  and  the  room  is 
decorated  by  the  busts  of  previous  Presidents, 
Sir  Henry  Acland,  Sir  James  Paget,  and  Mr.  Marshall. 
Among  the  important  matters  which  have  to  be 
decided  is  the  delicate  question  of  the  rejuvenescence  of 
the  Apothecaries*  Hall,  which  the  Privy  Council  appears 
singularly  loth  to  see  disappear.  The  Council  cannot 
go  back  on  their  previous  decisions  without  a  most 
ungraceful  '^  climbing  down,"  but  the  prospect  of  a  pos- 
sible difference  of  opinion  with  the  Privy  Council  may 
serve  to  weaken  the  iconoclastic  tendencies  of  certain 
of  the  members.  Among  the  matters  to  be  brou^^t 
before  the  Council  is  a  petition  from  the  Society  of 
Medical  Phonographers  requesting  the  Council  to  make 


shorthand  one  of  the  extra  optioned  subjects  at  the 
preliminary  examinatfons.  The  immense  assostance 
which  a  knowledge  of  shorthand  is  to  a  student 
appears  to  justify  the  demand,  and  we  shall  not  be 
surprised  if  it  be  acceded  to. 


Further  Marvehs  of  the  ^X"  Baya 
The  development  of  the  discovery  of  Professor 
Rontgen  continues  with  wonderful  rapidity.  The 
latest  news  is  that'the  apparatus  has  been  so  modified 
that  a  picture  of  the  internal  structures  of  the  body 
can  be  thrown  upon  the  fluorescent  screen.  In  this 
way  the  General  Electrical  Association  announce  from 
Berlin  that  it  is  possible  to  demonstrate  the  internal 
structure  of  the  head,  the  larynx,  and  more  especially 
the  action  of  the  respiratory  organs  and  heart.  If  this 
be  the  case,  it  will  simplify  diagnosis  of  many  organic 
lesions  to  a  marvellous  extent.  Indeed,  recent  improve- 
ments in  the  new  photography  give  promise  of  a  future 
in  scientific  medicine  that  may  be  described  as  marvel- 
lous and  revolutionary.  Not  the  least  remarkable 
feature  of  the  matter  is  the  lightning-like  rapidity 
with  which  the  whole  subject  of  the  "X"  rays  has 
been  investigated  all  over  the  world,  since  the  announce- 
ment of  the  discovery  in  the  early  part  of  the  present 
year.  It  is  announced  that  a  practical  demonstration 
of  the  fluorescent  internal  pictures  will  be  made  at  the 
forthcoming  Surgical  Congress  in  Berlin. 


Annual  Meeting  of  the  British  Medical 
Associatian. 
The  arrangements  for  the  Carlisle  meeting  of  the 
British  Medical  Association  at  the  end  of  July  are  in 
a  forward  state,  and  there  is  every  reason  to  anticipate 
a  successful  session.  The  successor  to  the  late  Siv 
Russell  Reynolds,  in  the  Presidential  Chair,  is  to  be 
Dr.  Barnes,  the  physician  to  Cumberland  Infirmary, 
who  has  chosen  one  of  his  colleagues,  Dr.  Roderick 
Maclaren,  to  deliver  the  address  in  surgery.  It  is 
understood  that  Dr.  Maclaren  will  devote  one  sectios 
of  his  address  to  some  comments  upon  the  new  aid  to 
surgery  presented  in  the  discovery  of  the  X  photo- 
graphic rays.  Of  the  nine  sectional  presidencies,  four 
will  be  filled  by  local  practitioners. 

The  Irish  Drug  Contract  System. 
With  the  utmost  satisfaction  we  note  that  the  Local 
Gfovemment  Board  for  Ireland  has  cancelled  the  con- 
tract entered  into  by  the  Castlereagh  Guardians  for  a 
supply  of  drugs  at  prices  largely  above  those  current 
in  the  drug  market.  We  welcome  the  precedent  thoa 
established,  especially  as  it  makes  manifest  the  compe- 
tency and  the  willingness  of  the  Local  Gfovemment 
Board  to  deal  with  one  of  the  grossest  abuses  of  the 
Irish  Poor-law  system. 


The  Royal  Botanical  Society  of  London  have  sgieed 
to  open  tiieir  gardens  to  the  public  on  six  oonseca- 
tive  Saturday  afternoons,  commencing  June  13t]ir 
for  musical  promenades,  several  of  the  leading  Fellows 
having  generously  guaranteed  the  Society  against 
loss. 


Juvx  3, 1896 


SCOTLAND. 


Tn  Mbmoal  Psne.     589 


The  Bleotiozis  at  the  Boyal    College  of 
Surgeons  in  Ireland. 

THseleotion  of  Preddent  and  Vioe-Preeident,  and 
Opuncfllon  took  place  at  the  College  on  Monday 
the  iBt  inst  Mr.  Thonuon,  the  oatgoing  Yioe-Presi- 
dent,  was  ehoeen  Preeident  and  Mr.  Kendal  Franks, 
Vioe-President,  and  Sir  Charles  Cameron,  Secretary  of 
the  College,  there  being  no  dissent  in  either  case.  For 
the  office  of  Councillor  23  candidates  presented  them- 
aelTes  for  19  vacancies.  The  whole  of  the  retiring 
CoundUors,  with  one  exception,  were  re-elected.  Sir 
Thomley  Stoker  reassnndng  his  council  seat  in  room 
of  Mr.  Thomson,  promoted  to  the  Presidency.  Sir 
William  Stokes,  who  had  served  as  Councillor  some 
years  ago,  and  had  left  it  in  order  to  occupy  an 
-ezaminership,  was  again  returned  as  a  Councillor  on 
this  occasion,  having  ceased  to  examine.  Mr.  Cranny, 
of  Jervis  Street  Hospital,  who  had  been  elected  on  the 
4th  of  May,  as  successor  to  Mr.  William  Stoker,  was 
not  re-elected  now. 


The  Irish  Medical  Assooiation. 
The  annual  meeting  of  the  Association  was  held  on 
the  1st  inst  at  the  Boyal  College  of  Surgeons  in  Ireland, 
«nd  was  attended  by  a  large  number  of  provincial 
members  as  well  as  many  resident  in  Dublin.  The 
meeting  opened  at  noon  but  the  first  hour  was  devoted 
to  conversation  upon  matters  of  interest  to  the  profes- 
sion and  the  association,  before  the  stated  business  of 
the  organisation  was  entered  upon.  Upon  scrutiny  of 
the  ballot  it  appeared  that  Mr.  Austin  Meldon  had 
been  elected  President  Drs.  Greene,  of  Ferns,  Sir  J. 
MacCullagh,  of  Derry,  Hayes,  of  Rathkeale,  and  Einkead 
of  Galway,  as  Vice-Presidents  for  Leinster,  Ulster, 
Munster,  and  Connaught  respectively.  For  the  32 
aeats  on  the  General  Council,  43  members  were 
nominated.  We  are  obliged  to  defer  a  report  of  the 
meeting  and  the  resolutions  passed  thereat,  until  next 
week. 


The  Profession  at  the  Levee. 
On  Monday  last,  June  Ist,  a  Levee  was  held  at  St 
James's  Palace,  by  H.RH.  the  Prince  of  Wales,  on 
behalf  of  H.M.  the  Queen,  when  the  following 
members  of  the  profession  had  the  honour  of  presen- 
tation :~Dr.  A.  E.  Bridger,  by  the  Duke  of  Norfolk ; 
Dr.  A.  L  Qalabin,  by  the  Duke  of  Devonshire ;  Dr. 
W.  W.  Groome,  by  Sir  Bindon  Blood ;  Surgeon-Major 
General  Jameson,  M.D.,  on  appointment  as  Director- 
General,  Army  Medical  Department;  Dr.  Geo.  C. 
Martin,  by  Lieut.-Col.  Collins  ;  and  Dr.  Isambard 
Owen,  by  Sir  J.  Puleston. 

Mr.  Kendal  Franks,  of  Dublin,  to  whose  candida- 
ture for  the  Vice-Presidency  of  the  Irish  College  of 
Surgeons  we  have  recently  referred,  has  returned  from 
South  Africa,  and  will  have  been  elected  to  the  Vice- 
Chair  before  this  reaches  our  readers.  We  understand 
that  he  has  finally  determined  to  relinquish  his  practice 
in  Dublin  after  some  months  and  to  enter  practice  at 
Johannesburg. 

TaxRBarel7,500medicalmen  in  the  active  practiceof 


their  profession  in  France.  The  number  which  die  annu- 
ally averages  about  450,  and  the  proportional  additional 
of  new  medical  men  to  the  ranks  of  the  profession  equals 
about  660  a  year.  This  excludes  foreign  practitioners 
who  may  have  settled  in  the  country. 


A  NBW  lectureship  in  ophthahnology  has  been 
created  by  the  Queen's  College,  Belfast,  in  order  to 
comply  with  the  requirements  of  the  Boyal  University, 
and  Dr.  W.  A.  McKeown  has  been  appointed  to  take 
charge  of  the  teaching  of  the  speciality. 


We  are  glad  to  note  that  the  charge  of  indecent 
assault  preferred  by  a  girl  of  seventeen  against  Mr.  J. 
P.  Crawford,  a  medical  man  practising  at  Liverpool, 
has  been  dismissed  after  a  four  hours'  inquiry. 


Ths  Medical  Registrarship  to  the  London  Hospital 
will  become  vacant  next  month,  for  which  application 
must  be  made  to  the  House  Governor,  who  will  supply 
particulars. 

At  the  Annual  General  Meetmg  held  on  Friday  the 
29th  ult,  Sir  Arthur  Watson,  Bart,  Q.C.,  and  the 
Rt  Hon.  A  J.  Balfour,  M.P.,  were  elected  Vice-Presi- 
dents of  the  Royal  Medical  Benevolent  College. 


Mr.  William  Kknnkdy,  LR.C.S.L,  practising  at 
Northampton,  died  last  week  from  having  drunk  half 
a  pint  oi  vin.  colchici  in  mistake  for  beer. 

The  Kent  County  Analyst  reports  that,  out  of  ei^t 
samples  of  sweet  spirit  of  nitre  examined  by  him  within 
the  quarter  seven  were  adulterated. 

SuRaEON-CAPTAiN  J.  J.  C.  Watson,  Army  Medical 
Staff,  now  at  Dublin,  has  been  ordered  for  service  with 
the  troops  at  Hong  Kong. 


[VBOM  CUB  OWN  OOBBBSPONDINT.] 

A  UsBPUL  Extension  of  the  Notipigation  Act.— The 
School  Board  of  Leith  follow  an  excellent  plan  in  oonneo-, 
tion  with  its  echoolfl  and  the  spread  of  infectioas  disease. 
An  official  of  the  School  Board  attends  each  day  upon  tihe 
Medical  Officer  of  Healtbforthe  Burgh  to  obtain  listsof  cases 
notified  to  him.  These  lists  are  handed  to  the  head 
masters  of  the  schools,  who  can  then  ensure  the  absence 
from  school  of  all  children  from  infected  houses  until  they 
have  been  disinfected  or  declared  clear  of  infection  by  the 
MecUcad  Officer  or  some  medical  practitioner.  On  the 
other  hand,  head  masters  notify  to  the  School  Board  all 
cases  of  sickness  coming  under  their  notice,  when  similar 
steps  are  taken.  A  rational  extension  of  the  Notification 
Act  such  as  this  seems  to  be  deserves  to  succeed. 

Thb  LATs  Thomas  GHSisna  Smabt,  F.R.C.S.Ed.— We 
regret  to  announce  the  death  of  this  distinguished  Edin* 
burgh  graduate,  which  occurred  on  March  26th.  After 
obtaining  his  degree,  Dr.  Smart  left  for  the  Antipodes, 
and  sett&d  in  Tasmania.  He  practised  there  for  over  fifty 
years,  but  took  great  interest  in  public  affairs  as  welL 
For  many  years,  also,  he  acted  as  Qovemment  Medical 
Officer,  and  at  one  time  he  was  a  member  oi  the  Colonial 
House  of  Parliament.  He  was  one  of  the  leading  spirits 
in  the  reformation  of  the  Hobart  General  Hospital,  acted 
as  honorary  surgeon  to  it,  and  as  chairman  to  its  Board  of 
Management  for  many  years.  His  younger  brother,  Dr. 
Andrew  Smart,  practises  in  Edinburgh. 


590      Thb  Midioal  Piubss. 


OBHUAR^. 


JuKK  3,  1896. 


SIB  JOHN  RUSSELL  REYNOLDS,  BART.,  M.D., 
r.R.S.,F.R.O.P. 

Ws  have,  with  maoh  regre*},  to  aDnoanoe  the  deftth  o! 
Sir  John  Raasell  ReyDolds,  Bart.,  whioh  took  place  at  hia 
recidenoe  in  Groevenor  Street,  W.,  on  the  afternoon  of  the 
29th  ult.  For  some  weeks  past,  the  poblic  and  the  pro- 
fession have  been  more  or  lees  prepared  for  this  sad  event, 
the  bulletins  issaed  by  those  in  attendance  upon  the  dis- 
tingnished  physician  having  been  of  a  nature  to  fore- 
shadow a  fatal  ending  of  the  illness.  It  was  in  the  latter 
davs  of  last  year  that  Sir  Rassell  Reynolds  first  appreci- 
ably beean  to  snfler  from  some  disturbance  of  health  ;  no 
very  definite  symptoms  showed  themselves,  and  the  exact 
cause  of  the  illness  was  a  matter  of  doubt.  Fear,  how- 
ever,  was  expressed  that  some  visceral  disease  of  a 
malipant  nature  was  present  in  the  abdomen,  in  the 
neiehbourhood  of  the  pancreas.  Beyond  a  gradual 
and!  persistent  decline  of  physical  strength,  no  pronounced 
symptoms  appeared  until  January  last.  The  occasion, 
however,  upon  which  the  first  evidence  of  the  serious 
naturo  of  his  illness  was  shown,  was  somewhat  noteworthy. 
Sir  Russell  was  giving  a  dinner  party  to  his  colleagues  at 


the  Royal  College  of  Physicians,  and  on  rising  from  the 
table  he  was  seen  to  s  tae  ger.  He  would  have  fallen,  save  for 
the  timely  assistance  ofaome  of  his  guests.  It  was  deemed 
necessary  to  remove  him  at  once  to  bod,  and  from  that 
moment  the  illness  may  be  said  to  have  commenced  from 
which  he  ultimately  died.  As  soon  as  thero  was  some 
change  for  the  better  Sir  Russell  was  taken  to  Hastings. 
But  Uie  stay  there  was  only  a  short  one  ;  no  benefit  was 
derived,  and  on  bis  return  to  London  it  was  found  that 
his  physical  weakness  bad  greatly  increased.  It  was  at 
this  tmie  that  the  question  of  his  ro-election  to  the 
Presidency  of  the  Royal  College  of  Physicians  was 
discussed.  But  the  state  of  his  health  was  evidently  such 
that  it  did  not  appear  either  to  himself  or  his  friends  wise 
for  him  to  assume  any  longer  the  responsible  duties  of 
that  office.  Accordingly  he  reluctantly  placed  his  resigna- 
tion in  the  hands  of  his  colleagues.  On  March  23ra  he 
went  for  a  drive,  and  on  idighting  from  his  carriage, 
slipped  on  the  doorstep  of  his  house  in  Grosvenor  Street, 
and  severely  sprained  his  ankle.  He  was  taken  to  his  bed, 
from  which  he  never  afterwards  rose.  The  shock  to  the 
nervous  system,  following  on  the  provious  enfeebled  state, 
proved  most  serious,  and  considerably  increased  the  former 
prostration.  Pneumonic  symptoms  developed  a  few  days 
after  he  had  been  in  bed,  and  placed  his  life  in  the  greatest 


peril.  However,  be  survived  the  attack,  and  it  then 
meroly  became  a  qneetioQ  of  struggling  oowarda,  fishfemg 
against  the  increasing  weakness  which  was  gradnaUy 
bringing  his  life  to  a  dose. 

For  some  weeks  bef  oro  death  a  condition  of  semi-con- 
sciousness supervened.  Thus  was  the  eod  Umf  fore- 
shadowed, and  when  at  last  it  came  peaoetfolly  on  the  29th 
ult.  the  mental  life  of  the  distin^ished  pbyeiciaD  had 
taken  its  departure  many  days  proviously,  leaving  only  tiie 
feeble  flicker  of  physical  life  to  pass  aleo  away.  In  his 
long  illness  Sir  Russell  was  attended  assidaoasly  by  Mr. 
Cooper  Bentham,  and  in  frequent  consultation  were  Drs. 
Buzzard  and  Barlow. 

The  grandfather  of  Sir  Russell  Reynolds  was  a  dis- 
tinguished  physician  and  a  Fellow  of  tho  Royal  Sodaty 
in  the  time  of  George  IIL,   and  thus  it  may  be  said 
that  the   late  President  of  the  Royal  College  of  Phy- 
sicians inherited  some  of  his  medical  instinct  from  his 
ancestor.    Born  at  Romsey  in  1828,  the  son  of  the  late 
Rev.  John  Reynolds,  Sir  Russell  completed  nearly  half  a 
century  of  professional  activity,  marked  by  no  striking 
events,  but  offering  a  singularly  full  record  of  success,  won 
gradually  and  in  the  most  orthodox  manner  by  the  diligent 
exeroise  of  good  natural  gifts.    His  whole  career  was  con- 
nected with  University  (Allege,  whero  he  beffan  brilliantly 
as  a  student,  and  ended  as  Professor  of  Medidne  and 
Consulting    Physician    to   the   Hospital.       He   entered 
about   the    date    when     Sir    William    Jenner    joined 
the   staff,    and    it   is    certainly   remarkable   that   two 
members    of    the    same   school    should    have   reached 
the  highest  honours  in  the  profession  within  so  short  a 
time  of  each  other.    Soon  after  starting  in  practice,  he 
turned  his  attention  to  the  spedal  subject  with  which  his 
name  is  chiefly  connected—namely,  diseases  of  the  brain 
and  nerves.    His  first  essay— on  Vertigo — was  published 
in  1854,    and  was  speedily    followed  by    others,   which 
carried  his  roputation  beyond  the  borders   of   his   own 
country.    It  was,  no  doubt,  the  original  work  he  con- 
tributed in  this   very  obscuro   field  of  reeearoh  whioh 
gained  for  him  the  coveted  distinction  of  F.R.S.  in  lv&9. 
Diseases  of  the  nervous  system  were  at  that  time  far  less 
studied  and  understood  than  they  are  to-day ,|and  Reynolds 
played  a  valuable  part  as  a  nioneer,  particularly  in  m^ing 
known  to  the  profession  in  England  the  uses  of  dectrieity 
as  a  therapeutic  agent,  on  which  subject  he  published  a 
series  of  lectures  in  1871.    His  chief  literary  undertakings 
however,  was  the  "System  of  Medicine,"  which  he  pro- 
jected and  carried  out  with  the  collaboration  of  a  numb^ 
of  eminent  contributors  in  1866-1870.     It  is  a  standard 
work  in  five  volumes,  containing  much  material  ot  per- 
manent vdne. 

In  1878  be  was  appointed  Physician  in  Ordinary  to  Her 
Majesty's  Household.  In  1893  he  received  the  highest 
honour  the  medical  profession  has  to  bestow  in  this 
country,  and  was  made  President  of  the  Royal  College  of 
Physicians. 

Sir  Russell  Reynolds  was  twice  married ;  first  to  the 
daughter  of  the  Rev.  Roberc  Ainslie,  and  secondly,  in  1881, 
to  Frances,  daughter  of  Mr.  William  Plunkett,  and  widow 
of  Mr.  John  Charles  Champion  Crespigny.  He  leaves  no 
issue. 


DEPUTY  INSPECTOR-GENERAL  SWEETNAM. 

DiPDTY    InSFBCTOB-GeNXRAL   R.    J.    SWBITNAIC,  BN., 

died  at  Dawlish  last  week  at  the  age  of  55.  He  was  a 
Licentiate  of  both  the  Irish  Colle^  of  Phyrioians  and 
Surgeons,  and  after  obtaining  his  diplomas  he  joined  toe 
Naval  Medical  Service  in  1864»  and  in  the  foUowing  year 
was  present  at  the  battle  of  Ikorudu,  in  the  ^^^ 
Lagoons.  His  services  in  attending  the  military  woondeo 
on  the  field  on  this  occasion  were  mentioned  in  despatches,, 
and  he  received  the  thanks  of  the  Secretary  d  State  for 
War.  He  was  in  medical  charge  of  the  Niger  ezpedittoos 
1864-66,  was  appointed  staff-surgeon  in  1878,  fleet-sorgeon 
1884,  and  retired  in  June,  1894,  with  the  rank  of  Depaty 
Inspector  GeneraL  He  was  the  author  of  the  "  Rdefl  »pd 
Regulations  for  preserving  the  health  of  Ships'  C)omps^ 
in  Lagos  Lagoons  and  the  Niger,"  which  have  oeeu 
embodied  in  the  North-East  Africa  *<  Station  Order-book. 


JoNV  3,  1896. 


CORRESPONDENCE. 


Thb  Mxdioal  Pbbss.     091 


dLontBpotihznct. 


(We  do  not  hold  oimelTei  ntponaible  for  th3  opinions  of  oar 
ootreqMudenta.)  

SIR  JOHN   WILLIAMS  AND  THE  QUESTION  OF 

PRIVILEGE. 

To  the  Editor  of  Ths  Mxdioal  Pbxss  akd  Oiboulab. 

Sib, — ^In  may  interest  your  readers,  in  view  of  Sir  John 
Williams'  letter  (see  Mxdioal  Pbxss  and  Giboulab,  May 
13th,)  to  read  the  text  of  the  qnestions  propounded  by,  and 
answers  famished  by  Oonnsel  to,  the  Royal  Golle|?e  of  the 
Physicians  of  London.  These,  in  view  of  recent  circam- 
stances,  can  no  longer  be  regarded  as  a  collegiate  secret. 
They  read  as  follows  :— 

Questioru :—  Armoers  :— 

**  Counsel  will  please  adrise  tbe  L  We  are  of  opinion  that  there 

College  :  is  no  pririlege  attaohing  to  state- 

1.  Has  a  Medical  Practitioner  ments  made  to  a  Medioal  Prao- 

any   prlTilese    with    regard   to  titioner  by  Ms  patient, 

secrets  confided  to  him   in  the  2.  We  are  of  opinion  that  It  is 

coarse  of  his  practice  analogoos  the  duty  of  a  Medical  Practitioner 

to  tbe  prlTiiege   as   between  a  who  knows  or  believes  that  he  is 

Solicitor  and  Client,  or  other-  in  attendance  In  a   case  where 

wise  ?  criminal  abortion  has  been  prac- 

0  mi.-*  1-  *K*  ^«*-  «#  -  If  .^1  ^«if  *o  attend  his  patient  to  the 
Jt  ^^ili^t  -hn  ^k«n«  «;  ^>^  •'  >»«■  ""U*  Mdthat  he  does 

5?2f^?  ihiil  ^^•wSrlynn     •>  "  »«es8ory  after  the  fact,  so 

5;S^ut?S^HJlf^L    hf    diSJ  thrpatlent  In  escaping  from  or 

iSL-iJ^*;5«*^2?««i  ^^Jn  MJZng  Jostlce.    See  I.    Hale. 

SSSiyjJSf,''^®"^  **•*  "*°"  88«-  WedonotthlnktheMedlcai 

Ooned  abOTC  1  PractiUoner  Is  liable  to  indictment 

8.  Does  the  law  forbid  the  pro-  for    misprision    of    felony    (an 

cnrement  of  abortion  during  preg-  offence  which  is  nearly  obsolete) 

nancy  for  the  purpose  of  saving  merely  becaose  he  does  not  give 

the  mother's  life?  information  In  a  case  where  he 

A  Tv..^««#A.kM«i«.4«.«M,^A»  nupects  that  criminal   abortion 

«f  iiS^nS  SnJ^J^^ihSSTih^^  basbeen  practised.    In  the  case 

« Jh^S^SfctlS?  A  H  J?  Jf  n^  aaggeated.  where  the  name  of  the 

■aiy  to  save  the  mother's  life  ?  commit  sa£  an  offence,  we  think 

fi.  In  the  event  of  qnestlons  8  it  is  tbe  dnty  of  the  Medio«l  Prac- 

and  4  being  answered  In  the  afllr-  titlooer  at  once  to  warn  such 

matlTe,  is  a  Medical  Practitioner  person  that  such  a  statement  has 

blameless  if.  In  order  to  escape  been  made. 

the  risk  of  prosecution,  he   re-  8,  4.  and  5.  We  are  ot  opinion 

frains  from  renderlns  assbtance,  that  the  law  does  not  forbid  tbe 

and   thus  deliberately   sacrifices  procurement  of  abortion  daring 

the  life  of  the  patient  when  he  pregnancy,  or  the  destruction  of 

could  save  It  eitber  (a)  by  indue-  the  child  during  labour,  where 

log  abortion,  or  (b)  by  destroying  such  procurement  or  destruction 

the  child  during  labour  ?  1«  necessary  to  save  tbe  mother's 

e.  If  It  were  desired  to  procure     "*?•  j,  _.  __^  _|_m-*  •„  .„_  -•«_. 

SSTulS^bTSS^^t^modi^Af^o'lS     no-ilJSti^SPtii^UwwSSS 
woidd  be  the  best  mode  of  pro-    probably  be  desired. 

**°"*'  7.  The    dnty  of    the   Medical 

7.  To  advise  generally  on  the    Practitioner  as  to  giving  informa- 

case.  tlon  in  particular  cases,  or  as  to 

his  action  where  the  lite  of  the 
patient  is  in  danger,  must,  we 
think,  be  exercised  according  to 
his  discretion." 
(Signed)   Edward  Clabke, 

HOKACI  B.  AVORT, 

Temple. 

1  mast  confess  that  I  am  unable  to  reconcile  Sir  John 
Williams'  affirmative  reply,  in  Court,  with  the  tenoar  of 
reply  No.  2.  I  am  fain  to  add  that,  in  my  opinion,  his 
reply  borders  on  the  disingenuous. 

I  am,  Sir,  yours,  M.R.C.P. 


THE  ETHICS  OF  PROFESSIONAL  ADVERTISING. 

To  the  Editor  of  Thb  Mxdioal  Prsss  and  Ciboulab. 
Sib, — You  have  been  eitber  misled,  or  tbe  wish  was 
father  of  the  thought,  when  you  state  "  Uiat  in  the  illness 
of  Sir  John  Millais,  a  noticeable  departure  from  what  is  so 
frequently  open  to  condemnation,  the  occasion  is  seized 
upon  to  puff  in  the  lay  press  the  eminent  men  in  attend- 
ance upon  so  distinguished  a  patient."  I  regret  to  say 
that  in  this  instance,  as  in  so  many  others,  the  too 
common  departure  in  medical  ethics  did  occur,  and  I 
enclose  for  your  information  a  cutting  from  the  Sunday 
Sun,  and  also  from  tbe  DaUy  News^  of  Sunday  and  Mon- 
day last.  Almost  word  for  word  appeared  in  some  other 
evening  papers.  You  will  see  that  in  the  notice  of  the 
operation  by  the  Sun,  "  the  keen  and  brilliant  physician 
who  was  called  upon  to  act  with  Mr.  Treves  '^  could  not 
have  well  had  '*  his  achievement  blazoned  forth  in  all 
quarters  of  the  globe"  bad  he  paid  for  the  advertisement.  ' 


With  regard  to  the  Daily  News  notice,  it  appears  that 
bulletins  have  been  issued  by  the  Specialists  and  Mr. 
Hames.  I  may  remark,  with  regard  to  the  Daily  News, 
this  morning  paper  is  notorious  for  its  conspicuous  and 
effusive  puffs  of  some  members  of  the  profession  in  atten* 
dance  upon  *'  distinguished  patients." 

lam, Sir, yours, &c.,  J.  H. 

[There  is  unfortunately  no  doubt  that  some  enterprising 
journalist  has  got  hold  of  the  name  of  the  surgeon  men" 
tioned,  and  has  advertised  the  fact  as  widely  as  possible. 
At  the  same  time,  our  former  statement  holds  good  that 
tbe  operator  did  all  that  lay  in  his  power  to  avoid 
publicity.  His  name  certainly  did  not  appear  in  three' 
fourths  of  the  London  newspapers  in  connection  with  the 
operation.— Ed.] 

THE  DIRECT  REPRESENTATION  FOR  SCOTLAND. 
To  the  Editor  of  the  Mxdioal  Pbxss  and  Ciboulab. 

Sib, — ^I  cordially  agree  with  your  correspondent,  ''A 
Supporter  of  Dr.  Campbell  Black,"  that  the  gentleman 
named  should  be  invited  to  stand  as  a  candidate  for  the 
Direct  Representation  of  the  Profession  in  Scotland  in  the 
General  Medical  Council.  That  Dr.  Campbell  Black  is  well 
acquainted  with  the  gprievances  and  the  requirements  of 
the  profession,  and  that  he  is  willing  and  capable  of 
giving  full  vent  to  them  both  by  voice  and  pen,  no  one,  1 
am  sure,  will  attempt  to  deny.  If  we  had  more  men  of 
Dr.  Campbell  Black's  stamp  in  the  Council,  we  would  hear 
less  of  Midwives*  Registration  Bills,  and  more  about 
questions  of  real  utility  to  the  general  body  of  the  pro* 
fession. 

I  would  suggest  that  a  requisition  be  drawn  up  in  Dr. 
Black's  favour  and  signatures  obtained  thereto — thus 
forming  a  provisional  committee,  pledged  to  do  every- 
thing requisite  to  secure  his  return.  Personally,  I  should 
Wigt^g^  in  the  work  con  amove, 

I  am.  Sir,  yours,  ^.,  J.  F.  S. 

To  the  Editor  ofTm  Mxdioal  Pbxss  and  Ciboulab. 

Sib, — Your  correspondent  of  the  13th  inst  could  not,  in 
my  opinion,  have  named  a  better  candidate  to  represent 
tbe  Profession  in  Scotland  than  Dr.  D.  Campbell  Black,  of 
Glasgow.  He  has  been  the  champion  of  the  rights  and 
interests  of  the  rank-and-file  of  the  profession  for  over  a 
quarter  of  a  century,  and  is  fully  alive  t«o  the  urgent  neces- 
sity for  reform  in  respect  to  medical  education  and  qusli- 
fication.  He  has  been  indefatigable  in  exposing  the  de- 
fects and  anomalies  of  our  hospital  system  in  so  fir  as  they 
are  detrimental  to  the  best  interests  of  medical  men  as 
well  as  of  the  public  at  large.  Dr.  CampbeU  Black  ie 
well  known,  not  onlv  in  Glasgow  and  neigboourbood,  but 
throughout  the  whole  country.  His  incisive  and  distinct 
expression  in  bis  frequent  deliverances  on  all  matters  of 
medical  ethics  and  reform  should  form  a  sufficient  mani- 
festo of  bis  views.  Dr.  Bruce,  the  present  representative, 
has  not  in  all  points  represented  the  interests  of  general 
practitioners,  and  has  notably  misrepresented  them  in  the 
proposed  Midwives'  Bill.  It  seems  very  strange  that  the 
profession  have  bad  to  go  to  an  obscure  town  in  the  ex- 
treme north  of  England  for  a  representative,  and  have- 
ignored  altogether  the  qualifications  of  the  largest  body 
(M  ^neral  practitioners  in  the  country  in  the  commercial 
capital  of  Scotland.  The  profession  ought  strongly  Ut 
urge  the  claims  and  qualifications  of  Dr.  Campbell  Black- 
as  their  best  candidate. 

I  am.  Sir,  yours,  &c., 

May  25th,  1896.  A  Gbnxbal  Piiactitionbb. 

[We  would  suggest  to  future  correspondents,  that  in  a 
matter  of  this  kind,  much  greater  weight  would  be 
attached  to  their  opinions,  were  their  names  to  be* 
appended. — Ed.] 


THE    MEDICAL  DEFENCE   UNION  AND  THE 
APPEAL  IN  THE  CARDIFF  CASE. 

To  the  Editor  of  The  Mxdioal  Pbxss  and  Ciboulab. 

Sib,— There  is  nothing  an  egotistical  man  can  so  little 
resist  as  the  temptation  to  exclaim  **  I  told  you  so,"  wheik 
any  event  occurs  in  remote  degree  acco.*ding  with  his  pre* 


592    Thb  Mbdioai.  Pbks. 


TEX  BIGHTS  OF  MEDICAL  MEN. 


JUKB  3,  IWb. 


-diotion ;  bot  it  is  oerbainly  with  no  egotistical  feeliof^,  and 
least  of  all  with  any  intoDtion  of  displaying  lack  of  sym- 
pathy with  the  Medical  Defence  Union,  that  I  call  atten- 
tion to  the  fact  that  I  distinctly  foretold  the  result  ot  the 
appeal  just  decided  in  the  High  Goort.    In  yonr  issue  <A 
the  18th  Dec.,  I  wrote  that  there  was  nothing  to  prevent 
any  anqaalified  man  from  assuming  the  title  "Doctor,"  and 
adding  M.D.  to  his  nama    I  said  this  in  spite  of  the  fact 
that  such  an  individual  had  been  fined  within  the  past  few 
days  for  such  an  offence.    I  pointed  out  that  his  conviction 
<was  the  only  one  which  had  oeen  obtained  for  years ;  that 
he  had  given  notice  of   appeal ;  and  I  did  not  hesitate 
to  afiirm,  in  spite  of  the  oonndent  opinion  to  the  contrary 
of  the  Secretary  to  the  Union,  that  the  conviction  would  bo 
-quashed  in  the  High  Court.    Sufficient  foundation  for  this 
assertion  existed  in  precedent  ca^es  tried  years  before,  and 
mostly  soon  after  passage  of  the  Medical  Act  of  1858.    I 
explained  later  that  my  opinion  was  not  changed  by  the 
fact  that  another  subsequent  conviction  for  a   similar 
ofienoe  had  been  confirmed  on  appeal  by  a  bench  of  magis- 
ttrates,  and  I  suggested  that  the  result  would  have  been 
•different  had  that  case  gone  to  the  High  Court.      It  is 
-evident  I  was  quite  right.    To  obtain  a  conviction  under 
the  Medical  Acts  sustainable  in  the  High  Court,  it  is,  in 
most  oases,  necessary  to  prove  that  the  offender  heufaUdy 
Sfretended  to  he  registered  under  the  Acts,  and  this  is  often 
difficult,  often  impossible.    To  put  an  end  to  these  abases 
new  legislation  is  needed.    That  the  construction  of  laws, 
•and  provision  of  machinery  for  working  them  for  the  pro- 
tection   of    the   public,    are    far   from  impossible,   is 
jgroved  by  the  working  of  the  Veterinary  Act,  of  1881. 
The  College  of  Veterinary  Surfreons  encountered  no  diffi- 
•culty  in  enforcing  this  law,  and  unqualified  farriers  have 
been  fined  for  no  more  serious  offence  than  public  display 
of  a  sign  inscribed,  '*  Veterinary  Forge,"  on  the  {ground 
that   the  use   of   the  word    "veterinary^'    was    calcu- 
lated  to   lead   to   their   being    mistaken   for    qualified 
'veterinary  surgeons.    These  convictions  have  never  been 
appealed  against,  and  the  Act  has  thus  been  fully  vindi- 
'<)Ated.    A  powerful  leader  on  the  weakness  of  medical 
law  in  the  Timei  of  this  date  (May  28th)  sugeosts  how 
•oafl^  it  might  be  to  arouse  public  opinion  on  this  subject, 
and  there  need  be  no  doubt  that  an  efficient  amendment 
of  the  Medical  Acts  can  be  obtained  as  soon  as  a  plain 
statement  of  the  case,  supported  by  the  unanimous  voice 
•of  the  profession,  is  laid  before  the  Legislature. 
I  am.  Sir,  yours,  Ara, 
May  28th,  1896.  H.  S. 
♦ 

DEATH  OF   AN    OLD   DUBLIN    MEDICAL 

LECTURER. 

To  the  Editor  of  Thi  Mbdioal  Pbiss  and  CiBonLAB. 

SiB,~In  1832,  the  late  Dr.  Hargrave '  founded  the 
^'DublinSchoolof  Medicine.l5  Digges  Street."  It  continued 
there  until  1841,  whenit  was  changed  to  27  Peter  Street,  and 
was  amalgamated  with,  or  rather  absorbed,  the  ''  Theatre 
of  Anatomy,  and  School  of  Surgery,"  located  in  27  Peter 
Street  from  1832.  It  may  interest  some  of  your  readers  to 
learn  that  there  died  last  month  in  Rome,  a  gentleman, 
who  so  far  back  as  1837  (58  years  afiro),  lectured  on  Materia 
Medica  in  the  Dublin  School  of  Medicine.  I  refer  to  the 
late  Dr.  John  Gason,  who  for  more  than  half  a  century 

J>ractised  in  Italy.  During  the  existence  of  this  School 
rem  1833  to  1857,  44  medical  men  tausht  in  it,  of  whom 
there  still  survive,  Dr.  Edward  Hamilton,  Dr.  William 
Moore,  Dr.  Humphrey  Minchin,  and,  yours  faithfully, 

Chablsb  a.  Camison. 


AN    APPEAL. 

With  the  permission  of  the  Editor  of  the  Mbdioal 
Pbiss  amd  Ciboulab,  we  beg  to  recommend  to  the 
generous  consideration  of  our  medical  brethren  the  case  of 
the  widow  and  children  of  the  late  Dr.  Charles  Rumney 
Hlingworth,  whose  death  occurred  under  most  distressing 
circumstances.  Owin^  to  specific  infection  acquired,  about 
three  years  ago,  during  his  attendance  on  an  obstetric 
case,  his  health  and  capacitv  for  work  were  materially 
interfered  with,  and  ultimately,  from  the  disease  affecting 
liis  brain,  he  died  within  a  few  davs  after  his  unavoidable 
removal  to  an  appropriate  hospital. 

During  the  latter  stages  of  his  lamentable  illness,  his 


a£Gurs  became  so  Involved  that  he  was  able  to  leave  no 
provision  whatever  for  his  widow  and  four  children,  who 
are  aged  fourteen,  thirteen,  eleven,  and  six  months 
respectively. 

Unfertunateiy  the  three  elder  children,  whose  education 
has  been  considerably  retarded  owing  to  the  removals  and 
other  circumstances,  brought  about  bv  their  Other's  ill 
health,  are-  on  account  of  ages,  ineligible  for  reception  into 
either  the  medical  or  the  masonic  schools.  Mrs.  Hling- 
worth intends  to  qualify  as  a  midwifery  nurse,  and  hopes 
in  this  way  to  earn  at  least  a  bare  subsistaoce  for  herself 
and  children. 

For  immediate  necessities,  some  small  temporary  assis- 
tance has  been  promised  by  two  uncles  of  the  late  Dr. 
Charles  Rumney  Illingworth,  the  only  relatives  who  can 
in  any  way  help.  This,  however,  is  totally  inadequate 
to  meet  the  requirements  of  the  case,  and  in  view  of  the 
sympathy  whion  many  <tf  our  medical  brethren,  especially 
those  who  knew  the  late  Dr.  niingworth,  and  who  could 
appreciate  his  sterling,  though  possibly  perftrwdMm  taqe^ 
fH»m  have  expressed,  we  venture  to  hope,  that  they  will  be 
pleased  to  contribute  towards  the  relief  of  the  helfdess 
ones  whom  he  has  left  in  such  distress.  :^ 

Subscriptions  on  their  behalf  will  be  gladly  received 
and  gratefully  acknowleged  by  any  of  the  undersigned. 
DcTNDAS  Grant,  M.D.Ed.,  F.R.C.S  , 

8  Upper  Wimpole  Street,  London,  W. 
GlOBOB  W.  POTTES,  M.D.Ed., 

8  King  Street,  Cheapside.  London. 
Gbrmak  Sims  Woophsad,  M.D.Ed., 

Conjoint  Laboratories,  Victoria  Em- 
bankment. 


THE  OBLIGATIONS  OF  THE  GENERAL  MEDICAL 
COUNCIL,  MEDICAL  SCHOOLS   AND  CORPOR- 
ATIONS IN  RELATION   TO   THE  RIGHTS  OF 
MEDICAL  MEN. 
At  a  meeting  at  Professor  Victor  Horsley's  on  May  16th, 
of  the  Select  C^mittee  of  the  Civil  Rights  Defence  Com- 
mittee on  this  subject,  Mr.  Timothy  Holmee  in  the  chair 
the    Resolution  appointing  this  Committee  having  been 
read,  the  Resolutions  of  the  meeting  of  the  Civil  Rights 
Defence  Committee  of  January  9th,  1896,  were  read  as 
follows : — 

1.  That  as  many  of  the  great  lay  and  medical  public 
bodies  will  refrain  from  co-operating  in  the  defence  of  the 
professional  and  civil  rights  entrusted  to  the  Committee 
until  a  strong  consensus  of  opinion  is  aroused  urging  them 
to  do  so,  the  oonstituent  bodies  of  the  Committee  are 
asked  to  adopt  resolutions  in  the  sense  of  those  adopted 
by  the  Committee. 

2.  That  the  professional  bodies  represented  on  the 
Civil  Rights  Defence  Committee  be  asked  to  use  their 
influence  with  the  Medical  Schools,  which  induce  young 
men  to  enter  the  medical  profession,  and  with  the  General 
Medical  Council,  the  Universities,  and  Corporations, 
which  confer  upon  them  supposed  rights,  now  Iformally 
declared  to  be  held  entirely  at  the  pleasure  of  the  Crown, 
acting  by  the  judges,  and  ask  them  to  unite  in  makine 
good  the  rights  which  they  take  part  in  pronusing,  ana 
which  are  now  imperilled  oy  the  aecision  of  the  Court  of 
Appeal. 

General  Graham's  Memorandum  of  Feb.  7^*h,  1896,  to 
the  medical  papers  requesting  an  expression  of  opinion  on 
these  Resolutions  was  brought  up,  and  also  the  Lancet  of 
May  9th,  with  an  article  on  the  work  of  the  Committee 
dealing  with  the  obligations  of  the  General  Medical 
Councu,  Medical  Corporations,  and  Medical  Schools  in 
relation  to  the  rights  of  medical  men,  taking  the  same 
view  as  that  adopted  by  the  Committee  in  the  Memoran- 
dum and  Resolutions,  and  declaring  that  these  bodies  are 
at  present  subsisting  by  holding  out  to  men  entering  the 
pnuession  "  false  promises  "  of  rights  now  declared  by  the 
aecision  of  the  Court  of  Appeal  to  have  no  existence,  and 
that  it  is  incumbent  on  such  bodies  to  diecontinne  re- 
ceiving such  moneys  until  the  rights  for  which  they  re- 
ceive  wem  are  vindicated. 

Correspondence  with  the  General  Medical  Connoil, 
University  of  London,  Royal  College  of  Physicians  of 
London,  Worshipful  Society  of  Apothecaries,  London ;  and 
St.  Mary's  Hospital  Medical  School,  inviting  co-operation 
was  laid  on  the  table. 


JuNB  3,  1896. 


MEDICAL  MEW8. 


Mbdig^l 


593 


Lord  Stamford's  latter  inviting  the  co-operation  of  the 
General  Medical  Council  in  defence  of  the  rights  confirmed 
by  its  certificate  of  reeistration  was  read. 

General  Graham  exi^ained  that  the  only  reply  had  been 
from  the  Solicitor  of  the  Council  (and  not  from  the  Presi- 
dent) stating  that  the  case  is  oatside  the  soope  of  the 
Ckrancil  and  ignoring  the  grounds  of  the  invitation. 

(1)  Resolved  that  a  letter  be  drafted  for  the  next  meet- 
ine  to  be  addressed  to  the  President  of  the  General  Medi- 
dJ  ConncU  for  signature  by  the  medical  members  of  the 
Committee,  snpj;x>rting  the  invitation  conveyed  by  the 
President. 

(2)  That  letters  be  similarly  prepared  to  be  written  to 
the  President  and  Council  of  the  following  bodies:  -The 
lU^al  Colle^  of  Surgeons  of  England,  the  British  Medi- 
cal Association,  the  Association  of  Fellows  of  the  College, 
the  Medical  Defence  Union,  and  the  West- London  Divi- 
sions of  the  London  and  Counties  Medical  Protection 
Society  requesting  each  to  act  independently  in  support 
of  this  Committee  in  earnestly  inviting  the  co-operation  of 
the  General  Medical  Council. 

Correspondence  with  the  Worshipful  Society  of  Apothe- 
caries was  next  considered  including  an  invitation  to  co- 
operate, to  which  no  answer  had  been  yet  received. 

Resolved  :— 

That  a  letter  be  drawn  up  for  signature  by  the  medical 
members  of  the  Committee  supporting^  the  invitation  to 
the  Society  to  nnite  in  vindicatmg  the  rights  of  the  Society 
under  its  Charter  infringed  in  the  violation  of  Mr.  Ander- 
son's rights  as  a  Licentiate,  and  to  use  its  inflnenoe  with 
other  guilds  to  nnite  in  this  defence  of  common  rights. 

That  a  report  of  the  meeting  be  sent  to  the  medical 
papers. 

Tlie  Society  fior  Stilef  of  .Widows  and  Orphans  of  Medical 
Men. 

The  annual  general  meeting  of  the  Society  was  held 
on  Wednesday,  May  20th,  at  11  Chandos  Street,  W.,  the 
President,  Sir  James  Paget  in  the  chair.  From  the  report 
read  by  the  Secretary  it  appeared  that  durins  the  year  7 
new  members  had  been  elected,  and  11  had  cued,  and  6  re- 
signed, leaving  296  at  the  end  of  the  year.  Three  widows 
had  been  added  to  the  49  on  the  funds,  and  4  had  died. 
The  number  of  orphans  reoeivinff  assistance  had  been 
reduced  bv  1,  leaving  8.  The  receipts  available  for  pay- 
ments haa  been  £3,2§9,  and  the  grants  and  expenses  had 
been  £3,223,  including  a  sum  of  £452  given  at  Christmas 
as  a  present  to  the  widows  and  orphans  on  the  books. 
The  funded  property  had  been  increased  by  the  purchase 
of  £500  stock,  the  funded  proper^  being  now  over 
£95,000.  An  additional  amount  of  £500  had  been  received 
from  the  executors  of  Miss  Carpin.  A  grant  of  £26  under 
Law  78  was  made  to  a  widow.  A  vote  of  thanks  to  the 
editors  of  the  medical  journals  for  their  great  kindness  in 
making  known  the  objects  of  the  Society  was  proposed  by 
Mr.  Christopher  Heath  and  carried  nnanimonsly.  The 
following  gentlemen  were  elected  directors  to  fill  the 
vacancies  caused  by  death  and  retirement,  vie,  Mr. 
Bennett,  Dr.  Wicks,  Dr.  Frederick  Roberts,  Dr.  Sylvester, 
Mr.  Fountaine,  Mr.  Maloolm  Morris,  and  Mr.  Bntlin.  A 
vote  of  thanks  proposed  by  Mr.  Felie  and  seconded  by  Mr. 
Day  was  passed  to  the  President,  Sfr  James  Paget  for  his 
kindness  m  presiding  at  the  meeting. 

St.  Thomas's  Hospital,  London. 

House  Appodtticxnts  :— The  following  gentlemen  have 
been  selected  as  House  Officers  from  Tuesday,  2nd  June, 
1896 :  House  Physicians— W.  H.  J.  Peterson,  L.KC.P., 
M.RC.S. ;  K  H.  T.  Nash,  LR.C.P.,  M.R.C.S.  ;  B.  W. 
PtOin,  M.A., M.B.,  BCh.Oxon.,  L.R.C.P.,  M.R.aS. ;  and 
P.  a  Hichens,  M.A.,  M.B.,  B.Ch.Oxon,  L.R.C.P., 
M.KC.S.  House  Surgeons— L.  A.  R.  Wallace,  B.A., 
M.B.,  B.Ch.Oxon.,  L.R.C.P.,  M.R CS. ;  M.  C.  Crouch, 
L.R.C.P.,  M.RC.S  ;  J.  L.  Pnun,  LRC.P.,  M.R.C.S.  ; 
and  G.  J.  Conford,  B.A.,  M.B.,  B.Ch.Oxon.,  L.KC.P., 
M.KC.&  Assistant  House  Surgeons— B.Dyball,LR.C. P., 
M.R.C.a  ;  P.  W.  Kent,  L.R.G.P.,  M.acr.S. ;  J.  Smith, 
B.A.,  M.B.,  B.C.Cantab.,  L.RC.P.,  M.R.C.S.  ;  and  W.  D. 
Frazer,  LR.C.P.,  M.R.C.8.  Obstetric  House  Physicians 
—(Senior)  C.  W.  Grant  Wilson,  LR.C.P.,  M.KC.S. ;  and 
(Junior)   P.    L.   BUber,    L.R.C.P.,    M.R.C.S.    Clinical 


Assistants  in  the  Special  Department  for  Diseases  of  the* 
Throat :  L.  W.  Riohitfds,   M.B.,    B.S.Durh.,    LR.C.P., 
M.R.C5.  ;  G.  L  HanweU,  L.R.C.P.,  M.R.C.S.;  Skin:  H.- 
G.  Toombs,  L.R.C.P.,  M.R.C.S. ;  G.  E.  0.  Taylor,  LR.C.P., 
M.R.C.S. ;  Ear :  R.  G.  Strange,  LR.C.P.,  M.R.C.S. ;  C.  E. 
Durrant,  L.R.C.P.,  M.R.C.S.    Clinical  Assistants  in  the- 
Electrical    Department— G.    B.    C.    Blonnc,   LR.C.P., 
M.R.C.S. ;  W.  D.  Knocker,  LR.CP.,  M.R.C.S. 
Guy's  Hospital  Bazaar. 
A  Fanot  Fair  was  opened  atShortlands,  in  aid  of  Guy's 
Hospital,  on  Friday  last,  by  H.R.H.    the   Duchess    of' 
Albany,  a  similar  ceremony  being  performed  by  Lady 
Randolph  Churchill  on  Saturday.      Considerable  enthu- 
siasm has  been  evoked  in  the  enterprise,  and  it  is  hoped' 
that  a  good  round  sum  will  accrue  to  the  sorely  depleted 
funds  of  this  ancient  Institution. 

Royalty  at  the  West  London  Hospital. 
Their  Royal  Highnesses  the  Prince  and  Princess  of' 
Wales  opened  the  Bazaar  and  FSte,   on  May   21st,  to- 
which  we  referred  in  a  previous  number  as  having  been 
organised  for  the  purpose  of  raising  funds  for  the  new 
wing  at  the  West  London  Hospital    In  addition  to  their 
Royal  Hiehnessee,  there  were  present  Her  Royal  Highness 
Princess  Maud  of  Wales,  Her  Royal  Highness  Princess- 
Mary  Adelaide,  Duchess  of  Teck,  and  Pnnce  Charles  of 
Denmark. 

University  of  London. 
Thb  following  is  an  official  list  of  candidates  who  passed 
the  M.B.  Examination  during  May,  arranged  in  alpha- 
betical order : — 

First  Division. 

Brlggi,  John  Aithnr  Otwald,  St.  Bartholomew's  Hotpltal. 

Oeoge,  Gooige  Oilbert,8t.  IhomM's  Hoq^taL 

Hoaih,  Aithor.  St.  Bartholomew'g  Hospital. 

Losg,  Thomas  Percy.  St.  Bartholomew's  HospltaL 

L^wster,  Joho  C^nrU  Holdiich,  B.Se.,  University  OoUefe. 

Waldron.  Franols  Thomas.  London  Hospital. 

Wells,  Thomas  Henry,  Middlesex  Hospital. 

Second  Division. 
Clooflji,  James  Arthur,  Leeds  Medical  SohooL 
Davies,  John  Edgar  Phnip.  B.8a.  St.  Mary's  HospltaL 
Daoat,  Arthur  David,  St.  Bartholomew's  HospltaL 
Oanner,  Joseph,  Mason  College. 
Oerrard,  Alfred  Henry,  TTniTeralty  College. 
Grfiaths,  John  Alban  Kendall,  UniTerstty  CoUon. 
Gnllan,  Arohibald  Gordon,  Universlly  College^  lifeipooL 
Bibbert,  Josej^  Goote,  UniTsrsity  College. 
Hngo,  James  Henry,  St.  Bartholomew's  Hospital. 
Instone,  Koel,  QnfB  HospltaL 
Johnston,  Bobert  Macfle,  Univerrtty  College. 
Leon,  John  Temple,  B.SO.,  St.  Mary's  Homltal. 
Le  Pelley,  Amelia  Maltland,  London  Soh.  o)  Med.  for  Women.- 
Lyle.  Herbert  WUlonghby,  King's  CoUern. 
Mackenzie,  Baohel  Bos.  W.,  London  ^eh,  ^  Med^  for  Women. 


Maoghan.  James,  &.  Inflrmaiy  L'pool  and  Univ.  ColL  London. 

Murray,  John  Hanna,  UnlTersity  OoUege. 

Nolan.  Harold,  Guy's  Hoq>itaL 

Bait,  John  Walter  Forbes,  University  College. 

9key,  Arthur  Bichard  Harrle,  St.  BartholooBeWs  Hoq>ltaL 

Smith,  Graham  Udale.  Kiag  s  CoUege  HospltaL 

Stevenson,  Thomas  Henry  Craig,  University  College. 

Thomas,  sran.  University  College. 

Townend,  Bichard  HamUton,  London  Hoq>ital. 

Warde,  WiUrid  Brougham,  St.  Bartholomew's  HospltaL 

Wnson,  Francis  Kenneth,  Westminster  HospltaL 

Wise,  Harry  Mortimer,  Guy's  HospltaL 

Boyal  University  of  Ireland :  Spring  Bxaminations,  1896 . 
The    followinf^    candidates  have   passed   the   nnder- 

tnentioned  examinations  :— 

M.B.,  B.Ch.,  B.A.O.  Degrees  Examination— Upper  Pass. 

*8amuel  T.  Bens,  Queen's  College,  Belfast ;  *8teTenson  L.  Cummins. 
Queen's  Couege,  Cork ;  ^Bobert  J.  Johnstone,  B.A..  Queen's  Col- 
lege, BelfSst ;  *Thomas  J.  Kenny,  B.A.,  Queen's  College.  Belfast ;: 
James  St.  L.  Kirwan.  B.A.,  Queen's  College,  Galway,  and  OathoUo 
UniTersity  School  of  Medidne ;  *  Walter  S.  Smyth,  Queen's  OollMe, 
Belfast ;  WflUam  M.  H.  Splller,  Queen's  CoUege,  Belfast. 

Candidates  marked  thus  (*)  may  present  themselves  for- 
the  further  examinations  for  hooonrs. 
Pass. 

Blohard  Ansa,  Queen's  College,  Belfast ;  Harry  F.  Browne,  Qneea't- 
Conege,  Belfast :  Bobert  A.  Cunningham,  Queen's  Collese,  Belfarti 


aadSohool  of  Mediotne,  Bdiabnigh;  Alna  L,  Dobble,' London 

School  of  Medicine  fbr  Women ;  George  K.  Fhilay,  GathoUo 

UniTersity  Sohool  of  Medidne ;  Francis  T.  Heron,  Queen's  College, 

Belfast ;  Benjamtai  B.  Hosford,  Queen's  College,  Cork ;  Bdward  J. 

liddle.  Queen's 

CoUe«e  B^Ssti 

and  Catholic  Universita 


B.  Hosford,'  Queen's  College,  G 

I's  College,  Belfast ;  George  M.  B. 


;  Flands  J.  L.  P.  M'Kenna,  Queen's  CoUece,  Cork, 

jiversitar  School  of  Medldnei  wnUam  J.  Prendsr- 

gast.  Queen's  College,  Cork :  Patrick  J.  ScanneU,  Queen's  Colltge, 
Cork ;  George  PooU,  Queen's  CoBege.  Belfast ;  John  Y.  G.  Tighe, 
CathoUo  University  Sohool  of  Mediohie ;  and  Clara  L.  WDliams,. 
BJL,  Boyal  College  of  Surgeons. 


594    Thb  Mbdioai,  Prh«. 


NOTICES  TO  COBBBSPONDENTS 


JURB  3.  1S9II> 


c^OttCtS  to 

€oxvteTponbtnt9,  *$ltort  Jcttcrs,  &c. 

W9^  OOBRMPOMDJUiTB  requiring  a  reply  In  thli  oolnmn  are  par- 
Moiiluly  requeeted  to  make  nie  of  a  ditUnoHte  Hgnaturt  or  inHtolf  , 
and  aTold  the  praotloe  of  ligntaiff  themMlTee  "  Beader,"  "  Snbeerlber/' 
'*01d8iibeoriber,''  Ac  Mnoh  oonfndon  wfll  be  ipaied  bf  attention 
tothlinle. 

DB.  F.  H.  Wioonf  (New  YorkX-Yonr'paper,  with  woodenti,  came 
io  hand,  and  wu  dnl?  acknowledged  In  thli  column  some  weeki  baok. 
Ita  length  has  mrednded  Iti  iniertlon  io  far.  on  account  of  great  pree- 
«nre  on  onr  epaoe.  We  hope,  howerer,  to  And  room  for  it  during  the 
nreeent  month.  A  note  baa  been  made  of  yonr  request  about  the 
flluBtrationt. 

Db.  Jaxeb  Outsr.— Next  week,  if  poislble. 

THE  ORIGINfOF  S00LI08I8. 

Srouosra  wag  not  known  to  the  Qreeki,  becauae  they  Ifyed  out  of 
doon  and  were  not  cramped  with  tight  dothei.  It  flrrt  appeared  about 
the  sixteenth  century  and  was  brought  about  by  the  tight  dressing  of 
the  French. 

»  Mb.  Ht.  p.— We  quite  appreciate  the  object  of  yonr  inquiry,  but  we 
cannot  reply  In  these  columns  for  obvious  ressons.    If  the  restriction 
has  been  Imposed  as  a  necessity  by  your  medical  attendant,  he  should 
be  asked  for  instructions  as  to  "  ways  and  means." 
BICYCUKG— A  8UOOS8TION. 
To  ths  Editor  of  THB  MlDIOAL  PBB80  AMD  CDUJDLAB. 

Bib,— I  have  a  happy  thought  about  a  bicycle  which  I  take  the 
liberty  of  communicating  to  you  In  the  hope  that  It  may  so  reach  the 
public  end  manufacturers.  The  ugliest  thing  about  a  bicycle  is  the 
cross-handle  for  steering.  It  is  also  the  most  objectionable  part  for 
Ibe  rider,  for  it  makes  him  lean  forward  with  both  arms  stretched  out, 
nntil  he  looks,  for  all  the  world,  like  a  leap-frog  about  to  Jump,  and 
this  attitude  is  much  to  the  detriment  of  a  good  sitting  figure.  But  all 
thli  ugl'ness  and  injury  may  be  got  rid  of .  Only  change  the  shape, 
sise,  and  position  of  the  steering  lever,  make  It  half  the  length  and  to 
project  one  way  only,  inwards,  like  the  tiller  of  a  baise.  Then  the 
rider,  instead  of  being  compelled  to  stoop  over,  will  be  forced  to  sit  up 
and  back,  with  the  handle  In  front  of  him  to  be  worked  by  either  one 
or  two  hands,  to  the  right  or  to  the  left.  This  would  be  but  a  small, 
merely  mechanical  alteration,  but  its  effects  would  be  important  in 
more  wajrs  than  one. 

I  am,  Sir,  youn,  ftc, 

JAxn  E.  HUZLST,  M.D. 

Maidstone.  June  1st.  1896. 

Bb.  J.  O.  COHOB  (Buenos  AyrvsX— Tour  paper  on  "  The  Treatment 
of  Traumatic  Lesions  of  Knee-joint,"  to  hand. 

BB.  HcCambbidoi  (Gcrmantown).— Certainly,  with  pleasux^ 
A  MBBICAL  EXAMIKATION. 

PB0FB880B !  What  are  the  causes  of  death  In  typhoid  fever 

Stvdent :  (1)  Perforation  of  the  intestinal  ulcers  and  consecutive 
peritonitis ;  (2)  Cardiac  paralysis  produced  by  toxines  and  typhoid 
bacilli ;  (8)  ^  the  physician's  overdoshig.  This  last  cause  is  in  the 
present  age  the  most  frequent  agent  in  producing  death  by  the  medical 
nihlllsts~the  wise  men  of  the  end  of  the  century  who  are  unhappily  so 
numerous. 

Professor :  What  is  your  prescription  for  this  defect  r 

Student:  One  grain  doses  of  common  sense  mixed  with  one  of 
medical  discretion,  the  whole  to  be  taken  immediately  before  each 
visit.-  H.  B.  in  JSX  Siglio  Medico. 

Pdkzlbd.— It  is  apparently  more  dimcult  than  really  so.  A  very 
simple  piece  of  school  arithmetic  will  convince  you  of  this  and  enable 

Ion  to  understand  the  figures  with  ease.    Taking  one  grain  as  equal 
0  *0648  grams  you  will  quickly  arrive  at  the  equivalent  of  five  grains 
or  twenty  by  simple  multiplication. 
Bb.  Bbzd  (Stafford).— we  hope  to  have  space  for  yonr  paper  in  our 


Bb.  SIMP90V  (Tunbridge  Wells).— The  eases  are  marked  for  early 
Insertion. 

notable^fobgbts. 

Thi  following  cases  of  foreign  bodies  left  In  the  abdomen  after 
laparotomy  are  dted  in  the  last  number  of  our  Spanish  contemporary, 
^l  Siglio  Medico  .-—Sir  Bpenoer  Wells  twice  forgot  forceps  in  the  abdo- 
men :  Pilatte,  a  comivess ;  Terrlllon,  a  forceps ;  Quenu,  a  compress ; 
Uichaut,  a  roll  of  iodoform  gause :  Severenao,  two  binders  of  1*30 
metres  long.  The  utmost  care  of  instruments  should  be  taken  during 
a  laparotomy,  for,  as  Pozsi  says,'a  pair  of  forceps  may  slip  into  a  basin 
pr  be  carried  off  attached  to  the  tumour  or  to  a  sponge  without  being 
perceived,  end  lead  to  the  opposite  error.  H.  C.  Coe.  on  two  occasions, 
re-opened  the  belly  to  search  for  a  sponge  that  had  fallen  into  a  pail. 

Miss  Ti8nB.~TTndoubtedly,  in  the  opinion  of  some  aothoritles 
washing  the  face  with  hot  water  is  ruinous  to  a  natnrilly  healthy 
complexion.  The  hot  water,  especially  when  used  with  unduly  alka- 
line soap,  removes  a  large  amount  of  the  natural  fat  of  the  skin,  leaving 
it  with  a  rongtaened  surface  which  is  liable  to  excoriate  or  "  chap." 
The  Frenchwoman  prefws  to  smear  off  the  grime  with  the  comer  of 
her  handkerchief  steeped  in  glycerine. 


JRtetntQB  of  the  §0ttttit0. 

Wedhesdat,  June  Sbd. 
OB8TBTBI0AL  SociBTT  OF  LoHDOH.— Sp.uL  Specimens  will  be  shown. 
Papers:— Mr.  A.  Boran :  Cases  of  Fibroma  of  the  Ovary  and  Ovarian 
Ligament  Removed  by  Operation,  with  a  Series  of  After-histories  of 
Cases  reported  in  the  "  Transactions  "  since  1879.  Br.  J.  Phillips :  An- 
terior Colpotomy.  Mr.  T.  H.  Morse :  A  Case  of  Impacted  Ovarian 
Bermoid  Cyst  Bemoved  during  the  Ninth  Month  of  Pregnancy. 


Fbipat,  Jmra  6th. 
West  Lohdov  MSDioo-CHiBiniaiOAL  Soczett  (West  London  Hos- 
pital, W.X— 8.80  p.m.  Clinical  Evening.  Br.  Glemow:  Bodent  Ulcer 
Excised  and  Grafted.  Mr.  S.  Edwards :  Curious  Anal  Affection.  Br. 
Abraham  and  Br.  Bockrell :  Skin  Affections.  And  other  Caaea  by  Br. 
Chapman.  Mr.  Keetley.  Mr.  BldweU,  and  Mr.  Ecdea. 


BiriEenhead  Borough  HospltaL —Junior  House  Buigeon.  Salary  £00 
per  annum,  wtth  board  and  lodging.  A  further  sum  of  from  MHO 
to  £t5  per  annum  is  usually  obtained  in  fees.  Particular*  of  tfia 
Chairman. 

Brentford  Union.— Medical  Siqwrlntendent  of  Infirmary  and  Medical 
Ofilcer  of  Workhouse  and  Schools.  Salary  £860  per  annum,  with 
furnished  reaidence  in  the  Infirmary,  rations,  washing,  Ao.,  or 
£800  with  furnished  residence,  washing,  Ac.  but  without  nttons. 
Also  an  Assistant  Medlosl  Oaoer.  Salary  £100  per  annum.  FnU 
Mrticulars  of  the  Clerk  to  the  Guardians,  Union  Oflloes,  laleworth. 

Cancer  Hospital,  Fnlham.— House  Surgeon.  Salary  at  the  rate  of  £50 
per  annum,  with  board  and  residence.    Applications  to  tbm  Baere- 

Parish  of  Crelch  (Sutheriand).— Medical  Oflloer.  Salary  £45  per  annum 
with  customary  fees  and  allowances.  Applications  to  Bavid  Boas, 
Inspector  of  Poor,  Bonar  Bridge,  Sutherland,  N.B. 

Stamford  Hill  and  Clapton  Dispensary.— Junior  Besident  Medical  Ofli- 
cer.  Salary  commencing  at  £60  per  annum,  with  board  and  lodg- 
ing. Immediate  qiplicatlons  to  the  Senior  Besident  Medical 
Officer. 


BLAEDVOBD,  J.  J.  G.,  L.B.C.P.  Loud.,  M.1LC.S.,  Fifth  Asdstant  Medi- 
cal Officer  to  the  London  County  Lunatic  Asylum  at  Banstead. 

BO8TO0K,  &.  H.  F^  L.R.O.P.,  L.B.C.A.  Ed.,  L.F.P.8.  Glaw..  Medical 
Officer  for  the  Norton  Sanitary  District  of  the  Malton  union. 

BuBaBS.  B»  B.,  M.D..  M.Ch.  IreL,  Medical  Officer  for  Hoole. 

BUBEBIT,  L.  B.,  LBCP.Lond.,  M.B.C.8.,  Assistant  House  Suiseon 
to  the  Leicester  Infirmary. 

Obawfubd,  BATicoirD,  M.A.,  M.D.  Oxon.,  M.E.aP.,  Physician  to  Out- 
patients, Victoria  Hospital  tor  Sick  Ghfidren,  Chelsea. 

Fbne,  a.  C,  L.S.A.,  Assistant  Medical  Officer  at  the  Fever  Hospital, 
Dover. 

FnrDLAT,  W.,  M.B.,  C.M.|Aberd.,  Medical  Officer  to  the  AbsKdeen 
General  Dispensary. 

FLOBT,  Ctbil  H.,  M.1LC.S.,  L.B.C.P.,  House  Phyiiolan  to  the  Boyal 
Hospital,  Sheffield. 

HAIXAX,  H.,  M.]LaS.,  LJLaP.,  Junior  Assistant  House  Physlolan  to 
the  Boysil  Hospital,  Bheflteld. 

HOQG,  F.  S.  D.,  L.B.C.P.  Lend.,  M.B.C.S.,  Medical  Oflicer  for  the  Bnd- 
well  Sanitary  District  of  the  Maldon  (Jnion. 

KAT,  J.  G.,  M.B,  MS.  Edin..  Medical  Officer  for  the  Tintem  Sanitary 
District  of  the  Chepstow  Union,  also  for  the  Trelllck  Sanitary  Dis- 
trict of  the  Monmouth  Union. 

KBB,  Claude  B.,  M.B.,  aM.  Edin.,  Medical  Superintendent  of  the 
Edinburgh  City  Hospital  for  Infectious  Diseases. 

LiDDOM,  BiOHABD,  M.B.C.S.  Eng.,  Medical  Officer  of  Health  to  the 
Urban  and  Port  Sanitary  Auworities,  Deal. 

MOBBIBOH,  A.  T..  M.B.,  B.Ch.  IreL,  District  Medlcal|  Oflicer  to  the 
Aylesbury  Union. 

Phillips,  L.  C.  p.,  M.B.,  BC.  Camb^  L.]LaP.  Loud.,  M.B.C.8,, 
House  Physician  to  the  Royal  Free  Hospital,  London. 

PoUoABD.  Geo.  W.,  M.K,  Edin.,  Senior  House  Suigeon  to  the  Chil- 
dren's Hospital,  Myrtte  ^itreet,  UverpooL 

BAWLiMas,  J.  B..  M.B.  Lend.,  L.B.C.P.,  M.R.C.S.,  House  Physician  to 
the  General  Lying-in  Hoapital,  Lambeth. 

Sabdall,  T.,  B.A..  M.B.,  B.C.,  Cantab.,  M.R.C.S.  Eng.,  Medical  Officer 
of  Health  by  the  Alford  Urban  District  CouncU. 


§ivthg. 


EMPSOM.-May  86th,  at|MUbome  Port,  Somerset,  the  wife  of  John 

Empson,  L.R.C.P.I..  L.B.C.S.I..  L  M.,  of  a  son. 
LuiVD.— May  29th,  at  Sandywood,  Pendleton,  Manchester,  the  wife  of 

Herbert  Lund,  F.R.C.S.,  of  a  son. 
SPEBOHLY.— May  21st,   at  Parkgate,  Cheshire,  the  wife  of  H.  Mi 

Speedily,  &i.R.C.S..  L.R.C.P.  Load.,  of  a  daughter. 


J9l«trt«gc«. 


Fbaseb— Phibbs.— On  May  28th,  at  Highbury  Congregational  Chnrdu 
Clifton,  Andrew  MeamsFraser,M.B.,  of  Portsmouth,  to  Alfreda 
Mary,  daughter  of  E.  W.  Phibbs,  CUfton. 

Read— Hudson.— On  Msy  28rd,  at  All  Souln',  Laogham  Place,  London, 
W.,  Henry  G.  Read,  M.R.C.S.,  L.R.C.P.,  L.S  A..  LB.S.Eng.  of 
1  Portland  Place.  London,  W.,  to  Mrs.  S.  T.  Hudson,  of  Barling 
House,  near  Southend,  Essex. 


HABXHE88.-MaT  82nd,  at  his  residence,  Falrlight  House,  Hampton 
BUI,  Alex.  Harfcness.  UR.C.P.  A  S.  Edin.,  aged  45. 


HOBTOB.— May  2Qth,  at  Bromley,  Kent,  the  residence  of  his  sen-ln-law, 
James  Horton.  M.R.i;.S.  Loud.,  of  Stepney,  aged  74. 

Pbaohbt.— May  22nd,  at  Ballyoonnel,  co.  Cavan,  Allan  Thomas 
Peachey,  M  R.C.S..  aged  88. 

WEBB.— May  80th,  at  Rock  Bank.  Tunbridge  Wells,  Ed.  L.  Webb, 
M.B.aP.  Ed.,  M.&CJS.  Eng.,  L.B.A.,  aged  7L 

yOTICB—Announcementti  of  Births,  Marriagetf  and  Death*  «n  CAs 
/Ofniliee  of  Sub«eribere  to  thie  Journal  are  ineartod  free,  and  mxut 
recch  the  publi^.rg  nAtUU»r  than  the  Monday  preceding  jAMieaHiion. 


Wnt  ^dmi  ^vtnn  mA  (SiitmUt 


««SALUB    POFUU    BUPREMA    LBX." 


Vou  oxn. 


WEDNE8DA5f,    JQNE    10,    1896. 


No.  24 


CANCER    OF    THE    BKEA&T.(a) 

By  WILLIAM  THOMSON,  F.fLC.S.L, 

rmUUnt of  tlM Bml Oonage of  Somong in Irdand;  Snigoon to tlw 
Blobmona  Hoipitid,  Dablin,  fto. 

We  have  become  so  much  aocnstomed  to  diwossioiiB 
xm  the  advanced  surgery  of  to-day  that  I  feel  ahnoet 
lx)and  to  apologise  for  asking  your  attention  for  a  short 
time  to  the  apparently  common-place  subject  of  cancer 
'of  the  breast  It  is  a  little  difficult  to  avoid  the  fasd- 
fiations  of  enterectom]r>  or  some  of  the  other  operations 
tipon  the  abdomen  or  its  contents ;  or  those  even  bolder 
procedures  in  brain  exploration  which  are  sometimes 
«o  successful  and  satisf:pig  to  the  operator.  But 
these  are  not  of  the  ordinary  every-day  work  of  the 
eurgeon.  On  the  other  hand,  the  breast  and  its 
tumours  are  the  subject  of  constant  experience  either 
for  diagnosis  or  operation.  They  are  the  cause  of  great 
mental  suffering ;  there  is  hardly  a  woman  who  does 
not  know  that  troubles  in  that  organ  are  common,  and 
very  many  who,  at  some  time  or  other,  believe  that 
ihey  have  a  **  lump,"  or  live  in  dread  that  they  may  get 
•one.  Now,  a  fiela  of  surgery  like  this,  although  it  may 
be  ordinary,  is  a  very  important  one,  especially  when 
we  have  to  deal  with  any  form  of  malignant  disease, 
with  all  its  known  persistence  and  resistance  to  treat- 
ment That  being  so,  I  think  the  surgeon  may  pause 
«nd  ask  himself  whether,  in  the  general  advance  of 
operative  work,  this  most  common  and  terrible  pla^e 
o!  cancer  of  the  breast  has  received  the  close  attention 
that  it  deserves ;  whether  it  is  one  of  the  few  things 
which  have  baffled  his  enterprise,  and  remain  pretty 
much  where  they  were. 

I  remember  that,  some  years  ago,  the  late  Mr. 
Eawdon  MacNamara  read  a  paper  on  this  subject 
before  the  Surgical  Societv,  and  that  he  gave  the 
gloomiest  view  of  the  results  of  operation.  He  was 
«peaking  as  a  professed  unbeliever  in  the  principles  or 
powers  of  antiseptic  and  aseptic  surgery,  and  of  the 
promise  which  it  held  out  to  us  as  to  safety  of  severer 
methods  of  operation.  But  at  the  time  he  was  riffht  in 
his  contention,  that  operation  was  practically  a  nope- 
less  proceeding,  and  that  at  the  best— which  might  be 
doubted— there  was  only  the  prospect  of  a  slightly 
prolonged  life,  and  the  chance  that  a  recurrence  would 
not  take  place  locally.  Well,  we  have  advanced  some- 
what upon  that  view  of  the  situation.  If  it  were  true, 
I  think  we  should  find  verj[  few  cases  upon  which 
•operation  would  be  at  fldl  justifiable,  and  we  should  be 
forced  to  leave  the  unhappy  patient  to  the  poor  solace 
•of  anodynes  to  smooth  her  way  to  the  grave.  Not  only 
that,  but  we  should  perforce  abandon  all  operations 
for  cancerous  disease  of  whatever  form.  The  fact 
vemains,  however,  that  we  have  not  done  so :  nor  is 
there  the  least  likelihood  of  such  an  attitude  being 
taken.  We  operate  upon  cancer  of  the  lip,  of  the 
rectum,  of  the  tongue ;  and  we  do  so,  not  with  the 
purpose  of  givinjg^  a  temporary  relief  only,  but  with  the 
distinct  impression  in  our  mmd  that  the  disease  mav 
not  recur  at  all,  and  that  the  patient  may  be  cured. 

<a)  Eeid  in  the  Section  of  Surgery,  Boyal  Academy  of  Medicine. 

1696. 


Why,  then,  should  we  shut  out  from  ourselves  the  view 
that  cancer  of  the  breast  may  be  cured  ?  Ibelievethat 
it  can  be ;  I  have,  myself,  had  two  patients  in  whom 
there  was  no  sign  of  any  return  six  and  seven  years 
after  operation.  They  were  both  cases  of  ^  undoubted 
scirrhus,  verified  by  microscopic  examination.  One  I 
saw  six  years  ago,  ai^d  she  may  be  alive  yet  The 
second  I  have  seen  within  the  past  three  months.  She 
is  absolutely  without  a  sign  or  symptom  of  return  of 
the  disease.  Two  cases  are  at  present  living,  without 
any  return,  and  have  almost  reached  Yolkmann's  limit 
of  safely— three  years.  Other  surtjeons  can  relate  the 
same  satisfactory  results.  Mr.  Mitchell  Banks  and 
Mr.  Watson  Cheyne  reports  21  and  19  per  cent  of 
cures  respectively ;  and  the  latter  now  chums  that  he 
has  had  as  much  as  57  per  cent  under  improved 
methods.  Even  those  who  nold  strongly  that  cure  is 
exceedingly  problematical  admit  that  it  does  take  place 
in  ten  per  cent  of  the  cases,  and  this  admission  is 
enough  tor  my  purpose,  when  I  contend  that  the  posi- 
tion of  amputation  of  uie  breast  for  cancer  is  to-dav 
more  satisfactory  than  it  has  ever  been,  and  that  with 
thoroughness  and  care,  a  considerable  number  of  the 
cases  which  come  before  us  mav  be  saved. 

It  used  to  be  the  fashion  with  surgeons  to  rest  con- 
tent with  removal  of  the  breast  alone  ;  or  to  abandon 
the  case  cdtogether  if  the  glands  in  the  axilla  were 
engaged.  I  remember  that  when  I  was  beginning  to 
practise,  a  wise  consultant  dissuaded  me  from  opera- 
ting in  a  case  for  this  cause  alone.  I  saw  no  reason 
why  the  glands  should  not  be  removed  as  well,  but  the 
patient  adopted  his  view.  Herein  lies  the  first  impor- 
tant advance— the  thorough  removal  of  the  affected 
glands  from  the  axilla,  in  my  experience  there  is 
nothing  so  likely  to  deceive  one  as  the  condition  of  this 
space  helore  operation.  It  is  ve^  deep,  and  sometimeB 
there  is  no  inmcation  that  the  disease  nas  yet  laid  hold 
upon  glands.  But  a  free  opening  out  of  it  will  expose 
small  clusters  of  the  glands,  quite  sufficiently  engaged 
to  perpetuate  the  disease.  They  must  be  all  cleared 
ouC  with  careful  patience,  until  the  sur^n  is  satisfied 
that  only  vessels  and  nerves  and  undiseased  tissues 
remain  behind. 

But  some  surgeons  do  not  rest  content  with  this. 
Mr.  Cheyne,  for  instance,  makes  very  extensive  incisions 
and  removals.  He  holds  that  the  breast  is  a  much 
wider  spread  organ  than  we  have  imagined,  and  that 
it  reaches  as  far  as  the  sternum,  the  clavicle,  and  the 
origins  of  the  abdominal  musclei^  But  the  important 
point  is,  that  the  whole  of  the  lymphatics,  as  contained 
in  the  fascia,  over  the  great  pectoral,  and  the  chain 
which  passes  along  its  ed^  into  the  axilla  should  be 
completely  removed  ;  for  in  these  lymph  vessels  there 
is  lurkinff  disease,  even  if  the  glands  have  not  been 
apparentiy  engi^rod.  I  have  practised  this  method  for 
some  years,  as  nave  my  colleagues,  and  with  some 
encouraging  results.  When  I  have  found  adhesions  to 
the  muscle,  portions  of  this  have  been  cut  awav ;  and 
in  some  cases  we  have  divided  the  great  pectoral  freely, 
in  order  to  follow  up  any  glandular  disease  which  may 
have  extended  towards  the  clavicle. 

But  we  have  got  a  step  further.    Most  surgeons 

I  have,  I  think,  regarded  the  enlargement  of  the  supra- 
clavicular glands  in  the  posterior  inferior  triangle  of 
the  neck  as  a  well-defined  contra-indication.    In  a 


J96     Thi  MiDiuAL  Puns. 


ORIGLfAL  COMMUMCATIONS. 


JiTNi  10,  18M. 


certain  namber  of  caaeo  it  is  no  longer  aa  The  spaoe 
is  now  o^ned  above,  and  the  whole  chain  of  the  lym- 
phatics IS  pursued  up  under  the  clavicle  from  the 
axilla,  and  cleared  away.  This  may  sometimes  be 
done  quite  effectively,  but  with  less  chiAnce  of  ultimate 
recovery.  Where  this  condition  exists,  the  first  fflan* 
dularline  of  defence  has  been  overcome,  and  we  nave 
in  most  cases,  I  fear,  reached  the  limits  of  interference. 
Still  the  operation  is  not  very  formidable,  and  any 
additional  risk  is  worth  the  chance  of  improvement 
Of  the  further  advance— amputation  at  the  shoulder 
joint,  and  division  of  the  clavicle— I  have  no  exper- 
ience, but  it  seems  to  me  to  introduce  an  enormous 
risk  without  anv  compensating  advantages. 

I  pass  from  this  to  refer  to  another  question  upon 
which  very  much  depends— is  cancer  produced  locally, 
or  is  it  the  result  of  an  already  existing  constitutional 
state.  I  believe  that  in  the  great  bulk  of  cases,  it  is 
at  first  purely  local,  although  I  know  that  there  are 
many  who  regard  it  as  the  local  expression  of  a  dia- 
thesis. So  far  as  clinical  experience  goes,  I  hold  that 
we  have  no  evidence  to  show  that  the  patient  is  al- 
ready cancerous  when  the  first  signs  of  the  new  growth 
appear.  If  I  were  convinced  of  the  truth  of  that  con- 
tention I  should  not  operate  for  cancer  at  all,  because 
I  should  not  have  the  dimmest  hope  that  I  could  do 
more  than  palliate.  I  admit  that  we  find  this  disease 
occasionally  developing  in  successive  generations  from 
an  original  stock.  That  is  not  a  mere  coincidence.  I 
have  no  doubt  that  in  some  of  these  cases  there  is  in- 
herited a  peculiar  constitutionsd  state  which  may  render 
the  individual  more  liable  to  the  results  of  prolonged 
irritation  applied  to  some  particular  tissue.  But  ad- 
mitting all  this,  we  cannot  get  beyond  a  suspicion 
that  in  a  particular  case  the  hope  of  ultimate  recovery 
may  be  less  than  in  one  in  which  we  have  no  history  of 
poasible  taint.  We  know  nothing  of  the  existing  con- 
oition,  whether  the  bias  that  may  be  given  towards 
the  development  of  the  disease  is  a  strong  or  a  weak 
one.  Wb  judge  that  it  is  certainly  not  a  state  of  satu- 
ration ;  we  know  that  there  is  no  apparent  pathological 
chspsn.  There  is  no  peculiar  modification  of  type  bj 
which  we  can  recognise  it  as  we  do  inherited  syphilis 
or  tuberculosis.  If  there  is  a  taint  at  all  it  appears  to 
be  passive,  not  virulent ;  it  has  not  the  power  to  set 
its  impress  upon  the  whole  organism,  as  does  either  of 
the  diseases  I  have  just  mentioned*  Compared  then 
with  tuberculosis,  which  is  admittedly  constitutional, 
oancer  appears  to  be  less  potent  in  effecting  those 
changes  upon  the  individual,  which  make  it  easy  for 
us  to  identify  them.  There  is  unquestionably  in  these 
cases  a  peculiarity  of  contour  and  of  structure,  to 
which  the  so-called  cancerous  diathesis  has  no  corres- 
pondence whatever.  There  is  no  character  that  we 
know  of  that  will  indicate  to  us  an  existing  cancerous 
tendencv.  May  we  not  then  draw  the  conclusion  that 
tuberculosis  in  heredity  is  able  to  influence  the  body 
more  profoundly  than  cancer  1 

I  think  that  is  a  fair  conclusion ;  but  let  us  see 
where  it  leads  us.  The  true  believer  in  a  cancerous 
diathesis  has  no  faith  in  the  possibility  of  cure  bv  the 
removal  of  the  tumour.  Ask  nim  why  and  he  will  tell 
you  that  the  tissues  are  already  poisoned  by  the  disease 
—not,  remember,  as  the  result  of  infection  from  the 
loo&l  outbreak,  but  by  an  inherited  virus.  He  can 
point  to  nothing  more  tangible  than  a  family  history  ; 
there  is  no  physical  alteration  of  any  kind— apart  from 
the  tumour—  upon  which  he  can  lay  his  finger  and  say 
that  that  indicates  an  undoubted  cancerous  diathesis. 
Now,  observe  how  illogical  he  may  be.  We  bring  him 
to  a  case  which,  so  far  as  the  admitted  appearances  go, 
is  stamped  everywhere  with  the  signs  of  inherited 
tuberculosis.  A  joint  has  become  diseased,  but  he 
does  not  despair  ;  he  will  excise  it  or  amputate  a  limb 
— not  to  paluate  but  to  cure,  and  to  cure  bv  removing 
the  local  affection,  although  he  leaves  behind  it  the 
inherited  tendency  which  is  marked  on  every  feature.  I 


confess  I  do  not  see  how  these  two  views  can  be 
reconciled. 

I  have  no  intention  to  minimise  the  gnkyity  of  cancer. 
It  is  to  me  the  most  terrible  and  unsatisfactory  dinase 
which  we  have  to  deal  with  as  surgeons  ;  but,  think- 
ing as  I  do,  that  in  its  first  stages  it  has  only  a 
lo^  virulence,  I  wish  to  say  so  much  in  encoura^ 
ment  of  operation.  There  is  a  period  during  which  its 
progress  is  slow,  dejMnding  sometimes  upon  thedc^gree 
of  natural  vascularity,  as  in  the  tongue :  sometimes 
upon  the  acauired  increased  vascularis  wnieh  follows 
tiie  birth  of  a  new  growth.  The  process  of  general 
infection  is  delayed  by  the  lymphatic  glands,  which  I 
call  the  first  line  of  defence.  The  activitv  of  the 
poison  is  at  first  centred  in  the  initial  growtn,  and  if 
we  see  this  early  I  believe  we  may  remove  it  with  a 
reasonable  hope  of  success.  But  no  matter  whether 
we  are  called  late  or  early  the  important  law  must 
always  be  obeyed— to  clear  out  the  axilla  with  the 
greatest  care. 

I  should  like  very  much  to  deal  with  another  impor- 
tant aspect  of  this  subject— the  diagnosis  of  tumours 
sometimes  mistaken  for  sdrrhus.  But  it  would  occupy 
too  much  time  now,  and  I  must  postpone  it  for  another 
occasion. 

I  have  avoided  bringing  before  you  long  and  quite 
uninteresting  details  of  numerous  cases.  I  have  rather 
tried  in  a  short  paper  to  raise  a  few  points  for  discus- 
sion ;  to  awaken  more  interest  in  a  disease  and  its 
treatment  which  we  have  perhaps  looked  upon  with 
too  litUe  hope,  and  to  show  that  the  outlook  for  it  is 
less  dark  than  it  has  been.  It  is  beyond  doubt  that 
breast  scirrhus  is,  under  certain  conditions,  a  curable 
affection  in  a  fair  percentage  of  cases.  At  present  that 
percentage  is  not  as  high  as  I  think  it  will  become 
under  doser  attention  to  operative  methods.  We  may 
look,  too,  for  its  earlier  recognition  ;  but  given  this, 
wiUi  its  co-existing  favourable  conditions  of  mobility 
and  slight  infection  of  the  axillary  glands,  I  think  we 
may  expect  still  better  results  than  we  have  yet 
attained. 


LARGE  FIBRO- MYOMA  OF  UTERUS 

ENUCLEATED  AND  REMOVED  FROM  THE 
LEFT  BROAD  LIGAMENT  BY  ABDO- 
MINAL SECTION-PREGNANCY 
SUBSEQUENTLY. 

By  JAMES  OLIVER,  M.D.,  F.L.S.,  F.RAE., 
PhytlcUuD  to  the  Hospital  for  Women,  Sdio. 

Annie  G ,  »t  26,  and  married  nine  years :  has 

had  one  child,  which  was  bom  ekht  years  aga  Men- 
struation, established  at  the  a^^  of  twelve,  has  recurred 
every  three  weeks  since  the  birth  of  the  diild.  It  used 
to  last  five  or  six  days,  but  during  the  last  twelve 
monliis  the  discharge  has  been  excessive  in  amount^ 
and  has  often  persisted  for  fourteen  days. 

For  two  years  patient  has  ooinplained  more  or  less  of 
pain  in  the  lower  abdomen,  it  has  generally  been 
worse  just  before  menstruation,  but  independently  of 
this  phenomenon  the  paroxysmal  attacks  of  pain  iuive 
sometimes  been  so  severe  as  to  cause  the  patient  to 
double  "  herself  up.  The  pain  was  first  complained  of 
about  fourteen  days  id^r  a  fall  sustained  two  years* 
ago,  and  simultaneously  she  detected  a  small  Inmpui 
the  left  Oiac  region,  which  has  increased  in  size 
gradually.    There  is  no  bladder  symptom. 

On  Sept.  28th,  1892,  the  patient  came  under  my  care^ 
and  the  following  are  the  physical  signs  which  were 
then  recorded  :  The  abdomen  is  prominent,  especialiy 
its  left  half.  It  is  occupied  by  a  swelling—regolar.^^ 
outline  and  somewhat  globular  in  shape— whicn. 
extends  from  the  pubes  to  the  umbilicus.  At  a  spot 
midway  between  tne  pubes  and  umbilicus  the  tumour 
measures  8  inches— 6  inches  lie  to  the  left  and  2  to  tner 


Juki  10,  1896. 


CLINICAL  KECORDS. 


Ths  MiDioAL  Press.     597 


right  of  the  linea  alba.  It  ia  soft  in  ooneistence,  but 
fluctuation  cannot  be  elicitecL 

VcbgincU  Examination,— The  cervix  uteri  is  in 
apposition  with  the  right  wall  of  the  pelvis,  and  the  os 
is  rather  patent.  Hie  left  hdf  of  the  pelvis  is  occupied 
by  a  globular  mass  which  is  continuous  with  the  abdo- 
miniu  tumour,  and  the  whole  is  fairly  movable.  Bv 
bimanual  examination  the  body  of  the  uterus,  which 
is  slightly  enlarj^ed,  can  be  defined  to  the  right  of,  and 
in  apposition  with,  the  abdomino-pelvic  tumour. 

I  considered  the  tumour  to  be  a  cyst  in  the  left 
broad  ligament,  and  advised  its  removal. 

Operation.— On  opening  the  abdomen  the  tumour 
was  found  to  be  a  nbro-myoma  of  the  uterus  which 
had  grown  into  the  left  broad  ligament  It  was 
enucleated  from  its  surrounding  tissue,  and  its  attach- 
ment to  the  uterus,  which  formed  a  pedicle  with  a 
diameter  of  about  three  inches,  after  being  carefully 
covered  with  peritoneum  was  constricted  by  the  wire 
of  a  serrenoeud  and  fixed  in  the  abdominal  wound. 
By  this  method  of  dealing  with  the  stump  the  uterus 
was  so  rotated  that  the  anterior  and  posterior  surfaces 
looked  somewhat  laterally.  On  account  of  the  unusu- 
ally larse  size  of  the  stump,  granulation  proceeded 
slowly,  but  the  patient  was  able  to  walk  about  ten 
weeks  after  the  operation. 

Menstruation  had  ceased  eleven  days  before,  but  it 
recurred  four  days  after  the  operation,  and  on  this 
occasion  it  persisted  for  nine  days.  Since  the  opera- 
tion the  menstrual  diachar^  has  never  been  excessive, 
and  the  duration  of  the  inter-menstrual  period  has 
usually  been  twenty-five  days. 

Three  years  after  the  removal  of  the  tumour  this 
patient  conceived,  and  when  four  months  pregnant  she 
consulted  me  on  account  of  severe  attacks  of  cramp  in 
the  right  hip  and  thigh  coming  on  at  night,  and  from 
which  she  had  suflTered  for  fourteen  days. 

The  stump  in  the  abdominal  cicatrix  had  become 
greatly  increased  in  size  and  projected  markedly.  It 
measured  six  inches  transversely  and  two  and  three- 
quarters  vertically.  The  skin  immediately  covering  it 
was  of  a  purplish  hue.  Underlsring  the  skin  was  a 
large  and  branching  vein  coursing  from  right  to  left. 

The  patient  is  now  pregnant  six  and  a  half  months, 
and  as  yet  no  unusual  symptom  has  been  complained  of. 


TWO    CASES    OF 

EHEUMATOID    AETHEITIS 

TREATED    BY    THE 

HOT-AIR    METHOD. (a) 

By  W.  KNOWSLEY  SIBLEY,  M.D.  Cantab., 
M.R.C.S.  Lond., 

Fhydciaii  to  Oat-patlente,  Horth-West  London  HotpltaL 

Thb  first,  a  woman,  »t  66,  a  dressmaker,  came 
tinder  my  c&re  at  the  North- West  London  Hospitcd  in 
1892,  havinj^  previously  been  under  treatment  at  an- 
other hospital.  At  this  time  she  had  considerable 
enlargement  of  all  the  fingers  of  both  huids ;  these 
were  quite  fixed,  and  very  painful.  The  movements 
of  the  wrists  were  also  very  limited,  so  also 
was  the  right  elbow.  The  knees  and  shoulders 
were  enlarged  and  painful.  The  patient  attended 
for  many  months,  and  although  a  large  num- 
ber of  drugs  and  remedies  were  tried,  she  ^n^^^Uy 
became  worse,  and  had  to  give  up  her  occupation ;  then 
she  was  unable  to  dress,  and  finally  unable  to  feed  her- 
self, and  was  becoming  more  hopeless  every  day. 

At  this  time,  in  August,  1894,  one  of  the  Tallerman- 
Sheffield  hot-air  cylinders  was  brought  to  the  hospital, 
and  this  new  treatment  was  prescribed.    After  the 

(a)  Ftttiente  shown  and  remark!  made  before  the  Harreian  Society 
of  LoDdon,  Hay  2Ut,  189& 


first  ai>plication  the  pain  was  considerably  relieved  and 
the  joints  showed  some  improvement  After  the 
fourth  application,  the  patient,  who  had  been  unable 
to  follow  ner  business  for  many  months,  was  a|pdn 
able  to  use  her  needle.  After  the  eighth  application, 
with  the  exception  of  the  right  index-finger,  all  the 
otJiers  could  be  flexed  without  much  dimcnlty.  On 
August  24th,  after  the  ninth  operation,  the  patient 
reported  she  had  resumed  her  occupation  as  a  dress- 
maker, and  she  was  able  to  walk  up  and  down  stain 
witiiout  pain.  The  patient  continued  under  this  treat- 
ment till  September  13th,  having  then  had  twenty 
baths,  when  she  considered  herseff  practically  cnrecL 
but  as  the  apparatus  was  still  at  the  hospital,  she  had 
an  occasional  bath  up  to  the  end  of  October,  1894. 
From  that  date  to  November,  1895,  she  continued  at 
her  work,  and  with  the  exception  of  minor  ailments, 
suffered  no  inconvenience  from  her  former  trouble.  At 
this  time  she  again  complained  of  pain  and  stiffness 
in  the  right  hand,  so  three  more  baths  were  prescribed 
She  again  rapidly  improved,  and  from  that  time  to  the 
present,  the  patient  nas  continued  much  as  she  now 
IS,  and  nas  not  relapsed. 

Hie  other  case  was  a  tailoress.  »t  69.  For  some 
vears  her  hands  had  been  painful  and  the  joints  en- 
larged. She  first  came  under  my  care  at  ths  Hospital 
on  April  22nd,  1896.  Her  knees  and  ankles  were  some- 
what stiff  and  painful,  but  the  hands  were  chiefly 
affected,  all  the  finger  joints  were  much  enlarged,  she 
also  suffered  from  bronchitis  and  asthma.  Thb  patient 
has  now  had  fifteen  baths  with  the  result  tluit  her 
knees  and  ankles  were  much  less  swollen,  so  also  her 
cough  and  general  nervous  condition  have  greatly 
improved. 

To  those  unacquainted  with  the  system,  I  may 
explain  that  the  treatment  consists  in  placing  one  limb, 
usually  the  most  affected  one,  in  a  cylinder  heated  to 
about  ISO''  and  this  temperature  is  gradually  increased 
up  to  about  240°.  The  limb  is  allowed  to  remain  in 
for  about  fort^  minutes.  During  this  time  the  patient 
usually  perspired  freely  from  the  limb,  and  in  fact 
from  the  whole  body.  The  temperature  taken  in  the 
mouth  rises  one  or  two  degrees  and  the  frequency  of 
the  pulse  is  also  increased.  About  a  quarter  of  an 
hour  after  the  limb  is  removed,  the  temperature 
returns  to  what  it  was  before  the  treatment  The  pain 
in  the  affected  and  other  parts  is  greatly  relieved,  and 
the  patient  experiences  a  considerable  feeling  of  relief 
generally,  especially  it  is  noticed  that  the  bronchitic 
condition  which  so  often  accompanies  this  affection  is 
also  much  benefited. 


CASE  OF  SYMBLEPHARON  CURED  BY  THE 
TRANSPLANTATION  OF  A  LARGE  PIECE  OF 
SKIN  WITHOUT  PEDICLE  ON  TO  THE  SUR- 
FACE OF  THE  EYEBALL  ITSELF,  (a) 

Under  the  care  of  Db.  a  B.  Tatlob»  F.R.C.S.E., 
Hon.  Sorgeon  to  the  Nottingham  and  Midland  TSje  Inflnnary. 

Thb  patient,  who  is  forty  years  of  age,  was  struok  in 
the  open  eye  by  a  lump  of  hot  slaff  while  engaged  in 
paddling  at  the  Codnor  Park  Iron  Works,  and  when  first 
seen  the  lower  lid  was  firmly  adherent  to  the  globe,  the 
result  of  an  extensive  bum  which  had  destroyed  a  con- 
siderable portion  of  the  ocular  and  palpebral  conjunctiva. 
Rei>eated  attempts  to  secure  separation  of  the  adherent 
tissues  by  the  usual  conjunctival  methods  having  failed 
the  lid  was  dissected  from  the  eyeball,  a  pieoe  of  skin 
excised  from  the  upper  lid  of  the  uninjured  eye,  and  trans- 
planted at  once  on  to  the  surface  of  the  ^lobe,  its  lower 
margin  beinsr  well  pulled  down  between  the  lid  and  the 
eyelMdl  by  sutures  which  emerged  on  the  cheek.    The  flap 


Bril 


[a)  Patient  ehown  before  the  Ophthalmological  Society  of  Oreat 
^taln,  May  7th,  1896  ,  ^ 


598    Tn  MiDKUL  Puaa.        TBAKBACIttUn  OF  SOCIETIES. 


Jottb  10, 18iB 


»dh&nd.  by  the  flnfc  inttntUm ;  there  wm  not  the  digfatest 
tendeooy  to  aboffhing  thronghoot  the  whole  progiew  of 
the  oeee ;  and  the  remit  was  all  that  ooald  hare  been 
deiiied.    Of  ooune,  a  graft  might  hare  been  taken  from 


the  opper  lid  of  the  iojared  eye,  in  which  caae  it  would 
hare  been  yoteible  to  hare  preeerved  a  pediole  o 
tranepUnted  a  bridge ;  but,  aafortnnatefy,  the  upper 


or  to  have 


Ud  of  the  patient  in  qneetlen  wee  damaged  at 
time  aa  the  lower,  ite  oartJiage^mt  aeroes,  ite  nnder  ear- 
laoe  ezoorinted  and  the  margin  etcongly  inonrved,  ao  that 
the  laahea  ewept  upon  the  glehe,  prodeoinf;  the  tttmoat 
pain  and  dieoomfort.  Tliit  eondition  was  treaited  by  a 
method,  the  only  one  so  far  aa  Dr.  Bell  Taylor's  experi- 
ence soes,  by  which  inveterate  cases  of  entropion— cases 
whioh  have  resisted  the  neoal  methods  of  treatment— may 
be  sncoessfally  dealt  with,  a  perpendionlar  incision  is  made 
at  each  extremity  of  the  affected  lid  which  is  everted,  the 
two  incisions  connected  by  a  deep  e«t  on  the  inside  }ast 
within  the  roots  of  the  lashes,  and  carried  right  down 
through  the  cartilage  to  the  ontiole,  a  strip  ef  skin  is  then 
taken  from  the  lid,  and,  retaining  a  broaa  pedicle  trans- 
planted into  the  wennd  thos  made.  The  approximation  ef 
the  edges  of  the  gap  on  the  snrfaoe  of  the  lid  everts  the 
lashes,  and  the  transplanted  skin  effeotoaUy  prevents  any 
return  to  their  abnormal  aitoation. 


HARVSIAN  SOCIETY. 
MnnKo  BiLD  Thursday,  Mat  218t,  1896. 

OUNICAL  EVININO. 

Dr.  Gow  in  the  Chair. 

OASl  or  60-CALLRD  VITIUOO. 

Dr.  Travibs  Smith  showed  for  Dr.  MaeEvoy  a  man,  »t. 
57,  whoee  skin  had  lately  become  generally  pigmented,  the 
parts  HMMt  deeply  pigmented  being  the  f  aoe,  the  shonlders, 
and  backs  of  the  arms,  the  external  aspect  of  the  lees,  a 
narrow  line  running  over  the  spine,  and  a  broad  lielt 
spreading  from  over  the  scapala  to  the  front  of  the  thorax 
and  pasmg  nndemeath  the  axillie,  where  by  contrast  the 
skin  appeared  quite  pale.  The  darker  areas,  with  the 
exception  of  the  thin  hne  over  the  spine,  were  more  or  less 
thickly  studded  over  with  circular  or  oval  white  patches, 
varying  in  size  from  that  of  a  hemp  seed  to  that  of  a  split 
pea.  On  the  lees  most  of  these  spots  were  distinctly 
below  the  level  M  the  surrounding  dark  skin,  and  were 
anesthetic.  The  man  complains  that  the  past  six  months 
his  appetite  has  been  flagging,  and  that  his  skin  has  been 
irritable.  He  denies  having  had  syphilis  or  small-pox,  or, 
indeed,  any  eruption,  but  says  that  he  heard  that  when  a 
child  he  had  the  "cow-pox." 

Dr.  T.  D.  Savill  expressed  the  opinion  that  this  case 
presented  the  condudioff  stage  of  prurigo,  by  which  he 
meant  a  disease  attended  by  severe  itching  accompanied 
by  small  papules  and  larcper  ervthematous  blotches.  Such 
cases  were  frequently  foUowea  by  considerable  pigmenta- 
tion around  the  positions  of  the  original  skin  lesions,  and 
the  diap^osis  was  in  this  case  supported  by  the  history,  and 
the  irritation  from  which  the  patient  still  suffered  which 
were  absent  in  vitiliga  The  position  across  the  shoulders 
and  its  characters  here  favoured  the  idea  that  the  prurigo 
in  this  instance  had  been  or  nearly  initiated  by  pediouli. 

Mr.  Jaoksok  Clarxx,  referring  to  Dr.  Travers  Smith's 
oase^  obeerved  that  the  lesions  in  this  case  were  not  scars, 
but  due  to  pigment  atrophy  as  in  leuoodermia  or  vitiligo. 
In  several  pwtionlars  the  case  differed  from  average  cases 
of  leuoodermia.  In  the  first  place  the  lesions  were  small 
and  tended  to  run  in  streaks,  then  the  patient  was  much 
older  (70)  than  was  usual  when  the  mssase  began,  and 
again  the  affection  was  attended  with  pruritus,  which  was 
not  the  rule. 

THREE  OASIS  OF  8TPHILI8  IN  CHILDRXN. 

Mr.  Jackson  Clarkb  showed  these.  The  first  patient, 
a  little  girl,  et.  3,  had  probably  acquired  the  disease  after 
birth,  seeing  that  the  mother  was  treated  for  a  hard  sore 
when  the  child  was  three  months  old,  and  that  when  she 
first  came  for  treatment  at  the  age  of  12  months,  she  had 
a  general   superficial   eruption.    She  had  done  well  on 


healthy'OookiMir 


foom 


Tlie  aeeond  ease  was  that  of  a 
girl,  mt.  12.  Three  years  ago  she  had  small  { 
9m  tongue.  These  oleeeated,  ami  had  Isfe 
enperfimal  gloetitis.  There  were  typical 
teeth.  When  first  seen,  the  child  was  almost  blind 
intsntltial  keratitis,  though  at  the  psesent  time  the  I 
had  a  normal  appearance  and  the  patient  eonld  see  welL 
She  had  been  kept  steadily  on  lodkle.  The  third  oaae 
was  that  of  a  baby,  mL  10  months,  who  had  been  under 
treatment  for  three  weeks.  When  first  seen  she  was  ex- 
tremeW  asthenic  and  anemic,  and  there  were  muoone 
tubwtues  at  the  anus.  Tftiere  was  no  enlargement  of  liver 
or  spleen.  Half  a  draohm  of  meronrv  ointment  had  been 
rubbed  in  over  the  lower  pert  of  the  abdemen  «vei7  «ight» 
and  the  patient  had  gained  greatly  in  strength. 


OAfli  or  ORKnNiaic 

Mr.  HuBaw  C.  PhilxiIFS  showed  a  girl,  »t.  26,  enfl  _ 
from  eretinisns.  Patient  was  in  good  health  until  siie  wae 
rix,  when  she  moved  from  Kent  to  London.  Typioal  oaae 
— weight  and  measurements  have  much  diminished  ainoe 
eommenoement  of  treatment  by  thyroid  tabloids  (Oppen- 
heimer),  of  which  she  is  now  takmg  m,  15  per  diem. 
Coarseness  of  skin  and  hair  much  uss  marked,  and 
strength  increased.  Intellect  fairly  developed,  only  objec- 
tionable symptom  during  treatment  being  oephalalgiA. 
Patient  is  three  feet,  ten  inehes,  in  height. 

GASB   or   P8T0HROJB8THXBIA. 

Dr.  Leonard  Quthrib  showed  a  bricklayer,  sst.  52; 
euffering  from  «'Psyohro0sthesia"  (Silvio's).  The  sym- 
ptoms were  of  four  years'  duration,  and  dated  from  the 
occurrence  of  loose  cartilages  in  the  right  knee.  They 
consisted  chiefiy  of  constant  subjective  sensations  of 
extreme  and  painful  odd  affecting  the  whole  of  the  right 
lower  extremitv  at  first,  but  more  recently  involving  the 
right  arm  and  left  leg  to  a  lees  extent  The  right  Uitgfa 
and  leg  were  somewhat  wasted.  There  was  no  local 
heaviness  or  anesthesia  in  the  course  of  the  nerves.  The 
electrical  reactions  were  normal,  but  he  showed  a  remark- 
able  tolerance  of  etrong  Faradie  currents.  Tactile  sensa- 
tions were  perfect,  and  also  apprsciation  of  heat  and  cold. 
The  applioatiou  of  heat  relieved,  whilst  that  of  cold  inten- 
sified the  symptoms.  There  was  no  actual  loss  of  tempe- 
rature in  the  limb,  and  no  cedema.  The  knee-jerks  were 
normal ;  muscular  sense  was  perfect.  He  regarded  the 
case  as  possibly  one  of  earlv  syringo-myelia. 

Dr.  Savill  thought  the  case  was  one  of  extreme 
interest,  and  that  its  features  had  been  most  lucidly 
brought  before  the  society.  He  agreed  with  the  diagnosis 
of  s^rineo-myelia.  Although  the  symptoms  of  this  msease 
usually  began  in  the  arms,  he  had  seen  a  case  which  had 
startea  and  predominated  ar  this  one  had  done,  in  the 
lower  extremities.    The  patient  was  a  female,  et.  29,  who 


admitted  under  his  care  into  the  Paddinffton  Infinnary 
for  paraplegia.  The  svmptoms  had  startetf  with  a  numb- 
ness and  weakness  of  the  feet,  followed  later  on  by  numb- 
ness and  weakness  of  the  hands.  The  paresis  always  pre- 
dominated in  the  legs,  though  the  patient  could  walk 
a  few  steps  on  admission.  A  few  weeks  after  admission 
she  suddenW  fell  back  and  died.  At  the  autopey  the 
central  cans!  of  the  spinal  cord  was  found  to  be  dilated 
from  end  to  end,  and  surrounded  in  the  upper  half  by  a 
small-celled  gUomatous  new  erowth,  which  by  its.  exten- 
sion into  the  medulla  had  prcduoed  sudden  death. 

Dr.  Caonbt  congratulated  Dr.  Guthrie  on  the  very 
admirable  summary  of  clinical  facts  he  had  given  the 
Sodetv.  The  inference  which  Dr.  Outhrie  based  upon 
these  facts,  vis ,  the  diagnosis  of  early  syringo-myelia  was, 
after  all,  but  matter  for  speculation,  since  the  early  sym- 
ptoms of  that  disease,  he  submitted,  had  not  been  ado- 
quately  observed.  It  was  equally  true  that  the  interesting 
case  before  the  Society  did  not  cloeely  conform  to  any 
clinical  type  at  present  recognised  in  the  text-books  but 
was  doubtless  one  of  a  very  large  class  with  which 
riper  experience  would  make  us  familiar.  He  |wae  not^ 
himself,  disposed  to  assign  a  special  cause  to  the 
symptoms.  He  pointed  out  that  the  wasting  paralysii 
was  approximately  hemiplegic  in  character.  Extensive^ 
albeit  unusual,  sensorv  changes  was  a  combination  sugges- 
tive of  cerebral  disturoanoe.  He  did  not  suppose  that  in 
such  a  case  any  change  would  be  found  post-mortem. 

Dr.  Guthrie  replied  and  also  showed  a  case  of 


JV9M  10,  IHMw 


FRANCE. 


Tb>  filBmAiA 


599^ 


Hnn-AN.«STHK8XA  AKD  HBMI-ANAUDHIA  WITH  PA&4LT8I8 
OF  LBFT  SIDB  OT  SOFT  PALATB»  THOUGH  NOT  OF  THB 
STMRNO-MASTOID  OR  TRAPEZIUS; 

Tho  symptomB  were  regarded  as  fanctioiial,  bob  perhape 
as  foremnneri  of  disseminated  sclerosis,  as  there  was 
doable  nystagmas  with  limitatioD  of  fields  of  vision. 

TWO  OASIS  OF  OHROKIO    BH1IUVATD1D    ARTHRITIS  TRRATBD 
BT  THR  HOT-AIR  MRTHOD. 

These  cases,  exhibited  by  Dr.  K.  Siblkt,  will  be  found 
in  another  colamn. 

BOX^AL  ACADEMY   OF  MEDICINE  IN  IRELANDi 

Srotion  OOP  Patholoot. 

Mrbtoio  hrld  Friday,  April  24th,  1896. 


The  President,  Dr.  Conollt  Norman,  in  the  Chair. 

kxhibits. 

Dr.  a.  R.  Parsons  exhibited  specimens  of  lesions  of  the> 
ffastro-intestinal  traot^a)  Extensive  nicer  of  stomach ; 
(6)  perforating^  nicer  of  daodennm;  (c)  malignant  stric- 
ture of  pylorus ;  (d)  fibrous  stricture  cA  pylorus  (gastro- 
enterostomy by  Murphy's  button). 

Mr.  Benson  read  a  paper  on  <*  IntraKionlar  Sarcoma." 

Mr.  Whrrlrr  exhibited  a  specimen  of  "Malignant 
Tumour  and  Abnormal  Condition  of  Kidneys,"  removed 
from  a  male  patient  in  the  City  of  Dublin  Hospital, 
which  extended  from  the  sacro-coccvgeal  ariiculatioQ 
to  about  the  second  lumbar  vertebra.  It  could  be 
felt  occupying  the  right  and  left  iliac  reffion%  and 
could  be  felt  by  recuJ  examination,  about  four  inches 
from  the  anus.  The  patient  had  lost  weight  and  was  of 
sallow  complexion.  The  tumour  was  firmly  adherent  to 
the  sacrum,  and  when  torn  away  the  bone  was  bared  and 
roughened.  The  growth  was  hard  and  nodular ;  the 
enlarged  glands  were  hard  but  small;  superiorly  the 
aorta  and  inferior  vena  cava  were  surrounaed  by,  and 
almost  disappeatine  in,  the  tumour.  The  small  intestines 
andcaacum  were  cBsteiided  with  air;  in  the  ascending 
transverse  and  descending  colon  could  be  felt  small  msimos 
of  hardened  faces.  The  sigmoid  fiexure  was  pushed  over 
to  the  right  side  of  the  middle  line.  The  upper  part  of 
the  rectum  was  involved  and  surrounded  by  the  growth, 
and  from  the  posterior  part  of  the  mucous  membrane  the 
growth  appears  to  have  had  its  origin.  The  posterior 
wall  of  the  bladder  was  adherent  to  the  tumour  ;  the  UAt. 
ureter  was  dilated,  embedded  in,  and  nipped  by  the 
tumour ;  the  right  ureter  was  normal ;  the  left  kidney 
was  a  dilated  pyst ;  the  kidneys  presented  the  horse-shoe 
variation  ;  the^  stomach,  spleen,  and  liver  were  healthy. 

Dr.  McWbsnxt  had  received  part  of  the  tumour  for 
miokoecopical  examination.  It  was  a  carcinoma,  but  could 
not  exactly  be  called  either  scirrhus  or  encephaloid.  It 
had  not  sufficient  fibrous  tissue  in  proportion  to  the  glan- 
dular tissue  to  be  called  scirrhus.  The  shape  of  the  ceUs 
was  not  readily  determinable,  as  the  specimen  was  not  in 
good  condition.  With  reference  to  the  horse-shoe  kidney, 
he  wished  to  know  whether  both  kidneys  were  displaced 
downwards,  and  over  what  vertebra  the  connecting  band 
between  them  passed,  and  the  relation  of  the  ureters? 

Mr.  Whbelrr,  replying,  said  that  the  ureters  were 
exactlv  in  the  normal  condition.  The  kidneys  were  a 
little  lower  down  than  usual,  and  the  connecting  band 
passed  over  the  second  lumbar  vertebra. 

Dr.  McWxRNXT  read  a  paper  on  **  Pyelitis  Calculosa, 
with  Ulceration  of  the  Stomach." 


BRITISH  BALNEOLOGICAL   AND   CLIMATOLOGI- 

CAL  SOCIETY. 

Mestino  hrld  Wednisdat,  Mat  20th. 

The  President,  Dr.  Hxnrt  Lewis  in  the  Chair. 

Dr.  Haldanb  read  a  paper  on  the 

CUMATX  and  mineral  springs  of  bridge  of  ALLAN. 

He- pointed  out  that  the  mildness  and  freshness  of  the 
climate,  due  to  the  situation  of  the  town  on  a  gentle  slope 
facing  south,  surrounded  behind  and  at  sides  by  hills,  make 
it  a  suitable  Scottish  winter  resort  for  many  invalids,  while 


the  waters  act  as  a  mild  and  safe  aperienrt,  diuretic,  and 
deobstvnent,  and  are  used  with  suooess  in  chronic  oonsti* 
pation,  and  liver  and  glandular  affsetio^s,  the  treotaiedt 
and  baths  being  carried  on  equallj  well  in  summer  or 
winter.  The  b^ths  are  found  useful  in  some  cases  of 
chronic  skin  diseases  and  rheumatism*  The  ^'NauheAffl 
treatment"  of  cardiac  affeetioBS  is  now  being  tested  afe 
Bridge  of  Allan. 

Dr.  Mtrtli  (Harrogate)  considered  Bridge  of  Allan 
more  suitable  for  cases  of  bronchial  irritation  and  phthisis 
than  any  other  part  oi  Scotland. 

Dr.  MoxoN  ( Matlock)  and  Dr.  GiLBRier  (Tunbrldge  Wells> 
considered  the  change  of  climate  and  mode  of  life  haa 
more  to  do  with  the  benefit  ceqeived  by  patients  at  BridfBS 
of  Allan  than  the  waters. ' 

Dr.  Ttson  (Folkestone)  said  they  would  do  a  great 
amount  of  good  by  placing  their  own  he«lth  resorts  in  the 
proper  position  they  deserved,  and  they  did  not  wish  tO 
push  the  claims  of  their  own,healtb  reeorts  to  the  exclu- 
sion of  foreign  spas. 

Dr.  Htde  (Buxton)  then  moved  the  fUk) wing  resolution : 
*'  This  meeting  is  of  opinion  that  increased  travelling  faci- 
lities in  the  shape  of  specially  reduced  fares,  through 
communication,  and  quicker  and  more  frequent  tram 
services  in  connection  with  British  Health  Resorts  are 
desirable,  not  only  in  the  interests  of  sudi  resorts,  but  also 
in  those  of  the  visitors,  and  particularly  invalids^  who 
have  to  reeort  to  the  spas  and  watering-places  in  search  of 
health,  and  the  meeting  further  resolves  that  the  Council 
be  requested  to  appoint  a  committee  to  consider  the  sub- 
ject with  the  view  to  infloeocing  the  various  ndlway 
authorities,  and  taking  such  other  stepe  ae  may 
be  deemed  desirable."  He  showed  the  aisadvantagee 
under  which  our  home  resorts  labour  on  account  of  the 
cheaper  traveUing  facilities  granted  to  visitors  to  contin- 
ental resorts,  giving  numerous  illustrations.  He  said 
health  resorts  were  not  ordinary  towns,  that  the  traffie* 
was  esentially  a  holiday  traffic,  and  that  the  fares  should 
be  reduced,  and  other  concessions  and  alterations  mado 
as  to  the  length  of  stay,  &c. 

Dr.  Snow  (Bournemouth)  warmly  seconded  the  resolu*' 
tion  and  said  the  railway  companies  should  be  approached 
in  the  most  iriendlv  way,  and  he  thought  it  would  be 
better  to  do  this  tnrough  the  Councils  of  the  different- 
towns. 

Dr.  Myrtle  (Harrogate)  said  on  manv  lines,  hunters^ 
golfers  and  curlers  could  travel  for  reauoed  fares,  and  r 
visitors  to  health  resorts  ought  to  be  treated  similarly.  H» 
pleaded  for  a  better  sanitary  accommodation  in  all  trains. 

Dr.  CurFB  (Woodhall  Spa)  said  at  Woodhall  Spa  they 
had  approached  the  railway  company  some  years  pse- 
viouslv  with  the  greatest  success  as  regards  reduced  fares, 
extended  time  of  stay,  and  through  carriages. 

Dr.  Leonard  Williams  (Sidmouth)  thought  a  Com- 
mittee should  be  appointed,  but  should  |  only  exercise  ite 
influence  on  application  from  the  various  health  resorts. 

Dr.  Htdb,  replying,  agreed  that  th^  could  not  do  mueb^ 
on  account  d  the  commercial  aspects,  but  he  thought 
concentrated  influence  would  be  more  powerful  and 
efficient  than  that  of  individuals. 

The  resolution  was  carried  unanimously. 


J^tMXtt. 


[from  our  own  correspondent.] 

PABI8,  Jane  eth,  1899. 
POST-PARTUM  HiEMORRHAOE. 

Prof.  Tarnier  described  before  the  Obstetrical  Society 
the  treatment  to  be  followed  in  case  of  hemorrhage  after 
delivery.  In  the  first  instance,  it  was  necessary  to  distin* 
guish  Uie  origin  of  the  hemorrhage,  whether  from  the  os, 
the  vagina,  or  the  vnlva^  or  from  the  body  of  the  utems. 
In  the  former  case,  it  was  generally  due  to  the  rupture  of 
some  small  arteries,  which  bled  slowly,  but  continuously. 
A  minute  examination  in  a  good  light  was  necessary  to 
discover  the  source  of  the  bleeding.  If  instruments  wer» 
at  hand,  an  artery  forceps  should  be  applied,  or  a  suture 

C 


600    T|q  Mm>ioal  Pwa, 


GERMANY. 


Joan  10.  1896. 


made,  but  freqneotly  outside  an  hospital  snch  treatmont 
was  not  pocaiblo,  and  then  plugging  should  be  tried. 

In  hsBmorrfaage  from  the  body  of  the  uterus,  ergot  used 
to  be  constantly  gi^n  at  the  dose  of  the  confinement  as  a 
prophylactic  remedy,  but  to-day  that  drug  is  oonsidered 
dangerous,  and  is  consequently  abandoned,  warm  water 
injections  taking  its  place.  As  a  curative  treatment,  oon- 
traction  of  the  uterus  should  be  provoked,  and  he  knew  of 
no  better  means  than  that  of  emptying  immediately  the 
organ  of  its  contents  by  the  hand  or  the  curette,  and  then 
employing  subcutaneous  injections  of  ergotine.  The  con- 
secutive treatment  consisted  In  the  administration  of  hot 
drinks  and  alcohol,  in  the  ligature  of  the  limbs,  so  as  to 
send  back  the  blood  to  the  heart  and  finally,  if  necessary, 
injecting  artificial  serum  into  the  veins. 

Mbthod  or  DiBiNFxonNG  THi  Blood  ih  Bsbious 
iNnsonons  Disiasbs. 

An  important  eontribution  on  this  subject  has  just  been 
made  by  Dr.  Henri  Barr^.  The  process  to  which  Dr. 
Barr^  has  given  the  name  '*  disintoxication  of  the  blood  " 
is  derived  from  nmuUaneaus  employment  of  two  therapeu- 
tic means  already  made  use  of  in  medicine  ;  the  one  very 
ancient,  bleeding ;  the  other  very  modem,  the  intravenous 
injection  of  artificial  serum. 

The  aim  of  this  treatment  is  to  oombat  the  phenomena 
of  general  intoxication  which  manifest  themselves  in  the 
course  of  or  towards  the  end  of  many  diseases,  and  which 
in  themselves  put  in  peril  the  life  of  the  patient.  Before 
this  treatment  is  begun  there  ought,  of  course,  to  be 
brought  to  bear  the  ordinary  methods  at  the  disposition  of 
the  physician :  purgatives,  diuretics,  stimulants,  sedatives^ 
Aa,  and  it  is  not  until  the  insufficiency  of  these  is  evident 
that  as  a  last  resort  recourse  is  to  be  had  to  *'  disintoxica- 
tion of  the  blood." 

This  is  most  often  indicated  in  the  following  maladies : 
fir»mia,  eclampsia,  diphtheria  (when  Roux's  serum  does 
not  suffice),  infectious  pneumonia,  capillary  bronchitis, 
malignant  icterus,  general  acute  peritonitis,  cerebro-epinal 
meningitis,  typhoid  fever,  measles,  small-pox,  scarlet 
iever,  puerperal  fever,  cerebral  complications  of  rheuma- 
tism and  gout,  poisoning  by  alkaloids,  extensive  bums  of 
the  skin,  &o. ;  in  short,  in  all  cases  in  which  there  may  be 
expected  danger  as  much  or  more  from  general  intoxica- 
tion as  from  actual  lesions  of  the  organs  themselves. 

In  all  these  diseases  there  is  to  be  noted  a  oonsiderable 
diminution,  if  not  a  complete  cessation,  of  the  urinary 
function,  and  the  disintoxication  of  the  blood  has  for  its 
immediate  purpose — (1)  to  eliminate  artificially  a  certain 
quantity  of  toxines;  (2)  to  help  to  achieve  complete 
elimination  by  re-establishing  the  secretion  of  urine. 

The  instruments  necessary  consist  essentially  of  two 
indiarabber  tubes,  terminating  at  their  extremities  by  a 
needle  of  a  diameter  a  little  greater  than  that  of  a  Pravas 
syringe.  The  longer  of  these  tubes  (about  1^  in.)  con- 
ducts into  the  veins  of  the  arm  the  artificial  seram  from  as 
graduated  vessel  plaoed  at  a  position  more  or  less  elevated 
in  accordance  with  the  degree  of  force  with  which  the  fiow 
of  liquid  into  the  venous  system  is  required.  The  second 
tube  (1  metre),  of  which  the  needle  is  inserted  in  a  vein  of 
the  other  arm,  has  its  free  end  in  a  graduated  vessel,  and 
thus  serves  to  extract  blood. 

The  fiow  of  the  two  liquids  by  this  arrangement  can  be 
eo  regulated  that  no  more  serum  enters  than  blood  flows 
out,  and  thus  the  circulatory  system,  being  always 
equally  full,  arterial  tension  need  not  be  diminished,  as  it 
is  as  a  consequence  of  ordinary  bleeding. 


The  quantity  of  serum  introduoed  and  the  quantity  of 
diluted  blood  withdrawn*  may  vary  between  500  grammes 
and  one  litre  for  an  adult  in  accordance  with  the  degree 
of  intoxication. 

As  will  be  seen,  this  method  of  disintoxication  of  the 
blood  diSbrs  materially  from  another  method  which  has 
been  styled  «  washing  the  blood,"  and  which  has  been  for 
some  tiSie  applied  by  by  preference  in  oases  of  surgical 
infection.  The  diflisrence  consists  mainly  in  the  contem- 
poraniety  of  the  injection  and  bleeding.  This  prevents 
any  severe  interference  with  the  circulatory  system,  and 
allows,  if  death  from  intoxication  seem  imminent,  the 
withdrawal  of  the  greatest  quantity  of  blood,  and  conse- 
quently disintoxication  with  the  least  danger  to  the 
patient. 

The  exchange  of  liquids  is  made  very  quickly  (in  90  to 
00  minutes),  so  that  no  sharp  reaction  ensues;  grave 
symptoms  insensibly  diminish,  gradually  disappear,  and 
are  followed  soon  by  refreshing  sleep.  On  waking,  the 
patient  desires  to  pass  water.  Sometimes  sweating  aocom- 
panies  the  re-establishment  of  urination  as  in   natural 


In  the  three  cases  (two  of  uraemia,  one  of  infections 
pneumonia)  in  whioh  Dr.  Barre  has  applied  his  method, 
cases  in  whioh  everything  had  proved  useless  and  in  which 
death  appeared  imminent,he  obtained  improvement  asrapid 
as  that  just  described.  Not  only  did  the  most  serious 
symptoms  cease  but  at  the  end  of  the  urinary  crisis  th^ 
did  not  reappear  and  the  patient  progressed  steadily 
towards  cure. 

Dr.  Barr^  expounds  the  following  theory  to  explain  the 
phenomena  of  the  cure. . 

1.  There  is  elimination  of  the  excess  of  toxines,  which 
constitute  the  immediate  dangec 

2.  The  good  efiects  continue  because  the  bulk  of  blood 
is  not  diminished  in  volume  in  the  system  and  does  not 
need  reforming  at  the  expense  of  the  fluids  of  the  economy, 
and  the  arterial  pressure  not  being  diminished  no  obstade 
to  diuresis  is  created. 

3.  Not  only  are  toxines  eliminated  which  appear  to  have 
an  inhibitory  action  on  the  urinary  action,  but  the  toxines 
which  remain  become  diluted  and  less  powerful  for  eviL 

4.  As  recent  researches  have  pigDved,  the  alkaline  salts 
have  a  favourable  action  on  the  bactericide  powers  of  tlie 
blood,  and  the  method  thus  provides  the  economy  with  a 
new  means  of  fighting  successfully  against  the  microbes. 

Dr.  Barr^  believes  the  method  will  be  found  of  enormous 
advantage  in  veterinary  as  well  as  human  pathology. 


[fbom  oub  owk  ookbmfondbkt.] 

ButLni,  JuM  Srd 
Ths  Jbnnbb  Gblbb&ation  in  Bbbun. 
Thb  Jenner  celebration  passed  off  with  great  editt.  The 
city  of  Berlin  lent  for  the  occasion  the  Festsaal  ot  the  dtj 
Rathhaus,  and  decorated  it  suitably  to  the  occasion. 
About  300  medical  men  took  part  in  the  commemoration, 
amongst  them  Dr.  Bosse,  the  Gultus  Minister,  the  Rector 
of  the  University,  the  Surgeon-General  of  the  Army,  with 
a  number  of  the  higher  officials  and  several  members  of  the 
Reichs-Gesundheitsamt.  The  Medical  Faculty  were  nearly 
all  present,  and  these  were  also  deputations  from  nearly  all 
the.  medical  societies  of  the  city,    I  have  no  intention  of 


JjnsTK  10,  1896. 


AUSTRIA. 


Thb  Mcdioal  PlUM.     601 


reportiDg  the  proceedings.  I  sboald  probably  oofc  have 
mentlODed  the  celebration  farther  bat  for  one  statement  by 
Prof.  Virohow,  who  opened  the  proceedings  in  the  name  of 
the  Committee  of  Honoar.  He  said  we  lived  in  aa  era  of 
reverence  for  the  great  benefactors  of  mankind  Of  the 
namber  of  these,  as  regarded  the  number  of  haman  beings 
saved,  Jenoer  stood  at  the  head.  As  an  ethncdogist  he 
was  impelled  to  mention  an  ethnological  fact  in  the  history 
of  protective  vaccination :  "  AU  the  peoples  that  had  not 
})een  rectched  hy  vctceination^  or  that  had  not  accepted  it  had 
disappeared  from  the  Jaee  qf  the  earth  destroyed  by  the 
sTnall-poxJ" 

I  mast  jast  permit  myself  one  more  statement.  In  the 
address  of  Prof.  Gerhardt  appears  the  following,  bearing 
on  the  thoroagh  protection  of  German  soldiers  and  the 
very  imperfect  protection  of  another  foreign  army : — "  The 
war  of  1870  and  1871  famiehed  the  most  brilliant  proof  of 
the  protective  power  of  vaccination.  Of  the  one  and  a 
half  millions  of  men  composing  the  German  Army  only 
459  died  of  small-pox,  whilst  in  the  French  Army,  vac- 
cinated imperfectly  or  not  at  all,  23,400  men  died  of  the 
epidemic  of  small-poz  then  raging." 

LUMBAS  PUNOTUEB. 

In  the  papers,  and  at  the  Congress  for  Medicine  this 
subject  has  been  recently  discassed.  Dr.  Hermann 
Ricken  devotee  an  article  to  it  in  the  Arch,  f,  Klin,  Med,, 
and  gives  the  history  of  33  cases  on  whom  it  had  been 
carried  oat.  The  quantity  of  fluid  evacuated  varied  from 
3  to  63  com.  Very  often  nothing  followed  the  puncture, 
and  sometimes  sharp  pain  followed  the  withdrawal  of  the 
needle.  The  needle  had  to  be  withdrawn  at  once  when 
the  rapidly  sinking  pressure  caused  headache.  The  opera- 
tion was  of  interest  both  from  a  diagnostic  and  a  thera- 
peutic point  of  view.  The  ntormal  pressure  within  the 
dural  sac  had  been  estimated  at  from  40  to  60  mm.,  a 
pressure  of  100  mm.  was,  therefore,  pathological  He 
thought  himself  justified  in  stating  that  moderately 
increased  pressure  with  grave  symptoms  pointed  to  acute 
disease,  whilst  high  pressure  with  moderate  symptoms 
pointed  to  an  affection  that  was  chronic. 

As  regarded  the  therapeutic  standpoint,  the  essential 
action  was  the  unburdening  of  the  oerebro-spinal  cavity 
from  abnormal  pressure.  Resorption  was  also  furthered 
by  it.  Of  7  cases  of  meningitis  benigna  5  either  recovered 
or  improved.  No  good  effects  followed  in  tuberculous  and 
chronic  serous  meningitis.  Of  5  cases  of  cerebral  tumour 
1  showed  slight  improvement. 

AttheCongress  forlnnereMedirin,  Hr.  Lenhartz  of  Ham- 
burgh, had  of  late  oome  to  the  oonviotion  that  the  opera- 
tion was  of  extraordinary  diagnostic  and  therapeutic  value. 
He  had  punctured  in  126  coses,  and  had  made  accurate 
pressure  measurements  in  all  but  20.  Pressure  of  400  to 
600  mm.  were  often  met  with,  and  the  quantity  of  fluid 
evacuated  was  astounding.  No  injury  had  ever  been 
observed  from  the  puncture.  He  had  conflrmed  the  state- 
ment of  Quincke  that  a  proportion  of  albumen  of  1/4  per 
cent,  indicated  inflammatory  disturbance.  He  thought 
puncture  would  be  useful  in  acute  and  chronic  serous 
meningitis,  in  chronic  hydrocephalus,  and  in  many  middle 
forms  of  acate  serous  and  epidemic  oerebro-spinal  menin- 
gitis  he  had  seen  good  results.  He  had  also  met  with 
good  results  in  many  bad  forms  of  chlorosis,  with  cerebral 
oonditions,  and  in  acute  oedema  of  the  brain  following 
injury. 

Hr.  Kr6nig  (Berlin)  had  foand  tubercle  bacilli  in  the 
fluid  in  lour  cases  out  of  a  total  of  flve  cases  of  tuber* 


onions  meningitis.  In  a  girl  with  chlorosis,  who  suffered 
much  from  headaches,  this  symptom  disappeared  after 
puncture,  and  had  not  returned  fourteen  days  after. 

Hr.  Goldscheider,  Berlin,  had  gained  his  experience  of 
the  operation  in  the  Moabit  Hospital.  He  saw  some  alle- 
viation in  two  oases  of  tumour,  but  observed  no  good 
effect  in  tuberculous  meningitis.  lt\  desperate  cases 
of  cerebral  tumour  the  coma  might  be  diminished.  He 
had  al^o  punctured  several  times  in  uraemia,  and  had 
several  times  found  a  large  quantity  of  fluid,  but,  also, 
several  times  only  a  little. 

At  the  Society  for  Innere  Median,  Hr.  H.  Kohn  again 
brought  up  the  subject.  A  young  man  was  admitted  into 
hospital  suffering  from  headache  and  some  fever.  As 
pieces  of  tapeworm  were  passed,  he  was  treated  forut,  and 
the  worm  was  expelled.  But  the  headache  got  no  better* 
nor  did  the  other  symptoms.  A  provisional  diagnosis  of 
tuberculous  meningitis  was  arrived  at^  although  neither 
the  eyes  nor  the  ears  gave  any  evidence  of  it.  Lumbar 
puncture  was  made  twice,  and  both  times  numerous 
tubercle  bacilli  were  found.  The  diagnosis  was  then  eon- 
firmed,  although  the  puncture  hadno  goodefifect  whatever  on 
the  disease,  and  death  took  place  in  a  short  time.  At  the 
autopsy,  extensive  miliary  tuberculosis  was  found,  that 
had  given  rise  to  no  symptoms. 

Hr.  Fraenkel  said  that  t-he  diagnosis  of  tuberculous 
meningitis  was  often  diflicult,  and  for  such  lumbar  punc- 
ture was  of  great  service.  In  examining  the  fluid,  care 
should  be  taken  to  get  a  sediment  and' examine  that  care- 
fully. The  invasion  was  interesting  on  account  of  the 
locidity  and  on  account  of  the  implication  of  the  thoracic 
duct,  on  which  Ponflck  was  the  flrst  to  report.  The  pro- 
cedure was  generally  so  that  the  near  glands  were  the  first 
attacked,  then  the  process  spread  to  the  walls  of  the  duct, 
then  passed  through  them,  and  then  spread  more  widely. 
According  to  Weigert,  this  mode  of  progress  was  rare,  the 
disease  more  frequently  spread  through  the  blood-vessels. 

Hr.  Stadelmann  confirmed  the  diagnostic  value  of  the 
operation.  In  a  case  associated  with  pneumonia  a  remit- 
tent fever  came  suddenly  on  and  head  symptoms.  There 
was  no  opisthotonos  or  slowing  of  the  pulse  or  headache. 
The  suspicion  of  meningitis  led  them  to  lumbar  puncture. 
The  pressure  was  not  great,  and  the  fiuid  contained  only 
Fraenkel's  pneumococd.  Without  the  aid  of  puncture  it 
would  have  been  difficult  to  arnve  at  a  diagnosis. 

Hr.  Ftirbringer  had  in  the  same  way  been  able  to  make 
a  diagnosis  that  otherwise  could  not  have  been  made,  and 
which  was  afterwards  confirmed  at  the  autopsy. 
♦ 

[»BOM  CUB  OWV   OOBSMPONDUr*.] 

VimA,  June  6th.  18M. 
Mtbinoitis. 

Politzeb's  paper  on  this  dubject  resolved  itself  into  a 
history  of  <*  Otiatria,"  with  which  he  has  been  identified 
during  the  last  thirty-five  years.  His  first  pathological 
researches  and  pubUoations  were  rehearsed  and  explained. 

The  tympanum  in  the  normal  condition  was  composed 
of  three  layers,  viz.,  the  middle  or  substantia  propria, 
which  was  the  principal  framework  of  the  organ.  The 
outer  surface  was  covered  by  cutis,  the  inner  surftuse  by 
mucous  membrane,  in  common  with  the  internal  covering 
of  the  middle  ear. 

The  primary  diseases  of  the  tympanum,  per  w,  are  very 


602    Ths  Msdioal  Psisb. 


GENERAL  MEDICAL  COUNCIL. 


June  10.  1896. 


nre.  The  mott  freqaent  are  deriyed  from  neigboor- 
ing  Btniotaree  such  as  the  catie  eztemally,  and  the 
mocom  membrane  of  tympanum  internally.  Arate  in- 
flammation of  the  external  ear  is  marked  by  a  broken  scarfy 
denudation  of  the  cutiealar  snrfaoe.  Exudation  of  a 
eerons  or  hsemorrbagio  character  |with  vesicles  points  to  an 
influenza  myringitii.  This  usually  runs  a  favourable 
course,  and  terminates  with  perfect  restoration  of  func- 
tion. Similar  symptoms  are  to  be  met  with  in  otitis 
media,  when  the  catarrhal  effects  have  stretched  beyond 
the  tympanum.  The  differential  diagnosis  depends  on  the 
power  of  hearing,  as  in  simple  isolated  myringitis  this 
function  is  no  way  affected. 

Chronic  myringitis,  pure  and  simple,  is  also  a  rare 
phenomenon,  and  is  commonly  diagnosed  by  the  dirty, 
oUy,  irregular  surface  due  to  the  thickening  of  the  mem- 
brane. When  this  form  assumes  the  granulation  appear- 
ance the  affection  has  become  grave. 

Traumatic  ruptures  are  recognised  by  a  tear  in  the 
membrane,  with  flapping  edges,  red  and  bleeding,  with 
ecchymosis  on  other  parts  of  the  surface.  In  catheterising 
the  Eustachian  tube  the  air  rushes  through  with  a  soft 
blast,  while  in  the  pathological  rupture,  the  opening  being 
small  causes  the  air  to  assume  a  higher  pitch  in  sound, 
being  under  greater  pressure. 

The  results  in  the  traumatic  form  are  usually  favourable, 
while  the  labyrinth  is  preserved  by  the  very  accident. 

Secondary  catarrhal  processes  occur  with  or  without 
perforation  of  the  tympanum,  while  the  phenomena  met 
with  are  so  varied  that  no  uniform  picture  of  diagnosis 
can  be  drawn,  owing  no  doubt  to  the  implication  of  the 
middle  ear  in  the  morbid  changes.  There  is  one  important 
symptom  which  he  claimed  should  not  be  forgotten  in  the 
diagnosis,  viz.,  the  evidence  of  the  retention  of  fluid 
by  the  presence  of  a  line  on  the  membrane  marking 
the  highest  level  of  the  pent-up  fluid.  In  cases 
where  the  fluid  has  covered  the  whole  of  the  tympanum 
the  membrane  will  have  a  yellow  appearance  easily 
recognised  from  the  normal  condition.  The  fluid  may  drain 
off  naturally  by  the  nose,  but  when  this  does  not  occur 
more  heroic  treatment  must  be  resorted  to  by  paracentesis 
of  the  membrane  and  the  more  viscid  fluid  abstracted.  In 
connection  with  these  secondary  changes  that  occur  that 
of  the  calcareous  degeneration  is  of  considerable  import- 
ance. It  is  usually  recognised  by  the  abnormal  trans- 
parency of  the  tympanum,  its  vaulting  with  slight  folds  on 
the  membrane  making  a  short  perspective  of  the  handle  of 
the  hammer. 

Affections  of  the  tympanum  arising  from  otitis  media 
acuta  are  usually  of  a  catarrhal  nature,  and  induce 
myringitis  acuta  with  the  swelling  and  vesicular  appear- 
ance described  above  with  a  vanishing  arrangement  of  the 
manubrium.  This  form  can  also  go  on  to  recovery  with- 
out perforation,  but  in  some  cases  the  perforation  is  so 
small  that  it  may  be  overlooked  in  the  examination,  which 
may  be  suspected  from  an  undue  amount  of  secretion 
found  in  the  external  ear.  Pulsation  is  an  important 
diagnostic  sign,  as  it  points  to  adrying-upof  the  secretion. 
An  abscess  which  usually  developes  after  influenza,  can 
easily  be  recognised  by  the  nipple-like  appearance  on  the 
tympanic  area.  Perforation  is  not  always  successful  in 
these  cases  as  a  fresh  accumulation  may  take  place  and 
necessitate  a  repetition  of  operations.  It  not  infrequently 
happens  that  operation  aggravates  the  condition,  which 
ultimately  leads  to  destruction  of  the  entire  tympanum, 
especially  so  in  cases  of  diphtheria  and  scarlatina. 


Chronic  aflisotions  of  the  middle  oar  are  equally  destrae- 
tive  in  their  reeults  on  the  tympanom,  where  severml 
perforations  may  be  met  with|particularly  in  tubercalou» 


Other  forms  of  morbid  changes  affecting  the  tympanum 
wereseptama  in  the  Eustachian  tube ;  perforations  of  the 
upper  part  of  the  processus  brevis  or  membrane  Schrmp- 
nelli,1whioh  testify  to  the  presence  of  pus  in  the  outer 
attions.  These  do  not  affeet  the  power  <^  hearing  but  are* 
stubborn  under  treatment,  neceesitating  the  removal  of 
the  manubrium  when  there  is  danger  of  the  base  of  brain 
becoming  involved. 

Chdesteoma  were  easily  recognised  when  the  morbid 
mass  lay  near  the  perforation,  but  when  ooncealed  in  the 
upper  vault  of  the  middle  ear  the  diagnosis  was  di£Bcnlt. 


GENERAL    MEDICAL    COUNCIL 

OF 

EDUCATION  AND  REGISTRATION. 


SUMMEK  SESSlOli,  1896. 


FIRST  DAY.— TuwBAT,  Juvn  2nd. 

Sib  Riohabd  Qdaih's  term  of  office  as  President  having 
expired,  Sir  Dyce  Duckworth  was  temporarily  voted  to  the 
chair.  Thereupon  Sir  William  Roberts  was  introduced 
as  a  Member  of  Council  vies  Dr.  Wilks  ;  Dr.  W.  Thomson 
as  the  new  Dirsct  Remresentative  for  Ireland,  and  Dr.  (X 
R.  C.  Tichbome  vke  Dr.  C.  Moore. 

Tlie  next  step  was  to  re-elect  Sir  Richard  Quain  ae 
President  until  the  expiration  of  the  term  for  which  he 
was  appointed  a  Member  of  Council  by  the  Crown.    The 
motion  to  this  effect  was  carried  by  aodamation. 
Pbksidxntial  Abdbkbb. 

Having  resumed  the  chair,  the  Pbbsidknt  delivered  his 
Inaugurfi  Address.  After  some  interesting  allusions  to 
the  history  of  the  post  which  he  himself  had  graced  during 
the  last  five  vears,  he  directed  attention  to  the  delicate 
and  responsible  nature  of  the  duties  which  theCoundl 
was  called  upon  to  discharge,  insisting  on  tlie  advantage 
of  acting  by  "moral  suasioo."  He  congratulated  the 
Council — as  well  he  mieht — on  the  wonderful  progress  and 
improvement  which  had  taken  place  in  all  its  proceedings 
since  he  first  joined  that  body,  an  advance  outwardly 
manifested  by  the  improvement  in  the  material  circum- 
stances under  which  the  Council  now  meets  as  oompwred 
with  the  days  when  it  occupied  a  couple  of  rooms  in  Soho 
Square  as  ioint  lodgers  with  the  Dental  HospitaL  He 
stated  that  four  cases  under  the  penal  clauses  would  come 
before  the  Council,  and  he  mentioned  the  satisfactory  fact 
that  in  two  instances  the  penalties  recovered  as  the  result 
of  proceedinflTS  had  been  handed  over  to  the  Council  instead 
of,  as  heretctfore,  remaining  in  the  hands  of  the  police. 
Progress  with  the  Pharmacopoeia,  he  informed  them,  had 
been  continuous,  but  necessarily  slow.  Four  of  the  ten 
sections  were  alreadv  in  tjrpe,  two  of  them  having  been 
revised  and  two  still  awaiting  revision.  He  announced 
that  the  Committee  had  decided  to  introduce  the  metric 
system  ot  weights  and  measures,  side  by  side  with  the 
imperial,  throughout  the  general  text,  and  to  employ  the 
metric  system  alone  in  the  paragraphs  referring  to 
analysiB.  It  was  impossible  at  present  he  said,  to  forecast 
the  date  of  its  appearance.  He  concluded  his  addrese 
with  a  brief  and  guarded  allusion  to  the  important  ques- 
tion awaiting  solution  at  the  hands  of  the  Councol  in 
respect  of  the  status  of  the  Apothecaries'  Hall  of  Dublin,, 
and  to  the  various  reports  which  would  come  up  for  dis- 
cussion. 

Ths  Examinatiok  Ststsm. 

Mr.  TsAiii  brought  forward  a  motion  asking  the  Council 
to  take  into  consideration  how  far  examinations  and  the 
occasions  for  rejection  could  be  reduced  in  number,  and  as 
to  the  practicability  of  withdrawing  from  the  sphere  of 
public  examinations  various  subjects  which  the  medical 
man  should  "  know  about,"  but  with  the  details  of  which 
he  need  not  permanently  burden  his  mind. 


JUKJ,  10,  1896, 


GENERAL.  MEDICAL  COUNCIL. 


Thb  Mbdioal  Pbmi.     603 


Dr.  Pettigrbw  seoondad  ibe  motion,  expreseing  the 
opinion  that  the  preeent  syetem  had  broken  down,  owing 
either  to  the  ednoetion  of  the  preaent  day  being  imperfect 
or  too  high  a  atandard  of  examination  reqoirementa. 
He  orged  that  the  main  object  of  the  Cooncu  ehoald  be 
to  ■ecore  the  beat  poaaible  education,  ezaminationa  being 
«f  secondary  imjportanoe. 

Sir  William  TuBinat  objected  that  the  motion  was  abto- 
Intely  wanting  in  practical  sng||e8tiona,  and  Mr.  B.  Cabtxb 
took  advantage  of  the  opportunity  to  cast  aspersions  on  the 
■ability  of  examiners  as  evidenced  in  the  written  questions. 

Dr.  Glovxr  advocated  referring  the  matter  to  the  Com- 
fnittee,  while  Dr.  McVail  argned  that  the  only  oontzol 
the  CoQocil  conld  exercise  was  by  means  of  examinations. 

Mr.  Whbelhoitsb,  speaking  with  his  experience  as 
Visitor,  agreed  that  extreme  snb-division  of  examinations 
was  a  mistake. 

Ultimately  Mr.  Tsalb  agreed  to  an  amendment  referring 
the  matter  to  the  Examination  Committee  for  considera- 
tion and  report. 

SECOND  DAY— W^DNXSDAT,  Juni  3rd. 
Thk  Afothbgabiis'  Hall  of  Ibxland. 

Mr.  Fasbbb,  the  Coonoil's  Solicitor,  read  a  report  on 
the  recent  application  of  the  Irish  Apothecariee*  Hall  to 
the  Privy  Cooncil  in  reference  to  the  appointment  of 
assistant  examiners  in  snrgery,  from  which  it  appeared 
that  the  Privr  Council  had  recommended  the  Hsll  to  re- 
apply to  the  General  Medical  Council  for  the  appointment 
ox  examiners  in  medicine  as  well  as  surgery,  that  sugges- 
tion having  been  acquiesced  in  by  the  Hall.  This  applica- 
tion was,  therefore,  made  to  the  Council  by  the  Aixythe- 
caries'  Hall,  and  Dr.  Tichbobni,  the  representative  of 
this  body,  moved  that  the  application  in  question  be 
agreed  to,  the  examiners  proposed  by  the  Hall  being 
appointed,  or  such  other  examiners  appointed  as  to  the 
douncil  might  seem  fit. 

The  motion  was  seconded  by  Sir  John  Banks,  and  it 
was  supported  by  Sir  Philip  Smtlt,  who  insisted  on  the 
fact  that  the  minority  at  the  last  division  of  the  Council 
was  an  important  one,  and  he  concluded  by  urging  on  the 
Council  to  hesitate  before  wiping  out  of  existence  so  ancient 
and  respectable  an  institution  as  the  Apothecaries'  Hall  of 
Dnblm. 

Mr.  Bbtant,  on  the  other  hand,  argued  that  nothing 
had  since  occurred  of  a  nature  to  justify  the  Council  in 
reversing  their  decision. 

Mr.  WHKELHOUsa  asked  what  educational  powers  the 
Hall  possessed  with  no  available  means  of  teaching  medi- 
cine, surgery,  or  midwifery.  His  own  mistake  in  reporting 
«  having  passed  into  the  profession  a  gentleman  who  had 
passed  his  final,  but  had  failed  in  patholoiry,  did  not  afieot 
the  material  fact  that  this  student  had  been  improperly 
passed  on  his  clinical  examination.  His  mistake  was 
merely  in  supposing  that  the  **  final "  examination  was  the 
last.  Until  the  examinations  of  the  Hall  were  placed  on 
A  much  higher  level  than  anvthing  he  had  yet  seen  they 
would  not  reach  the  standard  which  was  attained  by 
.  almost  every  other  examining  body  in  the  United  King- 
dom. 

Dr.  Gloysb  urged  that  the  Council  ought  to  reconsider 
its  decision,  for  there  were  one  or  two  things  which  had 
transpired  in  the  course  of  the  proceedings  at  the  Privy 
<}ouncil  which  had  obviously  influenced  the  decision  of 
that  body.  He  recalled  that  it  was  not  the  General 
Medical  Council,  but  the  Examination  Committee,  which 
snade  the  suffgestion  that  the  CoUeee  of  Surgeons  in 
Ireland  should  separate  itself  from  the  Hall. 

Dr.  Thomson  spoke  in  favour  of  the  previous  decision  of 
the  Council,  observing  that  the  claims  advanced  in  favour 
of  the  Hall  were  mainly  of  the  sentimental  order.  Senti- 
ment, he  held,  ought  not  to  be  allowed  to  warp  their 
.judgment,  and  it  was  for  the  Council  to  consider  whether, 
if  they  acceded  to  the  request  of  the  Hall,  they  would  be 
acting  in  the  best  interests  of  the  profession. and  of  the 
public.  He  pointed  out  that  the  average  number  of  can- 
•didates  passed  by  the  Hall  did  not  exceed  11  or  12 
annuallv,  and  he  concluded  by  asking  the  Council  to 
•reject  the  present  application  of  the  Apothecaries'  HalL 

Sir  Dtgb  Duokwobth  said  the  Cooncol  was  asked  to  set 
•on  its  legs  asain  a  body  which  had  been  shown  to  be 
inadequate,  i^ch,  moreover,  though  a  medical  qualifying 


body,  was  pronounced  to  be,  and  had  declared  iteelf  to  be, 
unfit  to  eleot  examiners  in  medicine.  He  said  he  had 
looked  into  the  matter,  and  had  found  that  the  practi- 
tioners who  attended  upon  the  poorer  classes  in  Ireland 
mostly  held  the  diploma  of  the  Oonjoint  Board  in  Dublin 
or  the  triple  Soottuh  qniJifieatfon.  The  disappearance  of 
the  Hall,  therefore,  oomd  not  be  said  toentail  any  hardship 
on  these  people.  He  urged  that  the  Council  ought  not  to 
be  called  upon  to  relieve  the  Privy  Council  of  the  dis- 
agreeable duty  of  disfranchising  the  Hall,  and  nothing 
had  occurred  nnoe  the  last  occasion  to  alter  the  opinion 
at  which  the  Council  had  deliberatelv  arrived.  ELe  noped 
the  Council  would  do  its  duty  whether  the  Privy  Council 
liked  it  or  not. 

Sir  Waltkb  FoeTBB  remarked  that  the  Council  had 
arrived  at  a  point  in  which  they  mieht  easily  be  landed 
in  a  position  of  humiliation  and  dif&ulty.  He  thought 
the  former  decision  of  the  Council  refusing  the  application 
of  the  Apothecaries'  Hall  was  unjust  and  ungenerous,  for 
it  was  really  attempting  to  do,  by  a  side  issue,  what  the 
Act  of  Parliament  did  not  intend  to  be  done,  vis,  to 
suppress  one  of  the  licensing  bodies  in  Ireland.  If  the 
Council  did  not  appoint  examiners,  the  Privy  Council 
possibly  would,  and  this  must  inevitably  place  the 
Council  in  a  very  unfortunate  position.  He  regretted 
that  no  opportunity  had  so  far  presented  itself  of  getting 
the  various  bodies  in  Ireland  to  form  a  central  licensing 
body,  but  such  an  opportunity  existed  at  the  present 
moment  He  hoped  that  the  Council,  instead  of  negativing 
the  motion,  would  find  some  way  out  of  the  difficulty,  so 
that  the  matter  mi^ht  be  reconaidered  with  a  view  to  the 
formation  of  a  oonjomt  board  in  Dublin. 

Dr.  Thoxni  Thobni  repudiated  the  idea  that  there  was 
any  lack  of  sympathy  with  the  Hall  on  the  part  of  the 
Council.  The  inefficiency  of  the  examinations  had  been 
under  consideration  for  ten  years  or  more,  yet  it  was  not 
until  1895  that  the  examination  was  declared  to  be 
inefficient.  He  quite  failed  to  see  that  any  new  circum- 
stances had  arisen.  The  Council  was  only  asked  to  recon- 
sider their  decision,  and  if,  after  so  doing,  they  decided  to 
adhere  to  their  former  decision,  he  believed  the  Privy 
Council  would  be  perfectly  satisfied. 

Dr.  Gaibdnsr  urged  that  it  was  not  the  intention  of  the 
Medical  Act  that  the  Council  ahould  bolster  up  the 
examination  of  a  body  in  a  point  as  to  which  that  body 
was  empowered  to  act  independently.  Such  a  practice 
would  ultimately  land  the  Council  in  a  veiy  unenviable 
position.  The  Privy  Council  had  referred  the  matter 
back  to  the  General  Medical  Council  for  reconsideration 
but  without  any  intention  of  dictating  to  them. 

Dr.  MoVail  supported  the  motion  urging  that  if  the 

ed  for  til 


Council  appointea  the  examiners  asked  i 
tions  would  in  future  be  sufficient. 

Dr.  MAoALisnB  urged  that  their  answer  to  the  Privy 
Council  must  be  that  after  careful  consideration  of  the 
amended  application  of  the  Hall  it  did  not  appear  that  it 
would  enable  the  Council  to  carry  out  its  statutory  duties 
of  maintaining  efficiency  in  all  subjects  and  was  therefore 
unable  to  accede  to  the  application. 

Dr.  Q.  Watson  supported  the  motion. 

Sir  William  Tubnxb  regretted  that  the  Royal  College 
of  Surgeons  in  Ireland  haanot  afforded  the  Council  some 
means  of  getting  out  of  the  difficulty.  The  original  con- 
joint boara  had  not  been  on  a  satitfactonr  basis  and  this 
had  led  to  the  subsequent  difficulties.  Ble  asked  whether 
it  was  not  possible  to  reconstitute  the  board  on  a  more 
satiBfactory  oasis  now.  In  order  to  afford  theae  bodies  an 
opportunity  of  adjusting  their  differences  he  proposed  as 
an  amendment :~ 

*'  That  the  Council  defers  for  the  present  the  expres- 
sion of  an  opinion  on  the  application  of  the  Apothe- 
caries' Hall  of  Ireland  for  the  appointment  of  assistana 
examiners  in  medicine  and  surgery,  and  directe  communi- 


cations to  be  made  to  the  Apothecaries'  Hall  and  to  the 
Royal CoUe^ of  Sur^ns  in  Irdand,  with  a  view  tea 
reconsideration  of  their  respective  positions,  so  that  such 
a  combination  may  be  effected  between  them  as  may 
ensure  that  an  efficient  standard  of  examination  shall  be 
maintained  which  would  be  satisfactory  to  the  General 
Medical  ConnciL"  This  dilatory  and  utterly  futile  pro- 
posal was  seconded  by  Mr.  Txalb,  and  Dr.  Tiohbobnb 


604    Ths  Mcdigal  Pbkia. 


GENERAL  MEDICAL  COUNCIL. 


Jots  10»  1808. 


hAvioff,  by  eooMDt,  witlHirawii  hi«  motion,  theamaidiiient 
WM  Mopted  as  a  rabstentlFe  motion. 
The  debate  wm  tbere«ipon  adjourned. 

THIRD  DAY.— Thubsdat,  Juni  4th. 
On  the  moMon  of  Dr.  MAcAuanB,  the  Ckmncil  adopted 
a  new  Standing  Order  to  take  the  plaoe  of  panigrH»b 
XIV.  of  Standing  Order  No.  14,  regulating  the  prooedare 
in  oaaes  in  which  a  deeinon  has  been  poe^ioned. 

Gau  of  J  amis  Chablbs  Adt. 

The  Gonneil  prooeeded  to  the  consideration  of  the  penal 
eases,  the  first  of  which  was  that  of  Mr.  James  Charles 
Ady,  L.R.G.P.  and  8.Ed.,  of  Brixton  HUl,  who  some  few 
months  since  obtained  sach  nnenviabls  notoriety  in  the 
lay  press  in  connection  with  proposals  to  perform  illegal 
operations  on  pregnant  women  and  the  oisposal  of  the 
infants.  This  case  was  postponed  from  last  session  on 
aocoant  of  police  eoart  proceedings  then  pending. 

Mr.  Ady,  a  colonred  gentleman  of  onprepossossing 
appearance,  attended  in  person  to  defend  himself.  The 
cnarge  was  supported  by  Mr.  Avory,  instmcted  by  the 
proprietors  of  toe  Sun  newspaper,  who  laid  the  case 
before  the  Conncil.  The  charge  was  based  mainly  on 
statements  poblished  in  the  Sun  parporting  to  be  reports 
of  two  intenriews  between  representatiyes  of  that  paper 
and  the  defendant  along  wiUi  a  female  named  Graham 
with  whom  the  defendant  was  charged  with  having  acted 
in  collasion. 

Briefly  resumed  it  appeared  from  these  narratives, 
supported  by  their  authors,  that  the  woman  Graham  had 
been  living  with  defendant,  nominally  as  his  foster  daugh- 
ter, but  in  reality  as  his  mistress.  She  had  advertised  from 
his  address  for  accouchement  cases,  and  she  had  also  adver- 
tised "  pills  for  females,"  alleged  to  overcome  all  irregu- 
larities, and  so  on.  Evidence  of  the  dose  association  of 
the  defendant  with  the  woman  was  furnished,  and  it  was 
elicited  that  Ady  once  lived  at  Rangoon,  and  that  while 
there  bis  name  was  removed  from  the  membership  of  the 
local  branch  of  the  British  Medical  Association  for  reasons 
of  which  he  professed  to  be  ignorant,  but  ascribed  to  mere 
jealousy. 

Mr.  Avory  urged  that  there  was  ample  IsvideUce 
to  prove  that  defendant,  in  association  witli  the  woman 
Graham,  had  deliberately  entertained  proposal!  to  induce 
premature  labour,  and  Graham  had  even  eone  as  far  as  to 
hint  that  it  might  be  taken  for  grantea  that  the  child 
would  not  be  bom  aUve,  or  if  so,  could  be  disposed  of 
without  giving  any  further  trouble,  for  a  sum  of  £50. 
The  defence  was  of  the  flimsiest  description,  and,  though 
invited  to  cross-examine  the  witnesses  for  the  prosecution, 
the  defendant  conflned  his  remarks  to  a  general  denial  of 
the  allegations  made  against  him,  interspersed  with 
diatribes  against  those  wtko  sought  to  meddle  with  his 
domestic  arrangements. 

Dr.  Thorns  Tbobnb  in  the  course  of  the  proceedings, 
called  attention  to  the  fact  that  attempts  were  apparently 
being  made  by  someone  in  the  gallery  to  prompt  the 
defendant,  and  at  his  snegestion  the  person,  who  turned 
out  to  be  the  woman  Gn3iam,  was  allowed  to  take  a  seat 
close  to  the  defendant  for  the  purpose  of  assisting  him  to 
the  best  of  her  ability.  Mrs.  Graham,  as  she  ciSled  her- 
self (for  as  to  her  right  to  this  name  some  doubt  appears 
to  exist)  was  a  young  and  comely  woman,  fashionably 
dressed,  and  evidently  gifted  with  much  natural  astute- 
ness. She  courageously  volunteered  her  evidence,  and  it 
must  be  admitted  that  Counsel  did  not  succeed  in  getting 
much  out  of  her  in  spite  of  her  volubility.  She  denied 
that  the  defendant  bad  any  knowledge  of  her  advertise- 
ments (thoneh  this  had  been  admitted  by  the  defendant,) 
and  she  said  he  only  assisted  her  as  others  were  ready  to 
do.  On  being  asked  she  mentioned  several  names  of  medi- 
cal men  who,  she  said,  would  have  been  prepared  to  assist 
her  if  required.  She  asserted,  however,  that  her  advertise- 
ments had  not  brought  her  any  clients. 

Counsel,  in  conclusion,  urged  that  sufficient  evidence 
was  before  the  Council  to  justify  the  defendant's  name 
being  erased  from  the  Begister,  although  none  was  forth- 
coming of  any  actual  criminal  act.  He  added,  however, 
that  i  f  the  Council  reanired  such  evidence,  he  was  prepared 

satisfy  the  Council  on  that  point. 

The  Council  then  proceed^  to  deliberate  in  camerA, 
without  undue  delay  Mr.  Ady  was  informed  that  he 


had  been  adjudged  gnilty  of  *'  infamous  oondnot  in  a  pro- 
fessional respeot "  and  that  his  name  had  been  ocderod  to 
be  removed  from  the  RegitUr. 

PHOKOORAPHT  at  THB  PBBUmVABT  EXAMIKAnOK. 

A  communication  from  Dr.  Gowera,  enclosing  a  petition 
from  the  Society  of  Medical  Fhonoeraphy,  requestmg  that 
shorthand  be  made  an  optional  subject  at  the  Preliminary 
Examination  in  Arte,  was  refecred  to  the  Edncatiao 
Committee. 

ThB  CA8B  of  GbOBOB  LfOBBSAIli  CUBBAH. 

Mr.  Cnirah,  registered  as  L.S.  A,  was  ehareed  with  act- 
ing as  cover  to  one  Keating,  an  unqualified  man,  al>^ 
Hoxton.  Tlie  charge  was  supported  by  Dr.  Bateman  on 
behalf  of  the  Medical  Defence  Union,  and  was  based  on 
the  report  of  Dr.  Wynn  Westoott,  her  Majesty's  ooroiier 
for  East  London,  in  respect  of  an  inquest  on  the  body  of 
a  child  who  had  been  attended  by  Keating  aforesaid. 

It  transpired  that  Mr.  Currah,  who  had  issued  handbflls 
of  a  most  objectionable  deeoription,  had  purchased,  two 
chemist's  shops  in  the  neighbourhood,  atone  of  which  the 
man  Keating  was  in  charge,  nominally  as  chemiefs  assia- 
tant,  but  in  reality,  it  was  alleged,  as  a  medical  practi- 
tioner. 

Mr.  Currah,  who  appeared  in  person,  maintained  that 
Keating  was  only  engaged  as  a  chemist's  assistant,  be  him- 
self being  a  registered  chemist.  He  admitted,  however, 
that  he  was  not  actually  on  the  Register  of  Pharmaeentical 
Chemists,  and  it  was  pohited  out  to  him  that  if  Keatin); 
were  reidly  a  chemist's  assistant  he  was  not  quali- 
fied to  take  charge  of  a  chemist's  shop,  he  having 
no  qualification.  He  admitted  that  the  child  in 
question  had  been  attended  by  Keating,  but  said  it 
had  been  in  deflance  of  his  orders,  and  he  had  dis- 
charged him  at  once.  He  challenged  the  accural  of  the 
coroner's  depoeitions,  in  which  he  was  stated  to  have  said 
that  people  who  only  paid  sixpence  for  medicine  did  no* 


expect  to  be  attenclecl  by  a  qualified  man,  and  also  that 
the  waees  of  an  unqualified  man  were  much  less  than  of 
a  qualified  man. 

It  appeared  that  the  defendant  had  several  addressee^ 
one  in  Falmouth,  and  others  jJbout  London. 

After  a  brief  deliberation  in  camerd^  he  was  informed 
that  he  had  been  adjudsed  guilty  of  the  charge  brought 
against  him,  and  that  his  name  had  been  directed  to  be 
erased  from  the  SegiHer, 


FOURTH  DAY.— Fbiday,  Junb  6th. 
Thb  Ca8b  or  Mb.  Gobdon  Gbiffiths  Johbs. 

The  Council  resumed  the  consideration  of  penal  cases» 
the  first  being  that  of  Mr.  Gordon  Griffiths  Jones,  L.F.P.S. 
Glasg.,  L.R.C,P.£d.,  who  was  charged,  at  the  instance  ol 
the  Medical  Defence  Union,  with  **  covering  "a  certain 
Ihitvid  Jones  (his  father),  an  unqualified  person,  who 
carries  on  a  medical  practice  at  (5  Welbeck  Street,  and  10 
Dean  Street,  London  ;  further  it  was  charged  against  him 
that  in  the  carrying  on  of  the  said  practice  the  defendant 
promoted  and  associated  himself  with  methods  of  obtain- 
mg  and  attracting  patients  which  are  professionally  dis- 
creditable, vis.,  by  systematic  advertisements  of  cures  by 
the  said  unregistered  person  and  publications  invoking 
persons  to  resort  to  the  unregistered  person  for  such 
cures. 

The  case  for  the  prosecution  was  based  on  certain  adver- 
tisements issued  in  respect  of  the  Dean  Street  institution^ 
together  with  a  work  on  Diseases  of  the  Urinary  Organs 
written  by  the  defendant,  in  which  various  statements 
were  made  disparaging  onher  practitioners  in  favour  of 
the  said  unregistered  person,  who  happens  to  be  the 
father  of  the  defendant.  It  transpired  that  the  said 
unregistered  person  had  at  one  time  been  on  the  RegxHmr 
and  that  his  name  had  been  removed  in  virtue  of  one  of 
the  Standing  Orders  after  conviction.  There  was  ample 
evidence  to  prove  the  close  association  of  the  defen- 
dant with  the  practice  in  question,  indeed,  the  defen* 
dant  made  no  attempt  to  controvert  such  evidence, 
merely  alleging  that  no  complaint  had  ever  reached 
him  as  to  his  conduct,  and  promising  to  observe 
TOch  recommendations  as  the  Council  nught  see  fit  to 
make  to  him.  As,  however,  the  functions  of  the  Council 
are  punitive  rather  than  advisory,  he  was  found  guilty  of 


Jvsm  10,  1«06. 


THE  OPERATfliO  THRATRE8. 


M»pwml.Ebiw.    605 


in  A  ptofoMional  nspeot"  and  hit 
\  to  bo  vemoTod  from  the  Beffitter.  Thoa 
tonniiMitoii  a  ooondaloiii  state  of  affain,  the  daratUm  of 
wlueb  his  kog  been  a  matter  of  astonishment  and  nsgnt. 

Thb.Cabb  or  John  Hamilton  Folbt. 

The  next  oase  was  that  of  John  Hamilton  Foley,  of 
Weedene,  Looks  Heath,  Titohfleld,  Hants,  registered  as 
L.R.aF.1.,  L£.Q.C.P.L,  who  was  charged  with  having 
aoted  as  **  cover  "  to  one  Oliver.  The  charge  was  embodied 
in  a  declaration  signed  by  several  practitioners  in  the 
neighbourhood,  but  was  technically  broaght  before  the 
Coandl  by  Dr.  Bateman,  on  behalf  of  the  Ifodioal  Defence 
Union.  It  appeared  that  Oliver  had  for  upwards  of  twenty 
years  been  acting  as  a  medical  practitioner  tine  diploma. 
The  defendant  went  to  Weetdene,  and  at  once  engaged 
Oliver  as  assistant.  The  defendant  (who  was  re- 
presented by  a  legal  adviser)  denied  having  allowed 
Oliver  to  take  charge  of  cases  and  asserted  that 
he  was  well  known  to  be  nnqnalified.  In  every  instance, 
moreover,  lie  had  seen  the  cases  with  Oliver,  never  allowing 
him  to  take  charge  of  cases  on  his  own  account.  In  the 
declaration  referred  to  it  was  alleged  that  the  defendant 
resided  three^uarters  of  a  mile  from  Oliver,  at  whose 
house  is  a  sargery  with  a  notice  that  Mr.  Foley  attended 
at  certain  hours ;  also  that  the  two  drove  about  to  visit 
patients,  Mr.  Foley  at  times  remaining  in  charge  of  the 
horse  while  Oliver  went  into  the  house  to  see  the  patient. 

Mr.  Foley  said  he  had  gone  to  Westdene  to  practise  in 
consequence  of  an  invitation  from  *'  some  of  the  leading 
sentry  and  residents  of  the  district,"  adding  that  Oliver 
had  been  in  the  employ  of  one  inractitioner  for  16  years, 
another  for  three  years,  and  a  third  for  six  months,  during 
which  periods  he  was  employed  by  them  under  drcnm- 
stances  which,  he  doubted  not,  would  be  considered 
"  oovennff.*'  He  handed  in  a  number  of  death  certificates 
signed  in  blank  by  one  of  them,  to  be  used  by  Oliver  dur- 
ing the  absence  of  his  principal.  A  number  of  letters  were 
put  in  from  residents  m  the^district  declaring  that  if  they 
emploved  Oliver  it  was  in  full  cognisance  of  his  being 
uoq ualified  and  expressing  surprise  that  the  very  men  who 
had  formerly  employed  Oliver  under  similar  circum- 
stances should  now  impnte  a  dishononrable  motive  to 
another. 

The  defendant  was  closely  examined  by  Members  of  the 
Council  as  to  his  relations  with  Oliver.  He  admitted  that 
it  was  not  usual  for  a  man  who  was  going  into  a  new  place 
to  work  up  a  practice  to  forthwith  engage  an  assistant, 
but  he  acknowledged  that  he  was  nothing  loth  to  derive 
what  assistance  he  could  from  Oliver's  local  reputation. 
At  tlie  same  time,  he  said  he  had  caief  ully  steered  dear  of 
infrin^g  any  of  the  Council's  resolutions  and  he 
animadverted  on  the  conduct  of  the  complainants,  who  had 
sought  to  fasten  upon  him  a  charge  of  covering  after 
havmg  themselves  emploved  Oliver  for  long  periods  (^ 
time  under  far  more  questionable  circumstances. 

After  a  prolonsed  discussion  in  camerd  the  President 
informed  Mr.  Foley  that  it  had  not  been  proved  to  the 
satisfaction  of  the  Council  that  he  had  "  covered  "  Oliver, 
admonishing  him  at  the  same  time  to  be  careful  of  his 
future  conduct  in  this  connection. 


FIFTH  DAY— Satubdat,  Juki  6th. 

The  Kieater  part  of  to-day*8  meeting  was  spent  by  the 
Coundl  in  ctmerA  discussing  a  question  wbico  had  been 
brought  before  the  Penal  Committee.  Ultimately,  the 
matter  was  remitted  to  that  Committee  for  continued 
inquiry  and  report  to  the  Council  at  the  November 
meeting. 

Casn  or  CiJDfXNT  HsNBT  Sandnbs. 

Mr.  Clement  Henry  Sanders,  a  dentist,  was  summoned 
before  the  Council,  at  the  instance  of  the  British  Dental 
Assodation,  to  answer  the  charge  of  acting  as  "  cover  "  to 
an  unqualified  person.  It  appeared  that  the  defendant 
carried  on  dentiJ  practices  at  Exeter,  Okehampton,  and 
Aldershot. 

After  the  usual  ddiberation,  the  defendant  was  found 
guilty  of  the  charge  brought  against  him,  and  the  further 
consideration  of  toe  charge  was  adjourned   until   next 


received  from  the  Medical  Defence  Union,  of  May  28th, 
1896,  in  rdetenoo  to  legislation  for  strengthening  Clause 
40  of  the  Medical  Act  (1886).  The  matter  was  retored  to 
Counsel  for  hi4  opinion  thereupon. 


Thb  Mxdioal  DcrjBNOK  Union  and  thx  Council. 
The  Council  then  proceeded  to  consider  in  oamerd  a  letter 


SIXTH  DAT.~Mondat,  Juki  8th. 
The  Apothbgabobb'  Hall,  Dublou 
The  first  item  on  the  programme  was  the  adjourned 
debate    on   Dr.  MacAlister's   amendment   to  Sir  Wm. 
Turner's   motion.     After  a   prolonged   disoussicn.   Dr. 
MacAlister's  amendment  was  rejected,  and  the  Coundl 
passed  the  original  motion,  deferring  any  expreenon  of 
qinnion  for  the  present,  in  order  to  a£E6rd  the  Rc^  Col- 
^Se  of  Surgeons  an  opportunity  for  reconsidenng  the 
matter. 
The  Council  was  left  dtting. 

(A  full  report  of  Monday's  proceedings  will  appear  in 
our  next  number.) 

♦ 

ST.  THOMAS'S  HOSPITAL. 
Laminbotomt  fob  TuBntouLOus  DisBAn  of  thb  Spinb 
with  Pabaltsis.— Mb.  Andbbson  operated  on  a  child, 
et.  9,  suffering  from  tuberculous  diseaee  of  the  spine  with 
paraplegia.  The  patient,  a  fat  fhcalthy  looking  boy,  had 
been  suffering  from  disease  of  the  spine  for  two  years  with 
paraplegia  of  eighteen  months.  There  was  angular 
curvature  in  the  upper  dorsal  region,  the  chief  point  of 
projection  being  at  the  third  dorsal  vertebra;  the  soft 
parts  near  the  seat)  of  disease  were  healthy ;  the  paralysis 
affected  the  lower  interossei,  the  abdominal  musdes,  and 
the  lower  extremities,  leaving,  however,  control  of  the 
bladder  and  rectum ;  the  breathing  was  almost  entirely 
diaphragmatic ;  the  sensation  of  the  paralysed  parts  was 
apparently  unaffected,  the  boy's  general  health  was  good, 
and  the  functions,  other  than  those  of  locomotion,  were 
carried  on  normally.  The  patient  had  been  under  obser- 
vation for  nine  months  and  as  no  improvement  in  the 
paralytic  symptoms  took  place  during  that  time  an 
operation  was  considered  advisable.  Mr.  Anderson  per- 
formed the  operation  in  the  usual  manner,  making 
a  longitudinal  mesial  indsion  over  the  diseased  vertebr», 
peeUng  the. muscular  and  other  structures  from  the 
laminiB,  and,  after  full  exposnro,  these  last  wero 
almost  completely  divided  with  a  small  saw  dose  to  the 
transverse  processes  on  either  side  ;  the  detachment  was 
then  completed  with  a  bone  forceps,  and  the  detached 
laminae  wero  removed^  expodng  the  membranes  of  the  cord« 
The  bleeding  during  the  operation  was  very  slight.  The 
laminae  of  the  2nd,  3rd,  and  4th  were  removed.  Opposite 
the  3rd  dorsal  vertebra  a  large  quantity  of  purulent 
matter  partially  solidified  was  [found  overlying  the  dura 
mater,  and  a  sinus  was  traced  on  the  left  side  of  the  cord 
into  the  body  of  the  vertebra.  No  sequestrum  could  be 
fdt^  but  by  means]  of  a  curotte  a  quantity  of  pus,  broken- 
down  tuberoulous  matter  and  bone  dAhrit  wero  removed  » 
The  sinus  was  then  gently  filled  with  iodoform,  a  drainage 
tube  inserted  down  to  the  diseased  body,  the  soft  parts 
roplaced,  and  the  wound  united  with  silkworm  gut  sutures. 
The  operation  was  well  borne;  the  patient  left  the 
table  in  good  condition.  It  was  noticed  after  the 
romoval  of  the  lamin»  that  thoradc  respiration, 
scarody  perceptible  beforo  the  operation,  was  visibly 
increased.  Mr.  Anderson  romarked  that  the  operation 
had  been  performed  with  varying  success  during  the  last 
few  years  for  tuberoulous  caries  with  paralysis.  It  must, 
be  romembered,  he  said,  that  the  operation  is  a  severo  one. 


606      THI  MXDICA.L  Pbssb. 


LEADING  ARTICLES. 


JoKS  10,  18M. 


and  that  it  ahoald  only  be  ondertakeo  «ftor  kMkg  and 
patioDt  watching,  and  in  sabjeettwhoaegwidral  condition 
wai  fairly  promising.  In  niitable  cases  ic  was,  be  thought, 
hopefol,  by  relieving  the  cord  from  the  pressure  of 
aooumnlated  inflammatory  prodnots,  and  by  allowing  some 
treatment  of  the  foons  of  ^disease  at  the  time  of  operation 
and  afterwards.  The  most  dfficalt  part  of  the  operation 
was  the  detachment  of  the  'laminsB,  since  an  injury  to 
the  dura  mater,  or  even  to  the  cord,  might  easily  be 
inflicted,  and  the  results  might  then  be  disastrous.  Tbe 
almost  complete  division  of  the  lamin«  by  the  saw 
rendered  the  subsequent  section  by  the  bone  foroeps  com- 
paratively soft  and  easy,  and  the  surgeon  had  only  to 
take  care  in  levering  off  the  bone  that  no  portion  of  the 
cnt  edge  pressed  against  the  dura  mater.  It  was  to  be 
noticed  he  remarked  in  this,  as  in  other  cases,  that  the 
epinal  veins  bled  but  little,  and  the  very  slight  haemor- 
rhage  ceased  sponbaneously.  It  is,  of  course,  he  said,  un- 
desirable to  open  the  membranes. 

A  week  after  the  operation  the  patient  was  in  a  good 
condition,  with  normal  temperature  and  without  any  sign 
of  spinal  irritation  beyond  a  slight  spasmodic  flexure  of 
«he  right  leg  noticed  the  day  following  the  operation,  but 
which  subsided  at  the  end  of  twenty-four  hours.  The 
respiration  war  still  mainly  abdominal. 


%kt  JRtbical  fxtBB  nxCt^  €itatlar« 

PttblidMd  •voy  Wsdnttdajr  monliiff ,  Pries  id.   Foit  tx—  6^4. 


torn  ora  imisiov:—wiioit  Pigs,  js  Ok  od.;  Hslf  Pifs,  «i  iol  od, 
QMfftor Pigs,  Alls.;  (hM-dghth,  ItL  Sd. 

vom  A  Bmnm  ot  munom :— Wlmls  Fags,  IhlrtM 
(wssklf»  fottaigktij,  or  BoatUjIat  tf  10a  Sd. ;  twt^-dti 
tlMii  (wMklj  or  fortnightly)  st  tf  Si.  Od. ;  flflgr-two 
<wsdd7)  At  U  osoiL  Half-pMIs,  thirtom  loMrtlont  st  S6s. ; 
twontj-dzst  Ml  ;  flfty-twolnaortloiii  at  lOa  Moh.  Qnartor-psge 
tbtatoailBSMMoDistiaa;  timtj-dz  InsMtlou  at  Ua ;  flftj-ilz 
iBMrtioBsstliaoaah 

BoiaU  Annoanoononti  of  FnetlcM,  AwtoUDoloi,  'ViosdoIoi.  Book 
*o.— 4tavoD  Ubm  or  nndor,  ii  par  InaafftlOB ;  6d.  per  lloa  beyoDd 

LHtsrs  In  tlili  dapartmant  should  ba  addraMad  to  tha  Pnbllabav. 

tVBSOBXPTIOHB. 
Poet  tan  «o  AnuAL  BussoEnnts  in  i  o 

„        AsaoAD.wnHDi  THB  FosiALUnov      ill  •  6 

„  In>IA,  OHZVA,  An>  JAPAS  .  .      Al    i    6 

Post-oAoa  Ordaia  and  Ghaqnaa  to  ba  drawn  In  favour  of ~ 

A.  A.  TmALL,  M-tl  King  wnilam  Btraat,  Btrand,  London. 

A.  H.  JACOB,  M  Molaaworth  Btraal,  DnbUa. 
BuisouFROBS  rem  VaASCi  ara  raoalvad  by  Maaan.  nA¥T.T.f»«  ^na 

HaatafaolUa,  Paria-poatfraa  In  advanoa,  «1  Si.  Sd.  par  annUB. 
BVBSOBipnoBS  rem  thb  UniraD  BTAmi,    post  fraa  in  advanoa 

(Al  la  Od.  par  annmn),  ahoald  ba  aant  dfraot  to  tha  < 

this  oeontiy  by  Intamational  P««t  Oflloa  Ordar. 


^t  S^tiikid  Hress  ^  ^itcnlvx. 


<8ALUB  POPULI  aUPBEMA  LSX. 


WEDNE8DAY.  JUNE  10,  1896. 


THE  GENERAL  MEDICAL  COUNCIL. 
Tn  meeting  of  the  Qeneral  Medical  Council  has  not 
BO  far  been  of  a  very  exciting  natare.  ItB  first  da^  was 
theBelectioD  of  a  President,  and  Sir  Richard  Qaain,  after 
a  long  and  honourable  career  in  the  higher  walks  of 
the  profession,  has  now,  for  the  second  time,  attained 


the  most  honourable  post   within  the  reach  of  an^ 
medical   man.     He  has   attained  a  venerable  and 
respected  aice,  and  may   be  depended  on  to  retire 
from  this  or  any  other  public  position  aa  soon  as  he 
feels   himself   no   longer    physically   equal   to  the 
arduous  functions  to  be  discharged.    There  is  very 
little  to  discuBB   in  the  proceedings  t>f  the  Council 
during  the  past  week.     The  penal  cases,  or  one  of 
them,  it  is  true,  imported  an  element  of  gaiety  into 
the  proceedings  which  is  usually  wanting;  indeed, 
the  etemdh/emme  was  veiy  much  to  the  fore  in  one 
instance,  as  will  be  seen  from  the  report  of  the  pro- 
ceedings which  we  publish  elsewhere.    In  the  ease  of 
Mr.  Ady,  whose  name  was  erased  from  the  Regitter  for 
conduct  which  was  not  only  infamous,  but  BUggestiye  of 
much  that  might  fairly  be  considered  infinitely  worse,  the 
unsuitability  of  such  a  large  and  unwieldly  body  as  the 
Council  for  the  conduct  of  quasi-criminal  investigations 
was  rendered  very  conspicuous.  There  was  the  spectacle 
of  witneBsesbandyingsarcasm  with  counsel,  unoontroUed 
by  the  chair,  of  acrimonious  discussions  between  wit- 
nesses for  tiie  prosecution  and  the  defendants.    One 
was  astounded  to  see  one  member  of  Council  advising 
the  defendant  not  to  reply  to  questions  propoBed'by  a 
fellow  member— in  fact,  one  had  pretty  well  every  cir- 
cumstance which  is  calculated  to  shock  the  impartial 
obflerver   as   part   and  parcel  of  a  judicial  inqairy. 
There  is  no  doubt  that  the  Council  posBesBes  ample 
powers  for  ezercisiQg  a  very  salutary  intra-professional 
discipline,  but  owing  to  the  indefensible  nature  of  the 
Standing  Orders,  it  is  possible  for  one  or  two  officials 
practically  to  diamiss  complaints  without  the  Council 
hearing  the  evidence  on  either  side.  A  complaint  is  made 
to  the  Council  by  an  individual  or  an  association,  and 
is  considered  by  the  President  in  conjunction  with  the 
legal  adviser  to  the  Council,  and  it  is  in  their  power 
to  prevent  the  case  ever  coming  to  the  knowledge 
of  the  Council  generally.    The  extent  to  which  this 
power  is  exercised  may  be  gauged  from  the  fact  that 
probably  not  one  quarter  of   the  charges   formally 
made  ever    come  under   the  consideration  of  the 
Council   BB   a  whole.    Such  a  method  of  conduct- 
ing one  of  the  most  important  partB  of  the  business  of 
the  Council  is  obviously  open  to  the  grayest  objections, 
and  the  least  that  is  required  to  conform  with  the  most 
elementary  ideas  of  justice  and  common  sense  is,  that 
all  charges  should  be  laid  before  thecommitteespecially 
appointed  to  take  such  allegations  into  oonsideratioo, 
such  committee  to  act,  in  fact,  as  a  grand  jury  to  the 
Qeneral   Council.      The  "Penal  Commission,'    ap- 
pointed in  1893,  does  not  fulfil  this  purpose.    If  any 
further  proof  were  necessary  to  prove  the  uigenpy 
of  a  reform  in  this  direction,  it  would  be  the  difficulty 
that  has  been  experienced  in  inducing  the  Council  to 
proceed  to  an  investigation  of  certain  charges  brought 
in  connection  with  a  recent  notorious  abortion  esse,  in 
which  a  certain  peraon,  whose  name  was  removed  from 
the  Register  by  reason  of  his  conviction  for  a  felony, 
appeared  from   the   published  reports  to  have  beso 
screened  by  one  or  more  medical  men,  thanks  to  whose 
assistance  he  sought   to  get  over  the  difficult  of 
not  being  able  to  certify  a  very  suspiciouB  death  which 


JuNB  10,  1896. 


LEADING  ABTIGLE8. 


Thb  Mbdioal  Psns.     607 


was  subsequently  investigated  by  a  coroner's  jury.  One 
is  at  a  loss  to  imagine  what  influences  can  have  been 
at  work  to  prevent  the  usual  inquiry  into  the  conduct 
of  the  practitioners  whose  names  were  associated  with 
that  of  the  disbarred  practitioner.  It  is  quite  possible 
that  satisfactory  reasons  might  be  furnished  of  conduct 
which  otherwise  appears  objectionable  to  the  last 
degree,  but  that  matters  which  have  attained  such 
notoriety  in  the  press  should  be  allowed  to  remain 
unelucidated  is  discreditable  to  the  Council,  especially 
as  the  circumstances  have  on  several  occasions  been 
formally  brought  before  them  or  their  officials.  We 
have  frequently  protested  against  the  practice  which 
has  grown  up  of  the  Council  passively  delegating  to 
quasi-private  corporations  the  duty  of  working  up 
cases  for  their  consideration.  It  ought  to  be  sufficient 
for  the  complainant  to  make  out  ^  prima  facie  case  to 
ensure  the  Council  taking  the  matter  up.  In  any  case, 
inasmuch  as  one  of  the  duties  of  the  Council  is  to 
inquire  into  such  matters,  the  expense  of  collecting  the 
necessary  evidence  ought  to  be  reimbursed  to  the  com- 
plainant or  complainants,  who  aro  often  at  very  great 
expense  in  discharging  what  is  after  all  a  strictly  pro- 
fessional matter. 

♦' 

ARMY  MEDICAL  COMPETITION. 
As  the  August  examination  for  entry  to  the  Army 
Medical  Service  approaches,  the  demoralised  condition 
of  that  service  acquires  increased  interest,  and  a  roview 
of  the  status  quo  will  not  be  out  of  place.  Certain 
facts  which  cannot  be  questioned  are  before  the  public. 
Eor  the  August  examination  of  last  year,  twenty-three 
candidates  offered  themselves  for  Udrteen  vacancies 
but  the  quality  of  the  competitors  was  so  low  that  only 
ten  attained  the  necessary  minimum  of  marks.  At  the 
Februaiy  (1896)  examination  only  eighteen  candidates 
offered  themselves  for  seventeen  vacancies,  and, 
of  these,  only  nine  were  able  to  reach  the  irredu- 
cible minimum.  These  figures,  reinforced  by  the 
grumblings  in  Piarliament  and  in  the  organs  of  medi- 
cal opinion,  and  taken  in  conjunction  with  the  fact 
that  Colleges  and  Universities  have  [felt  called  upon 
to  take  action,  places  beyond  dispute  the  fact  that  the 
Service  has  become  and  is  becoming  increasingly  un- 
popular, and,  as  a  consequence,  the  War  Office  is  now 
obliged  to  double  the  number  of  prizes  (f)  offered  to  the 
profession,  and  is  put  to  its  wits  end  to  inveigle  students 
to  accept  Her  Majesty's  invitation  to  serve.  Without, 
at  present  entering  into  the  particular  causes  of 
this  state  of  affairs  we  may  point  out  that  the 
Army  Medical  Service  must  be  in  the  worst  repute 
when  it  does  not  attract  candidates.  The  profession 
is  admittedly  overstocked,  the  competition  in  private 
practice  is  severe,  and  even  the  foreign  market  for 
young  medical  practitioners  is  by  no  means  a  walk 
over  for  a  newly  qualified  man.  Moreover,  the  Service 
presents— on  the  surface— a  gloss  which  is  very 
attractive  to  the  youthful  practitioner  who  aspires  to 
social  enjoyment  It  endows  him  with  a  nice  costume, 
enables  him  to  pose  as  of  superior  social  rank,  and 
ensures  him  plenty  of  invitations  to  afternoon  teas.  It 
might,  therefore,  be   reasonably    expected  that  the 


advertisement  of  numerous  vacancies  at  an  Army 
Medical  examination  would  bring  about  a  rush  some- 
thing like  that  of  recent  occurrence  in  Moscow.  But 
the  fact  is  that  the  men  who  have  been  wheedled  into 
the  Army  Medical  net  give  so  unpleasant  a  report  of 
their  experience  therein,  that  the  studential  flies, 
for  whom  the  net  is  newly  spread,  are  very  wary 
about  walking  into  the  War  Office  parlour.  Let 
us  recapitulate  the  situation.  The  insults  publicly, 
deliberately,  and  officially  levelled  at  the  Army  Medical 
Officers  by  the  Duke  of  Cambridge  had  scarcely  ceased 
to  re-echo  when  they  were  repeated  by  Lord  Wolseley 
and  Sir  Redvers  Buller,  and  its  was  thus  publicly  pro- 
claimed that  the  new  order  of  departmental  govern* 
ment  created  by  the  retirement  of  the  Duke  was 
nothing  better,  but  rather  worse,  than  that  which  pre- 
ceded it,  and  the  purport  of  that  proclamation  was 
confirmed  by  the  harsh,  exceptional,  and  most  unjust 
treatment  meted  out  hy  the  military  authorities  to 
Suigeons  Briggs,  Smith,  Fowler,  Oardner,  and  Walsh. 
More  recent  events  have,  moreover,  made  it  manifest 
that  the  Acts  of  the  War  Office  and  Horse  Guards 
were  not  mere  casual  acts  of  oppression  or  personal 
spleen,  but  are  the  public  evidences  of  a  determinate 
policy  to  keep  the  medical  department  under  foot, 
officially  and  socially,  and  to  make  its  membera  under- 
stand that  they  are  of  inferior  grade,  no  matter  what 
Her  Majesty's  warrant  may  say,  and  that  they  must  not 
expect  the  same  treatment  as  their  combatant  brethren 
under  similar  cireumstanoes.  The  Irish  Universities 
and  Colleges,  it  will  be  recollected,  recently  took  con- 
certed action  to  remonstrate  against  this  policy,  and 
especially  against  the  Regulation  which  has  practically 
'* boycotted''  Irish  examiners  and  Irish  candidates, 
and  with  that  object  they  interviewed  Lord  Lans- 
downe  by  deputation.  Favourable  consideration  of  their 
representations  was  then  promised  by  the  War  Secre- 
tary and,  subsequently  pledges  were  given,  when  the 
Army  estimates  were  under  discussion  in  the  House, 
that  changes  would  be  made  to  meet  some,  at  least,  of 
the  complaints  then  formulated.  It  has  since  become 
known  that  Lord  Lansdowne  had  made  up  his  mind 
as  to  the  concessions  which  might  be  granted,  and  we 
have  been  surprised  that  he  took  so  long  to  make  his 
intentions  known.  The  truth  now  leaks  out  that  the 
War  Secretary's  desire  to  satisfy  the  lawful  wishes  of 
the  Army  Medical  Officers  has  been  completely  blocked* 
by  Lord  Wolseley  and  Sir  Bedvers  Buller,  who  are  thus 
in  contest  with  the  Parliamentary  head  of  their  depart- 
ment It  is,  therefore,  probable  that  nothing  will  be 
heard  of  Lord  Lansdowne's  reforms  until  the  August 
examinations  have  been  held,  and  that  nothing  will  be 
heard  of  them,  even  then,  if  tiie  supply  of  candidates  at 
that  examination  is  such  as  toenoourage  the  War  Office 
in  the  hope  that  an  abundance' of  Army  Surgeons  can  be 
had,  even  on  the  present  humiliating  conditions  of  ser- 
vice. This  game  has  been  played  by  the  antiiorities 
with  success  on  former  occasions.  Promises  of  reform 
have  been  fluttered  before  the  eyes  of  the  student 
practitioners  and  all  sorts  of  blandishments  held  out 
to  them  to  send  in  their  names  as  competitors,  and 
when  the  requisite  demand  had  thus  been  created  and 


Thb  Mbsmal 


LEADING  ARTICLES: 


JuKV  10,  1886. 


the  requiBite  sapply  of  candMhtea  of  a  certain  sort 
0ecnrad,  nothing  mom  was  thenceforward  heard  of  the 
reforms. 

Oar  object  in  now  diaeoeaing  the  matter  ia  that  we 
may  point  out  to  the  atodent-praetitionera  the  riak 
which  they  ran  of  profeational  fulnre  and  personal 
rain  if  they  accept  a  commiaaion  in  the  Army  Medi- 
cal Service  under  existing  circnmatancea.  Their 
poaition  will  be  comparable  to  that  of  a  tenant  who 
takea  an  apparently  tempting  leaae  from  a  landlord 
who  hates  him  and  under  an  agent  who  ia  ready  to  strain 
eveiy  point  of  the  law  to  injure  and  annoy  him.  This 
comparison  is  indeed  in  favour  of  the  tenant,  because 
he  is  fully  protected  by  the  terms  of  his  lease,  and  by 
the  law  of  the  land  against  oppreaaion  by  hia  landlord 
or  agent,'and  though  he  lives  in  dread,  ia  aafe  aa  longaa 
he  fulfils  strictly  the  terms  of  Ms  bargain.  The 
Army  Medical  Officer  enjoys  no  such  safeguard.  He 
joins  the  Service  under  the  impression  that  he  is  pro- 
tected by  the  terms  of  Her  Majesty's  warrant,  but  he 
speedily  learns  that  those  terms  have  already  been 
set  aside  in  many  instances  by  regulations  made  at  the 
pure  will  of  the  War  Office  Authorities,  that  fresh 
orders  may  be  at  any  time  issued  which  may  deprive 
him  of  hia  privileges,  social  and  financial,  and  that,  if 
the  warrant,  the  regulations,  and  the  law  are  brazenly 
violated,  he  haa  no  practicaUe  remedy  against  the 
War  Office  and  Horse  Guards.  We  warn  student- 
candidates  against  the  gUt  so  oetentatiously  displayed 
upon  the  Army  medical  gingerbread.  If  they  enter 
the  Service,  or  even  offer  themselves  under  present 
conditions,  they  will  incur  the  risk  of  placing  them- 
selves in  a  position  from  which  they  cannot  retreat, 
but  of  which  they  will  bitterly  repent  before  they  are 
a  year  in  the  Service,  and  which  they  will  deplore  with 
lamentations  when  they  are  married  men  with  depen- 
dent families,  and  with  a  reasonable  ambition  to  hold 
up  their  heads  in  the  social  rank  of  the  Army  to  which 
they  have  unwarily  attached  themselves. 

The  diplomacy  of  Lord  Wolseley,  Sir  Redvers  BuUer, 
and  the  rest  of  "  my  military  advisers  "  was  exposed  in 
the  last  issue  of  our  contemporary  the  British  Medical 
Journal^  but  we  cannot  believe  that  any  '*  prominent 
member  of  the  profession  "  in  Ireland  therein  hinted 
at  would  allow  himself  to  become  a  party  to  the  bar- 
gain, but  the  impression  to  which  our  contemporary 
thus  gives  expression  may  have  arisen  from  the 
knowledge  {that  a  certain  Councillor  of  the  Irish 
College  of  Surgeons  went,  uninvited  and  at  his  own 
expense,  on  the  occasion  of  the  recent  deputation  from 
that  College  to  the  War  Secretary,  and  that  he,  also 
withoutsuggestion  or  invitation,  produced  a  programme 
of  his  own,  totally  unauthorised  by  the  College,  the 
chief  item  in  which  was  the  suppression  of  the  Army 
Medical  Department  altogether,  and  its  merging  in  the 
War  Office  as  a  petty  back-stairs  office,  and  that,  when 
he  returned  home,  the  Council  of  the  College  repudiated 
his  action  by  passing  a  resolution  for  the  purpose  of 
preventing  such  unauthorised  intervention  in  future. 
We  do  not,  however,  venture  to  suggest  any  person 
as  indicated  by  our  contemporary,  and  we  can 
answer  for  it  that  among  the  Dublin  teachers,  mean- 


ing thereby  lecturers  and  '*  grinders,"  no  each  tout  for 
the  War  Office  exists. 


THE  NATURE  OF  GENERAL  PARALT8IB. 


It  haa  become  mora  and  mora  eivident  of  leeank  years 
that  our  first  conoeptiona  of  general  paralyaie  have  been 
forced  to  give  place  to  newer  and  wider  coaeeptiooa  of 
its  symptoms  and  pathology.    Clinical  studies  have 
led  to  a  differentiation  of  symptoms  and  a  classifica- 
tion of  groups,  which  have  made  the  literature  on  the 
subject  much  more  copious  than  anyone  oould  have 
dreamed  of  twenty  years  ago.    It  is  possible  that  in 
our  eagerness  to  detect  new  symptoms,  new  features 
of  the  disease,  and  more  satisfactory  explanations  of 
these  symptoms  and  features,  we  may  have  strained 
our  efforts  and  included  under  the  head  of  general 
paralysis  many  cases  which,  strictly  (speaking,  do  not 
belong  to  it.    The  acute  maniacal  type  with  grandiose 
delusions  and  distinctive  nervous  features  which  spread 
inaidioualy,  paripa$9u^  with  the  recession  of  the  acute 
mental  symptoms,  and  a  downgrade  towards  dementia, 
waa  the  one  and  only  type  of  any  importance  recognised 
twenty  years  ago.  Such  cases  were  relatively  moracom- 
mon  than  they  are  to-day.  General  paialysiB  as  seen  in 
asylums  to-day  as  often  manifests  early  dementia  as 
mental  symptoms  of  acute  character,  and  a  diagnods  is 
made  more  because  of  paralytic  symptoms  than  mental 
The  question  whether  these  cases  have  all  the  same 
essential  pathological  characters  has   not    yet  been 
satisfactorily  settled,  but  it  \b  admitted  that  the  site 
of  the  lesion  cannot  always  be  precisely  the  same.    In 
the  last  number  of  the  Journal  of  Mental  Science,  Dr. 
Hyslop  has  made  a  very  desirable  effort  to  have  this 
question  opened  up  by  the  publication  of  a  paper  on 
'<  Plaeudo-General   Paralysis."     He  admits  that  this 
term  may  be  objected  to  as  not  only  useless  but  even 
misleading,  and  he  is  probably  right  in  saying  so.    He 
quotes  several  writers  who  have  used  this  term  in  con- 
nection with  alcoholic  and  saturnine  causations  but  in 
doing  so  the  issue  ia  confused  and  the  work  of  clearing  up 
this  very  involved  question  is  rather  hindered.     Dr. 
Hyslop  believes  that  many  insanities  regarded  as  general 
paralysis  are  not  general,  but  special,  in  the  distribu- 
tion of  the  seat  and  manifestations  of  the  disease.   He 
speaks  of  cases  of  alcoholic  pseudo-general  paralysis 
where  recovery  often  takes  place,  and  of  cases  associ- 
ated with  syphilis  where  there  is  arrest  or  protraction 
of  the  disease  in  the  pseudo  form,  so  that  the  patient 
may  live  for  many  years.    He  regards  it  as  difficult  to 
prove  that  syphilis  is  the  actual  or  immediate  cause  of 
insanity.    With  this  statement  we  are  in  entire  accord- 
ance, but  are  surprised  at  the  statement  wliich  follows 
on  the  next  page. "  My  experience  in  Bethlem  leads  me 
to  believe  that  a  large  proportion  of  the  general  para- 
lytics admitted  to  that  hospital  suffer  from  cerebral 
degeneration  due  to  syphilitic  disease."    If  syphilis  is 
the  cause  of  true  general  paralysis,  and  also  the  cause 
of  pseudo-general  pfluralysis,  how  is  a  distinction  to  be 
drawn  between  the  two.   No  attempt  is  made  by  Dr, 
Hyslop's  paper  to  give  us  sufficient  clinical  data  of  the 
one  kind  or  the  other.    The  fact  that  so  much  confasion 


Jxm  10,  1896. 


NOTES  ON  CUEBENT  TOPICS. 


tax  Hbdical  Pbbbb.     609 


arifles  regaidlDg  what  U  geoeral  paralysis  and  what  is 
pseudo-general  panJysu,  maybe  due  to  the  strong  views 
held  by  some  physicians  that  syphilis  is,  in  a  veiy  great 
proportion  of  cases,  the  canse  of  general  paralysis.  There 
IS  no  more  fatal  drawback  to  the  progress  of  medical 
science  than  the  disposition  to  accept  as  facts  what  is 
merely  presumption  of  fact,  and  not  infrequently  a  very 
slender  presumption  at  the  best.  The  presumption 
of  qrphilis  is  accepted  too  readily.  Admitting,  how- 
ever, for  the  sake  of  argument  that  there  is  the  fact, 
and  not  the  presumption  of  syphilis,  in  how  many 
cases  has  the  causal  relation  between  it  and  insanity 
been  actually  demonstrated.  It  is  an  argument /Toat 
hoe,  ergo  propter  hoc^  and  this  is  unscientific.  It 
is  a  most  unfortunate  fact  in  connection  with  the 
science  of  medicine  that  a  great  many  of  the 
statements  with  which  our  journals  and  text-books  are 
crowded  have  been  made  without  verifying  the 
references  clinically  or  pathologically.  What  per- 
centage of  post-mortem  evidence  have  we  of  syphilitic 
lesion  of  any  part  of  the  nervous  system  in  general 
paralysis  f  A  too  hasty  assumption,  because  we  wish 
to  prove  a  particular  theory  correct,  has  done  more  to 
discredit  medical  teaching  than  anything  else.  These 
remarks  are  intended  to  apply,  not  to  Dr.  Hyslop's 
statements,  but  rather  to  the  unsatisfactory  position 
which  the  teaching  of  insanity  holds  to-day.  Dr.  Hyslop 
has  done  well  in  raising  this  question,  and  we  hope  the 
discussion  which  is  sure  to  arise  upon  it  in  the  Medico- 
Psychological  Association  will  break  up  some  traditions 
which  die  hard,  and  will  open  up  a  new  and  more 
scientific  view  of  the  wh^  subject.  There  can  be  no 
question  that  the  study  of  general  paralysis  needs  a  new 
and  fresh  impetus ;  that,  as  at  present  regarded,  there 
are  varieties  and  groups  which  we  have  not  been  able  to 
differentiate  clearly  from  each  other,  and  the  prognosis 
of  which  is  not  always  the  same.  Mr.  Bevan  Lewis 
has  recentiy  been  attempting  a  constructive  criticism 
of  the  subject,  as  distinguished  from  Dr.  Hyslop's 
destructive  criticism.  Both  methods  of  attack  will 
help  onwards  our  knowledge  of  this  disease,  and  we 
look  forward  with  interest  to  what  comes  out  of  it. 


Jl(rte0  on  (Hnxxmt  ^opxcB. 

The  Deadlock  at  the  Liverpool  Lying-in 
Hospital 

Last  week  we  printed  the  terms  of  the  reference 
which  the  Board  of  Management  of  the  above  hospital 
proposed  should  be  laid  before  the  Lord  Mayor  of 
Liverpool.  The  pith  of  the  matter  was  contained  in 
the  first  proposition,  namely,  "that  the  arbitrator 
decide  whether  the  reading  of  the  rules  by  the  Board 
of  Management  or  the  medical  staff  be  the  correct  one." 
On  referring  to  a  copy  of  the  rules  of  the  institution, 
we  find  that  the  ambiguous  passages  are  as  follows :« 
Under  Rule  11,  defining  the  objects  of  the  charity,  (1) 
*'  To  provide  poor  married  women,  dbc  .  .  .  with  the 
assistance  of  trained  midwives  during  their  confine- 
ments, and,  when  requisite,  of  surgeon  accoucheurs,'' 
dJEc.     This  is  a  typical  instance  of  loose  wording  of 


rules ;  the  words,  **  when  requisite,"  would  furnish 
material  for  endless  litigation.  Rule  XXY  states  that 
each  of  the  hospital  medical  officers  **  shall  in  turn  have 
the  sole  charge  of  the  patients  in  the  hospital  foV  a 
period  of  three  months."  That  position  seems  definite 
enough,  but  in  the  opinion  of  the  Management  is  over- 
ridden by  Rule  XXXVII,  which  says :"  The  matron 
shall  be  responsible  for  the  attendance  on  the  hospital 
patients,  and  the  management  of  the  various  depart- 
ments of  the  hospital,  subject  to  the  direction  of  the 
Ladies'  Committee,  and  in  conformity  with  the  by- 
laws and  regulations  from  time  to  time  laid  down  by 
the  Board  of  Management ;  she  shall  be  responsible 
for  the  carrying  out  of  the  orders  of  the  medical 
officers."  These  rules,  so  far  as  can  be  gathered,  allow 
of  various  interpretations.  It  is  clear,  however,  that 
the  medical  staff  have  done  right  in  resigning  rather 
than  brook  the  attempt  to  place  a  woman  unskilled 
in  the  art  of  medicine  over  the  head  of  a 
qualified  medical  man  to  decide  when  and 
how  far  the  latter  is  to  be  called  in,  and  they 
have  now  absolutely  declined  the  proposed  arbitration 
in  the  following  terms  :— 

After  tiie  resolution  passed  by  your  Board  on  May 
I9tlL  accusing  the  medical  profession  of  'wanton 
crusty,' and (3  being  'utterly  r^rdless  of  common 
humanity,'  <fec  ;  further  as  it  is  very  questionable 
whether  ^our  Board  lonc;er  represents  the  wishes  of 
the  majority  of  the  subscnbers  to  the  charity,  we  feel 
that  further  communication  with  your  Board  is 
attended  with  difficulty.  Moreover,  there  is  no  room 
for  arbitration.  We  have  repeatedly  laid  before  you 
our  lequest  for  complete  authority  in  our  own  depart- 
ment and  for  representation  on  the  Board  of  Manage* 
ment,  which  we  nave  formulated  in  these  words  :~ 

1.  That  the  medical  officer  on  duty  at  the  hospital 
shall  have  sole  and  entire  medical  charge  of  all  the 
patients  in  tiie  hospital 

2.  That  the  medical  staff  shall  be  represented  on  the 
Board  of  Management  by  four  members  of  the  Medical 
Board,  to  be  selected  from  time  to  time  by  the  staff." 

This  provoked  an  authorised  report  in  an  evening 
paper  on  the  5th  inst,  to  the  effect  that— 

The  late  medical  staff,  and  the  medical  profession 
ffenenJly,  having  declined  to  submit  the  questions  of 
difference  to  the  arbitration  of  the  Lord  Mayor,  the 
Board  of  Management  have  decided  to  call  together  a 
special  general  meeting  of  the  subscribers,  as  early  as 
convenient,  to  consider  the  course  to  be  adopted  with 
reference  to  the  future  conduct  of  the  hospital." 

The  so-called  Board  of  Management  appears  to  be 
under  the  impression  that  its  action  receives  the  sup- 
port of  the  Ladies'  Committee.  An  authorised  com- 
munication from  the  Ladies'  Ck>mmittee  in  the  papers 
of  the  6th  inst  shows,  however,  that  the  Board  has 
been  under  a  wrong  impression  in  the  matter,  and  that 
in  reality  the  ladies  are,  now  at  any  rate,  on  the  side  of 
the  doctors.    The  communication  is  as  follows  : — 

The  Ladies'  Committee,  at  their  meeting  yesterday, 
held  at  the  hospital,  decided  that  the  following  state- 
ment should  be  sent  to  the  newspapers  :— 

As  the  Board  of  Management  of  the  Ladies'  Charity 
and  Lying-in  Hospital  have  mentioned  the  resolutions 
passed  by  tiie  ladies  at  their  own  committee  on  May 
22nd,  they  consider  it  desirable  that  they  should  be 
published.    The  resolutions  are  as  follows  :~ 

1st.  '*  In  view  of  the  position  taken  by  the  medical 
profession  the  Ladies'  Clommittee  of   the  Lying-in 


610    TbbMbpioal  PMbs.  l^OTES  ON  CURRENT  TOPICS. 


JuKB  10,  1896. 


HoB^tal  desire  to  record  their  opinion  that  the  medi- 
cal officer  on  dutv  should  have  sole  and  entire  medical 
charge  of  all  patients  in  the  hospital." 
^2nd.  "Miat  the  Medical  Board  be  represented  on  the 
ix)ard  of  Management  by  two  members  of  the  medical 
etoff,  having  a  right  to  vote." 

3rd.  ''That  the  matron-midwife  should  stand  in  the 
p^ition  Qf  house  surgeon  under  the  hon.  medical 
officer  on  rota." 

If  resolutions  in  the  spirit  of  that  of  the  forogoing  are 
passed  at  the  forthcoming  meeting  of  the  subscribers, 
the  dispute  will  be  at  an  end.  We  can  scarcely  look  upon 
the  controversy  as  an  altogether  unfortunate  one,  as 
there  has  been  an  impression  abroad  that  anjrthing 
was  good  enough  for  doctors,  and  that  they  must  be 
kept  under  whatever  happened.  The  Board  thought 
they  had  them  well  under  their  thumb  when  theyposses- 
ced  the  power  to  practically  dismisH  them  by  the  simple 
process  of  not  re-electing  them  at  their  last  secret 
meeting  of  the  year.  Events  have  shown  that  when 
the  Board  made  such  shameful  use  of  their  power  on 
the  present  occasion  they  gained  nothing  by  it  but 
odium,  and  that  the  doctors  in  spite  of  summary  un- 
just dismissal  have  been  fully  able  to  hold  their  own, 
and  more  than  that,  are  certain  to  gain  their  point. 
Will  the  beaten  Board  then  retire,  and  will  the  Courier 
again  contemptuously  put  the  question—"  What  do  the 
doctors  want  ?"  We  may  add,  how  dcvre  they  have  a 
wish  not  approved  by  Mr.  Bartlett  ? 

Payments  by  Hospital  Out-Patients. 
Thb  Hon.  Sydney  Holland  is  a  well-meaning,  indus- 
trious, outspoken  and  able  philanthropist  But  it 
looks  at  times  as  if  he  allowed  his  zeal  to  outrun  his 
judgment  in  some  of  his  schemes  for  the  better  control 
of  the  medical  charities.  One  of  his  plans  to  check 
the  growth  of  the  number  of  out-patients  is  to  impose 
on  them  a  money  tax.  This  method,  he  explained  a 
abort  while  since  to  the  Hospitals  Association,  was,  in 
many  instances,  followed  by  the  exodus  of  patients  to 
neighbouring  hospitals.  In  one  such  institution,  with 
the  management  of  which  he  was  connected,  a  charge 
of  2d  per  out-patient  resulted  in  a  marked  decrease  of 
attendances,  but,  he  adds,  these  who  have  left  off 
coming  to  that  particular  place  have  doubtless  gone  to 
the  London,  West  Ham,  or  the  Seamen's  Hospital.  It 
may  be  questioned  if  even  so  keen  a  man  as  Mr. 
Holland  fully  realises  what  he  is  doing  when  he 
inflicts  a  fine  of  2d.  on  each  person  attending  as  an  out- 
patient By  so  doing,  he  is  virtually  excluding  the 
abject  poor,  and  is  fostering  a  class  who  might  get 
good  club  attendance  for  the  sum  in  question.  More- 
over, he  is  trading  on  money  subscribed  for  the  benefit 
of  the  poor.  We  are  perfectly  aware  that  the  prac- 
tice is  adopted  at  Guy's  Hospital,  or  was  so  until  quite 
lately,  where  an  even  higher  charge  has,  for  many  years, 
been  made  for  medicine.  Whatever  excuse  there  may  be 
in  some  instances  for  attempting  to  raise  revenue  or  to 
curtail  expenditure  in  this  fashion  there  can  be  none 
in  the  case  of  a  hospital  enjoying  a  huge  endowment. 
It  is  too  much  the  fashion  of  arm-chair  philanthropists, 
with  the  best  intentions  in  the  world,  to  attempt  to 
solve  intricate  social  problems  at  the  expense  of  the 


medical  profession  or  of  the  poor,  for  that  appears  to 
be  the  practical  outcome  of  imposing  a  tax  on  out- 
patients. Far  better  have  some  carefully  organised 
system  of  inquiry  into  the  means  and  position  of  appli- 
cants. It  may  be  at  once  admitted  that  Mr.  Holland's 
facts  are  strongly  in  favour  of  the  need  of  central  con- 
trol and  common  action  of  hospitals. 


Pure  Beer. 
The  subject  of  pure  beer  has  recently  been  discussed 
in  the  Kent  and  Suuex  Courier  from  a  Hop-Grower^s 
point  of  view.  In  their  anxiety  to  account  for  the 
present  depression  in  the  hop  market  they  have  attri- 
buted it  to  the  general  employment  by  brewers  of  sub- 
stitutes for  hop.  We  have  it,  however,  on  the  authority 
of  a  correspondent,  who  evidently  knows  what  he  is 
writing  about,  that  the  cause  must  be  looked  for  else- 
where. It  is  satisfactory  from  a  consumer's  point  of 
view  to  learn  from  him  that  brewers  long  since  found 
out  that  hop  substitute  does  not  answer  their  purpose, 
indeed,  he  hints  that  persons  unable  at  once  to  distin- 
guish beer  brewed  with  hops  from  that  brewed  without, 
are  not  worth  legislating  for.  The  interesting  part  of 
his  letter,  however,  lies  in  the  explanation  which  be 
gives  of  the  greater  tendency  to  decomposition  on  the 
part  of  the  present-day  beer.  Formerly,  a  good-keeping 
beer  could  be  brewed  from  English  malt  and  hops 
without  any  difficulty,  but  since  farmers  have  learned 
the  advantage  of  using  strong  ammoniacal  manures  the 
grain  has  come  to  contain  so  much  larger  a  propor- 
tion of  nitrogenous  matter  that  the  greatest  difficulty 
is  often  experienced  in  brewing  a  good  keeping  beer 
unless  it  contains  a  high  percentage  of  alcohol  As  the 
public  taste  inclines  to  beer  less  strong  in  alcohol 
brewers  have  found  it  necessary  to  fall  back  upon  other 
starch  grains  or  foreign  malt,  in  place  of  the  too  nitro- 
genous English  malt.  The  flavour  of  a  beer  in  any  case 
does  not  depend  so  much  upon  the  grain  used  as  upon 
the  hops,  and  to  seek  to  impose  a  legislative  obligation 
on  the  brewer  to  employ  British  produce,  in  spite  of  the 
fact  of  its  unsuitability,  would  be  an  absurd  and  iojudl- 
cious  step. 

Meals  and  Food  for  the  Schoolboy, 
Mr.  Horace  Savory  recently  read  a  paper  before 
the  Association  of  Medical  Officers  of  Schools,  which, 
is  of  considerable  interest  to  teachers,  parents,  and 
medical  men.  The  dietary  of  the  schoolboy  is  one  of 
the  fundamental  questions  of  our  existence,  and  the 
paper  before  us  is  useful  and  suggestive.  He  commnoi- 
cates  several  practical  suggestions  with  regard  to  the 
order  of  meals,  the  nature  of  the  food  to  be  takeo,  the 
relation  of  food  and  play,  and  the  question  of  food  on 
rising  in  the  morning,  as  well  as  the  question  ci  supper. 
Regarding  the  early  meal  he  finds  that  early  beddera 
like  this  meal,  but  as  a  rule  the  schoolboy  is  too  lazy  to 
get  up,  and  when  he  does  get  up  is  in  too  great  a  hurry 
to  do  those  things  which  he  has  leit  undone  till  the  last 
moment,  to  be  troubled  by  breaking  his  fast  Dr. 
Savory  is  strongly  of  opinion  that  this  early  meal 
fortifies  against  epidemic  and  other  diseases,  and  he  is 
of  opinion  also  that  leaving  off  the  first  lesson  and 


JUVB  10, 1896. 


NOTES  ON  CXJBKENT  TOPICS. 


Thb  Mh>ioal  Press.     611 


taking  the  meal  before  work,  helps  to  check  the  spread 
of  illiiess.  In  the  text  he  gives  the  hour  of  play  as 
2.90  p.m.,  but  in  the  time  table  he  givee  it  as  2  o'dock, 
the  dinner  being  at  1.30.  While  we  agree  with  him 
that  no  great  harm  seems  to  be  done  to  the  boy  who 
rises  from  meals  and  indnlges  in  the  yigoroos  exercise 
of  play  right  away,  still  cases  do  occnr  now  and  again 
of  sickness  after  meals,  when  a  proper  paose  is  not 
allowed,  and  we  should  be  inclined  to  think  that  an 
interval  of  half -an-hour  would  be  advantageous.  The 
paper  is  one  which  will  naturally  evoke  discussion  and 
interesti  and  it  is  one  well  worthy  of  consideration. 


The  Afternoon  Nap. 
Ths  frequency  with  which  medical  men  are  asked 
whether  it  is  harmful  to  indulge  in  the  '^  afternoon 
nap,"  is  not,  perhaps,  surprising,  for  several  reasons. 
Most  persons  have  had  experience  of  the  seductive 
charms  of  the  somnolence  which  has  followed  the  com- 
fortable ingestion  of  a'mid-day  or  evening  meal.  The 
meal  finished,  the  diner  arranges  himself  comfortably 
in  an  arm  chair ;  it  may  be  he  lights  a  (pipe  or  cigar, 
takes  up  a  newspaper,  and  i»repares  to  make  the  most 
of  the  restful  conditions  of  Ms  mind  and  body.  But 
Nature  soon  begins  to  assert  her  sway.  In  time,  the 
eyelids  close,  the  head  begins  to  nod,  the  newspaper 
falls  from  the  hands,  the  pipe,  no  longer  supported  in 
the  mouth,  falls  to  the  floor,  and  the  symptoms  of  a 
nap  are  complete.  Whether  the  ''winks "be  forty  or 
one  hundred  in  number,  the  result  is  the  same— a  short, 
sound  sleep.  Then  comes  the  question— Is  it  harmful 
thus  to  fall  asleep  after  a  meal  ?  By  no  means ;  for 
the  very  obvious  reason  that  the  process  is  merely  a 
physiological  one,  and  as  such,  when  it  occurs,  is  quite 
natural.  When  digestion  is  in  progress.  Nature  has 
arranged  that  all  the  available  blood  in  the  body  shall 
be  collected  in  and  about  the  digestive  organs.  Con- 
sequently, the  blood  supply  to  the  brain  falls  to  a  low 
ebb,  and  thus  sleep  is  easily  induced.  On  the  other 
hand,  of  course,  physiologically,  it  is  wrong  for  brain 
work  to  be  attempted  immediately  after  a  solid  meal. 


Street  Odours. 
The  exceptional  warmth  and  dryness  of  the  present 
year  have  emphasised  the  unsavoury  nature  of  the 
wooden  road  paving  that  is  now  common  both  in  the 
metropolis  and  in  many  provincial  towns.  There  can 
be  no  doubt  whatever  that  the  unpleasant  odours  in 
question  are  more  constant  and  offensive  than  in  the 
case  of  the  old-fashioned  stone  pavings.  It  is  not  sur- 
prising, then,  that  the  lay  press  generally  should  take 
up  the  view  that  the  wooden  roadway  is  less  sanitary 
than  its  stone  predecessor.  Speaking  from  a  scientific 
standpoint,  it  is  by  no  means  certain  that  such  is  the 
case.  The  mere  presence  of  a  '*  stink  "  does  not  neces- 
sarily imply  a  danger  to  mankind ;  indeed,  as  a  rule,  it 
will  be  found  to  be  the  aromatic  product  of  non-patho- 
genic moulds  or  bacteria.  Although  at  the  same  time, 
it  must  be  admitted  that  the  street  wood-blocks  have 
a  worse  smell  than  the  macadam,  yet  it  seems  probable 
that  they  are  quite  as  harmless  to  health.  Nay, 
further,  as  the  stone  pavement  is  more  dusty,  it  is  far 


more  likely  to  spread  about  any  pathogenic  organisms 
through  the  medium  of  disturbed  air.  Besides,  the 
wooden  way  Is  infinitely  easier  to  cleanse  and  to  keep 
clean  than  the  one  which  is  fashioned  of  stone. 

The  Immoral  Advertisement  Question  in 
Australia. 

Ths  insertion  of  immoral,  indecent,  advertisements 
in  many  of  the  Australian  newspapers  is  an  ever 
present  evil  in  the  colony,  and  Dr.  Jenkins,  in  his 
recent  presidential  address  at  the  annual  meeting  of 
the  New  South  Wales  Branch  of  the  British  Medical 
Association,  animadverted  upon  it  in  strong  terms. 
He  very  truly  observed  that  the  insertion  of  such 
advertisements  was  a  direct  incentive,  not  only  to 
undesirable  practices  among  the  married,  but  to  gross 
immorality  among  the  young  of  both  sexes.  Abor- 
tionbts,  he  also  adds,  practice  a  lucrative  trade  in 
Sydney.  Thus  the  unfortunate  girls  who  "buy  the 
merry  madness  of  an  hour  with  the  penitence  of  after- 
time,"  often  fall  into  what  afterwards  proves  to  be  a 
death-trap.  Of  course,  the  interference  of  the  Legisla.. 
tureof  New  South  Wales,  with  a  view  of  puttinga  stop  to 
these  advertisements,  is  imperatively  demanded ;  and 
the  same  interference  is  called  for  so  far  as  this  country 
is  concerned.  Abortion-mongers  will  always  flourish, 
regardless  of  the  risks  that  th^y  may  incur  from  their 
trade,  as  long  as  they  can  make  their  existence  known, 
by  newspaper  announcements,  to  those  who  may  dasirs 
their  attentions. 


The  Relative  Health  of  Postal  Servants. 

Ak  interesting  return  was  made  last  January  to 
Lord  Tweedmouth,  as  Chairman  of  the  Committee 
on  Postal  establishments,  with  reference  to  the  general 
health  of  the  employes,  differentiating  the  telegraph- 
ists from  the  ordinary  postal  hands.  Eleven  questions 
were  submitted  to  the  postal  medical  ofScers  and  replies- 
were  received  from  142  officers,  the  purport  of  which 
we  may  epitomise.  We  give  them  as  question  and 
answer  :— 

1.  Are  postal  employes  less  healthy  than  other  com- 
munities, on  an  average  P     On  the  whole  not  less 
healthy,  out  in  large  towns  to  some  extent  less  so. 

2.  Is  there  any  difference  between  the  health  of 
postal  or  telegra^  officers  ?  Opinions  about  equally 
divided,  the  mcgority  being  of  opinion  that  there  is  no 
material  difference. 

3.  Are  tele^phists  abnormally  phthisical  ?  Opinions 
almost  unanimously  negative. 

4.  Do  they  suffer  especially  from  respiratory  disease  ? 
No,  almost  unanimously. 

5.  Are  telegraphists  especially  nervous?  Majority 
answer  yes,  especially  female  officers. 

6.  Are  telegraphists  subjecttodigestiveailmentsP  The 
prevalence  of  such  disorders  seems  to  be  established 
generally. 

8.  Are  overtime  and  irregular  duties  productive  of 
ill-health  P  Yes,  in  the  case  of  the  large  cities,  but  not 
so  much  in  rural  districts. 

10.  Is  the  insanitary  condition  of  postal  offices 
responsible  to  any  considerable  extent  for  ill-health  P 
Yea,  in  the  case  of  44  of  the  142  officers  questioned. 


The  average    consumption  of  oysters  in  Paris  is 
thirty-nine  millions  a  year. 


612    Tm  lISDioAL 


BOXB  tor  CDUBHT  TOPICa 


JlTNK  10,  IMk 


Univeraity  Bntexpriae  m  Bdinburgh. 
Thx  andent  oapitai  of  Scotland  has  long  held  a  fore- 
most position  in  medical  teaehing.  Nor  has  the  enter- 
prise of  Edinburgh  been  satisfied  by  the  msgnifictent 
"newboildings,"  for  the  faculty  of  medicine  Utely 
added  to  the  Uniyersity.  Its  latest  sdieme  is  the 
formation  of  a  limited  liability  company  to  be  called 
the  ''  Town  and  Gown  Asociation,"  with  a  capital  of 
£100,000  divided  into  20,000  shares  of  ;£5  each.  The 
objects  of  the  proposed  society  are  manifold.  Th^ 
inclnde,  for  instance,  the  pmrdiaae  and  provision  of 
residential  halls  for  students,  to  found  laboratories, 
lectureships,  and  other  educational  machinery  ;  to 
triKle  as  printers  and  publishers,  and  to  engage  in 
industrisl  co-operation.  This  is  a  part  only  of  the 
extremely  wide  programme  advertised  in  the  prospectus 
of  the  Association.  Whether  the  project  be  carried 
out  or  not  it  proves  that  Edinburgh  has  not  one  whit 
abated  its  enlightened  educational  policy.  The  energy 
and  foresight  to  be  traced  in  every  line  of  the  prelim- 
inary document  might  well  be  taken  to  heart  by  the 
oniversitieB  that  have  long  since  settled  into  the  con 
tented  apathy  of  prosperous  age.  But  above  all  the 
object  lesson  of  Edinburgh  with  its  brilliant  University 
should  bring  home  to  Londoners  the  loss  they  have 
sustained  in  their  want  of  a  teaching  institution  of  the 
kind. 


•The  Annnal  mectioii  at  the  Boyal  Ck>llege 
of  Surgeons,  Bngland. 
The  annual  election  to  the  Council  of  the  Royal 
<College  of  Suigeons,  England,  will  take  place  on  July 
2nd  next  The  three  retiring  CSoundllors  are  Mr. 
Thomas  Bryant,  Mr.  Cadge,  and  Mr.  T.  P.  Pick.  Mr. 
Oadge  will  not  seek  rejection,  but  both  Mr.  Bryant, 
who  has  served  two  terms  of  ofSce,  and  Mr.  Pick  will 
4»me  forward  again.  Thus  there  will  be  only  one 
actual  vacancy,  but  the  two  Councillors  who  are  offering 
themselves  for  re-election  will,  of  course,  have  to  sub- 
mit to  the  ordeal  of  a  contest  One  or  both  may  be 
successful,  and  if  the  latter  proves  to  be  the  case  the 
Council  will  gain  only  one  new  member.  At  the 
-present  juncture,  new  members,  with  the  spirit  of 
reform  in  them,  equal  to  that  displayed  by  a  large 
body  of  the  Fellows,  are  sadly  needed.  The  old  con- 
servatism is  fast  waning  in  the  Council,  and  rightly  so. 
"The  reforms  advocated  by  the  Fellows  are  bound  to 
be  conceded  by  the  Coundl,  and  time  only  stands  in 
the  way  of  the  members  of  the  College  being  directly 
(represented  on  the  governing  body  of  the  College.  If 
Mr.  Bryant  and  Mr.  Pick  be  returned  at  the  election 
^n  the  2nd  proz.,  it  may  be  trusted  that  the  third 
vacancy  will  be  filled  by  a  thoroughly  sound  reforming 
Fellow. 

Sixnilia  Sixnilibus  Ourantur. 
Although  it  is  discordant  with  medical  opinion 
that  any  of  the  tenets  of  homceopathy  should  have  a 
place  in  educated  medical  practice,  we  admit  that  the 
most  modern  phase  of  therapeutics  trends  in  this  direc- 
tion. The  fashion  just  now  is  to  prescribe,  for  the 
disease  of  any  organ,  an  extract  from  the  active 


principle  of  that  organ  itself.  Tins  it  happens  iibat 
the  firms  which  cater  for  advanced  tinrapeutic  ideas 
of  this  sort  are  offering  to  the  profession  suitable  pre- 
parations of  such  active  principles.  MeHm.  Burroughs 
Wellcome  &  Co.,  for  instance,  announce  that  they  are 
ready  to  supply— 

Salivaij-gland  tabloids  for  use  in  amylaceous  dys- 
pepsia. 
Pineal^land  tabloids  for  softening  of  the  bnin,  &c 
Nuclein  tabloids  for  nervous  prostration,  &c 
Kidney-substance  tabloids  for  diseases  depending 

upon  disturbance  of  the  renal  functions. 
Cervical   lymphatic-gland   tabloids  for   glandular 

swellings,  dtc. 
Fallopian-tube  tabloids  for  neurotic  affections. 
Liver-substance  tabloids  for  uraemia,  kc 
Spinal- cord  tabloids  for  brain  diseases. 

They  have  retained  the  services  of  a  former  pupil  of 
Pasteur,  who  devotes  his  whole  attention  to  this  branch 
of  the  business,  and  who  maintains  that  the  adive 
principles  can  be  thus  iwlated  and  preserved  in  perfec- 
tion. No  doubt,  if  disease  does  not  "  mock  the  meat 
it  feeds  on,"  these  preparations  will  prove  effectual. 

The  Frees  and  the  General  Medioal  GounciL 
While  the  Council  chamber  has  emerged  from  the 
cellar-like  depression  which  it  formerly  occupied, 
enlarged  and  considerably  embeUished,  we  are  fain  to 
notice  that  the  architect  has  treated  the  press  with  a 
total  want  of  consideration.  The  unfortunate  reporters 
have  been  relegated  to  an  exiguous  recess  dug  out  of 
one  of  the  walls,  which  the  waves  of  sound  only  reach 
in  a  very  attenuated  form,  andi  the  view  from  which  is 
obstructed  by  a  gigantic  pillar.  If  the  reporters  con- 
tinue to  display  the  assiduity  and  impartiality  which 
have  hitherto  characterised  their  work,  it  will  show 
that  they  possess  an  almost  Oriental  resignation.  The 
gallery  for  the  curious  public,  on  the  other  hand,  is  a 
great  improvement  on  that  formerly  assigned  to  viu- 
tors.  We  would  respectfully  suggest  to  the  "  Improve- 
ments Committee,"  if  there  be  one  (and,  if  not,  that 
such  committee  be  appointed  ad  hoc\  the  desirability  of 
providing  more  ample  and  more  suitable  accommoda- 
tion for  a  body  of  men  to  whom  they  are  so  largely 
indebted  for  notoriety,  if  not  for  fame. 


Sterility  in  the  Female  due  to  Gonorrhcsal 
Infection. 
The  significance  of  gonorrhoea  in  interfering  with 
the  due  course  of  conception  has  been  made  the  subject 
ef  a  special  study  by  Fehliug,  who  recently  communi- 
cated his  conclusions  to  a  meeting  of  the  Society  of 
Physicians,  Halle.  Experience  and  inquiry  show  that 
ten  to  fifteen  per  cent  of  all  marriages  are  sterUe,  and 
of  these  over  fifty  per  cent  are  due  to  gonorrhooa  in 
the  husband.  In  such  cases,  generally  a  history  of 
gonorrhoeal  epididymitis  is  to  be  obtained,  as  the  result 
of  which  the  vas  deferens  becomes  impermeable  and 
no  spermatozoa  are  contained  in  the  semen.  In  rare 
cases,  however,  the  author  admits,  with  a  compara- 
tively recent  gonorrhoea  of  the  male,  it  is  possible  for 
conception  to  occur  quite  early  after  marriage,  before 
infection  takes  place.    la  still  rarer  oases,  especiaDy 


Juki  10«  18M. 


NOTES  ON  CUKRKNT  TOPICS. 


Thb  Mxdioal  Pemb.     613 


in  the  unmarried,  gonorrhceal  infection  may  not  occur 
until  the  second  or  third  month  of  gestation.  Accord- 
ing to  Weitheim,  a  man  may  have  a  latent  gonorrhoea, 
in  which  a  few  only  yirulent  gonococci  remain  in  his 
urethra ;  daring  marital  intercourse  these  cocci  reach 
the  genital  mucous  membrane  of  the  wife  and  find 
there,  favoured  by  the  multiplied  relations  of  the  honey- 
moon, a  most  propitious  field  for  propagation,  with 
increased  virulence ;  these  in  turn  reinfect  the  husband 
with  an  acute  gonorrhoea;  thus  both  man  and  wife 
are  mutually  infected.  The  more  recent  the  gonor- 
rhoea of  the  husband,  the  greater  is  the  danger 
of  infection  for  the  wife.  Exceptions,  however, 
may  occur ;  pregnancy  may  result  with  a  recent 
gonorrhoea  in  the  husband.  But  while  one  of  the 
results  of  gonorrhoea  in  the  male  may  be  sterility, 
it  is  at  the  same  time  scarcely  needful  to  refer 
to  the  seriousness  of  the  symptoms  which  may  ensue 
to  the  female  as  the  result  of  gonorrhoea!  infection. 
OyniBColQgists  know  too  well  the  direful  effects  which 
gonorrhoea  in  women  may  produce.  The  facts 
therefore,  in  this  connection,  should  be  brought  home 
to  an  those  men  intending  to  marry,  who  have  been 
the  victims  of  a  severe  gonorrhoeal  attack. 

The  Cholera  Blot  in  Cairo. 
Ths  Egyptian  fanatics  had  an  excellent  opportunity, 
as  Arabi's  soldiers,  of   expending  their  superfluous 
fanaticism  in  the  Anglo-Egyptian  War  of  1882.    But 
the  process  was  a  costly  one  to  themselves,  costly  in 
the  sense  that  it  involved  a  great  loss  of  life— 4o  the 
fanatics.    Nevertheless,  the  lesson  was  not  lost  upon 
the  Egyptians,  and  th^  were  taught  many  things  of 
the  ways  and  habits  of  Europeans  which  they  have 
«ince  found  useful  to  cultivate  and  adhere  to.    It 
would  appear,  however,  that  they  have  ^still  to  learn 
the  necessity  and  advantages  of  sanitation.    The  out. 
break  of  cholera  in  Cairo  has  rendered  it  imperative 
for  the  authorities  to  exact  the  utmost  sanitary  pre- 
•cautions  against  the  dissemination  of  the  disease. 
jDuring  the  course  of  last  week  a   case  of  cholera 
occurred  in  the  University  of  El  Azhar,  and  in  due 
course  a  medical  man'of  the  Sanitary  Department  of 
the  town  arrived  in  order  to  attend  to  the  case.    But 
lie  was  refused  admission.    Accordingly  he  applied  to 
the  police  and  a  force  was  sent     The  door  of  the 
t>uilding  was  forced  under  a  shower  of  stones  thrown 
by  the  students  from  overhead.    The  necessities  of  the 
situation  demanding  it,  the  police  fired  a  volley  from 
their  rifles,  with  the  result  that  one  student  was  killed 
and  four  wounded,  one  fatally ;  while  one  hundred  and 
twenty  were  arrested.    This  was  the  third  attack  upon 
the  sanitary  officials  in  Cairo  within  a  week.    Several 
persons  in  high  official  position  were  wounded   by 
Atones  thrown  by  the  students.    With  that  unreason- 
able perverseness  which  Orientals  are  wont  to  exhibit, 
the  head  of  the  University  and  the  other  officials 
refused  to  assist  the  sanitaiy  authorities  in  the  ner- 
f  ormance  of  their  duties,  even  when  the  riot  had  broken 
out    It  is  hoped  in  Cairo  that  this  discreditable  con- 
^ct  will  be  signalised  by  the  Khedive  dismisnng  the 
officials  of  the  universi^  from  their  posts,  a  punish- 
ment which  would  be  richly  deserved. 


The  Marriage  of  Bpileptios. 
Whether  epileptics  should  or  should  not  marry  has 
been  desided  by  a  Cincinnati  judge  in  the  negative.  He 
has  announced  that  he  will  not  issue  a  marriage 
licence  in  cases  in  which  either  of  the  persons  propos- 
ing marriage  is  an  epileptic.  In  the  abstract,  no  doubt 
the  decision  is  an  expedient  one.  But  nothing  is  said 
as  to  the  means  to  be  adopted  in  order  to  ascertain  the 
epileptic  tendencies  of  the  persons  concerned.  In  the 
first  place,  it  is  not  the  least  likely  that  such  persons 
would  incriminate  themselves,  either  by  a  personal 
statement  or  by  producing  a  certificate  from  their 
family  doctor.  Nor  could  the  judge  demand  from  the 
doctor  a  certificate  in  any  way  pointing  to  the  fact  that 
any  patient  of  the  latter  was  an  epileptic.  The  question 
of  privilege  would  here  undoubtedly  arise.  It  would, 
for  example,  be  very  serious  for  two  young  persons, 
highly  wishful  to  enter  the  marriage  state,  if  the  judge 
were  able  to  obtain  from  a  doctor  a  certificate  to  the 
effect  that  one  of  them  was  an  epileptic,  and,  on 
these  grounds,  refuse  to  marry  them.  Thus, 
however .  much  wisdom  may  be  contained  in  the 
decision  to  decline  to  marry  epileptics,  the  fact 
remains  that  almost  insuperable  difficulties  would  pre- 
vent it  from  being  carried  into  effect  These  remarks 
would  also  apply  to  the  defective  of  all  classes,  to  habi- 
tual drunkards,  and  so  forth.  But  noteven  in  America 
can  we  see  that  under  these  circumstances  a  judge  could 
interfere  with  the  determination  of  two  young  persons 
to  become  joined  in  wedlock. 


BxnaU-Pox  in  the  West  of  BnglancL 
The  continued  prevalence  of  small-pox  in  the  West 
of  England  is  seriously  interfering  with  this  year's 
training  of  the  militia  and  volunteers,  as  owing  to  the 
wide  distribution  of  the  disease,  the  military  authori- 
ties do  not  consider  it  wise  to  mass  large  bodies  of 
men.  This  is  only  one  of  the  penalties  which  have 
fallen  upon  the  district,  owing  to  the  insensate  action 
of  the  anti-vaccination  faddists.  The  misguided  people 
who  have  been  induced  to  accept  the  ** arguments"  of 
the  latter,  and  have  suffered  accordingly,  must  now 
feel  that  they  were  following  **  false  prophets"  whose 
teaching  has  been  most  disastrous,  and  from  the  effects 
of  which  it  will  take  years  for  the  district  to  recover. 


A  Serum  Scandal 
Db.  Boobb,  Chief  of  the  Pathological  Department 
of  the  Piaris  Eskculty  of  Medicine,  has  been  compelled  to 
resign  his  appointment,  because  he  appears  to  have 
engaged  in  the  surreptitious  manufacture  of  anti- 
streptococcic serum  winch,  had  been  already  exploited 
by  Dr.  Marmoreck,  of  the  Pftsteur  Institute.  It  appears 
that  an  assistant  of  Dr.  Roger  was  the  medium  of  this 
manufacture,  but  the  Doctor,  when  his  attention  was 
called  to  the  business,  did  not  take  any  steps  to  put  a 
stop  to  it 

The  Rontgen  Bays  in  the  Witneee-Boz. 

We  note  that  at  the  trial  of  an  action  for  damages 
at  Nancy,  in  France,  the  surgeon  who  had  charge  of 
the  injured  plaintiff  was  accused  of  having  caused  the 


614)     Tmi  MsDiOAXi  Pbms. 


OBITUARl. 


Jmiq,  18»> 


damage  by  mistaking  a  dislooatioQ  for  a  fracture.  The 
aocosatioii  was  sastained  hj  producing  in  court  a 
Bontgen  photograph,  which  showed  clearly  the  bonee 
in  the  dislocated  position  without  any  fracture. 


It  is  announced  from  the  War  Office  in  an  Army 
Order  that  Revised  Instructions  for  the  Organisation 
and  Distribution  of  the  Army  Medical  Staff,  the 
Medical  Staff  Corps  and  ita  Besei^TOts,  and  the  Militia 
and  Volunteer  Medical  Staff  Corps  on  Mobilisation  for 
Home  Defence  have  been  approved,  and  will  be  issued 
to  all  concerned. 

At  the  last  meeting  of  the  Halifax  Town  Council 
the  Health  Committee  decided,  that  as  the  Board  of 
Guardians  had  deferred  for  six  months  the  considera- 
tion of  enforcing  the  provisions  of  the  Vaccination  Acts, 
to  refer  the  matter  to  the  Local  Qovemment  Board. 


Thb  Governors  of  the  Bedford  Infirmary  have 
adopted  designs  for  a  new  County  Hospital,  to  be 
built  at  Bedford,  at  an  estimated  cost  of  £26,300. 
Among  the  subscribers  to  the  fund  is  the  Duke  of 
Bedford,  who  has  given  £5,000. 

Wb  regret  to  announce  the  sudden  death  of  Sir 
George  Johnson,  M.D.,  F.R.S.,  on  the  3rd  instant  at 
lus  London  residence,  from  hemiplegia.  Deceased  was 
in  his  seventy-eighth  year.  A  full  obituary  notice  will 
be  found  in  another  column. 


Ths  Bowman  Lecture,  **  The  Influence  of  lic^t  on 
Vision,"  by  Professor  Snellen,  of  Utrecht,  will  be 
delivered  on  Friday  next,  at  9  p.m.,  before  the  Ophthal- 
mological  Society  of  Great  Britain,  in  the  rooms  of  the 
Medical  Society  of  London. 


MxASLBS  have  broken  out  in  Clapham  in  epidemic 
form,  and  by  order  of  the  local  authority  the  three 
Board  schools  have  been  closed. 

The  death-rate  of  London  further  fell  last  week  to 
16-9  per  1,000. 


[VBOM    OUR  OWN  OOBBWFONDBNT.] 

Thb  Rotal  Society,  Edinboroh.— At  the  last  meeting 
of  the  Rojal  Society  of  Edinbargh,  Mr.  R.  C.  Moesmaii 
read  a  paper  on  the  meteorology  of  Edinburgh  compiled 
from  atatistics  for  the  last  125  years.  From  the  long 
period  under  review,  and  from  the  fact  that  he  had  taken 
daily  values  instead  of  monthly  or  even  weekly  means 
with  regard  to  the  element  of  pressure,  an  extraordinary 
dip  in  the  barometer  appeared  with  great  regularity  on  or 
about  the  26th  of  November,  which  was  the  annual 
minimum.  Although  the  figures  given  were  for  so  long  a 
period  and  were  alFo  expressed  in  averages  of  threes 
(Blozamed),  those  representing  the  temperature  showed 
no  gradual  rise  and  fall  during  the  year,  but  very  con- 
siderable variations  from  day  to  day.  The  coldest  day  of 
the  year  was  the  8th  of  January,  the  warmest  the  8th  of 
Auflfust.  The  wettest  days  of  the  yeir  were  the  seven 
ending  on  the  18tb  of  August,  known  as  the  Lammas 
floods.  The  driest  were  the  seven  ending  on  the  27th  of 
March.    No  appreciable  difference  could  be  observed  in 


the  namber  of  gales  about  tha  time  of  the  eqainooc,  not- 
withstanding popnlar  opinions.  The  definite  weather 
types  reoaried  year  alter  year  with  great  reenlarity,  due 
to  the  direoiion  of  the  wind  at  theee  taBMB,;  wEidi,  in  tam» 
was  raled  hj  the  periodieity  in  the  distribation  of  ppas 
saret  In  wmter  a  low  preseore  system  over  lodaiia  ;  in 
spring  and  summer  a  nigh  pressure  over  Rossta,  and  a 
low  one  over  India  had  mnoh  to  do  with  this* 

Typhoid  Vmvwr  at  KnxoALOT.—Ovec  thirty  oases  of 
typhoid  fever  have  been  reported  in  Kirkcaldy,  Fifeshire, 
within  -the  last  fbrtnif^ht.  Most  of  them  have  beeor  of  m 
very  mild  type.  No  ladieatioo  has  yet  been  given  of  tb» 
origin  of  the  ontbreak,  but  the.  difficulty  of  treating  the 
cases  at  present  will  give  a  mnoh-needea  impetus  to  the 
proposed  erection  of  a  new  hospital  for  infeetioos  eases,  to 
oeat  senething  like  £0,000. 

EpmuBOH  Innoxious  Diskasis  Hospital  —Dr. 
Clande  Buchanan  Ker  has  been  appointed  Medical  Super- 
intendent  to  the  Edinbnigh'  Olty  Hospital  for  Infeetioos 


.  in  sndoession  to  the  late  Dr.  A.  F.  Wood.  Dr. 
Ker.  who  graduated  six  years  ago,  was  formerly  Assistant 
Medical  (^cer  to  the  same  hospital 

Thb  Glasgow  Hospital  Pboblsm.— A  series  of  artidee 
is  at  present  appearing  in  one  of  the  evening  pepere  of 
Olasgow  on  the  sobject  of  *'  maintenance."  Up  to  ITriday 
last  two  of  these  had  been  pnblisbed,  which  were  chiefly 
concerned  with  an  historiesl  survey  of  thequestion.  The  ' 
writer,  who  does  not  give  hie  nams^  is  evidently  in  fiwonr 
of  the  mnnicipalisation  of  all  hospitals,  we  suppose  for  the 
good  of  the  ratepayers,  who  would  all  be  eUgible  for 
gratnitous  treatment  to  the  detrimeat  of  the  medical  pro- 
fession. If  all  the  hospitals  in  Glasgow  are  to  be  snppovted 
by  the  rates  all  the  medical  officers  will  have  to  be  paid 
for  their  services,  and  we  shall  look  for  the  further  arti- 
cles of  tlie  series  to  see  if  this  intending  benefactor  of  the 
race  proposes  to  pay  the  staff  or  not  in  the  developnteoe  of 
his  wonderful  scheme. 

A  CocKADS  AND  Cbsstb  Prbfbbbxd  !— The  subjoined 
advertisement  appears  under  ''special"  in  the  Guuffom 
Bvming  News  of  the  6th  inst.  In  theee  days  of  diapated 
questions  in  "  Medical  Ethics  "  and  punitory  eocentncitiee 
on  the  part  of  the  General  Medical  Council,  it  is  really  too 
good  to  be  left  neglected  in  the  oolumos  of  a  daily  newe- 
paper  :— 

DocTOu's  OocKADS.— Wanted  from  Gab  Owners,  by 
Doctor  who  has  recently  become  surgeon  in  a  Volnn- 
teer  Regiment,  estimates  for  hire  of  a  Brougham  three 
hours  a  day ;  driver  must  wear  a  Cockade :  Breugbam 
with  one  or  two  crests  on  doors  preferred.— Apply  No. 
10.737,  News  Office. 


(Dbitojmi, 


SIR  GEORGE  JOHNSON^  M.D.,  F.R.S. 

Tub  death  of  Sir  George  Johnson  has  followed  quickly 
that  of  Sir  Russell  Reynolds,  and  thus  another  pro- 
minent member  ot  the  profeesion  has  passed  away  wiuiia 
the  short  period  of  a  week.  Sir  George  died  on  the  drd 
instant,  at  his  London  residence,  11  Savile  Row  after  a 
brief  illness  of  only  forty-eight  hours'  duration.  He  wae 
in  his  usual  health  on  the  morning  of  the  1st  inst.  (Mon- 
day), and  was  engased  in  replying  to  a  recent  critioiam 
which  had  appearedupon his  book — *<  The  Cholera  Contro- 
versy." In  the  afternoon  he  went  out  for  a  drive,  during- 
whicli  he  made  no  complaint  of  feeling  unwelL  However, 
after  his  return,  he  suddenly  became  unconscious,  and 
hemiplegia  and  aphasia  supervened.  Sir  Alfred  Garrod 
and  Dr.  Tirard  were  summoned,  and  it  was  soon  seen 
that  his  case  had  assumed  a  serious  aspect.  He  rallied 
somewhat  during  the  earlier  part  of  Uie  following  day. 
But  subsequently  a  change  for  the  worse  ensued,  the  circu- 
lation became  very  feeble,  and  death  took  place  as  stated 
above,  on  the  afternoon  of  the  3rd. 

Sir  George  was  bom  in  November,  1818,  at  Gondhurst, 
in  Kent,  and  was  educated  at  the  Grammar  School 
there.  At  the  age  of  nineteen  he  was  apprenticed 
to  a  relative,  a  general  practitioner,  residing  in  Cranbrook, 
Kent,  and  two  years  later,  in|October  1839,  he  entered  the 
Medical  School  at  King's  College,  London,  where  he  greatly 
distinguished  himself  as  a  student,  gaining  many  prizes. 


JVBB  10,  laM. 


GOBRESFOITDENCE. 


ThB  MSDIOAX.  l^OBBB.      916 


Intlie  wsrdB  be  wm  a  Glintal  Clerk  onder  Dr.  Todd,  and 
m  dYOieer  to  Sir  William  Ferfrawn,  And  sfter  qualifying, 
lie^Ued  Um  posts  of  bonae  physioiaa  and  honae  snreaon. 
In  1844  bo  took  his  degree  of  M.D.  at  the  University  of 
Loridon  aftsr  having  passsd  tbroogii  a  liighly  creditable 
^mlvweityoarser.  The  position  to  which  he  bad  attained 
9m  >»  pnNninent  Alamnns  of  his  medical  school  at  once 
nasffked  him  oat  as  a  Hkelv  candidate  f6r  an  appointment 
•CO  the  staff  of  his  hospital,  and  in  1857  he  was  eleoted  one 
•of  the  assistant  physicians,  sacoeeding  Boyle  as  Prolsssor 
•of  Materia  Medioa  and  Thempeatios.  In  this  appointment 
he  continued  until  1863,  when  he  became  Prdsssor  of  the 
Frineiples  and  Praotioe  of  Medicine,  an  appoiatuent  which 
he  resigned  in  1876  wlien  lie  became  prcnssor  of  clinical 
enedidne.  His  connection  with  the  Bavai  OoUege  of  Physi- 
cians began  when  he  became  a  memner  of  that  bodv  in 
1846.  Four  years  later,  an  unpsecedently  shortperiod,  he 
was  elected  a  Fellow  of  tbe  College,  and  subsequently  be 
held  the  oifices  of  Examiner  in  Medicioe,  Jnliior  Censor, 
Senior  Censor,  and  Vice-President.  The  bhie  ribbon  of 
science  was  conferred  open  him  in  1872,  wlien  be  was 
elected  a  Fellow  of  the  Royal  Bociety.  The  following  an 
-further  bonoors  of  which  he  was  the  recipient : — ^In  1884, 
the  Presidency  of  tbe  Royal  Medical  and  Chirnrgical 
Society;  in  1889,  a  Physicianoy  extraordinary  to  tbe 
*^neen  ;  in  1892,  a  Knighthood. 

Sir  George  Johnson  has  left  behind  him  many  evidences 
of  his  professional  work  in  the  form  of  publications  upon 
subjects  which  he  had  made  his  own.  it  is  only  true  to 
say  that  he  was  a  voluminous  writer.  But  his  contribu- 
tions to  the  literature  of  Bright's  disease,  epidemic  diar- 
rhoaa  and  cholera  are  the  most  original  that  ne  produced, 
and,  perhaps,  tbe  best.  In  tbe  evening  of  his  days  he 
devoted  much  of  his  time  to  literary  work  in  connection 
with  his  profession.  In  1887  he  published  a  volume 
entitled  ''Medical  Lectures  and  Essays,"  in  which 
appeared  man v  of  hie  scattered  papers  on  medical  subjects. 
A  feature  of  his  writings  was  tbe  controversial  matters 
which  he  introduced  into  them.  His  views  on  various 
debated  points  in  the  pathologv  and  treatment  of  chronic 
Bright's  disease  and  cholera  aid  not  meet  with  general 
acceptance,  and  consequently  he  wap  often  called  upon  to 
defend  the  position  which  he  had  taken  in  regard  thersta 
On  these  grounds  maj^be  partly|explained  the  large  number 
of  papers  and  pamphlets  issued  from  the  press  under  bis 
name.  But  controversv  was  an  occupation  in  which  he 
delighted,  as  may  also  oe  judged  from  tbe  perusnal  of  the 
correspondence  columns  of  the  medical  journals  of  previous 

5 ears.  In  reflecting  upon  the  life  work  of  Sir  George 
obnson,  it  is  somewhat  difficult  to  determine  hie  posi* 
tion  on  tbe  roll  of  famous  physicians.  That  the  profession 
is  greatly  poorer  by  bis  loss  goes  without  sayine,  not  only 
bv  reason  of  his  Bcientific  attainments,  but  also  oecause  of 
his  personal  qualities,  which  were  such  as  to  render  him  a 
persona  grtUa  among  a  large  circle  of  his  professional 
friends.  Sir  George  marriM  in  1850,  but  was  left  a 
widower  ten  years  later  with  ^v^  children. 

On  the  afternoon  of  the  8th  inst.  Sir  George  Johnson 
was  buried  in  the  little  churchyard  at  Addington,  Surrey, 
the  first  portion  of  the  funeral  service  having  taken 
place  earlier  in  the  day  at  St.  James's  Church,  Piccadilly. 
There  were  many  beautiful  wreaths  sent  by  Sir  George's 
•children,  grandchildren,  and  servants.  A  stained 
window  in  tbe  church  bears  testimony  to  tbe  fact 
that  Sir  George's  wife  and  siiter-in«law  were  buried  in 
4t  vault  there  some  thirty-six  years  ago. 

DR.  JOHN  RYAN,  OF  DUBLIN. 
Bt  the  death  last  week  of  Dr.  John  Ryan,  of  Francis 
Street,  Dublin,  one  of  the  last  remaining  links  with  the 
past  generation  of  Irish  practitioners  is  broken.  Dr. 
Ryan  was  an  ancient  baGhelor,  once  a  dispensary  doctor, 
one  of  the  original  founders  of  the  Irish  Pharmaceutical 
Society,  and  an  Examiner,  Director  of  the  Apothecaries' 
HalL  By  tbe  bumble  means  at  his  disposal  ne  accumu- 
lated a  fortune  which  is  valued  at  over  £40,000.  He 
•qualified  as  L.  AH.  sixty-three  years  ago,  and  at  his  death 
must  have  been  close  to  ninety  years  of  age. 

Mb.  H.  C.  Bubdsit  was  veeterdav  presented  by  the 
Prince  of  Wales  with  an  Address  and  Album  in  recogni- 
tien  of  his  services  last  year  on  behalf  of  the  Hospital 
Sunday  Fund. 


tflft  ito  not  hoM  oonelvM  refponifMe'for  tbe  opinions  of  our 
eosrMpoBdsBti.)  

THE  NEW  GALENUS. 

To  tht  EdUar  of  Thb  Msdioal  Pans  akd  CmouLAm. 

SiB,>-In  your  issue  of  this  week,  yon  comment  upon 
an  agitation  by  Dublin  students  against  the  appotntment 
of  a  lady  examiner  in  eynacology  and  obstetrics  to  the 
College  of  Surgeons,  Ireland.  May  I  be  allowed  to  make 
a  few  observations  on  the  whole  question  of  the  admission 
of  women  to  the  profession,  in  the  hope  that  your  ccdumae 
will  be  opened  to  the  discussion  of  the  subject  and  an 
opinion  formed  of  the  views  of  the  general  medical  world. 

In  the  first  place,  I  may  state  that  I,  with  many  that  I 
know,  strongly  protest  against  the  admission  of  women 
into  the  profession  for  four  principal  reasons : — 

1.  They  are  not  worthv  of  it. 

2.  They  lower  the  professional  status. 

3.  Their  motives  are  essentiallv  selfish. 

4.  It  is  Mpdnst  the  established  laws  of  Nature. 

If  you  wiU  allow  me,  I  will  take  these  reasons  ssriatim. 
That  they  are  not  worthy,  that  is,  do  not  deserve,  to  be 
admitted  to  the  profession  is  evident  from  their  past 
history. 

The  science  and  art  of  medicine  and  surgery  have  been 
built  up  step  by  step  through  the  ages  by  mm  who  sacri- 
ficed their  all  in  adding  to  our  knowledge,  often  against 
overwhelming  odds,  even  to  death  at  tbe  stake  itself,  in 
order  to  advance  or  promote  relief  to  sufierin^  humanity. 
How  much  did  woman  add  to  our  knowledge  in  medicine, 
surgery,  or  any  other  sdenoe  ?  Even  in  our  own  time, 
which  judged  by  the  advances  made  in  the  sciences,  is  very 
long,  woman,  as  far  as  my  experience  goes,  has  not  added 
one  iota  to  our  knowledge. 

She  might  have  had,  a  full  century  ago,  every  facility  of 
becoming  well  versed  in  all  the  sciences  excepting  the 
anatomical  and  clinical  parts  of  our  profession,  if  she 
wished,  such  as  diemist^,  electricity,  geology,  botany, 
physics  in  all  its  branches,  and  so  on. 

But  no !  they  are  not  good  enough.  Nothing  will  suit 
her  but  to  take  advantaffc  of  the  labours  of  centuries,  and 
through  the  weakness  ofsome  members  of  the  profession 
take  Si  the  profits  that  accrue. 

That  they  lower  the  professional  status  I  maintain, 
because  not  only  are  the  vast  majority  of  their  own  sex 
against  it,  but  the  profession  is  made  a  laughing  stock  of 
by  the  community  at  large. 

That  their  motives  are  selflsh  is  proved  by  my  first 
contention.  That  is,  they  pick  out  the  profession  that 
«>ay«  best,  not  in  money,  for  as  a  rule  they  are  independent, 
out  in  notoriety,  without  adding  anything  to  our  common 
stock  of  learning. 

Lastly,  it  is  against  the  laws  of  Nature  because  it  sweeps 
away  the  barriers  erected  by  Nature  between  the  sexes. 

Let  those  members  who  support  them  follow  the  matter 
to  its  logical  conclusion  and  havine  accepted  women  as 
Fellows  vote  to  place  them  on  the  Council  of  their 
particular  College,  the  General  Medical  Council,  the 
Coronerships,  the  Army  and  the  Navy.  Do  not  do  things 
by  halves.  In  reference  to  your  remarks  anent  Modesty 
(?)  as  between  the  Dublin  Medical  student  and  the  Lady 
Examiner.  Shade  of  Hunter  1  !  That  does  not  oppress, 
nor  interfere  with  his  sleep  I  assure  you.  Nor  aces  he 
object  in  the  least  to  a  female  examining  him,  but  they  do^ 
I  feel  competent  to  sav,  very  strongly  object  to  having 
women  on  the  roll  at  all,  either  as  F^ows,  Examiners,  or 
Licentiates,  and  to  their  being  placed  in  positions  of 
emolument  from  which  others  equally  efficient  are  excluded* 
having  in  view  the  above-mentioned  objections  to  them. 
To  sum  up  I  consider  it  bad  for  the  profession,  bad  for  the 
individual,  bad  for  the  State,  and  bad  for  the  home. 

Hoping  I  have  not  trespassed  too  much  on  your  space 
and  assuring  you  of  my  deep  respect  in  all  other  matters, 
I  am,  Sir,  yours,  &a, 
C.  L.  Hodgson,  L.R.C.P.  &  S.L 

187  Great  Brunswick,  Street,  Dublin, 
May  aoth,  1896. 

[We  gladly  afford  our  correspondent  the  opportunity  to 
express  his  opinion,  but  we  suggest  that  it  is  somewhat 


816     Thm  Mbdioal  Pj 


LITERATURE. 


JuKX  10,  1886. 


too  Uto  to  diMoas  the  policy  of  admitting  womm  to  the 
profeeaion,  considering  that  yeen  ago  that  question  has 
been  decided  affinnatiTely  in  almosterery  civilised  coantry 
in  the  world.  Nor  is  this  the  qneeUon  raised  by  the 
Dublin  students,  who— in  common  with  the  profession  in 
Ireland  and  the  Fellows  of  the  Irish  GoUege  of  Bargeons— 
allowed,  without  efieetnal  protest,  the  admission  of 
women.  Not,  indeed,  without  plenty  of  debate  of  the 
proe  and  com^  for  we  know  that  here,  in  Edinburgh  and  else- 
where, their  admission  was  carried  against  uncompromising 
resistance,  both  lay  and  professional,  and  after  years  of 
hard  fighting.  Our  correspondent  says  that  women 
doctors  are  unworthy,  selfish,  and  unnatural,  but^  suppos- 
ing they  are,  we  submit  that  their  bemg  so  is  not  sufficient 
reason  for  excluding  them.  Many  men  present  similar 
disqualifications,  yet  they  are  admitted  and  aie  failures- 
just  as  it  may  be  expected  that  women,  if  they  are  as  our 
correspondent  describes  them,  may  be  failures  aUK>.  To 
upbraid  them  with  not  having  contributed  to  medical 
science  is  likd  the  objection  to  allow  the  boy  to  enter  the 
water  because  he  does  not  know  how  to  swim.  The 
women  have  been,  until  quite  recently,  denied  the  means 
for  educating  themselves  in  medicine  and  refused  the 
right  to  practise  it,  when  educated,  and  yet  are  sneered  at 
because  they  fail  to  make  bricks  without  straw. 

The  fact  is  that  the  public  has  pretty  well  made  up  its 
mind  that,  however  at  variance  with  good  taste  or  with 
preconceived  ideas  of  the  position  of  women,  their  studies 
and  practice  of  medicine  may  be,  it  is  just  that  they  shall 
have  a  fair  stage  and  no  favour,  and  the  prejudice  against 
their  assuming  functions  heretofore  strictly  masculine  is 
not  strong  enough  to  overcome  this  feeling  in  favour  of 
fair  play.  As  to  the  suggestion  that  they  ought  to  be 
excluded  lest  they  may  push  the  nude  practitioner  to  the 
wall  by  competicdon,  it  is  unworthy  of  a  liberal  profession. 
—Ed.] 

♦ 

THE  ETIQUETTE  OF  LADY  MEDICALS. 

To  the  Editor  qf  the  Medical  Pbus  and  Ciboulab. 

Sib,— What  your  correspondents  have  lately  said  about 
the  position  of  the  lady  doctors  leads  me  to  mention  an- 
other fact  that  may  have  some  bearing  on  the  subject. 

In  an  Edinburgh  paper  (The  Scotmnan)^  before  the  open- 
mg  of  the  present  Summer  Session,  a  notice   appeared 

eying  particulars  of  a  class  which  had  been  formed  for 
iy  medicals  by  Dr.  Sophia  Jex  Blake.  Now,  euch  an 
advertisement  appearing  in  the  columns  of  a  lay  paper 
from  a  male  lecturer  would  have  raised  an  immediate 
storm  of.hoetile  criticism,  and  the  matter  would  certainly 
have  engaged  the  attention  of  the  medical  journals,  if  not 
of  the  General  Medical  Council 

Surely  here,  at  any  rate,  we  find  a  lady  doctor  makine 
a  Uw  unto  herself. 

In  pointing  out  the  fact  I  do  not  express  any  opinion  as 
to  whether  there  is  any  harm  in  open  advertisement. 
From  the  example  of  the  many  of  the  leaders  of  the  pro- 
iMsion,  it  seems  not  unlikely  that  one  day  we  shall  all 
?^  in  the  open  instead  of  by  furtive  and  mean 
methods  such  as  you,  sir,  have  more  than  once  fearlessly 
opposed  in  vour  journal.    But  while  the  seneral  view  says 

Erofessional  advertisements  of  lecturers  should  not  go  into 
fcy  newspapers  it  will  be  wiser  for  Dr.  Jex  Blake  and  her 
fnends  to  accept  that  position. 

I  am.  Sir,  yours,  &c., 

^    .  Fiat  Justitia. 

Carliale,  June  4th,  1896. 


THE  TREATMENT  OF  THE  EXANTHEMATA  BY 
RED  HANGINGS. 
To  the  Editor  o/Tbr  Medical  Press  and  CmcrjLAB. 
Sib,— In  Defoe's  novel ''  Roxana,"  the  following  passage 


occurs :— "  My  lord's  man  had  received  orders  to 
his  bed  in  the  crimson  room,  which  name  it  received  from 
the  colour  of  the  bed  and  furniture,  and  was  reserved 
against  the  coming  of  strangers,  or  sickness." 

The  work  was  originally  published  bv  Defoe  in  1724, 
and  the  continuation  of  Roxana's  life  in  1745.  It  naturally 
occurs  to  readers  who  are  famiUar  with  the  '<Bosa 
Anselica  "  of  John  Gaddesden,  that  the  "  crimson  room  " 
of  Defoe  is  a  popularising  of  Gaddesden's  views,  and  it  is 
interestiziff  to  note  that  the  teacbinff  of  the  «  Bom 
Angelica^'^influeoeed  the  English  peopto  for  more  than 
two  hundred  and  fifty  vears. 

In  connection  with  this  I  mifrht  refer  to  Professor  Feil- 
bers's  article  (Danish  Hospital  Reports)  published  in  1894 
on  Uie  treatment  of  exanthemata,  in  which,  referring  to  the 
treatment  of  these  fevers,  he  mentions  that  dark  red  cotton 
doth  was  hung  inside  the  window-pane,  making  the  room 
dark. 

John  of  Gaddesden's  treatment  was  empirical,  but  the 
empiricism  was  based  on  observation,  and  as  almost  all  exan- 
themata were  treated  in  the  crimson-room  we  find  that  for 
250  odd  years  the  domestic  medicine  of  England  antici- 
pated our  scientific  views  of  to-day.  May  we  not  learn  a 
lesson  from  this  and  be  not  too  hasty  to  condemn  uaagei 
that  are  the  growth  of  centuries!  Oui  aoy  reader  aay 
from  whom  the  idea  of  the  red  hangingi  in  exanthemata 
came! 

I  am.  Sir,  yours,  &a, 

Gbdbqb  Fot. 


HYPNOTISM  FOR  THE  CURE  OF  INSANITY. 

To  the  Editor  ofTKM  Mbdioal  Pbbss  and  Cibculab. 

Sib, — ^I  am  somewhat  surprised  that  you  should  have 
criticised  the  absurd  article  which  recently  appeared  on 
the  above  subject  in  the  New  Torh  World,  without  having 
first  acquainted  yourself  of  the  actual  facts  of  the  case. 

I  am  therein  accoaed  of  the  most  vulgar  and  criOfoosive 
form  of  advertising.  And  I  beg  to  state  most  emphatic- 
ally  that  I  had  no  nand  whatever  in  the  insertion  of  the 
article  to  which  you  refer.  The  claims  which  I  am  sap- 
posed  to  put  forward  in  it,  indeed,  appear  to  be  altogether 
too  ridiculous  to  require  raf  utation. 

I  am.  Sir,  yours,  Jba, 

J.  F.  Woods,  M.D. 

Hoxion  House  Asylum, 
London,  N.,  June  8th. 


KAPOSI  ON  SKIN  DISEASES,  (a) 
This  volume  has  appeared  at  the  proper  moment,  for 
hardly  anv  branch  of  medical  study  has  shown  more  resUesa 
activity  than  dermatology  during  the  past  few  years.  It 
is  the  work  of  a  writer  who  occupies  a  foremost  rank 
among  European  dermatologists.  The  present  book 
represents  the  progressive  developments  on  the  former 
work  of  Hebra  and  Kaposi  (translated  by  Mr.  Waren  Tay 
for  the  New  Sydenham  Society).  It  contains  a  systematic 
and  thorough  treatment  of  the  diseases  of  the  skin  in  the 
liffht  of  modem  scientific  advances,  and  contains  many 
lustrations.  In  re'^iewing  a  work  of  this  kind  it  is  hardly 
possible  to  do  more  than  point  out  its  general  feataros 
and  its  particular  place  in  medical  literature.  First  of 
all,  it  may  be  said  that  Kaposi's  clearness  and  philosophi- 
cal handling  of  a  complicated  subject  has  made  his  hook 
fitted  for  the  teacher,  as  well  as  the  student  of  dermato- 
logy, and  for  the  practitioner  of  medicine.  Anyone  who 
reads  this  volume  and  is,  at  the  same  time,  acquainted 
with  English  writings  on  the  same  subject,  cannot  help 
being  struck  with  the  enormous  influence  Kaposi  has  haa 
on  English  teaching.  Tumine  to  some  of  the  diseases 
described  we  finoT  an  excellent  chapter  on  rhino- 
sderoma,  a  condition  first  described  by  Hebra  and 
Kaposi  in  1870.  The  origin  of  this  intractable  affection  is 
traced  to  a  definite  bacillus,  in  relation   to  which  the 


(a)  <*  Diseases  of  theSldo."  By  Moriz  Kaposi.  Professor  of  Dermaft»* 
logy  in  Yienna  UniTenity.  T^mnslated  from  the  last  Germu  Sditioa 
by  J.  S.  Johnston,  M.D.    London :  BailUtee,  Tlndall,  A  Goz.   1806. 


Juva  10. 1806 


LrTEKATTJBK 


Thb  Msdioai.  Pbms.     617 


aathor  makes  the  following;  strikiod;  and  sng^^tive 
remarks :  "  If  we  take  into  conrideration  the  looSisation 
of  rhinoederoma,  ite  ooastant  development  in  the  nares 
and  upon  the  nasal  mncons  membrane,  the  frecnient  pri- 
mary afieetion  of  the  nasal,  pharyngeal,  and  larjmgeal 
maooos  membrane,  and,  finally,  the  fact  that  inflamma- 
tory retractile  jjrocesses  take  place  in  these  parts  as  the 
resnlts  of  chronic  catarrhs,  we  may  assume  some  relation, 
which  is  not  wdl  defined,  between  the  bacilli  of  the 
catarrhs  and  those  of  rhinosderoma,  and  between  the 
latter  badlli  and  the  rhinosderoma  itself."  In  discussing 
the  interesting  condition  of  herpes  zoster  the  author 
thinks  it  may  follow  diseases  of  the  spinal  cord,  bat  not  as 
the  result  of  affections  of  the  spinal  ganglia.  The  occur- 
rence of  herpes  durine  an  arsenical  coarse  he  reg^eurds  as 
aoddental.  The  book  is  most  admirably  translated,  and 
handsomely  and  substantially  brought  out.  It  should  be 
in  the  library  of  every  dermatologist,  and  of  every 
advanced  physidan. 


SCOVILLES  ART  OF  COMPOUNDING,  (a) 

Tbb  art  of  dispensing  prescriptions,  as  the  author  cor- 
rectly premises,  depends  largely  on  the  practical  applica- 
tion of  small  details,  that  is  to  sav,  the  dae  recognition  of 
the  importance  of  certain  details  of  manipulation.  As 
these  details  cannot  always  and  everywhere  be  Dome  in  mind 
the  author  has  set  himself  the  task  of  providing  a  work  oi 
reference,  where  he  who  runs  may  read — what  he  has  for- 
gotten or  has  never  known.  The  work  is,  of  course,  b^ed 
on  the  United  States  Pharmacopoaia,  but  as  the  main 
prindples  of  practical  pharmacy  are  everywhere  the  same, 
this  does  not  constitute  any  very  great  drawback  for  phar- 
macy students  and  dispensers  on  this  side  of  the  Atlantic. 
In  case  of  difficulty  or  doubt,  much  valuable  information 
may  be  obtained  by  medical  men  from  this  work  as  to  the 
methods  of  dispensing  the  numerous  preparations  which 
are  not  often  prescribed  by  them,  presumably  because  they 
do  not  remember  at  the  moment  how  they  can  beet  be 
combined  or  exhibited,  and  have  not  at  hand  a  readv 
reference  book  containing  the  exact  information  required. 
But  to  pharmacists  it  should  prove  even  more  useful,  for 
we  know  of  no  work  of  the  kmd  at  all  approaching  this 
one  in  comprehensiveness.  We  have  chapters  devoted  to 
mixtures,  emulsions,  pills,  &c.,  in  which  the  various  pro- 
cesses, difficulties,  and  incompatibilities  met  with  in  eac^ 
are  carefully  explained,  and  many  valuable  hints  given. 
Articles,  such  as  compressed  tablets,  tablet-triturates, 
cachets,  capsules,  and  the  like,  are  also  fully  dealt  with. 

We  mav  observe  en  pctasant  that  it  would  have  been 
better  if  the  metric  system  had  been  used  exclusively,  or, 
at  any  rate,  if  attention  had  been  directed  to  the  differ- 
ences between  American  and  British  standard  weights  and 
measures.  This  difference  is  most  apparent  in  the  para- 
graphs on  percentage  solutions,  and  it  is  necessary  to 
bear  in  mind  that  the  figures  ^iven  are  according  to  the 
American  standards,  as  otherwise  errors  may  resiut. 

We  note  a  few  doubtful  statements  here  and  there,  as, 
for  example,  when  (page  47)  it  is  stated  that  undissolved  car- 
bolic ada^o^  v^fon  the  turf  ace  of  the  water.  That  is  not  our 
experience,  and,  as  it  has  a  specific  gravity  of  about  1050, 
we  see  no  reason  to  believe  that  such  is  the  case.  Then, 
apun,  it  is  not  the  case  that  the  rapidity  with  which  a  solu- 
tion (of  a  salt)  is  formed,  as  well  as  the  amount  dissolved,  is 
dependent  on  the  temperature,  witness  the  action  of 
chloride  of  sodium,  for  instance.  There  is  a  distinctly 
erroneous  statement  on  pa^e  65,  viz.,  that  solutions  for 
hypodermic  use  are  to  be  injected  directly  into  the  cvrcuUt- 
turn.  This  is  the  one  thing  to  be  avoided  !  We  must  also 
demur  to  the  view  (page  51)  that  pharmacists  are 
expected  to  make  such  additions  to  prescriptions  as 
shall  make  them  more  elegant  in  appeiEurance  or  taste 
(elegant  in  taste  ?).  Certainly  not  without  consulting  the 
physician,  we  should  say.  Our  criticisms,  however,  bear 
mainly  on  details.  The  information  given,  and  the 
ability  with  which  it  has  been  arranged  should  make  this 
book  a  useful  addition  to  the  library  of  every  physician 
and  pharmacist. 

(a)  *"£he  Art  of  Compoanding."  By  W^.  L.  SooTiUe,  Ph.G.,  ProfMsor 
of  Applied  Phsrmao/  sad  Director  of  the  Pharmaeeatioei  Laborato^ 
la  thie  MaseaohiuettB  College  of  Fhamiacy.  London :  Keef^an,  Paol, 
Trench,  Trnhner,  k  Co.,  Limited.    1805. 


THE  NEW  SYDENHAM   SOCIETY'S  LEXICON.  (o> 

Thosb  who  are  impatient  for  the  completion  of  this  the 
most  generally  useful  work  undertaken  by  the  New 
Sydenham  Societv  should  reflect  on  the  fact  that  this  is 
the  twenty-second  part.  Twenty  parts,  each  of  which  on 
the  average  included  9,500  definitions.  It  is  no  exaggera- 
tion to  say  that  each  number  iisned  is  equal  to  many  a 
lexicon  in  the  number  of  words  defined. 

But  more  than  that  its  value  is  enhanced  by  the 
number  of  difficult  and  unusual  words  dealt  with,  the 
great  majority  of  which  are  not  to  be  found  in  any  other 
foxicon. 

As  we  turn  over  its  pages  we  recall  to  memory  MayneV 
preface  to  the  lexicon  on  wliich  the  present  work  is  based, 
his  desire  was  to  have  a  convenient  reference  book  ior 
which  the  difficult,  obscure,  and  unusual  words  would  be 
explained.  This  object  the  Sydenham  lexicon  keeps  io 
view,  and  so  far  as  it  has  gone  it  has  fulfilled  all  the 
requirements  of  a  lexicon  that  the  most  exacting  critic- 
could  demand. 

Had  the  Society  never  done  anything  more  than  pro- 
duce this  great  work,  they  might  claim  to  have  earned  the 
g^titude  of  all  succeeding  ages. 

^  THE  INTERNATIONAL  ENOYC  LOPiEDIA  OF 
SURGERY.  (&) 

Ths  object  of  ttiis  supplementary  vdume  is  to  fumisb 
to  the  readers  of  the  "International  Encyclopedia  of 
Surgery"  a  brief  but  sufficient  account  of  such  additions 
to  surgical  science  and  art  as  have  been  brought  forward 
during  the  seven  years  wliich  have  elapsed  since  the 
revised  edition  of  the  original  book  was  published.  The 
object  has  been  satisfactorily  attained,  and  the  results  of 
such  progress  incorporated  in  this  great  work,  and  with  rare 
judgment  it  ma^  be  added  ephemeral  theories  have  not 
been  included  in  its  pages. 

Amongst  the  articles  which  deserve  more  than  passing 
notice  is  that  of  McFadden  Gaston  on  Hydrophobia,  that 
of  Dr.  Wyeth  on  Hernia,  and  Dr.  Hunter  McGuire's 
description  of  his  operation  lor  the  production  of  an  artifi- 
cial anterior  urethra — a  very  marked  advance  in  urinary 
surgery. 

BINZ'S  LECTURES  ON  PHARMACOLOGY,  (c) 
One  of  the  advaantages  of  the  New  Sydenham^ 
Society  is  the  judicious  selection  of  books  made  for 
subscribers.  It  has,  however,  been  complained  of  that 
subscribers  occasionally  get  volumes  on  subjects  in  whicb 
they  have  little  or  no  interest.  Such  a  condition  of  affairs 
is  unavoidable.  A  subscriber  to  a  medical  journal  find» 
artides  on  subjects  in  which  he  has  little  interest,  but  he 
finds  that  the  great  majority  of  the  articles  deal  with 
matters  which  concern  him ;  so  it  is  with  the  Society's 
books.  In  the  present  instance,  the  selection  cannot,  wo 
think,  prove  other  than  pleasing.  All  practitioners  are 
interested  in  pharmacology.  Adopting  the  author's  defi- 
nition that  pharmacology  denotes  the  scientific  investisn- 
tion—with  reference  spedally  to  the  reiuiremente  of  the 
physician — of  such  substances  as  are  contained  in  the 
offidal  pharmacopoeias  of  various  countries,  and  are  em- 
ployed m  the  treatment  of  disease,  we  at  once  find  our- 
selves on  a  common  ground,  where  i^ysician,  surgeon, 
spedalist,  and,  in  short,  every  member  of  the  profession 
finds  something  worth  culling. 

This,  the  first  volume  of  Binz's  work,  treats  of  anes- 
thetics, morphine,  bromides,  nitrites,  iodides,  hypnotics, 
strychnine,  alcohol,  and  so  forth,  of — 

(a)  *'  The  New  Sydenham  Soolety'B  Lezloon  of  Medicine  and  the 
AUled  Science!  "  (baaed  on  Mayne'i  Lexicon.).  Tvreniy-eeoond  Part. 
Pin— Pnlce.    London :  The  New  Sydenham  Society.    1806. 

(6  "The  Intematlontl  EncydopeBdla  of  Sorgery:  A  ByBtematlo 
Treetlse  of  the  Theory  and  Practice  of  Snigery."^  By  Aathors  of 
varloas  Nations.  Edited  by  John  Aahhnnt,  jr.,  M.D.,  LL.D..  Barton 
Professor  of  Sorgery  and  Professor  of  Clinical  Surgery  In  the  University 
of  Pennsylvania ;  Suigeon  to  the  Pennsylvania  Hospital,  dc.  Illus- 
trated with  chromo-Uthographs  and  woodcuts.  In  seven  volumes. 
VoL  vn  (supplementary  volume).  London :  MaomlUan  and  Co. ;  and 
New  York.    1895. 

(c)  **  Lectures  on  Pharmacology  for  Professors  and  Students.*'  By 
Dr.  C.  Bins,  Ord.  Professor  and  Gehelmer  Medicioal  Path. ;  Director 
of  the  Pharmacological  Institute  In  the  University  of  Bonn.  Trans* 
lated  from  the  Second  German  ISdltion,  by  Arthur  C.  Latham,  liLA.r 
li.B.  Qxon.,  M.  A.  Cantab.,  Radcllffe  Travelling  Fellow  In  the  Univer- 
sity of  Oxford.    VoL  I.    London :  The  New  Sydenham  Society.    18M.. 


618    Tmi  MsDiOAL  Psan. 


K0VELTIE8. 


Jun  10,  i9tbm 


"Herb0,  many  that  are  bealiog  Id  the  eop,  and  Inany 

baneful." 
A  knowled^  of  the  phytiologjoal  effeeto  of  drngt  ie 
enential  to  scientific  medkdne.  We  cannot  oontinne  pre- 
scribing, empirically,  after  the  manner  of  evangeueal 
qnaoks,  who  aose  every  epQeptic  with  bromides ;  or  of  a 
pharmacentieal  chemist  wno  aoeee  erery  case  of  constipa- 
tion with  purgatives  whether  the  ceito  is  one  of  hernia^ 
carcinoma,  or  intassnsception. 

The  practitioner's  stady  most  embrace  the  corative 
properties  of  drugs.  He  most  know  their  effect  on  the 
healthy,  and  the  influence  of  disease  in  modifying  their 
action — if  he  is  to  practise  scientific  medicine.  He  should 
be  able  to  say,  with  Cerimon : 

"lever 
Have  studied  physic,  through  which  secret  art, 
Bv  turning  o'er  authorities  I  have 
<Together  with  my  practice)  made  familiar 
To  me  and  to  my  aid,  the  bless'd  infusions 
That  dwell  in  vegetives,  in  metals,  stones ; 
And  I  can  speak  of  the  disturbances 
That  Nature  w6rks,  and  of  her  cures." 
We  warmly  recommend  the  present  work,  although, 
perhaps,  to  tne  modem  scientific  pharmaoolorist,  it  can 
scarcely  be  said  to  be  up  to  date.    It  is,  nevertneless,  the 
result  of  a  life's  work  carried  on  with  eveirv  facility  for 
its  accomplishment.  Those  who  read  it  will,  like  ourselves, 
be  quick  to  acknowledge  that  they  have  learned  much 
from  it,  and  will  feel  that  in  some  of  our  oldest  and  best- 
known  drugs  there  was  a  potentiality  for  good  which  the 
profession  generally  little  dream  of. 

The  New  Sydenham  Society  has  done  a  good  work 
in  placing  such  a  valuable  book  in  the  hands  of  its 
subscribers. 

COOPER  ON  SYPHILIS,  (a) 

Thx  second  edition  of  this  work  marks  a  considerable 
advance  in  knowledge  since  the  appearance  of  the  first 
edition.  This  statement  is  admirably  illustrated  by  the 
fact  that  a  new  chapter  has  been  added  on  the  relationship 
between  syphilis  and  insanity.  The  fact  that  this  connec- 
tion has  been  recognised  should  stimulate  afresh  the  efforts 
of  practical  prevention  of  both  these  scourges  of  mankind. 
We  notice  that  the  author  mentions  rupia  as  generally 
developed  towards  the  end  of  the  second  or  third  year,  or 
later,  but  in  malignant  syphilis,  it  may  appear  quite  early. 
We  have  seen  this  condition  while  the  primary  chancre 
etiU  existed  on  the  penis.  We  note  that  the  treatment  by 
mercury  is  advised  over  a  period  of  two  years,  to  be  given 
ifirst  for  six  months,  left  off  for  a  month  or  six  weeks,  to 
be  resumed  for  three  months.  After  a  second  interval, 
longer  than  the  first,  a  third  and  fourth  course  of  three 
«months,  to  be  then  given,  with  intervals  of  a  similar  dura- 
tion. Many  surgeons  would  think  these  divisions  rather 
long  and  arbitrary.  The  value  of  iodide  of  potassium  as 
a  curative  agent  is  (questioned,  but  no  mention  is  made  of 
its  suggested  use  m  washing  the  mercury  out  of  the 
system.  The  value  of  the  present  edition  is  much  en* 
Iwnoed  by  a  number  of  beautifully  executed  and  artistic 
.  chromolithog^phs. 

» 

THE   OPHTHALMOLOGICAL    SOCIETY    OP    THE 

UNITED  KINGDOM. 

Wb  are  asked  to  publish  the  following  letter  which  has 
been  addressed  to  the  members  of  the  |Ophthalmological 
Society :  - 

DxAB  Sib,— I  beg  to  inform  you  that  a  Committee  has 
been  appointed  by  the  Council  to  report  to  this  Society 
on  the  relative  vslue  of  simple  enucleation  of  the  eyebidl, 
and  the  operations  which  nave  been  substituted  for  it, 
viz.,  evisceration,  with  or  without  tbe  introduction  of  a 
g:lobe ;  insertion  of  a  globe  into  Tenon's  capsule  ;  abscis- 
sion ;  optico-ciliary  neurectomjr,  and  neurotomy. 

The  Committee  invite  you  kindly  to  furnish  them  with 
any  of  your  unpublished  cases,  or  reference  to  published 
ones,  which  you  may  consider  have  any  bearing  upon  the 
followini;  questions : — 

1.  What  are  the  relative  risks  of  meningitis  ? 

(a)  "  Sypbllia."    By  Alfred  Cooper.  F.R.C.8.     Lste  Surgeon  to  the 
Hospital,  &e.    London :  J.  and  A.  Chnrchlll.    1896.    Price  18k 


lis 


2.  What  are  the  reUtive  risks  of  sympathetie  afiEao- 


3.  What  are  tbe  other  div^dvanteges,  immediate  or 

remote,  of  tbe  varioMfaltematiye  operations  (eoob 
as  ezoessive  reaction  or  non-permanenoe  of  desired 
reenlt,  fta)? 

4.  What  are  tbe^special  advantages  with  relation  to 

the  wearing  at  an  artificial  eye  ? 
6.  Are  there  any  special  points  to  be  eraphaeiaed  in 

the  technique  of  any  of  the  above  operations? 
8.  To  what  extent  should  the  choice  of  operation 
depend  on  the  nature  of  the  case  ! 
It  is  requested  that,  if  possible,  any  oommnnioationa  in 
answer  to  this  letter  should  be  sent  in  before  October  letu 
I  am,  dear  Sir,  yours  truly, 

E.  TssAOHBB  CoLum, 
Secretary  to  the  Committee. 
84  Whnpole  St.,  London,  W. 

AN    APPEAL. 
Thb  following  is  a  first  list  of  snbecriptions  reoeiyed  on 
behalf  of  the  widow  and  children  of  the  late  Dr.  0.  R. 
mingworth,    since   the   publication   of  the  appeal  laet 


T.  J.:  Walker,  Esq.,  M.D.,  Peterborough 

Geo.  W.  Potter,  Esq.,  M.D.,  London       

"A.  B." 

F.  Mansy,  Esq.,  Tunbridge  Wells  

A.  Kershaw,  Esq.,  M.D.,  farmouth        

W.  E.  Humble,  Esq.,M.D 

"A,  B. " 

O.  Sims  Woodhead,  Esq.   ...' 

Thomas  Milne,  Esq ,  M.JD.,  14  Bonocord  Square^ 

Aberdeen 
J.  Injglis  Parsons,Esq„  M.D.,  M.R.C.P., 3 Queen's 

Street,    Mayfair  

J.  A.  Erskin  Stuart,  Esq.,  L.R.C.P.,  Batley    ... 
Geo.  Kirkwood,  Esq.,  M.D..  Peterborough 

Peter  McBride,  Esq ,  M.D.,  Edinburgh. 

Griffith  Wilkin,  Esq.,  M.R.C.S.,  London 

W.  A.  SatcheU,  Esq.,  F.R.C.P.,  Ealing 

Edgar  Duke,  Esq.,  M.RC.S.,  St.  Leonards-on- 

Sea.         

F.  Birtwhistle,  Esq.,  M.B.,  Lincolnshire 

Jr.  Jl.  ...  ...  ...  ...  ...  ••* 

J.  N.  Brown,  Em.,  M.RC.S.,  London     

Dundas  Grant,  Esq.,  M.D.,  F.R.C.S 


£   1. 

d. 

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0 

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0 

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0 

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3    3 

0 

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JlobeltiesL 

THE  ZEPHYRON. 
Thb  object  of  this  invention  is  to  provide  for  the  com 
bination  of  various  medicinal  agents,  such  as  opium,  stra- 
monium, and  cannabis  indica,  so  that  the  fumes  can  be 
easily  inhaled,  and  their  effects  obtained  without  smoking. 
For  the  relief  of  asthma,  whooping-cough,  and  many 
other  maladies  affecting  the  pulmonary  organs  there  is  no 
doubt  but  that  inhalation  is  oeing  much  resorted  to  ;  and 
considering  the  advantages  to  be  derived  from  the  use  of 
opium  by  mhalation,  it  is  probable  that  any  method  will 
be  useful  by  which  combustion  is  supported. 


X   Marked  for  Fumerettes. 

The  Zephyron  is  a  small  vulcanite  tube,  into  which  a  jet 
of  air  is  forosd  by  an  elastic  ball,  and  an  induced  current 
is  obtamed  by  which  the  combustion  of  any  substance  is 
effectei.  Messrs.  Maw,  Son,  k  Thompson  are  introducing 
the  Zephyron  to  the  profession,  and  the  Apothecarier 
Society  of  London  are  preparing  Fumerettee  for  use  in 
I  it.    As  there  is  no  other  instrument  of  the  kind,  and  the 


Juki  10,  189^ 


MEDICAL  NEWS. 


Tarn  MsMO^L  Pbms.     619 


ivmnt  has  long  been  felt  of  some  simple  way  to  obtain  tbe 
fumes  of  many  drags,  tbe  Zepbyron  is  likely  to  be  timed 
to  good  acconnt  in  tbe  relief  of  many  complainte. 

THE  LIQUOR  CABKIS  GO.'S  PBEPABATIONS. 

Wb  bave  received  from  tbe  liquor  Gamis  Ck>.  a  fresb 
b«tcb  of  samfdesy  including  one  or  two  novelties.  Some 
are  old  friends,  sucb,  for  instance,  as  the  veritable  Liquor 
Ounis,  a  preparation  of  tbe  uncooked  juice  of  muscle- 
plasma,  itadered  proof  against  decomposition  as  to  the 
merits  of  which  we  need  on  this  occasion  add  nothing  to 
our  previous  encomiums  beyond  observing  that  the  recent 
samples  are  decidedly  more  palatable.  Then  we  have 
Viri  (red  bone-mairow),  an  excellent  food  material  for 
tbe  delicate  and  the  ailing.  It  is  rich  in  the  orsanic  com- 
pounds of  iron  and  phospboras,  also  Virol  Sans  Sucre  which 
contains  neither  sugar  nor  starch.  It  is,  therefore,  indicated 
especially  in  cases  where  maltose  and  the  like  are  disliked 
or  forbidden,  though  its  usefulness  is  not  restricted  to 
these  cases.  We  arealso  introduced  to  Malto  Carnis,  an 
elegant  and  tasteful  combination  of  Liquor  Carnis,  malt 
extract,  and  cocoa.  Mixed  with  hot  or  cold  milk  Malto 
Carnis  makes  a  highly  nutritious  and  nalatable  beverage, 
oomprising  the  qutdities  of  meat  as  well  as  those  of  malt 
and  cocoa.  As  an  artificial  food-product  it  takes  a  first 
place,  iforro;  has  already  been  dealt  with.  It  isa  prepara- 
tion of  white  bone-marrow,  and  although  it  does  not  con- 
tain nd  marrow  as  supplied  by  Virol,  it  is  an  excellent 
substitute  for  cod-liver  oil  and  the  like. 


LITMUS  PENCIL. 
Thb  new  **  Litmus  Pencil,"  manufactured  by  Messrs.  T. 
Christ;^  and  Co.,  of  lime  Street,  London,  is  a  simple  and 
ingenious  device  for  dispensing  with  the  use  of  reactive 
papers.  It  contains  red  and  blue  litmus  inserted  in  an 
oroinary  wood  pencil,  and  if  tbe  pointed  ends  are  moist- 
ened  and  rubbed  on  a  strip  of  paper,  we  have  the  means 
of  ascertaining  forthwith  the  reaction  of  the  fluid  under 
examination.  It  is  claimed  to  be  vastly  more  sensitive 
than  litmus  paper,  though  this  is  possibly  less  important 
than  its  convenience  in  other  directions. 

JRtdtcal  JletoB. 

The  Annual  Meeting  of  the  Irish  Medieal  Association. 
Thb  annual  reunion  of  the  Association  was  held  on 
Monday,  tbe  Ist  inst.,  at  the  Royal  Collie  of  Surgeons, 
and  it  was  followed  in  the  evening  by  the  annual  dinner,  at 
which  73  members  and  guests,  including  many  distin- 
guished and  official  personages,  were  present.    We  rmret 
that  the  great  pressure  on  our  space  compels  us  to  "  hold 
over  "  until  next  week  our  report  of  the  proceedings. 
Banquet  to  Mr.  Kendal  Franks,  of  Dublin. 
Abbavobmxnts  are  being  made,  with  the  approval  of 
the  Council  of  the  Royal  Collie  of  Surseons,  to  entertain 
tbe  Vice-president,  Mr.  Franks,  of  the  Adelaide  Hospital, 
at  a  banquet,  before  he  proceeds  to  South  Africa,  wnere, 
in  consequence  of  domestic  considerations,  he  will  reside 
and  practioe  in  future.    The  entertainment  will  take  place 
on  the  25th  inst.,  and  applications  for  dinner  tickets  will 
be  received  frcnn  members  of   the  profession  by  G.  F. 
Blake,  Esq.,  at  the  College,  up  to  the  15th  inst. 
A  Baeteriologioal  Laboratory  for  London. 
Os  Saturday  last  a  joint  deputation  of  the  British 
Institute  of  Public  Health  and  the  Incorporated  Society 
of  Medical  Officers  of  Health  waited  upon  the  Asvlums 
Board,  at  the  County  Councirs  Board  Room,  Sprine 
Gardens,  to  ui^  the  establishment  of  a  bacteriological 
laboratory.    Sir  Charles  A.  Cameron,  Vice-President  of 
the  Institute,  said  that,  as  representing  both  departments, 
he  thanked  the  Board  for  their  courtesy  in  receiving 
them.    At  considerable  length,  he  pointed  out  the  advan- 
tages which  would  result  from  having  a  well-equipped 
ami  manned  bacteriological  laboratory  in  connection  with 
the  Asylums  Board,  who  had  tbe  care  of  the  infective  sick 
of  4)  millions,  and  from  whose   enormous  revenue  of 
^000,000  a  year  it  would  be  easy  to  supply  the  fund  neces- 
sary for  founding  and  maintaining  sucn  a  laboratory.    In 
it  rapid  diaffnosM|of  such  diseases,  for  example,  as  diph- 
theria, COU&  be  made  for  the  ordinary  practitioner,  and  it 
should  be  done  for  him  through  the  local  medical  officer  of 
health  without  any  charge.    Much  valuable  information 


was  published  by  the  Board  in  their  invaluable  reports, 
and  the  results,  if  tried  in  a  great  laboratory,  such  as 
that  proposed  to  be  eetablisbw,  would  greatlv  enhance 
the  value  of  tbeee  reports.   Dr»  Dempster  said  a  few  word» 
in  support  of  the  proposal,  and  the  Chairman  said  .that  it 
would  nave  tbe  most  careful  consideration. 
Congress  of  Dermatology. 
Thb  Third  International  Congres  of  Dermatology  will 
take  place  this  year  in  London,  from  August  4th  to  8th 
inclusive.     The  Meetings  of  the  Congress  will  be  held  at 
tbe  Examination  Hall,  on  the  Victoria  Embankment,  andk 
the  programme  will  be  as  follows : — August  4th  :  Presi* 
dential  Address;  '' Prurigo "  will  be  discussed    by    Dr. 
Besnier  (Paris),  Prof.  Kacosi  (Vienna),  Dr.  J.  C.  White 
(Boston,  U.S. A.),  and  Dr.  Payne  (London).     August  5th  r 
''Keratosis/'  by  Dr.  Unna  (Hamburg),  Dr.  H.  G.  Brooke 
(Manchester),  Prof.  V.  Mibelli  (Parma),  Dr.  W.Dnbreuilh 
(Bordeaux)  ;  "  Syphilitic  Re-Infection,"  by  Prof.  Foumier 
(Paris),  Prof.  Leug  (Vienna),  Mr.  Alfred  (jooper  (London), 
Dr.  Fitzffibbon  (Dublin).    August  6th :  Clinical  demons- 
tration of  cases,  followed  by  papers  on  "Tbe  Connection^ 
of  Tuberculosis  with  Diseases  of  the  Skin,"  discussed  by 
Dr.  J.  Nevins  Hyde  (Chicago),  Dr,  Hallopeau  (Paris),  Dr. 
Radcliffe  Crocker  (London),  Prof.  G.  Rietil    (Leipziff);. 
"  The  Duration  of  Contagion  of  Syphilis,"  Mr.  Hutchin- 
son  (London),   Prof.     Campana    (Kome),    Prof.    Lassar 
(Berlin),  Dr.  Foulard  (Paris)  ;  and  "  Ringworm  and  the 
Tricophytons."  discussed  by  Dr.  Sabouraud  (Paris),  Prof. 
Rosenbaoh  (Gottingen),  Mr.  Malcolm  Morris  (London). 
August  7ch,  the  subjects  are :  "  The  Erythema  Multiforme- 
Group,"  by  Prof,  de  Amicis  (Naples),  Dr.  T.  H.  Veiel 
(Stuttgarc),  Dr.    Prince    A.  Morrow    (New    York),  Dr. 
Stephen  Mackenzie  (Lcmdon)     "  Malignant  Syphilis,"  by 
Prol.  Haslund    (Copenhagen),   Prof.   Neisser    (Breslau)^. 
Prof.  Tamovsky  (St.  Petersburg).      The  programme  for 
the  last  day  is  not  yet  definitely  settled. 

The  Royal  College  of  Surgeons. 
Thb  following  gentlemen,  having  passed  the  neoessaKy 
examinations,   were  admitted  Members  of  the  College, 
viz.: — 

J.  M.  AcUnd.  H.  K.  Emms,  A.  C.  H.  J.  Hackney,  J.  a  LetoetWr.  H.  /. 
Price,  of  (IniTertity  doll.  Hosp.;  H.  Hallam,  of  Firth  CoIL  and 
General  Hoap.,  Sbeflleld;  B.  C.  Hope,  of  Melboiinie  Univ.  and 
UnlT.  OoU.  Bom.;  J.  W.  Frldmore,  of  Unlvenl^  Collafce  Hoapltal 
and  Maiona'  Coll.;  W.  F.  Adama,  M.  Cameron,  H.  W.  Bvana,  A,  B. 
Fry,  A.  8.  Grant,  B.  K,  Hamilton,  H.  Innoa,  and  T.  Jonea.  of 
London  Hosp.;  C.  B.  Daahwood,  W.  B.  Hey  wood,  of  Cambridge 
CJniT.  and  London  Hoapi;  W,  A.  Greene,  of  Ledwlch  School  and 
Meroen'_Hoap.^  Dablln ;  J.  B.  Gunaoii,  of  Adelaide  Univ.  and 


London  Hoap.;  E.  8.  SaTage,  of  Oxford  Univ.  and  London  Hoip.:  C. 
W.  Aifom.  w.  F.  V.  Bonney,  H.  C.  Clark.  J.  Gardiner,  H.  B.  Gomden, 
H.  P.  Goble,  H.  B.  Shepherd,  A.  B.  Walter,  of  Mlddleaex  Hoap.;  L. 
P.  Black,  ol  Cambridge  Univ.  and  Mlddleaex  Hosp. ;  W.  H.  Allen,  N. 
W.  Bley.  J.  W.  Famdale.  H.  Lowe,  T.  H.  Price,  w.  H.  Bowlandii 
W.  G.  Tnomaa,  of  Ifaaoni'  CoUmo,  Blrmlnaham ;  J,  S.  Andenon, 
T.  Anftey-Chave,  J.  J.  Blagden,  /.  A.  O.  Brlgn,  J.  Brock,  A.  B.  J« 
Donglaa,  8.  B.  Doofdaa,  E.  G.  Druy,  G.  H.  wemyai,  EU. ;  EL  B. 
ElUa,  F.  FoUlott.  G7HriV>rman,  C.  H.  Hopklna,  T.  J.  Horder,  J.  J. 
Mnrphy,  J.  C.  Powell,  B.  Pratt,  B.  G.  Slmmonds,  J.  A.  Spear,  C.  M. 
Welbnm,  H.  C.  Wimble,  of  St.  Bartholomew^  Hoap.;  A.  B.  Ward, 
of  Cambridge  Oniv.  and  St.  Bartholomew's  Hosp.;  ri.  C.  Barclay,  of ' 
UnlT.  of  Otago ;  E.  M.  Barker,  of  Cambridge  Univ.  and  St  Thomaa's 
Hoap.;  E.  L.  CoUis,  of  Oxford  Univ.  and  St  Thomas's  Hoap.;  G.  L. 
HanweU,  H.  E.  Haymea,  H.  A.  L.  HUl.  E.  H.  T.  Nash,  L.  W. 
Bichards,  W.  G.  Bldgeway-Macanley,  Bw  Blooook.  F.  H.  Sturdee,  E. . 
H.  Sutcliffe,  G.  E.  O.  Taylor,  M  A.  TealCjA,  Warner,  of  St  Thoa's. 
Hosp.,  T.  W,  K.  Barlow,  B.  J.  Evans,  S.  W.  Williams,  of  Univ.  ColL 
and  Boyal  Infhrmary  Liverpool,  E.  E.  Grakebrook,  of  Univ.  ColL 
and  Boyal  Infirmary,  liverpool,  and  King's  Coll.  Hoap.,  E  A.  Smith, 
of  Yorkshire  Coll.  and  General  Inflrmary»  Leeds,  8.  Gross,  W.  H. 
HoUiday,  A.  E.  Button,  A.  T.  Letchmore,  a  A.  PhUlips,  A.  C.  B. 
Pleraon.  of  Yorkshire  Coll.  and  General  Infirmary,  Leeds,  D.  B. 
Behramjee,  of  Bombay,  Univ.  and  Charing  Cross  Hosp..  K.  8.  Biefc- 
ford,  F.  J.  Godwin,  A.  W.  Henley,  H.  H.  P  Johnson,  P.  C.  Spuk. 
S.  B.  Wright,  of  Charing  Cross  Hosp.,  W.  B.  Bell.  J.  B.  Benson,  C. 
Bnunwell,  8.  A.  Francisco  W.  B.  Murray,  J.  B.  Prior,  C.  E,  WlUlams, 
B.  P.  Williams,  of  King's  Coll.  Hosp..  F.  Hennets.  0.  O.  B. 
Browne-liason,  F.  G.  Ballmore,  8.  C.  C.  Fenwlck,  H.  B. 
Fryer,  W.  B.  Maurice,  E.  G.  Moon,  G.  0.  Panons,  8.  Stephens, 
E.  H.  Sweet,  E.  G.  Swocder,  F.  Whltelaw,  of  St  Mary's  Heap., 
B.  A.  Draper,  M.  B.  Johnson,  B.  P.  U'Carthy,  of  cambildae 
Univ.  and  Bt  Mary's  Heap..  C.  C.  Preston,  of  Owen's  ColL 
and  Boyal  Infirmary,  Manchester,  and  St.  Mary's  Hosp. ;  G.  O.  F. 
Sealy,  of  Grant  Medical  CoUrge  and  Bombay  Univ.,  L.  B.  Betfes, 
J.  Heard,  J.  N.  B.  Vise,  of  Westminster  Hosp  ;  J.  Broadbent,  B. 
Knowlea,  of  Owen's  ColL  and  Boyal  Infirmary.  Manchester;  G. 
Coventry,  of  Owen's  ColL  and  Boyal  Infirmary,  Manchester,  and 
Guy's  Horn. :  F.  H.  Cann,  J.  W.  Culmer,  W.  L.  B.  Davles,  B.  Flak,  G. 
H.  Flory,  J.  J.  Foster,  K  Heddon,  A.  B.  Hltohfield,  8.  Infield,  H.  J. 
M.  Mllbank-Smith,  B,  F.  Pendred,  W.  E.  Plunmer,  B.  A.  Bichmond, 
B.  L.  Boberts,  A.  H.  Spicer.  T.  W.  Stanton.  E.  H.  Tipper,  P.  N. 
Yallaoott,  of  Guy's  Hosp.i  A«  V.  Clarke,  W.  L.  Gamer,  G.  B 
Muriel,  M.  H.  Smith,  C.  C.  Stead,  of  Cambridge  Univ.  and  Guy's 
Hosp. :  H.  M.  Cooper,  8.  F.  Smith,  B.  B.  Tahmlilan,  of  St  George's 
Hoap.;  C.  F.  Dmttt,  of  Unlvstdty  ColL  and  Bristol  Inflrmaiy.- 


620    The  Mtoioal  Prws.        NOTICES  10  CORRE8P0HDEKT8 


J1S9X  10,  1898. 


c^OtiC£d  to 

CotrcBponbentfi,  §hott  %ttttXB,  Ac 


flir  OOBamtowumnt  nqnlrliit  a  nplj  tn  llilt  ootaom  an  puv 
MoQlarly  raqneiAad  to  nuika  hm  of  a  diatimMm  tignMiam  or  iaiitaZf , 
and  avoid  the  praotiiM  of  ilgniBff  tbcmMliFw  "BMidw,**  "BvlMOtflMr,'' 
"OMSnbterllMr,"  dfco.  Much  oonfasion  wUl  bo  ipaMd  by  afttontton 
tothtaralo. 

EiADiKO  Oiraa.  ^Oloth  board  oaaea,  gUt-lettered,  ooatolnlog  twenfy- 
afac  itringi  lor  hoMIng  the  niunben  of  TBI  M roiOAL  Pbbss  AHD 
CBOULAB,  maj  DOW  be  had  at  either  ottoe  of  thli  Journal,  prioe  li.  ed. 
Theee  caaee  will  be  foand  very  naefol  to  keep  each  weekly  number 
intact,  olean,  and  flat  after  It  haa  paiaed  through  the  poet. 

LOOAL  XBPOETB  ASD-  ViWB-OorNipoiidenti  deiinMi  of  drawing 
attention  to  theie  are  reqneeted  kindly  to  mark  the  newipapen  whan 
•ending  them  to  the  Bdltor. 

OuonrAL  AETI0L18  or  Lnsns  intended  for  pablloatlon  ehoold  be 
written  on  one  side  of  the  paper  only,  and  m nit  be  aothentleated  -with 
the  name  and  addreet  of  the  writer,  not  neoeeaarfly  for  pablloatlon, 
but  aa  oTldenee  of  Identtty. 

lliiFRim.~Aatlion  of  papan  reqolrlng  reprlnte  In  pamphlet  form 
after  they  haye  appeared  In  theee  oolnmni  can  have  them  at  half  the 
oinal  ooet,  on  appUoatlon  to  the  printen  before  typo  li  broken  ap. 
Br.  J.  B.  (Boeton)L~Oiir  oorreepondenthaa  been  correctly  Informed. 
M.J1.0.B..  L.K.C.P.  (Lond.).— The  annoonoement  reached  at  In  time* 
txit  at  the  laet  moment  ipaoe  ooald  not  be  foond  for  It.  owing  to  the 
.erowdad  etato  of  oar  oolomna.  Oar  correopondent  will  aee  that  hia 
wlihea  have  been  attoadad  to  In  the  preient  uiae. 

FBoyiHOLLL  P&AOnTiORiB.— We  ondorrtand  tbat  the  matter  la  atlQ 
mkJvdiM, 

A  mXBD  METAPHOB. 
TBI  VIoe-Preeldent  of  the  Bnallih  Fharmaoentlcal  Society,  at  ito 
annoal  meeting  laat  week,  attenng  a  euloglam  apon  the  retiring 
Preeldent,  Mr.  cartelghe.  who  had  filled  that  poet  for  14  yean  wltb  dis- 
tinction and  ability,  tela  tbat  *'  the  bread  which  that  gentleman  had 
^aat  apon  the  pharmaoeatlcal  wateia  woald  bring  forth  frait  to  hli  o  wo 
latiafactloo." 

MB&  SKnniiR.~We  cannot  recommend  any  partlcalar  ipeoialitt. 
•Oar  correspondent  shonld  oonsolt  her  medical  aum,  and  be  goldad  by 
him  as  to  Uie  choloe  of  a  aorgeon. 

fL  P.  O.— The  matter  has  not  come  ander  oar  notice,  and,  anderany 
dicamstanoes.  It  woald  be  against  oar  role  to  deal  with  it. 

Poud  SuBflsoH.— The  oontente  of  the  stomach  shoald  have  been 
saved,  and  sabmllted  to  a  carefal  analysis. 

AsbhtjUIT  (Kzeter).— There  Is  no  precedent  that  we  know  of  for 
anch  a  decision,  nor  do  we  think  that  oar  correspondent's  prlnelpal 
could  legally  enuroe  it  Pertiapa  it  would  be  best  to  take  the  advice 
xA  a  soUoltor  upon  the  point 

4aeetmg0  of  the  ^odttieft 

TH1TB8DAT,  JUVI  llTH. 

Opbteuluiolooioal  SoonTT  OF  TBI  UnnD  Khgdom  (U  Chandos 
Bt,  Cavendish  8q.,  W.).-8  p.m.    Card  8peclmens:~lCr.  8.  Walker: 

S)  Tumour  of  Opttc  Nerve ;  (2)  Oyitlcereus  of  the  Conjunctiva.— Dr. 
,  Taylor :  Oases  of  Cataract  Ifiztractlon.— l£r.  Lawford  :  Plgmeutatlon 
4A  the  Conjunctiva.— Mr.  SUoock :  Lymphangioma  of  Orbit.— Mr.  Jaler: 
Macroblepharon.— Mr.  M.  Ounn :  Acute  Ballons  Eruption  with  Asso- 
ciated Affection  of  the  Conjunctiva.— Mr.  H.  Spioer :  Acute  Doable 
Optic  Keuiitls.  8.80  p.m.  i'apers :— Mr.  Bocklilfe :  (1)  Leaoo-s«rcoma 
of  Choroid;  (2)  Cataract  Intractlon  and  Gout— Mr.  T.  Collins: 
On  the  Origin  of  Knptores  In  Detached  Betbw.  -Mr.  W.  S.  Cant :  Cyst 
tA  Orbit— Mr.  Snell :  (1)  Cases  of  Acquired  Nystagmus  in  Oocapatloas 
other  than  that  of  Coal  Mining ;  (2)  Note  on  Electrolysis  In  Detach- 
ment of  the  Eetina. 

BBrnSH  GTHJBOOLOQIOAL  SooiSTT  (20  Hanover  Square,  W.)  — 
&80  p.m.  Specimens  will  be  shown  by  Mr.  O'Callaahan  and  Dr. 
Lawrie.  Paper :— Dr.  Fanoourt  Bamea :  On  Some  Psydiologloal  Con- 
sequences of  Suppressed  Menstruation.  A  Note  by  Dr.  Holland  on  a 
Buocessful  Csae  en  Transfusion. 

Vioio&iA  Hospital  fob  CmLPRnr  (Chelsea).— 4  p.m.  Mr.  R. 
Johnson  :  Hernia  in  Childhood. 

Fbidat,  Jurs  12tb; 

Ofhthalmologioal  Sooutt  of  zbi  Uvitid  KnroooM  (ll  Chandoa 
Bt,  cavendish  So..  ^.X— 0  P-m.  Prof.  Snellen  (Utrecht):  The  Influ- 
ence of  Light  on  vision.    (Bowman  Lecture.) 

LoNDOH  P09I-OejLduath  Ooubsi,  King's  (JoUege,  S  to  5  p.m.,  ProL 
Orookshank :  Typhoid  Fever  and  Diphtheria. 


Brentford  Union.— Medical  Superintendent  of  Inflrmary  and  Medical 
Officer  of  Woikhouse  and  Sobooli.  Salary  £260  per  annum,  witb 
furnished  resldeoce  in  the  Inflrmary,  rations,  washing,  a&,  or 
£800  with  furnished  residence,  washing,  ^to..  but  without  rattona. 
Also  an  Assistant  Medical  Omoer.  Salary  £100  per  annum.  Full 
"    -    lof  the  Clerk  to  the  Ouaidiana,  Union  Onoee,Isleworth, 


particulars  ( 


tester  Gtoneral  Infirmary.— Visiting  Burgeon.    Salary  to  commence  at 
...        ..         and  mall  "  


Isle  of  Man  General  Hoepltal  and  Dlspeneaiy,  Doaglaa.— Boose  Bar- 
geon.  Salny  £80  per  year,  with  apartmeots,  gaa,  coals,  and 
wadilng  freei  Full  pariloalan  of  Mr.  Fredk.  Bw  flaming,  Hon. 
Seo. 

Lewes  Dispensary  and  Inflrmary  and  Victoria  HoepltaL— Besldnt 
Medical  Oflloer.  Salary  £110  per  annum,  fOrnlahed  snartmenti, 
ooaL  gas,  and  attendance.  AppUoatlon  and  testimonials  to  tbs 
Hon.  Bee.  by  June  SOth. 

Parish  of  Crelch  (Sutherland).— Medical  Oflloer.  Salary  £45  per  annnm 
with  customary  tees  and  allowances.  Appllcationa  to  David  Boss, 
Inspeotor  of  Poor,  Bonar  Bridge,  Sutherland,  N.B. 

Parish  of  Kincardine  (BoesV— Besldent  Medical  Ofllcer  and  Vaeoinator. 

as  Medical  Oflloer  £4<  10s.  per  annum,  aa  Vaccinator  the 

fees,  with  an  additional  £5  per  annnm.    AppttcatlcDs 

monlals  to  the  Chairman  of  the  Pariah  Ooancll  by  Juas 


£80  per  annnm,  with  residence  and  maintenance.  Applications 
and  testimonials  to  the  C9iairman  of  theBoard  of  Management,  28 
Bastgate  Bow,  North  Chester,  not  Uter  than  June  87th. 


CHAlOia-PXABCB,  A.,  M.B.,  B.S.Lond.,  House  Bnrgaon  to  the  Ks  a 
County  Ophthalmic  Hospital,  Maidstone. 

Di  BAiiTi,  P.  IL  W.,  F.1LC.S.,  Lecturer  on  Aursl  Surgery  to  the  West- 
minster Hospital  Medical  School. 

HAIXLIT,  J.,  mTBw,  &Ch.l^ct,  LB.aSw,  L.B.aP.lSd.,  Junior  Hooae 
Surgeon  to  the  Anooata  Hoq^tal,  Manchester. 

HATiri,  L.  B..  M.B.,  B.C.Cantab.,  House  Burgeon  to  the  Victoria  Hos- 
pital fbr  Children,  Cheleea. 

HILL,  B.  A.  L.,  L.B.C!.P.,  M.K.C.S.,  House  Borgeon  to  the  Cfblchsster 
Inflrmary. 

UOBTFOOT,  C.  L.,  M.D.,  C.M.Bdln.,  M.B.C.S.,  Sargeon  to  the 
Northumberland,  Durham,  and  Newcastle  Ks%  Inflrmary. 

LT0H8,  S.,  M.B  ,  RCh.,  B.A.O.DubL,  L.M.Botunda.  Senior  Besldent 
Burgeon  to  the  Jervis  Street  Hospital,  Dublin. 

BOLSTOV,  J.  E.,  L.B.C.P.Bdin.,  M.K.US.,  Honorary  Sorgeon  to  the 
Plymouth  Boyal  Eve  Inflrmary. 

TAQOAiiT,  J.  S.,  M.B.,  Ch.B.VIct,  Senior  Besident  Medical  Ofllosr  to 
St  Mary'e  Hospital  for  Diseases  of  Women  and  Children,  Man- 
chester. 

TH0MP801I,  W.,  F.B.O.S.,  Senior  Annsthetlst  to  the  General  Inflrmary, 


WiAWiOK,  Jm   M.B.,  C.M.Aberd.,  Beaident   Medical  Ofltoer  to  the 
Burnley  Victoria  HospitaL 


firtbtf. 


AJTDEIWB.  -June  7th,  at  86  Welbeck  Street,  London,  W.,  the  wife  of 

F.  W.  Andrewet,  M.D.,  of  a  son. 
EHBHARDT.^Jnne  4th.  at  Portland  House,  Battersea,  the  wife  of  J. 

M.  Bhrhardt,  L.B.C.P.,  of  a  daughter. 
HOVOHTON.— May  81st  at  East  Looe,  Cornwall,  the  wife  of  Leonard 

F.  Houghton,  M.E.aS..  L^ILCP.,  of  a  son. 
PLOWXAii.— June  8od,  at  Etgle  Honse.  Clapham  Common,  &W.,  the 

wife  of  T.  A.  Barrett  Plowman,  M.]LaS.,  L.&.C.P.,  of  a  daughter, 

prematurely. 


J9l«tirt«geB. 

OOLLKT-WATIB.— June  2nd,  at  Oudtshoom,  South  Africa,  Courtenay 
B.  Colley,  M.B.C.S.,  L.B.C.P.,  of  Streatham,  to  Jennie  Watts,  of 
Ondtohoom.    (By  telegram.) 

COLLm-BowATiR.— June  eth.  at  Bt  John's  Church,  Lewisham, 
Kent  Henry  WUliam  Collier.  M.B..  B.S.Lond.,  of  Adderboiy, 
Ozon..  to  (^eth,  daughter  of  FMmols  Bowater,  of  Apna  Ghur, 
St  John's.  _^ 

HOYKRDnr -PHILLIPS.— June  1st,  at  Holy  Trinity  Church,  Ssuiunt 
B.E.,  Arthur  CecQ  Hovmiden,  M.B.,  B.S.Lond.,  s«n  of  the  late 
Thos.  Henry  Hovenden,  Esq.,  of  South  Norwood,  to  Madeline 
Bessie,  youngM-  daughter  of  the  late  WUtiam  FhlUlps,  Esq.. 
formerly  of  South  Plaoe>.  Flnsbnry,  and  Sbepton  Mallet 

LiAV— Orhrsov.— June  Oth,  at  St  Barnabas  Church,  Kensington, 
Cecil  Huntington  Leaf,  ILA.,  M.a,  F.B.C.8^  to  Fanny,  dauAter 
off  the  late  James  GMerson,  Esq.,  of  4  Holland  Villas  Boad, 
Keosiniitoa. 

MxriE-BiiD.-June  2nd,  at  Bt  George's  Church,  Hanworth,  Middle- 
sex, Harold  Mulr,  M.D.Lond.,  of  Lowestoft,  to  Violet,  second 
danghter  of  Nevile  Beid,  The  Oaks,  Hanworth. 

BBSPHIRD— STACKH01T8B.  -  June  8rd,  at  St  Peter's  Church,  Stalnforth, 
near  Bettte,  Henry  Bowman  Bhenherd,  L.B.C.P.Lond,  M.B.G.& 
Eng.,  of  CasUeton,  near  Sheffield,  to  EUena,  youngest  daughter  of 
the  Ute  Thomas  Btackfaouse.  of  TattlandsTBettle. 

THOMAS— McLiOD.— June  6th,  at  Christ  Church,  OaUe  Face,  Colombo^ 
Thomaa  J.  Uew^yn  Thomas.  F.B.a8.,  son  of  the  late  Bev.  J. 
Davies,  C.M.S.,  Ceylon,  to  Mary,  eldest  daughter  of  the  kite  Lt- 
CoL  W.  S.  McLeod,  M.S.C.,  of  dmnp 


StathB* 


FBAUisn>i.~May  28th,  at  Merrow,  Bournemouth,  Henry  Feamside, 

M.B.LondI7F.E.C.P.,  aged  78. 
MoLabu.— May  28th,  at  Newport  Boad,   Cardiff,   of  pneumm^ 

Kenneth  McLaren,  M.B.Lond.,  third  son  of  the   late  J.  W. 

McLaran. 
BUD. -June  8rd.  at  804  Walworth  Boad.  London,  after  years  of  suffer- 
ing, FIrank  Bold,  M.B.C  S.,  eldest  son  of  the  late  Commander 

Bobert  Beid,  BJN. 
SH0PP11.-May  8Ut,  at  the  residence  of  his  father,  Bd.  a  Shon 

Dudley  House,  TufneU  Park,   Blda«y  &   Shoppee,    MJLG 

L.B.aP.,aged24. 

NOTICE— AnwmnctmenlUt  atf  Births,  Marriages,  and  DeoAt  m  tk» 
/amUisM  nf  .s^bMcritert  to  thit  Journal  ars  irugrted  fns,  and  faaK 
rscek  the  publishirt  »^  laUr  than  tht  Monday  preeeditig  yubUeation 


Wht  ^tAiai  ^vm  mA  ^ivmUt 


»SALU8  POPULI  SUPRBMA  LBX." 


Vol.  CXII. 


WEDNESDAiC,    JtTNE    17,     1896. 


No.  25. 


wrignmi  (!Eontmimt£atitnt& 

ON  SOME  POINTS  CONCERNING 

THE   HYGIENE   OF   INFANCY  AND 

CHILDHOOD. 

By  THOMAS  MORE  MADDEN,  M.D.,  F.R.C.S.E<L, 

Consulting  PhyBidan  to  the  Children's  Hospital,  Dublin ;  Obstetric 
Physician  Mater  Miserioordlse  HosDital,  Consultant  and  J£x- 
Master.  Katloual  Lying -In  Hospital,  Ac 

The  object  of  the  CouDcil  of  the  Dublin  Health 
Society  in  instituting  this  Course  of  Lectures  is,  as  I 
understand  it,  to  afford  a  platform  for  the  exposition 
of  those  elementary  principles  of  sanitary  science  and 
hycriene  by  attention  to  which  so  many  of  the  ills  of 
suffering  humanity  might  be  obviated.  Hence,  trite  as 
is  the  subject  of  the  folloiiving  observations,  and  al- 
though I  nave  on  previous  occasions  taken  a  similar 
part  in  its  discussion,  I  have  willingly  acceded  to  the 
suggestion  that  I  should  address  you,  firstly,  in  the 
hope  of  securing  your  interest  and  co-operation  m  the 
much  needed  work  of  diminishing  the  appalling  waste 
child-life  now  going  on  around  us. 

Secondly,  I  shalfendeavour  to  point  out  some  of  the 
preventible  causes  of  disease,  suffering,  and  death  to 
which,  as  I  have  learned  by  long  experience  as  Physi- 
cian to  the  Hospital  for  Sick  Cmldren.  the  young  are 
exposed.  And,  thirdly,  as  this  mortality  or  suffering 
is  largely  due  to  either  ignorance  or  nefflect  of  the 
principles  of  child  culture — hygienic  or  physical,  and 
moral  or  mental — ^I  shall  venture  to  make  a  short 
reference  to  the  most  important  of  those,  and  so  afford 
a  bird's-eye  view  of  some  salient  features  in  the  vast 
range  of  topics  included  under  the  heading  of  this 
lecture. 

We  find  that  at  the  present  time  the  mortality  of  the 
first  year  of  life  still  constitutes  nearly  one-filth  of  the 
total  death  rate,  or  very  little  if  anvthing  less  than  it 
was  accordinff  to  the  earliest  of  those  reports  half  a 
century  ago.  Moreover,  although  the  average  mortality 
of  our  population  of  all  a^res  is  onlv  twenty  per  thous- 
and, the  death-rate  in  children  under  five  years  of  age 
is  fifty-nine  per  thousand  in  England  and  Wales,  and 
thirty-six  per  thousand  in  Ireland  ;  whilst  in  the  case 
of  children  under  one  year,  it  is  one  hundred  and 
thirty-six  per  thousand,  ana  in  some  places  such  as 
Dublin,  it  has  reached  two  hundred  and  ten  per 
thousand. 

With  re^rd  to  the  mortality  of  infancy  and  early 
childhood  in  these  countries,  it  has  been  shown  that 
of  evetj  million  children,  160,000  die  in  the  first  year 
after  birth,  53,000  in  the  second  year,  and  28,000  in  the 
third  year.  From  other  Reports  of  the  Registrar- 
General  this  fearful  death-rate  may  be  easily  shown  to 
be  directly  consequent  on  the  hygienic  mismanage- 
ment  of  infancy,  and  more  especiuly  to  the  substitu- 
tion of  unsuitable  artificial  foods  for  the  natural  nutri- 
ment of  infants.  Thus,  for  instance,  of  10,000  deaths 
in  the  first  year  of  existence  registered  in  Dublin  no 
less  than  7,646,  or  three-fourths,  occurred  in  the  case 
of  children  who  were  thus  artinciall^  fed.  Moreover, 
the  consequences  of  this  hygienic  mismanagement  are 
as  distinctly  recognisable  in  the  causation  of  many  of 


the   non-immediately  fatal   diseases   by  which  the 
fairest  portion  of  existence  is  too  often  embittered. 
Management  of  Infancy. 

Commencing  our  brief  survey  of  the  principles  of 
child-culture  with  the  first  of  the  periods  into  which 
life  is  divisible— namely,  infancy— we  may  here  con- 
sider how  our  new  bom  fellow-creatures  should  be 
treated  on  their  arrival  amongst  us,  or  in  what  manner 
should  infants  be  fed,  clad,  and  managed. 

The  first  of  these  questions  may  be  briefly  disposed 
of.  Nature  has  written  in  unmistakable  characters  the 
primary  law  of  hygiene— namely,  that  every  infant 
should,  unless  under  exceptional  circumstances,  be 
nursed  b^  its  mother,  whose  milk,  if  she  is  fairly 
healthy,  is  a  more  salutary  compound  of  nutriment 
than  it  can  ever  otherwise  receive. 

For  perfect  nutrition,  as  Dr.  Eustace  Smith  says,  four 
classes  of  food  are  required,  viz.,  albuminates,  fatty 
substances,  carbo-hydrates,  and  salts.  These  are  found 
in  the  most  digestible  form  and  the  most  perfect  pro- 
portions for  the  youn^  child  in  the  casein,  butter,  sugar, 
and  salts  of  human  milk. 

Nor  in  this  connection  should  it  be  lost  sight  of  that 
the  nursing  mother  herself  generally  profits  hardly  less 
as  regards  future  health  than  her  child  from  the  dis- 
charge of  this  duty  whenever  it  is  possible.  Otherwise, 
a  wet  nurse  should  be  sot  for  the  child  if  there  be  one 
obtainable  of  unimpeachable  mental  and  moral  tone  as 
weU  of  physical  health.  These  requirements  are,  how- 
ever, so  difficult  to  secure  that,  unless  in  the  case  of 
some  delicate  children  who  require  the  personal  warmth 
of  the  nurse,  and  with  whom  nothing  out  breast  milk 
agrees,  I  generally  advise  my  patients  to  bottle-feed 
their  children. 

When  a  child  is  to  be  fed  by  hand,  its  best  nutriment 
is  that  which  comes  nearest  to  its  natural  food,  the 
most  generally  available  substitute  for  which  is  the 
properly  prepared,  fresh  milk  of  a  healthy  cow. 

Every  nurse  knows  that  this  is  richer  than  woman's 
milk  and  hence  she  imagines  that  the  addition  of  so 
much  water  is  all  that  is  wanted  to  bring  the  former  to 
the  standard  of  the  latter.  Now  this  error  cannot  be 
too  strongljr  insinted  on-  Bovine  milk  is  not  merely  of 
higher  specific  fzravity,  or,  in  other  words,  contains  a 
larger  proportioa  of  solid  matter,  but  it  also  differs 
from  the  natural  food  of  an  infant  in  character,  as  well 
as  in  the  amount  of  these  constituents,  containing  less 
sugar  and  more  insoluble  casein.  Hence  it  is  less  easilv 
digested,  and  the  resulting  curd,  or  caseous  mass,  left 
in  the  child's  stomach  commonly  gives  rise  to  discom- 
fort, pain,  or  disease. 

To  prevent  this,  cow's  milk  should  be  diluted  and 
rendered  non-ascesent  by  the  addition  of  from  two  to 
four  ounces  of  lime-water  with  a  little  sugar  and  milk, 
and  a  few  drops  of  fresh  cream  if  procurable,  to  each 
pint.  After  four  or  five  months  the  amount  of  lime- 
water  may  be  gradually  lessened  and  curdification 
effectually  prevented  by  adding  a  small  pinch  of  salt 
and  as  mucn  bread-soda  to  each  bottle.  If  the  child 
appears  unsatisfied  or  is  not  thriving,  one  part  of  thick 
barley-water  may  be  added  to  three  or  four  parts  of 
milk.  This  should  be  given  by  the  old-fashioned  boat- 
shaped  bottle  in  preference  to  those  furnished  with 
ruboer  tubes,  whidi  are  difficult  to  keep  clean,  and  with 
which  a  child  is  more  liable  to  be  overfed. 


6^2     Thx  MsDioAL  Pbsss. 


ORIGL>rAL  COMMTTMCATlOlfS. 


JuNit 


1896. 


With  regard  to  the  use  of  cow's  milk  as  a  sabstitate 
for  the  natural  food  of  an  infant  there  is,  however,  a 
new  possible  source  of  danger  that  must  be  referred 
to,  VIZ.,  the  practice  now  largely  adopted  in  some 
places  by  milk  dealers  of  adding  antiseptics,  such 
as  boric  acid  and  other  still  more  active  germicides  to 
their  milk.  Some  of  the  agents  thus  employed,  such 
as  formaline,  are  of  a  toxic  character,  and  even  the 
least  poisonous  of  tibem,  viz.,  boric  acid,  cannot  be  added 
to  milk  in  sufficient  quantities  to  act  as  a  preservative 
of  it  without,  at  the  same  .time  endangering  the  health 
possibly  of  adults  and  still  more  certainly  that  of  any 
infants  thus  subjected  to  its  long  continued  action. 
This  abuse  is,  therefore,  a  matter  urgjently  demanding 
the  attention  of  the  sanitary  authorities,  and  if  neces- 
sary the  interposition  of  the  legislature  for  its  re- 
pression. 

The  most  common  causes  of  infantile  disease  are 
overfeeding  and  unsuitable  food.  It  cannot  be  too 
often  reiterated  that  children  are  nourished  by  what 
they  digest  and  not  merely  by  whatever  they  swallow. 
Hence  overfed  children  are  frequently  at  the  same  time 
semi^starved  by  the  unsuitable  aliments  with  which 
thef  are  supplied. 

For  the  first  few  weeks  the  child  must  be  fed  fre- 
quently, not  every  time  it  cries,  as  is  too  often  the  case, 
out  at  regular  intervals  of  two  or  three  hours,  the 
interval  between  feediuff  bein^  gradually  lengthened 
as  the  child  approaches  the  period  of  weaning  or  den- 
tition. 

Artificial  Milk  Foods. 

At  the  present  time,  besides  cow's  milk,  artificial 
foods  are  very  commonly  siven  from  the  earliest  period 
of  child-Ufa  Many  of  these  tinned,  preservea,  and 
edticentrated  to-called  lacteal  aliments  mainly  consist 
of  atl  admixture  of  various  farinaceous  compounds 
with  a  considerable  amount  of  saccharine  matter  and  a 
certain  proportion  of  evaporated  milk.  Such  articles 
may  be  handy  to  use  and  cheap,  but  these  advantages 
cannot  compensate  for  their  deficiency  in  elements 
essential  for  child-nurture.  Moreover,  in  some  instances 
artificial  foods,  if  not  previously  malted,  are  actually 
injurious,  as,  owing  to  the  non-secretion  of  saliva  in  the 
case  of  infants,  the  digestion  of  unmalted  starchy  sub- 
stanees  is  rendered  impossible.  In  other  cases  these 
also,  apparently,  retard  the  elimination  of  waste 
mateiiai  irom  the  system  hj  their  tendencv  to  appro- 
priate the  oxygen,  by  the  aid  of  which  this  physiolo- 
gical process  Is  accomplished. 

Withiti  the  last  twenty  years  the  proportion  of 
strumotis  afid  tuberculous  disorders  brought  under 
observation  in  the  Children's  Hospital  has,  as  I  else- 
where ihowed  beeome  notably  increased.  This  fact  is 
probably  connected  with  the  indisposition  to  nurse 
their  children  observable  in  women  of  all  classes,  and 
unsuitable  to  the  substitution  of  artificial  compounds 
for  the  natural  food  of  an  infant. 

Tuberculosis  in  human  beings  is  undistinguishable 
from  the  tuberculous  bovine  epizootic  known  as  perl- 
sucht  Moreover,  those  acute  forms  of  tuberculosis 
which  are  most  common  during  childhood  resemble 
closely  the  infective  diseases  in  their  zymotic  origin 
from  a  specific  virus,  whether  generated  in  the  body 
from  caseous  matter  or  introduced  from  without.  The 
latter  seetns  not  unlikely  to  be  the  ease  in  the  tuber- 
culous diseases  especially  prevalent  amongst  children  of 
tl^e  poorer  classes,  of  whose  common  dietary,  preserved 
or  prepared,  starcny  foods,  that  may  be  mixed  with 
imported  'or  other  milk  possibly  contaminated  by  the 
germs  of  tuberculous  infection,  now  constitutes  so 
large  a  portion. 

Hygiene  of  Early  Childhood. 
No  less  important  than  its  dietary  is  the  personal 
cleanliness  ot  the  child  and  its  surroundings,  6uch  as 
the  nursery,  &c    Every  child  should  be  thoroughly 


tubbed  once  or,  preferablv  twice,  a  day.  In  the  latter, 
the  evening  bath  should  always  be  warmer  than 
the  morning  one,  which  at  first  should  be  fairly  warm, 
and  gradually  reduced  in  temperature  as  the  child 
grows  stronger^  until  it  can  be  given  cold  in  summer 
and  tepid  in  winter.  If  the  child  be  puny,  a  handful 
of  seasalt should  be  added  to  each  batn,  and  in  eveiv 
case  it  should  immediatelv  after  the  bath  be  well 
rubbed  with  a  soft  Turkish  towel  until  the  skin  is 
aglow. 

The  NwMry, 

To  a  large  extent  the  health  of  children  is  dependent 
on  the  sanitary  condition  of  their  nursery,  which, 
when  possible,  should  consist  of  two  rooms— one  for 
day,  the  other  for  night,  and  should  be  the  most  sunny, 
spacious,  best  ventilated,  and  further  removed  from 
septic  emanations  of  all  the  rooms  of  the  house.  I 
need  hardly  add  that  there  should  be  no  gas  in  the 
nurser^r  or  any  water-closet  adjoining  it 

Special  attention  should  be  always  given  to  the 
lightsomeness  or  free  exposure  to  sunshine  of  the 
nursery,  as  the  development  and  health  of  children 
are  greatlv  influenced  bv  this  circumstance.  Thus  the 
physical  deformities  ana  tendencies  to  stmmo-tuberca- 
lous  diseases  here  so  commonly  observed  amongst 
children  are  comparatively  inf  renquent  in  those  sunnier 
Oriental  and  southern  chmes,  in  which  much  of  my 
early  life  was  passed.  To  the  want  of  sufficient  insola- 
tion in  this  country  is  mainly  due  the  pallid,  saUow 
aspect  and  stunted  phvsical  development  especially 
noticeable  in  town-bred  children,  to  whom  too  fre- 
quently— 

*'  The  goodly  liffht  and  air 
Are  banned  and  barr^— forbidden  fare.'* 

In  fact,  the  influence  of  sunlight  on  the  sanitary  and 
physical  condition  of  the  young  ma/  be  tersely  summed 
up  in  the  Italian  proverb,  "  Dove  il  sole  non  intra,  il 
medico  viene." 

Exercise. 

Little  need  be  said  on  this  point,  as  during  infancy 
the  child  will  be  sufficiently  exercised  by  the  move- 
ments of  its  nurse,  in  whose  arms  it  should  be  carried 
for  the  first  year,  and  never  allowed,  as  is  commonly  the 
case,  to  shiver  or  roast  in  the  perambulator  at  the 
caprice  of  its  attendant. 

Sleep. 

With  regard  to  sleep  no  better  rule  can  be  adopted 
than  Uiat  when  fatiffue  is  experienced  rest  should  be 
allowed.  Young  infants  require  a  great  deal  of  repose 
—the  first  few  weeks  after  birth  being  passed  almost 
entirely  in  sleep,  with  the  exception  "if  the  time  occu- 
pied in  satisfying  the  instinctive  calls  for  food  ;  and 
even  as  they  fp*adually  grow  older  throughout  the  whole 
period  of  childhood  :more  sleep  is  required  tiian  in 
adult  age.  To  permit  of  this,  children  should  be  put 
to  bed  early  in  the  evening,  so  that  they  may  enjoy 
sleep  for  ten  or  twelve  hours ;  and  until  they  are  three 
or  four  years  old,  the/  must  be  allowed  to  rest  for  an 
hour  or  two  in  the  middle  of  the  day  before  dinner.  In 
awaking  a  child  care  should  be  taken  to  do  so  gradually 
and  gently,  otherwise  much  injurious  excitement  may 
be  produced. 

All  children  are  disposed  to  be  early  risers ;  this  pro- 
pensity Phould  therefore  be  cultivated,  by  putting 
them  sufficiently  earl/  to  rest,  and  not  allowing  any 
preventible  interruption  of  this.  When  children  first 
awake  in  the  morning,  however  early  this  may  be, 
provided  it  be  after  davUght,  they  should  be  allowed 
to  get  up  and  be  dressed  in  clothing  which  during  early 
childho(Kl  should,  in  a  climate  such  as  this,  be  as  warm, 
loose,  and  light  as  possible. 

ChildJhood. 

For  the  first  years  of  life,  or  from  one  to  ten  years  of 
af^e,  the  child's  food  should  be  such  as  may  be  easily 
digested  and,  at  the  same  time,  supply  material  for  its 


Jwra  17,  I890« 


ORIGINAL  COMMUNICATIONS. 


Ttts  UmDidAL  PtL^aa.     62S 


daily  increariDg  physical  development.  The  period 
when  animal  diet  may  begin  to  be  used  is  indicated  by 
Nature,  which  furnishes  teeth  when  solid  nutriment 
begins  to  be  necessary.  The  teeth  are  then  slowly  and 
successively  protruded,  and  during  this  period  milk  and 
farinaceous  diet  should  predominate  over  that  purely 
animal,  the  proportions  of  which  should  be  gradually 
increased  as  the  incisor  teeth  multiply. 

Children  should  breathe  a  pure  atmosphere  both  by 
day  and  night.  By  du^  they  should  be  much  in  the 
open  air,  and  allowed  to  exercise  their  limbs  freely, 
short  of  fatigue,  it  being  borne  in  mind  that  the  bones 
of  infants  have  little  resistance,  and  time  is  required 
ere  those  of  the  legs  are  capable  of  sustaining  the 
weight  of  the  body.  From  the  termination  of  the 
period  of  dentition  exercise  should  be  regulated  chiefly 
by  the  impulses  of  nature— in  the  first  years  of  life 
exercise  being  play,  and  play  being  exercise.  Bovs 
generallv  in  this  respect  come  off  better  than  girls, 
being  left  more,  under  ordinary  circumstances,  to  follow 
Nature's  dictates  than  the  latter,  who,  amongst  the 
better  classes,  are  subjected  to  the  restraints  imposed 
on  the  free  exercise  of  physical  powers  by  the  trammels 
of  preiudice  and  system,  and  are  consequently  more 
specially  subject  to  pulmonary  and  spinal  diseases.  To 
prevent  this,  the  dress  of  a  girl  should  b«  as  light  and 
mcompressive  as  that  of  a  boy,  and  as  much  indulgence 
in  play  and  sportive  amusement  allowed  as  may  be 
consistent  with  the  habits  it  is  right  to  encourage. 
Moral  Culture  of  Children, 

From  the  earliest  period  of  childhood  its  moral 
discipline  and  training  is  a  matter  the  practical  import- 
ance of  which  cannot  be  over-estimated.  Even  in 
infancy  natural  propensities  and  mental  disturbances 
manifest  themselves,  and  good  dispositions  are  capable 
of  being  cultivated  and  evil  ones  of  being  restrained 
even  in  the  cradle.  Children  cry  from  pain  ;  they  cry 
also  from  passion.  The  one  should  be  promptly 
quieted  by  removing  the  cause  of  pain  ;  the  other  is 
less  speedy  corrigible,  requiring  both  time  and  a  system 
of  kindly  sound  moral  discipline.  With  regard  to  the 
mental  amusement  of  children— much  as  I  prize  the 
dear  old  nursery  rhymes  and  tales,  which  have  been 
hallowed  by  the  usage  of  countless  generations,  and 
which  will  survive,  as  they  have  preceded,  all  other 
literature  — some  caution  should  be  observed.  It 
should  not  be  forgotten  that  many  a  child  is  seriously 
iiyured  by  its  mother's  fond  anxiety  to  foster,  develop, 
and  extend  its  budding  talente  in  the  committal  to 
memory  of  those  time-honoured  and  familiar  nursery 
stories  and  tales,  the  recital  of  which  in  the  gladsome 
voice  of  a  favourite  child  is  sweetest  music  to  a  parent's 
ear,  but  the  acquisition  of  which  may  prove  an  undue 
and,  possibly,  a  disastrous  strain  on  the  little  child's 
brain.  Under  no  circumstances  should  children 
be  frightened  with  ghost  stories  or  sent  to  bed 
in  the  dark  and  then  punished  for  cnring.  Nor  should 
the  nursery  ever  be  made  a  place  of  punishment,  by 
banishing  children  to  it  for  any  little  delinquency. 
On  the  former  point  I  would  venture  to  commend  to 
the  consideration  of  all  interested  in  the  care  of  children 
an  observation  of  the  founder  of  the  first  Children's 
Hospital  in  England^  Dr.  Charles  West,  to  whom 
modem  podriatic  medicine  so  larselv  owes  its  present 
development,  viz.,  *'  The  mind  of  tne  child  is  feebler 
than  that  of  an  adult,  but  it  majr  be  proportionately 
active  and  vivid  in  its  imaginations.  The  child  who 
dreads  solitude,  and  asserts  that  it  hears  sounds  and 
sees  objects,  otten  tells  a  literal  truth.  The  sounds 
have  been  heard  ;  in  the  stillness  of  the  nursery  the 
little  one  has  listened  to  what  seemed  to  be  a  voice 
calling  to  it ;  or,  in  the  dark,  phantoms  have  risen 
before  its  eves,  and  the  agony  of  terror  betrays  an 
impression  tar  too  real  to  be  explained  away  or  to  be 
suitably  met  with  by  hard  words  or  unkind  treatment.'' 

In  morale,  as  weU  as  i^iysique,  the  growing  genera- 


tion I  may  repeat  contrasts  unfavourably  with  the 
physically  stronger,  morally  superior,  and  less  intellec- 
tual race  of  the  pre-educational  period.  Looking  at 
the  pallid  and  anaemic  little  children  chained  to  the 
desk  by  the  School  Board,  we  might  well  be  tempted 
to  believe  that— 

"  Twas  not  the  sires  of  snch  as  the<^ 
Who  dared  the  elements  and  pathlees  seas  ; 
Who  made  proud  Asia's  monarchy  feel 
How  weak  their  gold  against  Europe's  ateel. 
But  beings  of  another  mould — 
Rough,  hardy,  vigorous,  manly,  bold  ! " 

The  deterioration  of  physical  and  mental  stamina 
thus  observable  is,  I  think,  mainly  due  to  the  fact  that 
a  lar^e  part  of  the  first  ten  years  of  life,  which  should 
be  primaril^r  devoted  to  religious  or  moral  as  well  as 
physical  training,  is  now  given  up  to  the  development 
of  the  mental  powers.  For  this  purpose,  by  the  element- 
ary education  code,  the  child  when  a  mere  infant  is 
compelled  to  attend  some  school,  where  the  immature 
brain  is  forced  into  abnormal  and  disastrous  activity. 
On  its  return  home,  jaded  in  mind  and  body,  to  pre- 
pare for  next  day's  task,  such  a  child  is  necessarily 
unfit  to  receive  that  far  more  important  elementary 
training  of  the  affections  and  moral  faculties  and  that 
instilment  of  Christian  principles  which  are  best,  if  not 
only,  acquirable  from  a  mother's  teaching.  If,  there- 
fore, there  was  no  other  objection  to  the  Compulsory 
Elementary  Education  Code  than  its  interference  with 
home,  and  religious  training,  the  acquisition  of  which 
in  early  childhood  is  no  less  essential  to  the  safety  of 
society  at  large,  than  to  the  welfare  and  future 
happiness  here  and  hereafter  of  our  children,  this  alone 
would  justify  resistance  to  that  system. 

In  connection  with  the  moral  management  of  child- 
hood, I  may  add  a  few  words  on  the  abuse  of  alcoholic 
stimulants  aikd  of  tobacco  even  during  the  early  period 
of  life.  The  former  I  have  brought  before  the  British 
Medical  Association,  and  may  here  repeat  that  the 
evils  resulting  from  the  abuse  of  alcohol  were  never 
so  prevalent  as  at  present,  and  are  traceable  in  the 
diseases  of  youth  as  well  as  in  those  of  adult  existence. 
Amongst  the  results  of  the  killing  pace  at  which  the 
race  of  life  is  now  generally  run  from  its  start,  child- 
hood has  now  become  so  abridged,  in  many  instances, 
by  the  necessity  of  entering  on  the  struggle  fur  exist- 
ence before  the  sufficient  development  of  the  moral, 
mental,  and  physical  powers,  that  a  premature  break- 
down in  any  of  these  is  no  longer  exceptional.  This,  in 
one  of  its  phases,  is  exemplified  by  the  painful  exhibi- 
tions of  juvenile  drunkenness  daily  witnessed,  especially 
amongst  the  neglected  little  street  arabs,  who  are  forced 
into  the  thoroughfares  of  our  great  cities,  there  to  eke 
out  a  living  as  best  they  may,  and  the  pathological 
consequences  of  whose  acquired  or  inherited  alcoholism 
are  brought  under  clinical  observation  in  the  form  of 
gastric  and  hepatic  disorders,  and  especially  cirrhosis 
of  the  liver,  as  well  as  the  protean  forms  of  cerebro- 
spinal disease  and  the  various  neuroses,  which  are  so 
frequently  noticed  in  hospitals  for  children. 

Elsewhere  I  have  reported  several  instances  of 
juvenile  alcoholism  that  came  under  my  care  in  the 
Children's  Hospital  where  some  deaths  from  this 
cause  have  occurred  amongst  children  under  ten  years 
of  age.  In  the  majority  of  those  cases  of  juvenile 
alcoholism  this  tendency  appeared  inherited,  and  was 
most  marked  in  those  whose  mothers  were  inebriates- 
intemperance  in  women  also  bearing  in  other  ways  on 
the  diseases  treated  in  the  hospitals  for  children,  where 
its  effects  are  strikingly  evinced  by  the  moral  and 
physical  deterioration  of  the  offspring  of  the  drunken, 
and  by  their  special  predisposition  to  strumous, 
tuberculous,  and  other  cou»ticutional  taints. 

The  evil  thus  resulting  from  the  prevailing  intem- 
perance of  the  young  as  well  as  the  old  should  induce 
us  to  warn  those  whom  our  counsel  may  infiuence 


o24     Trs  MiDioAL  Pftias. 


ORIGINAL  COMMUNICATIOlf a 


JuKB  17,  1896. 


against  that  custom  of  givinff  alcoholic  stimalants  as  a 
bonne  bauche  to  children  which  is  so  genend  in  its 
practice  amongst  all  classes,  and  so  calamitous  in  its 
results.  Even  in  those  exceptional  cases  in  which  such 
stimulants  may  be  necessafjr  for  children,  we  should 
never  sanction  their  administration  save  under  the 
guise  and  in  the  defined  doses  of  other  remedial  agents 
— mv  experience  in  hospital  and  private  practice  having 
amplj  confirmed  the  view  expressed  in  a  work  of  mine 
published  many  years  since,  viz.,  that  it  is  physiologi- 
cally wrong,  as  well  as  morally  unjustifial&e,  ever  to 
allow  a  healthy  child  to  taste  alcohol  in  any  form. 

Withri«ard  to  the  effects  of  the  abuse  of  tobacco 
during  childhood,  of  which  we  see  too  many  instances 
amongst  the  neglected  children  of  the  poor  in  this  city, 
I  may  refer  to  an  observation  I  made  long  ago  on  Uie 
stunted  and  prematurelv  aged  appearance  of  children 
in  Portugal,  where  smoking  is  indulged  in  from  the 
earliest  possible  age.  There,  in  the  streets  of  Lisbon, 
I  have  often  seen  with  astonishment  boys,  whose  ages 
could  not  have  exceeded  five  or  six  years,  gravely 
sucking  a  strong  cigar  with  apparently  the  same  gusto 
which  our  less  precocious  infants  derive  from  the  for- 
bidden delights  of  the  sugar  stick.  There  can  be  no 
doubt  that  the  influence  of  the  nicotine  thus  absorbed 
must  be  most  injurious  at  this  tender  ase.  and  this  is 
evident  in  the  physical  aspect  of  the  chuaren  referred 
to.  (a) 

Afental  Training  or  Education  of  Children. 

This  question,  always  of  great  importance,  is  of 
special  interest  at  the  present  time  in  connection  with 
the  Compulsory  Elementary  Education  Law.  We  are 
all,  of  course,  agreed  as  to  the  duty  of  suitably  educat- 
ing children  so  as  to  fit  them  properly  for  the  daily 
increasing  requirements  and  competition  of  modern 
life.  But  as  to  the  extent  to  which  this  should  be 
carried  in  early  childhood  there  is  unfortunately  a 
great  discrepancy  between  the  doctrinaires  of  the 
Education  Department  and  the  views  of  those  who 
have  any  knowledge  of  the  laws  of  Nature,  or  who  as 
physicians  have  to  deal  in  disease  wiUi  the  con- 
seouences  of  their  violation.  And  hence,  whilst  little 
chudren  are  therefore  overworked  into  disease  or  death, 
the  physician  must  still  raise  his  protesting  voice, 
albeit  it  would  apparently  seem  unheeded. 

The  firot  ei^ht  or  ten  years  of  child-life  should  be 
mainly  occupied  by  moral  and  physical  training,  and 
during  this  period  the  amount  of  mental  cultivation 
which  a  child's  brain  is  capable  of  receiving  with 
permanent  advantage  h  much  less  than  is  commonly 
believed.  No  ^preater  physiological  mistake  is  possible 
than  the  prevuling  idea  of  attempting  any  consider- 
able degree  of  mental  culture  untLL  the  sufficient 
development  of  the  physical  stamina  and  moral 
faculties  ib  acoompUshed.  The  organ  of  the  mind  is 
as  much  a  part  of  the  body  as  the  hand,  and  ere  either 
can  perform  its  function  properly  its  vital  force  must 
be  develop«>d  and  maintained  by  nutrition.  Hence 
arises  a  very  important  practical  question  in  connection 
with  compulsory  elementanr  education.  A  large  pro- 
portion of  those  who  in  this  and  other  cities  must 
come  within  the  provisions  of  this  law  are  those 
semi-starved  children  of  the  poorest  class,  such  as 
those  with  whom  for  many  years  I  have  had  to 
deal  in  the  Hospital  for  Sick  Children.  As  a 
matter  of  fact,  I  may  observe  that  children  thus 
debilitated  by  privation  are  necessarily  as  much  inca- 
pacitated for  any  mental  strain  as  they  are  for  the 
accomplishment  of  any  feat  of  physical  strength  and 
that  it  is  as  inhuman,  injudicious,  and  impolitic  to 
expect  the  former  as  it  would  be  the  latter  from 
children  so  circumstanced. 

If  the  State,  for  reasons  of  public  policy,  determines 

(a)  •;  The  Health  BMoits  of  En  ope  and  AMo«  io  the  Traatment  of 
Chronic  MseMe."  By  ThomM  More  Madden,  M.D.  Third  edition, 
p.  186.    ISOL  ' 


that  all  children  shall  be  compulsorily  educated  from 
their  earliest  years,  it  should  certainly  afford  the  means 
by  which  this  may  be  least  injuriously  and  most  effec- 
tually carried  out,  by  providing  food  as  well  as  educa- 
tion for  evenr  pauper  child  compelled  to  attend  an 
elementary  school. 

Amongst  the  results  of  over-pressure  in  such  schools, 
referred  to  in  Sir  Crichton  Browne's  Heport  on  this 
subject,  are  cerebral  disease  in  all  forms  :— viz.,  cepha- 
litis, cerebritis,  and  meningitis,  as  well  as  headache, 
sleeplessness,  neuroses  of  every  kind,  and  other  evi- 
dences of  cerebro-nervous  disorders.  On  no  other 
ground  can  the  increasing  prevalence  of  these  affections 
amongst  the  little  victims  of  the  Education  Department 
be  explained,  than  by  ascribing  them  to  the  new 
factors,  i.e.,  "brain  excitement ''  and  ''over-preesure," 
which  in  the  case  of  young  diildren  are  associated 
with  the  abuse  of  education. 

It  would  be  difficult  toover-estimate  the  pathological 
consequences  of  thus  directing  all  the  avaUable  energies 
of  the  system  to  the  brain  during  early  childhood,  to 
the  irreparable  injury  of  the  over-stimulated  cerebral 
organisation  and  at  the  expense  of  the  other  functions 
and  organs  of  the  body.  Time,  however,  does  not 
permit  my  dwelling  on  the  ill-effects  of  mental  over- 
pressure brought  under  my  own  observation,  nor  of 
any  reference  here  to  the  painful  scenes  of  misery  thus 
occasioned  with  which  a  long  and  sad  experience  has 
made  me  but  too  familiar.  I  now  allude  to  thissubject 
merely  with  the  view  of  pointing  out  the  imminence  of 
the  danger  and  the  importance  of  its  avoidance. 

I  may,  in  conclusion,  venture  to  hope  that  you^  being 
so  forewarned, maybe  thus  spared,  and  may  oe  instru- 
mental in  sparing  others,  from  ever  beins  helpless  and 
hopeless  witnesses  of  the  intense,  and  often  most 
patiently  endured,  suffering  of  some  little  child,  and 
more  especially  of  one  peculiarly  bright  and  ffifted,  for 
such  are  the  favourite  victims  of  meningeal  disease, 
untimely  stricken  down  in  the  moment  of  fidrest 
promise  and  dying  in  cruel  pain  from  the  pemidons 
results  of  the  premature  over-straining  of  its  mental 
powers. 


CASES  IN  PRIVATE    PRACTICR 

UKDSR  THE  CABS  OF 

J.  CHRISTIAN  SIMPSON,  M.D.,  CM., 

Tnnbridge  WelU. 

A  Case  of  Perforative  Appendicitis  and  Extra-peri" 
toneal  Abscess  Containing  a  Fcecal  Concretion. 
J.  W.,  a  carpenter,  sBt  16,  had  to  leave  his  work  on 
July  15th,  1893,  on  account  of  sudden  abdominal 
pain.  He  was  treated  at  home  by  Ms  mother  for  a 
week,  and  as  he  did  not  improve  a  medical  man  was 
called  in  to  see  him.  During  his  absence  from  home  on 
July  26th,  I  saw  him,  and  found  him  in  a  very  critical 
state,  temperature  102^.  and  pulse  120,  small  and  wiry. 
He  was  vomiting,  ana  Ids  legs  were  drawn  up.  On 
examining  the  abdomen,  the  right  iliac  fossa  was 
particularly  tender  to  the  touch  and  a  considerable 
swelling,  fairly  localised,  was  discovered  in  that  region. 
Rectal  examination  revealed  tenderness  and  tension  in 
the  right  side  of  the  pelvis.  There  was  no  doubt  as  to 
the  correct  line  of  treatment,  so  next  day,  I  made  an 
incision  about  3  inches  in  length,  half  an  inch  internal 
to  Poupart's  li^ment  and  the  middle  of  it  opposite  the 
anterior  superior  spine.  When  the  muscles  were 
divided  to  the  same  extent  as  the  cutaneous  incision, 
adhesions  were  found,  and  on  gently  separating  them, 
pus  welled  up.  On  introducing  the  finger,  I  found  a 
smooth-walled  cavity  the  size  of  a  walnut ;  there  was 
no  palpable  orifice,  but  it  contained  a  f adcal  concretion 
the  size  and  shape  of  a  date  stone.  After  this  was 
extracted,  a  large  drainage  tube  was  inserted  down  to 


JcTNK  17,  189«. 


ORIGINAL  COMMUNICATIONS. 


the  bottom  of  the  cavity ;  the  muscles  were  stitched 
with  catfmt  and  the  skin  with  horse-hair.  On  the  third 
day  the  flatus  became  very  troublesome,  but  was  c^ot 
down  with  mist,  alb.,  and  a  turpentine  enema.  The 
subsequent  progress  of  the  case  was  uninterrupted ;  the 
tube  was  removed  on  August  4th,  and  by  the  10th  the 
wound  was  superficial  He  was  soon  able  to  be  up  and 
has  been  perfectly  well  ever  since.  When  I  saw  him 
in  April,  1896,  he  stated  that  there  was  no  tendency  to 
a  hernial  protrusion,  and  onlv  complained  of  sli^^ht 
dra^^ng  sensation  in  the  right  iliac  region  dunng 
Militia  drill. 

Excision  of  LympliodenomcUous  Glands  causing 
Dyspnoea, 

Mrs.  S.,  adt.  24,  was  suffering  from  lymphadenoma 
chiefly  on  the  right  side  of  the  neck,  and  in  the  supra- 
clavicular and  axillary  regions.  There  were  a  few 
enlarged  glands  elsewhere,  but,  as  far  as  could  be 
ascertained,  there  were  none  in  the  thorax.  She  com- 
plained mostly  of  dyspncBa,  and  had  bad  paroxysmal 
attacks,  which  at  first  were  evidently  due  to  nerve  pres- 
sure from  the  enlarged  riands  at  the  site  of  the  bifur- 
cation of  the  carotid.  Her  temperature  was  constantly 
varying  from  100  to  lor,  and  sometimes  higher. 
The  pulse  was  rapid,  and  there  was  considerable  pallor 
and  emaciation.  No  splenic  enlargement  could  be 
detected  at  this  time.  As  she  begged  for  relief,  I 
excised  five  enlarged  glands  in  front  of.  and  behind,  the 
sterno-mastoid  muscle  on  account  of  an  attack  of 
dyspnoea  being  always  produced  when  slight  pressure 
was  applied  to  them.  Dr.  Aldren  Turner  kindly 
examined  these  microscopically,  and  reported  that  each 
had  a  typically  simple  lympnadenomatous  structure. 
The  relief  from  dyspnoea  was  almost  immediate,  and 
the  wound  healed  by  first  intention.  This  operation 
was  performed  on  June  lOth,  1893.  She  continued  to 
feel  better  for  some  time,  then  the  supraclavicular 
mass  began  to  trouble  her.  apparently  pressing  both  on 
the  trachea  and  nerves.  It  was  about  the  size  of  a 
small  fist,  and  extended  from  the  middle  line  to  the 
outer  third  of  clavicle.  It  was  connected  with  the  mass 
in  the  axilla  and  also  deMBply  up  the  neck.  It  was  very 
tender  and  pressure  on  it  caused  great  distress.  The 
temperature  remained  hip;h,  but  unfortunately  I  had 
no  opportunity  of  examining  the  blood  minutely. 

There  was  no  recurrence  at  the  site  of  the  former 
operation,  nor  was  there  any  enlargement  of  the  spleen, 
ascites,  or  thoracic  pressure  symptoms.  I  again 
operated  on  July  29th,  1893,  at  her  urgent  request. 
The  supraclavicular  tumour  was  exposed  by  an  inci- 
sion ab^ut  four  inches  long,  parallel  to,  and  above  the 
clavicle.  The  skin  was  very  adherent,  probably  in 
part  due  to  a  liberal  application  of  iodine  for  some 
time  before  my  attendance  commenced.  The  sterno- 
mastoid  was  partly  divided,  and  the  inner  end  of  the 
mass  freed,  but  it  was  firmly  adherent  ^x)steriorly,  and, 
while  separating  these  adhesions,  the  internal  jugular 
vein  was  unfortunately  torn.  The  haemorrhage  was 
immediately  arrested  by  digital  pressure  by  my 
assistant,  and  I  cut  off  the  whole  remaining  part  of  the 
tumour  as  deeply  as  possible.  The  vein  was  now  able 
to  be  secured  by  forceps.  Some  more  of  the  tumour 
was  then  removed,  and  the  brachial  plexus  was  visible. 
The  breathing  was  manifestly  greatly  relieved,  a  double 
ligature  was  now  applied  to  the  vein,  and  the  wound 
sutured.  The  patient  made  an  uninterrupted  recovery, 
and  was  so  far  relieved  that  she  was  able  to  go  about 
again.  In  the  middle  of  September,  considerable 
enlargement  of  the  spleen  and  ascites  were  detected. 
Though  tbe  breathing  was  rapid,  on  account  of  the 
aneemia,  which  was  not  improved  at  all  by  iron  and 
arsenic  which  had  been  administered  since  May,  there 
was  none  of  the  old  dyspnoea.  She  left  the  town 
shortly  after  this,  and  her  husband  informed  me  that 
she  died  in  July,  1894.  There  is  no  doubt  death  would 
have  resulted  long  before  this,  had  not  these  operations 


Thb  MiniCAL  Pbms.     625 

been  performed,  though,  as  a  rule,  and  according  to 
Qowers,  operative  interference  is  not  advisable  if  the 
temperature  be  constantly  high,  or  if  the  blood  con- 
tains less  than  60  per  cent  of  haemoglobin. 


INFECTIOUS    SORE    THROAT    AND 

DIPHTHERIA,     (a) 

By  GEORGE  REID,  M.D.,  CM.,  D.P.H., 

Medical  Officer  of  Health  for  Staffordshire, 

It  ia  with  considerable  diffidence  I  venture  to  direct 
your  attention  to  a  subject  of  so  debatable  a  character  as 
infections  throat  ailmentfl ;  and  I  wish  to  emphasiee  the 
fact  that  my  only  object  is  to  present  for  discussion  cer- 
tain imprebsions  I  have  formed  as  to  the  nomenclature  of 
such  ailments — impressions  which  in  the  first  instance 
were  the  outcome  of  personal  obaervi^tion,  but  which  have 
since  been  ptrengbhened  by  tbe  experience  of  others.  I 
cannot  say  I  have  any  definite  theory  to  advance,  as  my 
impressions  are  too  visionary  to  admit  of  being  formulated  ; 
bus,  such  as  they  are,  they  may  serve  as  an  introduction 
to  what  may  prove  to  be  a  uaetul  debate  upon  a  subject  in 
which  we  are  all  keenly  interested,  and  concerning  which 
there  is  by  no  means  unanimity  of  opinion,  namely— the 
relationship  between  diphtheria  and  allied  infectious  throat 
ailments. 

It  is  a  generally  recognised  fact  that  diphtheria  out- 
breaks are  frequently  preceded  b^,  and  associated  with,  a 
throat  affections  of  a  comparatively  trivial  character, 
which,  however,  do  not  present  the  typical  feature  of 
diphtheria  proper.  Also,  in  recent  years,  bacteriology  has 
introduced  a  considerable  element  of  doubt  as  to  the  true 
nature  of  certain  throat  ailments  which  previously  would 
have  been  pronounced  to  be  diphtheria,  and  the  term 
pseudo-diphtheria  has  been  coined  in  consequence. 

Under  the  circumstances,  and  until  our  knowledge  of 
such  ailments  becomes  more  exact,  this  torm  will  serve  a 
useful  purpose  in  limiting  the  risk  of  minimising  the 
danger  of  outbreaks  in  which  bacteriological  proof  is 
wanting,  and  in  stimulating  inquiry  into  the  true  nature 
of  these  so-called  spurious  ailments. 

Dr.  Thome  Thome,  who  in  his  {well-known  '*  Milroy 
Lectures  "  has  so  ably  presented  the  evidence  on  this  ques- 
tion—to which,  indeed,  he  himself  has  so  largely  contri- 
bntod— propounds  the  theory  **  that  attacks  of  so-called 
sore  throat  exhibit  under  favouring  conditions  a  progres- 
sive development  of  the  property  of  infectivencss,  cul- 
minating in  a  definito  specific  type  which  is  indistinguish- 
able from  true  diphtheria."  This  theory,  I  think,  has 
been  pretty  generally  accepted,  although  its  accuracy  has 
been  doubted  by  more  than  one  observer.  It  is  in  some 
measure  in  support  of  these  doubts  that  this  paper  has 
been  written,  although  I  fear,  as  I  have  said,  it  may  be 
thought  I  have  nothing  more  substantial  in  the  shape  of 
a  theory  to  offer  in  its  place. 

In  these  days  of  germ  diseases  one  can  well  understand 
why  the  throat  should  be  a  favonrito  site  for  septic  ail- 
ments conveyed  by  the  air  and  by  food,  but,  according  to 
our  present  nomenclature,  the  number  of  such  ailments  is 
very  limitod.  Excluding  scarlatinal  sore  throat,  which  is 
fairly  distinctive,  and  although  frequently  asFociated 
with  other  nondescript  throat  ailments,  may  usually  be 
differentiated  from  them  by  accompanying  symptoms 
which  are  characteristic  of  the  disease,  the  list  of  septic 
throat  ailments  is  narrowed  down  to  diphtheria,  pseudo- 
diphtheria,  and  an  ill-defined  affection  called  lacunar  or 
follicular  tonsillitis,  membranous  croup  being  now  usually 
resrarded  as  laryngeal  diphtheria.  Quinsy,  it  would  seem, 
must  be  classed,  with  other  simple  catarrhal  inflammations, 
which  are  neither  infectious  nor  septic ;  and,  strictly 
speaking,  mumps  can  hardly  be  looked  upon  as  a  throat 
disease. 

The  symptoms  of  all  inflammatory  throat  ailments  are, 
naturally,  owing  to  physical  causes,  more  or  less  identical. 
When  we  consider  that  the  physical  effects  which  ret^ult 
from  scalding  the  throat  with  hot  water  may  give  rise  to 
symptoms  which  are  hardly  distinguishable  from  so  called 

(a)  Bead  before  the  Epidemiologiral  Society  of  Great  Btitain  and 
Ireland,  May  15th,  IbM. 

D 


626     Thb  Mbdigal  Prbbs. 


ORIGINAL  COMMUNICATIONS. 


Jmne  17,  1896- 


membranous  oroap,  it  is  not  surprising  that  idiopathic 
inflammatory  throat  affections  sbonld  occasionally  be 
mistaken  one  for  another,  and  it  is  but  reasonable  to  ask, 
whether  nnder  the  term  lacunar  or  f  oUicalar  throat,  several 
distinct  though  symptomatioally  allied  diseases  may  not 
be  included. 

This  idea,  which  for  some  time  1  had  entertained,  was 
very  forcibly  impressed  upon  me  three  years  ago  by  the 
oocurrenoe  of  a  nondescript  throat  outbreak,  apparently  of 
an  infectious  nature,  in  which  I  was  consulted.  This  out- 
break formed  the  subject  of  a  paper  I  read,  soon  after  its 
occurrence,  at  a  meeting  of  the  Birmingham  and  Midland 
Counties  Branch  of  the  Society  of  Medical  Officers  of 
Health,  and  the  conclusions  arrived  at  were  warmlv 
discussed  and  by  no  means  generally  accepted,  although 
several  observers  have  since  then  recorded  outbreaks  which 
bear  out  my  contention. 

In  support  of  the  theory  which  I  will  afterwards  attempt 
to  explain  I  will  trouble  you  with  a  short  account  of  these 
outbreaks. 

The  one  in  which  I  was  interested  occurred  in  a  village 
school  in  a  scattered  rural  district  of  Staffordshire.  It  was 
not  until  about  a  fortnight  after  the  first  cases  occurred 
that  the  Medical  Officer  of  Health  of  the  district  became 
aware  of  their  existence,  and  he  consulted  me  reearding 
them  the  following  da^.  On  inquiry,  I  found  that  the 
disease  started  in  the  infants'  department  of  the  school, 
beginning  with  twelve  cases,  ana  increasing  daily  up  to 
that  time.  Ten  da^s  after  its  first  appearance  the  numoen 
attacked  greatly  mcreased,  and  then  the  older  children, 
whose  class-rooms,  it  is  important  to  note,  were  situated 
some  distance  from  the  infants'  department,  for  the  first 
time  showed  any  symptoms  of  attack.  By  the  date  of  my 
visit,  at  least  one-third  of  the  three  hundred  children 
attending  the  school  either  had  sufiered,  or  were  suffering, 
from  the  ailment ;  and  at  that  time  the  whole  staff  of 
teachers,  including  the  schoolmaster  and  his  wife,  the 
assistant  mistress,  and  the  papil-teacher,  were  actually  ill, 
some  of  them  seriously  so. 

The  first  symptoms  complained  of  were  headache,  fever- 
ishness,  and  pain  on  swallowing  ;  on  the  second  day  the 
throat  began  to  swell  and  become  painful,  and  the 
patients,  as  a  rule,  felt  too  ill  to  get  about.  In  addition 
to  the  throat  symptoms,  the  lymphatics  of  the  neck  became 
swollen  and  tender,  in  some  cases  very  much  so,  in  others 
less,  bat  in  all  to  some  extent ;  in  fact,  the  swelling  and 
tendemefs  in  many  of  the  cases  was  so  great  that  the 
master  of  the  school  thought  the  patients  were  suffering 
from  mumps,  until  he  was  disabused  of  this  idea  by  the 
Medical  Officer  of  Health,  who  was  consulted  only  when 
the  master's  own  children  were  attacked.  The  throat 
appearances  resembled  those  of  follicular  tonsillitis,  and 
in  none  of  those  examined,  either  by  the  Medical  Officer  of 
Health  or  by  myself,  was  there  any  trace  of  diphtheritic 
membrane  to  be  found  ;  neither  was  any  skin  rash  appar- 
ent. About  the  fourth  day  the  acute  symptoms  Mgan 
to  subside,  but  the  tonsillar  swelling  and  the  enliurgement 
of  lymphatics  remained  for  some  days  after  the  patients 
were  able  to  swallow  oidinary  food.  There  were  no  fatal 
cases,  and  although  careful  inquiry  was  made  concernmg 
upwards  of  a  hundred  children  who  had  suffered,  no  siflpi 
of  any  paralytic  trouble,  however  slight,  was  met  with. 
As  regards  the  numbers  attacked  among  Uie  three  hundred 
children  attending  the  school,  during  a  period  of  about 
fourteen  days  previous  to  its  closure,  when  the  disease 
appeared  to  die  out,  it  is  probable  that  the  hundred  known 
cases  did  not  reprasent  the  total,  for  on  examining  some 
of  the  throats  of  the  children  who  had  not  complained, 
I  discovered  that  some  showed  symptoms  of  the  affection 
in  a  mild  degree,  accompanied  in  some  instances  by  slight 
glandular  swelling— the  most  striking  symptom  in  the 
more  pronounced  cases. 

As  regards  the  possible  origin  of  the  outbreak,  two  or 
three  days  previous  to  the  occurrence  of  the  first  cases  an 
old  drain  had  to  be  opened  at  a  point  immediately  under 
the  windows  of  the  infant  class-room,  in  connection  with 
certain  structural  alterarions  which  were  being  carried  out. 
This  drain— which  was  allowed  to  remain  open  for  a  fort- 
night, althoup^h  it  had  been  covered  in  previous  to  my 
visit— was  found  to  be  almost  completely  obstructed  with 
foal  deposit,  the  mmell  from  which  was  sai^  to  be  most 
offensive.  Besides  the  sink  waste  from  the  schoolmaster's 
house,  the  school  privies  and  urinals  were  all  connected 


with  the  drain,  so  it  is  not  surprising  that  a  most  offensive 
nuisance  was  experienced  when  it  was  opened. 

In  view  of  the  poesible  connection  between  this 
nuisance  and  the  sudden  outbreak,  the  order  of  attack  la 
of  mterest.  As  I  have  stated,  it  was  in  the  infanta' 
department  that  the  first  cases  occurred,  and  these 
happened  almost  simultaneously,  a  few  days  after  the 
opening  of  the  drain.  After  this,  for  some  days,  there  was 
a  lull,  followed  by  a  sudden  increase  of  attacks — also  in 
the  infants'  department— which  was  maintained  for  a 
week  before  the  affection  broke  out  among  the  elder 
children  in  another  part  of  the  school.  A  Table  which  I 
prepared  at  the  time,  showing  the  daily  percentage  of 
absentees  in  the  respective  departments  for  some  weeks 
previous  to  the  outbreak,  and  up  to  the  day  of  the 
closure  of  the  school  in  consequence  of  it,  indicated  this 
very  plainly,  but  the  fact  in  itself  was  so  apparent  that 
the  schoolmaster  had  observed  it,  and  called  our  attention 
to  it. 

If,  then,  one  is  right  in  attributing  the  outbreak  to  the 
drain  nuisance,  it  would  seem  that  a  certain  nomber  of 
children— the  more  susceptible  possibly — contracted  the 
ailment  from  the  original  source  of  contagion,  and  that 
the  others  were  subsequently  infected  from  them  direct. 
This  theory  is  also  borne  out  by  the  fact  that  the  infants, 
whose  class-room  was  in  dose  proximity  to  the  open 
drain,  were  attacked  in  the  first  instance,  while  the  elder 
children  in  the  more  distant  class-rooms — the  windows  of 
which,  I  should  mention,  were  all  on  the  other  side  of  the 
building  from  the  open  drain — were  not  attacked  for  some 
eight  or  ten  days. 

Ab  against  tnis  theory  of  infection,  however,  it  is  bat 
fair  to  state  that  a  house-to-house  inspection  of  the  village 
failed  to  afford  any  very  positive  evidence  that  the  school 
children  who  had  suffered  had  conveyed  the  disease  to 
others  not  attending  the  school.  It  is  true  that  here  and 
there  an  inflammatory  throat  was  met  with,  but  the 
symptoms  were  of  the  mildest  description  and  unattended 
by  glandulitf  swellings. 

As  to  the  nature  of  this  outbreak,  I  unfortunately  hax'e 
no  bacteriological  evidence,  either  of  a  positive  or  negative 
character,  to  offer,  as  the  facilities  which  now  exist  for 
conducting  such  investigations  were  not  then  conveniently 
available.  I  have  no  hesitation  in  saying,  however,  that, 
apart  from  the  fact  that  the  ailment  was  located  in  the  throat, 
and  was  attended  with  glandular  enlargement,  there  were 
absolutely  no  diphtheritic  symptoms.  The  fact  also,  that 
among  upwards  of  100  persons  who  suffered  no  fatal  cases 
occurred,  although  the  illness  in  many  instances  was  by  no 
means  trivial,  together  with  the  entire  absence  of  subse- 
quent paralytic  symptoms,  points  to  the  non-diphtheritic 
nature  of  the  ailment.  The  impression  I  formed  at  the 
time  was  that  everything  pointed  to  this  being  a  specific 
nfectious  throat  affection,  with  characteristic  symptoms 
which,  viewed  collectively,  did  not  fit  in  with  any  named 
disease ;  and  this  impression  has  since  been  strengthened 
by  other  recorded  examples  of  outbreaks,  the  symptoms  of 
which  resemble  in  a  marked  degree  those  of  the  school 
outbreak  I  have  described. 

Two  years  aeo  Dr.  Wheaton  read  a  paper  before  this 
Society  entitled,  *  <  Certain  Affections  of  the  Mucous  Surfaces 
and  their  Relation  to  Diphtheria,"  and  from  his  description 
of  the  symptoms  in  outbreaks  he  had  met  with,  it  would 
appear  that  the  ca^es  resembled  very  closely  those  I  have 
just  referred  to.  His  attention  was  first  directed  to  these 
ailments  in  1890,  when  they  were  very  prevalent  in  a 
district  in  South  London.  Up  to  the  date  of  the  reading 
of  bis  paper  he  had  seen  about  150  cases,  and  had  excep- 
tional opportunities  of  watching  the  coarse  of  the  disease, 
as  sevend  of  the  cases  were  nnder  his  care  in  hospital. 
From  notes  which  he  preserved  of  over  thirty  cavee  he 
describe?  the  symptoms  very  fully,  aid  his  description  may 
be  suoimarisea  as  follows  :  —The  tace  of  the  patient  is  at 
first  fluched,  swollen,  and  puffy,  and  in  all  cases  there  is 
marked  eolargement  of  the  glands  on  both  sides  of  the 
neck,  together  with  tenderness  on  pressure.  Indeed,  itwae 
pointed  out,  as  in  my  cases,  that  the  swelling  of  the  glands 
of  the  neck,  which  persisted  for  a  considerable  time  after 
all  other  i^ymptoms  had  disappeared,  was  one  of  the  meet 
marked  features  of  the  affection.  At  the  commencement  of 
the  disease  there  is  more  or  less  swelling  of  the  palate  and 
fauces,  and  also,  in  some  cases,  but  not  invariably,  of  the 
tonsils.    The  throat  presents  red,  inieoted  patchee,  with  a 


Jtjnm  17,  1896. 


ORIGINAL  COMMUNICATIONS. 


The  Mbdioal  Pbbss.     627 


oentral  white  film,  which  soon,  however,  disappears,  and 
is  rarely  to  be  seen  from  twenty-four  to  forty-eight  hours 
After  the  first  appearance  of  the  symptoms  After  the 
disappearance  of  this  film,  which  has  none  of  the  micro- 
scopic appearances  of  diphtheritic  membrane,  a  red,  raw 
sarfaoe  is  exposed,  very  much  resembling  the  exposed 
snrfaoe  after  the  separation  of  the  membrane  in  cases  of 
undoubted  diphtheria.  The  temperature  at  first  rises  to 
102°  to  103°,  but  in  the  course  of  two  or  three  days  it  sub- 
sides to  normal.  The  illness  is  followed  by  prolonged 
debility,  but,  although  the  patients  were  under  observation 
for  from  four  to  six  weeks,  no  paralytic  sequels  were 
observed  in  any  instance.    There  were  no  fatal  cases. 

Dr.  Wheaton  then  referred  to  certain  affections  of 
other  mucous  surfaces  presenting  identical  appearances 
to  those  descriued,  which  had  also  come  under  his 
observation,  sometimes  associated  with  the  throat  affection, 
and  at  other  times  not,  and  which  bacteriologically  proved 
to  be  identical.  Subsequently,  in  1893,  Dr.  Wheaton  met 
with  a  similar  outbreak,  associated  with  an  epidemic  of 
diphtheria,  in  a  town  of  about  10,000  inhabitants,  where 
the  evidence  pointed  to  the  public  elementary  schools  as 
being  the  chief  means  of  spread.  It  is  interesting  to  note 
that,  besides  the  cases  of  this  throat  affection  associated 
with  diphtheria,  it  was  found,  on  inquiry  at  the  houses  of 
the  town,  that  similar  cases  occurred  unassociated  with 
diphtheria,  in  families  in  which  no  children  attended 
school.  Also,  the  infection  was  found  to  exist  in  an  insti- 
tution in  which  none  of  the  children  had  been  attacked 
with  diphtheria. 

The  bacteriological  evidence  in  Dr.  Wheaton's  cases  was 
entirely  negative  ;  no  organisms  resembling  the  bacillus 
diphtheria)  were  ever  found,  neither  was  the  '*  thrush " 
fungus  nor  any  other  fungus  met  with,  but  a  micro- 
coccus growing  in  orange-yellow  colonies  was  always 
obtained  by  cultivation  tests  with  the  throat  pellicles  and 
secretions. 

Dr.  Thresh  has  paid  considerable  attention  to  this  sub- 
ject, and  for  some  years  past  has  carefully  inquired  into  all 
throat  outbreaks  in  schools,  special  notice  of  which  had 
been  sent  to  him,  at  his  request,  by  various  schoolmasters. 
By  this  means  his  attention  was  directed  to  many  such 
outbreaks,  and  the  information  he  thus  acquired,  in  addi- 
tion to  facts  ascertained  in  consultation  witn  local  medical 
officers  of  health,  formed  the  subject  of  a  paper  which  was 
read  at  the  Home  Counties  Biancb  of  the  Society  of 
Medical  Officers  of  Health  a  year  ago. 

In  this  paper  Dr.  Thresh  detailed  the  facts  of  nine  or 
ten  outbreaks  to  which  his  attention  had  been  directed. 
In  some  instances  true  diphtheria  cases  were  met  with, 
associated  with  cases  supposed  to  be  diphtheritic  but  which 
proved  not  to  be  so ;  and  in  other  cases  Dr.  Thresh  came 
to  the  conclusion  that  the  throat  symptoms  were  sympto- 
matic of  influenza.  On  more  than  one  occasion,  however, 
somewhat  extensive  outbreaks  occurred,  which,  although 
infectious,  did  not  present  the  symptoms  of  diphtheria, 
and  in  which  bacteriological  examination  failed  to  detect 
the  presence  of  the  bacillus.  Dr.  Thresh  thus  describes 
the  typical  symptoms  of  such  cases  :  "  One  or  more  points 
in  the  mucous  membrane  of  the  tonsiU,  soft  palate,  or 
uvula  become  infiltrated,  appearing  paler  than  the  sur- 
rounding membrane.  The  patch  becomes  paler  and  paler, 
until  nearly  white.  It  is  but  slightly,  if  at  all,  raised, 
and  has  no  sharply-defined  margin.  Before  becoming 
white  the  infiltrating  material  may  be  absorbed,  and  the 
part  resume  its  normal  appearance,  but  when  it  has 
assumed  the  milkv  white  colour,  it  finalW  peels  off,  leaving 
a  shallow  ulcer  which  speedily  heals.  It  may  or  may  not 
be  associated  with  a  mild  form  of  tonsillitis.  The  consti- 
tutional disturbance  is  as  a  rule  very  slight,  but  occasion- 
ally there  are  maked  premonitory  symptoms — headache, 
nausea,  languor,  and  feverishnees — but  these  speedilv 
pass  away  and  the  patient  feels  fairly  well."  Dr.  Thresh 
also  refers  to  an  accompanying  glandular  enlargement,  so 
marked  in  many  of  the  cases  that  they  were  regarded  as 
mumps,  although  the. patients  had  no  affection  of  the 
parotid  gland. 

As  regards  the  bacteriology  of  these  cases.  Dr.  Thresh 
found  various  organisms  associated  with  them,  but  came 
to  no  definite  conclusion  as  to  whether  they  had  any  direct 
caudal  relation  to  the  disease.  In  concluding  his  paper, 
he  said :  — **  One  thing  is  becoming  clear  :  that  under  the 
name  '  iiphtheria '  we  are  includinir  two,  if  not  several. 


distinct  diseases,  due  to  the  development  of  different  or- 
ganisms on  or  in  the  mucous  membrane  of  the  throat. 
Amongst  the  countless  multitude  of  micro-omnisms 
which  occur  in  nature,  it  would  indeed  be  wonderful  if  one 
only  were  capable  of  developing  upon  nature's  medium, 
ana  in  nature's  incubator,  and  of  injuriously  affecting  its 
host.  During  sleep,  the  back  of  the  mouth  forms  the 
incubator  par  excdUnce,  Many  different  organisms 
flourish  there,  more  than  one  of  which  are  probably  capable 
of  penetrating  the  mucous  membrane,  and  causing  its  infil- 
tration and  exfoliation ;  and  the  products  of  its  meta- 
bolism, toxins,  &c,  becoming  absorbed,  may  be  the  cause 
of  constitutional  disturbances,  such  as  those  described  in 
connection  with  the  epidemic  of  '  sore  throat.' " 

Among  other  nonaescript  infectious  throat  outbreaks 
which  have  recently  been  recorded,  may  be  mentioned  one 
which  occurred  in  the  Finchley  district,  and  was  investi- 
gated by  Dr.  Kenwood.  This  outbreak  presented  several 
interesting  features.  The  disease  attacked  adults  in  pre- 
ference to  children,  in  the  proportion  of  two  to  one,  and 
the  origin  was  traced  to  a  certain  milk-supply  from  a  dairy 
farm  wnere  three  of  the  cows  were  found  to  be  suffering 
from  a  febrile  ailment  accompanied  by  ulcerated  teats. 
Milk  from  this  dairy  was  supplied  to  seventeen  per  cent, 
of  the  houses,  and  ninty-four  per  cent,  of  the  families 
attacked  obtained  their  supply  from  chis  source. 

Gentlemen,  I  think  it  will  be  admitted  that  the  occur- 
rence of  the  outbreaks  which  I  have  shortly  summarised 
points  to  the  existence  of  other  throat  ailments  of  an  in- 
fections nature  besides  scarlet  fever  and  diphtheria.  It 
is  true  these  ailments  are  often  associated  with  diphtheria 
and  scarlet  fever,  but  sometimes  they  are  met  with  alone. 
Aldo,  although  one  outbreak  may  differ  from  another  in 
some  respects,  they  have  many  features  in  common,  and, 
apart  from  differences  in  degree,  the  cases  in  each  outbreak 
strikingly  reeemble  each  other ;  and  one  cannot  but  look 
upon  them  as  specific  although  unnamed  ailments,  which 
are  entitled  to  a  special  place  in  the  zymotic  group,  even 
if,  for  the  present,  no  more  distinctive  name  than  "  pseudo- 
diphtheria  "  can  be  found  for  them. 

I  would  now  refer,  very  shortly,  to  the  possible  light 
which  snch  outbreaks  throw  on  the  '*  prop^ressive  develop- 
ment "  theory.  First,  however,  as  a  (mmis  of  argument,  I 
must  attempt  to  define  what,  as  I  understand,  is  meant 
by  that  theory.  It  would  seem  to  imply  that  under  certain 
conditions  throat  ailments,  which  present  no  characteristics 
of  diphtheria,  and  are  not  even  infections,  may  in  the 
course  of  an  outbreak  assume  infective  properties,  and 
ultimately  become  truly  diphtheritic,  as  proved  by  the 
presence  of  the  characteristic  bacillus :  the  development 
process  being  a  gradual  one,  brought  about  by  conditions 
intimately  associated  with  the  patients  themselves  or  their 
surroundings. 

Now  I  may  say  at  once  that  I  am  willing  to  accept  this 
theory,  provided  it  can  be  shown  to  be  the  only  reasonable 
explanation  of  events.  In  fact,  I  am  prepared  to  go  almost 
any  length  in  upholding  evolution  as  a  ractor  in  the  pro- 
duction of  zymotic  disease,  but  I  am  inclined  to  think  that 
it  operates  in  a  leas  radical  fashion.  For  example,  it  is  not 
unlikely  that  a  mild  ailment  of  a  specific  type  may,  by  pro- 
gressive development  during  the  same  outbreak,  assume  a 
more  malignant  form,  but  this  is  very  different  to  the 
transformation  of  one  affection  of  a  specific  type  into 
another  of  a  different  type.  To  my  mind,  if  this  were 
possible,  one  might  with  as  much  reason  conclude  that 
measles  may  develop  into  whooping-cough,  or  small-pox 
into  scarlet  fever. 

Evolution,  in  my  opinion,  exercises  a  most  potent  in- 
fluence in  the  production  of  disease,  but  there  are  Umits  to 
its  operation.  It  is  likely  that  to  it  is  to  be  attributed  the 
apparent  de  novo  production  of  disease — an  occurrence, 
indeed,  which  is  sometimes  used  as  an  argument  against 
its  bacterial  origin,  because  it  is  supposed  that  it  occasion- 
ally implies  a  belief  in  the  recreation  of  life.  This  argu- 
ment was  recently  made  use  of  by  Dr.  Harrison,  who 
hesitated  to  accept  as  proven  the  bacterial  origin  of  diph- 
theria, because  of  his  experience  fifty  years  ago  in  Ontario. 
He  writes :— "  Diphtheria  reached  us  before  railways  had 
opened  up  the  country,  and  I  repeatedly  saw  it  on  isolated 
farms  surrounded  by  woods,  and  where  it  could  not  possibly 
have  been  carried  from  without,  and  where  the  land  had 
been  so  recently  redeemed  from  the  forest  that  it  could  not 
have  been  derived  from  some  previous  but  forgotten  < 


628     Thi  Midigal  Pbxss. 


TRANSACTIONS  OF  SOdEHES. 


JuNB  17,  1898 


Id  reply  to  Dr.  Harriaon,  I  woald  ask  why  shonld  we  be 
at  a  losa  for  an  explanation  of  rach  an  ocearrence,  when  we 
know  that  ander  oor  very  eyee  organisms  aesame  different 
forms  and  shapes,  through  infinitesimal  changes  in  their 
enviionment  brought  abont  bjr  artificial  means,  and  that 
the  chemical  proaucts  of  their  existence — which,  in  all 
probability,  are  in  most  oases  the  active  disease- poisons — 
are  entirely  altered  by  the  process?  May  not  similar 
changes  be  constantly  brought  about  by  natural  prooetses, 
and  ii  so  does  not  this  explain  the  apparent  mystery  ?  If, 
owing  to  the  extreme  morphological  variability  of  micro- 
organisms their  character  and  habits  can  be  altered  by 
artificial  means,  such  as  a  change  of  pabulum,  a  lowering  or 
raiting  of  temperature,  a  moistening  or  drying  of  their 
surroundings,  may  not  similar  changes,  acting  in  nature,  be 
instrumental  in  transforming,  not  one  type  of  organism 
into  another  type,  but  one  in  a  non-pathogenic  phase  of 
its  existence  into  a  pathogenic  phase,  and  thus  give  rise  to 
disease.  A  great  aeal  more  than  this  must  take  place, 
however,  if  the  progressive  development  theory  impltee  all 
that  it  would  seem  to  imply,  when  viewed  in  the  light  of 
the  outbreaks  to  which  I  have  called  attention. 

In  all  probability,  in  the  case  of  my  school  outbreak,  had 
a  case  of  diphtheria  been  introduced  into  the  school  many 
children  would  have  been  attacked,  in  consequence  of  tfaie 
favourable  field  which  the  already  impaired  throats  pre- 
sented for  the  reception  and  growth  of  the  bacillus ;  and  in 
that  case  it  is  highly  probable  that  the  outbreak  would 
have  been  cited  as  an  example  of  the  progressive  develop- 
ment theory.  In  the  case  of  similar  outbreaks  to  which  I 
have  referred,  diphtheria  did  break  out  and  run  concur- 
rently with  the  other  cases  ;  and  Dr.  Kenwood  mentione  a 
case  m  which  thirty  persons  suffered  from  true  diphtheria 
during  an  outbreak  of  so-called  acute  follicular  tonsillitis, 
ten  of  whom  showed  the  first  symptoms  of  the  disease 
after  convalescence  from  the  original  ailment  had  been 
well  established,  and  the  throats  had  resumed  almost  their 
normal  appearance. 

It  is  now  known  that  the  bacillus  diphtheriae  is  frequently 
found  in  perfectly  healthy  throats ;  it  may  be,  therefore, 
that  an  impaired  surface  is  essential  to  its  development,  and 
that  this  is  the  sole  explanation  of  the  fact  that  diphtheria 
outbreaks  are  so  frequently  associated  with  milder  throat 
ailments. 

Gentlemen,  this  question  is  not  merely  one  of  scienti6c 
interest.  If  the  contagia  are  often  the  outcome  of  a  process 
of  evolution  dependent  upon  agencies  which  are  within  our 
control,  may  we  not,  by  exercising  that  control,  be  able  to 
stamp  out  such  diseases  before  they  can  get  hold  of  our 
bodies,  and  so  propagate  themselves  direct  from  person  to 
person.  So  far,  our  efforts  in  the  case  of  those  affections 
we  are  considering  this  evening  have  not  been  successful, 
but  with  improved  knowledge  of  the  life-history  of  the 
responsible  bacteria,  I  believe  that  such  disea(>e8  will  no 
longer  remain  the  only  ones  in  the  zymotic  class  which 
hare  not  yielded  to  the  advance  of  sanitation. 


OBSTETRICAL  SOCIETY  OF  LONDON. 
MiKTiNo  Hbld  Wbdnesdat,  Juvb  3rd. 

The  President,  Dr.  Champnets,  in  the  Chair. 

Spicimen. 
Db.  a  Routh  showed  a  specimen  of  Hydrosalpinx  re- 
moved by  anterior  colpotomy. 

CASIS  OF  FIBROMA  OF  THE  OVART  AND   OVARIAN  LIUAMIKT 
REMOVED  BY  OPERATION. 

Mr.  Alban  Doran  first  read  notes  of  two  cases  of  fibroma 
of  1  he  ovary  in  his  own  operative  practice ;  one  typical 
and  recently  in  hand,  whilst  in  the  second  the  tumour 
was  removed  in  1889,  and  though  it  seemod  to  present 
some  of  the  microscopic  characters  of  sarcoma,  no  recur- 
rence has  occurred.  Eleven  cases  are  tabulated;  they 
include  the  above,  whilst  the  remainder  were  reported, 
when  recent,  in  the  Society's  *' Transactions  "  sioce  1879, 
t  he  author  adding  after-histories.  This  is  done  on  account 
of  the  question  of  rf  currence  ;  since  in  four  (No*.  1,  8,  9, 
and  IC)  at  least,  malignancy  was  suspected,  yet  the  after- 


histories  proved  innocence.    Meet  of  the  eleven  bore  the 
naked-eye   characters   of   a    fibroma.      The     snspicious 
microscopic  elements  in  Nos.  1,  8,  9,  and  10  were  appar- 
ently connective- tissue  eells  between  bundles    of   wnite 
fibre.    Myomata  of  the  ovary  are  not  considered  in  this 
communication.     In  only  one  case  (No.  1)  was  the  disease 
bilateral.    One  (Na  4)  exceeded  ten  pounds  in  weight ; 
but  older  writers,  in  days  when  operation  was  defetied 
long  after  diagnosis,  reoorded  heavier  fibromata.    In  two 
the  patient  was  under  twentv  ;  in  four  under  twenl^-five ; 
in  one  no  age  was  reported,  but  the  patient  was  young. 
In  three  she  was  between  twenty-seven  and  thirty-six ; 
and  in  one  (Na  7),  under  the  author's  care,  she  was  fifty- 
two.    Thus  the  disease  is  relatively  frequent  in  youth,  yet 
may  develop  after  the  menopause,    The  tumour  was  ob- 
served in  most  cases  abont  eighteen  months  before  opera- 
tion.   In  the  onl^  instance  (Na  1)  where  there  was  do 
operation  the  patient  died  of  double  pleurisy  with  ascitei 
six  years  after  the  tumour  was  first  detected.   In  six  (Sot. 
1, 2, 3, 7,  8,  and  11)  extreme  hardness  was  noted  on  dioicsl 
examination  :  none  seem  to  have  been  actually  soft.  Calci- 
fication was  observed  in  one  case  (No.  2).    Dysuria  was  a 
prominent  symptom  in  two  cases  (Nos.  3  and  11)  ;  indeed 
in  one  of  them  (No.  11)  an  attack  occurred  a  year  before 
the  tumour  was  detected.    In  more  than  half  the  oases  the 
catamenia  were  regular.    In  three  at  least  (Nos.  3,  7,  and 
11)  the  uterine  cavity  was  abnormally  long,  though  no 
uterine   myoma  existed.    In  ten  out  of  the  eleven  tbe 
tumour  was  removed  by  ovariotomy.    In  none  was  the 
operation  very  difiicult,  and  all  recovered.    In  seven  no 
adhesions  were  found.     The  pedicle  was  always  anatomi- 
cally normal  and  long  enough  to  be  secured  with  ease.   In 
two  cases  (Nos.  3  and  11)  it  was  twisted,  without  earning 
the  pain  and  other  symptoms  so  prominent  in  twisted 
dermoids.    In  the  eleven  cases  free  fluid  was  found  in  tbe 
peritoneum  in  at  l«ast  five  (Nos.  1,  7,  8,  9,  and  11).    The 
after-histories  of   the  ten  oporation  cases   are,  witboat 
exception,  favourable.     Eight  remaineu  free  from  recor- 
rence  two  to  twelve  years  after  the  operation.    Tbe  two 
which  remain  reoovered    rapidly,  but   are  quite  reoeut 
eases.    Though    always  hard  and  heavy,  fibroma  of  the 
ovary  causes  Tees  pain  than  dermoid  or  any  other  solid  or 
semi-solid  ovarian  tumour.    A  markedly  hard  and  painless 
tumour,   moving  separately  from  the  uterus,  in  a  very 
young   woman   is   meet    probably   an    ovarian   fibroma. 
iPedunculated  subperitoneal  uterine  myoma  is  praotioally 
unknown    in    early    womanhood,  whilst   dermoids,  very 
common      in     youth,    are     seldom      uniformly    hard ; 
and     the     hardest     usually    set    up    the    most    pain. 
Sarcoma  of    the    ovary,    relatively    frequent    in   girl- 
hood,    is     nearly    always     soft    and    associated    with 
amenorrhcea  and  cachexia.    Ovariotomy  is  the  only  treat. 
ment  for  fibroma  of  the  ovary.     The  abdominal  woaod 
bleeds  very  freely,  as  in  cases  of  uterine  myoma ;  it  mast 
not  be  made  too  short,  else  it  may  be  badly  bruised  dariDg 
extraction  of  the  hard  tumour.    Three  authentic  oassfi  ot 
fibroma  of  the  ovarian  ligament  are  tabulated.     Two  (Noc. 
1  and  2)  are  certainly  fibromata  with  cystic  cavities ;  one 
(No.  3)  is  said  to  be  sarcoma,  but  its  extreme  hardness  aod 
slow  growths  do  not  favour  that   theory.    Thistnmoar 
grows  to  a  large  size,  the  author's  (No.  1)  weighing  over 
sixteen  pounds.    In  all  three  the  disease  was  unilateral 
an*!  the  adjacent  tube  and  ovary  free  from  the  new  growth. 
When  large,  the  tumour  may  become  osdematous  and  sofc. 
Ascites  and  adhesions  do  not  readily  develop.    In  all  three 
cases  the  patient  was  in  the  prime  of  sexual  life.    3den- 
struation  was  regular  in  every  case.     Diagnosis  is  hardly 
possible.     The  uterus  may  be  enlarged,  yet  free  from 
fibroids.    All  three  tumours  were  removed.    In  two  caM« 
(Nos.  2  and  3)  the  tumour  alone  was  taken  away,  the 
ovary  and  tube  being  saved ;  but  one  (No.  3)  died  on  the 
fourth  day.    There  seems  to  be  no  tendency  co  recurrence, 
the  author's  case  (No.  1)  and  M.  Dol^ris'^  (Na  2)  beisg 
both  still  alive  and  healthy  six  years  and  a  half  alter  the 
operation. 

Dr.  MacNauohton-Jonbs  related  a  case  of  his  own 
which  confirmed  the  remarks  made  by  the  author.  Tbe 
patient  was  a  young  woman,  set.  22,  who  came  with 
anemia,  gastric  troubles,  and  amenorrhcea  of  two  yean' 
standing.  He  accidentally  discovered  the  existence  of  a 
roundea  tumour  in  the  left  iliac  region,  whicb  felt  like  a 
pedunculated  uterine  fibroid.  He  decided  to  examine  her 
under  an  anesthetic,  but  on  H ting  so  he  waa  sorprisod  to 


JuxB  17,  1806. 


TRANSACTIONS  OF  SOCIETIES. 


The  Mxdioal  Vbbbs. 


find  that  all  trace  of  the  tamoar  had  disappeared  throQsh 
the  abdominal  wall.  Per  vaginam,  however,  a  aoud 
tumour  could  be  felt  lying  in  front  of  the  uterus,  blocking 
the  pelvi*.  This  waa  removed,  and  proved  to  be  a  fibroid 
tumour  of  the  ovary.  The  ovary  on  the  other  side  was 
healthy.  He  showed  sections  from  the  growth  which 
proved  it  to  be  composed  of  fibrous  tissue. 

Dr.  Handfibld  Jonbs  said  that  his  first  case  of  the  kind, 
referred  to  by  the  author  in  his  list  (No.  8),  was  also 
a  young  woman,  but  a  second  case  of  the  kind  which  had 
come  under  his  notice  was  in  a  woman,  »t.  58.  She  had  a 
slowly-enlarging  tumour  above  Poupart's  ligament,  which 
ultimately  developed  to  the  size  of  a  full-term  pregnancy. 
On  its  removal  it  was  found  to  be  a  fibroma  of  the  left 
ovary,  which  had  been  pushed  up  under  the  ribs  by  a 
cystic  tumour  of  the  opposite  ovary.  Sections  of  the 
growth  looked  very  much  like  those  from  his  first  case,  i.e., 
rather  sarcomatous  than  fibrous.  Clinically,  however,  the 
appearances  were  in  favour  of  fibroma  rather  than 
sarcoma. 

Dr.  HoBRociLs  aaid  he  would  really  like  to  have  further 
and  more  precise  information  as  to  the  distinguishing 
features  b^  which  they  could  decide  whether  a  eiven  sec- 
tion was  nbroma  or  sarcoma.  The  more  he  had  inquired 
into  the  matter  the  less  he  understood  what  these 
differences  were.  He  suggested  that  sarcomatous  growths 
possibly  commenced  as  fibromata,  and  that  in  certain 
cases  the  fibroma  was  removed  before  it  had  developed 
into  a  parcoma. 

Dr.  CuLLiNowOBTH  pointed  out  that  the  fact  of  no  recur- 
rence having  taken  place  did  not  per  st  suffice  to  establish 
the  non- malignancy  of  the  growth.  Otherwise  it  might  be 
inferred  that  all  operations  for  sarcomatous  growths  must 
necessarily  be  unsuccessful.  The  most  that  could  be  said 
was  that  the  subsequent  history  of  the  case  threw  some 
doubt  upon  the  validity  of  the  orisrinal  diagnosis.  His 
view  of  tne  occurrence  of  fibroids  of^  the  uterus  in  young 
people  was  that  they  wore  exceedingly  rare,  but  he  could 
not  agree  with  the  author  that  they  were "  practically 
unknown." 

Dr.  Spbkoer  said  his  own  experience  of  this  class  of 
cases  was  limited  to  three.  He  agreed  with  what  had 
fallen  from  the  author  in  the  main,  that  growths  contain- 
ing spindle  cells  might  remain  many  years  without  recur- 
rence. He  had  come  across  such  a  tumour  in  a  woman 
who  had  died  of  phthisis  and  the  most  careful  search 
failed  to  reveal  any  other  growth  of  the  kind  elsewhere. 
In  his  third  case  there  was  a  small  tumour  on  the  right 
side,  and  on  the  other  side  an  enormous  multilocular  cyst. 
She  was  kept  under  observation  for  several  vears  without 
any  recurrence  taking  place.  In  this  case  there  were  the 
same  microeoopioal  appearances.  The  presence  of  effu- 
sions into  the  peritoneum  or  pleura  was  not  in  his  exper- 
ience a  certain  sign  of  malignancy,  for  in  two  non- malig- 
nant oases  these  have  been  present.  He  had  several  times 
observed  small  fibrous  nodues  in  the  walls  of  multilocular 
cysts  of  the  ovary  which  were  not  followed  by  recurrence. 
He  had  also  met  with  diffuse  tumours  and  tniokening  of 
the  pedicle  and  broad  ligament,  but  these  oases  belonged 
to  a  different  class. 

The  PREHIDBMT  ssksd  the  author  whether  he  considered 
non -recurrence  as  a  sufiioient  proof  of  non- malignancy  ; 
also  whether  be  maintained  that  fibroid  tumours  before  the 
age  of  SS5  were  '*  practically  unknown,"  or,  as  Dr.  Culling- 
worth  had  suggested,  only  ** exceedingly  rare"? 

Mr.  Alban  DoKAN,  in  reply,  urged  3iat  malignancy  was 
a  clinical  term,  and  if  the  growths  did  not  behave  in  a 
malignant  manner  he  took  it  that  thejr  were  not  malignant. 
He  had  asked  a  number  of  experienced  gynecologists 
whether  they  had  met  with  instances  of  fibroid  tumours 
before  25,  and  they  have  all  replied  in  the  negative,  and 
this  fact  appearecT  to  him  to  justify  the  statement  that 
they  were  "  practically  unknown." 

ANTSBIOK  C0IJ»0T0My. 

Dr.  John  Puilups  read  a  paper  on  this  subject,  in 
which  he  pointed  out  that  the  credit  of  proposing  this 
operation  appeared  to  belong  to  Diihrssen.  Anyone  vho 
had  performed  either  vaginal  hysterectomy  or  fixation 
must  have  been  struck  by  the  ease  with  which  the  pelvio 
organs  could  be  examined  through  the  opening  in  tbe 
anterior  oal-de<sac  He  had  performed  the  operation  foor 
times,  in  the  first  of  which  vaginal  fixation  only  was  origin-  I 


ally  intended.  All  did  well.  When  practicable  this 
operation  presented  the  advantages  over  the  abdominal 
operation  of  avoiding  the  risk  of  subsequent  adhesions  of 
omentum  or  intestine,  or  of  intestinal  obstruction,  which 
were  apt  to  follow  abdominal  operations,  and,  moreover,  it 
does  not  leave  the  patient  exposed  to  the  risk  of  ventral 
hernia.  There  was  no  troublesome  sickness  afterwards, 
and  the  convalescence  was  materially  shortened.  There 
was  no  bleeding  of  consequence,  and  no  drainage  was 
required.  On  the  other  hand,  there  was  ereate*-  difficulty 
in  rendering  the  vagina  antiseptic,  and  there  was  greater 
risk  of  wounding  the  bladder,  ureter,  or  rectum.  The 
operation  was  unsuitable  in  large  ovariotomies  or  large 
fibroid  tumours,  also  in  cases  of  abscess  pointing  towards 
the  abdominal  walls.  It  must,  moreover,  always  be  borne 
in  mind  that  the  peritoneal  cavity  was  opened  with  the 
usual  risks,  and  its  ease  did  not  do  away  with  the  fact  that 
removal  of  the  ovary  was  a  mutilation,  to  be  avoided  if 
possible. 

Dr.  A.  RoUTH  alluded  to  the  two  alternative  incisions 
used  in  this  operation,  viz.,  the  transverse  incision  in 
front  of  the  cervix,  or  the  longitudinal  incision  from  the 
cervix  to  the  neck  of  the  bladder.  He  thought  that  a  com- 
bination of  the  two  incisions,  as  originally  suggested  by 
Martin,  was  preferable.  If  the  bladder  were  stripped 
from  the  anterior  wall  of  the  vagina,  it  rose  out  of  harm's 
way.  He  had  always  found  a  difficultjr  in  tilting  the 
uterus,  and  he  suggested  that  possibly  this  might  be  done 
either  by  means  of  the  finger  in  the  rectum  or  by  sutures 
passed  through  tbe  fundus  by  which  it  could  be  dragged 
down.  These  sutures  might  in  certain  cases  be  subee- 
quently  used  for  suturing  the  fundus  for  fixation  pur- 
po«>es. 

Mr.  Malcolm  said  there  was  always  the  very  great 
difficulty  of  rendering  the  vagina  aseptic,  and  it  would  be 
difficult  to  improve  on  the  statistics  of  the  abdominal 
method.  Then  too,  if  one  happened  to  stumble  upon  a 
difficult  case — audit  was  impossible  beforehand  to  know 
whether  a  case  would  be  easy  or  difficult — it  might  bein»)Os- 
eible  to  complete  the  operation  in  this  way.  He  failed  to 
see  how  the  results  in  tne  easy  cases  treated  by  tbe  abdo- 
minal method,  could  be  improved  upon,  the  mortality  being 
almost  nil 

The  Prssidkmt  did  not  think  that  cases  of  chronic 
ovaritis  with  adhesions  could  be  as  effectually  dealt  with 
by  this  method  as  by  the  abdominal  operation.  Indeed, 
under  certain  circumstances,  it  would  not  be  j  ossible  to 
break  down  the  adhesions  through  the  vaginal  openinf' 
He  thought  too  it  would  be  risky  to  attempt  to  deal  with 
an  extra-uterine  gestation  sac  through  the  vagina.  Small 
fibroids  of  the  anterior  part  of  the  uterus  rarely  called  for 
removal  and  if  they  had  to  enucleate  a  small  ovarian 
tumour  it  would  be  difficult  by  this  operation.  In  shor  , 
cases  where  tbe  operation  would  be  easy,  might  very  we.l 
be  left  alone,  and  when  serious  they  had  better  be  dea^t 
with  by  the  other  method.  He  pointed  out  that  although 
theoretically  it  ought  to  be  dangerous  to  operate  through 
the  vagina  on  account  of  the  difficulty  of  rendering  it 
aseptic,  statistics  prove  the  reverse  to  be  the  case. 

IMPAGTBD  DERMOID  GTbT  REMOVBD  DURING  THE  NINTH 
MONTH   OF   PREGNANCY. 

Mr.  T.  H.  Morse,  of  Norwich,  contributed  the  case  of 
a  woman,  sot.  30,  multipara,  whose  last  confinemeot  was 
two  years  previously.  She  was  seen  at  the  eighth  month 
of  pregnancy,  when  it  was  seen  that  the  pelvis  was  blocked 
by  a  semi-solid  tumour.  This  was  not  attached  to  tLe 
sacrum.  Delivery  under  these  circumst«noee  being  im- 
possible, it  was  removed  by  abdominal  section  through 
an  incision  11  inches  in  length,  of  which  the  middle  was 
opposite  the  umbilicus  It  proved  to  be  a  dermoid  cyst'  of 
the  right  ovary,  just  large  enough  to  fill  the  pelvis.  The 
pedicle  was  3  inches  long,  and  was  twisted  one  and  a  hajf 
times  from  left  to  right.  The  operation  lasted  twent}- 
five  minutes,  and  the  patient  made  an  uneventful  recover} , 
labour  taking  place  at  term  without  complication. 

Dr.  BoXALL  asked  whether  the  cicatrix  became  pig- 
mented. He  was  engaged  in  collecting  data  with  reference 
to  the  pigmentation  of  cicatrices  at  different  periods  of 
pregnancy.  This  pigmentation  did  not  appear  to  cease 
with  labour,  for  he  had  seen  the  scar  become  pigmented 
when  the  operation  was  performed  during  labour,  even  the 
suture  holes  becoming  pigmented. 


650    Ths  Mboioal  Phms. 


TKANSACTIOJ^^S  OF  SOCIETIES. 


Juki  17,  1880. 


ROTAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

SsCTIOir  OF  SUBOBRT. 

Mbstino  hbld  Fkidat,  May  Ist,  1896. 


The  President!  Sm  THomrLET  Stoksb,  in  the  Chair, 

NOTBS  OV  OVARIOTOMY. 

Sib  William  Stokbs  read  a  paper  on  this  subject,  and 
commenoed  by  pointing  out  that  in  the  modem  evolution 
of  abdominal  sorgery  ovariotomy  stands  out  in  boldest 
relief.  Reminiscenoes  connected  with  the  keen  interest 
that  was  excited  in  the  surgical  world  by  the  early  cases 
of  Clay,  Sir  Spencer  Welfi,  and  Baker  Brown  were 
detailed,  and  reference  made  to  the  fact  that,  although  the 
operation  was  for  many  years  regarded  as  exclusively  in 
tflkO  domain  of  specialism,  it  has  now,  owing  to  improve- 
ments in  technique  and  a  wider  knowledge  of  aseptic  and 
antiseptic  surgery,  become  one  constant^  performed  with 
siffDal  success  in  our  general  hospitals.  The  author's 
''Notes  "  were  based  on  the  results  of  the  last  twelve  cases 
he  had  operated  on,  of  which  ten  were  brought  to  a  suc- 
cessful issue.  Some  of  these  cases  had  alret^y  been  pub- 
lished, but  the  principal  details  of  the  last  four  ones  were 
given.  All  these  were  successful.  The  treatment  pre- 
paratory to  operation  of  such  cases  was  discussed,  and  the 
views  of  Professor  Ashton,  of  Philadelphia,  on  this  subject 
were  quoted  with  approval.  Several  points  in  connection 
with  the  technique  of  the  operation  as  regards  the  question 
of  a  free  or  limited  incision,  the  mode  of  dealing  with 
adhesions  and  with  the  pedicle,  the  variety  of  ways  in 
which  the  ligature  may  be  employed,  and  sutures  inserted, 
and  lastly,  the  rules  that  should  be  observed  in  the  post- 
operative treatment,  were  all  discussed.  The  author  con- 
cluded by  remarking  that  although  the  number  of  the 
cases  in  which  he  based  his  observations  were  few  in 
number,  in  comparison  with  the  stupendous  «>tati8tics 
published  by  some  practitioners,  they  were  sufficient  to 
justify  him  in  maintaining  the  view  that  the  operation 
should  no  longer  be  regard^  as  belonging  exclusively  to 
the  limited  province  of  the  specialist,  but  mav  be  under- 
taken with  confidence,  in  the  great  majority  of  instances, 
in  a  general  surgical  hospital — the  hygienic  surroundings 
being  suitable,  and  the  operator  one  who  works  conscien- 
tiouslv  and  is  possessed  of  judgment  and  ordinary  mani- 
pulative  dexterity. 

Mr.  FiTzoiBBON  said  that  the  best  incision  was  one  which 
would  let  the  operator's  hand  into  the  abdominal  cavity 
with  ease. 

Mr.  TwuDY  did  not  think  that  general  surgeons  should 
perform  the  operation  of  ovariotomy.  All  the  tumours 
mentioned  by  Sir  William  were  large.  The  larger  the 
case  the  more  difficult  was  the  disgnosis  and  the  operation. 
In  none  of  the  cases  were  the  symptoms  mentioned  of  any 
practical  value  as  regards  the  diagnosis  of  an  ovarian 
tumour.  A  fibro-myoma  would  present  the  same  sym- 
ptoms, as  far  as  measurements  were  concerned.  A  fibro- 
myoma  often  lasted  for  years  without  any  menstrual  show. 
The  onl^  way  to  diagnose  an  ovarian  tumour  was  to  feel 
the  pedicle  and  the  round  ligament.  The  person  who 
diagnosed  the  case  should  operate  on  it.  The  necessary 
asepsis  could  only  be  obtained  in  a  room  wholly  set  aside 
for  abdon&inal  surgery  and  not  in  an  ordinary  operating 
theatre.  As  regards  uie  abdominal  incision,  if  the  tumour 
was  cystic,  by  tapping  the  cysts  an  enormous  tumour 
could  be  brought  through  a  small  incision.  The  larger 
the  incision  the  greater  the  danger  of  abdominal  hernia, 
though  if  the  operation  was  stricter  aseptic  and  no  stitch 
abscess  formed,  there  was  very  little  fear  of  abdominal 
hernia.  In  lijgaturing  the  stump  the  danger  was  not  that 
the  stump  might  tie,  but  that  the  stump  might  become 
adherent  to  the  int-estine,  and  intestinal  obstruction 
follow.  A  good  precaution  to  prevent  adhesions  was  to 
suture  the  peritoneum  over  the  Ptump.  There  was  another 
danger,  that  the  ligature  might  slip.  The  best  knot  to 
tie  on  a  small  stump  was  a  Staffordshire  knot,  although 
even  it  sometimes  dipped.  Martin,  of  Berlin,  even  liga- 
tured the  ovarian  ligament  as  well  as  the  stump.  He 
wished  to  know  how  Sir  William  stitched  up  tne  ab- 
dominal incision. 

Mr.  William  Thomson  said  the  length  of  the  incision 
entirely  depended  upon  the  size  and  character  of  the 
tumour.    It  was  never  desirable  to  make  an  incision  longer 


than  was  necessary,  and  therefore  he  first  made  a  small 
one  and  enlarged  it  as  required.  Sir  William  Stokes  had 
rightly  claimed  that  these  cases  should  be  operated  upon 
by  the  seneral  surgeons.  Mr.  Tweedy's  claim  was  for  the 
gjmiBCoTogist.  But  when  it  came  to  a  question  of  septic 
bands,  he  wanted  to  know  what  position  the  gynsBcologiet 
held  in  that  respect  after  his  morning's  work  of  examina- 
tion of  his  cases.  If  a  general  surgeon  was  not  fit  to  open 
a  serous  cavity  because  of  the  state  of  his  hands,  then  he 
ought  not  to  operate  at  all  or  touch  a  wound.  Yet,  in 
spite  of  this  inability  to  have  aseptic  hands,  septicsemia 
had  been  practically  banished  from  general  hospitals.  Mr. 
Tweedy  said  that  the  case  ought  to  belong  to  the  person 
who  diagnosed  it— meaning  the  gynsdcologist.  But  this 
assumed  that noone  else  could  diagnose  an  ovarian  tumour, 
and  that  only  a  gynascologist  was  necessarily  able  to 
operate.  This  whcSe  question  of  diagnosis  was  abandoned 
when  it  was  laid  down  that  doubuul  cases  were  to  be 
determined  by  opening  the  abdomen.  Anyone  could  dia- 
gnose under  such  conditions.  This  claim  was  an  impos- 
sible one.  The  gynsecologists  had  been  taught  by  the 
general  surgeon,  to  whom  were  due  the  splendid  develop- 
ments in  abdominal  surgery. 

Mr.  Cboly  said  that  tbe  only  difficulty  he  found  in 
ovariotomy  was  the  diagnosis.  His  ovariotomy  and 
hernial  cases  did  best  witn  rectal  feeding  for  three  days 
after  the  operation.  He  strongly  condemned  Spencer 
Wells'  trocar  and  cannula.  Having  made  the  abdominal 
incision,  be  punctured  with  an  ordinary  scalpel. 

Mr.  M'Abdi^  said  that  a  general  surgeon  might  cut 
into  the  liver,  might  remove  the  kidneys  or  spleen,  but  he 
was  not  to  be  aUowed  to  touch  an  ovarian  tumour.  It 
was  a  great  deal  more  dangerous  to  deal  with  a  kidney 
than  with  an  ovarian  tumour.  He  had  had  to  remove 
portions  of  the  bladder  and  to  interfere  with  the  intestines 
and  ureters,  and  had  no  calamity.  He  agreed  with  Br. 
Tweedy  that  a  long  stump  was  a  great  danger  on  account 
of  its  adhering  to  the  intestines.  He  [had  to]  open  the 
abdomen  twice  on  this  account. 

Dr.  Winifbbd  Dickson  said  that  a  gynaecologist  did  not 
meet  with  much  dus  because  the  general  rule  was  that  the 
patient  was  doucfied  before  being  examined.  The  vagina 
did  not  generally  contain  streptococci  or  etaphylocooei, 
and  the  gonococcus  was  not  particularly  dangerous  in  tbe 
peritoneum.  One  point  about  the  after-treatment,  not 
mentioned  by  Sir  William,  was  that  the  sooner  purgatives 
are  begun  the  more  quickly  the  patient  seems  to  recover. 
A  great  many  Burge<ms  gave  a  purge  twelve  hours  alter 
the  operation. 

Mr.  LxNTAioNE  said  that  in  cases  of  laparotomy  a  great 
diminution  in  shock  could  be  eflected  by  avoiding  injury 
to  the  peritoneum  by  a  foreign  fluid.  He  now  always 
donchea  and  irrigated  with  sterile  normal  saline  solution. 
In  suturing  the  wound  he  first  sutured  the  peritoneum, 
and  then  the  layers  of  the  abdominal  wall  with  silk,  and, 
lastly,  the  skin  with  catgut.  He  then  sealed  up  the  wound 
with  celloidin,  and  used  no  dressing  except  to  prevent  it 
from  being  rubbed  by  the  bed  clothes.  The  wound  could 
be  seen  through  the  transparent  'celloidin.  The  celloidin 
was  a  great  improvement  in  the  treatment  of  strictly 
aseptic  wounds.  He  thought  it  made  no  matter  whether 
a  man  was  a  general  sureeon  or  a  gynsecologisti  if  he 
was  a  good  surgeon  he  showd  do  ovariotomy  wdl  enough. 

Sir  William  Stokbs,  replying,  said  that  Mr.  Tweedy 
said  that  large  tumours  were  difficult  to  diagnose.  That 
was  not  in  accordance  with  his  experience.  His  fourth 
ca*e  was  a  very  small  ovarian  tumour,  and  it  was  verjr 
difficult  to  diagnose.  He  also  stated  that  unless  the  pedi- 
cle C3uld  be  felt  an  ovarian  tumour  could  not  be  diagnosed. 
A  considerable  number  of  ovarian  tumours  had  no  pedicle 
at  all.  He  agreed  with  Mr.  Thomson  with  regard  to  the 
incision.  In  Germany  they  made  very  large  incisions,  but 
it  increased  the  shock  of  the  operation  and  the  tendency 
to  the  formation  of  abdominal  nemia.  He  always  trans- 
fixed the  pedicle  before  tying  it  i  to  |  inch  above  where 
the  section  was  made,  and  he  thought  there  was  no  possi- 
bility then  of  it  slioping.  In  stitching  the  abdominal 
wound  he  did  it  in  tne  same  way  as  Mr.  Lentaigne,  but 
without  the  celloidin  dressing.  If  Wells'  trocar  was  used 
with  discretion  there  was  no  danger.  With  it  there  was 
less  chance  of  the  contents  getting  into  the  peritoneum. 

The  Section  then  adjourned. 


JVMX  17,  1890. 


GERMANY. 


Thb  MBDiOAL  Piuns.     631 


V^EST LONDON  MEDIOOCHrRURGICAL SOOIBTY. 
MiXTiNo  HSLD  Friday,  June  5th,  1896. 

GlINIQAL  EVBNUfG. 

Mr.  A.  Stmons  EooLBS,  M.B.,  President,  in  the  Chair. 

Bodent  Ulcer, — Dr.  Glkmow  showed  this  case,  in  which 
an  area  of  skin  of  the  up^r  lip  of  aboat  the  size  of  a  six- 
pence was  involved.  Excision,  with  grafting  according  to 
Thfersoh's  m^^thod.  had  been  entirely  saccessfaL 

A  Shin  Affection  of  Doubtful  Origin.— J>t.  Swinfobd 
Edwakds  showed  drawings  of  this  case  taken  from  a  mUe 
patient,  the  subject  of  acnte  phthisis.  There  were  two 
drcnmstantial  areas  involved,  one,  the  smaller,  being 
apparently  papillomatous,  the  other  closely  resembling 
eczema.  The  discnosis  appeared  to  rest  between  mucous 
tubercle  and  scroraloderma. 

Dr.  Abraham  suggested  that  the  case  presented  some 
analogies  with  Paget^  disease  of  the  nipple. 

Chronic  Ulceroiion  and  IndurcUian  of  the  Lip, — Mr. 
SwiNPORD  Edwards  also  brought  forward  this  case.  The 
history  dated  back  some  20  years,  and  the  original  lesion 
appeared  to  have  been  inflammatory.  The  present  condi- 
tion was  not  typical  and  presented  some  features  consistent 
with  epithelioma,  syohili",  lupus,  or  simple  ulceration. 

Bodent  Ulcer  of  the  CAeeJk.-— Mr.  Kixtlby  showed  this 
case  in  which  owing  to  the  failure  of  Thiersch's  grafts,  an 
arm  flap  had  be^n  brought  into  requisition. 

(Edema  of  Both  Lege  from  Venoua  Thromhonia. — Dr. 
Chapman  showed  this  ease,  a  girl,  »t.  17,  the  subject  of 
heart  disease  both  of  whose  legs  became  oedematous,  but 
with  an  interval  of  a  year  between  tiie  onset  of  the  swel- 
lincr  on  each  side. 

Dr.  Chapman  also  showed  a  case  of  "  Linear  Yieldiag 
of  the  Skin  from  Premature  Obesity  "  in  a  girL  SBt.  16, 
and  weighing  twelve  stone.  The  skin  of  the  shoulders, 
mamm»,  and  buttocks,  was  affected 

ExUntive  Acne  with  Comedones. — Dr.  Abraham  showed 
this  case  and  also  water  colour  drawings  of  a  congenital 
lymphangioma  of  the  shoulder  which  had  been  succMsfully 
removed  by  scraping. 

OtteO'Arthritis  in  Father  and  Dattghter.^Mv,  MoAdah 
EooLKS  showed  these  cases.  In  the  male  patient,  set.  45, 
the  hands  were  affected  in  the  typical  manner.  His 
daughter,  est.  12,  had  worn  ill-fitting  boots,  and  presented 
a  punful  swelling  on  the  metatarso-phalangeal  joint  of  the 
groat  toe. 

Mr.  EocLXs  also  showed  a  woman,  »t.  44,  whose  hand 
was  typical  of  osteo-arthritis,  she  had  also  swelling  of  the 
-  elbow,  probably  of  the  same  naturo. 

Mr.  Adam  Eoclbs  also  exhibited  a  man.  st.  28,  with 
*'  Cleft  of  the  Soft  Palate  and  a  Double  Haro  Lip,"  who 
through  debility  had  escaped  operation  during  infancy. 
The  clefts  on  the  two  sides  of  the  lip  wero  not  complete ; 
the  intermaxillary  bone  was  not  carried  forward,  but  the 
prolabium  was  attached  to  tbe  columna. 

Dr.  Morgan  Dogkrbll  showed  the  case  of  a  boy,  set.  11, 
with  *'  Uterythema.''  The  end  of  the  nose  and  Doth  ears 
were  involved. 

Deformity  of  the  Cheat  produced  by  Bicycle  Biding. — Dr. 
William  Hunter  showed  this  case,  a  boy,  »t.  16,  well- 
nourished  and  of  good  personal  history.  His  occupation 
involved  a  considerable  stndn,  and  always  with  an  inclina- 
tion of  the  body  to  the  right.  He  presented  a  projection 
of  the  right  edjK6  of  the  sternum  and  adjacent  costal 
cartilages,  with  nilling  in  of  the  corresponding  ribs  and 
another  projection  of  the  left  costal  arch  outwards  and 
forwards.  On  imitating  with  the  right  arm  tbe  usual 
position  necessary  lor  supporting  the  bicvde  learner,  the 
deformity  was  much  exag^eratM,  which  when  placed 
supine  pressuro  on  the  projecting  edge  of  the  sternum 
nearly  annulled  the  deformity. 

The  Prrsidsht  pointed  out  that  in  addition  to  the 
deformity  deeoribed  there  was  slight  gastroptosis,  which 
was  probably  also  due  to  the  excessive  strain  involved  in 
his  occupation. 

Aneuriem  of  the  DortcUia  Pedia  Artery. — Dr.  Homs 
showed  this  case,  a  man,  »t.  56,  the  subject  of  general 
atheromatous  degeneration  of  the  arteries.  The  aneurism 
followed  a  crush  of  the  foot. 


EDINBURGH  MEDICO-CHIRUROICAL  SOCIETY. 

MSKTINO    HELD  WSDNBSDAT,  JUNS  3RD. 


The  President,  Dr.  Argyll  Robbrtson,  in  tbe  Chair. 

Mr.  C.  W.  Cathoart  demonstrated  on  a  patient  the 
similarity  which  tertiary  syphilitic  sores  often  present  to 
tuberculous  inflammation  of  the  skin. 

Dr.  Logan  Turner  exhibited  Dr.  Kirstein's  Autoscope 
for  examination  of  the  larynx  without  the  use  of  a  reflect- 
ing mirror,  and  demonstrated  its  use  on  the  human  sub- 
ject. 

The  President  showed  three  Indian  instruments  used 
bv  native  oculists  for  couching  cataract.  The  points  were 
of  copper  and  were  roughly  bayonet-shaped. 

Dr.  Aitohison  Robertson  read  a  paper  entitled — 
the  role  of  the  carbohydrates  in  dietetics,  with  an 

inquiry  into  thb  constitution  of  infants'  foods. 

Only  the  second  part  of  the  paper  was  read. 

Dr.  Robertson  commenced  with  a  statement  as  to  the 
digestion  of  starch  in  the  stomach.  It  was  a  mistake  to 
say  that  infants  were  unable  to  digest  starch  shortly  after 
birth,  although  the  secretion  of  saliva  at  that  period  was 
very  small.  Carbohydrates,  however,  should  oe  given  in 
an;^  quantity  only  after  the  first  year.  Gastric  cugestion 
in  infants  was  practically  the  same  as  in  adults.  He  then 
gave  details  of  some  analyses  of  infant  foods,  all  of  which 
contained  certain  amounts  of  unchanged  or  soluble  starch, 
erythro-  and  achroo-dextrins,  and  sugars.  Summine  up, 
he  concluded  that  it  was  better  to  do  without  them,  if  pos- 
sible. 

Drs.  Carmichael,  Black,  Gillespie,  Jamieson,  Bum 
Murdoch,  and  Ritchie  took  part  in  the  discussion. 

Dr.  Byrom  Bramwell  gave  a  short  description  of  a 
remarkable  case  of 

PRIMARY  sarcoma  OF  THE  LIVBR   WHICH  8IMI7LATBD 
HEPATIC  ABSCESS. 

There  was  an  enlargement  of  the  liver  in  an  adult 
patient  which  felt  like  a  fluid-containing  sac,  and  which 
presented  a  painful  spot.  Some  dark  chooolate-oolonred 
fluid  was  drawn  ofi*  with  a  hypodermic  syrinffe,  and  later 
63  oz.  of  a  similar  fluid  with  an  aspirator.  The  fluid  was 
very  like  that  found  in  hepatic  abscess.  As  the  cavity  refil- 
led again  it  was  incised  and  drained.  Hemorrhage  continued 
from  the  wound  in  such  quantities  and  for  such  a  length 
of  time  that  it  was  found  necessary  to  stitch  up  its  edges. 
The  sac  had  again  to  be  aspirated  shortly  after,  but  the 
pMatient  died  a  month  after  admission.  The  only  alterna- 
tive diagnosis  to  abscess  which  he  could  make  was  that  of 
angioma  of  the  liver. 

Dr.  Lbtth  described  the  post-mortem  appearances,  and 
handed  round  {^otographs  and  specimens  of  the  tumour. 
It}  had  proved  to  m  a  large  soft  primary  sarcoma,  with 
parts  broken  down  into  a  thick  grumous  materiaL 

D^.  Affleck  detailed  a  case  with  much  the  same  sym- 
ptoms, in  which,  however,  an  abscess  cavity  was  found  in 
the  liver  communicating  directly  with  the  stomach  through 
a  psriorated  gastric  ulcer. 

Dr.  J.  Ritchie  read  a  note  on  two  cases  of  opium  poison- 
ing, in  the  first  of  which  laudanum  was  removed  from  the 
stomaeh  several  hours  after  ingestion  by  means  of  the 
stomach  tube,  owing  to  delayed  absorption  consequent  on 
catarrh  of  the  stomaish.  In  the  other  case  permanganate 
of  potash  had  been  tried  with  satisfactory  results. 


[FROM  OUR  OWN  00REB8P0NDBNT.] 

BiELlE,  Jane  lOCh. 
THE    TWENTY-FIFTH    GERMAN    SURGICAL 

CONGRESS. 
The  celebration  of  the  Twenty-Fifth  Anniversary  of 
the  formation  of  this  Society  has  given  more  than  usual 
interest  to  ite  proceedings.  Amongst  other  things  it  has 
brought  to  remembrance  the  ciroumstances  under  which 
it  was  founded.    After  the  return  of  the  army  from  Nancy 


^3$     Th«  Midioal  Pkk^ 


AtTSTRlA. 


JuK»  17.  18M. 


to  OermADy,  GiiBtov  Bfa&on  and  Bernhard  v  Langenbeok 
prepared  a  plan  for  a  yearly  meeting  of  Qerman  surgeons 
for  the  purpose  of  interchange  of  experience  and  opinion, 
and  for  social  intercourse.  After  Volkmann  and  Billroth 
had  with  pleasure  fallen  into  the  proposal,  a  call  was  sent 
out  in  the  autumn  of  1871  for  a  meeting  in  Baster  week 
of  1872  in  Berlin.  Since  that  time  the  meeting  has 
regularly  taken  place  in  Berlin. 

In  1892,  the  Society  took  possession  of  the  present 
house,  a  building  erected  to  the  memory  of  its  chief 
founder  and  called  after  him  the  Langenbeck  Haus. 

In  pious  memory  of  departed  worthies  the  members 
proceeded  to  the  graves  of  Langenbeck  and  v.  Bardeleben, 
and  there  deposited  costly  wreaths,  Bergmann,  for  the 
German  Society  of  Surgeons ;  Sir  Spencer  Wells  for 
English  surgeons  ,  Prof.  Oilier  for  French  surgeons  ;  and 
representatives  of  the  Berlin  Medical  Society.  The  meet- 
ing hall  of  the  Langenbeck  House  was  specially  decorated 
for  the  occasion  with  portraits.  The  only  one  on  the  walls 
previously  was  that  of  L&ngenbeok,  but  for  the  occasion 
a  number  of  others  bad  been  added.  They  were  those  of 
surgeons  whose  names  are  household  words  in  all  lands, 
amongst  them  those  of  Billroth,  Volkmann,  Bardeleben, 
Thiersch,  Esmarch,  Bergmann,  Konig,  Gussenbauer, 
Wilms,  Gr&fe,  Lister,  Spencer  Wells,  Paget,  and  Oilier. 

After  the  meeting  had  been  addressed  by  Hr.  v.  Berg- 
mann, theCultus  Minister,  Dr.  Bosser,  was  called  upon. 
He  said  that  if  the  German  Society  for  Surgery  celebrated 
that  day  its  twenty-fifth  anniversary  it  had  every  cause 
to  look  back  with  pride  and  joy  on  its  activity  during 
those  twenty-five  years.  The  country  itself  participated 
with  them  in  that  pride  and  joy.  The  State  Government 
also  participated  in  chat  joy.  It  had  been  very  justly 
remarked  that  the  great  aims  of  science  could  not 
be  reached  by  state  organisations,  at  least  not  by 
these  alone ;  they  had,  therefore,  every  reason  to  be 
thankful  that  they  had  united  their  powers  in  the  service 
of  science  and  suffering  humanity.  The  presence  of 
numerous  foreign  guests  was  a  proof  how  highly  the 
efforts  of  the  Society  were  valued.  But  the  presence  of 
these  foreign  guests  was  also  a  proof  of  the  great  and 
exalted  idea  of  the  international  solidarity  of  science  and 
of  humanity.  He  offered  the  Society  the  congratulations 
of  the  Royal  Government,  and  hoped  the  next  quarter  of  a 
century  would  be  as  fruitful  in  good  work  as  the  last ; 
then  would  its  glory,  and  also  the  gratitude  of  humanity, 
be  secured. 

Hr.  Bruns,  Tiibingen,  gave  an  address  on  the  modern 
treatment  of  goitre.  He  said  that  it  was  in  1877  that 
Rose,  supported  by  his  wide  experience,  first  decidedly 
advocated  radical  measures,  for  the  reason  that  gottre  was 
not  only  a  local  lesion,  but  that  it  also  endangered  the 
whole  organism.  Up  to  1877,  150  goitre  operations  had 
been  performed,  with  a  mortality  of  21  per  cent.;  between 
1877  and  1882  205  operations  had  been  performed  with  a 
mortality  of  12  per  cent. 

The  operation  was  at  first  looked  upon  as  a 
removal  of  a  tumour,  and  it  was  later  under  the 
influence  of  Billroth  and  Kocher  that  it  began  to  be  looked 
upon  as  the  extirpation  of  an  organ.  Preliminary  tracheo- 
tomy was  not  advisable,  as  soiling  of  the  field  of  operation 
was  then  unavoidable.  He  had  never  seen  a  case  where 
the  dyspnoea  continued  after  removal  of  the  goitre,  even 
when  the  trachea  had  been  badly  compressed  by  it. 

Total  strumectomy  was  carried  out  for  a  time  until 
Reverdin  and  Kocher  observed  those   peculiar  changes 


that  had  become  known  under  the  name  of  cachexia 
etrumipriva,  and  which  had  already  been  seen  by  Schiff, 
in  1856,  in  animals,  after  extirpation  of  the  thyroid,  bat 
which  had  not  at  the  time  attracted  great  attention. 
The  study  of  the  physiology  of  the  thyroid  was  therefore 
begun  afresh,  from  which  it  became  plain  that  the  thyroid 
was  a  true  gland,  with  a  spedfle  secretion  that  was  indis- 
pensable for  the  economy  of  the  body. 

Endeavours  were  now  made  to  treat  the  gottre  but  not 
remove  the  gland.  In  about  fifty  oases,  the  arteries  were 
igatured,  but  the  operation  was  abandoned.  Enuclea- 
tion found  greater  favour,  but  it  was  not  practicable 
where  the  capsule  was  not  sharply  defined.  He  hcul  per- 
formed the  operation  in  about  200  cases.  In  70  per  cent. 
the  bleeding  was  slight,  in  20  considerable,  and  in  10  per 
cent,  profuse.  Resection  of  the  struma  was  a  further  step 
that  could  be  properly  combined  with  enucleation.  The 
operation  was  difficult,  but  interesting,  as  careful  indivi- 
dualism was  necessary. 

He  had  performed  400  gottre  operations ;  40  per  cent, 
were  enucleations,  24  per  cent,  resections,  and  12  per  cent, 
were  combined  operations.  The  operation  was  now  so  far 
developed  that  there  was  no  danger  when  the  tumour  was 
benign  and  the  delay  had  not  been  too  great.  He  had  had 
no  death  in  his  last  150  cases. 

Hr.  Konig,  Berlin,  gave  an  address  on 
Advanoss  in  cub  Knowlbdgs  of  Local  Tubebculosis. 

He  said  that  although  tubercle  had  been  known  for  one 
hundred  years,  the  knowledge  of  its  specific  character  was 
of  a  much  later  date,  as  the  study  of  tuberculosis  of  the 
lungs  was  very  complicated.  It  was  only  when  the  disease 
was  known  in  other  organs,  glands,  bone,  &c.,  that  we 
gained  an  insight  into  its  natures  There  war  no  such 
strictly  local  tuberculosis  as  was  at  one  time  represented. 
Forty  years  ago  we  were  powerless  as  regarded  any  form 
of  tuberculosis.  It  was  v.  Volkmann  who,  by  his  obser- 
vations and  experiment,  brought  tuberculosis  of  the  bone 
into  the  foreground  of  interest.  It  was  known  that  tuber- 
culosis of  the  bone  might  heal,  it  was  seen  later  that  it 
might  sequestrate.  He  agreed  that  joint  tuberculosis  in 
great  part  started  in  the  bonee,  but  in  an  equally  large 
proportion  from  the  synovial  membrane,  from  a  serofi- 
brinous infiammation.  When  it  was  recognised  that  joint 
tuberculosis  started  from  a  focus  .in  the  bone  it  was  at 
first  hoped  that  early  resection  would  bring  about  complete 
recovery,  but  these  hopes  were  not  realised  and  so  treat- 
ment became  more  limited  in  its  f  cope.  V.  Volkmann's 
investigation  led  to  the  attempt  to  seek  and  remove  the 
bone  affection  before  the  joint  was  attacked.  This  did  not 
succeed  often,  but  when  it  did  the  recovery  was  an  ideal 
one.  To  the  modem  achievements  belong  the  introduc- 
tion of  medicinal  applications  such  as  iodoform  and 
carbolic  acid,  in  favour  of  which  he  spoke  strongly  and  the 
treatment  by  stasis — that  had  often  been  successful  If 
operative  measures  had  to  be  resorted  to  one  could  often 
be  satisfied  in  children  with  removal  of  the  capeule ;  in 
adults  it  was  advisable  to  add  to  this  resection  of  the  ends 
of  the  bones. 

'    ■  ♦ ■ 

[fBOM  OUB  OWV   OOBBBSPOITDBK*.] 

VniiHA,  June  ISih.  1896. 
Spontaneous  Fbact0be  of  the  TfiioR. 
Ebdheim  recorded  the  history  of  two  cases  of  spontanea 


JuKB  l7,  1896. 


GENERAL  MEDICAL  OOUKCIL. 


Thb  Mxdical  P&S88.     633 


OU8  fracture  to  the  Medical  Club.  The  first  was  a  young 
man,  et.  39,  who  received  a  slight  injury  to  the  leg  in 
September  last  by  colliding  with  a  piece  of  furniture. 
The  wound  became  tender  and  inflamed,  subsequently 
becoming  phlegmonous  and  rapidly  extending  up  the  leg. 
On  his  recovery  from  this  severe  attack  he  felt  a  sharp 
pain  in  the  right  leg  while  sitting  on  the  closet  one  day, 
and  on  endeavouring  to  rise  discovered  that  he  was 
helpless.  When  Erdheim  examined  the  leg  he  found  a 
large  tumour  extending  from  the  middle  of  the  femur  to 
the  trochanter,  which  be  diagnosed  as  sarcomatous.  At 
the  lower  margin  of  this,  abnormal  movement  and  crepita- 
tion cculd  be  distinctly  observed.  It  was  resolved  to 
disarticulate  the  leg  at  the  hip,  which  revealed  an  osteo- 
mylitic  condition  of  the  bone. 

The  second  case  was  attacked  with  pain  in  the  right 
thigh  a  year  previously,  and  the  sympton  was  relieved  by 
massage.  On  putting  on  his  boots  one  morning  he  was 
suddenly  seized  with  severe  pain  in  the  affected  leg,  with- 
out power  to  move  it.  On  examination  it  was  found  to  be 
fractured,  and  forthwith  put  up  in  splints.  After  several 
weeks'  confinement,  in  the  usual  way,  it  was  found  that  no 
union  had  taken  place.  It  was  then  diBcovered  that  a 
tumour  lay  along  the  upper  fragment  of  bone,  presumably 
a  sarcoma,  for  which  disarticulation  at  the  hip  was  per- 
formed, with  the  result  of  the  microscope  revealing  a 
"  perithelioma.'*  In  this  case  another  centre  seems  to  have 
commenced  simultaneously  in  the  right  kidney,  though 
the  growth  did  not  become  palpable  or  suspicious  till 
shortly  before  death. 

CARcntoMi  Pylori. 

Kukula  in  his  lecture  on  gastrotomy  this  week  gave  a 
vivid  picture  of  the  insidious  onset  of  carcinoma  of 
the  pylorus  and  its  consequences.  Pain  in  the  hypochon- 
drinm,  vomiting,  and  diarrhosa  are  frequent  precursors 
that  are  finally  confirmed  by  emaciation,  local  swelling, 
and  feebleness.  These  were  the  common  symptoms  of  a 
labourer,  set.  35,  whom  he  operated  on  a  short  time 
ago.  Within  two  months  he  lost  18  kilos.  »  39  lbs. 
A  firm  dense  tumour  could  be  felt  under  the  xiphoid 
cartilage  and  extending  to  the  imibilicus.  By  insu* 
fllation  the  greater  curvature  of  the  stomach  could  be 
traced  in  an  arc  three  inches  below  the  navel.  Splashing 
and  movement  with  respiration,  Jbc,  led  to  the  diagnosis 
of  carcinoma  of  the  pylorus  with  gastroptosis  and  dilatation. 

The  operation,  undertaken  after  the  patient  was  nar- 
cotised with  chloroform  55  grammes,  and  ether  70  grammes, 
lasted  one  hour  and  a  half. 

The  tumour  was  smooth  and  circular,  surrounding  the 
pylorus,  but  without  adhesions.  There  was  no  swelling  or 
enlargement  of  any  of  the  mesenteric  or  omental  glands  that 
favoured  pylorectomy.  The  whole  disease  was  removed 
and  the  lumen  of  the  duodenum  brought  into  apposition 
with  the  opening  of  the  stomach,  the  two  free  ends  being 
secured  by  outures.  The  section  removed  measured  six 
centimetres  of  the  smaller  curve  and  11  of  the  greater, 
with  a  lumen  that  would  not  admit  a  quill.  The  thickness 
was  about  7  centimetres.  The  hypertrophy  of  the  muscular 
and  mucous  coats  was  inconsiderable,  while  the  submucous 
measured  5  millimetres  alone  and  was  made  up  of  a  fine 
cellular  infiltration.  The  indurated  submuoosa  contained 
epithelioid  cells  in  small  groups  resembling  incipient  scir- 
rbus.  The  patient  was  collapsed  immediately  after  the 
operation,  but  this  was  obviated  by  wine  enemata  and 
saline  solution.  On  the  following  day  the  temperature 
was  37%  pulse  92.    The  day  after,  the  collapse  recurred, 


and  was  successfully  treated  in  a  similar  manner  as  the 
first  occasion.    On  the  tenth  day  profuse  diarrhcaa  super- 
vened, and  the  case  terminated  fatally. 
Morbus  Mbnixbei. 

Alt  gave  theldetails  of  a  case  of  Meniere's  disease,  whose 
history  he  had  followed  in  common  with  Peneles.  The 
patient,  a  labourer,  aE^t.  66,  took  ill  in  the  winter  of  1894  with 
indefinable  pains,  among  which  were  headache,  weakness, 
and  feelings  of  great  fatigue.  About  the  end  of  last  year  he 
was  attacked  with  giddiness  and  *'  buzzing  "  in  the  ears, 
which  finally  resulted  in  inseneibility.  After  recovering 
from  this  sudden  attack  he  found  his  hearing  defective, 
which  gradually  became  woree  till  total  deafness  was 
established  in  fourteen  days.  In  this  condition  he  was 
brought  to  hospital,  and  the  diagnosis  pronounced  "  leu- 
caemia myelo-linealis  chronica.*'  The  red  blood  corpuscles 
were  2,600,000,  while  the  white  were  600,050,  or  1  in  4. 
There  were  many  mononuclear  cells  with  large  leucocytes, 
lymphocytes,  and  granular  blood  corpuscles.  The  spleen 
was  enormously  enlarged,  as  well  as  the  liver.  On  examin- 
ing the  tympani  both  were  retracted,  aod  « he  radial  reflex 
destroyed.  The  C,  sound  could  not  be  perceived.  When 
placed  on  the  left  mastoid  G^,  C^,  and  C  were  negative, 
while  slightly  heard  on  the  right.  Loud  calling  could  also 
be  heard  on  the  right,  but  the  left  was  completely  gone. 
A  current  of  15  to  20  milliampdres  did  not  produce 
giddiness. 

After  death  the  leucsmio  condition  with  hnmatomawas 
confirmed.  A  microscopic  examination  of  the  cerebral 
centres  and  ganglia  was  undertaken  by  Politzer,  who 
adopted  Weigert-Pal's  method.  The  intra-medullary 
origin  of  the  auditory  nerve  in  the  lateral  as  well  as  the 
medial  root  had  numerous  small  as  well  as  large  leucasmic 
patches  with  fine  cellular  infiltration.  At  the  part  where 
both  roots  join,  the  infiltration  was  more  intense  and  the 
pia  mater  decidedly  thickened.  No  other  changes  of  a 
pathological  nature  could  be  found  in  the  brain  to  account 
for  the  phenomena.  The  middle  ear  was  found  intact  and 
nothing  in  the  labyrinth  of  a  morbid  condition  could  be 
discovered.  Calcareous  degeneration  was  present^  although 
small  in  degree,  a  condition  which  in  other  observers  has 
been  chiefly  assigned  as  the  cause  of  the  disorder.  In 
the  whole  of  the  literature  of  the  subject  no  other  author 
has  referred  the  morbid  condition  to  the  auditory  nerve 
alone. 


GENERAL    MEDICAL    COUNCIL 


OF 


EDUCATION  AND  REGISTRATION. 


SUMMER  SESSION,  1896. 

SIXTH  DAY.— Monday,  June  8th. 
Thk  Mbdical  ]>ifbngb  Union  and  Ambndmbkt  of  thb 
Mbdioal  Act. 
The  first  thing  was  the  reading  of  an  opinion  by  Mr. 
Muir  Mackenzie  on  the  subject  of  a  letter  received  from 
the  Medical  Defence  Union.  The  opinion  en  r6nimS  was 
as  follows : — In  reference  to  the  question  whether  the 
CJounoil  should  submit  to  Parliament  an  Act  for  the 
amending  of  the  Medical  Acts  by  altering  the  provisions 
of  Section  XL.  of  the  Act  of  1858,  he  thought  any  such 
legislation  would  present  ^rave  diflSculties.  He  himself 
YiSdi  found  the  task  of  drawing  ap  such  an  amended  clause 
a  diflicult  one.  On  the  whole,  he  did  not  think  that  there 
was  any  urgent  need  for  such  amendment,  and  he 
asserted  that  no  difficulty  was  experienced  in  securing  a 


6S4    Tea  Mbdioal  Pbhio, 


GENERAL  MEDICAL  COUNCIL. 


uUVB  17,  1896. 


eonviotion  under  tbit  section  h^<fre  a  strong  and  eompeUnt 
tribynak  He  admitted  that  the  decisions  of  jastices 
▼aried  in  this  respect,  and  he  farther  admitted  that  the 
two  recent  decisions  woald  afford  weak  jastices  an  ezcase 
for  dismissing  cases  under  this  section.  After  discussing 
▼arioas  recent  oases,  he  concluded  by  saying  that  any 
amendment  to  Section  XL.  should  oe  with  a  view  to 
including  a  large  number  of  false  assumptions  of  title  not 
at  present  included  under  that  Section,  and  not  merely  for 
the  purpose  of  more  easily  securing  conviction. 

Apothsoakibs'  Hall  of  Dubuh. 

The  Gonncil  then  resumed  the  debate  on  Sir  William 
Turner's  motion,  deferring  the  expression  of  an  opinion  on 
the  application  of  the  Hail  pending  representationf  to  the 
Koyal  College  of  Surgeons  in  Ireuina  (see  Thb  Medical 
Pbbss  akd  Circdlar,  page  603). 

The  legal  advisers  of  the  Council  pointed  out  that  no 
decision  had  been  arrived  at  by  the  Privy  Council  as  to 
whether  the  General  Medical  Council  had  or  had  not  a 
discretion  to  decline  to  appoint  the  assistant  examiners 
for  which  the  Hall  had  applied.  They  suggested  that  the 
observations  of  the  Lords  of  the  Council  afforded  ample 
grounds  for  the  Council  to  review,  and  if  thought  fit,  to 
alter  its  former  decision,  thus  avoiding  any  possible  differ- 
ence of  opinion  between  the  Privy  ConncU  and  the  Oeneral 
Medical  Council. 

Dr.  Chuboh  pointed  out  that  the  Council  could  not  alter 
their  decision  on  a  point  which  they  had  not  yet  con- 
sidered. 

Counsel  replied  that  the  last  application  differed  in 
that  medical  examiners  were  also  asked  for. 

Dr.  MacAlistbr  brought  forward  an  amendment  to  the 
effect  that  the  Council  did  not  see  its  way  to  acceding  to 
the  application,  and  urged  that  a  direct  vote  should  be 
taken  on  the  subject. 

Dr.  Atthill  supported  the  amendment,  considering 
that  the  grant  of  the  application  would  have  most  disas- 
trous consequences  on  the  Irish  School  of  Medicine. 

Sir  Phiup  Smtly  did  not  think  the  College  of  Surgeons 
would  be  likely  to  recombine  with  the  Hall. 

Sir  John  Banks  supported  Sir  William  Turner's 
motion  as  did  also  Sir  Waltxb  Fostbb,  and  the  Pbbsi- 
dbnt  opined  that  <*  no  suggestion  more  condemnatory  of 
the  Council  than  the  second  part  of  the  amendment  could 
be  penned  "  in  that  if  the  Council  admitted  its  inability  to 
maintain  a  proper  standard  of  efficiency  the  Privy  Council 
might  hold  that  it  was  not  fit  to  exist. 

ultimately  the  amendment  was  lost  by  a  majority  of  1. 

On  the  original  motion  being  put  the  voting  was  equal 
when  the  President  gave  his  casting  vote  in  its  favour, 
and  it  was  consequently  declared  to  be  carried, 

Mb.  F.  Thbobald  again. 
Mr.  Theobald  renewed  his  application  to  be  re-instated 
on  the  Mtgister  from  which  his  name  was  removed  in  con- 
sequence of  the  support  he  had  given  to  Mattel's  perni- 
cious fraud.  As  he  has  at  present  no  diploma  which  could 
be  registered  the  Council  declined  to  re-open  the  case. 

Withdrawal  of  a  Qoalifigation. 
A  communication  was  received  from  the  Royal  College 
of  Surgeons  in  Ireland  announcing  that  the  name  of  Mr. 
Samuel  Frederick  Murphy  (whose  name  was  removed  from 
the  Medical  BegisUr  in  June,  1895)  had  also  been  erased 
from  the  list  of  licentiates. 

Thi  Pknal  Powbbs  of  thb  Qualiftino  Mbdioal 
Authobitibs. 

Mr.  Bbyant  brought  up  the  report  on  the  penal 
powers  of  the  various  qualifying  bodies.  It  appeared, 
therefrom,  that  a  certain  numb(Br  of  the  educational 
bodies  had  power,  others  had  very  little  ;  meet  of  the  cor- 
porations bad  power,  but  the  universities  had  very  little. 

Mr.  Mens  Mackbnzie,  in  a  letter  addressed  to  the 
President,  pointed  out  that  the  law  in  respect  of  persons 
whose  names  bad  been  removed  from  the  Register  con- 
tinuing to  practice  was  in  an  uncertain  and  unsatisfactory 
position,  and  he  suggested  that  it  would  be  of  the  greatest 
public  benefit  if  tne  charters  of  the  bodies  which  have 
insufficient  penal  powers  could  be  amended  as  suggested 
in  the  report.  He  added  that  in  each  case  the  formal  pro- 
cedure would  be  for  the  University  or  other  body  to  peti- 
tion Her  Majesty  in  Council  for  amendment  of  its  charter. 


On  the  motion  of  Mr.  Bryakt,  it  was  agreed  *'  that  this 
report,  as  amended,  be  adopted,  and  that  the  reoommeoda- 
tions  contained  therein  be  carried  into  effect  by  forward- 
ing this  report,  first,  to  the  universities  and  other  bodies 
concerned,  secondly,  to  the  Scottish  Universitiee  Com- 
missioners, and,  thirdly,  to  the  Privy  Council. 
Dbntal  Businbss. 

The  rest  of  the  sitting  was  mainly  devoted  to  a  dis- 
cussion on  documents  bearing  on  the  appeal  of  ooe 
Merrill,  a  dentist,  to  the  Privy  Council,  and  the  optnioD 
of  the  Council's  l^al  adviser  was  ordered  to  be  forwarded 
to  the  Privy  Council  as  an  answer  to  Mr.  Merrill's  appesL 


LAST  DAY— TuiSDAY,  Jctnb  9th. 

After  deciding  to  cause  copies  of  the  resolution  passed 
by  the  Council  in  respect  of  the  application  of  the 
Apothecaries'  Hall  to  be  sent  to  the  various  bodice  con- 
cerned, the  Council  entered  upon  the  oonsideratien  of 

Tub  Rbport  of  the  Education  Committbb, 
on  which  Dr.  TrKB  moved  *'that,  in  the  opinion  of  the 
Council,  each  candidate  for  a  licence  to  practise  should 
produce  evidence  in  a  specified  form  of  having  attended 
twenty  cases  of  labour,  nve  of  which  at  least  have  been 
conducted  throughout  under  the  direct  supervision  of  a 
registered  practitioner." 

This  motion  was  seconded  by  Dr.  Glovxb,  and  was 
agreed  to,  and  copies  thereof  were  directed  to  be  sent  to 
the  aathorities  of  the  Scottish  Universities,  and  to  the 
other  licensing  bodies. 

Rbport  on  Pbbliminart  Examinations. 

Dr.  TuKB  submitted  for  approval  the  form  in  which  the 
Education  Committee  proposed  to  issue  the  revised  list  of 
recognised  examinations.  From  the  report,  it  i^peam 
that  the  recommendations  of  the  Council  have  been  carried 
into  effect,  with  the  one  exception  of  the  Royal  Colleges 
of  Physicians  and  Surgeons  in  Ireland,  and  the  Committee 
express  the  opinion  that  their  preliminary  examination 
should  be  abandoned  in  the  interests  of  general  education. 

Dr.  MacAlister  animadverted  on  the  persistence  of 
the  Irish  Colleges  in  holding  this  examination  in  spite  of 
the  recommendations  of  the  Council 

Mr.  Bryant  criticised  the  second  dass  certificates  of  the 
College  of  IVeoeptors,  the  standard  beins,  in  his  opinion, 
very  u>w  indeed.  He  suggested  that  in  Inture  only  first 
class  certificates  should  be  accepted,  and  he  asked  whether 
the  time  had  not  come  for  the  second  class  certificate  to 
be  erased  from  the  list  of  recognised  preliminary  examina- 
tions. He  moved  that  the  Education  Committee  should 
be  asked  to  consider  this  aueetion. 

Mr.  B.  Carter  seconded  the  motion,  taking  advantage 
of  the  opportunity  to  insinuate  that  candidatee  who  failed 
in  the  Arts  examination  of  the  Apothecariee'  Society 
usually  adjourned  to  the  College  of  Preceptors. 

Dr.  Take's  motion  was  then  agreed  to,  and  was  ordered 
to  be  transmitted  to  the  Colleges  concerned. 

Dr.  Thomson  pointed  out  that  the  examinations  of  the 
two  Irish  Universities  and  of  the  intermediate  Board  were 
both  held  at  about  the  same  time,  so  that  practically  there 


was  only  one  opportunity  of  f^ing  in  for  a  prelimin- 
ary examination  in  a  year.  This  was  why  the  Colleges, 
which  were  not  otherwise  wedded  to  the  examinati<», 
thought  Uieir  examination  ought  not  to  be  discontinued 
until  the  whole  subject  was  dealt  with.  He  said  that  in 
his  opinion  ih»  Council  had  for  ^ears  occupied  itself  with 
the  professions^  parts  of  the  curriculum  leaving  untouched 
what  was  possibly  the  most  important  part  en  the  educa- 
tional course,  viz.,  the  standarci  of  the  entrance  examina- 
tion. He  thought  that  under  the  circumstances  the 
Council  should  not  strike  off  the  examination  fcMr  the 
present. 

Dr.  MacAlistsb  pointed  out  that  there  was  no  proposal 
to  strike  it  off. 

After  some  remarks  by  Dr.  Atthill  and  Sir  John  Banks 
the  motion  was  agreed  to. 

Mr.  Bryant's  motion  {vide  enpra)  was  then  agreed  ta 

Dr.  TuKB  stated  that  the  Education  Committee  had 
admitted  to  the  list  of  recognised  preliminary  examinatioDS 
the  first  examination  in  Arts  by  tne  University  of  Madrss, 
and  the  matriculation  examination  of  the  College  of 
Physicians  and  Surgeons  of  New  Brunswick.  This  p«rtof 
the  xeport  was  agreed  to. 


JuNBl7»  1896. 


THE  OPERATING  THEATRES. 


ThI  MlDIOAL  PIUN8.       635 


RbCOMMBNDATIONS     BBSPBCfTINO     PBOFSSIONAL    EXAMINA- 
TIONS. 

"  Sir  DroB  Duckworth  brota^ht  forward,  in  a  consolidated 
form,  a  series  of  definitive  recommendations  saitable  for 
transmission   to    the    several    licensing  bodies,  and  the 
sehedole  was  adopted  by  the  Council  as  proposed. 
Rbport  of  Public  Health  Committbs. 

Dr.  Thoeke  Thorns  brought  up  the  report  of  the 
Public  Health  Committee.  He  discussed  the  bearings  of 
the  definition  of  the  Council  of  ''  a  large  urban  district "  as 
one  with  over  50,000  inhabitants,  and  pointed  out  that  this 
entailed  some  hardship  on  certain  medical  ofScers  of 
health  in  districts  with  less  than  this  number  of  inhabi- 
tants. They  had  been  uliable  to  frame  any  recommenda- 
tions which  would  include  all  the  medical  officers  of  the 
metropolis,  but  they  were  prepared  to  admit  medical 
officers  of  health  in  districts  under  60,000  wherever 
situated  if  they  were  also  teachers  in  public  health  in  con- 
nection with  a  recognised  medical  school.  To  put 
England  and  Scotland  on  an  equality  they  thought  that 
30,000  in  Scotland  might  be  taken  as  equivalent  to  50.000 
in  England.  As  Ireland  had  not  as  yet  a  Local  (Govern- 
ment Act  that  point  could  not  be  at  present  dealt  with. 

These  proposals  were  agreed  to. 

The  Report  of  the  Inspector  on  the  Examinations  tor  the 
Diploma  in  Public  Health  of  the  University  of  Oxford,  to 
the  effect  that  they  were  in  all  respects  satisfactory,  was 
received  and  adopted,  and  a  copy  of  it  was  ordered  to  be 
sent  to  the  University  authorities,  "  no  further  action 
being  on  this  occasion  required." 

Midwifery  Diplomas. 

Mr.  Wheblhouss  brought  up  the  Report  of  a  Commit- 
tee appointed  to  report  and  consider  a  letter  received 
from  Dr.  Rentonl,  in  November,  1895,  accusing  the  auth- 
orities of  the  Rotunda  and  Coombe  Lying-in  Hospitals 
with  granting  diplomas  to  other  than  qualified  medical 
practitioners,  which,  he  alleged,  entitled  the  holders  to 
conduct  confinements  on  their  own  responsibility,  in  fact, 
to  '*  practise  midwifery."  The  Committee  reported  that 
in  so  doing  the  bodies  referred  to  acted  under  Royal 
Charters,  and  all  they  suggested  was  that  the  certificates 
should  assume  a  more  simple  character. 

In  spite  of  a  warm  protest  by  Dr.  Atthill  copies  of  the 
adopted  report  were  directed  to  be  sent  to  ^-he  bodies  in 
question. 

Resignation  of  Diploma. 

Mr.  Rutherford,  of  Exeter,  is  a  gentleman  wholfeels  so 
strongly  on  the  question  of  the  Royal  College  of  Phy- 
sicians of  Ireland  in  respect  of  its  members  acting  as 
officers  of  Medical  Aid  Associations  that  he  returned  his 
diplomas  of  Member  and  Licentiate* to  the  College,  and 
requested  that  these  qualifications  should  be  removed  from 
the  Medical  Register.  Circumstances  prevent  the  College 
at  present  from  accepting  the  resigned  diplomas  and  the 
Council  was  asked  to  decide  what  should  be  done. 

As  it  was  not  very  obvious  what  the  Council  had  to  do 
in  the  matter,  the  further  consideration  thereof  was 
postponed. 

After  the  transaction  of  some  formal  business  the 
Session  came  to  an  end. 


ST.  MARY'S  HOSPITAL. 
Acute  Septic  Osteo-Myelitis.— Resection  of  Upper 
End  of  Fbmub. — Mr.  Edmund  Owen  operated  on  a  girl, 
set.  about  10,  who  a  few  days  previously,  while  playing  in 
the  street^  had  been  pushed  down  and  had  fallen  upon  her 
left  hip.  The  child  seemed  to  have  been  in  a  good  deal 
of  pain  for  a  while,  but  next  day  was  running  about  as 
well  as  ever.  A  few  days  subsequently,  however,  she  began 
to  complain  of  her  hip,  and  could  not  bear  it  to  be 
touched  ;  she  passed  sleepless  nights,  and  was  so  ill  that 
admission  to  the  hospital  was  sought.  The  temperature 
was  found  to  be  102°.  The  pulse  was  quick,  and  the  face 
flushed.    Mr.  Owen  said  that  in  all  probability  it  was  a 


case  of  acute  septic  diaphysitis,  but  that,  as  the  gitl 
dreaded  being  hurt,  he  would  have  an  ansBsthetic 
administered  before  examining  her.  Whilst  she  was 
being  put  under  chloroform,  he  remarked  that  it  evidently 
was  not  a  ease  of  fracture  or  dislocation,  as  the  child  had 
completely  recovered  from  the  effects  of  the  injury  within 
twenty-four  hours,  and  that  the  symptoms  were  far  too 
acute  for  ordinary  traumatic  synovitis,  and  too  sudden  in 
their  onset,  and  too  acute  for  tuberculous  disease.  He 
thought,  therefore,  that  it  would  turn  out  to  be  one  of 
those  serious  and  disastrous  cases  in  which,  as  a  result  of 
the  injury,  staphylococci  had  undergone  successful  culti- 
vation at  the  upper  end  of  the  femoral  diaphysis — that  is, 
in  the  upper  part  of  the  neck  of  the  femur,  within  the 
embrace  of  the  capsular  ligament.  On  careful  examination 
under  chloroform,  however,  no  thickening  about  the  neck 
of  the  femur,  or  fulness  of  the  synovial  capsule,  could 
be  detected,  and  all  the  movements  of  the  joints  were 
found  to  be  perfectly  free  and  smooth.  The  house  sur- 
geon, Mr.  Brodribb,  also  examined  with  a  like  result.  Mr. 
Owen,  however,  remarked  that  although  he  had  been 
unable  to  confirm  his  diagnosis  he  still  held  to  it,  and  said, 
moreover,  that  he  feared  an  unfavourable  termination  to 
the  case.  On  the  same  evening — the  first  night  of  the 
child  being  in  the  hospital— she  was  so  much  worse 
that  an  exploratory  trephining  was  done  through 
the  great  trochanter  and  up  into  the  neck  of 
the  femur,  but  no  abscess  was  reached.  Next 
morning  she  was  rather  better,  though  her  aspect, 
temperature,  and  pulse  were  still  unsatisfactory.  She  had 
less  dread  of  her  thigh  being  moved.  On  the  following 
morning  the  thigh  was  a  good  deal  swollen  and  a  little  pus 
was  escaped  from  the  wound.  There  was,  moreover,  a 
red  patch  on  the  back  of  the  left  hand  which  was  thought 
to  be  septicsemic,  though  it  had  been  attributed  to  her 
having  struck  the  extremity  against  the  comer  of  the 
locker :  The  trephine  wound  was  enlarged,  and  the  interior 
of  the  joint  was  explored  by  thrusting  a  director- 
guided  by  the  fingers— through  the  front  of  the  capsular 
ligament.  But  the  paracentesis  revealed  do  intra-articular 
suppuration.  For  the  next  day  or  two  she  seemed  brighter, 
though  she  was  occasionally  light-headed  and  delirious. 
The  thigh  became  more  swollen,  and  on  the  third  day  she 
had  a  serious  hssmorrhagefrom  the  wound.  On  the  day  of 
the  operation  it  was  found  that  broken  clot  and  serum  were 
escaping  from  the  wound  ;  the  base  of  the  great  trochanter 
and  the  shaft  of  the  femur  were  bare  and  a  pyaemic 
abscess  was  found  upon  the  dorsum  of  the  left  foot.  It 
looked  as  if  amputation  at  the  hip- joint  would  give  the  girl 
the  only  chance— and  that  a  very  poor  one.  But  as  permis- 
sion had  not  been  obtained  for  so  serious  an  ordeal,  Mr. 
Owen  had  to  content  himself  with  a  resection  of  the  upper 
end  of  the  femur.  There  was  no  pus  in  the  joint,  but  the 
trochanteric  region  of  the  cervix  and  diaphysis  were 
found  after  removal  to  be  darkly  mottled  and  blood- 
stained ;  there  was  no  purulent  infiltration  of  the  bone.  It 
was  noticed  that  during  the  resection  the  trochanteric 
epiphysis  had  become  detached  from  the  diaphysis,  the 
site  of  its  disjunction  being  covered  by  purulent  granula- 
tion-tissue, and  it  became  manifest  that  that  part  of  the 
diaphysis,  and  not  the  intra-capsnlar  part  of  the  shaft,  had 
been  the  starting-point  of  the  disease.  The  periosteum 
had  been  stripped  from  the  chief  part  of  the  diaphysis  by 
hnmorrhage,  with  a  certain  amount  of  suppuration.  Over 
the  lower  end  of  the  diaphysis,  in  the  space  between  the 
ilio-tibial  band  and  th«  tendon  of  the  biceps,  an  opening 


636      Tn  MtDICAL  PR«S«. 


LEADING  ARTICLES. 


JuKX  17,  1896. 


WM  mAde  in  order  that  the  sub-perioflteal  oollection 
of  septic  dot  and  aeram  miffht  be  tlioroaf^hly 
cleared  out  and  the  cavity  effectually  drained.  In  the 
conree  of  his  remake  npon  the  cave,  Mr.  Owen  said  that 
he  had  met  vrith  several  instances  of  acute  septic  ostitis 
beginning  in  the  neck  of  femur,  just  below  the  head  of  the 
bone ;  they  were,  as  in  this  case,  characterised  by  great 
constitutional  disturbance,  by  much  local  tenderness,  and 
by  acute  effusion  into  the  capsule,  and  they  almost  invari- 
ably ran  on  to  complete  wreckage  of  the  joint.  In  his 
experience,  it  was  quite  unusual  for  the  disease 
to  start  in  that  part  of  the  diaphysis  which  under- 
lies the  great  trochanter,  though  in  the  unfortunate 
case  which  had  just  been  seen,  there  was  no  doubt 
as  to  its  having  begun  in  that  situation.  The  disease  was 
an  acute  pyaemia  from  the  very  commencement,  and  was 
apt  to  be  mistaken  for  acute  rheumatism.  Salicylic  acid, 
however,  failed  to  bring  down  the  temperature  as  it  would 
do  in  the  case  of  rheumatic  fever  ;  the  rapid  occurrence  of 
metastatic  abscesses,  he  considered,  sometimes  revealed 
the  exact  nature  of  a  doubtful  case. 

RICHMOND  HOSPITAL,  DUBLIN. 
Total  Extibpation  of  thb  Larynx.  —  Mr.  Robert 
H.  Woods  performed  total  extirpation  of  the  larynx 
for  cancer  on  a  man,  ec.  05,  whose  symptoms  began 
twelve  months  ago  with  hoarseness  and  slight  cough. 
The  laryng^cope  showed  a  growth  on  the  right 
larynx  wall  extending  across  the  mesial  plane  both  in  front 
and  behind.  The  tumour  was  diagnosed  cancer,  and  a 
morsel  taken  away  with  forceps  through  the  mouth  con- 
firmed the  diagnosis  under  the  microscope.  An  incision 
was  made  in  the  middle  line  of  the  neck  from  the  hyoid 
bone  to  the  sternum.  A  transverse  incision  was  carried 
across  the  thyrohyoid  membrane,  and  two  triangular 
flaps  reflected  outwards  ;  the  patient  was  then  tracheoto- 
mised,  and  chloroform  administered  through  the  tube 
during  the  subsequent  steps  of  the  operation.  The  thyroid 
cartilage  was  divided  in  the  middle  line,  and  a  sponge 
inserted  into  the  trachea  above  the  tube.  The  growth  was 
then  inspected,  and  complete  excision  decided  on.  The 
larynx  was  bared  laterally,  the  trachea  cut  across  below 
the  cricoid  cartilage,  and  the  dissection  carried  on  from 
below  upwards,  care  being  taken  not  to  buttonhole  the 
oesophagus.  The  larynx  being  freed  from  its  inferior  con- 
nections, the  epiglottis  was  cut  transversely ;  it  was»  how- 
ever, found  that  the  epiglottic  was  infiltrated,  and  the 
remaining  portion  was  dissected  away  from  the  base  of  the 
tcibgue.  The  trachea  was  next  sutured  to  the  tracheotomy 
wound,  the  posterior  wall  and  anterior  wall  of  the  oeso- 
phagus drawn  forwards  like  a  cowl,  thus  shutting  the 
trachea  off  from  the  pharynx,  and  obviating  the  necessity 
of  wearing  a  tube.  A  stomach  tube  was  then  tied  in  the 
end  coming  through  the  wound  in  the  neck,  between  two 
sutures.  An  enlarged  gland  lying  under  the  stemo- 
mastoid,  and  on  the  jugular  vein,  was  next  dissected  out 
through  a  separate  skin  wound,  and  the  patient  put  to 
bed. 

"The  Cavendish  Lecture"  will  be  delivered  this 
(Wednesday)  evening  by  Mr.  Thos.  Bryant,  ex-Presi- 
dent of  the  Royal  College  of  Sargeons  of  England,  at 
the  West  London  Hospital,  at  8  p.m.,  the  subject 
being  ''  Jenner  and  his  Work."  A  large  gathering  is 
expected  to  greet  the  lecturer.  A  conversazione,  with 
music  and  smoking,  will  follow  the  delivery  of  the 
lecture. 


Eiennam)  rom  Tbassicisbiov  abboao 

^he  Jdtbical  fxtBB  anb  (Eixcvdxt. 

FobUslMd  svtiy  Wsdatsdsj  mornliiff,  Pilot  6d.    Post  trso  Hd. 
ADyBETXlBMBHTI. 

Fob  On iwuamom :— WboU Pico,  46 Qi.  Od. ;  Half  Pst«, «iiOk  od. 
Qnsrtor  Pifo,  Ml  So. ;  Opoolehtli,  ItL  6d. 

rom  ▲  Baans  o?  lamnoas :— Wbolo  Pifo,  ihlrtMB  tniottloiu 
(wooUy,  fortDlghtlj,  or  mootUy)  at  £8  IQi.  Od. ;  twrntj-sfac  lamr- 
ttons  (wookly  or  f ortniglitly)  at  £8  ti.  Od. ;  flfly-two  taMntloa* 
(wookly)  st  £8  osoh.  HsU-poso,  thirtooo  liMrtlooi  st  ■•.; 
twoDtrdxsl8flL;flfk]r-t«oliis«tioiMstWi.oMh.  Qasftarv^t 
ttilrtooii  Insertioiii  st  ISi. ;  twontf -stz  Insortlons  st  lOi. ;  flftjr-dx 
loMrtions  st  ISo.  osoh 

Small  ▲nnottnoomonti  of  Praotlcoa,  AHlatanelM,  VaeanelM,  Book 
te.— Sovoa  ISaso  or  under,  4s  por  InsorttoB ;  6d.  per  Ubo  boToad 

Utters  la  tills  depanment  shonld  be  addressed  lo  the  PsbUsber. 

lUBlOBIPTIOirS. 
Poei  tarn  to  ammval  subsceibbbs  £i  i  o 

ABBOAD,WIfHnfHB  PoSZALVnoa        £1    t    6 
„  IBMA,  CimiA,  ABD  JAPAB  .  .      <1    f    6 

Poet-oAee  Orden  and  Cbeones  to  be  drawn  In  favour  of— 

A.  A.  TDn>ALL,  80-tl  Kfcng  WQUam  Street,  Strand,  London. 
A.  H.  Jacob.  SQ  Moleswortli  street.  DnbUn. 
SUBSOBipnoBS  f  OB  FBABOB  are  received  by  If atns.  HATT.rm»  tumm 
HantefeolUe,  Paris— post  free  In  advance,  £1  Bi.  6d.  per  annum. 

BUBSOBIPTIOBS  fOB  THB  UBmD  Statbb,  DOflt  tTee  In  advance 
(£1  Bi.  6d.  per  annum),  thonld  be  lent  duect  to  the  OOeeB  In 
this  country  by  International  Poet  Office  Order. 


S^l^e  ^jeMral  ^tm  ^  €itcnlsa[. 


'SALUS  POPULI  SUPREHA  LEX. 


WEDNESDAY,  JUNE  17,  1896. 


GENERAL  MEDICAL  COUNCIL. 
After  a  session  fully  up  to  the  average  in  point  of 
duration,  the  General  Medical  Council  has  been  dis- 
banded and  we  are  at  liberty  to  indulge  in  a  retrospect 
of  their  proceedings.  The  thorny  question  of  the 
application  of  the  Apothecaries'  Hall  of  Dublin  for 
the  appointment  of  examiners  in  all  departments  was 
discussed  in  a  half-hearted  sort  of  way,  and  it  looked 
for  a  time  as  if  the  threat  of  a  possible  conflict  between 
the  Privy  Council  and  the  General  Medical  Council  would 
have  the  desired  effect  of  rallying  the  waverers  to  the 
views  so  forcibly  expressed  by  the  President  The 
division  lists,  however,  show  that  no  material  change 
has  taken  place  in  the  relative  position  of  the  parties 
to  the  resolution  which  has  proved  the  source  of  so 
much  friction ;  indeed,  the  motion  by  which  the  matter 
has  been  temporarily  shelved,  was  carried  only  by  ihe 
President's  casting  vote.  The  representative  of  the 
Royal  CoUege  of  Surgeons  in  Ireland  held  out  but  little 
hope  that  the  proposal  to  recombine  would  be  favour- 
ably received  by  that  body,  and  it  seems  extremely 
likely  that  when  the  Council  next  meets  it  will  be 
confronted  by  the  question  quo  ante  bdlum,  except  that 
possibly  feeling  may  run  a  trifle  higher  after  having  been 
allowed  to  ferment  for  another  six  months.  It  would 
perhaps  have  been  better  for  the  Council  to  define  its 
attitude  in  the  matter  once  and  for  all ;  there  the  matter 
must  be  left  for  the  present,  so  that  we  may  pass  on  to 
other  matters  of  interest,  of  which  we  are  constrained  to 
admit  there  are  not  many.   A  distinct  step  in  advance  in 


JtTNB  17,    1896. 


LEADING  ARTICLES. 


Thx  Mbdioal  Pbms.     637 


respect  of  practical  education  in  midwifery  has  been 
made  in  that,  in  future,  candidates  for  a  licence  to 
practise  will  be  required,  as  an  alternative  to  three 
months'  attendance  on  the  indoor  practise  of  a  lying-in 
hospital,  to  have  been  present  at  not  less  than  twenty 
labours,  of  which  at  least  five  shall  have  been  conducted 
under  the  direct  supervision  of  a  registered  practitioner. 
If  proper  precautions  be  taken  to  ensure  the  validity  of 
such  certificates  a  distinct  progress  will  have  been  effec- 
ted, for  midwifery  is  a  subject  which  cannot  be  wholly 
learned  from  books,  and  neo- practitioners  of  the  future 
will  no  longer  cut  such  a  sorry  figure  when  called  to  theii 
first  labour  after  starting  in  practice.  The  brief  discus- 
sion which  took  place  on  the  persistence  of  the  Royal 
Colleges  of  Physicians  and  Surgeons  in  Ireland  in  con- 
tinuing to  hold  their  preliminary  examination  in  arts 
threw  into  bold  relief  the  unsatisfactory  position  of 
the  whole  question  of  preliminary  education.  At 
present  the  second  class  certificate  of  the  College  of 
Preceptors  is  recognised  as  admitting  to  the  study  of 
medicine,  but  no  one  can  honestly  deny  that  the 
standard  thus  enforced  is  ridiculously  low.  During 
the  last  few  years  the  Council  has  devoted  an  enormous 
amount  of  time  and  energy  to  the  elaboration  of  the 
professional  curriculum,  possibly,  as  has  been  asserted 
more  than  once,  to  an  irritating  and  unneces- 
sary degree,  but  the  great  question  of  the 
standard  of  preliminary  education  has  been  sadly 
neglected.  There  may  be  difficulties  in  the 
way  of  reform  which  do  not  strike  outsiders, 
who  cannot  but  wonder  at  the  apathy  of  the  Council 
in  this  important  department  of  education.  There  are 
signs  that  we  are  within  measurable  distance  of  a 
thorough  reconsideration  of  this  matter,  and  for  the 
present  we  can  only  express  the  hope  that  when  it  does 
come  up  it  will  be  dealt  with  in  a  manner  worthy  of 
its  importance.  The  Medical  Defence  Union  has  been 
well  en  evideftice  this  session,  not  only  in  the  prosecu- 
tion of  penal  cases  but  also  in  suggesting  certain  neces- 
sary amendments  of  the  Medical  Acts  with  the  view  of 
extending  their  scope  acd  defining  their  meaning. 
Ttiere  is  no  disguising  the  fact  that  the  efficacy  of 
Section  40  has  been  immensely  weakened  by  recent 
judicial  decisions,  indeed,  the  penalty  of  erasure  from 
the  Regiater  has  been  shorn  of  many  of  its  terrors,  thanks 
to  the  curious  construction  which  two  of  Her  Mcgesty's 
judges  have  seen  fit  to  place  on  the  section  in  question. 
This  fact  gives  special  interest  to  the  suggestions  made 
by  the  Council  to  the  various  licensing  or  degree-con- 
ferring bodies  in  the  direction  of  obtaining,  where  neces- 
sary, additional  penal  powers,  those  at  present  in  force 
being,  in  many  instances,  very  small,  and,  in  some,  alto- 
gether wanting.  Here  we  are  confronted  by  the  difficulty 
that  the  licensing  bodies,  unprovided  or  inadequately 
provided  with  penal  powers,  do  not  seem  at  all  anxious 
to  possess  the  power  to  purge  their  Registers  of  the 
names  of  peccant  licentiates  or  graduates,  but  if  they 
have  the  best  interests  of  the  profession  at  heart  they 
will  not  fail  to  act  on  the  suggestion  thus  thrown  out, 
and  will  take  the  necessary  steps  to  remedy  the  defi- 
ciency. We  may  congratulate  the  Council  on 
having    remodelled     the     Standing    Orders    bear- 


ing on  the  procedure  in  penal  cases  so  as 
to  obtain  uniformity  of  treatment,  but  there 
is  still  ample  scope  for  improvement  in  this 
not  unimportant  department  of  the  Council*s  duties. 
It  ought  to  be  possible,  without  engaging  the  Council 
in  the  investigation  of  unfounded  or  idle  charges,  to 
secure  the  investigation  of  cases  in  which  professional 
misconduct  is  alleged  without  the  enormous  cost  to  the 
prosecutors  which  is  at  present  entailed.  All  com- 
plaints ought  to  be  referred  to  a  penal  committee,  aided, 
where  necessary,  by  the  Council's  legal  advisers,  and 
on  this  committee  should  fall  the  duty  of  ordering 
such  further  investigations  as  may  appear  necessary, 
and  of  formulating  the  mi$e  en  acctuatton  cf  the  guilty 
parties.  It  is  intolerable  that  the  whole  trouble, 
expense,  and  responsibility  of  initiating  these  proceed- 
ings should  be  thrown  on  the  shoulders  of  private 
individuals  or  corporations,  seeing  that  very  important 
interests  of  the  profession  are  involved. 
♦' 

MEASLES  AND  ITS  DEATH-RATE. 
The  reduction  of  the  general  death-rate  is  one  of  the 
chief  aims  of  modern  sanitary  administration.  Such 
an  attempt  has  long  been  recognised  by  the  State  as  a 
matter  of  sufficient  importance  to  warrant  the  levying 
of  vast  sums  from  the  popular  purse  in  support  of  an 
elaborate  preventive  system.  Moreover,  in  tiie  case  of 
infectious  diseases  public  health  legislators  have 
insisted  upon  the  necessity  of  interfering  with  the 
liberty  of  the  subject,  so  far  as  to  render  compulsory 
the  measures  of  notification,  isolation,  and  disinfection. 
On  the  whole,  the  special  laws  dealing  with  these 
points  have  worked  with  little  friction,  and  have  been 
tacitly  accepted  by  the  average  citizen  throughout  the 
United  Kingdom.  This  fact  offers  a  remarkable  testi- 
mony to  the  sound  common-sense  that  underlies  the  sem- 
blance of  discontent,  and  the  jealous  hatred  of  inter- 
ference with  the  individual,  which  are  among  our  most 
fixed  national  characteristics.  Nor  has  this  tolerance 
been  without  its  reward.  Cholera  has  been  expelled 
from  our  midst,  small-pox  reduced  to  a  fraction  of  its 
former  prevalence,  scarlatina  sensibly  diminished,  and 
the  incidence  of  other  zymotics,  notably  typhoid, 
signally  checked.  The  economic  benefits  of  such  re- 
sults are  simply  incalculable,  and  it  is  not  open  to  a 
moment's  serious  question  that  they  are  in  the 
main  due  to  the  progressive  triumphs  of  public 
health  reformers.  But  great  as  the  fruits  of  con- 
quest have  been,  there  is  still  a  large  field 
in  the  possession  of  the  enemy.  Among  the  preventi- 
ble  causes  that  swell  the  mortality  rates,  and  are  at 
present  practically  unchecked,  measles  and  whooping- 
cough  take  the  foremost  place.  The  question  of  the 
prevention  of  measles  has  been  discussed  in  the  current 
number  of  the  Nineteenth  Century  by  Drs.  Waldo  and 
Walsh.  They  estimate  that  the  case  mortality  from 
the  disease  in  a  poor  district  of  the  metropolis  averages 
about  thrice  that  of  a  rich  quarter.  They  point  out 
that  in  1694  measles  headed  the  zymotic  death-rate  iu 
London  with  3,293  deaths,  as  against  2,670  due  to 
diphtheria,  and  2097  to  whooping-cough.  But  their  chief 
emphasis  is  laid  on  the  remarkable  statistical  deduction 


638    Thi  Midioal  Pbibs. 


LEADING 


that  daring  the  year  mentioned  measles  killed  in  the 
metropolis  nearly  twice  as  many  persons  as  scarlet 
fever,  fevers  generally  (including  typhoid),  and  small- 
pox pat  together.  In  considering  whether  or  no  the 
disease  should  be  made  notifiable  they  pertinently 
remark  :  '*The  wisdom  and  necessity  of  these  (preven- 
tive) measures  have  been  admitted  in  the  case  of 
small-pox,  of  diphtheria,  of  scarlet  and  other  specific 
fevers,  and  of  erysipelas.  It  seems  illogical  to  exclude 
measles,  which  has  been  shown  to  cause  a  greater 
mortality  than  any  of  the  diseases  named.  .  .  .  Why  it 
should  be  right  to  notify  and  control  or  attempt  to 
control,  diphtheria,  while  measles  and  whooping  cough 
are  left  untouched,  is  somewhat  of  a  mystery." 
About  the  main  facts  advanced  in  this  timely 
article  there  can  be  no  dispute,  any  difference 
that  may  arise  will  be  on  the  main  con- 
clusion that  measles  should  be  added  to  the  list  of 
notifiable  diseases.  As  to  this  important  question,  It 
may  be  broadly  stated  that  if  it  is  the  duty  of  the 
legislature  to  endeavour  to  prevent  the  loss  of  life  by 
preventible  causes,  such  as  scarlatina  and  small-pox,  it 
is  difflcalt  to  see  why  a  similar  obligation  should  not 
apply  to  measles  and  whooping-cough.  The  cost  of 
preventive  measures  in  the  case  of  measles  would  be, 
on  the  face  of  it,  enormous.  An  outlay  of  this  kind, 
however,  many  economists  regard  simply  in  the  light 
of  a  national  insurance.  So  far  as  the  people  who  die 
and  the  folks  who  pay  the  direct  and  indirect  costs  of 
sickness  are  concerned,  it  matters  not  one  jot  whether 
the  destroyer  comes  in  the  shape  of  cholera  or 
small-pox,  or  the  more  homely,  but  far  more 
fatal,  measles.  Whatever  views  be  taken  upon  the 
advisability  of  notification,  everyone  must  agree  with 
the  concluding  remarks  of  the  authors  above  quoted. 
"  In  conclusion,"  they  write,  "  it  is  not  too  much  to  say 
of  measles  and  its  death-toll  that  the  question  is  one 
of  national  importance.  Whether  it  is  to  be  let  alone, 
as  heretofore,  or  to  be  dealt  with  in  a  manner  worthy 
of  this  scientific  and  progressive  age,  must  to  a  great 
extent  be  decided  by  the  verdict  of  educated  public 
opinion.  Experience  has  shown  again  and  again  that 
the  health  reformer  cannot  travel  far  beyond  the  popu- 
lar standard  of  enlightenment  in  these  matters.  That 
general  rule  holds  good  even  in  a  matter  so  closely 
affecting  the  common  welfare  as  the  control  of  measles, 
one  of  the  most  deadly  of  the  preventible  diseases  that 
devastate  the  populace  of  Great  Britain." 


TRADE-UNIONISM  IN  ASYLUMS 
We  are  not  surprised  to  find  that  trades-unionism 
is  beginning  to  break  out  in  asylums,  though  some 
people  might  suppose  that  Ireland  would  be  the  last 
place  in  the  world  where  it  would  first  see  the  light* 
It  is  not  at  all  surprising  when  we  think  of  the 
occasional  outbursts  of  complaint  made  by  attendants 
in  the  newspapers  regarding  their  treatment,  their  long 
hours,  the  want  of  sympathy  shown  with  them  in  their 
work,  and  so  forth.  The  drones  are  usually  the  most 
troublesome  in  all  industrial  communities :  they  do 
least  work,  and  make  most  mischief.  The  same  may 
be  said  of  asylums.    Just  at  present  it  seems  to  be  the 


AKTICLES.  JuK»  17gJigW.__ 

fashion  in  medicine  to  develop  self  defence  unions,  and 
the  recent  combination  to  boycott  a  medical  institution 
in  Liverpool  is  an  example  of  it.  It  is  one  of  the  un- 
fortunate signs  of  the  times,  and  however  high  our 
moral  ideas  may  be  in  this^n  de  Steele  age,  there  is  no 
question  about  it  that  self  is  the  predominant  idea, 
however  much  it  may  be  cloaked  by  other  names. 
There  is  bound  sooner  or  later  to  arise  antagonism 
between  asylum  staffs  and  their  superintendents,  and 
sooner  or  later  a  union  will  be  as  necessary  on  the  part 
of  superintendents  as  on  the  part  of  their  subordinates. 
This  does  not  apply  so  much  to  the  male  side  of  the 
official  staff  as  to  the  female,  because  woman  is  assert- 
ing herself  more  and  more  every  day,  and  the  more  she 
asserts  herself  the  more  she  is  taken  at  her  own 
value.  It  is  doubtless  true  that  she  gives  cheaper 
labour,  and  for  this  reason  she  is  more  in  demand  than 
the  male  competitor.  In  asylums  it  is  difficult  to  draw 
the  best  class  of  women  into  the  service,  because  there 
are  so  many  outlets  for  them  elsewhere,  and  asyluma 
have  not  become  fashionable  as  hospitals  have  up  to 
the  present.  There  is  no  doubt  that  a  check  could  be 
put  on  the  restlessness  of  female  attendants  by  a  com- 
bination of  asylums,  which  would  keep  a  register,  and 
80  prevent  a  too  easy  re-entrance  into  another  asylum. 
In  the  case  of  Richmond  Lunatic  Asylum,  Dublin,  a 
Committee  of  the  whole  board  have  recently  taken  into 
consideration  this  question  of  trades-unionism,  and 
resolved  that  the  Board  of  Governors  be  requested  to 
decline  to  recognise  the  National  Union  of  Asylum 
Attendants  of  Ireland,  with  the  result  that  the  follow- 
ing resolution  was  adopted— "  That  we  adopt  the 
report  of  the  Committee,  the  Medical  Superintendent 
to  see  the  men  whose  names  are  attached  to  the 
rules  of  the  Society  called  'Asylum  Attendants  of 
Ireland  Trades  Union,'  and  communicate  to  them  the 
decision  of  the  board,  and  that  they  are  dismissed 
from  service  in  the  asylum  unless  they  at  once  with- 
draw from  the  Society."  This  might  be  regarded  by 
some  as  high-handed  and  arbitrary,  but  asylum  service 
is  one  which  requires  high-handed  and  arbitrary 
administration*  for  a  strike  of  attendants,  happening 
at  any  moment  would  be  a  terrible  calamity.  To 
replace  a  whole  staff  at  less  than  a  month's  notice,  in 
the  face  it  may  be  of  boycotting  or  picketing,  is  a  very 
different  thing  from  meeting  an  ordinary  industrial 
strike  when  you  have  sane  men  to  deal  with  ;  and  the 
action  of  the  Board  of  Governors  of  Richmond  Luna- 
tic Asylum  was  therefore  the  only  action  open  to  them 
in  the  matter.  The  more  experience  one  has  in  asylums 
the  more  one  is  satisfied  that  prompt  measures  and 
strict  discipline  are  best  for  all  concerned. 


The  Medical  Officer  of  Health  for  Battersea  reports 
a  high  mortality  from  the  epidemic  of  measles  and 
whooping-cough  in  the  parish.  During  the  past  seven 
weeks  there  have  been  112  deaths  in  all  from  these 
diseases,  and  there  are  now  a  great  number  of  serious 
cases. 


Two  medical  women  have  been  elected  to  the  staff 
of  the  Melbourne  Hospital,  Victoria. 


Juinn7,1896. 


NOTES  ON  CXTRItENT  TOPICS. 


Ths  Mbdioull  Pbms.     639 


^ttB  on  dttttrent  ^opxtB. 

Royalty  and  Hospital  Oharitiee. 
The  past  three  weeks  have  been  phenomenal  for  the 
good  work  done  by  the  ▼arioos  members  of  the  Royal 
Family  in  the  cause  of  hospital  charities.  Bat  far  and 
away  above  every  effort  of  the  kind  which  has  so  far 
been  brought  to  a  successful  issue,  there  stands  the 
extraordinary  result  of  the  appeal  for  Guy's  Hospital, 
the  announcement  of  which  was  made  at  a  Festival 
Dinner  in  the  Imperial  Institute  last  week.  The  sum 
announced  was  £160,000,  and  the  applause  with  which 
the  statement  was  greeted  by  the  five  hundred  visitors 
present  can  be  well  imagined  But  now  that  the 
success  of  the  appeal  has  so  far  transcended  the  antici- 
pations of  the  most  sanguine  of  its  promoters  it  is  meet 
that  some  attention  should  be  directed  to  the  means  by 
which  it  was  attained.  It  is  perhaps  scarcely  needful  to 
remind  our  readers  that  the  patron  of  the  special  effort 
was  His  Royal  Highness  the  Princeof  Wales.  No  sooner 
had  the  importance  and,  strictly  speaking,  national 
character,  of  the  appeal  in  aid  of  Guy's  Hospital  been 
impressed  upon  His  Royal  Highness  than  he  at  once 
accepted  the  position  and  entered  heart  and  soul  into 
the  enterprise.  It  is  characteristic  of  the  Prince  that 
when  he  undertakes  to  do  anything  by  which  he  hopes 
to  benefit  his  future  subjects  he  makes  up  his  mind  to 
succeed.  Frequently  has  this  been  proved  in  the 
national  undertakings  with  which  he  has  been  closely 
identified.  But  His  Royal  Highness  succeeds  where 
others,  even  of  exalted  position,  would  fail.  The  Prince 
has  a  great  faculty  of  gathering  around  him  those  who 
are  only  too  willing  to  help  him  in  his  enterprises. 
This  willingness  springs  not  from  the  fact  that  Hb 
Royal  Highness  is  the  Prince  of  Wales,  but  almost 
solely  from  the  popularity  which  he  enjoys.  The 
Prince  is  known  to  be  a  man,  endowed  with  those 
personal  characteristics,  which  attract  men  to  each 
other ;  he  is  genial,  natural,  full  of  good  nature,  as  a 
man,  and  as  a  Prince  tactful,  kindly,  and  always 
knowing  when  to  say  the  right  thing  at  the 
right  time.  It  is  mainly  by  these  qualities  that 
this  appeal,  promoted  by  the  Prince,  has  proved  such 
a  phenomenal  success,  that  is  to  say,  hb  great 
popularity  and  the  friendship  with  which  he  is 
regarded,  doubtless  endowed  many  hundreds  of 
persons  with  an  infective  enthusiasm  to  work  for  a 
cause  of  the  success  of  which  he  was  so  keenly  desirous. 
Never  again,  perhaps,  can  it  happen  that  the  pecuniary 
needs  of  a  great  charitable  institution  will  be  assisted 
by  such  a  collection.  But  if  the  result  was  pheno- 
menal, so  also  were  the  circumstances  unusual  for 
which  the  appeal  was  promoted.  The  re-endowment 
of  a  great  hospital  which  in  the  days  before  agricul- 
tural depression  had  a  large  and  adequate  income 
of  its  own,  was  an  undertaking  which  naturally 
called  for  a  supreme  effort  on  the  part  of  its  friends, 
and  it  may  be  regarded  as  certain  that  no  one  was 
more  pleased  with  the  result  of  thb  effort  than  Hb 
Royal  Highness  the  Prince  of  Wales  himself. 


The  Dublin  Coi^'oint  Preliminary  Bzamina- 
tion. 
It  will  be  observed,from  the  report  of  the  proceedings 
of  the  General  Medical  Council,  that  the  Education 
Committee  of  that  Council  has  reiterated  the  suggestion 
that  the  preliminary  examination  held  by  the  Royal 
Colleges  of  Physicians  and  Surgeons,  Ireland,  should 
be  dbcontinued,  and,  with  the  flippancy  characteristic 
of  insufficient  information,  a  member  of  the  Council 
upbraided  the  Colleges  for  maintaining  thb  examina- 
tion.   The  Report  says :  "  In  view  of  the  fact  that,  iu 
addition  to  those  conducted  by  the  Irish  Universities 
three  examinations  held  by  the  Intermediate  Education 
Board  of  Ireland  are  recognised  by  the  Council,  the 
Committee  reiterate  their  conviction  that  it  b  desirable, 
in  the  interests  of  general  education,  that  the  Roya 
Colleges  should  cease  to  examine  in  Arts.''    If  the 
Committee  had  thought  it  worth  its  while  to  inquire,  it 
would    have  learned   that  the   Irbh    Intermediate 
examinations  are  not  utilised  by  one  in  a  hundred  of 
the  Conjoint  examination  candidates,  simply  because 
the  arrangements  of  those  examinations  are  entirely 
discordant  with  those  of  medical  students.    In  the 
first  place,  these  examinations  are  held  at  a  period  of 
the  year  least  convenient  for  such  students— in  June- 
July.    Secondly  and  chiefly,  the  latest  age  at  which  a 
student  can  present  himself  for  the  Middle  Grade 
examination  (which  is  the  analogue  of  the  Conjoin 
preliminary)  b  16— too  early    to  commence  medica 
study.    If  the  student  should  wait  and  offer  himself 
for  the  Senior  Grade  he  could  postpone  the  oideal 
until  his  eighteenth  year,  but,  in  that  case,  he  would 
have  to  pass  a  proportionately  severer  test,  and,  if  he 
then  failed,  would  be  shut  out  for  ever  from  the  pro- 
fession, inasmuch  as  he  would  not  be  admissible  at  any 
future  period  to  any  Intermediate  examination  of  any 
grada    Nor,  as  alternatives,  are  the  Irish  University 
examinations  acceptable,  because  their  dates  are  not 
convenient     and    the    subjects     required    by    the 
General     Medical     Council     are     not     necessarily 
included.    There    is    abo    a   most    potent    reason 
which  the  Council  cannot  be  expected  to  appreciate, 
against  re-examinations  being  substituted  for  the  Irbh 
Conjoint   Preliminary.    In   England,   an   examining 
body,  t>.,  the  College  of  Preceptors,  is  available,  which 
is  outside  aU  professional  influence,  and  to  which  all 
schools  may  unhesitatingly  remit  their  students  for 
examination.    In  Ireland  thb  b  not  so.    The  Univer- 
sities are  in  active  competition  with  the  Colleges  as 
diploma-granting  bodies,  and  the  University  of  Dublin 
as  a  teaching  body  also.    If  the  Conjoined  Colleges 
handed  over  their  alumni^  for  preliminary  examination, 
to  either  of  these  institutions,  it  b  nearly  certain  that 
they  would  never  see  them  again.    The  Irish  Colleges 
would  be  excessively  foolish  if  they  faced  such  a  risk, 
and  until  the  General  Medical  Council  can  indicate  a 
practicable,    independent,  Preliminary  Examination 
Body  for  Ireland,  it  may  save  itself  the  trouble  of  ful- 
minating ridiculous  resolutions  which  it  cannot  carry 
out. 


640     Thk  Mbdioal  Prjws. 


NOTES  ON  CURRENT  TOPICS. 


Juke  17»  IMB. 


Vaccination  and  the  House  of  OommonB. 

Despite  the  delay,  and  the  supposed  opinions 
expressed,  in  the  forthcoming  report  of  the  Royal 
Commission  on  Vaccination,  it  is  evident  that 
the  House  of  Commons  is  a  strong  centre  favour- 
able to  vaccination.  In  reply  to  a  question  last  week 
in  the  House  as  to  the  recalcitrant  action  of  a  particular 
Board  of  Guardians,  which  had  rejected  a  resolution  to 
enforce  the  Vaccination  Act,  the  President  of  the 
Local  Government  Board  stated  that  he  had  addressed 
a  communication  to  the  Board  in  question  pointing  out 
to  them  that  by  failing  to  enforce  the  provisions  of  the 
Act  they  were  incurring  a  very  grave  responsibility. 
This  announcement,  it  is  especially  worthy  of  note,  was 
received  with  cheers,  thus  showing,  unmistakably,  that 
the  results  of  the  Gloucester  epidemic  have  not  been 
lost  upon  the  Members  of  the  House  of  Commons.  The 
Gloucestershire  Chronicle  recently  published  some  inter- 
esting statistics  respecting  the  visitation  of  small-pox 
to  the  town  to  which  some  reference  may  be  made,  and 
here  it  may  be  said  that  the  inhabitants  of  Gloucester 
owe  a  large  measure  of  gratitude  to  the  editor  of  our 
contemporary  for  the  unvarying,  convincing,  and  dis- 
interested manner  in  which  he  has  pointed  out  to  his 
fellow-townsmen  the  right  course  to  take  in  regard  to 
vaccination.  In  temperate  language  he  has  consis- 
tently advocated  vaccination,  simply  because  he  had 
honestly  satisfied  himself  that  there  was  no  other 
alternative  to  adopt  in  the  presence  of  the  terrible 
epidemic  which  was  raging  in  the  town.  The  statistics, 
moreover,  which  appeared  in  a  recent  number  of  our 
contemporary,  regarding  the  epidemic,  form  a  strong 
argument  showing  the  utility  of  vaccination.  The 
mortality  among  the  total  number  of  cases  attacked 
was  21*7  per  cent;  of  the  un vaccinated  cases,  41*4 
per  cent. ;  of  the  vaccinated  only  in  infancy,  8-5  per 
cent. ;  and  of  the  uncertain  cases,  32*2  per  cent.  When 
the  anti-vaccinationist  faddists  of  Gloucester  and 
elsewhere  attempt  to  reply  to  these  statistics,  we  trust 
that  they  will  endeavour  to  find  some  new  answer 
than  that  of  attributing  the  epidemic  to  insanitary 
conditions  upon  which  they  have  been  harping  ad 
natiseani. 

The  Charity  Organisation  Society  and 
Pauper  Schools. 
The  Charity  Organisation  Society  has  of  late  been 
showing  a  good  deal  of  activity  in  various  directions. 
A  short  while  since  it  dealt  with  the  central  adminis- 
tration of  hospitals,  a  subject  which  might  be  supposed 
to  fall  within  the  remoter  spheres  of  the  Society's 
work.  Now  it  has  held  a  special  meeting  to  consider 
the  question  of  the  education  of  pauper  children. 
How  the  state  of  the  Poor-law  schools  can 
possibly  concern  the  Society  is  a  problem  pas- 
sing strange.  The  Chairman  appeared  to  think 
some  apology  was  needed,  judging  from  his  lame 
assertion  that  the  subject  concerned  that  body  very 
considerably,  because  they  had  a  good  deal  to  do  with 
children  coming  from  Poor-law  schools,  and  a  large 
number  of  their  members  were  guardians.  On  similar 
grounds,  he  might  claim  the  right  of  the  Society  to 


interfere  with  Board  schools,  with  reformatories,  with 
all  scholastic  charities,  as  well  as  with  county  councils, 
school  boards,  and  municipal  authorities.    Why  cannot 
the  Charity  Organisation  Society  stick  to  its  last  t    It 
was  founded  for  the  very  proper  and  laudable  purpose 
of  supervising  the  distribution  of  the  gifts  of  charitable 
persons.    While  it  is  spending  its  energies  in  the  dis- 
cussion of  abstract  problems  alien  to  its  foundation,  it 
has  become  an  object  of  execration  to  the  self-respect- 
ing poor,  in  whose  interests  it  was,  to  a  great  extent, 
created.    Let  this  society  amend  its  wnys,  while  the 
day  of  grace  is  yet  at  hand. 


The  Climbing  Foot. 
An  interesting  theory  has  lately  been  advanced 
by  Mr.  George  Wherry,  of  Cambridge,  in  an  Alpine 
mountaineering  book.  It  is  to  be  found  in  a  chapter 
devoted  by  the  author  to  a  description  of  **the 
climbing  foot."  As  most  readers  knonr,  the  peculiar 
grip  of  a  baby's  hands  and  feet  has  been  traced  with 
every  appearance  of  probability  to  an  inherited  mani- 
festation of  the  arboreal  habits  of  an  ancestral  race. 
This  inherited  form  is  now  further  compared  with  the 
acquired  grip  of  the  mountain  guide,  whose  leg  muscles 
are  supposed  to  have  reverted  to  the  original  type  of 
our  tree-liviug  ancestors.  The  chief  objection  that 
occuis  to  us  is  that  the  ancestral  grip  must  have  been- 
made  by  the  naked  foot,  whereas  all  native  guides 
known  to  us  have  been  heavily  shod  in  boots  with  un- 
bending soles.  The  book  which  contains  this  ingeni- 
ous observation  has  been  prominently  reviewed  in  the 
lay  press,  and  its  author  described  in  so  many  words 
as  "  a  surgeon  in  a  Cambridge  hospital.'*  But  we  do 
not  mention  this  in  reproach,  for  he  has  many  well- 
known  brethren  to  keep  him  company  with  their  names 
and  their  medical  works  in  the  same  non-professional 
columns.  Perhaps,  after  all,  it  is  the  publishers  who 
are  answerable  for  courting  this  form  of  notoriety 
for  medical  authors  in  the  great  outside  vanity  fair. 

Diplomas  in  Midwifery. 
Following  up  the  successful  campaign  against  the 
London  Obstetrical  Societyand  other  bodies  which  have 
been  heretofore  granting  certificates  in  midwifery, 
colourably  resembling  diplomas  in  that  subject,  Dr. 
Kentoul  took  in  hand,  at  the  last  meeting  of  the  General 
Medical  Council,  the  Rotunda  and  Coombe  Hospitals  of 
Dublin,  which  he  challenged  for  issuing  certificates 
of  similar  purport  and  effect.  The  Sub-committee  ap- 
pointed to  consider  the  subject  reported  that  the  docu- 
ments issued  by  these  institutions  do  not  represent 
authority  tolpractise,  nor  are  they  colourable  imitations, 
but  it  cannot  be  denied  that,  as  a  matter  of  practice, 
the  documents  are  used  as  authorised  diplomas,  being 
recognised  as  such  by  the  Regulations  of  the  Irish 
Local  Government  Board.  It  would  seem,  however, 
that  Dr.  Rentoul  and  everyone  else  ought  to  be  satis- 
fied, inasmuch  as  the  two  hospitals  have  intimated  their 
readiness  to  alter  their  certificates  to  the  form  approved 
by  the  General  Medical  Council.  We  do  not  think  that 
any  certificate  issued  by  any  hospital  in  any  subject 
ought  to  be  accepted  as  an  official  authorisation  to 


JuNs  17,  1896. 


NOTES  ON  CURREMT  TOPICS. 


Thx  Mmdioal  Pbbmu     641 


practise  anything,  and  we  therefore  soggeat  that  the 
liOral  Government  Board  shall  amend  its  regulation 
in  this  regard. 

Drug  Stores  and  the  Public. 
Tke  danger  of  dealing  with  cheap  drug  stores  is 
sofficiently  exemplified  by  a  case  which  was  set  down 
for  hearing  in  the  Court  of  Queen's  Bench  one  day 
last  week.  It  appears  that  some  months  ago  a  lady 
who  happened  to  be  passing  an  establishment  of  this 
kind  casually  entered  and  asked  for  a  dose  of  saJ-vol- 
atile  for  a  bad  headache.  The  young  man  behind  the 
counter  in  an  equally  casual  way,  judging  from  the 
sequel,  gave  her  a  dose  of  a  strong  solution  of  ammonia, 
and  was  probably  considerably  surprised  when  he  found 
that  it  produced  an  agonising  pain  in  the  throat,  and 
caused  the  patient  to  cry  out  as  soon  as  she  could 
speak  that  she  was  poisoned.  The  manager  who  then 
appeared  on  the  scene  seems  to  have  had  some  inkling 
that  the  symptoms  were  unusual,  for  after  dragging 
her  into  the  back  of  the  shop,  he  administered  what  he 
described  as  an  emetic.  Finding  that  it  f  aUed  to  act, 
he  probably  did  the  best  thing  under  the  circumstances 
and  sent  her  home  in  a  cab,  telling  her  to  send  for  a 
doctor  at  once.  It  was  too  late,  however,  for  medical 
treatment  to  be  o£  much  avail,  and  for  some  days  she 
remained  in  a  critical  condition,  the  greater  part  of  the 
mucous  membrane  of  the  oesophagus  coming  away  in 
sloughs.  After  a  tedious  convalescence,  she  recovered 
from  the  acute  symptoms  only  to  find  that  her  sense  of 
taste  was  gone,  and  that  she  was  not  only  unable  to 
distinguish  between  different  articles  of  food,  but  that 
even  such  pungent  substances  as  oil  of  cloves,  acetic  acid, 
and  strong  solution  of  quinine,  when  applied  freely  to 
the  tongue  produced  no  sensation.  She  lost  her  ap- 
petite, and  also  lost  considerably  in  weight  Dr. 
Murrell  and  Mr.  Tubby,  of  the  Westminster  Hospital, 
as  expert  witnesses,  were  prepared  to  state  that  in  their 
opinion  the  iigury  was  permanent,  while  Mr.  A.  J. 
Pepper,  who  was  retained  for  the  defence,  was  prepared 
to  take  a  somewhat  more  favourable  view  of  the  cir- 
cumstances. A  goodly  array  of  counsel  was  engaged 
and  damages  were  laid  at  £1,000.  At  the  last  moment 
the  matter  was  settled  out  of  court,  on  terms  which 
were  understood  to  be  favourable  to  the  plaintiff,  the 
defendants  undertaking  to  pay  all  costs.  The  unfor- 
tunate feature  of  the  case  is  that  the  lady  remains 
permanently  injured  from  a  mishap,  the  occurrence  of 
which,  with  the  exercise  of  ordinary  skUl  and  care, 
would  have  been  impossible. 


How  History  is  Mskde. 
In  an  article  which  appeared  in  a  recent  number  of 
the  Paris  Figaro  on  the  malady  of  Napoleon  III,  the 
author,  a  Dr.  £dmond  Barr^  among  many  other 
inaccurate  and  misleading  statemants,  ventured  on  the 
assertion  that  the  fatal  termination  was  largely  due  to 
the  treatment  carried  out  by  Sir  Henry  Thompson.  To 
justify  this  remarkable  statement.  Dr.  Barr6  mentions 
that  the  crushing  was  done  on  three  consecutive  days, 
that  the  patient  during  this  period  (!)  was  constantly 
under  the  influence  of  chloroform,  and  finally,  that 


when  actually  dying,  a  fresh  dose  of  the  anaesthetic 
was  adminbtered.  A  complete  and  crushing  refuta- 
tion of  these  preposterous  allegations  has  since  been 
given  in  a  spirited  letter  signed  by  Sir  Henry 
Thompson,  published  in  a  subsequent  number  of  the 
Figarro,  From  this  conununication,  it  appears  that 
lithotrity  was  practised  on  only  two  occasions, 
at  four  days  interval,  neither  in  duration 
exceeding  five  minutes,  and  that  chloroform, 
administered  by  the  famous  anaesthetist  Clover,  was 
not  given  except  on  these  two  occasions.  It  is  difficult 
to  appreciate  tiie  motives  that  could  have  prompted 
Dr.  Barr^  to  endeavour  to  make  literary  capital  of  state- 
ments so  obviously  absurd  and  so  calculated  to  hurt 
the  feelings  of  one  of  the  most  illustrious  representa- 
tives of  English  surgery,  indeed,  the  most  eminent  in 
this  particular  branch  of  practice.  One  can  only  sur- 
mise that  politics,  which  are  at  the  root  of  all  journal- 
ism in  France,  may  have  had  something  to  do  with  the 
writing  of  the  article.  This,  however,  does  not  inspire 
confidence  in  Dr.  Barr6  as  an  amateur  historian,  nor 
admiration  for  his  sense  of  professional  amenities. 

Vaccination    and    Small-Pox. 

To  the  literature  of  vaccination.  Dr.  Robert  Cory's 
paper,  '*  The  Condition  as  to  Vaccination  of  Persons 
Scarred  by  Small-pox,"  which  appears  in  the  new 
volume  of  "St.  Thomas's  Hospital  Reports,"  is  a  valu- 
able addition.  We  are  apt  to  forget  how  great  a  blessing 
vaccination  is  until  an  outbreak  of  small-pox  opens  our 
eyes  to  the  terrible  nature  of  the  disease  from 
which  the  labours  of  Jenner  protected  us.  Even 
those  who  live  through  the  sufferings  of  variola  not  in- 
frequently bear  traces  of  the  attack  in  loss  of  sight  or 
painful  disfigurement  for  life.  Noticing  the  tendency  to 
belittle  the  value  of  vaccination,  Dr.  Cory  commenced 
in  November,  1884,  his  investigations  with  the  intent 
of  placing  on  record  the  result  of  his  labours.  In  1888 
he  had  collected  notes  of  152  cases,  which  he  published 
in  the  "  Transactions  of  the  Epidemiological  Society" 
of  that  year.  Up  to  the  time  of  writing  he  had  collected 
448,  of  these,  210  were  admittedly  unvaccinated  before 
their  attack  of  small-pox,  or  46*87  per  cent,  and  these 
admittedly  unvaccinated  people  had  by  small-pox  at  the 
average  age  of  6-68  years.     Criticising,  he  remarks  :— 

'*  This  age  is  indeed  high,  when  comj^red  with  the 
average  age  individuals  were  attacked  with  the  disease 
in  the  last  century ;  however,  there  are  three  circum- 
stances to  be  borne  in  mind.  First,  the  greatly 
diminished  prevalence  of  small-pox  in  the  present  day 
to  that  which  it  obtained  in  the  last  centacy.  It 
follows,  therefore,  that  the  opportunity  to,  become 
affected  is  accordingly  not  so  great,  and  this  would 
delay  theavera^^  age  at  which  unvaccinated  individuals 
contract  the  disease.  Secondly,  a  large  proportion  of 
the  unvaccinated  individuals  die  of  the  disease,  and 
these  would,  in  the  main,  be  infants ;  hence,  we  have  a 
considerable  portion  of  the  youngest  eliminated  by 
death.  And,  thirdly,  only  those  who  have  been 
obviously  pitted  with  small-pox  are  dealt  with  in  this 
paper." 

Of  those  who  professed  to  having  been  vacdnated 
23*44  per  cent  had  no  scar  of  vaccination.  And,  as  a 
matter  of  fact  70*31  per  cent  of  those  pitted  by  small- 
pox bore  no   evidence  of  having  been   vaccinated. 


648    Tarn  UamcAh  Puts. 


NOTES  ON  GUBItENT  TOPICS. 


Juim  17, 18M. 


Now,  ta  Dr.  Oory  ujb,  th«  proportion  of  the  unTftc- 
cinated  to  the  vaceinated  in  London  ii  not  more  than 
5  per  cent,  yet  we  haTO  seen  that  people  pitted  with 
small-pox  are  to  the  extent  of  5S'51  per  oent.  nnTac- 
dnated.  If  there  be  no  protective  power  in  yacdnation, 
how  can  thii  be  explained  t  We  think  our  readers  will 
agree  with  the  author  of  the  paper— that  vaccination  is 
a  marreUooB  preventive  of  small'pox,  and  that  hie 
labours  have  done  much  to  demonstrate  the  fact 

Aoademy  Headache. 
YiBiTOBS  to  the  Academy  and  to  other  picture  galleries 
are  usually  conscious,  in  a  more  or  less  pronounced 
degree,  of  a  peculiar  variety  of  headache  which  has,  not 
inaptly,  been  termed  *'  academy  headache/'  It  is  mani- 
fested by  a  strange  feeling  of  exhaustion  and  lassitude 
with  a  desire  for  rest  in  the  horizontal  position,  with 
perfect  quiet  in  the  absence  of  strong  light.  Many  are 
the  theories  that  have  been  snggested  to  explain  this 
affection,  but  we  think  that  the  credit  of  diagnosing 
the  real  cause  belongs  to  Mr.  Simeon  Snell,  of  Sheffield. 
In  the  course  of  his  investigations  on  the  occurrence  of 
nystagmus  in  persons  whose  occupation  obliges  the 
eyes  to  be  raised  above  the  horizontal  line,  of  which, 
curiously  enough,  miners  afford  the  most  frequent  as 
well  as  the  most  striking  examples,  he  noticed  that  the 
actual  development  of  the  oscillations  of  the  globe  was 
preceded  by  a  stage  of  weariness  of  the  elevators  of  the 
eye.  In  this  modified  form  what  is  usually  known  as 
"miners'  nystagmus"  is  far  more  common  than  is 
generally  supposed.  When,  as  at  the  Academy,  it  is 
necessary  to  direct  the  eyes  considerably  above  the 
horizontal  line  a  considerable  number  of  times  a  great 
strain  is  thrown  upon  the  muscles  which  rotate  the  eye 
upwards  as  well  as  upon  the  elevators  of  the  upper 
eyelids,  which  have,  of  course,  to  be  correspondingly 
raised  to  accommodate  the  eyeball.  It  is  true  that  this 
strain  may  be  largely  avoided  by  tilting  back  the  head 
so  as  to  alter  the  visual  angle,  but  from  ignorance  or 
laziness  comparatively  few  people  take  the  trouble  to 
do  so,  and  the  consequence  ib  that  after  an  afternoon 
spent  in  glancing  at  pictures  which,  independently  of 
their  intrinsic  merit,  have  been  hung  above  the  line, 
the  visitor  leaves  the  buUding  with  the  symptoms 
above  described.  It  is  time  that  those  who  are  respon- 
sible for  the  distribution  of  the  pictures  in  galleries 
should  recognise  the  fact  that  the  human  eye  is  not 
oonstmcted  for  looking  upwards  for  any  length  of 
time,  and  if  considerations  of  space  oblige  the  whole  of 
the  available  wall  space  to  be  utilised,  the  higher 
pictures  should  be  tilted  at  a  suitable  angle  in  order  to 
minimise  the  strab  on  the  ^ye  muscles. 

Thb  health  of  the  British  troops  in  Egypt  is  reported 
to  be  excellent.  Of  the  4,142  men  comprising  the  force 
only  146  were  on  the  sick  list  up  to  the  11th  inst.  Of 
these  41  were  in  Cairo,  and  45  in  Alexandria.  At 
Wadi  Haifa  the  sick  amounted  to  66  per  cent. 

The  Rev.  J.  G.  Hine,  B.A.Oxon.,  M.D.Lond., 
has  accepted  the  post  of  the  Bishopric  of  Likoma.  Dr. 
Hine  was  formerly  Senior  Resident  Medical  Officer  at 
the  Raddiffe  Infirmary,  Oxford. 


The  Meotion  of  Oouncillors  at  the  Boyal 
College  of  Surgeons,  England. 
The  11th  instant  was  the  last  day  upon  which 
nominations  could  be  received  for  the  election  to  the 
Council  of  the  Royal  CoUege  of  Surgeons,  England,  to 
be  held  on  the  2nd  proximo.  The  foUowing  is  the 
complete  list  of  candidates  from  whom  applications 
have  been  received.  The  first  two  named  are  retiring 
Councillors  who  are  seeking  re-election,  Mr.  Thomss 
Bryant,  who  has  already  served  two  terms  of  eight 
years  each,  and  Mr.  Pickering  Pick,  Mr.  George  Pollock, 
(date  of  fellowship  1846),  Mr.  Davies  Colley  (1870), 
Sir  William  Dalby  (1870),  Mr.  Qement  Lucas  (1871), 
Mr.  Edmund  Owen  (1872),  Mr.  Walsham  (1875).  Thus 
eight  Fellows  are  competing  for  three  vacancies,  and  it 
is  curious  to  note  that  three  of  the  former  belong  to  the 
Medical  School  of  Guy's,  three  to  the  Medical  School 
of  St  George's,  one  to  St  Mary's,  and  one  to  St 
Bartholomew's.  Mr.  Pollock  will  come  forward  repre- 
senting the  Association  of  Fellows,  of  which  he  is 
President,  and  Mr.  Clement  Lucas  will  also  deserve  all 
the  votes  of  those  Fellows  desirous  of  seeing  the 
reforms  in  the  College  for  which  the  Fellows  have 
more  especially  lately  been  agitating. 

A  Fiendish  Act. 
This  week's  issue  of  our  Spanish  contemporary,  El 
Siglo  Medico  contains  an  account  by  Don  Decio  Osirlan 
of  a  fiendish  cruelty  practised  by  the  Cuban  rebels  on 
a  young  surgeon  of  the  Royal  Army.  A  mongrel  crowd 
of  rebels  having  surprised  a  small  detachment  of 
Royal  troops,  took  the  surgeon  of  the  party  prisoner. 
At  their  request  he  attended  the  wounded  rebels,  and 
when  he  had  completed  his  task  his  captors  bound  him 
and  chopped  off  both  his  hands  with  a  hatchet ;  they 
then  bound  him  to  a  tree  and  left  him  to  his  fate. 
Fresh  from  a  work  of  mercy  he  becomes  a  prey  to  the 
tender  mercies  of  the  wicked,  which  were  carried  ent 
with  fiendish  cruelty.  Probably  none  are  more  vile  or 
cruel  than  the  half-castes  and  filibusters  recruited  from 
Yankee  corner-boys,  who  form  the  rebel  troops. 

Another  Medical  Anti-Vacoinatiomst. 
It  cannot  be  said  that  a  medical  man,  in  the 
words  of  St  Paul,  *'  magnifies  his  office  "  when  he  has 
to  appear  at  a  police  court  in  order  to  answer  a  sum- 
mons for  refusing  to  have  his  child  vaccinated ;  and  yet 
this  was  the  case  with  a  practitioner  at  Bournemouth 
last  week.  The  only  consistent  feature  about  Dr. 
Tebb's  refusal  to  have  vaccination  performed  was  that 
he  is  the  son  of  Mr.  William  Tebb,  whose  epistolatory 
inspirations  against  vaccination  are  so  frequently  to  be 
seen  in  the  columns  of  the  Echo, 


The  Recent  Blot  in  Cairo. 
Faxaticish  has  just  had  another  blow  in  Egypt, 
In  commenting  last  week  upon  the  riot  which  occurred 
in  Cairo,  caused  by  the  students  of  £1  Azhar,  the  hope 
was  expressed  that  the  latter  would  be  taught  a  lesson 
for  obstructing  the  sanitary  authorities  in  the  perform- 
ance of  their  duties.  That  hope  has  been  fulfilled.  The 
ringleaders  of  the  outbreak  were  tried  last  week  and 
sentenced  to  various  terms  of  hard  labour,  from  three 


Junk  i7,  18M. 


CORRESPONDENCE. 


Thb  Mxdioal  PBS8S.     643 


and  a  half  years  to  six  months,  and  some  students 
were  banished  from  the  country.  Altogether  these 
Orientals  have  now  had  good  reason  to  become  sadder 
and  wiser  men,  if  it  is  possible  to  make  an  Oriental 
"  sadder  and  wiser  "  when  a  severe  lesson  in  wisdom  is 
tanght  him. 

The  Alleged  Death  ttom  Antitoxin  Serum  in 
Berlin. 
It  is  satisfactory  to  be  able  to  record  that  the  fullest 
investigation  has  been  made  into  the  circumstances  of 
the  death  of  the  son  of  Dr.  Langerhans,  alleged  to 
have  been  due  to  an  injection  of  antitoxin  serum, 
administered  as  a  prophylactic  against  diphtheria.  The 
inquiry  has  shown  that  the  serum  could  be  acquitted 
of  all  blame ;  it  was  submitted  to  a  minute  analysis 
and  found  to  be  quite  pure.  It  is  now  held  that  the 
child  died  of  shock,  arising  from  the  excitement  to 
which  he  became  subject,  caused  by  the  act  of  the 
injection.  Thus  the  outcry,  of  which  some  of  our  lay 
contemporaries  made  so  much,  agabst  the  anti- 
diphtheritic  serum,  is  proved  to  have  been  decidedly 
premature  and  unwarranted. 

The  Late  Sir  Buasell  Rejrnoldet'  Snoceseor. 
Ths  Queen  has  been  pleased  to  appoint  Thomas 
Barlow,  M.D.,  F.RC.P.,  to  be  Physician  to  the  House- 
hold in  Ordinary  to  Her  Majesty,  in  the  room  of  the 
late  Sir  John  Russell  Reynolds,  Bart.,  M.D.  Dr. 
Barlow,  who  received  his  medical  training  at  University 
College  Hospital,  took  his  M.D.  (Loud.)  in  1874,  and 
was  formerly  Examiner  in  Medicine  at  Edinburgh 
University.  He  holds  the  appointments  of  Physician 
to  University  College  Hospital  and  to  the  Hospital  for 
Sick  Children  in  Great  Ormond  Street,  and  of  Medical 
Adviser  to  the  British  Museum.  Thus  is  the  old  con- 
nection between  Royalty,  Sir  William  Jenner,  and 
University  CoU0ge  Hospital,  maintained.  Many  of  the 
staff  of  this  hospital  have  had  reason  to  be  indebted  to 
Sir  William. 

Ths  following  is  a  list  of  Medical  Officers  detailed 
for  service  with  the  Indian  expedition  to  Suakim,  in 
addition  to  those  already  mentioned :— Principal  Medi- 
cal Officer,  Brigade-Surgeon-Lieut-Colonel  C.  W. 
Calthrop ;  K^o.  34  f^ield  Hospital  (from  the  Bombay 
command),  Surgeon-Major  BuU^Surgeon-Captains  Basu 
and  Jackson,  and  Surgeon-Lieut.  Kilkelly;  No.  32 
Field  Hoq;>ital,  Surgeon-Major  Cretin  and  Surgeon- 
Lieut.  Robertson  from  Bengal,  and  Snrgeon-Capt 
Morton  and  Surgeon-Lieut  T.  Stodart  from  Madras. 

Ths  Committee  of  the  Metropolitan  Asylums  Board 
have  for  some  weeks  past  been  actively  engaged  in 
finding  a  site  for  permanMit  offices,  to  replace  the  pre- 
sent temporary  offices  at  Norfolk  House.  It  is  expected 
that  a  site  will  be  purchased  on  the  Victoria  Embank- 
ment at  a  cost  between  £70,000,  and  £80,000. 

Thb  Pasteur  Chair  at  the  Academy  of  Medicine  that 
has  been  vacant  since  the  death  of  the  savant,  will  now 
be  fiUed  by  Dr.  Rou3c,  who  has  been  made  an  Associate. 


[fbom  cub  own  oouunrovDm.] 

Nsw  AsTLUM  roB  Edinboboh.— For  some  time  back 
the  accommodation  at  Momingside  Asylum  has  proved 
qaite  madeqnate  for  the  reception  of  all  the  paaper 
lanatice  coming  under  the  juriediction  of  the  Parish 
Council.  Only  onc-tbird  can  be  provided  for*  Under  the 
circumstances  the  Parish  Council  will  be  called  upon 
shortly  to  erect  an  asylum  capable  of  accommodating  from 
400  to  600  lunatics,  the  building  of  which  alone  will  cost 
about  £50,000.  A  conference  was  lately  held  between  the 
Council  and  the  Lunacy  Board,  at  which  the  above  under- 
standing was  arrived  at.  Although  the  initial  expense 
will  be  very  great,  the  saving  afterwards  will  probably 
counterbalance  it. 

Poisoning  tbom  Pbb^bbvsd  Mbat. — Some  weeks  ago 
several  members  of  a  family  in  Dundee  developed  serious 
symptoms  of  ptomaine  poisonirg  after  partaking  of  some 
preserved  meat.  Those  of  the  household  who  had  not 
eaten  any  of  it  escaped.  Ail  the  patients  convalesced  in  a 
little  over  a  week,  except  the  master  of  the  house,  who 
began  to  snfler  from  severe  pain  in  the  left  leg.  The  unusual 
sequel  of  gangrene  of  the  left  foot  supervened  and  the  leg 
has  had  to  be  amputated  above  the  knee,  with  satisfactory 
results  80  far. 

DuNDBX  Royal  iNFnufABV.^At  the  annual  Court  of 
the  Governors  of  this  institution  it  was  practically  resolved 
to  proceed  with  the  establishment  of  a  maternity  hospital 
in  the  city.  Of  the  £10,000  deemed  necessary  by  the 
Managers,  £7,000  have  abeady  been  subscribed,  and  little 
doubt  was  felt  but  that  the  remainder  could  be  obtained 
without  much  difficulty.  The  Managers  of  the  infirmary 
have  shown  a  commendable  sense  of  duty  in  undertaking 
the  supervision  of  this  hospital  in  addition  to  the  work 
already  in  their  hands,  and  are  to  be  congratulated  on  so 
reasonably  assenting  to  the  proposal  of  the  Forfarshire 
Medical  Association  with  regard  to  the  use  of  the  Cobb 
bequest. 


CTarrtBponbtttcc. 

fWe  do  not  hold  owielvts  responsible  for  the  opinions  of  our 
ootretpondenta.]  

;the  forthcoming  election  of  direct 

REPRESENTATIVES. 
To  the  Editor  of  Thb  Mbdioal  Prbss  and  Ciboular. 
Sib, — With  your  permission  I  should  like,  as  a  humble 
member  of  the  profession,  to  associate  myself  with  the 
letters  that  have  appeared  in  your  columns  in  support  ol 
the  proposed  candidature  of  Prof.  Campbell  Black  for  the 
General  Medical  Council.  In  mv  judgment  a  more  admir- 
able candidate  could  not  weU  be  found.  I  take  it 
that  something  more  is  desiderated  in  a  representative  of 
the  profession  than  mere  professional  eminence.  That  is 
one  important  desideratum,  certainly,  but  a  candidate, 
however  eminent  professionally,  whose  interests  are  bound 
up  with  those  of  the  privilegedfew,  who  regards  "the  rights 
and  interests  of  the  rank  and-file  of  the  profession  **  with 
Laodieean  complacency,  who  '*  coldly  recognises  the  evils 
from  which  he  does  not  suffer  himself,  and  reserves  his 
chief  enthusiasm  for  the  critical  examination  of  every  pro- 
posal for  their  redress,"  such  a  candidate,  I  say,  will  not 
do.  The  interests  and  cnrievances  of  eeneral  practitioners 
require  a  champion,  and  such  they  already  possess  in  Dr. 
Campbell  Black.  That  he  is  an  expert  in  questions  affect- 
ing the  welfare  of  the  profession,  and  approaches  these 
questions  in  no  scrimp,  lukewarm  spirit,  hut  90m  tHnore^ 
his  brilliant  and  trenchant  public  utterances  Sufficiently 


644    Thb  Mbdioal  Mubb. 


CORRESPONDENCE. 


Jura  VTt  1896. 


testify.  Dr.  BUok  ham  proved  himself  one  of  the  rare  few 
capable  of  taking  a  eoiirae  that  is  not  popular  in  hieh 
plaoee,  and  of  mudng  saorifices  for  an  idea.  Aa  a  oanoi- 
date.  Dr.  Black  hiw,  therefore,  all  the  qnalificatioos 
neoeeeary*  and  hie  olainu  can  hardly  be  ignored.  I  cordi- 
ally support  the  proposal  that  Dr.  Black's  claims  shoald 
be  strongly  argeo,  and  a  provisional  committee  appointed 
to  carry  tnisadecniately  in^io  effect 

I  am.  Sir.  yoors*  ftc., 

C.  RUTHnKTOBD. 

Hartmanor,  Langholm,  K.B., 
Jane  nth,  1896. 


JOURNALISTIC  CONFIDENCE. 

To  the  Editor  of  Thi  Mxdioal  Pbus  akd  Ciboulab. 

Sir,— In  Toar  issue  of  Jone  Srd,  yon  publish  a  leading 
article  in  which  yoo  reflect  severely  upon  some  correspon- 
dence concerning  the  action  of  the  General  Medical 
Council  with  regard  to  the  Apothecaries'  Hall,  which  took 
place  between  a  member  of  that  Council  who  sits  upon  it 
as  the  representative  of  a  London  Corporation,  and  what 
you  are  pleased  to  call  "  personages  in  Dublin."  Of  the 
plural  of  this  gracious  term  I  know  nothing  ;  but  although 
1  cannot  claim  to  be  a  "  personage"  even  in  the  singular, 
the  context  of  the  article  clearly  points  to  me  as  the  reci- 
pient of  a  letter  to  which  you  allude,  and  the  writer  of 
which  YOU  just  as  clearly  indicate. 

I  claim  the  same  publicity  for  the  denial  of  your  state- 
ments as  you  have  i^orded  them  in  your  leading  article. 

The  letter  I  received  was  a  perfectly  proper,  parliamen- 
taiT,  and  moderate  expression  of  views  which  its  writer 
had  previously  stated  to  me  by  word  of  mouth,  in  London. 
They  were  views  which  it  required  no  pressure  from  him 
to  induce  me  to  accept,  as  I  held  them,  to  his  knowledge, 
even  more  strongly  than  he  did.  Had  he  hesitated  to 
write  such  a  letter,  he  would  have  been  disfranchising 
himself  from  the  rights  of  a  citizen,  no  matter  what  his 
ofScial  position,  and  would,  in  my  opinion,  have  failed  in 
his  public  duty. 

I  take  two  exceptions  to  your  leading  article.  One  is, 
that  you  utterly  misrepresent  and  exaggerate  the  nature 
and  purpose  of  the  letter.  The  other,  more  grave^  is  that 
your  references  to  it  are  a  violation  of  confidence.  I  read 
the  letter  as  an  emphasis  of  mv  own  opinion,  in  the  sur- 
geons' room  of  the  Richmond  Hospital  in  the  presence  of 
Mr.  Thomson,  now  President  of  the  College  of  Suigeons 
in  Ireland,  Mr.  Woods,  the  Secretary  to  its  CounciC  and 
Dr.  Jacob.  The  letter  was  communicated  to  no  other 
person,  and  I  specially  and  emphatically  said  to  those 
present  that  it  was  a  private  one.  Mr.  Thomson  and  Mr. 
woods  assure  me  that  the  violation  of  a  confidence  usually 
observed  has  not  come  from  them.  I  leave  to  yon  the 
alternative,  and  I  repudiate  both  the  accuracy  of  your 
article  and  the  method  of  journalism  which  so  abuses  a 
private  conversation. 

I  am,  Sir,  yours,  ftc, 

W.Thobnlbt  Stoksb. 

8  Ely  Place,  Dublin,  June  12th,  1896. 

[We  interpret  the  duty  of  a  journalist  to  be  that,  when 
he  receives  information  in  confidence  or  in  a  quasi-confi- 
dential official  capacity,  he  is  bound  to  observe  the  privacy 
imposed  by  the  circumstances,  but  that,  if  afterwards  he 
ascertains  that  the  subject  matter  of  the  communication 
has  become  public  (even  to  a  limited  extent),  he  is  absolved 
from  the  obligation  for  such  privacy^-  This  is  exactly 
what  has  happened  on  the  prevent  occasion.  The  fact  that 
the  writing  of  the  letter  or  letters,  and,  in  a  general  way, 
the  purport  therefor,  became  known  to  other  persons 
than  Sir  Thomley  Stoker  and  the  other  gentlemen  named, 
decided  us  to  give  the  information  to  our  subscribers  and 
to  express  opinions  thereon.— Ed.] 

ARMY  MEDICAL  COMPETITION, 
To  the  Editor  of  the  Mbdioal  Pbsss  and  Cib€UI«as. 
Sm, — In  the  concluding  portion  of  your  article  on  "Army 
Medical  Competition"  whiohai^NarsinyoariMneoltheiOth 


inst.,  Tou  say,  '*  that  a  certain  Councillor  of  the  Irish  Col- 
lege of  Surgeons  went  uninvited  and  at  his  own  expense 
on  the  occasion  of  the  recent  deputation  from  that  College 
to  the  War  Secretary,  and  that  na  also  without  snggestion 
or  invitation  produced  a  programme  of  his  own,  totelly 
unauthorised  by  the  CoUege,  toe  chief  item  in  which  was 
the  suppression  4>f  the  Army  MedicU  Department 
altogether,  and  its  merging  in  tne  War  Office  as  a  pet^ 
back  stairs  office,  and  that,  when  he  returned  home,  the 
Council  of  the  CoUege  repudiated  his  action  by  passiDg  a 
resolution  for  the  purpose  of  preventing  such  nnaathoriaed 
intervention  in  future." 

Although  I  am  not  named  in  your  article,  I  have  no 
doubt,  nor  have  many  professional  friends  who  are  ac- 
quainted with  the  circumstances,  that  these  observations 
are  intended  to  apply  to  me.  As  the  extract  I  have 
quoted  contains  three  separate  and  distinct  cliarges,  I 
hasten  to  answer  them.    These  charges  are : — 

1st.  That  I  obtruded  myself  as  an  uninvited  and  unwel- 
come member  of  the  deputation. 

2nd.  That  I  prod  need,  at  the  interview  with  the  Secre- 
tary of  State  for  War,  a  programme  of  my  own,  totally 
unauthorised  by  the  College. 

3rd.  Tliat  the  Council  by  special  resolution  repudiated 
my  action. 

I  attended  with  the  full  sanction  of  the  President,  who 
introduced  me,  and  who  was  aware  of  my  views  (expressed 
at  the  committee  when  the  College  memorial  was  drawn 
up)  upon  the  necessary  reforms  of  the  Army  Medical  De- 
partment. I  did  not  apply  to  the  Council  for  nomination 
when  the  deputation  was  formed,  as  I  was  not  certain 
at  that  time  when  I  would  require  to  be  in  London  on  my 
own  business.  It  is  not  necessary  that'  a  member  of 
Council  shall  be  nominated  by  that  body  to  attend  depu- 
tations, and  on  a  comparatively  recent  date,  when  a  depu- 
tation from  the  College  attended  at  the  War  Office,  a 
distinguished  journalist  was  present  as  well  as  medical 
gentlemen  not  Fellows  of  the  Irish  Colle|(e,  nor,  I  brieve, 
in  any  way  connected  with  it.  It  is  quite  true  I  went*  at 
my  own  expense,  as  did  another  member  of  the  Council. 
Tne  Colleffs  limits,  and  rightly  so,  the  number  whose 
expenses  shall  be  paid. 

With  reference  to  the  second  charge,  it  is  inaccurate  to 
say  that  I  produced  a  programme  of  my  own  totally 
unauthorised  by  the  Colleijpe.  I  had  with  me  at  the  depu- 
tation the  document  sanctioned  by  the  College,  aad  had  I 
not  been  in  accord  with  the  views  there  expressed  I  would 
not  have  attended.  The  question  of  the  advantages  of 
having  examiners  from  every  licensing  body  ws^  one  to 
which  I  did  not  give  much  consideration,  and  as  it  had 
been  exhaustively  dealt  with  by  a  speaker  who  preceded 
me  I  did  not  allude  to  it,  but  I  emphasised  the  reasons  of 
the  unpopularity  of  the  Army  Medical  Department  as 
alluded  to  in  the  concluding  paragraph  of  the  Collage 
memorial,  and  advocated  the  advantMras  of  converting  the 
Armjr  Medical  Deptftment  into  a  distinct  oorps,  with 
individuality  such  as  is  possessed  bv  the  Royal  En^neers, 
&c.  This  latter  suggestion  I  have  for  years  held  to  be  the 
solution  of  the  difficulty.  I  have  advocated  it  within  the 
walls  of  the  College  and  elsewhere,  and  am  aware  that  it 
is  the  view  held  by  numerous  medical  officers  of  all  grades 
on  the  active  and  retired  Usts. 

With  reference  to  the  third  charge  that  the  Council 
passed  a  resolution  repudiating  my  acUon,  this  is  inaccu- 
rate. True,  Dr.  Jacob  propoMd  a  resolution  with  rsfer- 
ence  to  future  deputations,  but  it  contained  no  repudiation 
of  any  of  my  actions  and  I  had  no  hesitation  in 
seconding  it 

With  reference  to  the  suggestions  which  lurk  in  your 
article,  but  whidi  you  have  not  the  courage  to  convert 
into  definite  charges,  to  the  effect  that  my  action  was 
attributable  to  personal  motives,  and  that  in  furtherance 
of  these  motives,  and  with  the  object  of  securing  for 
myself  a  personal  advantage,  I  had  undertaken  to  supply 
the  War  Office  with  a  sufBcient  number  of  candidates  for 
the  Medical  Department  of  the  Army,  I  shall,  for  the 
present,  merely  say  that  each  and  every  one  of  these 
suggestions  is  devoid  of  the  smallest  particle  of  foundation. 
I  am.  Sir,  yours,  &e., 

W.  I.  Whulib. 

32  Merrion  Square,  Dublin. 
Jnae  13th,  1806 


Jvvn  17,  1898. 


MEDICAL  NEWS. 


Thb  Msdioull 


645 


FLEET-SURGEON  W.  GORDON  AYRB,  R.N. 

Wb  ngret  to  annoance  the  death  of  this  gentlemaD,  at 
Cheltenham  on  the  9th  inet.,  in  hiR  70th  year.  He  obtained 
hie  medical  education  at  St*  Bartholomew's  Hoepital, 
London,  and  took  hia  diploma  of  M.R.C.8.,  Eog.,  in  1850. 
The  following  year  he  was  appoinned  a  porfzeon  in  the 
Navy,  and  was  Aesistant-Sanaceon  of  the  Penelope  on  the 
West  Coast  of  Africa,  when  he  participated  in  much  active 
service  against  the  slavi^  trade,  incladinff  the  attack  on 
the  town  of  Lagos  in  1852.  He  served  in  the  BecruU 
during  the  Russian  War  in  the  Black  Sea,  1855,  and  was 
present  at  the  expedition  to  Kertch  and  the  operations  in 
the  Sea  of  Azoff  (Crimean  and  Turkish  merfais,  Azoff 
Clasp).  He  was  promoted  to  be  Staff-Surgeon  in  1860 
and  Fleet-Surgeon  in  1872,  and  was  retired  in  1873.  He 
was  in  the  enjoyment  of  a  Greenwich  Hospital  pension.  . 


The  Nnrsixig  Exhibition. 

This  exhibition,  which  wai»  organised  by  the  Nursing 
Record^  has  been  open  at  St.  Martin's  Town  Hall,  Charing 
Cross,  for  the  past  fortnight,  and  closed  on  Saturday  last. 
Taken  as  a  whole  it  has  differed  but  little  from  the 
'*  Museum "  one  is  accustomed  to  see  at  every  annual 
meeting  of  the  Britiph  Medical  Association,  and  it  ap- 
peared to  attract  no  more  public  attention  than  does  its 
congener  in  August.  As  a  matter  of  fact,  exhibitions  of 
this  kind  are  "done  to  death,"  and  the  profession  and  the 
public  have  ceased  to  interest  themselves  in  them,  except 
for  the  purpose  of  getting  ''free  samples"  which  the 
generous  exhibitor  is  ever  ready  to  grant.  Whilst  the 
exhibition  was  in  prc^^ress,  conferences  were  held  and 
papers  read  on  the  various  points  connected  with  nurses 
ana  nursing  ;  and  a  band  discoursed  mu'ic,  not  perhaps 
quite  up  to  Philharmonic  pitch  at  intervals,  and  several 
well-known  professional  instrumentalists  and  vocalists 
kindly  gave  their  services  from  time  to  time.  Among  the 
exhibitors  Messrs.  Burroughs  and  Wellcome  were  as  usual 
to  the  fore  with  their  preparations,  which  are  so  well 
known  to  our  readers  as  to  require  no  notice  at  our  hands. 
Beside  their  own  manufactures,  they  exhibited  the 
splendid. pepsins  and  digestive  ferments  of  Messrs.  Faur- 
cnild  Broi ,  of  New  York,  and  the  unique  beef  juice  of 
Messrs.  A  yeth  Bros.,  of  Philadelphia,  which  has  now  an 
established  reputation  in  this  country.  The  Sanitas  Com- 
pany also  had  an  imposing  show  of  their  disinfectants, 
Hoaps,  fumigators,  and  antiseptics  in  every  conceivable 
form ;  whilst  the  instrumental  section  was  well  repre- 
sept«d  by  Messrs.  Maw,  Son,  and  Thompson,  Messrs. 
Down  Bros.,  Messrs.  Arnold,  and  Messrs.  Bailey  and 
Son.  Space  was  also  found  for  some  of  the  leading 
meat  extracts,  euch  as  the  Liebig  Company,  the  Bovril 
Comoany,  &c.,  but  food -stuffs,  which  one  would  expect  to 
find  largely  represented  at  a  nursing  exhibition,  were  con- 
fined to  one  stall,  that  of  the  Frame  Food  Company,  which 
contained  specimens  of  their  highly  nutritious  produc- 
tions for  invalids,  children,  and  nursing  mothers.  Messrs. 
Cadbury  Brothers  had  a  very  complete  exhibit  of  cocoa, 
from  the  early  stage  of  the  bean-pod  to  its  final  evolution 
into  the  delicious  cocoa  essenoe  and  chocolates  for  which 
the  firm  is  so  justly  celebrated.  Messrs.  Cook  and  Sons, 
the  well-known  soap  manufacturers,  exhibited  some 
novelties  in  the  shape  of  medicinal  and  antiseptic  toilet 
soaps.  That  of  biniodide  of  mercury  is  maoe  in  two 
strengths,  containing  respectively  1  per  cent,  and  3  per 
cent.  As  is  well-known,  this  mercurial  salt  has  an  exceed- 
ingly powerful  germicide  and  antiseptic  action.  In  the 
present  case  it  has  been  incorporated  with  a  delicate  and 
freely  lathering  toilet  soap,  and  should  prove  invaluable 
in  the  treatment  of  eczematous  and  other  irritable  con- 
ditions of  the  skin.  Another  good  article  supplied  by  the 
same  firm  is  a  10  per  cent,  carbolic  acid  super-fatted 
soap,  free  from  colouring  matter,  and  prepared  by  a 
new  process,  whereby  the  necessity  of  using  an  excess 
of  alkali  is  avoided.  Water  was  also  spanely  shown, 
it  being  confined  to  the  well-known  aperients,  Hunyadi 


Janos,  Carlsbad,  and  Vichy.  Wine  was  represented 
by  one  or  two  novelties.  Messrs.  Blandy  Brothers, 
whom  we  do  not  remember  as  exhibitors  previously,  were 
officially  responsible  for  a  display  of  Australian  wines. 
The  inortosed  imports  from  our  Australasian  colonies  in 
this  direction  have  certainly  been  very  pronounced  of  late, 
f6r  wher6as  in  1885  they  were  53,000  gsJlons,  in  1895  they 
riacbed  607,000  gallons.  Nor  is  this  to  be  wondered 
at,  as  their  purity  is  guaranteed  bv  having  to  pass 
the  Government  tests  both  in  Adelaide  and  in 
London  before  they  reach  the  consumer.  Those  we 
saw  were  from  South  Australia,  the  "  Orion  Brand,"  and 
were  certainly  excellent  specimens  of  cheap  and  whole- 
some wines,  and  though  the  palate,  in  virtue  of  usage  with 
more  highly-alcoholised  beverages,  is  at  first  prejudiced, 
the  limine  grape-juioe,  and  the  absence  of  volatile  acids  in 
these  wines,  quickly  gain  for  them  converts.  The  only 
other  exhibitors  ot  wine  were  Messrs.  Stephen  Smith  k  Co  , 
of  Bow,  whose  Coca  Wine  is  too  well-known  to  need  com- 
ment, and  who  were  exhibiting  for  the  first  time  specimens 
of  the  Liebig  Company's  extract  of  meat  in  a  Spanish  red 
wind,  a  decidedly  palatable  preparation.  The  exhibition 
of  nursing  appliances  was  dec'oedly  attractive  and  com- 
plete, a  practical  application  of  which  was  shown  by  the 
inventor— a  Mrs.  Brooke  carrying  about  her  own  baby 
during  the  exhibition  slung  on  a  support  of  webbing  in 
front  of  her,  while  her  own  arms  were  free,  and  the  child 
apperently  comfortable.  Some  of  the  hospitals  contri- 
buted nursing  appliances,  and  beautifully-modelled  dolls 
were  shown  fitted  with  Mr.  Bryant's  sphnts  in  hip-joiot 
disease.  The  Gorham  bedstead  was  also  worthy  of  atten- 
tion, showing  as  it  did  the  wonderful  facility  with  which 
an  invalid  can  be  handled,  placed  in  any  desired  position, 
or  shifted  from  house  to  train  if  necessary  with  little  or  no 
movement  or  fatigue. 

Vital  SUtistioa. 

Ths  deaths  registered  last  week  in  thirty-three  great 
towns  of  England  and  Wales  oorresponded  to  an  annual 
rate  of  17*8  per  1,000  of  their  aggregate  population,  which 
is  eetimatea  at  10,846,948  persons  in  the  middle  of  this 
year.  The  deaths  registerea  in  each  of  the  last  four  weeks 
in  the  several  towns,  alphabetically  arranged,  corres- 
ponded to  the  following  annual  rates  per  1,0CWI  :— 

Birkenhead  16,  Birmingham  16.  Blackburn  18,  Bolton 
23,  Bradford  15,  Brighton  16,  Bristol  18,  Burnley  12, 
Cardiff  20,  Crovdon  11,  Derby  12,  Dublin  19,  Edinburgh 
14,  Gateshead  22,  Glasgow  21,  Halifax  19,  Huddersfieid 
19,  Hull  18,  Leeds  18,  Leicester  16,  Liverpool  21,  London 
17,  Manchester  23,  Newcastle-on-Tyne  16,  Norwich  16, 
Nottingham  20,  Oldham  21,  Plymouth  12,  Portsmouth  13, 
Preston  10,  Salford  22,  Sheffield  17,  Sunderland  14, 
Swansea  13,  West  Ham  14,  Wolverhampton  19.  The 
highest  annual  death-rates  per  1,000  living,  as  measored 
by  last  week's  mortality,  were: — From  measles,  1*4  in 
London  and  Manchester,  1*8  in  Portsmouth  and  in 
Oldham,  and  2*6  in  Gateshead  ;  from  whoOping-cough, 
1  9  in  Cardiff,  and  2*2  in  Salford;  ;  from  fever,  1*1  in 
Gateshead;  and  from  diarrhoea,  1*0  in  Burnley.  In  no 
case  did  the  death-rate  from  scarlet  fever  reach  1  *0  per  1,000 
in  any  of  the  largo  towns.  The  76  deaths  from  diphtheria 
included  52  in  London,  6  in  Birmingham,  and  3  in  Liver- 
pool. No  death  from  small-pox  was  registered  in  any 
of  the  large  towns,  but  in  Gloucester,  which  is  one  of 
the  small  towns,  11  deaths  were  registered  from   this 

The  Mortality  of  Foreign  Cities. 

Turn  annual  death-rate  per  1,000  in  the  principal  foreigi 
cities  according  to  the  weekly  returns  communicated 
the  Heeistrar-Goneral,  is  as  foAows :— Bombay  35,  Madras 
37,  Pans  20,  Brussels  18,  Amsterdam  22,  Rotterdam  17, 
TheHagne  17.  Copenhagen  15,  Stockholm  18.  Christiaoia 
23,  St.  Petersbunr  37,  Moscow  43,  Berlin  18,  Hambuig  20, 
Dresden  26,  BresUu  30,  Munich  23,  Vienna  27,  Prague  32, 
Buda-Pestb  33,  Trieste  22,  Rome  19,  Turin  25,  Venice  20, 
New  York  22,  Brooklyn  17,  Philadelphia  17. 

Metropolitan  Hospital  Sunday  Fund. 

It  is  as  yet  impossible  to  forecast  the  probable  result  of 
the  collection  which  took  place  in  London  on  Sunday  last 
in  aid  of  this  fund,  but  so  far  as  the  amounts  were 
announced  at  the  time  of  going  to  press,  a  slight  falling 
off  was  observable  from  last  ymr's  receipte. 


646    Thk  Msdigal  Prw.       NOTICES  TO  COBKKBPONDENTS 


Jum  !?• 


^tia6  to 

^S9^  CosBMroVDim  nqamnc  ft  rapiy  la  Ihit  ootaan  an  par- 
ttcnlftrij  reqnettad  to  make  hm  of  a  digtjnctim  tignmim*  or  imitiaht 
and  aTold  the  praetlot  of  rignlnc  tbaBualTM  *'  S«ad«r/'  "  SabaerfbOT, " 
" OldSabMHlbar, '  Ae.  Much  ooofwloo  vfU  ba  ipand  bf  attMitioa 
ID  tlila  nila. 

IKFECf  I0U8  DISEASES  XOTIFICATION. 
w.  E.  B.  »tlta-  "  In  caaaa  of  tcarlat  fevar,  or  typhoid,  oooontaff 
amoBg  tba  labooriiig  cla»i  In  a  miml  dlafrict,  who  It  the  proper 
anthority  to  eee  that  the  hooae  la  thoroughly  disinfected,  and  who 
mutt  bear  the  ^zpetiie  of  each  disinfection  ? " 

(The  lUiral  DIttrlct  Councfl  are  teqnire  *,  aa  the  tanitary  anthorlty, 
ui  der  eec  6.  of  the  Infectlona  I>iMaM  (Prerentioo)  Ace,  1890,  where 
their  medical  oAcer  of  liealth  or  any  other  regittered  medical  practl- 
Honer  certiflea  that  the  eloaing  and  di»lnfectin<c  of  any  hooee  or  part 
(hereof,and  of  any  artteiea  therein  lilcely  to  retain  InfeclioB  woold  tend 
to  prerent  or  cheek  inf ec|loaa  diaeaae,  to  give  noi&oe  In  writins  to  the 
owner  or  occupier  of  anch  hooae,  or  part  thereof,  tliat  the  tame  and 
any  articlea  therein,  will  be  cieanaed  and  diainfected  by  the  local 
anthorlty,  at  the  ooat  of  anch  owner  or  occupier,  anleaa  he  mforma  the 
DittrictConnctt  within  24  hotira  from  the  receipt  o<  the  notice,  that  he 
will  cleanee  and  dlainfect  the  honae,  or  part  thareof ,  and  any  anch 
articlea  therein,  to  the  f  atlafaction  of  the  medical  oAoer  of  health 
within  a  time  fixed  in  the  notice.— Ed.) 

Mr.  Ed.  Cohvib  (Be'graTie)  -The  propoaal  contained  in  your  latter 
•hall  be  considered,  and  a  prlTate  note  sent  yon. 

TBI  BoMouKABLi  8n>nT  HoLLAVD  Is  thanked  for  hia  eommnnloa- 
tian,  with  which  we  hope  to  deal  faliy  in  our  next. 

X.T.Z.— Unleia  it  can  be  proTcd  that  B  acted  dishoooorably  and  was 
the  means  of  bringing  about  your  diacharge,  we  do  not  think  yon 
woold  be  JusUfled  in  assoming  it,  or  in  blaming  him  for  acting  aa 
he  did. 

On  IVTIRIRIP.—Ihe  point  waa  datermlnad  at  the  meeting  of  the 
Oenaral  Ifedioal  Coondl  laat  week,  and  will  be  found  in  onr  Baporiof 
Proceedings. 

THE  LAY  PRBB8  AND  MEDICAL  AYFAniS. 

AS  eridence— if  any  were  needed— of  the  abenrdltlea  In  which  the 
lay  press  indolge  when  stepping  ootalde  their  own  sphere  Into  medical 
rMons,  we  may  refer  to  the  paragraph  that  went  the  round  of  the 
daily  papers  laat  week  on  the  appointment  of  Dr.  Bailow  to  the 
Qoeen  •  honsehokt,  vice  Sir  J  ftosaell  Seynolda,  deceased.  Our  eon- 
firere  is  described  as  haring  "  won  the  h:gheat  diatinctlon  as  a  child- 
doctor,*'  not  a  recommendation  for  Bar  MaJeety's  hoosehold,  one 
woold  knagine  ;  and  that  he  It  was  to  whom  *^  Mr.  Oladatowi  turned 
on  the  death  of  Sir  Edward  Clarfca."  Again.  H  may  be  remarked  that 
at  this  period  of  hia  life  Mr.  Oiadatone  would  not  hare  needed  to  turn 
to  a  '*  child^lootor,"  and.  moreorer.  that  Sir  Edward  Clarke  was  rery 
mneh  allTC  when  we  saw  him  a  day  or  two  alnce.  Dr.  Barlow  may 
well  ezdaim,  "  aare  me  from  my  frlenda." 

Dr.  RUTHiftromD  MoKiaOM.— Cuaea  reeelTed.  A  note  hss  bean  made 
of  yourraqoeat. 

Latmah  (Leeds).— It  woold  be  Impossible  to  deiermlne  the  qpestlon 
by  statbtiGS,  for  the  rcMon  that  no  statlstiosare  avallahle  for  the  pur- 
pose. Nerertheleas.  common  obaerration  would  seem  |o  show  that 
the  oonsunration  of  meat  la  mora  general  Ihan  used  formerly  to  be 
thecase.  It  has  been  stated  that  tttti  greater  conaumplioo.  If  It  be  a 
fact,  may  be  accounted  for  by  the  large  Importation  into  this  country 
of  k>w-prioed  refrigerator  meat.  Our  oorrsspoodent  might  make 
inquiry  uimself  into  the  increase  or  otherwise  of  the  trade  carried  on 
under  this  head. 

STUDIUT  (Highbury).— Placenta  prwria  is  said  to  be  more  frequent 
in  women  who  have  boine  children  rapidly,  and  in  whom  ptegnandea 
hare  doeeiy  followed  an  abortion. 

Mb.  SHiBLkT  MATHXW8.'Tour  premisea  are  not  quite  correct, 
inasmodi  as  the  flgoteaon  which  ther  are  foonded  are  wrong  accord- 
ing to  the  latest  official  calcolatlons.  These  am  taken  from  last  ceosos 
returns,  which  give  the  popoiation  of  the  three  largest  American 
cities  as :  New  York,  1,996.000  ;  Fhiladelphla.  1,198.800  ;  Brooklyn, 
1,105,000.  We  do  not  know  the  exact  figure  for  Chicago,  bot  it  ia 
piobably  not  far  short  of  that  for  the  three  cities  referred  to. 


4Rtttm:90  of  the  $0dttte& 

WlDnSDAT,  JUHS  17TH. 

RATAL  MxnoROLOOiOAL  SocnTT  (22  Ot.  OeoKe  St..  Westminster). 
—7.30  p.a>.  Papers :— Mr.  H.  Harries^  Arotic  Hall  and  Thonderstorma. 
Mr.  J.  K.  Cnllum :  Climatology  of  Valencia  Island,  co.  Kerry.  Dr.  H. 
K  Leigh  Canney :  The  Winter  Climate  of  Egypt,  bsaed  on  results  from 
Self-recording  instruments. 

RoTAL  MiORoaooPlOAL  Sooutt  (20  HanoTCT  Square,  W.).-.8  p.m. 
Meeting. 

BRITISH  Balhsoloqioal  avd  (Tumatological  SoavTT  (Linuner's 
Hotel,  Conduit  Street,  W.X— 8.80p.m.  Dr.  C.  T.  Williams:  Sea- 
bathing  and  the  Open  air  Treatment  of  Diaease.  Followed  by  a  Oon- 
reiaazione. 

THUBSDAT,  JUVB  18IH. 

Cbblsba  Victoria  Hospital  FOB  Childbd.- 4  p.ai.  Dr.W.Catr: 
Pneumonias  in  Children  and  their  Sequelie. 


Bittanttes. 


Birmiogham  City  Asylum.— Junior  Assistant  Medical  OfBoer.  Salary 
£80  per  annum,  with  board,  lodging,  and  washing.  Appllcatlona 
and  teettmoaiais  to  the  Medical  Superintendent. 


Salaiytoc 


Cheater  Qeoeral  laflrmtry.  —VUUb^  Suneon. 
£$0  per  ai'iu'w,  vith  rasldasca  ani  bmIM 
aod  teetimoolal4  to  the  Chairman  of  thedovtl  of  Ma 
Eastcato  Row,  North  Cheater,  not  later  than  June  27th. 

Isle  of  Man  i^eoerai  Hoepttal  asd  DUpensarj.  Douglas.- aouae  Sw- 
genn  8aUry  £90  per  year,  with  apaftoseota,  gas,  eoula,  and 
washing  f reei    KuU  panleularB  of  Mr.  Kredk.  a  Klealag,  Boa. 

Seo 

Lewes  DUpeneary  ftnd  Inflrmary  and  Victoria  HospitaL— E  swisnf 
Medical  Officer.  Salary  £lltf  per  aaaum,  fuiuiahed  apurtmsats, 
coal,  gas,  and  attendance, '  AppUcatlou  and  teatimoniaU  to  the 
Bob.  aec  by  June  20th, 

Norfolk  County  Asylum,  Thorpe,  Norwleh.- Temporary  AasislBBt 
Medical  Officer.  Board,  lodging,  and  wisriiii«  (no  aalary).  Apply 
to  the  Medical  Sitpariateadeot.  ^^  ^^ 

Seamen's  Hospital  Society.- House  Surfeoa  for  Bnaeh  Boapltal, 
Ro>al  Victoria  aad  Albert  Docfca,  E.  Salary  £76  peraaaam,  with 
board  aadfiaideaei.  PUitleutanoCP.  MlohaUl.aecretaffy.Clflaea- 
wksh.  S.E. 

Stockport  Inflrmary.- Assistant  House  aad  Visiting  Suiyeoa.    Salary 
£S0  per  annum,  wftn  board,  waahlwr.  and  sesldenceL  AppU 
and  testhaooials  to  the  Secrataty  aot  later  than  June  2Srd. 


^ppnintmtnxm 


Cabtu,  R.  J.,  M.D.Lond.,  D.P.H.  Assistant  Fhysldan  to  the  Weatern 
Skin  Boapltal  London,  W. 

Oowib,  O.,  M.B.  JI  S.  Ahead.,  Usistaat  Medical  Offiosr  lor  the  Inflr- 
mary of  the  Whitechapel  Cnlon. 

EWB1I8,  J..  L  R.C.P.Lond..  L.R.aS.Edla.,  Cbaaultl^  Saivwm  to  the 
Bristol  Hoepital  for  Sick  Chiktren  and  Women. 

OBnnr,  R.,  M.D,  B.Hy.  (Durh.X  MedtealOfllcer  of  Haattk  to  the 
County  Borough  of  (^Oeahead. 

Helm,  R.  D.,  M.D..  C.li.Edin.,  Assistant  Physician  to  the  Combsriaad 
Inflrmary,  Carlisle. 

Huxx,  w.,  M.B.,  C.M.Edln..  Senior  Surgeon  to  the  Searboro^h  DIs- 

*lcp^nmf:ii%)  to  tbe  BHstoJ  BovpUiJ  tar  atf k  i^'hU^irva. 
McK:i^.'U!(,  w  a  ,  M^DJrei,  MCh.,  Uctonr  uu  c^thabaokir  and 

tJt'>logy.  QafccB'*  C Hjllewr.  B«UMt. 
M1LL1&,  O.  B.,  L.£.CF.^la.r  ^-^  C.S.Eug.,  Hedkal  Oactfr  ol  ^lift 

1  tr  the  lk*Fv>ag!i  of  €i>irbri(lg«. 
MoiLU'vy.  A«,  M.L^,  I'.g.C.F.kd..  M.RC  PLodd.,  PUyiiclao  to  iM^ 

pjiclt*ti^*  at  the  aiiidren't  RospiiAl  PsJiliiigton, 
MuiiToN,  €.  A.,    LR.€  f.Loiid  ,     M.R.LUH.,    Sanrwu    (oui-puteato' 

depaitmnit)  10  the  HrUto!  LIcicplul  r^>r  Ai^W  rnillilreii  an^  v^mmss 
KauAiN,  T,  C,  »l.K,c,J^.  4  ou^uULse  Htirg««Q  to  %hit  imatU  B^^rilal 

tor  tikk€t]llilreti  nu'l  Womeu 
PAi.fiDRT,».   J.,  M.B..  LR,C,F.Loiid.,  M.B.C.8,,  Uedk^   OflLrtr  ^f 

Membury  Sanitary  Diatrlct  of  the  Axmlnster  Union. 
Rob,  B.  H..  M.R.C.S.,  Medical  Oflteer  for  the  Ashfoid  Sanitary  Diitriet 

of  the  Stainea  Unkm.  ^^ 

ST.  LMBB,  R.  A.,    M.B.,  M.S.Edfai.,  Madtoal   Oflkwr  for  Watted, 

Berta. 
SIBWABT,  W.  A.,  M.B.,  M.8.Aberi.,  Medical  Oflloer  lor  the  Va  6 

Sanitary  Distrtet  of  the  Oldham  Unkm. 
W0ODHOU8B,  T.  S.,  M.B.,  OlB.  Vtet.,  Bouse  Surgeon  to  the  Btockpott 

Inflrmary. 


$irtlt«e 


BUBTOB-fApppra.-  June  Sth.  at  Koprich,  the  wife  of  r  W.  Burton- 

ranaln|,  M.B.Oaipb.,  M-fLCpSoad.,  M.|Lc!s.,  dTaaoa. 
PoWBLL^-Jnae  Uth  at  Olenarm  Bouse,  Upper  autoh,  the  wifa  o< 
_  Berbert  E.  Powell,  M.R.C.8y  of  ason.  ^^      ^^ 
PBAn..«June  nth.  at  Penrhoe  House.  Rugby,  the  wife  of  W.  flalloa 
Pratt,  M.D.,  L.R.C.P.Lond..  of  aAanJSter. 

GiVBB-OABKBTr.— lune  10th.  at  St.  Ann's  Church,  Turton,  J.  C.  M. 

OlTen,  ll.D..  of  The  Orange,  UTerpool.  to  May,  eldeet  daughter  of 

J.  Oamett,  Esq..  The  Grange,  near  Bolton. 
GooDwiH— DUM nouB-^-June  lOth,  at  St  Jude's  CTbureh.  South  Ken- 

sington,  Wydiffe  «4oodwin,  M.B.,  of  Rhyl.  N.  Walea,  to  OUria 

Adeline,  fifth  daughter  of  the  late  Captain  Edward  DumeRue,  of 

B.M.'s  Madras  Ar«y. 
Hoabb-Oowlaiid.-.  June  10th,  at  Boly  Trinity  Ohurob,  Bastboui^e. 

Edwin  Stanley  Boare.  N.R.as,.  L.^  C.P.,  of  Sydenham,  to  Jeasia 

May.  only  daughter  of  Thomas  Stafford  Qowland,  of  BMthoume. 

Thompsok-Cottob.- June  9th,  at  St.  John's  Church,  Bampatead,a 

Sinclair  Thompaon  M.&.  of  Mdeford,  to  Florence,  eldest  <langhter 

of  the  UteF.,^  Cotton,  of  The  Knoll,  Weft  Bawpetead.   ^^ 
WaLTKB-^Sodbk.— June  18th,  at  St.  James's  Church,  Hampstead 

Richard  A.  Walter,  M.R.C.8.,  L  ILCrP.Lnnd..  of  Blackpool,  to 

Roee  Sherman,  daughter  of  the  late  Rer.  Frank  aoden,  of  Lower 

Ctayton. 
WITBBB8-  SumcTO  -Junf  9th,  at  St.  Peter's  (Thureh,  Ashtoa-uader. 

Lyne.  Percy  Withers,  M.B.,  of  Ashford,  Hale,  Cheahire,  to  Mary 

WooUey.  youngest  daughter  of  the  late  John  Summers,  of  Suany. 

side,  Ashton-nnder-Lyne. 

^^^^^J^  •*  Shafleabury,  Charles  SOroster  Erans,  M.A.. 

M.B.,  B.O.Cantab..  M.R.C.H.,  i^  86.  t~       — ,       «., 

LABOSBAW.-Jnne  6th,    at    Elmdde,    Lancaster,    Jamee   Pearaoo 

Ungshaw,  F.R.C.S.,  aged  82. 
MOBBI^-Junetol,  at TheGrore.  Cambarwell,  Isaw) Mosria,  M.D.,  of 

Wallands  Crescent,  Lewes,  af^  68. 

Am&ies  0/  Sub»eribert  to  thii  Journal  «ri  73KV4f>Sraa5  aMlS 


ik  ^tAiai  ^vt$&  mA  (^itmlm. 


'SALUS    POPUU    SUPRBIIA    LBX." 


Vol.  CXn. 


WEDNESDAY,    JUNE    24,     1896. 


No.  26. 


mtgiat&l  (Eommrmiadions. 
MAUNSELL'S    METHOD 

OF 

INTESTINAL   ANASTOMOSIS, 

WITH  A 

SUMMARY  OF  THE  CASES  OF  OPERATION. 
By  FREDERICK  HOLME  WIGGIN,  M.D., 

Burgeon  to  the  New  York  City  Hoepital,  Blaokwell'i  Iiluid,  Oynseoo- 
logical  DifMon  ;  Fellow  of  the  American  Medical  Association,  and 
of  the  New  York  Academy  of  Medicine  ;  Honorary  Member  of  the 
German  Surgical  Asaociatioa  Berlin,  Ao, 

So  mach  interest  has  been  manifested  during  the 
past  few  vears  in  the  surgery  of  the  abdomen,  and  its 
viscera,  that  it  seems  timely  to  call  attention  to  the 
method  of  intestinal  suture  devised  and  practiced  some 
years  since  by  the  late  Professor  H.  Widenham  Maun- 
seU,  of  New  Zealand  and  London.  This  procedure,  the 
writer  believes,  has  not  yet  received  its  oroper  degree  of 
recognition,  owing  to  the  fact  that  Professor  Maunsell 
delayed  the  public  description  of  his  work  till  about  the 
time  of  the  presentation  to.the  profession  by  Murphy,  of 
Chica^i  of  his  device  for^  effecting  the  same  end, 
intestmal  anastomosis.  This  latter  method,  from  its 
safety,  ease,  and  the  lack  of  special  skill  required  for 
its  accomplishment,  captivated  the  professional  mind, 
temporarily  overshadowing  the  not  less  brilliant  but 
more  scientific  procedure  about  to  be  described. 

Technics  of  Maunsell's  Method  of  Intestinal 
Anastomosis. 

The  patient  having  been  prepared  in  the  usual 
manner  for  the  performance  of  a  laparotomy,  and 
having  been  anaBSthetised,  the  operation  is  besun  by 
making  a  median  incision  in  the  abdominal  wall  below 
the  navel,  extending  it  upwards  if  it  prove  to  be 
necessary.  This  opening  permits  a  quick  and  thorough 
search  to  be  made  for  the  diseased  or  injured  portion 
of  the  bowel.  For  operations  on  the  appendix  vermi- 
formis,  the  csecum,  or  anjr  part  of  the  ascending  or 
descending  colon,  the  rule  is  to  make  an  incision  over 
the  site  ofthe  disease  or.injury,  if  it  can  be  localised.  In 
all  doubtful  cases  the  median  incision  is  to  be  preferred. 
The  abdomen  having  been  opened,  and  the  portion  of 
the  intestine  to  be  excised  located,  it  is  brou|^t  out- 
side of  the  cavity,  accompanied  by  about  six  inches  of 
healthy  intestine  on  either  side.  It  is  next  emptied  of 
its  contents  above  and  below  the  diseased  part  by 
passing  it  between  the  finger  and  thumb,  and  gently 
compredsed.  The  empty  gut  should  be  clamped  on 
either  side  of  the  diseased  portion  of  the  bowel  at 
points  six  inches  distant,  to  prevent  the  escape  of  faecal 
matter  at  the  time  of  excision,  or  during  the  subse- 
quent manipulations,  either  by  the  clamps  devised  bv 
McLaren,  or  b;^  improvised,  as  suggested  by  Maunsell. 
from  a  safety-pin  and  a  sponge.  The  general  peritoneal 
cavitv  is  shut  off  by  flat  sponges  which  have  oeen  ren- 
dered sterile  and  wrung  out  in  hot  saline  solution,  and 
the  exposed  portion  of  the  bowel  should  be  protected 
bv  similar  means.  The  mesenteric  vessels  are  prefer- 
ably ligated  before  being  cut,  by  means  of  a  needle 


armed  with  catgut  being  passed  around  them,  the 
ligature  tied^  as  suggested  bv  Halsted,  The  portion 
ofthe  intestme  to  be  removed  is  excised  by  means  of 


^ 


MUfiM 


Figs.  1  and  2. — McLaren's  Intestinal  Clampe. 

a  V-shaped  incision  having  its  apex  in  the  mesentery, 
and  its  lateral  borders  on  either  side  of  the  diseased 
point. 


Fio.  3.— a  b,  portion  of  intestine  and  mesentery  to  be 
removed  ;  b  b,  mesentery  ;  o  o  c,  lines  of  the  incision. 

The  wound  in  the  mesentery  is  closed  hj  means  of  a 
continuous  or  interrupted  suture,  as  seen  in  Fig.  4. 


Fig.  4.— CO, incision  in  mesentery  milted  by  conbinaotis 


suture. 

After  the  divided  ends  of  the  intestine  have  beeo 
carefully  washed  with  a  hot  saline  solution,  followed 
by  a  small  quantity  of  a  fifteen-volume  solution  of 
hydrogen  dioxide,  the  proximal  and  distal  ends  are 


648    Thb  Mbdioal  Pbms. 


ORIGINAL  COMMUNICATIONS. 


Jun24,18M- 


nnitad  primarily  b^  means  of  two  satores  which  aie 
passed  throDgh  all  the  intestinal  ocats,  and  tied,  the 
«nds  being  left  long.  The  first  suture  is  placed  at  the 
inferior  or  mesenteric  border^  and  is  passed  in  such  a 
manner  as  to  include  a  portion  of  mesentery  on  both 
aides,  as  is  shown  in  Fig.  5,  and  the  second  is  placed 


Fig  6.  — a  a,  segments  of  bowel ;  b  b,  segments  of  mesen- 
tery. 

directly  opposite  at  the  highest  point  of  the  superior 
border. 

A  longitudinal  incision,  an  inch  and  a  half  long,  is 
next  made  in  the  superior  border  of  the  larger  intes- 
tinal segment,  two  inches  from  its  severed  end,  by 
pinching  up  the  intestinal  coats  between  the  finser 
and  thumb,  and  dividing  them  with  a  narrow-bladed 
iaiif  e  (shown  in  Fig.  6).    Through  this  opening  a  for- 


FiG.  6. — A,  shows  the  point  of  loDgitadinal  incieion  made 
^  I  in  the  saperior  border  of  the  larger  iDtestinal  segment, 
ceps  is  passed,  and  the  long  ends  of  the  temporary 
sutures  are  caught  up  and  drawn  back  through  the 
opening. 

By  now  drawing  on  these  sutures,  the  ends  of  both 
segments  of  the  bowel  are  invaginated  and  made  to 
appear  through  the  longitudinal  incision  as  concentric 
nngs.  Figs.  8  and  9  show  this  to  have  been  accom- 
plished, and  the  peritoneal  surfaces  are  seen  to  be  in 
contact  on  all  sides. 

The  ends  of  the  long  primary  sutures  previously 
alluded  toareheld  by  an  assistant,  while  a  fine,  straight 
needle  (milliner's  No.  6),  armed  with  a  strand  of  horse- 
hair, is  passed  through  all  the  coats  of  the  bowel  and 
through  both  sides  about  a  quarter  of  an  inch  from  the 
divided  ends.  The  suture  is  caught  up  hj  forceps 
divided  in  the  middle,  and  tied  at  once  on  either  side, 
thus  avoiding  the  confusion  that  would  result  if  all 
the  sutures  were  passed  before  anjr  of  them  were  tied. 
This  process  is  repeated  nine  times  more,  or  until 
twenty  sutures  are  placed  and  tied.  The  long  ends 
of  the  primary  sutures  having  served  their  purpose  as 
retractorsi  are  cut  off  short     The  cut  ends  of  the 


bowel  are  dusted  over  with  either  iodoform  or  acetani- 
lide,  and  the  invagination  is  reduced  hv  means  ci 
gentle  manipulation  accompanied  by  slight  tractioiL 
The  edf^  ot  the  longitudinal  opening  are  turned  in, 
and  it  is  closed  by  Halsted's  sutures  passed  through 
the  peritoneal,  muscular  and  submucous  coats. 


Fio.  7.— LongitndiDal  section  of  gut,  showing  A  A,  peri- 
toneal coat ;  B  B,  muscular  coat ;  C  C,  mneons  coat ; 
DD,  primary  sutures  passed  into  the  bowel  and  out 
through  the  longitudinal  slit  made  in  the  larger  intes- 
tinal segment ;  F,  mesentery. 


Fio.  8. — Lon^tudtnal  section  of  intestine,  showing  the 
relative  position  of  the  peritoneal  coats  of  bowel  inva- 
ginated at  the  longitudinal  opening. 

Anastomosis  of  segments  of  ileum  and  colon  may  be 
effected  by  this  method  in  the  following  manner  :— 

A  primary  suture  is  passed  through  all  the  coats  of 
the  greater  and  lesser  intestinal  segments  at  their 
mesenteric  border,  care  being  taken  to  adapt  this 
border  of  either  segment,  to  the  corresponding  border 
of  the  other.  This  suture  is  tied  and  the  ends  left 
long.  A  second  suture  is  passed  through  the  side  of 
the  larger  segment  at  the  point  where  the  superior 
border  of  the  smaller  segment  touches  it,  and  through 
which  the  suture  is  also  passed,  tied,  and  the  endd  left 
long.  A  third  suture  is  passed  through  all  the  coats 
of  the  highest  free  end  of  the  larger  segment  The 
location  of  these  sutures  and  the  accurate  adaptation 
of  the  mesenteric  borders  of  the  segments  is  shown  in 
Fig.  11.  A  loujptudinal  incision  is  made  in  the 
superior  border  of  the  larger  segment,  two  inches  from 


JuKB   24,  1896. 


0R1GD4AL  COMMUNTCAnONS. 


TfiM  Mbdioal  Pbmbb. 


649 


the  divided  gut    The  ends  of  these  sutures  are  now 
-drawn  through  this  opening,  traction  is  made,  and  the 


Fio.  9. — A,  shows  the  needle  passed  tbroagh  both  sides  of 
the  bowel  and  through  all  the  intestinal  coats,  and 
shows  that  one  passage  of  the  needle  places  two  satares. 


\/:vh\/i'M^'mi 


Fia.  10. — ^This  figure  shows  the  intestine  after  the  com- 
pletion of  the  anastomosis  and  the  reduction  of  the 
mvagination.  A,  line  marking  the  point  of  union 
between  the  ends  of  the  bowel,  showing  that  the  peri- 
toneal coat  is  well  turned  in,  and  that  the  sutures  and 
knots  are  all  inside  the  gut ;  b,  longitudinal  slit  in  the 
bowel  closed  by  Lembert  sutures. 


Fig.  11.— a  a  A,  primary  sutures  passed  through  all  the 
coats  of  both  segments ;  B,  longitudinal  slit  made  in 
the  superior  border  of  the  larger  bowel ;  G  C  C,  mesen- 
tery, 
iree  edge  of  the  larger  segment  is  inverted  and  invagi- 
nated,  and  the  free  edges  of  the  intestine  now  appear 
in  the  longitudinal  opening  as  concentric  rings.    If  the 
•difference  of   calibre  between  the  two  segments   is 
great,  a  Y-shaped  portion  of  the  convexitnr  of  the  larger 
segment  may  be  removed.    This  and  the  method  of 
suturing  are  shown  in  Fig.  12. 

The  intussusception  is  reduced  and  the  longitudinal 
«lit  is  dosed,  as  previously  described ;  all  of  which  is 
«hown  in  Fig.  13. 

When  the  disease  is  located  in  the  caecum,  or  in  the 
tleo-csecal  valve,  the  anastomosis  maj  be  effected  as 
follows,  instead  of  in  the  manner  previously  described : 


The  diseased  caecum  having  been  completely  excised, 
an  owning  is  made  in  the  side  of  the  healthy  colon^ 
two  mches  from  its  cut  end ;  into  this  opening  the 


Fig.  12. — Diagram  showing  the  union  by  invaeination  in 
a  case  whe^  a  decided  difference  in  calibre  existe 
between  the  segments  of  bowel  to  be  united,  and  the 
method  of  suturing. 


Fig  13. — Diaeram  showing  the  segments  after  the  reduc- 
tion of  the  mvapnation,  and  the  closure  of  the  longitu- 
dinal incision  m  the  superior  border  of  the  larger 
segment. 


650    Thb  Mbdioal 


ORIGINAL  COMMUMCATIONS. 


Jimsdi.  18M. 


free  end  of  the  ileum  IB  inaertad.  The  primary  eotares 
an  applied,  tied,  and  brooght  oat  throng  the  cat  end 
of  the  ooloD,  as  ia  ahowa  in  ¥itf.  14,  and,  traction  beinff 
made  on  them,  the  cat  edge  of  the  colon  and  free  end 
of  the  ilenm  are  invagintrted,  and  drawn  throng  the 
free  end  of  the  colon.  The  aataraabnng  applied  m  the 
manner  previoaaly  deacribed,  the  inraguation  ia 
redooed.  The  free  end  of  the  colon  ia  turned  in  to  the 
extent  of  an  inch,  and  the  opening  ia  cloaed  bj  a  row 
of  Halated  antnrea,  care  being  taken  to  paaa  the  needle 
throng  a  few  ahreda  of  the  aabmocooa,  aa  well  aa  the 
peritoneal  and  moacolar,  coata. 

When  the  diaeaaed  c»cam  cannot  be  exdaed.  owing 
to  the  exiatence  of  firm  and  long-atandina;  adneaiona 
formed  between  thia  portion  of  the  bowel,  the  right 
oreter,  and  the  iliac  veaaela,  ileo-coloatomy  ahoald  be 
aabatitated  for  ileo-colotomy.  The  diaeaaed  c»cam 
and  the  i]eo-c»cal  end  of  the  ileum  having  been  emptied 
of  their  contenta,  damps  are  applied  tour  inchea  on 
either  aide  of  the  dia^used  atrncture.  The  ileum  ia 
divided.  The  end  of  the  ileum  which  ia  attached  to 
the  caecum  ia  invaginated^  and  the  opening  cloaed  bj 
Halated  suturea.  An  inciaion  ia  made  in  the  convex 
surface  of  the  colon,  larfje  enough  to  receive  the  free 
end  of  the  ileum,  which  la  attached  to  the  edgea  of  the 
cut  in  the  colon  by  the  uaual  primary  suturea.  An 
openinff  ia  now  made  in  the  colon  two  inchea  hi^er  up, 
tnrougn  which  opening  a  forospa  ia  paaaed  and  the  enoa 
of  the  primary  sutures  are  seiziBd,  all  of  which  is  shown 
to  have  been  accomplished  in  Fiff.  15.  Bv  their  aid  the 
free  end  of  the  ileum  and  the  edges  of  the  opening  in 
the  colon  to  which  it  has  been  attached  are  invacd- 
nated,  and  drawn  out  through  the  upper  slit  in  the 
colon.  The  permanent  sutures  are  passed  as  usual, 
tied,  and  cut  off  short.  The  invagination  is  reduced, 
and  the  longitudinal  opening  in  the  colon  closed. 


Fig.  15. 
(To  be  concluded  in  our  ne^i.) 


A  CASE  OF  EESTOKATION 


BT 


INDIAN    OPERATION     MODIFIED, 

or    A 

NOSE   DESTROYED    BY   LUPUS. 

By    ROBERT   H.    WOODS,    M.B.,   F.RC.&, 

Iteoftt  Surgeon  to  BlefamoiMl  Hoipltol,  Dublin. 

Kati  F.,  »t  29,  suffered  since  before  puberty  from 
true  lupus  of  the  nose.  For  this  she  was  successfully 
treated  in  the  Richmond  Hospital,  by  my  colleague. 
Sir  Thomley  Stoker,  the  treatment  lasting  inter- 
mittently over  some  years.  She  was  submitted  to 
the  Koch  treatment  and  was  one  of  the  few  who 
derived  lasting  benefit  theref  rouL  The  local  treatment 
consisted  in  scraping  the  diseased  area  and  cauterising 
the  raw  surface  with  add  nitrate  of  mercury.  In  the 
summer  of  18d4,  the  disease  was  finally  cured  and 
the  patient  sent  to  the  country. 

Before  taking  her  leave  she  desired  to  have  a  sub- 
stitute for  the  lost  ors^n,  and  preferred  a  mechanical 
appliance  to  undergoing  an  operation.  Her  measure 
was  accordingly  taken,  and  a  nose  of  the  selected  pat- 
tern was  constructed  to  haujs  from  the  bridge  of  a  pair 
of  spectacles  fitted  with  plain  glasses.  But  the  effect 
greatly  disappointed  her,  and  her  disappointment  grew 
mto  disgust  when  she  found  that  on  stooping  to  aavib, 
the  ficBe  ornament  dropped  from  its  position  and 
mockingly  flapped  before  ner  eyes.  In  addition  to 
this  there  was,  in  the  wearing  of  spectacles,  a  tacit 
implication  of  defective  vision  from  which  she  was 
most  anxious  to  protect  herself :  While  the  incon- 
gruity of  having  to  remove  her  nose  in  order  to  use  her 
pocket  handkerchief  was  very  galling  to  her  pride.  She 
therefore  rejected  the  apparatus  witii  scorn,  declaring 
that  she  would  rather  be  without  a  nose  than  be 
troubled  with  so  shabby  a  substitute. 

Twelve  months  later,  November  18d5^  she  a^ain 
sought  admission  with  a  view  to  a  plastic  operation. 
There  was  no  recurrence  of  the  lupus,  all  the  scraped 
surfaces  were  healthv.  The  operation  was  performed 
as  follows  :— A  flap  of  skin  (see  Fig.  1)  of  a  shape  and 
size  determined  by  a  carefully  adapted  piece  of  gutta- 
percha, of  Dieffenbach's  pattern,  was  taken  from  the 
forehead  a  little  to  the  left  of  the  middle  line,  the  left 
end  of  the  incision  was  prolonged  downwards  so  as  to 
cross  the  bridge  of  the  nose  and  end  at  the  lower  part 
of  the  opening  at  the  right  nasal  cavity. 


Fio.  1. 

From  the  point  at  which  this  incision  crossed  the 
bridge,  a  corresponding  cut  was  made  down  the  left 
side  ending  similarly.  The  triangular  flap  between 
these  latter  two  was  then  reflected  from  the  bridge  so 
that  its  raw  surface  looked  forwards,  its  base  acting 
like  a  hinge. 

Two  parallel  incisions  (A  and  B)  were  then  made  m 
the  large  flap,  and  the  outer  portions  turned  bade  aa 


Juki  84,  1896. 


OBIGINAL  CUMMUNICATIONS, 


ThS  MlDIOAL  PBBS8.       651 


represented  by  the  dotted  lines  (Fig.  1),  and  coaptation 
secured  by  tiny  leaden  plates  on  the  two  skin  surfaces 
connected  by  a  horsehair.  The  square  flap  between 
the  incisions  (A  and  B)  intended  for  the  columella  was 
then  doubled  on  itself  along  its  middle  line,  so  as  to 
bring  its  raw  surfaces  into  contact  and  secured  in  that 
shape  by  a  horsehair  suture. 


Pig.  2. 
The  large  flap  was  then  brou£[ht  down,  the  pedicle 
being  twisted  as  lightly  as  possible  in  order  to  avoid 
strangulation  ;  this  was  made  easier  on  account  of  the 
flap  having  been  taken  from  the  left  side  of  the  middle 
line.  To  its  raw  surface  the  triangular  flap  from  the 
bridge  was  adapted  and  fixed  by  two  leaden  plates  with 
a  horsehair  between.  A  small  surface  high  on  the  upper 
lip  was  freshened  for  the  reception  of  the  columella  and 
the  whole  flap,  except  a  racquet-shaped  surface  on  the 
right  side,  finally  secured  in  its  place  by  a  large  num- 
ber of  horsehair  sutures.  It  wifi  be  seen  that  practi- 
cally the  whole  of  the  inside  of  the  artificial  nose  was 
covered  with  skin. 


Fig.  3. 

There  still  remained  the  raw  surface  on  the  forehead. 
To  cover  this,  instead  of  drawing  the  edges  towards  one 
another  and  allowing  the  interval  to  sranulate  and 
cicatrise  as  in  the  classical  operation,  a  flap  of  skin  of 
the  same  shape  and  size  as  the  deficiency  was  taken 
from  the  left  arm,  carefully  avoiding  the  subcutaneous 
fat.  The  skin  was  put  into  warm  sterilised  water  until 
required.  This  though  unattended  by  any  bad  result 
was^  I  have  since  been  led  to  believe,  wrong  in  principle. 
Plain  water  has  a  destructive  effect  on  tissues,  and  it 
might  have  been  better  had  the  skin  been  kept  in 
normal  saline  solution  or  put  in  a  clean  dry  vessel  im- 
in  tepid  water  until  required. 

The  flap  when  detached  shrunk  to  less  than  one- 
third  the  size  of  the  surface  which  it  once  covered.  It 
was  flxed  to  the  forehead  b)r  about  twenty  horsehair 
points  of  suture.  A  small  triangular  depression  which 
existed  at  its  junction  with  the  pedicle  of  the  forehead 
flap  was  used  as  a  drain  for  the  fluid  exuded,  for  this 
purpose  a  small  wad  of  moistened  cotton  wool  was  put 


into  the  depression  and  renewed  by  the  nurse  eveiy 
few  hours.  ,    ,    .        . 

No  ligatures  were  used  on  the  vessels  during  the 
operation.  One  artery  in  the  scalp  refusing  to  stop 
with  forcipressure  was  secured  by  passing  a  loop  of 
horsehair  under  it,  through  the  skm  at  a  little  distance 
from  the  wound. 

Horsehair  was  the  material  used  for  sutures  throu^- 
out,  and  it  more  than  fulfilled  our  hopes,  not  a  point 
suppurated  and  it  left  no  trace  in  the  skin.  It  had 
previously  been  sterilised  by  boiling  for  five  minutes  in 
1  per  cent  sodium  carbonate  solution.  This  had  the 
ef^t  of  greatly  increasing  its  elasticity  without  dimin- 
ishing its  strength. 

It  was  thought  better  in  mapping  out  the  flap  on  the 
arm  to  take  exactly  the  size  of  the  surface  to  be  covered 
and  not  to  allow  for  shrinking,  because  if  a  flap  shrinks 
it  must  thicken  and  there  would  be  greater  risk  run  of 
a  thick  flap  dying  than  of  a  normally  thin  one. 

No  dressing  was  used  except  a  piece  of  dry  Gkimgee 
tissue,  laid  lighUy  across  the  forehead  so  as  to  keep 
the  part  warm,  and  yet  allow  enough  ventilation  to 
keep  it  dry. 

Three  oays  later  the  flap  on  the  forehead  was  of  a 
purple  black  colour,  except  at  one  point  It  looked  a» 
if  it  were  past  recovery,  but  day  by  da^  its  appearance 
improved  and  it  cleared  up  very  much  in  the  same  way 
ana  at  about  the  same  rate  as  a  black  eye. 

The  sutures  were  removed  on  the  sixth  day  and 
the  lead  plates  on  the  ninth.  The  new  nose  united  by 
first  intention. 

Needless  to  say  the  patient's  appearance  was  greatly 
improved,  but  of  this  I  shall  allow  the  photographs 
taken  before  and  after  operation  to  speak.  The  pale- 
ness of  the  new  flap  on  the  forehead  is  due  to  the 
lighter  colour  of  the  skin  ot  the  arm,  but  when  it  has 
been  exposed  for  a  time  to  the  sun  and  weather,  it  will 
probably  simulate  the  rest  of  the  forehead. 

The  second  stage  of  the  classical  operation  (division 
of  the  pedicle  of  the  flap)  was  not  proceeded  with.  It 
was  found  that  the  pedicle  after  about  three  weeks 
adapted  itself  perfectly  to  its  position,  while  there  was 
no  necessity  for  utilising  it  to  cover  the  forehead  sur- 
face. The  racquet-shaped  surface  on  the  side  of  the 
nose  which  had  contracted  to  a  verjr  small  space,  was 
excised  i^ter  a  month  by  an  oval  incision.  This  had 
the  double  effect  of  taking  away  a  cicatrix  and  reduc- 
ing the  somewhat  parrot-shaped  prominence  of  the 
bndge  to  more  elegant  proportions. 


Fig.  4. 

In  operations  like  this  contraction  of  the  new  nostrSv 
has  always  been  a  great  stumbling  block  in  the  way  of 
success,  so  much  so  that  some  operators  recommended 
that  the  columella  should  not  be  sutured  but  aUowed 
to  hang  down  so  as  to  produce  the  effect  of  two  nostrih,. 
while  in  reality  there  is  but  one.  My  experience  in 
this  case  shows  me  that  this  can  be  avoided.  Contrac- 
tion of  the  nostrils  takes  place  in  proportion  to  the 
quantity  of  raw  surface  left  to  cicatrise,  especially  if 

C 


652    Thi  Mbdioal  Pxxss. 


TRANSACTIONS  OF  SOCEETIES. 


Jen  24,  1896 


this  be  low  down.  If  the  inside  be  well  lined  with 
skin  and  if  immediate  union  takes  place  between  the 
two  layers  of  skin,  then  there  will  be  as  in  this  ease 
little  or  no  contraction.  Hence  it  is  of  prime  import- 
ance that  the  flap  originally  cat  from  the  forehead 
should  be  of  such  a  shape  and  size  that  the  whole  or  at 
least  as  much  as  is  neoessarv  of  the  interior  of  the  nose 
shall  be  coated  with  skin  aerived  from  the  forehead. 
This  of  course  inyolves  a  larger  forehead  flap  and  up  to 
the  present  surgeons  have  had  to  choose  between  the 
Scylla  of  contracting  nostrils  and  the  Charybdis  of  a  too 
great  scar  on  the  forehead.  Mr.  Treves  has  thus  been 
led  in  his  operative  surgery  to  advocate  Langenbeck's 
pattern  betkuse  the  forehead  wound  can  be  better 
Drought  together,  though  it  is  obvious  from  a  look  at 
Langenbeck's  in  preference  to  Diffenbach's  diagram, 
that  there  must  be  cicatricial^  contraction  in  the 
neighbourhood  of  the  new  nostrils.  It  will  thus  be 
seen  that  if  we  can  overcome  the  necessity  for 
economy  in  cutting  the  forehead  flap,  we  shall 
rsolve  the  difficulty  of  great  subsequent  contraction  of 
the  nostrils.  By  transplanting  the  flap  from  the  arm, 
the  breach  in  the  forehead  however  great,  can  be  easily 
'filled  up,  so  that  this  method  has  the  double  advantage 
of  contributing  towards  the  patency  of  the  nostrils,  and 
the  perhaps  more  important  entire  avoidance  of  the 
scar  on  the  forehead. 


SCARLET    FEVER    IN    THE    PUER- 

PEKAL    STATE. 

By  J.  O.  SYMES,  M.D.Lond., 

Lato  Anlstant  Medical  Officer,  Loodon  f  eTer  HoaplUL 

It  is  now  generally  admitted  that  there  is  no  special 
felationship  between  scarlatina  and  puerperal  fever, 
beyond  the  fact  tiiiat  septic  infection  may  be  derived 
from  one  or  more  of  the  numerous  lesions  of  the  former 
disease,  and  may  give  rise  to  septicnmia  after  child- 
birth. The  following  two  cases  are  of  interest  as 
showing  that  with  modern  antiseptic  precautions  this 
•danger  may  be  minimised.  They,  and  the  additional  case 
mentioned,  also  illustrate  the  fact  that  the  rule  of 
pregnant  women  appearing  to  have  a  special  immunity 
trom  scarlet  fever  is  not  constant  Tne  patients  were 
onder  the  care  of  Dr  J.  W.  Washboum. 

Case  1.— £.  H.,  was  admitted  during  the  third 
month  of  pregnancy.  Had  well-marked  attack  of 
rscarlet  fever.  Two  of  her  children  were  in  hospital  at 
the  time  suffering  from  the  same  disease.  There 
was  occasionally  morning  vomiting  and  nausea,  and  on 
several  occasions  faint  traces  of  albumen  in  the  urine. 
Desquamation  was  free,  and  patient  made  a  perfect 
recovery  without  complications. 

Case  2.— Mrs.  M.  C,  »t  38,  primipara,  was  ad- 
mitted Dec.  18th.  Had  had  scarlet  fever  in  child- 
hood. On  Dec.  4th,  noticed  a  rash  on  chest,  and 
•complained  of  a  slight  sore  throat  and  malaise, 
but  went  about  her  work  as  usual.  Dec.  17th, 
noticed  that  the  skin  of  the  hands  was  coming 
away  in  large  pieces.  On  admission  to  the  ward 
desquamation  was  found  to  be  very  profuse.  Pa- 
tient was  supposed  to  be  eight  months  advanced  in 
pregnancy.  Trace  of  albumen  in  urine.  During  the 
thira  week  in  January  she  was  removed  to  a  private 
room,  where  she  was  confined  on  January  23ra.  The 
labour  was  normal,  but  tedious.  Only  one  vaginal 
examination  was  made,  and  no  douche  was 
used  at  anj  time.  The  strictest  antiseptic  pre- 
cautions with  regard  to  person,  bedding,  and 
room  were  observed  throughout  There  was  no 
rise  of  temperature  subsequent  to  the  confinement,  but 
patient  desquamated  a  second  time,  and  consequently 
was  not  ddscharffed  until  February  15th.  The  child  at 
birth  weighed  7  Ids.  1  oz.  It  subsequently  desquamated 
very  freely,  but  there  was  at  no  time  any  rise  of  tem- 
perature, or  other  sign  of  sickness. 


Case  3.— Mrs.  0.,  on  November  9th,  was  seized  with 
vomiting.  This  was  followed  by  a  sore  throat  and 
scariatiniform  rash.  November  11th  she  aborted,  this 
being  the  fifth  month  of  pregnancy.  Her  condition 
gradually  got  worse,  and  on  November  24th  she  waa 
admitted  to  hospital.  The  temperature  was  high  ;  the 
throat  sloughing,  with  rhinorrhoea  ;  and  large  cervical 
abscess,  and  rheumatism  in  both  knees  and  shoulders. 
The  abdomen  was  not  distended,  there  was 
no  pelvic  tenderness,  and  the  slight  vaginal 
discharge  was  inoffensive.  On  the  day  following 
admission  an  erythematous  red  rash  covered  the  body. 
Nov.  27tL— The  cervical  abscess  was  opened  widi 
antiseptic  precautions.  Cultivations  made  from  the 
pus  snowed  numerous  colonies  of  strei^tococci  and 
cultivations  made  from  the  fauces  gave  a  similar  result 
By  Dec.  10th  the  acute  symptoms  had  subsided,  and 
the  patient's  condition  was  much  improved  The 
vaginal  discharge  had  ceased,  and  recovery  was  unin- 
terrupted except  by  occasional  erythematous  rashes^ 
and  tne  presence  of  a  trace  of  albumen  in  the  urine. 
There  was  the  usual  amount  of  desquamation. 

As  far  as  I  could  ascertain  no  vaginal  examination 
had  been  made  in  Case  3  during  any  period  of  the 
illness,  and  the  immunity  from  puerperal  septicaemia 
may  have  been  due  to  the  fact  that  the  contagion  was 
not  conveyed  in  this  way  to  the  genital  canal.  As 
previously  mentioned  bacteriolofjical  examination 
revealed  the  presence  of  streptococci  both  in  the  fauces 
and  in  the  pus  of  the  cervical  abscess,  yet  no  se^c 
pelvic  trouble  arose.  A  bacteriological  cultivation 
from  the  fauces  in  Case  2  showed  chiefly  colonies  of 
staphylococci  with  a  few  streptococci. 

Clifton,  June  1896. 


OPHTHALMOLOGICAL   SOCIETY    OF    GREAT 

BRITAIN. 

Mebting  hxld  Thussdat,  Juki  IIth,  1896. 

The  President,  Mr.NKTTLxsHiP,  in  the  Chair. 


OASE  OF  ACXTTB  DO0BIJB  OFTIO  MlUaiTIS. 

Dr.  H.  Sfigbb  showed  a  patient,  a  married  woman,  «t. 
21,  who  came  to  him  on  April  15th,  complaining  of  head- 
ache and  dimness  of  riBion.  She  had  been  under  obeerva- 
tion  for  two  months,  and  all  this  time  vision  had  been 
steadily  deteriorating.  For  this  there  was  no  obTions 
cauee ;  there  was  no  paralysis  of  any  sort,  there  had  bean 
vomiting  on  a  few  occasions  only,  with  slight  headaGAm. 
She  had  had  a  child  thirteen  months  mgo,  and  she  soffered 
from  diphtheria  jast  before  Christmas.  Be  gave  her  iodide  of 
potassium  in  20-grain  doses  three  times  a  day,  with  mer- 
curial inunctions,  but  no  treatment  seemed  to  have  had  any 
effect  The  headache  had  been  mostly  frontal.  There  was 
no  history  of  syphilis. 

UnrOOSABOOMA  OF  CHOBOID. 

Dr.  RocKUFFE,  of  Hull,  read  notes  of  a  case  in  which 
he  had  been  enabled  to  watch  the  early  symptoms  which 
usually  escaped  detection.  The  patient  was  a  strong 
healthy  man,  »t.  82,  who  came,  in  July,  1895,  oomplaui- 
ing  of  defective  vision  in  the  left  eye.  In  September,  1894^ 
he  saw  black  spots,  and  it  was  not  until  Jnlv,  1895,  that 
he  awoke  to  the  fact  that  the  sight  of  the  left  eye  was 
waning.  He  read  best  at  an  anele  of  46\  His  family 
history  was  good,  and  he  himself  had  always  bad  good 
health.  He  bad  a  fall  on  the  back  of  the  head  four  years 
ago,  not  followed  by  any  trouble.  Vision,  when  first  seen, 
R,  with  -ID,  was  6/6  ;  in  the  left  eye,  with  +  I D,  ft 
was  6/36.  The  field  was  normal  and  the  colour  sense  good. 
The  fundus  was  normaL  As  he  was  a  heavy  smoker, 
he  stopped  the  tobacco,  and  put  him  on  strydi- 
nine.  &y  August  9th,  vision  in  the  left  eye  had  declined 
to  6/60,  he  could  only  read  No.  10  at  an  angle  of  45^.  He 
was  ordered  iodide  of  potassium  and  mercury,  but  at  the 
end  of  three  months  he  was  only  able  to  count  fingers  at 


UUNX  24,  1»96. 


TKANSACTTONS  OF  SOCIETIEB. 


Ths  Mbdioal  Puss.     653 


two  feet.  The  field  of  vision  began  to  contract  above.  A 
month  later  there  was  detachment  of  the  retina,  extend- 
ing downwards,  and  nearly  up  to  the  optic  disc,  with 
proptoeis.  No  tenderness,  or  obvioos  growth.  Tension 
was  normal,  and  there  was  no  fflandnlar  infiltration.  He 
hesitated  between  a  solid  growth  and  simple  detachment. 
On  October  14th,  the  patient  consulted  Mr.  Nettle8hip,and 
Mr.  Critchett,  and  both  diagnosed  a  tumour  of  the  choroid. 
He  thereupon  excised  the  eye  and  sent  it  to  Mr.  Marshall, 
who  reported  ib  to  be  a  round-celled  sarcoma  springing  from 
the  choroid.  All  his  other  cases  of  pigmented  sarcoma  of 
the  choroid  had  died  within  a  short  time,  but  he  hoped 
this  one  would  prove  an  exception. 

The  Pbbsidbnt  observed  that  all  such  cases  were  inter- 
esting whether  pigmented  or  not,  especially  in  respect  of 
the  examination  of  the  difference  in  refraction  between 
the  two  eyes. 

Mr.  Mabshall  said  that  in  121  cases  of  sarcoma  of  the 
choroid  which  he  had  collected,  there  were  12  31  per  cent, 
pigmented,  and  87*18  per  cent,  non-pigmented. 

Mr.  Gbitfiths  said  he  had  examined  some  35  cases  of  sar- 
coma of  the  choroid  and  ciliary  body,  of  which  eight  were 
oases  of  leucosarcoma.  In  the  majority  there  were  a  few 
pigment  cells,  indeed,  in  adults  it  was  the  rule  to  find  a 
lew  scattered  pigment  cells  which  were,  on  the  other  hand, 
very  rere  in  infancy,  whatever  the  origin  of  the  growth  in 
leucosarcoma,  the  cells  were  invariably  round,  whereas  in 
retinal  sarcoma  the  cells  were  more  often  spindle-shape. 

The  Pkssidbnt  said  it  must  have  been  very  difScult  to 
diagnose  such  a  case,  the  growth  having  a  wide  base  and 
no  great  thickness. 

OATABAOT  BXTBAOnON  AND  OOUT. 

Dr.  RocKiJTFsalso  read  notes  of  a  casein  which  extraction 
of  a  cataract  was  complicated  by  an  attack  of  gout  involv- 
ing the  operated  eye.  The  patient  was  a  country  squire,  »t. 
62,  who  came  under  observation  in  February,  1892,  with  inci- 
pient cataract.  He  remained  under  observation  until  March, 
1893,  without  any  obvious  gouty  manifestations  though  he 
had  suffered  therefrom.  On  Maroh  23rd,  he  extracted  the 
cataract  of  the  right  eve  at  10  a.m.  At  9  p.m.  be  was 
called  to  him  and  found  him  belching  up  a  dark  brown 
grumous  fluid,  his  extremities  cold  and  his  pulse  almost 
imperceptible,  in  fact,  he  was  almost  comatose.  He  had 
another  attack  of  vomiting  twentv  minutes  later,  after 
which  he  gradually  rallied  and  the  next  day  he  had  a 
characteristic  attack  of  gout  in  the  hands  and  feet.  On 
Maroh  27tb,  he  examine  the  eye  and  tested  his  vision, 
when  he  readily  told  the  time  bv  his  watch.  He  was,  how- 
ever, somewhat  puzzled  to  see  the  conjunctiva  discoloured. 
On  the  29th,  the  patient  complained  of  irritation  of  the 
operated  eye,  and  he  found  very  marked  chemoeis  with 
much  swelling  of  the  conjunctiva  and  slight  chemosis  of 
the  other  eye.  The  cornese,  however,  were  very  dear  and 
there  was  no  photophobia.  He  ultimately  made  a  good 
recovery.  On  the  twelfth  day  vision  was  6/6,  and  on  May 
15th,  two  months  later,  it  was  6/9.  He  haa  not  been  able 
to  find  any  reference  to  this  complication  in  the  text- 
books, and  he  asked  whether  any  of  the  members  bad  ever 
met  with  a  similar  set  of  symptoms. 

The  Prbsidbmt  suggested  that  if  the  coincidence  of 
gout  with  cataract  extraction  had  not  been  more  frequently 
recorded,  it  was  presumably  because  it  was  not  thought 
worthy  of  mention.  He  aid  not  think  it  was  rare  lor 
gouty  patients  to  have  such  an  attack  soon  after  an 
operetion. 

Mr.  Lano  had  met  with  four  cases  in  people  who  had 
gout  in  the  joints  attacking  the  patient  on  the  day  of  or 
Uie  day  following  the  operation  without  any  local  trouble. 

ON  THB  OBiaiN  OF  BUFTUBBS  IN  DICIACHED  BBTINiE. 

Mr.  Tbbaohbb  Collins  read  a  paper  on  this  subject, 
illustrated  by  lantern  slides.  He  mentioned  that  GrsBfe 
and  Rechlman  held  that  ruptures  were  due  to  the  tension 
of  the  sub-retinal  fiuid,  while  Leber  and  Nordenson 
believed  they  were  produced  by  traction  on  the  retina  from 
flhrinking  bands  in  the  vitreous.  He  was  enabled  to  bring 
before  them,  and  illustrete  by  lantern  slides,  two  cases 
which  afforded  distinct  anatomical  proof  of  the  occasional 
formation  of  these  ruptures  in  the  way  thought  out  by 
Elschning,  from  the  appearenoes  seen  bv  him  in  two  cases 
which  he  had  examined  ophthalmoscopically.  In  each  of 
the  eyes  which  he  had  examined  the  retina  was  detached, 


and  lay  folded  up  in  the  centre  of  the  globe.  In  each, 
microscopical  examination  showed  a  patch  of  atrophied 
retina  intimately  adherent  to  the  choroid  in  the  yellow 
spot  region,  ana  completely  isolated  from  the  rest  of  the 
retina.  It  would  seem,  therefore,  that  there  must  have 
been  some  central  choroido-retinitis,  which  had,  over  a 
localised  area,  firmly  united  the  retina  and  choroid,  and 
when,  subsequently,  the  former  became  detached,  the 
adhering  patch  tore  away  and  remained  attached  to  the 
choroid,  a  hole  thus  being  formed  in  the  detached  retina. 

Mr.  Lang  said  he  had  seen  two  or  three  cases  of  detach- 
ment of  the  retina  with  holes  in  the  yellow  spot  region, 
and  in  all  the  detachment  was  moderate  in  extent  and 
rather  low  down.  In  ruptures  in  other  parts  of  the  retina 
there  was  no  apparent  loss  of  tissue,  so  that  such  cases 
could  not  be  explained  in  the  same  way  as  the  ruptures 
occurring^  in  the  yellow  spot. 

0T8T  OF  THB  OBBIT. 

Mr.  W.  E.  Cant,  of  Jerusalem,  contributed  notes  of  the 
case  of  a  man,  »t.  34,  who  was  admitted  for  proptosis. 
He  said  the  eye  had  been  prominent  ever  since  ne  was  a 
little  boy.  The  left  eye  was  much  proptosed,  being  dis- 
placed downwards  and  inwards,  depressing  the  lower  lid 
a  good  deal.  It  moved  with  its  fellow,  but  not  so  freely. 
V  =  6/12,  no  pain.  A  firm  substance  could  be  felt  above 
and  to  the  outer  side  of  the  globe,  which  appeared  to  be 
the  lachrymal  gland.  On  looking  at  the  patient  from  the 
front  there  was  obvious  fulness  in  the  temporal  region, 
and  a  swelling  was  made  out  in  the  temporel  fossa,  which 
had  a  tense,  elastic  feel.  There  was  evidently  a  fluid 
tumour  which  occupied  the  orbit  and  extended  into  the 
temporal  fossa.  Through  an  incision  along  the  upper 
margin  the  solidsubstanoe  was  found,  as  surmiMd,  to  be  the 
unaltered  lachrynial  gland,  but  further  back  a  tense  cyst 
could  be  felt.  This  he  opened  carefully,  and  a  g^ood  deal 
of  dark  yellow  or  brown  fluid  escaped  containing  frag- 
ments of  a  pearly  white  friable  substance.  On  passing  the 
finger  into  the  orbit  the  cvst  was  found  to  be  lying  next  to 
the  roof  and  outer  wall  of  the  orbit,  much  of  which  was 
wanting.  The  cyst  cavity  was  drained  for  the  next  four 
months,  and  the  discharge  ultimately  became  pumlenti 
Six  months  after  fluid  injected  into  the  orbit  still  found 
its  way  into  the  temporal  fossa,  so  a  direct  opening  was 
made  into  the  latter  and  the  actual  cautery  was  applied. 
The  cavity  then  contracted  until  it  was  only  a  mmute 
sinus  half  an  inch  deep.  The  ^lobe  of  the  eye  had 
returned  to  almost  its  original  position,  and  its  movements 
were  naturaL  Though  two  y«ara  had  since  elapsed  no 
further  trouble  has  hSem  experienced.  He  observed  that 
cysts  of  the  orbit  appear  to  form  a  rather  rere  group  of 
cases,  and  this  particular  case  was  peculiar  in  its  extend- 
ing through  the  orbital  wall  into  the  temporal  fossa. 
The  chief  interest  was  its  mode  of  origin.  In  Palestine 
one  was  naturally  suspicious  of  a  parasitic  origin,  but  he 
was  not  in  a  position  to  give  any  definite  information 
thereon.  ,  ,     ,    , .    • 

Dr.  Abotlb  Robebtsok,  of  Edinburgh,  said  he  had  had 
one  or  two  cases  of  cysts  of  the  orbit,  but  he  proposed  to 
speak  rether  of  cases  of  dermoid  cyst,  cysts  with  very  tbin 
walls,  which  might  be  adherent  to  the  periosteum,  and  so 
be  very  difficult  to  remove  completely,  with  a  consequent 
liability  to  recurrence,  much  to  the  surgeon's  annoyance. 
Some  twenty  yean  ago  a  namesake  of  his,  practising  at 
Singapore,  suggested  to  him  a  method  of  treatment  wmch 
he  said  had  yielded  the  best  results,  viz.,  to  evacuate  the 
cyst  as  far  as  possible  and  then  to  introduce  a  minute 
fragment  of  lunar  caustic.  This  gave  rise  to  suppuretive 
inflammation  of  moderate  intensity,  and  by-and-bye  the 
cyst  wall  was  completely  extruded  through  the  external 
opening.  He  could  testify  from  his  personal  experience 
that  such  was  the  case,  and  this  was  why  he  had  thought 
it  worth  while  mentioning. 

AOQUIBED    NYSTAGMUS  IN  OTHBB  OCCUPATIONS  THAN  THAT 
OF  COAL  MINING  AND  BXMABKS. 

Mr.  SiMBON  Snill,  Sheffield,  read  a  paper  on  this 
subject.  He  observed  that  the  labour  bestowed  in 
recent  years  on  the  investigation  of^  the  etiology  of 
miners'  nystagmus  was  bearing  fruit  in  demonstrating 
the  existence  of  a  similar  occupation-neurosis  in  the 
workers  in  other  employments  than  that  of  coal  mining. 
The   constrained  position  in   which  the  collier  worked 


654    Thb  MmpiCAL 


TMNSACTIONS  OF  SOCIEriES. 


Jinni24,  UK. 


vodld*  perfaapt,  reouua  par  exeeUenee,  the  most  ooo- 
daeiT«  to  tiie  prodoetloD,  in  freqaAiey  and  termty, 
of  •eqnirad  Djrttefi^iu,  bat  tiio  cmm  he  reUtod  tbowod 
that  nvstittmiia  mmI  waMrinew  of  the  ocular  elevaton 
waa  alreamr  to  be  found  in  a  ▼arietv  of  oocapatiooa 
He  lefenea  to  tbe  inteteating  hiatorical  fact  that  Michael 
Angelo  autSond  in  hii  eyee  from  painting  the  vaolt  of  the 
SitUne  Chapel,  and  he  wrote  a  sonnet,  which  Mr.  Snell 
quoted,  describing  the  constrained  attitude  he  was  com- 
pelled to  occupy  at  his  work.  Vasari,  the  painter's  bio- 
grapher, suffeied  in  a  similar  manner  from  painting  the 
Medicsan  Palace.  Mr.  Snell  mentioned  that  since  rMord- 
ing  his  case  of  nystagmus  in  a  compositor,  in  1891, 
tweWe  other  cases,  fiTo  of  them  compositors,  had  come 
under  his  observation.  Three  cases  baa  been  communi- 
cated to  him  by  Mr.  Priestler  Smith,  and  three  by  Dr. 
Simons,  of  Mertbvr  Tydvil^and  Kieden  had  recorded  an  in- 
stance of  acquired  nystagmus  in  a  plank  cutter.  The  total 
number  of  cases  referred  to  in  toe  paper  was  nineteen, 
and  comprised  six  compositors,  two  metal  rollers,  a  plate- 
layer, a  plank  cutter,  a  saw  maker,  a  sanitary  tube  maker,  a 
fitter,  an  iron  founder,  a  worker  in  a  '*  cage"  at  a  mine, 
two  employee  at  a  glass  factory,  a  youth  engaged  at  a  con- 
fectionery warehouse,  and  a  man  employed  at  the  screens 
at  the  surface  of  a  coal  mine.  They  Tsmd  very  much  in 
degree,  and  in  some  there  was  more  wearinees  of  the 
ocular  elevators  than  very  noticeable  nystagmus,  but  it 
was  held  that,  as  in  the  case  of  miners,  the  oedllations 
would  have  been  more  marked  if  the  examinations  had 
been  made  when  the  patients  had  been  at  work  for  some 
time.  Generally  speaking,  the  nystagmus  was  less  marked 
than  that  met  with  in  miners.  Mr.  Snell  thought  that 
attention  having  been  drawn  to  the  matter,  nvstagmus  and 
strain  or  weariness  in  the  elevators  would  be  much  more 
widely  recognised  as  caused  bv  different  employments 
than  was  the  case  at  present.  He  deprecated  a  too  hasty 
assumption  that  because  a  patient  was  employed  at  this 
or  that  trade  that  therefore  there  could  be  no  ocuhur  strain. 
The  plan  of  investigation  advocated  was  to  get  the  patient 
to  place  himself  in  the  position  in  which  he  worked,  or 
better,  to  see  the  patient  actually  at  his  employment.  In 
conclusion,  Mr.  Snell  remarked  that  be  thought  a  main 
factor  in  the  causation  of  "academy  headache"  was  the 
weariness  induced  in  the  ocular  muscles  by  turning  the 
gaze  so  frequentlv  above  the  horizontal  line.  This  could 
be  compensated  for  by  a  backward  movement  of  the  head. 


ROYAL   ACAD£MY    OF  MEDICINE  IN  IRELAND. 

Section  of  Mbdicine. 

Mkstino  held  Friday,  May  8th,  1896. 

The  President,  Db.  Walter  G.  Smith,  in  the  Chair. 


LIVING   EXHIBITS. 

Dr.  a.  R.  Parsons  exhibited  the  following  patients  :— 
(a)  A  Case  of  Atazic  Paraplegia ;  {h)  A  Woman  with 
Atresia  Aaris,  Unilateral  Facisl  Paialysii,  and  Loss  of 
Sensation  of  Taste ;  (c)  A  Case  of  Hemichorea  ;  {d)  A  Case 
of  Empyema. 

CASE    OF    SUPPURATIVR    PERICARDITIS    TREATED    BY 
DRAINAGE. 

Dr.  O'Carroll  read  an  account  of  a  case  of  suppurative 
pericarditis  secondary  to  pneumonia,  which  had  been 
treated  by  free  and  constant  drainage.  The  patient  lived 
for  two  months  afterwards.  The  pericardii^  cavity  eradu- 
ally  contained  less  and  less  pus,  but  unfortunately  the 
patient  died  of  asthenia.  Post-mortem,  the  walls  of  the 
pericardial  cavity  were  adherent  everywhere  except  in 
front,  where  there  was  about  a  drachm  of  pus. 

The  Chairman  said  he  thought  Dr.  O'Carroirs  paper 
g:ave  great  encouragement  to  tne  early  exploration  of 
similar  cases,  m  the  operation  seems  devoid  of  danger, 
and  when  performed  in  time  gave  satisfactory  results. 

Dr.  M.  a.  Botd  related  the  particulars  of  a  case  in  which 
he  drew  off  four  ounces  of  serous  fluid  and  the  patient 
recovered.  The  temperature  might  be  normal,  with  pus 
in  the  pericardium.  In  children  broncho* pneumonia  often 
preceded  the  collection  of  fluid  in  the  pericardium  ;  he 
thought  that  paracentesis  should  be  resorted  to  more  fre- 
quently than  at  present  in  cases  of  pericarditis  in  child- 
ren. 


Dr.  Doyle  asked  was  the  peiiesidinm  suinredtothe 
integument'  in  the  sorgjical  operation  enccaeding  the 
operation  of  tapping,  as  if  so  this  might  aoeoont  lor  the 
secondary  infection  of  the  left  Inng.  « 

Dr.  Hrard  drew  attenlMMi  to  tiie  remarlES  of  Dr.  Ewut, 
of  London,  that  a  patch  of  dnlness  might  be  detected  at 
the  inner  aide  of  the  an^  ef  the  left  acapnia  at  the  base 
of  the  left  pleura  as  an  early  symptom  in  theae  eases. 

Dr.  Deurt  asked  Dr.  CCarroU  to  mention  tiie  exact  site 
selected  for  tiie  operatioD,  as  it  had  been  recommended 
some  time  ago  to  tap  the  perioardium  as  dose  aa  possible 
to  the  left  margin  of  steninm  in  the  fourth  interepaoe.  He 
had  examined  a  large  number  of  subjects  in  the  dissecting- 
room,  and  found  that  in  a  considerable  proportion  of  caaei 
eitlier  the  internal  mammary  artery  or  vein  would  be 
wounded  by  such  a  proceeding. 

Dr.  FnrBY  said  that  in  his  long  experience  be  had  only 
met  with  one  such  case  of  suppurative  pericarditia  requir- 
ing operation,  the  result  was  fatal,  the  fault  being  one  of 
omission  rather  than  commission  ;  as,  though  he  t^iped 
the  pericardium  one  inch  outside  the  sternum,  between 
the  fourth  and  fifth  ribs,  and  drew  off  eight  ounceeaf 
purulent  fluid,  giving  immediate  relief,  a  second  attempt 
to  perform  the  same  operation  with  a  larger  needle  did 
not  succeed,  as  for  some  nnaooonntable  reason  he  failed  to 
reach  the  pericardium. 

Dr.  O'Carroll,  in  reply,  said  that  he  left  the  suigicel 
detailB  to  Sir  Thomley  Stoker,  who  performed  the  opera- 
tion for  him  ;  there  was  no  infection  of  the  left  pleura,  as 
the  fluid  which  it  contained  was  a  clear  serous  fluid  due 
to  the  cardiac  failure  which  occurred  at  the  end  of  the 
patient's  life.  Though  he  had  carefully  examined  the 
patient's  diest  he  had  not  remarked  the  symptom  referred 
to  by  Dr.  Heard.  In  replv  to  Dr.  Drury,  he  stated  tint 
in  making  hie  puncture  he  had  selected  a  point  in  the 
fourth  space  a  thumb's  breadth  internal  to  the  nipple 
line. 

I^UOOCTTHfM  LA. 

Dr.  Craio  read  a  short  paper  on  Leucocythnmia.  'B» 
exhibited  photographs  and  stained  blood  films  of  a  esse  of 
the  lymphatic  type  of  this  disease  which  had  died  in  hoe- 
pital  after  a  short  but  acute  illness  of  two  months'  don- 
tion.  The  symptoms  were  general  enlaigement  of  sU  the 
lymphatic  glands,  pallor,  severe  epistaxis,  diarriicBS, 
temperature  varjing  from  90<'— lOS''  F.,  dyspnoea,  iUght 
increase  in  size  of  spleen  smd  liver,  no  tendemese  over 
bones,  and  in  the  case  of  the  blood  there  was  a  diminutioD 
in  red  cells  to  at  least  one-third  of  the  normal  number,  and 
an  absolute  and  relative  increase  of  the  leucocytes,  so  that 
the  proportion  of  white  to  red  averaged  about  1  to  20. 
The  writer  of  the  paper  drew  attention  to  the  detailed 
description  of  the  leucocytes  found  in  normal  bkiod 
given  in  a  recent  article  by  Kanthack  and  Hardy,  and 
pointed  out  that  in  the  case  he  was  recording  all  the  fonns 
of  white  cells  could  be  seen,  although  the  increase  was 
entirely  due  to  the  presence  of  lymphocjrtes.  It  was 
pointea  out  that  a  purely  lymphatic  form  of  leucaemia  was 
rare,  that  when  it  did  occur  its  victims  were  among  the 
young,  and  that  the  disease  generally  ran  an  acute  and 
rapidly  fatal  course.  The  correctness  of  these  observa- 
tions was  borne  out  in  tiie  present  instance,  as  the  patient^ 
an  Italian  boy,  was  only  nineteen  years  of  age,  and  the 
illness  terminated  fatally  within  two  months  from  its  onaet. 
The  severe  epistaxis  and  persistent  diarrhoea  required 
symptomatic  treatment,  so  that  arsenic  was  not  given  a 
fair  chance,  and  bone  marrow  was  not  tried. 

The  Chairman  asked  if  arsenic  had  been  administered 
in  this  case,  or  if  the  treatment  by  marrow  fat  had  beeo 
tried.  He  laid  stress  on  the  great  advancement  that  had 
been  made  in  the  microscopic  examination  of  the  blood  in 
these  cases,  and  thought  that  it  should  be  more  generally 
carried  out  in  hospital  practice,  as  the  process  was  not 
a  difficult  one ;  he  thought  that  the  specific  signifioanoe 
clinically  of  the  variou*  leucocytes  was  still  very  doubtful. 
He  stated  that  the  continuous  use  of  arsenic  in  chnmie 
cases  was  not  devoid  of  danger,  as  peripheral  neuritifl 
might  follow  as  a  result ;  be  mentioned  the  great  chemical 
changes  that  occurred  in  the  urine  in  this  disease,  the  uric 
acid  increased  and  xanthine  bodies  also  increased,  tbe 
normal  oxidizing  power  of  the  body  was  not  serioiuly 
affected. 

Dr.  Craio,  in  reply,  said  that  he  had  tried  arsenic,  bat 


Juki  24,  1896. 


TRANSACTIONS  OF  SOCIETIES. 


Thx  Mjn>ioAL  Pbxss.     655 


as  it  caused  diarrhoBa  and  pain  in  the  stomach,  he  had  to 
cease  administering  it.  He  had  thought  of  using  marrow- 
fat, but  had  to  content  himself  with  trying  bo  keep  his 
patient  alive. 

N0TB8  ON  GLINIOAL  OASBS. 

(a)  Extensive  empyema.    (Patient  exhibited.) 

lb)  Unusually  short  case  of  croupous  pneumonia. 

Dr.  A.  R.  Pabsovs  read  notes  ox  the  above  oases,  and 
exhibited  the  patient,  who  had  been  treated  for  an  exten- 
sive empyema. 

The  Chairman  said  that  in  such  cases  the  heart  was 
generally  the  first  organ  to  return  to  its  normal  position. 
After  aspiration,  the  effects  of  the  diplococcus  of  pneu- 
monia seemed  more  amenable  to  treatment  than  those  of 
the  streptococcus,  the  examination  of  the  pus  drawn  off 
was  therefore  of  the  greatest  consequence.  He  agreed 
with  Dr.  Parsons  that  a  peculiar  tympanitic  note  on  per- 
cussion with  rouehness  on  breathing  were  often  the  first 
symptoms  in  suc^  cases  as  he  related. 

Dr.  DoTLS  questioned  whether  the  heart  was  not  now 
displaced  to  the  right,  and  the  right  lung  still  considerably 
nnexpanded.  He  agreed  that  good  results  followed 
washing  out  the  pleural  cavity  with  antiseptic  solution. 

Dr.  RkBSONS,  in  reply,  said  that  he  did  not  claim  that 
the  organs  had  fully  recovered  both  position  and  function, 
but  considered  that  the  improvement,  so  far  as  it  went, 
was  remarkable. 

The  Section  then  adjourned. 


LARYNGOLOGICAL  SOCIETY  OF   LONDON. 

OsDINABY  IdEBTINQ   HBLD  MaT   13TH,   1896. 

The  President,  Db.  Fklix  Ssmon,  in  the  Chair. 
Db.  Basclay  Baron  (Bristol)  showed  a  case  of 

OBSTKDOnON   OF  LAKYNX  DUB  TO  A  WEB. 

A  man,  set.  39  years,  who  had  not  had  syphilis  nor  other 
constitutional  dyscrasia.  In  October,  1894,  he  had 
hoarseness  and  loss  of  voice  with  gradually  increasing  diffi- 
culty of  breathing,  which  induced  his  own  doctor  to  per- 
form laryngotomy.  On  being  admitted  into  the  Bristol 
General  Hospital  under  Mr.  Baron,  there  was  found  to  be 
intense  inflammation  of  the  whole  of  the  larynx,  the  vocal 
oords,  which  were  in  apposition,  were  especially  affected, 
being  intensely  red,  swollen,  and  motionless.  In  spite  of 
all  that  was  done  he  continued  in  this  condition  for  three 
months.  Tracheotomy  was  then  performed,  and  the 
laryngotomy  tube  removed.  The  effect  of  this  was  soon 
benencial, — first  one  vocal  cord  and  then  the  other  leaving 
the  middle  line,  and  then  the  anterior  two-thirds  of  the 
vocal  cords  was  found  to  be  united  by  a  web.  This  was  cut 
by  Whistler's  cutting  dilator,  and  dilated  by  Schrotter's 
and  other  bougies,  and  now  only  a  small  amount  of  web 
tissue  uniting  the  under  surface  of  the  vocal  cords  in 
front  persists.  The  tracheotomy  tube  has  been  removed, 
and  the  man  is  able  to  do  his  work  as  a  farm  labourer. 

Dr.  Fblix  Sbmon  showed  a  case  of 

THYBOTOMY  FOB  BPITHBIilOMA  OF  THB  LABYNX. 

The  patient,  a  gentleman,  set.  65,  was  first  seen  on 
February  18th  of  this  year.  The  only  symptom  was  hoarse- 
ness dating  back  nearly  a  year  and  a  half,  and  supposed  to 
have  commenced  after  an  attack  of  infinenza,  which  had 
also  caused  purulent  discharge  from  the  right  no«tril ;  this, 
however,  troubled  the  patient  very  little.  The  whole  of 
the  left  vocal  cord,  particularly  in  its  middle  part,  was 
considerably  tumefied,  and  showed  a  granular  appearance. 
At  the  same  time  its  mobility  was  surprisingly  free,  and 
the  hoarseness  comparatively  speaking  very  slight.  Malig- 
nant disease  had  already  been  diagnosed  by  Dr.  Madden 
and  Mr.  Dudlev  Wright.  The  diagnosis  was  further 
corroborated  by  Mr.  Bntlin.  The  operation  was  performed 
on  February  27th,  and  offered  no  incidents  of  importance. 
On  opening  the  larvnx  the  growth  was  seen  to  extend  all 
over  the  left  vocal  cord,  and  the  ventricular  band  also 
appeared  somewhat  swollen.  In  front  the  growth  just 
extended  to  the  median  line.  The  whole  affected  portion 
was  delineated  by  two  semicircular  cuts  at  a  distance  of 
about  three-quarters  of  an  inch  from  the  growth,  meeting 
in  front  and  behind  and  cut  out  with  curved  scissors. 
Posteriorly  the  extirpation  extended  to  the  front  part  of 


the  arytsanoid  cartilage,  which  was  also  removed.  The 
patient  made  an  excellent  recovery,  except  that  on  the 
third  day  some  ominous  black  spots  appeared  in  the  wound, 
supposed  to  be  due  to  infection  from  the  purulent  nasal 
diacnarge.  These  were  scraped  out,  and  nothing  further 
occurred. 
Dr.  Bond  showed  a  case  of 

UNCONTBOLLABLB,   INTEBMITTENT,   LABYNGEAL  CBY. 

A  boy,  set.  11,  began  in  March,  1895,  one  night 
when  in  bed  to  utter  at  irregular  intervals  a  loud  cry. 
This  he  continued  to  do  until  August,  1895,  when  he  went 
to  stav  for  about  ten  days  in  the  country,  and  towards  the 
end  of  the  visit  the  cry  **  gradually  "  ceased.  At  Christ- 
mas, 1895,  a  second  attack  came  on  at  3  a.m.,  and  had 
continued  since.  He  appeared  to  be  dull  and  stupid,  with 
hands  and  arms  continually  working  like  those  of  a  child 
with  chorea.  At  intervals,  varying  from  about  12  seconds 
to  H  minutes,  he  utters  an  explosive,  sudden  cry  of  con- 
siderable volume,  very  like  part  jf  a  milkman's  cry,  but 
not  resembling  any  word.  The  C17  is  associated  with 
somewhat  violent  action  of  the  diaphragm,  and  with  a 
lifting  of  the  soft  palate.  It  is  never  emitted  during  a 
laryngoscopical  examination,  but  Jirectly  after  such  an 
examination  has  been  made  the  cry  is  emitted.  The  boy 
has  double  proptosie,  also  he  has  adenoids  of  the  naso- 
pharynx. Dr.  Bond  thought  that  the  removal  of  adenoids 
(which  would  end[a  source  of  irritation,  and  ensure  sounder 
sleep),  in  conjunction  with  the  administration  of  arsenic 
and  a  prolonged  change  of  air  in  the  country,  would  be 
the  only  treatment  likely  to  improve  the  patient. 

Dr.  Bond  also  showed  a  "  Case  of  Tubercular  Laryn- 
gitis," in  a!  man,  set.  45,  An  exploratory  thyrotomy 
performed  on  November  15th,  when  the  whole  left 
ventricular  band  was  found  affected  and^was  removed,  and 
also  the  inner  edge  of  the  brim  on  left  and  the  left  cord. 
On  the  posterior  commissure  were  several  papillary 
excrescences,  and  the  mucous  membrane  here  was  also 
removed.  The  left  thyroid  plate  was  scraped,  and  also 
the  anterior  commissure.  The  patient  lejft  hospital  a 
month  after  the  operation  with  a  narrow  sinus  unhealed, 
and  with  some  cough.  Since  which  he  had  considerably 
improved,  his  temperature  being  normal  and  his  weight 
had  increased  to  12  stone. 

A  third  ca^e  was  also  shown  by  Dr.  Bond,  it  being  one 
of  "  Sarcoma  Recurring  in  Nose,  in  a  man,  set.  62.  When 
seen  at  the  Throat  HospiUl,  in  October,  1893,  the  left  side 
of  nose  was  congested,  greatly  swollen,  and  completely 
plugged  in  front  by  a  f ungating,  slightly  movable  mass, 
which  bled  freely  on  examination  with  a  probe ;  enlarged 
glands  could  be  felt  below  the  angle  of  left  jaw.  The 
mass  was  removed  piecemeal  by  a  snare,  and  its  base  tho- 
roughly curetted,  and  the  nose  firmlv  plugged.  After- 
wards the  site  of  growth  was  cauterised  with  the  galvano- 
cautery.  The  enlarged  glands  were  also  removed. 
Recurrence  occurred  after  two  and  a  half  years,  and  in 
March,  1896,  a  mass  was  removed  from  lower  part  of 
septum  and  floor  of  nose. 

CASB  OF  HBALXD  TX7BEBCUL0US  DISBASB    OF    THS    LABYNX. 

Shown  by  Mr.  Lambxbt  Lack.  Patient  a  girl,  nt.  28, 
was  quite  well  until,  1893,  when  symptoms  of  phthisis 
developed,  and  she  lost  her  voice.  In  October,  1893,  the 
patient  was  losing  flesh,  had  much  cough,  and  a  hectic 
look.  She  was  nearly  aphonic.  Examination  of  lungs 
showed  dulness  over  the  upper  half  of  bhe  chest  on  both 
sides,  back  and  front,  with  abundant  moist  sounds  and 
bronchial  breathing  at  the  right  apex.  Examination  of 
larynx  showed  irregular  fleshy  thickening  of  both  vocal 
cords,  with  very  deficient  movement  on  the  right  side. 
There  was  a  prominent  ulcerating  growth  on  the  anterior 
surface  of  the  right  arytenoid,  and  some  oedema  of  both 
arytsenoids.  Treatment :  cod-Uver  oil  and  iron  internally 
and  pure  lactic  acid  well  rubbed  in  locally  once  a  week. 
After  some  months'  rather  irregular  attendance,  she  was 
much  improved,  but  the  tumour  remained  much  the  same. 
This  was  then  entirely  scraped  away  with  the  curette, 
and  pure  chromic  acid  applied  to  the  resulting  ulcer.  This 
slowly  healed,  and  in  the  spring  of  1895  the  ulcer  of  the 
larynx  was  quite  healed.  In  November  the  larynx  appeared 
almost  normal,  the  movements  being  quite  free,  and  there 
was  no  trace  of  swelling  or  ulceration. 

Mr.  Lack  showed  also  a  "  Case  of  Lupus  Pharyngis  "  in 
a  patient,  set.  34.    Arsenical  treatment  and  the  cautery 


^^    Tbs  Mbmcal 


FKA9CE. 


JmSi. 


ftodacMfoM  loftftral«c,tiMcaMWacaDMtooM. 

^  wlM  lor  alMNit  wrtMi  Twa  hud  m£^ 

olwtmtliuii,  with  nrriw 1  tUck  yvDovii 

•ad|MMiwoyrhftwd<of  h— d.  Thekfiii 
pol7pindpoa,UMri|eb»,pol7pibiiSno|miL  TlMpoljpi 
wmm  nmow^d,  aad  tlw  liit  mouum  dnaST  The  ^^^ 
eoDteiaad  pus,  bus  wm  evrad  hf  a  f«w  wmU  tr 
n«|»tMiiiwMr«7ilJghUyiin|irDr«d.  lo  IddtthS 
froBtal  nniM  wm  opmd  throoch  an  meiMiB  in  tha 
Hm of  Um •jabrow, t&fiakl  of  openrtm  hnc bomfad 
^UMMpnorbttal  Dotch  aad  tha  paOaf  of  thawporior 
oWqaa.  A  large  pieoe  of  bone  wet  feioored  by  the  ehieel, 
mad  flracb  poe  wee  evecnated.  A  kmg  nibber  t«be  wee 
pMied  throogfa  tha  iofaadibalam  into  the  noee,  and 
rat^oedfbr  eboat  tan  daya,  whan  h  wee  replaeedbje 
abort  Mlver  tabe.  After  eix  weeke  all  eymptooM  1^ 
dseappeered,  the  tebe  wee  left  oat,  and  the  woond  aooo 
heeled,  leering  ea  ioeonepieaooe  tear  aiider  the  eyebrow. 
The  patieot  now,  neerly  two  jeera  later,  remaine  weO. 

Dr.  H.  TiLLBT  aleo  rabmiited  a  '<Geee  and  SpedoMa  of 
eared  Polypi  of  Frontal  Sinoe ^'^  and  the  two  ceeee  were 
diecoMed  at  the  aame  time. 

Mr.  C.  Babbe  thought  that  Mr.  Lack's  eaee  weeintereat- 
?!?^**  .'^^'ng.  •*»«  recovery,  left  only  a  alight  tear 
hidden  by  the  eyebrow.  He  related  a  eeee  under  his  care 
in  which  there  wee  protrusion  of  the  eyeball  fraas  disteo- 
eioD  of  the  left  frontal  sinne  with  noo-totid  mooooe  liquid 
oontaintog  cbolesterioe  ctyetele.  On  opening  the  nnus 
from  the  forehead  it  wee  found  oompleCely  cut  off  from  the 
neeal  cavity,  where  there  existed  purulent  diseaee  of  the 
ethmoidal  cells.    The  caee  was  still  under  treatment. 

The  PMsiDBiTreUtedacaeehehad  with  Mr.  Horeley  in 
wbicb  a  transrerse  incision  wee  made,  a  portion  of  the 
nont  of  the  sinus  taken  away,  and  the  whole  mucous  mem- 
brane removed.  During  this  operation  the  hopeleesness  of 
operating  through  the  noee  was  apparent,  as  it  was  impoe- 
eible  to  get  at  all  the  diseaee  through  the  noee.  He  asked 
whether  in  these  cases  it  wouki  not  be  poMible  to  fill  up 
the  sinuses  with  foil  or  something  to  prevent  the  falline  in 
of  the  cavity.  • 

Mr.  8FEVCEB  suggested  plasterof  Paris  as  being  good 
for  filling  up  bone. 

Mr.  Stbwabt  thought  that  plaster  of  Paris  wonU  be 
too  heavy  for  the  frontal  sinus. 

Dr.  DcjfDAH  Gkaht  mentioned  a  ease  of  Waterhoose 
in  which  decalcified  bone  was  used  to  fill  up  a  hole  in  the 
astragaluf.  He  pointed  out  the  difficulty  of  any  bone 
healing  without  a  drawing  in  of  the  cavity. 

Dr.  HiBBBBT  TiLLBT  Stated  that  he  had  recently 
examined  the  frontal  sinuses  in  a  large  number  of  skulls 
(over  a  hundred),  and  that  the  constant  and  extreme 
variation  in  the  size  and  extent  of  the  sinuses  was  in  favour 
of  an  external  opening,  and  he  preferred  the  vertical 
median  incision  in  the  majority  of  cases. 

Dr.  ScANKs  SpicmtL  showed  a  "  Case  of  Mycosis  of  Tonsils 
and  Pharynx,"  an  1  Dr.  Prairiss  Pottee  one  of  "  Malie. 
nant  (?)  Disease  of  Larynx." 

CASl  OF  ABDUOTOB  PABALTSI8. 

Shown  by  Mr.  Bpenobr.  Patient,  a  man,  »t.  35,  had 
worn  a  tracheotomy  tube  since  June,  1882,  He  was  a 
•oldier  who  served  in  Egypt,  and  an  abscess  formed  in  the 
neck  in  the  site  of  a  scar  at  the  anterior  border  of  the  left 
stomo-mastoid  just  above  its  insertion.  He  had  felt 
nothing  wrong  with  his  throat,  but  a  few  hours  after  the 
opening  of  the  abscess  he  was  eating  his  dinner  when  he 
was  suddenly  attacked  by  difficult  breathing,  for  which 
tracheotomy  was  done  the  pame  eveninsr.  Subsequently 
an  attempt  to  leave  off  the  tube  failed.  He  came  concern- 
ipg  a  warty  growth  in  the  tracheotomy  wound,  which  bas 
been  removed.  He  can  speak  well  with  the  finger  over  the 
tracheotomy  tube.  The  vocal  cords  are  apparently 
normal,  but  fixed  in  adduction,  no  abduction  beyond  1—2 
mm.  can  be  done.  The  affection  is  doubtless  duo  to 
eyphilis.  A  nerve  lesion  there  may  have  been  distinct 
from  the  above.  If  perichondritis,  it  is  remarkable  that 
be  should  have  had  no  throat  trouble  beforehand. 


Smtt, 


ellorte,  sod  above  all, 
peine  and  repeated 
The  mode  of  ptodi 
by  rupioie  of  the  pulmonary 
the  crioo-thyraid 
ee  tothevaelcaaae. 
To  ekuskiata  the  queetioB.  M.  Xicaise  eaid  that 
to  oooeider  the  phyaiology  of  the  trachea 
ly,  it  wae  thonght  that  thie  canal  ezpaoded 


For- 


Thkbe  has  been  a  great  increase  of  tvphoid  fever  at 
Jofaannesbarg,  conf  equent  on  the  impurity  of  the  water. 


the  caee,  and  the  diletetaon  dnring  repeated  and  | 
rae  often  oonaiderable.  The  tracho 
cooditiona,  so  distended  that  rupture 
poesible ;  it  wee  thus  that  shoald  be  explained  the  qpon- 
taoeons  emphysema  of  the  nedc  observed  in  child-biithi 
and  in  chikben  suffering  from  whoopii^-cough. 

The  treatment  of  the  oompUcarion  in  parturient  woomb 
consisted  in  hastening  the  d^very,  and  if  that  wen  net 
possible,  chloraform  might  be  given  in  order  to  dtminirii 
the  peine,  and  oonaequently  the  criee,  by  which  meaaa 
the  emphyeema  would  at  leaet  remain  atafciaoary  and  not 
invade  the  whole  of  the  neck  as  was  more  than  oooe  eeen, 
and  with  fatal  reeulte. 

As  to  the  emphysema  exiating,  itwas  sufficient  to  enjoin 
rest  to  the  patient  and  to  speak  only  in  whiqMre ;  the 
rupture  of  the  trachea  healed  rapidly. 

Typhoid  Fevkr  ahd  Otstkbs. 

M.  Chantemesse  read  a  paper  on  this  enbjeet  in  which 
he  described  an  incident  which  proved  that  typhoid  fever 
could  be  transmitted  through  oysters. 

In  a  small  town  of  one  of  the  southern  departmental 
where  a  case  of  typhoid  fever  had  been  obeerved  a  year 
previously,  a  shopkeeper  received,  in  February  last,  a 
basket  of  qyeters  from  Cette.  These  bivalves  were  eold 
and  eaten  raw  by  fourteen  persons  of  the  town  and  all  fell 
ill,  eight  were  quit  with  slight  gastric  trouble  (pain, 
vomiting,  diarrhoea,  &c.),  four  others  suffered  from  dyeen* 
tory  of  an  infectious  nature,  while  the  remaining  two^  a 
girl,  »t.  20,  and  a  man,  aet.  21,  were  seized  with  typhoid 
fever  of  an  extremely  grave  form.  The  young  girl 
succumbed. 

When  this  accident  had  been  brought  under  his  notioe^ 
M.  Chantemesse  bought  from  one  of  the  principal  oyster- 
sellers  in  Paris  fresh  oysters  from  different  beds.  They 
were  alive  and  well  preserved.  He  submitted  them  to  a 
bacteriological  examination.  All  of  them  contained 
numerous  germs  and  some  of  them  were  contaminated 
with  the  coli  bacilli.  He  placed  some  of  these  oysters  Ia 
sea  water  soiled  intentionally  with  typhoid  dejections. 
After  a  sojourn  of  twenty-four  hours  in  this  water,  they 
were  taken  out  and  preserved,  firmly  dosed  for  another 
twenty-four  hours,  after  which  they  were  examined 
again  with  the  result  that  both  in  the  water  which  aur* 
rounded  them,  and  in  the  bodies  of  the  fish,  a  largo 
amount  of  coli  bacilli  and  bacilli  of  typhoid  fever 


JWM  24,  1898. 


GERMANY. 


Tea  MiDiOAL  Pans.    657 


found.  It  WM  probable  that  oysters  beoame  contamiDated 
in  the  beds  situated  near  the  months  of  rivers  and  canals, 
which  carry  germB  and  dejections  of  every  kind. 

Similar  accidents  have  occurred  in  England  and 
America,  and  attracted  the  attention  of  the  Qovemments 
of  these  countries. 

In  presence  of  these  facte,  M.  Chantemesse  thought  it 
desirable  that  the  sanitary  measures  employed  to  ensure 
the  innocnity  of  butchers  meat  should  be  extended  to 
molluscs  eaten  raw,  since  the  number  of  oysters  consumed 
annually 'in  Paris  exceeded  thirty  millions. 

M.  Chatin  said  that  the  nocive  effects  of  oysters  were 
attributed  to  four  causes :  Chromatism,  period  of  reproduc- 
tion, degeneration  of  tissue,  and  the  milieu  in  which 
they  were  reared.  The  first  cause  should  not  be  main- 
tained, as  yellow  or  green  oysters  are  annually  eaten  by 
millions  without  any  evil  effects.  It  was  generally 
admitted  that  at  spaying  time  oysters  were  dangerous,  as 
in  the  case  of  other  aquatic  species,  but  he  was  not  of  that 
opinion,  and  attributed  the  belief  to  a  popular  prejudice. 

Disease  of  the  oyster  is  easily  recognised  by  the  yellow, 
greenish,  or  blackish  aspect  of  the  tissues,  derived  from  a 
diffusion  of  the  hepatic  pigment. 

The  fourth  cause,  or  that  of  the  milieu,  was,  in  his, 
opinion,  the  only  serious  ono.  The  water  in  which  the 
oyster  lived  required  to  be  particularly  attended  to,  for  in 
it  lay  the  great  danger. 

Sbdativx  Gargles. 

At  the  Society  de  Therapeutique,  M.  Bardel  said  that  a 
gargle  composed  of  1  part  of  liq.  Van  Swieten  (corrosive 
sublimate  1,  water  1,000)  and  4  parts  of  boiled  water 
relieved  the  most  violent  toothache.  It  was  sufficient  to 
gargle  two  or  three  times  for  a  few  minutes,  taking  care 
to  keep  the  solution  in  contact  with  the  diseased  tooth,  to 
get  ease. 

» 

[from  OUB  own  OOBRB8P01ID11IT.] 

BBBUif»  Jane  19tb. 
THE  SURGICAL  CONGRESS. 

Hb.  v.  Esmabch  gave  an  address  on 

Artificial  Bloodlessnbss. 

Ho  said  there  were  three  things  that  troubled  the 
pleasures  of  the  surgeon  in  operating :  the  pain  he  caused, 
the  danger  to  life  caused  by  a  wound,  and  the  hemor- 
rhage, which  it  was  often  enough  difficult  to  master.  In 
1846  anesthesia  was  introduced,  and  in  it  one  difficulty 
was  removed,  and  by  Lister's  discoveries  of  the  antiseptic 
treatment  of  wounds  another  was  got  rid  of.  Dae  diffi- 
culty still  remained,  however,  the  arrest  of  bleeding.  As 
assistant  to  Langenbeck  and  to  Stromeyer,  he  bad  ample 
opportunity  of  practising  the  tying  of  ligatures,  the  only 
method  of  arresting  hemorrhage  known  at  the  time.  It 
was  through  accident  that  in  1873  he  came  upon  his 
method  of  artificial  bloodlessness.  A  Danish  lady 
had  an  inflamed  finger  and  wished  to  have  a  mourn- 
ing ring  rem6ved.  To  effect  this,  he  wrapped  a 
thread  cloiely  round  the  fiogef'  from  the  tip 
up  to  the  ring.  He  then  passed  it  under  the  ring 
and  unwound  the  thread  in  the  reverse  direction.  The 
ring  was  then  easily  removed  on  account  of  the  artificial 
bloodlessnees  thus  produced.  This  was  the  principle  of 
producing  artificial  bloodlessness  in  a  limb.  By  encircling 
the  limb  in  an  elastic  tube  the  vessels  were  kept  empty  as 


long  as  neoessary.  It  was  objected  to  this  method,  how« 
ever,  that  the  procedure  caused  paralysis,  that  the  edgee 
of  the  wound  died,  and  that  after  removing  the  tube  the 
bleeding  was  more  profuse  than  before.  These  objec- 
tions were  not  altogether  invalid,  and  he  endeavoured  to 
periect  the  method.  He  did  not  use  the  tube  any  longer 
but  an  elastic  band,  but  in  operation  on  the  shoiUder  and 
hip-joint  the  elastic  tube  was  still  indispensable.  The 
following  was  the  procedure  in  the  Kiel  Klinik  -.—The 
limb  was  first  of  all  held  perpendicular  if  possible,  and 
enveloped  in  an  elastic  bandage.  The  elsstic  girdle  was 
then  applied  at  the  desirod  level,  but  care  was  to  be 
taken  not  to  cause  paralysis.  On  the  other  hand 
it  should  not  be  applied  too  loosely,  so  that  some 
expertness  was  required.  After  the  operation  the 
vessels  were  ligatured,  the  wound  closed,  and  the  girdle 
only  taken  off  after  a  good  compressing  bandage  had  been 
applied.  The  patient  was  then  put  to  bed,  and  placed  in 
such  a  way  that  the  limb  operated  on  was  suspended  per- 
pendicularly for  a  quarter  of  an  hour,  when  it  could  be 
placed  horizontally.  A  good  compressing  dressing  was  an 
essential  part  of  the  process.  The  advantages  of  this 
method  were  not  doubtful,  the  idea  of  forcing  the  blood 
from  a  limb,  and  without  losing  it  to  the  organism,  had 
already  found  acceptance  in  the  method  of  saline  trans- 
fusion, which  was  based  upon  it. 

Other  subjects  that  passed  under  review  of  the  last 
twenty-five  years  were  operations  on  the  stomach  and 
intestinal  canal,  on  the  vermiform  appendix,  and  the  sur- 
gery of  the  gall-bladder. 
Opxrations  on  thb  Stomaoh  and  Intbstinal  Canal. 

The  first  subject  was  treated  by  Hr.  Wolfler,  Prague. 
He  said  that  twenty-five  years  ago  nothing  was  imagined 
of  the  brilliant  development  of  intestinal  surgery  that  was 
then  before  it.  The  first  operations  were  on  the  rectum^ 
and  these  were  followed  by  one  on  the  sigmoid  fiexure  by 
Thiersch.  The  first  resection  of  intestine  was  performed 
by  Billroth.  The  impression  would  never  be  forgotten 
that  was  made  by  Biilroth's  communication  in  1879  on  his 
first  resection  of  the  pylorus.  The  sutures  at  first  caused 
great  difficulties.  Murphy's  buti>on  had  the  undoubted 
advantage  of  allowing  rapid  operation,  but  it  possessed 
two  considerable  drawbacks.  The  opening  was  too  small, 
so  that  fecal  masses  could  not  always  find  their  way 
through,  and  a  foreign  body  remained  in  the  intestinal 
canal,  and  might  cause  injury  to  it.  The  mortality  of 
resection  of  intestine  in  1888  was  45  per  cent.,  since  then 
it  had  fallen  more  than  10  per  cent.  Resection  of  the 
pylorus  gave  rather  bad  results,  but  where  it  was  success- 
f ul  it  prolonged  life  more  than  gastroenterostomy  ;  in  the 
case  of  carcinoma,  it  prolonged  life  only  when  the  sym- 
ptom of  stenosis  appeared  early.  But  the  thing  to  be 
considered  was  not  how  long  patients  lived  aiter  the  opera- 
tion, but  how  they  lived,  and  we  must  confess  that 
an  operation  that  saved  the  patient  from  the  horrible 
death  by  starvation,  and  still  more  when  it  was  not  an 
exceedingly  dangerous  operation,  was  a  perfectly  justi* 
fiable  one. 

Hr.  Sonnenburg,  Berlin,  discussed 

Opbratioks  on  thb  Vbrmiform  Appsndix. 

He  said  that  25  years  ago  perityphlitis,  both  pathologi- 
cally and  clinically,  preeented  a  good  deal  that  was 
mysterious  and  incomprehensible;  but  which  was  now 
much  clearer  and  much  more  simple,  thanks  to  the  intel- 
ligent co-operation  of  German  surgeons,  who  had  nob 
contributed  least  to  our  knowledge  of  the  disease,  and  the 


658     Thi  Mjn>ioAL  Press. 


THE  OPERATING  THEATEES. 


Juwi  24.  1896. 


means  of  o^erooming  it.  Surgical  treatment  was  at  first 
limited  to  opening  abscesses,  the  seat  of  the  disease  itself 
was  only  attacked  when  the  dread  of  opening  the 
peritoneam  had  disappeared.  The  knowledge  that  the 
process  itself  was  always  the  seat  of  the  disease,  had  [the 
result  that  the  name  appendicitis,  introduced  from  America, 
was  accepted  amongst  us,  and  the  misleading  term 
typhlitis  became  more  and  more  forgotten.  As  time 
went  on  recurring  perityphlitis,  without  suppuration, 
became  more  and  more  frequently  the  object  of  treatment. 
Perityphlitis,  according  to  our  present  knowledge, 
was  a  slowly  progressing  disease  of  the  vermiform 
appendix  showing  various  stages  and  grades  of 
inflammation,  often  lasting  for  years,  often  healing 
spontaneously,  but  mostly,  however,  progressing.  The 
•oonstantlyiretuming recurrences  werecharacteristic.  Some- 
times after  even  severe  symptoms  the  appendix  would  be 
-found  but  little  changed.  Chronic  catarrh  made  the  pro- 
cess rigid,  adherent,  and  thickened.  Adhesion  took  place 
to  the  surrounding  parts,  the  contents  were  emptied  with 
more  and  more  difficulty,  coprolltes  or  pus  collected  in  the 
{)ouched  parts.  Infection  might  be  associated  with  any 
etage,  and  might  lead  to  foudroyant  symptoms ;  infection 
might  prove  fatal  so  quickly  that  there  would  not  be  time 
for  gangrene  to  take  place,  but  an  acute  purulent  oadema 
would  be  found.  Sometimes  the  symptoms  would  be  very 
slight,  but  they  were  never  absent  altogether.  Sometimes 
they  had  been  misinterpreted,  attributed  to  the  stomach 
or  liver,  or  there  would  be  slight  pain  with  [attacks  of 
partial  obstruction  or  diarrhoea  that  had  attracted  no 
attention,  or,  on  the  other  hand,  moderate  swelling  of  the 
mucous  membrace  might  cause  violent  pains.  The  disease 
was  characterised  by  the  so-called  appendix  colic,  with  a 
tendency  to  diarrhoea  or  constipation  in  the  free  intervals, 
pain  in  the  ileo-cecal  region,  fever,  and  a  gradually 
increasing  resistance,  caused  by  exudation.  The  addition 
of  complications  or  infection  naturally  changed  the  picture 
according  to  the  nature  of  the  addition. 


ilnBtm 


(FEOM  OUB  OWH   OOBBMPOlTDWrV.] 

Vimi,  Jane  lOth.  1896. 
MUSOULAB  HkBNIA. 

This  was  a  peculiar  case  of  a  young  man  who  sprained 
himself  two  years  ago  when  lifting  a  weight  while  following 
his  daily  avocation,  though  on  this  occasion  he  heard  a 
crack,  with  subsequent  pain  and  swelling  on  the  inside  of 
the  thigh  4  centimetres  below  the  pubic  arch.  In  the  act 
of  adducting  the  leg  the  swelling  greatly  increased,  jutt- 
ing forward  like  a  hen's  egg. 

Meinlechner  made  an  incision  about  10  centimetres  long 
over  the  prominence,  and  cutting  down  on  the  muscle, 
discovered  the  tear  in  the  tissue  of  the  adductor  lougus. 
The  ruptured  parts  of  the  muscle  were  eoaptated  and  united 
with  stitches,  finally  closing  the  superficial  parte  of  the 
wound  with  perfect  success. 

The  same  operator  related  how  he  had  removed  a 
number  of  lipomata  from  neck,  face,  and  body  in  the  same 
individual. 

Pbominbnt  Eabs. 

In  another  case  of  projecting  ears  a  cosmetic  opera- 
tion was  performed,  with  surprising  success,  where  a 
pair  of  donkey  ears  were  transformed  into  a  pair  of  respect- 
able human  auricles  by  the  removal  with  the  chisel  of  a 


part  of  the  mastoid  bone,  the  soft  coverings  being  held 
aside  during  the  operation. 

LUPUB. 

Notwithstanding  the  commendations  of  less  heroic 
measures  in  the  treatment  of  lupus.  Professor  Lang  holds 
tenaciously  to  the  excision  method  of  dealing  with  this 
disease.  The  success  of  his  operation  certainly  vindi- 
cates his  enthusiastic  advocacy.  The  difficulty  of  the 
operation,  he  affirms,  is  only  in  the  situation  of  the 
operation  at  the  orifices  of  canals  where  skin  and  mucous 
membrane  meet,  suoh  as  mouth/nose,  ear,  genitals,  or  arms, 
He  describes  the  necessity  of  having  to  decorticate  the 
ear  to  protect  the  cartilage  from  the  progressive  eroeioo 
that  accompanies  the  disease.  In  such  cases  a  doable 
operation  is  necessary,  first,  the  removal  of  all  trace  of 
the  disease,  and  secondly  a  plastic  or  cosmetic  operation 
to  restore  the  original  appearance.  This  was  well  illus- 
trated in  one  case  where  repeated  attacks  on  one  cheek, 
involving  the  nose,  and  lip  below,  with  dacryocystitis 
above,  had  been  ingeniously  restored  by  plastic  operations. 
Dboiduoma  Maligna. 

Neumann  brought  forward  a  specimen  from  Schauta's 
Ward,  of  a  deciduous  malignant  tumour.  This  affection  may 
be  considereil  as  rare,  although  the  malignant  formatioa 
may  take  place  after  a  normal  confinement^  abortion,  or 
tubular  pregnancy  as  a  cystic  mole.  The  age  of  the 
individual  or  number  of  pregnancies  have  no  apparent 
importance  in  the  formation,  but  it  is  evident  that  pro- 
fuse hemorrhage,  endometritis,  &c.,  favour  the  primary 
morbid  changes.  The  phenomenal  changes  sometimss 
take  place  immediately  after  the  retention  of  the  lochisl 
discharge,  in  others  they  may  not  appear  for  several  weeks. 
In  most  cases  this  is  accompanied  with  great  anemia,  while 
the  tumour  can  be  observed  rapidly  increasing.  I>egenara- 
tion  with  metastasis  in  the  lungp,  hsemoptosis  and  intense 
cachexia  to  speedily  destroy  life.  Theearly  recognition  of  this 
accident  was  an  absolute  necessity  for  successful  treat- 
ment. In  the  diagnosis,  hasmorrhage,  enlargement  of  the 
uterus,  patency  of  the  cervical  canal,  and  the  consistence 
of  the  tumour  are  the  clinical  pointe  in  diagnosis.  Excoch- 
leation  and  microscopical  examination  of  a  portion  of  the 
tumour  may  verify  the  necessity  of  undertaking  an  opera- 
tion of  total  extirpation  of  the  uterus  before  metastasis 
commences.  The  pathological  anatomy  of  the  tumour  is 
described  by  difierent  observers  as  being  varied  in  origin. 
Its  immediate  point  of  origin  appears  to  be  the  internal 
wall  of  the  uterus,  forming  an  irregular  substance  on  its 
surface  which  penetrates  like  polypi  into  the  small  struc- 
ture forming  a  succulent  reddish  grey  deposit.  Sanger  first 
recorded  the  structural  element  in  1889  which  he  con- 
sidered was  developed  from  the  decidua,  although  many 
other  authors  were  inclined  to  view  it  as  a  sarcoma  arising 
from  the  chorion  cells. 


ST.  THOMAS'S  HOSPITAL, 
OvABiOTOHT.— Mr.  Battlb  operated  on  a  woman,  aeti 
60,  for  tumour  of  the  abdomen  which  had  been  noticed  for 
about  three  months.  The  patient  was  a  very  stout  woman 
who  had  borne  several  children.  She  had  only  noticed  the 
enlargement  of  the  abdomen  but  had  had  no  pain  or  discom* 
fort,  she  had  consulted  her  doctor  simply  on  account  of 
the  enlargement  He  told  her  that  she  had  an  ovarian 
tumour  and  must  undergo  operation.    On  admission  to 


Juki  24,  1896. 


LEADING  ARTICLES. 


Thx  Mbuioal  Pbb8.     659 


the  hospital  the  patient  was  in  good  health  thongh  Tery 
Btont.    The  tumour,  about  the  size  of  her  head,  could  be 
felt  on  the  left  side  of  the  abdomen.    It  was  rounded  in 
outline,  dull  on  percussion,  fluctuating  and  very  movable. 
When  she  lay  on  the  right  side  the  sensation  of  ballottement 
could  be  easily  obtained.    The  hand  could  be  introduced 
between  the  tumour  and  the  pubes.     The  rest  of  the 
abdomen  was  quite  resonant,  there  being  no  abnormal 
dulness  anywhere  excepting  near  the  region  of  the  tumour. 
When  the  patient  lay  on  her  back  the  umbilical  region 
was   the  most  prominent.     Examination   per   vaginam 
showed    the    vaginal    orifice   to    be    much    contracted 
as  the  result  ef  a  former  destructive  process  probably 
sloughing    after    the     last    confinement.      The    uterus 
was   freely   movable    and   quite   normal;    the   tumour 
could  be  moved  quite  independently  of  it.    At  the  opera- 
tion it  was  found  that  the  tumour  was  a  multilocular  one, 
as  had  been  anticipated,  and  that  it  was  attached  to  the 
right  side  of  the  uterus,  although  it  had  always  been  noticed 
on  the  left  side  of  the  abdomen.  A  Spencer  Wells' trocar  and 
cannula  was  used  to  diminish  the  size  of  the  large  cysti 
and  was  then  passed  from  the  same  opening  into  other 
cysts  around.    The  wall  of  the  cyst  was  very  friable  and 
tore,  allowing  some  fluid  to  escape,  as  also  was  the  wall  of 
another  cyst  in  the  upper  part  of  the  tumour.    The  fluid 
was,  however,  taken  up  by  the  sponges  placed  around. 
The  incision,  which  was  about  four  inches  long,  permitted 
the  remaining  portion  of  the  tumour  to  be  withdrawn ; 
the  pedicle  was  then  ligatured  in  two  parts  with  silk,  the 
first  ligature  being  made  to  again  encircle  the  whole  pedi- 
cle.    The  peritoneum  was  carefully  cleansed  with  sponges, 
the  omentum  drawn  down  over  the  intestines  and  the  wound 
dosed.  The  peritoneum  and  sub-peritoneal  tissue  and  the 
fibrous  sheath  of  the  rectus  were  closed  with  interrupted 
silk  sutures,  in  one  layer,  the  skin  and  deep  layer  of  fatty 
tissue  being  closed  by  a  second  row  of  fish  gut.     The 
usual  dressings  were  applied.     Mr.  Battle  remarked  that 
the  case  was  one  which  presented  no  difficulty  in  dia- 
gnosis.   The  patient  was  extremely  stout,  and,  therefore, 
not  particularly  favourable    to    undergo    an   important 
operation,  but  her  obesity  did  not  suffice  to  hide   the 
characters  of  the  tumour.    The  interesting  point  about  the 
case,  he  thought,  was  this :  that  although  the  tumour  had 
always  been  noticed  on  the  left  side,  it  was  growing  from  the 
right  ovary.    The  point  which  was  noticeable  on  opening 
the  peritoneal  cavity  was  the  escape  of  a  considerable 
quantity  of  ascitic  fluid  ;  this  accounted  for  the  ease  with 
which  haUoiiement  could  be  obtained,  but  it  was  curious 
that  so  little  evidence     ad  been  given  of  its  presence 
before.    The  operation  ^as  rendered  more  difficult  by  the 
great  depth  of  the  wound  owing  to  the  deposit  of  fat  in 
the  abdominal  wall. 

MIDDLESEX  HOSPITAL. 

RUFTUBB  OF  AN   OVASIAN   CyST  SIMULATING  A  MaUO- 
KANT     TUHOUB    OF    THE     BkLLY.— Mr.      BlAND      SuTTON 

operated  on  a  woman,  »t.  40,  admitted  into  a  medical 
ward  for  ascites  and  hydrothorax.  On  physical  examina- 
tion a  large  solid  mass  was  made  out  in  the  right  side  of 
the  belly  surrounded  with  much  free  fluid.  The  right  half 
of  the  chest  was  filled  with  fluid,  and  respiration  was  so 
hindered  that  paracentesis  thoracis  was  resorted  to  with 
marked  benefit.  As  the  fluid  did  not  re-accumulate  Mr. 
Sutton  was  asked  to  see  the  patient,  and  he  strongly 
recommended  the  adoption  of  coeliotomy.  The  abdomen 
was  opened  in  the  usual  way  and  a  large  quantity  of 


A  large,  semi-solid  ovarian  adenoma  was  then  detected  ; 
the  incision  was  prolonged  nearly  to  the  ensiform  cartilage, 
and  after  the  adhesions  at  the  pelvic  brimhad  been  detached 
the  mass  was  extracted  and  its  pedicle  secured.  Some  large 
vessels  which  bled  freely  along  the  margin  of  the  meso- 
metrium,  were  secured  with  silk.  The  remainder  of  the 
mucus  was  removed  with  sponges.  The  serous  surface  of 
the  intestines  was  covered  with  a  deposit  resembling 
partially  boiled  sago  ;  this  was  derived  from  the  mucoid 
stuff  which  had  exuded  from  the  adenoma.  The  wound  was 
closed  by  the  triple  method  and  a  small  india-rubber  drain 
was  introduced  into  the  pelvis.  The  wound  was  dressed 
with  iodoform  gauze,  charpie  and  a  flannel  binder.  Mr. 
Sutton  stated  that  he  operated  in  this  case  because  he  had 
learned  long  ago  that  the  association  of  free  fluid  in  the 
belly  and  an  ovarian  tumour  was  not  a  sure  indication  of 
malignancy.  Happily  it  transpired  in  this  case  that  the 
free  fluid  was  due  to  rupture  of  a  loculus  of  the  adenoma 
and  the  jelly-like  stuff,  too  thick  to  be  absorbed  into  the 
circulation  and  then  excreted  by  the  kidneys,  had  slowly 
accumulated  in  the  belly  and  simulated  ascites.  In  the  last 
ten  years,  he  remarked,  he  had  operated  on  a  score  of  cases 
in  which  a  precisely  similar  state  of  things  existed,  and  in 
one  case  he  had  operated  and  removed  an  adenoma,  with 
an  abundance  of  free  jelly-like  stuff  in  the  belly :  the 
remaining  ovary  was  to  all  appearance  healthy.  Three 
years  later  the  same  patient  again  came  under  his  case 
with  a  large  adenoma  and  a  collection  of  free  jelly-like 
stuff  in  the  belly. 


^he 


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*SALUS  POPULI  8UPREMA  LEX.* 


WEDNESDAY,  JUNE  24,  1896. 


SPLENIC   ANiEMIA. 
_     _         .  UxDEK  the  general  head  of  splenic  anaemias  most 

mncas  of  the  density  of  size  was  drawn  cot  by  handfuls.  j  textbooks  describe,  more  or  less  vaguely,  a  number  of 


660    Tea  Mbdioal  Pbsbb. 


LEADING  ARTICLES. 


Juki  24,  1898. 


affectioDfl  characterised  by  anaemia  in  association  with 
an  enlarged  spleen.  For  the  present  these  may  be 
roughly  divided  into  Hodgkin's  disease,  lencocythssmia, 
and,  finally,  splenic  ansemia,  properly  so-called.  This 
term  of  splenic  anaemia  has  recently  been  introduced, 
not  merely  to  indicate  mere  anaemia  with  enlarged 
spleen,  but  to  designate  a  peculiar  and  still  obscure 
condition  in  which,  among  other  symptoms,  there  is 
more  or  less  pronounced  anaemia  and  an  enlarged 
spleen,  the  distinguishing  feature  ot  this^  particular 
disease  being  the  absence  of  anything  approaching 
leucocyfosis.  With  this  definition  before  us  it  is  obiri- 
ous  that  the  diagnosis  must  rest  largely,  if  not  entirely, 
upon  repeated  and  careful  microscopical  examinations 
of  the  blood  by  the  latest  and  most  approved  methods. 
In  this  disease  the  enlarged  lymphatic  glands  which 
inter  alia  stamp  a  given  case  of  anaemia  with  enlarged 
spleen  as  Hodgkin's  disease,  are  wanting  and  the  large 
increase  in  the  proportion  of  white  corpuscles  which 
characterises  leucocythtomia  is  conspicuous  by  its 
absence.  These  cases  were  formerly  described  as 
pseudo-leukaemia,  but  such  a  description  is  very  mis- 
leading because  it  leads  one  to  infer  that  there  is  some 
pathological  relationship  between  splenic  anaemia  and 
lencocythaemia  which  has  been  satisfactorily  shown 
not  to  be  the  case.  It  was  in  order  to  clear 
up  the  confusion  which  has  been  creeping  into 
medical  literature  by  the  abusive  use  of  the  term 
p  lenic  anaemia  that  Dr.  West  brought  forward  a  typi- 
cal case,  and  discussed  the  whole  subject  in  an  able 
paper  read  at  the  last  meeting  of  the  Royal  Medi- 
cal and  Chirurgical  Society.  Splenic  anaemia,  properly 
so-called,  commences  insidiously  with  gradually  increas- 
ing weakness,  associated  with  occasional  pains  in  the 
splenic  region.  Later,  the  anaemia  usually  becomes 
more  marked  and  the  enlargement  of  the  spleen 
becomes  a  very  prominent  feature  of  the  case.  Ultim- 
ately, and  usually  within  a  year  or  so,  the  patient 
reaches  a  final  stage  of  cachexia  culminating  in  death. 
Such  cases  are  rare  and  do  not  generally  come  under 
observation  until  the  second  stage  has  been  reached. 
The  patient  then  presents  marked  anaemia  with  an 
extremely  enlarged  spleen,  the  temperature  is  raised 
the  pyrexia  being  of  the  continuous  type.  As  the 
disease  progresses  a  marked  tendency  to  haemorrhage 
is  developed.  Under  the  microscope  the  number  of 
red  corpuscles  is  seen  to  steadily  diminish  and  the 
haemoglobin  value  of  the  blood  falls  in  a  corresponding 
ratio.  The  difficulty  of  establishing  an  absolutely  cer- 
tain diagnosis  is  considerable  because  it  has  not  only 
to  be  distinguished  from  the  maladies  already  referred 
to,  but  also  from  malarial  and  syphilitic  affections  of 
the  viscera.  The  uncertainty  of  diagnosis  was  amply 
proved  by  the  fact  that  of  the  comparatively  large 
number  of  cases  adduced  by  those  who  took  part  in 
the  discussion  on  the  occasion  referred  to,  quite  a  large 
proportion  obviously  belonged  to  some  other  category, 
indeed,  in  several,  the  essential  precaution  of  examin- 
ing the  blood  was  not  even  attempted.  The  disease  is 
stated  to  occur  at  any  age,  but  to  be  commonest  in 
adults  and  in  males.  It  is,  however,  doubtful  whether 
the  pathology  is  the  same  in  children  as  in  adults,  for 


in  the  former  a  certain  amount  of  leuoocytosia  is  Hhe 
rule.  The  only  treatment  that  appears  to  render  any 
service  is  arsenic,  but  judging  from  the  published 
reports  of  cases  the  benefit  is  very  limited.  In  a  few 
cases  in  which  splenectomy  has  been  resorted  to  the 
greatest  relief  has  followed  the  operation,  and  the 
patients  have  survived,  in  some  instances,  for  years 
In  lencocythaemia  removal  of  the  spleen  has  proved 
almost  invariably  fatal,  hence  the  importance  of  making 
sure  of  the  diagnosis  before  resorting  to  so  radical  » 
measure.  It  is  worthy  of  note  that  in  a  case  related  by 
Dr.  Coupland  great  improvement  followed  splenectomy 
performed  by  Mr.  Gould  in  spite  of  the  fact,  discovered 
at  the  autopsy  two  years  later,  that  the  case  was  not  of 
the  kind  suspected.  The  more  we  consider  the 
obscurity  which  surrounds  the  pathology  of  all  kinds 
of  anaemia  the  more  imperative  does  it  appear  that 
methodical  investigations  should  be  carried  out  in  all 
cases  of  severe  anaemia  without  regard  to  the  immediate 
bearing  on  the  individual  case. 


SCIENCE  AND  PRACTICK 
The  increase  in  the  accumulation  of  scientific  know- 
ledge is  nowhere  more  embarrassing  in  its  vastness 
than  in  the  comprehensive  profession  of  medicine. 
Hence  the  busy  practitioner,  who  has  to  carry  on  the 
daily  warfare  against  disease,  is  hard  pressed  by  the 
evergrowing  difficulty  of  adapting  the  latest  advances 
of  science  to  the  immediate  wants  of  the  sick  and  the 
consulting  rooms.  In  the  old  days  the  average  well 
educated  practitioner  would  be  content  with  a  know- 
ledge of  the  chemical  and  microscopical  tests  of  urine, 
blood,  vomited  matter,  and  a  few  similar  points  ci 
clinical  routine.  But  nowadays  the  needs  and  necessi- 
ties of  minute  investigation  are  far  wider  and 
more  exacting.  A  generation  ago  the  extraction 
and  demonstration  beneath  a  cover  glass  of  the  aearw 
scabiet  would  have  satisfied  the  most  advanced 
standard.  At  the  present  moment,  we  should  not  be 
in  the  least  surprised  by  the  appearance  of  a  mono- 
graph dealing  with  the  parasitic  diseases  of  the  itch- 
mite  itself.    The  familiar  lines  :— 

*'  And  little  fleas  still  smaller  fleas  have  on  their 

backs  to  bite  'em, 
And  these  again  have  smaller  fleas,  and  so  on 

ad  infinitum" 
have  in  the  whirligig  of  time  become  simply  a  state- 
ment of  sober  truth.  It  is  the  case  of  the  '^little  fleas" 
as  investigated  by  the  biological  tests  of  our  bacterio- 
logical laboratories  that  constitutes  one  of  the 
rocks  ahead  of  everyday  practice.  Supposing 
a  case  of  early  diarrhoea  to  come  under  observation. 
A  doubt  exists  as  to  whether  it  is  a  simple  or  a 
specific  malady.  The  only  immediate  test  is  that  of 
the  cover-glass  or  the  culture-tube,  which  will  speedily 
determine  if  any  of  the  specific  pathogenic  organisms, 
such  as  those  of  enteric  fever  or  cholera,  be  present. 
Or  take  the  instance  of  doubtful  sore-throat,  where  an 
early  diagnosis  of  the  condition  is  all-important.  The 
bacteriological  examination  of  the  throat  discharges 
furnishes  the  one  crucial  test  In  most  cases,  if  only 
on  the  score  of  time,  it  is  impossible  for  the  busy  medi- 


JuNi  24,  1896. 


LEADING  ARTICLES. 


Tbb  Mbdioal  Pbbss.     661 


cal  man  to  carry  out  such  highly  technical  investiga- 
tions. Hence,  he  has  learned  to  an  increasing  extent  to 
relegate  that  branch  of  his  work  to  skilled  specialists, 
who  place  the  resources  of  an  organised  cliniosd  labora- 
tory at  the  disposal  of  the  worker  in  practical  medicine. 
To  read  a  modern  work  on  clinical  diagnosis  is  to 
realise  the  enormous  development  of  this  branch  of 
knowledge.  In  the  older  manuals,  for  example,  the 
examination  of  the  urine  would  be  dismissed  in,  say, 
half  a  dozen  pages  :  whereas  in  the*  latest  published 
handbook  on  clinical  medicine  no  less  than  163  octavo 
pages  are  devoted  to  that  portion  of  the  subject.  In 
short,  owing  to  the  vast  growth  of  special  knowledge, 
it  seems  that  the  future  general  practitioner  will 
have  to  resort  to  the  consulting  clinician,  if  we 
may  use  that  term,  for  many  of  the  data  on 
which  he  is  to  found  diagnosis,  prognosis,  and  treat- 
ment. In  his  own  interests  it  is  advisable  for  the 
medical  man  to  obtain  the  support  of  such  skilled 
workers  in  not  a  few  cases  of  doubtful  nature.  That 
proposition  will  be  readily  supported  by  those  who 
have  a  practical  acquaintance  with  the  modern  handling 
of  medical  evidence  in  the  law  courts.  Only  a  few 
weeks  since  a  surgeon  in  the  Divorce  Court  swore  that 
a  female  respondent  had  suffered  from  gonorrhoea. 
"  How  do  you  know  it  was  gonorrhoea  P  "  was  the  next 
question  of  the  cross-examining  counsel.  In  reply,  the 
witness  ran  through  a  list  of  the  usual  signs  and 
symptoms  of  the  condition,  but  was  forced  to  admit 
that  they  might  also  be  due  to  non-specific  vaginitis. 
Had  he  been  able  to  state  that  a  bacteriological  exam- 
ination of  the  discharges  revealed  the  gonococcus,  then 
his  evidence  would  have  been  valuable,  and,  to  a  great 
extent,  convincing.  Of  course,  it  need  hardly  be 
pointed  out  that  the  mere  presence  of  the  specific  gono- 
coccus does  not  necessarily  imply  sexual  transference, 
as  the  organism  is  found  in  purulent  ophthalmia  and 
other  conditions,  such  as  the  non-specific  vulvitis  of 
children.  Still,  under  certain  circumstances,  its  dis- 
covery would  constitute  overwhelming  contributory 
evidence.  On  the  whole,  it  is  fortunate  that  medical 
men  are  able  to  accept  with  confidence  the  facts  fur- 
nished by  the  skilled  laboratory  workers.  Such  a  result 
emphasises  the  exactitude  and  infallibility  of  some 
fields  of  scientific  work.  The  great  problem  now  be- 
fore medical  authorities  is  how  to  preserve  the  balance 
between  the  science  and  the  practice  of  medicine  as 
regards  the  standards  to  be  fixed  for  examination 
purposes. 


PRESCRIBING  BY  PHARMACISTS. 
The  Council  of  the  Pharmaceutical  Society  of 
Ireland  debated  at  some  length,  at  a  reeent  meeting 
the  editorial  observations  made  by  the  Mbdical  Press 
Ain>  CiBCTJLAR  with  reference  to  an  inquest  recently 
held  upon  a  child  which  had  died  from  neglect,  having 
been  physicked  by  a  pharmacist  who  had  never 
seen  the  patient,  and  who  simply  prescribed,  upon 
hearsay  evidence,  over  the  counter.  The  remarks  of 
the  President  and  other  Members  of  the  Council  were 
gratifying,  inasmuch  as  they  admitted  the  fairness  of 


the  spirit  in  which  our  criticism  was  conceived,  and 
because  the  President  explicitly  stated  that— 

**  He  expressed  the  feeling  of  his  colleagues  when  he 
declared  that  pharmacists  had  no  right  to  engage 
in  counter-prescribing,  and  that  the  Council  had  na 
sympathy  with  the  practice.  They  had  no  excuse 
for  it  in  Dublin,  as  the  medical  men  did  not  make 
up  their  own  medicines  but  wrote  prescriptions 
and  left  the  compounding  to  the  chemist.  Therefore, 
the  chemist  should  be  loyal  to  the  doctors  and  leave 
them  the  prescribing  to  do." 

We  do  not,  however,  quite  concur  in  the  plea  of 
the  President  that  the  Pharmaceutical  Society  has  no 
power  to  discourage  counter-prescribing.  We  are 
aware  that  the  terms  of  the  Pharmacy  Act  do  not 
give  the  Society  authority  to  proaecute  or  to  punish 
its  licentiates  for  so  doing,  although  it  is  expressly 
stated  by  the  Act  that  prescribing  is  legally  declared 
to  be  outside  and  beyond  the  function  of  the 
chemist.  Nevertheless,  we  think  that  the  Councii 
might  do  a  good  deal,  short  of  prosecution,  to  prevent 
the  abuse.  It  would,  for  instance,  we  believe,  be 
within  its  powers  to  exact  from  all  candidates  for 
licence  a  formal  and  solemn  written  declaration  not 
to  engage  in  any  practice  which  they  are  not 
authorised  by  the  Act  to  adopt,  and  if  the  Council 
should  find  any  licentiate  breaking  this  promise 
it  mighc  officially  remonstrate  with  him,  and,  if  he 
persisted,  might  publicly  express  its  disapproval  of 
his  conduct.  We  apprehend  that  such  moral  suasion 
as  this  would  be  almost  as  efficacious  in  preventing 
counter-prescribing  as  any  actual  penalty  which  might 
be  imposed.  .  The  President  further  said  that  the 
person  through  whose  counter-prescribing  the  child 
died — 

"  Did  not  claim  the  right  of  prescribing  under  the 
Pharmacy  Act,  but  on  account  of  his  training  in  his 
father's  shop.  Many  apothecaries  left  their  shops  to 
apprentices,  who  prescribed  for  persons  who  came  in.'' 

We  submit  that  it  does  not  matter  what  may  have 
been  the  ground  of  the  totally  illegal  "  claim  "  to  pre- 
scribe ;  the  person  who  put  forward  that  claim  is  a  phar^ 
maceutical  chemist,  and  the  Society  remains  morally 
responsible  for  his  acts  if  it  omits  to  exercise  such 
powers  as  it  possesses  to  control  them.  There  is  no 
analogy  with  the  case  of  the  apothecary  assistant,  be* 
cause  the  apothecary  master  possesses  the  right  to 
prescribe,  and,  very  improperly  and  negligently,  dele* 
gates  that;  function,  temporarily,  to  an  assistant  for 
whose  acts  he  remains  fully  responsible,  whereas  the 
chemist  has  no  right  to  prescribe^either  in  himself,  or 
delegated  by  anyone.  Lastly,  we  would  observe  that 
the  President  is  under  a)  total  misapprehension  if  he 
supposes  that  the  Irish  Apothecaries  Company  has  any 
power  to  prevent  prescribing  by  unqualified  persons. 
The  authority  is  possessed  by  the  English  Apothe- 
caries Company  by  its  Act  but  is  not  given  to  the 
Irish  Company  by  any  law.  We  devote  special  atten- 
tion to  this  matter  because  we  believe  that  counter- 
prescribing  by  chemists  in  Ireland  has  grown,  and  is 
daily  growing,  to  formidable  dimensions,  and  that  ii  is 
largely  practised,  to  the  full  knowledge  of  the  leaders  of 
the  Society,  who,  though  they  will  not  pursue  that 
trade  themselves,  take  no  steps  to  check  it  in  those 


662     Tea  Midical  Prmb. 


NOTES  ON  CURRENT  TOPICS. 


Juiri  24,  1896. 


who  are  under  their  jariBdiotioQ.  The  authority  of  the 
Council  may  not  be  as  large  as  we  should  desire  to  see 
it,  but  it  possesses  great  moral  power,  and  we  confi- 
dently hope  that  it  will  exereise  that  power  so  that  no 
one  shall  be  able  to  say  that  it  connives  at  the  offence 
which  it  publicly  condemns. 


^tzB  on  (Etttnnt  ^opkB. 

The  Control  of  Quack  Practice. 

We  recently  called  attention  to  the  refusal  of  magis- 
trates to  convict  certain  persons  who  had  placarded 
themselves  as  M.D.,  U.S.A.,  and  with  other  similar 
titles,  it  being  held  by  them  that  such  afl^es  did  not 
amount  to  a  representation  that  the  person  using  them 
was  qualified.  Manifestly  this  was,  on  the  face  of  it, 
a  very  serious  decision,  considering  that,  if  it  were 
allowed  to  stand,  it  would  admit  to  practice  all  manner 
of  quacks  with  titles  misleading  to  the  public.  The 
Oeneial  Medical  Council  has,  therefore,  thought  it 
necessary  to  take  the  opinion  of  its  legal  adviser  as 
to  the  expediency  of  applying  for  an  amendment  of 
the  Medical  Act.  The  reply  of  Mr.  Muir  Mackenzie 
deserves  to  be  reproduced  for  the  information  of  the 
profession  :— 

I  think  that  any  such  proposed  legislation  would  be 
involved  in  considerable  difficulty.  I^have  attempted 
to  draw  more  than  one  clause  for  the  amendment  of 
the  law  as  enacted  in  Section  40  of  the  Act  of  1858, 
but  I  have  found  it  a  very  difficult  task.  Any  such 
clause  would,  I  think,  lead  to  very  considerable  dis- 
cussion in  Parliament  which  might  have  the  effect  of 
ultimately  weakening  some  extremely  beneficial  pro- 
visions. I  cannot  agree  that  there  are  such  difficultiees 
in  the  way  of  securing  a  conviction  as  mi^es  it  neces- 
sary that  there  should  be  an  attempt  at  further  legisla- 
tion. I  think  that  in  a  case  presented  to  the  courts 
before  a  strong  and  competent  tribunal,  there  is  no 
difficulty  in  securing  a  conviction.  From  my  experi- 
ence of  the  cases  in  which  I  have  personally  oeen 
engaged  as  counsel,  no  serious  difficulty  has  been  found 
in  a  case  in  which  the  charge  is  carefully  framed,  and 
also  in  which  the  evidence  b  careful  and  abundant, 
and  also,  I  am  bound  to  add,  in  which  one  has  a  suffi- 
ciently strong  tribunal.  The  tribunal  to  whom  one  has 
to  go  is  a  justice  of  the  peace ;  and  I  am  not  wanting 
in  respect  to  that  body  if  I  say  that  the  quality  of 
justice  administered  by  justices  of  the  peace  M  over 
the  country  varies  considerably.  Now,  the  misfortune 
of  these  two  cases,  in  my  opinion  Ib,  that 
they  will  afford  a  handle  to  weak  mspBtrsXes 
to  dismiss  charges  made  under  Section  40, 
and  so  far  as  one  of  the  cases  was  a  decision  that  a 
person  might  assume  the  title  of  M.D.  with  U.S.A. 
attached  to  it,  with  impunity,  it  was  a  very  unfortu- 
nate deceision.  But,  on  the  other  hand,  one  may  con- 
trast with  these  decisions  the  decision  in  the  case  of 
Steele  against  Ormsby,  where  a  person  signed  himself 
M.D.  with  Be.  (signifying  Botanic)  attached  to  it,  and 
no  difficulty  was  experienced  in  obtaining  a  conviction. 
In  Regina  v.  Baker,  where  a  person  with  an  American 
degree  si^ed  a  certificate  M.D.,  no  difficulty  was  found 
in  obtaining  a  conviction ;  and  in  the  case  of  Ferdin- 
and, where  a  man  assumed  the  title  of  M.D.,  U.S.A., 
no  dlfficulbr  was  ex^rienced  in  obtaining  a  conviction 
and  the  f uliest  possible  penalty.  In  addition  to  those 
cases,  no  difficulty  was  experienced  in  obtaining  con- 
victions in  some  cases  in  which  the  practitioners  had 
been  removed  from  the  Register,  and  had  had  their 
qualifications  taken  away  by  the  Bodies  which  had 


granted  them,  and  who  had  yet  continued  to 
assume  the  titles  granted  by  those  Bodies.  In  one  of 
those  cases  it  had  been  contended  that  it  was  not 
illegal  for  the  practitioner  to  assume  a  title  which  had 
been  originally  granted  to  him,  although  it  had 
been  taken  away,  but  that  contention  was  dismiased 
by  a  very  strong  magistrate,  and  a  conviction  was 
secured.  The  one  case  upon  which  one  of  the  judges 
expressed  opinion  that  a  decision  ought,  if  possible,  to 
be  obtained,  was  the  ease  of  a  person  who  is  strack  off 
the  Register,  but  whose  registrable  qualification  is  not 
taken  away  oy  the  qualifying  Body  which  granted  it, 
and  who  continues  nevertheless  to  practise  under  that 
qualification.  There  is  a  strong  dictum  of  Lord 
Coleridge  in  the  case  of  the  Queen  v.  Baker  that  a 
person  who  so  practises  is  practising  in  circumstances 
which  imply  falsely  that  he  is  registered  in  respect 
of  the  qualification  which  he  assumes.  But  suffice  it 
to  say  that  the  cases  of  Frikart  and  Bridgewater  did 
not  present  that  particular  point  of  law  in  a  form  in 
which  it  could  be  conveniently  decided  by  the  High 
Court  I  venture  to  think  that  the  breakdown  of  these 
two  cases  was  a  breakdown  mainly  due  to  the  way  in 
which  the  magistrate  dealt  with  it,  and  is  by  no  means 
such  a  serious  matter  as  is  thought  On  the  other 
hand,  I  venture  to  think  that  any  proposition  to 
amend  legislation  would  be  embarking  upon  a  veiy 
troublesome  and  risky  adventure,  and  my  opinion  is 
that  there  is  no  present  necessity  for  it 

This  is  a  safe,  but  to  the  profession,  scarcely  a  satis- 
factory opinion.  It  amounts  to  a  suggestion  that  any 
one  who  wishes  to  protect  the  profession  against  the 
ravages  of  quacks  had  better  go  to  the  High  Court  and 
not  to  the  magistrates,  but  that,  in  any  case,  the 
General  Medical  Council  had  better  not  burn  its 
fingers  with  attempts  at  amending  legislation  lest 
inconvenient  questions  might  be  asked  respecting  other 
medical  affairs.  The  only  persons  who  will  suffer  by 
adopting  these  sage  suggestions  are  the  Medical  De- 
fence Union,  which  would  have  to  pay  in  the  High 
Court  ten  times  the  cost  of  prosecutions  in  the  inferior 
Court,  and  the  general  practitioner,  who  will  be  obliged 
to  endure  the  competition  of  the  quack  until  money 
can  be  found  to  carry  the  matter  into  the  more  expen- 
sive tribunal.  It  seems  to  us  that,  if  the  Qeneral 
Medical  Council  acts  upon  this  advice,  which  no  doubt 
it  will  do,  the  only  course  for  the  Medical  Defence 
Union  is  to  force  the  hand  of  that  body  by  introduc- 
ing a  Bill  of  its  own.  The  British  Medical  Association 
is  the  organisation  naturally  indicated  to  undertake 
such  work,  and  we  presume  that  it  will  see  that  the 
time  has  come  for  it  to  do  so. 


Dangers  of  Qyneecological  Practice. 
Onb  of  those  legal  inquiries  which  frequently  illus- 
trate the  risks  of  medical  practice,  and  which  should 
serve  as  a  warning  to  practitioners,  was  held  in  the 
Dublin  police  courts  last  week,  when  an  application 
was  made  to  the  magistrate  to  accept  informations 
against  Dr.  Auchinleck,  Physician  to  Mercer's  Hospital, 
charged  with  a  criminal  assault  upon  a  female  patient 
at  his  own  house.  Without  entering  into  details  it  is 
sufficient  to  say  that  the  complainant  completely 
failed  to  establish  even  the  probability  of  the  truth  di 
her  story,  and  the  magistrates  refused  to  receive  the 
informations.  Upon  the  investigation  of  the  woman's 
allegations  her  case  entirely  broke  down.    In  the  first 


JnNB24,1896. 


NOTES  ON  CURRENT  TOPICS. 


Ths  Mbdioal  Pans.     ^^ 


place  the  offence  was  alleged  to  have  been  committed 
on  the  20th  of  January,  and  was  not  brought  to  trial 
antU  five  months  afterwards.  An  attempt  was  made 
by  the  prosecution  to  explain  this  delay  by  saying  that 
successive  solicitors  and  lawyers  were  all  this  time 
considering  whether  a  civil  action  would  lie,  but  such 
a  plea  was  evidently  inconsistent  with  the  expressed 
determination  of  the  complainant  to  avenge  instanta- 
neously her  injured  virtue.  Then  again  she  asserted 
that  she  was  accompanied  by  another  woman,  but  it 
was  flatly  sworn  by  the  servant  and  the  doctor  that  no 
other  woman  was  there,  and  that,  in  fact,  no  such 
person  was  known  by  them  to  exist.  Lastly  it  was 
admitted  that,  after  theallegedcommissionoftheoffence, 
the  complainant  left  the  house  without  making  any 
noise  or  complaint,  although  the  servant  was  waiting 
in  the  hall  and  the  other  members  of  the  family  were 
within  call.  Judging  the  complainant  upon  her  own  tes- 
timony and  not  at  all  upon'that  of  Dr.  Auchinleck,  or  of 
the  Master  of  the  Rotunda,  or  of  Dr.  More  Madden, 
who  gave  evidence  on  his  behalf,  it  seems  to  us]that  the 
refusal  of  the  magistrate  to  put  Dr.  Auchinleck  on  his 
trial  was  fully  justified.  That  gentleman  is  entitled  to 
our  sympathy  in  having  been  forced  to  defend  in  open 
court  a  charge  for  which  no  proofs  worthy  of  the 
name  could  be  produced.  Dr.  Auchinleck  has  suffered 
great  distress  of  mind,  much  loss  of  money,  and  con- 
siderable public  opprobrium,  and  his  sole  compensation 
is  that  he  has  cleared  his  professional  character ;  for 
persons  who  make  such  accusations  are  rarely  open  to 
legal  proceedings.  But  it  might  have  been  worse. 
Some  of  our  readers  may  recollect  that,  many  years 
ago,  we  took  up  the  case  of  a  humble  practitioner  in 
Manchester  who  was  not  only  accused  of  a  similar 
offence,  but  was  convicted  and  sentenced  to  eighteen 
months  imprisonment  Yet  when  the  circumstances 
were  further  investigated  upon  pressure  by  the 
Medical  Press  and  Cibcttlae  and  the  local  members 
of  the  profession,  the  Home  Secretary  concluded  that 
there  had  been  a  miscarriage  of  justice,  and  the  poor 
man  was  magnanimously  *' pardoned"  for  a  crime 
never  committed,  but  for  which,  nevertheless,  he  had 
served  five  months  hard  labour.  An  organisation  for 
the  defence  of  medical  practitioners  against  black- 
mailing attacks  would  serve  an  excellent  purpose  but 
would  be  difScult  to  work,  and  we  apprehend  that  no 
effective  remedy  is  available  for  similar  attacks  in  the 
future. 


Surgeon-Captain  Fowler's  Case  in  the  House 
of  Commons. 
Sib  Waltek  Fosteb,  in  the  House  of  Commons  last 
week,  made  an  earnest  appeal  to  the  Government  to 
reconsider  the  case  of  Surgeon-Captain  Fowler.  It 
will  be  remembered  that  this  officer  was  called  upon  to 
retire  from  the  Service  by  the  War  Office,  without  any 
official  inquiry  into  his  case  in  the  nature  of  a  court- 
martial.  The  injustice  of  the  proceeding  was  self- 
evident  from  the  first ;  and  in  the  discussion  in  the 
House  which  followed  Sir  Walter  Foster's  speech  many 
of  the  speakers  expressed  their  disapproval  of  the  course 
which  the  authorities  had  adopted.    The  War  Office, 


however,  sheltered  themselves  behind  the  question  of 
discipline.  They  held  that  a  breach  of  discipline  had 
been  committed  by  the  officer,  and  consequently  that 
no  redress  could  be  given.  No  charge  was  made  against 
him  of  incapacity  in  a  professional  respect  It  waa 
simply  that  he  had  failed  to  conform  to  the^Queen'fr 
regulations  in  a  matter  which  related  to  military 
discipline.  Unfortunately  for  the  Army  Medical 
Department,  and  for  the  Army  as  a  whole,  the  House- 
of  Commons  accepted  this  explanation,  and  Sir- 
Walter  Foster's  praiseworthy  and  kindly  attempt 
to  obtain  justice  for  a  confrh-e  failed.  Although^ 
perhaps,  in  a  technical  sense,  the  War  Office  are  within< 
their  legal  rights  in  dismissing  Surgeon-Captain  Fowler 
as  they  have  done,  it  is  impossible  to  doubt  that  they 
have  committed  a  serious  error  of  judgment  in  insist- 
ing upon  his  retirement.  The  circumstances  under 
which  his  alleged  offence  was  committed  belonged 
entirely  to  matters  which  concerned  the  discipline  of 
the  combatant  branch  of  the  Service ;  that  is  to  say 
although  every  effort  is  made  by  the  War  Office  and* 
the  combatant  officers  of  the  Army  to  impress  upon  the 
officers  of  the  Medical  Department  that  they  are 
merely  "civilians,''  no  opportunity  is  lost  to  visit 
upon  the  latter  the  pains  and  penalties  of  failure 
to  conform  to  the  regulations  which  especially  apply 
to  the  combatant  branch  of  the  Service.  It  is  really 
difficult  to  discuss  this  case  dispassionately.  Here  is 
the  War  Office  summarily  dismissing  a  good  officer  of 
the  Medical  Department  upon  mere,  paltry,  techni- 
cal grounds,  and  this  in  face  of  the  fact  that 
the  unpopularity  of  the  Service  is  such  that  com« 
petent  young  medical  men  cannot  be  inveigled  to 
apply  for  the  vacancies  in  the  Service  which- 
are  continually  arising.  We  earnestly  trust  that  Lord 
Lansdowne  will  exert  his  authority  on  the  side  of  the 
Department,  and  teach  *'  my  military  advisers  "  a  lesson- 
which  they  will  not  readily  forget. 

The  Islington  Board  of  Guardians  and 

Vaccination. 
After  the  experience  of  the  people  of  Gloucester  inv 
regard  to  the  ravages  of  small-pox  in  an  unvaccinated 
community,  it  might  be  thought  that  other  Boards  of 
Guardians  would  take  warning  and  proceed  without 
hesitation  to  enforce  the  compulsory  clause  in  the 
Vaccination  Act,  and  so  give  effect  to  the  law.  But 
such  is  not  the  case  with  the  Islington  Board,  as  we> 
learn  from  the  Islington  Gazette.  Our  contemporary, 
in  a  forcible  article  last  week,  shows  how  sadly  the 
Board  have  neglected  their  duty  in  this  respect. 
''The  mischief,"  says  the  writer,  ''has  been  going 
on  for  three  or  four  years,  and  Islington  has 
only  been  spared  by  the  mercy  of  Gkxl  from  the  fate  • 
which  she  has  absolutely  invited."  It  is  then  pointed 
out  that  Islington  was  for  many  years  a  model  for  the  • 
rest  of  the  country  for  its  sanitary  precautions, 
and  especially  for  its  enforcement  of  the  Vaccina- 
tion Act  But  while,  in  the  progress  of  time,  its  people 
have  not  changed,  its  guardians  have.  There  has  been 
a  decline  in  tone  and  in  intelligence  in  the  personnel  of 
the  Board,  and  hence  crochet-mongers  and  faddists,  of 


664     Thx  MiDicAL  Puss. 


NOTES  ON  CUBBENT  TOPICa 


JuvB  2i»  1896. 


ihe  less  informed  type,  are  doing  their  best  to  obtain 
thtir  own  way  to  the  detriment  of  the  district.  What 
onr^>contemporary  observes  here  with  regard  to  the 
Islington  Board  of  Guardians  is  probably  the  trath  in 
respect  to  most  of  the  boards  which  set  at  defiance  the 
Vaccination  Act  in  England.  Of  course,  it  is  the 
popular  vote  which  returns  the  half-educated  and  unin- 
telligent aspirants  to  positions  on  the  Boards  of  Guar- 
dians, and  the  people  are  thus  able  to  have  their  views 
represented.  But  the  policy  of  returning  those  who 
Are  faddists  and  who  easily  become  the  tool  of  the  dan- 
gerous and  pronounced  anti-vaccinationists  has  lately 
been  demonstrated  to  have  been  conspicuously  harmful. 

The  Bemuneration  of  Medical  Offloers  of 

Health. 
A  RBTUBN  has  been  issued  to  Parliament  giving  a 
list  of  the  Medical  Officers  of  Health  appointed  by 
Oounty  Councils.  One  of  the  most  curious  details  in 
this  official  document  is  the  prominence  given  to  the 
fact  that  in  the  whole  of  Wales  there  is  only  one 
4X)unty,  Glamorgan,  the  County  Council  of  which  has 
seen  fit  to  appoint  a  Medical  Officer  of  Health.  But 
the  same  negligence  is  apparent  in  the  Western 
•Counties  of  England.  Neither  Devon,  Cornwall, 
Dorset,  Somerset,  Wiltshire  nor  Gloucester  have  any 
public  official  of  the  kind.  There  are,  moreover,  no  less 
ihan47  Councils  in  England  and  Wales  which  have  failed 
to  take  advantage  of  the  privileges  conferred  upon  them 
by  the  law  in  this  matter.  The  question,  however,  of 
ihe  various  salaries  paid  to  these  guardians  of  the 
Public  Health  will  probably  afford  most  general 
interest  The  payments,  it  is  pointed  out,  run  from 
iSSOO  per  annum  with  travelling  expenses,  to  £1,000 
without  these  when  the  officers  engage  to  devote  their 
whole  time  to  the  public  service.  There  are  eleven 
countieswhichpay  such  salaries,  namely,  Chester,Derby, 
Durham,  Essex,  Glamorgan,  London,  Northumberland, 
Stafford,  Surrey,  Worcester,  and  the  West  Riding  of  York. 
Appointments,  otherwise  conditioned,  are  made  in  Bed- 
iordshire,  which  pays  a  retaining  fee  of  50  guineas, 
^travelling  expenses,  and  '* suitable  fees"  for  each 
inspection,  inquiry,  or  attendance  at  a  meeting;  in 
Shropshire,  where  there  is  '^  an  honorarium "  of  ten 
.guineas  and  a  ''fee  for  any  special  inspection  and 
report  he  may  be  required  to  make";  and  in  the 
North  Riding,  which  has  a  fixed  fee'of  £l00  a  year  to 
cover  attendance  at  quarteriy  meetings,  and  5  guineas 
<to  include  expenses)  for  every  otherfday  on  which  the 
Medical  Officer  is  required  by  the  Council  to  leave 
home.  In  Cumberland  the  reports  of  the  local  Medical 
Officers  are  annotated  and  reported  on  for  10  guineas  a 
year ;  in  Leicestershire  a  similar  service  is  remunerated 
with  £50  a  year ;  and  in  East  Sussex  there  is  a  Consult- 
ing Medical  Officer  who  receives  2  guineas  a  year.  It 
will  thus  be  seen  from  the  above  facts  how  various  is 
the  remuneration  with  which  different  counties  re- 
quite the  services  of  their  Medical  Officers  of  Health. 
The  absence  of  these  appointments  in  certain  counties 
to  which  attention  is  drawn  is  probably  dependent 
upon  economical  grounds,  but  surely  the  important 


subject  of  the  public  health  is  above  being  decided  by 
a  policy  of  economy. 

Lunatios  in  Workhouses. 
Thb  Local  Government  Board  has  addressed  an 
important  letter  to  the  Hampstead  Board  of  Gnardiana 
impressing  upon  the  medical  officers  of  the  Workhouse 
the  absolute  necessity  of  making  a  careful  examination 
of  lunatics  on  admission  to  the  Workhouse  and  on 
their  departure  from  it  The  Local  Government  Board 
insists  on  such  examinations  being  made,  and  the  record 
preserved  in  each  case.  The  examination  should  be  of 
such  a  character  as  will  permit  of  the  medical  officer 
ascertaining  and  certifying  from  personal  knowledge, 
not  only  the  fact  of  the  existence  of  any  disease,  bat 
also  as  to  the  presence  or  absence  of  any  broiaes  or 
other  injuries.  The  medical  officer  should  also  in  con- 
nection with  his  examination  of  a  lunatic  for  transfer 
elsewhere,  report  not  only  as  to  the  mental  condition 
but  as  to  the  physical  fitness  to  travel  These  are 
very  important  instructions.  Lunatics  not  infrequently 
come  into  institutions  with  injuries  of  greater  or  lesser 
import  It  IS  sometimes  a  nice  question  to  settle 
whether  the  injuries  were  received  in  the  institution  or 
outside.  The  fact  that  the  medical  officer  examines 
the  patient  immediately  on  admission  would  at  once 
settle  this  doubt  And  for  that  reason  alone  this  is  a 
very  important  instruction  of  the  Local  Government 
Board.  No  less  important  is  the  instruction  to  see 
that  the  physical  condition  of  the  patient  is  such  that 
he  can  properly  be  removed.  From  time  to  time 
scandalous  reports  appear  in  the  papers  of  patients 
dying  soon  after  removal  as  the  result  of  carelessness 
on  the  part  of  the  medical  officer  or  other  officials  of 
the  workhouse. 

A  Flaw  in  the  Notification  Act. 
A  SERIOUS  flaw  in  the  Notification  of  Infectious 
Diseases  Act  was  last  week  brought  under  the  notice 
of  the  Vestry  of  St  George  the  Martyr,  Southward 
The  defect  was  clearly  stated  in  a  special  report  by  Dr. 
Waldo,  Medical  Officer  of  Health  for  the  district  It 
appears  that  scarlet  fever  broke  out  in  a  children's 
hospital  within  his  authority,  but  that  the  knowledge 
of  the  fact  was  brought  to  his  notice  merely  aa  a 
matter  of  courtesy  on  the  part  of  the  hospital  manage- 
ment. The  Act  provides  in  its  wisdom  that  the  fact  of 
any  inmate  of  the  hospital  contracting  one  of  the  noti- 
fiable diseases  notice  of  the  occurrence  shall  be  sent  to 
the  Medical  Officer  of  the  district  to  which  the  patient 
belongs.  That  is  to  say,  that  no  report  is  to  be  sent  to 
the  sanitary  authority  most  affected,  namely,  that  in 
whose  area  the  hospital  lies,  and  which  is  naturally  the 
only  one  likely  to  enforce  those  proper  measures  of 
isolation  and  disinfection  which  are  the  logical  com- 
panions of  notification.  It  is  quite  evident  that  an 
outbreak  of  infectioua  disease  in  any  institution  what- 
ever should  be  at  once  notified  to  the  Medical  Officer 
of  the  particular  area  in  which  it  occurs.  A  more 
absurd  arrangement  than  the  one  to  which  Dr.  Waldo 
has  drawn  attention  could  hardly  be  imagined.  That 
a  change  must  be  effected  in  this  particidar  clause  of 
the  Act  is  a  self -evident  fact 


JCKX  24.  1896. 


NOTES  ON  CURRENT  TOPICS. 


ThS  M BDIOAL  PKI88.      665 


The  Hospital  Saturday  Fund  and  the 
Medical  Profession. 
In  the  eyes  of  the  public  the  Hospital  Saturday  Fund 
IB  a  fioand  and  progreesiye  institation,  full  of  practical 
l^ood  for  the  present  and  of  promise  for  the  future.  On 
the  whole,  that  opinion  is  most  likely  correct,  but  at 
the  same  time,  it  has  from  time  to  time  appeared  to 
us  that  the  fund  is  still  engaged  in  shaking  off  a  chry- 
salis load  of  youthful  faults  and  follies  from  its  back. 
One  such  error,  to  our  mind,  was  committed  at  last 
week's  quarterly  meeting  of  delegates,  when  it  was 
decided  to  obtain  a  medical  certificate  from  persons 
applying  for  chest  hospital  letters.  The  Distribution 
Committee  proposed  that  such  certificates  should  be 
obtained  in  all  cases  from  a  body  known  as  the  Metropoli- 
tan Provident  Medical  Association  at  a  cost  of  Is.  each. 
We  are  glad  to  learn,  however,  that  the  good  senseof  the 
delegates  insisted  that  the  certificate  of  any  duly  quali- 
fied medical  man  should  be  accepted.  In  this  way  a 
gratuitous  injury  to  the  mass  of  general  practitioners 
has  been  to  some  extent  avoided.  It  may  be  ques- 
tioned whether  the  Saturday  Fund  is  empowered  to 
spend  money  on  medical  certificates.  The  points 
raised  by  these  proposals  are  so  important  as  to  the 
relations  existing  between  the  Fund,  the  public,  and 
the  medical  profession,  that  we  propose  to  deal  with 
the  whole  question  in  an  early  issue. 


The  Influence  of  Asylum  Life  on  the  Minds 
of  the  Sane. 
Dr.  Howdsn,  Montrose,  has  usually  something 
novel  and  instructive  to  say  in  his  annual  report,  and 
the  present  is  no  exception.  He  regards  insanity  in  a 
great  many  instances  as  the  result  of  insufficient  nour- 
ishment. The  allegation  sometimes  made  that  asylum 
attendants  are  themselves  liable  to  become  insane,  the 
Doctor,  from  his  forty  years'  experience,  says  is  an 
entire  mistake,  but  that  sometimes  cases  are  met  with 
in  which  the  association  of  the  sane  with  the  insane 
outside  asylums  seems  to  have  had  a  prejudicial 
effect  on  the  former.  In  such  cases  it  is  likely  there 
has  been  a  relationship  between  the  sane  and  the 
insane,  and  a  hereditary  strain  affecting  both,  but  in 
asylums  where  there  is  no  such  thing,  our  experience 
confirms  Dr.  Howden's.  And  yet  it  is  an  experience 
that  apriori  one  would  not  expect  The  long  hours 
on  duty  of  attendants  and  nurses,  the  turmoil  and 
etrife,  and  the  irritation  of  some  asylum  wards  must 
be  very  trying  to  the  nerves,  and  yet,  strange  to  say,  we 
do  not  find  insanity  as  the  result  of  a  breakdown  at 
any  time  of  asylum  officials. 

Foreign  Doctors  in  France. 
It  seems  almost  incredible  that  any  serious  proposal 
flhould  be  made,  even  in  Protectionist  France,  to  pro- 
hibit duly  qualified  foreigners  practising  their  profes- 
sion in  that  country.  Yet  such  is  the  case,  and  the 
sense  of  justice  and  common  sense  among  French 
deputies  is  not  so  conspicuous  as  to  render  the  rejec- 
tion of  the  proposed  measure  a  foregone  conclusion. 
There  would  be  some  sense,  though  very  little  justice, 
in  the  proposal  if  French  medical  men  were  cultured 


lingmsts,  but  it  is  notorious  that  nowhere  are  foreign 
languages  less  cultivated  than  in  France,  and  the 
medical  men  of  French  birth  who  can  speak  even 
passable  English  might  almost  be  counted  on  one's 
fingers.  It  may  be  urged  that  foreigners  are  at 
an  advantage  compared  with  natives  in  that  they  are 
not  under  any  obligation  to  devote  any  part  of  their 
life  to  military  service,  and  in  respect  of  Englishmen 
this  is  certainly  true,  but  it  does  not  apply  to  medical 
practitioners  of  other  nationalities.  The  plight  of  the 
average  British  matron  who  should  be  constrained  to 
seek  medical  advice  at  the  hands  of  a  French  d'^otor 
would  not  be  enviable.  In  no  profession  is  tact  and 
delicacy  in  the  choice  of  words  and  phrases  more 
imperative  than  in  medicine,  and  these  are  qualities  only 
to  be  acquired  by  long  familiarity  with  the  language. 
A  vaudeville  might  be  written  on  the  ambiguities  likely 
to  result  from  a  medical  conversation  under  such  cir- 
cumstances, which  would  certainly  be  amusing  though 
possibly  more  in  accordance  with  the  ethics  of  the  French 
than  the  English  stage.  Perhaps  the  most  regrettable 
feature  of  the  movement  is  that  it  is  endorsed  by  men 
whose  eminence  and  talent  ought  to  have  placed  them 
above  such  miserably  narrow  ideas.  Their  adhesion 
simply  proves  that  petty  egotism  may  be  masked,  but 
not  abrogated,  by  superior  intelligence  and  education. 

Qxiardians'  Notions  of  Workhouse  Elanita- 
tion. 

The  gentlemen  and  ladies  who  have  made  public 
complaint  of  the  abominations  of  Irish  workhouses 
have  been  roundly  abused  for  so  doing,  and  accused  of 
gross  exaggeration.  Judging  from  newspaper  reports 
it  really  appears  that  many  guardians  hold  opinions 
on  the  proposed  workhouse  reform  which  will  scarcely 
be  credited  to  them  by  civilised  people.  The  Mon- 
aghan  Board  might  be  supposed  to  be  at  least  respect* 
able  in  its  views,  yet  we  find  in  the  report  of  its  visiting 
committee  the  following  statements  :— 

We  observe  that  no  proper  provision  for  a  supply 
of  hot  water  is  available  for  this  bath,  the  old  boiler 
being  wasteful  and  taking  a  long  time  to  heat.  The 
order  of  the  Board  as  to  bathing  casuals  in  water  of  a 
suitable  temperature  is  therefore,  we  fear,  nugatory. 
We  call  attention  to  the  dirty  condition  and  misuse  of 
the  bath,  by  the  porter,  who  employs  it  as  a  sink 
for  emp^ing  water,  used  for  wasning  his  kitchen 
utensils,  &c. 

We  notice  that  five  dogs  are  kept  by  him  in  an 

As  to  the  suggestion  for  improved  sanitary  arrange- 
ments, we  consider  that  there  is  no  reasonable  objec- 
tion to  the  system  of  buckets  for  ni^^ht  requirements. 

There  is  no  need  for  the  use  of  knives  and  forks,  the 
meat  being  always  chopped  up,  so  that  spoons  are 
sufficient 

The  lunatic  ward  is  very  dirty,  the  chimney  smokes 
and  should  be  altered,  and  a  new  grate  supplied.  The 
paint  should  be  washed,  and  the  walls  whitened. 

It  is  obvious  that  remonstrance  is  wasted  on  a 
conclave,  which  is  not  moved  to  action  by  an  official 
report  that— (a)  No  hot  water  bath  is  to  be  had.  (6) 
The  bath  is  used  as  a  sink,  (c)  No  sanitary  appliances 
exist  at  night,  some  pails  within  the  wards,  reeking 
with  odoriferous  abominations,  (d)  The  paupers  have 
to  tear  asunder  their  food  with  their  fingers.    Surely 


666      Thb  MXDICIL  P&ISB. 


SCOTLAND. 


JUKX  24,  1896. 


it  is  loss  of  time  to  try  to  convince  administrators  who 
hold  no  higher  sanitary  aspirations  than  these. 


The  Diagnosis  of  Measles  by  the  Public. 

In  Dr.  Matthew  Hay's  report  for  May,  we  notice 
that  he  complains  forcibly  of  the  reluctance  of  Aber- 
deen householders  to  report  the  occurrence  of  cases  of 
measles  in  their  families  when  the  cases  are  so  mild 
that  a  medical  man  is  not  called  in.  In  order  to  bring 
the  matter  more  directly  under  the  notice  of  the  public 
the  parents,  in  one  case,  were  brought  into  court,  and 
fined  19s.  6d.  (fines  and  expenses),  for  not  reporting  a 
ease  of  measles.  Several  observations  follow,  written  in 
a  high  strain  about  the  intolerable  wrong  done  to  the 
public  by  such  concealment  and  the  difficulties  thus 
created  for  the  Public  Health  Department  We 
wonder  if  Dr.  Hay  thinks  all  parents  competent  to 
diagnose  a  case  of  measles,  especially  if  very  mild,  or 
if  he  is  of  opinion  that  they  can  tell  a  mild  case  of 
measles,  which  may  not  exhibit  to  their  minds  sufficient 
symptoms  of  disease  to  warrant  the  taking  of  any  pre- 
cautions, from  a  case  of  German  measles,  which  is  not 
notifiable  ?  Perhaps  the  good  housewives  of  Aberdeen 
are  taught  to  diagnose  the  crescentic  rash  of  measles 
before  marriage,  and  to  be  able  to  tell  from  the 
presence  or  absence  of  knotted  glands  in  the  neck  or 
axillffi  whether  it  is  a  case  of  the  true  or  of  the  (German 
variety.  Although  Dr.  Hay  has,  probably,  no  intention 
of  censuring  those  who  do  not  notify  doubtful  cases, 
the  logical  outcome  of  his  remarks  is  to  show  that  the 
provisions  of  the  Notification  Act  may  be  pressed  by 
enthusiastic  disciples  a  good  deal  further  than  is 
rational,  and  that  in  time  it  may  be  necessary  for  the 
school  boards  to  include  in  their  curriculum  informa- 
tion as  to  the  signs  and  symptoms  of  the  notifiable 
diseases,  especially  when  they  are  of  a  mild  character. 


The  Charity  Organisation  Society  and  the 

Hospital  Sunday  Fund. 
Last  week  we  made  some  remarks  on  the  duties  of 
the  Charity  Organisation  Society.  It  may  be  well  to 
point  out  one  particular  subject  to  which  the  society 
ought  to  direct  its  attention,  if  it  is  at  all  interested 
in  assisting,  as  it  ought  to  be,  in  the  dispensing  pro- 
perly of  the  results  of  Hospital  Sunday.  A  close  scru- 
tiny is  necessary  to  prevent  the  great  abuse  of  hospital 
charity,  which  now  arises  from  the  number  of  those 
who  go  to  hospitals  for  advice  and  treatment  who  have 
no  claims  to  such  charity.  Now  that  subscribers' 
letters  have  been  done  away  with,  and  the  great  boast  of 
a  hospital  is  the  number  of  its  patients  when  adver- 
tising for  funds,  we. think  that  this  is  a  species  of 
robbery  which  the  Charity  Organisation  Society  is 
supported  to  correct.  The  sooner  the  society  is  dis 
solved  the  better  unless  it  reforms  itself,  for  otherwise 
it  must  be  classed  amongst  those  offenders  it  pretends 
to  expose. 


The  vacancy  in  succession  to  Surgeon  Migor-Qen- 
eral  Patterson,  Principal  Medical  Officer  at  Aldershot, 
is  to  be  filled  by  the  promotion  of  Surgeon-Colonel 


Churchil],  now  serving  in  India,  and  who  will  come 
home  from  the  Soudan  Campaign  for  that  porpoaa 


The  Secretary  to  the  Colonies  has  learned  by  tele- 
gram from  the  Governor  of  Hong  Kong  that  there  were 
twenty-seven  fresh  cases  of  bubonic  plague  in  the  week 
ending  June  15th,  and  twenty-two  deaths  from  the 
plague  during  the  same  period. 


Dr.  Gborge  Murray,  after  a  close  contest,  has  been 
appointed  by  the  Governors  of  the  Boyal  Infirmary, 
Newcastle-on-Tyne,  Physician  to  that  Institution,  in 
succession  to  Dr,  George  Philipson,  whose  term  of 
office  recently  expired. 

Surgeon  Lieutenant-Colonel  W.  Caicpbell,  of 
the  Grenadier  Guards,  has  been  again  selected  for  the 
poet  of  Principal  Medical  Officer  at  the  Bialey  Rifle 
Meeting. 


[fbom  cub  own  oobbupovdent.] 

Edinburgh  Univbbhitt  Court. — A  meeting  of  tlie 
Court  was  held  on  Monday  of  last  week,  at  which  the 
SenatuB  reported  that  a  new  Vans  Dunlop  Scholarahip 
had  been  instituted  in  Pathology  and  Medical  Jarispni- 
denoe,  and  that,  on  the  recommendation  of  the  Faculty  of 
Medicine,  the  Pattison  Bursary  had  been  assigned  to  the 
subject  of  Clinical  Surgery. 

The  Dispute  between  St.  Andrews  and  Dundee.— 
Still  another  addition  to  the  already  voluminous  mass  of 
papers  relating  to  this  dispute  appeared  last  week  in  the 
form  of  an  elaborate  memorandum  issued  by  the  Univer- 
sity Court  of  St.  Andrews.  The  memorandum  recapitu- 
lates the  clauses  of  the  Universities  (Scotland)  Act  dealing 
with  affiliation,  the  agreement  made  between  the  St. 
Andrews  University  Court  and  the  Council  of  the  Univ- 
ersity College,  Dundee,  and  tells  how  the  University 
Commissioners  issued  an  order  *'  purporting  to  give  the 
alleged  agreement  the  force  of  law,"  and  then  a  declara- 
tion that  the  University  Court  was  constituted  in  accord- 
ance with  this  order  ;  and  adds  that  "  a  number  of  persons 
accordingly  met  from  time  to  time  in  that  capacity." 
The  protests  lodged  and  legal  action  raised,  which 
resulted  in  the  reduction  of  these  two  orders  are  then 
dealt  with,  and  the  objections  of  the  Court  to  various 
ordinances  of  the  University  Court  are  stated  in  detaiL 
The  Court  then  submit  their  objections  to  the 
agreement  between  St.  Andrews  and  Dundee,  which 
is  at  present  sub  lite.  These  are  chiefly  that  the 
old  Court  had  not  power  to  enter  into  such  an 
agreement,  that  it  was  never  approved  in  its  final  form, 
that  many  of  its  articles  are  fdtra  vires,  that  after  a  trial 
of  five  years  the  agreement  has  proved  a  complete  failure, 
that  very  few  in  St.  Andrews  look  with  favour  upon  it, 
and  that  there  is  reason  to  believe  that  the  authorities  of 
Dundee  College  are  oonvinced  that  a  union  based  upon 
this  agreement  is  impossible.  They  add  that,  while  '*  wil- 
ling to  consider  proposals  for  affiliation  (which  can  be 
equally  effected  without  the  aid  of  the  Commissioners), 
or  for  incorporation  (which  the  University  Commissioners 
have  no  power  to  efiiset),  refuse  to  consent  to  any  unioa 


Jxnsm  24,  1896. 


COERESPONDENCK 


Thb  Mxdioal  Pbbbs.     667 


moh  as  that  for  which  alone  the  pecaliar  powers  of  the 
Universitiee  CommiBsioiiers  are  necessary,  and  which 
would  be  neither  an  affiliation  nor  an  incorporation,  bat 
both  and  neither."  The  condading  sentenoee  intimate 
that  the  Court  are  not  willing  to  oondnde  any  agreement 
as  long  as  there  is  any  possibility  of  the  provisions  of 
Ordinance  No.  5  being  enforced,  and  express  the  opinion 
that  the  University  of  St.  Andrews  can  do  better  service 
by  itself,  than  by  joining  Dundee  College  to  engage  in  an 
experiment  for  tiie  purpose  of  endeavouring  to  find  out  if 
that  institution  can  be  kept  alive,  *'even  if  simulated 
for  a  short  while  by  the  consequent  ruin  of  St.  Andrews." 

A  UispUTXD  CoNTBAor. — Lord  Low  in  the  Court  of 
Session  has  closed  the  record  in  an  action  by  J.  M.  Thom, 
M.B.,  CM.,  formerly  in  p^ractice  at  Crieff,  now  living  near 
Glasgow  on  his  appointment  as  Medical  Officer  under  the 
Prison  Board  for  Scotland,  against  J.  R.  Marshall,  M.B., 
CM.,  Dean  Terrace,  Bo'ness.  Dr.  Thom  claims  £500  as 
damages.in  respect  of  defender  having  failed  to  implement 
a  contract  for  the  sale  of  the  goodwill  of  his  practice  at 
Crieff  It  appears  that  when  Dr.  Thom  was  appointed  to 
the  post  under  the  Prison  Board  he  was  desirous  of  selling 
his  {-ractice  and  entered  into  an  agreement  with  Dr. 
Marshall  by  which  he  was  to  receive  £100  at  once  and  £50 
more  if  the  practice  yielded  as  much  during  the  first  year. 
The  pursuer  introduced  the  defender  to  his  patients  on 
the  strength  of  the  agreement,  but  was  surprised  a  short 
time  afterwards  to  receive  a  letter  from  the  defender 
refusing  to  implement  it.  The  defender  pleads  that  the 
bargain  was  never  completed,  and  that  as  he  was  not 
satisfied  with  the  information  as  to  the  practice  he  never 
completed  it.  The  case  will  come  on  in  due  course  before 
the  Court  and  the  decision  will  be  of  considerable  interest 
to  medical  men  on  the  vexed  question  of  proprietary 
rights  in  a  private  practice.  It  may  be  noted  that  such 
transactions  are  not  nearly  so  common  north  of  the  Tweed 
as  they  are  south  of  it. 


THE  LADY-EXAMINER  QUESTION  IN  DUBLIN. 
Wb  understand  that  the  Council  of  the  Royal  College  of 
Surgeons  in  Ireland,  considered  on  last  Thursday,  the 
memorial  of  students  praying  that  a  male  examiner  in 
Midwifery  and  Gyn  ecology  might  be  appointed  in  place  of 
the  lady  who  was  chosen  by  the  Council  on  the  occasion  of 
the  last  election.  It  was,  we  believe,  resolved  by  the 
Council  that  the  memorialists  be  informed  that,  inasmuch 
as  a  Fellow  of  the  College,  duly  qualified,  had  been  selected 
in  conformity  with  the  obligation  imposed  by  the  Charters, 

the  Council  could  not  accede  to  the  request  of  the 
students.  It  should  be  understood  that,  if  the  Council 
had  been  ever  so  anxious  to  draw  back  from  its  selection  it 
has  no  power  to  remove  an  examiner  nor  is  it  probable 
that  it  would  be  disposed  to  exercise  such  power  if  it 
possessed  it. 


[We  do  not  hold  oiUMlvei  refponsible  for  the  opinions  of  ooi 
eonespoBdenti.]  

THE  ««HAT"  FOR  GUY'S  HOSPITAL. 

To  the  IBditor  qf  the  Msdioal  Press  and  Ciboitlab. 

Sib, — Although  I  am  not  in  complete  sympathy  with 

the  gratitude  and  satisfaction  which  you  express  because 

a  number  of  well-meaning,  wealthy,  unthinking  people 

have  planked  down   £150,000  at  the  dinner  for  Gu/s 


Hospital,  nor  because  our  future  Kin{c  lent  his  influence' 
and  approval  to  the  appeal,  it  is  but  just  that,  as  I  have 
unsparingly  criticised  the  administration  of  London  hos- 
pit&,  I  ought  to  say  that  Guy's  possesses  the  negative 
merit  of  not  being  quite  to  extravagant  and  unmeritorioue 
as  some  of  tiie  others.    Its  administration  (let  us  say)  has 
not  been  able  to  avoid  the  loss  of  nearly  one-half  of  its 
endowments,  and  has  also  frittered  away  the  substantial* 
sum  of  ^100,000,  which  the  last  rotation  of  the  "hat" 
yielded  fifteen  years  ago.    Let  us  assume  that  the  depre- 
ciation of  income  from  investment  was  no  one's  fault,  and* 
that  the  £100,000  was  necessarily  expended  to  keep  the 
hospital  running:  nevertheless,  1  ask— What  would  be- 
thought of  a  commercial  concern  which,  with  a  rapidly 
falling  income  and  no  chance  of  a  turn  in  the  tide,  would* 
omit  to  retrench  expenditure,  and  would  spend  its  last 
shilling  ?    It  would  be  reasonably  thought  that  such  a* 
firm  would  shortly  become  insolvent  and  its  bankers  would' 
immediately  shorten    its   credit.     Happily  for  London' 
hospitals  tJiey  never  become  bankrupt,  and  their  bankers, 
the   public,    never   dose    their    accounts.     They  may 
make  ducks  and  drakes  of  their  monev  and  run  them- 
ivelves  up  to  the  throat  in   debt,   and  they  have  only 
to    come    back     to    the   public,    whimper   over    their 
inability  to  do  everything  that  is  philanthropic,  and  get- 
a  Royal  Prince  into  the  chair,  and,  forthwith,  the  monied 
innocents  are  found  ready  to  pay  out  their  thousands* 
without  the  least  concern  where  that  money  is  going  to. 
It  is  very  safe  to  predict  that  the  £150,000  now   contri-* 
buted  will  follow  the  £100,000  collected  fifteen  years  ago 
and  will  be  lost  like  the  investment  capital  of  the  hospital, 
and  that,  in  another  decade,  the  monied  admirers  of  Royalty 
will  sit  at  another  monster  dinner,  with  the  same  or 
another  Royal  Prince  in    the  diair,  and  will  hear  the 
successors  of  the  present   financial  wire-pullers  of  the* 
hospital  making  lamentation  speeches  because  the  institu- 
tion is  not  able  to  accommodate  as  many  of  the  comfort- 
able independent  shopkeepers  and  artizans  as  they  could 
wish. 

But  I  have  said  that  I  desire  to  do  justice  to  the  ad- 
ministration of  Guy's  as  not  being  so  extravagant  and 
unmeritorious  as  that  of  other  London  hospitals.  I  find 
that  the  cost  of  keeping  a  bed  in  the  hospital  is  £05  annnalljT 
and  the  cost  of  ever^r  patient  £5  58.  This  is  <Mirt^' 
cheap  as  London  hospitcus  go,  for  I  note  that  St.  Bart's 
costs  £131  per  bed ;  Middlesex,  £136,  and  St  Thomas's, 
j£121,  and  in  these  hospitals,  each  in-patient  costs  from  £8* 
to  £10.  The  administration  of  Gov's,  however,  is  some- 
what extravagant,  for  I  see  that  it  absorbs  £5  15s.  a  bed, 
while  the  London  expends  on  the  same  unproductive  item 
only  £3  5s„  and  St.  George's  only  £3  158.  However,  in 
this  respect,  Guy's  is  better  than  King's,  which  costs 
£12  15s.,  and  Charing  Cross,  which  costs  £10^ 
for  the  same  item.  Comparably  with  London  hospitals, 
Guy's  deserves  sympathy  and  support,  but  comparably 
with  hospitals  outside  London  it  merits  condemnation* 
The  Edinburgh  Royal  Infirmary  and  the  Meath  Hospital, 
Dublin,  not  to  speak  of  many  cheaper  and  not  less  efficient 
institutions  throughout  Great  Britain,  maintain  a  bed  for 
£64  and  £54  respectively,  while  Guy's  outlays  £95  for  the 
same  purpose.  The  official  administrative  expenditure  of 
the  Edinburgh  and  the  Meath  is  £4 12s.  and  £3 10s.  respec" 
tively,  while  that  of  Guy's  is  £5  15s.  I  see  no  reason  to 
doubt  that  either  of  these  hospitals  is  as  well  kept,  nursed, 
fed,  and  administered  as  Guy's  at  two-thirds  the  price. 
Yet  let  us  be  thankful  for  small  benefits,  and  let  us  follow 
the  fashion  and  dieer  to  the  echo  this  most  admirably- 
managed  establishment,  which  disposes  of  £100,000  and 
loses  half  its  property  within  fifteen  years.  Such  an 
exploit  certainly  merits  all  the  enoomiums  bestowed  upon 
it  by  His  Royal  Highness  the  Prince  of  Wales,  and  the 
rest  of  the  speakers  at  the  recent  symposium. 

To  think  that  £150,000  can  be  raised  in  one  evenmg  for 
the  gratification  of  such  extravag^ance,  and  can  be  only 
laised  by  making  the  occasion  fashionable  and  by  putting 
a  Royal  Prince  into  the  chair,  while  thousands  of  poor 
workers  live  their  lives  out  within  a  stone's  throw  of  the 
hospital  in  a  state  of  semi-starvation,  is  enough  to  **  make 
the  angels  weep."    What  Pharisees  we  are ! 

I  am.  Sir,  yours,  &c., 

Thb  Youno  Man  fbom  tbm  Countbt. 


668     Tmi  Mn>iOAL  Pbbm. 


L1TERATX7RE. 


JuNB  24.  1886. 


THE  ETIQUETTE  OF  LADY  MEDICALS. 

To  th€  Editor  of  The  Mbdioal  Pbbbb  and  Ciboulab. 

Sib, — Tour  annonymoiu  oorrMpondent  from  Carlisle  has 
ioTind  a  fine  mare's  neat. 

As  I  have  advertieed  no  class  whatever  of  my  own,  I 
can  only  suppose  he  refers  to  an  advertisement  of  Soienoe 
•Classes  at  the  Edinbarsh  School  of  Medicine  for  Women, 
which  I  inserted  officially  as  Dean  of  the  School,  by  direc- 
tion of  the  Executive  Committee.  As  that  Committee 
includes  a  late  President  of  the  Edinburgh  College  of 
Physicians,  and  a  present  Member  of  the  General  MMical 
Oonndl,  they  are  probably  as  good  judges  of  Medical 
Etiquette  as  the  correspondent  who  does  not  venture  to 
endorse  his  statements  with  his  si^pature.  Moreover, 
the  names  of  the  lecturers  were  not  given,  and  the  adver- 
tisement was  addressed  not  to  "lady  medicals/'  but  to 
other  ladies  who  might  probably  be  interested  in  science, 
and  who  would  certainly  not  be  likely  to  see  notices  in  any 
medical  paper. 

Lastly,  I  may  inform  *'  Fiat  Justitia"  (!)  that  it  is  the 
^mstomof  the  Extra-mural  School,  as  a  whole -t.e.,  of 
Edinburgh  *'  male  lecturers,"  -  to  insert  advertisements  in 
the  Scotsman  before  each  winter  and  summer  session,  and 
if  anyone  wishes  to  try  conclusions  with  them  on  the  sub- 
ject openly,  and  not  anonymously,  be  will  have  ample 
opportunities  of  doing  so. 

I  am.  Sir,  yours.  Ac., 

Sophia  Jbx-Blaks,  M.D. 

Bmntsfield  Lodge,  Whitehouse  Loan, 
Edinburgh,  June  18th. 

[The  chief  comment  to  be  offered  on  this  letter  is  that 
no  evidence  is  furnished  in  proof  of  its  assertions.  This 
criticism  applies  equally  to  the  original  letter  sent  by  our 
Carlisle  Correspondent.  If  either  the  latter  gentleman  or 
Dr.  Jex  Blake  could  enclose  cuttings  of  the  newspaper 
advertisements  to  which  their  communications  refer,  we 
should  be  in  a  better  position  to  judge  as  to  the  relative 
weight  of  their  contradictory  assertions.  It  will  be  just 
its  impossible  for  our  readers,  in  the  absence  of  such  quo- 
tations, to  arrive  at  any  definite  opinion  on  the  subject 
Perhaps  it  would  be  worth  while  for  Dr.  Jex-Blake  to  look 
up  a  file  of  the  Scotsman  and  let  us  know  the  exact  word- 
ing of  the  advertisement  as  to  the  Women's  Medical  Class 
which  appeared  before  the  present  Summer  Session. — Ed.] 
# 

THE  FORTHCOMING  ELECTION  OF  DIRECT 
REPRESENTATIVES  ON  THE  MEDICAL  COUNCIL. 
Wb  are  asked  to  publish  the  following  correspondence 
in  the  nature  of  replies  to  questions  submitted  by  the  Hon. 
Sec.  of  the  Incorporated  Medical  Practitioners'  Associa- 
tion, by  Dr.  Aldersoo,  a  former  candidate  for  the  post  of 
Direct  Representative  for  England. 

Sib, — 1.  The  amendments  proposed  by  the  British 
Medical  Association  meet  with  my  approval,  and  with  a 
few  additions  might  be  desirable  to  accept,  perhaps  all  that 
•could  be  obtained. 

2.  I  should  oppose  any  Bill  that  would  create  a  new 
order  of  partlv  qualified  practitioners  and  thus  violate  the 
principle  of  the  Bill  of  86.  At  the  same  time  I  am  not 
opposed,  and  believe  some  legislation  is  necessary  to 
^xintrol  and  prevent  the  present  unlicensed  (and  in 
many  cases  the  lamentably  ignorant)  practice  of  mid- 
wives  in  poor  neighbourhoods.  The  midwife  should 
be  known  and  leguly  described  as  an  obstetric  nurse, 
And  the  term  midwife  should  never  be  used  officially, 
and  in  my  opinion  it  is  desirable  tbat  the  practice  of 
•obstetric  nurse  should  be  under  the  supervision  and 
control  of  the  eeneral  practitioner,  and  in  the  present 
■crowded  state  ofcJie  promsion  is  quite  feasible. 

I  am  in  favour  of  the  suggestion  of  Dr.  Eraser  as  men- 
tioned in  the  Lancet  of  Feb.  29th,  and  especially  as  to  the 
registration  of  still-births. 

3.  I  am  strongly  opposed  to  "  Medical  Aid  Associa- 
tions" that  make  a  profit  of  the  skill  and  labour  of  their 
Medical  Officers,  and  which  canvass  from  door  to  door. 


It  is  this  practice  that  has  proved  so  inimical  to  the 
interests  of  the  general  practitioner,  but,  in  m^  opinion^ 
the  only  effectual  remedy  is  to  render  the  practice  illegal 
by  the  Oeneral  Medical  CounciL 

4.  I  have  advocated  in  my  speeches  and  writings  for 
many  years  for  an  increase  of  the  number  of  Direct  Mem- 
bers of  the  General  Medical  Council,  and  this  effort  shall 
have  my  strong  support. 

Fbbdxbick  H,  Aldebsoit,  M.D. 

Hammersmith,  W., 

June  16th,  1896. 


Obitttdtp. 


SIR   THOMAS   0.   LOGAN,    M.D. 

Dbobasxd,  who  was  formerly  Director-General  of  the 
Army  MediceJ  Department,  died  last  week  at  the  ripe  age 
of  88.  His  diploma  of  LR. C.P.Ed.,  was  obtained  so  far 
back  as  1827,  and  the  degree  of  M.D.Glasgow,  in  1828. 
He  entered  the  Army  Medical  Department  in  the  latter 
vear,  beine  appointed  an  Assistant  Surgeon  in  1830.  He 
became  full  Surgeon  in  1»42,  and  served  in  the  Sutiej 
Campai^  of  1845-46  with  the  53rd  Regiment,  was 
present  m  the  affair  of  Buddiwal,  and  took  part  in  the 
actions  of  Aliwal  and  Sobraon,  for  which  he  had  the  medsl 
and  one  clasp.  Appointed  a  Surgeon-Major  in  1852,  he 
went  out  to  the  Crimea  in  1855,  serving  at  the  siege  of 
Sebastopol,  and  was  present  at  the  taking  of  the  Quarries 
on  June  7th,  at  the  assault  a  few  days  later,  and,  as 
Principal  Medical  Officer  of  the  Highland  Division,  at  the 
final  assault  on  September  8th.  For  these  services  he  was 
awarded  the  medal  with  clasp,  the  Fifth  Class  of  the  Med- 
jidie,  and  the  Turkish  medal.  He  reached  the  rank  of  In- 
spector General  in  1859,  was  Director-General  of  the  Army 
Medical  Department  from  1867  to  1874,  being  created  a 
K.C.B.  (Military  Division)  in  1869,  and  was  placed  on  the 
retired  list  in  April,  1874.  He  had  been  hon.  physician  to 
the  Queen  from  1859,  and  he  was  a  Fellow  of  tne  Royal 
College  of  Physicians,  London,  from  1867,  and  hon.  Fellow 
of  the  Royal  College  of  Surgeons,  Ireland.  Sir  Thomas 
Logan,  who  marrira,  in  1858,  Christiana,  only  daughter  of 
the  late  Colonel  Welford,  late  of  the  Royal  Staff  Corps 
and  School  of  Musketry,  was  a  Fellow  of  the  RoyiU 
Geographical  Society,  and  on  the  Royal  Patriotic  Fund 
Commission. 


TWENTIETH  CENTURY  PRACTICE,  (a) 

This  second  volume  of  the  great  storehouse  of  informa- 
tion for  the  practitioners  of  the  coming  age  has  pleased  us 
more  than  the  first.  The  articles  seem  to  us  to  be  more 
symmetrical  in  structure— better  rounded  off,  and  with 
less  unnecessary  dovetailing  or  objectionable  overlapping. 
They  are  disposed  as  follows:  <* Addison's  Disease  and 
other  Diseases  of  the  Ardrenal  Bodies,"  by  Sir  Dyce  Duck- 
worth, London  ;  "Diabetes  Mellitus,"  by  Carl  von  Noor- 
den,  Frankfort-oM. ;  *'  Rheumatism,"  by  T.  J.  Maclagan, 
London;  "Grout,"  by  Henry  M.  Lyman,  Chicsgo; 
"  Arthritis  Deformans,'^  by  Archibald  E.  Garrod  ;  "  Dis- 
«>ases  of  the  Muscles,"  by  Dujardin-Beaumets,  Paris ;  and 
*' Obesity,"  by  M.  J.  Oertet,  Munich. 

Sir  Dyce  Duckworth's  account  of  Addison's  disease  is, 
as  all  of  us  who  are  acquainted  with  his  former  works 
would  have  expected,  characterised  by  discriminating  care 
and  conscientious  accuracy.  Symptoms  are  described  with  a 
degree  of  clearness  which  we  do  not  often  meet  in  the  lite- 
rature of  the  present  day.  With  regard  to  the  nature  of 
this  mystical  disorder  there  is  still  scope  for  further 
enlightenment.  "  We  are  confronted  with  the  stranee 
fact  that  mere  destruction  of  the  ardrenals  is  not  of  itself 
a  necessary  cause  of  true  Addison's  disease."    "...  We 


(a)  "Twentieth  Oentary  Practice:  An  iDtemstlonal  Encyolopadia 
of  Modern  Medical  Science  by  Leedlng  Aatborittei  of  JCmope  sad 
Amerioe.' •  Kdlted  bv  Thoaaae  L.  Btodman,  M.D.,  New  York  C&f.  In 
twenty  volnmee.  Vol.  II-NutritiTe  Dieordert.  New  York  :  Wood  dt 
Ca    London :  Sampson,  Low,  Itfariton  sad  Oompany.    189S. 


JuwB  24>  1896. 

have  to  account  for  caaea  in  which  melafma  ocean,  as  a 
leading  symptoin,  without  any  obvious  disease  of  the 
adrenals."  '*  It  has  to  be  confessed  that  with  increase  in 
car  knowledge  both  of  the  nature  and  symptoms  of  this 
malady  no  corresponding  improvement  has  been  made  in 
respect  of  its  treatment.^  The  reader,  under  such  circum- 
stances, will  hardly,  we  think,  be  led  to  overestimate  the 
amount  of  *•  increase  of  our  knowledge."  The  practitioners 
and  pathologists  of  the  twentieth  century  will  probably 
have  something  left  for  them  to  discover  in  the  domain  of 
adrenal  setiology. 

Dr.  Carl  von  Noorden  has  certainly  treated  the  fertile 
subject  of  Diabetes  Mellitus  with  the  exhaustive  thorough- 
ness which  characterises  the  best  work  of  the  combined 
Professor  and  Physician  of  the  highest  German  centres. 
The  reader  will  find  here  everything  that  is  known  on  the 
subject,  and  the  article  is  followed  by  a  splendid  biblio- 
graphy ;  still,  on  turning  back  over  its  pages,  we  feel 
pretty  exactly  as  we  felt  on  concluding  the  perusal  of  the 
preceding  one— that  certainty  as  to  either  causation  or 
treatment  will  hardly  be  attained  on  this  side  of  the 
coming  age. 

We  have  something  more  definite  to  grasp  and  grapple 
with  in  the  case  of  "  Rheumatism"  ;  and  this  very  impor- 
tant subject  is  very  fully  treated  by  Dr.  Maclagan,  the 
great  modem  apostle  of  salicyl  therapeutica.  He  speaks 
with  full  confidence  of  the  power  of  this  mode  of  treatment 
in  preventing  the  terrible  cardiac  complications— if  com- 
menced in  fjTood  time  and  carried  out  with  rigorous 
decision.  '*  Thirty  grains  [of  salicin  or  salicylic  acid] 
ehould  be  given  every  hour  till  the  temperature  is  normal 
and  the  pain  gone."  He  does  not  claim  so  decided  a  cura- 
f»v6  action,  if  the  valvular  lesion  has  once  been  established. 
The  subject  of  rheumatic  hyperpyrexia  is  discussed  at 
length,  and  the  results  of  clinical  study  and  of  theoretical 
investi^tion  are  fairly  well  displayed  for  the  advantage  of 
the  reader ;  but  we  fear  that  the  twentieth-century  prac- 
titioner will  not  feel  edified  by  the  perusal  of  such  a 
clause  as  :  *'  Heat  is  an  excretory  product  requiring  to  be 
eliminated." 

The  discussion  of  "The  Relation  of  Rheumatism  and 
Chorea"  revolves  around  the  axial  statement  that,  **  Rheu- 
matism is  essenti^ly  a  disease  of  the  motor  apparatus ; 
chorea  is  essentially  a  disease  of  the  motor  centres." 

We  have  a  greater  amount  of  combined  pleasure  ani 
instruction  from  the  perusal  of  Dr.  Lyman's  article  on 
'*  Gout  "than  of  any  of  its  predecessors  in  the  pages  of 
the  *'  Twentieth  Century  Practice,"  although  presenting 
in  its  opening  sentence  a  bit  of  arthritic  Greek  composed 
in  rather  phthisical  type.  His  style  is  well  character- 
ised by  the  vividness  of  description  and  lightness  of  touch 
which  we  have  been  taught  to  look  for  in  the  higher  class 
of  the  scientific  literature  of  America.  The  result  i^i 
that  he  exhausts  his  subject  without  exhauating  his 
reader. 

In  a  correspondingly  exhaustive  manner,  bat  in  a  some- 
what more  tedious  style.  Dr.  Archibald  E.  Garrod  deals 
with  "  Arthritis  Deformans."  We  think  highly  of  it ; 
and  this  is  something,  for  we  know  the  disease— from  per- 
sonal experience. 

The  articles  on  ''Diseases  of  the  Muscles"  and 
**  Obesity "  have  beenprepared  with  great  care  by  the 
respective  authors.  We  have  bean,  upon  the  whole, 
greatly  pleased  with  this  second  instalment  of  "Twen- 
tiefh  Century  Practice." 


LITERATURK. 


Th«  Msdioal  Pbs98.     669 


OLIVER  ON  PULSEGAUGING.  (a) 
Thb  accident  which  has  delayed  our  review  enables  ua 
to  speak  with  greater  advantage  of  the  excellence  of  this 
original  work.  Based  upon  studies  performed  wiUi  the 
help  of  the  arteriometer  and  the  pulse-pressure  gauge- 
instruments  which  bid  fair  to  become  indispensable  in 
clinical  work — the  contents  of  this  compact  volume  may 
be  described  as  from  first  to  last  original,  with  an  essen- 
tially clinical  scope.  The  instruments  and  their  mode  of 
employment  are  described,  and  the  auUior  proceeds  to  re- 
port his  results -in  health  and  disease.  Of  great  import- 
ance to  physiologists  are  the  observations  made  as  to  the 

(a)  "  Pnlte-gmiigtng :  A  Clinical  fltady  of  Radial  MeaanremeDt  and 
PnlM-preMnre."  By  Qeoifpe  OUver,  M.D.Lond.,  F.E.C.P.,  anthor  of 
«<Bedalde  Urine  Teatlng," '< Th^  Harrogate  Waten/'«c  London: 
H.  K.  Lewia.    1896. 


variations  in  the  calibre  of  healthy  arteries  under  varying 
influences,  such  as  temperature,  digestion,  posture,  and 
muscular  and  cerebral  activity.  Still  greater  practical 
value  is  offered  to  the  clinical  physician  in  the  determina- 
tion of  the  variations  in  calibre  due  to  pathological  causes. 
Thesft  observations  afford  valuable  help  in  diagnosis,  and 
particularly  in  the  diagnosis  of  chronic  kidney  disease* 
arterio-sderosis,  myxcedema,  acquired  syphUis,  and 
chronic  gout ;  all  of  which  abolish  the  normal  variation 
in  calibre  under  changes  in  posture,  probably,  as  the 
author  thinks,  owing  to  structural  changes  in  the  vessel 
wall.  With  the  help  of  the  arteriometer,  the  physician 
would  be  in  a  position  to  recognise  with  the  greatest 
ease  the  presence  of  these  important  changes,  and  would 
readily  identify  their  cause.  Illustrations  are  given  of  the 
diagnostic  value  of  the  restricted  or  amplified  postural 
venations,  and  obvious  deductions  are  made  bearing  upon 
treatment.  •      ,     ^      .      l 

No  less  important  is  the  estimation  of  pulse  tension  bv 
Oliver's  pulse-pressure  gauge,  which  is  constructed  much 
on  the  same  principle  as  the  arteriometer.  For  both 
instruments  it  may  be  claimed  that  they  are  small  and 
handy,  and  easily  managed— a  strong  recommendation 
with  all  those  who  have  worked  with  more  complicated 
altht>ugh  not  equally  delicate  forms  of  apparatus.  We 
have  long  been  familiar  with  the  idea  of  estimating  the 
tension  <3  the  pulse,  and  with  the  value  which  must  be 
attached  to  its  determination,  but  hitherto  we  have  failed 
in  the  means  of  obtaining  its  absolute  value.  This,  the 
pulse-pressure  gauge  professes  to  do,  and  the  observations 
which  Dr.  Oliver  records  possess,  in  consequence,  weight 
not  equalled  by  the  usual  clinical  statements  as  to  the 
pulse  tension  in  given  cases.  , 

The  author  informs  us— and  it  need  hardly  be  msisted 
on— that  this  is  but  an  early  instalment  of  results  which 
it  is  hoped  may  acquire  considerable  development,  espe- 
cially if  the  practical  methods  suggested  are  widely 
employed.  At  any  rate,  no  physician  should  be  without 
the  practical  help  which  the  book  itself  conveys,  and  we 
may  hopefully  predict  that  the  employment  of  the  methods 
suggested  will,  in  most  cases,  be  a  consequence  of  ite 
perusal. 

BOURNEMOUTH  IN  LUNG  TROUBLES,  (a) 

Thx  Author  says,  in  his  preface,  "  Physicians  are  now 
beginning  to  recognise  the  inadvisability  of  sending  all 
consumptives  out  of  our  own  country  in  search  of  pure 
air." 

Doubtless,  to  a  large  extent,  this  is  true  ;  the  fact  being 
that  many  foreign  health  resorts  for  the  consumptive  have 
been  greatly  over- valued  as  to  any  curative  powers  they 
may  possess.  Physicians,  as  they  learn  this  from  exper- 
ience, become  much  more  cautious  and  prudent  as  to  the 
class  of  patient  they  may  send  abroad,  looking  rather  to 
prevention  of  threatening  disease  than  cure  of  actual  chest 
mischief  by  a  stay  in  a  foreign  health  resort. 

At  page  15,  Dr.  Milner  shows  from  good  authority  that 
the  climates  of  elevated  regions  such  as  Davos  Plats,  St. 
Moritz,  &c.,  are  quite  unsuitable  for  the  majority  of  con- 
sumptive invalids. 

Chapter  II  deals  specially  with  Bournemouth  and  ite 
climate,  its  dry  porous  soil,  and  htXmj  pine  forests.  The 
rest  of  the  chapter  speaks  of  the  draina^  lodginp^,  and 
hotels  at  Bournemouth,  and  tells  that  which  we  think  will 
be  fully  accepted  by  those  who  have  had  experience  of  a 
reeidence  in  this  favoured  watering-place. 

The  subsequent  chapters  in  the  nook  treat  briefly,  but 
ooncisely ,  of  the  diseases  of  the  larynx  and  chest  generally, 
giving  bints  at  the  close  of  the  chapter  on  the  suitability 
of  Bournemouth  to  these  cases. 

At  page  67,  we  have  some  remarks  on  asthma.  We 
are  told  that  Dr.  Williams  considers  that  80  per  cent,  of 
cases  of  astibma  are  due  to  bronchitis.  What  is  said  on 
the  treatment  of  asthma  is  good,  though  the  citrate  of 
caffeine,  so  much  extolled  by  Dr.  Thorowgood  and  some 
others,  obtains  very  scant  notice  as  a  remedy.  What, 
however,  impresses  us  most  is  that  nothiuflr  is  said  of  the 
excellent  effect  that  the  Bournemouth  climate  has  over 


(a)  *'  Bonmemonth  in  Lung  Tronblea.    A  Summary  of  Dlseaaes  di 
"  ~  -  ..   .  —    -    ial  reference  to  the 


,_,       MfTT 

the  Air  PaMaget  and  their  Treatment,  witli 

air  of  Boomemontli  as  a  Caratlve  Aaency."  By  Viocent  MUner,  M.B., 


M.Ch.  Univ.  Bdln., 
1896. 


pp.  lOe.   London: 


."  By 
Baim< 


V>^^ 


lire,   TindaU  and  Coa, 


670    Thb  Midioal  Pbib». 


NOVELTIES. 


owm  24,  1898. 


many  oaaes  of  broDchitic  asthma.  we  are  not  wrong, 
many  oheet  specialiste  coald  supply  ezamplee  of  the  cura- 
tive influence  of  Bournemouth  ana  ite  pine  climate  in  some 
of  these  cases. 

The  remaining  chapters  of  the  book  deal  with  the  man- 
agement of  chronic  bronchitis  and  phthisis,  and  contain 
much  information  as  to  the  prevention  and  cure  of  these 
diseases.  The  printing  and  general  *'  get-up  "  of  the  book 
is  most  commendable,  and  the  illustrations  well  and  care- 
fully executed.  Dr.  Yeo's  inhalation  respirator,  perhaps, 
might  be  a  little  puzzling  at  first  signt  to  those  not 
familiar  with  this  instrument.  The  frontispiece  view  of 
Bournemouth  Foreshore  is  one  that  will  be  well  appre- 
ciated by  all  who  are  familiar  with  the  pretty  and.  usually, 
sunny  prospect. 


ST.    BARTHOLOMEW'S  HOSPITAL  REPORTS,    (a) 

Ths  volume  commences  with  two  obituary  notices.  One 
of  Sir  William  Savory,  which,  although,  in  no  way  flatter- 
ing to  the  great  surgeon— who  stood  amazed  and  amused 
at  the  paraphernalia  which  ushered  in  antiseptic  surgery— 
they  recalled  Hogarth's  picture  of  the  apparatus  for  draw- 
ing a  cork,  three  men  were  able  in  four  hours  to  pull  a 
cork,  and,  yet,  as  the  inventor  explained  there  was  not  an 
unnecessary  screw  or  lever  in  the  machine.  Sir  William 
Savory  very  properly  believed  that  the  antiseptic  drees- 
inffs  were  redundant ;  but  he  promptly  recoenised  the 
yslue  of  aseptic  surgery,  and  in  the  exercise  of  bis  art  was 
inferior  to  none ;  which  latter  fact  the  authors  of  the 
obituary  freelv  acknowledge.  The  more  than  fifty  and 
five  years  of  Mr.  Mark  Morrises  faithful  servitude  at  St. 
Bartholomew's  deserved  and  has  received  a  kindly  notice 
from  an  old  friend,  one  who  knew  Mr.  Morris's  gentle 
nature  and  appreciated  his  courteous  manner  of  carrying 
out  his  duties. 

Of  the  twenty-five  contributions  to  the  report  we  can 
only  refer  to  those  of  more  than  usual  interest,  and  we 
would  draw  attention  to  Mr.  Richard  Qill's  paper  on 
the  ''Mechanical  Factor  in  Chloroform  Anesthesia"  which 
we  should  like  to  see  reprinted  in  pamphlet  form,  and  a 
copy  sent  to  every  hospital  in  the  country.  If  its  wise  pre- 
cepts were  followed  the  heading,  ■■  Death  from  Chloro- 
form "  should  appear  less  frequently. 

" The  *<  Physiological  Aspects  of  Disease"  is  a  thought- 
ful paper  on  the  adaptability  of  viscera  to  altered  environ- 
ment, by  Dr.  Campbell,  and  the  author  enlarges  on  the 
views  which  the  late  Dr.  Wm.  Stokes  was  so  food  of 
enunciating  at  his  clinical  lectures  on  structural  diseases 
of  the  heart. 

Mai  des  Moniagues.^A  rather  long  paper  from)Dr.|Hep- 
bum  is  noticed  as  being  one  of  the  few  accounts  of  the  die 
OAse  we  possess,  though  there  are  many  short  sketches,  and 
most  mountain  climbers  incidentally  refer  to  it.  Dr.  Hepburn 
arrives  at  the  conclusion  that — '*  The  symptoms  of  Mai 
des  Montagues  can  all  be  explained  by  the  diminution  of 
oxygen  per  unit- volume."  And  that  it  cannot  be  recog- 
nised as  existing  below  about  16,500  feet. 

In  his  article  "On  CeU  Memory,"  Dr.  T.  Clage  Shaw 
discusses  one  of  those  interesting  subjects  that  engages 
the  physiologist  and  psychologist.  The  author  plunges 
at  once  in  meeUas  res  to  the  question— Where,  or  in 
what  ooodition  (during  anesthesia),  have  been  all  the 
memories,  ideas,  associated  grouping,  characteristics,  all 
the  knowledge  that  we  recognise  on  its  return  to  be  much 
the  same  in  character  and  composition  as  it  was  before  ? 
Who  can  return  a  satisfactory  answer?  The  question 
will  give  our  readers  some  idea  of  the  nature  of  the  paper. 
We,  however,  regret  that  space  will  not  allow  of  our 
giving  some  quotations. 

We  cannot  close  without  drawing  attention  to  the 
statistics  of  anesthetics.  Durine  the  year  1894,  anesthe- 
tics were  administered  5,714  times  ;  chloroform,  2,350 
times  ;  ether  981  times ;  nitrous  oxide  gas,  1,682  times  ; 
gas  and  ether  701  times.  That  chloroform  is  used  so  much 
more  frequently  than  the  other  anesthetics  needs  no 
comment,  the  fact  alone  is  more  than  worth  all  the  hys- 
terical babble  that  is  poured  forth  in  its  disparagement. 

(a)  "St.  Barthnlomew't  HotplUl  RaporU."  Edited  1^  Samoel 
W«t.  ll.D.,  and  W.  J.  Walalisai,  F.K.C.B.,  voL  zxxl.  London  :  Smith, 
lOderAOo.    1896. 


ASHBY'S  DISEASES  OF  CHILDREN,  (a) 

A  NMW  edition  of  an  establishhd  work  does  not  call  for 
the  same  oritictal  examination  as  a  new  pretender  to  pro- 
fessional bookshelves :  and  the  appearance  of  a  third  editioa> 
six  years  after  the  publication  of  the  first,  still  further 
disarms  criticism.  Of  late  years  many  books  on  d'*^^*!^ 
of  children  have  appeared  and  so  the  evolution  of  a  thira 
edition  suggests  professional  selection. 

The  arrangement  is  admirable ;  in  spite  of  one  author 
chiefly  dealing  with  surgery  and  the  otner  with  medicine^ 
there  is  no  appearance  (H  '*  crazy  "  work,  but  each  subject 
is  treated  with  due  regard  to  proportion  and  perspective. 
"  Tuberculosis "  may  be  cited  as  an  example  of  surgical 
and  medical  aspects  being  admirably  fitted  in,  and  the 
included  paragraph  on  "Scrofula  and  Tuberculosis"  may 
be  cited  as  a  good  example  of  author's  word-pictures 

In  dealing  with  treatment  the  authors  have  again  «<^>^^ 
the  happy  mean.  General  conditions  are  discussed  and 
treatments  su^igested,  but  there  are  no  long  lists  of 
possible  remedies  like  pages  from  a  drug  circular.  Toe- 
reader  of  average  intelligence  armed  with  a  B.P.f  ^m 
Extra-pharmacopceia,  or  some  other  work  of  the  same 
genus,  can  easily  ring  the  changes  for  himself. 

Dr.  Alex.  Williams  supplies  a  well  written  and  practice 
chapter  on  anesthetics ;  but  why  does  he  advise  the  ^^^e- 
of  a  piece  of  lint  for  chloroform  ?  He  may  considei;  ^ 
"  Skinner "  old-fashioned,  and  so  object  to  mention  ^% 
but  those  who  use  it  look  upon  the  man  with  a  piece  <» 
lint  somewhat  as  brother-workmen  look  upon  one  who» 
having  pledged  his  screw -driver,  is  trying  to  extract  ^ 
screw  with  a  bradawL 


NOTTER  AND  FIRTH'S  HYGIENE.  (6) 
Thxri  could  be  no  better  argument  advanced  for  the 
merit  or  utility  of  an  elementary  work  in  science,  than  » 
rapid  appearance  of  the  second  edition.  The  work  is  well 
arranp^  for  students  in  Hvgiene,  and  up-to-date  in  the 
principles  of  examination  and  research  in  this  complicated 
subject. 

To  the  present  edition  is  appended  a  resum^  of  the  Acte 
of  Parliament,  bearing  on  samtary  subjects  in  London  and 
the  provinces.  Many  useful  extracts  are  taken  from  the 
model  Bye-laws  of  t-he  Local  Government  Board,  that  may 
enhance  its  value  for  the  general  reader.  The  authors 
assure  us  that  this  legislative  instruction  is  added  for  the 
benefit  of  Patter  f amilms  whom  we  fear  will  eschew  it  as  too 
technical,  although  invaluable  to  the  student  as  a  concise 
enumeration  of  Uie  enactments,  &c.,  bearing  on  the  sub- 
ject of  sanitation. 


Jlob€ltte6. 

THE  "8ELZ0D0N." 
SoDA-wATBH  has  long  since  ceased  to  be  a  luxury  and  i» 
now  a  simple  necessity  of  modem  civilised  life.  Its  pre- 
sence in  everv  household,  down  to  the  humblest,  has  been 
hitherto  hindered  by  the  two  facte  ot  cost  and  inconveni- 
ence. As  everyone  knows,  to  supply  a  family  of  average 
sise  with  soda-water  as  retailed  in  the  familiar  wired  haif- 
pints  is  a  somewhat  expensive  matter,  to  say  nothing  of 
the  trouble  of  opening  and  of  stowing  away  the  botils^ 
and  the old-fashioneagas-seltogene  is  not  only  a  costly, 
but  a  cumbrous  and  troublesome  engine  to  boot.  Of  Use, 
however,  science  has  been  brought  to  bear  upon  the  subject 
and  that  marvel  of  modem  chemistry,  liquefied  carbonic 
acid  gas,  has  been  pressed  into  the  service  of  the  aSrated 
water  manufacturer.  The  best  thing  of  the  kind  we  have 
yet  seen  is  the  *'  Sebsodon,"  of  Messrs.  Dnrafort  &  Fils, 
of  Parifi.  In  effect,  the  invention  consists  of  a  five-pint 
decanter,  which  is  simply  filled  with  water  and  diamd 
with  carbonic  acid  gas  from  a  little  iron  cylinder.  The 
householder  in  want  of  a  supply  of  soda-water  fills  up  the 
decanter,  fixes  on  a  gas  charger  (which  costs  him  about 
threepence),  presses  a  lever,  and  in  one  short  moment  he 

(a)  '*  The  DiMSMt  of  Gaaidron,"  Mediosl  and  SmicicaL—Bf  Heoir 
kOkhy,  M.D.,  F.K.C.P .  and  G.  A.  Wrisht,  M.B.,  F.1LC.S.  lliird 
■ditloD.  London ;  Longman,  Ofmb  and  Co.  1&96.  Pp.  814.  niastnu 
Uoni,  192. 

(»)  Hyglens  by  J.  Lum  ITottsr  and  B.  H.  Firth.  Second  Edition. 
Longman  A  Co.,  London.    18B6. 


JuNS  2i,  1808. 


MEDICAL  NEWS. 


Tmi  MnoiOiLL  Pbbb«.     671 


tMOomee  the  poaeeesor  of  five  pinte  of  ezcelleiit  aSrated 
water.    One  word  as  to  the  carbonic  acid  ga«  cylinder 
which  forms,  so  to  say,  the  core  of  the  invention.    It 
k  a  steel  globe,  about  the  size  of  a  bantam's  egg,  and, 
despite  a  somewhat  bomb-like  appearance,  is  absolntel^ 
safe.    The  solidified  carbonic  acid  gas  with  which  it  is 
charged  is  nnaflfected  by  ordinary  temperatures.    Further, 
every  gas  cylinder,  before  being  sent  out  from  the  factorr, 
is  tested  by  being  passed  through  boiling  water.    The 
enterprising  firm  which  is  puttmg  this  extreo^ely  useful 
and  clever  little  invention  mto  the  market  proposes  to 
supply  these  cylinders  in  boxes  of  a  dozen.    The  '*  Sel- 
zodon"  has  a  special  interest  for  the  medical  profession, 
which  for  many  years  has  recognised  the  value  of  carbonic 
acid  eas  as  a  gastric  sedative,  and  of  soda  water  as  an  article 
of  orfinary  diet.    Nurses,  too,  will  find  these  ^Unders  of 
the  utmost  service  for  invalids,  especially  in  the  country 
and  on  board  ship.    Indeed,  the  merits  of  the  "  Selzodon 
cannot  fail  to  make  their  mark  even  in  the  history  of  ^  so 
progressive  an  industry  as  that  of  aSrated  water  making 
in  the  nineteenth  century. 


STOWER'S  UMB  JUICE. 
Mbssbs.  Biddub  &  Co.,  36  and  38  Commercial  Street, 
London,  have  submitted  to  us  samples  of  *'  Stower's  Pure 
lime  Juice  *'  and  "  Lime  Juice  Cordial."  These  prepara- 
tions are  certified  to  be  free  from  alcohol  as  well  as  from 
sulphurous  add,  and  manufactured  only  from  the  pure  juice 
of  the  fruit.  We  can  testify  to  their  extremely  agreeable 
and  characteristic  flavour,  to  their  freedom  from  musti- 
ness,  which  is  so  objectionable  in  many  similar  prepara- 
tions, and  to  their  keeping  properties.  Properly  diluted 
with  water,  plain  or  effisrvescing,  Stower's  Lime  Juice 
affords  a  very  palatable  and  salutary  drink,  likely  to  be 
appreciated  at  this  season  of  the  year,  quite  apart  from  its 
known  antinscorbutic  properties. 


FreseatatKm. 
Mb.  Williah   Copb   Hamiltok,  son  of  Mr.  Edward 
Hamilton,  sometime  President  of  he  Royal  College  of  Sur- 
geons of  Ireland,  received  last  week  a  very    gratifying 


testimony  of  respect  and  regard  from  the  past  and  present 
students  of  Dr.  Stevens's  Hospital  on  his  retirement  from 
the  House  Surgeoncy  of  the  institution,  which  he  has 
held  for  the  last  four  years.  The  presentation  took  the 
form  of  a  handsome  gold  watch,  a  purse  of  soverei^s,  a 
large  photograph  cl  the  hospital,  and  an  illuminated 
adorass.  Mr.  Hamilton  also  received,  as  a  mark  of  the 
esteem  of  the  resident  medical  staff,  a  very  handsome 
eilver  cigar  box  engraved  with  a  suitable  inscription.  Mr. 
Hamilton  must  be  congratulated  upon  having  deservedly 
acquired  a  warm  feeling  of  friendship  and  respect  on  the 
part  of  those  with  whom  he  has  been  associated,  which  is 
very  creditable  to  him. 

Inter-Hospital  Boat  Race. 

Last  Thursday,  the  annual  Inter-HospitalBoat  Race  took 
place  from  Hammersmith  to  Putney,  in  brilliant  weather, 
and  was  witnessed  by  a  large  assembly*    Three  Metro- 

S>litan  Hospitals  were  represented,  viz. :— Middlesex 
ospital,  St.  George's  Hospital,  and  London  Hospital.  A 
gooa  race  ensued,  for  the  first  mile,  between  Middlesex 
And  St.  George's,  the  former,  however,  gradually  increas- 
ing their  leadT  At  the  point  opposite  to  the  Ranelagh  Club, 
the  St.  Georg&'s  crew  were  evidently  beaten,  and  the 
Middlesex  holding  the  race  well  in  hand  passed  under 
Putney  Bridge  with  a  clear  lead  of  two-and-a-half  lengths. 
London,  who  rowed  a  plucky  stem  chase,  finishea  five 
lengths  b^ind.  The  winners  carried  the  course  in  the 
excellent  time  of  9  minutes  3  seconds.  The  winning  crew 
were  as  follows :— Bow,  C.  H.  Reissmann,  lOst.  41be. ;  2  H. 
C.  Whiteside,  list.  71bs. ;  3  G.  P.  Bletohley,  list.  111b. ; 
Stroke,  C.  Chamock-Smith,  lOst. ;  Cox.,  W.  G.  Higgins, 
^t.  21bs. 

The  British  HMUcal  ABiocUtlon. 
Sir  William  Pbixstlby»  as  president,  and  Lady  Priest- 


ley held  a  reception  and  convenaaione  of  the  membersof  the 
Metropolitan  Counties  Branch  of  the  British  Medical 
Association,  on  Thursday  evenine  last  in  the  Natural 
History  Museum  at  Kensington.  The  central  hall  and  the 
bird  gallery,  specially  illuminated  for  the  evening,  were 
thronged  by  a  large  crowd  of  members  and  their  ladies, 
and  a  very  pleautnt  re- union  of  friends  resulted.  Music 
by  the  band  of  the  2nd  Life  Guards  and  by  the  Edelweiss 
Alpine  Singers  enlivened  the  proceedings,  and  light 
refreshments  were  served  during  the  evenmg.  It  is  the 
first  time  that  a  medical  ctmversazione  has  been  held  in  this 
building,  whose  beautiful  internal  architectural  features 
lend  themselves  for  purposes  like  the  one  on  Thursday,  to 
thorough  enjoyment.  We  may  add  that  great  credit  is 
due  to  those  who  organised  and  carried  out  the  entertain- 
ment. 

An  mterestlBg  Experiment. 

SoMB  time  ago  the  District  Medical  Officer  for  Poplar 
and  Bromley  suggested  to  the  Millwall  Dock  Company 
that  they  should  plant  a  large  mud  heap  (composed  A 
river  dredgings,  oelon^g  to  them  in  the  East  Ferry 
Road)  with  willows,  which  he  said  would  not  only  save 
the  company  the  expense  of  using  disinfectants,  but  would 
purify  the  ground  by  a  natural  process,  beeides  creating 
a  new  industry  in  the  district.  The  novel  proposal  was 
adopted  by  the  dock  company,  and  two  acres  of  the  fifty 
which  comprise  the  land  were  planted  with  10,000  willow 
plants— 6,000  for  coarse  basket  work  and  4,000  for  fine 
articles.  Dr.  Alexander,  in  his  annual  report  just  issued, 
records  the  great  success  of  the  experiment,  especially 
from  the  point  of  view  of  the  public  health,  ana  points 
out  that  the  planting  of  osiers  on  a  large  scale  in  North- 
western India  has  assisted  to  stamp  out  malaria  in  a 
notoriously  unhealthy  valley  covered  with  stagnant  pools* 

Fmiotitifl  on  the  Britannia. 
It  is  reported  that  a  severe  outbreak  of  mumps  has  oe« 
corred  among  the  cadets  of  the  training  ship  Britanniot 
at  Dartmouth.    The  infectious  hospital  on  shore  is  full  cd 

Ktients,  and  yesterday  the  gunboat  Bacer,  which  has  just 
en  commissioned  as  tender  to  the  Britannia,  was  sent 
to  sea  with  a  large  number  of  cadets  who  have  not  yet 
contracted  the  disease.  Surgeon  Robert  F.  Bowie,  R.N., 
has  been  placed  in  charge  of  Uie  infectious  hospital.  The 
Staff-Surgeon  James  Porter,  R-N.,  has  been  ordered  to 
take  up  his  quarters  on  board  the  Britannia, 


Royal  College  of  Surgeons  of  England. 

The  following  candidates  having  passed  the  necessary 
examinations,  were  admitted,  last  week,  <*  Licentiates  in 
Dental  Surgery  of  the  College  "  -.^Messrs.  Edear  Ashby, 
Ernest  D.  Basoombe,  Luther  Bidlake,  Wallace  W.  Briant, 
Ernest  Coltman,  Hector  C.  Cowles,  Harold  S.  Crapper, 
A.  E.  B.  Crosby,  Albert  De  Mierra,  Joseph  E.  Dupigny, 
George  R.  Edey,  Harold  O.  W.    Harris,    Edwin  B.  D. 
Heeson,  Charles  J.  Hinchliff.  Albert  F.  A.  Howe,  William 
J.  Mark  Lacey,  Norman  H.  Oliver,  Arthur  G.  G.  Plumley, 
Arthur  Read,  Norris  Snell,  Richard  H.  Stevens,  Leopold 
Ta'  Bois,    Benjamin  G.   Tasker,  and    Ernest   Reginald 
Tebbitt,  of  GuVs  Hospital ;  Walter  B.  Barnard,  Edgar 
A.  Blomfield,  Harold  Conder,  E;endrew  J.  Eay,  Harry 
Dunlop,  Frederick  Hemsted,  Sydney,  A.  Elnaggs,  FreoL 
W.  Mardon,  Osbert  Mordaunt,  Walter  Mudie,  driest  A« 
Newbery,  Alfred  E.  H.  Orridge,  Frank  J.  Padgett,  and 
Harry  H.  Staton,  of  Charing   Cross   Hospital   and  the 
Dental  Hospital  of  London;    George  W.    Connor   and 
Walter  Sexton,  of  Middlesex  Hosmtal  and  the  Dental 
Hospital  of  London  ;   Ernest  F.   B.  Beyer,  of   Owens, 
Royal  Infirmary,  and  Victoria   Dental   Hospital,  Man- 
chester ;  Thomas  W.  Byrne,  Arthur  P.  Nixon,  and  John 
W.  Skae,  of  University  College,  Royal  Infirmanr,  and  the 
Dental  Hospital,  Liverpool ;  Stuart   Carter,  Sydney  B. 
Fisher,  and  Arthur  M.  ftobev,  of  Mason's  ColU«e,  Queen's 
and  General  Hospital,  and  the  Dental  Hospitu,  Birming- 
ham ;  William  E.  Hill,  Charles  J.  H.  Riches,  of  Middlesex 
and  the  National  Dental  Hospital ;  Hubert  W.  Moore,  of 
Glasgow  University,  Middlesex  Hospital,  and  the  Natia«ial 
Dental  Hospital;  Charles  Mullord,  of  the  London  Hos- 
pital, and  the  National  Dental  Hospital.    Sixteen  candi- 
dates did  not  pass,  and  were  referred  back  to  their  pro- 
fessional studies. 


672    Tu  MiDioAL  Pubs.       NOTICES  10  CORRESPONDENTS. 


JCHB  S4,  1886. 


c^loticea  to 
€oxttsponbmt8,  §hott  ^ctttrg,  4tc 

■#~  OOBKHPovDian  nqvliiiig  a  npiy  in  Ihli  ootamn  an  par- 
llealarlj  nqnartad  to  make  naa  of  a  di§tincth»  wi^fnatwr*  or  fnMob, 
and  aTold  tha  praetloa  of  ■Ignlng  thamiolyii "  lUadar,"  •*  Bvbaerilwr," 
"OldBiitiKifbar,"*e.  Mnoh  oonfuioii  wUl  ba  varad  bf  att«ittoii 
ftolhlfnila. 

M.  0.— Ilia  pamphlet  wbloh  aooompanled  your  letter  hardly  londa 
ItMtf  to  Mtloiu  erlUdiiD.  except,  perhaps,  on  the  ground  of  i  ti  beiofe  a 
diaereet  advertiiameot  i>r  Ito  author,  a  point  you  would  poasibly 
prefer  to  leave  untouohed. 

Db.  Spbaob  (BirmioghamX— a  movement  haa  already  been  sag- 
geeted  to  ratee  a  memorial  to  the  gentua  of  Jenaer,  Uie  memorial  to 
take  the  form  of  a  statue  in  London.  But  no  definite  steps  have  as  yet 
been  taken. 

A  HINT  FOB  ANALYSTS. 

A  CHBMI8T,  near  Dartford, 'was  proeecuted  recently  for  aelling 
adulttdrated  "sweei  spirits  of  nitre."  but  he  ese^ied  penalty  beoauae 
the  anal)  at,  Instead  of  confining  hlmaeU  to  a  simple  atatement  of  the 
natore  and  amount  of  the  adulteration,  put  it  on  hia  certiflcttte  that 
the  drug  was  "bad."  The  magutntes,  acting  upon  a  previoua 
decision  of  the  High  Court,  considered  that  the  oartifloate  was  invalid 
because  itexpreesed  an  opinUm  on  the  aubJecL 

Db.  Dookbbll.— Paper  on  **  The  Preaent  Poaltion  of  Dermatology  " 
received. 

Db.  Fabooubt  Babnbs's  paper  "On  Some  Paychologioal  Conae- 
quenoea  of  Bnppreaaed  Menatruatlon  "  shall  appear,  if  poasihld,  in  our 

0UB8UFPLBMBMT. 

WB  regret  that  the  necessity  for  lodudinv  the  half-yearly  Index  of 
the  Journal  In  the  present  issue  prevents  na  from  iaanlng  the  mual 
weekly  Supplement  devoted  to  Inah  Poor-law  intelligence  and  local 
Iriah  affaire.  The  oonunta  of  the  Supplement^  which  we  have  in  type, 
will  appear  next  week. 

liBSBBfl.  Maomillaii  A  BoWBS  (Cambridge). -The  remark  waa 
Intended  to  apply  to  all  publiahara  who  eend  medical  booka  to  tne  uy 
pceas  for  review. 

YoUBQ  CoBSULTABT.— Our  oorrsapondant  need  not  take  the  system 
of  spelling  adopted  by  certain  Ameilflaa  medical  Jjumala  aerioualy. 
It  hiM  become  quite  a  mania  with  the  editors  of  some  of  our  oontem- 
porarlee  on  the  other  side  of  the  Atlantic  The  proof  that  it  is  merely 
a  fad  la  that  all  the  leading  medical  Journals  oc  the  United  SUtee 
adhere  to  the  usual  BngUah  method  of  spelling  medical  terma-and  aa 
long  aa  thia  la  the  caae  "  American  spelling  "  can  never  make  any  pro 
grass. 

Q.  B.— A  "  pocket ambulaace ease"  which  may  answer yovrpurpoee 
la  aold  by  Meaars.  Maw,  Son,  and  Thompaon.  It  oontalna  a  aupply  of 
**  first  aid  "  accessories  in  a  small  compass,  all  that  a  cyclist  is  likely 
to  require,  unless  he  fracturee  his  skull  or  a  long  bone. 

Db.  W.  B.  (LondonX— There  are  at  present  plenty  of  "  atudioe  " 
where  skiographic  photographs  may  be  obtained.  In  your  district 
the  nearest  is  probably  at  Messrs.  Coxeter  A  Sons  (4  Grafton  Street, 
W.C.),  where  tkiographs  of  intareeting  cases  can,  we  are  informed,  be 
executed  forthwith. 


WBPBBaDAT,  JUBB  SATB. 

NATIOBAL  HOSPITAJi  rOE  TBB  PABALT8BD  ABD  BPILBPTIO  (BloOOS- 
bnry).— S  p.m.    Lectnre  by  Dr.  Qowera. 

LoMDOB  PoaT-OBADUATB  CouBBB.— Hoapltal  fOT  Skin  Disaasee, 
Blacktrlars,  4.80  p.m..  Dr.  Payne :  Selected  Csses. 

WbstLomdob  Pom-OBAPUATB  COUBSB  (West  Londou  Hoapltal,  W.) 
—6  p.m.    Dr.  W.  Hunter :  Pathological  DeaM>nstrations. 

THVBSDAT,  JUBB  2MH. 

LOBDOB  Poer-OBAPUATB  CoUBSB.-Brtt.  Inst.  of  Preventive  Medi- 
cine, Great  Buaaell  atreet,  W.C.,  8.80  p.m..  Dr.  Allan  Mscfadyen  and 
Mr.  A.  G.  Foulerton :  Detection  of  Druita  in  Urine.— Central  London 
Sick  Asylum,  Cleveland  Street,  W.,  6.30  p.m.,  Mr.  J.  Hopkins :  Clinical 
Lecture. 

VicvoBiA  Hospital  bob  Child&bb  (Chalaea).  >4  p.m.  Mr.  Water- 
houae :  Adenoid  Vegetationa  in  the  Naao-Phaiynx  and  Their  Treat - 


HOXB  BOB  TBBATMBBT  OF  WOUBDB  ABD  ULCBB8  BT  OZTOBB  (86 
St  Geoiire's  Square).— 4  to  6.80  p.nL  DemonstraUoos  of  Treatment, 
Apparatna,  and  Caaea. 

FBIDAT,  JUBB  aOlH. 

LoBiMB  Poer-GBADUATB  CouBBB.— Kiog'a  CoUage.  8  to  6  p.m.. 
Prof.  Crookahank  :  Tetanus,  Babies,  and  Cholera. 

SATVEDAT,  JUBB  STTH. 
BOXB  FOB  TBBACMBBT  OF  WOUBM  ABD  ULOBBB  BT  OXTOBB   (S6 
St.  George's  Square).— 4  to  6.80  p.m.    Demonstrationa  of  Treatment, 
Appaiatua,  and  Caaea. 


BatancftB. 

Brighton  and  Hove  LyliiB-in  Institution  and  Homital  for  Women.— 
Houae  Surgeon.  Salary  £80  per  annum,  with  fumiahed  apart- 
menta.  board,  gas.  coals,  and  attendance.  Diplomas  and  teatl- 
monlala  to  the  Secretary  before  July  let. 

Dundee  Boyal  Infirmary.- Matron.  Salary  £100  per  annum,  with 
board,  lodging,  and  washing.  Appllcatlona,  wttb  teetimonlala,  to 
the  Secretary  on  w  before  July  let. 


Hiiddataflald.-lledloal  Ofltoer  of  Health.    Salary  £100  par  aonuoa^ 
Appttoationa,  with  taetlmoaiala,  to  F.  C.  Lloyd,  Town  Clark,  not 
later  than  July  7th. 

DiapMiaanr.-Beridant  Medical  OIBoer.  Salaiy  £lt6  per 
with  fumiahed  rooma,  eoala»  gaa,  and  attendance.  AppU- 
OAtlona  and  teetimonlala  to  the  Hun.  Sec,  F.  Leach,  Baq.,  7  Stan- 
ford Bead,  Kenalngton  Square,  by  July  4tlL 

Newport  and  Monmouthshire. -House  Snrgaon.  Salary  £100  per 
aannm,  with  board  and  realdauca.  AppUeatlona,  with  teatf- 
menials,  to  the  Secretary  not  later  than  July  11th. 

Seaman's  Hoapltal  Sodety.— Houae  Surgeon  for  Branch  Hospital, 
Boyal  Victoria  and  Albert  Doeka,E.  Bidary  £76  par  annum,  wtti& 
board  and  realdenoe.  ParttoiilanolP.Mlohalli,8eeretary,(kaen- 
wioh,S.B..  by  June  80th. 

St  Mark'a  Ophthalmic  Hoapltal,  DnbUn.-Baaldent  Surgeon.  Salary 
£68  per  annum,  with  apartments  attendance,  Jt&    (See  advert  > 

Taunton  and  Someraet  HoapitaL— Hooae  Saigeon.  Saiaiy  £100  per 
annum,  with  board,  lodging,  and  waaUeg.  Appllcatlona  and  teeM- 
monials  to  J.  H.  Biddolpli  Pinohard,  Secretary,  on  or  before 
JnlylSth. 

Western  General  Dlspenaary,  Maiyleboae  Boad.— Houae  Surgeon. 
Salary  £60  ayear,  with  board  and  realdenoe  ApiiUoatlona  and 
teetimonlala  to  the  Hon.  Sec  not  later  than  the  20th  Inst 

Willlttm  Union,  Someraet— Medical  Ofllcor  and  Public  Vaccinator. 
Salary  £80  per  annum.  AppUoatiooa,  with  testimonials.  Lto- 
Thomas  Joyce,  Clerk,  before  10  o'olock  on  Saturday,  June  i7th. 


ALBXABDBB,  ADOLPHua  fi.,  Dental  Surgeon  to  the  Weatem  SUn  Hos- 
pital, London. 
FoxwBLL,  ABTBOB,  M.D.,  F.ltaP.,  Bxsmlner  In  Medicine  in  Gam- 

bridge  Univeralty. 
GOODHUB,  FBBD  W.  J.,  B.A.C«ntab.,  M.ltas.,  L.B.C.P.Lond.,  Aaab- 

tant  Uouse  Physician  to  the  Mortal  for  Women,  London.  W. 
HBAD,   Hbbbt,   M.A.,    M.U.Camb,  M.a.C.P.Loud.,   M.B.C.S.Bng., 

Medical  Beglstrar  to  the  London  HirepitaL 
HU0BB9.  B.  T.,  L.B.C.P.Lond..  M.B.C.S.,  Assistant  Medical  Officer  for 

the  Workhouse  and  Schools  of  the  Birkenhead  Union. 
KBBDALL.  H.  W..  L.B.C.P.Lond.,  M.B.C.3.,  Surgeon  to  the  Briatol 

Hospital  for  Sick  Children  and  Women. 
Matbbh,  B.  O.,  L.B.C.P.,  LB.C.S.ifidln.,  Medical  Oflloer  for  the 

HiUinge  Sanitary  District  of  the  Wigan  Unloa. 
MILBBB,  £.  A.,  M.B.,  M.Cb.Bdio..  Medloel  Officer  for  the  Sixth  Sani- 
tary District  of  the  Bodm«n  Union. 
MOBGAH,  Wm.  L.,  M.A.,  L.B.C.P.LoDd  ,  M.B.C.S.,  Uchfleld  COiOfitX 

Lecturer  in  Surgery,  Oxford  Univenity. 
MoBTOB,  C.  A.,  F.B.C.S.Bog.,  L.B.C.P.Lood.,  Surgeon  to  the  Briatoft 

Hospital  for  Sick  Children  and  Women, 
soon,  W.  B..  M.D.,  M.Ch.DubL,  MediOAlOAcerof  Health  for  Bloem. 

f  ontein  Orange  Free  State. 
STABEIB.  E.  G.  li.,  M.B.,C.M.Bdln.,  Medical  Officer  for  the  lylde 

Bnral  Sanitary  District 
TATLOB,  W.  J..  L.B.0  P.,  L.B.O.S  UtL,  Medicsl  Officer  of  Health  for 

the  A  mpUiul  Sanitary  District 
WILBOB,  Gbo.  J.,  M.A.Oxon.,  M.D.Dubl.,  M.B.C.S.,  Lichfield  (3Ihilcal 

Lecturer  In  Medicine.  Oxford  University. 
WiBTLB.  COLSTOB,  L.B.C.P.Lond.,  M.B.C.S.,  Surgeon  (ont-pattanta: 

department)  to  the  Bristol  Hospital  for  Sick  Children. 


Bbll.— June  18th,  at  U] 
Charlea  W.  J.  BeU,  M 


9t]:tii0« 


Louth,  Ltncoloahhre,  the  wifb  loff 
C.S.Kng  ,  of  a  daughter, 
bsrle^ 


DODD.-Jnne  4th,  at  ililford,  Chsrleville,  the' wife  of  W.  &  Dodd, 

L.B.C.S.I.,  IJiLQ.C.P.S.,  of  a  daughter. 
Hatohoft.— June  lOth,  at  4  Snton  Terrace,  Exmouth,  the  wife  of  F. 

T.  Haycroft,  L.D.S.,  of  a  son. 
BI0HABDS.-June  18th,  at  47  Chumet  Street.  Mancfaeetar,:the  wife  of 

Arthur  laod  Biehsrda,  M.B.a8.,  L.S.A.,  of  a  son. 


BATB80B-DuBHAX.~Jnne  lOth,  at  St  Paul's  Church,  South  Hamp- 
stesd,  William  Bsteson.  Fellow  of  St  John's  College,  Cambridge,, 
to  Caroline  Beatnoe,  daughter  of  the  late  Arthur  B.  iDurham» 
F.B.O.S.,  Consulting  Surgeon  to  Guy's  Hospital. 

BUOHABAB-ATKIBBOB.-June  16th,  at  the  British  Consulate,-. 
Lausanne,  and  at  Christ  Churoh.  George  Seaton  Buchanan,  M.D., 
of  London,  son  of  the  late  Ulr  George  Buchanan,  M.D..  r.R.8.,  to 
Bhoda  Atldnaon,  daughter  of  the  Uto  Thomaa  Atkinson,  of 
Windermere. 

CBUM-SiBYBXiiia.- June  SOth,  at  St.  Thomaaa  Churoh,  Orohardk 
Street,  London,  w.  Walter  jEwing,  eldest  sou  of  the  late  Alexander 
Crum,  of  IhomUebank,  to  Ella,  second  daughter  lof  illir  Bdward. 
Sleveklng,  M.D. 


9t«th0. 


Cholmblbt.— June  18th,  at  71  Clarendon  Boad,  London,  W.,'Wllliam« 
Cholmeley ,  M.D. ,  F. B  C.P. ,  aged  78.  •--  A 

FBA8BB.-June  19th,  at2TettenbaU  Bead,  W6lTeriiampton,|Chai1otte 
Ann,  wife  of  John  Fraser,  M.D. 

KlBBT.-June  16th,  at  Cambridge  Tsrraoe,  Hyde  Park,  London. 
Thomas  Charles  Klrby,  M.D.,  aged  62. 

PAQBT-BiABB.- June  ISth,  at  Alverstoke  Vale,  St  Marychurch,  Tor- 
quay, Charlea  Paget-Blake,  M.D.,  F.B.C.P.,  BetlrBd  Surgeon  AJf., 
aged  76. 

NOTICE^Awunino^entM  of  Dirt  Km,  Marrioffet^  and  Deatlu  in  tAe- 
/amaie$  r/  Svtmcribers  to  thi*  Journal  ar4  intertad  Jrm,  end  nm&$i 
r»-eh  the  jmUuh^m  «««( later  than  ih0  Monday  yrtcoding  rmblitatiom. 


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